Atrial fibrillation and survival on a medical intensive care unit.

BACKGROUND: Atrial fibrillation (AF) is common among patients in the intensive care unit (ICU) and can be triggered by severe illness or preexisting conditions. It is debated if AF is an independent predictor of poor outcome. METHODS: Data derives from a single center retrospective registry including all patients with a stay on the medical ICU for >24 h. The primary endpoint was ICU survival. Secondary endpoints included receiving mechanical support (renal, respiratory or circulatory), hemodynamic parameters during AF, rate and rhythm control strategies, anticoagulation, and documentation. RESULTS: A total of 616 patients (male gender 62.3%, median age 75 years) were included in our analysis. New-onset AF was diagnosed in 87 patients (14.1%), 136 (22.1%) presented with preexisting AF, and 393 (63.8%) did not develop AF. Initial episodes of new-onset AF exhibited higher hemodynamic instability than episodes in preexisting cases, with elevated heart rates and increased catecholamine doses (both p < 0.001). ICU survival in new-onset AF was 80.5% (70/87) compared to 92.4% (363/393) in patients without AF (OR 0.340, CI 0.182-0.658, p < 0.001). Likewise, ICU survival in preexisting AF was 86.8% (118/136) was significantly lower compared to no AF (OR 0.542, CI 0.290-0.986, p = 0.050*). Independent predictors of ICU survival for patients were atrial fibrillation (p = 0.016), resuscitation before or during ICU stay (p < 0.001), and receiving acute dialysis on ICU (p = 0.002). CONCLUSIONS: ICU survival is noticeably lower in patients with new-onset or preexisting atrial fibrillation compared to those without. Patients who develop new-onset AF during their ICU stay warrant special attention for both short-term and long-term care strategies.

[Extracorporeal cardiopulmonary resuscitation-When the heart no longer functions]. / Extrakorporale Reanimation ­ wenn das Herz nicht mehr funktioniert.

Extracorporeal cardiopulmonary resuscitation (ECPR) is an option for restoring blood circulation in patients with refractory circulatory failure. While conventional resuscitation measures are being continued, venoarterial extracorporeal membrane oxygenation (VA ECMO) is established in patients with cardiac arrest. This bypass can compensate for the functions of the heart and lungs until recovery of organ function. The benefit of ECPR compared to conventional resuscitation appears to be evident, especially after a prolonged resuscitation period; however, in three prospective randomized controlled studies an advantage has not yet been conclusively proven for widespread use in clinical routine. ECPR systems are complex and resource-intensive and should therefore be limited to specialized centers where sufficient numbers of patients are treated to ensure a high level of expertise in the teams.

A short, animated storytelling video about sodium intake as a major cardiovascular risk factor and recommendations for a healthy diet: an online, randomized, controlled trial.

BACKGROUND: Increased uptake of sodium is a major cause for cardiovascular disease and mortality. Reduction of daily salt intake below a reference level of 2 g per day (the equivalent to 5 g salt/day) is known to effectively reduce cardiovascular mortality. The widespread use of social media, with a constant increase in video consumption, is opening new avenues for the dissemination of innovative and scalable approaches to health-related information and recommendations for a healthy diet, such as via video interventions with short animated stories (SAS). OBJECTIVE: This study will evaluate the effect of a sodium intake-SAS video intervention on immediate and medium-term knowledge about dietary sodium. Beyond that, immediate and medium-term effects on behavioral expectation to reduce sodium intake as well as voluntary post-trial engagement with the video content will be examined. METHODS: In this 4-armed, parallel, randomized controlled trial, 10,000 adult, US participants will be randomly assigned to (1) a short, animated storytelling intervention video on sodium as a cardiovascular disease risk factor followed by surveys assessing the facts on sodium and cardiovascular disease conveyed in the video (2) the surveys only, (3) an attention placebo control video followed by the before mentioned surveys, and (4) an arm that is exposed to neither the video nor the surveys. Two weeks later, participants in all four arms will complete all of the surveys. RESULTS: Primary outcomes are the immediate and medium-term effects of the short, animated storytelling intervention video on knowledge about dietary sodium. Secondary outcomes are immediate and medium-term effects of the short, animated storytelling intervention on behavioral expectation to reduce sodium intake as well as voluntary post-trial engagement with the video content. CONCLUSION: This study will extend the knowledge on the effects of short, animated storytelling for the containment of the global cardiovascular disease burden. Knowledge on the groups that may be more likely to voluntarily engage with SAS video content will help to improve targeting of future interventions towards audiences at risk. TRIAL REGISTRATION {2A}: ClinicalTrials.gov NCT05735457. Registered on February 21, 2023.

["Liquid ecstasy": gamma-butyrolactone withdrawal delirium with rhabdomyolysis and dialysis dependent renal failure]. / "Liquid Ecstasy": Gamma-Butyrolacton-Entzugsdelir mit Rhabdomyolyse und dialysepflichtiger Niereninsuffizienz.

HISTORY AND ADMISSION FINDINGS: A 24-year-old man with known abuse of gamma-butyrolactone (GBL) was found with stupor and myoclonies on all extremities. He had been known to have ingested 2 ml of pure GBL every half an hour. Decubiti were detected on the knuckle of the right foot, on both elbows and at the rump. INVESTIGATIONS: Laboratory findings revealed signs of severe rhabdomyolysis and renal failure as well as elevated markers of inflammation. Other routine laboratory parameters were normal. A toxicological screening revealed no signs of an acute intoxication. DIAGNOSIS, TREATMENT AND COURSE: A GBL withdrawal syndrome was diagnosed. The treatment of agitation and myoclonies required repeated applications of benzodiazepines. Because of the resulting respiratory depression the patient had to be intubated. To cope with myoclonies and other symptoms of substance withdrawal we had to administer midazolame and clonidine continuously until day four. Because of acute renal failure resulting from rhabdomyolysis hemodialysis was necessary three times. After 19 days the patient was transferred to a psychiatric clinic. CONCLUSIONS: Primary care physicians treating patients with a coma of unknown cause always have to think of the possibility of GBL withdrawal. The treatment will be symptomatic.