ECMO CPR saves lives after cardiac arrest in NSW

Clinicians at Westmead Hospital are implementing early ECMO CPR program that they say substantially improve survival rates in  out-of-hospital cardiac arrest.

Cardiac anaesthetists and clinical ECMO lead Dr Natalie Kruit says the program is based on results from a US trial that showed ECMO facilitated resuscitation for patients within 30 minutes of out-of-hospital cardiac arrest and refractory ventricular fibrillation significantly improved survival to hospital discharge by 36% compared with standard advanced cardiac life support (ACLS) treatment.

Dr Kruit said the ECMO CPR program was in its infancy at Westmead, however it has so far saved three lives in the first six months of the program at Westmead.

The ARREST trial, published in the Lancet, showed that survival to hospital discharge was observed in one (7%) of 15 patients in the standard ACLS treatment group versus six (43%) of 14 patients in the early ECMO-facilitated resuscitation group.

Women have worse outcomes post-CABG vs men

Women fare worse than men in the five years post coronary artery bypass grafting (CABG), according to US-based research.

A study of 13,193 CABG patients revealed women had a higher risk of major adverse cardiac and cerebrovascular events (MACCE) (adjusted hazard ratio (HR): 1.12, 95% CI: 1.04–1.21, P = 0.004), myocardial infarction (adjusted HR: 1.30, 95% CI: 1.11–1.52) and repeat vascularisation (adjusted HR: 1.17, 95% CI: 1.04–1.43) in the first five years post surgery than men.

However, mortality (adjusted HR: 1.03, 95% CI: 0.94–1.14, P = 0.51) and stroke (adjusted HR: 1.17, 95% CI: 0.90–1.52) risks were similar between the sexes, and the difference in MACCE risk became non-significant in patients 75 years or older.

Off-pump surgery and multiple arterial grafting did not affect the differences in men and women, the authors, led by Weill Cornell Medicine cardiothoracic surgeon Dr Mario Gaudino, wrote in the European Heart Journal.

In an accompanying editorial, Amsterdam University Medical Centers’ cardiac surgeon Professor Jolanda Kluin and University Medical Center Utrecht epidemiologist, Associate Professor Sanne Peters suggested women’s higher rates of acute CABG complications, older age and greater comorbidity burden pre-operation, anatomical and physiological differences and undetected coronary problems and calcifications not manageable by or indicated for CABG may help explain their increased risk for adverse events.

Further studies with better female representation and sex-disaggregated analyses, and concerted efforts in the cardiology community are needed to “dismantle the social, behavioural, pathophysiological, and clinical factors underpinning sex differences in outcomes of CABG and to translate those into medical education, clinical guidelines, and clinical practice,” they wrote.

“This will lead to new mechanistic insights and improved preventive, diagnostic, and therapeutic targets, and will improve health outcomes for women and men, and reduce health inequalities,” they concluded.

SGLT2 inhibitor approved as first new treatment for CKD in 20 years

Dapagliflozin (Forxiga) has been TGA approved to reduce the risk of worsening kidney function in adults with proteinuric chronic kidney disease.

Professor Carol Pollock, renal research lead at the Kolling Institute, Royal North Shore Hospital, said the new indication represents a significant milestone to better manage chronic kidney disease.

“It is promising to see new treatments have been proven to reduce the likelihood that patients with chronic kidney disease (CKD) will progress to dialysis, require kidney transplantation or suffer cardiovascular disease including heart attack, stroke or heart failure,” she said in a statement from AstraZeneca.

The TGA granted a priority review of Forxiga for people with chronic kidney disease following the pivotal DAPA-CKD study which was stopped early because of efficacy.

Professor Jonathan Shaw, Deputy Director of the Baker Heart and Diabetes Institute, said new treatments for chronic kidney disease will help drive better education on the interconnectedness with other chronic conditions, like type 2 diabetes.

“All the patients that I see with type 2 diabetes are at risk of chronic kidney disease due to the complex interplay between these chronic conditions. We need to be vigilant in recognising the early signs and drive early detection and diagnosis to achieve better outcomes for people with diabetes. By initiating treatment early it gives us an opportunity to slow down the progression of the disease and prevent some of the other related complications,” he said.