Research Spotlight

Chou, E. H., C. H. Wang, R. Monfort, A. Likourezos, J. Wolfshohl, T. C. Lu, Y. L. Hsieh, L. Haines, E. Dickman and J. Lin (2020). “Association of ultrasound-related interruption during cardiopulmonary resuscitation with adult cardiac arrest outcomes: A video-reviewed retrospective study.” Resuscitation 149: 74-80.

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OBJECTIVES: To determine the association of focused transthoracic echocardiography (ECHO) related interruption during cardiopulmonary resuscitation (CPR) with patient outcomes in the Emergency Department (ED). METHODS: This was a retrospective, single center, cohort study, conducted in an urban community teaching ED. Eligible study subjects were adult patients in the ED with sustained cardiac arrest. Exclusion criteria include traumatic cardiac arrest and age less than 18. All resuscitations were video recorded and were subsequently reviewed by 2 study investigators. The no-flow time from chest compression interruption was analyzed using video review and separated into ECHO-related and non-ECHO related. Our primary outcome was patient survival to hospital discharge and the secondary outcome was the rate of return of spontaneous circulation (ROSC). Multivariate logistic regression analyses were performed to examine the associations between independent variables and outcomes. RESULTS: From January 2016 to May 2017, a total of 210 patients were included for final analysis. The median total no-flow time observed on video was 99.5s (IQR: 54.0-160.0s). Among these, a median of 26.5s (IQR: 0.0-59.0s) was ECHO-related and a median of 60.5s (IQR: 34.0-101.9) was non-ECHO-related. The ECHO-related no-flow time between 77 and 122s (OR: 7.31, 95 % confidence interval [CI]: 1.59-33.59; p-value=0.01) and ECHO-related interruption<==2 times (OR: 8.22, 95% CI: 1.51-44.64; p-value=0.01) were positively associated with survival to hospital discharge. ECHO-related interruption<==2 times (OR: 5.55, 95% CI: 2.44-12.61; p-value<0.001) was also positively associated with ROSC. CONCLUSION: Short ECHO-related interruption during CPR was positively associated with ROSC and survival to hospital discharge. While ECHO can be a valuable diagnostic tool during CPR, the no-flow time associated with ECHO should be minimized.

Bohm, M., K. Kario, D. E. Kandzari, F. Mahfoud, M. A. Weber, R. E. Schmieder, K. Tsioufis, S. Pocock, D. Konstantinidis, J. W. Choi, C. East, D. P. Lee, A. Ma, S. Ewen, D. L. Cohen, R. Wilensky, C. M. Devireddy, J. Lea, A. Schmid, J. Weil, T. Agdirlioglu, D. Reedus, B. K. Jefferson, D. Reyes, R. D’Souza, A. S. P. Sharp, F. Sharif, M. Fahy, V. DeBruin, S. A. Cohen, S. Brar and R. R. Townsend (2020). “Efficacy of catheter-based renal denervation in the absence of antihypertensive medications (SPYRAL HTN-OFF MED Pivotal): a multicentre, randomised, sham-controlled trial.” Lancet Mar 27. pii: S0140-6736(20)30554-7. [Epub ahead of print].

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BACKGROUND: Catheter-based renal denervation has significantly reduced blood pressure in previous studies. Following a positive pilot trial, the SPYRAL HTN-OFF MED (SPYRAL Pivotal) trial was designed to assess the efficacy of renal denervation in the absence of antihypertensive medications. METHODS: In this international, prospective, single-blinded, sham-controlled trial, done at 44 study sites in Australia, Austria, Canada, Germany, Greece, Ireland, Japan, the UK, and the USA, hypertensive patients with office systolic blood pressure of 150 mm Hg to less than 180 mm Hg were randomly assigned 1:1 to either a renal denervation or sham procedure. The primary efficacy endpoint was baseline-adjusted change in 24-h systolic blood pressure and the secondary efficacy endpoint was baseline-adjusted change in office systolic blood pressure from baseline to 3 months after the procedure. We used a Bayesian design with an informative prior, so the primary analysis combines evidence from the pilot and Pivotal trials. The primary efficacy and safety analyses were done in the intention-to-treat population. This trial is registered at ClinicalTrials.gov, NCT02439749. FINDINGS: From June 25, 2015, to Oct 15, 2019, 331 patients were randomly assigned to either renal denervation (n=166) or a sham procedure (n=165). The primary and secondary efficacy endpoints were met, with posterior probability of superiority more than 0.999 for both. The treatment difference between the two groups for 24-h systolic blood pressure was -3.9 mm Hg (Bayesian 95% credible interval -6.2 to -1.6) and for office systolic blood pressure the difference was -6.5 mm Hg (-9.6 to -3.5). No major device-related or procedural-related safety events occurred up to 3 months. INTERPRETATION: SPYRAL Pivotal showed the superiority of catheter-based renal denervation compared with a sham procedure to safely lower blood pressure in the absence of antihypertensive medications. FUNDING: Medtronic.

Boals, A., Z. Trost, A. M. Warren and E. E. McShan (2020). “Injustice is Served: Injustice Mediates the Effects of Interpersonal Physical Trauma on Posttraumatic Stress Symptoms and Depression Following Traumatic Injury.” J Trauma Stress Mar 26. [Epub ahead of print]

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Previous research has consistently found that traumas of an interpersonal nature are associated with elevated levels of posttraumatic stress symptoms (PTSS). In the current study, we examined whether feelings of injustice related to sustained physical trauma mediate the association between the interpersonal nature of a traumatic injury and two outcomes: PTSS and depressive symptoms. The sample consisted of 176 patients admitted to a Level 1 trauma center for traumatic injuries. Participants completed measures of PTSS, depressive symptoms, and injury-related injustice perception at baseline and again at 3- and 6-month postinjury follow-ups. The results revealed that, compared to noninterpersonal injuries, interpersonal injuries were related to significantly higher levels of perceived injustice, PTSS, and depressive symptoms at all three assessment points, except for PTSS at baseline, ds = 0.47-1.23. These associations remained significant after accounting for injury severity. It is important to note that higher levels of perceived injustice 3-month postinjury follow-up mediated the association between the interpersonal nature of the trauma and higher levels of PTSS and depressive symptoms at 6 months postinjury. Our results suggest injustice may be an important factor that helps explain why interpersonal traumas are associated with poorer mental health outcomes than noninterpersonal traumas. Additionally, the current study provides some of the first prospective analyses of injustice perception and trauma outcomes.

Bhimani, A. A., J. M. Rizkalla, K. J. Kitziger, P. C. Peters, Jr., R. D. Schubert and B. P. Gladnick (2020). “Surgical automation reduces operating time while maintaining accuracy for direct anterior total hip arthroplasty.” J Orthop 22: 68-72.

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Objective: Investigate the efficiency/accuracy of surgical automation versus manual component implantation in DA THA. Methods: Retrospective review of 111 hips: 51 hips via automation and 60 hips via manual technique for DA THA. Results: OR time averaged 8 min faster in the Automated group, compared to Manual group (p = 0.0009). Average femoral size was one size larger in the Automated group compared to Manual group (p = 0.007). No clinically significant differences were found between Manual and Automated groups for cup position or limb-length discrepancy. One calcar fracture occurred in the Automated group. Conclusion: Surgical automation is efficient and accurate for DA THA.

Baxter, R. D., J. I. Fann, J. M. DiMaio and K. Lobdell (2020). “Digital Health Primer for Cardiothoracic Surgeons.” Ann Thorac Surg pii: S0003-4975(20)30504-X. [Epub ahead of print].

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The burgeoning demands for quality, safety, and value in cardiothoracic surgery, in combination with the advancement and acceleration of digital health solutions and information technology, provide a unique opportunity to simultaneously improve efficiency and effectiveness in cardiothoracic surgery. This primer on digital health will explore and review data integration, data processing, complex modeling, telehealth with remote monitoring, and cybersecurity as they shape the future of cardiothoracic surgery.