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Heart Rhythm 2012

Examining Criteria for ICD Primary Prevention Therapy The Particulars: Studies have suggested that nearly 25% of implantable cardioverter-defibrillators (ICDs) for primary prevention are implanted outside of evidence-based criteria. Currently, there is little information comparing the long-term outcomes among patients receiving ICDs within evidence-based guidelines and those outside of such criteria. Data Breakdown: A retrospective analysis of patients who received ICDs for primary prevention found that those who received their device outside of evidence-based criteria experienced similar results to those within such criteria. Similar findings were observed in time to first appropriate ICD therapy, risk of death, and time of first inappropriate ICD therapy. Take Home Pearl: Patients who receive ICDs for primary prevention outside of evidence-based criteria appear to experience similar therapeutic benefits and outcomes as patients who receive their device within evidence-based criteria. Real-World Results With Subcutaneous ICD The Particulars: The Subcutaneous Implantable Cardioverter-Defibrillator (S-ICD) System does not require the intravascular leads used in typical transvenous implantable cardioverter-defibrillator (ICD) procedures. The device is inserted under the skin and outside the ribcage of patients at risk for sudden cardiac arrest (SCA). Long-term performance of the S-ICD System, including patient quality of life and long-term resource use, has yet to be studied. Data Breakdown: Researchers reviewed the real-world experiences of 230 recipients of the S-ICD System in nine countries. They found a conversion rate of more than 98% for induced and ambulatory ventricular tachycardia or fibrillation. No patients received therapy for any supraventricular tachycardia within a programmed conditional shock zone. Take Home Pearl: According to real-world experiences, the S-ICD System appears to be a safe and effective option for most...

Managing Pediatric Septic Shock

Those who undergo major surgical procedures or who have certain medical hardware placed, such as a central line, are at increased risk for infection and subsequent septic shock. Despite the growing knowledge of this problem, overall recognition in pediatric patients remains relatively low among physicians. To address this issue, my colleagues and I published a study in the May 16, 2011 issue ofPediatrics to describe strategies that have been effective at our institution to improve the management of pediatric septic shock. Recognizing & Treating Septic Shock Early Studies have shown that early recognition and early, aggressive, goal-directed treatment can improve clinical outcomes for children with septic shock. For each additional hour of persistent shock, the mortality risk increases twofold. It’s critical that clinicians become aware of the warning signs of pediatric septic shock. For example, they should be on the lookout for key vital signs, such as age-appropriate heart rate, respiratory rate, and blood pressure. Signs and symptoms include fever, tachycardia, tachypnea, altered mental status, and poor perfusion that may be manifested by cool skin or decreased capillary refill. Hypotension would be a late finding. Developing Protocols for Septic Shock Each hospital should develop its own systems and protocols for recognizing pediatric patients with septic shock. A key note from our study in Pediatrics was that all patients presenting to the ED who met criteria for three or more of the above symptoms or who met any one item and had low blood pressure met our protocol for septic shock. Although most patients in the protocol did not have septic shock, we wanted to cast a wide net to be able to...
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