Current cardiology reports
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This review aims to summarize and discuss the safety and efficacy of ulnar arterial approach for cardiac catheterization. ⋯ Ulnar access has been found to be as safe and efficacious as radial access. However, the number of access attempts and cross-over rates is higher than with radial access. Ulnar access is an excellent alternative after failed radial access as femoral access is associated with more bleeding and worse clinical outcomes. Future research should focus on ultrasound-guided ulnar access to reduce the number of puncture attempts.
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Review Meta Analysis
ECMO and Short-term Support for Cardiogenic Shock in Heart Failure.
This review aims to discuss the role of ECMO in the treatment of cardiogenic shock in heart failure. ⋯ Trials done previously have shown that IABP does not improve survival in cardiogenic shock compared to medical treatment, and that neither Impella 2.5 nor TandemHeart improves survival compared to IABP. The "IMPRESS in severe shock" trial compared Impella CP with IABP and found no difference in survival. A meta-analysis of cohort studies comparing ECMO with IABP showed 33% improved 30-day survival with ECMO (risk difference 33%; 95% CI 14-52%; p = 0.0008; NNT 3). ECMO is indicated in medically refractory cardiogenic shock. ECMO can be considered in cardiogenic shock patients with estimated mortality of more than 50%. ECMO is probably the MCS of choice in cardiogenic shock with; biventricular failure, respiratory failure, life-threatening arrhythmias and cardiac arrest.