Background: The estimated incidence of acute kidney injury requiring continuous renal replacement therapy (CRRT) in patients necessitating extracorporeal membrane oxygenation (ECMO) is approximately 50%. Currently, two well-known techniques—integration and separation—are utilized for combining CRRT and ECMO circuits. The efficacy of these two techniques is still unknown. Therefore, this study aimed to compare the circuit lifespan of CRRT between the integration and separation techniques. Methods: A multicentered randomized controlled study with an unblinded design will be conducted to determine circuit lifespan differences between integration and separation techniques. Hypothesis: We hypothesize that the integration technique will yield a longer circuit lifespan for CRRT compared to the separation technique. Trial registration: NCT05036616
Abstract Background Enterococcal infective endocarditis (EIE) is associated with substantial morbidity and mortality, while optimal vancomycin pharmacodynamic targets for this condition remain uncertain. Objective To determine the association between vancomycin area under the concentration–time curve to minimum inhibitory concentration ratio (AUC/MIC) and clinical outcomes in patients with EIE. Methods This retrospective cohort study included adult patients with enterococcal infective endocarditis (EIE) who received intravenous vancomycin and had at least one measurable serum concentration. Vancomycin exposure parameters, including the 24-hour area under the concentration–time curve (AUC₀–₂₄, day 1) and steady-state AUC (AUCss), were retrospectively estimated using Bayesian modeling software and were not used to guide dose adjustment during patient care. The primary outcome was 30-day all-cause mortality, and secondary outcomes included microbiological failure and nephrotoxicity defined according to KDIGO criteria. Results A total of 120 patients with EIE were included. The optimal cut-points for predicting 30-day survival were an AUC₀–₂₄/MIC ≥ 450 and an AUCss/MIC ≥ 420. Patients achieving these thresholds had significantly lower 30-day mortality compared with those below the thresholds. Adequate vancomycin exposure remained independently associated with improved survival. A prespecified AUCss ≥ 650 mg·h/L was associated with increased nephrotoxicity. In multivariate analysis, acute renal failure, septic shock, and low vancomycin AUC/MIC were independent predictors of 30-day mortality, whereas cardiac surgery demonstrated a protective effect. Conclusions In patients with EIE, achieving AUC₀–₂₄/MIC ≥ 450 or AUCss/MIC ≥ 420 improves survival, whereas AUCss ≥ 650 mg·h/L significantly heightens nephrotoxicity risk. Early AUC-guided dose optimization and renal monitoring are crucial for balancing efficacy and safety in this high-risk population. Clinical trial registration Not applicable.
The use of secondary prevention medications after acute coronary syndrome (ACS) is commonly suboptimal despite strong evidence and recommendations for their benefits. This study aimed to compare the usage rates of secondary prevention medications between the post-percutaneous coronary intervention (PCI) clinic, a coordinated, multidisciplinary service for patients who underwent cardiac stenting after ACS, and the historical control group. This single-center, retrospective cohort study with a historical control was performed in ACS patients undergoing PCI during 2015–2020 in a tertiary care hospital in Thailand. Primary outcomes were the usage rates of secondary prevention medications including antiplatelets, high-intensity statins, beta blockers, and angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) at 3, 6, and 12 months. Secondary outcomes included all-cause rehospitalization, recurrent myocardial infarction, and death. Finally, there were 273 and 1,050 patients in the control and intervention groups, respectively. Baseline characteristics between the two groups were mostly similar, with a mean age of 59.44 ± 12.29 years. After adjustment for confounding factors, the usage rate of high-intensity statins was higher in the intervention group compared to the control group at 3, 6, and 12 months with adjusted odds ratios (aORs) of 2.40 (95
Abstract Background/Introduction Transcatheter closure of secundum atrial septal defect (ASD) is commonly performed under general anaesthesia with transoesophageal echocardiography. Local anaesthesia with transthoracic echocardiography (TTE) may reduce resource use while maintaining procedural safety; robust large-cohort data remain limited. Purpose To evaluate procedural success and 24-hour safety of ASD device closure under local anaesthesia with TTE and fluoroscopy, and to perform a prespecified subanalysis of outcomes by age, defect size and time period (learning curve), including predictors of major complications. Methods In a retrospective single-centre cohort, consecutive patients undergoing transcatheter secundum ASD closure under local anaesthesia between November 2008 and May 2024 were analysed. Procedures were guided by TTE and fluoroscopy with optional balloon sizing. The primary endpoint was procedural success at 24 hours (successful device implantation with no clinically significant residual shunt by colour Doppler). Secondary endpoints included immediate success, major complications within 24 hours, and procedural parameters. Subgroup analyses were performed by age (<18, 18–40, >40 years), ASD size (<20, 20–30, >30 mm), and time period (2008–2012, 2013–2018, 2019–2024). Multivariable analysis assessed predictors of major complications. Results A total of 856 patients were included (68.2% female; mean age 28.4±16.7 years; range 3–78). Immediate success was 97.7% (836/856; 95% CI 96.8–98.6) and 24-hour success was 96.9% (830/856; 95% CI 95.9–97.9). Mean procedure time was 45±15 minutes and fluoroscopy time 12±8 minutes. Major complications occurred in 2.9% (25/856), including device embolisation (0.9%), significant vascular complications (1.4%), emergency surgery (0.4%), stroke (0.1%) and complete atrioventricular block (0.1%); there was no procedural mortality. Subanalysis showed similar success across age groups (p=0.48) and ASD size groups (p=0.61). A significant learning-curve effect was observed with increasing success from 95.8% (2008–2012) to 98.4% (2019–2024) (p=0.003). Independent predictors of major complications were ASD diameter >25 mm (OR 2.8, 95% CI 1.4–5.6), age >60 years (OR 2.1, 95% CI 1.1–4.2) and deficient aortic rim <4 mm (OR 1.9, 95% CI 1.0–3.7). Conclusion(s) In this large cohort, transcatheter secundum ASD closure under local anaesthesia with TTE and fluoroscopic guidance achieved high early success with low 24-hour major complication rates. Subanalysis suggests stable performance across age and defect-size strata, improvement over time consistent with a learning curve, and identifies anatomic and clinical predictors that may refine patient selection and procedural planning.
