St. Anthony's Hospital is a private 393-bed hospital in St. Petersburg, Florida. It was founded by the Franciscan Sisters of Allegany in 1931 and is part of BayCare Health System.
BACKGROUND:Percutaneous ventricular assist device (pVAD)-induced electromagnetic interference (EMI) can disrupt implantable cardioverter-defibrillator (ICD) telemetry. We describe a novel mitigation strategy using a cast iron skillet. CASE SUMMARY:An 81-year-old woman with an ICD underwent pVAD-assisted percutaneous coronary intervention for cardiogenic shock. Postprocedure interrogation for slow ventricular tachycardia failed due to significant EMI. Because hemodynamic instability precluded reducing pVAD flow to mitigate interference, a cast iron skillet was placed over the heart. This pseudo-Faraday cage successfully restored telemetry. DISCUSSION:Although the "skillet method" aids durable left ventricular assist device interrogation, prior reports suggest inefficacy with pVADs, favoring flow reduction. We report the first successful use of a cast iron skillet to shield Impella EMI, offering a vital strategy for unstable patients unable to tolerate pump weaning. TAKE-HOME MESSAGES:pVAD systems can generate EMI, disrupting ICD telemetry. When hemodynamic instability prevents lowering pVAD flow, a cast iron skillet can assist in shielding EMI and restoring communication.
Background: Acute intermediate-high risk pulmonary embolism — defined by preserved hemodynamics with RV dysfunction and myocardial injury — carries significant risk of hemodynamic collapse despite anticoagulation. Catheter-directed thrombolysis (CDT) delivers fibrinolytics directly into the pulmonary artery, enabling faster RV offloading with potentially lower hemorrhagic risk than systemic thrombolysis. Prior meta-analyses were limited by retrospective data and lacked recent trials, including HI-PEITHO, STRATIFY, and CANARY. Hypothesis: CDT would significantly improve hemodynamic and clinical outcomes versus anticoagulation alone without a proportional increase in major bleeding or intracranial hemorrhage. Methods: Five databases were searched from inception through 2026 per PRISMA and Cochrane guidelines. Eligible studies compared CDT to anticoagulation in hemodynamically stable patients with RV dysfunction. A random-effects model with restricted maximum likelihood estimation was used. Primary outcomes included RV/LV ratio, pulmonary artery pressure, thrombus burden, and short- and long-term mortality. Secondary outcomes included clinical deterioration, bleeding, and length of stay. Risk of bias was assessed using RoB 2 and ROBINS-I, with subgroup analyses comparing ultrasound-assisted versus standard CDT and RCTs versus observational studies. Results: Eighteen studies (11,542 patients; 2,744 CDT, 8,798 anticoagulation; 4 RCTs, 14 observational) were included. CDT significantly reduced RV/LV ratio (MD = –0.06; 95% CI [–0.10, –0.03]; p<0.001), mean pulmonary artery pressure (MD = –2.93 mmHg; p<0.05), and thrombus burden (SMD = 0.86; p<0.001). Short-term mortality fell 55% (RR = 0.45; p<0.001) and long-term mortality 49% (RR = 0.51; p<0.01). RCTs showed a 64% reduction in clinical deterioration (RR = 0.36; p<0.01). CDT did not significantly increase major bleeding (RR = 1.59; p=0.08) or intracranial hemorrhage (RR = 1.77; p=0.19), though minor access-site bleeding was higher (RR = 3.08; p<0.001). No differences were observed between ultrasound-assisted and standard CDT. Conclusion: In acute intermediate-high risk PE, CDT accelerates RV recovery, reduces pulmonary pressures, and lowers short- and long-term mortality without meaningfully increasing major bleeding or intracranial hemorrhage. Ultrasound facilitation confers no additional benefit, supporting standard catheters as the more cost-effective approach.
BACKGROUND:Door-to-electrocardiogram (D2E) time is a critical quality metric in evaluating patients with suspected acute coronary syndromes (ACS), yet adherence to the ≤10-minute benchmark remains suboptimal. This study aimed to quantify D2E performance, identify predictors of delayed electrocardiogram (EKG) acquisition, and evaluate associations between D2E delays, in-hospital mortality, and length of stay (LOS). OBJECTIVE:To quantify D2E performance, identify patient- and system-level predictors of delayed EKG acquisition, and evaluate associations between D2E delays, in-hospital mortality, and LOS. METHODS:This retrospective cohort study included adults presenting to a single community hospital emergency department in 2024 with symptoms suggestive of ACS. The primary outcome was receipt of a 12-lead EKG within 10 minutes of arrival. Secondary outcomes included D2E distribution, in-hospital mortality, and hospital LOS. Multivariable logistic regression examined predictors of D2E >10 minutes. RESULTS:Among 3435 patients (median age 62 years; 52.3% female), 49.7% achieved D2E ≤10 minutes (median 10.0 minutes). In ACS subgroup analysis, female sex, atypical presentation, lower triage acuity, and afternoon shift were independently associated with D2E >10 minutes. Delayed EKG acquisition correlated with longer LOS, including a higher proportion of stays >4 days and a higher median LOS (3.0 vs. 2.0 days, P < 0.01). Overall, in-hospital mortality was 6.5%. CONCLUSIONS:Fewer than 5 in 10 patients met the 10-minute D2E target. Delays were more frequent among women, patients with atypical presentations, lower triage acuity, and those arriving during afternoon shifts. Delayed EKG acquisition was associated with prolonged hospitalization, underscoring D2E time as a modifiable process measure.
