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Objective: To assess the capability of the Acute Physiology and Chronic Health Evaluation II (APACHE-II), Sequential Organ Failure Assessment (SOFA) scores, Cardiac Surgery Score (CASUS), and Survival After VA-ECMO (SAVE) in predicting outcomes among a cohort of patients undergoing venoarterial extracorporeal membrane oxygenation (VA-ECMO)., Design: This is an observational retrospective study of 142 patients admitted to the cardiothoracic intensive care unit (CTICU) after undergoing VA-ECMO insertion., Setting: CTICU of a tertiary care center., Participants: All patients admitted to the CTICU for a minimum of 24 hours, post-VA-ECMO insertion, between 2015 and 2022., Interventions: Review of electronic patient records., Measurements and Results: Scores for APACHE-II, SOFA, and CASUS were calculated 24 hours after intensive care units (ICU) admission. The SAVE score was computed from the last available patient details within 24 hours of ECMO insertion. Relevant demographic, clinical, and laboratory data for the study was retrieved from electronic patient records. Pre-ECMO serum levels of lactates and creatinine were significantly associated with mortality. Lower ECMO flow rates at 4 and 12 hours post-ECMO cannulation were significantly correlated with survival to discharge. The development of arrhythmias, acute kidney injury, and the need for continuous renal replacement therapy while on ECMO were significantly associated with mortality. The APACHE-II, SOFA, and CASUS scores, calculated at 24 hours of ICU admission, were significantly higher amongst nonsurvivors. Following risk score categorization using receiver operating characteristic curve analysis, it was found that APACHE-II, SOFA, and CASUS scores calculated 24 hours post-ICU admission after ECMO insertion demonstrated moderate predictive ability for mortality. In contrast, the SAVE score failed to predict mortality. APACHE-II >27 (area under the curve = 0.66), calculated 24 hours post-ICU admission after ECMO insertion, showed the greatest predictive ability for mortality. Multivariate logistic regression analysis of the four scores showed that APACHE-II >27 and SOFA >14, calculated 24 hours post-ICU admission after ECMO insertion, were independently significantly predictive of mortality., Conclusion: The APACHE-II, SOFA, and CASUS, calculated at 24 hours of ICU admission, were significantly higher among nonsurvivors compared with survivors. The APACHE-II demonstrated the highest mortality predictive ability. APACHE-II scores of 27 or above and SOFA scores of 14 or above at 24 hours of ICU admission after ECMO cannulation can predict mortality and assist physicians in decision-making., Competing Interests: Declaration of competing interest None of the authors received, in the past 5 years, reimbursements, fees, funding, or salary from an organization that may in any way gain or lose financially from the publication of this manuscript. However, Hamad Medical Corporation is funding article processing charges. None of the authors hold any stocks or shares in an organization that may in any way gain or lose financially from the publication of this manuscript, either now or in the future. None of the authors hold, nor are currently applying for, any patents relating to the manuscript's content. The authors did not receive reimbursements, fees, funding, or salary from an organization that holds or has applied for patents relating to the manuscript's content. None of the authors have any other financial competing interests. None of the authors have any other nonfinancial competing interests (political, personal, religious, ideological, academic, intellectual, commercial, or other) to declare., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Introduction: Chronic myeloproliferative neoplasms (MPNs) such as polycythaemia vera (PV) and essential thrombocytosis are associated with atherosclerosis and cardiovascular events, especially if JAK2 mutation is there. In rare cases, also spontaneous coronary artery dissection (SCAD) can be seen., Case Presentation: This case series describes two case reports of MPNs in which SCAD was found in both of them in addition to standard atherosclerosis. First one was about a 42-year-old man who was admitted for acute myocardial infarction (MI) and was later found to have PV and SCAD. The second one was about a 52-year-old man who was also admitted for acute MI and was later found to have SCAD and essential thrombocythemia. JAK2V617F missense mutation was found in both cases., Conclusion: MPNs with JAK2 mutations are associated with SCAD in addition to usual atherosclerosis. This association needs further research., Competing Interests: The authors have no conflicts of interest to declare., (© 2024 The Author(s). Published by S. Karger AG, Basel.)

Radical sternectomy with sternal reconstruction using synthetic mesh or titanium plates has been described before with excellent results. However, radical removal of the sternum without reconstruction is a rare surgical treatment for complicated deep sternal wound infections (DSWI). The long-term outcome following this radical operation is not well-known due to the limited number of cases in the literature. We report on a patient 10 years after a radical sternectomy for DSWI who presented with shortness of breath. We highlight some of the anatomical and physiological changes the chest cavity may undergo and the fact that this patient had a near normal quality of life in the 10 years following the sternectomy.