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Approximately 5.7 million adults in the United States are diagnosed with heart failure (HF). Durable mechanical circulatory support (MCS) is a proven therapy to improve survival for those who progress to stage IV HF and have failed guideline directed medical therapy (GDMT). When selecting candidates for durable MCS, ISHLT guidelines recommend a detailed psychosocial assessment including: treatment adherence/health behaviors, mental health history, substance use history, cognitive status and capacity to give consent, knowledge and understanding of illness and treatment options, coping with illness, social support, social history, knowledge about and capacity to operate MCS devices. Currently, there are no formally validated psychosocial evaluation tools for LVAD candidacy; though they are commonly used for heart transplant evaluation. The Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) uses a multidisciplinary algorithm to evaluate the impact of pre-transplant risk factors on post-transplant outcomes. Emerging literature suggests that the SIPAT might be useful for assessing psychosocial risk factors for LVAD intervention; though further research is needed. This study examined the association of SIPAT scores for patients undergoing evaluation for durable MCS with 30-day readmission, 30-day mortality, two-year readmission and two-year mortality rates. Two hundred and sixty-eight (268) consecutive patients (median age 66 years, 15.4% female) with terminal HF were evaluated prior to LVAD implantation with a SIPAT assessment. Two hundred and thirty-four (234) of those patients had available 30-day and 2-year outcome data. Results indicated a significant relationship between total scores on the SIPAT and two-year mortality rates (r=.251, n= 234, p <.001). Furthermore, 3 of the 4 SIPAT subscales, which comprise the total score, were significantly correlated with two-year mortality rates (Patient Readiness, r=.235, n= 234, p <.001; Social Support, r=.158, n= 234, p=.016; Lifestyle/Substance Use, r=.143, n= 234, p =.029). Scores on the SIPAT did not relate to 30-day readmission or 30-day mortality rates. Consistent with transplant outcomes, higher SIPAT scores were associated with poorer outcomes, specifically mortality, in LVAD patients. [ABSTRACT FROM AUTHOR]

Abstract: Background: Out-of-hospital cardiac arrest carries a dismal prognosis. Percutaneous extracorporeal membrane oxygenation (ECMO) has been used with success for in-hospital arrests, and some literature suggests improvement in long-term survival for out-of-hospital arrests as well. Objectives: This case highlights the use of ECMO in the emergency department. Case Report: We report a case in which emergency physician-initiated ECMO was used as a bridge to definitive care in an out-of- hospital cardiac arrest in the United States. Conclusions: ECMO is a novel adjunct for patients in cardiac arrest in whom the usual advanced life support techniques have failed. [Copyright &y& Elsevier]