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Background and aim. The effect of sudden cardiac arrest (SCA) prior to admission to the anesthesia and intensive care unit (ICU) in patients with cardiovascular diseases has not been previously assessed in population studies. The study was aimed to answer the question what is the epidemiology of patients after previous SCA admitted to the ICUs in Poland in the population of patients with cardiovascular diseases. Also, the aim of the study was to evaluate what differs the population of patients with cardiovascular diseases in whom SCA preceded admission to the ICU from the remaining patients with cardiovascular diseases and to determine whether the SCA occurring prior to the admission had a significant effect on the course and outcome of treatment in the ICU. Material and methods. We analyzed 20229 hospitalizations of adult patients from the Silesian Registry of Intensive Care Units conducted in the Silesian Region of Poland since October 2010. The analysis was restricted to patients with major cardiovascular pathologies (myocardial infarction, heart failure, pulmonary embolism), identified by ICD-10 codes in the Registry. Results. In the ICUs reporting their data to the Registry, there were 5101 patients in whom SCA was the only primary cause or one of the primary causes of admission (25.2% of the analyzed population). Restriction of the analysis to major cardiovascular pathologies decreased the number of analyzed hospitalizations from 20229 to 2362 (11.7% of the whole population in the Registry). In this group there were 1090 patients in whom SCA was the only primary cause or one of the primary causes of admission to the ICU (46.1% of patients with cardiovascular diseases). Patients following SCA were younger (68.3 ± 11.6 vs. 70.6 ± 12.1 years, p < 0.001), with higher APACHE II, SAPS III and TISS-28 scoring (p < 0.001). Inotropic medications (65.5% vs. 58.0%, p < 0.001) and therapeutic hypothermia (4.0% vs. 0.2%, p < 0.001) were more frequently used. Mortality in patients after SCA was significantly higher in comparison the remaining population (60.3% vs. 47.8%, p < 0.001). Conclusions. SCA before admission is very frequent among patients admitted to the ICU, in particular in patients with cardiovascular diseases. SCA before admission significantly affects the prognosis of the patient. [ABSTRACT FROM AUTHOR]

Left ventricular assist device (LVAD) thrombosis remains a dreadful complication of mechanical circulatory support, with an incidence of 8-12% depending on the pump type and patient's comorbidities. Fibrinolysis may be considered early in pump thrombosis, but when contraindicated a pump exchange remains the only alternative. This short report documents an emergency LVAD exchange in a 55-year-old man who underwent LVAD (HeartWare Inc) implantation in 2013 as a bridge to transplantation. Four months after the initial surgery, he suffered from a hemorrhagic stroke despite properly managed anticoagulation. On February 17th, 2017 he was re-admitted with LVAD pump thrombosis. As fibrinolysis was contraindicated, an emergency pump exchange was performed via a limited thoracic incision in order to minimize surgical trauma, reduce intraoperative complications and facilitate immediate postoperative recovery. This report documents the very first LVAD pump exchange as well as the first one performed via a minimally invasive approach in Poland. [ABSTRACT FROM AUTHOR]