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Introduction: Mortality following cardiac arrest (CA) is extremely high, with rates as high as 91.5% after out-of-hospital cardiac arrest (OHCA) and 76.1% after in-hospital cardiac arrest (IHCA). This study assessed the clinical profile and outcomes of a large cohort of patients undergoing primary percutaneous coronary intervention (PCI) for OHCA to determine its effect on clinical outcomes and mortality. Methods: 247,456 patients with OHCA due to acute coronary syndrome (ACS) were abstracted from the Nationwide Inpatient Sample database (2001-2011). Results: Among 247,456 OHCA patients, 11,111 (4.5%) had PCI while 236,345 (95.5%) did not. Patients who underwent PCI were younger than those who did not receive PCI (64 vs. 66 years), p p p p 65 years, female gender, AA or Hispanic race, advanced cancer, and liver dysfunction as independent factors associated with increased mortality, while PCI conferred a survival advantage in OHCA, p 50 years old, and those with Medicare. PCI significantly reduces mortality in OHCA patients and should be considered in all OHCA patients. Further investigation and development of methods to overcome the apparent socioeconomic barriers to PCI is required.

BioMEMS relates to the implementation of Micro-Electro-Mechanical Systems (MEMS), in the biological and medical sphere. BioMEMS sensors are being utilized for many clinical applications, including a wireless urinary pressure system, right heart pressure sensor, and measurements on shearing force on the vascular system An important application of BioMEMS is on Heart failure (HF), a common disease, with a prevalence of 10% or more in persons 70 years of age or older, associated with high morbidity and mortality. HF affects over 5 million people and contributes to over 200,000 deaths a year in the United States alone.The purpose of this paper is to provide a short overview on the successful implementation of BioMEMS sensors in heart failure and vascular medicine. Expert commentary: BioMEMS devices have overcome current limitations in pharmacotherapies for resistant hypertension by electrical modulation of the baroreceeptors. This represents a step towards the development of biomedical micro-devices for those conditions in which pharmacotherapies result poorly effective or elicit unacceptable toxicity.

Chagas cardiomyopathy affects one third of patients infected with Trypanosoma cruzi. Classically the posterior and apical regions are affected. We present a rare case of Chagas cardiomyopathy affecting the basal inferior and inferoseptal wall. 75-year-old Haitian female with hypertension and

Introduction Peripheral arterial disease (PAD) can restrict vascular access options for venoarterial extracorporeal membrane oxygenation (VA ECMO). In emergent situations, a comprehensive vascular assessment is impractical, and when severe PAD is encountered, cannulation approaches may be limited. We report a successful cannulation strategy in a patient with severe PAD using bilateral femoral arterial access. Case A 69-year-old White male with ischemic cardiomyopathy with baseline EF 20-25%, coronary bypass grafting (CABG), and peripheral arterial disease (PAD) was admitted to an outside hospital for an elective redo CABG. He had post-cardiotomy shock requiring inotropes and a balloon pump. In 48 hours, he progressed to refractory cardiogenic shock and multiorgan failure with oliguria, coagulopathy, and mild cognitive impairment. VA-ECMO was emergently initiated as a potential bridge to durable ventricular assist device, pending renal recovery.After cut down, heavy circumferential calcification of the left common femoral artery (CFA) was observed, with no palpable pulse. Seldinger technique with incremental dilation was performed. However, a standard 180 cm wire met resistance and could not be advanced beyond 20 cm. Hoping this was extensive plaque, rather than a complete occlusion, a 19-French arterial cannula was placed, with a 6-French antegrade perfusion cannula in the left superficial femoral artery (SFA). ECMO was initiated and only 1 L of flow at 4000 RPM was achieved, indicating the resistance encountered likely implied a complete or critical stenosis of the left iliac artery. A second 19-French arterial cannulation in the right CFA was performed with no resistance this time. The arterial cannulae were connected in a Y configuration and ECMO resumed with roughly 3.5 L at 4000 RPM. The right common femoral vein was accessed with a 21-French venous cannula.He was extubated in less than 48 hours and did well for about 5 days, with evidence of LV recovery on ramp studies. Unfortunately, he then developed hypoxic respiratory failure, hemoptysis, recurrence of multiorgan failure, and hemodynamic instability, suspicious for septic shock. At this point, his family elected to initiate comfort measures, particularly in light of worsening cognitive status. Summary Atherosclerotic vessels pose access difficulties and risk vascular complications. As such, severe PAD often limits patient selection for VA ECMO. To the best of our knowledge, this is the first reported case utilizing a bilateral femoral arterial approach to augment a low flow state in the setting of severe PAD. Various hybrid cannulation strategies may be considered with respect to individual anatomy and broaden the patient pool eligible for VA ECMO.

Background: Nailfold videocapillaroscopy (NFC) is a non-invasive imaging technique that is used clinically in the rheumatology arena in order to directly visualize capillaries for the identification of microvascular abnormalities related to systemic sclerosis. More recently, this technique has been