JACC advances最新文献

{"title":"Full Issue PDF","authors":"","doi":"10.1016/S2772-963X(25)00650-7","DOIUrl":"10.1016/S2772-963X(25)00650-7","url":null,"abstract":"","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 10","pages":"Article 102211"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145195781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medical Education and Critical Care Cardiology in the Modern Era","authors":"Rebecca Garber MD , Satish Mishra MD , Adam Mikolajczyk MD , Amit Goyal MD, MAS , Daniel Ambinder MD , Catherine Vanchiere MD, MA","doi":"10.1016/j.jacadv.2025.101804","DOIUrl":"10.1016/j.jacadv.2025.101804","url":null,"abstract":"","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 10","pages":"Article 101804"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144176095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Moving From the Epidemiology to the Treatment of Respiratory Failure in Patients With Cardiogenic Shock","authors":"P. Elliott Miller MD, MHS , Omar El Charif MD , Mark Jacobs MD","doi":"10.1016/j.jacadv.2025.101970","DOIUrl":"10.1016/j.jacadv.2025.101970","url":null,"abstract":"","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 10","pages":"Article 101970"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144700551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advanced Echocardiographic Assessment Predicts 1-Year Mortality in Critically Ill Patients With Pulmonary Arterial Hypertension","authors":"Hoda Mombeini MD ,&nbsp;Vivek P. Jani MS, PhD ,&nbsp;Jasmine Malhi MD ,&nbsp;Ryan Osgueritchian MD ,&nbsp;Garrett Goldin MS ,&nbsp;Kaidong Wang PhD ,&nbsp;Mario Naranjo MD, MHS ,&nbsp;Valentina Mercurio MD, PhD ,&nbsp;Hussein Hassan MD ,&nbsp;Steve Hsu MD ,&nbsp;Catherine E. Simpson MD, MHS ,&nbsp;Todd M. Kolb MD, PhD ,&nbsp;Stephen C. Mathai MD, MHS ,&nbsp;Paul M. Hassoun MD ,&nbsp;Monica Mukherjee MD, MPH","doi":"10.1016/j.jacadv.2025.102080","DOIUrl":"10.1016/j.jacadv.2025.102080","url":null,"abstract":"<div><h3>Background</h3><div>Despite advancements in diagnosing and managing pulmonary arterial hypertension (PAH), critically ill patients with PAH experience high mortality and current risk scores offer limited utility for risk stratification.</div></div><div><h3>Objectives</h3><div>The purpose of this study was to evaluate whether echo-derived right heart metrics improve risk prediction for in-hospital and 1-year mortality in critically ill PAH patients.</div></div><div><h3>Methods</h3><div>We analyzed PAH patients admitted to the intensive care unit from January 2010 to December 2020, with follow-up through January 2025. Echocardiographic assessments included right atrium (RA) area and phasic function, tricuspid annular plane systolic excursion (TAPSE), fractional area change, regional and global right ventricular (RV) free wall strain (RVFWS), and RV to pulmonary artery (PA) systolic pressure (PASP) coupling ratios. Cox regression evaluated in-hospital and 1-year mortality, and a random survival forest (RSF) model identified nonlinear predictors of 1-year mortality.</div></div><div><h3>Results</h3><div>Of 102 patients, 77 (20 idiopathic PAH, 45 connective tissue disease-associated PAH, 12 other subtypes) had adequate echocardiograms. Cox regression revealed significant associations between in-hospital mortality and TAPSE and RA enlargement. Impaired TAPSE, RVFWS_global, and RV-PA coupling predicted a higher 1-year mortality. Kaplan-Meier analysis identified prognostic thresholds for TAPSE, TAPSE/PASP, RVFWS, and RVFWS/PASP. RSF modeling identified TAPSE, left ventricular diastolic filling parameters, left ventricular end-diastolic volume, and fractional area change/PASP as significant mortality predictors, with a time-varying area under the curve of 0.84.</div></div><div><h3>Conclusions</h3><div>In critically ill PAH patients, echocardiographic markers were independently associated with mortality. A novel RSF model identified key variables for risk prediction, emphasizing the value of comprehensive echocardiographic assessment in this high-risk population.</div></div>","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 10","pages":"Article 102080"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144981491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Pressure-Adjusted Heart Rate and In-Hospital Mortality in Cardiogenic Shock","authors":"Curtis R. Ginder MD, MBA ,&nbsp;Jacob C. Jentzer MD, MSc ,&nbsp;Siddharth M. Patel MD, MPH ,&nbsp;Erin A. Bohula MD, DPhil ,&nbsp;Carlos E. Alfonso MD ,&nbsp;Christopher F. Barnett MD, MPH ,&nbsp;Gregory W. Barsness MD ,&nbsp;Mark W. Dodson MD, PhD ,&nbsp;Shahab Ghafghazi MD, MRCP ,&nbsp;Umesh Gidwani MD, MS ,&nbsp;Jianping Guo MAS ,&nbsp;Younghoon Kwon MD ,&nbsp;Shuangbo Liu MD ,&nbsp;Venu Menon MD ,&nbsp;Sarah A. Morrow ,&nbsp;Connor G. O’Brien MD ,&nbsp;Brian J. Potter MDCM, SM ,&nbsp;Jason N. Katz MD, MHS ,&nbsp;Sean van Diepen MD, MSc ,&nbsp;David D. Berg MD, MPH","doi":"10.1016/j.jacadv.2025.102065","DOIUrl":"10.1016/j.jacadv.2025.102065","url":null,"abstract":"<div><h3>Background</h3><div>Among patients with cardiogenic shock (CS), higher right atrial pressure (RAP) and lower mean arterial pressure (MAP) are associated with higher in-hospital mortality. Pressure-adjusted heart rate (PAHR), defined as heart rate × RAP/MAP, integrates these parameters. The prognostic significance of PAHR has not been assessed in patients with CS.</div></div><div><h3>Objectives</h3><div>The authors aimed to assess if PAHR values are associated with risk of in-hospital mortality in patients with CS.</div></div><div><h3>Methods</h3><div>CCCTN (Critical Care Cardiology Trials Network) is a multinational registry of cardiac intensive care units coordinated by the TIMI Study Group. Among CS admissions (2018-2023) undergoing invasive hemodynamic assessment within 24 hours of cardiac intensive care unit admission, we assessed the relationship of PAHR with in-hospital mortality. Patients with concurrent mechanical circulatory support were excluded in the primary analysis. ORs were adjusted for age, sex, vasoactive-inotropic score, Society for Cardiovascular Angiography and Interventions (SCAI) stage, and preceding cardiac arrest.</div></div><div><h3>Results</h3><div>Among the 1411 CS admissions in the analysis (18% with acute myocardial infarction), 75% were receiving vasoactive support at the time of assessment. Median heart rate was 92 beats/min, RAP 15 mm Hg, MAP 75 mm Hg, and PAHR 17. There was a stepwise gradient of higher in-hospital mortality with higher presenting PAHR values. In adjusted models, a higher PAHR was incrementally associated with higher in-hospital mortality (adjusted OR per 10 units: 1.35 [95% CI: 1.15-1.58]), and PAHR had stronger prognostic associations with mortality than its individual hemodynamic components.</div></div><div><h3>Conclusions</h3><div>PAHR, a simple hemodynamic index calculated from vital signs and central venous pressure, is strongly associated with in-hospital mortality in CS.</div></div>","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 10","pages":"Article 102065"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145195779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pulmonary Effective Arterial Elastance by Echocardiography and Mortality in the Cardiac Intensive Care Unit","authors":"Mitchell Padkins MD ,&nbsp;Garvan Kane MD ,&nbsp;Jeremy Thaden MD ,&nbsp;Joseph G. Murphy MD ,&nbsp;Michael A. Solomon MD, MBA ,&nbsp;Meir Tabi MD ,&nbsp;Christopher Barnett MD ,&nbsp;Jacob C. Jentzer MD","doi":"10.1016/j.jacadv.2025.101806","DOIUrl":"10.1016/j.jacadv.2025.101806","url":null,"abstract":"<div><h3>Background</h3><div>Elevated right ventricular systolic pressure (RVSP) is associated with higher mortality in cardiac intensive care unit (CICU) patients. Markers of right ventricular-pulmonary artery (PA) coupling may be superior to RVSP.</div></div><div><h3>Objectives</h3><div>The authors sought to determine whether effective PA elastance (E_PA, RVSP to stroke volume ratio) and the ratio of pulmonary and systemic elastances (RVSP to systolic blood pressure [SBP] ratio) predicted mortality in a CICU population.</div></div><div><h3>Methods</h3><div>Mayo Clinic CICU admissions from 2007 to 2018 with available data for E_PA or RVSP/SBP were included. The primary outcome was in-hospital mortality, and predictors of in-hospital mortality were analyzed using multivariable logistic regression.</div></div><div><h3>Results</h3><div>The included 5,004 unique CICU patients had a median age of 72.2 years; 40.9% were females. The 348 (7.7%) patients who died during hospitalization had higher E_PA (0.75 vs 0.51) and RVSP/SBP ratio (0.44 vs 0.33). Greater values of E_PA (adjusted OR: 1.12 per 0.1 higher, 95% CI: 1.09-1.16) and RVSP/SBP (adjusted OR: 1.18 per 0.1 higher, 95% CI: 1.11-1.25) ratios were incrementally associated with higher severity of illness, more comorbidities, and increased in-hospital mortality. One-year mortality was incrementally higher with increasing values of E_PA (adjusted HR: 1.09 per 0.1 higher, 95% CI: 1.08-1.1) and RVSP/SBP ratio (adjusted HR: 1.09 per 0.1 higher, 95% CI: 1.07-1.1). Both E_PA and RVSP/SBP ratio had higher discrimination than RVSP alone for predicting in-hospital mortality.</div></div><div><h3>Conclusions</h3><div>Noninvasive echocardiographic E_PA and RVSP/SBP ratio can be used to incrementally prognosticate among CICU patients, and these parameters predict mortality better than RVSP alone.</div></div>","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 10","pages":"Article 101806"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144176097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fever in Myocardial Infarction-Related Cardiogenic Shock","authors":"Matthew Pierce MD ,&nbsp;Abduljabar Adi MD ,&nbsp;Rohit Jain MD ,&nbsp;Ahmed Calvo MD ,&nbsp;Satvinder Guru MD ,&nbsp;Shuojohn Li MD ,&nbsp;Ramsis Ramsis MD ,&nbsp;Moein Bayat Mokhtari MD ,&nbsp;Dechen Samdrup MD ,&nbsp;Sapana Yonghang MD ,&nbsp;Joshua Roubin MD ,&nbsp;Atul D. Bali MD ,&nbsp;Joao D. Fontes MD ,&nbsp;Matthew Griffin MD ,&nbsp;Miguel Alvarez Villela MD","doi":"10.1016/j.jacadv.2025.102071","DOIUrl":"10.1016/j.jacadv.2025.102071","url":null,"abstract":"<div><h3>Background</h3><div>The role of fever in acute myocardial infarction-related cardiogenic shock (AMI-CS) in the contemporary era is not well described.</div></div><div><h3>Objectives</h3><div>The aim of the study was to describe the epidemiology of fever in AMI-CS and its impact on clinical outcomes.</div></div><div><h3>Methods</h3><div>Among all AMI-CS patients in the Northwell-Shock registry (n = 1,372), fever was identified via ≥2 temperatures ≥38.0 °C or one ≥38.3 °C. Characteristics, management, and outcomes were compared between patients with and without fever.</div></div><div><h3>Results</h3><div>Fever occurred in 40% of patients at a median of 2 days [0-6] after admission. Patients with fever were younger, more often male, and had higher shock severity, receiving more invasive treatment. Febrile patients received more antibiotics (84% vs 42%; <em>P</em> &lt; 0.001), yet only 21% had positive microbial cultures. Early fever (&lt;72 hours) was associated with a lower rate of positive cultures (13% vs 24%; <em>P</em> = 0.002). In-hospital mortality was similar between the groups (30% vs 31%; <em>P</em> = 0.78), but patients with fever had longer hospital stays (19 days vs 9 days; <em>P</em> &lt; 0.001) and more discharges to skilled nursing facilities (49% vs 36%; <em>P</em> &lt; 0.001). On multivariable logistic regression, female sex (OR: 1.9; <em>P</em> = 0.001), non-ST-segment elevation myocardial infarction etiology (OR = 1.5; <em>P</em> = 0.047), mechanical ventilation (OR: 2.1; <em>P</em> &lt; 0.001), and acute dialysis (OR: 1.6; <em>P</em> = 0.040) were associated with positive cultures in febrile patients.</div></div><div><h3>Conclusions</h3><div>Fever in AMI-CS is common and is associated with greater illness severity but seems to be noninfectious in most cases. Further research should focus on improving antibiotic use in this population.</div></div>","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 10","pages":"Article 102071"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144981196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimal ECLS Support in Mixed Cardiogenic and Septic Shock","authors":"Lyana Labrada MD ,&nbsp;Mohammad Alarfaj MBBS ,&nbsp;Lena Tran MD ,&nbsp;Hannah Granger MD ,&nbsp;Antonio Hernandez MD, MSCI ,&nbsp;Jinxiang Hu PhD ,&nbsp;Jordan Baker MS ,&nbsp;Edward W. Grandin MD, MPH ,&nbsp;Alvaro A. Delgado MD ,&nbsp;Jason N. Katz MD, MHS ,&nbsp;P. Elliott Miller MD, MHS ,&nbsp;Carlos L. Alviar MD ,&nbsp;Erik Osborn MD ,&nbsp;Matthew D. Bacchetta MD, MBA ,&nbsp;JoAnn Lindenfeld MD ,&nbsp;Zubair Shah MD ,&nbsp;Aniket S. Rali MD","doi":"10.1016/j.jacadv.2025.101965","DOIUrl":"10.1016/j.jacadv.2025.101965","url":null,"abstract":"<div><h3>Background</h3><div>Mixed cardiogenic and septic shock has been shown to have a higher mortality than cardiogenic shock alone and presents a unique hemodynamic phenotype.</div></div><div><h3>Objectives</h3><div>This study aimed to evaluate whether higher circulatory support with veno-arterial extracorporeal life support (VA-ECLS) was associated with increased survival to discharge in patients with mixed shock.</div></div><div><h3>Methods</h3><div>We queried the Extracorporeal Life Support Organization database to identify adult (age &gt;18 years) patients in mixed (cardiogenic and septic) shock requiring VA-ECLS between 2017 and 2022. Patients were categorized into lower (&lt;2.2 L/min/m² flow) or higher (≥2.2 L/min/m² flow) circulatory support on VA-ECLS at 24 hours post-ECLS initiation.</div></div><div><h3>Results</h3><div>A total of 452 patients supported with VA-ECLS with mixed shock were identified. Overall mortality was 63% (n = 285). Older age (adjusted OR [aOR]: 1.02; 95% CI: 1.01-1.04; <em>P</em> &lt; 0.001), pre-extracorporeal membrane oxygenation cardiac arrest (aOR: 1.71; 95% CI: 1.11-2.65; <em>P</em> = 0.016), and baseline Charlson Comorbidity Index (aOR: 1.13; 95% CI: 1.01-1.28; <em>P</em> = 0.043) were associated with increased mortality. Patients receiving higher VA-ECLS support at 24 hours were numerically more likely to survive to discharge (42.6% vs 33.8%, <em>P</em> = 0.063). When evaluated as a continuous variable, higher VA-ECLS flow at 24 hours was associated with an aOR of 1.31 (95% CI: 0.87-1.97; <em>P</em> = 0.19) for survival to discharge.</div></div><div><h3>Conclusions</h3><div>Patients with mixed shock requiring VA-ECLS have a high mortality. Patients with mixed shock receiving higher support at 24 hours had a trend toward increased survival to discharge compared to those with lower support. These results are hypothesis-generating, and further studies are needed.</div></div>","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 10","pages":"Article 101965"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144700552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiac Critical Care in 2025 and in 2035","authors":"Patrick R. Lawler MD, MPH ,&nbsp;Alastair G. Proudfoot MBChB, PhD ,&nbsp;Thomas S. Metkus MD, PhD ,&nbsp;Sean van Diepen MD, MSc ,&nbsp;Erin A. Bohula MD, DPhil","doi":"10.1016/j.jacadv.2025.102170","DOIUrl":"10.1016/j.jacadv.2025.102170","url":null,"abstract":"","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 10","pages":"Article 102170"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145195780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management Patterns and Outcomes of Invasive Mechanical Ventilation in Patients With Cardiogenic Shock","authors":"Christopher S. Grubb MD ,&nbsp;Grant Tucker BS ,&nbsp;Neda Bionghi MD ,&nbsp;Catherine Chen MD, MSHI ,&nbsp;Bethany L. Lussier MD ,&nbsp;Corey D. Kershaw MD ,&nbsp;Gregory Ratti MD ,&nbsp;Roma Mehta MD ,&nbsp;Colby R. Ayers MS ,&nbsp;Nicholas S. Hendren MD ,&nbsp;Justin L. Grodin MD, MPH ,&nbsp;Jennifer T. Thibodeau MD, MSCS ,&nbsp;Ann Marie Navar MD, PhD ,&nbsp;Maryjane A. Farr MD, MSc ,&nbsp;Sandeep R. Das MD, MPH ,&nbsp;James A. de Lemos MD ,&nbsp;Eric J. Hall MD","doi":"10.1016/j.jacadv.2025.101916","DOIUrl":"10.1016/j.jacadv.2025.101916","url":null,"abstract":"<div><h3>Background</h3><div>Approximately one-half of patients with cardiogenic shock (CS) require invasive mechanical ventilation (IMV). Much of the data regarding IMV management is extrapolated from other populations, and little is known regarding management and outcomes of patients with CS who require IMV.</div></div><div><h3>Objectives</h3><div>This study aims to provide data on IMV management in a CS-specific cohort.</div></div><div><h3>Methods</h3><div>Retrospective study of 104 patients treated for CS requiring IMV at an academic safety net hospital from 2017 to 2023. Indications for IMV, ventilator settings, and medications were obtained. Outcomes included in-hospital mortality, survival to extubation, and reintubation.</div></div><div><h3>Results</h3><div>Reasons for intubation included ongoing cardiac arrest (37%) and hypoxic respiratory failure (32%). Most were on low-level ventilator support 24 hours after intubation (median fraction of inspired oxygen 40% [IQR: 30%-50%], positive end-expiratory pressure 5 cm H₂O [IQR: 5-8]). Spontaneous breathing trials were delayed in 78%, primarily due to hemodynamic instability (82%). Nonpalliative extubation occurred in 62% after a median of 4.8 days (IQR: 2.3-8.0). Among patients who received temporary mechanical circulatory support (tMCS) (49%) and survived, tMCS was removed before extubation in 98%. Reintubation occurred in 14% within 48 hours, and in-hospital mortality was 41%.</div></div><div><h3>Conclusions</h3><div>In this cohort, patients were frequently on minimal ventilator support within 24 hours of intubation, yet spontaneous breathing trials and extubation were delayed due to hemodynamic instability. Rates of failed extubation were comparable to other forms of critical illness. Further research is necessary to determine optimal approaches to ventilator liberation in patients with CS, particularly when hemodynamic derangements or tMCS persist in patients who are otherwise candidates for extubation.</div></div>","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 10","pages":"Article 101916"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144700550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}