Objective. To describe a clinical case of venoarterial extracorporeal membrane oxygenation (VA-ECMO) used in a patient with a combination of penetrating cardiac injury, myocardial infarction, and emergency coronary artery bypass grafting (CABG).
Materials and methods. A 37-year-old male patient with a stab wound to the anterior chest wall complicated by hemopericardium, cardiogenic shock, and acute myocardial infarction is presented. Due to persistent systemic hemodynamic instability following initial surgical intervention, peripheral VA-ECMO was initiated, followed by emergency CABG.
Results. The use of VA-ECMO allowed hemodynamic stabilization and created optimal conditions for subsequent bypass surgery without aortic crossclamping. After 72 hours of support, positive dynamics were achieved, with recovery of left ventricular ejection fraction to 52% by the time of discharge.
Conclusion. This case demonstrates the potential effectiveness of VA-ECMO as a component of complex therapy in patients with combined cardiac injury. A multidisciplinary approach played a key role in achieving a favorable outcome.

Introduction. Acute heart failure (AHF) is the leading cause of admission in intensive care units with a high incidence of deaths. The development of models for predicting the unfavourable course during the hospitalization period, regardless of the AHF phenotype, can significantly affect clinical decision-making algorithms and improve outcomes.
The purpose of the study. Determining the risk factors of in-hospital mortality for patients with acute renal failure and assessment of the possibility of constructing a multifactorial prognostic model.
Materials and methods. A pilot single-centre prospective cohort study was conducted, including 208 patients diagnosed with acute respiratory failure in the intensive care unit. Anamnestic, clinical, laboratory and instrumental data were evaluated. The Mann–Whitney test and the Fisher precision test were used to compare the groups. The odds ratio (OR) was evaluated with a 95% confidence interval. The threshold values of quantitative variables were determined by the Yuden criterion in the ROC analysis.
Results. Hospital mortality was 13.9%. In a one-dimensional analysis, risk factors for death included: age ≥76 years (p=0.017), coronary heart disease (p=0.008), chronic kidney disease (p=0.040), peripheral atherosclerosis (p=0.011), and a history of CABG (p=0.037). Laboratory parameters showed an increase in creatinine (p=0.006), urea (p<0.001), bilirubin (p=0.005), LDH (p<0.001), CRP (p=0.004), D-dimer (p=0.041), INR (p=0.006), as well as a decrease in GFR (p=0.003), albumin (p=0.049), total protein (p=0.012), cholesterol (p=0.017) and iron (p=0.027). Physical data and most instrumental parameters, with the exception of the presence of a hydrothorax (p=0.025), did not demonstrate prognostic significance. Multifactorial analysis proved impossible due to the clinical heterogeneity of the AHF phenotypes.
Conclusion. The study identified risk factors for in hospital mortality in acute renal failure. The construction of a multifactorial model turned out to be impossible due to the pronounced clinical incompatibility of different AHF phenotypes. The data obtained call into question the validity of considering AHF as a single nosological category and indicate the expediency of switching to phenotype-specific prediction of outcomes.

Objective. To assess the potential of an integral index α, calculated from the dynamics of liver stiffness and liver density, for predicting the course of chronic heart failure (CHF).
Materials and methods. This prospective single-center study included 124 patients with CHF of NYHA functional class I–IV, who underwent standard clinical, laboratory and echocardiographic assessment, ultrasound liver elastography (2D shear-wave elastography, 2D-SWE), and non-contrast multidetector computed tomography (MDCT) of the liver at baseline, 3 and 6 months. The control group consisted of patients without clinically significant cardiac or hepatic pathology. The index α was defined as the angle between the trend lines of liver stiffness (kPa) and liver density on MDCT (HU) over time. According to the value of α, CHF patients were divided into three groups: 30–60°, 60–90° and >90°. The diagnostic performance of index α for predicting a composite adverse endpoint (death, hospitalization for decompensated CHF, increase in NYHA class by ≥1 during follow-up) was evaluated using ROC analysis.
Results. With increasing index α, a significant worsening of the clinical and instrumental status was observed: a decrease in left ventricular ejection fraction, an increase in pulmonary artery pressure, NT-proBNP level, hospitalization rate, and the severity of signs of congestive hepatopathy according to laboratory parameters, elastography, and liver MDCT (p<0.05 for most between-group comparisons). A threshold of α ≥60° was associated with a sensitivity of 85% and a specificity of 65% for identifying an unfavorable course of CHF, whereas a threshold of α ≥90° demonstrated a sensitivity of 62% and a specificity of 84%. The area under the ROC curve (AUC) for index α considered as a continuous variable was 0.82 (95% CI 0.74–0.89), indicating good prognostic performance of the proposed parameter.
Conclusions. The integral index α, based on the dynamics of liver stiffness and liver density, is associated with the severity of the clinical course of CHF and the frequency of adverse outcomes. The use of indexed α thresholds allows stratification of patients according to the risk of disease progression and may be considered a promising component of a personalized prognostic algorithm in patients with CHF.

The diagnosis, management, and treatment issues of ischemia with nonobstructive coronary arteries (INOCA) patients remain unresolved, especially in “real-life” clinical practice settings. The goal of this retrospective observational study was to analyze the clinical and instrumental features of INOCA patients. An attempt was made to identify the most likely pathogenetic variants of the disease for further high-tech diagnostics and treatment strategy optimization. We analyzed 52 medical records of patients with INOCA hospitalized at the N.V. Sklifosovsky Research Institute for Emergency Medicine with a diagnosis of «acute coronary syndrome without ST-segment elevation.» Coronary angiography revealed no coronary artery stenosis or stenosis less than 50%. According to coronary angiography 41 patients (78.8%) had coronary artery anomalies (muscular myocardial bridge, pathological coronary tortuosity, coronary slow flow phenomenon and spasm). Old myocardial infarction was diagnosed in 42.3% of patients. Patients were classified according to presumed INOCA endotypes, with the vasospastic variant being the most common. In a cardiology department physicians should promptly and comprehensively assess the patient’s clinical and instrumental characteristics to determine indications for intracoronary diagnostics and to prescribe optimal therapy, including endovascular and surgical techniques. 

In recent years, noninvasive respiratory support has taken a key place in the hypoxemic acute respiratory failure treatment. Modern methods of respiratory support – noninvasive ventilation and high-flow oxygen therapy are widely used both in the hypoxemia development and at the stage of mechanical ventilation discontinuation at severe forms of respiratory failure. Along with many undeniable advantages, one of the main limitations of non-invasive respiratory support is the timely detection of signs of its ineffectiveness, indications for intubation, and the risk of delaying the initiation of invasive respiratory support. In the second part of this review, we systematized data on the possibilities and limitations of non-invasive lung ventilation and high-flow oxygen therapy, as well as the criteria for assessing their clinical effectiveness at the stages of developing hypoxemic acute respiratory failure and discontinuing mechanical ventilation, including in patients with cannulas.

Prehabilitation is a component of perioperative medicine and an important stage in the treatment of surgical patients, aimed at improving the patient’s functional capacity and adapting to surgical stress. The key components of multimodal prehabilitation include physical exercise, adequate nutritional support, and psychological support. The authors discuss the potential for optimizing nutritional support using enteral nutrition products in surgical patients to enhance their rehabilitation potential, reduce the severity of sarcopenia, and decrease the incidence of perioperative complications.

The article examines the features of the development of nosocomial urinary infections. Urinary tract diseases have long occupied one of the leading places among the most common medical problems. They not only burden the economy due to the high costs associated with their treatment, but also have a tendency to frequent recurrence and the development of antibiotic resistance, due to uropathogens. Urinary tract infections cause a wide range of diseases among various population groups, including children, women of all ages and older men. Among the most common consequences of these infections are not only frequent relapses of the disease, but also dangerous complications such as pyelonephritis, a number of kidney diseases in children and premature birth. Scientists emphasize the increase in the number of mutations in the genes of bacteria responsible for infectious diseases, which leads to the appearance of more aggressive variants of pathogens. In such circumstances, the importance of using antibacterial agents wisely is emphasized, as well as the active search for alternative treatment methods, in light of the development of drug-resistant strains. As a result of the research, a review of the literature was carried out, the author’s conclusions were given.