LAUSR

The 2019 June issue of SHOCK presents its readers with 15 clinical and basic science studies covering the areas of sepsis and septic shock, cardiac arrest and resuscitation, hemorrhagic shock, ischemia and reperfusion, and other disease conditions. These articles significantly advance our knowledge in these fields for more accurate prognostication, better treatment, and improved understanding of the mechanisms underlying injury, damage, and mortality in these conditions. The short-term changes in the number of circulating immune cells in individuals experimentally subjected to endotoxin injection are well known, but the long-term effects have not been adequately studied. To fill this knowledge gap, RodriguezRosales et al. (1) challenged healthy subjects with endotoxin and then quantified several circulating immune cells at up to 20 days post endotoxin administration, and then compared the changes with those observed in patients during the first 9 days after the onset of septic shock. At 20 days post endotoxemia, the investigators observed an increase in the number of circulating HLA-DR monocytes which differed from septic shock patients. They also detected elevated numbers of effector CD8þ cells and an increased percentage of activated CD8þ cells, and these phenomena were also present in sepsis patients. They concluded that experimental endotoxemia recapitulates the behavior of CD8þ T cells, making this model of sepsis relevant for the development of new therapies targeting this population of immune cells. Veno-arterial extracorporeal membrane oxygenation (VAECMO) has been used to resuscitate patients with acute myocardial infarction (AMI) complicated by cardiac arrest (CA). In order to determine predictors of successful weaning from VAECMO, Sugiura et al. (2) reviewed the clinical data of 55 patients with AMI complicated by CA and treated with VAECMO and percutaneous coronary intervention (PCI). The authors identified post-PCI thrombolysis in myocardial infarction (TIMI) flow grade, mean arterial pressure (MAP) at 4 h after ECMO initiation, and serum lactate at 24 h as independent predictors of successful weaning. Left ventricular ejection fraction at 24 and 48 h was significantly greater in the successful weaning group. Therefore, post-PCI TIMI flow grade, MAP at 4 h, and serum lactate at 24 h can be used to predict which patients may require adjunctive use of other circulatory mechanical devices in order to wean from ECMO.