Controlling Reperfusion Injury With Controlled Reperfusion: Historical Perspectives and New Paradigms
This review article first provides a basic overview of the primary pathways to cell death that have the potential to be addressed by various forms of controlled reperfusion, including no-reflow phenomenon, ion imbalances (particularly calcium overload), and oxidative stress. Descriptions of various controlled reperfusion approaches are described, along with summaries of both mechanistic and outcome-oriented studies at the pre-clinical and clinical phases.
International Survey of Neuromonitoring and Neurodevelopmental Outcome in Children and Adults Supported on Extracorporeal Membrane Oxygenation in Europe
This survey demonstrated significant variability in the use of different neuromonitoring modalities during and after ECMO. The perceived importance of neuromonitoring and follow-up was noted to be very high with agreement for a longitudinal structured follow-up programme, particularly in paediatric patients. Scientific society endorsed guidelines and minimum standards should be developed to inform local protocols.
Calcium Administration In Patients Undergoing CardiAc suRgery Under Cardiopulmonary BypasS (ICARUS trial): Rationale and Design of a Randomized Controlled Trial
This trial is designed to assess whether intravenous calcium chloride administration could reduce the need for inotropic support after cardiopulmonary bypass weaning among adults undergoing cardiac surgery.
Surgical Setup for Cardiopulmonary Bypass Through Central Cannulation
This tutorial discusses the access, surgical technique, and initiation of cardiopulmonary bypass through central cannulation and describes the safeguards and pitfalls.
Timing of Congenital Cardiac Surgery in Children who Turned COVID-19 Positive
We conclude that children with asymptomatic or mild COVID-19 disease may be subjected to surgery as early as within 1 week since COVID-19 negative.
A Communication Guide for Pediatric Extracorporeal Membrane Oxygenation
The communication framework presented can be adapted to unique institutional and clinical settings. Future research is required to investigate utility and potential barriers to implementation. We anticipate that structured conversations during extracorporeal membrane oxygenation support will facilitate clear expectations toward a common treatment goal, foster therapeutic relationships, ensure clinician alignment and consistent language, mitigate communication gaps, support bereavement, and minimize conflict.
Health Technology Assessment for Cardiovascular Digital Health Technologies and Artificial Intelligence: Why is it Different?
In this review, we compare digital health technologies and artificial intelligence with traditional healthcare technologies, review existing health technology assessment frameworks, and discuss challenges and opportunities related to cardiovascular digital health technologies and artificial intelligence health technology assessment. Specifically, we argue that health technology assessments for digital health technologies and artificial intelligence applications must allow for a much shorter device life cycle, given the rapid and even potentially continuously iterative nature of this technology, and thus an evidence base that maybe less mature, compared to traditional health technologies and intervention
Cardiopulmonary Bypass–Induced Inflammation and Myocardial Ischemia and Reperfusion Injury Stimulates Accumulation of Soluble MER
Soluble MER concentrations increase with cardiopulmonary bypass–induced inflammation and myocardial ischemia and reperfusion injury in pediatric patients. The utility of soluble MER as a clinical biomarker to identify pediatric patients at risk for exacerbated postoperative outcomes after bypass-induced myocardial ischemia and reperfusion injury requires further investigation.
Methylprednisolone Plasma Concentrations During Cardiac Surgery With Cardiopulmonary Bypass in Pediatric Patients
We report similar methylprednisolone plasma concentrations as earlier studies performed in children undergoing cardiopulmonary bypass, and we confirmed the large interindividual variability in achieved methylprednisolone plasma concentrations with weight-based methylprednisolone administration. A larger volume of distribution and a lower clearance of methylprednisolone for neonates were suggested. The half-life of methylprednisolone in our study was calculated to be longer than 6 h for neonates, 4.7 h for infants, 3.6 h for preschool children and 4.7 h for school children. The possible influence of treatment of pulmonary hypertension with sildenafil and temperature needs to be investigated further.
Prevention of Cardiac Surgery–Associated Acute Kidney Injury by Implementing the KDIGO Guidelines in High-Risk Patients Identified by Biomarkers: The PrevAKI-Multicenter Randomized Controlled Trial
Implementation of a KDIGO-derived treatment bundle is feasible in a multinational setting. Furthermore, moderate to severe AKI was significantly reduced in the intervention group.
Impact of Left Ventricular Unloading Using A Peripheral Impella®-Pump in eCPR Patients
Concomitant Impella® support might positively influence survival and ECMO weaning in eCPR patients. Treatment-associated complications such as the need for dialysis were more common in this highly selected patient group. Further studies with larger numbers are necessary to evaluate the clinical relevance of concomitant LV-unloading in eCPR patients using an Impella® device.
Acute Kidney Injury in Extracorporeal Membrane Oxygenation Patients: National Analysis of Impact of Age
AKI is common and is increasing among patients on ECMO support. Patients on ECMO have high mortality and AKI is an independent predictor of mortality. Though age is also an independent predictor of mortality in patients on ECMO, it is neither a predictor of AKI nor does not modify the relationship between AKI and mortality.