Risk Factors for Vasoplegia after Coronary Artery Bypass and Valve Surgery
Patients with long CPB duration, preoperative use of ACE inhibitors or Angiotensin receptor blockers, and a history of renal failure requiring dialysis are under increased risk of vasoplegia. Vasoplegia necessitates large-scale studies for a better understanding of its risk factors.
Controversies in the Clinical Practice of Patient Blood Management
This special article focuses on the current evidence and controversies in the clinical practice of PBM and on emerging data related to specific PBM-related interventions in patients undergoing cardiac surgery. Strong evidence for many PBM-related interventions is limited because of missing studies or the poor quality of published findings and study endpoints.
Peripheral Cannulation for Extracorporeal Membrane Oxygenation Yields Superior Neurologic Outcomes in Adult Patients Who Experienced Cardiac Arrest Following Cardiac Surgery
Peripheral VA-ECMO allows for continuous CPR and systemic perfusion while obtaining vascular access. Compared to central cannulation, a peripheral cannulation strategy is associated with improved neurologic outcomes and decreased likelihood of anoxic brain death.
Cardiovascular Professional Societies Fall Short in Providing Impartial, Clear and Evidence-Based Guidelines
Why are there so many guidelines? What are the limitations of our current approach? How can we optimise guideline development to improve care of patients with cardiovascular disease?
Outcome and Cost of Nurse-led versus Perfusionist-led Extracorporeal Membrane Oxygenation
Use of a perfusionist-led ECMO model may be more cost-conscious in the context of low utilization, smaller case volume and shorter ECMO duration. However, once annual case volume exceeds 10 and mean ECMO duration exceeds 10 days, the nurse specialist-led model may be more cost-conscious.
Novel Application of Indocyanine Green Fluorescence Imaging for Real-Time Detection of Thrombus in A Membrane Oxygenator.
Under ICG imaging, the inside of the oxygenator was observed as a white area. A black dot suspected to be the thrombus appeared 6-8 hours after measurement initiation. The thrombus and the black dot on ICG imaging were finely matched in terms of morphology. Thus, we succeeded in real-time thrombus detection in an oxygenator using ICG imaging. The combined use of ICG imaging and conventional routine screening tests could compensate for each other's weaknesses and significantly improve the safety of ECMO.
Carboxyhemoglobin Elevation, a Marker for Hemolysis, Is Common in Veno-venous Extracorporeal Membrane Oxygenation
Thus, we believe that COHb elevation is a prevalent phenomenon in patients supported on VV ECMO. Causes include but are not limited to excessive negative pressure and high-blood flow.
Measuring and Publishing Quality Improvement
Misalignment of measures, measurement and analysis with the goals and methods of quality improvement efforts in healthcare may create confusion and decrease effectiveness. In healthcare, measurement is used for accountability, research, and quality improvement, so distinguishing between these is an important first step. Using a case vignette, this paper focuses on using measurement for improvement to gain insight into the dynamic nature of healthcare systems and to assess the impact of interventions.
Rationale and Design of the Intravenous Iron for Treatment of Anemia Before Cardiac Surgery Trial
The ITACS Trial will be the largest study yet conducted to ascertain the benefits and risks of IV iron administration in anemic patients awaiting cardiac surgery.
Validation of the Relationship Between Coagulopathy and Localization of Hydroxyethyl Starch on the Vascular Endothelium in A Rat Hemodilution Model
HES was shown to cover the endothelium, possibly due to its high shear viscosity, and this mechanism potentially acted to protect, rather than damage, the endothelium and glycocalyx. However, this covering effect may be the cause of coagulopathy due to inhibition of von Willebrand factor secretion from the endothelium.
Postoperative Cerebral Oxygen Saturation in Children After Congenital Cardiac Surgery and Long-Term Total Intelligence Quotient: A Prospective Observational Study
Increased dose of cerebral tissue oxygen saturation desaturation and reduced mean cerebral tissue oxygen saturation during the early postoperative period independently increase the probability of having a lower total intelligence quotient, 2 years after PICU admission.
Pharmacokinetics of Anti-Infective Agents during Cytosorb Hemoadsorption
Hemoadsorption with CytoSorb appears to increase to a clinically significant extent the clearance of five among 17 tested anti-infectives. Studies in human patients are required to confirm the need for dosage adjustment of these agents.