Association of Plasma Fibrinogen and Thromboelastography With Blood Loss in Complex Cardiac Surgery
After adjustment for multiple confounders, viscoelastic clot strength instead of fibrinogen concentration showed a similar performance for 24 hour blood loss and a better performance for 6 hour blood loss. This makes intraoperative viscoelastic testing a useful tool to strengthen early clinical decision-making with the potential to reduce perioperative blood transfusions.
Mammalian Enteral Ventilation Ameliorates Respiratory Failure
EVA has proven effective in mammalians such that it oxygenated systemic circulation and ameliorated respiratory failure. Due to the proven safety of perfluorochemicals in clinics, EVA potentially provides an adjunctive means of oxygenation for patients under respiratory distress conditions.
Clinical Outcomes of Cardiac Surgery Patients Undergoing Therapeutic Plasma Exchange for Heparin-Induced Thrombocytopenia
Therapeutic plasma exchange with heparin re-exposure was not strongly associated with HIT-related thrombosis/death after cardiac surgery with CPB.
Accidental Systematic Administration of 1 Litre of Cardioplegia Solution during Paediatric Cardiac Surgery
The systemic administration of cardioplegia solution is a rare but important iatrogenic clinical emergency that anaesthetists working in cardiac centres should be aware of. This case demonstrates that full recovery is possible.
Effects of Circulatory Arrest and Cardiopulmonary Bypass on Cerebral Autoregulation in Neonatal Swine
In a validated swine model of cardiac surgery, DH-CPB had a significant effect on cerebral autoregulation, whereas DHCA and SCP did not.
Microcirculatory Changes in Pediatric Patients During Congenital Heart Defect Corrective Surgery
Children with congenital heart disease exhibited decreased vascular density and microvascular blood flow and increased heterogeneity during cardiopulmonary bypass. All these parameters returned to baseline values after surgery.
Directing A Dispersion Cannula Tip Toward the Aortic Root during Thoracic Aortic Arch Surgery Does Not Adversely Affect Cardiac Function
Directing the aortic cannula tip toward the aortic root does not adversely affect the postoperative cardiac function after aortic arch surgery.
Protamine Test Dose: Impact on Activated Clotting Time and Circuit Integrity
Regardless of the protamine test dosage, there is no reliable way to predict how a patient’s ACT will respond to a protamine test dose. Clot formation and circuit integrity is at risk when pump suction devices are continuously in use during PTD administration. Therefore, we strongly recommend that the direct recovery of mediastinal shed blood into the pump circuit be discontinued before any amount of protamine is administered to the patient.
Importance of High-Performing Teams in the Cardiovascular Intensive Care Unit
In surgery, recent initiatives have been adopted in the United States and worldwide, aiming to train surgical providers, from novices to senior levels, on important nontechnical skills, such as situational awareness, leadership, decision-making, communication, and teamwork.
Degradation of the Endothelial Glycocalyx Contributes to Metabolic Acidosis in Children Following Cardiopulmonary Bypass Surgery
Our data show that metabolic acidosis (increased strong ion gap) is associated with plasma concentration of heparan sulfate, a negatively charged glycosaminoglycan cleaved from the endothelial glycocalyx during cardiopulmonary bypass. In addition, cleavage of heparan sulfate was associated with renal dysfunction, capillary leak, and global markers of cardiovascular dysfunction. These data highlight the importance of designing translational therapies to protect the glycocalyx in cardiopulmonary bypass.
Blood Conservation and Hemostasis in Cardiac Surgery: A Survey of Practice Variation and Adoption of Evidence-Based Guidelines
The survey demonstrated widespread adoption of several best practices, including the tolerance of lower hemoglobin transfusion triggers, use of antifibrinolytics, minimization of hemodilution, and use of red cell salvage. The survey also confirms that gaps remain in preoperative anemia management and the use of transfusion algorithms supplemented with POC hemostasis testing. Serial use of this survey can be used to identify barriers to implementation and audit the effectiveness of interventions described in this article. This instrument could also help harmonize local, regional, and national efforts and become an essential component of an implementation strategy for PBM in cardiac surgery.
Rheumatic Heart Disease: The Role of Global Cardiac Surgery
In this review, we describe historical developments in the global response to RHD with a focus on regional, international, and political commitments to address the global burden of RHD. We discuss the surgical and clinical considerations to properly manage surgical RHD patients and describe the logistical needs to strengthen cardiac centers caring for RHD patients worldwide.