The Use of Cerebral NIRS Monitoring to Identify Acute Brain Injury in Patients With VA-ECMO
Our results support that cerebral NIRS is a useful, real-time bedside neuromonitoring tool to detect ABI in VA-ECMO patients. A >25% drop from the baseline was sensitive in predicting ABI occurrence. Further research is needed to assess how to implement this knowledge to utilize NIRS in developing appropriate intervention strategy in VA-ECMO patients.
The 10 Commandments of ERAS for Cardiac Surgery
These guidelines recommend 22 evidence-based care bundles for cardiac surgery. In addition to implementation of these bundles, the creation of a cardiac ERAS program involves pivoting the culture of care to a standardized, patient-centered philosophy with rigorous auditing and benchmarking. Adherence to several guiding principles described below is essential to build a successful cardiac ERAS program and improve outcomes.
Effect of Intra-articular Platelet-Rich Plasma vs Placebo Injection on Pain and Medial Tibial Cartilage Volume in Patients With Knee Osteoarthritis: the RESTORE Randomized Clinical Trial
Among patients with symptomatic mild to moderate radiographic knee OA, intra-articular injection of PRP, compared with injection of saline placebo, did not result in a significant difference in symptoms or joint structure at 12 months. These findings do not support use of PRP for the management of knee OA.
The Challenge of Estimating Treatment Effects in Cardiac Surgery
For several decades the cardiac surgery community has relied on observational comparative studies, often due to the perception than randomized trials are too challenging and complex. We have described how only less than 10% of the available evidence on the 10 most commonly performed surgical procedures comes from randomized trials and how the number of published cardiac surgery trials has decreased significantly over the course of the last 20 years.
Data-Driven Individualized Surgical Decision-making: Beyond “Better on Average” Clinical Trial Results
Commonly used surgical risk models do not provide the probability of outcome resulting from a counterfactual scenario of not undergoing surgery, providing only half of the information needed to make informed treatment decisions. Risk models developed from RCT data could inform comparative risks and potential benefits of undergoing alternative treatment options.
Left Heart Decompression on Veno-Arterial Extracorporeal Membrane Oxygenation in Children With Dilated Cardiomyopathy and Myocarditis: An Extracorporeal Life Support Organization Registry Review
Retrospective review of the Extracorporeal Life Support Organization registry revealed an association between left heart decompression and greater odds of survival in children with myocarditis and dilated cardiomyopathy on extracorporeal membrane oxygenation. When comparing patients with dilated cardiomyopathy against those with myocarditis, we could not exclude a three-fold greater odds of survival associated with the use of left heart decompression. This finding warrants further prospective evaluation.
Sequestration of Midazolam, Fentanyl, and Morphine by an Ex Vivo Cardiopulmonary Bypass Circuit
We successfully characterized the adsorption of various combinations of midazolam, fentanyl, and morphine to our CPB circuit, showing that fentanyl and midazolam behave differently based on other medications present.
Pediatric ECMO: Unfavorable Outcomes Are Associated with Inflammation and Endothelial Activation
High levels of circulating inflammatory, endothelial activation, and fibrinolytic markers are associated with mortality and abnormal neuroimaging in children on ECMO.
Clinical Debriefing: TALK© to Learn and Improve Together in Healthcare Environments
The TALK© structure consists of four steps: Target, Analysis, Learning and Key actions, which guide individuals in having focussed and constructive conversations with practical outcomes. It enables effective communication across diverse health care professional teams that work together on a regular or occasional basis in any healthcare environment.
Association Between Exogenous Nitric Oxide Given During Cardiopulmonary Bypass and the Incidence of Postoperative Kidney Injury in Children
This single-center, retrospective, cohort study found no change in the incidence and severity of postoperative AKI after the administration of nitric oxide into the cardiopulmonary bypass circuit in children.
The Effect of Selective Cerebral Perfusion on Cerebral versus Somatic Tissue Oxygenation During Aortic Coarctation Repair in Neonates and Infants
SctO2 and SstO2 have distinct patterns of changes before and after aortic opening during neonate/infant aortic coarctation repair. SctO2/SstO2’s correlations with MAP and PaCO2 are confounded by SCP. The outcome impact of combined SctO2/SstO2 monitoring remains to be studied.
Efficacy and Safety of Aprotinin in Paediatric Cardiac Surgery: A Systematic Review and Meta-Analysis
This meta-analysis suggests that aprotinin is effective and well tolerated in paediatric cardiac surgery. Given the large heterogeneity of the results and the risk of selection bias in observational studies, large randomised controlled trials are warranted.