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This viewpoint addresses 10 points that may be of interest both the logistics, as well as actual clinical care of critically ill COVID-19 patients.
A Comparison of Activated Coagulation Time-Based Techniques for Anticoagulation During cardiac Surgery With Cardiopulmonary Bypass
This study compared the efficacy of a modified ACT-based system versus an HMS (Hepcon; Medtronic Inc, Minneapolis, MN) for CPB anticoagulation.
The Use of Corticosteroids for Cardiopulmonary Bypass in Adults
The perioperative application of corticosteroids did not improve mortality rates beyond standard care or other secondary outcomes, such as myocardial infarction, stroke, renal failure, and infection. The observed increased risk of myocardial damage in patients receiving corticosteroids in the SIRS trial is mainly related to the author-defined CK-MB threshold as indicator for early myocardial injury. Interestingly, the use of steroids may have some beneficial effects on secondary outcomes: they significantly decreased the risk of respiratory failure and pneumonia and shortened the length of ICU and hospital stay, but the mechanism involved in pulmonary injury is multifactorial and it is difficult to evaluate this result. Patients receiving steroids did not have a decreased incidence of atrial fibrillation shown by the two large trials unlike some previous small sample size trials have demonstrated.