Perfusion.com Cardiovascular News Roundup: January 3, 2023
Relevant reading, listening, or viewing – curated by the creator of Tiny Perfusion Letter, Luc Puis
Every week, we collect 10 or 20 articles from the peer-reviewed literature that we think will be of interest to the perfusionist community. Feel free to comment on the findings or suggest entries for the newsletter by emailing the Editor – Luc Puis.
Cardiac Surgery and CPB Quality Rises
Today’s Cardio RoundUp can be loosely divided into three topics. Before we start with measures to improve the quality of care to our patients on cardiopulmonary bypass, we take a look at three observations on surgical quality improvement: data, well-conducted efforts, and local small-scale improvements.
Things you can do on bypass are the following: read this expert review on the neurologic decline after CPB and get caught up on the latest findings. Like this randomized controlled study on the effects of intraoperative hyperoxygenation on neurologic outcomes. Pssst! It’s bad for your patients!
The jury is still not out on what the ideal MAP during CPB is, and this retrospective study is not able to shed light on that. It concludes that a higher MAP (65–75 mmHg) during cardiopulmonary bypass does not significantly prevent acute kidney injury in elderly patients undergoing cardiac valve surgery.
A different approach, gaining much popularity in Europe, is the use of Minimal Invasive ECC (MiECC). This study showed that the expression of mitochondrial DNA (a marker of inflammation) was significantly lower in patients undergoing cardiac surgery with MiECC compared to conventional CPB.
Something else that works for quality improvement is a checklist. In this study, researchers from the Netherlands discuss their pre-incision checklist and how adaptation of surgical handling affects the outcome of their patients.
Blood Management
Every week we have a portion on patient blood management and (anti)coagulation. It’s what we do, right? Well, we still don’t know exactly what we’re doing when giving heparin, but machine learning might help us in predicting the therapeutic response to heparin therapy.
Meanwhile, perfusionists’ autotransfusion wisdom is sometimes needed in other types of surgery, like orthopedics. The WHITE-9 study will compare intraoperative cell salvage and autotransfusion with standard care in the treatment of hip fractures: this is the protocol.
Lately, there has been a big buzz around adsorptive blood purification strategies during CPB. This review summarizes the relevant evidence and suggests future potential research areas.
ECLS
To conclude this RoundUp, we report on a comparative multicenter study showing that adjunctive IABP did not translate into better outcomes in patients treated with VA-ECMO for postcardiotomy shock. Bummer.
Enjoy the read!
Sources
Quality Improvement in Cardiac Surgery and Cardiopulmonary Bypass
- Three Observations for Improving Efforts in Surgical Quality Improvement.
- Neurocognitive Decline in Cardiac Surgery Patients: What Do We Know?
- Intraoperative Hyperoxygenation May Negatively Affect Postoperative Cognitive Functions in Coronary Artery Bypass Graft Operations: A Randomized Controlled Study.
- Higher Mean Arterial Pressure during Cardiopulmonary Bypass May Not Prevent Acute Kidney Injury in Elderly Patients Undergoing Cardiac Surgery.
- Minimized Extracorporeal Circulation Is Associated with Reduced Plasma Levels of Free-Circulating Mitochondrial DNA Compared to Conventional Cardiopulmonary Bypass: A Secondary Analysis of an Exploratory, Prospective, Interventional Study.
- Mortality Reduction After a Preincision Safety Check Before Cardiac Surgery: Is It the Aorta?
PBM
- Predicting Therapeutic Response to Unfractionated Heparin Therapy: Machine Learning Approach.
- Randomised Controlled Trial Comparing Intraoperative Cell Salvage and Autotransfusion with Standard Care in the Treatment of Hip Fractures: A Protocol for the WHITE 9 Study.
- Application of Adsorptive Blood Purification Techniques during Cardiopulmonary Bypass in Cardiac Surgery.
ECLS – VAD
