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Bicarb Alternatives: Sodium Acetate & Balanced Crystalloids

Editor’s Note:   Authorization for the contributions below were obtained from each contributor via email.  Please see comments section… THAM A a Buffer Tham Description Tham Solution (tromeThamine injection) is a sterile, non-pyrogenic 0.3 M solution of tromeThamine, adjusted to a pH of approximately 8.6 with glacial acetic acid. It is administered by intravenous injection, by…

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Neuroprotective Effects of Dynamic Bubble Trap Use in Patients Undergoing Pulmonary Endarterectomy: A Two-Arm Randomized Controlled Trial

DBT positively influences memory function after PEA. This effect is most likely caused by the reduction of gaseous microemboli.

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Outcomes and their State-Level Variation in Patients Undergoing Surgery with Perioperative SARS-CoV-2 Infection in the USA: A Prospective Multicenter Study

Patients with perioperative SARS-CoV-2 infection have a significantly high risk for postoperative complications, especially elderly males. Postponing elective surgery and adopting non-operative management, when reasonable, should be considered in the USA during the pandemic peaks.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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Association Between Perioperative Hypotension and Postoperative Delirium and Atrial Fibrillation after Cardiac Surgery: A Post-Hoc Analysis of the DECADE Trial

In patients having cardiac surgery with cardio-pulmonary bypass, neither intraoperative nor postoperative hypotension were associated with delirium. Postoperative hypotension was associated with atrial fibrillation, although intraoperative hypotension was not.

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21st Century Evidence: Randomized Controlled Trials Versus Systematic Reviews and Meta-Analyses

In this foreword, we will review benefits and downsides of SRMAs and address the value of SRMAs in relation to RCTs and their respective roles in clinical decision-making.

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Left Ventricular Assist Device Implants in Patients On Extracorporeal Membrane Oxygenation: Do We Need Cardiopulmonary Bypass?

Omitting CPB for an LVAD implant in patients on ECLS is safe and results in shorter operating time, less re-exploration for bleeding and fewer blood products. However, no survival benefit is observed.

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Measures to Prevent Neurological Deficits in Urgent CABG Surgery with Bilateral Carotid Occlusion

Patients with previous CVA/TIA in the presence of carotid disease requiring coronary arterial bypass surgery (CABG) are associated with a higher risk of neurological ischemic event.

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New Technology for the Use of Inhaled Nitric Oxide to Protect the Heart and Lungs during Operations with Cardiopulmonary Bypass

The developed technology for the use of inhaled NO in surgery with CPB provides a clinically marked protective effect on the heart and lungs. The effectiveness of the protective action of NO depends on the duration of its administration and is most pronounced when used during the entire operation, including CPB time.

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Impact of Arterial Carbon Dioxide and Oxygen Content on Cerebral Autoregulation Monitoring Among Children Supported by ECMO

We observed a complex relationship between PaCO2 and CA, influenced by the level of blood pressure. Hypercapnia seems to be globally protective in normotensive or hypertensive condition, while, in case of very low MAP, hypercapnia may disturb CA as it increases LLA. These data add additional arguments for very cautiously lower PaCO2, especially after ECMO start.

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Perfusion Art: “1st Responders”

Perfusion Art: “1st Responders” Photographer: Frank Aprile, CCP, BBA, LP Equipment: I Phone 8+ Editing: Photoshop Narrative: Fighting Back!!! Giving Covid Hell! Time & Place:   2021 – Daniel Boone Country About The Artist:  CCP Commentary:  ICU Nurse Elaine– Doesn’t quit- Doesn’t quit her patients- and she doesn’t back down from Covid! She definitely marches the halls like a Marine Corps Drill Sgt.…

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Comparative Effects of On-Pump Versus Off-Pump Coronary Artery Bypass Grafting Surgery on Serum Cytokine and Chemokine Levels

Cardiopulmonary pump in patients under CABG surgery can activate systemic inflammation and the changes of serum cytokines levels in off-pump CABG were lower compared with on-pump CABG.

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Extracorporeal Membrane Oxygenation for COVID-19: Evolving Outcomes from the International Extracorporeal Life Support Organization Registry

Mortality after ECMO for patients with COVID-19 worsened during 2020. These findings inform the role of ECMO in COVID-19 for patients, clinicians, and policy makers.

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Anesthetic Management of Successful Extracorporeal Resuscitation After Six Hours of Cardiac Arrest Due to Severe Accidental Hypothermia

The case of a patient who experienced cardiac arrest due to severe AH and was resuscitated for more than six hours using extracorporeal life support recently was published. Herein that case is reviewed, with the anesthetic management during cannulation detailed.