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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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Thromboelastography During Rewarming for Management of Pediatric Cardiac Surgery Patients

Lower MA during rewarming is associated with increased risk of perioperative bleeding. In patients with rewarming MA<45mm, intraoperative platelet transfusion may reduce the risk of subsequent bleeding. Individualized platelet transfusion therapy based on rewarming TEG may reduce the risk of bleeding while minimizing unnecessary platelet transfusion.

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Same Data, Opposite Results?A Call to Improve Surgical Database Research

Surgical database research is here to stay, and its use will only increase. Decisions made from the time the data set is imported to the final regression model can impact the validity of the findings. A system that questions these steps will pay off with replicable, valid data that are more likely to be accurate and beneficial when informing clinical practice.


Perioperative Circulatory Support for Lung Transplantation

The use of ECMO during lung transplantation seems to reduce postoperative complications and improve short-term outcomes, relative to CPB. However, additional data should be collected through large multicenter randomized controlled trials. Furthermore, preoperative ECMO as a bridge to lung transplantation appears to provide favorable outcomes, although additional data are also needed from experienced transplant centers.

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Intra-Operative Autologous Blood Donation for Cardiovascular Surgeries in Japan: A Retrospective Cohort Study

Intra-operative autologous blood donation could reduce the transfusion rate or amount of red blood cells and fresh frozen plasma for patients undergoing index cardiovascular surgery and could be an effective blood transfusion strategy in cardiovascular surgery for Japanese patients.


Comparison of Anticoagulation Strategies in Patients Requiring Venovenous Extracorporeal Membrane Oxygenation: Heparin Versus Bivalirudin

Patients receiving bivalirudin for systemic anticoagulation on venovenous extracorporeal membrane oxygenation experienced a decrease in the number of extracorporeal membrane oxygenation circuit-related thrombotic events as well as a significant decrease in volume of blood products administered.


Hydroxyethyl Starch on Kidney and Haemostatic Function in Cardiac Surgical Patients: Is A Non-Inferiority Study Design Appropriate for This Setting?

In light of the existing concerns on HES use, this study leaves several unanswered questions: how should patients be informed when they are asked to participate in a clinical trial that may randomise them to receive HES? How can a prestigious research group consider it appropriate to adopt a ’non‐inferiority’ study design to evaluate the safety profile of a controversial drug such as HES, when any proven beneficial effects (if there are any) remain unanswered?


Changes in Intraocular Pressure During Coronary Artery Bypass Graft Surgery: An Observational Study

During cardiac surgery regardless of the technique (on-pump CABG, off-pump CABG), intraocular pressures remain in the normal ranges. It should be kept in mind that patients should be avoided from long and extreme Trendelenburg position, low CVP, and MAP levels during cardiac surgery to prevent eye-related complications.

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Comparison of Normal Saline, Ringer’s and Ringer’s Lactate As Z-BUF Fluids in Management of Perioperative Serum Sodium and Potassium Levels

Ringer’s lactate is more efficient than Ringer’s and normal saline regarding managing sodium and potassium abnormalities.


Unusual Complication of a Right Ventricular Support–Extracorporeal Membrane Oxygenation Cannula

The RVS-ECMO cannula was repositioned at the time of catheterization. The patient remained hemodynamically stable without cardiac complaints. He subsequently underwent a successful lung transplant.


Blood Transfusion Trends by Disease Category in The United States, 2000 to 2014

Blood transfusion rates decreased from 2011 to 2014 in the United States. This decline occurred in most disease categories, which points towards broad strategies like patient blood management systems and disease specific improvements like changes in surgical techniques being effective.


Evaluation, Treatment, and Impact of Neurologic Injury in Adult Patients on Extracorporeal Membrane Oxygenation: a Review

Extracorporeal membrane oxygen (ECMO) is increasingly used as an advanced form of life support for cardiac and respiratory failure. Unfortunately, in infrequent instances, circulatory and/or respiratory recovery is overshadowed by neurologic injury that can occur in patients who require ECMO. As such, knowledge of ECMO and its implications on diagnosis and treatment of neurologic injuries is indispensable for intensivists and neurospecialists.


The International Society for Minimally Invasive Cardiothoracic Surgery Expert Consensus Statement on Transcatheter and Surgical Aortic Valve Replacement in Low- and Intermediate-Risk Patients: A Meta-Analysis of Randomized and Propensity-Matched Studies

In RCTs comparing TAVR and SAVR in low-risk patients, early mortality and stroke were lower in TAVR, but did not differ at 1 year. There was no difference in mortality and stroke in intermediate-risk patients. The Multidisciplinary Heart Team must consider individual patient characteristics and preferences when recommending TAVR or SAVR. The decision must consider the long-term management of each patient’s aortic valve disease.


Malaria and the Heart: JACC State-of-the-Art Review

Although there is a paucity of data regarding cardiac manifestations of malaria, an algorithm for appropriate use of diagnostic tools to assess cardiac involvement has been developed in this paper. Furthermore, it is important to note that typical antimalarial treatment regimens can have fatal cardiac side-effects.


Effect of Hematocrit on the CO2 Removal Rate of Artificial Lungs

In conclusion, the hematocrit level significantly affects vCO2 and should be taken into account when interpreting changes in the vCO2 of an ECCO2R device.

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Improving Hemocompatibility: How Can Smart Surfaces Direct Blood To Fight against Thrombi

Our work demonstrates the first report of a coating that self-regulates its fibrinolytic activity depending on the conditions of blood.

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Intraoperative Cell Salvage

By reading this article you should be able to:

•Discuss why it may be beneficial to avoid allogeneic (donor) transfusion.
•List the benefits that intraoperative cell salvage (ICS) can provide.
•Identify when ICS usage is both appropriate and safe.
•Explain the complications of ICS.
•Describe areas of controversy relating to the use of ICS.

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Computer Vision in the Operating Room: Opportunities and Caveats

Leveraging computer vision approaches through interdisciplinary collaboration and advanced approaches to data acquisition, modeling, interpretation, and integration promises a powerful impact on patient safety, public health, and financial costs.


Viscoelastic Coagulation Monitor as a Novel Device to Assess Coagulation at the Bedside. A Single-Center Experience During the COVID-19 Pandemic

In conclusion, VCM provided reliable results in COVID-19 patients and was easy to perform with minimal training at the bedside.


Impact of Single versus Double Clamp Technique on Blood Lactate Levels and Postoperative Complications in Coronary Artery Bypass Surgery

CPB time, cross-clamp time and numbers of proximal saphenous graft and distal anastomosis showed a significant positive correlation with the postoperative lactate level. In the regression analysis, CPB time emerged as the only independent predictor of PHL (OR 1.04, CI 95% 1.01-1.07, P=0.011). There was no difference in postoperative blood lactate levels between SCT and DCT groups.

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Cardiopulmonary Bypass Preparation Is Mandatory in Cardiac Exploration for Blunt Cardiac Injury Patients

This report introduces how such decision was made based on what supporting evidence and the diagnostic process leading to the initiation of surgical intervention. This report may help with decision-making process when confronted by blunt cardiac injury patients who need cardiac exploration.

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Feasibility of Healthcare Providers’ Autonomic Activation Recognition in Real-Life Cardiac Surgery Using Noninvasive Sensors

This work supports the possibility to detect real-time SNS activation, which could enable interventions to proactively mitigate errors. Additional studies on our large database of surgical cases are underway to confirm this observation.

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Early Outcomes After Lung Transplantation for Severe COVID-19: A Series of the First Consecutive Cases from Four Countries

We aimed to describe the course of disease and early post-transplantation outcomes in critically ill patients with COVID-19 who failed to show lung recovery despite optimal medical management and were deemed to be at imminent risk of dying due to pulmonary complications.


LESS than a “10” An ECMO Journey

Editor’s Note: First of all… Happy Easter all 🙂 We all like to talk about adversity and how we overcome it. Rarely do we elaborate on clinical events and the sequence of clinical and/or operational failures that lead to unintended outcomes. The story below is a pretty straight forward account of mishaps and miscues that…

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Professionalism: Microaggression In the Healthcare Setting

This review offers education on the correlation of microaggression and unconscious bias to health disparities, provides tools to address microaggressions as a bystander, and outlines processes for institutional improvement.