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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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How Would We Treat Our Own Heparin-Induced Thrombocytopenia During Cardiac Surgery?

The aim of this article is to provide a comprehensive review of the current state of knowledge on heparin-induced thrombocytopenia (HIT) in cardiac surgery.

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Transport and Retrieval on Extracorporeal Membrane Oxygenation (ECMO): Setup and Activities of an Immersive Transport and Retrieval on ECMO Workshop

This article describes the authors’ experience of developing and running a simulation-based ECMO Transport and Retrieval workshop, with multiple immersive scenarios and opportunities for participants to familiarize themselves with the process and the ambulance equipment and environment.

perfusion timers

Appropriate Clinical Trial Registration Is the Key to Transparent Reporting and Publication

In summary, since the advent of the ClinicalTrials.gov platform, the importance of trial registration has been recognized gradually but consistently throughout the globe. However, challenges remain, including the reluctance to participate on the part of pharmaceutical companies and a mindset among the individual researchers that registration is onerous and may result in the report of insignificant primary outcomes.

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Brain Injury in Extracorporeal Membrane Oxygenation: A Multidisciplinary Approach

Extracorporeal membrane oxygenation (ECMO) represents an established technique to provide temporary cardiac and/or pulmonary support. ECMO, in veno-venous, veno-arterial or in extracorporeal carbon dioxide removal modality, is associated with a high rate of brain injuries.

Machine for cardiopulmonary bypass
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Minimally Invasive Cardiac Surgical Procedures in Children

In this summary we will review the approaches that have been described and comment on the evidence that they achieve the desired goal of minimizing the trauma of the surgical procedure and enhancing recovery.

surgery with hands

Development and Validation of a Risk Score for Respiratory Failure After Cardiac Surgery

This risk score can stratify patients by risk for developing postoperative respiratory failure after major cardiac surgery, which may help in the development of preventive measures.

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From Less Invasive to Minimal Invasive Extracorporeal Circulation

MiECC use translates to improved end-organ protection and clinical outcome, as evidenced in multiple clinical trials and meta-analyses. MICS performed with MiECC provides the basis for developing a multidisciplinary intraoperative strategy towards a “more physiologic” cardiac surgery by combining small surgical trauma with minimum body’s physiology derangement. Integration of MiECC can advance MICS from non-full sternotomy for selected patients to a “more physiologic” surgery, which represents the real face of modern cardiac surgery in the transcatheter era.

Artwork - Stormy Cells

Platelet Transfusion: Alloimmunization and Refractoriness

This review evaluates the indications for platelet transfusion, both prophylactic and therapeutic, in the light of recent studies and clinical trials. It highlights new developments in the fields of platelet storage and platelet substitutes, and novel ways to avoid complications associated with platelet transfusions.

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Literature-Based Considerations Regarding Organizing and Performing Cardiac Surgery Against the Backdrop of the Coronavirus Pandemic

There is little evidence on the strategies to organize cardiac surgery in the Covid-19 pandemic. Most authors agree on reducing elective operations based on patients’ clinical condition and the status of the Covid-19 pandemic. Admission screenings and the use of percutaneous or minimally invasive approaches should be preferred to reduce in-hospital stays.

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Anticoagulation in Critically Ill Adults during Extracorporeal Circulation

This review gives a practical view on current concepts of anticoagulation strategies in patients with extracorporeal assist devices.

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Intraoperative Cell Saving: Is the Solution the Actual Problem?

Washing residual cardiopulmonary bypass pump blood with Balsol solution results in a resuspended red cell concentrate with a superior electrolyte profile and a strong ion difference similar to that of residual pump blood.

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Clinical and Hematological Outcomes of Aminocaproic Acid Use During Pediatric Cardiac ECMO

ACA administration was not associated with specific adverse effects. A clinically significant reduction in bleeding amount, red blood cell transfusions, and other hematologic interventions occurred following ACA administration for pediatric patients on ECMO. Wider consideration for ACA use as a part of a multipronged strategy to manage bleeding during ECMO should be considered.

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Effective Use of Reporting Guidelines to Improve the Quality of Surgical Research

Surgical investigators must continue to raise the bar for research across all specialties and aim for the highest standards by which evidence for surgical interventions is evaluated and disseminated. The routine use of reporting standards represents another incremental step toward meeting these goals.

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Association of Intravenous Tranexamic Acid With Thromboembolic Events and Mortality

Findings from this systematic review and meta-analysis of 216 studies suggested that intravenous TXA, irrespective of dosing, is not associated with increased risk of any TE. These results help clarify the incidence of adverse events associated with administration of intravenous TXA and suggest that TXA is safe for use with undetermined utility for patients receiving neurological care.

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Nnemo (Neonatal Neuromonitor) – A Hybrid Optical System to Characterize Perfusion and Metabolism in The Newborn Brain

Optical measures of perfusion and metabolism show potential to act as prognostic markers of injury and could aid clinicians in patient management before significant damage persists.

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Thromboembolic and Bleeding Events in COVID-19 Patients receiving Extracorporeal Membrane Oxygenation

This study describes the incidences of TEE and BE in critically ill COVID-19 patients treated with ECMO. The most common adverse event during ECMO support was bleeding, which occurred at a comparable rate to non-COVID-19 patients treated with ECMO.

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Oxygen Delivery-Guided Perfusion for The Prevention of Acute Kidney Injury: A Randomized Controlled Trial

An oxygen delivery strategy for cardiopulmonary bypass management was superior to a conventional strategy with respect to preventing the development of acute kidney injury.

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Interventions to Reduce Medication Errors in Anesthesia: A Systematic Review

Multimodal interventions and improved labelling reduce medication errors in anesthetized patients.

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Monitoring of the Progression of the Perioperative Serum Lactate Concentration Improves the Accuracy of the Prediction of Acute Mesenteric Ischemia Development After Cardiovascular Surgery

Late intraoperative and early postoperative lactate levels >3 mmol/L and increases >200%, even when remaining within the normal range, should raise the suspicion of subsequent mesenteric ischemia development.

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Intraoperative Urinary Biomarkers and Acute Kidney Injury After Cardiac Surgery

Intraoperative KIM1 but not IL-18 excretion was associated with postoperative development of AKI.

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Myocardial Protection in Adult Cardiac Surgery With del Nido Versus Blood Cardioplegia: A Systematic Review and Meta-Analysis

Although this meta-analysis failed to find any mortality benefits with del Nido cardioplegia, significant benefits were seen in a number of intraoperative and postoperative variables. del Nido cardioplegia is a safe and favourable alternative to blood cardioplegia in adult cardiac surgery.

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Is Extracorporeal Membrane Oxygenation the Standard Care for Acute Respiratory Distress Syndrome: A Systematic Review and Meta-Analysis

Compared with CMV, ECMO contributed to lower 60-day and 1-year mortality, and increased ICU mortality in patients with ARDS. However, H1N1 ARDS was independently associated with higher ICU mortality and nosocomial pneumonia. The results were not affected by removing retrospective control studies or articles published >20 years ago from the sensitivity analysis. This meta-analysis demonstrates the effectiveness of ECMO and its importance in standard treatment of patients with ARDS.

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Computed Tomography Angiography as an Adjunct to Computational Fluid Dynamics for Prediction of Oxygenator Thrombus Formation

In the studied oxygenator, clot burden follows a pattern consistent with clinical observations. Computed tomography angiography–based flow analysis provides a useful adjunct to computational fluid dynamics–based flow analysis in understanding oxygenator thrombus formation.

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Identification of Risk Factors for Renal Failure After Cardiac Surgery by RFILE Classification

This study identified several risk factors for the development of AKI after cardiac surgery. Further validation of these risk factors could allow the implementation of adequate patient management, and the appropriate implementation of risk-adverse interventions in cardiovascular surgery.