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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…

surgery

The Paradox of Exceptionalism: Setting Priorities Straight

Unless we reprioritize the delivery of higher quality care at a reduced cost, robotic surgery will not deliver on its promises to better care for our patients.

cover, ecmo, ecls, nautilus

Utility of Gas Inlet Pressure Monitoring in Extracorporeal Membrane Oxygenation

This study confirmed that monitoring the gas inlet pressure changes of an oxygenator during ECMO is clinically useful.

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Inhaled Nitric Oxide Reduces Injury and Microglia Activation in Porcine Hippocampus after Deep Hypothermic Circulatory Arrest

Using DHCA for 30 minutes, consistent with clinical exposure, we noted that iNO reduces neuronal degeneration in the hippocampus. In addition, iNO reduces microglial activation in the hippocampus after DHCA. The data suggest that iNO reduces neuronal degeneration by ameliorating inflammation and may be a practical mode of neuroprotection for infants undergoing DHCA.

HIT

Comparative Effectiveness and Safety of Anticoagulants for the Treatment of Heparin-Induced Thrombocytopenia

Effectiveness and safety outcomes were similar among various anticoagulants, and significant factors affecting these outcomes were not identified. These findings support fondaparinux and DOACs as viable alternatives to conventional anticoagulants for treatment of acute HIT in clinical practice.

level sensor

The Hemodynamic Effects of Warm Versus Room-Temperature Crystalloid Fluid Bolus Therapy in Post-Cardiac Surgery Patients

In postoperative cardiac surgery patients, warm FBT preserved core temperature and induced smaller but more sustained CI increases among responders. Fluid temperature appears to impact both core temperature and the duration of CI response.

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Extracorporeal Cytokine Adsorption Therapy As a Preventive Measure in Cardiac Surgery and As a Therapeutic Add-On Treatment in Sepsis: An Update Systematic Review of Comparative Efficacy and Safety

Given the available evidence, the efficacy and safety of extracorporeal cytokine adsorption therapy in combination with standard care in the investigated indications was not established. We strongly recommend considering well-powered studies with patient-relevant endpoints instead of investing further research funds on studies that may not shed light on the clinical benefit of extracorporeal cytokine adsorption therapy.

Prime

Does A Balanced Colloid Decrease Perioperative Blood Loss in Paediatric Cardiac Surgery: A Double-Blinded Randomized Controlled Trial?

The use of a balanced colloid for peri-operative fluid therapy compared with a saline one is not associated with decreased blood loss or exposure to blood products.

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Association of Plasma Fibrinogen and Thromboelastography With Blood Loss in Complex Cardiac Surgery

After adjustment for multiple confounders, viscoelastic clot strength instead of fibrinogen concentration showed a similar performance for 24 hour blood loss and a better performance for 6 hour blood loss. This makes intraoperative viscoelastic testing a useful tool to strengthen early clinical decision-making with the potential to reduce perioperative blood transfusions.

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Mammalian Enteral Ventilation Ameliorates Respiratory Failure

EVA has proven effective in mammalians such that it oxygenated systemic circulation and ameliorated respiratory failure. Due to the proven safety of perfluorochemicals in clinics, EVA potentially provides an adjunctive means of oxygenation for patients under respiratory distress conditions.

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Clinical Outcomes of Cardiac Surgery Patients Undergoing Therapeutic Plasma Exchange for Heparin-Induced Thrombocytopenia

Therapeutic plasma exchange with heparin re-exposure was not strongly associated with HIT-related thrombosis/death after cardiac surgery with CPB.

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Accidental Systematic Administration of 1 Litre of Cardioplegia Solution during Paediatric Cardiac Surgery

The systemic administration of cardioplegia solution is a rare but important iatrogenic clinical emergency that anaesthetists working in cardiac centres should be aware of. This case demonstrates that full recovery is possible.

perfusion timers

Effects of Circulatory Arrest and Cardiopulmonary Bypass on Cerebral Autoregulation in Neonatal Swine

In a validated swine model of cardiac surgery, DH-CPB had a significant effect on cerebral autoregulation, whereas DHCA and SCP did not.

cover, cpb, cardiopulmonary bypass

Microcirculatory Changes in Pediatric Patients During Congenital Heart Defect Corrective Surgery

Children with congenital heart disease exhibited decreased vascular density and microvascular blood flow and increased heterogeneity during cardiopulmonary bypass. All these parameters returned to baseline values after surgery.

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Directing A Dispersion Cannula Tip Toward the Aortic Root during Thoracic Aortic Arch Surgery Does Not Adversely Affect Cardiac Function

Directing the aortic cannula tip toward the aortic root does not adversely affect the postoperative cardiac function after aortic arch surgery.

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Protamine Test Dose: Impact on Activated Clotting Time and Circuit Integrity

Regardless of the protamine test dosage, there is no reliable way to predict how a patient’s ACT will respond to a protamine test dose. Clot formation and circuit integrity is at risk when pump suction devices are continuously in use during PTD administration. Therefore, we strongly recommend that the direct recovery of mediastinal shed blood into the pump circuit be discontinued before any amount of protamine is administered to the patient.

The Team....

Importance of High-Performing Teams in the Cardiovascular Intensive Care Unit

In surgery, recent initiatives have been adopted in the United States and worldwide, aiming to train surgical providers, from novices to senior levels, on important nontechnical skills, such as situational awareness, leadership, decision-making, communication, and teamwork.

cover, heart, nurse

Degradation of the Endothelial Glycocalyx Contributes to Metabolic Acidosis in Children Following Cardiopulmonary Bypass Surgery

Our data show that metabolic acidosis (increased strong ion gap) is associated with plasma concentration of heparan sulfate, a negatively charged glycosaminoglycan cleaved from the endothelial glycocalyx during cardiopulmonary bypass. In addition, cleavage of heparan sulfate was associated with renal dysfunction, capillary leak, and global markers of cardiovascular dysfunction. These data highlight the importance of designing translational therapies to protect the glycocalyx in cardiopulmonary bypass.

cover, miecc, minimal invasive, hybrid

Blood Conservation and Hemostasis in Cardiac Surgery: A Survey of Practice Variation and Adoption of Evidence-Based Guidelines

The survey demonstrated widespread adoption of several best practices, including the tolerance of lower hemoglobin transfusion triggers, use of antifibrinolytics, minimization of hemodilution, and use of red cell salvage. The survey also confirms that gaps remain in preoperative anemia management and the use of transfusion algorithms supplemented with POC hemostasis testing. Serial use of this survey can be used to identify barriers to implementation and audit the effectiveness of interventions described in this article. This instrument could also help harmonize local, regional, and national efforts and become an essential component of an implementation strategy for PBM in cardiac surgery.

surgery up close

Rheumatic Heart Disease: The Role of Global Cardiac Surgery

In this review, we describe historical developments in the global response to RHD with a focus on regional, international, and political commitments to address the global burden of RHD. We discuss the surgical and clinical considerations to properly manage surgical RHD patients and describe the logistical needs to strengthen cardiac centers caring for RHD patients worldwide.

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Serum Metabolic Profile of Postoperative Acute Kidney Injury Following Infant Cardiac Surgery with Cardiopulmonary Bypass

Moderate-to-severe AKI after infant cardiac surgery is associated with changes in the serum metabolome, including prominent changes to purine, methionine, and kynurenine/nicotinamide metabolism. A portion of infants with mild AKI demonstrated similar metabolic changes, suggesting a potential role for metabolic analysis in the evaluation of lower stage injury.

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The Effect of Hemoadsorption on Rivaroxaban Blood Plasma Concentration in Emergency Cardiac Surgery

The evolution of the RBPC under hemoadsorption in vivo warrants a thorough investigation. Further clinical studies are required to assess the effectiveness and limitations of hemoadsorption to preclude a fatal bleeding event in patients with rivaroxaban in need of major emergency surgery.

capno

Extracorporeal Multiorgan Support Including CO2-Removal with the Advanced Organ Support (ADVOS) System for COVID-19: A Case Report

Irrespective of the outcome we conclude that extracorporeal CO2 removal and multiorgan-support were feasible in this COVID-19-patient. Combined and less invasive approaches such as ADVOS might be considered in old-age-COVID-19 patients with MOF.

cover, ecmo, ecls

Extracorporeal Membrane Oxygenation-Induced Hemolysis: An In Vitro Study to Appraise Causative Factors

Our preliminary results suggested that the choice of anticoagulant and blood donor gender could be critical factors in hemolysis studies, and should be taken into account to improve testing reliability during ECMO.

cover, cellsaver, cell salvage

Evaluation of Autologous Retransfusion from A Closed Suction Drainage System for Patient Blood Management in Elective Total Hip and Knee Replacement: A Two Cohort Study

Our study questions the effectiveness of postoperative autotransfusion as part of a patient blood management programme. In addition, the obvious signs of inflammatory reactions and coagulation activation raise safety concerns.