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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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A Profile in Courage: Covid (+) Returning to the Heart Team

Covid19: A Transformative Beast… I kind of feel like we are curving up from that BOTTOM of the slippery slope that we have been on for the last 1 ½ years- at least I hope so.  We are no longer frightened. We are no longer obsessed with the fear of exposure or how it relates…

cover, renal, kidneys

Improved Creatinine-Based Early Detection of Acute Kidney Injury after Cardiac Surgery

Model DynaLab’ improves early detection of CSA-AKI within 12 h after surgery. This simple Cr-based framework poses a fundament for further endeavours towards reduction of CSA-AKI incidence and severity.

level sensor

Dynamic Responses of Renal Oxygenation at the Onset of Cardiopulmonary Bypass in Sheep and Man

Renal medullary hypoxia is an early event during CPB. It starts to develop even before CPB, presumably due to a pressure-dependent decrease in renal blood flow. Medullary hypoxia during CPB appears to be promoted by hypotension and is not ameliorated by increasing blood hemoglobin concentration.

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Computational Numerical Analysis of Different Cannulation Methods During Cardiopulmonary Bypass of Type A Aortic Dissection Model Based on Computational Fluid Dynamics

Different cannulation modes have an effect on the hemodynamic characteristic of the tear, but this effect is related to different states of CPB. AAC was found to superior to IAC, especially in reducing velocity, stress, and shear stress of site of tear. However, IAC and AAC are more conductive to blood supply than FAC in branch vessels of the aortic arch without being affected by the CPB state.

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Hemolysis Testing In Vitro: A Review of Challenges and Potential Improvements

In this article, the main challenges of hemolysis testing are described, namely the difficult blood sourcing, the high experimental workload, and the low reproducibility of test results. Several approaches to address the challenges identified are proposed and the respective literature is reviewed. These include the replacement of blood as the “shear-sensitive fluid” by alternative test fluids, the replacement of sparse, manual sampling and blood damage assessment by a continuous and automated monitoring, as well as an analysis of categories and causes of variability in hemolysis test results that may serve as a structural template for future studies.

cover, cellsaver, cell salvage

Combined Platelet and Erythrocyte Salvage: Evaluation of a New Filtration-based Autotransfusion Device

This study demonstrated the performance of the SAME device. Platelets and red blood cells were salvaged without significant impact on cell integrity and function. In the meantime, leukocytes were not activated, and the washing quality of the device prevented reinfusion of high concentrations of heparin and plasma proteins.

cover, pumps, dual pump, peditrics

Neurocognitive Disorders Amongst Patients with Congenital Heart Disease Undergoing Procedures in Childhood

Increased surgical complexity, male sex and younger AAI were associated with increased risk of NCDs in pediatric CHD patients. Surveillance protocols should be considered to identify NCDs in CHD patients after cardiac intervention.

cover, bloodgas, heart

Metabolic Disturbance Affects Postoperative Cognitive Function in Patients Undergoing Cardiopulmonary Bypass

Postoperative metabolic disturbance and electrolyte imbalances are closely related to the development of delirium after CABG and need to be considered more carefully. Aging, DM, and preoperative use of narcotics are strong predictors of delirium following CABG.

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The Impact of Exogenous Nitric Oxide During Cardiopulmonary Bypass for Cardiac Surgery

This systematic review explored the findings of three pilot RCTs. Overall the hypothesis that NO delivered via the CPB circuit can provide cardioprotection has been supported by this study. There remains a significant gap in the evidence, further high-quality research is required in both the adult and paediatric populations.

cover, cpb, cardiopulmonary bypass

Daytime Variation of Clinical Outcome in Cardiac Surgery: A Propensity-Matched Cohort Study

These results did not support the hypothesis that the timing of the surgery could influence the tolerance to ischemia and reperfusion injury, at least in patients undergoing nonemergent AVR or a combined AVR with coronary artery bypass graft.

cover, ecmo, ecls, oxy

Comparison of Circulatory Unloading Techniques for Venoarterial Extracorporeal Membrane Oxygenation

This study identified clinically significant hemodynamic variability between the different circulatory unloading techniques evaluated. However, the applicability of these techniques will vary with different patient disease etiology. Further studies on ECMO unloading will help to quantify hemodynamic benefits and establish treatment guidelines.

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.