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surgery

Urgent Coronary Artery Bypass Graft Surgery Supported by Veno-Arterial Extracorporeal Membrane Oxygenation: A Report of Two Cases

Our report indicates that VA-ECMO can be used instead of the cardiopulmonary bypass machine (CPB) to support the circulation during CABG surgery in patients with complex coronary anatomy and unstable haemodynamics. Future studies focusing on the long-term outcomes of such patients will probably help to establish the optimal management of this type of patients.

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Bedside Angiography of Distal Perfusion Catheter for Veno-Arterial Extracorporeal Membrane Oxygenation

Bedside angiography of the distal perfusion catheter is feasible and can be a useful adjunct in informing the need for further intervention to the ipsilateral lower extremity.

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Quantification of Recirculation During Veno-Venous Extracorporeal Membrane Oxygenation: In Vitro Evaluation of a Thermodilution Technique

This study proved the technical feasibility and computation validity of the applied thermodilution technique in computing vv-ECMO RF.

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Acute Kidney Injury in Cardiac Surgery

Current evidence supports a multimodal risk-stratification approach with biomarker-guided management of high-risk patients, perioperative administration of dexmedetomidine, and implementation of a care bundle as recommended by the Kidney Disease: Improving Global Outcomes group.

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Acute Kidney Injury Post-Heart Transplant: An Analysis of Peri-Operative Risk Factors

Risk factors found to be associated with the presence of acute kidney injury included increased use of vasopressors and inotropes post‐transplant. Protective factors included cardiopulmonary bypass time <170 min. Acute kidney injury was found to be associated with increased 30‐day and 1‐year mortality.

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Usefulness of Self-Expanding Drainage Cannula in Venovenous Extracorporeal Membrane Oxygenation: Tips, Tricks, and Results of an Early Experience

We present a retrospective series of selfexpanding venous cannula 430 or 530 mm in length in six consecutive patients undergoing venovenous (VV) ECMO. No vascular or cardiac iatrogenic injury was caused during implantation. Target flows were reached, and no clinically significant recirculation was described in any case. The use of selfexpanding drainage cannulas was safe, and efficient drainage was achieved with easy and definitive unique positioning during cannulation.

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A Polysomnography Study Examining the Association Between Sleep and Postoperative Delirium in Older Hospitalized Cardiac Surgical Patients

Polysomnography measures of sleep obtained the night preceding surgery in hospitalized older patients scheduled for elective major cardiac surgery with cardiopulmonary bypass are suggestive of an association between longer sleep duration and postoperative delirium.

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A Cardiopulmonary Bypass Strategy to Support A Patient with Vein of Galen Malformation

We present a dissection of the patent ductus arteriosus and pulmonary artery for surgical repair utilising cardiopulmonary bypass in the setting of vein of Galen malformation.

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Volatile and Intravenous Anesthetics for Brain Protection in Cardiac Surgery: Does the Choice of Anesthesia Matter?

Several studies have reported an association of using volatile anesthetics with improvement of biochemical markers of brain injury and postoperative neurocognitive function. However, there is a need for additional studies to define the optimal anesthetic drug for protecting the brain in patients undergoing cardiac surgery.

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Extracellular Vesicles in Autologous Cell Salvaged Blood in Orthopedic Surgery

Retransfusate contains negligible amounts of potentially thrombogenic EVs from platelet and monocytic origin. Frequent EVs from erythrocytes may indicate red blood cell destruction and/or activation during autologous cell salvage. Further research is needed to investigate the clinical relevance of EVs from salvaged red blood cells.

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Variability in Anesthesia Models of Care in Cardiac Surgery

Given that anesthesia is proven to have an influence on the outcome of cardiac procedures, this study indicates the opportunity to further study how this variability influences outcomes and to identify best practices.

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Timeout Procedure in Paediatric Surgery: Effective Tool or Lip Service? A Randomised Prospective Observational Study

Errors in the timeout routine go unnoticed by the team in almost half of cases. Therefore, even if preoperative timeout routines are strictly implemented, mistakes may be overlooked. Hence, the timeout procedure in its current form appears unreliable. Future developments may be useful to improve the quality of the surgical timeout and should be studied in detail.

surgery

Perioperative Cryoprecipitate Waste Reduction

These results demonstrate that utilizing educational initiatives for optimization of blood product management can reduce unnecessary ordering, transfusions, and wastage; an outcome that could ultimately reduce costs.

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Fraction of Expired Oxygen: An Additional Safety Approach to Monitor Oxygen Delivery to The Heart Lung Machine Oxygenator

Monitoring the FEO2 is a more reliable way to verify O2 delivery to an oxygenator. An alarm can be set on the FEO2 monitor to alert the perfusionist if the FEO2 falls below a predetermined threshold so any issue with O2 delivery will always be recognized.

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Cerebrovascular Autoregulation and Arterial Carbon Dioxide in Patients with Acute Respiratory Distress Syndrome: A Prospective Observational Cohort Study

Our results suggest that moderate permissive hypercapnia during the acute phase of ARDS has no adverse effect on cerebrovascular autoregulation and may be tolerated to a certain extent to achieve low tidal volumes. In contrast, episodes of hypocapnia may compromise cerebral blood flow regulation.

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Neurological Complications During Veno-Venous Extracorporeal Membrane Oxygenation: Does the Configuration Matter? A Retrospective Analysis of The ELSO Database

In this large registry, the occurrence of neurological complications was not related to the type of cannulation in patients undergoing V-V ECMO.

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Different Mechanisms of Oxygenator Failure and High Plasma von Willebrand Factor Antigen Influence Success and Survival of Venovenous Extracorporeal Membrane Oxygenation

vWF:Ag levels alone cannot predict early MO failure and outcome in VV ECMO patients. Probably, the mechanism of clotting disorder in combination with the vWF:Ag level seems to be essential for clot formation within the MO. In addition, vWF:Ag levels allows the identification different patient populations In particular, WGT/high vWF:Ag represented a critically ill population with higher ECMO-associated mortality.

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Modern Practice and Outcomes of Reoperative Cardiac Surgery

Reoperative cardiac surgery is associated with low operative morbidity and mortality at an experienced center. Early and late CPB strategies have comparable outcomes in the context of an image-guided, team-based strategy.

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Cardiac Surgery Outcome During the COVID-19 Pandemic: A Retrospective Review of the Early Experience in Nine UK Centres

To mitigate against the risks of Covid-19, particularly the post-operative burden, robust and effective pre-surgery diagnosis protocols alongside effective strategies to maintain a Covid-19 free environment are needed. Dedicated cardiac surgery hubs could be valuable in achieving safe and continual delivery of cardiac surgery.

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Heparin-Free Lung Transplantation on Venovenous Extracorporeal Membrane Oxygenation Bridge

Despite the limited patient population, such an approach relies on a strong rationale and may be beneficial for managing ECMO bridging to LuTX. Prospective studies are necessary to confirm the validity of our strategy.

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Prognostic Utility of KDIGO Urine Output Criteria After Cardiac Surgery

Acute kidney injury classified by KDIGO urine output criteria was not associated with other biomarkers of kidney injury or worse patient outcomes. These data suggested that KDIGO urine output criteria after cardiac surgery may overclassify AKI stage; further research is needed.

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Hypercoagulopathy, Acquired Coagulation Disorders and Anticoagulation Before, During and After Extracorporeal Membrane Oxygenation in COVID-19: A Case Series

Coronavirus-induced coagulopathy and bleeding disorders during vvECMO cannot be discriminated via ‘routine’ coagulation tests. Precise and specific analyses followed by the appropriate treatment of coagulation disorders may help us develop tailored therapeutic concepts to better manage the phases described above.

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Hemoadsorption Eliminates Remdesivir from the Circulation: Implications for the Treatment Of COVID-19

Remdesivir and its main active metabolite GS‐441524 are rapidly eliminated from the perfusate by the CytoSorb® adsorber device in vitro. This should be considered in patients for whom both therapies are indicated, and simultaneous application should be avoided. In general, plasma levels of therapeutic drugs should be closely monitored under concurrent CytoSorb® therapy.

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Perfusion Art: “The Ready Room”

Perfusion Art: “The Ready Room” Photographer: Frank Aprile, CCP, BBA, LP Equipment: I Phone 8+ Editing: Photoshop Narrative: Rows of surgical shoes- at the ready Time & Place:   2021: UpNORTH About The Artist:  CCP Commentary:  It’s a busy place- Reminds me of the Corpsman barracks at the Marine Fleet Marine Force training center- Del Mar 21 Area- Camp Pendleton.