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Sequestration of Midazolam, Fentanyl, and Morphine by an Ex Vivo Cardiopulmonary Bypass Circuit

We successfully characterized the adsorption of various combinations of midazolam, fentanyl, and morphine to our CPB circuit, showing that fentanyl and midazolam behave differently based on other medications present.

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Pediatric ECMO: Unfavorable Outcomes Are Associated with Inflammation and Endothelial Activation

High levels of circulating inflammatory, endothelial activation, and fibrinolytic markers are associated with mortality and abnormal neuroimaging in children on ECMO.

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Clinical Debriefing: TALK© to Learn and Improve Together in Healthcare Environments

The TALK© structure consists of four steps: Target, Analysis, Learning and Key actions, which guide individuals in having focussed and constructive conversations with practical outcomes. It enables effective communication across diverse health care professional teams that work together on a regular or occasional basis in any healthcare environment.


Association Between Exogenous Nitric Oxide Given During Cardiopulmonary Bypass and the Incidence of Postoperative Kidney Injury in Children

This single-center, retrospective, cohort study found no change in the incidence and severity of postoperative AKI after the administration of nitric oxide into the cardiopulmonary bypass circuit in children.


The Effect of Selective Cerebral Perfusion on Cerebral versus Somatic Tissue Oxygenation During Aortic Coarctation Repair in Neonates and Infants

SctO2 and SstO2 have distinct patterns of changes before and after aortic opening during neonate/infant aortic coarctation repair. SctO2/SstO2’s correlations with MAP and PaCO2 are confounded by SCP. The outcome impact of combined SctO2/SstO2 monitoring remains to be studied.


Efficacy and Safety of Aprotinin in Paediatric Cardiac Surgery: A Systematic Review and Meta-Analysis

This meta-analysis suggests that aprotinin is effective and well tolerated in paediatric cardiac surgery. Given the large heterogeneity of the results and the risk of selection bias in observational studies, large randomised controlled trials are warranted.


Association Between Perioperative Hypotension and Postoperative Delirium and Atrial Fibrillation after Cardiac Surgery: A Post-Hoc Analysis of the DECADE Trial

In patients having cardiac surgery with cardio-pulmonary bypass, neither intraoperative nor postoperative hypotension were associated with delirium. Postoperative hypotension was associated with atrial fibrillation, although intraoperative hypotension was not.

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21st Century Evidence: Randomized Controlled Trials Versus Systematic Reviews and Meta-Analyses

In this foreword, we will review benefits and downsides of SRMAs and address the value of SRMAs in relation to RCTs and their respective roles in clinical decision-making.


Left Ventricular Assist Device Implants in Patients On Extracorporeal Membrane Oxygenation: Do We Need Cardiopulmonary Bypass?

Omitting CPB for an LVAD implant in patients on ECLS is safe and results in shorter operating time, less re-exploration for bleeding and fewer blood products. However, no survival benefit is observed.


Measures to Prevent Neurological Deficits in Urgent CABG Surgery with Bilateral Carotid Occlusion

Patients with previous CVA/TIA in the presence of carotid disease requiring coronary arterial bypass surgery (CABG) are associated with a higher risk of neurological ischemic event.

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New Technology for the Use of Inhaled Nitric Oxide to Protect the Heart and Lungs during Operations with Cardiopulmonary Bypass

The developed technology for the use of inhaled NO in surgery with CPB provides a clinically marked protective effect on the heart and lungs. The effectiveness of the protective action of NO depends on the duration of its administration and is most pronounced when used during the entire operation, including CPB time.


Impact of Arterial Carbon Dioxide and Oxygen Content on Cerebral Autoregulation Monitoring Among Children Supported by ECMO

We observed a complex relationship between PaCO2 and CA, influenced by the level of blood pressure. Hypercapnia seems to be globally protective in normotensive or hypertensive condition, while, in case of very low MAP, hypercapnia may disturb CA as it increases LLA. These data add additional arguments for very cautiously lower PaCO2, especially after ECMO start.

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Comparative Effects of On-Pump Versus Off-Pump Coronary Artery Bypass Grafting Surgery on Serum Cytokine and Chemokine Levels

Cardiopulmonary pump in patients under CABG surgery can activate systemic inflammation and the changes of serum cytokines levels in off-pump CABG were lower compared with on-pump CABG.


Extracorporeal Membrane Oxygenation for COVID-19: Evolving Outcomes from the International Extracorporeal Life Support Organization Registry

Mortality after ECMO for patients with COVID-19 worsened during 2020. These findings inform the role of ECMO in COVID-19 for patients, clinicians, and policy makers.

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Anesthetic Management of Successful Extracorporeal Resuscitation After Six Hours of Cardiac Arrest Due to Severe Accidental Hypothermia

The case of a patient who experienced cardiac arrest due to severe AH and was resuscitated for more than six hours using extracorporeal life support recently was published. Herein that case is reviewed, with the anesthetic management during cannulation detailed.


Antifibrinolytic Drugs for the Prevention of Bleeding in Pediatric Cardiac Surgery on Cardiopulmonary Bypass: A Systematic Review and Meta-analysis

The available data demonstrate efficacy for all 3 antifibrinolytic drugs. Therefore, the agent with the most favorable safety profile should be used. As sufficient data are lacking, large comparative trials are warranted to assess the relative safety and appropriate dosing regimens in pediatrics.

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Incidence of Postoperative Pulmonary Complications in Patients Undergoing Minimally Invasive Versus Median Sternotomy Valve Surgery: Propensity Score Matching

MIVS for isolated valve surgery reduces the risk of PPCs compared with the FS approach.

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Clinical Characteristics Between Survivors and Nonsurvivors of COVID-19 Patients Requiring Extracorporeal Membrane Oxygenation (ECMO) Support: A Systematic Review and Meta-Analysis

We found advanced age, multiple comorbidities, lower pre-ECMO pH, greater RRT, and vasopressor requirements, and bleeding are predictors of death in COVID-19 patients requiring ECMO support. The duration of MV before ECMO support initiation and total ECMO support duration was similar among survivors and nonsurvivors. Our study results have important clinical implications when considering ECMO support in critically ill COVID-19 patients.

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Use of Laboratory Testing for Prediction of Postoperative Bleeding Volume in Cardiovascular Surgery

These results suggest that several clinical and routine laboratory parameters of coagulation were individually associated with bleeding volume during cardiovascular surgery. Determining the patterns of coagulopathy may potentially help guide transfusion during cardiovascular surgery.

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A Uniform and Robust Bioinspired Zwitterion Coating for Use in Blood-Contacting Catheters with Improved Anti-Inflammatory and Antithrombotic Properties

Thus, it is envisioned that this biomimetic erythrocyte membrane surface strategy will provide a promising way to mitigate inflammation and thrombosis caused by the use of blood-contacting catheters.


A Pumpless Artificial Lung without Systemic Anticoagulation: the Nitric Oxide Surface Anticoagulation System

The NOSA system provides NO flux across a gas-exchange membrane of a pumpless artificial lung at a similar rate as native vascular endothelium and achieves effective local anticoagulation of an artificial lung circuit for 24 h.

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Methylprednisolone in Pediatric Cardiac Surgery: Is There Enough Evidence?

MP may provide a small benefit that is easily abolished by patient characteristics, surgical techniques, and perfusion management. The lack of evidence leads to large differences in practice between and within countries, and even within hospitals, so

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Comparison of Microplegia Solution and Del Nido Cardioplegia Solution in Coronary Artery Bypass Grafting Surgery: Which One is More Effective?

In light of short-term results, we can say that Del Nido cardioplegia provides better myocardial protection than microplegia. In addition, Del Nido cardioplegia can be given as a single dose for 90 minutes of cross-clamp time and therefore can be preferred to increase surgical comfort and reduce cross-clamp times.

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Management and Outcomes of Cardiogenic Shock in Cardiac ICUs With Versus Without Shock Teams

In this multicenter observational study, centers with shock teams were more likely to obtain invasive hemodynamics, use advanced types of MCS, and have lower risk-adjusted mortality. A standardized multidisciplinary shock team approach may improve outcomes in CS.