Cardiovascular Anesthesia and Critical Care

Structured review of post-cardiotomy extracorporeal membrane oxygenation: part 1 - Adult patients

2019-08-22T16:56:00.000+02:00

Structured review of post-cardiotomy extracorporeal membrane oxygenation: part 1 - Adult patients

The Journal of Heart and Lung Transplantation. 2019 Aug. (Published ahead of print)

Use of Dexmedetomidine in Cardiothoracic and Vascular Anesthesia

2018-01-23T21:42:00.003+01:00

Use of Dexmedetomidine in Cardiothoracic and Vascular Anesthesia

L. Gallego-Ligorit et al. (2018) Journal of Cardiotoracic and Vascular Anesthesia

Prevention of Ventilator-Associated Pneumonia: The Multimodal Approach of the Spanish ICU “Pneumonia Zero” Program*

2018-01-19T15:14:00.002+01:00

Prevention of Ventilator-Associated Pneumonia:The Multimodal Approach of the Spanish ICU “Pneumonia Zero” Program*

Critical Care Medicine: February 2018 - Volume 46 - Issue 2 - p 181–188 (Full Text PDF)

Annual Update in Intensive Care and Emergency Medicine 2015

2015-03-24T19:36:00.000+01:00

Selected articles from the Annual Update in Intensive Care and Emergency Medicine 2015.

State of the art review: the data revolution in critical care

2015-03-24T19:25:00.000+01:00

State of the art review: the data revolution in critical care

Ghassemi et al. Critical Care (2015) 19:118 (Full Text PDF)

This article is part of the series Selected articles from the Annual Update in Intensive Care and Emergency Medicine 2015.

Anesthetic Management During Cardiopulmonary Bypass: A Systematic Review

2015-03-20T22:00:00.000+01:00

Anesthetic Management During Cardiopulmonary Bypass: A Systematic Review

Anesthesia & Analgesia: April 2015 - Volume 120 - Issue 4 - p 749–769 (Full Text PDF)

Anesthesiologists Make a Difference

2015-03-20T17:27:00.000+01:00

Anesthesiologists Make a Difference

Anesthesia & Analgesia: March 2015 - Volume 120 - Issue 3 - p 497–498 (Link)

Related:

1. The impact of Anesthesiologists on coronary artery bypass graft surgery outcomes. (Anesthesia & Analgesia: March 2015 - Volume 120 - Issue 3 - p 526–533)

2. Does It Matter Who the Anesthesiologist Is for My Heart Surgery? (Anesthesia & Analgesia: March 2015 - Volume 120 - Issue 3 - p 499–501)

3. Cardiac Surgery: All for One and One for All (Anesthesia & Analgesia:
March 2015 - Volume 120 - Issue 3 - p 504–506)

Hypertrophic Cardiomyopathy: A Review

2015-03-20T03:30:00.000+01:00

Hypertrophic Cardiomyopathy: A Review

Anesthesia & Analgesia: March 2015 - Volume 120 - Issue 3 - p 554–569 (Abstract)

2014 ESC/EACTS Guidelines on myocardial revascularization The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI)

2015-02-23T17:08:00.000+01:00

2014 ESC/EACTS Guidelines on myocardial revascularization

Eur J Cardiothorac Surg (2014) 46 (4): 517-592. (Full Text PDF)

Which cannulation (axillary cannulation or femoral cannulation) is better for acute type A aortic dissection repair? A meta-analysis of nine clinical studies

2015-02-22T17:00:00.000+01:00

Abstract

Objective

There is a trend towards using the axillary artery cannulation (AXC) site for cardiopulmonary bypass surgery in patients requiring acute type A aortic dissection (AAD) repair. However, AXC has not been established as a routine procedure, because there is controversy about its clinical advantage when compared with femoral artery cannulation (FAC). This meta-analysis assesses major short-term outcomes in patients undergoing acute AAD repair with AXC or FAC using non-randomized retrospective studies dating from 1992 to 2011 comparing AXC and FAC for major outcomes. Outcomes of interest were short-term mortality, neurological dysfunction and malperfusion.

Methods

The fixed-effects model was used. Sensitivity and heterogeneity were analysed.

Results

Analysis of nine non-randomized studies comprising 715 patients [AXC, 359 (50.2%) and FAC, 356 (49.8%)] showed a significantly lower incidence of short-term mortality in the AXC group [odds ratio, 0.25, 95% confidence interval (CI) (0.15, 0.42), χ2 = 7.23, P < 0.01]. The pattern of incidence of neurological dysfunction among the AXC group [odds ratio, 0.46, 95% CI (0.29, 0.72), χ2 = 9.01, P < 0.01] was similar. The incidence of malperfusion did not differ [odds ratio, 0.84, 95% CI (0.37, 1.90), χ2 = 2.25, P = 0.67]. (p = 0.005) in the post-test score (median 80%) compared with the pretest score (median 20%).

Conclusion

Because no study was a randomized trial, our results are more uncertain than indicated by the 95% CI. Nevertheless, AXC seems to give better short-term mortality and neurological dysfunction rates than FAC.

Eur J Cardiothorac Surg (2015) 47 (3): 408-415. (Abstract)

2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: Executive Summary A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society

2015-02-21T16:50:00.000+01:00

2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: Executive Summary

J Am Coll Cardiol. 2014;64(21):2246-2280 (Full Text PDF)

Modified ultrafiltration in adult patients undergoing cardiac surgery

2015-02-21T16:44:00.000+01:00

Modified ultrafiltration in adult patients undergoing cardiac surgery

Interactive CardioVascular and Thoracic Surgery 20 (2015) 415–421 (Full Text PDF)

Isolated High Lactate or Low Central Venous Oxygen Saturation AfterCardiac Surgery and Association with Outcome

2013-09-15T14:15:00.000+02:00

Abstract

Objective

To determine if isolated abnormally low central venous oxygen saturation (ScvO₂) or elevated lactate levels on admission to an intensive care unit (ICU) are associated with increased morbidity and length of stay (LOS) after cardiac surgery.

Methods

Retrospective, observational. Academic tertiary care hospital. Six hundred twenty-nine adult, on-pump cardiac surgery patients with ScvO₂ and arterial lactate obtained on admission to the ICU.

Results

Comparing outcomes across the isolated low ScvO₂ and high lactate categories, no significant differences in ICU/hospital LOS, ICU readmission rate, length of mechanical ventilation, or incidence of major complications were observed in patients with ScvO₂<70% and lactate<2 mmol/L or in those with lactate 2-3.9 mmol/L and ScvO₂≥70%. However, patients with lactate≥4 mmol/L and ScvO₂≥70% exhibited significantly longer median ICU LOS (p = 0.018), hospital LOS (p = 0.032), length of mechanical ventilation (p = 0.0001), and higher incidence of major complications (p = 0.008). Multivariate analysis identified isolated elevated lactate levels≥4 mmol/L as an independent predictor for major complications (OR 4.29, p = 0.0008).

Conclusion

Low ScvO₂ with normal lactate or moderately elevated lactate with normal ScvO₂ upon ICU admission after cardiac surgery was not associated with increased morbidity or length of stay. Markedly elevated lactate levels in the setting of a normal ScvO₂was associated with significantly higher incidence of major complications and prolonged length of stay. Additionally, a lactate level≥4 mmol/L was an independent predictor of major complications.

J Card Vasc Anest 9 Set 2013 (Online First) (Abstract)

Selective cerebral perfusion with mild hypothermic lower body circulatory arrest is safe for aortic arch surgery

2013-04-28T22:46:00.001+02:00

Selective cerebral perfusion with mild hypothermic lower body circulatory arrest is safe for aortic arch surgery

Eur J Cardiothorac Surg (2013) 43 (4): e94-e98.
(Abstract)

Perioperative Dexmedetomidine Improves Outcomes of Cardiac Surgery

2013-03-19T09:19:00.000+01:00

Perioperative Dexmedetomidine Improves Outcomes of Cardiac Surgery

Circulation 2013; 127: 1576-1584 (Abstract)

Off-Pump versus On-Pump Coronary-Artery Bypass Grafting in Elderly Patients

2013-03-12T18:26:00.001+01:00

Abstract

Objective

The benefits of coronary-artery bypass grafting (CABG) without cardiopulmonary
bypass in the elderly are still undetermined.

Methods

We randomly assigned patients 75 years of age or older who were scheduled for elective first-time CABG to undergo the procedure either without cardiopulmonary bypass (off-pump CABG) or with it (on-pump CABG). The primary end point was a composite of death, stroke, myocardial infarction, repeat revascularization, or new renal-replacement therapy at 30 days and at 12 months after surgery.
Results

A total of 2539 patients underwent randomization. At 30 days after surgery, there was no significant difference between patients who underwent off-pump surgery and those who underwent on-pump surgery in terms of the composite outcome (7.8% vs. 8.2%; odds ratio, 0.95; 95% confidence interval [CI], 0.71 to 1.28; P = 0.74)or four of the components (death, stroke, myocardial infarction, or new renalreplacement therapy). Repeat revascularization occurred more frequently after offpump CABG than after on-pump CABG (1.3% vs. 0.4%; odds ratio, 2.42; 95% CI, 1.03 to 5.72; P = 0.04). At 12 months, there was no significant between-group difference in the composite end point (13.1% vs. 14.0%; hazard ratio, 0.93; 95% CI, 0.76 to 1.16; P = 0.48) or in any of the individual components. Similar results were obtained in a per-protocol analysis that excluded the 177 patients who crossed overfrom the assigned treatment to the other treatment.
Conclusion

In patients 75 years of age or older, there was no significant difference between on-pump and off-pump CABG with regard to the composite outcome of death, stroke, myocardial infarction, repeat revascularization, or new renal-replacement therapy within 30 days and within 12 months after surgery.

N Engl J Med 2013 (Online First) (Full Text PDF)

Effects of Off-Pump and On-Pump Coronary-Artery Bypass Grafting at 1 Year

2013-03-12T18:22:00.000+01:00

Abstract

Objective

Previously, we reported that there was no significant difference at 30 days in the rate of a primary composite outcome of death, myocardial infarction, stroke, or new
renal failure requiring dialysis between patients who underwent coronary-artery bypass grafting (CABG) performed with a beating-heart technique (off-pump) and
those who underwent CABG performed with cardiopulmonary bypass (on-pump). We now report results on quality of life and cognitive function and on clinical outcomes at 1 year.

Methods

We enrolled 4752 patients with coronary artery disease who were scheduled to undergo CABG and randomly assigned them to undergo the procedure off-pump or on-pump. Patients were enrolled at 79 centers in 19 countries. We assessed quality of life and cognitive function at discharge, at 30 days, and at 1 year and clinical outcomes at 1 year..
Results

At 1 year, there was no significant difference in the rate of the primary composite outcome between off-pump and on-pump CABG (12.1% and 13.3%, respectively; hazard ratio with off-pump CABG, 0.91; 95% confidence interval [CI], 0.77 to 1.07; P = 0.24). The rate of the primary outcome was also similar in the two groups in the period between 31 days and 1 year (hazard ratio, 0.79; 95% CI, 0.55 to 1.13; P = 0.19). The rate of repeat coronary revascularization at 1 year was 1.4% in the off-pump group and 0.8% in the on-pump group (hazard ratio, 1.66; 95% CI, 0.95 to 2.89; P = 0.07). There were no significant differences between the two groups at 1 year in measures of quality of life or neurocognitive function.
Conclusion

At 1 year after CABG, there was no significant difference between off-pump and on-pump CABG with respect to the primary composite outcome, the rate of repeat coronary revascularization, quality of life, or neurocognitive function.

N Engl J Med 2013 (Online First) (Full Text PDF)

Glucose-Insulin-Potassium Revived

2013-03-10T19:46:00.000+01:00

Glucose-Insulin-Potassium Revived. Current Status in Acute Coronary Syndromes and the Energy-Depleted Heart

Circulation 2013; 127: 1040-1048 (Abstract)

Cerebral Near-Infrared Spectroscopy Monitoring and Neurologic Outcomes in Adult Cardiac Surgery Patients: A Systematic Review

2013-03-01T12:37:00.001+01:00

Cerebral Near-Infrared Spectroscopy Monitoring and Neurologic Outcomes in Adult Cardiac Surgery Patients: A Systematic Review

Anest & Analg March 2013 vol. 116 no. 3 663-676 (Abstract)

Practice Guidelines for Management of the Difficult Airway: An Updated Report by the American Society of Anesthesiologists

2013-02-08T20:00:00.000+01:00

Practice Guidelines for Management of the Difficult Airway: An Updated Report by the American Society of Anesthesiologists

Anesthesiology: February 2013 - Volume 118 - Issue 2 - p 251–270 (Full Text PDF)

2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction

2013-02-08T10:29:00.001+01:00

2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction

Circulation. 2013;127:e362-e425 (Full Text PDF)

Constrictive Pericarditis After Cardiac Surgery

2013-02-07T15:02:00.000+01:00

Abstract

Constrictive pericarditis may develop as a midterm or late complication of cardiac surgery. Owing to limited incidence and scarce reports in the literature the pathophysiologic determinants of such conditions are scarcely known, although a number of mechanisms have been implicated. This disease often poses major diagnostic issues as its clinical picture at presentation is nonspecific, may develop at any moment during the postoperative follow-up, and transthoracic echocardiography may be not suggestive of the diagnosis. The present paper aims at critically revising the available literature on the topic, emphasizing the need to keep a high level of suspicion for all surgeons and physicians involved in the long-term care of cardiac surgery patients.

Ann Thorac Surg 2013;95:731-736. (Abstract)

Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock: 2012

2013-01-26T10:43:00.000+01:00

Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock: 2012

CCM 2013 Feb;41:2.580-637 (Full Text PDF)

Surviving Sepsis Campaign

Therapeutic Hypothermia After Cardiac Arrest

2013-01-15T18:46:00.001+01:00

Therapeutic Hypothermia After Cardiac Arrest

Circulation. 2013;127:244-250 (Full Text PDF)

Recommendations for the Use of Mechanical Circulatory Support: Device Strategies and Patient Selection

2012-11-28T23:50:00.000+01:00

Recommendations for the Use of Mechanical Circulatory Support: Device Strategies and Patient Selection

Circulation 2012; 126: 2648-2667 (Full Text PDF)

Cardiovascular Anesthesia and Critical Care

Structured review of post-cardiotomy extracorporeal membrane oxygenation: part 1 - Adult patients

The Journal of Heart and Lung Transplantation. 2019 Aug. (Published ahead of print)

Use of Dexmedetomidine in Cardiothoracic and Vascular Anesthesia

L. Gallego-Ligorit et al. (2018) Journal of Cardiotoracic and Vascular Anesthesia

Prevention of Ventilator-Associated Pneumonia: The Multimodal Approach of the Spanish ICU “Pneumonia Zero” Program*

Critical Care Medicine: February 2018 - Volume 46 - Issue 2 - p 181–188 (Full Text PDF)

Annual Update in Intensive Care and Emergency Medicine 2015

Selected articles from the Annual Update in Intensive Care and Emergency Medicine 2015.

State of the art review: the data revolution in critical care

Ghassemi et al. Critical Care (2015) 19:118 (Full Text PDF)

Anesthetic Management During Cardiopulmonary Bypass: A Systematic Review

Anesthesia & Analgesia: April 2015 - Volume 120 - Issue 4 - p 749–769 (Full Text PDF)

Anesthesiologists Make a Difference

Anesthesia & Analgesia: March 2015 - Volume 120 - Issue 3 - p 497–498 (Link)

Hypertrophic Cardiomyopathy: A Review

Anesthesia & Analgesia: March 2015 - Volume 120 - Issue 3 - p 554–569 (Abstract)

Eur J Cardiothorac Surg (2014) 46 (4): 517-592. (Full Text PDF)

Which cannulation (axillary cannulation or femoral cannulation) is better for acute type A aortic dissection repair? A meta-analysis of nine clinical studies

Objective

Methods

Results

Conclusion

2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: Executive Summary A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society

J Am Coll Cardiol. 2014;64(21):2246-2280 (Full Text PDF)

Modified ultrafiltration in adult patients undergoing cardiac surgery

Interactive CardioVascular and Thoracic Surgery 20 (2015) 415–421 (Full Text PDF)

Isolated High Lactate or Low Central Venous Oxygen Saturation AfterCardiac Surgery and Association with Outcome

Objective

Methods

Results

Conclusion

Selective cerebral perfusion with mild hypothermic lower body circulatory arrest is safe for aortic arch surgery

Eur J Cardiothorac Surg (2013) 43 (4): e94-e98. (Abstract)

Perioperative Dexmedetomidine Improves Outcomes of Cardiac Surgery

Circulation 2013; 127: 1576-1584 (Abstract)

Off-Pump versus On-Pump Coronary-Artery Bypass Grafting in Elderly Patients

Objective

Methods

Results

Conclusion

Effects of Off-Pump and On-Pump Coronary-Artery Bypass Grafting at 1 Year

Objective

Methods

Results

Conclusion

Glucose-Insulin-Potassium Revived

Circulation 2013; 127: 1040-1048 (Abstract)

Cerebral Near-Infrared Spectroscopy Monitoring and Neurologic Outcomes in Adult Cardiac Surgery Patients: A Systematic Review

Anest & Analg March 2013 vol. 116 no. 3 663-676 (Abstract)

Practice Guidelines for Management of the Difficult Airway: An Updated Report by the American Society of Anesthesiologists

Anesthesiology: February 2013 - Volume 118 - Issue 2 - p 251–270 (Full Text PDF)

2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction

Circulation. 2013;127:e362-e425 (Full Text PDF)

Constrictive Pericarditis After Cardiac Surgery

Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock: 2012

CCM 2013 Feb;41:2.580-637 (Full Text PDF)

Therapeutic Hypothermia After Cardiac Arrest

Circulation. 2013;127:244-250 (Full Text PDF)

Recommendations for the Use of Mechanical Circulatory Support: Device Strategies and Patient Selection

Circulation 2012; 126: 2648-2667 (Full Text PDF)

Eur J Cardiothorac Surg (2013) 43 (4): e94-e98.
(Abstract)