Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · May 2008
ReviewShould additional antibiotics or an iodine washout be given to all patients who suffer an emergency re-sternotomy on the cardiothoracic intensive care unit?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether it is beneficial to give additional antibiotics or an iodine washout after an emergency re-sternotomy on the intensive care unit. Using the reported search, 527 papers were identified. ⋯ The other two papers did not report whether this was done. We conclude that even though the incidence of subsequent infection is low in the cardiac arrest situation, full aseptic technique including gown and gloves might be regarded as best practice. It is common practice also to give additional antibiotics and a povodine-iodine washout although we could identify no studies other than uncontrolled cohort studies in support of this.
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Interact Cardiovasc Thorac Surg · May 2008
ReviewShould adrenaline be routinely used by the resuscitation team if a patient suffers a cardiac arrest shortly after cardiac surgery?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether adrenaline might be a useful addition to a protocol for the management of cardiac arrests for patients shortly after cardiac surgery. Altogether 889 papers were found using the reported search, of which 16 represented the best evidence to answer the clinical question. ⋯ However, they acknowledge that the evidence behind this recommendation is lacking and based entirely on animal studies which have as yet not been successfully replicated in human studies to show a benefit of survival to hospital discharge. They acknowledge that the current evidence is insufficient to support or refute the use of adrenaline in arrests and the International Liaison Committee on Resuscitation grade the recommendation to give adrenaline in cardiac arrests as 'indeterminate'. Thus, in the particular situation of a patient who arrests shortly after cardiac surgery where the chance of restoring sinus rhythm either by defibrillation or by an emergency re-sternotomy is high, and where adrenaline could in this situation be highly dangerous once sinus rhythm is restored, we recommend that 1 mg of adrenaline forms no part of the resuscitation protocol for patients who arrest after cardiac surgery.
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A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was: does re-expansion pulmonary oedema exist? Altogether 233 papers were found using the reported search, of which 13 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. ⋯ The British Thoracic Society guidelines suggest <1.5 l pleural fluid should be drained at a time. Provided no respiratory symptoms occur it is not unreasonable to drain larger volumes to dryness: caution should be taken to avoid high negative intrapleural pressures. Patients who appear to be at higher risk, which may warrant more gradual evacuation, are: those who have had large pneumothoraces; young patients; patients in whom the lung has been down for >7 days; and possibly those who need >3 l of pleural fluid drained.
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Interact Cardiovasc Thorac Surg · May 2008
Case ReportsThe use of intra-aortic balloon pump as cerebral protection in a patient with moyamoya disease undergoing coronary artery bypass grafting.
We performed coronary artery bypass grafting in an urgent and rare case of acute coronary syndrome with moyamoya disease in a 75-year-old female. Because of collateral dependent severe cerebrovascular obstruction, additional support for brain protection was necessary; we used high pressure pulsatile perfusion assist to maintain cerebral circulation with an intra-aortic balloon pump support throughout the cardiopulmonary bypass, giving a successful outcome.