Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Jul 2019
ReviewPediatric Transfusion Algorithms: Coming to a Cardiac Operating Room Near You.
Pediatric cardiac surgical patients are at particular risk for post-cardiopulmonary bypass hemorrhage. Moreover, both the incidence and volume of blood transfusions have been associated with increased morbidity in pediatric cardiac patients. Transfusion of red blood cells, platelets, and coagulation factors is necessary to combat the hemodilution associated with cardiopulmonary bypass and to treat postoperative bleeding. ⋯ Development of a transfusion algorithm for the pediatric cardiac population requires individualization at both the institutional level, considering local resources, equipment, and case mix, and the patient level, considering age, cardiac diagnosis, and planned procedure, at minimum. A growing body of literature suggests that application of appropriate intraoperative testing (platelet count, fibrinogen concentration, thromboelastometry) along with recognition of risk factors for bleeding, adequate bypass anticoagulation, and judicious use of factor concentrates allows for thoughtful transfusion and potentially improved outcomes in pediatric cardiac patients. This review examines the evolution of transfusion algorithms in pediatric cardiac surgery and examines the considerations involved in building an algorithm for this challenging, heterogenous population.
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J. Cardiothorac. Vasc. Anesth. · Jul 2019
ReviewThe Evolving Role of Extracorporeal Membrane Oxygenation in Lung Transplantation: Implications for Anesthetic Management.
Lung transplantation has become an accepted therapy for most causes of end-stage lung disease. Between 30 to 50% of lung transplants require extracorporeal life support (ECLS). In many lung transplantation centers, extracorporeal membrane oxygenation (ECMO) is replacing cardiopulmonary bypass (CPB) as the primary choice for intraoperative ECLS. This review will discuss the evolving role of ECMO in lung transplantation and its implications for anesthetic management.
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J. Cardiothorac. Vasc. Anesth. · Jul 2019
Multicenter Study Observational StudyAn Update on Racial Disparities With 30-Day Outcomes After Coronary Artery Bypass Graft Under the Affordable Care Act.
The impact of race on outcomes after coronary artery bypass graft (CABG) has been reported before the enactment of the Patient Protection and Affordable Care Act. However, the impact of race on outcomes post-Affordable Care Act enactment remains unclear. The authors evaluated the association of race with outcomes after enactment of the Affordable Care Act in CABG patients. ⋯ Differential outcomes were observed for morbidity and mortality outcome measures. The persistence of racial disparities beyond the Affordable Care Act calls for multidisciplinary action.
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J. Cardiothorac. Vasc. Anesth. · Jul 2019
ReviewFellowship Training in Pediatric Cardiac Anesthesia: History, Maturation, and Current Status.
Pediatric cardiac anesthesia as a discipline has evolved over the years to become a well recognized sub-specialty. Education and training in the field has also continued to change and develop. In this review, the author outline the changes in the field over the years and suggest a structure for an organized fellowship training process.