Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Feb 2020
ReviewThe Use of Umbilical Cord Blood for Autologous Transfusion in Neonatal Open Heart Surgery.
In the last few decades, the use of umbilical cord blood (UCB) has received increasing attention, not only as a source of stem cells, but also as a transfusion product for the treatment of anemia in the neonatal and even the adult population. This review focuses on data reports and collection efforts related to the autologous transfusion of UCB in full-term neonates with prenatally diagnosed critical congenital heart defects. This review summarizes different aspects of UCB transfusion, including indications and contraindications; the collection procedure; storage timing; and special properties of one of its constituents, fetal hemoglobin, in the setting of hypothermic cardiopulmonary bypass.
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J. Cardiothorac. Vasc. Anesth. · Feb 2020
ReviewAnesthesia in Pediatric Patients With Congenital Heart Disease Undergoing Noncardiac Surgery: Defining the Risk.
The incidence of moderate to severe congenital heart disease (CHD) in the United States is estimated to be 6 per 1,000 live-born, full-term infants. Recent advances in pediatric cardiology, surgery, and critical care have improved significantly the survival rates of patients with CHD leading to an increase in prevalence in both children and adults. ⋯ They often are faced with the question, "Is this patient too high risk for anesthesia?" The objective of this literature review is to provide a greater understanding of patients at high risk and to quantify the risk for patients, their families, and clinicians. In addition, specific high-risk lesions (single ventricle, Williams-Beuren syndrome, pulmonary hypertension, cardiomyopathies, and ventricular assist devices) are described.
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J. Cardiothorac. Vasc. Anesth. · Feb 2020
Randomized Controlled TrialStreptokinase Versus Unfractionated Heparin Nebulization in Patients With Severe Acute Respiratory Distress Syndrome (ARDS): A Randomized Controlled Trial With Observational Controls.
To examine and compare nebulizing heparin versus streptokinase for reversing alveolar collapse nonresponsive to recruitment. ⋯ Inhaled streptokinase serves as rescue therapy in patients with severe ARDS with improving oxygenation and lung mechanics more quickly than heparin or conventional management.
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J. Cardiothorac. Vasc. Anesth. · Feb 2020
Observational StudyThe Maximum Diameter of the Left Ventricle May Not Be the Optimum Target for Chest Compression During Cardiopulmonary Resuscitation: A Preliminary, Observational Study Challenging the Traditional Assumption.
Researchers have assumed that compressing the point beneath which the left ventricle (LV) diameter is maximum (P_max.LV) would improve cardiopulmonary resuscitation outcomes. Defining the midsternum, the currently recommended location for chest compression, as the reference (x = 0), the lateral deviation (x_max.LV) of personalized P_max.LV has become estimable using posteroanterior chest radiography. The authors investigated whether out-of-hospital cardiac arrest (OHCA) patients, whose x_max.LV was closer to the midsternum and thus had their P_max.LV compressed closer during cardiopulmonary resuscitation, showed better chances of return of spontaneous circulation (ROSC) and survival to discharge. ⋯ OHCA patients with a P_max.LV located closer to the midsternum showed worse chances of ROSC and survival to discharge, which challenges the traditional assumption of identifying P_max.LV as the optimum compression point.
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J. Cardiothorac. Vasc. Anesth. · Feb 2020
Transfer of Patients With Cardiogenic Shock Using Veno-Arterial Extracorporeal Membrane Oxygenation.
The authors describe the experience of patient transfer on veno-arterial extracorporeal membrane oxygenation (VA-ECMO) used as a salvage therapy for refractory cardiogenic shock, examining feasibility and long-term outcomes. ⋯ The authors' experience demonstrates the feasibility and survival benefit of a salvage VA-ECMO retrieval service for carefully selected patients with refractory cardiogenic shock. The authors suggest that a system based on the model of nationally commissioned severe respiratory failure services could be organized to support the transfer of these patients.