Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Sep 2020
Multicenter StudyOutcomes of Venoarterial Extracorporeal Membrane Oxygenation Patients Requiring Multiple Episodes of Support.
This study describes the largest North American single-institution experience with adult patients requiring multiple extracorporeal membrane oxygenation (ECMO) runs in the same admission and aims to describe outcomes of survival and complication rates in this patient population. ⋯ Fourteen of 326 patients in the authors' VA ECMO database required additional ECMO therapy after decannulation; this represents at least 1 to 2 cases per year at higher-volume centers. Despite the small number of patients in this retrospective review, it seems that certain patients are reasonable candidates for additional ECMO therapy should their cardiopulmonary function again decline. The findings of renal replacement therapy and infection being more common during a second ECMO run are logical, but larger cohorts (ideally multicenter or from within the Extracorporeal Life Support Organization registry) are required to validate these preliminary findings.
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J. Cardiothorac. Vasc. Anesth. · Sep 2020
ReviewThoracic Anesthesia of Patients With Suspected or Confirmed 2019 Novel Coronavirus Infection: Preliminary Recommendations for Airway Management by the European Association of Cardiothoracic Anaesthesiology Thoracic Subspecialty Committee.
The novel coronavirus has caused a pandemic around the world. Management of patients with suspected or confirmed coronavirus infection who have to undergo thoracic surgery will be a challenge for the anesthesiologists. ⋯ It should be emphasized that both the management of the infected patient with COVID-19 and the self-protection of the anesthesia team constitute a complicated challenge. The text focuses therefore on both important topics.
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J. Cardiothorac. Vasc. Anesth. · Sep 2020
ReviewPerioperative Interrogation of Medtronic Cardiovascular Implantable Electronic Devices: A Guide for Anesthesiologists.
This is the final review article in a 4-part series focusing on the perioperative management of the 4 major companies' cardiovascular implantable electronic devices (CIEDs) in the United States. This article presents information pertinent to the perioperative management of Medtronic (Minneapolis, MN) transvenous CIEDs, including responses to magnet application, interpretation of interrogation reports, and basic programming (eg, mode, rate, rate modulation, and tachyarrhythmia therapies). Information regarding the Medtronic Micra (Medtronic, Minneapolis, MN) has been published previously. In addition, it contains an introduction to the concept of magnetic resonance (MR) conditional devices and magnetic resonance imaging (MRI) practices.
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J. Cardiothorac. Vasc. Anesth. · Sep 2020
Randomized Controlled TrialHeparin Dose and Point-of-Care Measurements of Hemostasis in Cardiac Surgery-Results of a Randomized Controlled Trial.
High heparin doses during cardiopulmonary bypass (CPB) have been suggested to reduce thrombin activation and consumption coagulopathy and consequently bleeding complications. The authors investigated the effect of a high heparin dose during CPB on point-of-care measurements of coagulation. The authors hypothesized that during CPB a high heparin dose compared with a lower heparin dose would reduce thrombin generation and platelet activation and tested whether this would be reflected in the results of rotational thromboelastometry (TEM) and platelet aggregation, measured with multiple electrode aggregometry (MEA). ⋯ Compared with a lower dose of heparin during CPB, a high dose of heparin had little effect on the point-of-care measurements of hemostasis, TEM, and MEA. Based on the similarity of platelet and coagulation activity assessments, the higher heparin dose does not appear to offer benefit during CPB.