Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Jun 2021
Current Anesthetic Care of Patients Undergoing Transcatheter Aortic Valve Replacement in Europe: Results of an Online Survey.
Transcatheter aortic valve replacement (TAVR) has become an alternative treatment for patients with symptomatic aortic stenosis not eligible for surgical valve replacement due to a high periprocedural risk or comorbidities. However, there are several areas of debate concerning the pre-, intra- and post-procedural management. The standards and management for these topics may vary widely among different institutions and countries in Europe. ⋯ The results indicated that requirements and quality indicators (eg, periprocedural anesthetic management, involvement of the anesthesiologist in the heart team, etc) for TAVR procedures as published within the European guideline are largely, yet still not fully implemented in daily routine. In addition, anesthetic TAVR management also is performed heterogeneously throughout Europe.
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J. Cardiothorac. Vasc. Anesth. · Jun 2021
Use of the Hypotension Prediction Index During Cardiac Surgery.
The hypotension prediction index (HPI) is a novel parameter developed by Edwards Lifesciences (Irvine, CA) that is obtained through an algorithm based on arterial pressure waveform characteristics. Past studies have demonstrated its accuracy in predicting hypotensive events in noncardiac surgeries. The authors aimed to evaluate the use of the HPI in cardiac surgeries requiring cardiopulmonary bypass (CPB). ⋯ HPI predicted hypotensive episodes during cardiac surgeries with a high degree of sensitivity and specificity.
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J. Cardiothorac. Vasc. Anesth. · Jun 2021
Case ReportsSuspected Lower Extremity Ischemia After End-to-Side Femoral Arterial Grafting for VA-ECMO.
Lower extremity ischemic complications are frequently encountered after femoral cannulation for venoarterial extracorporeal membrane oxygenation (VA-ECMO). Many are attributed to mechanical obstruction of distal arterial blood flow related to intraluminal positioning of the arterial cannula. ⋯ Side- arm grafting instead of direct arterial cannulation is suggested as an alternative. Here, the authors present a case wherein a patient developed suspected lower extremity ischemia from hyperperfusion after femoral VA-ECMO cannulation during use of an arterial side- arm graft, calling into question the benefits of this cannulation strategy.
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J. Cardiothorac. Vasc. Anesth. · Jun 2021
Transport and Retrieval on Extracorporeal Membrane Oxygenation (ECMO): Setup and Activities of an Immersive Transport and Retrieval on ECMO Workshop.
Extracorporeal life support and extracorporeal membrane oxygenation (ECMO) are widely used for acute severe refractory cardiac and respiratory failure. An increasing number of patients are treated with ECMO worldwide. This can be attributed to technical and technologic advancements, easier access to modern equipment, and more regular and accessible training opportunities for practitioners to maintain current skills and develop new ones. ⋯ This article describes the authors' experience of developing and running a simulation-based ECMO Transport and Retrieval workshop, with multiple immersive scenarios and opportunities for participants to familiarize themselves with the process and the ambulance equipment and environment. Preparation is a key element to successfully run scenarios that are technically challenging to facilitate due to the environment and equipment involved. To date, 136 multidisciplinary ECMO providers have attended the workshop and no incidents have been reported by the authors' teams during actual transfers and retrieval missions with patients on ECMO.