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Pubblicazioni recenti - cardiopulmonary
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Parameters associated with successful weaning of veno-arterial extracorporeal membrane oxygenation: a systematic review.
Crit Care2022 Dec;26(1):375. doi: 10.1186/s13054-022-04249-w.
Charbonneau Francis, Chahinian Karina, Bebawi Emmanuel, Lavigueur Olivier, Lévesque Émilie, Lamarche Yoan, Serri Karim, Albert Martin, Noly Pierre-Emmanuel, Cournoyer Alexis, Cavayas Yiorgos Alexandros,
Abstract
PURPOSE:
Veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) can be used to restore organ perfusion in patients with cardiogenic shock until native heart recovery occurs. It may be challenging, however, to determine when patients can be weaned successfully from ECMO-surviving without requiring further mechanical support or heart transplant. We aimed to systematically review the medical literature to determine the biomarkers, hemodynamic and echocardiographic parameters associated with successful weaning of VA-ECMO in adults with cardiogenic shock and to present an evidence-based weaning algorithm incorporating key findings.
METHOD:
We systematically searched PubMed, Embase, ProQuest, Google Scholars, Web of Science and the Grey literature for pertinent original research reports. We excluded studies limited to extracorporeal cardiopulmonary resuscitation (ECPR) as the neurological prognosis may significantly alter the decision-making process surrounding the device removal in this patient population. Studies with a mixed population of VA-ECMO for cardiogenic shock or cardiac arrest were included. We excluded studies limited to patients in which ECMO was only used as a bridge to VAD or heart transplant, as such patients are, by definition, never "successfully weaned." We used the Risk of Bias Assessment tool for Non-Randomized Studies. The study was registered on the International prospective register of systematic reviews (PROSPERO CRD42020178641).
RESULTS:
We screened 14,578 records and included 47 that met our pre-specified criteria. Signs of lower initial severity of shock and myocardial injury, early recovery of systemic perfusion, left and right ventricular recovery, hemodynamic and echocardiographic stability during flow reduction trial and/or pump-controlled retrograde trial off predicted successful weaning. The most widely used parameter was the left ventricular outflow tract velocity time integral, an indicator of stroke volume. Most studies had a moderate or high risk of bias. Heterogeneity in methods, timing, and conditions of measurements precluded any meta-analysis.
CONCLUSIONS:
In adult patients on VA-ECMO for cardiogenic shock, multiple biomarkers, hemodynamic and echocardiographic parameters may be used to track resolution of systemic hypoperfusion and myocardial recovery in order to identify patients that can be successfully weaned.
© 2022. The Author(s).
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Successful management of hemodynamic instability secondary to saddle pulmonary embolism-induced cardiac arrest using VA-ECMO in advanced malignancy with brain metastases.
J Cardiothorac Surg2022 Dec;17(1):296. doi: 10.1186/s13019-022-02044-w.
Pan Jianneng, Zhou Xiaoyang, Xu Zhaojun, Chen Bixin,
Abstract
BACKGROUND:
Saddle pulmonary embolism (SPE) represents a rare type of venous thromboembolism that frequently causes circulation collapse and sudden death. While venoarterial extracorporeal membrane oxygenation (VA-ECMO) has been well established as a salvage treatment for SPE-induced circulatory shock, it is infrequently administered in patients with advanced malignancy, especially those with brain metastases, given the potential bleeding complications and an uncertain prognosis. As far, there are rare case reports regarding the successful management of hemodynamic instability secondary to SPE-induced cardiac arrest using VA-ECMO in advanced malignancy patients with brain metastases.
CASE PRESENTATION:
A 65-year-old woman presenting with cough and waist discomfort who had a history of lung cancer with brain metastases was admitted to the hospital to receive chemoradiotherapy. She suffered sudden cardiac arrest during hospitalization and returned to spontaneous circulation after receiving a 10-min high-quality cardiopulmonary resuscitation. Pulmonary embolism was suspected due to the collapsed hemodynamics and a distended right ventricle identified by echocardiography. Subsequent computed tomographic pulmonary angiography revealed a massive saddle thrombus straddling the bifurcation of the pulmonary trunk. VA-ECMO with adjusted-dose systemic heparinization was initiated to rescue the unstable hemodynamics despite receiving thrombolytic therapy with alteplase. Immediately afterward, the hemodynamic status of the patient stabilized rapidly. VA-ECMO was successfully discontinued within 72 h of initiation without any clotting or bleeding complications. She was weaned off invasive mechanical ventilation on the 6th day of intensive care unit (ICU) admission and discharged from the ICU 3 days later with good neurological function.
CONCLUSION:
VA-ECMO may be a 'bridging' therapy to circulation recovery during reperfusion therapy for SPE-induced hemodynamic collapse in malignancy patients with brain metastases.
© 2022. The Author(s).
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Cardio-pulmonary parasites of the European wildcat (Felis silvestris) in Germany.
Parasit Vectors2022 Dec;15(1):452. doi: 10.1186/s13071-022-05578-z.
Bisterfeld Katrin, Raulf Marie-Kristin, Waindok Patrick, Springer Andrea, Lang Johannes, Lierz Michael, Siebert Ursula, Strube Christina,
Abstract
BACKGROUND:
In the last years, research on feline cardio-pulmonary parasites has considerably increased in Europe. Not only domestic cats (Felis catus), but also European wildcats (Felis silvestris) can serve as definitive hosts for these nematodes. The F. silvestris population in Germany has been growing rapidly within the last decades; therefore, the assessment of its cardio-pulmonary parasite status is of importance to unravel whether the wildcat population serves as a substantial reservoir for these nematodes and might pose a health threat to domestic cats.
METHODS:
As part of a nature conservation project for European wildcats in the German federal state Rhineland-Palatinate, lungs (n?=?128) and hearts (n?=?111) of 128 F. silvestris found dead were examined for cardio-pulmonary parasites. All isolated parasites were identified morphologically, and results were confirmed by molecular analysis of a total of 3-11 specimens of each worm species.
RESULTS:
A total of 70.3% (90/128) wildcats were positive for at least one lungworm species. Angiostrongylus chabaudi was most common (53.1% [68/128]), followed by Aelurostrongylus abstrusus (42.2% [54/128]), Troglostrongylus brevior (31.3% [40/128]) and Capillaria spp. (3.1% [4/128]). Of note, about two-thirds of the infected wildcats harboured coinfections. Infection intensities ranged from 1 to 167 nematodes per wildcat. Generalised linear models revealed a strong correlation between A. chabaudi and A. abstrusus infection, and prevalences were higher in adult than in younger wildcats, except for T. brevior. Moreover, the T. brevior prevalence varied significantly with nutritional status.
CONCLUSIONS:
This study shows that feline cardio-pulmonary nematodes are common parasites in European wildcats in Germany but do not appear to have a serious impact on the overall health of the population. Due to presumed spillover events via prey, cardio-pulmonary nematodes may circulate between the wildcat population and domestic cats and might therefore pose a health risk to individual domestic cats.
© 2022. The Author(s).
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Evaluation of cardiopulmonary resuscitation quality during the pandemic of COVID-19.
BMC Emerg Med2022 Dec;22(1):193. doi: 10.1186/s12873-022-00754-x.
Yu Yang, Liu Xiaojie, Wang Lijuan, Gao Yuchen, Ding Yao, Ao Hushan,
Abstract
BACKGROUND:
Cardiopulmonary resuscitation (CPR) is an important technique of first aid. It is necessary to be popularized. Large-scale offline training has been affected after the outbreak of Coronavirus disease 2019 (COVID-19). Online training will be the future trend, but the quality of online assessment is unclear. This study aims to compare online and offline evaluations of CPR quality using digital simulator and specialist scoring methods.
METHODS:
Forty-eight out of 108 contestants who participated in the second Chinese National CPR Skill Competition held in 2020 were included in this study. The competition comprised two stages. In the preliminary online competition, the contestants practiced on the digital simulator while the specialist teams scored live videos. The final competition was held offline, and consisted of live simulator scoring and specialist scoring. The grades of the simulator and specialists in different stages were compared.
RESULTS:
There was no statistical significance for simulator grades between online and offline competition(37.7?±?2.0 vs. 36.4?±?3.4, p?=?0.169). For specialists' grades, the video scores were lower than live scores (55.0?±?1.4 vs. 57.2?±?1.7, p?0.001).
CONCLUSION:
Simulator scoring provided better reliability than specialist scoring in the online evaluation of CPR quality. However, the simulator could only collect quantified data. Specialist scoring is necessary in conjunction with online tests to provide a comprehensive evaluation. A complete and standardized CPR quality evaluation system can be established by combining simulator and specialist contributions.
© 2022. The Author(s).
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Minimum protamine dose required to neutralize heparin in cardiac surgery: a single-centre, prospective, observational cohort study.
Can J Anaesth2022 Dec;():. doi: 10.1007/s12630-022-02364-4.
Taneja Ravi, Szoke Daniel J, Hynes Zachary, Jones Philip M,
Abstract
PURPOSE:
Excess protamine contributes to coagulopathy following cardiopulmonary bypass (CPB) and may increase blood loss and transfusion requirements. The primary aim of this study was to find the least amount of protamine necessary to neutralize residual heparin following CPB using the gold standard assays of anti-IIa and anti-Xa activity. Secondary objectives were to evaluate whether the post-CPB activated clotting time could be used as a surrogate marker for quantifying heparin neutralization.
METHODS:
Twenty-eight consecutive patients undergoing elective cardiac surgery were enrolled. Protamine administration was standardized through an infusion pump at 25 mg·min. Blood samples were withdrawn prior to and following administration of 150, 200, 250, and 300 mg protamine and analyzed for activated clotting time and anti-IIa and -Xa activity.
RESULTS:
Following a mean (standard deviation) cumulative heparin dose of 67,700 (19,400) units and a CPB duration of 113 (71) min, protamine requirements varied widely. Eight out of 25 (32%) patients showed complete neutralization of anti-IIa and -Xa activity at the first sampling point (150 mg protamine; protamine:heparin ratio, 0.3 [0.1]). A protamine:heparin ratio of 0.5 (0.2) was sufficient for heparin neutralization in > 90% of patients. After CPB, a low to mid-range activated clotting time correlated well with anti-IIa and -Xa activity.
CONCLUSIONS:
The protamine:heparin ratio required to neutralize residual unfractionated heparin (UFH) following CPB is variable. A protamine:heparin ratio of 0.3 was sufficient to neutralize UFH in some patients, while a ratio of 0.5 is sufficient to neutralize both residual anti-IIa and -Xa activity in most patients. Larger studies are necessary to confirm these findings and evaluate their clinical implications.
STUDY REGISTRATION:
ClinicalTrials.gov (NCT03787641); registered 26 December 2018.
© 2022. Canadian Anesthesiologists' Society.
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TIMECARD score: An easily operated prediction model of unfavorable neurological outcomes in out-of-hospital cardiac arrest patients with targeted temperaturemanagement.
J Formos Med Assoc2022 Dec;():. doi: S0929-6646(22)00433-8.
Lin Jr-Jiun, Huang Chien-Hua, Chien Yu-San, Hsu Chih-Hsin, Chiu Wei-Ting, Wu Cheng-Hsueh, Wang Chen-Hsu, Tsai Min-Shan,
Abstract
BACKGROUND:
Targeted temperature management (TTM) is recommended for comatose out-of-hospital cardiac arrest (OHCA) survivors. Several prediction models have been proposed; however, most of these tools require data conversion and complex calculations. Early and easy predictive model of neurological prognosis in OHCA survivors with TTM warrant investigation.
MATERIALS AND METHODS:
This multicenter retrospective cohort study enrolled 408 non-traumatic adult OHCA survivors with TTM from the TaIwan network of targeted temperature ManagEment for CARDiac arrest (TIMECARD) registry during January 2014 to June 2019. The primary outcome was unfavorable neurological outcome at discharge. The clinical variables associated with unfavorable neurological outcomes were identified and a risk prediction score-TIMECARD score was developed. The model was validated with data from National Taiwan University Hospital.
RESULTS:
There were 319 (78.2%) patients presented unfavorable neurological outcomes at hospital discharge. Eight independent variables, including malignancy, no bystander cardiopulmonary resuscitation (CPR), non-shockable rhythm, call-to-start CPR duration >5 min, CPR duration >20 min, sodium bicarbonate use during resuscitation, Glasgow Coma Scale motor score of 1 at return of spontaneous circulation, and no emergent coronary angiography, revealed a significant correlation with unfavorable neurological prognosis in TTM-treated OHCA survivors. The TIMECARD score was established and demonstrated good discriminatory performance in the development cohort (area under the receiver operating characteristic curve [AUC] = 0.855) and validation cohorts (AUC = 0.918 and 0.877, respectively).
CONCLUSION:
In emergency settings, the TIMECARD score is a practical and simple-to-calculate tool for predicting neurological prognosis in OHCA survivors, and may help determine whether to initiate TTM in indicated patients.
Copyright © 2022 Formosan Medical Association. Published by Elsevier B.V. All rights reserved.
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The use of 100% compared to 50% oxygen during ineffective experimental cardiopulmonary resuscitation improves brain oxygenation.
Resuscitation2022 Dec;():. doi: S0300-9572(22)00729-8.
Nelskylä Annika, Humaloja Jaana, Litonius Erik, Pekkarinen Pirkka, Babini Giovanni, Mäki-Aho Tomi P, Heinonen Juho A, Skrifvars Markus B,
Abstract
INTRODUCTION:
Perfusion pressure and chest compression quality are generally considered key determinants of brain oxygenation during cardiopulmonary resuscitation (CPR) and the impact of oxygen administration is less clear. We compared ventilation with 100% and 50% oxygen during ineffective manual chest compressions and hypothesized that 100% oxygen would improve brain oxygenation.
METHODS:
Ventricular fibrillation (VF) was induced electrically in anaesthetized pigs and left untreated for 5 minutes, followed by randomization to ineffective manual CPR with ventilation of 50% or 100% oxygen. The first defibrillation was performed 10 minutes after induction of VF, and CPR continued with mechanical chest compressions (LUCAS2?) and defibrillation every 2 minutes until 36 minutes or return of spontaneous circulation (ROSC). Brain oxygenation was measured with near-infrared spectroscopy (rSO) and invasive brain tissue oxygen (PbtO) with a probe (NEUROVENT-PTO, RAUMEDIC) inserted into frontal brain tissue. Cerebral oxygenation was compared between groups with Mann-Whitney U tests and linear mixed models.
RESULTS:
Twenty-eight pigs were included in the study: 14 subjects in each group. During ineffective chest compressions relative PbtO was higher in the group ventilated with 100% compared to 50% oxygen (5.2mmHg [1.4-20.5] vs 2.2 [0.8-6.8], p=0.001), but there was no difference in rSO (22% [16-28] vs 18 [15-25], p=0.090). The use of 50% or 100% oxygen showed no difference in relative PbtO (p=1.00) and rSO (p=0.206) during mechanical CPR.
CONCLUSIONS:
The use of 100% compared to 50% oxygen during ineffective manual CPR improved brain oxygenation measured invasively in brain tissue, but there was no difference in rSO
Copyright © 2022. Published by Elsevier B.V.
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Prolonged smoldering Douglas fir smoke inhalation augments respiratory resistances, stiffens the aorta, and curbs ejection fraction in hypercholesterolemic mice.
Sci Total Environ2022 Dec;():160609. doi: 10.1016/j.scitotenv.2022.160609.
Eden Matthew J, Matz Jacqueline, Garg Priya, Gonzalez Mireia Perera, McElderry Katherine, Wang Siyan, Gollner Michael J, Oakes Jessica M, Bellini Chiara,
Abstract
While mounting evidence suggests that wildland fire smoke (WFS) inhalation may increase the burden of cardiopulmonary disease, the occupational risk of repeated exposure during wildland firefighting remains unknown. To address this concern, we evaluated the cardiopulmonary function in mice following a cumulative exposure to lab-scale WFS equivalent to a mid-length wildland firefighter (WLFF) career. Dosimetry analysis indicated that 80 exposure hours at a particulate concentration of 22?mg/m yields in mice the same cumulative deposited mass per unit of lung surface area as 3600?h of wildland firefighting. To satisfy this condition, male Apoe mice were whole-body exposed to either air or smoldering Douglas fir smoke (DFS) for 2?h/day, 5?days/week, over 8 consecutive weeks. Particulate size in DFS fell within the respirable range for both mice and humans, with a count median diameter of 110?±?20?nm. Expiratory breath hold in mice exposed to DFS significantly reduced their minute volume (DFS: 27?±?4; Air: 122?±?8?mL/min). By the end of the exposure time frame, mice in the DFS group exhibited a thicker (DFS: 109?±?3; Air: 98?±?3??m) and stiffer (DFS: 23?±?1; Air: 28?±?1?MPa) aorta with reduced diastolic blood augmentation capacity (DFS: 53?±?2; Air: 63?±?2?kPa). Cardiac magnetic resonance imaging further revealed larger end-systolic volume (DFS: 14.6?±?1.1; Air: 9.9?±?0.9??L) and reduced ejection-fraction (DFS: 64.7?±?1.0; Air: 75.3?±?0.9 %) in mice exposed to DFS. Consistent with increased airway epithelium thickness (DFS: 10.4?±?0.8; Air: 7.6?±?0.3??m), airway Newtonian resistance was larger following DFS exposure (DFS: 0.23?±?0.03; Air: 0.20?±?0.03 cmHO-s/mL). Furthermore, parenchyma mean linear intercept (DFS: 36.3?±?0.8; Air: 33.3?±?0.8??m) and tissue thickness (DFS: 10.1?±?0.5; Air: 7.4?±?0.7??m) were larger in DFS mice compared to air controls. Collectively, mice exposed to DFS manifested early signs of cardiopulmonary dysfunction aligned with self-reported events in mid-career WLFFs.
Copyright © 2022. Published by Elsevier B.V.
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Short-term exposure to ozone and cause-specific mortality risks and thresholds in China: Evidence from nationally representative data, 2013-2018.
Environ Int2022 Nov;171():107666. doi: 10.1016/j.envint.2022.107666.
Chen Chen, Li Tiantian, Sun Qinghua, Shi Wanying, He Mike Z, Wang Jiaonan, Liu Jing, Zhang Mengxue, Jiang Qizheng, Wang Menghan, Shi Xiaoming,
Abstract
BACKGROUND:
Ambient ozone pollution is steadily increasing and becoming a major environmental risk factor contributing to the global disease burden. Although the association between short-term ozone exposure and mortality has been widely studied, results are mostly reported on deaths from non-accidental or total cardiopulmonary disease rather than a spectrum of causes. In particular, a knowledge gap still exists for the potential thresholds in mortality risks.
METHODS:
This nationwide time-series study in China included 323 counties totaling 230,266,168 residents. Daily maximum 8-hour average was calculated as the ozone exposure metric. A two-stage statistical approach was adopted to assess ozone effects on 21 cause-specific deaths for 2013-2018. The subset approach and threshold approach were utilized to explore potential thresholds, and stratification analysis was used to evaluate population susceptibility.
RESULTS:
On average, the annual mean ozone concentration was 93.4 ?g/m across 323 counties. A 10-?g/m increase in lag 0-1 day of ozone was associated with increases of 0.12 % in mortality risk from non-accidental disease, 0.11 % from circulatory disease, 0.09 % from respiratory disease, 0.29 % from urinary system disease, and 0.20 % from nervous system disease. There may be a "safe" threshold in the ozone-mortality association, which may be between 60 and 100 ?g/m, and vary by cause of death. Women and older adults (especially those over 75) are more affected by short-term ozone exposure. Populations in North China had a higher risk of ozone-related circulatory mortality, while populations in South China had a higher risk of ozone-related respiratory mortality.
CONCLUSIONS:
National findings link short-term ozone exposure to premature death from circulatory, respiratory, neurological, and urinary diseases, and provide evidence for a potential "safe" threshold in the association of ozone and mortality. These findings have important implications for helping policymakers tighten the relevant air quality standards and developing early warning systems for public health protection in China.
Copyright © 2022 The Author(s). Published by Elsevier Ltd.. All rights reserved.
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[Pulmonary function testing and prehabilitation in thoracic surgery].
Khirurgiia (Mosk)2022 ;(12):99-103. doi: 10.17116/hirurgia202212199.
Chushkin M I, Kulagina T Yu, Kiryukhina L D, Karpina N L,
Abstract
Preoperative assessment should include spirometry and analysis of the diffusing capacity for carbon monoxide. If necessary, exercise tests can be performed. High risk patients can be revealed considering these data. These patients need for prehabilitation, i.e. preoperative measures increasing functional capacity. This review is devoted to preoperative assessment, principles of prehabilitation and perioperative nutritional support.
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[In-hospital and mid-term results of aortic root remodeling and aortic valve annuloplasty in patients with aortic root aneurysm and no severe aortic valve disease].
Khirurgiia (Mosk)2022 ;(12):5-10. doi: 10.17116/hirurgia20221215.
Lysenko A V, Salagaev G I, Lednev P V, Nikityuk T G, Dzeranova A N, Belov Yu V,
Abstract
OBJECTIVE:
To analyze early and mid-term results of aortic root remodeling with aortic valve annuloplasty in patients with aortic root aneurysm and no severe aortic valve disease.
MATERIAL AND METHODS:
There were 33 patients with connective tissue dysplasia, aneurysm of aortic root and/or ascending aorta and aortic regurgitation between September 2019 and December 2022. All patients underwent aortic root remodeling with aortic valve annuloplasty.
RESULTS:
Mean time of cardiopulmonary bypass was 138.5±21.5 min, aortic clamping - 115.3±20.5 min. According to postoperative transthoracic echocardiography, mild aortic regurgitation was observed in 28 patients, 5 patients had moderate regurgitation. Postoperative follow-up period varied from 3 months to 2 years. There was no in-hospital mortality or significant cardiovascular complications. Two-year freedom from moderate-to-severe aortic regurgitation was 93.9%, overall survival - 100%.
CONCLUSION:
Aortic root remodeling is characterized by favorable hemodynamic efficiency and low complication rate.
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Concomitant tricuspid valve repair in left ventricular assist device implantation may increase the risk for temporary right ventricular support but does not impact overall outcomes.
Eur J Cardiothorac Surg2022 Dec;():. doi: ezac555.
Mihalj Maks, Jezovnik Mateja K, Benk Julia, Heg Dik, Podstatzky-Lichtenstein Teresa, Beyersdorf Friedhelm, Radovancevic Rajko, Gregoric Igor D, Hunziker Lukas, Siepe Matthias, Reineke David,
Abstract
OBJECTIVES:
Tricuspid valve repair in left ventricular assist device implantation continues to pose a challenge and may impact the occurrence of early and late right heart failure. We investigated the effects of concomitant tricuspid repair on clinical outcomes.
METHODS:
A retrospective, multicentre study enrolled adult patients who received continuous-flow left ventricular assist devices between 2005 and 2017 and compared those who received concomitant tricuspid valve repair to those who did not. Primary outcomes were early right heart failure necessitating temporary ventricular assist devices and right heart failure-related rehospitalizations requiring inotropic or diuretic treatment.
RESULTS:
Out of 526 patients who underwent left ventricular assist device implantation, 110 (21%) received a concomitant tricuspid valve repair. Those patients were sicker, and most had moderate or severe tricuspid regurgitation. A significantly higher incidence of temporary right ventricular assist devices was observed in the group with concomitant tricuspid valve repair (18% vs 11%, P?=?0.049), with a significantly elevated risk for temporary right heart assist device (sHR 1.68 [95% CI 1.04-2.72], P?=?0.037). After adjusting for confounders, no significant differences were found in the incidence of and risk for most clinical outcomes, including right heart failure-related rehospitalizations (P?=?0.891) and death (P?=?0.563).
CONCLUSIONS:
Concomitant tricuspid valve repair, when deemed necessary in left ventricular assist device implantation, may increase the risk of early right heart failure requiring a temporary right ventricular assist device but does not impact the incidence or risk of death or rehospitalizations due to late right heart failure.
© The Author(s) 2022. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
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Cardiovascular surgery in very low birth weight (? 1500g) neonates.
Eur J Cardiothorac Surg2022 Dec;():. doi: ezac552.
Henmi Soichiro, Essa Yasin, Ozturk Mahmut, Tongut Aybala, Desai Manan, Yerebakan Can, d'Udekem Yves,
Abstract
OBJECTIVES:
Low birth weight and prematurity are known risks of increased morbidity and mortality with undergoing cardiovascular surgery. Our aim was to review the outcomes of very low birth weight (? 1500?g) patients who have undergone cardiovascular surgery.
METHODS:
A retrospective review was performed for 32 very low birth weight (? 1500?g) patients who underwent cardiovascular surgery from 2004 to 2021 in our institution.
RESULTS:
Fifteen patients weighting ? 1500 g at surgery (? 1500 g group) were compared to 17 patients born with a weigh ? 1500 g and weighting between 1500 g and 2500 g at surgery (>1500 g to ? 2500 g group) in this study. In-hospital mortality was 33% (5/15) in ? 1500 g group and 24% (4/17) in > 1500 g to ? 2500 g group (p = 0.55). All patients with simple biventricular lesion survived following full repair. The occurrence of postoperative intracerebral haemorrhage was significantly higher in those operated at weight ? 1500 g than those weighting >1500 g to ? 2500 g (40% vs 0%; p = 0.01). The 1- and 3-year survival rates were 66.0 ± 12.4% and 46.2 ± 14.8% in ? 1500 g group and 76.5 ± 10.3% and 70.6 ± 11.1% in > 1500 g to ? 2500 g group (Log-rank p = 0.12).
CONCLUSION:
Cardiac surgery for very low birth weight neonate resulted in a high early and late mortality. Early surgery is only acceptable for simple biventricular lesion if needed. Delayed surgery seems to provide better long-term outcomes in patients with complex lesions. Alternative strategies to neonatal cardiopulmonary bypass should be investigated in patients with complex biventricular and single ventricle lesions.
© The Author(s) 2022. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
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Contribution of hemoglobin concentration to cardiorespiratory fitness in black African American patients with recently decompensated heart failure and reduced ejection fraction.
Minerva Cardiol Angiol2022 Dec;():. doi: 10.23736/S2724-5683.22.06226-3.
Thomas Georgia K, Del Buono Marco G, Damonte Juan I, Moroni Francesco, Mihalick Virginia, Billingsley Hayley E, Vecchiè Alessandra, Trankle Cory R, Talasaz Azita, Carbone Salvatore, Markley Roshanak, Turlington Jeremy, Duncan Philip, Lu Juan, Arena Ross, VAN Tassell Benjamin, Abbate Antonio, Canada Justin M,
Abstract
BACKGROUND:
Previous studies have shown that patients with heart failure with reduced ejection fraction (HFrEF) and anemia have reduced peak oxygen consumption (VO2 ). Black or African American (B-AA) patients have a higher prevalence of anemia and are underrepresented in clinical studies of HFrEF. The aim of this study was to determine the contribution of hemoglobin to peak VO2 in B-AA patients recently hospitalized for acute decompensated HFrEF.
METHODS:
We analyzed cardiopulmonary exercise testing (CPX) data measured within two weeks of discharge for acute decompensated HF in B-AA patients with HFrEF (left ventricular ejection fraction [LVEF] ?40%) without severe anemia (Hb
RESULTS:
We included 81 patients; 27 (33%) women, 57 [27-79] years of age, Body Mass Index of 33 [15-55] kg/m and LVEF of 30 [23-36] %. Hemoglobin ranged between 9.1 to 18.1 g/dL (median= 13.3 [11.9-14.5] g/dL); 26 (32%) were considered to have anemia based on a Hb concentration of males 2 was lower in patients with anemia (11.8 [10.0-14.2] vs. 14.1 [10.6-17.0] mL·kg·min; P=0.010) with a significant correlation between peak VO2 and hemoglobin concentration (R=+0.455; P
CONCLUSIONS:
Anemia is prevalent among B-AA patients with recently decompensated HFrEF and appears to be a significant contributor to reductions in peak VO2 .
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Cannulation-related adverse events of peripheral veno-arterial extracorporeal membrane oxygenation support in heart transplantation: Axillary versus femoral artery cannulation.
Clin Transplant2022 Dec;():e14871. doi: 10.1111/ctr.14871.
Ohira Suguru, Dhand Abhay, Hirani Rahim, Martinez Sabrina, Lanier Gregg M, Levine Avi, Pan Stephen, Aggarwal-Gupta Chhaya, Gass Alan L, Wolfe Kevin, Spielvogel David, Kai Masashi,
Abstract
BACKGROUND:
In heart transplantation (HT), peripheral veno-arterial extracorporeal membranous oxygenation (VA-ECMO) is utilized preoperatively as a direct bridge to HT or postoperatively for primary graft dysfunction. Little is known about wound complications of an arterial VA-ECMO cannulation site which can be fatal.
METHODS:
From 2009 to 2021, outcomes of 80 HT recipient who were supported with peripheral VA-ECMO either preoperatively or postoperatively were compared based on the site of arterial cannulation: axillary (AX: N = 49) versus femoral artery (FA: N = 31).
RESULTS:
Patients in the AX group were older (AX: 59 years vs. 52 years, P = 0.006), and less likely to have extracorporeal cardiopulmonary resuscitation (0% vs. 12.9%, P = 0.040). Survival to discharge (AX, 81.6% vs. FA. 90.3%, P = 0.460), incidence of stroke (10.2% vs. 6.5%, P = 0.863), VA-ECMO cannulation-related bleeding (6.1% vs. 12.9%, P = 0.522), and arm or limb ischemia (0% vs. 3.2%, P = 0.816) were comparable. ECMO cannulation-related wound complications were lower in the AX group (AX, 4.1% vs. FA, 45.2%, P
CONCLUSIONS:
Given the lower rate of wound complications and comparable hospital outcomes with femoral cannulation, axillary VA-ECMO may be an excellent option in HT candidates or recipients when possible This article is protected by copyright. All rights reserved.
This article is protected by copyright. All rights reserved.
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Physician Self-Reported Practice Patterns: Midazolam for Minor Procedures in Pediatric Patients.
Clin Pediatr (Phila)2022 Dec;():99228221132020. doi: 10.1177/00099228221132020.
Trotter Zola, Mecham Cherisse, Bhattarai Bikash,
Abstract
Midazolam is frequently used as a single agent to provide minimal sedation (also called anxiolysis) when performing procedures in minor children. Published guidelines on the optimal use of intranasal (INM) and oral midazolam (POM) are lacking. The purpose of this study is to explore the self-reported physician practice related to midazolam use in facilitating minor procedures in children. We developed a survey that was approved by the Academy of Pediatrics Section on Emergency Medicine (APP-SOEM) and was then electronically distributed via its listserve. Questions were posed about the therapeutic and maximum dosing of INM and POM, consideration of Nothing-By-Mouth (NPO) status, use of cardiopulmonary monitors, as well as discharge criteria. There was a 47% (218/465) response rate. For therapeutic INM doses, 65% of responders used a dose range of 0.3 to 0.6 mg/kg, and 75% selected a maximum dose of 10 mg irrespective of the child's weight. About 20% of the responders selected a dosage range of 0.7 to 1 mg/kg for therapeutic POM dose, with 43% opting for a maximum dose of 20 mg irrespective of the child's weight. We observed a dichotomous variation in reported physician use of cardiopulmonary monitors; 42% never employ monitors, and the remainder used monitors some of the time. There was consensus on the NPO status and discharge criteria; 80% of physicians did not consider NPO status prior to midazolam use. The level of alertness was the most commonly selected discharge criterion. This nationwide survey of physicians indicates practice variation with midazolam dosing and cardiopulmonary monitor usage when performing minor procedures in children. Implementing practice guidelines, specifically for minimal sedation with mainstay agents such as midazolam, may standardize physician practice and improve overall patient care.
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Pediatric cardiopulmonary resuscitation in infant and children with chronic diseases: A simple approach?
Front Pediatr2022 ;10():1065585. doi: 1065585.
Uzun Davut D, Lang Kristin, Saur Patrick, Weigand Markus A, Schmitt Felix C F,
Abstract
Infants and children with complex chronic diseases have lifelong, life-threatening conditions and for many, early death is an unavoidable outcome of their disease process. But not all chronic diseases in children are fatal when treated well. Cardiopulmonary resuscitation is more common in children with chronic diseases than in healthy children. Resuscitation of infants and children presents significant challenges to physicians and healthcare providers. Primarily, these situations occur only rarely and are therefore not only medically demanding but also associated with emotional stress. In case of resuscitation in infants and children with chronic diseases these challenges become much more complex. The worldwide valid Pediatric Advanced Life Support Guidelines do not give clear recommendations how to deal with periarrest situations in chronically ill infants and children. For relevant life-limiting illnesses, a "do not resuscitate" order should be discussed early, taking into account medical, ethical, and emotional considerations. The decision to terminate resuscitative efforts in cardiopulmonary arrest in infants and children with chronic illnesses such as severe lung disease, heart disease, or even incurable cancer is complex and controversial among physicians and parents. Judging the "outcome" of resuscitation as a "good" outcome becomes complex because for some, life extension itself and for others, quality of life is a goal. Physicians often decide that a healthy child is more likely to have a reversible condition and thereby have a better outcome than a child with multiple comorbidities and chronic health care needs. Major challenges in resuscitation infants and children are that clinicians need to individualize resuscitation strategies in light of each chronic disease, anatomy and physiology. This review aims to highlight terms of resuscitation infants and children with complex chronic diseases, considering resuscitation-related factors, parent-related factors, patient-related factors, and physician-related factors.
© 2022 Uzun, Lang, Saur, Weigand and Schmitt.
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Effectiveness and safety of a one-yearly elongation approach of growing rods in the treatment of early-onset scoliosis: A case series of 40 patients with definitive fusion.
Front Pediatr2022 ;10():895065. doi: 895065.
Vittoria Francesca, Ceconi Viola, Fantina Lisa, Barbi Egidio, Carbone Marco,
Abstract
BACKGROUND:
Early onset scoliosis (EOS) can lead to marked spine and chest wall deformity and often to profound cardiopulmonary compromise. Nowadays, treatment benefits from the possibility of a growth-friendly surgical approach to avoid early spinal fusion. Growing rod spinal implants allow maximizing spine and thorax growth during childhood, performing lengthening procedures traditionally approximately every 6 months.
METHODS:
We retrospectively evaluated 40 patients affected by EOS who underwent growing rod implantations from 2000 to 2020. A 1-year interval between lengthening procedures was adopted. Data about the age at the first and final surgeries, T1-T12 length pre- and post-surgery, T1-S1 pre- and post-surgery, major coronal curve, pre- and post-surgery rate of complications, and unplanned surgeries were collected and compared with those reported in the literature to determinate the effectiveness and safety of this long period between distractions.
RESULTS:
The lengthening procedures were performed, on average, every 12.3 months; children underwent an average of 4.6 lengthening procedures each. Major curve pre-first surgery was 78°, post-first surgery 45°, pre-final surgery 55°, and post-final surgery 43°. The mean absolute difference between pre-initial to post-final major curve was 35°, representing a mean relative difference of 42%. On average, the T1-T12 segment measured 15?cm before the first surgery and 24?cm after the final surgery, while the T1-S1 segment was 25?cm before the growing rods implantation and reached 37?cm after treatment. During treatment, the adverse events affected 27 of the 40 total patients (67%) who experienced at least one complication. No differences were shown concerning both outcomes and complications, comparing these data with the available literature concerning most frequent elongations. This approach avoided four to five surgical procedures in this population.
CONCLUSION:
Our results related to deformity correction and complication rate are comparable with those found in the literature, where lengthening procedures are performed approximately every 6 months rather than with a 1-year interval between distractions. We also demonstrate a higher risk of complications for patients with implants before the age of 6.
© 2022 Vittoria, Ceconi, Fantina, Barbi and Carbone.
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Efficacy evaluation of pulmonary hypertension therapy in patients with portal pulmonary hypertension: A systematic review and meta-analysis.
Front Pharmacol2022 ;13():991568. doi: 991568.
Zhang Ruihua, Li Tengfei, Shao Yueming, Bai Wei, Wen Xiaoyu,
Abstract
To determine the therapeutic effect of pulmonary arterial hypertension (PAH) agents for portal pulmonary hypertension (POPH). Systematic review and meta-analysis. POPH is a serious complication of end-stage liver disease with a low survival rate. Liver transplantation (LT) is an effective treatment. Due to the presence of POPH, some patients cannot undergo LT. After PAH treatment, patients with POPH can obtain good hemodynamics and cardiac function for LT, but there are no standard guidelines. Two independent researchers searched PubMed, EMBASE, Cochrane Library, and Web of Science for studies published from inception to 27 September 2022, focusing on the changes in hemodynamics and cardiac function in all patients with POPH to understand the effect of PAH treatment on the entire population of POPH patients. Among these, we specifically analyzed the changes in hemodynamics and cardiac function in moderate and severe POPH patients. After collecting the relevant data, a meta-analysis was carried out using the R program meta-package. A total of 2,775 literatures were retrieved, and 24 literatures were included. The results showed that in all POPH patients ( = 1,046), the following indicators were significantly improved with PAH agents: mPAP: (MD = -9.11 mmHg,
Copyright © 2022 Zhang, Li, Shao, Bai and Wen.
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Peripheral extracorporeal membrane oxygenation support expands the application of robot-assisted coronary artery bypass.
JTCVS Tech2022 Jun;13():92-100. doi: 10.1016/j.xjtc.2022.02.034.
Patel Vivek, Gray Zachary, Alam Mahboob, Silva Guilherme Vianna, Simpson Leo, Liao Kenneth,
Abstract
OBJECTIVE:
Robot-assisted coronary artery bypass (RCAB) is typically not offered to higher risk patients with reduced cardiopulmonary function, critical coronary artery disease, and challenging chest wall anatomy. In this study, we report the novel use of nonemergency intraoperative peripheral extracorporeal membrane oxygenation as partial cardiopulmonary support during RCAB for patients who were considered high-risk candidates for conventional CAB and at the same time not eligible for RCAB without cardiopulmonary support.
METHODS:
Forty-five high risk patients (mean age, 68 years; Society of Thoracic Surgeons score, 6.27%; ejection fraction, 45%) underwent RCAB with nonemergency peripheral extracorporeal membrane oxygenation support for the following indications: inability to tolerate single-lung ventilation (n = 17; 38%), low ejection fraction
RESULTS:
Up to 30 days, there were no strokes (0%), myocardial infarctions (0%), or access vessel complications (0%). One noncardiac related mortality (2.2%) was related to hemodialysis access issues in a patient with preexisting end-stage renal disease. One redo-CAB (2.2%) patient required sternotomy to locate the target vessel. Thirty-four (75.6%) patients were extubated within 6 hours of surgery.
CONCLUSIONS:
Our results examine the feasibility of using peripheral extracorporeal membrane oxygenation during RCAB for high-risk patients who otherwise had limited options. The use of peripheral extracorporeal membrane oxygenation in RCAB can potentially expand the surgical treatment options in high-risk coronary artery disease patients.
© 2022 Published by Elsevier Inc. on behalf of The American Association for Thoracic Surgery.
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