Journal of cardiothoracic and vascular anesthesia
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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
Mentoring Fellows in Adult Cardiothoracic Anesthesiology for Academic Practice in the Contemporary Era-Perspectives From Mentors Around the United States.
This special article presents perspectives on the mentoring of fellows for academic practice in adult cardiothoracic anesthesiology. A comprehensive mentoring model should address the areas of clinical care, educational expertise and exposure to scholarly activity. The additional value of educational exposure to patient safety, quality improvement and critical care medicine in this model is also explored.
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J. Cardiothorac. Vasc. Anesth. · Feb 2020
Concomitant Cardiac Surgery and Radiofrequency Ablation of Atrial Fibrillation: A Retrospective Single Center Study.
Concomitant cardiac surgery and radiofrequency atrial fibrillation (AF) ablation is an established procedure recommended in guidelines. However, the results have not been as good as expected. The authors therefore searched for predictive factors of success of the ablation procedure. ⋯ Concomitant cardiac surgery and radiofrequency AF ablation provided freedom from AF for 60% of patients after 1-year follow-up. The authors have shown that paroxysmal AF and recent AF are predictive factors of success. Nevertheless, thorough postoperative care is necessary to improve long-term results, including the use of additional catheter ablation or cardioversion.