Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Dec 2024
Nighttime/Weekend Venoarterial Extracorporeal Membrane Oxygenation Cannulation Is Not Associated With Increased 1-Year Mortality for Non-Extracorporeal Cardiopulmonary Resuscitation Indications.
The process of placing a patient on venoarterial extracorporeal membrane oxygenation (VA-ECMO) is complex and requires the activation and coordination of numerous personnel from a variety of disciplines to achieve procedural success, initiate flow, and subsequently monitor the patient's condition. The literature suggests that nighttime cannulation for extracorporeal cardiopulmonary resuscitation (ECPR) is associated with adverse outcomes compared to daytime cannulation. Given the strain on personnel that this process can create, it is plausible that patients who are initiated on VA-ECMO for non-ECPR indications during the nighttime and on weekends, which are generally periods with reduced staffing compared to weekday daytime hours, also may experience worse outcomes, including decreased survival. This study aimed to determine whether nighttime/weekend VA-ECMO cannulation is associated with worse outcomes, including decreased survival. ⋯ We conclude that nighttime and weekend VA-ECMO cannulations can be performed safely at a large academic medical center.
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J. Cardiothorac. Vasc. Anesth. · Dec 2024
Echocardiographic Findings in Critically Ill COVID-19 Patients Treated With and Without Extracorporeal Membrane Oxygenation.
To describe echocardiographic findings among mechanically ventilated patients with COVID-19 acute respiratory distress syndrome, comparing those with and without venovenous extracorporeal membrane oxygenation (VV ECMO) support. ⋯ The prevalence of echocardiographic abnormalities, in particular RV dysfunction, was frequent among patients with COVID-19 receiving VV ECMO support and was associated with worse clinical outcomes.
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J. Cardiothorac. Vasc. Anesth. · Dec 2024
Predictors of Postoperative Morphine Milligram Equivalents in Cardiac Surgery.
Given both the short- and long-term deleterious effects of opioids, there has been an increased focused on reducing the use of postoperative opioid analgesia. As patients undergoing cardiac surgery often require high levels opioids postoperatively, understanding risk factors for increased postoperative opioid use may be helpful for the development of patient-specific opioid-sparing pain regimens for this patient population. ⋯ CABG, liver disease, patient-controlled analgesia, younger age, and higher BMI are associated with increased narcotic use after cardiac surgery. Implementation of more aggressive perioperative multimodal opioid-sparing regimens should be considered for these patient groups.
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J. Cardiothorac. Vasc. Anesth. · Dec 2024
Observational StudyImpact of Persistent Pulmonary Hypertension of the Newborn in Neonates with Dextro-transposition of the Great Arteries.
This study aimed to assess the impact of persistent pulmonary hypertension of the newborn (PPHN) on perioperative morbidity and mortality in patients with dextro-transposition of the great arteries. Secondarily, we evaluated the association between postoperative outcomes and intraoperative variables including the duration of cardiopulmonary bypass, cerebral oxygen desaturation, and hypotension. ⋯ PPHN did not significantly affect perioperative morbidity and mortality in d-TGA patients, suggesting a more favorable prognosis than previously reported.
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J. Cardiothorac. Vasc. Anesth. · Dec 2024
Perioperative Anesthetic Considerations for Catheter-Based Pulmonary Vein Interventions in Fibrosing Mediastinitis.
Fibrosing mediastinitis (FM) is a rare disease characterized by abnormal proliferation of fibrous tissue, causing compression and narrowing of the airway, blood vessels, and other mediastinal structures, including the pulmonary veins. Catheter-based interventions are available as palliative strategies. Due to the complex nature of the disease and the profound respiratory and hemodynamic sequelae that may ensue, anesthetic management requires meticulous interdisciplinary planning. ⋯ Patients with FM can achieve successful intraprocedural outcomes by ensuring a comprehensive understanding of the disease, addressing significant anesthetic concerns and considerations, and engaging a multidisciplinary team.