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Cerebral Protection

Cannula Placement for Cerebral Protection Without Circulatory Arrest in Patients Undergoing Hemiarch Aortic Aneurysm Repair

This retrospective study evaluates the efficacy and outcomes of left carotid antegrade cerebral perfusion (LCP) versus traditional right-sided perfusion with hypothermic circulatory arrest in hemiarch aortic aneurysm repairs. The study, encompassing 68 patients between 2015 and 2019, suggests that LCP via distal arch cannulation is a viable and safer alternative, showing comparable clinical outcomes but reduced cardiopulmonary bypass and cerebral perfusion times. The findings advocate for LCP as a method that potentially reduces the risks associated with circulatory arrest.


Comparative Analysis of Therapeutic Strategies in Post-Cardiotomy Cardiogenic Shock: Insight into a High-Volume Cardiac Surgery Center

This study compares treatment outcomes for post-cardiotomy cardiogenic shock (PCCS) at a high-volume center. It retrospectively analyzes 220 patients (3% of 7028) from 2018 to 2022, assessing outcomes between conservative treatments and additional mechanical support with ECMO. Findings show ECMO patients had lower in-hospital mortality (60% vs. 85%) and better end-organ recovery, despite higher complications like dialysis and myocardial infarction, suggesting ECMO’s potential to improve critical patient outcomes.

Arch Surgery

A New Minimal Invasive Technique with In-Situ Stent-Graft Fenestration for Type A Aortic Dissection

A new surgical method called the in-situ stent-graft fenestration (ISSF) technique is presented as an alternative for aortic arch reconstruction in type A aortic dissection. This technique offers shorter surgical durations and less intraoperative blood loss compared to the traditional Sun’s procedure. ISSF also results in lower in-hospital mortality rates and fewer postoperative complications. The six-month follow-up shows significant improvements in the dimensions of the aorta’s true and false lumens, suggesting promising short-term efficacy and safety.


Advancing Cardiotomy Suction Practices for Coronary Surgery via Multidisciplinary Collaborative Learning

This study focuses on a multidisciplinary quality-improvement intervention to standardize cardiotomy suction practices at the end of cardiopulmonary bypass during coronary artery bypass grafting. Conducted across 32 centers, the initiative showed significant improvements in adherence to recommended practices in Michigan centers compared to non-participating centers, with no adverse effects on clinical outcomes.


Alternative Venous Access Sites for Dual-Lumen Extracorporeal Membrane Oxygenation Cannulation

This multicenter case series examines the safety and feasibility of using alternative venous access sites for dual-lumen cannulas in veno-venous (VV) extracorporeal membrane oxygenation (ECMO) when the right internal jugular vein (RIJV) is inaccessible. Data from three high-volume ECMO centers were analyzed, involving 20 patients who required alternative access due to inaccessible RIJV. The study found no procedural complications with alternative sites, which included the left internal jugular, subclavian, and femoral veins. The outcomes were promising with half of the patients successfully bridged to lung transplantation or recovery, highlighting the viability of these alternative sites for critical ECMO support.


Impact of Center Volume on In-Hospital Mortality in Adult Patients with Out-of-Hospital Cardiac Arrest Resuscitated Using Extracorporeal Cardiopulmonary Resuscitation: A Secondary Analysis of the SAVE-J II Study

This secondary analysis of the SAVE-J II study evaluates the correlation between center volume and in-hospital mortality for patients with out-of-hospital cardiac arrest (OHCA) treated with extracorporeal cardiopulmonary resuscitation (ECPR). Analyzing data from 36 Japanese centers, the study categorizes centers into three groups based on ECPR volume. Findings reveal that high-volume centers (≥21 sessions/year) show a significantly higher survival rate at discharge (33.4%) compared to medium (24.1%) and low-volume (26.8%) centers. Adjusted analysis suggests that patients at high-volume centers are more likely to survive, indicating a positive correlation between center volume and ECPR success.

ECMO Tan Logo

Comparison of Conventional Methods with Pump-Controlled Retrograde Trial off for Weaning Adults with Cardiogenic Shock from Veno-Arterial Extracorporeal Membrane Oxygenation

This retrospective study evaluates the effectiveness of pump-controlled retrograde trial off (PCRTO) versus conventional weaning methods from veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in adults with cardiogenic shock. It found that the PCRTO method significantly improves survival rates to discharge compared to non-PCRTO methods (90% vs. 72%) and reduces the incidence of cardiogenic shock post-weaning (5% vs. 16%). PCRTO, offering a safe and reversible weaning process, emerges as a useful predictor for successful VA-ECMO weaning through a preload stress test, suggesting its viability as a preferred approach in clinical practice.

Coronary ECMO

The Jena Method: Perfusionist Independent, Standby Wet-Primed Extracorporeal Membrane Oxygenation (ECMO) Circuit for Immediate Catheterization Laboratory and/or Hybrid Operating Room Deployment

The Jena Method introduces a revolutionary approach to deploying extracorporeal membrane oxygenation (ECMO) rapidly in emergency situations, without needing a perfusionist on hand. By maintaining a wet-primed ECMO system ready for immediate use, this method significantly reduces the initiation time for life-support procedures. Sterility and functionality of the ECMO components are maintained up to 14 days, ensuring patient safety. Training staff for independent ECMO setup and a pictorial guide facilitate quick and efficient deployment. Since its implementation in 2015, this method has demonstrated feasibility, safety, and the potential for widespread adoption in critical care settings, providing a significant advancement in emergency cardiac care.

Exploding Kidney

Is Ultrafiltration Volume a Predictor of Postoperative Acute Kidney Injury in Patients Undergoing Cardiopulmonary Bypass?

This study investigates the relationship between intraoperative ultrafiltration (UF) volume during cardiopulmonary bypass (CPB) and the incidence of acute kidney injury (AKI) post-coronary artery bypass graft (CABG) surgery. Analyzing data from 641 patients, it found that higher UF volumes are significantly associated with an increased risk of AKI. Other identified predictors of AKI include patient age, the lowest mean arterial pressure during surgery, and red blood cell transfusions. These results underscore the importance of careful UF management during CPB to mitigate the risk of postoperative AKI.


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