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Lungs Feature

The Incidence, Risk Factors, and Hospital Mortality of Prolonged Mechanical Ventilation Among Cardiac Surgery Patients: A Systematic Review and Meta-Analysis

This systematic review analyzes prolonged mechanical ventilation (PMV) post-cardiac surgery, finding an incidence rate of 20%. PMV, defined as ventilation lasting ≥24 hours, is linked to in-hospital mortality (odds ratio: 14.13). Key risk factors include advanced age, female sex, ejection fraction <50%, and body mass index >28 kg/m². PMV also correlates with conditions like chronic renal failure and prolonged cardiopulmonary bypass time. These insights highlight the need for targeted prevention and management strategies.

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December 20, 2024
Ratatulli

A New Protocol for Removal of the Endothelium from the Perfused Rat Hind-Limb Preparation

This study introduces a novel method for selectively removing endothelial cells from rat hind-limb arteries using a high flow/air bubbles/high flow protocol. The technique effectively removes endothelium from larger arteries without damaging smooth muscle cells, arterioles, or capillaries. It enhances vascular reactivity, as shown by increased contractile responses to a,β-methylene ATP. This method provides a model for investigating vascular function with and without endothelial influence.

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December 10, 2024
Bad Impella

Efficacy and Safety of Impella in Cardiogenic Shock Following Acute Myocardial Infarction: A Meta-Analysis of Randomized Controlled Trials

This meta-analysis reviewed four randomized controlled trials (442 patients) to evaluate the use of Impella in managing cardiogenic shock (CS) following acute myocardial infarction (AMI). Impella reduced 6-month all-cause mortality (OR: 0.64, 95% CI: 0.43-0.95, P = .03) but showed no significant impact on 30-day mortality. However, Impella was linked to increased risks of major bleeding (OR: 3.61), limb ischemia (OR: 4.91), and sepsis (OR: 2.75). Future research is needed to balance survival benefits against these complications.

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December 3, 2024
Surgery vs. PCI

Comparing Percutaneous Coronary Intervention and Coronary Artery Bypass Grafting in Non-ST-Segment Elevation Acute Coronary Syndromes: A Systematic Review and Meta-Analysis

This systematic review and meta-analysis compared percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) for treating non-ST-segment elevation acute coronary syndromes (NSTE-ACS). Analyzing data from 15 studies with 48,891 patients, results showed no significant mortality difference between PCI and CABG. However, CABG reduced the risk of myocardial infarction (RR = 0.56) and repeat revascularization (RR = 2.94), while PCI was associated with a lower risk of cerebrovascular accidents (RR = 0.58). These findings emphasize individualized treatment strategies based on patient-specific risk profiles.

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November 29, 2024
Robo MVR

A Historical Perspective and Update on Robotic Mitral Valve Surgery

This study reviews the evolution of minimally invasive mitral valve repair, emphasizing the use of robotic platforms from 2005 to 2023. Analyzing 1,412 robotic repairs, it highlights improvements in outcomes, including reduced cross-clamp and bypass times and high repair durability. Degenerative disease was the most common indication, with 98.1% repair success and a ten-year survival rate exceeding 91%. The findings support robotic surgery as a durable, teachable, and safe option for mitral valve repair.

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November 19, 2024
VA ECMO

A Comparative Study of Femoral Artery and Combined Femoral and Axillary Artery Cannulation in Veno-Arterial Extracorporeal Membrane Oxygenation Patients

This study investigates the clinical outcomes of two cannulation strategies—femoral artery (FA) cannulation and combined femoral and axillary artery (FA+AA) cannulation—in patients receiving veno-arterial extracorporeal membrane oxygenation (VA-ECMO) after cardiac surgery. The FA+AA group showed significant benefits in reducing chronic renal failure, platelet drop, and creatinine levels. Despite similar 30-day mortality rates, the combined approach led to fewer complications and faster recovery.

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October 5, 2024
Lung Ventilation

Low Frequency Ventilation During Cardiopulmonary Bypass to Protect Postoperative Lung Function in Cardiac Valvular Surgery: The PROTECTION Phase II Randomized Trial

This trial assessed the safety and efficacy of low frequency ventilation (LFV) during cardiopulmonary bypass in patients undergoing valvular surgery. Sixty-three patients were randomized, and results showed LFV was associated with improved lung-specific biomarker levels and better-preserved lung function, including respiratory tests and walking ability. The study demonstrated LFV’s potential to protect lung function post-surgery, warranting further investigation in larger studies.

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October 1, 2024
Special K

Extraction of Ketamine and Dexmedetomidine by Extracorporeal Life Support Circuits

This study investigated the extraction of ketamine and dexmedetomidine by extracorporeal life support (ECLS) circuits such as ECMO and CRRT. Using an ex-vivo system, drug concentrations were measured over time in blood-primed circuits. Results showed significant reductions in drug recovery, with ketamine recovering only 43.8% from ECMO and 3.3% from CRRT after several hours. Dexmedetomidine recovery was similarly reduced, highlighting the need for dosage adjustments during ECLS support.

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September 26, 2024
Haemoadsorption

Impact of Extracorporeal Haemoadsorption During Prolonged Cardiopulmonary Bypass on the Incidence of Acute Kidney Injury

This study investigates the effects of haemoadsorption (HA) therapy on inflammatory markers and renal damage indices during cardiopulmonary bypass (CPB) and the early postoperative period. Conducted at a single tertiary care center, the retrospective analysis compared three groups of patients who underwent CPB for over 120 minutes. The results showed that haemoadsorption therapy did not significantly reduce the incidence of acute kidney injury (AKI) but decreased the need for renal replacement therapy.

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June 26, 2024
ECMO Neuro Monitoring

Multimodal Neurologic Monitoring in Patients Undergoing Extracorporeal Membrane Oxygenation

This study investigates the safety and feasibility of noninvasive multimodal neurologic monitoring (MNM) in patients undergoing extracorporeal membrane oxygenation (ECMO) at Baylor St. Luke’s Medical Center. The observational study spanned from January 2017 to February 2019 and included patients undergoing ECMO. Results showed that MNM was safe and feasible, with no adverse events reported. Specific EEG and transcranial Doppler (TCD) findings were identified that could help in early detection of neurologic deterioration. MNM may aid in monitoring, prognostication, and clinical decision-making for ECMO patients.

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June 5, 2024
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