Minimal Invasive Extracorporeal Circulation: An Alternative to ECMO in Ventricular Tachycardia Ablation
The clinical benefits of mechanical assistance during ventricular tachycardia (VT) ablation have yet to be well-established. This article discusses a new technique using minimally invasive extracorporeal circulation (MiECC) type III with a venous reservoir system, offering full cardiac flow support, blood oxygenation, and hemodynamic stability during extended procedures. The study retrospectively examines ten patients with…
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Ethical Choices in Organ Transplantation: Why Normothermic Machine Perfusion is Preferable to NRP
The article titled “Neither Ethical nor Prudent: Why Not to Choose Normothermic Regional Perfusion” by Adam Omelianchuk, published in The Hastings Center Report, critically examines the ethical dilemmas posed by the use of Normothermic Regional Perfusion (NRP) in organ transplantation, specifically in the context of Donation after Circulatory Determination of Death (DCD). NRP is a technique used to…
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Simultaneous Pancreas and Kidney Transplantation from Donors after Circulatory Death in Switzerland
A recent study by Fabian Rössler and colleagues reports the first simultaneous pancreas and kidney transplantation (SPK) from donors after circulatory death (DCD) in Switzerland. This procedure is a critical advancement for type I people with diabetes and end-stage kidney disease, as it offers a curative treatment and expands the organ donor pool. SPK is…
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Evaluation of Cannula Sizes and Flow Rates in Venoarterial Extracorporeal Membrane Oxygenation: Insights from a Simulation Study
The study by Avishka Wickramarachchi and colleagues investigates the performance of different arterial and drainage cannulae sizes in venoarterial extracorporeal membrane oxygenation (VA ECMO) using a simulated patient model. Large cannulae, though effective, are associated with increased complications, while the efficacy of smaller cannulae still needs to be understood. The research tested arterial cannulae sizes…
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Optimizing Left Ventricular Unloading with ECPELLA: A Case Study and Decision-Making Guide
Left ventricular (LV) unloading using the Impella device in conjunction with veno-arterial extracorporeal membrane oxygenation (VA ECMO), known as ECPELLA, has demonstrated improved survival for patients experiencing cardiogenic shock, particularly those resuscitated post-cardiac arrest. Clear criteria and additional diagnostic and therapeutic tools for optimal LV unloading remain undefined despite its benefits. This article by John…
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Outcomes Associated with Absent Blood Product Utilization in Jehovah’s Witness Patients Compared to the Standard of Care in Cardiac Surgery: A Ten-Year Experience
A ten-year retrospective study by Nathan Fields et al. examined the outcomes of Jehovah’s Witness (JW) patients undergoing cardiac surgery without blood transfusions in comparison to non-JW patients who either received or did not receive blood products. Given JW patients’ refusal of blood transfusions, alternative strategies such as erythropoietin-stimulating agents, intravenous iron, and non-pharmacologic interventions…
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A Pharmacokinetic Framework Describing Antibiotic Adsorption to Cardiopulmonary Bypass Devices
The study “A Pharmacokinetic Framework Describing Antibiotic Adsorption to Cardiopulmonary Bypass Devices” by Conor J. O’Hanlon et al. explores how cardiopulmonary bypass (CPB) can significantly alter the pharmacokinetic (PK) parameters of antibiotics, potentially leading to therapeutic failures. Cefazolin, a commonly used beta-lactam antibiotic for antimicrobial prophylaxis during cardiac surgery with CPB, may adsorb to the…
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Insights into Insulin Dynamics During Cardiopulmonary Bypass
Thilo Schweizer’s study delves into the complexities of insulin loss during cardiopulmonary bypass (CPB), aiming to uncover whether intraoperative hyperglycemia, commonly observed in patients undergoing cardiovascular surgery, is partly due to insulin adhesion to artificial surfaces or degradation by hemolysis. This investigation compares insulin dynamics in two distinct extracorporeal circulation circuits (ECCs): a conventional ECC…
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Outcomes of Emergent Cardiac Surgery After TAVI
A comprehensive study by Gijs J. van Steenbergen et al. evaluated the reasons and outcomes of emergent cardiac surgery (ECS) following transcatheter aortic valve implantation (TAVI) at a high-volume center in the Netherlands. The study, conducted between January 2008 and April 2022, included all patients who required ECS due to complications arising from TAVI procedures….
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Understanding Microcirculation in Perioperative Medicine
In a recent narrative review by Moritz Flick, the critical role of microcirculation—the network of the smallest vessels in the cardiovascular system—in perioperative medicine is explored. This network is essential for oxygen delivery at the capillary level, influencing the flow of oxygen-carrying red blood cells and the density of the capillary network within tissues. Advancements…
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The Early Mobilization of Patients on Extracorporeal Membrane Oxygenation: A Systematic Review
This systematic review by Anastasia A. Chatziefstratiou et al.rigorously examines the potential benefits of early mobilization for patients receiving extracorporeal membrane oxygenation (ECMO), a life-saving intervention for those with severe cardiac and respiratory failure. Traditionally, ECMO patients endure prolonged bed rest due to the critical nature of their condition and the necessity to maintain the…
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The Impact of Cardiopulmonary Bypass Time on Organ Failure After Cardiac Surgery
A recent study conducted by Tiago R Velho and colleagues has provided new insights into the relationship between cardiopulmonary bypass (CPB) duration and postoperative organ dysfunction, as measured by the Sequential Organ Failure Assessment (SOFA) score. This comprehensive retrospective analysis included 1032 patients who underwent cardiac surgery. The researchers found a significant association between extended…
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