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Current Guidelines for Cardiopulmonary Resuscitation

In August 2022, Adult Congenital Heart Disease researchers at Southampton University Hospital summarized current guidelines on cardiopulmonary resuscitation as provided by the Resuscitation Council UK. The complete summary by Panagiota Mitropoulou and Samantha Fitzsimmons can be found in Medicine. Their key points are detailed below.

Cardiac arrest occurs when cardiac activity suddenly stops, causing the affected individual to become unresponsive and display no signs of normal breathing or circulation. Cardiac arrest is a life-threatening condition requiring immediate corrective measures, such as cardiopulmonary resuscitation (CPR).

Mitropoulou et al. summarized the guidelines for CPR, with critical findings regarding hospital training, ethical guidelines, and the impact of the COVID-19 pandemic.


Obstacles Surrounding the Expansion of TAVR Use

In July 2022, researchers from the University Medical Center Schleswig-Holstein (Departments of Cardiovascular Surgery, Internal Medicine III (Cardiology, Angiology, and Critical Care), and Radiology and Neuroradiology), German Centre for Cardiovascular Research, Centre for Heart Lung Innovation & Providence Research, Centre for Cardiovascular Innovation, Centre for Heart Valve Innovation, Centre for Heart Lung Innovation, St. Paul’s Hospital (Department of Radiology), and Copenhagen University Hospital discuss the current data surrounding TAVR and the obstacles remaining for its expansion. The complete manuscript by Xiling Zhang, Thomas Puehler, Derk Frank, Janarthanan Sathananthan, Stephanie Seller, David Meier, Marcus Both, Philipp Blanke, Hatim Seoudy, Mohammed Saad, Oliver J. Muller, Lars Sondergaard, and Georg Liutter can be found in the Journal of Cardiovascular Development and Disease. A summary of the review article is detailed below.

Aortic valve stenosis (AS) due to degeneration is one of the most common valvular diseases, with an incidence that increases with age. Over one-third of those with AS are considered high risk for surgical aortic valve replacement (SAVR). In these patients, transcatheter aortic valve replacement (TAVR) is an alternative treatment option that is non-inferior to SAVR in many randomized trials and intermediate-risk patients. Current clinical trials for TAVR focus on determining if it can extend its use to younger patients or those at low risk; however, some challenges with TAVR remain.


A Review of Anticoagulant Options for Pediatric Patients on ECMO

In July 2022, researchers from Columbia University Medical Center (Department of Pediatrics), Children’s Hospital of Michigan (Division of Hematology), and Erasmus Medical Center University Medical Center Sophia Children’s Hospital (Department of Pediatric Hematology and Oncology) reviewed the use of unfractionated heparin (UFH) and direct thrombin inhibitors (DTIs) in pediatric patients with extracorporeal membrane oxygenation (ECMO) therapy. The complete manuscript by Cindy Neunert, Meera Chitlur, and Cornelia Heleen van Ommen can be found in Frontiers in Medicine. In addition, a summary of the review is included below.

Pediatric patients with life-threatening respiratory or cardiac failure are often put on ECMO, accounting for 20.1% of all ECMO runs. However, thrombotic complications occur in up to 37.5% of pediatric patients, and despite technological improvements, hemostatic complications, including thrombosis and bleeding, are still essential contributors to mortality and morbidity.


Outcomes for Left Ventricular Assist Device Usage with End-Stage Renal Disease

In April 2022, researchers from Queens Hospital Center (Internal Medicine), Icahn School of Medicine at Mount Sinai (Internal Medicine), Kettering Medical Center (Internal Medicine), Rawal Institute of Health Services (Medicine), Weill Cornell Medicine (Cardiology/Medicine), and Queens Hospital Center (Cardiology) examined the outcomes of end-stage renal disease (ESRD) patients requiring a left ventricular assist device (LVAD) as destination therapy (DT) or bridge to transplant (BTT). The complete manuscript by Sofia Lakhdar, Mahmoud Nassar, Chandan Buttar, Laura M. Guzman Perez, Shahzad Akbar, Anoosh Zafar, and Most Munira can be found in Cureus. The summary of their systematic review is detailed below.

The standard of care for patients with end-stage heart failure is heart transplantation, although there is a significant lack of donor's hearts compared to the number of recipients in need. For these patients awaiting transplantation requiring destination therapy (DT) or bridge to transplant (BTT), left ventricular assist devices (LVADs) are commonly used. However, renal dysfunction has been associated with a reduced survival rate after implantation of LVAD, especially in those with ESRD at the time of implantation.


Determining the Metabolites Removed by CRRT

In November 2022, researchers from the First and Second Affiliated Hospital of Harbin Medical University (Department of Intensive Care Medicine) completed a prospective study screening differential metabolic markers in AKI patients before and after CRRT to determine which are removed. The complete study by Yue Li, Wenhua Liu, Kaijiang Yu, Hongliang Wang, and Changsong Wang can be found in Critical Care. A summary of their research is detailed below.

Continuous renal replacement therapy (CRRT) is used on patients with acute kidney injury (AKI) to stimulate standard glomeruli filtration, which results in the removal of water and solute. CRRT filters out solutes that weigh less than 50,000 daltons, which can include trace elements such as glucose, K+, and Na+. Since these elements are needed in the body and are not desired to be filtered out, they are often supplemented in patients receiving CRRT. However, there has yet to be any experimental research regarding the loss of organic matter through CRRT, including if any is lost, how much is lost, and how this loss may affect the body.


Current Data on Minimalist TAVR Care Pathways and Future Research Directions

In June 2022, researchers from Emory University School of Medicine, Division of Cardiology, Department of Internal Medicine, and Division of Cardiothoracic Surgery summarized current data for a minimalist TAVR approach and what future studies need to focus on to optimize TAVR care. The full manuscript by Mariem A. Sawan, Avery E. Calhoun, Kendra J. Grubb, and Chandan M. Devireddy can be found in Current Cardiology Reports. Their review is summarized below.

Since its first application in 2002, transcatheter aortic valve replacement (TAVR) has become a central component in treating aortic stenosis. As TAVR continues to be a preferred treatment option for patients with aortic stenosis, there is an advancement in the "minimalist approach," which places a significant emphasis on early discharge.


Overcoming Complications of Cardiovascular Prevention in Diabetic Patients Through Aspirin

In March 2022, researchers from Université de Montréal (Faculties of Pharmacy and Medicine), Montreal Heart Institute (Department of Medicine and Research Center), and the Institut de Recherche Clinique de Montréal completed a review on the use of aspirin in patients with diabetes and its effect to prevent cardiovascular diseases.
The complete manuscript by Mélina Del Bianco-Rondeau, Maxime Robert Halabi, Samara Bloom, Remi Rabasa-Lhoret, Jean-Clause Tardif, Marie Lordkipanidzé, and Guillaume Marqui-Gravel can be found in Thrombosis and Haemostasis. Their findings are summarized below.

The risk of cardiovascular disease (CVD) is significantly higher in patients with diabetes; therefore, patients with diabetes are recommended healthier lifestyles and pharmacological interventions to prevent CVD, including the regular use of antiplatelet agent such as aspirin. However, recent large-scale trials on antiplatelet agent aspirin have not shown any benefit to its traditional, low-dose usage in those with diabetes.


Simultaneous Use of Percutaneous Aspiration (AngioVac) and Transcatheter Mitral Valve-in-Valve Intervention for Mitral Valve Vegetation

In July 2022, medical professionals from the University of Arkansas for Medical Sciences reported a case of mitral valve bioprosthesis failure due to significant vegetation successfully treated with percutaneous aspiration (AngioVac) evacuation followed by MViV intervention. The complete report by Jack Xu, Shravan Turaga, Jay Bhama, Srikanth Vallurupalli, and Gaurav Dhar can be found in Methodist DeBakey Cardiovascular Journal. The summary of their report is detailed below.

Mitral valve replacement is most often completed with bioprosthetic valves; however, they possess limited durability, and when operating on a failed bioprosthetic again, morbidity and mortality increase. Therefore, transcatheter mitral valve-in-valve (MViV) replacements using a transseptal approach are used more often because of their high technical success and low risk of complication. In addition, for patients at high surgical risk, the use of the AngioVac transcatheter aspiration system (Angiodynamics) for a minimally invasive technique is increasing in popularity, especially to debulk vegetation, tumors, or thrombi on the right side.


Updated Guidelines on The Perioperative Management of Diabetes

In January 2022, The Royal London Hospital clinicians provided guidance on perioperative management of diabetes to reduce postoperative complications. The complete manuscript by Bonnie Grant and Tahseen A. Chowdhury can be found in Clinical Medicine. Its summary is described below.

Surgical intervention is more likely in those with diabetes than those without it. In addition, those with diabetes are more likely to develop perioperative complications that can include poor wound healing, infection, or cardiovascular events.

The Centre for Perioperative Care (CPOC) has released new guidance on perioperative management for those with diabetes, an area of critical focus since diabetes in surgical patients increases the risk of unfavorable outcomes. Despite this, though, there has been inadequate diabetes care in the perioperative period.


Medical Education and Training Within Congenital Cardiology

In February 2022, researchers from Children’s Health Ireland at Crumlin (Department of Paediatric Cardiology), University College Dublin, The Heart Institute at Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine (Department of Pediatrics), East Midlands Congenital Heart Centre (Department of Pediatric Cardiology), Red Cross War Memorial Children’s Hospital (Division of Paediatric Cardiology), Groote Schuur Hospital University of Cape Town (Division of Cardiology), Royal Portuguese Hospital (Department of Paediatric Cardiology), Amrita Institute of Medical Sciences and Research Centre, University of Florida (Congenital Heart Center), and the University of Alberta ((Department of Cardiology) reviewed the current status of training in medical education regarding congenital cardiology. The full manuscript by Colin J. McMahon, Justin T. Tretter, Andrew N. Redington, Frances Bu’Lock, Liesl Zuhlke, Ruth Heying, Sandra Mattos, R. Krishna Kuma, Jeffrey P. Jacobs, and Jonathan D. Windram can be found in Cardiology In The Young. A summary is detailed below.

The improvements seen in the overlap between the fields of pediatrics and cardiac care have been numerous over the past five decades due to increased investments in research and development. Despite these advances, the training of next-generation researchers and clinicians has remained relatively the same across these decades.