Journal of cardiothoracic and vascular anesthesia最新文献

{"title":"Description and Management of Cardiac Arrests in Congenital Cardiac Patients Undergoing Cardiac Surgery, Cardiac Catheterization, and Cardiac Imaging","authors":"Alaa Basura MBBS,&nbsp;Viviane G. Nasr MD, MPH,&nbsp;Steven J. Staffa MS,&nbsp;Kirsten C. Odegard MD,&nbsp;James A. DiNardo MD,&nbsp;Morgan L. Brown MD, PhD","doi":"10.1053/j.jvca.2025.07.031","DOIUrl":"10.1053/j.jvca.2025.07.031","url":null,"abstract":"<div><h3>Objective</h3><div>To describe cardiac arrest during anesthesia care provided by a pediatric cardiac anesthesiologist in patients with congenital heart disease and identify predictors of outcome.</div></div><div><h3>Design</h3><div>Retrospective chart review.</div></div><div><h3>Setting</h3><div>Quaternary children’s hospital.</div></div><div><h3>Participants</h3><div>Patients with congenital cardiac disease undergoing cardiac procedures or imaging between January 2016 and December 2022</div></div><div><h3>Interventions</h3><div>None.</div></div><div><h3>Measurements and Main Results</h3><div>Seventy-six patients experienced cardiac arrest during anesthesia care. The median patient age was 424 days (interquartile range [IQR], 75-4596 days), and the median weight was 7.6 kg (IQR, 4.7-44.1 kg). Twenty-five patients had single ventricle physiology (34%), and 50 patients had normal systemic ventricular function (66%). Cardiac arrest occurred in the cardiac catheterization laboratory in 43 patients (57%) and in the cardiac operating room in 25 patients (33%). Cardiac arrest occurred most frequently during the procedure (n = 60; 79%). The etiology was arrhythmia in 29 patients (38%) and low cardiac output or ischemia in 21 patients (28%). The median duration of cardiopulmonary resuscitation (CPR) was 4 minutes (IQR, 1-11 minutes). Thirty-one patients (44%) received a code dose of epinephrine (10 µg/kg or 1 mg), and 25 patients (33%) required extracorporeal membrane oxygenation (ECMO). Death or neurologic injury within 7 days occurred in 18 patients (24%). On multivariable analysis, only the use of ECMO (adjusted odds ratio, 16, 95% confidence interval, 2.1-93.2; p = 0.006) was independently associated with the composite outcome of neurologic injury or death.</div></div><div><h3>Conclusions</h3><div>Patients who experienced cardiac arrest while under the care of a pediatric cardiac anesthesiologist had a median CPR duration of 4 minutes. The sole independent predictor of death or neurologic injury within 7 days was the use of ECMO.</div></div>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 11","pages":"Pages 3060-3064"},"PeriodicalIF":2.1,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144859241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dose-Dependent Changes in Clot Firmness in Thromboelastometry After Administration of Fibrinogen Concentrate: A Retrospective Observational Study","authors":"Stanislaw Vander Zwaag MD, DESAIC ,&nbsp;Imre Kukel MD ,&nbsp;Kinga Towarek-Nocon MD ,&nbsp;Jakob Labus MD ,&nbsp;Ali Taghizadeh-Waghefi MD ,&nbsp;Jens Fassl MD, PhD, FASE","doi":"10.1053/j.jvca.2025.07.025","DOIUrl":"10.1053/j.jvca.2025.07.025","url":null,"abstract":"<div><h3>Introduction</h3><div>Viscoelastic point-of-care diagnostics are crucial in cardiac surgery. In the FIBTEM assay of rotational thromboelastometry (ROTEM), guidelines suggest target maximum clot firmness values to reduce perioperative bleeding. The fibrinogen doses required to meet these targets remain unclear. This study analyzed the dose-response relationship between fibrinogen concentrate (FC) and clot strength at 5 minutes (A5) and assessed the predictive value of A5 for postoperative hypofibrinogenemia.</div></div><div><h3>Design</h3><div>Single-center retrospective observational study.</div></div><div><h3>Setting</h3><div>Tertiary academic cardiac hospital.</div></div><div><h3>Participants</h3><div>180 cardiac patients operated on between May 31, 2022, and August 31, 2024.</div></div><div><h3>Interventions</h3><div>Patients underwent 2 intraoperative ROTEM examinations and received coagulation factors.</div></div><div><h3>Measurements and Main Results</h3><div>Linear regression was used to examin the relationship between the FC dose and A5 changes. Receiver operating characteristic curves assessed the value of A5 in predicting hypofibrinogenemia and bleeding. Weight-based and estimated blood volume–based FC dosing closely correlated with A5 changes. Each 10 mg/kg increase in FC increased A5 by a mean of 1.37 mm (95% confidence interval [CI], 1.12-1.53 mm) for total body weight, 1.20 mm (95% CI, 1.08-1.33 mm) for ideal body weight, and 1.02 mm (95% CI, 0.9-1.13 mm) for lean body weight, as well as 8.857 mm (95% CI, 7.910-9.818 mm) per mg per mL of estimated blood volume. A5 ≤12 mm predicted hypofibrinogenemia (sensitivity, 77%; specificity, 94%). No thresholds predicted excessive blood loss.</div></div><div><h3>Conclusions</h3><div>Body weight–based fibrinogen dosing allows predictions of the mean changes in A5. Total, ideal, and lean body weights yielded similar correlation coefficients.</div></div>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 11","pages":"Pages 2940-2947"},"PeriodicalIF":2.1,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144955404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hyperoxia in Cardiac Surgery: Where Do We Stand?","authors":"Omar Elmadhoun, Sarvie Esmaeilzadeh, Miguel T Teixeira, Jeffrey Huang, Krishnan Ramanujan, Shahzad Shaefi, Harish Ramakrishna","doi":"10.1053/j.jvca.2025.07.013","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.07.013","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144846626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics Associated with Mortality in 623 Patients Who Received Recombinant Factor VIIa for Bleeding in Cardiac Surgery","authors":"Allianna Mitchell BS ,&nbsp;Kaitlyn Lorbiecki BS ,&nbsp;Cheen Alkhatib MD ,&nbsp;Andrew Gessouroun MD ,&nbsp;Jianghua He PhD ,&nbsp;Jaromme Kim MA ,&nbsp;Sara Zoubek PharmD ,&nbsp;Morgan Whisenhunt BSN ,&nbsp;Trip Zorn III MD ,&nbsp;Brigid C. Flynn MD","doi":"10.1053/j.jvca.2025.07.024","DOIUrl":"10.1053/j.jvca.2025.07.024","url":null,"abstract":"<div><h3>Objectives</h3><div>Activated recombinant factor VII (rFVIIa) has been used to treat cardiac surgical bleeding in an off-label manner. Due to the high risk of mortality with ongoing hemorrhage, assessing the risk of potential thrombotic effects of rFVIIa administration is important. This report analyzes the characteristics associated with mortality in patients who received very-low-dose rFVIIa for nonsurgical bleeding.</div></div><div><h3>Design</h3><div>A retrospective cohort study.</div></div><div><h3>Setting</h3><div>A tertiary care hospital.</div></div><div><h3>Participants</h3><div>There were 7,724 patients who had cardiac surgery from January 2012 to January 2025 with 623 receiving rFVIIa. The average dose of rFVIIa given was 18 μg/kg (min-max, 6-55 μg/kg).</div></div><div><h3>Interventions</h3><div>rFVIIa was administered perioperatively in doses of 0.5- to 1-mg aliquots.</div></div><div><h3>Measurements and Main Results</h3><div>Of the 623 patients, 66 died and 557 survived. The median dose of rFVIIa given was not different in survivors versus nonsurvivors (2.17 <em>v</em> 2.79 mg, respectively; p = 0.001). Procedure type was associated with mortality (p = 0.004) as patients receiving rFVIIa for heart transplant, ventricular assist device, or other complex procedure had a mortality rate of 29.5%. with the majority of these being in ventricular assist device patients. Those who underwent aortic procedures (n = 250) had a mortality rate of 12.4%. Of the 103 patients undergoing coronary artery bypass grafting who received rFVIIa, all but one patient survived. Mortality was higher in patients who had emergent or urgent surgical procedures (p &lt; 0.001), preoperative cardiogenic shock (p = 0.021), longer cardiopulmonary bypass time (p = 0.005), postoperative cardiac arrest (p = 0.001), and received more blood products (p &lt; 0.001). There were no associations between mortality and stroke (p = 0.071) or infections (p = 1.00).</div></div><div><h3>Conclusion</h3><div>rFVIIa can be administered to cardiac surgical patients with characteristics associated with mortality that are similar to cardiac surgical patients who did not receive rFVIIa.</div></div>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 11","pages":"Pages 2948-2952"},"PeriodicalIF":2.1,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144835194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combining A ‘Z’ Suture with a Stopcock Assembly for Pediatric Femoral Venous Access Closure","authors":"Madan Mohan Maddali MD ,&nbsp;Khalid Al Alawi MRCPCH, FRCPI ,&nbsp;Abdullah Mohammed Al Farqani MRCPCH ,&nbsp;Asim Yousuf Al Balushi FRCPC ,&nbsp;Haitham Al Abri MD ,&nbsp;Is’haq Al Aamri FRCPC","doi":"10.1053/j.jvca.2025.07.029","DOIUrl":"10.1053/j.jvca.2025.07.029","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 11","pages":"Pages 3198-3200"},"PeriodicalIF":2.1,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144835195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"2025 ASE Guidelines on Echocardiographic Evaluation of the Right Heart with Focus on Pulmonary Hypertension: A Welcome and Necessary Update","authors":"Daniel S. Cormican MD, FCCP","doi":"10.1053/j.jvca.2025.07.021","DOIUrl":"10.1053/j.jvca.2025.07.021","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 11","pages":"Pages 2910-2912"},"PeriodicalIF":2.1,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144955392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"MicroCLOTS: Immunothrombotic Culprit of Atypical Acute Respiratory Distress Syndrome","authors":"Alice Bottussi MD ,&nbsp;Fabio Ciceri MD ,&nbsp;Giovanni Landoni MD","doi":"10.1053/j.jvca.2025.07.017","DOIUrl":"10.1053/j.jvca.2025.07.017","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 11","pages":"Pages 2919-2921"},"PeriodicalIF":2.1,"publicationDate":"2025-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144775439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond the Three D’s of the Aortic Valve: Rethinking Durability, Dysfunction, and Decision-making in Transcatheter and Surgical Aortic Valve Replacement","authors":"Adham Farroukh MD ,&nbsp;Ankit Jain MBBS, MBA, FASE, FASA ,&nbsp;Brian R. Gebhardt MD, MPH, FASE","doi":"10.1053/j.jvca.2025.07.002","DOIUrl":"10.1053/j.jvca.2025.07.002","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 11","pages":"Pages 2913-2915"},"PeriodicalIF":2.1,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144955441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Articles to Appear in Future Issues","authors":"","doi":"10.1053/S1053-0770(25)00505-1","DOIUrl":"10.1053/S1053-0770(25)00505-1","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 8","pages":"Page xiv"},"PeriodicalIF":2.3,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144655637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"REMOTE Study: Feasibility and Effectiveness of Telemedicine-based Echocardiography Mentoring in Intensive Care","authors":"Hannah Conway MSc, PGCHE, FHEA ,&nbsp;Rachel Evley PhD ,&nbsp;Hakeem Yusuff MBBS, MRCP, FRCA, FFICM ,&nbsp;Rachel Wong BMedSc, MBChB, FRCA, FFICM ,&nbsp;Gary Lau MBChB, FRCA","doi":"10.1053/j.jvca.2025.07.019","DOIUrl":"10.1053/j.jvca.2025.07.019","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the feasibility, effectiveness, and user experiences of real-time remote mentoring for echocardiography in intensive care settings using the Remote Education, Augmented Communication, Training and Supervision (REACTS) telemedicine platform.</div></div><div><h3>Design</h3><div>Single center, mixed-methods feasibility study with convergent parallel design.</div></div><div><h3>Setting</h3><div>Adult intensive care unit at Glenfield Hospital, University Hospitals of Leicester NHS Trust.</div></div><div><h3>Participants</h3><div>Fifteen practitioners (12 novices, 3 accredited) participated between June 2020 and June 2021.</div></div><div><h3>Interventions</h3><div>Implementation of the REACTS platform for remote echocardiography mentoring with the Philips Lumify handheld ultrasound device.</div></div><div><h3>Measurements and Main Results</h3><div>Quantitative analysis demonstrated consistently high mean image quality scores (1.57-2.00/2.00) and mean report accuracy (1.86-2.00/2.00) across all echocardiographic views. All planned sessions were successfully completed with minimal connectivity interruptions. The teaching effectiveness evaluation consistently yielded high mean scores (5.87-6.00/6.00). Thematic analysis revealed four key themes: “accessibility of expertise,” “educational value,” “technical considerations,” and “implementation challenges.”</div></div><div><h3>Conclusions</h3><div>Real-time remote mentoring for critical care echocardiography is technically feasible and educationally valuable in the intensive care setting. Although implementation challenges exist, particularly regarding technical infrastructure and scheduling, these appear surmountable with appropriate planning. Remote mentoring shows promise as a potential strategy to address current disparities in echocardiography training and supervision.</div></div>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 11","pages":"Pages 3009-3019"},"PeriodicalIF":2.1,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144835196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}