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Background and aim: Pediatric patients undergoing cardiac surgery prior to 1992 in Denmark were at risk of hepatitis C virus (HCV) infection through donor blood used in extracorporeal circulation. HCV screening became possible in donors in 1991, eliminating the risk of iatrogenic infections. No formalized screening has been conducted for patients receiving non-screened blood, potentially leaving some with undetected HCV infection. Objectives: This study aimed to determine the prevalence of chronic HCV infection in this group of patients and offer treatment to those affected. Design: Nationwide cross-sectional study. Methods: Between 2020 and 2023, 1645 individuals who underwent pediatric heart surgery before 1992 in Denmark were identified. Participants were invited for HCV screening using anti-HCV-antibody and HCV-RNA tests. Patients testing positive for HCV were referred to direct-acting antiviral (DAA) treatment. Results: Of 1645 patients identified, 571 consented to participate, and 246 completed HCV screening. Two individuals tested positive for chronic HCV infection, resulting in a prevalence of 0.8%. Both patients were asymptomatic for many years before treatment and successfully cleared the virus after DAA treatment. Conclusions: The 0.8% prevalence of HCV in this cohort is higher than in the general Danish population although lower than in similar studies from the U.S. and Germany. This may reflect Denmark's practice of unpaid blood donation, reducing infection risks. Targeted screening for at-risk cohorts exposed to transfusions before 1992 could aid in HCV detection and treatment, potentially preventing long-term liver complications. Registration: The study was approved by the Capital Region Ethics Board in Denmark (j.nr. H-18062088). [ABSTRACT FROM AUTHOR]

Background: Paragangliomas are rare neoplasms arising from extra-adrenal chromaffin cells, with mediastinal paragangliomas representing an exceptionally rare subset. This report details the surgical management of a complex mediastinal paraganglioma case, presenting with refractory hypertension and invasion of critical surrounding structures. A comprehensive review of the current literature is included to underscore existing cases, enhance clinical awareness, and share our insights and experience in the diagnosis and treatment of this challenging condition. Case presentation: A 16-year-old female presented with recurrent headaches and persistent hypertension lasting over one year. Based on clinical findings and imaging studies, she was preliminarily diagnosed with a mediastinal paraganglioma. The patient underwent comprehensive preoperative management, including oral α- and β-adrenergic blockade, preoperative arterial embolization, and intravenous fluid volume expansion, to optimize endocrine control. Thoracoscopic resection of the mediastinal mass was initially attempted; however, the procedure became complex due to the high risk of uncontrolled hemorrhage and invasion of adjacent vital structures. Following the preoperative surgical plan, the incision was converted to a lateral thoracotomy, and cardiopulmonary bypass was initiated. Meticulous dissection enabled the complete removal of the tumor along with the affected posterior wall of the left atrium, followed by reconstruction of the left atrium and the right pulmonary vein. The surgery was successfully completed, and follow-up assessments showed no signs of tumor recurrence or metastasis. Conclusions: Functional mediastinal paraganglioma is a rare neuroendocrine tumor, with complete surgical resection being the gold standard treatment. Stringent perioperative management is crucial to mitigate the risk of cardiovascular complications associated with functional tumors. Lifelong surveillance is recommended to detect potential recurrence or metastasis. Effective collaboration within a multidisciplinary team is essential for ensuring accurate diagnosis and delivering optimal, individualized care. [ABSTRACT FROM AUTHOR]

OBJECTIVES Antiplatelet therapy increases the risk of bleeding and transfusion in patients undergoing extracorporeal circulation. Reduced goal-directed anticoagulation is a personalized approach to reduce the anticoagulation based on a lower targeted activated clotting time. We assessed whether reduced goal-directed anticoagulation using optimized extracorporeal circulation alleviates the risk of severe bleeding in patients treated by dual antiplatelet therapy (DAPT) compared to aspirin alone during coronary artery bypass grafting (CABG). METHODS A total of 2275 patients undergoing CABG from 2002 to 2022 were selected after propensity matching from a retrospective cohort of 3018 patients. Patients treated with a combination of aspirin and prasugrel or ticagrelor or clopidogrel were included in the DAPT group (n  = 1111). Patients treated with aspirin alone (ASA) constituted the control group (n  = 1164). Optimized extracorporeal circulation was conducted under reduced systemic anticoagulation with a target activated clotting time 250 s. Severe bleeding was assessed using 3 validated scores of bleeding: UDPB, E-CABG, and BARC-4. RESULTS While all scores showed low ranges of severe bleeding (<6%), they were significantly higher after DAPT compared to ASA (P values for UDPB, E-CABG, and BARC-4 at 0.016, 0.006, and 0.063, respectively). Higher maximal activated clotting time was associated with higher rate of transfusion (P  < 0.001) and bleeding (P  < 0.001) after multivariate adjustment. Mortality was 1.24% in DAPT vs 0.94% in ASA group (P = NS), whereas cardiac death, myocardial infarction, stroke, and transient ischaemic attack were low (<1%) and similar between groups. CONCLUSIONS Despite higher bleeding under DAPT compared to ASA alone, optimized extracorporeal circulation with reduced goal-directed anticoagulation alleviated severe bleeding which remained low in patients undergoing CABG. [ABSTRACT FROM AUTHOR]

Human organ transplantation has begun in the 1960s with donation after circulatory death. At that time this was named non heart beating donation, later donation after cardiac death and nowadays it is named donation after circulatory death. Currently, we are facing a significant shortage of transplant organs in Europe and worldwide. To increase the graft acceptance from donation after controlled or uncontrolled circulatory death, preceding regional normothermic perfusion by an extracorporeal circulation before organ procurement or ex-situ machine perfusion are frequently implemented in clinical practice as organ assessment and reconditioning techniques. Due to these advancements more organs can be potentially transplanted, even after out-of-hospital cardiac arrest (OHCA). First line actors like emergency physicians and pre-hospital paramedics must be aware of such programs to recognize and refer patients for donation in OHCA situations. This review provides an overview of organs transplanted from uncontrolled donation after circulatory death (uDCD) and emphasize the role of the emergency physician in the organ donation cascade. Outcome of uDCD has a lower effectiveness than donation after brain death (DBD) and controlled donation after circulatory death (cDCD) for short term graft survival. However, observational studies illustrate that long term outcome from uDCD is comparable to graft outcome from cDCD and DBD. We summarize the studies reporting the procured organ rate and functional outcome of organs originated from uDCD. European databases indicate a high incidence of OHCA, where resuscitation efforts are initiated but the rate of return of spontaneous circulation (ROSC) remains limited. These patients represent a substantial potential pool of organ donors for uDCD programs. However, these programs tend to overestimate the number of potential donors. While organ procurement from uDCD has yielded favorable outcomes, further research is required to accurately assess the associated costs and benefits and to establish clear donor selection guidelines. Furthermore, the use of new technologies like extracorporeal Cardiopulmonary Resuscitation (E-CPR) for organ donation should be investigated from both medical and economical perspectives. Emergency departments must also explore the feasibility of implementing these programs. [ABSTRACT FROM AUTHOR]

Background: Cardiac arrest is associated with high mortality rates and severe neurological impairments. One of the underlying mechanisms is global ischemia‐reperfusion injury of the body, particularly the brain. Strategies to mitigate this may thus improve favorable neurological outcomes. The use of extracorporeal cardiopulmonary membrane oxygenation (ECMO) during CA has been shown to improve survival, but available systems are vastly unable to deliver goal‐oriented resuscitation to control patient's individual physical and chemical needs during reperfusion. Recently, controlled automated reperfusion of the whoLe body (CARL), a pulsatile ECMO with arterial blood‐gas analysis, has been introduced to deliver goal‐directed reperfusion therapy during the post‐arrest phase. Methods: This review focuses on the device profile and use of CARL. Specifically, we reviewed the published literature to summarize data regarding its technical features and potential benefits in ECPR. Results: Peri‐arrest, mitigating severe IRI with ECMO, might be the next step toward augmenting survival rates and neurological recovery. To this end, CARL is a promising extracorporeal oxygenation device that improves the early reperfusion phase after resuscitation. [ABSTRACT FROM AUTHOR]

High-molecular-weight linear polymers (HMWLPs) have earned the name "drag-reducing polymers" because of their ability to reduce drag in turbulent flows. Recently, these polymers have become popular in bioengineering applications. This study investigated whether the addition of HMWLP in a venoarterial extracorporeal circulation (ECC) model could improve microvascular perfusion and oxygenation. Golden Syrian hamsters were instrumented with a dorsal skinfold window chamber and subjected to ECC using a circuit comprised of a peristaltic pump and a bubble trap. The circuit was primed with lactated Ringer solution (LR) containing either 5 ppm of polyethylene glycol (PEG) with a low molecular weight of 500 kDa (PEG500k) or 5 ppm of PEG with a high molecular weight of 3,500 kDa (PEG3500k). After 90 min of ECC at 15% of the animal's cardiac output, the results showed that the addition of PEG3500k to LR improved microvascular blood flow in arterioles and venules acutely (2 h after ECC), whereas functional capillary density showed improvement up to 24 h after ECC. Similarly, PEG3500k improved venular hemoglobin O2 saturation on the following day after ECC. The serum and various excised organs all displayed reduced inflammation with the addition of PEG3500k, and several of these organs also had a reduction in markers of damage with the HMWLPs compared to LR alone. These promising results suggest that the addition of small amounts of PEG3500k can help mitigate the loss of microcirculatory function and reduce the inflammatory response from ECC procedures.NEW & NOTEWORTHY High-molecular-weight linear polymers have gained traction in bioengineering applications. The addition of PEG3500k to lactated Ringer solution (LR) improved microvascular blood flow in arterioles and venules acutely after extracorporeal circulation (ECC) in a hamster model and improved functional capillary density up to 24 h after ECC. PEG3500k improved venular hemoglobin O2 saturation and oxygen delivery acutely after ECC and reduced inflammation in various organs compared to LR alone.

Objective To investigate the impact of esketamine hydrochloride in combination with ultrasound-guided transverse thoracic muscle plane block on stress response and inflammatory levels in patients undergoing cardiac valve replacement under general anesthesia. Methods A total of 120 patients who underwent elective extra-corporeal circulation-supported median open heart valve replacement were selected and randomly assigned into four groups using the random number table method: general anesthesia alone (Group G), general anesthesia with intravenous administration of esketamine (Group E), general anesthesia with transverse thoracic plane block (Group T), and esketamine combined with transverse thoracic muscle plane block (Group ET) ; each group consisted of 30 cases. Patients in group E and group ET received a continuous infusion of esketamine hydrochloride injection at a rate of 0.2 mg/kg-1 ⋅ h-1 until the completion of the surgical procedure, while patients in group G and group T received an equivalent volume of saline solution until the completion of the surgical procedure. After the induction of general anesthesia, patients in group T and group ET underwent ultrasound-guided bilateral transverse thoracic muscle plane block, while patients in group G and group E did not receive any specific intervention. All four groups received identical protocols for anesthesia induction and maintenance, with self- controlled intravenous analgesic pumps administered to all patients postoperatively. The following time points were recorded: 1 day prior to surgery (T0), pre-induction of anesthesia (T1), 1 minute post-tracheal intubation (T2), 1 minute post-median sternotomy (T3), 1 minute prior to initiation of cardiopulmonary circulation (T4), 1 minute after cessation of cardiopulmonary circulation (T5 ), 1 minute after completion of surgery (T6), 1 day post-surgery (T7), 2 days post-surgery (T8), and 3 days post-surgery(T9). Mean Arterial Pressure (MAP) and Heart Rate (HR) were continuously monitored from T1 to T6. The levels of blood glucose and lactate were measured and recorded at T1, T4 to T6. The levels of White Blood Cells (WBC) and C-Reactive Protein (CRP) were assessed at T0, as well as at T7 to T9. The occurrence of postoperative adverse reactions was documented in all four groups. Results (1) Comparison of hemodynamics among the four groups: Compared with group G, there was a significant decrease in MAP and HR at T3 in group T (P < 0.05). At the T5 time point, MAP was lower in group ET compared to group E, while HR was higher in group ET compared to group T (P < 0.05). (2) The lactate and blood glucose levels of the four patient groups after extracorporeal circulation transfer were higher than those at the T1 time point (P < 0.05). Patients in group E had lower lactate values at the T5 time point and lower blood glucose values at the T6 time point compared to group G (P < 0.05). Additionally, patients in group E exhibited lower lactate and blood glucose values at both the T5 and T6 time points compared to those in group T (P < 0.05). (3) Compared to T0, the levels of white blood cells (WBC) and C-reactive protein (CRP) were increased in all four groups after surgery (P < 0.05). At the T7 time point, the WBC levels in group E and group T were significantly lower than those in group G (P < 0.05). Furthermore, compared to group E and group T, the level of WBC in group ET was significantly lower at T7, while the level of CRP was significantly lower at T8 (P < 0.05). (4) There were no significant differences observed in postoperative adverse reactions among the four groups (P > 0.05). Conclusion Combining low-dose esketamine hydrochloride with transverse thoracic muscle plane block under general anesthesia during open heart valve replacement surgery can effectively stabilize the patient's hemodynamics, mitigate perioperative stress response and postoperative inflammation levels, thereby demonstrating significant clinical utility. [ABSTRACT FROM AUTHOR]

Introduction: Cardiac surgery in patients on chronic renal dialysis is associated with significant morbidity and mortality. Minimally invasive extracorporeal circuits (MiECC) have shown a positive impact on patient outcome in different high-risk populations. This retrospective study compares the outcome of these high-risk patients undergoing heart surgery either with a MiECC or a conventional extracorporeal circulation (CECC). Methods: This is a single-center experience including 131 consecutive dialysis dependent patients undergoing cardiac surgery between January 2006 and December 2016. A propensity score matching was employed leaving 30 matched cases in each group. Results: After propensity score matching the 30-day mortality was significantly lower in the MiECC group (n = 3 (10%) vs n = 10 (33%) in the CECC group, p =.028). Further, intraoperative transfused units of packed red blood cells were lower in the MiECC group (1.4 ± 1.8 units vs 2.8 ± 1.7, p <.001). Conclusions: There are evident advantages to using MiECC in dialysis dependent patients, especially regarding mortality. These findings necessitate additional research in MiECC usage in high-risk populations. [ABSTRACT FROM AUTHOR]

Background: Isolated limb perfusion (ILP) is a regional cancer treatment in which high-dose chemotherapy is administered in an isolated extremity. The main side effect is regional toxicity, which occasionally leads to nerve damage. Measuring neuroaxonal biomarkers, might be a method predicting such complications. Therefore, the primary aim of the study is to investigate if neuronal biomarkers are measurable and alters in an isolated extremity during ILP. Secondly, if postoperative regional toxicity, alterations in sensitivity, and/or muscle strength are correlated to the biomarker levels. Methods: Eighteen scheduled ILP-patients were included in the study. Glial fibrillary acidic protein (GFAP), neurofilament light (NfL), and tau concentrations were measured in plasma sampled preoperatively, at the start and end of the ILP, on days 3 and 30, using ultrasensitive Single molecule array (Simoa) technology. The patients were assessed by a physiotherapist pre- and postoperatively. Results: At ILP end, significantly higher NfL and tau levels were measured in the extremity than in the corresponding systemic circulation (NfL; 17 vs 6 ng/L, p <.01, tau; 1.8 vs 0.6 ng/L, p <.01), and the extremity levels were significantly increased at ILP end (NfL; 66 ± 37%, p <.001, tau; 75 ± 45%, p =.001). On days 3 and 30, significantly increased NfL and GFAP levels were measured systemically (NfL day 3: 69 ± 30%, p <.001; day 30: 76 ± 26%, p <.001; GFAP day 3: 33 ± 22%, p <.002; day 30: 33 ± 23%, p ≤.004). Finally, no significant correlations were found between regional toxicity or between postoperative muscle or sensitivity decrease and biomarker release. Conclusion: During ILP, NfL and tau levels increased significantly. No obvious correlations were observed between biomarker release and regional toxicity or decreased muscle strength or sensitivity, although large-scale studies are warranted. [ABSTRACT FROM AUTHOR]

Objective To observe the effect of dexamethasone in cardiopulmonary bypass priming (CPB) solution on pulmonary oxygenation function in pediatric cardiac surgery, and provide corresponding basis for clinical practice. Methods From February 2023 to January 2024,54 children with congenital heart disease (CHD) underwent elective ventricular septal defect repair and/or atrial septal defect repair surgery were selected from the Heart Center of Guiyang Maternal and Child Health Hospital. All patients were randomly divided into two groups, with 27 cases in each group. The control group did not use dexamethasone, and 5 mg/ kg dexamethasone was added to the priming solution in the dexamethasone group. Blood samples were taken before CPB(T0), CPB for 15 minutes (T1), aortic opening for 5 minutes (T2), at the end of CPB(T3) and CPB ending for 2 hours(T4) after anesthesia induction, and arterial blood gas was analyzed, and respiratory index (RI) and oxygenation index (OI) were calculated. Results The RI index of the control group was 2.52±2.57 at T2, which was significantly higher than that of dexamethasone group (1.39±1.42), and the difference was statistically significant (P<0.05); There was no significant difference in OI index and a/A between the two groups of patients (P>0.05). There was no significant difference in postoperative tracheal extubation rate and the duration of mechanical ventilation in ICU (P>0.05). Conclusion Dexamethasone can improve the pulmonary oxygenation function after CPB to a certain extent for a certain period of time. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusion This study evaluated the hemodynamic performance of arterial and venous cannulae in a compliant pediatric extracorporeal membrane oxygenation (ECMO) mock circuit in pulsatile and non‐pulsatile flow conditions.The ECMO setup consisted of an oxygenator, diagonal pump, and standardized‐length arterial/venous tubing with pressure transducers. A validated left‐heart mock loop was adapted to simulate pediatric conditions. The pulsatile flow was driven by a computer‐controlled piston pump set at 120 bpm. A roller pump was used for non‐pulsatile conditions. The circuit was primed with 40% glycerol‐based solution. The cardiac output was set to 1 L/min and the aortic pressure to 40–50 mmHg. Four arterial cannulae (8Fr, 10Fr, 12Fr, 14Fr) and five venous cannulae (12Fr, 14Fr, 16Fr, 18Fr, 20Fr) (Medtronic, Inc., Minneapolis, MN, USA) were tested at increasing flow rate in 12 combinations.The pulsatile condition required lower ECMO pump speeds for all cannulae combinations at a given flow rate, inducing a significantly smaller increase of flow in the mock loop. Under non‐pulsatile conditions, the aortic and arterial pressures in the cannulae were higher (p < 0.01) while no significant differences in pressure drop and pressure‐flow characteristics (M‐number) were observed. The total hemodynamic energy was higher in case of non‐pulsatile flow (p < 0.01).Under non‐pulsatile conditions, the system was characterized by overall higher pressures, resulting in higher support to the patient. The consequent increase of potential energy compensates for increases of kinetic energy, leading to a higher total hemodynamic energy. Pressure gradients and M number are independent of the testing conditions. Pulsatile testing conditions led to more physiological testing conditions, and it is recommended for ECMO testing. [ABSTRACT FROM AUTHOR]

Extracorporeal membrane oxygenation (ECMO) is a life-saving intervention for patients with circulatory and/or pulmonary failure; however, the rate of complications remains high. ECMO induces systemic inflammation, which may activate and damage the endothelium, thereby causing edema and organ dysfunction. Advancing our understanding in this area is crucial for improving patient outcomes during ECMO. The goal of this review is to summarize the current evidence of the effects of ECMO on endothelial activation and damage in both animals and patients. PubMed and Embase databases were systematically searched for both clinical and animal studies including ECMO support. The outcome parameters were markers of endothelial activation and damage or (in)direct measurements of endothelial permeability, fluid leakage and edema. In total, 26 studies (patient n = 16, animal n = 10) fulfilled all eligibility criteria, and used VA-ECMO (n = 13) or VV-ECMO (n = 6), or remained undefined (n = 7). The most frequently studied endothelial activation markers were adhesion molecules (ICAM-1) and selectins (E- and P-selectin). The levels of endothelial activation markers were comparable to or higher than in healthy controls. Compared to pre-ECMO or non-ECMO, the majority of studies showed stable or decreased levels. Angiopoietin-2, von Willebrand Factor and extracellular vesicles were the most widely studied circulating markers of endothelial damage. More than half of the included studies showed increased levels when compared to normal ranges, and pre-ECMO or non-ECMO values. In healthy animals, ECMO itself leads to vascular leakage and edema. The effect of ECMO support in critically ill animals showed contradicting results. ECMO support (further) induces endothelial damage, but endothelial activation does not, in the critically ill. Further research is necessary to conclude on the effect of the underlying comorbidity and type of ECMO support applied on endothelial dysfunction. [ABSTRACT FROM AUTHOR]

Objectives: This study aims to examine the relationship between microcirculation and macrocirculation in the early period after extracorporeal circulation (ECC). Specifically, it investigates whether macrocirculation parameters such as Double Product (DP) and Shock Index (SI) can predict microcirculation by studying their correlation with lactate levels, a marker of microcirculation, in the early post-ECC period. Methods: The study analyzed the demographic, hemodynamic, and laboratory data of 2039 patients who underwent isolated coronary bypass surgery with ECC at Acıbadem Kadıköy and Acıbadem Altunizade Hospitals between 1999 and 2023. The data included serum lactate levels, DP, and SI measurements taken before induction and after ECC for all patients, as well as for the subgroup with DP values above 12,000. Results: The analysis did not find any correlation between plasma lactate levels and DP and SI during the post-ECC period; p=0.11, r=0.04 (-0.01; 0.08) and p<0.001, r=0.11 (0.06; 0.15), respectively. Similarly, no correlation was found between plasma lactate values and DP in patients with DP values >12,000 (n=284) (p=0.643, r=0.03 (-0.09; 0.14)). Conclusion: Vital parameters do not fully capture circulatory disorders. It would be more appropriate for critically ill patients to assess microcirculation using parameters such as lactate directly. Therefore, further studies are necessary to evaluate microcirculation and develop independent parameters. [ABSTRACT FROM AUTHOR]

Introduction: The membrane oxygenator in extracorporeal circulation circuits is coated with acrylate-copolymer (ACP) or immobilized heparin (IHP) to enhance hemocompatibility. To evaluate the relative features of both coatings, we compared blood components circulated in the circuits with ACP-and IHP-coated membranes in vitro using whole human blood. Methods: Whole human blood was heparinized and circulated in two experimental circuits with an ACP-coated reservoir, tubes, and an ACP- or IHP-coated membrane. Platelet (PLT) counts and the amount of total protein (TP), complement component 3 (C3), and complement component 4 (C4) were measured at 0, 8, 16, 24, and 32 h in each experiment (n = 5). Results: The PLT count at 0-h circulation was lower in the IHP-coated than in the ACP-coated circuits (p = 0.034); however, no significant difference was observed at other time points. Reduction in TP at 8-h and 16-h circulation and in C3 at 32-h circulation was lesser in the ACP-coated than in the IHP-coated circuits (p = 0.004, 0.034, and 0.027, respectively); reduction in TP and C3 at other time points and C4 at each time point was not significantly different. There were significant interactions between coating type and circulation duration in the PLT, TP, and C3 transitions (p = 0.008, 0.020, and 0.043, respectively). Conclusions: Our findings suggest that ACP-coated membranes can prevent the initial drop in PLT count and C3 consumption over 32 h, whereas IHP-coated membranes could not prevent this drop in extracorporeal circulation. Therefore, ACP-coated membranes are suitable for short- and long-term extracorporeal life support. [ABSTRACT FROM AUTHOR]

Abstract Background Tracheobronchial injuries caused by blunt chest trauma are rare in children, and such injuries usually involve multiple organs. Most cases involve respiratory failure on the way to the hospital, and the mortality rate is high. Herein, we describe the case of a 5-year-old patient who fell from an electric vehicle, causing complete rupture of the bilateral main bronchus. Case presentation We treated a 5-year-old patient with complete bilateral main bronchus rupture. Chest computed tomography (CT) failed to detect bronchial rupture. Continuous closed thoracic drainage resulted in a large amount of bubble overflow. Tracheal rupture was suspected. Fibreoptic bronchoscopy revealed complete rupture of the right main bronchus and rupture of the left main bronchus. Emergency tracheoplasty was performed under cardiopulmonary bypass (CPB). During the operation, we found that the bilateral main bronchi were completely ruptured. Postoperative recovery was smooth. The traditional surgical method for treating these injuries is lateral thoracotomy. However, a median sternotomy provides a better opportunity for selective repair. Extracorporeal circulation-assisted surgery is required for patients with unstable breathing. Conclusion Complete fractures of the bilateral main bronchi are rare. Bronchial rupture should be suspected in the presence of expansion defect-dropped lungs and massive air leakage despite tube thoracostomy in haemopneumothorax developing after thoracic trauma. Extracorporeal circulation-assisted tracheoplasty is a relatively safe option for children whose respiratory system is difficult to maintain, thus ensuring oxygenation ventilation and a clear surgical field.

Purpose: To investigate the potential of dexmedetomidine in preventing or reducing postoperative arrhythmias in pediatric patients undergoing direct vision cardiac surgery with extracorporeal circulation (cardiopulmonary bypass (CPB)). Methods: 62 children undergoing elective CPB cardiac surgery in Northwest Women and Children's Hospital, Xian, China between May 2020 and June 2023 were randomly and equally divided into study and control groups. The study group received a loading dose of 1 μg/kg dexmedetomidine followed by continuous intravenous infusion during surgery, while control group received an equivalent volume of saline infusion during surgery. Clinical data, perioperative indices (adverse reactions and intraoperative use of vasoactive drugs), levels of lactic acid, blood urea nitrogen (BUN) glomerular filtration rate (GFR), and postoperative arrhythmias were compared between the two groups at the end of the surgery. Results: The study group showed significantly lower postoperative lactate and BUN levels compared to the control group (p < 0.05). There was no significant difference in incidence of intraoperative hypotension, bradycardia, tachycardia, and vasoactive drug use between the two groups (p > 0.05). The study group showed significantly lower incidences of postoperative nausea and vomiting as well as supraventricular and ventricular arrhythmias compared to control group (p < 0.05). Furthermore, mean arterial pressure (MAP) at T2 and T3 was significantly lower in study group compared to control group (p < 0.05). Conclusion: Dexmedetomidine reduces postoperative lactate, BUN levels, incidence of postoperative supraventricular and ventricular arrhythmias, maintains hemodynamic stability, attenuates stress responses, preserves renal function, and decreases postoperative nausea and vomiting in pediatric CPB cardiac surgery. Large-sample multicenter clinical trials are needed for validation in further studies. [ABSTRACT FROM AUTHOR]

OBJECTIVES Pharmacological postconditioning can protect against myocardial ischaemia-reperfusion injury during cardiac surgery with extracorporeal circulation. The aim of this study was to observe the protective effects of fructose-1,6-bisphosphate (FDP) postconditioning on myocardial ischaemia-reperfusion injury in patients undergoing cardiac valve replacement with extracorporeal circulation. METHODS Patients undergoing elective mitral valve replacement and/or aortic valve replacement were divided into normal saline postconditioning group (NS group) and FDP postconditioning group (FDP group). The primary outcome was the plasma concentration of creatine kinase-MB (CK-MB). The secondary outcomes were the plasma concentrations of lactate dehydrogenase, CK, high-sensitivity C-reactive protein, alpha-hydroxybutyrate dehydrogenase and cardiac troponin I, the spontaneous cardiac rhythm recovery profile, the extracorporeal circulation time and duration of surgery, intensive care unit and postoperative hospitalization. RESULTS Forty patients were randomly assigned to receive intervention and included in the analysis. The serum concentrations of CK-MB, lactate dehydrogenase, CK, cardiac troponin I, alpha-hydroxybutyrate dehydrogenase and high-sensitivity C-reactive protein at T1∼4 were lower in the FDP group than in the NS group (P  <   0.001). Compared with the NS group, the dosage of dopamine administered 1–90 min after cardiac resuscitation, the spontaneous cardiac rhythm recovery time and the incidence of ventricular fibrillation were lower in the FDP group (P  <   0.001, P  <   0.001 and P  =   0.040, respectively). The values of ST- changes were increased more significantly in the NS group than in the FDP group (median [standard deviation] 1.3 [0.3] mm vs 0.7 [0.2] mm; P  <   0.001). Compared with the NS group, the time of recovery of ST-segment deviations was shorter in the FDP group (50.3 [12.3] min vs 34.6 [6.9] min; P  <   0.001). CONCLUSIONS The FDP postconditioning could improve both myocardial ischaemia-reperfusion injury and the spontaneous cardiac rhythm recovery during cardiac valve surgery with extracorporeal circulation. [ABSTRACT FROM AUTHOR]

Factor XII (FXII) is a multifunctional protease capable of activating thrombotic and inflammatory pathways. FXII has been linked to thrombosis in extracorporeal membrane oxygenation (ECMO), but the role of FXII in ECMO-induced inflammatory complications has not been studied. We used novel gene-targeted FXII- deficient rats to evaluate the role of FXII in ECMO-induced thromboinflammation. FXII-deficient (FXII−/−) Sprague–Dawley rats were generated using CRISPR/Cas9. A minimally invasive venoarterial (VA) ECMO model was used to compare wild-type (WT) and FXII−/− rats in 2 separate experimental cohorts: rats placed on ECMO without pharmacologic anticoagulation and rats anticoagulated with argatroban. Rats were maintained on ECMO for 1 hour or until circuit failure occurred. Comparisons were made with unchallenged rats and rats that underwent a sham surgical procedure without ECMO. FXII−/− rats were maintained on ECMO without pharmacologic anticoagulation with low resistance throughout the 1-hour experiment. In contrast, WT rats placed on ECMO without anticoagulation developed thrombotic circuit failure within 10 minutes. Argatroban provided a means to maintain WT and FXII−/− rats on ECMO for the 1-hour time frame without thrombotic complications. Analyses of these rats demonstrated that ECMO resulted in increased neutrophil migration into the liver that was significantly blunted by FXII deficiency. ECMO also resulted in increases in high molecular weight kininogen cleavage and complement activation that were abrogated by genetic deletion of FXII. FXII initiates hemostatic system activation and key inflammatory sequelae in ECMO, suggesting that therapies targeting FXII could limit both thromboembolism and inopportune inflammatory complications in this setting. [Display omitted] [ABSTRACT FROM AUTHOR]

Extracorporeal circulation (ECC) is frequently implemented in a vast array of modalities such as hemodialysis, cardiopulmonary bypass, extracorporeal membrane oxygenation (ECMO), and others. Patients receiving any such therapy are frequently encumbered with chronic inflammation, which is inherently accompanied by oxidative stress. However, ECC treatments themselves are also responsible for sustaining or promoting inflammation. On these grounds, an in vitro study was designed to investigate the therapeutic potential of molecular hydrogen (H2) against pro-inflammatory agents in ECC settings. Five miniature ECMO circuits and a small vial (Control) were primed with heparinized blood from healthy adult donors (n = 7). Three of the ECMO systems were injected with lipopolysaccharide (LPS), out of which one was additionally treated with an H2 gas mixture. After 6 h, samples were drawn for the assessment of specific biomarkers (MCP-1, MPO, MDA-a, TRX1, and IL-6). Preliminary results indicate a progressive oxidative and inflammatory response between the six systems. Circulation has triggered inflammation and blood trauma, but the staggering influence of LPS in this outcome is indisputable. Accordingly, hydrogen's remedial potential becomes immediately apparent as biomarker concentrations tend to be lower in the H2-handled circuit. Future research should have distinct objectives (e.g., dosage/duration/cycle of hydrogen administration) in order to ascertain the optimal protocol for patient treatment. [ABSTRACT FROM AUTHOR]

Intracardiac air remains an unsolved problem in the realm of cardiac surgery, leading to embolic events encompassing conduction disturbance, heart failure, and stroke. Transesophageal echocardiography allows the visualization of three distinct types of retained intracardiac air: pooled air, coarse bubbles, and microbubbles. The former two predominantly manifest in the right upper pulmonary vein, left atrium, and left ventricle, exhibiting passive movement along the vessel walls by buoyancy. De-airing, involving "eradication" of air from circulation and "expulsion" of air from the heart into the systemic circulation assumes paramount importance in averting embolic events. Optimal de-airing strategies necessitate the thorough elimination of air during the static phase before the resumption of cardiac activity, achieved through aspiration or guided exit leveraging buoyancy. While the dynamic phase, characterized by active cardiac beating, presents challenges for air eradication, the majority of air expulsion occurs towards the aorta during this period. In this latter phase, collaborative efforts among the surgeon, anesthesiologist, and clinical engineer are pivotal to mitigate the risk of bolus air embolism. The efficacy of carbon dioxide insufflation is limited, as it is rapidly aspirated by wall suction or absorbed into the bloodstream. Consequently, the "air" identified by TEE is acknowledged as conventional air. Understanding the distinctive properties of air as well as timely and judicious collaboration for detection and removal, with the ultimate goal of eradication, emerges as an essential prerequisite for successful de-airing in the evolving era of cardiac surgery. [ABSTRACT FROM AUTHOR]

Background: The most common complication of thoracic aortic disease with shaggy aorta is cerebral infarction. We have performed "low-flow perfusion" as a method of extracorporeal circulation to prevent cerebral embolism in patients with strong atherosclerotic lesions in the aortic arch. Methods: "Low-flow perfusion" is a method in which cardiopulmonary bypass is started by partial blood removal, approaching deep hypothermia while maintaining self-cardiac output. We compared the outcomes of 12 patients who underwent the "low-flow perfusion" method (Group L) with those of 12 who underwent normal extracorporeal circulation (Group N) during aortic arch surgery since 2019. Results: Group L consisted of 8 males with an average age of 73 years old, and Group N consisted of 6 males with an average age of 73 years old. The average time from the start of cooling to ventricular fibrillation was 9.5 min in Group L and 3.6 min in Group N (p < 0.01). The eardrum temperature when ventricular fibrillation was reached was 28.2 °C in Group L and 32.5 °C in Group N (p = 0.01). A blood flow analysis also revealed low wall shear stress on the lesser curvature of the aortic arch. Conclusion: With this method, the intracranial temperature was sufficiently low at the time of ventricular fibrillation, and there was no need to increase the total pump flow. The low-flow perfusion method can prevent cerebral embolism by preventing atheroma destruction by the blood flow jet while maintaining the self-cardiac output during the cooling process. [ABSTRACT FROM AUTHOR]

Background: Tracheobronchial injuries caused by blunt chest trauma are rare in children, and such injuries usually involve multiple organs. Most cases involve respiratory failure on the way to the hospital, and the mortality rate is high. Herein, we describe the case of a 5-year-old patient who fell from an electric vehicle, causing complete rupture of the bilateral main bronchus. Case presentation: We treated a 5-year-old patient with complete bilateral main bronchus rupture. Chest computed tomography (CT) failed to detect bronchial rupture. Continuous closed thoracic drainage resulted in a large amount of bubble overflow. Tracheal rupture was suspected. Fibreoptic bronchoscopy revealed complete rupture of the right main bronchus and rupture of the left main bronchus. Emergency tracheoplasty was performed under cardiopulmonary bypass (CPB). During the operation, we found that the bilateral main bronchi were completely ruptured. Postoperative recovery was smooth. The traditional surgical method for treating these injuries is lateral thoracotomy. However, a median sternotomy provides a better opportunity for selective repair. Extracorporeal circulation-assisted surgery is required for patients with unstable breathing. Conclusion: Complete fractures of the bilateral main bronchi are rare. Bronchial rupture should be suspected in the presence of expansion defect-dropped lungs and massive air leakage despite tube thoracostomy in haemopneumothorax developing after thoracic trauma. Extracorporeal circulation-assisted tracheoplasty is a relatively safe option for children whose respiratory system is difficult to maintain, thus ensuring oxygenation ventilation and a clear surgical field. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to determine whether follow-up with standard base excess (SBE) and anion gap (AG) aids in the differential diagnosis of early postoperative hyperlactatemia, specifically in distinguishing between low cardiac output and lactate washout. Methods: The study involved 1203 patients who underwent isolated coronary bypass surgery with the help of Extracorporeal Circulation (ECC). These patients were divided into two groups based on their cardiac index (CI): Group 1 consisted of 1162 patients with CI ≥ 1.8 L/min/m², while Group 2 had 41 patients with CI<1.8 L/min/m². Blood gas measurements were taken at five different time points to examine the correlation between lactate, SBE, and AG. Results: The correlation between lactate and SBE in Group 1 was weak (r=-0.07, p<0.001). Similarly, the correlation between lactate and anion gap was weak (r=0.08, p=0.005). On the other hand, in Group 2 (CI<1.8 L/min/m²), a much stronger correlation was observed between lactate and SBE (r=-0.49, p<0.001). However, there was no correlation between lactate and anion gap (r=-0.007, p=0.964). Conclusion: Relying solely on SBE (standard base excess) and anion gap to distinguish hyperlactatemia is limited because they depend on various variables. Therefore, we recommend assessing hyperlactatemia by examining the patient's clinical condition, other tissue perfusion parameters, flow measurements, plasma chloride, and albumin values. [ABSTRACT FROM AUTHOR]

Angiotensin II (AT) is a potent vasoconstrictor and hypertensive drug that is registered for the treatment of severe hypotension in vasoplegic shock. Growing experience with the use of AT in cardiac surgery allows the first therapeutic algorithms to be created. This paper is a proposal for the use of AT in distributive shock after extracorporeal circulation.

Abstract Background The impact of the chronological sequence of events, including cardiac arrest (CA), initial cardiopulmonary resuscitation (CPR), return of spontaneous circulation (ROSC), and extracorporeal cardiopulmonary resuscitation (ECPR) implementation, on clinical outcomes in patients with both out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA), is still not clear. The aim of this study was to investigate the prognostic effects of the time interval from collapse to start of CPR (no-flow time, NFT) and the time interval from start of CPR to implementation of ECPR (low-flow time, LFT) on patient outcomes under Extracorporeal Membrane Oxygenation (ECMO). Methods This single-center, retrospective observational study was conducted on 48 patients with OHCA or IHCA who underwent ECMO at Hamad General Hospital (HGH), the tertiary governmental hospital of Qatar, between February 2016 and March 2020. We investigated the impact of prognostic factors such as NFT and LFT on various clinical outcomes following cardiac arrest, including 24-hour survival, 28-day survival, CPR duration, ECMO length of stay (LOS), ICU LOS, hospital LOS, disability (assessed using the modified Rankin Scale, mRS), and neurological status (evaluated based on the Cerebral Performance Category, CPC) at 28 days after the CA. Results The results of the adjusted logistic regression analysis showed that a longer NFT was associated with unfavorable clinical outcomes. These outcomes included longer CPR duration (OR: 1.779, 95%CI: 1.218–2.605, P = 0.034) and decreased survival rates for ECMO at 24 h (OR: 0.561, 95%CI: 0.183–0.903, P = 0.009) and 28 days (OR: 0.498, 95%CI: 0.106–0.802, P = 0.011). Additionally, a longer LFT was found to be associated only with a higher probability of prolonged CPR (OR: 1.818, 95%CI: 1.332–3.312, P = 0.006). However, there was no statistically significant connection between either the NFT or the LFT and the improvement of disability or neurologically favorable survival after 28 days of cardiac arrest. Conclusions Based on our findings, it has been determined that the NFT is a more effective predictor than the LFT in assessing clinical outcomes for patients with OHCA or IHCA who underwent ECMO. This understanding of their distinct predictive abilities enables medical professionals to identify high-risk patients more accurately and customize their interventions accordingly.

Background: Aortic valve-sparing aortic root replacement (VSARR) David procedure has not been routinely performed via minimally invasive access due to its complexity. Methods: We compared our results for mini-VSARR to sternotomy-VSARR from another excellence center. Results: Eighty-four patients, 62 in the sternotomy-VSARR group and 22 in the mini-VSARR group, were included. A baseline, the aneurysm dimensions were higher in the mini-VSARR group. Propensity matching resulted in 17 pairs with comparable characteristics. Aortic cross-clamp and cardiopulmonary bypass times were significantly longer in the mini-VSARR group, by 60 and 20 min, respectively (p < 0.001). In-hospital outcomes were comparable between the groups. Drainage volumes were numerically lower, and hospital length of stay was, on average, 3 days shorter (p < 0.001) in the mini-VSARR group. At a median follow-up of 5.5 years, there was no difference in mortality (p = 0.230). Survival at 1, 5 and 10 years was 100%, 100%, and 95% and 95%, 87% and 84% in the mini-VSARR and sternotomy-VSARR groups, respectively. No repeat interventions on the aortic valve were documented. Echocardiographic follow-up was complete in 91% with excellent durability of repair regardless of the approach: no cases of moderate/severe aortic regurgitation were reported in the mini-VSARR group. Conclusions: The favorable outcomes, reduced drainage, and shorter hospital stays associated with the mini-sternotomy approach underscore its potential advantages expanding beyond cosmetic outcome. [ABSTRACT FROM AUTHOR]

Introduction: the incidence of postoperative low cardiac output syndrome is variable in the different published series, from 4% to 15%, with a mortality that approaches 20%. Although in patients over 70 years of age the syndrome may be present in up to 63%, despite the development of better cardioprotection techniques and postoperative care, the incidence of this syndrome in high-risk populations has not changed in a significant proportion. Objective: build a predictive model of postoperative low cardiac output syndrome through risk factors. Methods: an analytical study of cases and controls was carried out in patients with postoperative low cardiac output syndrome treated at the Cardiology and Cardiovascular Surgery Center of the "Saturnino Lora" Provincial Teaching Hospital of Santiago de Cuba, in a period of three years; Logistic regression with adjustments was used to obtain the model. Results: the most valuable predictive risk factors are: age >65 years, decreased right ventricular systolic function, aortic cross-clamping time and postoperative bleeding, which were those shown by the logistic regression model. Its internal validation was carried out by data division. Conclusions: the predictive model developed from logistic regression was composed of the predictors: age >65 years, decreased right ventricular systolic function, aortic clamping time >90 minutes and prolonged postoperative bleeding; It presented good fit and discriminating power, especially positive predictive value. [ABSTRACT FROM AUTHOR]

Anesthetic management of patients with renal cell carcinoma with tumor thrombus in the inferior vena cava (IVC) is challenging. This paper reports the experience of anesthesia management in a patient with advanced renal cell carcinoma with thrombus accumulation in the IVC, right atrium, and pulmonary artery who underwent radical nephrectomy and tumor thrombus removal assisted by cardiopulmonary bypass. The emboli, measuring approximately 3 × 6 cm in the left inferior pulmonary artery and 4 × 13 cm in the right main pulmonary artery, were removed completely. During incision of the IVC under systemic heparinization, significant blood loss occurred in the surgical field. The surgery took 724 min, and cardiopulmonary bypass took 396 min. Intraoperative blood loss was 22,000 ml. The patient was extubated 39 hours after surgery and stayed in intensive care unit for 3 days. At 1 year follow-up, the patient was in good health and leading a normal life. [ABSTRACT FROM AUTHOR]

Cardiac surgery (CS) with extracorporeal circulation (ECC), induces intense oxidative stress (OS) and systemic inflammatory response (SIR), which may seriously affect postoperative lung function. We aimed to test if high parenteral (200 mg/kg/24 h) daily doses of Vitamin C (VitC), given within 48 h after the beginning of the operation, may reduce the incidence and severity of postoperative pulmonary complications (PPCs) in CS patients. This single-center, prospective, randomized, single-blinded, interventional trial included 150 patients, assigned to control Group A (n = 75) and interventional Group B (n = 75). Group B intraoperatively received one-fourth (i.e., 50 mg/kg) of the planned daily Vit C dose, divided into three equal parts and diluted in 10 mL of normal saline, while Group A received an equal volume of normal saline at the same time frames (i.e., the induction of anesthesia, aortic cross-clamp release, and sternal closure). After 6 h from the first intraoperative dose, the following regimen was applied: Group B: 50 mg/kg, 30 min i.v. infusion of VitC in 50 mL of normal saline, every 6 h, for the next 48 h, and Group A: 30 min i.v. infusion of an equal volume of normal saline every 6 h, for the next 48 h. Modified Kroenke's score was used to determine the incidence and severity of PPCs. The overall incidence of PPCs was 36.7% and was significantly lower in Group B (13.3% vs. 60.0%, p < 0.001). The PPCs severity score was also significantly lower in Group B (1 vs. 3, p < 0.001). In addition, patients from Group B had significantly less damaged lungs, better postoperative renal function, shorter ICU stays, fewer ICU re-admissions, and lower hospital mortality. No VitC-related adverse effects were recorded. High parenteral daily VitC doses given within 48 h after the beginning of CS are safe and effective in reducing the incidence and severity of PPCs. A multicenter RCT is needed to confirm these results. [ABSTRACT FROM AUTHOR]

Background: The impact of the chronological sequence of events, including cardiac arrest (CA), initial cardiopulmonary resuscitation (CPR), return of spontaneous circulation (ROSC), and extracorporeal cardiopulmonary resuscitation (ECPR) implementation, on clinical outcomes in patients with both out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA), is still not clear. The aim of this study was to investigate the prognostic effects of the time interval from collapse to start of CPR (no-flow time, NFT) and the time interval from start of CPR to implementation of ECPR (low-flow time, LFT) on patient outcomes under Extracorporeal Membrane Oxygenation (ECMO). Methods: This single-center, retrospective observational study was conducted on 48 patients with OHCA or IHCA who underwent ECMO at Hamad General Hospital (HGH), the tertiary governmental hospital of Qatar, between February 2016 and March 2020. We investigated the impact of prognostic factors such as NFT and LFT on various clinical outcomes following cardiac arrest, including 24-hour survival, 28-day survival, CPR duration, ECMO length of stay (LOS), ICU LOS, hospital LOS, disability (assessed using the modified Rankin Scale, mRS), and neurological status (evaluated based on the Cerebral Performance Category, CPC) at 28 days after the CA. Results: The results of the adjusted logistic regression analysis showed that a longer NFT was associated with unfavorable clinical outcomes. These outcomes included longer CPR duration (OR: 1.779, 95%CI: 1.218–2.605, P = 0.034) and decreased survival rates for ECMO at 24 h (OR: 0.561, 95%CI: 0.183–0.903, P = 0.009) and 28 days (OR: 0.498, 95%CI: 0.106–0.802, P = 0.011). Additionally, a longer LFT was found to be associated only with a higher probability of prolonged CPR (OR: 1.818, 95%CI: 1.332–3.312, P = 0.006). However, there was no statistically significant connection between either the NFT or the LFT and the improvement of disability or neurologically favorable survival after 28 days of cardiac arrest. Conclusions: Based on our findings, it has been determined that the NFT is a more effective predictor than the LFT in assessing clinical outcomes for patients with OHCA or IHCA who underwent ECMO. This understanding of their distinct predictive abilities enables medical professionals to identify high-risk patients more accurately and customize their interventions accordingly. [ABSTRACT FROM AUTHOR]

Venovenous extracorporeal membrane oxygenation (VV-ECMO) is a life-saving therapy for critically ill patients, but it carries an increased risk of thrombosis due to blood interacting with non-physiological surfaces. While the relationship between clinical variables and thrombosis remains unclear, our study aimed to identify which factors are most predictive of thrombosis. The Extracorporeal Life Support Organization Registry was queried to obtain a cohort of VV-ECMO patients aged 18 years and older from 2015 to 2019. Patients who were over 80-years-old, at the extremes of weight, who received less than 24 h of ECMO, multiple rounds of ECMO, or had missing data were excluded. Multivariate logistic regression modeling was used to assess predictors of thrombosis and mortality. A total of 9809 patients were included in the analysis, with a mean age of 47.1 ± 15.1 years and an average ECMO run time of 305 ± 353 h. Thrombosis occurred in 19.9% of the cohort, with circuit thrombosis (8.6%) and membrane lung failure (6.1%) being the most common. Multivariate analysis showed that ECMO runs over 14 days (OR: 2.62, P < 0.001) and pregnancy-related complications (OR: 1.79, P = 0.004) were associated with an increased risk of thrombosis. Risk factors for circuit thrombosis included incremental unit increases in the pump flow rate at 24 h (OR: 1.07 [1.00–1.14], P = 0.044) and specific cannulation sites. Increased body weight (OR: 1.02 [1.00–1.04], P = 0.026) and increased duration on ECMO (OR: 3.82 [3.12–4.71], P < 0.001) were predictive of membrane lung failure. Additionally, patients with thrombosis were at increased likelihood of in-hospital mortality (OR: 1.52, P < 0.001). This study identified multiple thrombotic risk factors in VV-ECMO, suggesting that future studies investigating the impact of pregnancy associated complications and ECMO flow rate on hemostasis would be illuminating. [ABSTRACT FROM AUTHOR]

Unilateral Tracheobronchial foreign body (TFB) present a common clinical disease, whereas bilateral TFB is a rare and acute condition associated with high mortality rates. This case study discusses a pediatric patient hospitalized due to respiratory distress following accidental ingestion of peanut kernels. A plain chest CT scan revealed obstructive emphysema in the right main bronchus and a foreign body at the opening of the left main bronchus. Surgical removal of the bilateral TFB under extracorporeal circulation resulted in a successful postoperative recovery, leading to discharge on the 9th day. A comprehensive literature search was conducted across databases including PubMed, Web of Science, EMBASE, Cochrane Library, and CNKI, spanning publications from January 2014 to October 2023, utilizing keywords “bronchial foreign body” and “Peanut”. After deduplication and relevance screening, 9 pertinent literature sources were included. The objective of this study is to enhance clinical practitioners' understanding of TFB management and improve diagnostic and treatment capabilities through analysis of age of onset, clinical manifestations, diagnosis, and treatment approaches in critically ill pediatric patients.

Extracorporeal circulation (ECC) procedures, such as cardiopulmonary bypass (CPB) and extracorporeal membrane oxygenation (ECMO), take over the function of one or more organs, providing clinicians time to treat underlying pathophysiological conditions. ECMO and CPB carry significant mortality rates for patients, despite prior decades of research focused on the resulting failure of critical organs. Since the focus of these procedures is to support blood flow and provide oxygen-rich blood to tissues, a shift in research toward the effects of ECMO and CPB on the microcirculation is warranted. Along with provoking systemic responses, both procedures disrupt the integrity of red blood cells, causing release of hemoglobin (Hb) from excessive foreign surface contact and mechanical stresses. The effects of hemolysis are especially pronounced in the microcirculation, where plasma Hb leads to nitric oxide scavenging, oxidization, formation of reactive oxygen species, and inflammatory responses. A limited number of studies have investigated the implications of ECMO in the microcirculation, but more work is needed to minimize ECMO-induced reduction of microcirculatory perfusion and consequently oxygenation. The following review presents existing information on the implications of ECMO and CPB on microvascular function and proposes future studies to understand and leverage key mechanisms to improve patient outcomes.

Meng Li, Xue Li, Yong Wu, Tianyu Zhang, Mengya Li, Ying Chen Department of Anesthesiology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, Jiangsu, People’s Republic of ChinaCorrespondence: Ying Chen, The Affiliated Lianyungang Hospital of Xuzhou Medical University, No. 6 East Zhenhua Road, Lianyungang, Jiangsu, People’s Republic of China, Email yingchen20825@163.comObjective: To investigate the correlation between the amount of sufentanil used during anesthesia and intraoperative hemodynamic fluctuation and postoperative recovery in patients undergoing cardiopulmonary bypass (CPB).Materials and Methods: A retrospective analysis was performed on 454 patients undergoing elective heart surgery under CPB. Patients were divided into two groups according to the amount of sufentanil used during anesthesia: Group L (induced sufentanil 0.4– 0.6 ug /kg, maintained sufentanil 0.01– 0.02 ug/kg/min, n = 223) and Group H (induced sufentanil 4– 6 ug/kg, maintained sufentanil 0.02– 0.03 ug/kg/min, n = 231). Propensity score matching (PSM) was used at a 1:1 nearest-neighbor ratio to compare the two groups. Intraoperative use of vasoactive drugs, spontaneous heart rebound, secondary endotracheal intubation, postoperative mechanical ventilation time, the length of stay (LOS) in ICU, postoperative LOS in hospital, postoperative in-hospital mortality were analyzed.Results: After matching, a total of 144 patients were included (72 patients in Group L, and 72 patients in Group H). Multivariate logistic regression analysis showed that the dosage of sufentanil during anesthesia was significantly correlated with the utilization rate of intraoperative vasoactive drugs (P < 0.001) and the success rate of spontaneous heart rebound (p = 0.001). The utilization rate of vasoactive drugs decreased significantly in Group H (OR, 0.062; 95% CI, 0.019– 0.200) compared to that of Group L. The success rate of spontaneous heart rebound (OR, 0.187; 95% CI, 0.071– 0.491) was higher in Group H. There were no differences on postoperative recovery outcomes between the two groups.Conclusion: On the basis of our data, the use of high-dose sufentanil is beneficial to keep the cardiovascular response of patients in a stable state, but there is no significant effect on the quality of early postoperative recovery.Keywords: sufentanil, extracorporeal circulation, cardiac anesthesia

Maintaining optimal cerebral perfusion during cardiopulmonary bypass and circulatory arrest is basis of intraoperative management of aortic arch surgery. Various cerebral protection techniques including hypothermia, cerebral perfusion, drug protection and blood gas management have been used in the clinic, but the optimal strategy remains difficult to determine. The clinical outcome of cerebral protection in aortic arch surgery largely depends on brain temperature, circulatory arrest time and cerebral perfusion at the time of circulatory arrest. The optimal brain protection strategy should be individualized treatment on the basis of comprehensive brain monitoring, so as to effectively reduce the occurrence of brain injury. This article summarizes the means or indicators of brain monitoring and management during cardiopulmonary bypass in aortic arch surgery, as well as perioperative brain protection strategies, in order to guide the clinical practice of intraoperative brain protection in aortic arch surgery.

Abstract Background Extracorporeal circulation auxiliary to open heart surgery is a common procedure used to treat heart diseases. However, the optimal transfusion strategy for patients undergoing this surgery remains a subject of debate. This study aims to investigate the association between hemoglobin levels and clinical outcomes in patients undergoing extracorporeal circulation auxiliary to open heart surgery, with the ultimate goal of improving surgical success rates and enhancing patients' quality of life. Methods A retrospective analysis was conducted on data from the Medical Information Mart for Intensive Care IV 2.2 (MIMIC-IV 2.2) database, including 4144 patients. The patients were categorized into five groups based on their minimum hemoglobin levels during hospitalization. Baseline characteristics, clinical scores, laboratory results, and clinical outcome data were collected. Statistical analyses utilized descriptive statistics, ANOVA or Kruskal-Wallis tests, Kaplan-Meier method, and Log-rank test. Results The results revealed a significant correlation between hemoglobin levels and in-hospital mortality, as well as mortality rates at 30 days, 60 days, and 180 days (p < 0.001). Patients with lower hemoglobin levels exhibited higher mortality rates. However, once hemoglobin levels exceeded 7g/dL, no significant difference in mortality rates was observed (p = 0.557). Additionally, lower hemoglobin levels were associated with prolonged hospital stay, ICU admission time, and mechanical ventilation time (p < 0.001). Furthermore, hemoglobin levels were significantly correlated with complication risk, norepinephrine dosage, and red blood cell transfusion volume (p < 0.001). However, there was no significant difference among the groups in terms of major complications, specifically sepsis (p > 0.05). Conclusion The study highlights the importance of managing hemoglobin levels in patients undergoing heart surgery with extracorporeal circulation. Hemoglobin levels can serve as valuable indicators for predicting clinical outcomes and guiding treatment decisions. Physicians should carefully consider hemoglobin levels to optimize transfusion strategies and improve postoperative patient outcomes. Further research and intervention studies are warranted to validate and implement these findings in clinical practice.

Limin Jia,1 Yanfeng Wang,2 Wenyuan Zhang,3 Yulian Lin,1 Fang Chen,1 Yixiao Wan,1 Xin Fu4,5 1Department of Cardiothoracic Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, Zhejiang, 317000, People’s Republic of China; 2Department of Geriatrics, Taizhou Central Hospital (Taizhou University Hospital) of Zhejiang, Taizhou, Zhejiang, 318000, People’s Republic of China; 3Department of ICU, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, Zhejiang, 317000, People’s Republic of China; 4Department of Radiology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, Zhejiang, 317000, People’s Republic of China; 5Department of Radiology, Enze Hospital, Taizhou Enze Medical Center (Group), Taizhou, Zhejiang, 318000, People’s Republic of ChinaCorrespondence: Xin Fu, Department of Radiology, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, No. 150 Ximen Street, Linhai City, Taizhou, Zhejiang, 317000, People’s Republic of China, Tel + 86-0576-85120120, Email fux005ing@126.comBackground and Purpose: To explore the feasibility of the modified blood collection method in pre-deposit autotransfusion in patients undergoing thoracotomy surgery.Methods: This double-blinded randomised controlled trial enrolled 92 patients from the cardiothoracic surgery department from February 2019 to October 2020.Results: Compared with the conventional blood collection method, the modified blood collection method avoided blood overflow from the oblique plane of the needle (χ2 = 61.986, P < 0.01) and reduced the diameter of the bruising area after 24 hours (χ2 = 24.611, P < 0.01). Furthermore, due to optimising the blood collection method, diastolic blood pressure reduced slightly before and after blood collection (t = 2.036, P < 0.05), and patients in the test group had less pain (based on the numerical rating score) (t = 5.556, P < 0.01). Meanwhile, the time required to collect 400 mL of blood was shortened (t = 17.744, p < 0.01).Conclusion: An improved blood collection method can enhance the blood donation experience, avoid blood spillage, lessen pain and reduce adverse reactions. This may be of great significance in ensuring blood quality and the safety of subsequent transfusions.Clinical Trials Registration: ClinicalTrials.gov Identifier: NCT05539846.Keywords: pre-deposit autotransfusion, extracorporeal circulation, open heart surgery

ABSTRACT Objectives: to map the factors associated with increased lactate levels in the postoperative period of cardiac surgery using extracorporeal circulation. Methods: this is a scoping review carried out in December 2022, across ten data sources. It was prepared in accordance with the recommendations of the Joanna Briggs Institute and the Preferred Reporting Items for Systematic Reviews and Meta Analyses Extension for Scoping Reviews checklist. Results: the most recurrent findings in studies regarding the factors responsible for the increase in lactate were: tissue hypoperfusion, cardiopulmonary bypass time and use of vasoactive drugs. In 95% of studies, increased lactate was related to increased patient mortality. Conclusions: discussing the causes of possible complications in cardiac surgery patients is important for preparing the team and preventing complications, in addition to ensuring quality recovery.

Background: Extracorporeal life support (ECLS) is pivotal for sustaining the function of failing hearts and lungs, and its utilization has risen. In cases where conventional cannulation strategies prove ineffective for providing adequate ECLS support, the implementation of an enhanced system with a third cannula may become necessary. Hybrid ECLS may be warranted in situations characterized by severe hypoxemia of the upper extremity, left ventricular congestion, and dilatation. Additionally, it may also be considered for patients requiring respiratory support or experiencing hemodynamic instability. Method: All hybrid ECLS cases of adults at the University Hospital Zurich, Switzerland, between January 2007 and December 2019 with initial triple cannulation were included. Data were collected via a retrospective review of patient records and direct export of the clinical information system. Results: 28 out of 903 ECLS cases were initially hybrid cannulated (3.1%). The median age was 57 (48.2 to 60.8) years, and the sex was equally distributed. The in-hospital mortality of hybrid ECLS was high (67.9%). In-hospital mortality rates differ depending on the indication (ARDS: 36.4%, refractory cardiogenic shock: 88.9%, cardiopulmonary resuscitation: 100%, post-cardiotomy: 100%, others: 75%). Survivors exhibited a lower SAPS II level compared with non-survivors (20.0 (12.0 to 65.0) vs. 55.0 (45.0 to 73.0)), and the allogenic transfusion of platelet concentrate was observed to be less frequent for survivors (0.0 (0.0) vs. 1.8 (2.5) units). Conclusion: The in-hospital mortality rate for hybrid ECLS was high. Different indications showed varying mortality rates, with survivors having lower SAPS II scores and requiring fewer platelet concentrate transfusions. These findings highlight the complexities of hybrid ECLS outcomes in different clinical scenarios and underline the importance of rigorous patient selection. [ABSTRACT FROM AUTHOR]