Publications by authors named "Alexander Kaserer"
Background: Iron deficiency anemia in the perioperative setting is treated predominantly with intravenous iron formulation, of which ferric carboxymaltose may induce hypophosphatemia by modulating fibroblast growth factor 23.
Methods: In this single-center, prospective, randomized, double-blind trial, we consented 92 adult patients scheduled for elective major abdominal or thoracic surgery. These patients either had isolated iron deficiency (plasma ferritin <100 ng/mL or transferrin saturation < 20 %) or iron deficiency anemia (hemoglobin (Hb) 100-130 g/L with plasma ferritin <100 ng/mL or transferrin saturation < 20 %).
Article Synopsis
- The study looked at how much blood patients lost during surgery if they had high levels of certain blood thinners called FXa inhibitors, without reversing their effects before surgery.
- Researchers collected data from 32 patients who had emergency operations between 2018 and 2022 and found that blood loss was generally low, even with high levels of the medicine in their systems.
- The results showed that one type of blood thinner caused a bit more blood loss than another, but overall, the method of waiting and monitoring worked fine, and no serious complications happened.
Background: Patients undergoing painless egg retrieval are prone to preoperative anxiety, and whether preoperative anxiety induces postoperative nausea and vomiting (PONV) is debated. The primary objective of this prospective, randomized, controlled study was to compare the clinical effect of ondansetron in preventing PONV for patients with and without preoperative anxiety. The secondary objective was to investigate whether preoperative anxiety was associated with PONV.
View Article and Find Full Text PDFWe describe the case of a 38-year-old man with a history of chronic portal vein thrombosis who presented with abdominal pain after a transjugular intrahepatic portosystemic shunt procedure. Under anticoagulation therapy with rivaroxaban, he experienced active splenic bleeding, leading to hemodynamic instability. Emergency interventions, including andexanet alfa and nanoparticle administration, successfully stopped the bleeding.
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- * A total of 614 patients from nine studies were analyzed, showing the score's ability to predict in-hospital mortality with an area under the curve (AUC) of 0.678 and for V-A-ECMO mortality with an AUC of 0.652, both statistically significant.
- * Results indicate that the PC-ECMO score can be an effective tool for assessing patient risk in clinical settings, making it useful for future research and potential treatment strategies.
Article Synopsis
- Extracorporeal life support (ECLS) is critical for patients with failing heart and lung function, and a third cannula may be added when standard methods are insufficient.
- A study at University Hospital Zurich from 2007-2019 found that only 3.1% of ECLS cases used a hybrid approach, with a high in-hospital mortality rate of 67.9% across various conditions.
- Survivors of hybrid ECLS had lower severity of illness scores and required fewer platelet transfusions compared to non-survivors, indicating the need for careful patient selection based on specific clinical scenarios.
Background: Traumatic tracheal rupture is a severe closed chest injury that often causes major respiratory and circulatory disturbances requiring emergency surgery. We have found that veno-venous extracorporeal membrane oxygenation (VV-ECMO) employs lung-protective ventilation strategies to facilitate lung rest, aiming to minimize the risk of ventilator-induced lung injury, while ensuring adequate oxygenation.
Case Description: We presented 3 critically ill patients who presented with traumatic bronchial rupture between 2019 and 2021, and underwent emergency thoracic surgery with the help of VV-ECMO.
Article Synopsis
- Patients undergoing postcardiotomy V-A-ECMO have a high risk of early mortality, with a 66.7% in-hospital mortality rate found in the analysis of 1269 patients across 25 hospitals.
- The study utilized a systematic review and methods like propensity score matching to identify performance differences among hospitals, revealing that some hospitals had significantly higher mortality rates than others.
- The research indicates that lower annual volumes of V-A-ECMO procedures may lead to worse outcomes, and it highlights the potential for improvement in many hospitals' results for this treatment.
Bleeding and thromboembolic (TE) complications in neurosurgical diseases have a detrimental impact on clinical outcomes. The aim of this study is to provide a scoping review of the available literature and address challenges and knowledge gaps in the management of coagulation disorders in neurosurgical diseases. Additionally, we introduce a novel research project that seeks to reduce coagulation disorder-associated complications in neurosurgical patients.
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- - The study focuses on creating a predictive model using machine learning to assess in-hospital mortality risk for patients undergoing veno-arterial extracorporeal membrane oxygenation (VA-ECMO), aiming to improve clinical decision-making prior to ECMO initiation.
- - Researchers analyzed data from 837 patients to develop and validate a model using two variable sets (small and comprehensive), finding similar error rates (~35%) and a moderate area under the curve (AUC) between 0.70 and 0.71, indicating decent predictive ability.
- - External validation showed varied performance, with higher error rates and lower AUCs (0.60 to 0.63), suggesting that while the model provides useful insights, there may
Sex-specific preoperative haemoglobin levels and the need for perioperative red cell transfusion in men and women are still debated. Cavalli and colleagues examined the appropriateness of World Health Organization (WHO) anaemia thresholds (haemoglobin <130 g L for males and <120 g L for females) in a retrospective cohort analysis of >6000 adult patients undergoing cardiac surgery with cardiopulmonary bypass. The authors concluded that the WHO anaemia threshold disproportionately disadvantages female cardiac surgery patients, and a preoperative haemoglobin level of at least 130 g L should be targeted in all cardiac surgical patients regardless of sex.
View Article and Find Full Text PDFBackground: Patient blood management (PBM) is a multidisciplinary and patient-centered treatment approach, comprising the detection and treatment of anemia, the minimization of blood loss, and the rational use of allogeneic transfusions. Pregnancy, delivery, and the puerperium are associated with increased rates of iron deficiency and anemia, which correlates with worse maternal and fetal outcomes and places pregnant women at increased risk of obstetric hemorrhage.
Summary: Early screening for iron deficiency before the onset of anemia, as well as the use of oral and intravenous iron to treat iron deficiency anemia, has been shown to be beneficial.
Article Synopsis
- The study investigates in-hospital mortality rates for adult patients undergoing veno-venous extracorporeal membrane oxygenation (V-V ECMO) therapy at University Hospital Zurich from 2007 to 2019.
- Among 221 patients, the in-hospital mortality rate was 37.6%, with no significant variation based on the specific clinical conditions treated.
- Key independent predictors of mortality identified include older age, newly detected liver failure, and the need for blood and platelet transfusions.
Background: The ideal perioperative oxygen concentration is controversial and study results are inconsistent.
Objective: Current knowledge on the beneficial and adverse effects of perioperative hyperoxia.
Material And Methods: Narrative review RESULTS: Perioperative hyperoxia is unlikely to increase the incidence of atelectasis, pulmonary or cardiovascular complications or mortality.
Article Synopsis
- Postcardiotomy veno-arterial extracorporeal membrane oxygenation (V-A-ECMO) has a high mortality rate, and determining which patients are at the greatest risk for death is challenging, making clinical judgment essential for initiating the procedure.
- A systematic review analyzed data from 1269 patients across 10 studies, revealing that higher arterial lactate levels at the start of V-A-ECMO correlate with increased in-hospital mortality rates and a significant cut-off level of 6.8 mmol/L for predicting outcomes.
- The findings suggest that monitoring arterial lactate levels may aid clinicians in making more informed decisions on when to start V-A-ECMO, especially in older patients with elevated lactate levels.
Article Synopsis
- - The study evaluates the management of coagulation and hypothermia in burn patients across European centers, highlighting a lack of consensus on treatment guidelines.
- - A survey conducted in 2016 and 2021 showed an increase in the use of point-of-care coagulation tests and specific treatment protocols for hypothermia, with participation rates of 84% and 91% respectively.
- - Findings indicate a shift towards more effective, factor-based coagulation management and enhanced temperature regulation, leading to improved patient care for those with severe burns.
Article Synopsis
- Severe trauma poses a significant public health challenge globally, with post-traumatic bleeding being a major cause of preventable death and organ failure if not managed promptly.
- The sixth edition of the European guidelines provides evidence-based recommendations for clinicians treating bleeding trauma patients, using a concise format focused on high-quality studies.
- The guidelines include 39 clinical practice recommendations organized by key decision points to improve outcomes, emphasizing the importance of systematic diagnostic and treatment approaches in reducing mortality from traumatic injuries.
Purpose: The impact of the type of anesthesia (regional vs. general anesthesia) on in-hospital complications in ankle fractures has not been thoroughly studied yet. Identifying factors that place patients at risk for complications following ankle fractures may help reduce their occurrence.
View Article and Find Full Text PDFBackground: It is unclear whether peripheral arterial cannulation is superior to central arterial cannulation for postcardiotomy veno-arterial extracorporeal membrane oxygenation (VA-ECMO).
Methods: A systematic review was conducted using PubMed, Scopus, and Google Scholar to identify studies on postcardiotomy VA-ECMO for the present individual patient data (IPD) meta-analysis. Analysis was performed according to the intention-to-treat principle.
Background: In case of bleeding patients and in acute care, the assessment of residual direct oral anticoagulant (DOAC) activity is essential for evaluating the potential impact on hemostasis, especially when a timely decision on urgent surgery or intervention is required. Viscoelastic tests are crucial in a modern goal-directed coagulation management to assess patients' coagulation status. However, the role of viscoelastic test to detect and quantify residual DOAC plasma levels is controversially discussed.
View Article and Find Full Text PDFBackground: Extracorporeal life support (ECLS) therapy is increasingly used for cardiac and respiratory support postcardiotomy, refractory cardiogenic shock and cardiopulmonary resuscitation. This study aims to describe in-hospital mortality of patients requiring ECLS, identify independent predictors associated with mortality and analyze changes of mortality over time.
Methods: This retrospective study includes all adult ECLS cases at the University Hospital Zurich, a designated ECLS center in Switzerland, in the period 2007 to 2019.
Prehospital Pain Management: Overview and Potential Improvements Pain is a frequent issue in the prehospital setting. Rapid and adequate analgesia has a positive effect on the physiological and psychological condition of patients. However, up to 43 % of patients still suffer insufficient analgesia.
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