Strengthening Discovery and Application of Artificial Intelligence in Anesthesiology: A Report from the Anesthesia Research Council.

Interest in the potential applications of artificial intelligence in medicine, anesthesiology, and the world at large has never been higher. The Anesthesia Research Council steering committee formed an anesthesiologist artificial intelligence expert workgroup charged with evaluating the current state of artificial intelligence in anesthesiology, providing examples of future artificial intelligence applications and identifying barriers to artificial intelligence progress. The workgroup's findings are summarized here, starting with a brief introduction to artificial intelligence for clinicians, followed by overviews of current and anticipated artificial intelligence-focused research and applications in anesthesiology.

Automated structured data extraction from intraoperative echocardiography reports using large language models.

Background: Consensus-based large language model (LLM) ensembles might provide an automated solution for extracting structured data from unstructured text in echocardiography reports.

Methods: This cross-sectional study utilised 600 intraoperative transoesophageal reports (100 for prompt engineering; 500 for testing) randomly sampled from 7106 adult patients undergoing cardiac surgery at two hospitals within the University of Pennsylvania Healthcare System. Three echocardiographic parameters (left ventricular ejection fraction, right ventricular systolic function, and tricuspid regurgitation) were extracted from both the presurgical and postsurgical sections of the reports.

One-year changes in body composition and musculoskeletal health following metabolic/bariatric surgery.

Context: There are limited comparative studies between one anastomosis gastric bypass (OAGB) versus Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) on body composition and musculoskeletal health.

Objective: To compare changes in body composition, areal bone mineral density (aBMD), muscle strength, and physical function in the first year following OAGB, RYGB and SG within a UK-based healthcare setting.

Methods: This is a secondary analysis of the BARI-LIFESTYLE trial in 119 adults (77% women; mean±SD, age: 45.

Spatiotemporal Deep Learning-Based Cine Loop Quality Filter for Handheld Point-of-Care Echocardiography.

The reliability of automated image interpretation of point-of-care (POC) echocardiography scans depends on the quality of the acquired ultrasound data. This work reports on the development and validation of spatiotemporal deep learning models to assess the suitability of input ultrasound cine loops collected using a handheld echocardiography device for processing by an automated quantification algorithm (e.g.

Testing clinical selection criteria for intraoperative transoesophageal echocardiography in isolated coronary artery bypass graft surgery.

Background: There is a lack of evidence associating intraoperative transoesophageal echocardiography (TOE) use with improved outcomes among coronary artery bypass graft (CABG) surgery subpopulations.

Methods: This matched retrospective cohort study used a US private claims dataset to compare outcomes among different CABG surgery patient populations with without TOE. Statistical analyses involved exact matching on pre-selected subgroups (congestive heart failure, single vessel, and multivessel CABG) and used fine and propensity-score balanced techniques to conduct multiple matched comparisons and sensitivity analyses.

The Society of Thoracic Surgeons Adult Cardiac Surgery Database: Intraoperative Echocardiography Reporting.

Objectives: To identify trends in the reporting of intraoperative transesophageal echocardiographic (TEE) data in the Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database (ACSD) and the Adult Cardiac Anesthesiology (ACA) module by period, practice type, and geographic distribution, and to elucidate ongoing areas for practice improvement.

Design: A retrospective study.

Setting: STS ACSD.

Pragmatic Evaluation of a Deep-Learning Algorithm to Automate Ejection Fraction on Hand-Held, Point-of-Care Echocardiography in a Cardiac Surgical Operating Room.

Objective: To test the correlation of ejection fraction (EF) estimated by a deep-learning-based, automated algorithm (Auto EF) versus an EF estimated by Simpson's method.

Design: A prospective observational study.

Setting: A single-center study at the Hospital of the University of Pennsylvania.

Extracorporeal Carbon Dioxide Removal to De-escalate Venovenous Extracorporeal Membrane Oxygenation in Severe COVID-19 Acute Respiratory Distress Syndrome.

Objectives: In a subset of patients with COVID-19 acute respiratory distress syndrome (ARDS), there is a need for extracorporeal membrane oxygenation (ECMO) for pulmonary support. The primary extracorporeal support tool for severe COVID-19 ARDS is venovenous (VV) ECMO; however, after hypoxemic respiratory failure resolves, many patients experience refractory residual hypercarbic respiratory failure. Extracorporeal carbon dioxide removal (ECCOR) for isolated hypercarbic type II respiratory failure can be used in select cases to deescalate patients from VV ECMO while the lung recovers the ability to exchange CO.

Placement of Temporary Left Ventricular Assist Device Using Monitored Anesthesia Care and Regional Anesthesia.

Patients with advanced cardiogenic shock requiring mechanical circulatory support are uniquely susceptible to clinical deterioration. Limiting physiologic perturbations via avoidance of general anesthesia and endotracheal intubation by awake Impella 5.5 placement is safe and may represent a novel strategy in mechanical circulatory support initiation among patients in cardiogenic shock.

Evolution in the treatment of gastroesophageal reflux disease over the last century: from a crural-centered to a lower esophageal sphincter-centered approach and back.

The surgical management of gastroesophageal reflux disease (GERD) has evolved significantly over the past century, driven by increased understanding of the physiology of the reflux barrier, its anatomic components, and surgical innovation. Initially, emphasis was on reduction of hiatal hernias and crural closure as the etiology behind GERD was felt to be solely related to the anatomic alterations caused by hiatal hernias. With persistence of reflux-related changes in some patients despite crural closure, along with the development of what is now modern manometry and the discovery of a high-pressure zone at the distal esophagus, focus evolved to surgical augmentation of the lower esophageal sphincter (LES).

Predictors of Intraoperative Echocardiography: Analysis of The Society of Thoracic Surgeons Database.

Background: Intraoperative transesophageal echocardiography (TEE) is associated with improved outcomes after cardiac surgery, but unexplained practice pattern variation exists. This study aimed to identify and quantify the predictors of intraoperative TEE use among patients undergoing isolated coronary artery bypass graft surgery (CABG) or cardiac valve surgery.

Methods: This observational cohort study used The Society of Thoracic Surgeon (STS) Adult Cardiac Surgery Database data to identify and quantify the predictors of intraoperative TEE use among adult patients aged 18 years or more undergoing either isolated CABG or open cardiac valve repair or replacement surgery between January 1, 2011, and December 31, 2019.

Neighborhood Socioeconomic Status Independently Predicts Outcomes After Mitral Valve Surgery.

Background: Socioeconomic status has increasingly recognized influence on outcomes after cardiac surgery. However, singular metrics fail to fully capture the socioeconomic context within which patients live, which vary greatly between neighborhoods. We sought to explore the impact of neighborhood-level socioeconomic status on patients undergoing mitral valve surgery in the United States.

Comprehensive Monitoring in Patients With Dual Lumen Right Atrium to Pulmonary Artery Right Ventricular Assist Device.

Right ventricular assist devices (RVADs) can be used in patients with acute right heart failure. A novel device that has recently been deployed is the right atrium to pulmonary artery (RA-PA) dual lumen single cannula (DLSC). One of the limitations is that it occupies a large proportion of the right ventricular outflow tract and PA; therefore, standard continuous hemodynamic monitoring with a pulmonary artery catheter is commonly not used.

Extracorporeal CO reduction for COVID-19: hypercapnic respiratory failure post extracorporeal membrane oxygenation.

COVID-19-induced acute respiratory distress syndrome (ARDS) has challenged medical providers. In severe cases, patients present with poor lung compliance, requiring not only lung protective mechanical ventilation strategies, but also extracorporeal support. Due to the nature of the pandemic, the extracorporeal carbon dioxide removal device called Hemolung Respiratory Assist System became available under the Food and Drug Administration Emergency Use Authorization for patients with COVID-19-induced ARDS.

Association of Intraoperative Transesophageal Echocardiography and Clinical Outcomes After Open Cardiac Valve or Proximal Aortic Surgery.

Importance: Intraoperative transesophageal echocardiography (TEE) is used frequently in cardiac valve and proximal aortic surgical procedures, but there is a lack of evidence associating TEE use with improved clinical outcomes.

Objective: To test the association between intraoperative TEE use and clinical outcomes following cardiac valve or proximal aortic surgery.

Design, Setting, And Participants: This matched, retrospective cohort study used national registry data from the Society of Thoracic Surgeon (STS) Adult Cardiac Surgery Database (ACSD) to compare clinical outcomes among patients undergoing cardiac valve or proximal aortic surgery with vs without intraoperative TEE.

Prolonged mechanical rib separation is a key element to prevent thoracic compartment syndrome in penetrating chest trauma: A case report.

Penetrating cardiac injury in trauma patients is highly morbid. Most cases do not survive long enough to manifest the severe physiologic consequences of massive blood product resuscitation, namely, thoracic compartment syndrome and right ventricular (RV) failure. This case exhibits a thoracic compartment syndrome and RV failure so severe that the open chest management required mechanical separation of a clamshell thoracotomy.

Application of machine learning approaches to administrative claims data to predict clinical outcomes in medical and surgical patient populations.

Objective: This study aimed to develop and validate a claims-based, machine learning algorithm to predict clinical outcomes across both medical and surgical patient populations.

Methods: This retrospective, observational cohort study, used a random 5% sample of 770,777 fee-for-service Medicare beneficiaries with an inpatient hospitalization between 2009-2011. The machine learning algorithms tested included: support vector machine, random forest, multilayer perceptron, extreme gradient boosted tree, and logistic regression.

Bridging preference-based instrumental variable studies and cluster-randomized encouragement experiments: Study design, noncompliance, and average cluster effect ratio.

Instrumental variable (IV) methods are widely used in medical research to draw causal conclusions when the treatment and outcome are confounded by unmeasured confounding variables. One important feature of such studies is that the IV is often applied at the cluster level, for example, hospitals' or physicians' preference for a certain treatment where each hospital or physician naturally defines a cluster. This paper proposes to embed such observational IV data into a cluster-randomized encouragement experiment using nonbipartite matching.

Validation of Claims Data for the Identification of Intraoperative Transesophageal Echocardiography During Cardiac Surgery.

Objective: The goal of this study was to assess the validity of Current Procedural Terminology (CPT) claims data for the identification of intraoperative transesophageal echocardiography (TEE) during cardiac surgery.

Design: This study was a retrospective, cohort analysis.

Setting: This study used data from electronic medical records (EMRs), in combination with CPT billing claims data, from two hospitals within the Penn Medicine Health System-Penn Presbyterian Medical Center and the Hospital of the University of Pennsylvania.

Association between Transesophageal Echocardiography and Clinical Outcomes after Coronary Artery Bypass Graft Surgery.

Background: Coronary artery bypass graft (CABG) surgery is the most widely performed cardiac surgery in the United States. Transesophageal echocardiography (TEE) is frequently used in a variety of cardiac surgical procedures, but its clinical benefit in isolated CABG surgery is unclear, and guidelines remain indeterminate. The aim of this study was to compare clinical outcomes among patients undergoing isolated CABG surgery with versus without TEE in order to test the hypothesis that TEE would be associated with improved clinical outcomes after CABG surgery.

A Case Series of Devastating Intracranial Hemorrhage During Venovenous Extracorporeal Membrane Oxygenation for COVID-19.

Objective: Anticoagulation may be a challenge in coronavirus disease 2019 (COVID-19) extracorporeal membrane oxygenation due to endothelial injury and dysregulation of coagulation, which may increase the risk of thrombotic and bleeding complications. This report was created to describe the authors' single institutional experience, with emphasis on the high rate of intracranial hemorrhage for the first 10 patients with COVID-19 placed on venovenous extracorporeal membrane oxygenation (VV ECMO).

Design: Case series, retrospective analysis.

Surgical training in the midst of a pandemic: a distributed general surgery residency program's response to COVID-19.

The coronavirus disease 2019 (COVID-19) pandemic has had a substantial impact on surgical training. We describe some of the challenges brought on by the pandemic and our program's province-wide response to them. We focus specifically on residents' provision of service, education and wellness.