Interprofessional Simulation in Cardiothoracic Surgery Improves Team Confidence.

Interest in simulation has grown substantially, as has enthusiasm for team-based approaches to surgical training. In cardiothoracic surgery, the dynamic ability of the entire team is critical to emergent events. We developed innovative, interprofessional simulation events to improve team confidence.

ECMO During COVID-19: A Society of Thoracic Surgeons/Extracorporeal Life Support Organization Survey.

Background: The Society of Thoracic Surgeons Workforce on Critical Care and the Extracorporeal Life Support Organization sought to identify how the coronavirus disease 2019 (COVID-19) pandemic has changed the practice of venoarterial (VA) and venovenous (VV) extracorporeal membrane oxygenation (ECMO) programs across North America.

Methods: A 26-question survey covering 6 categories (ECMO initiation, cannulation, management, anticoagulation, triage/protocols, and credentialing) was emailed to 276 North American Extracorporeal Life Support Organization centers. ECMO practices before and during the COVID-19 pandemic were compared.

Hybrid Ablation of Nonparoxysmal Atrial Fibrillation: The Convergent and Totally Thoracoscopic Approaches.

Nonparoxysmal atrial fibrillation continues to challenge electrophysiologist and surgeons alike. Stand-alone endocardial catheter ablation has resulted in less than satisfying results, and while the on-pump Cox-Maze surgery has excellent results, the invasiveness has limited its adoption amongst both referring providers and surgeons. The CONVERGE IDE trial has shed new light on this once dim problem.

2021: Perioperative and critical care year in review for the cardiothoracic surgery team.

For yet another year, our lives have been dominated by a pandemic. This year in review, we feature an expert panel opinion regarding extracorporeal support in the context of COVID-19, challenging previously held standards. We also feature survey results assessing the impact of the pandemic on cardiac surgical volume.

Surgical Triage and Timing for Patients With Coronavirus Disease: A Guidance Statement from The Society of Thoracic Surgeons.

The coronavirus disease 2019 (COVID-19) pandemic continues to disrupt the provision of cardiac procedural services due to overwhelming interval surges in COVID-19 cases and the associated crisis of cardiac intervention deferment. Despite the availability of widespread testing, highly efficacious vaccines, and intensive public health efforts, the pandemic is entering its third year, where new severe acute respiratory syndrome-coronavirus-2 variants have increased the likelihood that patients scheduled for a cardiac intervention will contract COVID-19 in the perioperative period. The Society of Thoracic Surgeons (STS) Workforce on Critical Care, the STS Workforce on Adult Cardiac and Vascular Surgery, and the Canadian Society of Cardiac Surgeons have developed this document, endorsed by the STS and affirmed by the Society of Cardiovascular Angiography and Interventions and the Canadian Association of Interventional Cardiology, to provide guidance for cardiac procedure deferment and intervention timing for preoperative patients diagnosed with COVID-19.

The Thoracic Surgery Medical Student Association: Understanding the needs of medical students pursuing cardiothoracic surgery in the United States.

Objective: Founded in 2020, the Thoracic Surgery Medical Student Association is the first national organization dedicated to supporting medical students interested in pursuing cardiothoracic surgery. Our inaugural survey aimed to describe their basic characteristics and needs.

Methods: An Institutional Review Board-approved, nonincentivized, anonymous electronic survey was distributed to any medical students enrolled in Liaison Committee on Medical Education-accredited medical schools through social media such as Twitter, national organizations (Association of Women Surgeons, Thoracic Surgery Resident Association), and medical school cardiothoracic surgery interest groups.

Perioperative Coronavirus Vaccination-Timing and Implications: A Guidance Document.

Cardiothoracic surgical patients are at risk of increased coronavirus disease severity. Several important factors influence the administration of the coronavirus disease vaccine in the perioperative period. This guidance statement outlines current information regarding vaccine types, summarizes recommendations regarding appropriate timing of administration, and provides information regarding side effects in the perioperative period for cardiac and thoracic surgical patients.

Accelerated versus delayed initiation of renal-replacement strategies following cardiac surgery.

Visual representation of the impact and controversy surrounding the timing of initiation for renal-replacement therapy for acute kidney injury after cardiac surgery. On the of the image is the impact of acute kidney injury on postoperative heart surgery patients. On the are the considerations a provider must undertake when determining the appropriating timing for renal-replacement therapy for individual patients.

Postcardiotomy extracorporeal membrane oxygenator: No longer a bridge to no where?

Background: Postcardiotomy extracorporeal membrane oxygenation (PC-ECMO) represents a unique subset of critically ill patients, with a paucity of data regarding long-term survival and correlated characteristics. We present a retrospective cohort of PC-ECMO patients, with outcomes at 1 and 3 years.

Methods: Data were collected retrospectively for all patients requiring ECMO within 72 hours of an index cardiac operation (excluding assist devices and transplants).

Outcomes of noncardiotomy patients requiring postoperative extracorporeal membrane oxygenation.

Background: The use of extracorporeal membrane oxygenation (ECMO) in the postoperative period has expanded to include a variety of noncardiotomy procedures. It is important to investigate outcomes for this uniquely ill subset of patients as currently published data on this subject is limited.

Methods: All ECMO events at our institution from 2006 to 2017 were retrospectively considered.

The effect of patient obesity on extracorporeal membrane oxygenator outcomes and ventilator dependency.

Objective: The effect of body habitus for patients who require extracorporeal membrane oxygenation (ECMO) support has not been well-studied and may provide insight into patient survival and outcomes. We sought to determine if there is a correlation of body mass index (BMI) with ECMO outcomes.

Methods: A retrospective chart review was performed for patients who required any form of ECMO support at our institution between 2012 and 2016.

Zero balance ultrafiltration using dialysate during nationwide bicarbonate shortage: a retrospective analysis.

Background: Zero balance ultrafiltration (Z-BUF) utilizing injectable 8.4% sodium bicarbonate is utilized to treat hyperkalemia and metabolic acidosis associated with cardiopulmonary bypass (CPB). The nationwide shortage of injectable 8.

Can we expect improvements in outcomes with centrifugal vs axial flow left ventricular assist devices in patients transitioned from extracorporeal life support?

Background: Several patient-related characteristics have been associated with inferior outcomes following durable left ventricular assist device (LVAD) implantation in patients transitioned from venoarterial extracorporeal membrane oxygenation (VA ECMO). The impact of LVAD pump type used is less well-known.

Methods: We compared outcomes between patents who received axial and centrifugal flow LVADs following stabilization with VA ECMO.

What are the results of venoarterial extracorporeal membrane oxygenation bridging to heart transplantation?

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether heart transplantation is a viable treatment option in patients in refractory cardiogenic shock who could not be weaned off venoarterial extracorporeal membrane oxygenation (VA ECMO). Altogether, 373 papers were found using the reported search, of which 7 papers represented the best evidence to answer the clinical question.