A Review of Bicarbonate Use in Common Clinical Scenarios.

Background: The use of sodium bicarbonate to treat metabolic acidosis is intuitive, yet data suggest that not all patients benefit from this therapy.

Objective: In this narrative review, we describe the physiology behind commonly encountered nontoxicologic causes of metabolic acidosis, highlight potential harm from the indiscriminate administration of sodium bicarbonate in certain scenarios, and provide evidence-based recommendations to assist emergency physicians in the rational use of sodium bicarbonate.

Discussion: Sodium bicarbonate can be administered as a hypertonic push, as a resuscitation fluid, or as an infusion.

Modeling Outcomes: Modified Aortic Arch Advancement for Neonatal Hypoplastic Arch.

Objective: Numerous surgical approaches regarding aortic arch advancement for neonatal arch hypoplasia have been described. These repairs can be classified into two categories: those that incorporate a patch and those that do not. The decision between repairs remains largely experiential, rather than empirical, because of the limited number of reported outcomes.

Novel Utilization of the Bridge During Weaning Off Venoarterial ECMO: The Hoffman Clamp Method.

Standard practice for weaning patients off venoarterial extracorporeal membrane oxygenation (ECMO) occurs by decreasing pump flows until idle flow is achieved. This method is limited in its use because it is difficult to assess a patient's true potential to successfully come off ECMO when supported by idle flow. We have developed a weaning technique that uses a Hoffman clamp on the bridge to decrease blood flow to the patient beyond idle flow.

Beating-Heart Sliding Arch Aortoplasty for Arch Hypoplasia Beyond Infancy.

Hypoplasia of the aortic arch commonly accompanies coarctation of the aorta and should be addressed at the time of coarctation repair to prevent residual gradient. Using a novel technique, McKenzie et al performed an ascending sliding arch aortoplasty to correct hypoplasia using native aortic tissue. This procedure was accomplished with an arrested heart and uses the fact that the ascending aorta associated with the hypoplastic arch is typically elongated.