- Controlled donation after circulatory death (DCD) donors: A focus on the utilization of pediatric donors and outcomes after lung transplantation. [Journal Article]
- JHJ Heart Lung Transplant 2019 Jun 19
- CONCLUSIONS: Controlled DCD provide a significant and quality donor lung pool to increase LTx opportunities for pediatric patients (and adults) with terminal lung disease.
- Cutdown Technique is Superior to Fascial Closure for Femoral Artery Access after Elective Endovascular Aortic Repair. [Journal Article]
- EJEur J Vasc Endovasc Surg 2019 Jul 08
- CONCLUSIONS: This study shows that cutdown is superior to fascial closure for femoral artery access after elective EVAR. In acute EVAR, however, fascial closure is still considered to be a good and fast method, and it has been kept in the present authors' armamentarium for this indication.
- Lifesaving interventions in blackout conditions using night vision technology: Come to the dark side. [Journal Article]
- JTJ Trauma Acute Care Surg 2019; 87(1S Suppl 1):S191-S196
- CONCLUSIONS: Lifesaving interventions can be safely and effectively performed in blackout conditions using NODs, although increased difficulty with select procedure types was identified. Focused training and technological improvements to currently available devices are needed.
- A High-Fidelity Surgical Model and Perfusion Simulator Used to Demonstrate ECMO Cannulation, Initiation, and Stabilization. [Journal Article]
- JEJ Extra Corpor Technol 2019; 51(2):94-99
- Our high-fidelity simulation model provides a realistic example for health-care professionals to experience cannulation, initiation, and hemodynamic stabilization during extracorporeal membrane oxyge…
Our high-fidelity simulation model provides a realistic example for health-care professionals to experience cannulation, initiation, and hemodynamic stabilization during extracorporeal membrane oxygenation (ECMO) therapy. This educational experience brings a variety of critical care specialties together, in a controlled simulation setting, to develop, master, and maintain clinical skills. This may include perfusionists, ECMO specialists, surgical technicians, registered nurses, physicians, and students. The simulation component includes a unique vascular access pad that is attached to either a static fluid model or to the Califia perfusion simulator system (Biomed Simulation, Inc., San Diego, CA). This collective high-fidelity simulation model can be surgically cannulated via a cutdown technique using an appropriately sized cannula and connected to an in situ ECMO circuit. This article explains the educational strategy, how the surgical pad is made, and the simulator connections so that any hospital can re-create this experience.
- Salvage of simultaneous acute coronary closure and retroperitoneal bleeding using veno-arterial extracorporeal membrane oxygenation and chronic total occlusion percutaneous coronary intervention techniques in a patient with ST-segment elevation myocardial infarction. [Journal Article]
- CRCardiovasc Revasc Med 2019 Mar 14
- Iatrogenic coronary artery dissection is a feared complication of percutaneous coronary intervention as it can potentially lead to severe myocardial ischemia, arrhythmias, shock, and death. Bailout-s…
Iatrogenic coronary artery dissection is a feared complication of percutaneous coronary intervention as it can potentially lead to severe myocardial ischemia, arrhythmias, shock, and death. Bailout-stenting or less often, emergent coronary artery bypass graft surgery may be needed for restoring antegrade flow. We describe a case of inferior ST-segment elevation acute myocardial infarction with preserved antegrade coronary flow. Percutaneous coronary intervention was complicated by acute right coronary artery closure during guide catheter engagement. Attempts for re-entry into the right coronary artery true lumen failed. Attempts to obtain right femoral arterial access resulted in retroperitoneal hematoma. The patient developed refractory ventricular fibrillation and could not be defibrillated. Veno-arterial extracorporeal membrane oxygenation was started using surgical right femoral cutdown for the venous cannula and the left common femoral artery for the arterial cannula. A dissection strategy with a knuckled guidewire was used around previously placed stents followed by successful re-entry into the distal right coronary artery using the Stingray system. The venous cannula was changed to the internal jugular vein and the right common femoral artery and vein were surgically repaired. The patient was decannulated two days later and was eventually discharged from the hospital neurologically intact.
- The effects of different sampling techniques on peripheral post mortem tryptase levels: a recommended sampling method. [Journal Article]
- IJInt J Legal Med 2019 Mar 16
- Different sampling techniques can impact on post mortem tryptase levels. A previous study demonstrated significantly lower femoral post mortem total tryptase levels in samples collected via transcuta…
Different sampling techniques can impact on post mortem tryptase levels. A previous study demonstrated significantly lower femoral post mortem total tryptase levels in samples collected via transcutaneous aspiration compared with directly sampling during internal examination. However, an outlier with high tryptase level was noted in one transcutaneous aspiration sample. This 6-month prospective study compared total post mortem tryptase levels between 21 paired aspirated venous and arterial femoral blood samples, and 19 paired aspirated and cutdown femoral venous blood samples in non-anaphylactic deaths only. No statistical differences were demonstrated between the different sampling methods. However, four outlier cases with higher tryptase levels in aspirated arterial and femoral cutdown samples compared with aspirated venous femoral samples were noted. The reasons for the outliers may be due to the bloods collected from these two methods being contaminated by central arterial and venous blood with high tryptase levels respectively. None of the aspirated venous femoral post mortem tryptase levels were above recognized post mortem tryptase cutoff to diagnose anaphylaxis. This study recommends aspirating blood samples from a clamped femoral/external iliac vein for post mortem tryptase analysis should be defined as the gold standard. Further study using the recommended sampling method on post mortem tryptase levels in non-anaphylactic and anaphylactic cases is warranted.
- Preoperative risk score for access site failure in ultrasound-guided percutaneous aortic procedures. [Journal Article]
- JVJ Vasc Surg 2019 Mar 06
- CONCLUSIONS: Percutaneous ultrasound-guided access can be safely performed in almost all patients undergoing endovascular aortic procedures, but access site failures do occur. This risk score can help users select patients with high likelihood of success, identify patients who need close scrutiny with postclosure femoral duplex ultrasound, and provide patient guidance about risk of unplanned groin cutdown.
- Detection of alcohol abuse in older patients with cancer: The integration of alcohol screening questionnaires in the comprehensive geriatric assessment. [Journal Article]
- JGJ Geriatr Oncol 2019 Feb 26
- CONCLUSIONS: It is feasible to implement an alcohol screening questionnaire as part of a CGA as results indicated a rather high level of alcohol abuse in this cohort.
- StatPearls: Superior Ophthalmic Vein Cannulation for Carotid Cavernous Fistula [BOOK]
- BOOKStatPearls Publishing: Treasure Island (FL)
- The superior ophthalmic vein (SOV) approach for embolization of carotid-cavernous fistulas (CCFs) was first described over 25 years ago. Carotid-cavernous fistulas are typically divided into four …
The superior ophthalmic vein (SOV) approach for embolization of carotid-cavernous fistulas (CCFs) was first described over 25 years ago. Carotid-cavernous fistulas are typically divided into four subtypes, defined by etiology and nature of the lesion. Direct (Barrow A) lesions involve an endothelial tear of the carotid itself while indirect lesions (Barrow B, C, or D) involve small branches of the internal or external carotid systems. While 10% to 60% of CCFs may spontaneously resolve and up to an additional 30% of low-flow CCFs may resolve with conservative management (carotid compression therapy), many progressive lesions require intervention. Direct lesions are amenable to endoarterial treatment. Indirect lesions are appropriately treated with transvenous embolization; the ipsilateral inferior petrosal sinus (IPS) is the preferred route. Initial reports characterized case series in which the SOV route was utilized when traditional access through the IPS failed. Typically, the SOV can be accessed through the facial-angular venous system. However, cases exist in which stenosis, hypoplasia, or tortuosity of the vessels prevent safe transvenous access via this route. Surgical cutdown for direct cannulation of the SOV is a safe, effective option in these cases in which other endovascular approaches have been exhausted. With advances in endovascular access techniques, the necessity of this approach has decreased. Still, direct cannulation of the SOV via surgical cutdown remains an important technique in the surgical armamentarium.
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- Evaluation of Dynamic Ultrasound for Arterial Access in Children Undergoing Cardiac Surgery. [Journal Article]
- JCJ Cardiothorac Vasc Anesth 2019; 33(7):1926-1929
- CONCLUSIONS: Dynamic US resulted in a significant reduction in surgical intervention to achieve arterial cannulation in children presenting for cardiac surgery.