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Journal and News Scan
May 28, 2014
Submitted by: Joel Dunning
365 Lung transplantions were reviewed and classified for optimal and extended both donors and recipients. Extended recipients were characterized by pulmonary fibrosis or pulmonary hypertension, pretransplant intubation, age >60 years and bypass >2 h. They experience early graft failure more frequently and had a poorer survival than optimal donors without an influence of donor quality or length of ischemic time.
May 28, 2014
Submitted by: Joel Dunning
The aims of this study were, in patients with MVP undergoing MV repair, to describe the prevalence and characteristics of MAC, to correlate MAC with clinical risk factors, coronary involvement, and aortic valve disease, and to describe prevalence, site, and extension of MAC in fibroelastic deficiency (FED) versus Barlow's disease (BD) and correlate MAC to surgical outcomes. Despite very high percentage of repairability, MAC influences surgical outcomes and very detailed echo evaluation is advocated.
May 28, 2014
Submitted by: Joel Dunning
Joe Novak, MD was an F-15 Combat Pilot and now is an Emergency Physician. In this fantastic lecture, he brings the concepts of Combat Aviation to the art of Resuscitation.
The Boldface
aka the no-shitters things that must be absolutely incorporated into your memory and available for immediate execution. You should not need to think about what to do in these situations.
Checklists
Cognitive unloading and guarantee of the performance of critical actions. Use after addressing the boldface
Prioritization of Attention and Tasks
In combat aviation:
- Aviate
- Navigate
- Communicate
In EM & Critical Care:
- Resuscitate
- Differentiate
- Communicate
The Cross-Check
Keep coming back to the global patient picture before diving into any minutiae
Efficient and Unambiguous Communication
- Directive
- Descriptive
- Informative
Click on the vimeo video near the end to hear his full lecture
May 27, 2014
Submitted by: Mark Ferguson
This metanalysis identified 26 eligible studies that assess the predictive value of PET for survival after induction therapy. Complete metabolic response was associated with a 50% decrease in mortality and in tumor recurrence compared to no response.
May 27, 2014
Submitted by: Mark Ferguson
This retrospective single institution review assessed the incidence of hiatal hernia after minimally invasive esophagectomy (MIE). Of 114 patients followed, 9 (8%) developed herniation, of whom 5 were symptomatic. All were repaired laparoscopically, except 2 who underwent emergent surgery, with good results.
May 27, 2014
Submitted by: Mark Ferguson
POEM is being increasingly used for primary treatment of achalasia. This study evaluated POEM use for retreatment of 5 achalasia patients after prior laparoscopic esophageal myotomy and compared their results to 3 patients who underwent redo laparoscopic surgery. Both groups had similar low complication rates and improved symptoms at intermediate-term follow-up. The authors conclude that POEM is feasible for reoperative surgery for achalasia.
May 25, 2014
Submitted by: J. Rafael Sadaba
Interesting images of one of the very few reports on transeptal mitral valve implantation, in this case with a SAPIEN XT valve. The valve was implanted in a 72-year old female patient with previous aortic valve replacement and tricuspid valve annuloplasty. She had symptomatic mitral stenosis with severe calcification of the mitral annulus.
May 23, 2014
Submitted by: Tom C. Nguyen
Stepped wedged cluster randomized control trial from the World Health Organization comparing outcomes in those who received a Checklist. Implementation of the WHO Surgical Safey Checklist decreased morbidty and hospital length of stay.
May 23, 2014
Submitted by: Ruben Osnabrugge
In this extensive review, the authors focus on extracorproreal membrane oxygenation (ECMO), both for cardiac and respiratory failure. They describe the explosive increase in ECMO use, the expanding indications, and the need for more evidence-based use. Moreover, they review the cannulation strategies, current indications and potential future applications.
May 22, 2014
Submitted by: J. Rafael Sadaba
Traditionally, patients undergoing TAVI are treated with dual antiplatelet therapy (DAPT). This strategy in not based on strong evidence. In this paper, the authors describe their findings in a randomized trial comparing outcomes (morbidity and mortality) in two groups of patients undergoing TAVI, one treated with aspirin only (ASA group) and another treated with aspirin and clopidogrel or ticlopidine (DAPT group). There were no significant differences in “all cause” and “cardiovascular” mortality at six months or in the VARC (Valve Academic Research Consortium) combined safety endpoints at 30 days. Nevertheless, at 30 days, vascular complications were significantly more frequent in the in the DAPT group. Based on their data, the authors suggest that, in patients undergoing TAVI, vascular complications may be reduced by the adoption of an antiplatelet therapy based only on aspirin.