Journal and News Scan

This study analyzes surgery versus chemoradiation for esophageal cancer in older patients.

Amirghofran et al. present a cohort of 21 patients receiving repair of tetralogy of Fallot (ToF) by a new surgical technique using autologous right atrial appendage tissue as a pulmonary valve substitute. This technique was proven feasible with good mid-term results and valve function in patients undergoing ToF repair requiring a PA valve substitute.

STAT Mortality Categories (developed 2009) stratify congenital heart surgery procedures into groups of increasing mortality risk to characterize case mix of congenital heart surgery providers. This update of the STAT Mortality Score and Categories is empirically based for all procedures and reflects contemporary outcomes. Cardiovascular surgical operations in the Society of Thoracic Surgeons Congenital Heart Surgery Database (January 1, 2010 – June 30, 2017) were analyzed. In this STAT 2020 Update of the STAT Mortality Score and Categories, the risk associated with a specific combination of procedures was estimated under the assumption that risk is determined by the highest risk individual component procedure. Operations composed of multiple component procedures were eligible for unique STAT Scores when the statistically estimated mortality risk differed from that of the highest risk component procedure. Bayesian modeling accounted for small denominators.

The authors conducted a systematic literature review for evidence regarding prone positioning during cardiopulmonary resuscitation (CPR).  Three observational or experimental studies determined that systolic blood pressure generated in the prone position was over 20 mmHg higher than supine, tidal volumes were within the recommended range of 6 mL/kg, and a majority of compressions met standard criteria.  An additional CT study led to the recommendation for hand positioning at the T7-T9 level in the midline, where the anatomy of the left ventricle is widest.  Fourteen case reviews revealed that return of spontaneous circulation was achieved in all cases after a median of 5 minutes, without repositioning the patient.  Recommended placement of defibrillator pads are illustrated as bilaterally under the axilla or alternatively, one midline under the left axilla and another above the right scapula.  This evidence suggests that prone CPR may generate superior blood flow due the relative stiffness of the costovertebral joint which allows greater exertional force, displacement of the diaphragm and abdominal viscera, but may be more strenuous for the rescuer. It should be noted that all patients in the case reports experienced a witnessed arrest with a secured airway, and CPR was initiated rapidly. While acknowledging that publication bias is likely, the authors conclude it is reasonable to perform CPR in the prone position for several minutes before repositioning. Given the recent increase in prone positioning due to COVID, this report is a timely review that is of great interest to OR and ICU providers.