Extracorporeal membrane oxygenation (EMCO) offers a therapeutic option for moribund patients of all ages with acute pumonary or cardiac failure. The authors present a retrospective analysis of the largest single institution experience with ECMO support, and present their perspective on the evolving use of ECMO supported by four decades of clinical r
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Critical Care
Evolution and Impact of Ventricular Assist Device Program on Children Awaiting Heart Transplantation
February 2, 2015
This single instutition study evaluated the impact of mechanical support in children awaiting heart transplant, comparing the pre-support era (1995-2005 and the post-support era (2005-2013); the latter era marked the transition to being able to provide support without concern for pt size. Support increased from 13% to 37%. Wait list mortality was d
January 29, 2015
The author recounts the posttraumatic distress that Captain Scully and other crewmembers experienced after the emergency landing of US Airways Flight 1549 on the Hudson River in New York City. She describes the counseling this team required after executing a nearly perfect recovery from a potentially disastrous aviation event. The author wonders wh
January 21, 2015
In this comprehensive article the author describes the potential harmful effects of peri-operative allogeneic transfusions during cardaic surgery employing the CPB circuit. The author also describes potenital risks of low hematocrits during CPB as would be seen when employing Acute Normovolemic Hemodilution technique for blood conservation.
January 14, 2015
The authors describe a "huge" increase in ECMO usage for pulmonay failure with a trend, though not statistically significant, towards improved outcomes.
January 14, 2015
This RCT compared daily 200mg or 300mg of FXI-ASO (an antisense oligonucleotide that reduces levels of factor XI) to daily 40mg of enoxaparin in pts undergoing knee replacement surgery. The end point was thromboembolism. FXI-ASO significantly reduced factor XI levels in a dose-response manner. FXI-ASO 200 mg was equivalent to enoxaparin in frequen
January 11, 2015
The CCF group conducted a study of their phlebotomy practices during a 6-month period in 2012. Phlebotomy volumes on each patient were estimated and calculated. Surprisingly, the group found that, on average, cardiac surgery patients lose ~10% of their blood volume due to postoperative phlebotomy alone.
January 10, 2015
The FDA recently approved the fourth new oral anticoagulant, Savaysa for use in non-valvular afib, DVT, and PE. It is another factor Xa inhibitor. Use in non-valvular afib requires renal function assessment prior to prescribing, as the drug is renally excreted. Paradoxically, efficacy may be reduced in patients with better-than-normal renal functi
December 27, 2014
The authors translated 10 common medical phrases into 26 foreign languages and had native speakers of those languages translate those phrases back to English. 42% of the translations were wrong, with the worst accuracy among African and Asian languages.
December 17, 2014
Hemodilution on CPB is a hotly debated topic.