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Hoffman JRH, Higa KC, Lin Y, Reece TB, Cleveland JC, Aftab M, Rove JY. Noteworthy Cardiac Literature From 2021: Coronary Guideline Change Without New Data, Heart Transplant Donation After Cardiac Death, Covid Effects on Global Cardiac Surgery, and Attempt to Improve Dissection Remodeling. Semin Cardiothorac Vasc Anesth 2022; 26:154-161. [PMID: 35591803 DOI: 10.1177/10892532221101298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cardiac surgery continues to evolve. The last year has been notable for many reasons. The guidelines for coronary revascularization introduced significant discord. The pandemic continues to affect the care on a global scale. Advances in organ procurement and dissection care move forward with better understanding and better technology.
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Affiliation(s)
| | - Kelly C Higa
- Division of Cardiothoracic Surgery, Department of, Surgery, 129263University of Colorado School of Medicine, Aurora, CO, USA
| | - Yihan Lin
- Division of Cardiothoracic Surgery, Department of, Surgery, 129263University of Colorado School of Medicine, Aurora, CO, USA
| | - T Brett Reece
- Division of Cardiothoracic Surgery, Department of, Surgery, 129263University of Colorado School of Medicine, Aurora, CO, USA
| | - Joseph C Cleveland
- Division of Cardiothoracic Surgery, Department of, Surgery, 129263University of Colorado School of Medicine, Aurora, CO, USA
| | - Muhammad Aftab
- Division of Cardiothoracic Surgery, Department of, Surgery, 129263University of Colorado School of Medicine, Aurora, CO, USA
| | - Jessica Y Rove
- Division of Cardiothoracic Surgery, Department of, Surgery, 129263University of Colorado School of Medicine, Aurora, CO, USA
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2
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Surgical Triage and Timing for Patients with COVID: A Guidance Statement from the Society of Thoracic Surgeons. Ann Thorac Surg 2022; 114:387-393. [PMID: 35595089 PMCID: PMC9113762 DOI: 10.1016/j.athoracsur.2022.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/26/2022] [Accepted: 05/07/2022] [Indexed: 12/13/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic continues to disrupt the provision of cardiac procedural services due to overwhelming interval surges in COVID-19 cases and the associated crisis of cardiac intervention deferment. Despite the availability of widespread testing, highly efficacious vaccines, and intensive public health efforts, the pandemic is entering its third year, where new severe acute respiratory syndrome-coronavirus-2 variants have increased the likelihood that patients scheduled for a cardiac intervention will contract COVID-19 in the perioperative period. The Society of Thoracic Surgeons (STS) Workforce on Critical Care, the STS Workforce on Adult Cardiac and Vascular Surgery, and the Canadian Society of Cardiac Surgeons have developed this document, endorsed by the STS and affirmed by the Society of Cardiovascular Angiography and Interventions and the Canadian Association of Interventional Cardiology, to provide guidance for cardiac procedure deferment and intervention timing for preoperative patients diagnosed with COVID-19. This document is intended for the perioperative cardiac surgical team and outlines the present state of the pandemic, the impact of COVID-19 on intervention outcome, and offers a recommended algorithm for individualized cardiac procedure triage and timing.
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Society of Cardiovascular Anesthesiologists Clinical Practice Update for Management of Acute Kidney Injury Associated With Cardiac Surgery. Anesth Analg 2022; 135:744-756. [PMID: 35544772 DOI: 10.1213/ane.0000000000006068] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Cardiac surgery-associated acute kidney injury (CS-AKI) is common and is associated with increased risk for postoperative morbidity and mortality. Our recent survey of the Society of Cardiovascular Anesthesiologists (SCA) membership showed 6 potentially renoprotective strategies for which clinicians would most value an evidence-based review (ie, intraoperative target blood pressure, choice of specific vasopressor agent, erythrocyte transfusion threshold, use of alpha-2 agonists, goal-directed oxygen delivery on cardiopulmonary bypass [CPB], and the "Kidney Disease Improving Global Outcomes [KDIGO] bundle of care"). Thus, the SCA's Continuing Practice Improvement Acute Kidney Injury Working Group aimed to provide a practice update for each of these strategies in cardiac surgical patients based on the evidence from randomized controlled trials (RCTs). PubMed, EMBASE, and Cochrane library databases were comprehensively searched for eligible studies from inception through February 2021, with search results updated in August 2021. A total of 15 RCTs investigating the effects of the above-mentioned strategies on CS-AKI were included for meta-analysis. For each strategy, the level of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology. Across the 6 potentially renoprotective strategies evaluated, current evidence for their use was rated as "moderate," "low," or "very low." Based on eligible RCTs, our analysis suggested using goal-directed oxygen delivery on CPB and the "KDIGO bundle of care" in high-risk patients to prevent CS-AKI (moderate level of GRADE evidence). Our results suggested considering the use of vasopressin in vasoplegic shock patients to reduce CS-AKI (low level of GRADE evidence). The decision to use a restrictive versus liberal strategy for perioperative red cell transfusion should not be based on concerns for renal protection (a moderate level of GRADE evidence). In addition, targeting a higher mean arterial pressure during CPB, perioperative use of dopamine, and use of dexmedetomidine did not reduce CS-AKI (a low or very low level of GRADE evidence). This review will help clinicians provide evidence-based care, targeting improved renal outcomes in adult patients undergoing cardiac surgery.
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Sguanci M, Mandolfino F. Standardized perioperative practice in surgery during the covid-19 pandemic: a narrative review of the evidences. Minerva Surg 2022; 77:263-271. [PMID: 35175016 DOI: 10.23736/s2724-5691.22.09417-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION The Coronavirus (Covid-19) pandemic activated a global health crisis. The best practice in operating room is a discussed argument. This review was performed to clarify the importance and effectiveness of standardized clinical practice (procedure, organization, guidance), identifying contemporary evidence deduced from some international experience. We decided to make a narrative review that analyses the most current shared guidelines and procedures in management of Covid-19 patients in perioperative theatre. EVIDENCE ACQUISITION Medline was searched using PubMed (from 1 April 2020 to 22 December 2020) for relevant study according with Prisma Guidelines. The studies were assessed and classified for levels of evidence and recommendation. Three factors were extracted: operating room organization, personnel safety and procedures. EVIDENCE SYNTHESIS 44 articles were identified: eleven met eligibility criteria: of these , four articles are expert opinion/experience/descriptive study, one is a multicentre/descriptive study and six are review/systematic review. 33 articles were excluded because didn't meet inclusion criteria. The studies selection is focused on clinical processes in the operating theatre, guidelines for the Operating Room safety, correct procedures for Personal Protective Equipement use, experience and recommendations related to COVID-19 context. CONCLUSIONS despite the modest number of studies and high-evidence, all the publications show agreement about many aspects of Operating Room practice. Global experiences selection confirms the role and the importance of a standardized practice in operating theatre instead personal interpretation; this study aims to provide a guidelines qualitative synthesis for all surgical staff, enclosing basic behaviours for the staff and patient safety in a complex assistant approach on a pandemic time.
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Bonalumi G, Giambuzzi I, Buratto B, Barili F, Garatti A, Pilozzi Casado A, Di Mauro M, Parolari A. The day after tomorrow: cardiac surgery and coronavirus disease-2019. J Cardiovasc Med (Hagerstown) 2022; 23:75-83. [PMID: 34958311 DOI: 10.2459/jcm.0000000000001223] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The impact of the coronavirus disease-2019 (COVID-19) pandemic forced the governments worldwide to deal with an unprecedented health crisis. The aim of this review is to summarize what happened to cardiac surgery worldwide during the first wave of this pandemic. A literature search was performed to extrapolate key concepts regarding guidelines and reorganization of cardiac surgery wards during COVID-19. Supporting literature was also included to discuss the hot topics related to COVID-19 and cardiac surgery. Hence, both official documents from national scientific societies and single- or multiple-center experiences during the pandemics are reviewed and discussed. In Italy, the first western country hit by the pandemic, two different models were proposed to cope with the need for ICU/ward beds and to reallocate cardiac surgical services: Hub-and-Spoke system ('Hubs', dedicated to perform urgent and nondeferrable surgery, and 'Spokes', turned into COVID centers) and/or a progressive reduction in surgical activity. Worldwide, several guidelines/consensus statements were published, suggesting how to deal with the outbreak. Two different approaches for stratifying surgical indications were proposed: dynamic, based on the number of hospitalized COVID-19 patients; static, based only on the severity of the cardiovascular disease. Moreover, the importance of personal protective equipment was stressed. Several measures should have been adopted to deal with an unprecedented need for healthcare resources allocation to care for COVID-19 patients, putting the healthcare systems under serious stress. Cardiac surgery has, as have most surgical activities, been asked to reduce its own activity, giving priority to emergency and nondeferrable cases.
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Affiliation(s)
- Giorgia Bonalumi
- Department of Cardiovascular Surgery, Centro Cardiologico Monzino, IRCCS
| | - Ilaria Giambuzzi
- Department of Cardiovascular Surgery, Centro Cardiologico Monzino, IRCCS
- DISCCO, University of Milan
| | - Beatrice Buratto
- SC Universitary Cardiac Surgery, IRCCS Policlinico S. Donato, University of Milan, Milan
| | - Fabio Barili
- Department of Cardiac Surgery, S. Croce Hospital, Cuneo
| | - Andrea Garatti
- Department of Cardiac Surgery, IRCCS Policlinico San Donato, Milan, Italy
| | | | - Michele Di Mauro
- Cardio-Thoracic Surgery Unit, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Alessandro Parolari
- Unit of Cardiac Surgery and Translational Research, IRCCS Policlinico S. Donato, University of Milan, Milan, Italy
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Roussakis A, Boumpoulis K, Nenekidis I, Gavalaki A, Petsios K, Dimopoulos S, Bisiadis I, Rellia P, Perreas K. Trends regarding the profile of cardiac surgery patients during the first wave of COVID-19 pandemic in Greece. Braz J Cardiovasc Surg 2022; 37:418-421. [PMID: 35605222 PMCID: PMC9162420 DOI: 10.21470/1678-9741-2021-0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Antonios Roussakis
- 1st Cardiac Surgery Department, Onassis Cardiac Surgery Center, Athens, Greece.
| | | | - Ioannis Nenekidis
- 1st Cardiac Surgery Department, Onassis Cardiac Surgery Center, Athens, Greece.
| | - Aikaterini Gavalaki
- 1st Cardiac Surgery Department, Onassis Cardiac Surgery Center, Athens, Greece.
| | | | | | - Ioannis Bisiadis
- Intensive Care Unit, Onassis Cardiac Surgery Center, Athens, Greece
| | - Panagiota Rellia
- Anesthesiology Department, Onassis Cardiac Surgery Center, Athens, Greece
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Recommendations for developing clinical care protocols during pandemics: From theory and practice. Best Pract Res Clin Anaesthesiol 2021; 35:461-475. [PMID: 34511233 PMCID: PMC7912357 DOI: 10.1016/j.bpa.2021.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 02/23/2021] [Indexed: 12/13/2022]
Abstract
In 2019, a novel coronavirus called the severe acute respiratory syndrome coronavirus 2 led to the outbreak of the coronavirus disease 2019, which was deemed a pandemic by the World Health Organization in March 2020. Owing to the accelerated rate of mortality and utilization of hospital resources, health care systems had to adapt to these major changes. This affected patient care across all disciplines and specifically within the perioperative services. In this review, we discuss the strategies and pitfalls of how perioperative services in a large academic medical center responded to the initial onset of a pandemic, adjustments made to airway management and anesthesia specialty services – including critical care medicine, obstetric anesthesiology, and cardiac anesthesiology - and strategies for reopening surgical caseload during the pandemic.
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Şentürk M, El Tahan MR, Shelley B, Szegedi LL, Piccioni F, Licker MJ, Karzai W, Gil MG, Neskovic V, Vanpeteghem C, Pelosi P, Cohen E, Sorbello M, MBChB JB, Stoica R, Mourisse J, Brunelli A, Jimenez MJ, Drnvsek-Globoikar M, Yapici D, Morsy AS, Kawagoe I, Végh T, Navarro-Ripoll R, Marczin N, Paloczi B, Unzueta C, Gregorio GD, Wouters P, Rex S, Mukherjee C, Paternoster G, Guarracino F. Thoracic Anesthesia during the COVID-19 Pandemic: 2021 Updated Recommendations by the European Association of Cardiothoracic Anaesthesiology and Intensive Care (EACTAIC) Thoracic Subspecialty Committee. J Cardiothorac Vasc Anesth 2021; 35:3528-3546. [PMID: 34479782 PMCID: PMC8313821 DOI: 10.1053/j.jvca.2021.07.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/09/2021] [Accepted: 07/11/2021] [Indexed: 02/07/2023]
Abstract
The novel coronavirus pandemic has radically changed the landscape of normal surgical practice. Lifesaving cancer surgery, however, remains a clinical priority, and there is an increasing need to fully define the optimal oncologic management of patients with varying stages of lung cancer, allowing prioritization of which thoracic procedures should be performed in the current era. Healthcare providers and managers should not ignore the risk of a bimodal peak of mortality in patients with lung cancer; an imminent spike due to mortality from acute coronavirus disease 2019 (COVID-19) infection, and a secondary peak reflecting an excess of cancer-related mortality among patients whose treatments were deemed less urgent, delayed, or cancelled. The European Association of Cardiothoracic Anaesthesiology and Intensive Care Thoracic Anesthesia Subspecialty group has considered these challenges and developed an updated set of expert recommendations concerning the infectious period, timing of surgery, vaccination, preoperative screening and evaluation, airway management, and ventilation of thoracic surgical patients during the COVID-19 pandemic.
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Affiliation(s)
- Mert Şentürk
- Dep. of Anesthesiology & Reanimation, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey.
| | - Mohamed R El Tahan
- Cardiothoracic Anesthesiology, College of Medicine, Mansoura University, Mansoura, Egypt
| | - Ben Shelley
- Cardiothoracic Anaesthesia and Intensive Care, Golden Jubilee National Hospital/West of Scotland Heart and Lung Centre, University of Glasgow Academic Unit of Anaesthesia, Pain and Critical Care, Scotland
| | - Laszlo L Szegedi
- Department of Anesthesiology, CUB Hôpital Erasme, ULB Université Libre de Bruxelles, Brussels, Belgium
| | - Federico Piccioni
- Anesthesia and Intensive Care Unit, Department of Critical and Supportive Care, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marc-Joseph Licker
- Anesthesia, Pharmacology and Intensive Care, University Hospital Geneva, Geneva, Switzerland
| | - Waheedullah Karzai
- Chefarzt, Zentralklinik Bad Berka GmbH, Robert-Koch-Allee, Bad Berka, Germany
| | | | - Vojislava Neskovic
- Anesthesia and Intensive Care, Military Medical Academy Belgrade, Belgrade, Serbia
| | | | - Paolo Pelosi
- Università degli Studi di Genova, UNIGE, Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate (DISC), Genoa, Italy
| | - Edmond Cohen
- Anesthesiology, Perioperative & Pain Medicine, Thoracic Surgery Specialty, Anesthesiology Icahn School of Medicine at Mount Sinai, New York, NY; Anesthesia and Intensive Care, AOU Policlinico Vittorio Emanuele San Marco, Catania, Italy
| | - Massimiliano Sorbello
- Anesthesia, Pharmacology and Intensive Care, University Hospital Geneva, Geneva, Switzerland
| | - Johan Bence MBChB
- Cardiothoracic Anaesthesiology, University Hospitals of Leicester Glenfield Hospital, Leicester, UK
| | - Radu Stoica
- Faculty of Medicine, Titu Maiorescu, Bucharest; Anesthesia and Intensive Care, Military Medical Academy Belgrade, Belgrade, Serbia
| | - Jo Mourisse
- Anesthesiology and ICU, Monza Oncolgy Hospital, Bucharest; Department of Anesthesia, Pain and Palliative Medicine, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands
| | - Alex Brunelli
- Department of Thoracic Surgery, St. James's University Hospital, Leeds, UK
| | - Maria-José Jimenez
- Anesthesiology, Centro Medico Teknon, Universitat de Barcelona, Barcelona, Spain
| | | | - Davud Yapici
- Anesthesia and Intensive Care, Mersin University School of Medicine, Mersin, Turkey
| | - Ahmed Salaheldin Morsy
- Department of Anesthesia, King Fahd Hospital of the Imam Abdulrahman bin Faisal University, Al Khober, Saudi Arabia
| | - Izumi Kawagoe
- Department of Anesthesiology and Pain Medicine, Juntendo University School of Medicine, Tokyo, Japan; Outcomes Research Consortium, Cleveland, OH
| | - Tamás Végh
- Department of Anesthesiology and Intensive Care, University of Debrecen, Debrecen, Hungary
| | | | - Nandor Marczin
- Department of Anesthesiology, Ljubjljana University Medical Centre, Ljubljana, Slovenia; Section of Anesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK; Department of Anesthesia, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield, Middlesex, UK
| | - Balazs Paloczi
- Department of Anesthesiology and Intensive Care, University of Debrecen, Debrecen, Hungary
| | - Carmen Unzueta
- Department of Anesthesiology, Hospital de la Santa Creu i San Pau, Barcelona, Spain
| | - Guido Di Gregorio
- Anesthesia and Critical Care Azienda Ospedaliera Università di Padova, Padova, Italy
| | - Patrick Wouters
- Department of Anesthesia and Perioperative Medicine, Ghent University, Ghent, Belgium
| | - Steffen Rex
- Clinic Department of Anesthesiology, University Hospitals Leuven, Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Chirojit Mukherjee
- Department of Anaesthesia & Intensive Care, Helios Clinic for Cardiac Surgery, Karlsruhe, Germany
| | - Gianluca Paternoster
- Division of Cardiac Resuscitation, Cardiovascular Anesthesia and Intensive Care San Carlo Hospital (Potenza) Italy Via Potito Petrone, Italy
| | - Fabio Guarracino
- Department of Anesthesia and Critical Care Medicine, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
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Mejia OAV, Borgomoni GB, Silveira LMV, Guerreiro GP, Falcão Filho ATG, Goncharov M, Dallan LRP, Oliveira MAP, de Sousa AG, Nakazone MA, Tiveron MG, Campagnucci VP, de Barros E Silva PGM, Dallan LAO, Lisboa LAF, Jatene FB. The arrival of COVID-19 in Brazil and the impact on coronary artery bypass surgery. J Card Surg 2021; 36:3070-3077. [PMID: 34091941 DOI: 10.1111/jocs.15712] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 04/20/2021] [Accepted: 04/24/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND AIM OF THE STUDY This study analyzed the arrival of coronavirus disease 2019 (COVID-19) in Brazil and its impact on coronary artery bypass grafting (CABG) surgery. METHODS Patients undergoing isolated CABG in six hospitals in Brazil were divided into two periods: pre-COVID-19 (March-May 2019, N = 468) and COVID-19 era (March-May 2020, N = 182). Perioperative data were included on a dedicated REDCap platform. Patients with clinical and tomographic criteria and/or PCR (+) for severe acute respiratory syndrome coronavirus 2 infection were considered COVID-19 (+). Logistic regression analysis was performed to create a multiple predictive model for mortality after CABG in COVID-19 era. RESULTS Compared to 2019, in 2020, CABG surgeries had a 2.8-fold increased mortality risk (95% confidence interval [CI]: 1-7.6, p = .041), patients who evolved with COVID-19 had a 11-fold increased mortality risk (95% CI: 2.2-54.9, p < .003), rates of morbidities and readmission to the intensive care unit. The surgical volume was decreased by 60%. The model to predict mortality after CABG in the COVID-19 era was validated with good calibration (Hosmer-Lemeshow = 1.43) and discrimination (receiver operating characteristic = 0.78). CONCLUSION The COVID-19 pandemic had an adverse impact on mortality, morbidity and volume of patients undergoing CABG.
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Affiliation(s)
- Omar A V Mejia
- Department of Cardiovascular Surgery, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina do Estado de São Paulo (InCor), São Paulo, São Paulo, Brazil.,Department of Cardiovascular Surgery, Hospital Samaritano Paulista, São Paulo, São Paulo, Brazil
| | - Gabrielle B Borgomoni
- Department of Cardiovascular Surgery, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina do Estado de São Paulo (InCor), São Paulo, São Paulo, Brazil
| | - Lucas M V Silveira
- Department of Cardiovascular Surgery, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina do Estado de São Paulo (InCor), São Paulo, São Paulo, Brazil
| | - Gustavo P Guerreiro
- Department of Cardiovascular Surgery, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina do Estado de São Paulo (InCor), São Paulo, São Paulo, Brazil
| | - Alexandre T G Falcão Filho
- Department of Cardiovascular Surgery, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina do Estado de São Paulo (InCor), São Paulo, São Paulo, Brazil
| | - Maxim Goncharov
- Department of Cardiovascular Surgery, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina do Estado de São Paulo (InCor), São Paulo, São Paulo, Brazil
| | - Luís R P Dallan
- Department of Cardiovascular Surgery, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina do Estado de São Paulo (InCor), São Paulo, São Paulo, Brazil
| | - Marco A P Oliveira
- Department of Cardiovascular Surgery, Beneficência Portuguesa de São Paulo, São Paulo, São Paulo, Brazil
| | - Alexandre G de Sousa
- Department of Cardiovascular Surgery, Beneficência Portuguesa de São Paulo, São Paulo, São Paulo, Brazil
| | - Marcelo A Nakazone
- Department of Cardiovascular Surgery, Hospital de Base de São José do Rio Preto, São José de Rio Preto, São Paulo, Brazil
| | - Marcos G Tiveron
- Department of Cardiovascular Surgery, Irmandade da Santa Casa de Misericórdia de Marília, Marília, São Paulo, Brazil
| | - Valquíria P Campagnucci
- Department of Cardiovascular Surgery, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, São Paulo, Brazil
| | | | - Luís A O Dallan
- Department of Cardiovascular Surgery, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina do Estado de São Paulo (InCor), São Paulo, São Paulo, Brazil
| | - Luiz A F Lisboa
- Department of Cardiovascular Surgery, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina do Estado de São Paulo (InCor), São Paulo, São Paulo, Brazil
| | - Fábio B Jatene
- Department of Cardiovascular Surgery, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina do Estado de São Paulo (InCor), São Paulo, São Paulo, Brazil
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10
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Postoperative Nosocomial COVID 19 infection in Cardiac Surgery: An Uncommon event with High Mortality. CJC Open 2021; 3:1217-1220. [PMID: 34109309 PMCID: PMC8178155 DOI: 10.1016/j.cjco.2021.05.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 05/31/2021] [Indexed: 01/10/2023] Open
Abstract
The COVID-19 pandemic has had a major impact on cardiac surgery patients. Significant reductions in access to surgical treatment have forced surgeons to prioritise patients and follow strict COVID-19 protocols to protect surgeons, staff, and patients.1 Nosocomial infections among Cardiac Surgery patients have been reported and are associated with a high mortality.2 As a COVID-19 tertiary care centre and a tertiary cardiac centre, we tried to balance the need to operate on urgent cardiac cases while protecting patients and staff from COVID-19. During the first wave of the pandemic, a total of 579 surgeries were performed. We report findings from an outbreak of four nosocomial infections. All patients tested negative within 24 hours of surgery or admission. Three patients were positive following surgery, suggesting an overall nosocomial rate during the first wave of 0.5% (3/579). One patient admitted for evaluation tested positive during mass screening. Two of the four patients died following respiratory complications. No healthcare worker (HCW) or family member with direct contact with these patients tested positive for COVID-19. Nosocomial COVID-19 infection is uncommon when adhering to safety protocols. Although uncommon, the mortality rate is high (50%) in our series. As widespread vaccination of HCWs and high-risk individuals susceptible to COVID-19 is in progress, we suggest that cardiac surgery patients, when feasible, be vaccinated prior to surgery given this could prevent excess mortality, protect HCWs and reduce resource use.
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11
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Guarracino F, Shernan SK, Tahan ME, Bertini P, Stone ME, Kachulis B, Paternoster G, Mukherjee C, Wouters P, Rex S. EACTA/SCA Recommendations for the Cardiac Anesthesia Management of Patients With Suspected or Confirmed COVID-19 Infection: An Expert Consensus From the European Association of Cardiothoracic Anesthesiology and Society of Cardiovascular Anesthesiologists With Endorsement From the Chinese Society of Cardiothoracic and Vascular Anesthesiology. J Cardiothorac Vasc Anesth 2021; 35:1953-1963. [PMID: 33766471 PMCID: PMC7889009 DOI: 10.1053/j.jvca.2021.02.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/10/2021] [Accepted: 02/12/2021] [Indexed: 12/20/2022]
Abstract
The European Association of Cardiothoracic Anaesthesiology (EACTA) and the Society of Cardiovascular Anesthesiologists (SCA) aimed to create joint recommendations for the perioperative management of patients with suspected or proven severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection undergoing cardiac surgery or invasive cardiac procedures. To produce appropriate recommendations, the authors combined the evidence from the literature review, reevaluating the clinical experience of routine cardiac surgery in similar cases during the Middle East Respiratory Syndrome (MERS-CoV) outbreak and the current pandemic with suspected coronavirus disease 2019 (COVID-19) patients, and the expert opinions through broad discussions within the EACTA and SCA. The authors took into consideration the balance between established procedures and the feasibility during the present outbreak. The authors present an agreement between the European and US practices in managing patients during the COVID-19 pandemic. The recommendations take into consideration a broad spectrum of issues, with a focus on preoperative testing, safety concerns, overall approaches to general and specific aspects of preparation for anesthesia, airway management, transesophageal echocardiography, perioperative ventilation, coagulation, hemodynamic control, and postoperative care. As the COVID-19 pandemic is spreading, it will continue to present a challenge for the worldwide anesthesiology community. To allow these recommendations to be updated as long as possible, the authors provided weblinks to international public and academic sources providing timely updated data. This document should be the basis of future task forces to develop a more comprehensive consensus considering new evidence uncovered during the COVID-19 pandemic.
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Affiliation(s)
- Fabio Guarracino
- Cardiothoracic and Vascular Anesthesia and Intensive Care, Department of Anesthesia and Critical Care Medicine, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
| | - Stanton K Shernan
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Mohamed El Tahan
- Department of Anaesthesia, Intensive Care and Pain Medicine, College of Medicine, Mansoura University, Mansoura, Egypt
| | - Pietro Bertini
- Cardiothoracic and Vascular Anesthesia and Intensive Care, Department of Anesthesia and Critical Care Medicine, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Marc E Stone
- Department of Anesthesiology, Division of Cardiothoracic Anesthesiology, Mount Sinai Medical Center, New York, NY
| | - Bessie Kachulis
- New York-Presbyterian Hospital/Weill Cornell Medical College, Cornell University, New York, NY
| | - Gianluca Paternoster
- Division of Cardiac Resuscitation, Cardiovascular Anesthesia and Intensive Care, San Carlo Hospital, Potenza, Italy
| | - Chirojit Mukherjee
- Department of Anesthesia and Intensive Care, Helios Clinic for Cardiac Surgery, Karlsruhe, Germany
| | - Patrick Wouters
- Anesthesia and Perioperative Medicine, Ghent University, Ghent, Belgium
| | - Steffen Rex
- Department of Anesthesiology, University Hospitals Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
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12
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Yang L, Yu X, Wu X, Wang J, Yan X, Jiang S, Chen Z. Emergency response to the explosive growth of health care wastes during COVID-19 pandemic in Wuhan, China. RESOURCES, CONSERVATION, AND RECYCLING 2021; 164:105074. [PMID: 32834492 PMCID: PMC7434318 DOI: 10.1016/j.resconrec.2020.105074] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/22/2020] [Accepted: 07/26/2020] [Indexed: 05/18/2023]
Abstract
During the Coronavirus Disease 2019 (COVID-19) as a worldwide pandemic, the security management of health care wastes (HCWs) has attracted increasing concern due to their high risk. In this paper, the integrated management of HCWs in Wuhan, the first COVID-19-outbreaking city with over ten millions of people completely locking down, was collected, investigated and analyzed. During the pandemic, municipal solid wastes (MSWs) from designated hospitals, Fangcang shelter hospitals, isolation locations and residential areas (e.g. face masks) were collected and categorized as HCWs due to the high infectiousness and strong survivability of COVID-19, and accordingly the average production of HCWs per 1000 persons in Wuhan explosively increased from 3.64 kg/d to 27.32 kg/d. Segregation, collection, storage, transportation and disposal of HCWs in Wuhan were discussed and outlined. Stationary facilities, mobile facilities, co-processing facilities (Incineration plants for MSWs) and nonlocal disposal were consecutively utilized to improve the disposal capacity, from 50 tons/d to 280.1 tons/d. Results indicated that stationary and co-processing facilities were preferential for HCWs disposal, while mobile facilities and nonlocal disposal acted as supplementary approaches. Overall, the improved system of HCWs management could meet the challenge of the explosive growth of HCWs production during COVID-19 pandemic in Wuhan. Furthermore, these practices could provide a reference for other densely populated metropolises.
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Affiliation(s)
- Lie Yang
- Hubei Key Laboratory of Mineral Resources Processing and Environment, School of Resources and Environmental Engineering, Wuhan University of Technology, Wuhan 430070, PR China
| | - Xiao Yu
- Wuhan Institute of Environmental Sanitation Science, Wuhan 430000, PR China
| | - Xiaolong Wu
- Hubei Solid Waste and Chemical Pollution Prevention Center, Wuhan 430000, PR China
| | - Jia Wang
- Hubei Provincial Engineering Laboratory of Solid Waste Treatment, Disposal and Recycling, Huazhong University of Science and Technology, Wuhan, 430074, PR China
| | - Xiaoke Yan
- Hubei Key Laboratory of Mineral Resources Processing and Environment, School of Resources and Environmental Engineering, Wuhan University of Technology, Wuhan 430070, PR China
| | - Shen Jiang
- Hubei Provincial Engineering Laboratory of Solid Waste Treatment, Disposal and Recycling, Huazhong University of Science and Technology, Wuhan, 430074, PR China
| | - Zhuqi Chen
- Hubei Provincial Engineering Laboratory of Solid Waste Treatment, Disposal and Recycling, Huazhong University of Science and Technology, Wuhan, 430074, PR China
- Key Laboratory of Material Chemistry for Energy Conversion and Storage, Ministry of Education, Hubei Key Laboratory of Material Chemistry and Service Failure, School of Chemistry and Chemical Engineering, Huazhong University of Science and Technology, Wuhan, 430074, PR China
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13
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Ziyaeifard M, Ziyaeifard P. Cardiac anesthesia and COVID-19 outbreak: What should we know? JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2020; 25:89. [PMID: 33273934 PMCID: PMC7698443 DOI: 10.4103/jrms.jrms_336_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 04/26/2020] [Accepted: 05/19/2020] [Indexed: 12/19/2022]
Abstract
The COVID-19 outbreak is public health emergency, spreads easily from human to human, and may cause acute severe respiratory syndrome. The anesthesia teams who perform this procedure are at risk aerosolization and need special consideration and safety measures. Cardiac anesthesiologist follows two aims, recognition of COVID-19 patients that need surgery and decreasing the risk of perioperative viral transmission to coworkers. An isolated operating room (negative pressure operating room for COVID-19) should be available. It is important to regulate workflow and practices, anesthesia management, healthcare, and staff. Cardiac anesthesiologist and health-care workers must be use guidelines to treat patients with COVID-19.
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Affiliation(s)
- Mohsen Ziyaeifard
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Parisa Ziyaeifard
- Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
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14
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Chatterjee S, Anton JM, Rosengart TK, Coselli JS. Cardiac surgery during the COVID-19 sine wave: Preparation once, preparation twice. A view from Houston. J Card Surg 2020; 36:1615-1623. [PMID: 32985747 PMCID: PMC7537308 DOI: 10.1111/jocs.14987] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The novel coronavirus disease (COVID-19) pandemic has created major challenges and disruptions to hospitals throughout the world, with profound implications for cardiac surgery and cardiac surgeons. In this review, we highlight the hospital and cardiac surgical experience at Baylor St. Luke's Medical Center in the Texas Medical Center in Houston, Texas as of mid-July 2020. Our local experience has consisted of a spring surge (early March to early May), followed by a relative flattening and then a summer surge (early June to present day), similar to a sine wave. Throughout the entire pandemic, our simultaneous medical priorities have been treating the growing number of patients with COVID-19 while continuing to provide needed care for those without COVID-19. The current situation will be the "new normal" until a vaccine becomes available. It will be vital to stay attuned to epidemiologists, public health officials, and infection control experts, because what they see today, the intensive care units will see tomorrow. The lessons we have learned are outlined in this review but can be summarized most succinctly: preparation. We must prepare in advance, stockpile supplies and personal protective equipment, have rapid and vigorous testing protocols in place, utilize technology (eg, online meetings, videoconference "office visits"), and encourage hospital-wide and community protective efforts (social distancing, mask wearing, hand hygiene). Hopefully, the lessons learned through this challenging experience will prepare us for the next time.
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Affiliation(s)
- Subhasis Chatterjee
- Michael E. DeBakey Department of Surgery, Division of General Surgery, Baylor College of Medicine, Houston, Texas.,Michael E. DeBakey Department of Surgery, Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, Texas.,Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Texas
| | - James M Anton
- Department of Anesthesiology, Division of Cardiovascular Anesthesia, Baylor College of Medicine, Houston, Texas
| | - Todd K Rosengart
- Michael E. DeBakey Department of Surgery, Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, Texas.,Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Texas
| | - Joseph S Coselli
- Michael E. DeBakey Department of Surgery, Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, Texas.,Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Texas
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15
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Zhang CH, Ma WG, Zhong YL, Ge YP, Li CN, Qiao ZY, Liu YM, Zhu JM, Sun LZ. Management of acute type A aortic dissection during COVID-19 outbreak: Experience from Anzhen. J Card Surg 2020; 36:1659-1664. [PMID: 32939857 DOI: 10.1111/jocs.15041] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 09/05/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVES We seek to report our management protocol and early outcomes of acute type A aortic dissection (ATAAD) repair during the early phase of coronavirus disease 2019 (COVID-19). METHODS From January 23 to April 30, 2020, we performed ATAAD repair for 33 patients, including three with pregnancy-related TAADs. Confirmation of COVID-19 depended on the results of two nucleic acid tests and pulmonary computed tomography scan. Based on testing results and hemodynamic stability, patients were triaged to an isolated intensive care unit or negative pressure operating room for emergency surgery. RESULTS Mean age 50.2 ± 13.3 years and 20 were male (60.1%) and 8 patients were febrile (>37.3°C; 24.2%) and 17 were lymphopenic (51.5%). No patient was excluded from COVID-19 infection preoperatively. Extensive aortic repair with total arch replacement (TAR) was performed in 24 (72.7%), and limited proximal repair in 9 patients (27.3%). Cardiopulmonary bypass and cross-clamp times averaged 177 ± 34 and 88 ± 20 min for TAR, and 150 ± 30 and 83 ± 18 min for hemiarch, respectively. The mean operation time was 410 ± 68.3 min. Operative mortality was 6.1% (2/33). Complications included reintubation in four (12.1%), acute kidney failure in two (6.1%), and cerebral infarction in one (3.0%). No paraplegia nor re-exploration for bleeding occurred. COVID-19 was excluded in 100% eventually. No nosocomial infection occurred. Nor did any patient/surgical staff develop fever or test positive during the study period. CONCLUSIONS The results of this study show that our management protocol based on testing results and hemodynamic stability in patients with ATAAD during the COVID-19 pandemic was effective and achieved favorable early surgical outcomes.
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Affiliation(s)
- Chen-Han Zhang
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Aortic Disease Center, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Wei-Guo Ma
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Aortic Disease Center, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Yong-Liang Zhong
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Aortic Disease Center, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Yi-Peng Ge
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Aortic Disease Center, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Cheng-Nan Li
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Aortic Disease Center, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Zhi-Yu Qiao
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Aortic Disease Center, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Yong-Min Liu
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Aortic Disease Center, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Jun-Ming Zhu
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Aortic Disease Center, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Li-Zhong Sun
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Aortic Disease Center, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
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Tridente A. Introducing video content into Scars, Burns & Healing. Scars Burn Heal 2020; 6:2059513120972603. [PMID: 33282340 PMCID: PMC7691894 DOI: 10.1177/2059513120972603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Ascanio Tridente
- Whiston Hospital, St Helens' and Knowsley NHS Trust, Prescot, UK and Sheffield University, Prescot, UK
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