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Davis HD, Habarth-Morales TE, Messa CA, Broach RB, Lin IC. Extracorporeal Membrane Oxygenation-Associated Compartment Syndrome: Review of a National Database. J Surg Res 2024; 298:94-100. [PMID: 38593603 DOI: 10.1016/j.jss.2024.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 01/28/2024] [Accepted: 02/16/2024] [Indexed: 04/11/2024]
Abstract
INTRODUCTION Extracorporeal membrane oxygenation (ECMO)-associated compartment syndrome (CS) is a rare complication seen in critically ill patients. The epidemiology and management of ECMO-associated CS in the upper extremity (UE) and lower extremity (LE) are poorly defined in the literature. We sought to determine the epidemiology and characterize treatment and outcomes of UE-CS compared to LE-CS in the setting of ECMO therapy. METHODS Adult patients undergoing ECMO therapy were identified in the Nationwide Readmission Database (2015-2019) and followed up for 6 months. Patients were stratified based on UE-CS versus LE-CS. Primary outcomes were fasciotomy and amputation. All-cause mortality and length of stay were also collected. Risk-adjusted modeling was performed to determine patient- and hospital-level factors associated with differences in the management UE-CS versus LE-CS while controlling for confounders. RESULTS A total of 24,047 cases of ECMO during hospitalization were identified of which 598 were complicated by CS. Of this population, 507 cases were in the LE (84.8%), while 91 (15.5%) were in the UE. After multivariate analysis, UE-CS patients were less likely to undergo fasciotomy (50.5 vs. 70.9; P = 0.013) and were less likely to undergo amputation of the extremity (3.3 vs. 23.7; P = 0.001) although there was no difference in mortality (58.4 vs. 65.4; P = 0.330). CONCLUSIONS ECMO patients with CS experience high mortality and morbidity. UE-CS has lower rates of fasciotomy and amputations, compared to LE-CS, with similar mortality. Further studies are needed to elucidate the reasons for these differences.
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Affiliation(s)
- Harrison D Davis
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania; Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania.
| | - Theodore E Habarth-Morales
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Charles A Messa
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robyn B Broach
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ines C Lin
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
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Solasz S, Ganta A, Robitsek RJ, Egol KA, Konda S. Thigh compartment syndrome: Outcomes in an urban level 1 trauma center. Injury 2024; 55:111331. [PMID: 38244251 DOI: 10.1016/j.injury.2024.111331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 01/04/2024] [Accepted: 01/14/2024] [Indexed: 01/22/2024]
Abstract
INTRODUCTION Thigh compartment syndrome (TCS) is a rare surgical emergency associated with a high risk of morbidity with mortality rates as high as 47 %. There is sparse literature discussing the management as well as outcomes of these injuries. The purpose of this study is to review a consecutive series of patients presenting to a single urban Level 1 trauma center with TCS to identify injury characteristics, clinical presentation, and outcomes associated with this injury. METHODS A trauma database was queried for all patients with a diagnosis of TCS at a single level 1 urban trauma center between January 1, 2011 and December 31, 2021. Demographic and injury variables collected included age, sex, BMI, mechanism of injury, and creatine phosphokinase levels (CPK). Hospital quality measures including time from admission to surgery, length of both hospital and ICU stay, complications, and cost of care were collected. Descriptive statistics are reported as median [interquartile range] or N (percent). RESULTS There were 14 patients identified with a diagnosis of TCS. All were men with an average age 33.5 [23.5 - 38] years and an average BMI of 26 [22.9-28.1]. The most common cause of injury was blunt trauma (71.4 %), and the remaining 28.6 % were gunshot wound injuries. Within the cohort, 6 (42.9 %) patients sustained a femoral shaft fracture, and 4 (28.6 %) patients sustained a vascular injury. The median initial CPK of patients within this cohort was 3405 [1232-5339] and reached a peak of 5271 [3013-13,266]. The median time from admission to diagnosis was 6.8 [0-236.9] hours. The median time from admission to the operating room was 8.2 [0.6-236.9] hours, and the median number of operating room visits was 3 [2 - 6]. Five patients (35.7 %) wounds were closed with split thickness skin grafting. There were 12 (85.7 %) patients who required ICU care. The median ICU length of stay was 7.5 days [4-15]. The median hospital length of stay was 16.5 days [13.25-38.0]. The median total charges for a patient with thigh compartment syndrome was $129,159.00 [$24,768.00 - $587,152.00]. The median direct variable cost for these patients was $86,106.00 For comparison, the median direct variable cost for patients with femur fractures without TCS at this institution was $8,497.28 [$1,903.52-$21,893.13]. No patients required readmission within 60 days. There were no mortalities. CONCLUSION TCS is a rare and life-threatening injury associated with significant morbidity. Despite rapid diagnosis and fasciotomy, the majority of the patients have prolonged hospital courses, ICU lengths of stay, and significant costs of treatment. Providers can reference the outcomes reported in this study when caring for TCS patients.
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Affiliation(s)
- Sara Solasz
- NYU Langone Health, NYU Langone Orthopedic Hospital, Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, 301 East 17th Street, New York, NY 10003, US
| | - Abhishek Ganta
- NYU Langone Health, NYU Langone Orthopedic Hospital, Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, 301 East 17th Street, New York, NY 10003, US; Jamaica Hospital Medical Center, Department of Orthopaedic Surgery, 8900 Van Wyck Expressway, Richmond Hill, NY 11418, Canada
| | - R Jonathan Robitsek
- NYU Langone Health, NYU Langone Orthopedic Hospital, Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, 301 East 17th Street, New York, NY 10003, US
| | - Kenneth A Egol
- NYU Langone Health, NYU Langone Orthopedic Hospital, Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, 301 East 17th Street, New York, NY 10003, US; Jamaica Hospital Medical Center, Department of Orthopaedic Surgery, 8900 Van Wyck Expressway, Richmond Hill, NY 11418, Canada
| | - Sanjit Konda
- NYU Langone Health, NYU Langone Orthopedic Hospital, Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, 301 East 17th Street, New York, NY 10003, US; Jamaica Hospital Medical Center, Department of Orthopaedic Surgery, 8900 Van Wyck Expressway, Richmond Hill, NY 11418, Canada.
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Amin RM, Chaudhry YP, Rao SS, Puvanesarajah V, Best MJ, Etchill E, Hasenboehler EA. Extremity fasciotomy for patients on extracorporeal membrane oxygenation is independently associated with inpatient mortality. Orthop Traumatol Surg Res 2022; 108:103144. [PMID: 34785372 DOI: 10.1016/j.otsr.2021.103144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 02/11/2021] [Accepted: 02/19/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Extracorporeal membrane oxygenation (ECMO) maintains end-organ perfusion in critically ill patients with cardiac or respiratory failure; however, ECMO cannulation in the extremities has been associated with significant limb ischemia and risk of compartment syndrome. Current literature on ECMO and fasciotomies is limited to small single-center retrospective studies. This study aimed to (1) compare the incidence of postoperative outcomes and mortality in patients undergoing fasciotomy while on ECMO to those of non-fasciotomy ECMO patients, and (2) assess the difference in adjusted mortality risk between the two groups. HYPOTHESIS We hypothesized that patients undergoing fasciotomy while on ECMO would have significantly higher odds of in-hospital mortality than non-fasciotomy ECMO patients after adjustment for perioperative variables. METHODS We conducted a retrospective review of NIS from January 1st, 2012-September 30, 2015 for all hospitalizations involving ECMO and stratified them into two cohorts based on whether they underwent fasciotomy after ECMO. Patient baseline characteristics, in-hospital procedures, and postoperative outcomes were compared between the two cohorts. Logistic regression was used to assess in-hospital mortality risk between the two cohorts adjusting for age, sex, Elixhauser score, and perioperative procedures and non-fasciotomy perioperative morbidity. RESULTS There were 7,085 estimated eligible discharges between 2012 and 2015 identified, 149 (2.1%) of which underwent fasciotomy following ECMO. One hundred and thirteen of the 149 hospitalizations (77%) in the fasciotomy cohort resulted in in-hospital mortality, compared to 3,805 of the 6,936 (55%) in the non-fasciotomy cohort. There were no differences in rates of transfusion (p=0.290), length of stay (p=0.282), or discharge disposition (p=0.126) between the two cohorts. In the logistic regression model, the fasciotomy cohort had a higher odds of in-hospital mortality than non-fasciotomy cohort (OR, 2.5; 95% CI, 1.1-5.6). DISCUSSION Operative treatment of acute compartment syndrome for patients on ECMO therapy is associated with significantly increased mortality and morbidity. Whether fasciotomy is a marker of sickness or represents a cause-and-effect relationship is unknown and future should investigate the role of non-operative treatment of compartment syndrome on mortality in this population. LEVEL OF EVIDENCE III; Prognostic.
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Affiliation(s)
- Raj M Amin
- Department of Orthopaedic Surgery, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Yash P Chaudhry
- Department of Orthopaedic Surgery, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Sandesh S Rao
- Department of Orthopaedic Surgery, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Varun Puvanesarajah
- Department of Orthopaedic Surgery, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Matthew J Best
- Department of Orthopaedic Surgery, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Eric Etchill
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Erik A Hasenboehler
- Department of Orthopaedic Surgery, Johns Hopkins School of Medicine, Baltimore, MD, United States.
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Peek K, Schmale G, Lindberg A, Ho C, Miller M, Steinman S. Poor Outcomes of Pediatric Acute Compartment Syndrome in the Setting of Extracorporeal Membrane Oxygenation: A Multicenter Case Series. J Pediatr Orthop 2022; 42:382-386. [PMID: 35420573 DOI: 10.1097/bpo.0000000000002158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Acute compartment syndrome (ACS) is a well-described condition that merits emergent surgical decompression. Peripheral arterial cannulation can increase the likelihood of ACS in patients requiring extracorporeal membranous oxygen (ECMO). Comorbidities in these critically ill patients may portend negative consequences of decompressive fasciotomy. This study investigated the clinical short-term and mid-term outcomes in pediatric patients with ECMO-associated ACS. METHODS This is a retrospective case series at 3 pediatric hospitals from 2006 to 2019, including children ages 0 to 19 years who underwent peripheral arterial cannulation and developed ACS. RESULTS Eighteen patients developed ACS after receiving peripheral cannulation ECMO. Mean time to diagnosis after cannulation was 63.1 hours. All patients were diagnosed clinically; the most common findings were tight compartments, swelling, and loss of peripheral pulses. Eight patients (44%) died due to underlying illness. Treating physicians decided against decompression for 5 patients due to their underlying illness, instability, and concern for infection. Thirteen patients (72%) underwent decompressive fasciotomies. Ten surgical patients required subsequent surgeries and 6 (33%) developed surgical site infections. Of the 7 surviving surgical patients, 4 (57%) required extremity amputations and 4 had lower extremity neurological deficits on follow-up. Two of 3 nonsurgical patients (66%) had functional lower extremity motor deficits on follow-up. No surviving nonoperative patients developed infections or required amputations. CONCLUSIONS ACS on ECMO is associated with high rates of complications including neurologic deficits, infection, and amputation. Patients treated nonoperatively avoided complications such as infection and amputation, but had more functional neurological deficits than surgical patients. Orthopaedic surgeons should consider the high morbidity of compartment release in these critically ill patients and, with critical care teams, assess whether the potential benefits of surgery outweigh expected risks. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Kacy Peek
- Department of Orthopaedics, University of Colorado, Denver, CO
| | - Gregory Schmale
- Department of Orthopaedics, Seattle Children's Hospital & University of Washington, Seattle, WA
| | - Antoinette Lindberg
- Department of Orthopaedics, Seattle Children's Hospital & University of Washington, Seattle, WA
| | - Christine Ho
- Department of Orthopaedics, Texas Scottish Rite Hospital for Children and UT Southwestern Medical Center, Dallas, TX
| | - Mark Miller
- Division of Pediatric and Adolescent Orthopaedic Surgery, Shriner's Hospital for Children and Washington University at St. Louis, St. Louis, MO
| | - Suzanne Steinman
- Department of Orthopaedics, Seattle Children's Hospital & University of Washington, Seattle, WA
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Pingpoh C, Kondov S, Schroefel H, Kreibich M, Puiu P, Kueri S, Berger T, Beyersdorf F, Siepe M, Czerny M. Efficacy of Vascular Closure Devices in Closing Large-Bore Sheath Arterial Sites after Treatment with Extracorporeal Life Support System. Thorac Cardiovasc Surg 2021; 69:537-541. [PMID: 34376000 DOI: 10.1055/s-0041-1728708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND We retrospectively evaluated vascular complications and wound infections after surgical or percutaneous transfemoral removal of temporary extracorporeal life support systems (ECLSs). METHODS A total of 83 patients were weaned from ECLS between August 2015 and September 2020. We analyzed for a composite endpoint of vascular complications and wound infections requiring negative-pressure wound therapy. Patients were divided into two groups: percutaneous group using the MANTA vascular occlusion system (VCD; Teleflex, Morrisville, North Carolina, United States) (n = 23) and surgical group (n = 60). RESULTS The median age in the entire cohort was 67 years. Vascular complications were seen in 20% (n = 12) in the surgical group and in 13% (n = 3) in the percutaneous group (p = 0.72). A total of 32% (n = 19) in the surgical group and 9% (n = 2) in the percutaneous group (p = 0.031) had wound infections. A composite endpoint of vascular complications and wound infections showed significantly more complications in the surgical group (52%, n = 31) as compared with the percutaneous group (22%, n = 5) (p = 0.020). The median duration in the intensive care unit was 13 days for the surgical group and 12 days for the percutaneous group without any significant difference in both groups (p = 0.93). CONCLUSIONS Using the MANTA VCD for percutaneous removal of ECLS cannulas after weaning from ECLS is safe and reproducible. A composite endpoint of vascular complications and wound infections was significantly lower in the percutaneous removal group as compared with the surgical group.
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Affiliation(s)
- Clarence Pingpoh
- Department of Cardiovascular Surgery, University Heart Center Freiburg, Bad Krozingen, Freiburg, Germany.,Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Stoyan Kondov
- Department of Cardiovascular Surgery, University Heart Center Freiburg, Bad Krozingen, Freiburg, Germany.,Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Holger Schroefel
- Department of Cardiovascular Surgery, University Heart Center Freiburg, Bad Krozingen, Freiburg, Germany.,Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Maximillian Kreibich
- Department of Cardiovascular Surgery, University Heart Center Freiburg, Bad Krozingen, Freiburg, Germany.,Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Paul Puiu
- Department of Cardiovascular Surgery, University Heart Center Freiburg, Bad Krozingen, Freiburg, Germany.,Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Sami Kueri
- Department of Cardiovascular Surgery, University Heart Center Freiburg, Bad Krozingen, Freiburg, Germany.,Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Tim Berger
- Department of Cardiovascular Surgery, University Heart Center Freiburg, Bad Krozingen, Freiburg, Germany.,Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Friedhelm Beyersdorf
- Department of Cardiovascular Surgery, University Heart Center Freiburg, Bad Krozingen, Freiburg, Germany.,Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Matthias Siepe
- Department of Cardiovascular Surgery, University Heart Center Freiburg, Bad Krozingen, Freiburg, Germany.,Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Martin Czerny
- Department of Cardiovascular Surgery, University Heart Center Freiburg, Bad Krozingen, Freiburg, Germany.,Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
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6
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Shah A, Arons D, Pasrija C, Kon ZN, Ghoreishi M. Bedside angiography of distal perfusion catheter for veno-arterial extracorporeal membrane oxygenation. Perfusion 2021; 37:499-504. [PMID: 33781131 DOI: 10.1177/02676591211007017] [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
BACKGROUND The aim of this study was to evaluate the ipsilateral lower extremity (ILE) outcomes of patients who underwent bedside angiography via the distal perfusion catheter while on femoral veno-arterial extracorporeal membrane oxygenation (VA ECMO). METHODS This is a retrospective analysis of all patients placed on VA ECMO at a single center from January 2017 to December 2019 who underwent bedside angiography via the distal perfusion catheter. RESULTS Twenty-four patients underwent bedside angiography via the distal perfusion catheter after being placed on VA ECMO. A vasodilator was directly administered in three patients for suspected spasm. One patient had distal thrombus and underwent thrombectomy and fasciotomy. One patient had a dislodged catheter and underwent thrombectomy, fasciotomy, and replacement of the catheter. One patient had severe ILE ischemia, however was not intervened upon due to critical acuity. Finally, one patient had inadvertent placement in the saphenous vein and had a new catheter placed in the SFA. No patients underwent amputation. Ultimately, 21 patients (87.5%) had no ILE compromise at the end their ECMO course. Survival to decannulation was 66.7% (n = 16). CONCLUSIONS Bedside angiography of the distal perfusion catheter is feasible and can be a useful adjunct in informing the need for further intervention to the ILE. CLASSIFICATIONS extracorporeal membrane oxygenation, ischemia.
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Affiliation(s)
- Aakash Shah
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Danielle Arons
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Chetan Pasrija
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Zachary N Kon
- Department of Cardiothoracic Surgery, New York University Langone Medical Center, New York, NY, USA
| | - Mehrdad Ghoreishi
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
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Pingpoh C, Salama A, Diab N, Kreibich M, Puiu P, Czerny M, Benk C, Beyersdorf F, Siepe M. Postcardiotomy mechanical support in patients with mitral valve prostheses is associated with poor survival. Int J Artif Organs 2020; 45:127-133. [PMID: 33339476 DOI: 10.1177/0391398820982621] [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
AIMS To elaborate on early survival in patients with mitral valve replacement requiring temporary extracorporeal life support system (ECLS). METHODS We analyzed survival, significant bleeding, wound infection, and ECLS duration in 421 from 14,400 patients with postoperative need for ECLS from January 2008 to December 2017 at our institution. Finally, patients were stratified according to the type of surgery performed: the mitral group (mitral valve replacement) n = 63 and the control group (any cardiac surgery excluding the mitral valve) n = 358. In order to adjust for preoperative patient characteristics, a propensity matching analysis was performed. Differences in in-hospital mortality were analyzed accordingly. RESULTS In-hospital mortality was significantly higher in the mitral group as compared to the control group before and after adjustment (p < 0.001). Median duration of ECLS was 4 days in both groups. Perioperative bleeding (p < 0.001) and wound infection (p < 0.001) also showed significant worse outcome parameters in the mitral group. The main causes of death in the mitral group were multiorgan failure, n = 48 (76%), stroke, n = 7 (12%), and intracardiac thrombus formation, n = 5 (10%). CONCLUSIONS ECLS is associated with a high in-hospital mortality rate in patients after mitral valve replacement.
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Affiliation(s)
- Clarence Pingpoh
- Department of Cardiovascular Surgery, University Heart Center Freiburg Bad Krozingen, Freiburg, Germany.,Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Alaa Salama
- Faculty of Medicine, University of Basel, Basel, Switzerland.,Department of Intensive Care, University Hospital Basel, Basel, Switzerland
| | - Nawras Diab
- Department of Cardiovascular Surgery, University Heart Center Freiburg Bad Krozingen, Freiburg, Germany.,Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Maximillian Kreibich
- Department of Cardiovascular Surgery, University Heart Center Freiburg Bad Krozingen, Freiburg, Germany.,Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Paul Puiu
- Department of Cardiovascular Surgery, University Heart Center Freiburg Bad Krozingen, Freiburg, Germany.,Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Martin Czerny
- Department of Cardiovascular Surgery, University Heart Center Freiburg Bad Krozingen, Freiburg, Germany.,Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Christoph Benk
- Department of Cardiovascular Surgery, University Heart Center Freiburg Bad Krozingen, Freiburg, Germany.,Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Friedhelm Beyersdorf
- Department of Cardiovascular Surgery, University Heart Center Freiburg Bad Krozingen, Freiburg, Germany.,Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Matthias Siepe
- Department of Cardiovascular Surgery, University Heart Center Freiburg Bad Krozingen, Freiburg, Germany.,Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
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Czerny M. The good, the bad and the ugly—or how to treat complications of complications. J Thorac Cardiovasc Surg 2018; 156:e107. [DOI: 10.1016/j.jtcvs.2018.03.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 03/16/2018] [Indexed: 10/17/2022]
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9
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Czerny M. Life with limb instead limb for life-selective perfusion safes extremities. J Thorac Cardiovasc Surg 2018; 156:171. [PMID: 29572023 DOI: 10.1016/j.jtcvs.2018.02.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 02/22/2018] [Indexed: 10/17/2022]
Affiliation(s)
- Martin Czerny
- University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany.
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