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Journal and News Scan
This trial of hypothermia for unconsious survivors of out-of-hospital cardiac arrest randomized 1359 patients to prehospital cooling and hospital cooling. Prehospital cooling achieved a 1.2º - 1.3º C. decrease in core temperature by the time of arrival to the hospital and reduced time to adequate cooling by 1 hour, but was associated with an increased risk of rearrest prior to hospital arrival. Survival to hospital discharge (62.7% vs 64.3%) and neurologic status at the time of discharge were similar between the 2 groups.
Hypothermia is recommended for unconscious survivors of out-of-hospital cardiac arrest to preserve heart and neurologic function. This study randomized 950 pts to determine whether 33º C or 36º C is the most appropriate target temperature. Mortality was similar (50% vs 48%) and outcomes at 180 days for mortality and poor neurologic function were also similar (54% vs 52%).
This study presents a comparison between PerOral Endoscopic Myotomy (POEM) and Standard Laparoscopic Approach in the treatment of achalasia. The authors report satisfactory results of the postoperative course and for grade of patients satisfaction with POEM. The complication incidence was similar for both procedures.
The scarcity of lung donors is a worldwide concern. This paper reports a single center experience on use of lungs of marginal donors with a rescue offer system. The results are satisfactory in terms of patients outcome and lung allocation.
Jennifer Nelson, the former STS Resident Director, discusses the past, present, and future of cardiothoracic surgery training. Changes that have occurred in the recent past include removal of the requirement for general surgery certification, the establishment of specialty tracks, and the development of integrated programs. This has resulted in a large number of applicants for integrated programs and a recent increase in applicants for traditional programs. The future of our field is bright.
The authors reviewed their experience between May 2008 and May 2011 with 107 patients who underwent surgical repair for acute Type I aortic dissection. They report favorable results of more effective end-organ protection with the use of intermittent lower body perfusion and moderate hypothermic circulatory arrest.
Acute myocardial infarction (AMI) may safely be ruled out by testing a single blood sample at patient presentation. In a recently-completed intervention study, using a Copeptin-based diagnostic algorithm enabled immediate discharge of 2/3 of patients with suspected acute coronary syndrome (ACS) from the emergency department. At 30 days, patients managed using Copeptin had 100% survival and a comparably low major cardiovascular event rate (MACE) to that in patients undergoing conventional multiple laboratory testing and hours-long observation. Based on these results, the Thermo Scientific™ B•R•A•H•M•S™ Copeptin biomarker assays improve patient care and clinical resource allocation - without compromising safety.
This is a review article of the diagnosis and treatment of the various forms of shock. The treatment of septic shock is well expounded as this makes up 62% of cases of shock in the ICU. Norepinephrine is the first choice of vasopressor agents and dopamine is discouraged due to its arrhythmogenicity. Dobutamine is the first choice of inotropic agents for increasing CO. Low dose of vasopressin in distributive shock is safe and has a survival benefit. Adequacy of circulation is measured by mixed venous saturation with a target of at least 70%. A decrease in blood lactate level signifies effective therapy. The conclusion discusses the four phases of treatment of shock: salvage, optimization, stabilization and deescalation.
In this multicenter study, a frailty scale was administered to 183 pts with ACS and the degree of frailty was correlated with outcomes. Increased frailty was associated with older age, increased comorbidities, great LOS, and decreased procedure use. After adjusting for baseline differences between the populations, frail patients' HR for mortality was 3.49 relative to fit patients.
This review/synthesis covers atrial fibrillation, the physiology of the atrial appendage, and indications/outcomes for mechanical closure of the appendage. The author, recognized as the originator of surgical treatments for atrial fibrillation, encourages a more aggressive approach to atrial appendage closure in an expanded pool of patients.