The January update of an expert panel from the American College of Chest Physicians on the expanding clinical entity of pulmonary hypertension, especially pertinent to the transplant community.
This site is not optimized for Internet Explorer 8 (or older).
Please upgrade to a newer version of Internet Explorer or use an alternate browser such as Chrome or Firefox.
Gershengorn and colleagues evaluated the incidence and safety of overnight extubation following coronary artery bypass grafting (CABG), using retrospective data from The Society of Thoracic Surgeons Adult Cardiac Surgery Database. Between 2014 and 2017, 42% of patients undergoing elective CABG had an overnight extubation, a rate that the authors report is similar to patients undergoing other cardiac procedures.
Ley J, Grant M, Parmet J, Kim MP. ERAS: The Multidisciplinary Team. August 2019. doi:10.25373/ctsnet.9700358.
Filmed at the 2019 STS Annual Meeting in San Diego, California, Jill Ley of California Pacific Medical Center in San Francisco moderates a discussion on the ERAS multidisciplinary team. She is joined by Michael Grant of Johns Hopkins University in Baltimore, Maryland, USA, Jon Parmet of Society Hill Anesthesia Consultants in Cherry Hill, New Jersey, USA, and the University of Pennsylvania, and Min Peter Kim of Houston Methodist Hospital in Texas, USA. They discuss the key components of the ERAS cardiac and thoracic models to manage pain without narcotics and accelerate postoperative recovery, as well as the importance of collaboration and communication among teams in a particular program.
An interesting discussion in this manuscript of a case-control study of 666 subjects.
Ljungqvist O, Batchelor T, Coates J. ERAS in Cardiothoracic Surgery and Digital Chest Drains. August 2019. doi:10.25373/ctsnet.9172451.
Enhanced Recovery After Surgery (ERAS) is a perioperative protocol that places the patient at the center of all medical decisions. It is designed to reduce stress for the patient, alleviate the amount of pain they experience, and crucially, speed up the recovery and mobilization process, where removing invasive lines and drains as soon as possible is essential.
During the Seventh ERAS World Congress, held in Liverpool, UK, in early May 2019, the myriad benefits of the protocol for both patients and the perioperative care team were discussed by three experts: Olle Ljungqvist, Professor of Surgery at Örebro University, Sweden, and co-founder and current president of the ERAS® Society; Tim Batchelor, a thoracic surgeon from Bristol in the UK and lead author of the recently published ERAS® Society/ESTS guidelines for lung surgery; and Jim Coates, clinical research fellow in cardiothoracic anesthesia and principal investigator of ERAS for heart patients at the James Cook University Hospital in Middlesbrough, UK. The group discusses the implementation of ERAS protocols, how patients benefit from ERAS approaches, and how digital chest drains fit into the ERAS philosophy.
Jim Coates directed a feasibility study for using digital chest drains during an ERAS program in Middelsbrough, UK, work that was supported by a grant from Medela. Additionally, the filming of this roundtable was organized and paid for by Medela; the panelists were not reimbursed for their participation.
The Throacic Surgery Residents Association (TSRA) Decision Algorithms in Cardiothoracic Surgery is a 100-chapter compendium with an individual algorithm for clinical decisions spanning the entire scope of cardiothoracic surgery. The resource was developed for cardiothoracic surgery residents by residents and cardiothoraicc surgery faculty.
Using deep learning employing data from over 700,000 patients (6 billion data points), an algorithm for continuous prediction of the risk of acute kidney injury (AKI) was developed. The model correctly predicted over 90% of AKI requiring dialysis with a lead time of up to 48 hours, with 2 false alerts for every true alert.
In this article, Umana-Pizana et al performed a phases-of-care mortality analysis amongst 5141 cardiac surgery cases with a 4.6% crude mortality in a population with a median STS risk score of 5.8%. They demonstrate that triggers for mortality occured primarily preoperatively (49.3%), followed by in the intensive care unit (23.9%), intraoperatively (13.4%), discharge phase (10.4%), and postoperative floor (3.0%).
Engelman D, Perrault L, Gerdisch M, Grant M, Williams J. ERAS Guidelines for Perioperative Care in Cardiac Surgery. July 2019. doi:10.25373/ctsnet.8321060.
Filmed at the 2019 AATS Annual Meeting in Toronto, Canada, Daniel Engelman of Baystate Medical Center in Springfield, Massachusetts, USA, moderates a discussion on enhanced recovery after surgery (ERAS) for cardiac surgery guidelines for perioperative care. Dr Engelman, who is also the President of the ERAS Cardiac Society, is joined by Louis Perrault of the Montreal Heart Institute in Quebec, Canada, Marc Gerdisch of Franciscan St. Francis Heart Center in Indianapolis, Indiana, USA, Michael Grant of the Johns Hopkins Hospital in Baltimore, Maryland, USA, and Judson Williams of Duke University Medical Center in Raleigh, NC, USA. The panelists highlight some of the recommendations from the first cardiac ERAS guidelines(1). They talk of the importance of prehabilitation and new preoperative nutritional recommendations, as well as intraoperative guidelines for multimodal analgesia, chest closure, and chest tube drainage. They note that many aspects of perioperative care are addressed in the guideline and note the recommendations on preventing venous thromboembolism and early extubation. Throughout the discussion, the group emphasizes the multidisciplinary nature of the ERAS effort.
Engelman DT, Ben Ali W, Williams JB, et al. Guidelines for perioperative care in cardiac surgery: Enhanced Recovery After Surgery Society recommendations [published online ahead of print May 4, 2019.]. JAMA Surg. doi: 10.1001/jamasurg.2019.1153.