ECMO after cardiac surgery: a single center study on survival and optimizing outcomes

Abstract Background The study purpose is to examine survival prognostic and extracorporeal membrane oxygenation (ECMO) application outcomes at our tertiary care center. Methods This is a retrospective analysis, January 2014 to September 2019. We analyzed 60 patients who underwent cardiac surgery and required peri-operative ECMO. All inpatients with demographic and intervention data was examined. 52 patients (86.6%) had refractory cardiogenic shock, 7 patients (11.6%) had pulmonary insufficiency, and 1 patient (1.6%) had hemorrhagic shock, all patients required either venous-arterial (VA) (n = 53, 88.3%), venous-venous (VV) (n = 5, 8.3%) or venous-arterial-venous (VAV) (n = 2, 3.3%) ECMO for hemodynamic support. ECMO parameters were analyzed and common postoperative complications were examined in the setting of survival with comorbidities. Results In-hospital mortality was 60.7% (n = 37). Patients who survived were younger (52 ± 3.3 vs 66 ± 1.5, p < 0.001) with longer hospital stays (35 ± 4.0 vs 20 ± 1.5, p < 0.03). Survivors required fewer blood products (13 ± 2.3 vs 25 ± 2.3, p = 0.02) with a net negative fluid balance (− 3.5 ± 1.6 vs 3.4 ± 1.6, p = 0.01). Cardiac re-operations worsened survival. Conclusion ECMO is a viable rescue strategy for cardiac surgery patients with a 40% survival to discharge rate. Careful attention to volume management and blood transfusion are important markers for potential survival.

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Abstract 15502: Clinical Outcomes in Patients Undergoing Non-cardiac Surgery Within 1 Year of Pci

Circulation ◽

10.1161/circ.142.suppl_3.15502 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Davide Cao ◽

Matthew A Levin ◽

Samantha Sartori ◽

Anastasios Roumeliotis ◽

Rishi Chandiramani ◽

...

Keyword(s):

Cardiac Surgery ◽

Antiplatelet Therapy ◽

Care Center ◽

Tertiary Care ◽

Coronary Intervention ◽

Secondary Outcome ◽

Cardiac Events ◽

Bleeding Events ◽

Target Vessel Revascularization ◽

Increased Risk

Introduction: Perioperative cardiovascular events are an important cause of morbidity and mortality associated with non-cardiac surgery (NCS), especially in patients with recent percutaneous coronary intervention (PCI) who require dual antiplatelet therapy. Objective: To illustrate the types and timing of different noncardiac surgeries occurring within 1 year of PCI, and to evaluate the risk of thrombotic and bleeding events according to perioperative antiplatelet management. Methods: All patients undergoing NCS within 1 year of PCI at a tertiary-care center between 2011 and 2018 were included. The primary outcome was major adverse cardiac events (MACE; composite of death, myocardial infarction, stent thrombosis or target vessel revascularization). The key secondary outcome was major bleeding, defined as ≥2 units of blood transfusion. All outcomes were evaluated at 30 days after NCS. Results: A total of 1092 NCS (corresponding to 747 patients) were included and classified by surgical risk (low: 50.9%, intermediate: 38.4%, high: 10.7%) and priority (elective: 88.5%, urgent/emergent: 11.5%). High-risk and urgent/emergent surgeries tended to occur earlier post-PCI compared to low-risk and elective ones ( Figure-A ). The incidence of MACE and bleeding was time-dependent, with an increased risk in surgeries occurring in the first 6 months post-PCI ( Figure-B ). Perioperative antiplatelet cessation occurred in 487 (44.6%) NCS and was more likely for intermediate-risk procedures and after 6 months of PCI. There was no significant association between antiplatelet cessation and cardiac events. Conclusions: Among patients undergoing NCS within 1 year of PCI, the perioperative risk of MACE is inversely related to time from PCI. Preoperative interruption of antiplatelet therapy was observed in less than half of all cases and was not associated with an increased risk of cardiac events.

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Sepsis, a Common Endpoint to Even Non-Infectious Comorbidities, A Single Center Study on 49,107 Patients, at a Tertiary Care Center in India

Indian Journal of Public Health Research & Development ◽

10.37506/ijphrd.v12i4.16513 ◽

2021 ◽

Keyword(s):

Care Center ◽

Tertiary Care ◽

Tertiary Care Center ◽

Single Center ◽

Single Center Study ◽

Common Endpoint ◽

Center Study

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Surgical ICU Underutilization Does not Significantly Discourage Discharge

Health Services Management Research ◽

10.1177/095148489600900403 ◽

1996 ◽

Vol 9 (4) ◽

pp. 238-242 ◽

Cited By ~ 3

Author(s):

F. Dexter ◽

K. Pearson ◽

D. L. Griffiths ◽

P. Jebson

Keyword(s):

Discharge Rate ◽

Care Center ◽

Tertiary Care ◽

Case Series ◽

Patient Discharge ◽

Poor Quality ◽

Excess Capacity ◽

Admission Rates ◽

Discharge Rates ◽

Number Of Patients

An SICU must have sufficient capacity to handle peak weekly demand to prevent re-admission and/or poor quality of care. Excess capacity may, however, encourage unnecessary SICU utilization. The goal of this study was to assess the influence of availability of SICU beds on patient discharge and re-admission rates. The case series included 1,492 days, 36,816 patient days, 8,821 discharges, and 186 re-admissions within 3 days from a 24-bed multidisciplinary SICU at a tertiary care center. Census was defined to equal the total number of patients in the SICU each day. We found low census levels were not associated with significantly lower discharge rates. Decreasing the census from 19–24 to 13–18 patients per day decreased discharge rates from 31% to 30%. Odds ratio that a decrease in census by five from 24 decreased discharge rate equaled 1.01 (95% confidence interval 0.96 to 1.06). We conclude that when hospital managers choose an appropriate SICU capacity they need not be concerned that intermittent excess capacity will prompt physicians to significantly decrease their discharge rates.

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Improving the Identification of Patients at Risk of Postoperative Renal Failure after Cardiac Surgery

Anesthesiology ◽

10.1097/00000542-200601000-00012 ◽

2006 ◽

Vol 104 (1) ◽

pp. 65-72 ◽

Cited By ~ 73

Author(s):

Duminda N. Wijeysundera ◽

Keyvan Karkouti ◽

W Scott Beattie ◽

Vivek Rao ◽

Joan Ivanov

Keyword(s):

At Risk ◽

Logistic Regression ◽

Renal Function ◽

Cardiac Surgery ◽

Renal Insufficiency ◽

Care Center ◽

Tertiary Care ◽

Receiver Operating Curve ◽

Alternative Measure ◽

Patients At Risk

Background Preoperative renal insufficiency is an important predictor of the need for postoperative renal replacement therapy (RRT). Serum creatinine (sCr) has a limited ability to identify patients with preoperative renal insufficiency because it varies with age, sex, and muscle mass. Calculated creatinine clearance (CrCl) is an alternative measure of renal function that may allow better estimation of renal reserve. Methods Data were prospectively collected for consecutive patients who underwent cardiac surgery requiring cardiopulmonary bypass at a tertiary care center. The relation between CrCl (Cockcroft-Gault equation) and RRT was initially described using descriptive statistics, logistic regression, and receiver operating curve analysis. Based on these analyses, preoperative renal insufficiency was defined as CrCl of 60 ml/min or less. Preoperative renal function was classified as moderate insufficiency (sCr > 133 microM), mild insufficiency (100 microM < sCr < or = 133 microM), occult insufficiency (sCr < or = 100 microM and CrCl < or = 60 ml/min), or normal function (sCr < or = 100 microM and CrCl > 60 ml/min). The independent association of preoperative renal function with RRT was subsequently determined using multiple logistic regression. Results Of the 10,751 patients in the sample, 137 (1.2%) required postoperative RRT. Approximately 13% of patients with normal sCr had occult renal insufficiency. Occult renal insufficiency was independently associated with RRT (odds ratio, 2.80; 95% confidence interval, 1.39-5.33). The magnitude of this risk was similar to patients with mild renal insufficiency (P = 0.73). Conclusions The inclusion of a simple CrCl-based criterion in preoperative assessments may improve identification of patients at risk of needing postoperative RRT.

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A case series of brain abscesses: an eleven-year retrospective single center study

The Journal of Infection in Developing Countries ◽

10.3855/jidc.12816 ◽

2021 ◽

Vol 15 (06) ◽

pp. 791-797

Author(s):

Rami Waked ◽

Hassan Tarhini ◽

Hussein Mansour ◽

Gebrael Saliba ◽

Nabil Chehata ◽

...

Keyword(s):

Stereotactic Biopsy ◽

Care Center ◽

Demographic Data ◽

Tertiary Care ◽

Case Series ◽

Rare Condition ◽

Source Of Infection ◽

Single Center Study ◽

Brain Abscesses ◽

Worse Prognosis

Introduction: We lack data on the epidemiology and management of brain abscesses in the Middle East. The aim of this study is to report a case series of brain abscesses admitted at a tertiary care center in Lebanon, between January 2008 and December 2018. Methodology: This retrospective study aimed at determining the demographic data, treatment, and correlations between different studied variables with prognosis of patients that received treatment. Results: Forty-one patients (30 males) were included with a median age of 37 years (2-85). The analysis showed that the classic triad of fever, headache and neurologic deficit was only present in 12% of patients on admission. The source of infection was contiguous in 36.5%, post surgical in 32%, and distant in 17% of cases. Stereotactic biopsy was performed in 41.5% of patients, and craniotomy in 19.5%. A microorganism was isolated in 63% of patients (26 cases). The most used antibiotics were carbapenems (46%) and glycopeptides (66%). Eighty percent of patient (33) had a good outcome. A worse prognosis was significantly correlated with immunosuppression and multiple cerebral abscesses. Conclusions: Brain abscess remains a relatively rare condition.

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Surveillance of Pediatric Cardiac Surgical Outcome Using Risk Stratifications at a Tertiary Care Center in Thailand

Cardiology Research and Practice ◽

10.4061/2011/254321 ◽

2011 ◽

Vol 2011 ◽

pp. 1-9 ◽

Cited By ~ 3

Author(s):

Chodchanok Vijarnsorn ◽

Duangmanee Laohaprasitiporn ◽

Kritvikrom Durongpisitkul ◽

Prakul Chantong ◽

Jarupim Soongswang ◽

...

Keyword(s):

Cardiac Surgery ◽

Hospital Mortality ◽

Heart Surgery ◽

Pediatric Patients ◽

Care Center ◽

Tertiary Care ◽

Congenital Heart Surgery ◽

Mortality Risks ◽

Surgery Mortality ◽

Overall Mortality

Objectives. To determine in-hospital mortality and complications of cardiac surgery in pediatric patients and identify predictors of hospital mortality.Methods. Records of pediatric patients who had undergone cardiac surgery in 2005 were reviewed retrospectively. The risk adjustment for congenital heart surgery (RACHS-1) method, the Aristotle basic complexity score (ABC score), and the Society of Thoracic Surgeons and the European Association for Cardiothoracic Surgery Mortality score (STS-EACTS score) were used as measures. Potential predictors were analyzed by risk analysis.Results. 230 pediatric patients had undergone congenital cardiac surgery. Overall, the mortality discharge was 6.1%. From the ROC curve of the RACHS-1, the ABC level, and the STS-EACTS categories, the validities were determined to be 0.78, 0.74, and 0.67, respectively. Mortality risks were found at the high complexity levels of the three tools, bypass time >85 min, and cross clamp time >60 min. Common morbidities were postoperative pyrexia, bleeding, and pleural effusion.Conclusions. Overall mortality and morbidities were 6.1%. The RACHS-1 method, ABC score, and STS-EACTS score were helpful for risk stratification.

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Supra-massive transfusion and interdisciplinary approach to cesarean hysterectomy due to complex placenta percreta: Case report

SAGE Open Medical Case Reports ◽

10.1177/2050313x211010011 ◽

2021 ◽

Vol 9 ◽

pp. 2050313X2110100

Author(s):

Efrain Riveros-Perez ◽

Maria Gabriela Sanchez ◽

Nadine Odo ◽

Mrinal Shukla ◽

Bunya Rungruang

Keyword(s):

Massive Transfusion ◽

Care Center ◽

Tertiary Care ◽

Interdisciplinary Approach ◽

Uterine Wall ◽

Placenta Percreta ◽

Blood Products ◽

Successful Management ◽

Perioperative Morbidity ◽

Risk Of Death

Placenta accreta spectrum encompasses a group of conditions of abnormal placental infiltration of the uterine wall and surrounding tissues. It is associated with significant blood loss, perioperative morbidity, and risk of death. A coordinated interdisciplinary approach to these complex cases and early resuscitation with blood products are critical factors in the successful management of patients affected by this disease. We describe the successful management of a patient with placenta percreta who required supra-massive transfusion of blood products and interventions by different specialized teams in a tertiary care center.

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Assessment of Appropriate Use of Blood Products in a Tertiary Care Center in India- An Audit Study

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2020/264 ◽

2020 ◽

Vol 7 (26) ◽

pp. 1239-1244

Author(s):

Anjali Sharma ◽

Heena Heena ◽

Sunil Ranga ◽

Rashmi Arora

Keyword(s):

Care Center ◽

Tertiary Care ◽

Tertiary Care Center ◽

Blood Products ◽

Appropriate Use

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Management of Postpartum Haemorrhage: A study on Transfusion of Blood and its components

Obsgyne Review: Journal of Obstetric and Gynecology ◽

10.17511/joog.2020.i06.01 ◽

2020 ◽

Vol 6 (6) ◽

pp. 108-113

Author(s):

Dr. Swati Swati ◽

◽

Dr. Fayaz Khan H ◽

Dr. Manju M ◽

◽

...

Keyword(s):

Postpartum Haemorrhage ◽

Care Center ◽

Tertiary Care ◽

Age Groups ◽

Obstetric Care ◽

Age Group ◽

Blood Products ◽

Medical College ◽

Essential Components ◽

A Prospective Study

Introduction: Blood Transfusion is identified as one of the essential components of comprehensiveemergency obstetric care which has drastically reduced maternal mortality. Material and Methods:This is a prospective study conducted at NC Medical College and Hospital, in the Department ofOBGY. (Tertiary care center) from January 2019 – September 2020. All patients requiringintrapartum transfusion of blood or blood products are enrolled in the study. No exclusion criteria.Results: In the present study, various age groups of patients were enrolled. Maximum transfusion(77.8%) rates are seen in the age group of 21-30 years and the minimum no. of patients wereranges from 31-40 years (8.4%). Conclusion: Postpartum hemorrhage, placental causes, andanemia are the commonest causes of the need for transfusion in obstetric practice.

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