Results Generated From:
Embase <1980 to 2014 Week 30>
Embase (updates since 2014-07-18)
<1>
Accession Number
2014469956
Authors
Ota H. Kitabata H. Magalhaes M.A. Bui A. Kardenas K. Thomas C.H. Chen F.
Torguson R. Satler L.F. Pichard A.D. Waksman R.
Institution
(Ota, Kitabata, Magalhaes, Bui, Kardenas, Thomas, Chen, Torguson, Satler,
Pichard, Waksman) Interventional Cardiology, MedStar Washington Hospital
Center, Washington, DC, United States
Title
Comparison of frequency and severity of longitudinal stent deformation
among various drug-eluting stents: An intravascular ultrasound study.
Source
International Journal of Cardiology. 175 (2) (pp 261-267), 2014. Date of
Publication: 01 Aug 2014.
Publisher
Elsevier Ireland Ltd
Abstract
Background Longitudinal stent deformation (LSD) in drug-eluting stents
(DES) has been described as a disruption of stent structure. This study
aimed to compare first- versus second-generation DES with respect to their
actual stent length post deployment. Methods A total of 617 DES for de
novo coronary lesions in 552 patients were analyzed. Intravascular
ultrasound (IVUS) was utilized to compare the degree and rate of LSD among
six different DES types. IVUS-measured stent length was compared to the
labeled length for calculation of absolute difference in stent length and
relative absolute difference (absolute difference divided by the labeled
length). Results The baseline characteristics were comparable between
groups, except for higher calcification in the sirolimus-eluting stent
(SES) group (p = 0.037). The absolute and relative difference in length
showed the lowest degree in the SES group and the highest degree in the
Endeavor zotarolimus-eluting stent group (p = 0.085 and 0.078,
respectively). The percentage of more than 5% relative absolute difference
was the lowest in the SES group compared to the other groups (p = 0.018).
However, the percentage of significant (> 15%) relative absolute
difference was similar among groups (p = 0.99). In multivariate linear
regression analysis, labeled stent length and stent diameter, but not
stent type, were identified as independent correlates to the absolute and
relative difference in the actual stent length post-deployment. Conclusion
This IVUS analysis confirms that among second-generation DES, there is
overall similar frequency and severity of LSD when deploying in common
coronary lesions. 2014 Elsevier Ireland Ltd.
<2>
Accession Number
2014472163
Authors
Danielsen A.K. Okholm C. Pommergaard H.-C. Burcharth J. Rosenberg J.
Institution
(Danielsen) Department of Nursing, Faculty of Health and Technology,
Metropolitan University College, Copenhagen, Denmark
(Okholm, Pommergaard, Burcharth, Rosenberg) Department of Surgery, Herlev
Hospital, University of Copenhagen, Herlev, Denmark
Title
Number of published randomized controlled multi center trials testing
pharmacological interventions or devices is increasing in both medical and
surgical specialties.
Source
PLoS ONE. 9 (7) , 2014. Article Number: e101383. Date of Publication: 14
Jul 2014.
Publisher
Public Library of Science
Abstract
Background: In general, there is a need for testing new interventions in
large randomized controlled trials. Depending on the research question it
may be advantageous to establish multicenter studies as a way of
organizing clinical trials in order to increase study power. Main
Objectives: The object of this study was to investigate the development in
the organization of multicenter studies, the distribution of studies
within different clinical specialties, across continents, and investigate
the differences related to testing various interventions. Methods and
Materials: A literature search was done in MEDLINE for multicenter studies
published in 1995, 2000, 2005, and 2010, respectively. Data extraction
identified data related to clinical specialties, interventions,
participating patients, departments, countries, and continents. Results:
The number of multicenter studies increased from 112 in 1995 to 1,273 in
2010, with a larger share of multicenter studies being performed in Europe
and North America. The pharmacological interventions were primarily being
tested in medical studies followed by the device tests predominantly in
surgical studies. The number of included patients as well as the number of
participating departments increased during the time span, though the
increase in studies was most evident in Europe and North America compared
with the rest of the world. 2014 Danielsen et al.
<3>
Accession Number
2014459791
Authors
Song Y. Kwak Y.L. Song J.W. Kim Y.J. Shim J.K.
Institution
(Song, Kwak, Song, Kim, Shim) Department of Anaesthesiology and Pain
Medicine, Yonsei University Health System, 134, Shinchon-dong,
Seodaemun-gu, Seoul 120-725, South Korea
(Song, Kwak, Song, Shim) Anaesthesia and Pain Research Institute, Yonsei
University Health System, 134, Shinchon-dong, Seodaemun-gu, Seoul 120-725,
South Korea
(Kwak) Severance Biomedical Science Institute, Yonsei University, 134,
Shinchon-dong, Seodaemun-gu, Seoul 120-725, South Korea
Title
Respirophasic carotid artery peak velocity variation as a predictor of
fluid responsiveness in mechanically ventilated patients with coronary
artery disease.
Source
British Journal of Anaesthesia. 113 (1) (pp 61-66), 2014. Date of
Publication: July 2014.
Publisher
Oxford University Press
Abstract
Background We studied respirophasic variation in carotid artery blood flow
peak velocity (Vpeak-CA) measured by pulsed wave Doppler ultrasound as a
predictor of fluid responsiveness in mechanically ventilated patients with
coronary artery disease. Methods Forty patients undergoing elective
coronary artery bypass surgery were enrolled. Subjects were classified as
responders if stroke volume index (SVI) increased >15% after volume
expansion (6 ml kg <sup>-1</sup>). The Vpeak-CA was calculated as the
difference between the maximum and minimum values of peak velocity over a
single respiratory cycle, divided by the average. Central venous pressure,
pulmonary artery occlusion pressure, pulse pressure variation (PPV), and
Vpeak-CA were recorded before and after volume expansion. Results PPV and
Vpeak-CA correlated significantly with an increase in SVI after volume
expansion. Area under the receiver-operator characteristic curve (AUROC)
of PPV and Vpeak-CA were 0.75 [95% confidence interval (CI) 0.59-0.90] and
0.85 (95% CI 0.72-0.97). The optimal cut-off values for fluid
responsiveness of PPV and Vpeak-CA were 13% (sensitivity and specificity
of 0.74 and 0.71) and 11% (sensitivity and specificity of 0.85 and 0.82),
respectively. In a subgroup analysis of 17 subjects having pulse pressure
hypertension (> 60 mm Hg), PPV failed to predict fluid responsiveness
(AUROC 0.70, P=0.163), whereas the predictability of Vpeak-CA remained
unchanged (AUROC 0.90, P=0.006). Conclusions Doppler assessment of
respirophasic Vpeak-CA seems to be a highly feasible and reliable method
to predict fluid responsiveness in mechanically ventilated patients
undergoing coronary revascularization. 2014 The Author [2014]. Published
by Oxford University Press on behalf of the British Journal of
Anaesthesia. All rights reserved.
<4>
Accession Number
2014459471
Authors
Jiang B. Wang J. Lv X. Cai W.
Institution
(Jiang, Wang) Departments of Radiology, 71 Hexi Street, Nanjing, Jiangsu
210019, China
(Lv) Interventional Radiology, Nanjing, China
(Cai) Departments of Cardiology, BenQ Medical Center, Nanjing Medical
University, Nanjing, China
Title
Prognostic value of cardiac computed tomography angiography in patients
with suspected coronary artery disease: A meta-Analysis.
Source
Cardiology (Switzerland). 128 (4) (pp 304-312), 2014. Date of Publication:
July 2014.
Publisher
S. Karger AG
Abstract
Objectives: The diagnostic accuracy of cardiac computed tomography
angiography (CCTA) is well reported. The prognostic value of CCTA has been
described in several studies, but many of these were underpowered and an
update of the meta-analysis is necessary to increase the power to predict
rare events. The purpose of this study was to perform a meta-analysis of
the ability of CCTA to predict future cardiovascular events. Methods: We
searched multiple databases for longitudinal studies of CCTA with a
follow-up of at least 12 months of symptomatic patients with suspected
coronary artery disease (CAD) reporting major adverse cardiovascular
events (MACE), death, myocardial infarction and revascularization. Summary
test parameters and receiver-operating characteristic curves were
calculated. Results: Eighteen studies evaluated 29,243 patients with a
median follow-up of 25 months. For MACE in patients with negative findings
on CCTA, there was a pooled negative likelihood ratio (LR) of 0.01 [95%
confidence interval (CI) 0.00-0.08], a positive LR of 1.72 (95% CI
1.54-1.91), a sensitivity of 1.00 (95% CI 0.97-1.00), a specificity of
0.42 (95% CI 0.36-0.48) and a diagnostic odds ratio of 159.07 (95% CI
22.20-1,139.80). The weighted average annualized MACE rate for positive
versus negative CCTA findings was 3.49 versus 0.21%. Stratifying by no
CAD, nonobstructive CAD or obstructive CAD, there were incrementally
increasing adverse events. Conclusions: Adverse cardiovascular events
among patients with normal findings on CCTA are rare. There are
incrementally increasing future MACE with increasing CAD by CCTA. 2014 S.
Karger AG, Basel.
<5>
Accession Number
2014460109
Authors
Mojadidi M.K. Bogush N. Caceres J.D. Msaouel P. Tobis J.M.
Institution
(Mojadidi, Bogush, Caceres, Msaouel) Department of Medicine, Albert
Einstein College of Medicine, Jacobi Medical Center, 1400 Pelham Parkway,
Bronx, NY 10461, United States
(Tobis) Program in Interventional Cardiology, David Geffen School of
Medicine, University of California, Los Angeles, CA, United States
Title
Diagnostic accuracy of transesophageal echocardiogram for the detection of
patent foramen ovale: A meta-analysis.
Source
Echocardiography. 31 (6) (pp 752-758), 2014. Date of Publication: July
2014.
Publisher
Blackwell Publishing Inc.
Abstract
Background Patent foramen ovale (PFO) is a remnant of the fetal
circulation present in 20% of the population. Right-to-left shunting (RLS)
through a PFO has been linked to the pathophysiology of stroke, migraine
with aura, and hypoxemia. While different imaging modalities including
transcranial Doppler, intra-cardiac echo, and transthoracic echo (TTE)
have often been used to detect RLS, transesophageal echo (TEE) bubble
study remains the gold standard for diagnosing PFO. The aim of this study
was to determine the relative accuracy of TEE in the detection of PFO.
Methods and Results A systematic review of Medline, using a standard
approach for meta-analysis, was performed for all prospective studies
assessing accuracy of TEE in the detection of PFO using confirmation by
autopsy, cardiac surgery, and/or catheterization as the reference. Search
results revealed 3105 studies; 4 met inclusion criteria. A total of 164
patients were included. TEE had a weighted sensitivity of 89.2% (95% CI:
81.1-94.7%) and specificity of 91.4% (95% CI: 82.3-96.8%) to detect PFO.
The overall positive likelihood ratio (LR+) was 5.93 (95% CI: 1.30-27.09)
and the overall negative likelihood ratio (LR-) was 0.22 (95% CI:
0.08-0.56). Conclusion While TEE bubble study is considered to be the gold
standard modality for diagnosing PFO, some PFOs may still be missed or
misdiagnosed. It is important to understand the limitations of TEE and
perhaps use other highly sensitive screening tests, such as transcranial
doppler (TCD), in conjunction with TEE before scheduling a patient for
transcatheter PFO closure. 2013, Wiley Periodicals, Inc.
<6>
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Accession Number
71534262
Authors
Gopal S. Luckraz H. Giri R. Nevill A. Bickerton S. Jenkins D.
Institution
(Gopal, Luckraz, Giri, Bickerton, Jenkins) Cardiothoracic Unit, Heart and
Lung Centre, Wolverhampton, United Kingdom
(Nevill) University of Wolverhampton, Wolverhampton, United Kingdom
Title
Benefits of the venner PneuX endotracheal tube in high-risk patients
undergoing cardiac surgery.
Source
Critical Care Medicine. Conference: 43rd Critical Care Congress of the
Society of Critical Care Medicine, SCCM 2014 San Francisco, CA United
States. Conference Start: 20140109 Conference End: 20140113. Conference
Publication: (var.pagings). 41 (12 SUPPL. 1) (pp A274), 2013. Date of
Publication: December 2013.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Patients who undergo major cardiac surgery are at risk of
developing Ventilator Associated Pneumonia (VAP). The Venner PneuX Y.P.VAP
Prevention system has been developed specifically with the aim of reducing
the incidence of VAP. This system is comprised of an endotracheal tube
with subglottic ports to allow irrigation and suction of the subglottic
space as well as a cuff pressure monitoring system to enable continuous in
vivo monitoring and maintenance of the endotracheal tube cuff at a
preselected pressure. Initial case series using this system have reported
promising results in reducing the incidence of VAP. However to date there
has been no randomised controlled trial to scentifically evaluate the
efficacy of the Venner PneuX Y.P. VAP Prevention system to reduce the
incidence of VAP compared to a standard endotracheal tube in high risk
patients scheduled for major heart surgery. Methods: 240 high risk
patients (age >70 years and/or impaired left ventricular function with
ejection fraction <40%) who were scheduled for elective or urgent cardiac
surgery were randomly assigned to be intubated with the Venner PneuX Y.P.
VAP Prevention system tube or a standard endotracheal tube at induction of
anaesthesia. Patients were monitored up for up to 48hours following
extubation for the development of VAP. VAP was diagnosed as per the HELICS
definition. The incidence of VAP between the two groups was the primary
outcome measure. Results: There were no significant differences between
the two groups in terms of pre-operative patient demographics. The mean
(SD) age was 72.4 (8.2) and 72.2 years (7.4) respectively (p=0.6).
Pre-operatively 16.7% and 18.5% (0.7) of patients respectively had a
history of lung disease (COPD or Asthma) p=0.6. The mean Euroscores were
6.39 (2.2) and 6.48 (2.6) respectively (p=0.9). There were no differences
in the types of cardiac procedures with 28.6% and 25.2% (p=0.3) of
patients undergoing complex operation (CABG+Valve, multiple valve
surgery). The median duration of endotracheal intubation were 15.1 and
13.1 hours respectively (p=0.3). The incidence of VAP was significantly
lower in patients intubated with the Venner PneuX Y.P.VAP Prevention
system compared to a standard endotracheal tube (10.8% V/S 21%) in this
high-risk patient group (p=0.031). There was no significant difference in
the ICU stay (p=0.2). Post-op survival was similar in both groups (97% V/S
99%; p=0.2). Multivariate regression analysis taking into account type of
ET tube, age, Left Ventricular Ejection Fraction, Euroscore, history of
lung disease, recent MI, in-hospital stay prior to surgery, type of
cardiac procedure, urgency of surgery, re-exploration for bleeding,
duration of ET intubation confirmed that the Venner PneuX Y.P. VAP
Prevention system as the only significant factor to reduce VAP (odds ratio
2.2, p=0.03). Conclusions: The the Venner PneuX Y.P. VAP Prevention system
reduces the risk of VAP in high-risk patients undergoing cardiac surgery
despite a short intubation time.
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Accession Number
71534170
Authors
Rigby M. Maher K. Preissig C. Nitu M. Rider C. Rotta A. Leong T.
Institution
(Rigby, Nitu) Indiana University, Riley Hospital for Children,
Indianapolis, IN, United States
(Maher) Emory University, Atlanta, GA, United States
(Preissig) Medical Center of Central Georgia, Macon, GA, United States
(Rider) Indiana University, Riley Hospital for Children, Indianpolis, IN,
United States
(Rotta) Case Western Reserve University, School of Medicine, Cleveland,
OH, United States
(Leong) Emory School of Public Health, Atlanta, GA, United States
Title
The pedietrol trial: A 2-center trial of glycemic control in pediatric
critical illness.
Source
Critical Care Medicine. Conference: 43rd Critical Care Congress of the
Society of Critical Care Medicine, SCCM 2014 San Francisco, CA United
States. Conference Start: 20140109 Conference End: 20140113. Conference
Publication: (var.pagings). 41 (12 SUPPL. 1) (pp A249), 2013. Date of
Publication: December 2013.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: In critical illness, hyperglycemia is associated with organ
dysfunction and failure, morbidity and mortality. Although not thoroughly
evaluated in children, evidence from existing randomized controlled trials
contradictory. Most trials in adults suggest that strict glycemic control
results in improved outcomes compared to conservative control. Methods:
This was a 2-center prospective randomized controlled trial which enrolled
children 1month-18 years old who were admitted to the medical/surgical ICU
(PICU) or cardiac ICU (CICU) and was receiving on mechanical ventilation,
vasopressors or both. After admission to the ICU blood glucose was
screened regularly. Once patients became hyperglycemic (BG > 140mg/dL),
patients were randomly assigned to undergo either strict glucose control
using an insulin infusion with a target blood glucose of 80-140mg/ dL or
conservative control with a target <220mg/dL with ICU unit (PICU vs CICU)
as the stratification. Our primary endpoint was the change in PELOD from
day of enrollment (day 0) to day 6 or ICU discharge (whichever came
first). Results: We randomized 153 patients where 75 were assigned to the
conservative arm and 78 to the strict arm. Average decrease in PELOD did
not differ by strict and conservative arms (4.5 vs 6.5, respectively) .
However, for CICU patients (n=121), the average decrease in PELOD of 9.3
in the strict arm was significantly greater than the average decrease of
4.6 in the conservative arm (p=.0384). The change in PELOD for PICU
patients (n=32) did not significantly differ. No difference was observed
in secondary outcomes such as mortality or length of stay (LOS). A total
of 6 deaths were observed with 2 (2.7%) on the conservative arm and 4
(5.1%) on the strict arm (p=.6816). For CICU patients, ICU LOS average was
4.4d vs 3.6d in the conservative arm respectively (p=.8104). In the PICU,
those averages were 15.4d vs 12.5d (p=.2708) for the conservative and
strict arms, respectively. Conclusions: Although this study did not meet
its primary endpoint, there was no difference in the change in PELOD form
day 0 to day 6/ discharge overall. This study did meet a pre-specified
secondary outcome where we did observe greater improvement in PELOD in the
CICU patients whose blood glucose was in a target range of 80-140mg/dL
without increased risk of mortality or other adverse events. This data
suggests that strict glycemic control may hasten organ recovery following
cardiac surgery in children. Because of low enrollment in the PICU arm, it
is challenging to make definitive conclusions on this population.
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Accession Number
71534060
Authors
Bioc J. Magee Cucchi J. Fraser G. Dasta J. Edwards R. Devlin J.
Institution
(Bioc, Magee, Cucchi, Edwards, Devlin) Northeastern University, Boston,
MA, United States
(Fraser) Maine Medical Center, Portland, ME, United States
(Dasta) University of Texas, Austin, TX, United States
Title
Cost-effectiveness of benzodiazepi ne vs. Non-benzodiazepi ne sedation
during mechanical ventilation.
Source
Critical Care Medicine. Conference: 43rd Critical Care Congress of the
Society of Critical Care Medicine, SCCM 2014 San Francisco, CA United
States. Conference Start: 20140109 Conference End: 20140113. Conference
Publication: (var.pagings). 41 (12 SUPPL. 1) (pp A221), 2013. Date of
Publication: December 2013.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: A meta-analyses of six RCTs (1,235 pts) comparing a
benzodiazepine (BZ) (lorazepam or midazolam) vs. a non-BZ (dexmedetomidine
or propofol) sedative regimen in non-cardiac surgery, critically ill
adults found that non-BZ sedation was associated with a shorter duration
of mechanical ventilation (MV) (1.9 less days (d); p < 0.00001) and ICU
length of stay (1.62 less d, p=0.0007) but a similar prevalence of
delirium and short-term mortality rate (CCM 2013;41:S30). Methods: A CE
analysis, from both an administrator & third party payer perspective and
including medical, critically ill adults requiring >1d MV and administered
either a BZ or non-BZ sedative, cycled health states and costs daily using
a Markov model that accounted for daily MV need until ICU discharge.
Transition probabilities were obtained from the meta-analysis and costs
were estimated as follows: 1) One ICU d (CCM 2005;33:1266) inflated to
2012 $US using medical CPI and based on continued need for MV [MV (d1
$6,848; > d2 $4,797); no-MV(> d2 $3,585)] and 2) sedative drug cost
[infusion time x mean dose/pt (from the 6 studies) and then weighted by
the # of pts per study x average AWP]. Sensitivity analyses were run for
all extubation and ICU discharge probabilities (0 to1) and for varying
cost estimates. Results: When a non-BZ rather than BZ sedation regimen was
used, the incremental CE ratio to avert 1d in the ICU (while MV) or 1d in
the ICU (while either MV or non-MV) was $3,406 and $3,136, respectively.
The base-case analysis revealed, over the course of an ICU stay, that use
of a non-BZ sedative (vs. a BZ sedative) resulted in higher drug costs
($1,327 vs. $65) but lower total ICU costs (% accounted for MV need):
$35,380 (71.0%) vs. $45,394 (70.6%). Sensitivity analysis revealed that a
BZ strategy would only be less costly if the daily rate of extubation was
> 16% and the overall rate of successful ICU discharge without MV was >
77%. Conclusions: Despite its higher acquisition cost, a non-BZ sedative
strategy appears to have a more favorable CE ratio for MV, critically ill
adults than a BZ sedative strategy over most cost estimates.
<9>
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Accession Number
71533740
Authors
Zaal I. Devlin J. Slooter A.
Institution
(Zaal, Slooter) University Medical Center-Utrecht, Utrecht, Netherlands
(Devlin) Northeastern Univ, Boston, United States
Title
A systematic review of risk factors for delirium in the intensive care
unit.
Source
Critical Care Medicine. Conference: 43rd Critical Care Congress of the
Society of Critical Care Medicine, SCCM 2014 San Francisco, CA United
States. Conference Start: 20140109 Conference End: 20140113. Conference
Publication: (var.pagings). 41 (12 SUPPL. 1) (pp A136), 2013. Date of
Publication: December 2013.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Clear delineation of variables that predispose and
precipitate delirium in the ICU is important for formulating prevention
strategies and model building during etiologic research. Methods: We
searched 4 electronic databases from 2000 to February 2013 for studies
that evaluated critically ill adults, not undergoing cardiac surgery, for
delirium at least once daily with a validated assessment method, and used
either multivariate analysis or randomization to evaluate > 1 variable as
a potential risk factor for delirium occurrence (PROSPERO
#CRD42013004886). In duplicate, data was abstracted and quality was scored
using SIGN checklists [i.e. high (HQ), acceptable (AQ), unacceptable]. As
substantial inter-study heterogeneity prevented statistical pooling, all
reported variables were qualitatively evaluated using 3 criteria: number
of studies evaluating the variable, the quality of each study, and whether
the direction of association was consistent (i.e., across > 75% of the
studies). The strength of evidence was defined as: strong (consistent
findings in > 2 HQ studies), moderate (consistent findings in 1 HQ study
or > 1 AQ studies), weak (1 HQ study or consistent findings in > 3 AQ
studies) or inconclusive (inconsistent findings or consistent findings in
< 2 AQ studies). Results: Among the 25 [observational (n=21); randomized
(n=4)] studies included, 60% were HQ and 89 different variables were
evaluated. Risk factors for delirium occurrence deemed strong were age,
dementia, pre-ICU emergency surgery or trauma, APACHE II score,
intubation, sepsis, metabolic acidosis and iatrogenic coma. Risk factors
classified as moderate were alcohol consumption, hypertension, moderate
cognitive impairment, admission with a respiratory problem or infection,
medical admission and opioid use. All other variables, including several
laboratory or environmental parameters, were either weak or inconclusive.
Conclusions: Among 89 variables hypothesized to increase the risk for
delirium occurrence in the ICU, only 16 have either a strong or moderate
level of evidence to support their role as risk factors.
<10>
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Accession Number
71533265
Authors
Albert N. Bena J. Hartig K. Horvath G. Rhoades V. Van Den Bossche R.
Vargas N. Wilson S.
Institution
(Albert, Bena, Hartig, Horvath, Rhoades, Van Den Bossche, Vargas, Wilson)
Cleveland Clinic, Cleveland, OH, United States
Title
A RCT of infection rates in ICU environments by EKG lead wire type:
Disposable and cleaned, reusable.
Source
Critical Care Medicine. Conference: 43rd Critical Care Congress of the
Society of Critical Care Medicine, SCCM 2014 San Francisco, CA United
States. Conference Start: 20140109 Conference End: 20140113. Conference
Publication: (var.pagings). 41 (12 SUPPL. 1) (pp A11), 2013. Date of
Publication: December 2013.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: It is unknown if non-sterile, disposable
electrocardiographic lead wires (ECG-LW) reduce infection rates compared
to clean, reusable ECG-LW. Methods: Unblinded, randomized, controlled
trial. Matched adult ICUs (2 medical, 4 cardiovascular surgery; 3 general
surgery and 2 neurological) were randomly assigned to reusable (usual
care) or disposable (intervention) ECG-LW. Patients were assessed for
blood stream infection, ventilator associated pneumonia, and in
cardiothoracic surgical patients, chest surgical site infection. Patient
factors and infections were collected from hospital databases. Event rates
were described using total counts and rate/100 pt days. Between groups,
event rates were compared using generalized linear mixed effect models
that were weighted by patients' length of ICU stay. Results: In 7240
patient cases, 4056 cases from 6 ICUs received disposable and 3184 cases
from 5 ICUs received reusable ECGLW. Among subjects, age, gender, race,
marital status, insurance type, and both intensive care and hospital
length of stays were similar between groups. Patients receiving disposable
ECG-LW were less likely to be discharged home (35% versus 38%, p=0.028)
and had higher median (IQR) comorbidity index scores (2.63 [2.56, 2.70]
versus 2.48 [2.40, 2.56], p=0.002). There were no differences in overall
infection rates between ECG-LW groups, between groups of matched ICUs,
based on each infection type or when only considering patients with ICU
stays beyond 48 hours (2578 cases). In multivariate analyses, there
continued to be no differences between ECG-LW groups in overall infection
for all cases or those with ICU stays beyond 48 hours (both p=0.10) or for
time to first infection for all cases or those with ICU stays beyond 48
hours (p=0.25 and 0.23, respectively). Conclusions: There was no observed
difference in infection rates of ICU patients receiving disposable versus
reusable ECG-LW.
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Accession Number
71531330
Authors
Benck U.T. Hoeger S. Goettmann U. Doenmez D. Yard B. Schnuelle P.
Institution
(Benck, Goettmann, Doenmez, Schnuelle) 5th Medical Clinic, University
Medical Centre, Mannheim, Germany
(Hoeger, Yard) Medical Clinic, University Hospital Mannheim, Mannheim,
Germany
Title
Effects of donor pretreatment with dopamine on graft function after heart
transplantation: Data from a randomized controlled trial.
Source
Transplantation. Conference: 23rd International Congress of the
Transplantation Society, TTS 2010 Vancouver, BC Canada. Conference Start:
20100815 Conference End: 20100819. Conference Publication: (var.pagings).
90 (pp 118), 2010. Date of Publication: 27 Jul 2010.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction Treatment of the deceased heart-beating donor with low-dose
dopamine results in less dialysis requirement after kidney
transplantation. This study investigates the development of all cardiac
allografts from multi-organ donors that were enrolled in the randomized
dopamine trial (clinicaltrials.gov Identifier: NCT00115115). Methods
Between March 2004 and August 2007, 264 brain-dead donors were randomly
assigned to receive or to not receive low-dose dopamine. Eligibility
criteria included circulatory stability under low-dose norepinephrine. The
present investigation was initiated under safety considerations and is
nested in the multicenter randomized controlled trial on donor
pretreatment with dopamine. We assessed the outcomes of 99 cardiac
transplants performed at 22 European centers. Results Dopamine was infused
for a median duration of 400 minutes [IQR 232 minutes]. Donors and
recipients were very similar in demographic and clinical baseline
characteristics. Fewer recipients of a pretreated graft required renal
replacement therapy immediately after transplantation[p=0.05].
Furthermore, a combined endpoint of early graft funtion comprising the
need for a ventricular assist device and left ventricular function was in
favor of the dopamine pretreated grafts [p=0.07]. The beneficial effects
were particularly enhanced when dopamine was applied to the donors until
cross clamping. Circulatory parameters of the donors did not affect the
transplantation outcome measures. Donor dopamine was associated with a
significant survival benefit 3 years after heart transplantation [85.7%
vs. 65.7%, p=0.02]. Conclusion Preconditioning of brain-dead donors with
low-dose dopamine at a dosage of 4mug/kg/min is definitely not harmful for
the cardiac allograft but appears to substantially improve patient and
graft survival after heart transplantation.
<12>
Accession Number
24684171
Authors
Calancie B. Donohue M.L. Harris C.B. Canute G.W. Singla A. Wilcoxen K.G.
Moquin R.R.
Institution
(Calancie) Departments of Neurosurgery and.
Title
Neuromonitoring with pulse-train stimulation for implantation of thoracic
pedicle screws: a blinded and randomized clinical study. Part 1. Methods
and alarm criteria.
Source
Journal of neurosurgery. Spine. 20 (6) (pp 675-691), 2014. Date of
Publication: Jun 2014.
Abstract
Reports of the accuracy of existing neuromonitoring methods for detecting
or preventing medial malpositioning of thoracic pedicle screws have varied
widely in their claimed effectiveness. The object of this study was to
develop, test, and validate a novel neuromonitoring method for preventing
medial malpositioning of pedicle screws in the thoracic spine during
surgery. This is a prospective, blinded and randomized study using a novel
combination of input (4-pulse stimulus trains delivered within the pedicle
track) and output (evoked electromyography from leg muscles) to detect
pedicle track trajectories that-once implanted with a screw-would cause
that screw to breach the pedicle's medial wall and encroach upon the
spinal canal. For comparison, the authors also used screw stimulation as
an input and evoked electromyogram from intercostal and abdominal muscles
as output measures. Intraoperative electrophysiological findings were
compared with postoperative CT scans by multiple reviewers blinded to
patient identity or intraoperative findings. Data were collected from 71
patients, in whom 802 screws were implanted between the T-1 and L-1
vertebral levels. A total of 32 screws ended up with screw threads
encroaching on the spinal canal by at least 2 mm. Pulse-train stimulation
within the pedicle track using a ball-tipped probe and electromyography
from lower limb muscles correctly predicted all 32 (100%) of these
medially malpositioned screws. The combination of pedicle track
stimulation and electromyogram response from leg muscles proved to be far
more effective in predicting these medially malpositioned screws than was
direct screw stimulation and any of the target muscles (intercostal,
abdominal, or lower limb muscles) we monitored. Based on receiver
operating characteristic analysis, the combination of 10-mA (lower alarm)
and 15-mA stimulation intensities proved most effective for detection of
pedicle tracks that ultimately gave rise to medially malpositioned screws.
Additional results pertaining to the impact of feedback of these test
results on surgical decision making are provided in the companion report.
This novel neuromonitoring approach accurately predicts medially
malpositioned thoracic screws. The approach could be readily implemented
within any surgical program that is already using contemporary
neuromonitoring methods that include transcranial stimulation for
monitoring motor evoked potentials.
<13>
Accession Number
2014461086
Authors
Haycock P.C. Heydon E.E. Kaptoge S. Butterworth A.S. Thompson A. Willeit
P.
Institution
(Haycock, Heydon, Kaptoge, Butterworth, Thompson, Willeit) Strangeways
Research Laboratory, Institute of Public Health, University of Cambridge,
Cambridge, United Kingdom
(Haycock) Medical Research Council Integrative Epidemiology Unit, School
of Social and Community Medicine, University of Bristol, Bristol, United
Kingdom
(Thompson) Roche, Welwyn Garden City, United Kingdom
(Willeit) Department of Neurology, Innsbruck Medical University, Austria
Title
Leucocyte telomere length and risk of cardiovascular disease: Systematic
review and meta- Analysis.
Source
BMJ (Online). 349 , 2014. Article Number: g4227. Date of Publication: 08
Jul 2014.
Publisher
BMJ Publishing Group
Abstract
Objective To assess the association between leucocyte telomere length and
risk of cardiovascular disease. Design Systematic review and meta-
Analysis. Data sources Studies published up to March 2014 identified
through searches of Medline, Web of Science, and Embase. Eligibility
criteria Prospective and retrospective studies that reported on
associations between leucocyte telomere length and coronary heart disease
(defined as non-fatal myocardial infarction, coronary heart disease death,
or coronary revascularisation) or cerebrovascular disease (defined as
non-fatal stroke or death from cerebrovascular disease) and were broadly
representative of general populations- That is, they did not select cohort
or control participants on the basis of pre-existing cardiovascular
disease or diabetes. Results Twenty four studies involving 43 725
participants and 8400 patients with cardiovascular disease (5566 with
coronary heart disease and 2834 with cerebrovascular disease) were found
to be eligible. In a comparison of the shortest versus longest third of
leucocyte telomere length, the pooled relative risk for coronary heart
disease was 1.54 (95% confidence interval 1.30 to 1.83) in all studies,
1.40 (1.15 to 1.70) in prospective studies, and 1.80 (1.32 to 2.44) in
retrospective studies. Heterogeneity between studies was moderate
(I<sup>2</sup>=64%, 41% to 77%, P<sub>het</sub><0.001) and was not
significantly explained by mean age of participants (P=0.23), the
proportion of male participants (P=0.45), or distinction between
retrospective versus prospective studies (P=0.32). Findings for coronary
heart disease were similar in meta- Analyses restricted to studies that
adjusted for conventional vascular risk factors (relative risk 1.42, 95%
confidence interval 1.17 to 1.73); studies with >200 cases (1.44, 1.20 to
1.74); studies with a high quality score (1.53, 1.22 to 1.92); and in
analyses that corrected for publication bias (1.34, 1.12 to 1.60). The
pooled relative risk for cerebrovascular disease was 1.42 (1.11 to 1.81),
with no significant heterogeneity between studies (I<sup>2</sup>=41%, 0%
to 72%, P <sub>het</sub>=0.08). Shorter telomeres were not significantly
associated with cerebrovascular disease risk in prospective studies (1.14,
0.85 to 1.54) or in studies with a high quality score (1.21, 0.83 to
1.76). Conclusion Available observational data show an inverse association
between leucocyte telomere length and risk of coronary heart disease
independent of conventional vascular risk factors. The association with
cerebrovascular disease is less certain.
<14>
Accession Number
2014465148
Authors
Ren H. Tong Y. Ding X.-B. Wang X. Jin S.-Q. Niu X.-Y. Zhao X. Li Q.
Institution
(Ren, Niu) Department of Anesthesiology, Shanghai Tenth People's Hospital,
Tongji University, Shanghai 200072, China
(Tong, Ding, Jin, Zhao, Li) Department of Anesthesiology, Shanghai East
Hospital, Tongji University, Shanghai 200120, China
(Wang) Department of Anesthesiology, First Clinical College of Nanjing
Medical University, Nanjing 210029, Jiangsu, China
Title
Abdominal wall-lifting versus CO2 pneumoperitoneum in laparoscopy: A
review and meta-analysis.
Source
International Journal of Clinical and Experimental Medicine. 7 (6) (pp
1558-1568), 2014. Date of Publication: 30 Jun 2014.
Publisher
E-Century Publishing Corporation (40 White Oaks Lane, Madison WI 53711,
United States)
Abstract
The aim of this study is to compare the operative parameters and outcomes
of conventional CO<sub>2</sub>-pneu-moperitoneum (PP) versus gasless
abdominal wall-lifting (AWL) for laparoscopic surgery. The literature
databases of PubMed, Google Scholar and Cochrane Library were searched for
randomized controlled trials (RCTs) that had compared the
CO<sub>2</sub>-PP approach with that of gasless AWL for laparoscopic
surgery and which had been published between 1995 and 2012. Data for the
operative parameters (i.e. surgery duration, intraoperative heart rate
(HR), perioperative complications, and postoperative duration of hospital
stay and time to activity) and outcomes (postoperative shoulder pain,
nausea/vomiting (PONV), partial pressure of CO<sub>2</sub> in the blood
(PaCO<sub>2</sub>), blood pH, and serum levels of the inflammatory
cytokine interleukin (IL)-6) were extracted from the identified RCTs.
RevMan software, version 5.2, was used for data synthesis and statistical
analysis. Nineteen RCTs were selected for the meta-analysis, involving a
total of 791 patients who had undergone laparoscopic operations with
CO<sub>2</sub>-PP (n = 399) or gasless AWL (n = 392). Sub-group analysis
indicated that the patients who underwent gasless AWL had significantly
shorter postoperative time to activity (weighted mean difference (WMD) =
-0.23 d, 95% confidence interval (CI): -0.37 to -0.09; P = 0.001), lower
incidence of PONV (odds ratio (OR) = 0.24, 95% CI: 0.10 to 0.57; P =
0.001) and lower postoperative PaCO<sub>2</sub> level (WMD = -3.09 mmHg,
95% CI: -4.66 to -1.53; P = 0.0001), compared to the patients who
underwent CO<sub>2</sub>-PP. However, the CO<sub>2</sub>-PP method was
associated with a significantly shorter surgery duration than the gasless
AWL method (WMD = 8.61, 95% CI: 3.19 to 14.03; P = 0.002). There were no
significant advantages detected for either approach with respect to the
intraoperative HR, the perioperative complication rate, or the
postoperative parameters of duration of hospital stay, shoulder pain,
blood pH, or serum IL-6 level. We concluded form present study that the
gasless AWL method has the features of shorter time, lower postoperative
PaCO<sub>2</sub>, and lower PONV incidence while the CO<sub>2</sub>-PP
method for laparoscopy requires shorter surgical time.
<15>
Accession Number
23733668
Authors
Xia R. Yin H. Xia Z.-Y. Mao Q.-J. Chen G.-D. Xu W.
Institution
(Xia, Yin, Mao, Chen, Xu) Department of Anesthesiology, First Affiliated
Hospital, Yangtze University, Jingzhou, 434000, China
(Xia) Department of Anesthesiology, People's Hospital, Wuhan University,
Wuhan, 430060, China
Title
Effect of Intravenous Infusion of Dexmedetomidine Combined with Inhalation
of Isoflurane on Arterial Oxygenation and Intrapulmonary Shunt During
Single-Lung Ventilation.
Source
Cell Biochemistry and Biophysics. 67 (3) (pp 1547-1550), 2013. Date of
Publication: December 2013.
Abstract
To investigate the changes in arterial oxygenation and intrapulmonary
shunt during one-lung ventilation (OLV) with intravenous infusion of
dexmedetomidine combined with isoflurane inhalation. ASA I-II 60 patients
aged 18-70 year, undergoing OLV during elective thoracic surgery were
randomly allocated to two groups: (1) isoflurane + saline (group NISO, n =
30) and (2) isoflurane + dexmedetomidine (group DISO, n = 30). After
induction, anesthesia was maintained with intravenous infusion of
remifentanil 0.1-0.2 mug kg<sup>-1</sup> min<sup>-1</sup> and inhalation
isoflurane (1.0-2.0 %). In addition, anesthesia was maintained with
intravenous infusion of dexmedetomidine 0.7 mug kg<sup>-1</sup>
h<sup>-1</sup> in DISO group and saline 0.25 ml kg<sup>-1</sup>
h<sup>-1</sup> in NISO group. Bispectral Index values were maintained
within 40-60 by changing the concentration of isoflurane in all groups.
Arterial blood gas samples and central venous blood gas samples were taken
as follows: during two-lung ventilation before OLV and during the first 40
min of OLV. 45 Patients completed the study, with 23 patients in DISO
group and 22 patients in NISO group. The two groups were comparable in
terms of demographic variables, hemodynamic, PaO<sub>2</sub>,
Qs/Q<sub>T</sub>, end expiration isoflurane and BIS levels during the
operation. Compared with patients in the group NISO, there were
significant increases with PaO<sub>2</sub>, significant decrease with
Qs/Q<sub>T</sub>, significant decrease with end expiration isoflurane, and
significant decrease with HR in the group DISO during the first 40 min of
OLV (P < 0.05). Dexmedetomidine infusions decrease the requirement for
isoflurane, decrease intrapulmonary shunt, and moderate the change in
PaO<sub>2</sub> and may be useful in managing OLV. 2013 Springer
Science+Business Media New York.
<16>
Accession Number
2014451575
Authors
Alavi S.M. Ghoreishi S.M. Chitsazan M. Ghandi I. Fard A.J. Hosseini S.S.
Mahjoobifard M. Fani K.
Institution
(Alavi, Ghoreishi, Ghandi, Mahjoobifard, Fani) Department of Cardiac
Anesthesiology, Rajaei Cardiovascular Medical and Research Center, Tehran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Chitsazan) Rajaei Cardiovascular Medical and Research Center, Tehran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Fard) Masih Daneshvari Research Institute of Tuberculosis and Lung
Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran,
Islamic Republic of
(Hosseini) Department of Cardiovascular Surgery, Shaheed Rajaei
Cardiovascular Medical and Research Center, Tehran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
Title
Patient-controlled analgesia after coronary bypass: Remifentanil or
sufentanil?.
Source
Asian Cardiovascular and Thoracic Annals. 22 (6) (pp 694-699), 2014. Date
of Publication: July 2014.
Publisher
SAGE Publications Inc.
Abstract
Background: adequate pain control after cardiac surgery is mandatory to
reduce its remarkable morbidity. In this study, we aimed to compare the
efficacy of patient-controlled analgesia with remifentanil or sufentanil
for pain management after coronary artery bypass grafting. Methods: 249
patients who underwent coronary artery bypass were randomly assigned to
receive patient-controlled analgesia with remifentanil or sufentanil
during the first 24 h postoperatively. Pain intensity during
patient-controlled analgesia was assessed using 4 different pain rating
scales. Results: patients given remifentanil had lower Visual Analog Scale
scores at 24 h compared to those given sufentanil (p=0.002). The Numeric
Rating Scale at 24 h was also significantly lower in patients using
remifentanil (p=0.004). The Faces Pain Scale scores at 4, 18, and 24 h
were significantly lower in patients using remifentanil compared to those
using sufentanil (p=0.045, 0.036, and 0.011, respectively). No significant
differences between groups were seen in the pain intensity assessed by the
Behavior Rating Scale at any time point during the first 24 h
postoperatively. Conclusion: our study showed that both remifentanil and
sufentanil patient-controlled analgesia can provide acceptable analgesia
after coronary artery bypass. The difference between their efficacies was
inconspicuous until 24 h postoperatively. Remifentanil seems to result in
better pain relief at 24 h postoperatively. 2013 The Author(s).
<17>
Accession Number
2014455212
Authors
Reents W. Hilker M. Borgermann J. Albert M. Plotze K. Zacher M. Diegeler
A. Boning A.
Institution
(Reents) Cardiovascular Clinic Bad Neustadt, Salzburger Leite 1, 97616 Bad
Neustadt, Germany
(Hilker, Borgermann, Albert, Plotze, Zacher, Diegeler, Boning) Department
of Cardiothoracic Surgery University Medical Center Regensburg Germany,
Clinic for Heart Thoracic and Cardiovascular Surgery Heart and Diabetes
Centre NRW Ruhr University Bochum Bad Oeynhausen Germany, Department of
Cardiac and Vascular Surgery Robert Bosch Hospital Stuttgart Germany,
Department of Cardiac Surgery University Heart Center Dresden Germany,
Department of Cardiovascular Surgery Justus-Liebig University Giesen
Germany
Title
Acute kidney injury after on-pump or off-pump coronary artery bypass
grafting in elderly patients.
Source
Annals of Thoracic Surgery. 98 (1) (pp 9-15), 2014. Date of Publication:
July 2014.
Publisher
Elsevier USA
Abstract
Background An exploratory analysis of the German Off Pump Coronary Artery
Bypass Grafting in Elderly Patients (GOPCABE) trial was performed to
investigate the effect of off-pump coronary artery bypass grafting (CABG)
on kidney function after the operation. Methods Data on kidney function
were available from 1,612 patients, representing 67% of the study
population. Preoperative kidney function was graded according to the
glomerular filtration rate. Acute kidney injury (AKI) within the first
week after the operation was defined and classified according to the Acute
Kidney Injury Network (AKIN) criteria. The incidence and severity of AKI
was compared between patients operated on on-pump or off-pump. Results
Impaired kidney function was seen in 642 patients (40%), and 19 patients
had preexisting end-stage kidney disease. AKI of any severity occurred in
half of all patients undergoing CABG, with AKIN stage 1 accounting for
most of the cases. The incidence and severity of AKI in patients
undergoing on-pump vs off-pump CABG was AKIN stage 1: 298 (37%) vs 329
(42%); AKIN stage 2: 38 (5%) vs 43 (5%); and AKIN stage 3: 44 (6%) vs 44
(6%), which did not differ significantly (p = 0.174). New renal
replacement therapy was necessary in 3.2% (on-pump) and in 2.7% (off-pump)
of all patients. Stratification according to preoperative kidney function
yielded comparable frequencies of AKI for on-pump and off-pump CABG.
Conclusions AKI was common in elderly patients undergoing CABG, but
deterioration of kidney function requiring renal replacement therapy was a
rare event. Off-pump CABG was not associated with decreased rates or
reduced severity of AKI in elderly patients. 2014 by The Society of
Thoracic Surgeons.
<18>
Accession Number
2014455164
Authors
Sharma V. Deo S.V. Huebner M. Dearani J.A. Burkhart H.M.
Institution
(Sharma, Deo, Huebner, Dearani, Burkhart) Division of Surgery, Wellspan
York Hospital, York, Pennsylvania; Cardiovascular Surgery, Adventist
Wockhardt Heart Hospital, Surat, Gujarat, India; Division of Biomedical
Statistics and Informatics, and Division of Cardiothoracic Surgery, Mayo
Clinic, Rochester, Minnesota; and Division of Cardiac Surgery, University
of Oklahoma Childrens Hospital, Oklahoma City, Oklahoma
Title
In search of the ideal pulmonary blood source for the norwood procedure: A
meta-analysis and systematic review.
Source
Annals of Thoracic Surgery. 98 (1) (pp 142-150), 2014. Date of
Publication: July 2014.
Publisher
Elsevier USA
Abstract
Background A clear consensus regarding the optimal source of pulmonary
blood flow in patients with hypoplastic left heart syndrome undergoing the
Norwood procedure is lacking. Methods A literature search was undertaken
to identify relevant articles from 2005 to 2012 using "Norwood, stage 1
palliation," "Modified Blalock Taussig shunt (MBTS)," "right
ventricle-to-pulmonary artery shunt (RV-PAS)" alone or in combination.
Three end points were selected: early/stage 1 mortality, interstage
mortality, and interstage total/shunt intervention. Results A total of 20
articles, including 19 observational studies and 1 randomized trial (MBTS,
n = 1,343; RV-PAS, n = 1,028), met the inclusion criteria. Mortality after
stage 1 was 22% in the MBTS cohort and 16% in RV-PAS cohort. A pooled
analysis showed no difference in early mortality between the two groups
(risk ratio [RR], 1.20; 95% confidence interval [CI], 0.99 to 1.45; p =
0.07). On pooling data from contemporary series (similar era) of 8 studies
(MBTS, n = 709; RV-PAS, n = 631), to minimize variability in surgical and
postoperative management practices, early mortality in both cohorts was
comparable (RR, 1.14; 95% CI, 0.89 to 1.45; p = 0.29). Interstage
mortality was 13.8% and 4.6% in the MBTS and RV-PAS cohorts, respectively,
and was significantly lower for RV-PAS (RR, 2.85; 95% CI, 1.65 to 4.89; p
< 0.00002). However, patients with MBTS had fewer shunt interventions (RR,
0.55; 95% CI, 0.44 to 0.68; p < 0.001; I<sup>2</sup> = 00%). Conclusions
Our pooled analysis demonstrated no survival benefit for the MBTS or
RV-PAS in patients undergoing the Norwood procedure. There appears to be
an advantage with the RV-PAS with regard to interstage mortality at the
cost of an increased rate of shunt intervention. 2014 by The Society of
Thoracic Surgeons.
<19>
Accession Number
2014455153
Authors
Darling G. Malthaner R. Dickie J. McKnight L. Nhan C. Hunter A. McLeod
R.S.
Institution
(Darling, Malthaner, Dickie, McKnight, Nhan, Hunter, McLeod) Division of
Thoracic Surgery, Department of Surgery, University Health Network,
Toronto; Division of Thoracic Surgery, Department of Surgery, London
Health Sciences Centre, Western University, London; Department of Surgery,
Lakeridge Health Corporation, Oshawa; Cancer Care Ontario; Department of
Surgery and Samuel Lunenfeld Research Institute, Mount Sinai Hospital; and
Department of Surgery and Department of Health Policy Management and
Evaluation, University of Toronto, Toronto, Ontario, Canada
Title
Quality indicators for non-small cell lung cancer operations with use of a
modified Delphi consensus process.
Source
Annals of Thoracic Surgery. 98 (1) (pp 183-190), 2014. Date of
Publication: July 2014.
Publisher
Elsevier USA
Abstract
Background The aim of this project was to develop a set of quality
indicators to assess surgical decision making in the care of patients with
non-small cell lung cancer (NSCLC). Methods A multidisciplinary Expert
Panel of 16 physicians used a modified Delphi process to identify quality
indicators that evaluated the processes of care in patients with NSCLC. A
systematic review identified potential indicators, which were rated on
actionability, validity, usefulness, discriminability, and feasibility in
two rounds of questionnaires. The first questionnaire was completed by the
Expert Panel and by the larger thoracic surgical community of practice;
the second questionnaire was sent to only the Expert Panel. Expert Panel
members attended an in-person meeting to review the results of the two
questionnaires and to compile the final list of indicators by consensus.
Results From the literature review, 41 potential indicators were
identified. An additional 16 indicators were suggested by the Expert
Panel: 13 indicators in the two rounds of questionnaires and three after
the discussion at the in-person meeting. One further indicator was
identified after the in-person meeting. In the end, 17 indicators were
chosen from seven domains: preoperative assessment, staging, surgical
procedures, pathology, adjuvant therapy, surgical outcomes, and
miscellaneous Conclusions By use of a modified Delphi process, 17
indicators to assess the quality of processes of surgical care for
patients with NSCLC were developed. 2014 by The Society of Thoracic
Surgeons.
<20>
Accession Number
2014448896
Authors
Rushton P.R.P. Grevitt M.P.
Institution
(Rushton, Grevitt) Centre for Spinal Studies and Surgery, Queen's Medical
Centre, Derby Road, Nottingham NG7 2UH, United Kingdom
Title
Do vertebral derotation techniques offer better outcomes compared to
traditional methods in the surgical treatment of adolescent idiopathic
scoliosis?.
Source
European Spine Journal. 23 (6) (pp 1166-1176), 2014. Date of Publication:
June 2014.
Publisher
Springer Verlag
Abstract
Purpose: In recent years, authors have described novel derotation
techniques for surgery in adolescent idiopathic scoliosis. These methods
include direct vertebral body derotation (DVD) and vertebral coplanar
alignment (VCA). By improved derotation it is hoped that there is further
reduction in rib hump prominence and corresponding improvement in
patients' quality of life. This paper aims to evaluate studies reporting
outcomes from DVD and VCA techniques to assess if these methods lead to
superior radiographic vertebral derotation, rib hump correction on surface
measurements or patient-reported outcomes compared to traditional
derotation manoeuvres using similar instrumentation. Method: Literature
review. Results: Fifteen reports were identified. Most comparative studies
represent class three or four data. DVD and VCA techniques have been shown
to reduce apical vertebral rotation by 37-63 %. Few studies compare
DVD/VCA techniques with traditional methods. Most DVD/VCA reports with
pedicle screw instrumentation have reported superior radiographic
derotation on CT compared with conventional techniques. Despite this the
majority of studies have found similar corrections of rib hump
measurements between DVD/VCA techniques and cantilever or global
derotation methods. There is no evidence that DVD/VCA techniques allow
greater correction of significant rib hump deformity without an adjuvant
thoracoplasty. No studies to date have used patient-reported outcomes
prospectively or demonstrated clinically meaningful differences
retrospectively between DVD/VCA and conventional techniques. Conclusions:
There is little evidence to recommend the widespread adoption of DVD/VCA
techniques. Whilst there is some weak evidence to suggest that novel
techniques may improve radiographic measures, there is little to suggest
that they offer patients improved correction of clinical rib hump or
quality of life compared to established techniques. Further well-designed
prospective studies are needed in this area. 2014 Springer-Verlag.
<21>
Accession Number
2014455883
Authors
Bernabe-Garcia M. Lopez-Alarcon M. Mansilla- Olivares A.
Maldonado-Hernandez J. Blanco-Favela F. Chavez-Sanchez L. Chavez-Rueda K.
Mancilla-Ramirez J. Arriaga-Pizano L. Riera-Kinkel C.
Institution
(Bernabe-Garcia, Lopez-Alarcon, Maldonado-Hernandez) Unidad de
Investigacion Medica en Nutricion, Hospital de Pediatria, Instituto
Mexicano del Seguro Social (IMSS), Mexico City, Mexico
(Mansilla- Olivares) Unidad de Investigacion Biomolecular, Hospital de
Cardiologia, Centro Medico Nacional Siglo XXI, Mexico City, Mexico
(Blanco-Favela, Chavez-Sanchez, Chavez-Rueda) Unidad de Investigacion
Medica en Inmunologia, Hospital de Pediatria, Centro Medico Nacional Siglo
XXI, Mexico City, Mexico
(Mancilla-Ramirez) Departamento de Infectologia e Inmunologia, Instituto
Nacional de Perinatologia, Mexico City, Mexico
(Arriaga-Pizano) Unidad de Investigacion Medica en Inmunoquimica, Hospital
de Especialidades, IMSS, Mexico City, Mexico
(Riera-Kinkel) Servicio de Cirugia Cardiotoracica, Hospital de
Cardiologia, Centro Medico Nacional Siglo XXI, Mexico City, Mexico
Title
Oral administration of n-3 long-chain fatty acids reduce inflammatory
response and improve clinical outcomes in patients with cardiovascular
surgery.
Source
Experimental and Clinical Cardiology. 20 (6) (pp 145-160), 2014. Date of
Publication: 2014.
Publisher
Cardiology Academic Press
Abstract
Background: Exacerbated post-surgery inflammation likely leads to adverse
clinical outcomes (ACO). Given the antiinflammatory properties of
n-3LC-PUFA potential beneficial effects are expected in patients with
myocardial revascularization. Objective: To evaluate the effect of oral
omega-3 LC-PUFA administration on the inflammatory response and ACO in
subjects undergoing cardiovascular surgery. Methods: A double-blind
randomized clinical trial was carried in 23 patients scheduled to
myocardial revascularization. Twelve patients received orally 1.6g/day EPA
+ 0.8g DHA (O3-G) throughout 7 days starting 1-day previous surgery; 11
patients who received placebo were controls (CO-G). Intracellular
expressions of IL-1beta, TNF-alpha, IL-6, IL-1ra, IL-10 and CD69
co-stimulatory molecule were measured in whole blood by flow-cytometry at
1-d before surgery, and at 2h, 24h, 48h and 7-day post-surgery. The
development of infection, and cardiovascular and respiratory dysfunctions
was evaluated daily; hospital stay was also assessed. Results: After
adjusting by confounders, O3-G patients exhibited lower cytokine and CD69
expressions than CO-G. The frequency of ACO (33% vs. 82%, P=0.03), and the
hospital stay (P<0.05) were also lower in O3-G than in CO-G. Conclusion:
The oral administration of n-3 LC-PUFA reduces inflammatory response and
protects surgical patients against adverse clinical outcomes. 2013 et
al.; licensee Cardiology Academic Press.
<22>
Accession Number
2014455847
Authors
Wang X.-W. Peng C. Lu Z.-Q. Huang C. Xiang X.-Y.
Institution
(Wang, Peng, Lu) Department of Cardiothoracic Surgery, Shanghai Jiao Tong
University, Sixth People's Hospital, NO. 600 Yishan Road, Shanghai,
200233, China
(Huang, Xiang) Department of Cardiothoracic Surgery, First Affiliated
Hospital, Chongqing Medical University, Chongqing 400016, China
Title
Minimally invasive direct coronary bypass compared with percutaneous
coronary intervention for left anterior descending artery disease: A
meta-analysis of data from randomized studies.
Source
Experimental and Clinical Cardiology. 20 (6) (pp 145-168), 2014. Date of
Publication: 2014.
Publisher
Cardiology Academic Press
Abstract
Background: The clinical outcomes for left anterior descending (LAD)
coronary artery lesion between minimally invasive direct coronary artery
bypass (MIDCAB) and percutaneous coronary intervention (PCI) are still
controversial. The objective was to compare safety and efficacy between
MIDCAB and PCI for LAD. Methods: Meta-analysis of randomised comparative
peer reviewed publications. End points included mortality, myocardial
infarction, target vessel revascularization (TVR), major adverse coronary
events (MACE), angina recurrence, and stroke. Results: Fourteen studies
with 941 patients were finally involved in the present study. The
mortality and incidence of myocardial infarction were similar in MIDCAB
and PCI groups at 30 days, 6 months, and at follow-up beyond 1 year.
Compared with PCI, MIDCAB decreased incidence of TVR and MACE at 6 months
and beyond 1 year follow-up. MIDCAB was associated with a lower incidence
of angina recurrence at 6 months compared with PCI. PCI was associated
with higher risk of restenosis in target vessel. No significant difference
was shown for stroke. Conclusion: Our meta-analysis indicates that there
are no significant differences in the safety between MIDCAB and PCI in
patients with LAD. However MIDCAB is superior to PCI for TVR and MACE.
<23>
Accession Number
2014455190
Authors
Shroyer A.L.W. Hattler B. Wagner T.H. Baltz J.H. Collins J.F. Carr B.M.
Almassi G.H. Quin J.A. Hawkins R.B. Kozora E. Bishawi M. Ebrahimi R.
Grover F.L.
Institution
(Collins) Cooperative Studies, Program Coordinating Center, VA Medical
Center, 151E Bldg 362T, Boiler House Rd, Perry Point, MD 21902, United
States
(Shroyer, Hattler, Wagner, Baltz, Carr, Almassi, Quin, Hawkins, Kozora,
Bishawi, Ebrahimi, Grover) Northport VA Medical Center, Northport, New
York; Eastern Colorado Health Care System, Department of Veterans Affairs,
Denver, Colorado; University of Colorado School of Medicine at the
Anschutz Medical Campus, Aurora, Colorado; VA Palo Alto Health Economics
Resource Center, Menlo Park, California; Department of Health Research and
Policy, Stanford University, Palo Alto, California; Zablocki Veterans
Affairs Medical Center, Milwaukee, Wisconsin; Medical College of
Wisconsin, Milwaukee, Wisconsin; VA and Greater Los Angeles VA Medical
Center, Los Angeles, California
Title
Comparing off-pump and on-pump clinical outcomes and costs for diabetic
cardiac surgery patients.
Source
Annals of Thoracic Surgery. 98 (1) (pp 38-45), 2014. Date of Publication:
July 2014.
Publisher
Elsevier USA
Abstract
Background Observational studies have documented an off-pump over on-pump
advantage for high-risk patients, including diabetic patients. Randomized
trials have not confirmed this advantage. The VA Randomization On Versus
Off Bypass (ROOBY) trial randomly assigned 2,203 coronary artery bypass
graft surgery (CABG) patients at 18 sites to either on-pump (n = 1,099) or
off-pump (n = 1,104) procedures. An a priori ROOBY aim was to evaluate
treatment impact on diabetic patients. Methods Actively treated diabetic
patients (n = 835, receiving oral hypoglycemic or insulin medications)
received off-pump CABG (n = 402) or on-pump CABG (n = 433). The primary
ROOBY trial endpoints were a short-term composite (30-day operative death
or major complications) and a 1-year composite (death, nonfatal acute
myocardial infarction, or repeat revascularization). Secondary ROOBY
endpoints included 1-year all-cause death, 1-year graft patency, 1-year
changes from baseline in neurocognitive status and health-related quality
of life, and costs. Results Diabetic patients' risk factors at baseline
were balanced across treatments. For diabetic patients, the primary
short-term composite outcome rate showed a worse trend for off-pump (8.0%)
than on-pump (3.9%, p = 0.013), with no difference in the 1-year primary
composite outcome or 1-year death rate. One-year patency was 83.1%
off-pump versus 88.4% on-pump (p = 0.004). No differences were found in
neurocognitive, health-related quality of life, discharge cost, and 1-year
cumulative cost. Conclusions Concordant with the ROOBY trial's overall
findings, off-pump CABG yielded no advantage over on-pump CABG for
actively treated diabetic patients. The 1-year graft patency was lower and
the short-term composite trended higher for off-pump CABG, with no other
significant outcome or cost differences. 2014 by The Society of Thoracic
Surgeons.
<24>
Accession Number
2014454886
Authors
Spanos K. Saleptsis V. Karathanos C. Rousas N. Athanasoulas A. Giannoukas
A.D.
Institution
(Spanos, Saleptsis, Karathanos, Rousas, Athanasoulas, Giannoukas)
Department of Vascular Surgery, University of Thessaly, University
Hospital of Larissa, Larissa, Greece
Title
Combined coronary artery bypass grafting and open abdominal aortic
aneurysm repair is a reasonable treatment approach: A systematic review.
Source
Angiology. 65 (7) (pp 563-567), 2014. Date of Publication: August 2014.
Publisher
SAGE Publications Inc.
Abstract
We reviewed the literature for studies investigating the outcomes of
combined 1-stage coronary artery bypass grafting (CABG) and abdominal
aortic aneurysm (AAA) open repair (OR) procedures. An electronic search of
the English literature was conducted using the PubMed, EMBASE, and
Cochrane databases. Age, coronary heart disease severity, AAA size, mean
duration from CABG to AAA OR procedures, details of each procedure,
mortality, and morbidity rates were analyzed. Between 1994 and 2012, 12
studies (256 patients) with 1-stage treatment fulfilled the inclusion
criteria and were analyzed. There were 20 early (30 days) deaths,
accounting for a 30-day mortality rate of 7.8%. The early morbidity was
53% (136 of 256). One-stage treatment when necessary can be undertaken
with acceptable mortality and reasonable morbidity rates considering the
complexity of both the operations. Nowadays, endovascular AAA repair is
preferred over OR. The outcomes of combined cardiac surgery and
endovascular AAA repair have not been extensively evaluated.
<25>
Accession Number
2014453481
Authors
Grosen K. Drewes A.M. Hojsgaard A. Pfeiffer-Jensen M. Hjortdal V.E.
Pilegaard H.K.
Institution
(Grosen, Hojsgaard, Hjortdal, Pilegaard) Department of Cardiothoracic and
Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
(Drewes) Mech-Sense, Department of Gastroenterology and Hepatology,
Aalborg University Hospital, Aalborg, Denmark
(Drewes) Center for Sensory-Motor Interaction, Department of Health
Science and Technology, Aalborg University, Aalborg, Denmark
(Pfeiffer-Jensen) Department of Rheumatology, Aarhus University Hospital,
Aarhus, Denmark
Title
Perioperative gabapentin for the prevention of persistent pain after
thoracotomy: A randomized controlled trial.
Source
European Journal of Cardio-thoracic Surgery. 46 (1) (pp 76-85), 2014.
Article Number: ezu032. Date of Publication: July 2014.
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
Objectives: To evaluate the effect of perioperative gabapentin treatment
for the prevention of persistent post-thoracotomy pain and to establish
whether gabapentin has a significant therapeutic impact on acute
postoperative pain. Methods: Consecutive patients with pulmonary
malignancies scheduled for anterior thoracotomy were enrolled in this
randomized, double-blinded, placebo-controlled trial. Patients were given
1200 mg gabapentin or placebo 2 h before surgery followed by increasing
doses during 5 postoperative days: 600 mg for day 1; 900 mg for day 2; and
1200 mg for days 3-5. Effective pain relief was provided with
perioperative multimodal analgesia with epidural infusion of bupivacaine
and morphine for 72 h, and oral acetaminophen, ibuprofen and morphine. The
main outcome was persistent post-thoracotomy pain at 6 months. Secondary
outcomes included measures of early postoperative post-thoracotomy pain,
morphine requirements, recovery and analgesia-related adverse effects over
the first 3 weeks as well as persistent post-thoracotomy pain at 3 months.
Results: A total of 104 patients were randomly assigned to the
intervention or control group; 86 (83%) patients were available for the
14- day analysis, 76 (73%) for the 3-month analysis and 67 (64%) for the
6-month follow-up. At 6 months postoperatively, 47% of patients treated
with gabapentin reported persistent post-thoracotomy pain compared with
49% in the placebo group (P = 0.9). No overall clinically or statistically
significant differences were observed between groups receiving placebo and
gabapentin, respectively, for the secondary outcome measures and
treatment-related adverse events. Conclusions: We found no evidence for
the superiority of gabapentin over placebo for the treatment of acute pain
following thoracotomy or for the prevention of persistent post-thoracotomy
pain. The Author 2014. Published by Oxford University Press on behalf of
the European Association for Cardio-Thoracic Surgery. All rights reserved.
<26>
Accession Number
2014461583
Authors
Svensson L.G. Blackstone E.H. Rajeswaran J. Brozzi N. Leon M.B. Smith C.R.
Mack M. Miller D.C. Moses J.W. Tuzcu E.M. Webb J.G. Kapadia S. Fontana
G.P. Makkar R.R. Brown D.L. Block P.C. Guyton R.A. Thourani V.H. Pichard
A.D. Bavaria J.E. Herrmann H.C. Williams M.R. Babaliaros V. Genereux P.
Akin J.J.
Institution
(Svensson, Blackstone, Rajeswaran, Tuzcu, Kapadia) Cleveland Clinic,
Department of Thoracic and Cardiovascular Surgery, 9500 Euclid Avenue,
Desk J4-1, Cleveland, OH 44195, United States
(Svensson, Blackstone, Rajeswaran, Leon) PARTNER Publication Office, New
York, NY, United States
(Brozzi) Cleveland Clinic, Westin, FL, United States
(Leon, Smith, Moses, Williams, Genereux) Columbia University Medical
Center, New York-Presbyterian Hospital, New York, NY, United States
(Mack, Brown) Baylor Health Care System, Dallas, TX, United States
(Miller) Stanford University Medical School, Stanford, CA, United States
(Akin) Edwards Lifesciences, Irvine, CA, United States
(Fontana, Makkar) Cedars-Sinai Medical Center, Los Angeles, CA, United
States
(Webb) University of British Columbia, St. Paul's Hospital, Vancouver, BC,
Canada
(Block, Guyton, Thourani, Babaliaros) Emory University School of Medicine,
Atlanta, GA, United States
(Pichard) Medstar Washington Hospital Center, Washington, DC, United
States
(Bavaria, Herrmann) Hospital of the University of Pennsylvania,
Philadelphia, PA, United States
(Svensson, Blackstone, Rajeswaran, Leon) PARTNER Publication Office,
Cleveland, OH, United States
Title
Comprehensive analysis of mortality among patients undergoing TAVR:
Results of the PARTNER trial.
Source
Journal of the American College of Cardiology. 64 (2) (pp 158-168), 2014.
Date of Publication: 15 Jul 2014.
Publisher
Elsevier USA
Abstract
Background Patients with severe aortic stenosis (AS) who were deemed too
high risk or inoperable for conventional aortic valve replacement (AVR) in
the PARTNER (Placement of Aortic Transcatheter Valves) trial were
randomized to transcatheter aortic valve replacement (TAVR) versus AVR
(PARTNER-A arm) or standard therapy (PARTNER-B arm). Objectives This study
compared when and how deaths occurred after TAVR versus surgical AVR or
standard therapy. Methods The PARTNER-A arm included 244 transfemoral (TF)
and 104 transapical (TA) TAVR patients, and 351 AVR patients; the
PARTNER-B arm included 179 TF-TAVR patients and 179 standard therapy
patients. Deaths were categorized as cardiovascular, noncardiovascular, or
uncategorizable, and were characterized by multiphase hazard modelling.
Results In the PARTNER-A arm, the risk of death peaked after randomization
in the TA-TAVR and AVR groups, falling to low levels commensurate with the
U.S. population within 3 months. Early risk was less in TF-TAVR patients,
resulting in initial superior survival; between 12 and 18 months, risk
increased, such that within 2 years, TF-TAVR and AVR patients had similar
survival rates. Cardiovascular, noncardiovascular, and uncategorizable
deaths for TF-TAVR were 37%, 43%, and 20%, respectively, versus 22%, 41%,
and 37%, respectively, for TA-TAVR and 33%, 43%, and 24%, respectively,
for AVR. In the PARTNER-B arm, risk with standard therapy was 60% per
year; TF-TAVR reduced risk to 20% per year, resulting in 0.5 years of life
added within 2.5 years. Conclusions In inoperable AS patients, TAVR
substantially reduced the risk of cardiovascular death. In high-risk
patients, TA-TAVR and AVR were associated with elevated peri-procedural
risk more than with TF-TAVR, although cardiovascular death was higher
after TF-TAVR. Therefore, TF-TAVR should be considered the standard of
care for severely symptomatic inoperable patients or those at high risk of
noncardiovascular mortality after conventional surgery. (THE PARTNER
TRIAL: Placement of AoRTic TraNscathetER Valve Trial; NCT00530894). 2014
By The American College of Cardiology Foundation Published By Elsevier
Inc.
<27>
Accession Number
2014461582
Authors
Siontis G.C.M. Juni P. Pilgrim T. Stortecky S. Bullesfeld L. Meier B.
Wenaweser P. Windecker S.
Institution
(Siontis, Pilgrim, Stortecky, Bullesfeld, Meier, Wenaweser, Windecker)
Department of Cardiology, Bern University Hospital, 3010 Bern, Switzerland
(Juni) Department of Clinical Research, Clinical Trials Unit, Bern,
Switzerland
Title
Predictors of permanent pacemaker implantation in patients with severe
aortic stenosis undergoing TAVR: A meta-analysis.
Source
Journal of the American College of Cardiology. 64 (2) (pp 129-140), 2014.
Date of Publication: 15 Jul 2014.
Publisher
Elsevier USA
Abstract
Background Atrioventricular (AV) conduction disturbances requiring
permanent pacemaker (PPM) implantation may complicate transcatheter aortic
valve replacement (TAVR). Available evidence on predictors of PPM is
sparse and derived from small studies. Objectives The objective of this
study was to provide summary effect estimates for clinically useful
predictors of PPM implantation after TAVR. Methods We performed a
systematic search for studies that reported the incidence of PPM
implantation after TAVR and that provided raw data for the predictors of
interest. Data on study, patient, and procedural characteristics were
abstracted. Crude risk ratios (RRs) and 95% confidence intervals for each
predictor were calculated by use of random effects models. Stratified
analyses by type of implanted valve were performed. Results We obtained
data from 41 studies that included 11,210 TAVR patients, of whom 17%
required PPM implantation after intervention. The rate of PPM ranged from
2% to 51% in individual studies (with a median of 28% for the Medtronic
CoreValve Revalving System [MCRS] and 6% for the Edwards SAPIEN valve
[ESV]). The summary estimates indicated increased risk of PPM after TAVR
for men (RR: 1.23; p < 0.01); for patients with first-degree AV block (RR:
1.52; p < 0.01), left anterior hemiblock (RR: 1.62; p < 0.01), or right
bundle branch block (RR: 2.89; p < 0.01) at baseline; and for patients
with intraprocedural AV block (RR: 3.49; p < 0.01). These variables
remained significant predictors when only patients treated with the MCRS
bioprosthesis were considered. The data for ESV were limited. Unadjusted
estimates indicated a 2.5-fold higher risk for PPM implantation for
patients who received the MCRS than for those who received the ESV.
Conclusions Male sex, baseline conduction disturbances, and
intraprocedural AV block emerged as predictors of PPM implantation after
TAVR. This study provides useful tools to identify high-risk patients and
to guide clinical decision making before and after intervention. 2014 By
The American College of Cardiology Foundation Published By Elsevier Inc.
<28>
Accession Number
71529443
Authors
Simpson A.
Institution
(Simpson) Royal Infirmary of Edinburgh, United Kingdom
Title
CPR in the prone position: A systematic review and guidelines for its
application.
Source
Anaesthesia. Conference: AAGBI GAT Annual Scientific Meeting 2014
Newcastle United Kingdom. Conference Start: 20140611 Conference End:
20140613. Conference Publication: (var.pagings). 69 (pp 113), 2014. Date
of Publication: June 2014.
Publisher
Blackwell Publishing Ltd
Abstract
Intra-operative cardiac arrest in the prone position is rare but presents
several unique challenges in the delivery of cardiopulmonary resuscitation
(CPR) [1]. In this situation turning the patient supine prior to
commencing CPR may incur significant delay in treatment [2] and additional
risk to the patient [3]. Performing CPR in the prone position may
therefore be preferable. The purpose of this review is to establish the
viability of such a technique and to provide appropriate guidelines on the
performance of prone CPR. Methods A systematic review of the available
literature was performed to identify previous work in this area. Pubmed
was searched using the following search terms: "CPR prone",
"cardiopulmonary resuscitation prone", "cardiac arrest prone",
"cardioversion prone", "cardiac arrest pins", "CPR pins", "cardiac arrest
Mayfield" and "CPR Mayfield". All languages were included. All retrieved
articles as of January 2014 were assessed by title for relevance. Full
text of relevant articles were then assessed against inclusion criteria.
In addition, the references of all retrieved relevant papers were examined
to identify further relevant work. Results The available literature on CPR
in the prone position is scant. Indeed, the majority of the published work
are case reports. Nevertheless, the available research has demonstrated
that CPR in the prone position can be successful, especially in certain
clinical circumstances. Based on the existing research and the techniques
which have been successfully employed, we propose guidelines for the
performance of prone CPR when indicated. These recommendations address
indications, cardiac compressions and hand position, application of
counter-pressure on the sternum, airway management, defibrillator pad
position, and management of the patient with head fixation (Mayfield) pins
in-situ. Discussion Whilst supine CPR remains the gold standard, prone CPR
represents a viable alternative in certain situations. It should be
considered for patients who suffer cardiac arrest in the prone position
where turning the patient into the supine position would present a time
delay or additional risk to the patient, particularly if the head is
secured in Mayfield pins. It may be appropriate to turn the patient into
the supine position for ongoing management of the arrest if prone CPR is
unsuccessful and staff and resources are available to facilitate this
change in position. As noted by previous authors, further quality research
into CPR in the prone position is recommended.
