1
|
Hu Y, Fan M, Zhang P, Li R. Preoperative prophylactic insertion of intraaortic balloon pumps in critically ill patients undergoing coronary artery bypass surgery: a meta-analysis of RCTS. J Cardiothorac Surg 2024; 19:489. [PMID: 39180139 PMCID: PMC11342580 DOI: 10.1186/s13019-024-02961-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 06/30/2024] [Indexed: 08/26/2024] Open
Abstract
BACKGROUND The intra-aortic balloon pump (IABP) technique plays a crucial role in providing circulatory support for patients experiencing hemodynamic instability. This study aimed to assess the effectiveness and safety of preoperative prophylactic IABP insertion in patients undergoing acute critical coronary artery bypass grafting (CABG). METHODS A comprehensive search was conducted in PubMed, Cochrane Library, and Embase databases, covering the period from January 1995 to September 2022. RESULTS The incidence of renal insufficiency, mechanical ventilation exceeding 24 h, and bleeding events in the IABP group did not exhibit significant differences compared to the control group (relative risk [RR] = 0.85, P = 0.26; RR = 0.81, P = 0.08; RR = 0.95, P = 0.87). However, the hospital mortality rate was significantly lower in the IABP group than in the control group (RR = 0.54, P = 0.0007), and the length of ICU stay was shorter in the IABP group (mean difference [MD] = -1.12, P < 0.000001). The IABP group also exhibited a lower incidence of low cardiac output syndrome (LCOS%) compared to the control group (RR = 0.61, P < 0.0001), and a lower incidence of major adverse cardiac and cerebrovascular events (MACCE%) (RR = 0.70, P = 0.001). No significant publication bias was observed in the funnel plot analysis. CONCLUSION Preoperative prophylactic insertion of IABP is currently considered beneficial in improving outcomes for critically ill patients undergoing CABG. This technique reduces hospital mortality, shortens ICU stays, and lowers the incidence of LCOS% and MACCE%.
Collapse
Affiliation(s)
- Yunnan Hu
- Weifang Medical University, Weifang, 261042, China
| | - Mumu Fan
- Yunnan Technology and Business University, Kunming, 651701, China
| | - Peirong Zhang
- Department of Critical Care Medicine, Affiliated Hospital of Weifang Medical University, Weifang, 261031, China.
| | - Rui Li
- Weifang Medical University, Weifang, 261042, China
| |
Collapse
|
2
|
Caldas J, Rynkowski CB, Robba C. POCUS, how can we include the brain? An overview. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE 2022; 2:55. [PMCID: PMC10245668 DOI: 10.1186/s44158-022-00082-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 12/06/2022] [Indexed: 06/18/2023]
Abstract
Point-of-care ultrasound (POCUS) is an essential tool to assess and manage different pathologies in the intensive care unit, and many protocols have been proposed for its application in critical care literature. However, the brain has been overlooked in these protocols. Brain ultrasonography (BU) is easily available, and it allows a goal-directed approach thanks to its repeatability and immediate interpretation and provides a quick management and real time assessment of patients’ conditions. Based on recent studies, the increasing interest from intensivists, and the undeniable benefits of ultrasound, the main goal of this overview is to describe the main evidence and progresses in the incorporation of BU into the POCUS approach in the daily practice, and thus becoming POCUS-BU. This integration would allow a noninvasive global assessment to entail an integrated analysis of the critical care patients.
Collapse
Affiliation(s)
- Juliana Caldas
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Brazil
- Instituto D’Or de Pesquisa e Ensino (IDOR), Salvador, Brazil
- Salvador, Brazil
| | - Carla Bittencourt Rynkowski
- Intensive Care Unit of Cristo Redentor Hospital, Porto Alegre, Brazil
- Intensive Care Unit, Hospital Ernesto Dornelles, Porto Alegre, Brazil
| | - Chiara Robba
- Italy Anesthesia and Intensive Care, Policlinico San Martino, IRCCS for Oncology and Neuroscience, Genoa, Italy
- Dipartimento di Scienze Chirurgiche Diagnostiche Integrate, University of Genoa, Genoa, Italy
| |
Collapse
|
3
|
Arduini M, Pham J, Marsden AL, Chen IY, Ennis DB, Dual SA. Framework for patient-specific simulation of hemodynamics in heart failure with counterpulsation support. Front Cardiovasc Med 2022; 9:895291. [PMID: 35979018 PMCID: PMC9376255 DOI: 10.3389/fcvm.2022.895291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 07/13/2022] [Indexed: 11/17/2022] Open
Abstract
Despite being responsible for half of heart failure-related hospitalizations, heart failure with preserved ejection fraction (HFpEF) has limited evidence-based treatment options. Currently, a substantial clinical issue is that the disease etiology is very heterogenous with no patient-specific treatment options. Modeling can provide a framework for evaluating alternative treatment strategies. Counterpulsation strategies have the capacity to improve left ventricular diastolic filling by reducing systolic blood pressure and augmenting the diastolic pressure that drives coronary perfusion. Here, we propose a framework for testing the effectiveness of a soft robotic extra-aortic counterpulsation strategy using a patient-specific closed-loop hemodynamic lumped parameter model of a patient with HFpEF. The soft robotic device prototype was characterized experimentally in a physiologically pressurized (50–150 mmHg) soft silicone vessel and modeled as a combination of a pressure source and a capacitance. The patient-specific model was created using open-source software and validated against hemodynamics obtained by imaging of a patient (male, 87 years, HR = 60 bpm) with HFpEF. The impact of actuation timing on the flows and pressures as well as systolic function was analyzed. Good agreement between the patient-specific model and patient data was achieved with relative errors below 5% in all categories except for the diastolic aortic root pressure and the end systolic volume. The most effective reduction in systolic pressure compared to baseline (147 vs. 141 mmHg) was achieved when actuating 350 ms before systole. In this case, flow splits were preserved, and cardiac output was increased (5.17 vs. 5.34 L/min), resulting in increased blood flow to the coronaries (0.15 vs. 0.16 L/min). Both arterial elastance (0.77 vs. 0.74 mmHg/mL) and stroke work (11.8 vs. 10.6 kJ) were decreased compared to baseline, however left atrial pressure increased (11.2 vs. 11.5 mmHg). A higher actuation pressure is associated with higher systolic pressure reduction and slightly higher coronary flow. The soft robotic device prototype achieves reduced systolic pressure, reduced stroke work, slightly increased coronary perfusion, but increased left atrial pressures in HFpEF patients. In future work, the framework could include additional physiological mechanisms, a larger patient cohort with HFpEF, and testing against clinically used devices.
Collapse
Affiliation(s)
- Mattia Arduini
- Department of Radiology, Stanford University, Palo Alto, CA, United States
| | - Jonathan Pham
- Mechanical Engineering, Stanford University, Palo Alto, CA, United States
| | - Alison L. Marsden
- Department of Bioengineering, Stanford University, Palo Alto, CA, United States
- Department of Pediatrics, Stanford University, Palo Alto, CA, United States
| | - Ian Y. Chen
- Cardiovascular Institute, Stanford University, Palo Alto, CA, United States
- Division of Medicine (Cardiology), Veterans Affairs Health Care System, Palo Alto, CA, United States
| | - Daniel B. Ennis
- Department of Radiology, Stanford University, Palo Alto, CA, United States
- Cardiovascular Institute, Stanford University, Palo Alto, CA, United States
- Division of Radiology, Veterans Affairs Health Care System, Palo Alto, CA, United States
| | - Seraina A. Dual
- Department of Radiology, Stanford University, Palo Alto, CA, United States
- Cardiovascular Institute, Stanford University, Palo Alto, CA, United States
- *Correspondence: Seraina A. Dual
| |
Collapse
|
4
|
LaPiano JB, Arnott SM, Napolitano MA, Holleran TJ, Sparks AD, Antevil JL, Trachiotis GD. Risk factors for cerebrovascular accident after isolated coronary artery bypass grafting in Veterans. J Card Surg 2022; 37:3084-3090. [PMID: 35822719 DOI: 10.1111/jocs.16751] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 05/20/2022] [Accepted: 06/04/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Cerebrovascular accident (CVA) after coronary artery bypass grafting (CABG) is a devastating complication. Patient comorbidities and intraoperative elements contribute to the risk of CVA. The aim of this study is to identify risk factors for CVA in Veterans undergoing CABG. METHODS Veterans undergoing isolated CABG from 2008 to 2019 were retrospectively identified using the Veterans Affairs Surgical Quality Improvement Program (VASQIP) database. Thirty-day postoperative outcomes were observed. Univariate analysis followed by multivariable logistic regression identified independent risk factors for postoperative CVA. Receiver operating characteristic diagnostics identified optimal inflection points between continuous risk factors and odds of CVA. RESULTS Twenty-eight thousand seven hundred fifty-seven patients met inclusion criteria. Incidence of CVA was 1.1% (310 cases). In multivariate analysis, preoperative cerebrovascular disease had the strongest association with postoperative CVA (adjusted odds ratio = 2.29; p < .001). There was an inverse relationship between CVA incidence and ejection fraction (EF), with EF of 35%-39% conferring a 2.11 times higher risk compared to EF >55% (p < .001). CVA incidence was not different in on-pump versus off-pump cases; however, after 104 min or more on bypass patients had a 55% greater adjusted odds of CVA (p < .001). Other risk factors included poor kidney function, prior myocardial infarction, and intra-aortic balloon pump use. CONCLUSION The risk of CVA after CABG is multifactorial and involves multiple organ systems, including cardiac disease, poor renal function, and cerebrovascular disease, which was the strongest contributing risk factor. Optimization of these comorbidities and time on bypass may help improve clinical outcomes and lower the risk of this devastating complication.
Collapse
Affiliation(s)
- Jessica B LaPiano
- Division of Cardiothoracic Surgery and Heart Center, Washington D. C. Veterans Affairs Medical Center and Heart Center, Washington, District of Columbia, USA.,Department of Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Suzanne M Arnott
- Division of Cardiothoracic Surgery and Heart Center, Washington D. C. Veterans Affairs Medical Center and Heart Center, Washington, District of Columbia, USA.,Department of Surgery, George Washington University, Washington, District of Columbia, USA
| | - Michael A Napolitano
- Division of Cardiothoracic Surgery and Heart Center, Washington D. C. Veterans Affairs Medical Center and Heart Center, Washington, District of Columbia, USA.,Department of Surgery, George Washington University, Washington, District of Columbia, USA
| | - Timothy J Holleran
- Division of Cardiothoracic Surgery and Heart Center, Washington D. C. Veterans Affairs Medical Center and Heart Center, Washington, District of Columbia, USA.,Department of Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Andrew D Sparks
- Department of Statistics, George Washington University, Washington, District of Columbia, USA
| | - Jared L Antevil
- Division of Cardiothoracic Surgery and Heart Center, Washington D. C. Veterans Affairs Medical Center and Heart Center, Washington, District of Columbia, USA
| | - Gregory D Trachiotis
- Division of Cardiothoracic Surgery and Heart Center, Washington D. C. Veterans Affairs Medical Center and Heart Center, Washington, District of Columbia, USA.,Department of Surgery, George Washington University, Washington, District of Columbia, USA
| |
Collapse
|
5
|
Lappalainen L, Rajamaki B, Tolppanen AM, Hartikainen S. Coronary artery revascularizations and cognitive decline - A systematic review. Curr Probl Cardiol 2021; 47:100960. [PMID: 34363848 DOI: 10.1016/j.cpcardiol.2021.100960] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 07/30/2021] [Indexed: 12/19/2022]
Abstract
Coronary artery disease (CAD) is a risk factor for cognitive decline. The aim of this study was to systematically review recent literature on whether coronary artery revascularizations are associated to cognitive decline and dementia. Pubmed, Scopus, and CINAHL (EBSCO) were searched systematically from January 2009 till September 2020. Studies were conducted on persons with CAD undergoing coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) procedure compared to other coronary artery disease treatments, and the outcome was cognitive decline or dementia. Altogether four of the 680 reviewed articles met inclusion criteria. Results were inconsistent, and the outcome measurements heterogeneous between studies. Our findings indicate an evidence gap in the current understanding of long-term outcomes following coronary artery revascularization. However, evidence of long-term effects on cognition would complement our understanding of their benefits. There is a need for more studies on long-term cognitive outcomes after coronary artery revascularizations.
Collapse
Affiliation(s)
- Laura Lappalainen
- School of Pharmacy, University of Eastern Finland, P.O. Box 1627, FI-70211, Kuopio, Finland.
| | - Blair Rajamaki
- Kuopio Research Centre of Geriatric Care, University of Eastern Finland, P.O. Box 1627, FI-70211 Kuopio, Finland; School of Pharmacy, University of Eastern Finland, P.O. Box 1627, FI-70211, Kuopio, Finland
| | - Anna-Maija Tolppanen
- Kuopio Research Centre of Geriatric Care, University of Eastern Finland, P.O. Box 1627, FI-70211 Kuopio, Finland; School of Pharmacy, University of Eastern Finland, P.O. Box 1627, FI-70211, Kuopio, Finland
| | - Sirpa Hartikainen
- Kuopio Research Centre of Geriatric Care, University of Eastern Finland, P.O. Box 1627, FI-70211 Kuopio, Finland; School of Pharmacy, University of Eastern Finland, P.O. Box 1627, FI-70211, Kuopio, Finland
| |
Collapse
|
6
|
Ortiz Garcia JG, Nathan S, Brorson JR. Neurologic complications of implantable devices. HANDBOOK OF CLINICAL NEUROLOGY 2021; 177:211-220. [PMID: 33632440 DOI: 10.1016/b978-0-12-819814-8.00019-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Technologies for repairing cardiac structures or sustaining cardiac function with implantable devices have helped patients with an ever-expanding array of cardiac conditions. Patients are surviving and thriving with cardiac conditions that would formerly have been disabling or fatal. With the implantation of devices in the heart, however, comes the inevitable risk of neurological complications. This chapter focuses on devices implanted in the chambers or valves of the heart itself, including prosthetic heart valves, closure devices for patent foramen ovale, atrial appendage occluder devices, short-term implantable circulatory assist devices, and long-term ventricular assist devices, but excluding coronary artery stents or extracardiac devices. Further, it considers the procedural and postprocedural risks of the devices, leaving the discussion of clinical effectiveness of the devices to other chapters of this book.
Collapse
Affiliation(s)
- Jorge G Ortiz Garcia
- Department of Neurology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Sandeep Nathan
- Section of Cardiology, Department of Internal Medicine, University of Chicago, Chicago, IL, United States
| | - James R Brorson
- Department of Neurology, University of Chicago, Chicago, IL, United States.
| |
Collapse
|
7
|
Caldas JR, Panerai RB, Passos R, Hajjar LA. Is there still a place for transcranial Doppler in patients with IABP? CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2020; 24:625. [PMID: 33097067 PMCID: PMC7585289 DOI: 10.1186/s13054-020-03324-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 10/04/2020] [Indexed: 12/02/2022]
Affiliation(s)
- Juliana R Caldas
- Critical Care Unit, Hospital São Rafael Rede DOR, Salvador, Brazil.,Universidade de Salvador- UNIFACS, Salvador, Brazil.,Escola Bahiana de Medicina e Saúde Pública- EBMSP, Salvador, Brazil
| | - Ronney B Panerai
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.,NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Rogério Passos
- Critical Care Unit, Hospital São Rafael Rede DOR, Salvador, Brazil
| | - Ludhmila A Hajjar
- Department of Cardiopneumology, Universidade de São Paulo, São Paulo, Brazil. .,Surgical Intensive Care, Heart Institute, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar 44, São Paulo, 05403-000, Brazil.
| |
Collapse
|