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Malik MI, Nagpal D. Estimated pulse-wave velocity predicts survival in patients requiring extracorporeal membrane oxygenation. Perfusion 2024; 39:344-352. [PMID: 36419384 DOI: 10.1177/02676591221141963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
INTRODUCTION Arterial stiffness, measured by estimated pulse-wave velocity is a known predictor of major adverse cardiovascular events, however its predictive value in patients requiring extracorporeal membrane oxygenation (ECMO) is unknown. METHODS A retrospective cohort study was performed at the London Health Science Centre in London, Canada between 1996-2021, totaling 255 patients requiring ECMO. Estimated pulse-wave velocity (ePWV) was calculated using an algorithm from the Reference Values for Arterial Stiffness Collaboration. Recorded outcomes included in-hospital death, ischemic stroke, hemorrhagic stroke, renal failure and need for renal replacement therapy (RRT). For adjusted analysis, survival-to-discharge was used. Multivariate logistic regression and propensity-score matching were utilized to control for confounding. RESULTS On univariate analysis, higher ePWV was significantly predictive of ischemic stroke (OR 1.676, p = 0.0002) and in-hospital death (OR 1.20, p = 0.006), but insignificant for predicting hemorrhagic stroke (OR 1.07, p = 0.710), and appeared protective for renal failure (OR 0.88 [0.78-0.99], p = 0.034) and RRT (OR 0.87, p = 0.027). On multivariate analysis and propensity-score matching, five of six models demonstrated ePWV as an independent predictor of survival-to-discharge. (OR 0.70, p = 0.00,021; OR 0.72, p = 0.0002; OR 0.87, p = 0.045; OR 0.85, p = 0.013; OR 0.57, p = 0.012). CONCLUSIONS ePWV is a promising marker for risk-stratification in ECMO patients. Further investigation is required to better delineate the role of arterial health assessment in disease trajectory and strengthen the validity of AS as a marker of interest in medical and surgical management.
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Affiliation(s)
- Mohsyn I Malik
- Department of Cardiac Surgery, Schulich School of Medicine and Dentistry, London, ON, Canada
| | - Dave Nagpal
- Department of Cardiac Surgery, Schulich School of Medicine and Dentistry, London, ON, Canada
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Caddell AJ, Nagpal D, Hegazy AF. Postarrest Care Bundle Improves Quality of Care and Clinical Outcomes in the Normothermia Era. J Intensive Care Med 2024:8850666231223482. [PMID: 38176890 DOI: 10.1177/08850666231223482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
PURPOSE Temperature targets in patients with cardiac arrest and return of spontaneous circulation (ROSC) have changed. Changes to higher temperature targets have been associated with higher breakthrough fevers and mortality. A post-ROSC normothermia bundle was developed to improve compliance with temperature targets. METHODS In August 2021, "ad hoc" normothermia at the discretion of the attending intensivist was initiated. In December 2021, a post-ROSC normothermia protocol was implemented, incorporating a rigorous, stepwise approach to fever prevention (temperature ≥ 37.8). We conducted a before-after cohort study of all adult patients post-ROSC who survived to intensive care unit admission between August 1, 2021, and April 1, 2022. They were divided into "ad hoc" and "protocol" groups. Clinical outcomes compared included fevers, active cooling, and paralytic use. RESULTS Fifty-eight post-ROSC patients were admitted; 24 in the "ad hoc" and 34 in the "protocol" groups. Patient demographics were similar between groups. The "ad hoc" group had more shockable rhythms (67% vs 24%, P = .001) and cardiac catheterizations (42% vs 15%, P = .03). The "protocol" group were significantly less likely to have a fever at 40 h (6% vs 40%, P < .001) and 72 h (14% vs 65%, P ≤ .001). Patients in the normothermia "protocol" used significantly less neuromuscular blocking agents (24% vs 50%, P = .05). The normothermia "protocol" resulted in similar mortality (56% vs 58%, P = 1.0). CONCLUSION Use of a normothermia "protocol" resulted in fewer fevers and less neuromuscular blocker administration compared to "ad hoc" management. A protocolized approach for improved quality of care should be considered in institutions adopting normothermia.
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Affiliation(s)
- Andrew J Caddell
- Cardiology Division, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Dave Nagpal
- Critical Care, Western University, London, Ontario, Canada
| | - Ahmed F Hegazy
- Critical Care, Western University, London, Ontario, Canada
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Zhao PJ, Drullinsky D, Nagpal D, Davey R, Paltser E, Hornby K, Smith S. A geographic information system dashboard for heart transplantation. Clin Transplant 2023; 37:e15075. [PMID: 37461212 DOI: 10.1111/ctr.15075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/26/2023] [Accepted: 07/04/2023] [Indexed: 09/08/2023]
Affiliation(s)
- Pei Jun Zhao
- Division of Cardiology, Department of Medicine, London Health Sciences Centre, Western University, London, Canada
| | - David Drullinsky
- Division of Cardiac Surgery, Department of Surgery, London Health Sciences Centre, Western University, London, Canada
| | - Dave Nagpal
- Division of Cardiac Surgery, Department of Surgery, London Health Sciences Centre, Western University, London, Canada
| | - Ryan Davey
- Division of Cardiology, Department of Medicine, London Health Sciences Centre, Western University, London, Canada
| | | | - Karen Hornby
- Trillium Gift of Life Network, Ontario Health, Toronto, Canada
| | - Stuart Smith
- Division of Cardiology, Department of Medicine, London Health Sciences Centre, Western University, London, Canada
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Zhao P, Drullinsky D, Nagpal D, Davey R, Hornby K, Smith S. An Interactive Dashboard for Analyzing the Geographic Epidemiology of Cardiac Transplantation. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Grunau B, Singh G, Bělohlávek J, Yannopoulos D, Tonna JE, Hutin A, Nagpal D, Cournoyer A, van Diepen S. A Second Chance for Survival: Clinical Trial Evidence, Eligibility, and Barriers to Implementation of ECPR for Out-of-Hospital Cardiac Arrest. Can J Cardiol 2022; 39:381-384. [PMID: 36526148 DOI: 10.1016/j.cjca.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 12/05/2022] [Accepted: 12/09/2022] [Indexed: 12/15/2022] Open
Affiliation(s)
- Brian Grunau
- Department of Emergency Medicine and the Centre for Health Evaluation & Outcome Sciences, St. Paul's Hospital and the University of British Columbia, Vancouver, British Columbia, Canada.
| | - Gurmeet Singh
- Department of Critical Care Medicine and Division of Cardiac Surgery, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Jan Bělohlávek
- Department of Internal Medicine II, Cardiovascular Medicine, First Medical School, Charles University and General University Hospital, Prague, Czech Republic
| | - Demetris Yannopoulos
- Division of Cardiology and Center for Resuscitation Medicine, University of Minnesota School of Medicine, Minneapolis, Minnesota, USA
| | - Joseph E Tonna
- Division of Cardiothoracic Surgery, Department of Surgery and Department of Emergency Medicine, University of Utah Health, Salt Lake City, Utah, USA
| | - Alice Hutin
- SAMU de Paris-DAR Necker University Hospital-Assistance Public Hopitaux de Paris, Paris, France
| | - Dave Nagpal
- Divisions of Critical Care Medicine and Cardiac Surgery, Western University, London, Ontario, Canada
| | - Alexis Cournoyer
- Hôspital du Sacré-Cœur de Montréal and Université de Montréal, Montréal, Québec, Canada
| | - Sean van Diepen
- Department of Critical Care Medicine and Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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Malik M, Nagpal D. ESTIMATED PULSE WAVE VELOCITY INDEPENDETLY PREDICTS SURVIVAL-TO-DISCHARGE IN PATIENTS REQUIRING EXTRACORPOREAL MEMBRANE OXYGENATION: A SINGLE-CENTRE RETROSPECTIVE COHORT STUDY. Can J Cardiol 2022. [DOI: 10.1016/j.cjca.2022.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Caddell A, Nagpal D, Hegazy A. A POST-ARREST CARE BUNDLE IMPROVES QUALITY OF CARE AND CLINICAL OUTCOMES DURING THE NORMOTHERMIA ERA. Can J Cardiol 2022. [DOI: 10.1016/j.cjca.2022.08.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Fagan A, Grunau B, Caddell A, Gould J, Rayner-Hartley E, Lamarche Y, Singh G, Nagpal D, Slessarev M. CEPP: Canadian Extracorporeal Life Support (ECLS) Protocol Project. CJC Open 2022; 4:520-531. [PMID: 35734512 PMCID: PMC9207773 DOI: 10.1016/j.cjco.2022.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 02/09/2022] [Indexed: 11/17/2022] Open
Abstract
Background Extracorporeal life support (ECLS) is associated with high morbidity and mortality. Complications and mortality are higher at lower-volume centres. Most Canadian ECLS institutions are low-volume centres. Protocols offer one way to share best practices among institutions to improve outcomes. Whether Canadian centres have ECLS protocols, and whether these protocols are comprehensive and homogenous across centres, is unknown. Methods Purposeful sampling with mixed methods was used. A Delphi panel defined key elements relevant to the ECLS process. Documentation used in the delivery of ECLS services was requested from programs. Institutional protocols were assessed using deductive coding to determine the presence of key elements. Results A total of 37 key elements spanning 5 domains (referral, initiation, maintenance, termination, and administration) were identified. Documentation from 13 institutions across 10 provinces was obtained. Institutions with heart or lung transplantation programs had more-complete documentation than did non-transplantation programs. Only 5 key elements were present in at least 50% of protocols (anticoagulation strategy, ventilation strategy, defined referral process, selection criteria, weaning process), and variation was seen in how institutions approached each of these elements. Conclusions The completeness of ECLS protocols varies across Canada. Programs describe variable approaches to key elements. This variability might represent a lack of evidence or consensus in these areas and creates the opportunity for collaboration among institutions to share protocols and best practice. The key-element framework provides a common language that programs can use to develop ECLS programs, initiate quality-improvement projects, and identify research agendas.
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Abbas A, Abdukahil SA, Abdulkadir NN, Abe R, Abel L, Absil L, Acharya S, Acker A, Adachi S, Adam E, Adrião D, Ageel SA, Ahmed S, Ain Q, Ainscough K, Aisa T, Ait Hssain A, Ait Tamlihat Y, Akimoto T, Akmal E, Al Qasim E, Alalqam R, Alam T, Al-dabbous T, Alegesan S, Alegre C, Alessi M, Alex B, Alexandre K, Al-Fares A, Alfoudri H, Ali I, Ali Shah N, Alidjnou KE, Aliudin J, Alkhafajee Q, Allavena C, Allou N, Altaf A, Alves J, Alves JM, Alves R, Amaral M, Amira N, Ammerlaan H, Ampaw P, Andini R, Andrejak C, Angheben A, Angoulvant F, Ansart S, Anthonidass S, Antonelli M, Antunes de Brito CA, Anwar KR, Apriyana A, Arabi Y, Aragao I, Arali R, Arancibia F, Araujo C, Arcadipane A, Archambault P, Arenz L, Arlet JB, Arnold-Day C, Aroca A, Arora L, Arora R, Artaud-Macari E, Aryal D, Asaki M, Asensio A, Ashley E, Ashraf M, Ashraf S, Asim M, Assie JB, Asyraf A, Atique A, Attanyake AMUL, Auchabie J, Aumaitre H, Auvet A, Azemar L, Azoulay C, Bach B, Bachelet D, Badr C, Baig N, Baillie JK, Baird JK, Bak E, Bakakos A, Bakar NA, Bal A, Balakrishnan M, Balan V, Bani-Sadr F, Barbalho R, Barbosa NY, Barclay WS, Barnett SU, Barnikel M, Barrasa H, Barrelet A, Barrigoto C, Bartoli M, Bartone C, Baruch J, Bashir M, Basmaci R, Basri MFH, Bastos D, Battaglini D, Bauer J, Bautista Rincon DF, Bazan Dow D, Bedossa A, Bee KH, Behilill S, Beishuizen A, Beljantsev A, Bellemare D, Beltrame A, Beltrão BA, Beluze M, Benech N, Benjiman LE, Benkerrou D, Bennett S, Bento L, Berdal JE, Bergeaud D, Bergin H, Bernal Sobrino JL, Bertoli G, Bertolino L, Bessis S, Betz A, Bevilcaqua S, Bezulier K, Bhatt A, Bhavsar K, Bianchi I, Bianco C, Bidin FN, Bikram Singh M, Bin Humaid F, Bin Kamarudin MN, Bissuel F, Biston P, Bitker L, Blanco-Schweizer P, Blier C, Bloos F, Blot M, Blumberg L, Boccia F, Bodenes L, Bogaarts A, Bogaert D, Boivin AH, Bolze PA, Bompart F, Bonfasius A, Borges D, Borie R, Bosse HM, Botelho-Nevers E, Bouadma L, Bouchaud O, Bouchez S, Bouhmani D, Bouhour D, Bouiller K, Bouillet L, Bouisse C, Boureau AS, Bourke J, Bouscambert M, Bousquet A, Bouziotis J, Boxma B, Boyer-Besseyre M, Boylan M, Bozza FA, Brack M, Braconnier A, Braga C, Brandenburger T, Brás Monteiro F, Brazzi L, Breen D, Breen P, Breen P, Brett S, Brickell K, Broadley T, Browne A, Browne S, Brozzi N, Brusse-Keizer M, Buchtele N, Buesaquillo C, Bugaeva P, Buisson M, Burhan E, Burrell A, Bustos IG, Butnaru D, Cabie A, Cabral S, Caceres E, Cadoz C, Callahan M, Calligy K, Calvache JA, Cam J, Campana V, Campbell P, Campisi J, Canepa C, Cantero M, Caraux-Paz P, Cárcel S, Cardellino CS, Cardoso F, Cardoso F, Cardoso N, Cardoso S, Carelli S, Carlier N, Carmoi T, Carney G, Carpenter C, Carqueja I, Carret MC, Carrier FM, Carroll I, Carson G, Carton E, Casanova ML, Cascão M, Casey S, Casimiro J, Cassandra B, Castañeda S, Castanheira N, Castor-Alexandre G, Castrillón H, Castro I, Catarino A, Catherine FX, Cattaneo P, Cavalin R, Cavalli GG, Cavayas A, Ceccato A, Cervantes-Gonzalez M, Chair A, Chakveatze C, Chan A, Chand M, Chantalat Auger C, Chapplain JM, Chas J, Chaudary M, Chávez Iñiguez JS, Chen A, Chen YS, Cheng MP, Cheret A, Chiarabini T, Chica J, Chidambaram SK, Chin-Tho L, Chirouze C, Chiumello D, Cho HJ, Cho SM, Cholley B, Chopin MC, Chow TS, Chow YP, Chua HJ, Chua J, Cidade JP, Cisneros Herreros JM, Citarella BW, Ciullo A, Clarke E, Clarke J, Claure Del Granado R, Clohisey S, Cobb JP, Coca N, Codan C, Cody C, Coelho A, Coles M, Colin G, Collins M, Colombo SM, Combs P, Connolly J, Connor M, Conrad A, Contreras S, Conway E, Cooke GS, Copland M, Cordel H, Corley A, Cormican S, Cornelis S, Cornet AD, Corpuz AJ, Cortegiani A, Corvaisier G, Costigan E, Couffignal C, Couffin-Cadiergues S, Courtois R, Cousse S, Cregan R, Crepy D'Orleans C, Croonen S, Crowl G, Crump J, Cruz C, Cruz Berm JL, Cruz Rojo J, Csete M, Cucino A, Cullen A, Cullen C, Cummings M, Curley G, Curlier E, Curran C, Custodio P, da Silva Filipe A, Da Silveira C, Dabaliz AA, Dagens A, Dahly D, Dalton H, Dalton J, Daly S, D'Amico F, Daneman N, Daniel C, Dankwa EA, Dantas J, D’Aragon F, de Boer M, de Loughry G, de Mendoza D, De Montmollin E, de Oliveira França RF, de Pinho Oliveira AI, De Rosa R, de Silva T, de Vries P, Deacon J, Dean D, Debard A, DeBenedictis B, Debray MP, DeCastro N, Dechert W, Deconninck L, Decours R, Defous E, Delacroix I, Delaveuve E, Delavigne K, Delfos NM, Deligiannis I, Dell'Amore A, Delmas C, Delobel P, Delsing C, Demonchy E, Denis E, Deplanque D, Depuydt P, Desai M, Descamps D, Desvallée M, Dewayanti S, Diallo A, Diamantis S, Dias A, Diaz P, Diaz R, Diaz Diaz JJ, Didier K, Diehl JL, Dieperink W, Dimet J, Dinot V, Diop F, Diouf A, Dishon Y, Dixit D, Djossou F, Docherty AB, Doherty H, Dondorp AM, Dong A, Donnelly CA, Donnelly M, Donohue C, Donohue S, Donohue Y, Doran C, Doran P, Dorival C, D'Ortenzio E, Douglas JJ, Douma R, Dournon N, Downer T, Downey J, Downing M, Drake T, Driscoll A, Dryden M, Duarte Fonseca C, Dubee V, Dubos F, Ducancelle A, Duculan T, Dudman S, Duggal A, Dunand P, Dunning J, Duplaix M, Durante-Mangoni E, Durham III L, Dussol B, Duthoit J, Duval X, Dyrhol-Riise AM, Ean SC, Echeverria-Villalobos M, Egan S, Eira C, El Sanharawi M, Elapavaluru S, Elharrar B, Ellerbroek J, Eloy P, Elshazly T, Elyazar I, Enderle I, Endo T, Eng CC, Engelmann I, Enouf V, Epaulard O, Escher M, Esperatti M, Esperou H, Esposito-Farese M, Estevão J, Etienne M, Ettalhaoui N, Everding AG, Evers M, Fabre I, Fabre M, Faheem A, Fahy A, Fairfield CJ, Fakar Z, Faria P, Farooq A, Farrar JJ, Farshait N, Fateena H, Fatoni AZ, Faure K, Favory R, Fayed M, Feely N, Feeney L, Fernandes J, Fernandes M, Fernandes S, Ferrand FX, Ferrand Devouge E, Ferrão J, Ferraz M, Ferreira B, Ferreira S, Ferrer-Roca R, Ferriere N, Ficko C, Figueiredo-Mello C, Fiorda J, Flament T, Flateau C, Fletcher T, Florio LL, Flynn B, Flynn D, Foley C, Foley J, Fomin V, Fonseca T, Fontela P, Forsyth S, Foster D, Foti G, Fourn E, Fowler RA, Fraher DM, Franch-Llasat D, Fraser C, Fraser JF, Freire MV, Freitas Ribeiro A, Friedrich C, Fritz R, Fry S, Fuentes N, Fukuda M, Gaborieau V, Gaci R, Gagliardi M, Gagnard JC, Gagné N, Gagneux-Brunon A, Gaião S, Gail Skeie L, Gallagher P, Gallego Curto E, Gamble C, Gani Y, Garan A, Garcia R, García Barrio N, Garcia-Diaz J, Garcia-Gallo E, Garimella N, Garot D, Garrait V, Gauli B, Gault N, Gavin A, Gavrylov A, Gaymard A, Gebauer J, Geraud E, Gerbaud Morlaes L, Germano N, ghisulal PK, Ghosn J, Giani M, Giaquinto C, Gibson J, Gigante T, Gilg M, Gilroy E, Giordano G, Girvan M, Gissot V, Gitahi J, Giwangkancana G, Glikman D, Glybochko P, Gnall E, Goco G, Goehringer F, Goepel S, Goffard JC, Goh JY, Golob J, Gomes R, Gomez K, Gómez-Junyent J, Gominet M, Gonzalez A, Gordon P, Gordon A, Gorenne I, Goubert L, Goujard C, Goulenok T, Grable M, Graf J, Grandin EW, Granier P, Grasselli G, Grazioli L, Green CA, Greene C, Greenhalf W, Greffe S, Grieco DL, Griffee M, Griffiths F, Grigoras I, Groenendijk A, Grosse Lordemann A, Gruner H, Gu Y, Guarracino F, Guedj J, Guego M, Guellec D, Guerguerian AM, Guerreiro D, Guery R, Guillaumot A, Guilleminault L, Guimarães de Castro M, Guimard T, Haalboom M, Haber D, Habraken H, Hachemi A, Hadri N, Haidash O, Haider S, Haidri F, Hakak S, Hall A, Hall M, Halpin S, Hamer A, Hamers R, Hamidfar R, Hammond T, Han LY, Haniffa R, Hao KW, Hardwick H, Harrison EM, Harrison J, Harrison SBE, Hartman A, Hashmi J, Hashmi M, Hayat M, Hayes A, Hays L, Heerman J, Heggelund L, Hendry R, Hennessy M, Henriquez A, Hentzien M, Herekar F, Hernandez-Montfort J, Herr D, Hershey A, Hesstvedt L, Hidayah A, Higgins D, Higgins E, HigginsOKeeffe G, Hinchion R, Hinton S, Hiraiwa H, Hitoto H, Ho A, Ho YB, Hoctin A, Hoffmann I, Hoh WH, Hoiting O, Holt R, Holter JC, Horby P, Horcajada JP, Hoshino K, Hoshino K, Houas I, Hough CL, Houltham S, Hsu JMY, Hulot JS, Hussain I, Ijaz S, Illes HG, Imbert P, Imran M, Imran Sikander R, Inácio H, Infante Dominguez C, Ing YS, Iosifidis E, Ippolito M, Isgett S, Ishani PGPI, Isidoro T, Ismail N, Isnard M, Itai J, Ito A, Ivulich D, Jaafar D, Jaafoura S, Jabot J, Jackson C, Jamieson N, Jaquet P, Jassat W, Jaud-Fischer C, Jaureguiberry S, Javidfar J, Jawad I, Jaworsky D, Jayakumar D, Jego F, Jelani AM, Jenum S, Jimbo-Sotomayor R, Job VDP, Joe OY, Jorge García RN, Joseph C, Joseph M, Joshi S, Jourdain M, Jouvet P, June J, Jung A, Jung H, Juzar D, Kafif O, Kaguelidou F, Kaisbain N, Kaleesvran T, Kali S, Kalicinska A, Kalomoiri S, Kamal S, Kamaluddin MAA, Kamaruddin ZAC, Kamarudin N, Kandamby DH, Kandel C, Kang KY, Kant R, Kanwal D, Kanyawati D, Karki B, Karpayah P, Karsies T, Kartsonaki C, Kasugai D, Kataria A, Katz K, Kaur A, Kaur Johal S, Kawasaki T, Kay C, Keane H, Keating S, Kellam P, Kelly A, Kelly A, Kelly C, Kelly N, Kelly S, Kelly Y, Kelsey M, Kennedy R, Kennon K, Kernan M, Kerroumi Y, Keshav S, Kestelyn E, Khalid I, Khalid O, Khalil A, Khan C, Khan I, Khanal S, Kho ME, Khoo D, Khoo R, Khoo S, Khoso N, Kiat KH, Kida Y, Kiiza P, Kildal AB, Kim JB, Kimmoun A, Kindgen-Milles D, King A, Kitamura N, Klenerman P, Klont R, Kloumann Bekken G, Knight S, Kobbe R, Kodippily C, Kohns Vasconcelos M, Koirala S, Komatsu M, Korten V, Kosgei C, Kpangon A, Krawczyk K, Krishnan S, Krishnan V, Kruglova O, Kumar A, Kumar D, Kumar G, Kumar M, Kumar Vecham P, Kuriakose D, Kurtzman E, Kusumastuti NP, Kutsogiannis D, Kutsyna G, Kyriakoulis K, Lachatre M, Lacoste M, Laffey JG, Lagrange M, Laine F, Lairez O, Lakhey S, Lalueza A, Lambert M, Lamontagne F, Langelot-Richard M, Langlois V, Lantang EY, Lanza M, Laouénan C, Laribi S, Lariviere D, Lasry S, Latif N, Launay O, Laureillard D, Lavie-Badie Y, Law A, Lawrence C, Lawrence T, Le M, Le Bihan C, Le Bris C, Le Falher G, Le Fevre L, Le Hingrat Q, Le Maréchal M, Le Mestre S, Le Moal G, Le Moing V, Le Nagard H, Le Turnier P, Leal E, Leal Santos M, Lee BH, Lee HG, Lee J, Lee SH, Lee TC, Lee YL, Leeming G, Lefebvre B, Lefebvre L, Lefevre B, LeGac S, Lelievre JD, Lellouche F, Lemaignen A, Lemee V, Lemeur A, Lemmink G, Lene HS, Lennon J, León R, Leone M, Leone M, Lepiller Q, Lescure FX, Lesens O, Lesouhaitier M, Lester-Grant A, Levy B, Levy Y, Levy-Marchal C, Lewandowska K, L'Her E, Li Bassi G, Liang J, Liaquat A, Liegeon G, Lim KC, Lim WS, Lima C, Lina B, Lina L, Lind A, Lingas G, Lion-Daolio S, Lissauer S, Liu K, Livrozet M, Lizotte P, Loforte A, Lolong N, Loon LC, Lopes D, Lopez-Colon D, Loschner AL, Loubet P, Loufti B, Louis G, Lourenco S, Lovelace-Macon L, Low LL, Lowik M, Loy JS, Lucet JC, Lumbreras Bermejo C, Luna CM, Lungu O, Luong L, Luque N, Luton D, Lwin N, Lyons R, Maasikas O, Mabiala O, MacDonald S, MacDonald S, Machado M, Macheda G, Macias Sanchez J, Madhok J, Maestro de la Calle G, Mahieu R, Mahy S, Maia AR, Maier LS, Maillet M, Maitre T, Malfertheiner M, Malik N, Mallon P, Maltez F, Malvy D, Manda V, Mandei JM, Mandelbrot L, Manetta F, Mangal K, Mankikian J, Manning E, Manuel A, Maria Sant`Ana Malaque C, Marino D, Marino F, Markowicz S, Maroun Eid C, Marques A, Marquis C, Marsh B, Marsh L, Marshal M, Marshall J, Martelli CT, Martin DA, Martin E, Martin-Blondel G, Martinelli A, Martin-Loeches I, Martinot M, Martin-Quiros A, Martins A, Martins J, Martins N, Martins Rego C, Martucci G, Martynenko O, Marwali EM, Marzukie M, Masa Jimenez JF, Maslove D, Maslove D, Mason P, Mason S, Masood S, Masood S, Mat Nor B, Matan M, Mateus Fernandes H, Mathew M, Mathieu D, Mattei M, Matulevics R, Maulin L, Maxwell M, Maynar J, Mazzoni T, Mc Sweeney L, McAndrew L, McArthur C, McCarthy A, McCarthy A, McCloskey C, McConnochie R, McDermott S, McDonald SE, McElroy A, McElwee S, McEneany V, McEvoy N, McGeer A, McKay C, McKeown J, McLean KA, McNally P, McNicholas B, McPartlan E, Meaney E, Mear-Passard C, Mechlin M, Meher M, Mehkri O, Mele F, Melo L, Memon K, Mendes JJ, Menkiti O, Menon K, Mentré F, Mentzer AJ, Mercier E, Mercier N, Merckx A, Mergeay-Fabre M, Mergler B, Merson L, Mesquita A, Metwally O, Meybeck A, Meyer D, Meynert AM, Meysonnier V, Meziane A, Mezidi M, Michelagnoli G, Michelanglei C, Michelet I, Mihelis E, Mihnovit V, Miranda-Maldonado H, Misnan NA, Mohamed NNE, Mohamed TJ, Moin A, Molina D, Molinos E, Molloy B, Mone M, Monteiro A, Montes C, Montrucchio G, Moore S, Moore SC, Morales Cely L, Moro L, Morocho Tutillo DR, Morton B, Motherway C, Motos A, Mouquet H, Mouton Perrot C, Moyet J, Mudara C, Mufti AK, Muh NY, Muhamad D, Mullaert J, Muller F, Müller KE, Munblit D, Muneeb S, Munir N, Munshi L, Murphy A, Murphy A, Murphy L, Murris M, Murthy S, Musaab H, Muyandy G, Myrodia DM, N N, Nagpal D, Nagrebetsky A, Narasimhan M, Narayanan N, Nasim Khan R, Nazerali-Maitland A, Neant N, Neb H, Nekliudov NA, Nelwan E, Neto R, Neumann E, Neves B, Ng PY, Nghi A, Nguyen D, Ni Choileain O, Ni Leathlobhair N, Nichol A, Nitayavardhana P, Nonas S, Noordin NAM, Noret M, Norharizam NFI, Norman L, Notari A, Noursadeghi M, Nowicka K, Nowinski A, Nseir S, Nunez JI, Nurnaningsih N, Nyamankolly E, O Brien F, O'Callaghan A, Occhipinti G, OConnor D, O'Donnell M, Ogston T, Ogura T, Oh TH, O'Halloran S, O'Hearn K, Ohshimo S, Oldakowska A, Oliveira J, Oliveira L, Olliaro PL, O'Neil C, Ong DS, Ong JY, Oosthuyzen W, Opavsky A, Openshaw P, Orakzai S, Orozco-Chamorro CM, Orquera A, Ortoleva J, Osatnik J, O'Shea L, O'Sullivan M, Othman SZ, Ouamara N, Ouissa R, Owyang C, Oziol E, Pabasara HMU, Pagadoy M, Pages J, Palacios A, Palacios M, Palmarini M, Panarello G, Panda PK, Paneru H, Pang LH, Panigada M, Pansu N, Papadopoulos A, Parke R, Parker M, Parra B, Parrini V, Pasha T, Pasquier J, Pastene B, Patauner F, Patel J, Pathmanathan MD, Patrão L, Patricio P, Patrier J, Patterson L, Pattnaik R, Paul C, Paul M, Paulos J, Paxton WA, Payen JF, Peariasamy K, Pedrera Jiménez M, Peek GJ, Peelman F, Peiffer-Smadja N, Peigne V, Pejkovska M, Pelosi P, Peltan ID, Pereira R, Perez D, Periel L, Perpoint T, Pesenti A, Pestre V, Petrou L, Petrov-Sanchez V, Pettersen FO, Peytavin G, Pharand S, Piagnerelli M, Picard W, Picone O, Piero MD, Pierobon C, Piersma D, Pimentel C, Pinto R, Pires C, Pironneau I, Piroth L, Pius R, Piva S, Plantier L, Plotkin D, Png HS, Poissy J, Pokeerbux R, Pokorska-Spiewak M, Poli S, Pollakis G, Ponscarme D, Popielska J, Post AM, Postma DF, Povoa P, Póvoas D, Powis J, Prapa S, Preau S, Prebensen C, Preiser JC, Prinssen A, Pritchard MG, Priyadarshani GDD, Proença L, Pudota S, Puéchal O, Pujo Semedi B, Pulicken M, Puntoni M, Purcell G, Quesada L, Quinones-Cardona V, Quirós González V, Quist-Paulsen E, Quraishi M, Rabaa M, Rabaud C, Rabindrarajan E, Rafael A, Rafiq M, Ragazzo G, Rahman AKHA, Rahman RA, Rahutullah A, Rainieri F, Rajahram GS, Rajapakse N, Ralib A, Ramakrishnan N, Ramanathan K, Ramli AA, Rammaert B, Ramos GV, Rana A, Rangappa R, Ranjan R, Rapp C, Rashan A, Rashan T, Rasheed G, Rasmin M, Rätsep I, Rau C, Ravi T, Raza A, Real A, Rebaudet S, Redl S, Reeve B, Rehan A, Rehman A, Reid L, Reid L, Reikvam DH, Reis R, Rello J, Remppis J, Remy M, Ren H, Renk H, Resende L, Resseguier AS, Revest M, Rewa O, Reyes LF, Reyes T, Ribeiro MI, Richardson D, Richardson D, Richier L, Ridzuan SNAA, Riera J, Rios AL, Rishu A, Rispal P, Risso K, Rivera Nuñez MA, Rizer N, Robb D, Robba C, Roberto A, Roberts S, Robertson DL, Robineau O, Roche-Campo F, Rodari P, Rodeia S, Rodriguez Abreu J, Roessler B, Roger C, Roger PM, Roilides E, Rojek A, Romaru J, Roncon-Albuquerque Jr R, Roriz M, Rosa-Calatrava M, Rose M, Rosenberger D, Rossanese A, Rossetti M, Rossignol B, Rossignol P, Rousset S, Roy C, Roze B, Rusmawatiningtyas D, Russell CD, Ryan M, Ryan M, Ryckaert S, Rygh Holten A, Saba I, Sadaf S, Sadat M, Sahraei V, Saint-Gilles M, Sakiyalak P, Salahuddin N, Salazar L, Saleem J, Saleem J, Sales G, Sallaberry S, Salmon Gandonniere C, Salvator H, Sanchez O, Sánchez Choez X, Sanchez de Oliveira K, Sanchez-Miralles A, Sancho-Shimizu V, Sandhu G, Sandhu Z, Sandrine PF, Sandulescu O, Santos M, Sarfo-Mensah S, Sarmento Banheiro B, Sarmiento ICE, Sarton B, Satyapriya S, Satyawati R, Saviciute E, Savio R, Savvidou P, Saw YT, Schaffer J, Schermer T, Scherpereel A, Schneider M, Schroll S, Schwameis M, Schwartz G, Scott JT, Scott-Brown J, Sedillot N, Seitz T, Selvanayagam J, Selvarajoo M, Semaille C, Semple MG, Senian RB, Senneville E, Sepulveda C, Sequeira F, Sequeira T, Serpa Neto A, Serrano Balazote P, Shadowitz E, Shahidan SA, Shahnaz Hasan M, Shamsah M, Shankar A, Sharjeel S, Sharma P, Shaw CA, Shaw V, Shi H, Shiban N, Shiekh M, Shiga T, Shime N, Shimizu H, Shimizu K, Shimizu N, Shindo N, Shrapnel S, Shum HP, Si Mohammed N, Siang NY, Sibiude J, Siddiqui A, Sigfrid L, Sillaots P, Silva C, Silva MJ, Silva R, Sim Lim Heng B, Sin WC, Singh BC, Singh P, Sitompul PA, Sivam K, Skogen V, Smith S, Smood B, Smyth C, Smyth M, Smyth M, Snacken M, So D, Soh TV, Solis M, Solomon J, Solomon T, Somers E, Sommet A, Song MJ, Song R, Song T, Song Chia J, Sonntagbauer M, Soom AM, Sotto A, Soum E, Sousa AC, Sousa M, Sousa Uva M, Souza-Dantas V, Sperry A, Spinuzza E, Sri Darshana BPSR, Sriskandan S, Stabler S, Staudinger T, Stecher SS, Steinsvik T, Stienstra Y, Stiksrud B, Stolz E, Stone A, Streinu-Cercel A, Streinu-Cercel A, Strudwick S, Stuart A, Stuart D, Subekti D, Suen G, Suen JY, Sukumar P, Sultana A, Summers C, Supic D, Suppiah D, Surovcová M, Suwarti S, Svistunov AA, Syahrin S, Syrigos K, Sztajnbok J, Szuldrzynski K, Tabrizi S, Taccone FS, Tagherset L, Taib SM, Talarek E, Taleb S, Talsma J, Tampubolon ML, Tan KK, Tan LV, Tan YC, Tanaka C, Tanaka H, Tanaka T, Taniguchi H, Tanveer H, Taqdees H, Taqi A, Tardivon C, Tattevin P, Taufik MA, Tawfik H, Tedder RS, Tee TY, Teixeira J, Tejada S, Tellier MC, Teoh SK, Teotonio V, Téoulé F, Terpstra P, Terrier O, Terzi N, Tessier-Grenier H, Tey A, Thabit AAM, Tham ZD, Thangavelu S, Thibault V, Thiberville SD, Thill B, Thirumanickam J, Thompson S, Thomson D, Thomson EC, Thurai SRT, Thuy DB, Thwaites RS, Tierney P, Tieroshyn V, Timashev PS, Timsit JF, Tirupakuzhi Vijayaraghavan BK, Tissot N, Toh JZY, Toki M, Tolppa T, Tonby K, Tonnii SL, Torres A, Torres M, Torres Santos-Olmo RM, Torres-Zevallos H, Towers M, Trapani T, Traynor D, Treoux T, Trieu HT, Tripathy S, Tromeur C, Trontzas I, Trouillon T, Truong J, Tual C, Tubiana S, Tuite H, Turmel JM, Turtle LC, Tveita A, Twardowski P, Uchiyama M, Udayanga PGI, Udy A, Ullrich R, Umer Z, Uribe A, Usman A, Vajdovics C, Val-Flores L, Valle AL, Valran A, Van de Velde S, van den Berge M, van der Feltz M, van der Valk P, Van Der Vekens N, Van der Voort P, Van Der Werf S, van Dyk M, van Gulik L, Van Hattem J, van Lelyveld S, van Netten C, Van Twillert G, van Veen I, Vanel N, Vanoverschelde H, Varghese P, Varrone M, Vasudayan SR, Vauchy C, Vaughan H, Veeran S, Veislinger A, Vencken S, Ventura S, Verbon A, Vidal JE, Vieira C, Vijayan D, Villanueva JA, Villar J, Villeneuve PM, Villoldo A, Vinh Chau NV, Visseaux B, Visser H, Vitiello C, Vonkeman H, Vuotto F, Wahab NH, Wahab SA, Wahid NA, Wainstein M, Wan Muhd Shukeri WF, Wang CH, Webb SA, Wei J, Weil K, Wen TP, Wesselius S, West TE, Wham M, Whelan B, White N, Wicky PH, Wiedemann A, Wijaya SO, Wille K, Willems S, Williams V, Wils EJ, Wing Yiu N, Wong C, Wong TF, Wong XC, Wong YS, Xian GE, Xian LS, Xuan KP, Xynogalas I, Yacoub S, Yakop SRBM, Yamazaki M, Yazdanpanah Y, Yee Liang Hing N, Yelnik C, Yeoh CH, Yerkovich S, Yokoyama T, Yonis H, Yousif O, Yuliarto S, Zaaqoq A, Zabbe M, Zacharowski K, Zahid M, Zahran M, Zaidan NZB, Zambon M, Zambrano M, Zanella A, Zawadka K, Zaynah N, Zayyad H, Zoufaly A, Zucman D. The value of open-source clinical science in pandemic response: lessons from ISARIC. Lancet Infect Dis 2021; 21:1623-1624. [PMID: 34619109 PMCID: PMC8489876 DOI: 10.1016/s1473-3099(21)00565-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/16/2021] [Indexed: 12/31/2022]
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Johnstone J, Meade M, Lauzier F, Marshall J, Duan E, Dionne J, Arabi YM, Heels-Ansdell D, Thabane L, Lamarche D, Surette M, Zytaruk N, Mehta S, Dodek P, McIntyre L, English S, Rochwerg B, Karachi T, Henderson W, Wood G, Ovakim D, Herridge M, Granton J, Wilcox ME, Goffi A, Stelfox HT, Niven D, Muscedere J, Lamontagne F, D’Aragon F, St.-Arnaud C, Ball I, Nagpal D, Girard M, Aslanian P, Charbonney E, Williamson D, Sligl W, Friedrich J, Adhikari NK, Marquis F, Archambault P, Khwaja K, Kristof A, Kutsogiannis J, Zarychanski R, Paunovic B, Reeve B, Lellouche F, Hosek P, Tsang J, Binnie A, Trop S, Loubani O, Hall R, Cirone R, Reynolds S, Lysecki P, Golan E, Cartin-Ceba R, Taylor R, Cook D. Effect of Probiotics on Incident Ventilator-Associated Pneumonia in Critically Ill Patients: A Randomized Clinical Trial. JAMA 2021; 326:1024-1033. [PMID: 34546300 PMCID: PMC8456390 DOI: 10.1001/jama.2021.13355] [Citation(s) in RCA: 80] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
IMPORTANCE Growing interest in microbial dysbiosis during critical illness has raised questions about the therapeutic potential of microbiome modification with probiotics. Prior randomized trials in this population suggest that probiotics reduce infection, particularly ventilator-associated pneumonia (VAP), although probiotic-associated infections have also been reported. OBJECTIVE To evaluate the effect of Lactobacillus rhamnosus GG on preventing VAP, additional infections, and other clinically important outcomes in the intensive care unit (ICU). DESIGN, SETTING, AND PARTICIPANTS Randomized placebo-controlled trial in 44 ICUs in Canada, the United States, and Saudi Arabia enrolling adults predicted to require mechanical ventilation for at least 72 hours. A total of 2653 patients were enrolled from October 2013 to March 2019 (final follow-up, October 2020). INTERVENTIONS Enteral L rhamnosus GG (1 × 1010 colony-forming units) (n = 1321) or placebo (n = 1332) twice daily in the ICU. MAIN OUTCOMES AND MEASURES The primary outcome was VAP determined by duplicate blinded central adjudication. Secondary outcomes were other ICU-acquired infections including Clostridioides difficile infection, diarrhea, antimicrobial use, ICU and hospital length of stay, and mortality. RESULTS Among 2653 randomized patients (mean age, 59.8 years [SD], 16.5 years), 2650 (99.9%) completed the trial (mean age, 59.8 years [SD], 16.5 years; 1063 women [40.1%.] with a mean Acute Physiology and Chronic Health Evaluation II score of 22.0 (SD, 7.8) and received the study product for a median of 9 days (IQR, 5-15 days). VAP developed among 289 of 1318 patients (21.9%) receiving probiotics vs 284 of 1332 controls (21.3%; hazard ratio [HR], 1.03 (95% CI, 0.87-1.22; P = .73, absolute difference, 0.6%, 95% CI, -2.5% to 3.7%). None of the 20 prespecified secondary outcomes, including other ICU-acquired infections, diarrhea, antimicrobial use, mortality, or length of stay showed a significant difference. Fifteen patients (1.1%) receiving probiotics vs 1 (0.1%) in the control group experienced the adverse event of L rhamnosus in a sterile site or the sole or predominant organism in a nonsterile site (odds ratio, 14.02; 95% CI, 1.79-109.58; P < .001). CONCLUSIONS AND RELEVANCE Among critically ill patients requiring mechanical ventilation, administration of the probiotic L rhamnosus GG compared with placebo, resulted in no significant difference in the development of ventilator-associated pneumonia. These findings do not support the use of L rhamnosus GG in critically ill patients. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02462590.
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Affiliation(s)
| | | | | | | | | | | | - Yaseen M. Arabi
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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- University of British Columbia, Vancouver, Canada
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- Western University, London, Canada
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Grunau B, Shemie SD, Wilson LC, Dainty KN, Nagpal D, Hornby L, Lamarche Y, van Diepen S, Kanji HD, Gould J, Saczkowski R, Brooks SC. Current Use, Capacity, and Perceived Barriers to the Use of Extracorporeal Cardiopulmonary Resuscitation for Out-of-Hospital Cardiac Arrest in Canada. CJC Open 2021; 3:327-336. [PMID: 33778449 PMCID: PMC7985000 DOI: 10.1016/j.cjco.2020.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 11/04/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Extracorporeal cardiopulmonary resuscitation (ECPR) is a therapeutic option for refractory cardiac arrest. We sought to perform an environmental scan to describe ECPR utilization in Canada and perceived barriers for application to out-of-hospital cardiac arrest (OHCA). METHODS This was a national cross-sectional study. We identified all cardiovascular surgery- and extracorporeal membrane oxygenation (ECMO)-capable hospitals in Canada and emergency medical services (EMS) agencies delivering patients to those centres. We requested the medical lead from each hospital's ECMO service and each EMS agency to submit data regarding ECMO and ECPR utilization, as well as perceived barriers to ECPR provision for OHCA. RESULTS We identified and received survey data from 39 of 39 Canadian hospital institutions and 21 of 22 EMS agencies. Of hospitals, 38 (97%) perform ECMO and 27 (69%) perform ECPR (74% of which perform ≤5 cases per year). Of the 18 (46%) sites offering ECPR for OHCA, 8 apply a formal protocol for eligibility and initiation procedures. EMS agencies demonstrate heterogeneity with intra-arrest transport practices. The primary rationale for nontransport of refractory OHCA is that hospital-based care offers no additional therapies. Perceived barriers to the use of ECPR for OHCA were primarily related to limited evidence supporting its use, rather than resources required. CONCLUSION Many Canadian cardiovascular surgery- or ECMO-equipped hospitals use ECPR; roughly half employ ECPR for OHCAs. Low case volumes and few formal protocols indicate that this is not a standardized therapy option in most centres. Increased application may be dependent on a stronger evidence base including data from randomized clinical trials currently underway.
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Affiliation(s)
- Brian Grunau
- Department of Emergency Medicine and Centre for Health Evaluation and Outcome Sciences, University of British Columbia and St Paul’s Hospital, Vancouver, British Columbia, Canada
| | - Sam D. Shemie
- Division of Critical Care Medicine, McGill University, Montreal, Quebec, Canada
- Deceased Donation, Canadian Blood Services, Ottawa, Ontario, Canada
| | | | - Katie N. Dainty
- Patient-Centred Outcomes, North York General Hospital, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Dave Nagpal
- Divisions of Cardiac Surgery and Critical Care Medicine, Western University, London, Ontario, Canada
| | - Laura Hornby
- Deceased Donation, Canadian Blood Services, Ottawa, Ontario, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Yoan Lamarche
- Divisions of Cardiac Surgery and Critical Care Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Sean van Diepen
- Department of Critical Care and Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Hussein D. Kanji
- Division of Critical Care Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - James Gould
- Department of Emergency Medicine, Dalhousie University, Saint John, New Brunswick, Canada
| | - Richard Saczkowski
- Division of Cardiac Surgery, Kelowna General Hospital, Kelowna, British Columbia, Canada
| | - Steven C. Brooks
- Department of Emergency Medicine, Queen’s University, Kingston, Ontario, Canada
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Drullinsky D, Hage F, Hage A, Valdis M, Nagpal D, Chu MWA. Emergent repair of post myocardial infarction ventricular septal defect with prophylactic left ventricular assist device. Ann Cardiothorac Surg 2021; 11:343-345. [DOI: 10.21037/acs-2021-ami-18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 02/01/2022] [Indexed: 11/06/2022]
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Singh G, Nahirniak S, Arora R, Légaré JF, Kanji HD, Nagpal D, Lamarche Y, Fan E, Singh Parhar KK. Transfusion Thresholds for Adult Respiratory Extracorporeal Life Support: An Expert Consensus Document. Can J Cardiol 2020; 36:1550-1553. [PMID: 32599018 PMCID: PMC7319637 DOI: 10.1016/j.cjca.2020.06.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/03/2020] [Accepted: 06/10/2020] [Indexed: 10/28/2022] Open
Abstract
Severe acute respiratory distress syndrome (ARDS) can complicate novel pandemic coronavirus disease (COVID-19). Extracorporeal life support (ECLS) represents the final possible rescue strategy. Variations in practice, combined with a paucity of rigourous guidelines, may complicate blood-product resource availability and allocation during a pandemic. We conducted a literature review around venovenous extracorporeal membrane oxygenation (VV-ECMO) transfusion practices for platelets, packed red blood cells, fresh frozen plasma, prothrombin complex concentrate, and antithrombin. Pertinent society guidelines were examined, and the practice of Canadian ECLS experts was sampled through an environmental scan. This paper represents a synthesis of these explorations, combined with input from the Canadian Cardiovascular Critical Care (CANCARE) Society, Canadian Society of Cardiac Surgeons, and the Canadian Critical Care Society. We offer a pragmatic guidance document for restrictive transfusion thresholds in nonbleeding patients on VV-ECMO, which may attenuate transfusion-related complications and simultaneously shield national blood product inventory from strain during pandemic-induced activation of the National Plan for the Management of Shortages of Labile Blood Components.
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Affiliation(s)
- Gurmeet Singh
- Department of Critical Care Medicine, Division of Cardiac Surgery, Mazankowski Alberta Heart Institute, Alberta Health Services and University of Alberta, Edmonton, Alberta, Canada.
| | - Susan Nahirniak
- Department of Laboratory Medicine and Pathology, National Advisory Committee on Blood and Blood Products, University of Alberta, Edmonton, Alberta, Canada
| | - Rakesh Arora
- Department of Surgery, Division of Cardiac Surgery, University of Manitoba, Winnepeg, Manitoba, Canada
| | - Jean-François Légaré
- Department of Surgery, Division of Cardiac Surgery, New Brunswick Heart Centre, Dalhousie University, St John, New Brunswick, Canada
| | - Hussein D Kanji
- Department of Medicine, Division of Critical Care, University of British Columbia, Vancouver, British Columbia, Canada
| | - Dave Nagpal
- Department of Surgery, Division of Cardiac Surgery, Western University, London, Ontario, Canada
| | - Yoan Lamarche
- Chirurgien cardiaque/intensiviste, Institut de Cardiologie de Montréal, Hôpital du Sacré Coeur de Montréal, Professeur agrégé de Chirurgie, Université de Montréal, Montréal, Québec, Canada
| | - Eddy Fan
- Interdepartmental Division of Critical Care Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Ken Kuljit Singh Parhar
- Department of Critical Care Medicine, Cumming School of Medicine-Alberta Health Services and University of Calgary and Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
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Yin C, Vrieze AM, Akingbasote J, Pawlak EN, Jacob RA, Hu J, Sharma N, Blackler G, Dikeakos JD, Barra L, Nagpal D, Heit B. The hematopoietic transcription factor GATA2 is a novel regulator of apoptotic cell clearance by macrophages in atherosclerosis. The Journal of Immunology 2020. [DOI: 10.4049/jimmunol.204.supp.146.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Abstract
Atherosclerosis is an inflammatory disease involving formation of lipid-rich lesions within the arteries. Macrophages clear apoptotic cells that accumulate within these lesions. Defective apoptotic cell clearance is a hallmark of advanced atherosclerotic disease, yet mechanisms that drive this defect are poorly understood. In this study, we identify the hematopoietic transcription factor GATA2 as a novel regulator of macrophage-mediated apoptotic cell clearance.
Macrophages were isolated by laser capture microdissection from atherosclerotic lesions in aortic tissue obtained from patients undergoing open heart surgery. Gene expression profiling was performed on these macrophages by microarray, with macrophages derived from peripheral blood monocytes used as a control.
We found approximately 3,000 genes to be differentially expressed in aortic punch macrophages, with enrichment in pathways involved in apoptotic cell clearance. In particular, we identified upregulation of GATA2. Mutations in GATA2 have previously been associated with increased risk of coronary artery disease and we found that overexpression of GATA2 in vitro resulted in decreased ability of macrophages to both internalize and degrade apoptotic cells. Conversely, GATA2 downregulation is sufficient to abrogate oxLDL-induced defective apoptotic cell clearance.
Atherosclerotic macrophages exhibit dysregulated expression of genes involved in apoptotic cell clearance and upregulation of GATA2. Recapitulation of GATA2 overexpression is sufficient to impair apoptotic cell clearance in vitro. To our knowledge, we are the first to identify a potential role for GATA2 in driving defective apoptotic cell clearance in atherosclerosis.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Lillian Barra
- 1Univ. of Western Ontario, Canada
- 2London Health Sciences Centre, Canada
| | - Dave Nagpal
- 1Univ. of Western Ontario, Canada
- 2London Health Sciences Centre, Canada
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15
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Honarmand K, Parsons Leigh J, Martin CM, Sibbald R, Nagpal D, Lau V, Priestap F, De S, Basmaji J, Healey A, Dhanani S, Weiss MJ, Shemie S, Ball IM. Acceptability of cardiac donation after circulatory determination of death: a survey of the Canadian public. Can J Anaesth 2020; 67:292-300. [PMID: 31898773 DOI: 10.1007/s12630-019-01560-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 08/19/2019] [Accepted: 12/19/2019] [Indexed: 01/08/2023] Open
Abstract
PURPOSE Cardiac transplantation is a definitive therapy for end-stage heart failure, but demand exceeds supply. Cardiac donation after circulatory determination of death (cardiac DCDD) can be performed using direct procurement and perfusion (DPP), where cardiac activity is restored after heart recovery, or (NRP), where brain blood supply is surgically interrupted, circulation to the thoraco-abdominal organs is restored within the donor's body, followed by heart recovery. While cardiac DCDD would increase the number of heart donors, uptake of programs has been slowed in part because of ethical concerns within the medical community. These debates have been largely devoid of discussion regarding public perceptions. We conducted a national survey of public perceptions regarding cardiac DCDD. METHODS We surveyed 1,001 Canadians about their attitudes towards cardiac DCDD using a rigorously designed and pre-tested survey. RESULTS We found that 843 of 1,001 respondents (84.2%; 95% confidence interval [CI], 81.8 to 86.3) accepted the DPP approach, 642 (64.1%; 95% CI, 61.1 to 67.0) would agree to donate their heart using DPP, and 696 (69.5%; 95% CI, 66.6 to 72.3) would consent to the same for a family member. We found that 779 respondents of 1,001 respondents (77.8%; 95% CI, 75.1 to 80.3) accepted the NRP approach, 587 (58.6%; 95% CI, 55.5 to 61.6) would agree to donate their heart using NRP, and 636 (63.5%; 95% CI, 60.5 to 66.4) would consent to the same for a family member. Most respondents supported the implementation of DPP (738 respondents or 73.7%; 95% CI, 70.9 to 76.3) and NRP (655 respondents or 65.4%; 95% CI, 62.4 to 68.3) in Canada. CONCLUSION The results of this national survey of public attitudes towards cardiac DCDD will inform the implementation of cardiac DCDD programs in a manner that is consistent with public values.
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Affiliation(s)
- Kimia Honarmand
- Department of Medicine, London Health Sciences Centre, Western University, London, ON, Canada.
| | - Jeanna Parsons Leigh
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
| | - Claudio M Martin
- Department of Medicine, London Health Sciences Centre, Western University, London, ON, Canada
| | - Robert Sibbald
- Department of Family Medicine, Western University, London, ON, Canada
| | - Dave Nagpal
- Department of Medicine, London Health Sciences Centre, Western University, London, ON, Canada
| | - Vince Lau
- Department of Medicine, London Health Sciences Centre, Western University, London, ON, Canada
| | - Fran Priestap
- Department of Medicine, London Health Sciences Centre, Western University, London, ON, Canada
| | - Sabe De
- Division of Cardiology, Western University, London, ON, Canada
| | - John Basmaji
- Department of Medicine, London Health Sciences Centre, Western University, London, ON, Canada
| | - Andrew Healey
- Trillium Gift of Life Network, Toronto, ON, Canada
- Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Sonny Dhanani
- Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
- Division of Pediatric Critical Care, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Matthew J Weiss
- Division of Pediatric Intensive Care, Centre-Mère Enfant Soleil du CHU de Québec, Québec City, QC, Canada
- Department of Pediatrics, Faculté de Médecine, Université Laval, Québec City, QC, Canada
- CHU de Québec - Université Laval Research Center, Population Health and Optimal Health Practices Research Unit, Traumatology-Emergency-Critical Care Medicine, Université Laval, Québec City, QC, Canada
| | - Sam Shemie
- Deceased Organ Donation, Canadian Blood Services and Division of Critical Care Medicine, Montreal Children's Hospital and McGill University Health Centre & Research Institute, Montreal, QC, Canada
| | - Ian M Ball
- Department of Medicine, London Health Sciences Centre, Western University, London, ON, Canada
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
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16
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Honarmand K, Parsons Leigh J, Basmaji J, Martin CM, Sibbald R, Nagpal D, Lau V, Priestap F, De S, Healey A, Dhanani S, Weiss MJ, Shemie S, Ball IM. Attitudes of healthcare providers towards cardiac donation after circulatory determination of death: a Canadian nation-wide survey. Can J Anaesth 2020; 67:301-312. [PMID: 31898778 DOI: 10.1007/s12630-019-01559-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 08/19/2019] [Accepted: 08/19/2019] [Indexed: 11/30/2022] Open
Abstract
PURPOSE The number of patients on cardiac transplant waitlists exceeds the number of available donor organs. Cardiac donation is currently limited to those declared dead by neurologic criteria in all but three countries. Cardiac donation after circulatory determination of death (cardiac DCDD) can be conducted using direct procurement and perfusion (DPP) or normothermic regional perfusion (NRP). Implementation of cardiac DCDD in many countries has been slowed by ethical debates within the donation and transplantation community. We conducted a national survey to determine the perceptions of healthcare providers regarding cardiac DCDD. METHODS We conducted an electronic survey of 398 healthcare providers who are involved in the management of heart donors and/or heart transplant recipients in Canada (226 nurses, 82 critical care physicians, 31 donation specialists, and 59 transplant specialists). Our primary outcomes were their attitudes towards and concerns regarding cardiac DCDD protocols and their implementation in Canada. We distributed the survey electronically through several Canadian donation and transplantation organizations. RESULTS We identified that 361 of 391 respondents (92.3%; 95% confidence interval [CI], 89.6 to 95.1) believed that DPP is acceptable, and 329 of 377 respondents (87.3%; 95% CI, 83.9 to 90.7) supported its implementation in Canada. We found that 301 of 384 respondents (78.4%; 95% CI, 74.2 to 82.6) believed that NRP is acceptable and 266 of 377 respondents (70.6%; 95% CI, 66.0 to 75.2) supported its implementation in Canada. CONCLUSION This is the first survey describing the attitudes of healthcare providers towards cardiac DCDD. We identified widespread support for cardiac DCDD and its implementation in Canada among Canadian healthcare providers within the organ donation and transplantation community in Canada.
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Affiliation(s)
- Kimia Honarmand
- Department of Medicine, Western University, London Health Sciences Centre, London, ON, Canada.
| | - Jeanna Parsons Leigh
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
| | - John Basmaji
- Department of Medicine, Western University, London Health Sciences Centre, London, ON, Canada
| | - Claudio M Martin
- Department of Medicine, Western University, London Health Sciences Centre, London, ON, Canada
| | - Robert Sibbald
- Department of Family Medicine, Western University, London, ON, Canada
| | - Dave Nagpal
- Department of Medicine, Western University, London Health Sciences Centre, London, ON, Canada
| | - Vince Lau
- Department of Medicine, Western University, London Health Sciences Centre, London, ON, Canada
| | - Fran Priestap
- Department of Medicine, Western University, London Health Sciences Centre, London, ON, Canada
| | - Sabe De
- Division of Cardiology, Western University, London, ON, Canada
| | - Andrew Healey
- Trillium Gift of Life Network, Toronto, ON, Canada
- Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Sonny Dhanani
- Department of Pediatrics, University of Ottawa and Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
- Division of Pediatric Critical Care, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Matthew J Weiss
- Division of Pediatric Intensive Care, Centre-Mère Enfant Soleil du CHU de Québec, Québec City, QC, Canada
- Department of Pediatrics, Faculté de Médecine, Université Laval, Québec City, QC, Canada
- Population Health and Optimal Health Practices Research Unit, Traumatology-Emergency-Critical Care Medicine, Université Laval, CHU de Québec - Université Laval Research Center, Québec City, QC, Canada
| | - Sam Shemie
- Deceased Organ Donation, Canadian Blood Services and Division of Critical Care Medicine, Montreal Children's Hospital and McGill University Health Centre & Research Institute, Montreal, QC, Canada
| | - Ian M Ball
- Department of Medicine, Western University, London Health Sciences Centre, London, ON, Canada
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
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17
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Zhu C, Su Y, Juriasingani S, Zheng H, Veramkovich V, Jiang J, Sener A, Whiteman M, Lacefield J, Nagpal D, Alotaibi F, Liu K, Zheng X. Supplementing preservation solution with mitochondria-targeted H 2 S donor AP39 protects cardiac grafts from prolonged cold ischemia-reperfusion injury in heart transplantation. Am J Transplant 2019; 19:3139-3148. [PMID: 31338943 DOI: 10.1111/ajt.15539] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 07/01/2019] [Accepted: 07/14/2019] [Indexed: 01/25/2023]
Abstract
Heart transplant has been accepted as the standard treatment for end-stage heart failure. Because of its susceptibility to ischemia-reperfusion injury, the heart can be preserved for only 4 to 6 hours in cold static preservation solutions. Prolonged ischemia time is adversely associated with primary graft function and long-term survival. New strategies to preserve donor hearts are urgently needed. We demonstrate that AP39, a mitochondria-targeting hydrogen sulfide donor, significantly increases cardiomyocyte viability and reduces cell apoptosis/death after cold hypoxia/reoxygenation in vitro. It also decreases gene expression of proinflammatory cytokines and preserves mitochondria function. Using an in vivo murine heart transplant model, we show that preserving donor hearts with AP39-supplemented University of Wisconsin solution (n = 7) significantly protects heart graft function, measured by quantitative ultrasound scan, against prolonged cold ischemia-reperfusion injury (24 hours at 4°C), along with reducing tissue injury and fibrosis. Our study demonstrates that supplementing preservation solution with AP39 protects cardiac grafts from prolonged ischemia, highlighting its therapeutic potential in preventing ischemia-reperfusion injury in heart transplant.
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Affiliation(s)
- Cuilin Zhu
- Department of Cardiovascular Surgery, The Second Hospital of Jilin University, Changchun, China.,Department of Pathology, Western University, Ontario, Canada.,Matthew Mailing Centre for Translational Transplant Studies, London Health Sciences Center, Ontario, Canada
| | - Yale Su
- Department of Cardiovascular Surgery, The Second Hospital of Jilin University, Changchun, China.,Department of Pathology, Western University, Ontario, Canada.,Matthew Mailing Centre for Translational Transplant Studies, London Health Sciences Center, Ontario, Canada
| | - Smriti Juriasingani
- Matthew Mailing Centre for Translational Transplant Studies, London Health Sciences Center, Ontario, Canada
| | - Hao Zheng
- Department of Pathology, Western University, Ontario, Canada.,Matthew Mailing Centre for Translational Transplant Studies, London Health Sciences Center, Ontario, Canada
| | - Vitali Veramkovich
- Department of Pathology, Western University, Ontario, Canada.,Matthew Mailing Centre for Translational Transplant Studies, London Health Sciences Center, Ontario, Canada
| | - Jifu Jiang
- Matthew Mailing Centre for Translational Transplant Studies, London Health Sciences Center, Ontario, Canada
| | - Alp Sener
- Matthew Mailing Centre for Translational Transplant Studies, London Health Sciences Center, Ontario, Canada.,Department of Surgery, Western University, Ontario, Canada.,Lawson Health Research Institute, Ontario, Canada.,Department of Oncology, Western University, Ontario, Canada
| | - Matthew Whiteman
- University of Exeter Medical School, St. Luke's Campus, Exeter, UK
| | - James Lacefield
- Department of Medical Biophysics, Western University, Ontario, Canada.,Department of Electrical & Computer Engineering, Western University, Ontario, Canada.,Robarts Research Institute, Western University, Ontario, Canada
| | - Dave Nagpal
- Department of Surgery, Western University, Ontario, Canada
| | - Faizah Alotaibi
- Department of Pathology, Western University, Ontario, Canada
| | - Kexiang Liu
- Department of Cardiovascular Surgery, The Second Hospital of Jilin University, Changchun, China
| | - Xiufen Zheng
- Department of Pathology, Western University, Ontario, Canada.,Matthew Mailing Centre for Translational Transplant Studies, London Health Sciences Center, Ontario, Canada.,Department of Surgery, Western University, Ontario, Canada.,Lawson Health Research Institute, Ontario, Canada.,Department of Oncology, Western University, Ontario, Canada
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18
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Fernandes P, O'Neil M, Del Valle S, Cave A, Nagpal D. A 24-hour perioperative case study on argatroban use for left ventricle assist device insertion during cardiopulmonary bypass and veno-arterial extracorporeal membrane oxygenation. Perfusion 2018; 34:337-344. [PMID: 30583712 DOI: 10.1177/0267659118813043] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A 44-year-old male with ongoing chest pain and left ventricular ejection fraction <20% was transferred from a peripheral hospital with intra-aortic balloon pump placement following a non-ST-elevation myocardial infarction (STEMI). The patient underwent emergent multi-vessel coronary artery bypass grafting requiring veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) on post-operative day (POD)#9 secondary to cardiogenic shock with biventricular failure. Due to clot formation, an oxygenator change-out was necessary shortly after initiation. Following a positive heparin-induced thrombocytopenia (HIT) assay, a total circuit exchange was required to eliminate all heparin coating and argatroban was deemed the anticoagulant of choice due to acute kidney injury. On POD#24, the decision was made to implant a left ventricle assist device (LVAD) as a bridge to heart transplantation. There was difficulty achieving an activated clotting time (ACT) >400 s: multiple argatroban bolus doses were required, along with accelerated up-titration of infusion dosing. Despite maintaining an ACT >484 s, clot formation was observed in the cardiotomy reservoir prior to separation. Subsequently, the patient developed severe disseminated intravascular coagulopathy, with both intra-cardiac and intravascular thrombi, requiring massive transfusion and continuous cell saving due to severe hemorrhage post cardiopulmonary bypass (CPB). The patient received a total of 105 units of plasma, 74 units of packed red cells, 19 units of platelets, 13 bottles of 5% albumin, 6 units of cryoprecipitate and 2 doses of factor VIIa intraoperatively over the course of 24 hours. A total of 19.7 L of washed red blood cells were returned to the patient from the cell saver. With the LVAD in place, the patient developed transfusion-related acute lung injury and acute respiratory distress syndrome with right ventricular dysfunction requiring VA ECMO once again. On POD#30, ECMO was discontinued and the patient was discharged from the intensive care unit (ICU) on POD 66. After a very complex post-operative stay with numerous surgeries and extensive rehabilitation, the patient was discharged home with the LVAD on POD#112.
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Affiliation(s)
- Philip Fernandes
- 1 Clinical Perfusion Services, London Health Sciences Centre, London, Ontario, Canada
| | - Michael O'Neil
- 1 Clinical Perfusion Services, London Health Sciences Centre, London, Ontario, Canada
| | - Samantha Del Valle
- 1 Clinical Perfusion Services, London Health Sciences Centre, London, Ontario, Canada
| | - Anita Cave
- 2 Cardiac Care, Perioperative Cardiac Anesthesiology, London Health Sciences Centre, London, Ontario, Canada
| | - Dave Nagpal
- 3 Division of Cardiac Surgery, London Health Sciences Centre, London, Ontario, Canada.,4 Western University, Lawson Health Research Centre, London, Ontario, Canada
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19
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Swinamer S, Fox S, Nagpal D, Chu M, Quantz M, Guo R, Novick R, Kiaii B, Sy J, Gelinas J. ENDOSCOPIC RADIAL ARTERY HARVEST--OUTCOMES AND LESSONS LEARNED AFTER 1000 HARVESTS. Can J Cardiol 2017. [DOI: 10.1016/j.cjca.2017.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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20
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Grunau B, Hornby L, Singal RK, Christenson J, Ortega-Deballon I, Shemie SD, Bashir J, Brooks SC, Callaway CW, Guadagno E, Nagpal D. Extracorporeal Cardiopulmonary Resuscitation for Refractory Out-of-Hospital Cardiac Arrest: The State of the Evidence and Framework for Application. Can J Cardiol 2017; 34:146-155. [PMID: 29249614 DOI: 10.1016/j.cjca.2017.08.015] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 08/01/2017] [Accepted: 08/16/2017] [Indexed: 01/08/2023] Open
Abstract
Out-of-hospital cardiac arrest (OHCA) affects 134 per 100,000 citizens annually. Extracorporeal cardiopulmonary resuscitation (ECPR), providing mechanical circulatory support, may improve the likelihood of survival among those with refractory OHCA. Compared with in-hospital ECPR candidates, those in the out-of-hospital setting tend to be sudden unexpected arrests in younger and healthier patients. The aims of this review were to summarize, and identify the limitations of, the evidence evaluating ECPR for OHCA, and to provide an approach for ECPR program application. Although there are many descriptions of ECPR-treated cohorts, we identified a paucity of robust data showing ECPR effectiveness compared with conventional resuscitation. However, it is highly likely that ECPR, provided after a prolonged attempt with conventional resuscitation, does benefit select patient populations compared with conventional resuscitation alone. Although reliable data showing the optimal patient selection criteria for ECPR are lacking, most implementations sought young previously healthy patients with rapid high-quality cardiopulmonary resuscitation. Carefully planned development of ECPR programs, in high-performing emergency medical systems at experienced extracorporeal membrane oxygenation centres, may be reasonable as part of systematic efforts to determine ECPR effectiveness and globally improve care. Protocol evaluation requires regional-level assessment, examining the incremental benefit of survival compared with standard care, while accounting for resource utilization.
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Affiliation(s)
- Brian Grunau
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada; St Paul's Hospital, Vancouver, British Columbia, Canada.
| | - Laura Hornby
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Rohit K Singal
- Section of Cardiovascular Surgery, University of Manitoba, Winnipeg, Manitoba, Canada; St Boniface Hospital, Winnipeg, Manitoba, Canada
| | - Jim Christenson
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada; St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Ivan Ortega-Deballon
- Faculty of Medicine and Health Sciences, Universidad de Alcalá, Madrid, Spain; Helicopter Emergency Medical Service, Servicio de Urgencias Medicas de Madrid, Madrid, Spain
| | - Sam D Shemie
- Division of Critical Care Medicine, McGill University, Montreal, Quebec, Canada
| | - Jamil Bashir
- St Paul's Hospital, Vancouver, British Columbia, Canada; Division of Cardiovascular Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Steve C Brooks
- Department of Emergency Medicine, Queen's University, Kingston, Ontario, Canada
| | - Clifton W Callaway
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Elena Guadagno
- McConnell Resource Centre, McGill University Health Centre, Montreal, Quebec, Canada
| | - Dave Nagpal
- Divisions of Cardiac Surgery and Critical Care Medicine, Western University, London, Ontario, Canada; London Health Sciences Centre, London, Ontario, Canada
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21
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Mehta RH, Leimberger JD, van Diepen S, Meza J, Wang A, Jankowich R, Harrison RW, Hay D, Fremes S, Duncan A, Soltesz EG, Luber J, Park S, Argenziano M, Murphy E, Marcel R, Kalavrouziotis D, Nagpal D, Bozinovski J, Toller W, Heringlake M, Goodman SG, Levy JH, Harrington RA, Anstrom KJ, Alexander JH. Levosimendan in Patients with Left Ventricular Dysfunction Undergoing Cardiac Surgery. N Engl J Med 2017; 376:2032-2042. [PMID: 28316276 DOI: 10.1056/nejmoa1616218] [Citation(s) in RCA: 178] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Levosimendan is an inotropic agent that has been shown in small studies to prevent or treat the low cardiac output syndrome after cardiac surgery. METHODS In a multicenter, randomized, placebo-controlled, phase 3 trial, we evaluated the efficacy and safety of levosimendan in patients with a left ventricular ejection fraction of 35% or less who were undergoing cardiac surgery with the use of cardiopulmonary bypass. Patients were randomly assigned to receive either intravenous levosimendan (at a dose of 0.2 μg per kilogram of body weight per minute for 1 hour, followed by a dose of 0.1 μg per kilogram per minute for 23 hours) or placebo, with the infusion started before surgery. The two primary end points were a four-component composite of death through day 30, renal-replacement therapy through day 30, perioperative myocardial infarction through day 5, or use of a mechanical cardiac assist device through day 5; and a two-component composite of death through day 30 or use of a mechanical cardiac assist device through day 5. RESULTS A total of 882 patients underwent randomization, 849 of whom received levosimendan or placebo and were included in the modified intention-to-treat population. The four-component primary end point occurred in 105 of 428 patients (24.5%) assigned to receive levosimendan and in 103 of 421 (24.5%) assigned to receive placebo (adjusted odds ratio, 1.00; 99% confidence interval [CI], 0.66 to 1.54; P=0.98). The two-component primary end point occurred in 56 patients (13.1%) assigned to receive levosimendan and in 48 (11.4%) assigned to receive placebo (adjusted odds ratio, 1.18; 96% CI, 0.76 to 1.82; P=0.45). The rate of adverse events did not differ significantly between the two groups. CONCLUSIONS Prophylactic levosimendan did not result in a rate of the short-term composite end point of death, renal-replacement therapy, perioperative myocardial infarction, or use of a mechanical cardiac assist device that was lower than the rate with placebo among patients with a reduced left ventricular ejection fraction who were undergoing cardiac surgery with the use of cardiopulmonary bypass. (Funded by Tenax Therapeutics; LEVO-CTS ClinicalTrials.gov number, NCT02025621 .).
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Affiliation(s)
- Rajendra H Mehta
- From the Duke Clinical Research Institute, Duke University School of Medicine, Durham (R.H.M., J.D.L., J.M., A.W., R.W.H., J.H.L., K.J.A., J.H.A.), and Tenax Therapeutics, Morrisville (R.J., D.H.) - both in North Carolina; the Canadian VIGOUR (Virtual Coordinating Centre for Global Collaborative Cardiovascular Research) Centre, University of Alberta, Edmonton (S.D., S.G.G.), Sunnybrook Health Sciences Centre, Toronto (S.F.), the Quebec Heart and Lung Institute, Quebec (D.K.), London Health Sciences Centre, London, ON (D.N.), and the Victoria Heart Institute Foundation, Victoria, BC (J.B.) - all in Canada; Cleveland Clinic Foundation (A.D., E.G.S.) and University Hospitals Cleveland Medical Center (S.P.) - both in Cleveland; Franciscan Health System, Tacoma, WA (J.L.); Columbia University Medical Center, New York (M.A.); Spectrum Health, Grand Rapids, MI (E.M.); the Heart Hospital Baylor Plano, Plano, TX (R.M.); the Medical University of Graz, Graz, Austria (W.T.); the University of Luebeck, Luebeck, Germany (M.H.); and the Department of Medicine, Stanford University, Stanford, CA (R.A.H.)
| | - Jeffrey D Leimberger
- From the Duke Clinical Research Institute, Duke University School of Medicine, Durham (R.H.M., J.D.L., J.M., A.W., R.W.H., J.H.L., K.J.A., J.H.A.), and Tenax Therapeutics, Morrisville (R.J., D.H.) - both in North Carolina; the Canadian VIGOUR (Virtual Coordinating Centre for Global Collaborative Cardiovascular Research) Centre, University of Alberta, Edmonton (S.D., S.G.G.), Sunnybrook Health Sciences Centre, Toronto (S.F.), the Quebec Heart and Lung Institute, Quebec (D.K.), London Health Sciences Centre, London, ON (D.N.), and the Victoria Heart Institute Foundation, Victoria, BC (J.B.) - all in Canada; Cleveland Clinic Foundation (A.D., E.G.S.) and University Hospitals Cleveland Medical Center (S.P.) - both in Cleveland; Franciscan Health System, Tacoma, WA (J.L.); Columbia University Medical Center, New York (M.A.); Spectrum Health, Grand Rapids, MI (E.M.); the Heart Hospital Baylor Plano, Plano, TX (R.M.); the Medical University of Graz, Graz, Austria (W.T.); the University of Luebeck, Luebeck, Germany (M.H.); and the Department of Medicine, Stanford University, Stanford, CA (R.A.H.)
| | - Sean van Diepen
- From the Duke Clinical Research Institute, Duke University School of Medicine, Durham (R.H.M., J.D.L., J.M., A.W., R.W.H., J.H.L., K.J.A., J.H.A.), and Tenax Therapeutics, Morrisville (R.J., D.H.) - both in North Carolina; the Canadian VIGOUR (Virtual Coordinating Centre for Global Collaborative Cardiovascular Research) Centre, University of Alberta, Edmonton (S.D., S.G.G.), Sunnybrook Health Sciences Centre, Toronto (S.F.), the Quebec Heart and Lung Institute, Quebec (D.K.), London Health Sciences Centre, London, ON (D.N.), and the Victoria Heart Institute Foundation, Victoria, BC (J.B.) - all in Canada; Cleveland Clinic Foundation (A.D., E.G.S.) and University Hospitals Cleveland Medical Center (S.P.) - both in Cleveland; Franciscan Health System, Tacoma, WA (J.L.); Columbia University Medical Center, New York (M.A.); Spectrum Health, Grand Rapids, MI (E.M.); the Heart Hospital Baylor Plano, Plano, TX (R.M.); the Medical University of Graz, Graz, Austria (W.T.); the University of Luebeck, Luebeck, Germany (M.H.); and the Department of Medicine, Stanford University, Stanford, CA (R.A.H.)
| | - James Meza
- From the Duke Clinical Research Institute, Duke University School of Medicine, Durham (R.H.M., J.D.L., J.M., A.W., R.W.H., J.H.L., K.J.A., J.H.A.), and Tenax Therapeutics, Morrisville (R.J., D.H.) - both in North Carolina; the Canadian VIGOUR (Virtual Coordinating Centre for Global Collaborative Cardiovascular Research) Centre, University of Alberta, Edmonton (S.D., S.G.G.), Sunnybrook Health Sciences Centre, Toronto (S.F.), the Quebec Heart and Lung Institute, Quebec (D.K.), London Health Sciences Centre, London, ON (D.N.), and the Victoria Heart Institute Foundation, Victoria, BC (J.B.) - all in Canada; Cleveland Clinic Foundation (A.D., E.G.S.) and University Hospitals Cleveland Medical Center (S.P.) - both in Cleveland; Franciscan Health System, Tacoma, WA (J.L.); Columbia University Medical Center, New York (M.A.); Spectrum Health, Grand Rapids, MI (E.M.); the Heart Hospital Baylor Plano, Plano, TX (R.M.); the Medical University of Graz, Graz, Austria (W.T.); the University of Luebeck, Luebeck, Germany (M.H.); and the Department of Medicine, Stanford University, Stanford, CA (R.A.H.)
| | - Alice Wang
- From the Duke Clinical Research Institute, Duke University School of Medicine, Durham (R.H.M., J.D.L., J.M., A.W., R.W.H., J.H.L., K.J.A., J.H.A.), and Tenax Therapeutics, Morrisville (R.J., D.H.) - both in North Carolina; the Canadian VIGOUR (Virtual Coordinating Centre for Global Collaborative Cardiovascular Research) Centre, University of Alberta, Edmonton (S.D., S.G.G.), Sunnybrook Health Sciences Centre, Toronto (S.F.), the Quebec Heart and Lung Institute, Quebec (D.K.), London Health Sciences Centre, London, ON (D.N.), and the Victoria Heart Institute Foundation, Victoria, BC (J.B.) - all in Canada; Cleveland Clinic Foundation (A.D., E.G.S.) and University Hospitals Cleveland Medical Center (S.P.) - both in Cleveland; Franciscan Health System, Tacoma, WA (J.L.); Columbia University Medical Center, New York (M.A.); Spectrum Health, Grand Rapids, MI (E.M.); the Heart Hospital Baylor Plano, Plano, TX (R.M.); the Medical University of Graz, Graz, Austria (W.T.); the University of Luebeck, Luebeck, Germany (M.H.); and the Department of Medicine, Stanford University, Stanford, CA (R.A.H.)
| | - Rachael Jankowich
- From the Duke Clinical Research Institute, Duke University School of Medicine, Durham (R.H.M., J.D.L., J.M., A.W., R.W.H., J.H.L., K.J.A., J.H.A.), and Tenax Therapeutics, Morrisville (R.J., D.H.) - both in North Carolina; the Canadian VIGOUR (Virtual Coordinating Centre for Global Collaborative Cardiovascular Research) Centre, University of Alberta, Edmonton (S.D., S.G.G.), Sunnybrook Health Sciences Centre, Toronto (S.F.), the Quebec Heart and Lung Institute, Quebec (D.K.), London Health Sciences Centre, London, ON (D.N.), and the Victoria Heart Institute Foundation, Victoria, BC (J.B.) - all in Canada; Cleveland Clinic Foundation (A.D., E.G.S.) and University Hospitals Cleveland Medical Center (S.P.) - both in Cleveland; Franciscan Health System, Tacoma, WA (J.L.); Columbia University Medical Center, New York (M.A.); Spectrum Health, Grand Rapids, MI (E.M.); the Heart Hospital Baylor Plano, Plano, TX (R.M.); the Medical University of Graz, Graz, Austria (W.T.); the University of Luebeck, Luebeck, Germany (M.H.); and the Department of Medicine, Stanford University, Stanford, CA (R.A.H.)
| | - Robert W Harrison
- From the Duke Clinical Research Institute, Duke University School of Medicine, Durham (R.H.M., J.D.L., J.M., A.W., R.W.H., J.H.L., K.J.A., J.H.A.), and Tenax Therapeutics, Morrisville (R.J., D.H.) - both in North Carolina; the Canadian VIGOUR (Virtual Coordinating Centre for Global Collaborative Cardiovascular Research) Centre, University of Alberta, Edmonton (S.D., S.G.G.), Sunnybrook Health Sciences Centre, Toronto (S.F.), the Quebec Heart and Lung Institute, Quebec (D.K.), London Health Sciences Centre, London, ON (D.N.), and the Victoria Heart Institute Foundation, Victoria, BC (J.B.) - all in Canada; Cleveland Clinic Foundation (A.D., E.G.S.) and University Hospitals Cleveland Medical Center (S.P.) - both in Cleveland; Franciscan Health System, Tacoma, WA (J.L.); Columbia University Medical Center, New York (M.A.); Spectrum Health, Grand Rapids, MI (E.M.); the Heart Hospital Baylor Plano, Plano, TX (R.M.); the Medical University of Graz, Graz, Austria (W.T.); the University of Luebeck, Luebeck, Germany (M.H.); and the Department of Medicine, Stanford University, Stanford, CA (R.A.H.)
| | - Douglas Hay
- From the Duke Clinical Research Institute, Duke University School of Medicine, Durham (R.H.M., J.D.L., J.M., A.W., R.W.H., J.H.L., K.J.A., J.H.A.), and Tenax Therapeutics, Morrisville (R.J., D.H.) - both in North Carolina; the Canadian VIGOUR (Virtual Coordinating Centre for Global Collaborative Cardiovascular Research) Centre, University of Alberta, Edmonton (S.D., S.G.G.), Sunnybrook Health Sciences Centre, Toronto (S.F.), the Quebec Heart and Lung Institute, Quebec (D.K.), London Health Sciences Centre, London, ON (D.N.), and the Victoria Heart Institute Foundation, Victoria, BC (J.B.) - all in Canada; Cleveland Clinic Foundation (A.D., E.G.S.) and University Hospitals Cleveland Medical Center (S.P.) - both in Cleveland; Franciscan Health System, Tacoma, WA (J.L.); Columbia University Medical Center, New York (M.A.); Spectrum Health, Grand Rapids, MI (E.M.); the Heart Hospital Baylor Plano, Plano, TX (R.M.); the Medical University of Graz, Graz, Austria (W.T.); the University of Luebeck, Luebeck, Germany (M.H.); and the Department of Medicine, Stanford University, Stanford, CA (R.A.H.)
| | - Stephen Fremes
- From the Duke Clinical Research Institute, Duke University School of Medicine, Durham (R.H.M., J.D.L., J.M., A.W., R.W.H., J.H.L., K.J.A., J.H.A.), and Tenax Therapeutics, Morrisville (R.J., D.H.) - both in North Carolina; the Canadian VIGOUR (Virtual Coordinating Centre for Global Collaborative Cardiovascular Research) Centre, University of Alberta, Edmonton (S.D., S.G.G.), Sunnybrook Health Sciences Centre, Toronto (S.F.), the Quebec Heart and Lung Institute, Quebec (D.K.), London Health Sciences Centre, London, ON (D.N.), and the Victoria Heart Institute Foundation, Victoria, BC (J.B.) - all in Canada; Cleveland Clinic Foundation (A.D., E.G.S.) and University Hospitals Cleveland Medical Center (S.P.) - both in Cleveland; Franciscan Health System, Tacoma, WA (J.L.); Columbia University Medical Center, New York (M.A.); Spectrum Health, Grand Rapids, MI (E.M.); the Heart Hospital Baylor Plano, Plano, TX (R.M.); the Medical University of Graz, Graz, Austria (W.T.); the University of Luebeck, Luebeck, Germany (M.H.); and the Department of Medicine, Stanford University, Stanford, CA (R.A.H.)
| | - Andra Duncan
- From the Duke Clinical Research Institute, Duke University School of Medicine, Durham (R.H.M., J.D.L., J.M., A.W., R.W.H., J.H.L., K.J.A., J.H.A.), and Tenax Therapeutics, Morrisville (R.J., D.H.) - both in North Carolina; the Canadian VIGOUR (Virtual Coordinating Centre for Global Collaborative Cardiovascular Research) Centre, University of Alberta, Edmonton (S.D., S.G.G.), Sunnybrook Health Sciences Centre, Toronto (S.F.), the Quebec Heart and Lung Institute, Quebec (D.K.), London Health Sciences Centre, London, ON (D.N.), and the Victoria Heart Institute Foundation, Victoria, BC (J.B.) - all in Canada; Cleveland Clinic Foundation (A.D., E.G.S.) and University Hospitals Cleveland Medical Center (S.P.) - both in Cleveland; Franciscan Health System, Tacoma, WA (J.L.); Columbia University Medical Center, New York (M.A.); Spectrum Health, Grand Rapids, MI (E.M.); the Heart Hospital Baylor Plano, Plano, TX (R.M.); the Medical University of Graz, Graz, Austria (W.T.); the University of Luebeck, Luebeck, Germany (M.H.); and the Department of Medicine, Stanford University, Stanford, CA (R.A.H.)
| | - Edward G Soltesz
- From the Duke Clinical Research Institute, Duke University School of Medicine, Durham (R.H.M., J.D.L., J.M., A.W., R.W.H., J.H.L., K.J.A., J.H.A.), and Tenax Therapeutics, Morrisville (R.J., D.H.) - both in North Carolina; the Canadian VIGOUR (Virtual Coordinating Centre for Global Collaborative Cardiovascular Research) Centre, University of Alberta, Edmonton (S.D., S.G.G.), Sunnybrook Health Sciences Centre, Toronto (S.F.), the Quebec Heart and Lung Institute, Quebec (D.K.), London Health Sciences Centre, London, ON (D.N.), and the Victoria Heart Institute Foundation, Victoria, BC (J.B.) - all in Canada; Cleveland Clinic Foundation (A.D., E.G.S.) and University Hospitals Cleveland Medical Center (S.P.) - both in Cleveland; Franciscan Health System, Tacoma, WA (J.L.); Columbia University Medical Center, New York (M.A.); Spectrum Health, Grand Rapids, MI (E.M.); the Heart Hospital Baylor Plano, Plano, TX (R.M.); the Medical University of Graz, Graz, Austria (W.T.); the University of Luebeck, Luebeck, Germany (M.H.); and the Department of Medicine, Stanford University, Stanford, CA (R.A.H.)
| | - John Luber
- From the Duke Clinical Research Institute, Duke University School of Medicine, Durham (R.H.M., J.D.L., J.M., A.W., R.W.H., J.H.L., K.J.A., J.H.A.), and Tenax Therapeutics, Morrisville (R.J., D.H.) - both in North Carolina; the Canadian VIGOUR (Virtual Coordinating Centre for Global Collaborative Cardiovascular Research) Centre, University of Alberta, Edmonton (S.D., S.G.G.), Sunnybrook Health Sciences Centre, Toronto (S.F.), the Quebec Heart and Lung Institute, Quebec (D.K.), London Health Sciences Centre, London, ON (D.N.), and the Victoria Heart Institute Foundation, Victoria, BC (J.B.) - all in Canada; Cleveland Clinic Foundation (A.D., E.G.S.) and University Hospitals Cleveland Medical Center (S.P.) - both in Cleveland; Franciscan Health System, Tacoma, WA (J.L.); Columbia University Medical Center, New York (M.A.); Spectrum Health, Grand Rapids, MI (E.M.); the Heart Hospital Baylor Plano, Plano, TX (R.M.); the Medical University of Graz, Graz, Austria (W.T.); the University of Luebeck, Luebeck, Germany (M.H.); and the Department of Medicine, Stanford University, Stanford, CA (R.A.H.)
| | - Soon Park
- From the Duke Clinical Research Institute, Duke University School of Medicine, Durham (R.H.M., J.D.L., J.M., A.W., R.W.H., J.H.L., K.J.A., J.H.A.), and Tenax Therapeutics, Morrisville (R.J., D.H.) - both in North Carolina; the Canadian VIGOUR (Virtual Coordinating Centre for Global Collaborative Cardiovascular Research) Centre, University of Alberta, Edmonton (S.D., S.G.G.), Sunnybrook Health Sciences Centre, Toronto (S.F.), the Quebec Heart and Lung Institute, Quebec (D.K.), London Health Sciences Centre, London, ON (D.N.), and the Victoria Heart Institute Foundation, Victoria, BC (J.B.) - all in Canada; Cleveland Clinic Foundation (A.D., E.G.S.) and University Hospitals Cleveland Medical Center (S.P.) - both in Cleveland; Franciscan Health System, Tacoma, WA (J.L.); Columbia University Medical Center, New York (M.A.); Spectrum Health, Grand Rapids, MI (E.M.); the Heart Hospital Baylor Plano, Plano, TX (R.M.); the Medical University of Graz, Graz, Austria (W.T.); the University of Luebeck, Luebeck, Germany (M.H.); and the Department of Medicine, Stanford University, Stanford, CA (R.A.H.)
| | - Michael Argenziano
- From the Duke Clinical Research Institute, Duke University School of Medicine, Durham (R.H.M., J.D.L., J.M., A.W., R.W.H., J.H.L., K.J.A., J.H.A.), and Tenax Therapeutics, Morrisville (R.J., D.H.) - both in North Carolina; the Canadian VIGOUR (Virtual Coordinating Centre for Global Collaborative Cardiovascular Research) Centre, University of Alberta, Edmonton (S.D., S.G.G.), Sunnybrook Health Sciences Centre, Toronto (S.F.), the Quebec Heart and Lung Institute, Quebec (D.K.), London Health Sciences Centre, London, ON (D.N.), and the Victoria Heart Institute Foundation, Victoria, BC (J.B.) - all in Canada; Cleveland Clinic Foundation (A.D., E.G.S.) and University Hospitals Cleveland Medical Center (S.P.) - both in Cleveland; Franciscan Health System, Tacoma, WA (J.L.); Columbia University Medical Center, New York (M.A.); Spectrum Health, Grand Rapids, MI (E.M.); the Heart Hospital Baylor Plano, Plano, TX (R.M.); the Medical University of Graz, Graz, Austria (W.T.); the University of Luebeck, Luebeck, Germany (M.H.); and the Department of Medicine, Stanford University, Stanford, CA (R.A.H.)
| | - Edward Murphy
- From the Duke Clinical Research Institute, Duke University School of Medicine, Durham (R.H.M., J.D.L., J.M., A.W., R.W.H., J.H.L., K.J.A., J.H.A.), and Tenax Therapeutics, Morrisville (R.J., D.H.) - both in North Carolina; the Canadian VIGOUR (Virtual Coordinating Centre for Global Collaborative Cardiovascular Research) Centre, University of Alberta, Edmonton (S.D., S.G.G.), Sunnybrook Health Sciences Centre, Toronto (S.F.), the Quebec Heart and Lung Institute, Quebec (D.K.), London Health Sciences Centre, London, ON (D.N.), and the Victoria Heart Institute Foundation, Victoria, BC (J.B.) - all in Canada; Cleveland Clinic Foundation (A.D., E.G.S.) and University Hospitals Cleveland Medical Center (S.P.) - both in Cleveland; Franciscan Health System, Tacoma, WA (J.L.); Columbia University Medical Center, New York (M.A.); Spectrum Health, Grand Rapids, MI (E.M.); the Heart Hospital Baylor Plano, Plano, TX (R.M.); the Medical University of Graz, Graz, Austria (W.T.); the University of Luebeck, Luebeck, Germany (M.H.); and the Department of Medicine, Stanford University, Stanford, CA (R.A.H.)
| | - Randy Marcel
- From the Duke Clinical Research Institute, Duke University School of Medicine, Durham (R.H.M., J.D.L., J.M., A.W., R.W.H., J.H.L., K.J.A., J.H.A.), and Tenax Therapeutics, Morrisville (R.J., D.H.) - both in North Carolina; the Canadian VIGOUR (Virtual Coordinating Centre for Global Collaborative Cardiovascular Research) Centre, University of Alberta, Edmonton (S.D., S.G.G.), Sunnybrook Health Sciences Centre, Toronto (S.F.), the Quebec Heart and Lung Institute, Quebec (D.K.), London Health Sciences Centre, London, ON (D.N.), and the Victoria Heart Institute Foundation, Victoria, BC (J.B.) - all in Canada; Cleveland Clinic Foundation (A.D., E.G.S.) and University Hospitals Cleveland Medical Center (S.P.) - both in Cleveland; Franciscan Health System, Tacoma, WA (J.L.); Columbia University Medical Center, New York (M.A.); Spectrum Health, Grand Rapids, MI (E.M.); the Heart Hospital Baylor Plano, Plano, TX (R.M.); the Medical University of Graz, Graz, Austria (W.T.); the University of Luebeck, Luebeck, Germany (M.H.); and the Department of Medicine, Stanford University, Stanford, CA (R.A.H.)
| | - Dimitri Kalavrouziotis
- From the Duke Clinical Research Institute, Duke University School of Medicine, Durham (R.H.M., J.D.L., J.M., A.W., R.W.H., J.H.L., K.J.A., J.H.A.), and Tenax Therapeutics, Morrisville (R.J., D.H.) - both in North Carolina; the Canadian VIGOUR (Virtual Coordinating Centre for Global Collaborative Cardiovascular Research) Centre, University of Alberta, Edmonton (S.D., S.G.G.), Sunnybrook Health Sciences Centre, Toronto (S.F.), the Quebec Heart and Lung Institute, Quebec (D.K.), London Health Sciences Centre, London, ON (D.N.), and the Victoria Heart Institute Foundation, Victoria, BC (J.B.) - all in Canada; Cleveland Clinic Foundation (A.D., E.G.S.) and University Hospitals Cleveland Medical Center (S.P.) - both in Cleveland; Franciscan Health System, Tacoma, WA (J.L.); Columbia University Medical Center, New York (M.A.); Spectrum Health, Grand Rapids, MI (E.M.); the Heart Hospital Baylor Plano, Plano, TX (R.M.); the Medical University of Graz, Graz, Austria (W.T.); the University of Luebeck, Luebeck, Germany (M.H.); and the Department of Medicine, Stanford University, Stanford, CA (R.A.H.)
| | - Dave Nagpal
- From the Duke Clinical Research Institute, Duke University School of Medicine, Durham (R.H.M., J.D.L., J.M., A.W., R.W.H., J.H.L., K.J.A., J.H.A.), and Tenax Therapeutics, Morrisville (R.J., D.H.) - both in North Carolina; the Canadian VIGOUR (Virtual Coordinating Centre for Global Collaborative Cardiovascular Research) Centre, University of Alberta, Edmonton (S.D., S.G.G.), Sunnybrook Health Sciences Centre, Toronto (S.F.), the Quebec Heart and Lung Institute, Quebec (D.K.), London Health Sciences Centre, London, ON (D.N.), and the Victoria Heart Institute Foundation, Victoria, BC (J.B.) - all in Canada; Cleveland Clinic Foundation (A.D., E.G.S.) and University Hospitals Cleveland Medical Center (S.P.) - both in Cleveland; Franciscan Health System, Tacoma, WA (J.L.); Columbia University Medical Center, New York (M.A.); Spectrum Health, Grand Rapids, MI (E.M.); the Heart Hospital Baylor Plano, Plano, TX (R.M.); the Medical University of Graz, Graz, Austria (W.T.); the University of Luebeck, Luebeck, Germany (M.H.); and the Department of Medicine, Stanford University, Stanford, CA (R.A.H.)
| | - John Bozinovski
- From the Duke Clinical Research Institute, Duke University School of Medicine, Durham (R.H.M., J.D.L., J.M., A.W., R.W.H., J.H.L., K.J.A., J.H.A.), and Tenax Therapeutics, Morrisville (R.J., D.H.) - both in North Carolina; the Canadian VIGOUR (Virtual Coordinating Centre for Global Collaborative Cardiovascular Research) Centre, University of Alberta, Edmonton (S.D., S.G.G.), Sunnybrook Health Sciences Centre, Toronto (S.F.), the Quebec Heart and Lung Institute, Quebec (D.K.), London Health Sciences Centre, London, ON (D.N.), and the Victoria Heart Institute Foundation, Victoria, BC (J.B.) - all in Canada; Cleveland Clinic Foundation (A.D., E.G.S.) and University Hospitals Cleveland Medical Center (S.P.) - both in Cleveland; Franciscan Health System, Tacoma, WA (J.L.); Columbia University Medical Center, New York (M.A.); Spectrum Health, Grand Rapids, MI (E.M.); the Heart Hospital Baylor Plano, Plano, TX (R.M.); the Medical University of Graz, Graz, Austria (W.T.); the University of Luebeck, Luebeck, Germany (M.H.); and the Department of Medicine, Stanford University, Stanford, CA (R.A.H.)
| | - Wolfgang Toller
- From the Duke Clinical Research Institute, Duke University School of Medicine, Durham (R.H.M., J.D.L., J.M., A.W., R.W.H., J.H.L., K.J.A., J.H.A.), and Tenax Therapeutics, Morrisville (R.J., D.H.) - both in North Carolina; the Canadian VIGOUR (Virtual Coordinating Centre for Global Collaborative Cardiovascular Research) Centre, University of Alberta, Edmonton (S.D., S.G.G.), Sunnybrook Health Sciences Centre, Toronto (S.F.), the Quebec Heart and Lung Institute, Quebec (D.K.), London Health Sciences Centre, London, ON (D.N.), and the Victoria Heart Institute Foundation, Victoria, BC (J.B.) - all in Canada; Cleveland Clinic Foundation (A.D., E.G.S.) and University Hospitals Cleveland Medical Center (S.P.) - both in Cleveland; Franciscan Health System, Tacoma, WA (J.L.); Columbia University Medical Center, New York (M.A.); Spectrum Health, Grand Rapids, MI (E.M.); the Heart Hospital Baylor Plano, Plano, TX (R.M.); the Medical University of Graz, Graz, Austria (W.T.); the University of Luebeck, Luebeck, Germany (M.H.); and the Department of Medicine, Stanford University, Stanford, CA (R.A.H.)
| | - Matthias Heringlake
- From the Duke Clinical Research Institute, Duke University School of Medicine, Durham (R.H.M., J.D.L., J.M., A.W., R.W.H., J.H.L., K.J.A., J.H.A.), and Tenax Therapeutics, Morrisville (R.J., D.H.) - both in North Carolina; the Canadian VIGOUR (Virtual Coordinating Centre for Global Collaborative Cardiovascular Research) Centre, University of Alberta, Edmonton (S.D., S.G.G.), Sunnybrook Health Sciences Centre, Toronto (S.F.), the Quebec Heart and Lung Institute, Quebec (D.K.), London Health Sciences Centre, London, ON (D.N.), and the Victoria Heart Institute Foundation, Victoria, BC (J.B.) - all in Canada; Cleveland Clinic Foundation (A.D., E.G.S.) and University Hospitals Cleveland Medical Center (S.P.) - both in Cleveland; Franciscan Health System, Tacoma, WA (J.L.); Columbia University Medical Center, New York (M.A.); Spectrum Health, Grand Rapids, MI (E.M.); the Heart Hospital Baylor Plano, Plano, TX (R.M.); the Medical University of Graz, Graz, Austria (W.T.); the University of Luebeck, Luebeck, Germany (M.H.); and the Department of Medicine, Stanford University, Stanford, CA (R.A.H.)
| | - Shaun G Goodman
- From the Duke Clinical Research Institute, Duke University School of Medicine, Durham (R.H.M., J.D.L., J.M., A.W., R.W.H., J.H.L., K.J.A., J.H.A.), and Tenax Therapeutics, Morrisville (R.J., D.H.) - both in North Carolina; the Canadian VIGOUR (Virtual Coordinating Centre for Global Collaborative Cardiovascular Research) Centre, University of Alberta, Edmonton (S.D., S.G.G.), Sunnybrook Health Sciences Centre, Toronto (S.F.), the Quebec Heart and Lung Institute, Quebec (D.K.), London Health Sciences Centre, London, ON (D.N.), and the Victoria Heart Institute Foundation, Victoria, BC (J.B.) - all in Canada; Cleveland Clinic Foundation (A.D., E.G.S.) and University Hospitals Cleveland Medical Center (S.P.) - both in Cleveland; Franciscan Health System, Tacoma, WA (J.L.); Columbia University Medical Center, New York (M.A.); Spectrum Health, Grand Rapids, MI (E.M.); the Heart Hospital Baylor Plano, Plano, TX (R.M.); the Medical University of Graz, Graz, Austria (W.T.); the University of Luebeck, Luebeck, Germany (M.H.); and the Department of Medicine, Stanford University, Stanford, CA (R.A.H.)
| | - Jerrold H Levy
- From the Duke Clinical Research Institute, Duke University School of Medicine, Durham (R.H.M., J.D.L., J.M., A.W., R.W.H., J.H.L., K.J.A., J.H.A.), and Tenax Therapeutics, Morrisville (R.J., D.H.) - both in North Carolina; the Canadian VIGOUR (Virtual Coordinating Centre for Global Collaborative Cardiovascular Research) Centre, University of Alberta, Edmonton (S.D., S.G.G.), Sunnybrook Health Sciences Centre, Toronto (S.F.), the Quebec Heart and Lung Institute, Quebec (D.K.), London Health Sciences Centre, London, ON (D.N.), and the Victoria Heart Institute Foundation, Victoria, BC (J.B.) - all in Canada; Cleveland Clinic Foundation (A.D., E.G.S.) and University Hospitals Cleveland Medical Center (S.P.) - both in Cleveland; Franciscan Health System, Tacoma, WA (J.L.); Columbia University Medical Center, New York (M.A.); Spectrum Health, Grand Rapids, MI (E.M.); the Heart Hospital Baylor Plano, Plano, TX (R.M.); the Medical University of Graz, Graz, Austria (W.T.); the University of Luebeck, Luebeck, Germany (M.H.); and the Department of Medicine, Stanford University, Stanford, CA (R.A.H.)
| | - Robert A Harrington
- From the Duke Clinical Research Institute, Duke University School of Medicine, Durham (R.H.M., J.D.L., J.M., A.W., R.W.H., J.H.L., K.J.A., J.H.A.), and Tenax Therapeutics, Morrisville (R.J., D.H.) - both in North Carolina; the Canadian VIGOUR (Virtual Coordinating Centre for Global Collaborative Cardiovascular Research) Centre, University of Alberta, Edmonton (S.D., S.G.G.), Sunnybrook Health Sciences Centre, Toronto (S.F.), the Quebec Heart and Lung Institute, Quebec (D.K.), London Health Sciences Centre, London, ON (D.N.), and the Victoria Heart Institute Foundation, Victoria, BC (J.B.) - all in Canada; Cleveland Clinic Foundation (A.D., E.G.S.) and University Hospitals Cleveland Medical Center (S.P.) - both in Cleveland; Franciscan Health System, Tacoma, WA (J.L.); Columbia University Medical Center, New York (M.A.); Spectrum Health, Grand Rapids, MI (E.M.); the Heart Hospital Baylor Plano, Plano, TX (R.M.); the Medical University of Graz, Graz, Austria (W.T.); the University of Luebeck, Luebeck, Germany (M.H.); and the Department of Medicine, Stanford University, Stanford, CA (R.A.H.)
| | - Kevin J Anstrom
- From the Duke Clinical Research Institute, Duke University School of Medicine, Durham (R.H.M., J.D.L., J.M., A.W., R.W.H., J.H.L., K.J.A., J.H.A.), and Tenax Therapeutics, Morrisville (R.J., D.H.) - both in North Carolina; the Canadian VIGOUR (Virtual Coordinating Centre for Global Collaborative Cardiovascular Research) Centre, University of Alberta, Edmonton (S.D., S.G.G.), Sunnybrook Health Sciences Centre, Toronto (S.F.), the Quebec Heart and Lung Institute, Quebec (D.K.), London Health Sciences Centre, London, ON (D.N.), and the Victoria Heart Institute Foundation, Victoria, BC (J.B.) - all in Canada; Cleveland Clinic Foundation (A.D., E.G.S.) and University Hospitals Cleveland Medical Center (S.P.) - both in Cleveland; Franciscan Health System, Tacoma, WA (J.L.); Columbia University Medical Center, New York (M.A.); Spectrum Health, Grand Rapids, MI (E.M.); the Heart Hospital Baylor Plano, Plano, TX (R.M.); the Medical University of Graz, Graz, Austria (W.T.); the University of Luebeck, Luebeck, Germany (M.H.); and the Department of Medicine, Stanford University, Stanford, CA (R.A.H.)
| | - John H Alexander
- From the Duke Clinical Research Institute, Duke University School of Medicine, Durham (R.H.M., J.D.L., J.M., A.W., R.W.H., J.H.L., K.J.A., J.H.A.), and Tenax Therapeutics, Morrisville (R.J., D.H.) - both in North Carolina; the Canadian VIGOUR (Virtual Coordinating Centre for Global Collaborative Cardiovascular Research) Centre, University of Alberta, Edmonton (S.D., S.G.G.), Sunnybrook Health Sciences Centre, Toronto (S.F.), the Quebec Heart and Lung Institute, Quebec (D.K.), London Health Sciences Centre, London, ON (D.N.), and the Victoria Heart Institute Foundation, Victoria, BC (J.B.) - all in Canada; Cleveland Clinic Foundation (A.D., E.G.S.) and University Hospitals Cleveland Medical Center (S.P.) - both in Cleveland; Franciscan Health System, Tacoma, WA (J.L.); Columbia University Medical Center, New York (M.A.); Spectrum Health, Grand Rapids, MI (E.M.); the Heart Hospital Baylor Plano, Plano, TX (R.M.); the Medical University of Graz, Graz, Austria (W.T.); the University of Luebeck, Luebeck, Germany (M.H.); and the Department of Medicine, Stanford University, Stanford, CA (R.A.H.)
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Welk B, Winick-Ng J, McClure A, Dubois L, Nagpal D. Cardiac Surgeons after Vacation: Refreshed or Rusty? Thorac Cardiovasc Surg 2017; 65:524-527. [PMID: 28511247 DOI: 10.1055/s-0037-1603203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Introduction Many surgeons describe feeling a bit out of practice when they return
from a vacation. There have been no studies assessing the impact of surgeon vacation
on patient outcomes. Methods We used administrative data from the province of Ontario to identify
patients who underwent a coronary artery bypass grafting. Using a propensity score,
we matched patients who underwent their procedure immediately after their surgeon
returned from vacation of at least 7 days (n = 1,161) to patients who were not
operated immediately before or after a vacation period (n = 2,138). Results There was no significant difference in patient mortality (odds ratio: 1.23,
p = 0.52), length of operation (relative risk [RR]: 1.00 p = 0.58), or intensive care unit/
hospital stay (RR: 0.97 p = 0.66/RR: 0.98 p = 0.54, respectively). Conclusion There was not a significant change in risk of death, operative length, or
hospital stay after a surgeon vacation.
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Affiliation(s)
- Blayne Welk
- Department of Surgery, Western University, London, Ontario, Canada
| | | | - Andrew McClure
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Luc Dubois
- Department of Surgery, Western University, London, Ontario, Canada
| | - Dave Nagpal
- Department of Surgery, Western University, London, Ontario, Canada
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Sack D, Nagpal D, Birara M, Bell J, Rominski S. Family planning messaging sources at primary health centers in Addis
Ababa, Ethiopia. Ann Glob Health 2016. [DOI: 10.1016/j.aogh.2016.04.420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Rahman A, Agarwala R, Martin C, Nagpal D, Teitelbaum M, Heyland DK. Nutrition Therapy in Critically Ill Patients Following Cardiac Surgery: Defining and Improving Practice. JPEN J Parenter Enteral Nutr 2016; 41:1188-1194. [DOI: 10.1177/0148607116661839] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Adam Rahman
- Department of Medicine, University of Western Ontario, London, Ontario, Canada
- Gastroenterology, St Joseph’s Healthcare Centre/London Health Sciences Centre, London, Ontario, Canada
| | - Ravi Agarwala
- Critical Care Medicine, Department of Anesthesia, Wake Forest University Medical Center, Winston-Salem, North Carolina, USA
| | - Claudio Martin
- Department of Medicine, University of Western Ontario, London, Ontario, Canada
- Critical Care/Trauma Centre, London Health Sciences Centre, Victoria Campus, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
| | - Dave Nagpal
- Department of Medicine, University of Western Ontario, London, Ontario, Canada
| | - Michael Teitelbaum
- Department of Medicine, University of Western Ontario, London, Ontario, Canada
| | - Daren K. Heyland
- Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, Ontario, Canada
- Department of Community Health and Epidemiology, Queen’s University, Kingston, Ontario, Canada
- Department of Medicine, Queen’s University, Kingston, Ontario, Canada
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Shetty N, Nagpal D, Koivu S, Mrkobrada M. Surgical and Medical Management of Isolated Tricuspid Valve Infective Endocarditis in Intravenous Drug Users. J Card Surg 2015; 31:83-8. [DOI: 10.1111/jocs.12682] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Nabha Shetty
- Department of Medicine; Dalhousie University; Halifax Nova Scotia
| | - Dave Nagpal
- Division of Cardiac Surgery and Intensive Care; Western University; London Ontario
| | - Sharon Koivu
- Division of Palliative Care; Western University; London Ontario
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Lee S, Halkar M, Nagpal D, Bennett M, Zein N, Moazami N, Starling R. Biopsy Proven Liver Fibrosis and Outcomes in Patients Supported with a Continuous-Flow Left Ventricular Assist Device. J Heart Lung Transplant 2013. [DOI: 10.1016/j.healun.2013.01.753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Kalavrouziotis D, Tong M, Nagpal D, Lee S, Soltesz E, Moazami N. Does Acuity of Presentation Impact the Incidence of Right Ventricular Failure Following Left Ventricular Assist Device Implantation? J Heart Lung Transplant 2013. [DOI: 10.1016/j.healun.2013.01.585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Chamogeorgakis T, Lima B, Shafii AE, Nagpal D, Pokersnik JA, Navia JL, Mason D, Gonzalez-Stawinski GV. Outcomes of axillary artery side graft cannulation for extracorporeal membrane oxygenation. J Thorac Cardiovasc Surg 2013; 145:1088-1092. [DOI: 10.1016/j.jtcvs.2012.08.070] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Revised: 08/17/2012] [Accepted: 08/24/2012] [Indexed: 11/25/2022]
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Nenshi R, Kennedy E, Baxter NN, Saskin R, Sutradhar R, Urbach DR, Sroka G, Feldman LS, Vassiliou MC, Kaneva PA, Fayez R, Fried GM, Krajewski SA, Brown CJ, Hur C, McCrea PH, Mitchell A, Porter G, Grushka J, Razek T, Khwaja K, Fata P, Martel G, Moloo H, Picciano G, Boushey RP, Poulin EC, Mamazza J, Haas B, Xiong W, Brennan-Barnes M, Gomez D, Nathens AB, Yang I, Forbes SS, Stephen WJ, Loeb M, Smith R, Christoffersen EP, McLean RF, Westerholm J, Garcia-Osogobio S, Farrokhyar F, Cadeddu M, Anvari M, Ponton-Carss A, Hutchison C, Violato C, Segedi M, Mittleman M, Fisman D, Kinlin L, Rousseau M, Saleh W, Ferri LE, Feldman LS, Stanbridge DD, Mayrand S, Fried GM, Pandya A, Gagliardi A, Nathens A, Ahmed N, Tran T, Demyttenaere SV, Polyhronopoulos G, Seguin C, Artho GP, Kaneva P, Fried GM, Feldman LS, Demyttenaere SV, Bergman S, Anderson J, Mikami DJ, Melvin WS, Racz JM, Dubois L, Katchky A, Wall WJ, Faryniuk A, Hochman D, Clarkson CA, Rubiano AM, Clarkson CA, Boone D, Ball CG, Dixon E, Kirkpatrick AW, Sutherland FR, Feliciano DV, Wyrzykowski AD, Nicholas JM, Dente CJ, Ball CG, Feliciano DV, Ullah SM, McAlister VC, Malik S, Ramsey D, Pooler S, Teague B, Misra M, Cadeddu M, Anvari M, Kaminsky M, Vergis A, Gillman LM, Gillman LM, Vergis A, Altaf A, Ellsmere J, Bonjer HJ, Klassen D, Orzech N, Palter V, Aggarwal R, Okrainec A, Grantcharov TP, Ghaderi I, Feldman LS, Sroka G, Kaneva PA, Fried GM, Shlomovitz E, Reznick RK, Kucharczyk W, Lee L, Iqbal S, Barayan H, Lu Y, Fata P, Razek T, Khwaja K, Boora PS, White JS, Vogt KN, Charyk-Stewart T, Minuk L, Eckert K, Chin-Yee I, Gray D, Parry N, Humphrey RJ, Bütter A, Schmidt J, Grieci T, Gagnon R, Han V, Duhaime S, Pitt DF, Palter V, Orzech N, Aggarwal R, Okrainec A, Grantcharov TP, Dubois L, Vogt KN, Davies W, Schlachta CM, Shi X, Birch DW, Gu Y, Moser MA, Swanson TW, Schaeffer DF, Tang BQ, Rusnak CH, Amson BJ, Vogt KN, Dubois L, Hobbs A, Etemad-Rezai R, Schlachta CM, Claydon E, McAlister V, Grushka J, Sur W, Laberge JM, Tchervenkov J, Bell L, Flageole H, Labidi S, Gagné JP, Gowing R, Kahnamoui K, McAlister CC, Marble A, Coughlin S, Karanicolas P, Emmerton-Coughlin H, Kanbur B, Kanbur S, Colquhoun P, Trottier DC, Doucette S, Huynh H, Soto CM, Poulin EC, Mamazza J, Boushey RP, Jamal MH, Rousseau M, Meterissian S, Snell L, Racz JM, Davies E, Aminazadeh N, Farrokhyar F, Reid S, Naeeni A, Naeeni M, Kashfi A, Kahnamoui K, Martin K, Weir M, Taylor B, Martin KM, Girotti MJ, Parry NG, Hanna WC, Fraser S, Weissglas I, Ghitulescu G, Bilek A, Marek J, Galatas C, Bergman S, Chiu CG, Nguyen NH, Bloom SW, Wiebe S, Klassen D, Bonjer J, Lawlor D, Plowman J, Ransom T, Vallis M, Ellsmere J, Menezes AC, Karmali S, Birch DW, Forbes SS, Eskicioglu C, Brenneman FD, McLeod RS, Fraser SA, Bergman S, Garzon J, Gomez D, Lawless B, Haas B, Nathens AB, Lumb KJ, Harkness L, Williamson J, Charyk-Stewart T, Gray D, Malthaner RA, Van Koughnett JA, Vogt KN, Gray DK, Parry NG, Teague B, Cadeddu M, Anvari M, Misra M, Pooler S, Malik S, Swain P, Chackungal S, Vogt KN, Yoshy C, Etemad-Rezai R, Cunningham I, Dubois L, Schlachta CM, Scott L, Vinden C, Okrainec A, Henao O, Azzie G, Deen S, Hameed M, Ramirez V, Veillette C, Bray P, Jewett M, Okrainec A, Pagliarello G, Brenneman F, Buczkowski A, Nathens A, Razek T, Widder S, Anderson I, Klassen D, Saadia R, Johner A, Hameed SM, Qureshi AP, Vergis A, Jimenez CM, Green J, Pryor AD, Schlachta CM, Okrainec A, Perri MT, Trejos AL, Naish MD, Patel RV, Malthaner RA, Stanger J, Stewart K, Yasui Y, Cass C, Damaraju S, Graham K, Bharadwaj S, Srinathan S, Tan L, Unruh H, Finley C, Miller L, Ferri LE, Urbach DR, Darling G, Spicer J, Ergun S, McDonald B, Rousseau M, Kaneva P, Ferri LE, Spicer J, Andalib A, Benay C, Rousseau M, Kushner Y, Marcus V, Ferri LE, Hunt I, Gazala S, Razzak R, Chuck A, Valji A, Stewart K, Tsuyuki R, Bédard ELR, Bottoni DA, Campbell G, Malthaner RA, Rousseau M, Guevremont P, Chasen M, Spicer J, Eckert E, Alcindor T, Ades S, Ferri LE, McGory R, Nagpal D, Fortin D, Inculet RI, Malthaner RA, Ko M, Shargall Y, Compeau C, Razzak R, Gazala S, Hunt I, Veenstra J, Valji A, Stewart K, Bédard ELR, Davis PJ, Mancuso M, Mujoomdar AA, Gazala S, Bédard ELR, Lee L, Spicer J, Robineau C, Sirois C, Mulder D, Ferri LE, Cools-Lartigue J, Chang SY, Mayrand S, Marcus V, Fried GM, Ferri LE, Perry T, Hunt I, Allegretto M, Maguire C, Abele J, Williams D, Stewart K, Bédard ELR, Grover HS, Basi S, Chiasson P, Basi S, Gregory W, Irshad K, Schieman C, MacGregor JH, Kelly E, Gelfand G, Graham AJ, McFadden SP, Grondin SC, Croome KP, Chudzinski R, Hanto DW, Jamal MH, Doi SA, Barkun JS, Wong SL, Kwan AHL, Yang S, Law C, Luo Y, Spiers J, Forse A, Taylor W, Apriasz I, Mysliwiec B, Sarin N, Gregor J, Moulton CE, McLeod RS, Barnett H, Nhan C, Gallinger S, Demyttenaere SV, Nau P, Muscarella P, Melvin WS, Ellison EC, Wiseman SM, Melck AL, Davidge KM, Eskicioglu C, Lipa J, Ferguson P, Swallow CJ, Wright FC, Edwards JP, Kelly EJ, Lin Y, Lenders T, Ghali WA, Graham A, Francescutti V, Farrokhyar F, Tozer R, Heller B, Lovrics P, Jansz G, Kahnamoui K, Spiegle G, Schmocker S, Huang H, Victor C, Law C, Kennedy ED, McCart JA, Aslani N, Swanson T, Kennecke H, Woods R, Davis N, Klevan AE, Ramsay JA, Stephen WJ, Smith M, Plourde M, Johnson PM, Yaffe P, Walsh M, Hoskin D, Huynh HP, Trottier DC, Soto C, Auer R, Poulin EC, Mamazza J, Boushey RP, Moloo H, Huynh HP, Trottier DC, Soto C, Moloo H, Poulin EC, Mamazza J, Boushey RP, Nhan C, Driman DK, Smith AJ, Hunter A, McLeod RS, Eskicioglu C, Fenech DS, Victor C, McLeod RS, Trottier DC, Huynh H, Sabri E, Soto C, Scheer A, Zolfaghari S, Moloo H, Mamazza J, Poulin EC, Boushey RP, Hallet J, Guénette-Lemieux M, Bouchard A, Grégoire RC, Thibault C, Dionne G, Côté F, Langis P, Gagné JP, Raval MJ, Phang PT, Brown CJ, Kuzmanovic A, Planting A, Raval MJ, Phang PT, Brown CJ, Huynh HP, Trottier DC, Moloo H, Poulin EC, Mamazza J, Friedlich M, Stern HS, Boushey RP, Tang BQ, Moloo H, Bleier J, Goldberg SM, Alsharif J, Martel G, Bouchard A, Sabri E, Ramsay CR, Mamazza J, Poulin EC, Boushey RP, Richardson D, Porter G, Johnson P, Al-Sukhni E, Ridgway PF, O'Connor B, McLeod RS, Swallow CJ, Forbes SS, Urbach DR, Sutradhar R, Paszat L, Rabeneck L, Baxter NN, Chung W, Ko D, Sun C, Brown CJ, Raval M, Phang PT, Pao JS, Woods R, Raval MJ, Phang PT, Brown CJ, Power A, Francescutti V, Ramsey D, Kelly S, Stephen W, Simunovic M, Coates A, Goldsmith CH, Thabane L, Reeson D, Smith AJ, McLeod RS, DeNardi F, Whelan TJ, Levine MN, Al-Khayal KA, Buie WD, Wallace L, Sigalet D, Eskicioglu C, Gagliardi A, Fenech DS, Victor C, McLeod RS. Abstracts of presentations to the Annual Meetings of the Canadian Association of General Surgeons Canadian Association of Thoracic Surgeons Canadian Hepato-Pancreato-Biliary Society Canadian Society of Surgical Oncology Canadian Society of Colon and Rectal Surgeons: Victoria, BC Sept. 10-13, 2009. Can J Surg 2009; 52:S1-S48. [PMID: 35488397 PMCID: PMC2726442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023] Open
Affiliation(s)
- R Nenshi
- From the Institute for Clinical and Evaluative Sciences, Toronto, Ont
| | - E Kennedy
- From the Institute for Clinical and Evaluative Sciences, Toronto, Ont
| | - N N Baxter
- From the Institute for Clinical and Evaluative Sciences, Toronto, Ont
| | - R Saskin
- From the Institute for Clinical and Evaluative Sciences, Toronto, Ont
| | - R Sutradhar
- From the Institute for Clinical and Evaluative Sciences, Toronto, Ont
| | - D R Urbach
- From the Institute for Clinical and Evaluative Sciences, Toronto, Ont
| | - G Sroka
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montréal, Que
| | - L S Feldman
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montréal, Que
| | - M C Vassiliou
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montréal, Que
| | - P A Kaneva
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montréal, Que
| | - R Fayez
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montréal, Que
| | - G M Fried
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montréal, Que
| | - S A Krajewski
- From the Department of Surgery, University of British Columbia, Vancouver, BC, and the Institute for Technology Assessment, Massachusetts General Hospital, Boston, Mass
| | - C J Brown
- From the Department of Surgery, University of British Columbia, Vancouver, BC, and the Institute for Technology Assessment, Massachusetts General Hospital, Boston, Mass
| | - C Hur
- From the Department of Surgery, University of British Columbia, Vancouver, BC, and the Institute for Technology Assessment, Massachusetts General Hospital, Boston, Mass
| | - P H McCrea
- From the Department of Surgery, Dalhousie University, Queen Elizabeth II Health Sciences Centre, Halifax, NS
| | - A Mitchell
- From the Department of Surgery, Dalhousie University, Queen Elizabeth II Health Sciences Centre, Halifax, NS
| | - G Porter
- From the Department of Surgery, Dalhousie University, Queen Elizabeth II Health Sciences Centre, Halifax, NS
| | - J Grushka
- From the Division of General Surgery, Montréal General Hospital, McGill University, Montréal, Que
| | - T Razek
- From the Division of General Surgery, Montréal General Hospital, McGill University, Montréal, Que
| | - K Khwaja
- From the Division of General Surgery, Montréal General Hospital, McGill University, Montréal, Que
| | - P Fata
- From the Division of General Surgery, Montréal General Hospital, McGill University, Montréal, Que
| | - G Martel
- From The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - H Moloo
- From The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - G Picciano
- From The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - R P Boushey
- From The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - E C Poulin
- From The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - J Mamazza
- From The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - B Haas
- From the Division of General Surgery, St. Michael's Hospital, University of Toronto, Toronto, and the Children's Hospital of Eastern Ontario, Ottawa, Ont
| | - W Xiong
- From the Division of General Surgery, St. Michael's Hospital, University of Toronto, Toronto, and the Children's Hospital of Eastern Ontario, Ottawa, Ont
| | - M Brennan-Barnes
- From the Division of General Surgery, St. Michael's Hospital, University of Toronto, Toronto, and the Children's Hospital of Eastern Ontario, Ottawa, Ont
| | - D Gomez
- From the Division of General Surgery, St. Michael's Hospital, University of Toronto, Toronto, and the Children's Hospital of Eastern Ontario, Ottawa, Ont
| | - A B Nathens
- From the Division of General Surgery, St. Michael's Hospital, University of Toronto, Toronto, and the Children's Hospital of Eastern Ontario, Ottawa, Ont
| | - I Yang
- From the Departments of Surgery and Anesthesiology, McMaster University, Hamilton Health Sciences, Hamilton, Ont
| | - S S Forbes
- From the Departments of Surgery and Anesthesiology, McMaster University, Hamilton Health Sciences, Hamilton, Ont
| | - W J Stephen
- From the Departments of Surgery and Anesthesiology, McMaster University, Hamilton Health Sciences, Hamilton, Ont
| | - M Loeb
- From the Departments of Surgery and Anesthesiology, McMaster University, Hamilton Health Sciences, Hamilton, Ont
| | - R Smith
- From the Departments of Surgery and Anesthesiology, McMaster University, Hamilton Health Sciences, Hamilton, Ont
| | - E P Christoffersen
- From the Departments of Surgery and Anesthesiology, McMaster University, Hamilton Health Sciences, Hamilton, Ont
| | - R F McLean
- From the Departments of Surgery and Anesthesiology, McMaster University, Hamilton Health Sciences, Hamilton, Ont
| | - J Westerholm
- From the Centre for Minimal Access Surgery, McMaster University, Hamilton, Ont
| | - S Garcia-Osogobio
- From the Centre for Minimal Access Surgery, McMaster University, Hamilton, Ont
| | - F Farrokhyar
- From the Centre for Minimal Access Surgery, McMaster University, Hamilton, Ont
| | - M Cadeddu
- From the Centre for Minimal Access Surgery, McMaster University, Hamilton, Ont
| | - M Anvari
- From the Centre for Minimal Access Surgery, McMaster University, Hamilton, Ont
| | - A Ponton-Carss
- From the Department of Surgery, University of Calgary, Calgary, Alta
| | - C Hutchison
- From the Department of Surgery, University of Calgary, Calgary, Alta
| | - C Violato
- From the Department of Surgery, University of Calgary, Calgary, Alta
| | - M Segedi
- From the Harvard School of Public Health, Beth Israel Deaconess Medical Center, Boston, Mass., the University of British Columbia, Vancouver, BC, and The Hospital for Sick Children, University of Toronto, Toronto, Ont
| | - M Mittleman
- From the Harvard School of Public Health, Beth Israel Deaconess Medical Center, Boston, Mass., the University of British Columbia, Vancouver, BC, and The Hospital for Sick Children, University of Toronto, Toronto, Ont
| | - D Fisman
- From the Harvard School of Public Health, Beth Israel Deaconess Medical Center, Boston, Mass., the University of British Columbia, Vancouver, BC, and The Hospital for Sick Children, University of Toronto, Toronto, Ont
| | - L Kinlin
- From the Harvard School of Public Health, Beth Israel Deaconess Medical Center, Boston, Mass., the University of British Columbia, Vancouver, BC, and The Hospital for Sick Children, University of Toronto, Toronto, Ont
| | - M Rousseau
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, Montréal, Que
| | - W Saleh
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, Montréal, Que
| | - L E Ferri
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, Montréal, Que
| | - L S Feldman
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, Montréal, Que
| | - D D Stanbridge
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, Montréal, Que
| | - S Mayrand
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, Montréal, Que
| | - G M Fried
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, Montréal, Que
| | - A Pandya
- From the Division of General Surgery, University of Toronto, Toronto, Ont
| | - A Gagliardi
- From the Division of General Surgery, University of Toronto, Toronto, Ont
| | - A Nathens
- From the Division of General Surgery, University of Toronto, Toronto, Ont
| | - N Ahmed
- From the Division of General Surgery, University of Toronto, Toronto, Ont
| | - T Tran
- From the Department of Surgery, McGill University, Montréal, Que
| | - S V Demyttenaere
- From the Department of Surgery, McGill University, Montréal, Que
| | | | - C Seguin
- From the Department of Surgery, McGill University, Montréal, Que
| | - G P Artho
- From the Department of Surgery, McGill University, Montréal, Que
| | - P Kaneva
- From the Department of Surgery, McGill University, Montréal, Que
| | - G M Fried
- From the Department of Surgery, McGill University, Montréal, Que
| | - L S Feldman
- From the Department of Surgery, McGill University, Montréal, Que
| | - S V Demyttenaere
- From the Department of Surgery, Ohio State University, Columbus, Ohio, and the Department of Surgery, Jewish General Hospital, McGill University, Montréal, Que
| | - S Bergman
- From the Department of Surgery, Ohio State University, Columbus, Ohio, and the Department of Surgery, Jewish General Hospital, McGill University, Montréal, Que
| | - J Anderson
- From the Department of Surgery, Ohio State University, Columbus, Ohio, and the Department of Surgery, Jewish General Hospital, McGill University, Montréal, Que
| | - D J Mikami
- From the Department of Surgery, Ohio State University, Columbus, Ohio, and the Department of Surgery, Jewish General Hospital, McGill University, Montréal, Que
| | - W S Melvin
- From the Department of Surgery, Ohio State University, Columbus, Ohio, and the Department of Surgery, Jewish General Hospital, McGill University, Montréal, Que
| | - J M Racz
- From the Department of Surgery, University of Western Ontario, London, Ont
| | - L Dubois
- From the Department of Surgery, University of Western Ontario, London, Ont
| | - A Katchky
- From the Department of Surgery, University of Western Ontario, London, Ont
| | - W J Wall
- From the Department of Surgery, University of Western Ontario, London, Ont
| | - A Faryniuk
- From the Department of Surgery, University of Manitoba, Winnipeg, Man
| | - D Hochman
- From the Department of Surgery, University of Manitoba, Winnipeg, Man
| | - C A Clarkson
- From the Neiva City University Hospital, Neiva, Huila, Colombia
| | - A M Rubiano
- From the Neiva City University Hospital, Neiva, Huila, Colombia
| | - C A Clarkson
- From the Department of Surgery, Memorial University of Newfoundland, St. John's, NL
| | - D Boone
- From the Department of Surgery, Memorial University of Newfoundland, St. John's, NL
| | - C G Ball
- From the Departments of Surgery, Emory University, Atlanta, Ga., and the University of Calgary, Calgary, Alta
| | - E Dixon
- From the Departments of Surgery, Emory University, Atlanta, Ga., and the University of Calgary, Calgary, Alta
| | - A W Kirkpatrick
- From the Departments of Surgery, Emory University, Atlanta, Ga., and the University of Calgary, Calgary, Alta
| | - F R Sutherland
- From the Departments of Surgery, Emory University, Atlanta, Ga., and the University of Calgary, Calgary, Alta
| | - D V Feliciano
- From the Departments of Surgery, Emory University, Atlanta, Ga., and the University of Calgary, Calgary, Alta
| | - A D Wyrzykowski
- From the Department of Surgery, Emory University, Atlanta, Ga
| | - J M Nicholas
- From the Department of Surgery, Emory University, Atlanta, Ga
| | - C J Dente
- From the Department of Surgery, Emory University, Atlanta, Ga
| | - C G Ball
- From the Department of Surgery, Emory University, Atlanta, Ga
| | - D V Feliciano
- From the Department of Surgery, Emory University, Atlanta, Ga
| | - S M Ullah
- From the Division of Clinical Anatomy, Department of Anatomy and Cell Biology, Department of Surgery, University Hospital, University of Western Ontario, London, Ont
| | - V C McAlister
- From the Division of Clinical Anatomy, Department of Anatomy and Cell Biology, Department of Surgery, University Hospital, University of Western Ontario, London, Ont
| | - S Malik
- From the Centre for Minimal Access Surgery, St. Joseph's Hospital, McMaster University, Hamilton, Ont
| | - D Ramsey
- From the Centre for Minimal Access Surgery, St. Joseph's Hospital, McMaster University, Hamilton, Ont
| | - S Pooler
- From the Centre for Minimal Access Surgery, St. Joseph's Hospital, McMaster University, Hamilton, Ont
| | - B Teague
- From the Centre for Minimal Access Surgery, St. Joseph's Hospital, McMaster University, Hamilton, Ont
| | - M Misra
- From the Centre for Minimal Access Surgery, St. Joseph's Hospital, McMaster University, Hamilton, Ont
| | - M Cadeddu
- From the Centre for Minimal Access Surgery, St. Joseph's Hospital, McMaster University, Hamilton, Ont
| | - M Anvari
- From the Centre for Minimal Access Surgery, St. Joseph's Hospital, McMaster University, Hamilton, Ont
| | - M Kaminsky
- From the Department of Surgery, University of Manitoba, Winnipeg, Man., the Department of Critical Care Medicine and Regional Trauma Services, University of Calgary, Calgary, Alta., and the Division of General Surgery, University of Toronto, Toronto, Ont
| | - A Vergis
- From the Department of Surgery, University of Manitoba, Winnipeg, Man., the Department of Critical Care Medicine and Regional Trauma Services, University of Calgary, Calgary, Alta., and the Division of General Surgery, University of Toronto, Toronto, Ont
| | - L M Gillman
- From the Department of Surgery, University of Manitoba, Winnipeg, Man., the Department of Critical Care Medicine and Regional Trauma Services, University of Calgary, Calgary, Alta., and the Division of General Surgery, University of Toronto, Toronto, Ont
| | - L M Gillman
- From the Department of Surgery, University of Manitoba, Winnipeg, Man., the Department of Critical Care Medicine, Regional Trauma Services, University of Calgary, Calgary, Alta., and the Division of General Surgery, University of Toronto, Toronto, Ont
| | - A Vergis
- From the Department of Surgery, University of Manitoba, Winnipeg, Man., the Department of Critical Care Medicine, Regional Trauma Services, University of Calgary, Calgary, Alta., and the Division of General Surgery, University of Toronto, Toronto, Ont
| | - A Altaf
- From the Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS
| | - J Ellsmere
- From the Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS
| | - H J Bonjer
- From the Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS
| | - D Klassen
- From the Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS
| | - N Orzech
- From the Departments of Surgery, St. Michael's Hospital, Toronto Western Hospital, University of Toronto, Toronto, and the Department of Biosurgery and Surgical Technology, Imperial College, London, Ont
| | - V Palter
- From the Departments of Surgery, St. Michael's Hospital, Toronto Western Hospital, University of Toronto, Toronto, and the Department of Biosurgery and Surgical Technology, Imperial College, London, Ont
| | - R Aggarwal
- From the Departments of Surgery, St. Michael's Hospital, Toronto Western Hospital, University of Toronto, Toronto, and the Department of Biosurgery and Surgical Technology, Imperial College, London, Ont
| | - A Okrainec
- From the Departments of Surgery, St. Michael's Hospital, Toronto Western Hospital, University of Toronto, Toronto, and the Department of Biosurgery and Surgical Technology, Imperial College, London, Ont
| | - T P Grantcharov
- From the Departments of Surgery, St. Michael's Hospital, Toronto Western Hospital, University of Toronto, Toronto, and the Department of Biosurgery and Surgical Technology, Imperial College, London, Ont
| | - I Ghaderi
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University, Montréal, Que., and the University of Western Ontario, London, Ont
| | - L S Feldman
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University, Montréal, Que., and the University of Western Ontario, London, Ont
| | - G Sroka
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University, Montréal, Que., and the University of Western Ontario, London, Ont
| | - P A Kaneva
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University, Montréal, Que., and the University of Western Ontario, London, Ont
| | - G M Fried
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University, Montréal, Que., and the University of Western Ontario, London, Ont
| | - E Shlomovitz
- From the Departments of Surgery and Diagnostic Imaging, University Health Network, University of Toronto, Toronto, Ont
| | - R K Reznick
- From the Departments of Surgery and Diagnostic Imaging, University Health Network, University of Toronto, Toronto, Ont
| | - W Kucharczyk
- From the Departments of Surgery and Diagnostic Imaging, University Health Network, University of Toronto, Toronto, Ont
| | - L Lee
- From the Departments of Surgery and Medicine, McGill University Health Centre, Montréal, Que
| | - S Iqbal
- From the Departments of Surgery and Medicine, McGill University Health Centre, Montréal, Que
| | - H Barayan
- From the Departments of Surgery and Medicine, McGill University Health Centre, Montréal, Que
| | - Y Lu
- From the Departments of Surgery and Medicine, McGill University Health Centre, Montréal, Que
| | - P Fata
- From the Departments of Surgery and Medicine, McGill University Health Centre, Montréal, Que
| | - T Razek
- From the Departments of Surgery and Medicine, McGill University Health Centre, Montréal, Que
| | - K Khwaja
- From the Departments of Surgery and Medicine, McGill University Health Centre, Montréal, Que
| | - P S Boora
- From the Department of Surgery, University of Alberta, Edmonton, Alta
| | - J S White
- From the Department of Surgery, University of Alberta, Edmonton, Alta
| | - K N Vogt
- From the Divisions of General Surgery and Hematology, Trauma Program, London Health Sciences Centre, London, Ont
| | - T Charyk-Stewart
- From the Divisions of General Surgery and Hematology, Trauma Program, London Health Sciences Centre, London, Ont
| | - L Minuk
- From the Divisions of General Surgery and Hematology, Trauma Program, London Health Sciences Centre, London, Ont
| | - K Eckert
- From the Divisions of General Surgery and Hematology, Trauma Program, London Health Sciences Centre, London, Ont
| | - I Chin-Yee
- From the Divisions of General Surgery and Hematology, Trauma Program, London Health Sciences Centre, London, Ont
| | - D Gray
- From the Divisions of General Surgery and Hematology, Trauma Program, London Health Sciences Centre, London, Ont
| | - N Parry
- From the Divisions of General Surgery and Hematology, Trauma Program, London Health Sciences Centre, London, Ont
| | - R J Humphrey
- From the Departments of Surgery and Pediatrics, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - A Bütter
- From the Departments of Surgery and Pediatrics, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - J Schmidt
- From the Departments of Surgery and Pediatrics, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - T Grieci
- From the Departments of Surgery and Pediatrics, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - R Gagnon
- From the Departments of Surgery and Pediatrics, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - V Han
- From the Departments of Surgery and Pediatrics, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - S Duhaime
- From the University of Ottawa, Ottawa, Ont
| | - D F Pitt
- From the University of Ottawa, Ottawa, Ont
| | - V Palter
- From the Departments of Surgery, St. Michael's Hospital, Toronto Western Hospital, Toronto, and Imperial College, London, Ont
| | - N Orzech
- From the Departments of Surgery, St. Michael's Hospital, Toronto Western Hospital, Toronto, and Imperial College, London, Ont
| | - R Aggarwal
- From the Departments of Surgery, St. Michael's Hospital, Toronto Western Hospital, Toronto, and Imperial College, London, Ont
| | - A Okrainec
- From the Departments of Surgery, St. Michael's Hospital, Toronto Western Hospital, Toronto, and Imperial College, London, Ont
| | - T P Grantcharov
- From the Departments of Surgery, St. Michael's Hospital, Toronto Western Hospital, Toronto, and Imperial College, London, Ont
| | - L Dubois
- From the Department of Surgery, University of Western Ontario, London, Ont
| | - K N Vogt
- From the Department of Surgery, University of Western Ontario, London, Ont
| | - W Davies
- From the Department of Surgery, University of Western Ontario, London, Ont
| | - C M Schlachta
- From the Department of Surgery, University of Western Ontario, London, Ont
| | - X Shi
- From the Centre for the Advancement of Minimally Invasive Surgery, Edmonton, Alta
| | - D W Birch
- From the Centre for the Advancement of Minimally Invasive Surgery, Edmonton, Alta
| | - Y Gu
- From the Department of Surgery, University of Saskatchewan, Saskatoon, Sask
| | - M A Moser
- From the Department of Surgery, University of Saskatchewan, Saskatoon, Sask
| | - T W Swanson
- From the Department of Surgery, Royal Jubilee Hospital, Victoria, BC, University of British Columbia, Vancouver, BC
| | - D F Schaeffer
- From the Department of Surgery, Royal Jubilee Hospital, Victoria, BC, University of British Columbia, Vancouver, BC
| | - B Q Tang
- From the Department of Surgery, Royal Jubilee Hospital, Victoria, BC, University of British Columbia, Vancouver, BC
| | - C H Rusnak
- From the Department of Surgery, Royal Jubilee Hospital, Victoria, BC, University of British Columbia, Vancouver, BC
| | - B J Amson
- From the Department of Surgery, Royal Jubilee Hospital, Victoria, BC, University of British Columbia, Vancouver, BC
| | - K N Vogt
- From the Divisions of General Surgery and Radiology, London Health Sciences Centre, London, Ont
| | - L Dubois
- From the Divisions of General Surgery and Radiology, London Health Sciences Centre, London, Ont
| | - A Hobbs
- From the Divisions of General Surgery and Radiology, London Health Sciences Centre, London, Ont
| | - R Etemad-Rezai
- From the Divisions of General Surgery and Radiology, London Health Sciences Centre, London, Ont
| | - C M Schlachta
- From the Divisions of General Surgery and Radiology, London Health Sciences Centre, London, Ont
| | - E Claydon
- From the Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ont
| | - V McAlister
- From the Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ont
| | - J Grushka
- From the Divisions of Pediatric Surgery and Nephrology, Department of Pediatrics, Montréal Children's Hospital, and the Department of Surgery, McGill University, Montréal, Que
| | - W Sur
- From the Divisions of Pediatric Surgery and Nephrology, Department of Pediatrics, Montréal Children's Hospital, and the Department of Surgery, McGill University, Montréal, Que
| | - J-M Laberge
- From the Divisions of Pediatric Surgery and Nephrology, Department of Pediatrics, Montréal Children's Hospital, and the Department of Surgery, McGill University, Montréal, Que
| | - J Tchervenkov
- From the Divisions of Pediatric Surgery and Nephrology, Department of Pediatrics, Montréal Children's Hospital, and the Department of Surgery, McGill University, Montréal, Que
| | - L Bell
- From the Divisions of Pediatric Surgery and Nephrology, Department of Pediatrics, Montréal Children's Hospital, and the Department of Surgery, McGill University, Montréal, Que
| | - H Flageole
- From the Divisions of Pediatric Surgery and Nephrology, Department of Pediatrics, Montréal Children's Hospital, and the Department of Surgery, McGill University, Montréal, Que
| | - S Labidi
- From the Québec Centre for Minimally Invasive Surgery, Centre hospitalier universitaire de Québec, Québec, Que
| | - J P Gagné
- From the Québec Centre for Minimally Invasive Surgery, Centre hospitalier universitaire de Québec, Québec, Que
| | - R Gowing
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - K Kahnamoui
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - C C McAlister
- From the University of Toronto, Toronto, Ont., Dalhousie University, Halifax, NS
| | - A Marble
- From the University of Toronto, Toronto, Ont., Dalhousie University, Halifax, NS
| | - S Coughlin
- From the University of Western Ontario, London, Ont
| | | | | | - B Kanbur
- From the University of Western Ontario, London, Ont
| | - S Kanbur
- From the University of Western Ontario, London, Ont
| | - P Colquhoun
- From the University of Western Ontario, London, Ont
| | - D C Trottier
- From the Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - S Doucette
- From the Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - H Huynh
- From the Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - C M Soto
- From the Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - E C Poulin
- From the Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - J Mamazza
- From the Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - R P Boushey
- From the Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - M H Jamal
- From the Centre for Medical Education, Division of General Surgery, McGill University, Montréal, Que
| | - M Rousseau
- From the Centre for Medical Education, Division of General Surgery, McGill University, Montréal, Que
| | - S Meterissian
- From the Centre for Medical Education, Division of General Surgery, McGill University, Montréal, Que
| | - L Snell
- From the Centre for Medical Education, Division of General Surgery, McGill University, Montréal, Que
| | - J M Racz
- From the Department of Surgery, University of Western Ontario, London, Ont
| | - E Davies
- From the Department of Surgery, University of Western Ontario, London, Ont
| | - N Aminazadeh
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - F Farrokhyar
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - S Reid
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - A Naeeni
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - M Naeeni
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - A Kashfi
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - K Kahnamoui
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - K Martin
- From the London Health Sciences Centre, London, Ont
| | - M Weir
- From the London Health Sciences Centre, London, Ont
| | - B Taylor
- From the London Health Sciences Centre, London, Ont
| | - K M Martin
- From the London Health Sciences Centre, Children's Hospital of Western Ontario, London, Ont
| | - M J Girotti
- From the London Health Sciences Centre, Children's Hospital of Western Ontario, London, Ont
| | - N G Parry
- From the London Health Sciences Centre, Children's Hospital of Western Ontario, London, Ont
| | - W C Hanna
- From the Department of Surgery, Jewish General Hospital, McGill University, Montréal, Que
| | - S Fraser
- From the Department of Surgery, Jewish General Hospital, McGill University, Montréal, Que
| | - I Weissglas
- From the Department of Surgery, Jewish General Hospital, McGill University, Montréal, Que
| | - G Ghitulescu
- From the Department of Surgery, Jewish General Hospital, McGill University, Montréal, Que
| | - A Bilek
- From the Department of Surgery, Jewish General Hospital, McGill University, Montréal, Que
| | - J Marek
- From the Department of Surgery, Jewish General Hospital, McGill University, Montréal, Que
| | - C Galatas
- From the Department of Surgery, Jewish General Hospital, McGill University, Montréal, Que
| | - S Bergman
- From the Department of Surgery, Jewish General Hospital, McGill University, Montréal, Que
| | - C G Chiu
- From the Richmond Hospital, Richmond, BC
| | - N H Nguyen
- From the Richmond Hospital, Richmond, BC
| | - S W Bloom
- From the Richmond Hospital, Richmond, BC
| | - S Wiebe
- From the Queen Elizabeth II Health Sciences Centre (QEIIHSC), Halifax, NS
| | - D Klassen
- From the Queen Elizabeth II Health Sciences Centre (QEIIHSC), Halifax, NS
| | - J Bonjer
- From the Queen Elizabeth II Health Sciences Centre (QEIIHSC), Halifax, NS
| | - D Lawlor
- From the Queen Elizabeth II Health Sciences Centre (QEIIHSC), Halifax, NS
| | - J Plowman
- From the Queen Elizabeth II Health Sciences Centre (QEIIHSC), Halifax, NS
| | - T Ransom
- From the Queen Elizabeth II Health Sciences Centre (QEIIHSC), Halifax, NS
| | - M Vallis
- From the Queen Elizabeth II Health Sciences Centre (QEIIHSC), Halifax, NS
| | - J Ellsmere
- From the Queen Elizabeth II Health Sciences Centre (QEIIHSC), Halifax, NS
| | - A C Menezes
- From the Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Alberta Health Services, Department of Surgery, University of Alberta, Edmonton, Alta
| | - S Karmali
- From the Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Alberta Health Services, Department of Surgery, University of Alberta, Edmonton, Alta
| | - D W Birch
- From the Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Alberta Health Services, Department of Surgery, University of Alberta, Edmonton, Alta
| | - S S Forbes
- From the Department of Surgery, University of Toronto, Toronto, Ont
| | - C Eskicioglu
- From the Department of Surgery, University of Toronto, Toronto, Ont
| | - F D Brenneman
- From the Department of Surgery, University of Toronto, Toronto, Ont
| | - R S McLeod
- From the Department of Surgery, University of Toronto, Toronto, Ont
| | - S A Fraser
- From the Department of General Surgery, Sir Mortimer B. Davis Jewish General Hospital, McGill University, Montréal, Que
| | - S Bergman
- From the Department of General Surgery, Sir Mortimer B. Davis Jewish General Hospital, McGill University, Montréal, Que
| | - J Garzon
- From the Department of General Surgery, Sir Mortimer B. Davis Jewish General Hospital, McGill University, Montréal, Que
| | - D Gomez
- From the Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ont
| | - B Lawless
- From the Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ont
| | - B Haas
- From the Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ont
| | - A B Nathens
- From the Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ont
| | - K J Lumb
- From the Department of Surgery, Trauma Program, London Health Sciences Centre, London, Ont
| | - L Harkness
- From the Department of Surgery, Trauma Program, London Health Sciences Centre, London, Ont
| | - J Williamson
- From the Department of Surgery, Trauma Program, London Health Sciences Centre, London, Ont
| | - T Charyk-Stewart
- From the Department of Surgery, Trauma Program, London Health Sciences Centre, London, Ont
| | - D Gray
- From the Department of Surgery, Trauma Program, London Health Sciences Centre, London, Ont
| | - R A Malthaner
- From the Department of Surgery, Trauma Program, London Health Sciences Centre, London, Ont
| | - J A Van Koughnett
- From the Division of General Surgery, University of Western Ontario, London, Ont
| | - K N Vogt
- From the Division of General Surgery, University of Western Ontario, London, Ont
| | - D K Gray
- From the Division of General Surgery, University of Western Ontario, London, Ont
| | - N G Parry
- From the Division of General Surgery, University of Western Ontario, London, Ont
| | - B Teague
- From the Centre for Minimal Access Surgery, St. Joseph's Healthcare, McMaster University, Hamilton, Ont
| | - M Cadeddu
- From the Centre for Minimal Access Surgery, St. Joseph's Healthcare, McMaster University, Hamilton, Ont
| | - M Anvari
- From the Centre for Minimal Access Surgery, St. Joseph's Healthcare, McMaster University, Hamilton, Ont
| | - M Misra
- From the Centre for Minimal Access Surgery, St. Joseph's Healthcare, McMaster University, Hamilton, Ont
| | - S Pooler
- From the Centre for Minimal Access Surgery, St. Joseph's Healthcare, McMaster University, Hamilton, Ont
| | - S Malik
- From the Centre for Minimal Access Surgery, St. Joseph's Healthcare, McMaster University, Hamilton, Ont
| | - P Swain
- From the Centre for Minimal Access Surgery, St. Joseph's Healthcare, McMaster University, Hamilton, Ont
| | - S Chackungal
- From the Division of General Surgery, Department of Radiology, Lawson Health Research Institute, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - K N Vogt
- From the Division of General Surgery, Department of Radiology, Lawson Health Research Institute, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - C Yoshy
- From the Division of General Surgery, Department of Radiology, Lawson Health Research Institute, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - R Etemad-Rezai
- From the Division of General Surgery, Department of Radiology, Lawson Health Research Institute, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - I Cunningham
- From the Division of General Surgery, Department of Radiology, Lawson Health Research Institute, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - L Dubois
- From the Division of General Surgery, Department of Radiology, Lawson Health Research Institute, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - C M Schlachta
- From the Division of General Surgery, Department of Radiology, Lawson Health Research Institute, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - L Scott
- From the Division of General Surgery, Department of Radiology, Lawson Health Research Institute, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - C Vinden
- From the Division of General Surgery, Department of Radiology, Lawson Health Research Institute, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - A Okrainec
- From the Toronto Western Hospital, University Health Network, Hospital for Sick Children, University of Toronto, Toronto, Ont
| | - O Henao
- From the Toronto Western Hospital, University Health Network, Hospital for Sick Children, University of Toronto, Toronto, Ont
| | - G Azzie
- From the Toronto Western Hospital, University Health Network, Hospital for Sick Children, University of Toronto, Toronto, Ont
| | - S Deen
- From the Department of Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, BC
| | - M Hameed
- From the Department of Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, BC
| | - V Ramirez
- From the University Health Network, University of Toronto, Toronto, Ont
| | - C Veillette
- From the University Health Network, University of Toronto, Toronto, Ont
| | - P Bray
- From the University Health Network, University of Toronto, Toronto, Ont
| | - M Jewett
- From the University Health Network, University of Toronto, Toronto, Ont
| | - A Okrainec
- From the University Health Network, University of Toronto, Toronto, Ont
| | - G Pagliarello
- From the Departments of Surgery, University of British Columbia, Vancouver, BC, University of Alberta, Edmonton, University of Calgary, Calgary, Alta, University of Toronto, Toronto, Ont., McGill University, Montréal, Que, Dalhousie University, CAGS Committee on Acute Surgery and Critical Care, Halifax, NS
| | - F Brenneman
- From the Departments of Surgery, University of British Columbia, Vancouver, BC, University of Alberta, Edmonton, University of Calgary, Calgary, Alta, University of Toronto, Toronto, Ont., McGill University, Montréal, Que, Dalhousie University, CAGS Committee on Acute Surgery and Critical Care, Halifax, NS
| | - A Buczkowski
- From the Departments of Surgery, University of British Columbia, Vancouver, BC, University of Alberta, Edmonton, University of Calgary, Calgary, Alta, University of Toronto, Toronto, Ont., McGill University, Montréal, Que, Dalhousie University, CAGS Committee on Acute Surgery and Critical Care, Halifax, NS
| | - A Nathens
- From the Departments of Surgery, University of British Columbia, Vancouver, BC, University of Alberta, Edmonton, University of Calgary, Calgary, Alta, University of Toronto, Toronto, Ont., McGill University, Montréal, Que, Dalhousie University, CAGS Committee on Acute Surgery and Critical Care, Halifax, NS
| | - T Razek
- From the Departments of Surgery, University of British Columbia, Vancouver, BC, University of Alberta, Edmonton, University of Calgary, Calgary, Alta, University of Toronto, Toronto, Ont., McGill University, Montréal, Que, Dalhousie University, CAGS Committee on Acute Surgery and Critical Care, Halifax, NS
| | - S Widder
- From the Departments of Surgery, University of British Columbia, Vancouver, BC, University of Alberta, Edmonton, University of Calgary, Calgary, Alta, University of Toronto, Toronto, Ont., McGill University, Montréal, Que, Dalhousie University, CAGS Committee on Acute Surgery and Critical Care, Halifax, NS
| | - I Anderson
- From the Departments of Surgery, University of British Columbia, Vancouver, BC, University of Alberta, Edmonton, University of Calgary, Calgary, Alta, University of Toronto, Toronto, Ont., McGill University, Montréal, Que, Dalhousie University, CAGS Committee on Acute Surgery and Critical Care, Halifax, NS
| | - D Klassen
- From the Departments of Surgery, University of British Columbia, Vancouver, BC, University of Alberta, Edmonton, University of Calgary, Calgary, Alta, University of Toronto, Toronto, Ont., McGill University, Montréal, Que, Dalhousie University, CAGS Committee on Acute Surgery and Critical Care, Halifax, NS
| | - R Saadia
- From the Departments of Surgery, University of British Columbia, Vancouver, BC, University of Alberta, Edmonton, University of Calgary, Calgary, Alta, University of Toronto, Toronto, Ont., McGill University, Montréal, Que, Dalhousie University, CAGS Committee on Acute Surgery and Critical Care, Halifax, NS
| | - A Johner
- From the Departments of Surgery, University of British Columbia, Vancouver, BC, University of Alberta, Edmonton, University of Calgary, Calgary, Alta, University of Toronto, Toronto, Ont., McGill University, Montréal, Que, Dalhousie University, CAGS Committee on Acute Surgery and Critical Care, Halifax, NS
| | - S M Hameed
- From the Departments of Surgery, University of British Columbia, Vancouver, BC, University of Alberta, Edmonton, University of Calgary, Calgary, Alta, University of Toronto, Toronto, Ont., McGill University, Montréal, Que, Dalhousie University, CAGS Committee on Acute Surgery and Critical Care, Halifax, NS
| | - A P Qureshi
- From the Division of General Surgery, University of Toronto, University Health Network, Toronto Western Hospital, Toronto, the Departments of Surgery and Oncology, University of Western Ontario, London, Ont., and Duke University Medical Center, Durham, NC
| | - A Vergis
- From the Division of General Surgery, University of Toronto, University Health Network, Toronto Western Hospital, Toronto, the Departments of Surgery and Oncology, University of Western Ontario, London, Ont., and Duke University Medical Center, Durham, NC
| | - C M Jimenez
- From the Division of General Surgery, University of Toronto, University Health Network, Toronto Western Hospital, Toronto, the Departments of Surgery and Oncology, University of Western Ontario, London, Ont., and Duke University Medical Center, Durham, NC
| | - J Green
- From the Division of General Surgery, University of Toronto, University Health Network, Toronto Western Hospital, Toronto, the Departments of Surgery and Oncology, University of Western Ontario, London, Ont., and Duke University Medical Center, Durham, NC
| | - A D Pryor
- From the Division of General Surgery, University of Toronto, University Health Network, Toronto Western Hospital, Toronto, the Departments of Surgery and Oncology, University of Western Ontario, London, Ont., and Duke University Medical Center, Durham, NC
| | - C M Schlachta
- From the Division of General Surgery, University of Toronto, University Health Network, Toronto Western Hospital, Toronto, the Departments of Surgery and Oncology, University of Western Ontario, London, Ont., and Duke University Medical Center, Durham, NC
| | - A Okrainec
- From the Division of General Surgery, University of Toronto, University Health Network, Toronto Western Hospital, Toronto, the Departments of Surgery and Oncology, University of Western Ontario, London, Ont., and Duke University Medical Center, Durham, NC
| | - M T Perri
- From CSTAR, Division of Thoracic Surgery, University of Western Ontario, London, Ont
| | - A L Trejos
- From CSTAR, Division of Thoracic Surgery, University of Western Ontario, London, Ont
| | - M D Naish
- From CSTAR, Division of Thoracic Surgery, University of Western Ontario, London, Ont
| | - R V Patel
- From CSTAR, Division of Thoracic Surgery, University of Western Ontario, London, Ont
| | - R A Malthaner
- From CSTAR, Division of Thoracic Surgery, University of Western Ontario, London, Ont
| | - J Stanger
- From the Department of Surgery, Cross Cancer Institute, University of Alberta, Edmonton, Alta
| | - K Stewart
- From the Department of Surgery, Cross Cancer Institute, University of Alberta, Edmonton, Alta
| | - Y Yasui
- From the Department of Surgery, Cross Cancer Institute, University of Alberta, Edmonton, Alta
| | - C Cass
- From the Department of Surgery, Cross Cancer Institute, University of Alberta, Edmonton, Alta
| | - S Damaraju
- From the Department of Surgery, Cross Cancer Institute, University of Alberta, Edmonton, Alta
| | - K Graham
- From the Department of Surgery, Cross Cancer Institute, University of Alberta, Edmonton, Alta
| | - S Bharadwaj
- From the Department of Surgery, University of Manitoba, Winnipeg, Man
| | - S Srinathan
- From the Department of Surgery, University of Manitoba, Winnipeg, Man
| | - L Tan
- From the Department of Surgery, University of Manitoba, Winnipeg, Man
| | - H Unruh
- From the Department of Surgery, University of Manitoba, Winnipeg, Man
| | - C Finley
- From the Division of Thoracic Surgery, Department of Surgery, University of Toronto, Toronto, Ont
| | - L Miller
- From the Division of Thoracic Surgery, Department of Surgery, University of Toronto, Toronto, Ont
| | - L E Ferri
- From the Division of Thoracic Surgery, Department of Surgery, University of Toronto, Toronto, Ont
| | - D R Urbach
- From the Division of Thoracic Surgery, Department of Surgery, University of Toronto, Toronto, Ont
| | - G Darling
- From the Division of Thoracic Surgery, Department of Surgery, University of Toronto, Toronto, Ont
| | - J Spicer
- From the Division of Thoracic Surgery, McGill University Health Centre, Montréal, Que
| | - S Ergun
- From the Division of Thoracic Surgery, McGill University Health Centre, Montréal, Que
| | - B McDonald
- From the Division of Thoracic Surgery, McGill University Health Centre, Montréal, Que
| | - M Rousseau
- From the Division of Thoracic Surgery, McGill University Health Centre, Montréal, Que
| | - P Kaneva
- From the Division of Thoracic Surgery, McGill University Health Centre, Montréal, Que
| | - L E Ferri
- From the Division of Thoracic Surgery, McGill University Health Centre, Montréal, Que
| | - J Spicer
- From the Division of Thoracic Surgery, Department of Pathology, McGill University Health Centre, Montréal, Que
| | - A Andalib
- From the Division of Thoracic Surgery, Department of Pathology, McGill University Health Centre, Montréal, Que
| | - C Benay
- From the Division of Thoracic Surgery, Department of Pathology, McGill University Health Centre, Montréal, Que
| | - M Rousseau
- From the Division of Thoracic Surgery, Department of Pathology, McGill University Health Centre, Montréal, Que
| | - Y Kushner
- From the Division of Thoracic Surgery, Department of Pathology, McGill University Health Centre, Montréal, Que
| | - V Marcus
- From the Division of Thoracic Surgery, Department of Pathology, McGill University Health Centre, Montréal, Que
| | - L E Ferri
- From the Division of Thoracic Surgery, Department of Pathology, McGill University Health Centre, Montréal, Que
| | - I Hunt
- From the Division of Thoracic Surgery, Departments of Surgery and Cardiology, University of Alberta, Institute of Health Economics, Edmonton, Alta
| | - S Gazala
- From the Division of Thoracic Surgery, Departments of Surgery and Cardiology, University of Alberta, Institute of Health Economics, Edmonton, Alta
| | - R Razzak
- From the Division of Thoracic Surgery, Departments of Surgery and Cardiology, University of Alberta, Institute of Health Economics, Edmonton, Alta
| | - A Chuck
- From the Division of Thoracic Surgery, Departments of Surgery and Cardiology, University of Alberta, Institute of Health Economics, Edmonton, Alta
| | - A Valji
- From the Division of Thoracic Surgery, Departments of Surgery and Cardiology, University of Alberta, Institute of Health Economics, Edmonton, Alta
| | - K Stewart
- From the Division of Thoracic Surgery, Departments of Surgery and Cardiology, University of Alberta, Institute of Health Economics, Edmonton, Alta
| | - R Tsuyuki
- From the Division of Thoracic Surgery, Departments of Surgery and Cardiology, University of Alberta, Institute of Health Economics, Edmonton, Alta
| | - E L R Bédard
- From the Division of Thoracic Surgery, Departments of Surgery and Cardiology, University of Alberta, Institute of Health Economics, Edmonton, Alta
| | - D A Bottoni
- From the Division of Thoracic Surgery, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - G Campbell
- From the Division of Thoracic Surgery, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - R A Malthaner
- From the Division of Thoracic Surgery, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - M Rousseau
- From the McGill University Health Centre, Montréal, Que
| | - P Guevremont
- From the McGill University Health Centre, Montréal, Que
| | - M Chasen
- From the McGill University Health Centre, Montréal, Que
| | - J Spicer
- From the McGill University Health Centre, Montréal, Que
| | - E Eckert
- From the McGill University Health Centre, Montréal, Que
| | - T Alcindor
- From the McGill University Health Centre, Montréal, Que
| | - S Ades
- From the McGill University Health Centre, Montréal, Que
| | - L E Ferri
- From the McGill University Health Centre, Montréal, Que
| | - R McGory
- From the Division of Thoracic Surgery, London Health Sciences Centre, London, Ont
| | - D Nagpal
- From the Division of Thoracic Surgery, London Health Sciences Centre, London, Ont
| | - D Fortin
- From the Division of Thoracic Surgery, London Health Sciences Centre, London, Ont
| | - R I Inculet
- From the Division of Thoracic Surgery, London Health Sciences Centre, London, Ont
| | - R A Malthaner
- From the Division of Thoracic Surgery, London Health Sciences Centre, London, Ont
| | - M Ko
- From the Division of Thoracic Surgery, St. Joseph's Health Centre, University of Toronto, Toronto, Ont
| | - Y Shargall
- From the Division of Thoracic Surgery, St. Joseph's Health Centre, University of Toronto, Toronto, Ont
| | - C Compeau
- From the Division of Thoracic Surgery, St. Joseph's Health Centre, University of Toronto, Toronto, Ont
| | - R Razzak
- From the Division of Thoracic Surgery, University of Alberta, Edmonton, Alta
| | - S Gazala
- From the Division of Thoracic Surgery, University of Alberta, Edmonton, Alta
| | - I Hunt
- From the Division of Thoracic Surgery, University of Alberta, Edmonton, Alta
| | - J Veenstra
- From the Division of Thoracic Surgery, University of Alberta, Edmonton, Alta
| | - A Valji
- From the Division of Thoracic Surgery, University of Alberta, Edmonton, Alta
| | - K Stewart
- From the Division of Thoracic Surgery, University of Alberta, Edmonton, Alta
| | - E L R Bédard
- From the Division of Thoracic Surgery, University of Alberta, Edmonton, Alta
| | - P J Davis
- From the Division of General Surgery, Department of Surgery, The Moncton Hospital, Moncton, NB, and Dalhousie University, Halifax, NS
| | - M Mancuso
- From the Division of General Surgery, Department of Surgery, The Moncton Hospital, Moncton, NB, and Dalhousie University, Halifax, NS
| | - A A Mujoomdar
- From the Division of General Surgery, Department of Surgery, The Moncton Hospital, Moncton, NB, and Dalhousie University, Halifax, NS
| | - S Gazala
- From the University of Alberta, Edmonton, Alta
| | | | - L Lee
- From the Division of Thoracic Surgery, McGill University Health Centre, Montréal, Que
| | - J Spicer
- From the Division of Thoracic Surgery, McGill University Health Centre, Montréal, Que
| | - C Robineau
- From the Division of Thoracic Surgery, McGill University Health Centre, Montréal, Que
| | - C Sirois
- From the Division of Thoracic Surgery, McGill University Health Centre, Montréal, Que
| | - D Mulder
- From the Division of Thoracic Surgery, McGill University Health Centre, Montréal, Que
| | - L E Ferri
- From the Division of Thoracic Surgery, McGill University Health Centre, Montréal, Que
| | - J Cools-Lartigue
- From the Departments of Surgery, Pathology and Medicine, McGill University, Montréal, Que
| | - S-Y Chang
- From the Departments of Surgery, Pathology and Medicine, McGill University, Montréal, Que
| | - S Mayrand
- From the Departments of Surgery, Pathology and Medicine, McGill University, Montréal, Que
| | - V Marcus
- From the Departments of Surgery, Pathology and Medicine, McGill University, Montréal, Que
| | - G M Fried
- From the Departments of Surgery, Pathology and Medicine, McGill University, Montréal, Que
| | - L E Ferri
- From the Departments of Surgery, Pathology and Medicine, McGill University, Montréal, Que
| | - T Perry
- From the Departments of Surgery and Diagnostic Imaging, University of Alberta, Edmonton, Alta
| | - I Hunt
- From the Departments of Surgery and Diagnostic Imaging, University of Alberta, Edmonton, Alta
| | - M Allegretto
- From the Departments of Surgery and Diagnostic Imaging, University of Alberta, Edmonton, Alta
| | - C Maguire
- From the Departments of Surgery and Diagnostic Imaging, University of Alberta, Edmonton, Alta
| | - J Abele
- From the Departments of Surgery and Diagnostic Imaging, University of Alberta, Edmonton, Alta
| | - D Williams
- From the Departments of Surgery and Diagnostic Imaging, University of Alberta, Edmonton, Alta
| | - K Stewart
- From the Departments of Surgery and Diagnostic Imaging, University of Alberta, Edmonton, Alta
| | - E L R Bédard
- From the Departments of Surgery and Diagnostic Imaging, University of Alberta, Edmonton, Alta
| | - H S Grover
- From the Division of Thoracic Surgery, Department of Surgery, William Osler Health Centre, Brampton, McMaster University, Hamilton, Ont
| | - S Basi
- From the Division of Thoracic Surgery, Department of Surgery, William Osler Health Centre, Brampton, McMaster University, Hamilton, Ont
| | - P Chiasson
- From the Division of Thoracic Surgery, Department of Surgery, William Osler Health Centre, Brampton, McMaster University, Hamilton, Ont
| | - S Basi
- From the Division of Thoracic Surgery, Department of Surgery, William Osler Health Centre, Brampton, McMaster University, Hamilton, Ont
| | - W Gregory
- From the Division of Thoracic Surgery, Department of Surgery, William Osler Health Centre, Brampton, McMaster University, Hamilton, Ont
| | - K Irshad
- From the Division of Thoracic Surgery, Department of Surgery, William Osler Health Centre, Brampton, McMaster University, Hamilton, Ont
| | - C Schieman
- From the Division of Thoracic Surgery, Departments of Surgery and Diagnostic Imaging, University of Calgary, Calgary, Alta
| | - J H MacGregor
- From the Division of Thoracic Surgery, Departments of Surgery and Diagnostic Imaging, University of Calgary, Calgary, Alta
| | - E Kelly
- From the Division of Thoracic Surgery, Departments of Surgery and Diagnostic Imaging, University of Calgary, Calgary, Alta
| | - G Gelfand
- From the Division of Thoracic Surgery, Departments of Surgery and Diagnostic Imaging, University of Calgary, Calgary, Alta
| | - A J Graham
- From the Division of Thoracic Surgery, Departments of Surgery and Diagnostic Imaging, University of Calgary, Calgary, Alta
| | - S P McFadden
- From the Division of Thoracic Surgery, Departments of Surgery and Diagnostic Imaging, University of Calgary, Calgary, Alta
| | - S C Grondin
- From the Division of Thoracic Surgery, Departments of Surgery and Diagnostic Imaging, University of Calgary, Calgary, Alta
| | - K P Croome
- From the Department of General Surgery, University of Western Ontario, London, Ont., Center for Transplant Outcomes and Quality Improvement, The Transplant Institute, Beth Israel Deaconess Medical Center, and the Department of Epidemiology, Harvard University, Boston, Mass
| | - R Chudzinski
- From the Department of General Surgery, University of Western Ontario, London, Ont., Center for Transplant Outcomes and Quality Improvement, The Transplant Institute, Beth Israel Deaconess Medical Center, and the Department of Epidemiology, Harvard University, Boston, Mass
| | - D W Hanto
- From the Department of General Surgery, University of Western Ontario, London, Ont., Center for Transplant Outcomes and Quality Improvement, The Transplant Institute, Beth Israel Deaconess Medical Center, and the Department of Epidemiology, Harvard University, Boston, Mass
| | - M H Jamal
- From the Department of Surgery, McGill University Health Centre, Montréal, Que., School of Population Health, University of Queensland, Brisbane, Australia
| | - S A Doi
- From the Department of Surgery, McGill University Health Centre, Montréal, Que., School of Population Health, University of Queensland, Brisbane, Australia
| | - J S Barkun
- From the Department of Surgery, McGill University Health Centre, Montréal, Que., School of Population Health, University of Queensland, Brisbane, Australia
| | - S L Wong
- From the Department of Surgery, Health Science Centre, St. John's, NL
| | - A H L Kwan
- From the Department of Surgery, Health Science Centre, St. John's, NL
| | - S Yang
- From the Sunnybrook Health Sciences Centre, Toronto, Ont
| | - C Law
- From the Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Y Luo
- From the Hôtel-Dieu Grace Hospital, Windsor, Ont
| | - J Spiers
- From the Hôtel-Dieu Grace Hospital, Windsor, Ont
| | - A Forse
- From the Hôtel-Dieu Grace Hospital, Windsor, Ont
| | - W Taylor
- From the Hôtel-Dieu Grace Hospital, Windsor, Ont
| | - I Apriasz
- From the Departments of General Surgery and Gastroenterology, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - B Mysliwiec
- From the Departments of General Surgery and Gastroenterology, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - N Sarin
- From the Departments of General Surgery and Gastroenterology, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - J Gregor
- From the Departments of General Surgery and Gastroenterology, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - C E Moulton
- From Cancer Care Ontario HPB Surgical Oncology Community of Practice, Department of Surgery, University of Toronto, Surgical Oncology Program, Cancer Care Ontario, Toronto, Ont
| | - R S McLeod
- From Cancer Care Ontario HPB Surgical Oncology Community of Practice, Department of Surgery, University of Toronto, Surgical Oncology Program, Cancer Care Ontario, Toronto, Ont
| | - H Barnett
- From Cancer Care Ontario HPB Surgical Oncology Community of Practice, Department of Surgery, University of Toronto, Surgical Oncology Program, Cancer Care Ontario, Toronto, Ont
| | - C Nhan
- From Cancer Care Ontario HPB Surgical Oncology Community of Practice, Department of Surgery, University of Toronto, Surgical Oncology Program, Cancer Care Ontario, Toronto, Ont
| | - S Gallinger
- From Cancer Care Ontario HPB Surgical Oncology Community of Practice, Department of Surgery, University of Toronto, Surgical Oncology Program, Cancer Care Ontario, Toronto, Ont
| | - S V Demyttenaere
- From the Department of Surgery, Ohio State University Medical Centre, Columbus, Ohio
| | - P Nau
- From the Department of Surgery, Ohio State University Medical Centre, Columbus, Ohio
| | - P Muscarella
- From the Department of Surgery, Ohio State University Medical Centre, Columbus, Ohio
| | - W S Melvin
- From the Department of Surgery, Ohio State University Medical Centre, Columbus, Ohio
| | - E C Ellison
- From the Department of Surgery, Ohio State University Medical Centre, Columbus, Ohio
| | - S M Wiseman
- From St. Paul's Hospital, Department of Surgery, University of British Columbia, Vancouver, BC
| | - A L Melck
- From St. Paul's Hospital, Department of Surgery, University of British Columbia, Vancouver, BC
| | - K M Davidge
- From the Divisions of Plastic, Orthopedic, and General Surgery, University of Toronto, Toronto, Ont
| | - C Eskicioglu
- From the Divisions of Plastic, Orthopedic, and General Surgery, University of Toronto, Toronto, Ont
| | - J Lipa
- From the Divisions of Plastic, Orthopedic, and General Surgery, University of Toronto, Toronto, Ont
| | - P Ferguson
- From the Divisions of Plastic, Orthopedic, and General Surgery, University of Toronto, Toronto, Ont
| | - C J Swallow
- From the Divisions of Plastic, Orthopedic, and General Surgery, University of Toronto, Toronto, Ont
| | - F C Wright
- From the Divisions of Plastic, Orthopedic, and General Surgery, University of Toronto, Toronto, Ont
| | - J P Edwards
- From the Department of Surgery, Medicine, Community Health Sciences, Health Information Network Calgary, Centre for Health Policy Studies, University of Calgary, Calgary, Alta
| | - E J Kelly
- From the Department of Surgery, Medicine, Community Health Sciences, Health Information Network Calgary, Centre for Health Policy Studies, University of Calgary, Calgary, Alta
| | - Y Lin
- From the Department of Surgery, Medicine, Community Health Sciences, Health Information Network Calgary, Centre for Health Policy Studies, University of Calgary, Calgary, Alta
| | - T Lenders
- From the Department of Surgery, Medicine, Community Health Sciences, Health Information Network Calgary, Centre for Health Policy Studies, University of Calgary, Calgary, Alta
| | - W A Ghali
- From the Department of Surgery, Medicine, Community Health Sciences, Health Information Network Calgary, Centre for Health Policy Studies, University of Calgary, Calgary, Alta
| | - A Graham
- From the Department of Surgery, Medicine, Community Health Sciences, Health Information Network Calgary, Centre for Health Policy Studies, University of Calgary, Calgary, Alta
| | - V Francescutti
- From the Division of General Surgery, Department of Medical Oncology, McMaster University, Hamilton, Ont
| | - F Farrokhyar
- From the Division of General Surgery, Department of Medical Oncology, McMaster University, Hamilton, Ont
| | - R Tozer
- From the Division of General Surgery, Department of Medical Oncology, McMaster University, Hamilton, Ont
| | - B Heller
- From the Division of General Surgery, Department of Medical Oncology, McMaster University, Hamilton, Ont
| | - P Lovrics
- From the Division of General Surgery, Department of Medical Oncology, McMaster University, Hamilton, Ont
| | - G Jansz
- From the Division of General Surgery, Department of Medical Oncology, McMaster University, Hamilton, Ont
| | - K Kahnamoui
- From the Division of General Surgery, Department of Medical Oncology, McMaster University, Hamilton, Ont
| | - G Spiegle
- From the Department of Surgery, Toronto General Hospital, Sunnybrook Health Science Centre, Mount Sinai Hospital, University of Toronto, Toronto, Ont
| | - S Schmocker
- From the Department of Surgery, Toronto General Hospital, Sunnybrook Health Science Centre, Mount Sinai Hospital, University of Toronto, Toronto, Ont
| | - H Huang
- From the Department of Surgery, Toronto General Hospital, Sunnybrook Health Science Centre, Mount Sinai Hospital, University of Toronto, Toronto, Ont
| | - C Victor
- From the Department of Surgery, Toronto General Hospital, Sunnybrook Health Science Centre, Mount Sinai Hospital, University of Toronto, Toronto, Ont
| | - C Law
- From the Department of Surgery, Toronto General Hospital, Sunnybrook Health Science Centre, Mount Sinai Hospital, University of Toronto, Toronto, Ont
| | - E D Kennedy
- From the Department of Surgery, Toronto General Hospital, Sunnybrook Health Science Centre, Mount Sinai Hospital, University of Toronto, Toronto, Ont
| | - J A McCart
- From the Department of Surgery, Toronto General Hospital, Sunnybrook Health Science Centre, Mount Sinai Hospital, University of Toronto, Toronto, Ont
| | - N Aslani
- From the British Columbia Cancer Agency, Vancouver, BC
| | - T Swanson
- From the British Columbia Cancer Agency, Vancouver, BC
| | - H Kennecke
- From the British Columbia Cancer Agency, Vancouver, BC
| | - R Woods
- From the British Columbia Cancer Agency, Vancouver, BC
| | - N Davis
- From the British Columbia Cancer Agency, Vancouver, BC
| | - A E Klevan
- From the Departments of Surgery, Pathology and Molecular Medicine, Hamilton Health Sciences, McMaster University, Hamilton, Ont
| | - J A Ramsay
- From the Departments of Surgery, Pathology and Molecular Medicine, Hamilton Health Sciences, McMaster University, Hamilton, Ont
| | - W J Stephen
- From the Departments of Surgery, Pathology and Molecular Medicine, Hamilton Health Sciences, McMaster University, Hamilton, Ont
| | - M Smith
- From the Division of General Surgery, Dalhousie University, Halifax, NS
| | - M Plourde
- From the Division of General Surgery, Dalhousie University, Halifax, NS
| | - P M Johnson
- From the Division of General Surgery, Dalhousie University, Halifax, NS
| | - P Yaffe
- From the Departments of Medical Sciences, Surgery, Pathology, and Microbiology and Immunology, Dalhousie University, Halifax, NS
| | - M Walsh
- From the Departments of Medical Sciences, Surgery, Pathology, and Microbiology and Immunology, Dalhousie University, Halifax, NS
| | - D Hoskin
- From the Departments of Medical Sciences, Surgery, Pathology, and Microbiology and Immunology, Dalhousie University, Halifax, NS
| | - H P Huynh
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - D C Trottier
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - C Soto
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - R Auer
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - E C Poulin
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - J Mamazza
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - R P Boushey
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - H Moloo
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - H P Huynh
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - D C Trottier
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - C Soto
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - H Moloo
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - E C Poulin
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - J Mamazza
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - R P Boushey
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - C Nhan
- From the Surgical Oncology Program, Cancer Care Ontario, the Department of Surgery, University of Toronto, Toronto, and the Department of Pathology, University of Western Ontario, London, Ont
| | - D K Driman
- From the Surgical Oncology Program, Cancer Care Ontario, the Department of Surgery, University of Toronto, Toronto, and the Department of Pathology, University of Western Ontario, London, Ont
| | - A J Smith
- From the Surgical Oncology Program, Cancer Care Ontario, the Department of Surgery, University of Toronto, Toronto, and the Department of Pathology, University of Western Ontario, London, Ont
| | - A Hunter
- From the Surgical Oncology Program, Cancer Care Ontario, the Department of Surgery, University of Toronto, Toronto, and the Department of Pathology, University of Western Ontario, London, Ont
| | - R S McLeod
- From the Surgical Oncology Program, Cancer Care Ontario, the Department of Surgery, University of Toronto, Toronto, and the Department of Pathology, University of Western Ontario, London, Ont
| | - C Eskicioglu
- From the Division of General Surgery, University of Toronto, Toronto, Ont
| | - D S Fenech
- From the Division of General Surgery, University of Toronto, Toronto, Ont
| | - C Victor
- From the Division of General Surgery, University of Toronto, Toronto, Ont
| | - R S McLeod
- From the Division of General Surgery, University of Toronto, Toronto, Ont
| | - D C Trottier
- From the Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - H Huynh
- From the Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - E Sabri
- From the Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - C Soto
- From the Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - A Scheer
- From the Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - S Zolfaghari
- From the Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - H Moloo
- From the Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - J Mamazza
- From the Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - E C Poulin
- From the Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - R P Boushey
- From the Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - J Hallet
- From the Centre de chirurgie minimalement invasive de Québec, Centre hospitalier universitaire de Québec, Université Laval, Québec, Que
| | - M Guénette-Lemieux
- From the Centre de chirurgie minimalement invasive de Québec, Centre hospitalier universitaire de Québec, Université Laval, Québec, Que
| | - A Bouchard
- From the Centre de chirurgie minimalement invasive de Québec, Centre hospitalier universitaire de Québec, Université Laval, Québec, Que
| | - R C Grégoire
- From the Centre de chirurgie minimalement invasive de Québec, Centre hospitalier universitaire de Québec, Université Laval, Québec, Que
| | - C Thibault
- From the Centre de chirurgie minimalement invasive de Québec, Centre hospitalier universitaire de Québec, Université Laval, Québec, Que
| | - G Dionne
- From the Centre de chirurgie minimalement invasive de Québec, Centre hospitalier universitaire de Québec, Université Laval, Québec, Que
| | - F Côté
- From the Centre de chirurgie minimalement invasive de Québec, Centre hospitalier universitaire de Québec, Université Laval, Québec, Que
| | - P Langis
- From the Centre de chirurgie minimalement invasive de Québec, Centre hospitalier universitaire de Québec, Université Laval, Québec, Que
| | - J-P Gagné
- From the Centre de chirurgie minimalement invasive de Québec, Centre hospitalier universitaire de Québec, Université Laval, Québec, Que
| | - M J Raval
- From the Department of Surgery, St. Paul's Hospital and University of British Columbia, Vancouver, BC
| | - P T Phang
- From the Department of Surgery, St. Paul's Hospital and University of British Columbia, Vancouver, BC
| | - C J Brown
- From the Department of Surgery, St. Paul's Hospital and University of British Columbia, Vancouver, BC
| | - A Kuzmanovic
- From the Department of Surgery, St. Paul's Hospital and University of British Columbia, Vancouver, BC
| | - A Planting
- From the Department of Colorectal Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - M J Raval
- From the Department of Colorectal Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - P T Phang
- From the Department of Colorectal Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - C J Brown
- From the Department of Colorectal Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - H P Huynh
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - D C Trottier
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - H Moloo
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - E C Poulin
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - J Mamazza
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - M Friedlich
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - H S Stern
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - R P Boushey
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - B Q Tang
- From the Department of Surgery, Division of General Surgery, Royal Jubilee Hospital, Vancouver Island Health Authority, Victoria, BC
| | - H Moloo
- From the Department of Colorectal Surgery, University of Minnesota, Minneapolis, Minn., the Department of Surgery, University of Ottawa, Ottawa, Ont., and the Department of Colorectal Surgery, University of Pennsylvania, Philadelphia, Pa
| | - J Bleier
- From the Department of Colorectal Surgery, University of Minnesota, Minneapolis, Minn., the Department of Surgery, University of Ottawa, Ottawa, Ont., and the Department of Colorectal Surgery, University of Pennsylvania, Philadelphia, Pa
| | - S M Goldberg
- From the Department of Colorectal Surgery, University of Minnesota, Minneapolis, Minn., the Department of Surgery, University of Ottawa, Ottawa, Ont., and the Department of Colorectal Surgery, University of Pennsylvania, Philadelphia, Pa
| | - J Alsharif
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - G Martel
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - A Bouchard
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - E Sabri
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - C R Ramsay
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - J Mamazza
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - E C Poulin
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - R P Boushey
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - D Richardson
- From the Division of General Surgery, Dalhousie University, Halifax, NS
| | - G Porter
- From the Division of General Surgery, Dalhousie University, Halifax, NS
| | - P Johnson
- From the Division of General Surgery, Dalhousie University, Halifax, NS
| | - E Al-Sukhni
- From the Mount Sinai Hospital, University of Toronto, Toronto, Ont
| | - P F Ridgway
- From the Mount Sinai Hospital, University of Toronto, Toronto, Ont
| | - B O'Connor
- From the Mount Sinai Hospital, University of Toronto, Toronto, Ont
| | - R S McLeod
- From the Mount Sinai Hospital, University of Toronto, Toronto, Ont
| | - C J Swallow
- From the Mount Sinai Hospital, University of Toronto, Toronto, Ont
| | - S S Forbes
- From the Department of Surgery, University of Toronto, Toronto, Ont
| | - D R Urbach
- From the Department of Surgery, University of Toronto, Toronto, Ont
| | - R Sutradhar
- From the Department of Surgery, University of Toronto, Toronto, Ont
| | - L Paszat
- From the Department of Surgery, University of Toronto, Toronto, Ont
| | - L Rabeneck
- From the Department of Surgery, University of Toronto, Toronto, Ont
| | - N N Baxter
- From the Department of Surgery, University of Toronto, Toronto, Ont
| | - W Chung
- From the Division of General Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - D Ko
- From the Division of General Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - C Sun
- From the Division of General Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - C J Brown
- From the Division of General Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - M Raval
- From the Division of General Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - P T Phang
- From the Division of General Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - J S Pao
- From the Department of Surgery, St. Paul's Hospital, BC Cancer Agency, Vancouver, BC
| | - R Woods
- From the Department of Surgery, St. Paul's Hospital, BC Cancer Agency, Vancouver, BC
| | - M J Raval
- From the Department of Surgery, St. Paul's Hospital, BC Cancer Agency, Vancouver, BC
| | - P T Phang
- From the Department of Surgery, St. Paul's Hospital, BC Cancer Agency, Vancouver, BC
| | - C J Brown
- From the Department of Surgery, St. Paul's Hospital, BC Cancer Agency, Vancouver, BC
| | - A Power
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - V Francescutti
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - D Ramsey
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - S Kelly
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - W Stephen
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - M Simunovic
- From the Department of Surgery, Clinical Epidemiology and Biostatistics, Hamilton Health Sciences, McMaster University, Hamilton, Ont
| | - A Coates
- From the Department of Surgery, Clinical Epidemiology and Biostatistics, Hamilton Health Sciences, McMaster University, Hamilton, Ont
| | - C H Goldsmith
- From the Department of Surgery, Clinical Epidemiology and Biostatistics, Hamilton Health Sciences, McMaster University, Hamilton, Ont
| | - L Thabane
- From the Department of Surgery, Clinical Epidemiology and Biostatistics, Hamilton Health Sciences, McMaster University, Hamilton, Ont
| | - D Reeson
- From the Department of Surgery, Clinical Epidemiology and Biostatistics, Hamilton Health Sciences, McMaster University, Hamilton, Ont
| | - A J Smith
- From the Department of Surgery, Clinical Epidemiology and Biostatistics, Hamilton Health Sciences, McMaster University, Hamilton, Ont
| | - R S McLeod
- From the Department of Surgery, Clinical Epidemiology and Biostatistics, Hamilton Health Sciences, McMaster University, Hamilton, Ont
| | - F DeNardi
- From the Department of Surgery, Clinical Epidemiology and Biostatistics, Hamilton Health Sciences, McMaster University, Hamilton, Ont
| | - T J Whelan
- From the Department of Surgery, Clinical Epidemiology and Biostatistics, Hamilton Health Sciences, McMaster University, Hamilton, Ont
| | - M N Levine
- From the Department of Surgery, Clinical Epidemiology and Biostatistics, Hamilton Health Sciences, McMaster University, Hamilton, Ont
| | - K A Al-Khayal
- From the Department of Surgery, University of Calgary, Calgary, Alta
| | - W D Buie
- From the Department of Surgery, University of Calgary, Calgary, Alta
| | - L Wallace
- From the Department of Surgery, University of Calgary, Calgary, Alta
| | - D Sigalet
- From the Department of Surgery, University of Calgary, Calgary, Alta
| | - C Eskicioglu
- From the Division of General Surgery, University of Toronto, Toronto, Ont
| | - A Gagliardi
- From the Division of General Surgery, University of Toronto, Toronto, Ont
| | - D S Fenech
- From the Division of General Surgery, University of Toronto, Toronto, Ont
| | - C Victor
- From the Division of General Surgery, University of Toronto, Toronto, Ont
| | - R S McLeod
- From the Division of General Surgery, University of Toronto, Toronto, Ont
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Pagala MK, Tetsoti L, Nagpal D, Wise GJ. Aging effects on contractility of longitudinal and circular detrusor and trigone of rat bladder. J Urol 2001; 166:721-7. [PMID: 11458124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
PURPOSE Aging is associated with bladder dysfunction, including difficult voiding and urinary leakage. Voiding involves reduction in the bladder lumen in all dimensions brought about by contraction of the meshwork of longitudinal, circular and oblique layers of detrusor smooth muscles. Most in vitro physiological studies of the effects of aging on bladder function used the longitudinal detrusor. To understand the region specific effects of aging on bladder function the contractile responses of longitudinal and circular detrusor, and trigone segments of the bladder from young and old rats were monitored. MATERIALS AND METHODS These studies were performed using male Fisher 344 rats 6 months (young) and 27 months (old) old obtained through the National Institute on Aging. Each rat was anesthetized and the bladder was isolated. From each bladder a strip of longitudinal detrusor, circular detrusor and trigone was isolated and mounted in an in vitro multi-muscle chamber containing normal physiological solution at 37C. Isometric contractions of the 3 bladder strips were monitored after electrical field stimulation, 120 mM. potassium and 1 to 1,000 microM. bethanechol using a digital oscilloscope. RESULTS In longitudinal detrusor from old rats there was no significant difference in the contractions evoked by electrical stimulation or high potassium but there was a significant reduction in contractions evoked by bethanechol compared with the responses of longitudinal detrusor from young rats. In circular detrusor from old rats there was a significant increase in contractions evoked by electrical stimulation and a slight increase in contractions produced by high potassium but no significant change in contractions evoked by bethanechol compared with the responses of circular detrusor from young rats. In trigone from old rats there was a significant decrease in contractions evoked by electrical stimulation, high potassium and bethanechol compared with young trigone. CONCLUSIONS The reduction in contractions evoked by bethanechol suggests an age related reduction in muscarinic receptors in the longitudinal detrusor of aged rats. An increase in contractions evoked by electrical stimulation without a change in contractions evoked by bethanechol suggests a decrease in compliance caused by an increase in collagen in the circular detrusor of aged rats. A general decline in all contractile responses, including those evoked by high potassium, suggests reduced membrane depolarization in the trigone of aged rats. The effect of aging is specific to different regions and functional components of the bladder, probably due to changes in muscarinic receptors, collagen and depolarization.
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Affiliation(s)
- M K Pagala
- Neuromuscular Research Laboratory, Division of Urology, Department of Surgery, Maimonides Medical Center, Brooklyn, New York 11219, USA
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