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2021: Perioperative and critical care year in review for the cardiothoracic surgery team

J W Awori Hayanga1, Philippe H Lemaitre2, HelenMari Merritt-Genore3

  • 1Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVa.

The Journal of Thoracic and Cardiovascular Surgery
|August 23, 2022
PubMed

Insights

This review challenges COVID-19 extracorporeal support standards and assesses pandemic impacts on cardiac surgery volume. It also examines pulmonary artery catheters, transfusion strategies, acute kidney injury, fluid resuscitation, dysphagia, and prehabilitation in cardiac surgery.

Area of Science:

  • Cardiology
  • Critical Care Medicine
  • Surgical Outcomes

Background:

  • The COVID-19 pandemic has significantly impacted healthcare, necessitating a re-evaluation of established medical practices and standards.
  • Cardiac surgery has faced unique challenges, including changes in patient volume and treatment protocols.

Purpose of the Study:

  • To provide an expert panel opinion on extracorporeal support in COVID-19 patients, challenging existing guidelines.
  • To assess the pandemic's effect on cardiac surgical volumes through survey data.
  • To review critical aspects of cardiac surgery, including invasive monitoring, transfusion strategies, acute kidney injury, fluid resuscitation, and prehabilitation.

Main Methods:

  • Expert panel discussions and opinion synthesis on extracorporeal membrane oxygenation (ECMO) and related technologies for COVID-19.
  • Survey distribution and analysis to quantify changes in cardiac surgical procedures during the pandemic.
  • Review of single-center data on pulmonary artery catheter use and findings from the REALITY trial comparing transfusion strategies.
  • Literature review and discussion on acute kidney injury, fluid resuscitation choices, and post-operative dysphagia management in cardiac surgery.

Main Results:

  • Expert opinions suggest a need to revise current standards for extracorporeal support in the context of COVID-19.
  • Pandemic-related disruptions have led to significant shifts in cardiac surgical volumes.
  • The REALITY trial provides insights into optimal transfusion strategies for acute myocardial infarction patients.
  • Evidence highlights the importance of managing acute kidney injury and optimizing fluid resuscitation in cardiac surgery.

Conclusions:

  • Revisiting extracorporeal support guidelines for COVID-19 is crucial.
  • Understanding and adapting to pandemic-induced changes in cardiac surgical practice is essential.
  • Optimizing perioperative care, including monitoring, transfusion, fluid management, and prehabilitation, can improve outcomes in cardiac surgery.

Keywords:
ECMOacute kidney injurycatheterscritical carefluid resuscitationtransfusions

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