Background Current practices regarding percutaneous dilatational tracheostomy in adult patients treated with extracorporeal membrane oxygenation (ECMO) after cardiac surgery is not completely defined. This study aimed to evaluate the safety of the percutaneous dilatational tracheostomy in patients with ECMO after cardiac surgery. Methods Between July 2017 and May 2021, 371 ECMO procedures were performed in more than 35,000 adult patients who underwent cardiac surgery in our hospital. Sixty-two patients underwent percutaneous dilatational tracheostomy (PDT) during or after ECMO. A retrospective analysis was performed comparing the incidence of complications and clinical outcomes of the two groups. Results Of the 371 patients treated with ECMO after adult cardiac surgery during the enrollment period, 22 (7.1%) and 40 (12.8%) underwent PDT during or after ECMO, respectively. The platelet count (PLT) of the day was significantly lower in the PDT during ECMO group (54 (34, 68) vs. 108 (69, 162) (thousands), p < 0.001)). The prothrombin time (PT) and activated partial thromboplastin time (APTT) of the day were longer in the PDT during ECMO group (15.8 (14.6, 19.9) vs. 13.8 (13.2, 15.2) seconds, p = 0.001, 43.8 (38.0, 49.4) vs. 35.2 (28.2, 40.9) seconds, p < 0.001, respectively). There was no significant difference in tracheotomy-related complications between the two groups. Significantly decreased ventilator time was observed in the PDT during ECMO group. Conclusions Despite poor coagulation of the day, PDT during ECMO is safe and can appropriately reduce the duration of mechanical ventilation compared with PDT after ECMO weaning in adult patients who have undergone cardiac surgery.

目的 探讨包含颈动脉超声参数的心脏外科手术后患者住院期间发生脑梗死的风险因素.方法 回顾性分析首都医科大学附属北京安贞医院2020年1月-2020年12月住院手术的491例成人患者资料,选择其中诊断为脑梗死的患者为病例组(脑梗死组),诊断为非脑梗死的患者为对照组(非脑梗死组).采用单因素和多因素Logistic回归分析风险因素.结果 心脏外科手术后患者在住院期间脑梗死的总发生率为1.8％,并发脑梗死患者的住院存活率约为77.8％.欧洲心血管手术危险因素评分(European System for Cardiac Operative Risk Evaluation,EuroSCORE)Ⅱ高(OR=1.585,95％CI:1.043～2.409)、双侧颈+椎动脉均有斑块(OR=14.513,95％CI:2.538～82.978)、体外膜氧合(extracorporeal membrane oxygenation,ECMO)辅助(OR=112.518,95％CI:8.967～1411.907)和术后新发心房颤动(以下简称房颤)(OR=20.800,95％CI:3.639～118.902)是心脏手术后脑梗死的独立风险因素.结论 EuroSCOREⅡ高、ECMO辅助和术后新发房颤之外,颈动脉超声发现双侧颈动脉和椎动脉斑块是心脏外科术后并发脑梗死的风险因素,有必要实施心脏术前颈动脉超声筛查并对有风险的患者严格术中、术后管理.

Background: Limited research is available on the pattern of double distal perfusion catheters in patients on venoarterial extracorporeal membrane oxygenation (VA-ECMO) with an intra-aortic balloon pump(IABP). Here, we compared the outcomes of a double distal perfusion catheter and conventional treatment in patients who received VA-ECMO with IABP and had severe lower limb ischemia on the IABP side.Methods: We reviewed the data of 15 adult patients with postcardiotomy cardiogenic shock who received VA-ECMO via femoral cannulation combined with an IABP in the contralateral artery that was complicated with severe acute limb ischemia (ALI) on the same side as the IABP between January 2004 and December 2016. Patients underwent symptomatic treatment (conventional group, n = 9) and double distal perfusion catheterization treatment (DDPC group, n = 6). ALI was monitored using near-infrared spectroscopy placed on both calves after double distal perfusion catheters. The outcomes were compared.Results: All 6 patients who underwent double distal perfusion catheters were successfully decannulated without the development of osteofascial compartment syndrome, amputation, or bleeding and infection of the double distal perfusion catheters. The number of patients who weaned from extracorporeal membrane oxygenation successfully in the DDPC and conventional groups was 6 (100%) and 3 (33%, p = 0.028), respectively. The in-hospital mortality rates were 17% and 89% for the DDPC and conventional groups, respectively (p = 0.011).Conclusions: DDPC can be considered a strategy for severe limb ischemia on the IABP side in patients who received femoro-femoral VA-ECMO with IABP.

Background: Agitation and delirium in critically ill patients after cardiac surgery carry poor in-hospital prognosis. Identifying risk factors may promote its prevention and management. Accordingly, this study aimed to evaluate the incidence of agitation and hyperactive delirium in postcardiotomy patients during the extracorporeal membrane oxygenation support and to identify the risk factors for its development. Methods: This single center, retrospective study was conducted at Beijing Anzhen Hospital, Capital Medical University. Data were extracted from the prospective institutional registry database of extracorporeal membrane oxygenation patients. Univariate and multivariate logistic regression analyses were performed to predict risk factors. Results: A total of 170 consecutive adult patients underwent extracorporeal membrane oxygenation in our hospital from January 2016 to December 2017. Ninety-four patients were included in the final analysis. The incidence of agitation and hyperactive delirium was 35% in our population of extracorporeal membrane oxygenation–supported postcardiotomy patients. Agitation and delirium usually occurred within the first 3 days of extracorporeal membrane oxygenation. Multivariable analysis showed that history of previous stroke (without preoperative cognitive dysfunction; odds ratio, 4.425, 95% confidence interval: 1.171-16.716; p = 0.028) and mean arterial pressure reduction (before extracorporeal membrane oxygenation initiation) ⩾ 49 mmHg (odds ratio, 7.570, 95% confidence interval: 2.366-24.219, p = 0.001) were independent risk factors for agitation and hyperactive delirium during extracorporeal membrane oxygenation support. The areas under the receiver operating characteristic curve for the prediction of agitation and hyperactive delirium was 0.704 (95% confidence interval 0.589-0.820, p = 0.001). There was more severe arrhythmia in the agitation patients. Conclusion: Our results suggest that the prevalence of agitation and hyperactive delirium in postcardiotomy patients with extracorporeal membrane oxygenation support is high. In addition, previous stroke and severe mean arterial pressure reduction before extracorporeal membrane oxygenation initiation is predictive of agitation and hyperactive delirium.

OBJECTIVE:Mortality of adult postcardiotomy cardiogenic shock patients after successfully weaned from venoarterial extracorporeal membrane oxygenation remains high. The objective of this study is to identify the risk factors associated with mortality after successfully weaning from venoarterial extracorporeal membrane oxygenation in adult postcardiotomy cardiogenic shock patients.METHODS:All consecutive patients who were successfully weaned from venoarterial extracorporeal membrane oxygenation between January 2011 and December 2016 at the Beijing Anzhen Hospital were analyzed retrospectively. Multivariate logistic regression was performed to identify risk factors associated with in-hospital mortality after successfully weaning from venoarterial extracorporeal membrane oxygenation.RESULTS:In total, 212 (58.4%) of 363 postcardiotomy cardiogenic shock patients were successfully weaned from venoarterial extracorporeal membrane oxygenation. The non-survivors had a longer duration of extracorporeal membrane oxygenation than the survivors (120.0 (98.0, 160.50) vs. 100.0 (77.0, 126.0), p = 0.000). Variables associated with mortality of patients successfully weaned from extracorporeal membrane oxygenation by univariable analysis were age, diabetes, vasoactive inotropic score pre-extracorporeal membrane oxygenation, vasoactive inotropic score at weaning, left ventricular ejection fraction at weaning, central venous pressure at weaning, sequential organ failure assessment score pre-extracorporeal membrane oxygenation, sequential organ failure assessment at weaning, survival after venoarterial ECMO pre-extracorporeal membrane oxygenation, and survival after venoarterial ECMO at weaning. In the multivariate analysis, sequential organ failure assessment score at weaning (odds ratio = 1.889, 95% confidence interval = 1.460-2.455, p < 0.001) was an independent risk factor for in-hospital mortality of patients successfully weaned from venoarterial extracorporeal membrane oxygenation. The cumulative 30-day survival rate in patients with a sequential organ failure assessment score < 7 was significantly (p < 0.001) higher than in patients with a sequential organ failure assessment score ⩾ 7 (87% vs. 56.7%, p < 0.001).CONCLUSION:Vasoactive inotropic score, left ventricular ejection fraction, central venous pressure, and sequential organ failure assessment score at weaning were associated with in-hospital mortality for postcardiotomy cardiogenic shock patients successfully weaned from venoarterial extracorporeal membrane oxygenation. Sequential organ failure assessment score might help clinicians to predict in-hospital mortality for patients successfully weaned from venoarterial extracorporeal membrane oxygenation.

Objectives: The benefit of preoperative intra-aortic balloon pump implantation in high-risk cardiac surgery patients is still debated. The role of preoperative intra-aortic balloon pump insertion in acute myocardial infarction patients without cardiogenic shock undergoing off-pump coronary artery bypass grafting remains unknown. This study aimed to determine the efficacy and safety of the preoperative intra-aortic balloon pump insertion in those patients undergoing off-pump coronary artery bypass grafting. Methods: A total of 421 consecutive acute myocardial infarction patients without cardiogenic shock who underwent isolated off-pump coronary artery bypass grafting were enrolled in this retrospective observational propensity score–matched analysis study. Patients who received intra-aortic balloon pump before off-pump coronary artery bypass grafting (the intra-aortic balloon pump group, n = 157) were compared with those who had not (control group, n = 264). The 30-day postoperative survival, postoperative complications, and postoperative hospital length of stay were compared between the two groups. Results: A total of 99 pairs of patients were matched. The preoperative intra-aortic balloon pump did not show a 30-day postoperative survival benefit compared with the control group (hazard ratio, 0.9; 95% confidence interval, 0.2-4.2; p = 0.92). Patients with preoperative intra-aortic balloon pump were more likely to have shorter postoperative lengths of stay (8 (6-11) days vs. 10 (6-15) days, p = 0.02) and decreased total days in the hospital (median days: 18.2 vs. 21.8, p = 0.02) compared to patients without balloon pumps. Conclusion: Preoperative intra-aortic balloon pump insertion in acute myocardial infarction patients without cardiogenic shock undergoing off-pump coronary artery bypass grafting improved convalescence as shown by significantly shorter postoperative lengths of hospital stay.

BACKGROUND:Hypothermic circulatory arrest (HCA) with adjunctive unilateral antegrade cerebral perfusion (UACP) is widely used as a cerebral protection strategy during aortic arch surgery. However, the ideal temperature for HCA during UACP remains unknown. The study compared clinical outcomes of patients in different temperature groups for HCA during UACP. METHODS:From January 2009 to January 2016, 1691 patients who underwent aortic arch surgery for HCA during UACP in Beijing Anzhen Hospital were categorized into 2 groups according to nasopharyngeal temperature before initiating systemic circulatory arrest: the low temperature group (≤ 24°C, 22.9°C; 22.0°C-23.5°C; n = 1207) and the high temperature group (24.1°C-28.0°C, 24.6°C; 24.3°C-24.9°C; n = 484). After balancing the differences of baseline conditions by propensity score matching, 473 pairs of patients were matched, and the prognosis was compared with matched patients. RESULTS:The multivariable Cox regression analysis shows the high temperature group was an independent predictor for 30-day mortality (hazard ratio [HR], 0.55; 95% confidence interval [CI], 0.33-0.93; P = 0.03). After matching, the high temperature group was still an independent predictor of 30-day mortality (HR, 0.55; 95% CI, 0.32-0.98; P = 0.04). In subgroup analyses, there was an interaction between the high temperature group and UACP > 40 minutes for 30-day mortality (Pfor interaction< 0.05). The high temperature group had a significant protective effect in the UACP ≤ 40 minutes subgroup (HR, 0.30; 95% CI, 0.12-0.74; P = 0.01) but not in the UACP > 40 minutes subgroup (HR, 1.00; 95% CI, 0.46-2.20; P = 0.99). CONCLUSIONS:This study shows that the high temperature (24.1°C-28.0°C) management strategy for HCA during UACP is safer for UACP ≤ 40 minutes. High temperature benefits were not found in patients for UACP > 40 minutes.

目的:评价不同程度中低温停循环联合顺行性脑灌注技术用于超重(BMI≥24kg/m2)成人主动脉弓部手术的临床效果.方法:选取2009年1月至2015年12月,于北京安贞医院,在中低温停循环选择性脑灌注下行主动脉弓手术超重患者997例,按停循环开始时鼻咽温不同,分低温组(LM组,20.1 ～ 24.0℃,n=662)和高温组(HM组,24.1 ～28.0℃,n=335).比较其临床预后,并分析相关风险因素.结果:62例(6.2％)住院死亡,42例(4.3％)严重神经系统损伤.与低温组患者相比较,高温组患者行半弓置换术比率较高(23.0％vs.11.0％),而行孙氏手术操作比率较低(75.2％vs.87.2％),差异均具有统计学意义(P＜0.01).经1:1匹配后,两组患者临床资料可比性较好.两组患者住院病死率(4.3％vs.7.6％,P=0.19)、术后永久性神经系统并发症(6.5％vs.5.5％,P=0.67)及术后其他并发症发生率差异无统计学意义(P＞0.05).回归分析结果未见高温是住院死亡及术后并发症的风险因素.结论:中低温停循环联合选择性脑灌注用于主动脉弓部手术时,较高的鼻咽温能够安全用于超重患者.

Background: This study aims to describe the prevalence of neurologic complications and hospital outcome in adult post-cardiotomy cardiogenic shock (PCS) patients receiving veno-arterial extracorporeal membrane oxygenation (V-A ECMO) support and factors associated with such adverse events.Methods: Four hundred and fifteen adult patients underwent cardiac surgery and received V-A ECMO for more than 24 h because of PCS. Patients were divided into two groups: those who developed a neurological complication and those who did not (control group). Multivariable logistic regression was performed to identify factors independently associated with neurologic complications.Results: Neurologic complications occurred in 87 patients (21.0%), including cerebral infarction in 33 patients (8.0%), brain death in 30 patients (7.2%), seizures in 14 patients (3.4%), and intracranial hemorrhage in 11 (2.7%) patients. In-hospital mortality in patients with neurologic complications was 90.8%, compared to 52.1% in control patients (p < 0.001). In a multivariable model, the lowest systolic blood pressure (SBP) level pre-ECMO (OR, 0.89; 95% CI: 0.86–0.93) and aortic surgery combined with coronary artery bypass grafting (OR, 9.22; 95% CI: 2.10–40.55) were associated with overall neurologic complications. Age (OR, 1.06; 95% CI: 1.01–1.12) and lowest SBP (OR, 0.81; 95% CI: 0.76–0.87) were correlative factors of brain death. Coagulation disorders (OR, 9.75; 95% CI: 1.83–51.89) and atrial fibrillation (OR, 12.19; 95% CI: 1.22–121.61) were shown to be associated independently with intracranial hemorrhage, whereas atrial fibrillation (OR, 8.15; 95% CI: 1.31–50.62) was also associated with cerebral infarction.Conclusions: Neurologic complications in adult PCS patients undergoing V-A ECMO support are frequent and associated with higher in-hospital mortality. Identified risk factors of neurologic complications might help to improve ECMO management and might reduce their occurrence.

Objective To evaluate the efficacy and safety of preoperative intra-aortic balloon pump(IABP) insertion in acute myocardial infarction(AMI) without cardiogenic shock(CS) patients receiving off-pump coronary artery bypass grafting ( OPCABG).Methods 444 consecutive AMI patients who underwent isolated OPCABG from January 2009 to December 2016 were enrolled.158 patients who underwent preoperative IABP placement(IABP group) and the other of 286 patients who did not have IABP placement(control group).The in-hospital mortality rate, postoperative complications, mechanical ventilation time, ICU stay and hospital length were compared between the two groups.Results The overall mortality was 5.0%.135 pairs of patients were matched.The preoperative IABP insertion showed benefits in postoperative survival rate compared with the control group(0 vs.5.9%, P＝0.004).However, patients with preoperative IABP were more likely to prolong duration of mechanical ventilation and ICU stay.The postoperative length of stay in hospital didn't show significant difference between the two groups.Conclusion Survival advantage was observed from preoperative IABP insertion in AMI patients without CS under-going OPCABG.

The intra-aortic balloon pump (IABP) has been the most commonly used mechanical circulatory support device for nearly five decades. In theory, the IABP can increase the blood and oxygen supply of the coronary artery by increasing the diastolic pressure in the aortic root when the balloon is inflated and reduce left ventricular afterload by rapidly deflating the balloon during the systolic phase. Therefore, some researchers put forward the idea of preoperative prophylactic use of an IABP, which has been frequently performed in high-risk patients undergoing elective percutaneous coronary intervention (PCI) or coronary artery bypass graft surgery (CABG). Previous studies have suggested preoperative IABP has a controversial effect on patients undergoing revascularization; the role of preoperative IABP insertion in those patients undergoing CABG alone remains uncertain. This review will give further insight into routine IABP use by presenting the basic principles and discussing current evidence.

European Journal of Heart FailureVolume 19, Issue S2 p. 5-21 Cardiac AdultsFree Access Cardiac Adults First published: 04 May 2017 https://doi.org/10.1002/ejhf.844AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Volume19, IssueS2Special Issue: Proceedings of the 6th Euro-ELSO Annual Congress, May 4–7, 2017, Maastricht, The Netherlands - Invited PapersMay 2017Pages 5-21 RelatedInformation

Severe left ventricular (LV) dysfunction patients undergoing off-pump coronary artery bypass grafting (OPCAB) are often associated with a higher mortality. The efficacy and safety of the preoperative prophylactic intra-aortic balloon pump (IABP) insertion is not well established. 416 consecutive patients with severe LV dysfunction (ejection fraction ≤35%) undergoing isolated OPCAB were enrolled in a retrospective observational study. 191 patients was enrolled in the IABP group; the remaining 225 patients was in control group. A total of 129 pairs of patients were propensity-score matched. No significant differences in demographic and preoperative risk factors were found between the two groups. The postoperative 30-day mortality occurred more frequently in the control group compared with the IABP group (8.5% vs. 1.6%, p = 0.02). There was a significant reduction of low cardiac output syndrome in the IABP group compared with the control group (14% vs. 6.2%, p = 0.04). Prolonged mechanical ventilation (≥48 h) occurred more frequently in the control group (34.9% vs. 20.9%, p = 0.02). IABP also decreased the postoperative length of stay. Preoperative IABP was associated with a lower 30-day mortality, suggesting that it is effective in patients with severe LV dysfunction undergoing OPCAB.