Rosuvastatin-loaded injectable immunomodulatory hydrogel mitigates local immune response against transplanted stem cells and promotes heart repair in vivo.

In clinical trials allogeneic mesenchymal stem cells (MSCs) from young and healthy donors have shown promise to repair the heart following a heart attack. However, immune rejection of transplanted MSCs has prevented the clinical translation of stem cells-based therapies for cardiac patients. Therefore, strategies to improve survival of implanted stem cells in the heart would be of immense therapeutic value.

State-of-the-Art Review: Operating Room Extubation.

Enhancing recovery protocols seek to optimize multiple aspects of care throughout the patient's perioperative cardiac surgery journey. Fast-track recovery protocols, specifically those involving earlier extubation, have been among the early methods to enhance a patient's recovery. However, how early these protocols should be implemented after surgery remains a source of ongoing controversy.

The prevalence and predictors of post-intensive care syndrome following cardiac surgery.

Objective: Post-intensive care syndrome has been well documented in the general critical care population, but the prevalence of post-intensive care syndrome in the cardiac surgery population remains uncertain. We sought to define the prevalence of post-intensive care syndrome and associated risk factors after adult cardiac surgery.

Methods: Data were collected on 397 consecutive adult patients undergoing cardiac surgery.

Diaphragm dysfunction from phrenic nerve injuries during LVAD or heart transplant: Positive role of diaphragm pacing.

Background: Phrenic nerve dysfunction in left ventricular assist device (LVAD) implantation or heart transplant (HTx) leads to dependency on noninvasive ventilation and difficulty weaning off mechanical ventilation (MV). This study reports on diaphragm pacing (DP) to improve diaphragm function postphrenic nerve injury.

Methods: In a single-center cohort study, 2 DP systems were used in HTx or LVAD recipients.

Contemporary Prevention and Management of Postoperative Delirium in Cardiac Surgery Patients.

This review examines the prevention and management of postoperative delirium in cardiac surgery patients, a frequent complication linked with significant mortality, morbidity, prolonged hospitalization, and cognitive decline. The aim was to consolidate current evidence on postoperative delirium pathophysiology, risk factors, diagnostic approaches, and pharmacologic and non-pharmacologic interventions. A PubMed/MEDLINE database review was conducted through October 2024, identifying studies that evaluated the relationship between cardiac surgery and the occurrence of postoperative delirium.

Best Management Practices on Temporary Mechanical Circulatory Support: Joint Consensus Report of the PeriOperative Quality Initiative and the Enhanced Recovery After Surgery Cardiac Society.

Background: Effective use of temporary mechanical circulatory support (tMCS) mandates a multifaceted understanding of patient physiology, device technology, procedural techniques, patient-device interactions, and interdisciplinary collaboration. The consensus statement presented here endeavors to provide clinicians with a practical roadmap incorporating evidence-based best practices in several key areas that delineate the initial priorities in mechanical ventilation, anticoagulation, sedation, and monitoring for patients requiring tMCS.

Methods: With an interdisciplinary, international group of clinicians and through a structured literature review, a modified Delphi method was used to achieve consensus on best practices in tMCS.

Temporary Mechanical Circulatory Support in Cardiogenic Shock: Executive Summary of the Joint Consensus Reports of the PeriOperative Quality Initiative and the Enhanced Recovery After Surgery Cardiac Society.

Background: The identification, triage, and management of cardiogenic shock (CS) are complex and resource intensive, particularly given the recent surge in the use of temporary mechanical circulatory support (tMCS) devices. This document is an executive summary of a series of consensus statements that guide the bedside clinician regarding the management of tMCS in the setting of CS.

Methods: The PeriOperative Quality Initiative (POQI) and Enhanced Recovery After Surgery (ERAS) Cardiac Society convened an interdisciplinary, international panel of experts and used a structured appraisal of the literature and the modified Delphi method to derive consensus on a series of topics related to both CS and tMCS.

Postoperative Brain Attack: Current Perspectives and Future Directions.

The incidence of stroke after cardiac surgery poses significant challenges. This expert review piece explores current knowledge, challenges, future directions, and offers insights into improving patient outcomes through optimal prevention, early recognition, and management strategies. By addressing the challenges and opportunities in this area, we can enhance patient care, reduce long-term disabilities, and improve the overall quality of life for affected individuals.

ECMO for the pregnant and peripartum patient: A practical review of indications, unique management considerations, and an approach framework.

The use of extracorporeal membrane oxygenation (ECMO) to support the pregnant patient and fetus requires a complex decision-making process. Peripartum ECMO requires coordinated and informed decision-making between an interdisciplinary team of experts, incorporating the unique considerations and, at times, competing physiologic priorities of the pregnant patient. It is often confounded by a scarcity of local relevant experience engendered by its rare occurrence.

Trial of Oxygen Delivery on Cardiopulmonary Bypass and Major Clinical Outcomes.

Background: Low oxygen delivery (DO2) on cardiopulmonary bypass has been associated with acute kidney injury. We sought to determine the association of intraoperative DO2, postoperative length of stay, and major postoperative events.

Methods: DO2 values were calculated in 845 patients after initiation, and every 30 minutes on bypass.

Preoperative medication management turnkey order set for nonemergent adult cardiac surgery.

Objective: The management of preoperative medications is an essential component of perioperative care for the cardiac surgical patient. This turnkey order set is part of a series created by the Enhanced Recovery After Surgery Cardiac Society, first presented at the Annual Meeting of The American Association for Thoracic Surgery in 2023. Numerous guidelines and expert consensus documents have been published to provide guidance in preoperative medication management.

Randomized study of temporary diaphragm pacing for enhanced recovery after surgery in cardiac surgery patients at risk of prolonged mechanical ventilation.

Objective: Prolonged mechanical ventilation after cardiac surgery significantly increases morbidity and mortality. The aim of this study is to establish the role of diaphragmatic pacing to decrease mechanical ventilation burden in high-risk patients undergoing cardiac surgery.

Methods: This is a prospective, randomized trial of temporary diaphragmatic pacing electrode use in patients undergoing cardiac surgery (NCT04899856).

Enhanced Recovery After Surgery (ERAS) cardiac turnkey order set for perioperative pain management in cardiac surgery: Proceedings from the American Association for Thoracic Surgery (AATS) ERAS Conclave 2023.

Objective: Optimal perioperative pain management is an essential component of perioperative care for the cardiac surgical patient. This turnkey order set is part of a series created by the Enhanced Recovery After Surgery Cardiac Society, first presented at the Annual Meeting of The American Association for Thoracic Surgery in 2023. Several guidelines and expert consensus documents have been published to provide guidance on pain management and opioid reduction in cardiac surgery.

Mobility in a cardiac surgery intensive care unit: A behaviour mapping study.

Purpose: Mobilization within 24 h post-cardiac surgery (CS) supports improved patient health outcomes. Despite being safe and recommended, it is unknown how much mobility takes place post-CS in the intensive care unit (ICU). Behaviour mapping was used to describe patterns of patients' mobility in one CS ICU.

Use of Intraoperative Hemostatic Checklists for Blood Management in Patients Undergoing Cardiac Surgery: A Scoping Review.

Background: Using intraoperative hemostatic checklists may improve rates of surgical re-exploration and utilization of allogenic blood products in patients undergoing cardiac surgery. In this review, the authors explore the current evidence describing the impact of using intraoperative hemostatic checklists on reducing rates of surgical bleeding and perioperative blood product transfusion in this group of patients.

Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, electronic information was obtained via sources that included Scopus, MEDLINE, EMBASE, and the Cochrane Library.

The Use of Arts-Based Methods to Enhance Patient Engagement in Health Research.

Introduction: Patient and care partner engagement in research (PER) is important in generating knowledge to improve healthcare. Arts-based methods (ABM) use art in the research process to share aesthetic knowledge, which is knowledge that may be too complex to share only verbally. Together, PER and ABM are potentially synergistic, as both are participatory, problem-focused, dialogic, and collaborative; yet little is known of the utility of ABM for PER.

The role of Impella in the pre-procedural management of post-infarct ventricular septal defect: a systematic review.

Objectives: Post-infarct ventricular septal defect is a rare but devastating complication. Delayed treatment offers better outcomes than emergency surgery, but when acute cardiogenic shock or unstable haemodynamics occur, temporary mechanical circulatory support may be needed to stabilize patients until treatment. The aim of our systematic review was to assess the outcomes of using Impella in this setting.

Relationship between critical illness recovery and social determinants of health: a multiperspective qualitative study in British Columbia, Canada.

Objectives: There are health disparities and inequities in the outcomes of critical illness survivors related to the influence of social determinants of health on recovery. The purpose of this study was to describe the relationship between critical illness recovery and the intermediary social determinants of health in the Canadian context. Because Canadian healthcare is provided within a universal publicly funded system, this analysis sheds light on the role of social determinants of health in the context of universal health services and a relatively robust social safety net.

Neurological Complications and Outcomes in Critically Ill Patients With COVID-19: Results From International Neurological Study Group From the COVID-19 Critical Care Consortium.

Background: In this COVID-19 Critical Care Consortium (CCCC) sub-study, we qualified neurological complications associated with SARS-CoV2 infection.

Methods: The CCCC is an international, multicenter study. Eligible patients were COVID-19 patients admitted to intensive care units (ICU) across 23 centers between 1/7/2020 to 6/23/2022.