Early Percutaneous Heparin-Free Veno-Venous Extra Corporeal Life Support (ECLS) is a Safe and Effective Means of Salvaging Hypoxemic Patients with Complicated Chest Trauma.

BACKGROUND: The objective of this study was to assess the feasibility and safety of heparin-free veno-venous extracorporeal life support (VV ECLS) as a means of salvaging polytrauma patients with life-threatening hypoxemia. METHODS: This is a retrospective observational study on 7 consecutive trauma patients who underwent VV ECLS for severe chest trauma unresponsive to conventional measures. RESULTS: The median time to ECLS was within 10 hrs (IQR 2-53) of mechanical ventilation. Surgical interventions were performed before and during ECLS based on management priorities consistent with advanced trauma life support guidelines. No heparin was used for at least 4 days in this group with activated coagulation time (ACT) approximating 170 seconds by the 3(rd) and 4(th) day. There were no thromboembolic complications. Four patients were successfully discharged and three of these survivors had concomitant traumatic brain injury (TBI) without neurologic sequel. CONCLUSIONS: Early VV ECLS can be used for salvage of patients with traumatic lung injury. Acute trauma care can be continued as needed under heparin-free ECLS without the fear of thromboembolic complications. KEY WORDS: Adult respiratory distress syndrome; Extracorporeal life support; Multiple trauma; Thoracic injury; Traumatic brain injury.

Plasma B-type natriuretic peptide in predicting outcomes of elective coronary artery bypass surgery.

The risks of surgery and its clinical outcome are of great importance for both patients and physicians when choosing coronary artery bypass (CABG) surgery for coronary artery disease. The purpose of the current study was to clarify the relationship between serum B-type natriuretic peptide (BNP) and patient clinical outcome. Seventy-six eligible patients who underwent CABG were enrolled into the prospective study. Venous blood samples were drawn for serum BNP and N-terminal (NT)-proBNP levels measurement on preoperative Day 1, postoperative Day 1, and postoperative Day 7. Clinical end points were: (1) intensive care unit (ICU) stay longer than 4 days postoperatively and/or hospital stay longer than 13 days postoperatively; (2) major complications and poor outcomes. Patients who had prolonged ICU stay and hospitalization had significantly higher postoperative Day 1 BNP and postoperative Day 1 NT-proBNP level (p = 0.02 and 0.005, respectively). Age was significantly older in patients with prolonged ICU stay and hospitalization than those without prolonged ICU stay and hospitalization (p = 0.03). Serum creatinine level was also significantly increased in patients with prolonged ICU stay and hospitalization (p = 0.009). However, age was the only remaining factor that correlated with prolonged ICU stay and hospitalization in the multivariate logistic regression model. These results suggest that research using BNP and NT-proBNP for predicting ICU stay and hospitalization in patients who have undergone CABG must adjust risk factors to present a more appropriate estimation of its clinical outcome.

Acute cholecystitis after minimally invasive coronary artery bypass grafting: a report 2 cases.

Acute cholecystitis following coronary artery bypass grafting (CABG), although rare, is a potentially life-threatening consequence of prolonged cardiopulmonary bypass (CPB)procedures. Minimally invasive direct coronary artery bypass (MIDCAB), performed without sternotomy and without CPB, is perhaps the least traumatic type of CABG procedure.Nevertheless, we present 2 cases of acute cholecystitis following MIDCAB, demonstrating that a MIDCAB does not eliminate the risk of gastrointestinal complications. Our experience with these cases points to the benefits of early and aggressive management in the treatment of acute cholecystitis after MIDCAB.