Extracorporeal membrane oxygenation cardiopulmonary resuscitation, a luxury we cannot afford missing: a narrative review Hisham Hosny, Katherine A Good The Egyptian Journal of Cardiothoracic Anesthesia 2019 13(1):1-5 Extracorporeal membrane oxygenation (ECMO) was introduced into practice since more than four decades to support patients with advanced yet potentially reversible cardiopulmonary failure. Following several prospective clinical trials, ECMO is considered a widely accepted support modality in severe neonatal respiratory failure and in pediatric cardiac failure, particularly in the perioperative environment. Compared with conventional CPR, ECPR provides higher level of cardiac output support and several potential advantages including a higher rate of successful ROSC, support of post-resuscitation cardiogenic shock while arranging and performing coronary interventions and maintaining organ perfusion during recovery of native cardiac output.

Antiplatelet therapy and the anaesthetist Sian I Jaggar The Egyptian Journal of Cardiothoracic Anesthesia 2019 13(1):6-9 Increasing numbers of patients internationally are taking dual antiplatelet therapy (DAPT). Both continuing and stopping this treatment may be risky for the patient. It is vital to consider the competing thrombotic and bleeding risks in the perioperative period. It is incumbent upon anaesthetists to maintain their knowledge base in this rapidly developing area. This article provides information to support practice as.

Superior vena cava syndrome after cardiac surgery Heba Arafat, Ghada Ali The Egyptian Journal of Cardiothoracic Anesthesia 2019 13(1):10-13 Superior vena cava (SVC) syndrome is a group of symptoms caused by obstruction of the SVC at the junction of the right atrium. This obstruction was found to be caused by either external compression or internal occlusion. It leads then to impaired venous drainage into the heart, which will in turn reduce the preload and consequently the cardiac output that might be fatal at some stage. On the flip side, it causes blood engorgement of the upper half of the body resulting in swelling and increased pressures. SVC syndrome may happen acutely in relation to cardiac surgery as a less frequent complication. It might be then caused by mechanical obstruction by a retractor, improper placement of venous cannula, thrombus formation on top of indwelling catheters or pacemaker wires, or overflow following ‘Glenn’ surgery in pediatrics. Diagnosis of the SVC syndrome should involve a high index of suspicion in the context of cardiac surgery especially that the manifestations are not classic in all cases. So, once the manifestations of the syndrome start to appear, prompt actions should be taken to confirm the diagnosis and to start treatment to avoid hemodynamic instability resulting from the dramatic decrease in preload, taking into consideration the limited time available for the collateral drainage (e.g. from azygos, hemiazygos, or internal mammary veins) to develop and bypass the obstruction. Exploring different causes of developing SVC syndrome after cardiac surgery would help early diagnosis and management, which could be lifesaving in many scenarios.

Off-pump coronary artery grafting in awake patients with comorbidities using high thoracic epidural anesthesia Ahmed S Mahmoud, Passaint M Fahim The Egyptian Journal of Cardiothoracic Anesthesia 2019 13(1):14-18 Background General anesthesia (GA) can be itself an obstacle to some patients with comorbidities to operate upon a mandatory cardiac surgery. Patients and methods Between January 2013 and May 2017 in the Cardiothoracic Surgery Department, Cairo University Hospitals; 31 patients of awake ‘off-pump’ (without cardiopulmonary bypass) coronary bypass surgery were performed by sternotomy, facilitated by thoracic epidural anesthesia. Analgesia was provided with thoracic epidural anesthesia at T2–3 interspace, using bupivacaine 0.5%, lidocaine 2%, and fentanyl 2 μg/ml until T1–8 dermatomal block was achieved, and then was maintained at 8–12 ml/h throughout the surgery. Success of awake off-pump coronary artery bypass grafting, without GA with appropriate surgical and medical conditions, was the target of the study. Results Thirty-one patients (range, 50–70 years) median, 61 years, weight (range, 70–109 kg) median, 78 kg, underwent surgery. Five (16%) patients needed conversion to GA: the left internal mammary artery was dissected, a saphenous vein graft was needed instead. Awake surgery was successful without complications in 68% of cases. Conclusions Off-pump coronary artery bypass grafting in awake old patients can be considered a safe and feasible technique with convenient surgical outcome especially in patients who cannot tolerate GA.

Sudden onset of coma with anisocoria in a patient with type A aortic dissection: dilemma in management? Srinath Damodaran, Krishna P Gourav, Sunita Kajal, Kamal Kajal The Egyptian Journal of Cardiothoracic Anesthesia 2019 13(1):19-22