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Books on the topic 'Extracorporeal Membrane Oxygenation (ECMO)'

Author: Grafiati

Published: 4 June 2021

Last updated: 10 March 2023

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1

B, Zwischenberger Joseph, Bartlett Robert H, and Extracorporeal Life Support Organization, eds. ECMO: Extracorporeal cardiopulmonary support in critical care. 2nd ed. [Ann Arbor, Mich.?]: Extracorporeal Life Support Organization, 2000.

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2

B, Zwischenberger Joseph, Bartlett Robert H, and Extracorporeal Life Support Organization, eds. ECMO: Extracorporeal cardiopulmonary support in critical care. [Ann Arbor, MI]: Extracorporeal Life Support Organization, 1995.

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3

Harris, Samantha. A grounded theory study to explore the experiences of nurses concerning the withdrawal of extracorporeal membrane oxygenation (ECMO) treatment. Leicester: De Montfort University, 2001.

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4

Schmidt, Gregory A., ed. Extracorporeal Membrane Oxygenation for Adults. Cham: Springer International Publishing, 2022. http://dx.doi.org/10.1007/978-3-031-05299-6.

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5

M, Arensman Robert, and Cornish J. Devn, eds. Extracorporeal life support. Boston: Blackwell Scientific Publications, 1993.

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6

1948-, Boynton Bruce R., Carlo Waldemar A, and Jobe Alan H, eds. New therapies for neonatal respiratory failure: A physiological approach. Cambridge: Cambridge University Press, 1994.

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7

1958-, Duncan Brian W., ed. Mechanical support for cardiac and respiratory failure in pediatric patients. New York: M. Dekker, 2001.

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8

Maybauer, Marc O., ed. Extracorporeal Membrane Oxygenation. Oxford University Press, 2022. http://dx.doi.org/10.1093/med/9780197521304.001.0001.

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Extracorporeal Membrane Oxygenation—An Interdisciplinary Problem-Based Learning Approach provides an overview of the latest techniques, management strategies, and technology surrounding the clinical use of ECMO. This interdisciplinary book reviews the most common scenarios of ECMO in 62 chapters exploring the conditions and problems arising in ECMO practice. Each chapter begins with a stem case, followed by open questions to encourage critical thinking and enable the reader to follow the management strategies of the authors, who are world leaders in the field. Followed by an evidence-based discussion, each chapter concludes with multiple-choice questions for self-assessment. This book is current in its knowledge of organ systems and management and keeps pace with new ECMO technology and surgical techniques coupled with current guidelines for management. Starting with the history of ECMO to technical aspects, circuit biocompatibility and interaction with blood, drugs, and flow physics, the volume then continues into pediatric and adult sections, focusing on both respiratory and cardiovascular support, followed by a section on trauma. The volume then concludes with a section on neurologic complications and ethics, as well as rehabilitation and ambulation of ECMO patients. In addition, to reflect the current global health situation, this book includes a chapter on ECMO management in patients suffering with COVID-19 to cover the most urgent and pressing questions around ECMO during the ongoing pandemic. This is the first ECMO book on the market to utilize a problem-based learning approach and as such is an important unprecedented project on ECMO education.

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9

Manual of Extracorporeal Membrane Oxygenation (ECMO) in the ICU. Jaypee Brothers Medical Publishers (P) Ltd., 2014. http://dx.doi.org/10.5005/jp/books/12297.

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10

Baram, Michael, Nitin Puri, and Nicholas Cavarocchi. Extracorporeal Membrane Oxygenation (ECMO), an Issue of Critical Care Clinics. Elsevier - Health Sciences Division, 2017.

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11

Dalton, Heidi J., Mark Davidson, and Peter P. Roeleveld. Extracorporeal Life Support. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199918027.003.0002.

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Extracorporeal membrane oxygenation (ECMO) can provide support as a bridge to recovery or a bridge to more definitive therapy for patients with severe respiratory or cardiorespiratory disease. In this chapter, the criteria for ECMO are discussed and a practical decision tree for mode of ECMO (venovenous or venoarterial) is presented. A stepwise approach to initiation and management of ECMO for the patient is described, including flow rate goals, ventilator management, anticoagulation, blood product replacement, identification of recovery, weaning procedures, and specific issues relating to the two different modes of ECMO.

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12

Bellani, Giacomo, and Antonio Pesenti. Treating respiratory failure with extracorporeal support in the ICU. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0105.

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During extracorporeal support or extracorporeal membrane oxygenation (ECMO) blood is diverted from the patient to an artificial lung for gas exchange, then returned into the patient’s circulation once arterialized. While a low-blood-flow bypass can remove comparatively high amounts of CO2, oxygenation is limited by venous haemoglobin saturation and requires high flows. Several technical improvements led to a profound change in the safety and applicability of ECMO in recent years, even permitting the transfer of patients undergoing ECMO. ECMO has been proposed as salvage therapy for the most severe acute respiratory distress syndrome patients—warranting viable levels of oxygenation. In 2009, the ‘CESAR’ trial provided formal evidence in favour of ECMO application in adults with ARDS. An important indication for the early use of ECMO in ARDS came from the outbreaks of H1N1 influenza, when several countries set up networks aimed at coordinating the application of ECMO. Recent reports suggest the use of ECMO in less severe patients with the purpose of removing CO2, decreasing the need for ventilation and ventilator-induced lung injury,

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13

Khan, Sabina A., and Nitin Wadhwa. Congenital Diaphragmatic Hernia. Edited by Kirk Lalwani, Ira Todd Cohen, Ellen Y. Choi, and Vidya T. Raman. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190685157.003.0016.

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Congenital diaphragmatic hernia (CDH) is characterized by malformation of the diaphragm, allowing for herniation of abdominal contents into the thoracic cavity. The most significant sequelae of this herniation are pulmonary hypoplasia and pulmonary hypertension, both contributing to significant morbidity and mortality. Multiple strategies exist to minimize respiratory compromise and improve outcome in a patient with CDH, including fetal intervention in selective cases, medical and pharmaceutical management, advanced ventilation strategies, extracorporeal membrane oxygenation (ECMO), and complete surgical repair. Veno-arterial ECMO (circuit between the internal jugular vein and the carotid artery) is used in infants who are unstable and require aggressive cardiopulmonary support, and veno-venous ECMO (circuit with a double lumen catheter in the internal jugular vein) is used in infants who only need respiratory support.

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14

ANSI/AAMI/ISO 15676:2016; Cardiovascular implants and artificial organs—Requirements for single-use tubing packs for cardiopulmonary bypass and extracorporeal membrane oxygenation (ECMO). AAMI, 2016. http://dx.doi.org/10.2345/9781570206382.

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15

Kreit, John W. Acute Respiratory Distress Syndrome (ARDS). Edited by John W. Kreit. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190670085.003.0012.

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Acute Respiratory Distress Syndrome reviews the definitions, causes, pathophysiology, and management of this relatively common, life-threatening disorder. This chapter describes how to ensure adequate tissue oxygen delivery while minimizing ventilator-induced lung injury and provides an in-depth review of how to determine the optimum level of positive end-expiratory pressure (PEEP). The first topic addressed is the precipitating factors and pathophysiology of acute respiratory distress syndrome. Next the chapter turns to mechanical ventilation, and covers the subjects of adequate oxygenation, ventilator-induced lung injury, ancillary therapies, ventilatory therapies, and high I:E ventilation. The topics addressed in the area of non-ventilatory therapies include: prone positioning of the patient, neuromuscular blockade, inhaled vasodilators, and extracorporeal membrane oxygenation (ECMO).

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16

Wagner, Beth. Withdrawal of Respiratory Technology. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190204709.003.0012.

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Respiratory failure can be defined as the inability of the lungs to provide adequate oxygenation or ventilation to sustain life. Respiratory failure can lead to abrupt clinical deterioration and is extremely distressing for patients and families. Advances in technology over the past decade have produced many life-sustaining therapies for patients with respiratory failure. Examples include high-flow oxygen therapy, invasive and noninvasive mechanically assisted breathing ventilation, prostacyclin therapy, and extracorporeal membrane oxygenation (ECMO). The care of these complex patients necessitates policies and procedures to assure quality care in withdrawal. Standardized protocols for withdrawal of life-sustaining respiratory therapies provide structured guidance, reduce variation in practice, and improve family and healthcare provider satisfaction.

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17

Fox, Grenville, Nicholas Hoque, and Timothy Watts. Respiratory support. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780198703952.003.0008.

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This chapter includes sections on various modes of both invasive (i.e. via an endotracheal tube) and non-invasive respiratory support in neonates, including conventional ventilation, volume-targeted ventilation, high-frequency oscillatory ventilation (HFOV), extracorporeal membrane oxygenation (ECMO), nasal continuous positive airways pressure (nCPAP), nasal intermittent positive pressure ventilation (nIPPV), and high and low-flow nasal cannula oxygen. There is also a brief section on the care of babies with a tracheostomy as well as management of babies requiring home oxygen. Reference is made to the most recent European Consensus Guidelines. A separate chapter on neonatal respiratory problems (Chapter 7) gives further detail on common lung pathologies requiring respiratory support in neonates.

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18

Blaikley, John, and Andrew J. Fisher. Lung transplantation. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780198702948.003.0011.

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This chapter describes common issues along the transplantation journey from assessment to common conditions that are diagnosed post transplantation. Assessment for transplant suitability against several objective criteria is covered as well as the importance of optimizing techniques prior to this. Recent advances mean that some patients can now be bridged to transplant using extracorporeal membrane oxygenation (ECMO) when previously they would have been removed from the transplant list. Drawbacks to ECMO are discussed. Ex-vivo lung perfusion (EVLP) of a donor organ is covered. Follow-up is considered, especially in the early phase whilst being stabilized on their new medications as well as monitoring for the development of lung rejection (acute and chronic). These conditions often present when patients are being seen away from the transplant centre. CF patients have the best outcomes of the groups after lung transplantation, emphasising that lung transplantation should be considered in this specific group of patients.

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19

Botsch, Alex, Julie Aultman, Michael S. Firstenberg, and Dianne McCallister. Extracorporeal Membrane Oxygenation. DI Press, 2022.

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20

Evans, Charlotte, Anne Creaton, Marcus Kennedy, and Terry Martin, eds. Cardiac. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198722168.003.0009.

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Retrieval of patients with cardiac emergencies makes up a large chunk of the workload of most retrieval services. Cases range from the routine to the most challenging unstable patients with complex physiology and high-level support requirements. The transfer of patients for time-critical interventions mean that the adrenaline levels of the retrieval clinician may approach those of the patient. Included are clinical and logistical considerations for patients with acute coronary syndromes, pulmonary oedema, cardiogenic shock, arrhythmias, and those requiring pacing. Aortic dissection and pulmonary embolus are also discussed in detail. With the development of smaller more portable devices the use of intra-aortic balloon pumps (IABP) and extracorporeal membrane oxygenation (ECMO) in the retrieval environment has increased. While many retrieval services routinely perform retrieval of these patients, the technology can intimidate those who do not use it regularly. The operation and key features of these devices is included.

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21

Schmidt, Gregory A. Extracorporeal Membrane Oxygenation for Adults. Springer International Publishing AG, 2022.

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22

Firstenberg, Michael S., ed. Extracorporeal Membrane Oxygenation: Advances in Therapy. InTech, 2016. http://dx.doi.org/10.5772/61536.

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23

Extracorporeal Membrane Oxygenation Support Therapy [Working Title]. IntechOpen, 2022. http://dx.doi.org/10.5772/intechopen.101000.

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24

S. Firstenberg, Michael, ed. Advances in Extracorporeal Membrane Oxygenation - Volume 3. IntechOpen, 2019. http://dx.doi.org/10.5772/intechopen.77697.

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25

Firstenberg, Michael S. Extracorporeal Membrane Oxygenation: Types, Medical Uses and Complications. Nova Science Publishers, Incorporated, 2020.

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26

Firstenberg, Michael S. Extracorporeal Membrane Oxygenation: Types, Medical Uses and Complications. Nova Science Publishers, Incorporated, 2021.

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27

Firstenberg, Michael S. Practice and Principles of Extra-Corporeal Membrane Oxygenation (ECMO). Nova Science Publishers, Incorporated, 2021.

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28

Firstenberg, Michael S. Practice and Principles of Extra-Corporeal Membrane Oxygenation (ECMO). Nova Science Publishers, Incorporated, 2021.

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29

Kapoor, Poonam Malhotra. Manual of Extracorporeal Membrane Oxygen (ECMO) in the ICU. Jaypee Brothers Medical Publishers, 2013.

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30

Extracorporeal Membrane Oxygenation: An Interdisciplinary Problem-Based Learning Approach. Oxford University Press, Incorporated, 2021.

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31

Dan M., M.D. Meyer and Michael E., M.D. Jessen. Extracorporeal Life Support (Vademecum). Landes Bioscience, 2001.

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32

Landauer, B., and E. Kolb. Zur Funktionellen Beeinflussung der Lunge Durch Anaesthetica. Springer London, Limited, 2013.

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33

Westrope, Claire, and Giles Peek. Extracorporeal respiratory and cardiac support techniques in the ICU. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0104.

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Extra corporeal life support (ECLS) is an essential tool for the modern intensivist and surgeon. The addition of extracorporeal therapy should be considered in all cases when pathology is potentially reversible and conventional therapy is clearly failing. ECLS is a general term to describe prolonged, but temporary support of heart and lung function using mechanical devices, which has developed as an extension of cardiopulmonary bypass techniques used in the operating theatre. Use in adult severe respiratory and cardiac failure is increasing following significant advances in ECLS techniques learnt from paediatric and neonatal experiences, and successful use of extra corporeal membrane oxygenation in the 2009 and 2001 H1N1 (swine flu) outbreaks. This chapter describes the techniques required for providing successful ECLS in adult respiratory and cardiac failure.

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34

Mechanical Circulatory Support (Landes Bioscience Medical Handbook (Vademecum)). Landes Bioscience, 1999.

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35

Navaratnam, M., and C. Ramamoorthy. Hypoplastic Left Heart Syndrome. Edited by Kirk Lalwani, Ira Todd Cohen, Ellen Y. Choi, and Vidya T. Raman. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190685157.003.0009.

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Approximately 960 babies are born per year in the United States with hypoplastic left heart syndrome. Over the last 20 years, advances in surgical techniques, perioperative care, cardiopulmonary bypass, and intensive care unit management have converted this previously fatal condition to one with a neonatal survival rate of 90% to 92% for standard risk patients. Understanding the factors affecting the balance of pulmonary blood flow and systemic blood flow and ensuring adequate cardiac output and end-organ perfusion is critical to successful outcomes. Extracorporeal membrane oxygenation remains an important support modality following stage I palliation. This chapter discusses this syndrome and describes treatment options.

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36

Cropsey, Christopher L., and Patrick B. Knight. Beta Blocker/Calcium Channel Blocker Overdose. Edited by Matthew D. McEvoy and Cory M. Furse. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190226459.003.0088.

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Beta blocker and calcium channel blocker overdose is a rare perioperative complication that manifests with symptoms of altered mental status, hypotension, bradycardia, and cardiovascular collapse. Although the clinical presentation is often similar, the underlying pathophysiology can differ between either cardiogenic or vasodilatory shock. Standard therapies such as calcium administration or beta-adrenergic agonists may be effective but often require much higher doses than normal. The evidence for targeted therapies, such as high-dose insulin infusion and glucagon, is mixed, but these should be considered. Refractory toxicity may require advanced lifesaving measures such as intra-arterial balloon counterpulsation or extracorporeal membrane oxygenation. If prompt cardiovascular support can be achieved, patient outcomes are generally very positive.

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37

Ferguson, Colin. Pathophysiology and management of hypothermia. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0354.

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Accidental hypothermia is defined as a core temperature of <35°C and is uncommon. It may present in any age group at any time of the year. Hypothermia may be primary, where the cold injury is the major pathology, or secondary where patients develop hypothermia incidental to another illness. Since the severely cold patient may be in cardiac arrest, areflexic, and in coma, decision making regarding treatment, its initiation, and continuation, may be difficult. Hypothermia is classified into mild (33–35°C), moderate (28–33°C) and severe (<28°C), but these are not distinct clinical syndromes. A more recent classification into stages has emerged from alpine medicine along with a treatment algorithm based on it. Many pathophysiogical changes are due to reduced enzyme action. Clinical features include changes in higher cerebral functions with bizarre behaviour progressing to coma. In the circulation initial tachycardia and hypertension (‘cold stress’) are replaced, as the patient cools, with worsening hypotension and bradycardia and, eventually, ventricular fibrillation and asystole. Rewarming methods are classified as passive or active and the latter subdivided into external, core, and extracorporeal. Active warming should be considered for patients with a temperature of 32°C or lower. Peritoneal lavage has the advantage of warming the liver directly and also the heart through the diaphragm. Cardiopulmonary bypass is the extracorporeal method with most experience, but the advent of extracorporeal membrane oxygenation has the advantage of portability.

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38

Garner, Justin, and David Treacher. Intensive care unit and ventilation. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199657742.003.0009.

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Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are characterized by rapidly developing hypoxaemic respiratory failure and bilateral pulmonary infiltrates on chest X-ray. ALI/ARDS are a relatively frequent diagnosis in protracted-stay patients in the intensive care unit. The pathology is a non-specific response to a wide variety of insults. Impaired gas exchange, ventilation-perfusion mismatch, and reduced compliance ensue. Mechanical ventilation is the mainstay of management, along with treatment of the underlying cause. Mortality remains very high at around 40%. The condition is challenging to treat. Injury to the lungs, indistinguishable from that of ARDS, has been attributed to the use of excessive tidal volumes, pressures, and repeated opening and collapsing of alveoli. Lung-protective strategies aim to minimize the effects of ventilator-induced lung injury. Use of low tidal volume ventilation has been shown to improve mortality. Emerging ventilatory therapies include high-frequency oscillatory ventilation and extracorporeal membrane oxygenation.

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39

Almond, Mark H., and Mark J. Griffiths. Swine ‘flu’ in pregnancy. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199657742.003.0020.

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Influenza viruses are a significant cause of morbidity and mortality globally, resulting in severe illness in 3-5 million people and death in up to 500,000 during epidemic years. In March 2009, a novel H1N1 virus emerged in Mexico, spreading rapidly around the globe and achieving pandemic status within 3 months. Although it is now generally considered that the 2009 pandemic resulted in mild disease in most individuals, serious complications still occurred, with 12,000 deaths by mid-February 2010 in the United States alone. Risk factors for severe disease included asthma, cardiac disease, immunosuppression, pregnancy, diabetes mellitus, and obesity. The chapter outlines the case of a young pregnant female who presented with an influenza-like illness and subsequently developed acute respiratory distress syndrome requiring extracorporeal membrane oxygenation. The origins, presentation, diagnosis, complications, and management of pandemic influenza are discussed, in addition to a summary of the pulmonary physiology and pathology of pregnancy.

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40

Rady, Mohamed Y., and Ari R. Joffe. Non-heart-beating organ donation. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0390.

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The transplantation community endorses controlled and uncontrolled non-heart-beating organ donation (NHBD) to increase the supply of transplantable organs at end of life. Cardiac arrest must occur within 1–2 hours after the withdrawal of life-support in controlled NHBD. Uncontrolled NHBD is performed after failed cardiopulmonary resuscitation in an unexpected witnessed cardiac arrest. Donor management aims to protect transplantable organs against warm ischaemic injury through the optimization of haemodynamics and mechanical ventilation. This also requires antemortem instrumentation and systemic anticoagulation for organ perseveration in controlled NHBD. Interval support with extracorporeal membrane oxygenation or cardiopulmonary bypass is generally required for optimal organ perfusion and oxygenation in uncontrolled NHBD, which remains a controversial medical practice. There are several unresolved ethical challenges. The circulatory criterion of 2–10 minutes of absent arterial pulse does not comply with the uniform determination of death criterion of the irreversible cessation of functions of the cardiovascular or central nervous systems. There are no robust safeguards in clinical practice that can prevent faulty prognostication, and premature withdrawal of treatment or termination of cardiopulmonary resuscitation. Unmanaged conflicting interests of increasing the supply of transplantable organs can have serious consequences on the medical care of potentially salvageable patients. Perimortem interventions can interfere with the delivery of an optimal quality of end-of-life care. The lack of disclosure of these NHBD ethical controversies does not uphold the moral obligation for an informed consent.

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41

Davierwala, Piroze M., and Friedrich W. Mohr. Coronary artery bypass graft surgery. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199687039.003.0048.

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The surgical management of acute coronary syndrome still remains a challenge for the cardiac surgeon. Although most patients can be managed by percutaneous coronary intervention, for patients with complex multivessel or left main coronary artery disease (high SYNTAX score), in whom percutaneous coronary intervention is not possible or is unsuccessful, urgent or emergent coronary artery bypass graft surgery is the only available option. It is very important for surgeons to determine the optimum timing of surgical intervention, which is usually based on the clinical presentation, coronary anatomy, and biomarkers. Surgeons should be conversant with the different operative techniques, whether off- or on-pump coronary artery bypass graft surgery, that would help in achieving the best possible outcomes in such situations. Early and late survival of patients depends not only on an efficiently executed operation, but also on the competency of the post-operative care delivered. Modern perioperative management is reinforced by the availability of a variety of mechanical cardiopulmonary assist devices, like the intra-aortic balloon pump, the extracorporeal membrane oxygenation, and an array of ventricular assist devices, which aid us in managing very sick patients presenting with cardiogenic shock. The results of coronary artery bypass graft surgery for acute coronary syndrome, as published in the literature, vary significantly, because of the heterogeneity of patient populations, operative timing, and haemodynamic status, making a comparison of surgical outcomes almost impossible. Only one randomized trial has been conducted to that effect, to date. A heart team approach, involving an interventional cardiologist and a cardiac surgeon, is mandatory to determine the best treatment strategy and achieve the best possible outcomes in patients with acute coronary syndrome.

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42

Davierwala, Piroze M., and Friedrich W. Mohr. Coronary artery bypass graft surgery. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199687039.003.0048_update_001.

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The surgical management of acute coronary syndrome still remains a challenge for the cardiac surgeon. Although most patients can be managed by percutaneous coronary intervention, for patients with complex multivessel or left main coronary artery disease (high SYNTAX score), in whom percutaneous coronary intervention is not possible or is unsuccessful, urgent or emergent coronary artery bypass graft surgery is the only available option. It is very important for surgeons to determine the optimum timing of surgical intervention, which is usually based on the clinical presentation, coronary anatomy, and biomarkers. Surgeons should be conversant with the different operative techniques, whether off- or on-pump coronary artery bypass graft surgery, that would help in achieving the best possible outcomes in such situations. Early and late survival of patients depends not only on an efficiently executed operation, but also on the competency of the post-operative care delivered. Modern perioperative management is reinforced by the availability of a variety of mechanical cardiopulmonary assist devices, like the intra-aortic balloon pump, the extracorporeal membrane oxygenation, and an array of ventricular assist devices, which aid us in managing very sick patients presenting with cardiogenic shock. The results of coronary artery bypass graft surgery for acute coronary syndrome, as published in the literature, vary significantly, because of the heterogeneity of patient populations, operative timing, and haemodynamic status, making a comparison of surgical outcomes almost impossible. Only one randomized trial has been conducted to that effect, to date. A heart team approach, involving an interventional cardiologist and a cardiac surgeon, is mandatory to determine the best treatment strategy and achieve the best possible outcomes in patients with acute coronary syndrome.

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43

Davierwala, Piroze M., and Friedrich W. Mohr. Coronary artery bypass graft surgery. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199687039.003.0048_update_002.

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The surgical management of acute coronary syndrome still remains a challenge for the cardiac surgeon. Although most patients can be managed by percutaneous coronary intervention, for patients with complex multivessel or left main coronary artery disease (high SYNTAX score), in whom percutaneous coronary intervention is not possible or is unsuccessful, urgent or emergent coronary artery bypass graft surgery is the only available option. It is very important for surgeons to determine the optimum timing of surgical intervention, which is usually based on the clinical presentation, coronary anatomy, and biomarkers. Surgeons should be conversant with the different operative techniques, whether off- or on-pump coronary artery bypass graft surgery, that would help in achieving the best possible outcomes in such situations. Early and late survival of patients depends not only on an efficiently executed operation, but also on the competency of the post-operative care delivered. Modern perioperative management is reinforced by the availability of a variety of mechanical cardiopulmonary assist devices, like the intra-aortic balloon pump, the extracorporeal membrane oxygenation, and an array of ventricular assist devices, which aid us in managing very sick patients presenting with cardiogenic shock. The results of coronary artery bypass graft surgery for acute coronary syndrome, as published in the literature, vary significantly, because of the heterogeneity of patient populations, operative timing, and haemodynamic status, making a comparison of surgical outcomes almost impossible. Only one randomized trial has been conducted to that effect, to date. A heart team approach, involving an interventional cardiologist and a cardiac surgeon, is mandatory to determine the best treatment strategy and achieve the best possible outcomes in patients with acute coronary syndrome.

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44

Davierwala, Piroze M., and Friedrich W. Mohr. Coronary artery bypass graft surgery. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199687039.003.0048_update_003.

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The surgical management of acute coronary syndrome still remains a challenge for the cardiac surgeon. Although most patients can be managed by percutaneous coronary intervention, for patients with complex multivessel or left main coronary artery disease (high SYNTAX score), in whom percutaneous coronary intervention is not possible or is unsuccessful, urgent or emergent coronary artery bypass graft surgery is the only available option. It is very important for surgeons to determine the optimum timing of surgical intervention, which is usually based on the clinical presentation, coronary anatomy, and biomarkers. Surgeons should be conversant with the different operative techniques, whether off- or on-pump coronary artery bypass graft surgery, that would help in achieving the best possible outcomes in such situations. Early and late survival of patients depends not only on an efficiently executed operation, but also on the competency of the post-operative care delivered. Modern perioperative management is reinforced by the availability of a variety of mechanical cardiopulmonary assist devices, like the intra-aortic balloon pump, the extracorporeal membrane oxygenation, and an array of ventricular assist devices, which aid us in managing very sick patients presenting with cardiogenic shock. The results of coronary artery bypass graft surgery for acute coronary syndrome, as published in the literature, vary significantly, because of the heterogeneity of patient populations, operative timing, and haemodynamic status, making a comparison of surgical outcomes almost impossible. Only one randomized trial has been conducted to that effect, to date. A heart team approach, involving an interventional cardiologist and a cardiac surgeon, is mandatory to determine the best treatment strategy and achieve the best possible outcomes in patients with acute coronary syndrome.

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