Faculty Bibliography

Vasoplegic syndrome, a form of distributive shock that may manifest during or after cardiopulmonary bypass, is a serious complication that increases morbidity and mortality after cardiac surgery. No consensus definition exists, but vasoplegic syndrome is generally described as a state of pathologic vasodilation causing hypotension refractory to fluid resuscitation and vasopressor therapy, and resulting in organ malperfusion despite a normal or increased cardiac output. Diagnosis can be complex as there is a broad differential diagnosis for low systemic vascular resistance in the cardiac surgical patient. Interpretation of hemodynamic data can also be challenging in the setting of mixed shock states and mechanical support. This narrative review summarizes the pathophysiology of vasoplegic syndrome, the literature concerning its incidence and risk factors, the hemodynamic parameters important to the diagnosis of vasoplegic syndrome, a consensus definition of the syndrome, and a proposed goal-directed treatment framework.

The presence of underrepresented minorities (URMs) in cardiothoracic anesthesiology is underwhelming, and progress toward diversity has been slow at best. Despite decades of efforts, change seems hard to achieve. For example, it took more than 30 years for women to make up 50% of medical school matriculants. However, women continue to be underrepresented in our professional subspecialty and notably. This slow movement is not idiosyncratic to women but also applies to equity related to race and ethnicity. Given this current state, this article seeks to bring attention to the lack of diversity in cardiac anesthesiology and is a call to action to accelerate efforts and the pace of change toward greater equity both in our field and in medicine in general. This piece is the final part of a 4-part series exploring opportunities for improving diversity in cardiac anesthesiology. The authors focus specifically on the professional experience of URMs in medicine in our subspecialty and the opportunities for improving diversity. While many barriers for URM physicians reflect those of women, the experience of URM practicing physicians is unique and solutions need to incorporate.

OBJECTIVES/OBJECTIVE:This study aims to characterize the risks and benefits of in-OR extubation after cardiac surgery. DESIGN/METHODS:This is a retrospective chart review. SETTING/METHODS:Single tertiary care hospital. PARTICIPANTS/METHODS:Cardiac surgical patients >18 years. Exclusion criteria included patients extubated after 6 h in the ICU, those with a history of congenital heart disease (CHD), those intubated prior to arrival to the OR, procedures including circulatory arrest and/or selective cerebral perfusion, cardiothoracic transplantation, and intraoperative death. De-identified data was collected via the hospital's electronic medical record. INTERVENTIONS/METHODS:None. MEASUREMENTS AND MAIN RESULTS/RESULTS:Perioperative data was collected for 726 patients, of which 303 (42 %) were extubated in the OR. Multivariable regression models were derived with covariates based on expert clinical reasoning. When compared to fast track extubation, in-OR extubation was independently associated with decreased index hospitalization length of stay (-1.74, 95 % CI [-2.22, -1.08], p < 0.001) and decreased incidence of in-hospital new post-operative atrial fibrillation (OR 0.56 95 % CI [0.37, 0.86], p < 0.01). There were no differences in persistent vasoactive therapy requirement, postoperative mechanical circulatory support or extubation failure. CONCLUSIONS:In-OR extubation is associated with decreased index hospitalization length of stay and decreased new onset in-hospital atrial fibrillation.

The Society of Cardiovascular Anesthesiologists (SCA) is committed to improving the quality, safety, and value that cardiothoracic anesthesiologists bring to patient care. To fulfill this mission, the SCA supports the creation of peer-reviewed manuscripts that establish standards, produce guidelines, critically analyze the literature, interpret preexisting guidelines, and allow experts to engage in consensus opinion. The aim of this report, commissioned by the SCA President, is to summarize the distinctions among these publications and describe a novel SCA-supported framework that provides guidance to SCA members for the creation of these publications. The ultimate goal is that through a standardized and transparent process, the SCA will facilitate up-to-date education and implementation of best practices by cardiovascular and thoracic anesthesiologists to improve patient safety, quality of care, and outcomes.