Section 1: Enhanced Recovery in the ICU After Cardiac Surgery
Preface
How to Start an Enhanced Recovery After Surgery Cardiac Program
Key points
Background
Organizing a dedicated enhanced recovery after surgery cardiac team
Designing an enhanced recovery after surgery cardiac protocol
Receiving input from all key stakeholders
Implementing effective educational initiatives
Pursuing continuous process improvement
Summary: building a timeline for success
Surgical Site Infections in Cardiac Surgery
Key points
Introduction
Definitions
Preoperative interventions: before admission
Preoperative interventions on admission
Intraoperative interventions
Postoperative interventions
Summary
Preoperative Treatment of Malnutrition and Sarcopenia in Cardiac Surgery: New Frontiers
Key points
Introduction
Optimization of Nutritional Status
Optimization of muscle mass and physical function
Summary
Orthopedic Principles to Facilitate Enhanced Recovery After Cardiac Surgery
Key points
The evolution from “fast-track” to “enhanced recovery” after cardiac surgery
Median sternotomy as an obstacle and opportunity for eras after cardiac surgery
Orthopedic principles: the recipe for successful healing and early mobilization after sternotomy
Sternal-closure techniques in the context of orthopedic principles
Rigid-plate fixation and rapid mobilization
Summary
Postoperative Multimodal Analgesia in Cardiac Surgery
Key points
Introduction
Traditional opioid analgesia
Multimodal/opioid-sparing analgesia
Regional anesthetics in cardiac surgery
Alternative analgesic therapies
Pain assessment
Success with multimodal therapy
Goal-Directed Therapy for Cardiac Surgery
Key points
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Introduction
Goal-directed therapy outcomes
Quality and value considerations
Innovation and research
Summary
Early Extubation in Enhanced Recovery from Cardiac Surgery
Key points
Introduction
Background
Early extubation
Perioperative journey
Preoperative phase
Intraoperative
Postoperative
Summary
Delirium Prevention in Postcardiac Surgical Critical Care
Key points
Introduction
How common is delirium among postcardiac surgery patients?
Who gets delirious, and why does it happen after cardiac surgery? The risk factors of delirium
Why does it matter? The short- and long-term impact of the occurrence of postoperative delirium following cardiac
surgery
Identifying delirium in cardiac surgery intensive care unit patients
It takes a team! A multicomponent approach to delirium management
Call for action/future work
Summary
Prevention of Acute Kidney Injury
Key points
Introduction
What? Definition of acute kidney injury
Why? Pathogenesis of cardiac surgery–associated acute kidney injury
Who? Risk stratification and prediction
When? Cardiac surgery–associated acute kidney injury—diagnosis and early recognition
If…Prevention of cardiac surgery–associated acute kidney injury
How…Clinical management
Summary
Section 2: New Developments in Cardiopulmonary Resuscitation
Preface
Optimal Airway Management in Cardiac Arrest
Key points
Introduction
Bag-valve mask ventilation
Cardiac Arrest Airway Management trial
Bag-valve mask performance
Supraglottic airways
Pragmatic Airway Resuscitation Trial
Airways-2
Endotracheal intubation
First-attempt success
Intubation skill development and maintenance
Adjuncts for intubation
Summary
Role of Vasopressors in Cardiac Arrest
Key points
Introduction
Review of evidence
Summary
Current Work in Extracorporeal Cardiopulmonary Resuscitation
Key points
Introduction
Current evidence suggesting extracorporeal pulmonary resuscitation improves survival and strength of evidence
Selected program development around the world
Areas of uncertainty and controversy
Future areas of research
Summary
Precision Cardiac Arrest Resuscitation Based on Etiology
Key points
Introduction
Pathophysiological distinctions between asphyxial cardiac arrest and sudden cardiac arrest
Clinical distinctions between asphyxial cardiac arrest and sudden cardiac arrest
Implications of etiology on clinical management
Summary
Critical care points
Impact of the Opioid Epidemic
Key points
Introduction
Clinical features
Prehospital and emergency management of opioid overdose
Critical care management of opioid overdose
Modifications to resuscitation
Primary prevention
Secondary prevention and take-home morphine-equivalent naloxone
Summary
Comprehensive Cardiac Care After Cardiac Arrest
Key points
Introduction
Overview of postarrest cardiovascular care
Diagnostic considerations
Coronary angiography in suspected acute coronary syndrome
Therapeutic considerations
Summary