The Year 2022 in Review and a Glimpse into the Future.

Abstract

Innovation has consistently been the hallmark of progress in the care of cardiac surgery and transplant patients— forward thinking in hopes of creating a better future. From the moment Ludwig Rehn sutured a myocardial laceration in 1896, or in 1954 when Joseph Murray performed the first successful solid organ transplant, there has been a clear eye towards the future and using innovative means of tackling the problems we see before us. The year 2022 was no exception, with a major advance made in xenotransplantation with a cardiac graft that functioned adequately for 7 weeks after implantation, as 1 example. Many such advancements are highlighted in this issue of Seminars in Cardiothoracic and Vascular Anesthesia, which compiles a series of review articles summarizing the notable research and innovations from this past year. The relevant publications have been divided into 5 separate categories for the reader, including critical care medicine, abdominal transplantation, congenital heart disease, cardiac anesthesia, and cardiac surgery. It was a busy year in critical care medicine and Alber et al have done a wonderful job summarizing the advancements made in the care of post-cardiac arrest patients, resuscitation, mechanical ventilation, septic shock, and nutritional support, as well as improving neurologic outcomes in the critically ill. The use of VA-ECMO as a means of rescue in the care of post-cardiac arrest patients has gained more attention this year, where there has been a focus towards temperature management and cytokine adsorption. Additionally, following the COVID-19 pandemic there was work done describing the neurocognitive outcomes of ECMO survivors. Building on prior work done evaluating the utility of targeted temperature management (TTM), the HYPO-ECMO group randomized patients with cardiac arrest or refractory cardiogenic shock that received ECLS to either moderate hypothermia (33-34°C) or normothermia (36-37°C) finding a non-statistically significant differences in the primary outcome of 30 day mortality though the composite outcome of death, or escalation to LVAD or heart transplant at 30 days favored the mild hypothermia group, and importantly there were no increased risks of adverse events in the mild hypothermia group. Post-cardiac arrest syndrome (PCAS) is a well-established inflammatory condition following ROSC that results in ischemia-reperfusion injury and the release of proinflammatory cytokines, such as interleukin-6 (IL-6). The CYTER Trial Group utilized a hemoadsorber in the ECMO circuit at the time of VA ECMO cannulation in the setting of ECPR, postulating that it maymitigate reperfusion injury at the time of cannulation. There was not a statistically significant fall in the IL-6 levels or any differences in a host of secondary outcomes, including mortality and SOFA score, though this single-center study was limited by a relatively small and heterogeneous population. Fernando et al added additional insight into neurocognitive outcomes for patients that spent time on ECMO (either VVor VA) in the province of Ontario. As postulated, the ECMO group had a higher incidence of mental health diagnoses, though secondary outcomes including substance misuse and self-harm did not differ. Moving on to updates in resuscitation, Cheskes et al evaluated novel techniques for defibrillation including double sequential external defibrillation (DSED; 2 shocks one second apart and in 2 different planes) and vector change (defibrillation pads moved to anterior posterior from anterior lateral positions). In this extension of their previous work, the authors concluded that DSED produced higher rates of survival to hospital discharge, suggesting that 2 shocks are truly better than one. Turning to ventilator management, the authors focus on the evolution of low tidal volume ventilation with respect to lung-diaphragm interaction and protection. With the original ARDS Network low tidal volume ventilation paper being 23 years old, De Vries and colleagues offered a new potential avenue to expand on these protective strategies to include respiratory muscles by considering a diaphragm protective