Seminars in Cardiothoracic and Vascular Anesthesia | 2021
The Year 2020 in Review: Coronavirus Disease 2019 Cloud and Its Impact Excelling the Clinical Practice
Abstract
The year 2020 has been an “unusual” year, in every way, for everyone. As if the only consistency has been the “inconsistent.” These inconsistencies have been met with both resilience and resistance alike. Not only has it been the year of the pandemic but also the year of societal unrest; introspection; recouping diversity, ethics, and equality; and domestic violence. During the worldwide lockdown and distancing, while active laboratories and research (other than coronavirus disease 2019 [COVID19]) came to a standstill, the year 2020 saw an unprecedented rise in research papers, even aside from COVID science.2 Submissions in journals by publisher Elsevier alone found a 58% increase from February to May of 2020 when compared with the same period in the year 2019. This rise has been explained by more available time due for researchers to work on completing their manuscripts owing to the lockdown; evolution of robust preprint servers like medRxiv, SSRN, and Research Square; and push for a faster review process by journals. The editors of Seminars in Cardiothoracic and Vascular Anesthesia (SCVA), keeping this in mind, decided to come up with this current issue to summarize all the salient publications that happened in the year 2020 broadly into 6 categories pertinent to the readership, namely, cardiothoracic anesthesiology, anesthesia for congenital heart disease (CHD), thoracic transplant anesthesiology, cardiothoracic critical care, abdominal organ transplantation, and cardiothoracic surgery. A literature review on cardiothoracic anesthesia by Clendenen et al discusses preoperative iron therapy, acute kidney injury, postoperative pain, anticoagulation after transcatheter aortic valve replacement (TAVR), mechanical circulatory devices, and machine learning.3 The authors conclude in their review that for cardiac surgery, preoperative iron supplementation may increase hemoglobin that may potentially translate to improved outcomes. A recent prominent randomized controlled trial (RCT), although performed for major abdominal surgery (PREVENTT), did not demonstrate preoperative intravenous (IV) iron to be superior to placebo in reducing the need for blood transfusion when administered to patients with anemia 10 to 42 days prior to surgery.4 Two primary composite end-points were studied, namely, blood transfusion/death and number of transfusions from randomization until 30 days after index operation. Another recent study in cardiac surgery patients showed a significant reduction in transfusion by following a central venous saturation-guided restrictive strategy.5 Previously, the TRICS trial in patients for cardiac surgery demonstrated that a restrictive strategy for transfusion based on hemoglobin <7.5 g/dL was noninferior to liberal strategy for those with hemoglobin <9.5 g/ dL.6 After cardiac surgery, blood volume reduction is about 18%, red blood cell volume 38%, while plasma volume only 8%, implying hemoglobin may after all not be the best trigger for transfusion.7,8 This brings us back to the same questions with yet uncertain answers: What is the best trigger for transfusion? Does the rise in hemoglobin preoperatively translate to improved outcomes? How do we measure deficit in oxygen-carrying capacity: by anemia (low hemoglobin), by regional oxygen saturation, by red cell mass indexed to patient`s size, or by oxygen-debt (SaO2 minus SvO2, lactate rise)? Cardiac surgery-associated acute kidney injury (CSA-AKI) is a vexing problem in about 40% patients with 3% needing renal replacement therapy.9 Authors report a novel tool, the soluble urokinase receptor for predicting CSA-AKI. This may be blocked by a monoclonal antibody leading to the prevention of AKI. As reiterated by Vijayan, while biomarkers and preclinical identification of potential AKI remain under aggressive investigation, clinically speaking, only prevention, the 1016152 SCVXXX10.1177/10892532211016152Seminars in Cardiothoracic and Vascular AnesthesiaPal et al editorial2021