HESHAM EWILA | Hamad Medical Corporation (original) (raw)

Papers by HESHAM EWILA

Research paper thumbnail of Role Of Recombinant Factor Viia In The Management Of Severe Perioperative Bleeding In Cardiac Surgery, Qatari Experience

Introduction: Intractable bleeding is one of common adverse events after cardiac surgeries. Recom... more Introduction: Intractable bleeding is one of common adverse events after cardiac surgeries. Recombinant activated factor VII (rVIIa) showed efficiency in controlling postoperative intractable bleeding (1). Its usage after cardiac surgeries should be more investigated. Patients and methods: - All patients received rVIIa post cardiac surgeries over a period of two years were included in a retrospective descriptive study. All patients were evaluated for base line laboratory results and comorbidities, operative details, dose of rVIIa received, total chest drains pre and post rVIIa administration, total blood and blood products given pre and post rVIIa, post rVIIa laboratory results, complications of rVIIa, length of stay in intensive care unit. Results: -. We recruited 19 patients with a mean age of 49±18 years who received RVIIa in a dose of 90 mcg/kg. Packed red blood cells transfusion post rVIIa administration was decreased from mean of 10±6 units to 3.7±1.7 units P<0.0001. Chest drains post rVIIa administration were decreased from median of 2000 ml and IQR of 1200 to median of 500 ml and IQR of 500 P<0.1 .No complications related to rVIIa administration were observed. Discussion: - The study highlight the following findings: Efficiency and safety of rVIIa in the control of intractable bleeding post cardiac surgeries. Usage of rVIIa saves blood bank resources, decreases the need of surgical reopening and decreases morbidity. More studies needed to elaborate clinical guidelines for the usage of rVIIa in the management of intractable bleeding post cardiac surgeries. Conclusion: - There is increase need for clinical guidelines for the usage of rVIIa post cardiac surgeries. In our experience at Qatar heart hospital recombinant activated factor VII is safe and efficient treatment to control intractable bleeding post cardiac surgeries. Reference: - (1) Conrad V. Bishop, William E.P. Renwick, Chris Hogan, Michael Haeusler, Annabel Tuckfield and James Tatoulis: Recombinant Activated Factor VII: Treating Postoperative Hemorrhage in Cardiac Surgery. Ann Thorac Surg 2006; 81:875-879.

Research paper thumbnail of ROLE OF RECOMBINANT FACTOR VIIa IN T HE MANAGEMENT OF SEVERE PERIOPERATIVE BLEEDING IN CARDIA C SURGERY, QATARI

Introduct ion: Intractable bleeding is one of common adverse events af ter cardiac surger ies . R... more Introduct ion: Intractable bleeding is one of common adverse events af ter cardiac surger ies . Recombinant act ivated factor VII (rVIIa) showed effic iency in control l ing postoperat ive intractable bleeding (1) . I ts usage af ter cardiac surger ies should be more invest igated. Pat ients and methods: Al l pat ients received rVIIa post cardiac surger ies over a per iod of two years were inc luded in a retrospect ive descr ipt ive s tudy. Al l pat ients were evaluated for base l ine laborator y resul ts and comorbidit ies , operat ive deta i l s , dose of rVIIa received, tota l chest drains pre and post rVIIa administrat ion, tota l b lood and blood products g iven pre and post rVIIa, post rVIIa laborator y resul ts , complicat ions of rVIIa, length of s tay in intensive care unit . Results : . We recruited 19 pat ients with a mean age of 49±18 years who received RVIIa in a dose of 90 mcg/kg. Packed red blood ce l l s t ransfus ion post rVIIa administrat ion was decreased from mea...

Research paper thumbnail of Post Cardiac Surgery Statins Related Morbidity

Qatar Foundation Annual Research Conference Proceedings Volume 2014 Issue 1, 2014

Introduction: The notion of the favorable outcome related to continuation of statins in the perio... more Introduction: The notion of the favorable outcome related to continuation of statins in the perioperative cardiac surger y settings had gained wide approbation,1 but the complications related to statins therapy in this period remains a major concern. Aim of the work: To study whether perioperative treatment with statins could be associated with increased post-operative complications in terms of increased liver enz ymes and rhabdomyol ysis with possible associated acute kidney injur y (AKI). Methodolog y : Prospective, obser vational study with pur posive sampling where we anal y z ed morbidit y af ter cardiac surger y as well as the outcome related to statins therapy in 202 consecutive patients over a period of one year. We collected perioperative individual data inc luding age, gender, race, Euro score, cardiopulmonar y bypass time (CPB), aor tic cross c lamp time (ACC), length of ventilation, length of stay in intensive care unit (ICU), and association of elevation of liver enz ymes, rhabdomyol ysis, AKI, post-operative atrial fibrillation (POAF), nosocomial infections and post-operative cardiac enz ymes. Patients divided into two groups; group I was statins users and group II was non-users. The groups were compared by t-test, or Mann-W hitney U test, as appropriate for inter val variables, and Chi square tests used for categorical variables. Data expressed as mean±SD or propor tions/percentages for inter val and categorical variables respectivel y. P<= 0.05 (two-tailed) was considered the statistical significant level. Results: Both groups were matched regarding the age, gender, body mass index, Euro score, preoperative liver enz ymes, creatinine, and creatine kinase. S tatins group did not show significant elevation in liver enz ymes, nosocomial infections or higher association of AKI. The incidence of rhabdomyol ysis and POAF were significantl y lower in the statins group (p=0.025&0.02 respectivel y). In addition, initial cardiac troponin and CK-MB were significantl y lower in the statins group (p=0.01&0.04 respectivel y). S tatins treated group had significant lower lengths of ventilation, stay in ICU and hospital (p=0.002, 00.05&0.001 respectivel y). Conc lusions: Therapy with statins before cardiac surgeries was not associated with high incidence of adverse events; moreover statins treated group had a favorable outcome regarding the POAF events and lengths of stay in ICU as well as hospital. Reference(S). Liakopoulos OJ, Kuhn EW, S lottosch I, Wassmer G&Wahlers T. Preoperative statins therapy for patients undergoing cardiac surger y. Cochrane Database S yst, 2012.Rev, 4. Acknowledgment: I am highl y indebted to all members of the depar tment of Cardiothoracic surger y depar tment, as well as medical research center, Hamad Medical Cor poration. Health and Biomedical

Research paper thumbnail of Role Of Recombinant Factor Viia In The Management Of Severe Perioperative Bleeding In Cardiac Surgery, Qatari Experience

Qatar Foundation Annual Research Conference Proceedings Volume 2014 Issue 1, 2014

Introduction: Intractable bleeding is one of common adverse events after cardiac surgeries. Recom... more Introduction: Intractable bleeding is one of common adverse events after cardiac surgeries. Recombinant activated factor VII (rVIIa) showed efficiency in controlling postoperative intractable bleeding (1). Its usage after cardiac surgeries should be more investigated. Patients and methods: - All patients received rVIIa post cardiac surgeries over a period of two years were included in a retrospective descriptive study. All patients were evaluated for base line laboratory results and comorbidities, operative details, dose of rVIIa received, total chest drains pre and post rVIIa administration, total blood and blood products given pre and post rVIIa, post rVIIa laboratory results, complications of rVIIa, length of stay in intensive care unit. Results: -. We recruited 19 patients with a mean age of 49±18 years who received RVIIa in a dose of 90 mcg/kg. Packed red blood cells transfusion post rVIIa administration was decreased from mean of 10±6 units to 3.7±1.7 units P<0.0001. Chest drains post rVIIa administration were decreased from median of 2000 ml and IQR of 1200 to median of 500 ml and IQR of 500 P<0.1 .No complications related to rVIIa administration were observed. Discussion: - The study highlight the following findings: Efficiency and safety of rVIIa in the control of intractable bleeding post cardiac surgeries. Usage of rVIIa saves blood bank resources, decreases the need of surgical reopening and decreases morbidity. More studies needed to elaborate clinical guidelines for the usage of rVIIa in the management of intractable bleeding post cardiac surgeries. Conclusion: - There is increase need for clinical guidelines for the usage of rVIIa post cardiac surgeries. In our experience at Qatar heart hospital recombinant activated factor VII is safe and efficient treatment to control intractable bleeding post cardiac surgeries. Reference: - (1) Conrad V. Bishop, William E.P. Renwick, Chris Hogan, Michael Haeusler, Annabel Tuckfield and James Tatoulis: Recombinant Activated Factor VII: Treating Postoperative Hemorrhage in Cardiac Surgery. Ann Thorac Surg 2006; 81:875-879.

Research paper thumbnail of Improving Incidence of Postoperative Atrial Fibrillation After Cardiac Surgery Using Simplified Clinical Practice Guidelines

Journal of intensive care medicine, Jan 8, 2016

Postoperative atrial fibrillation (POAF) remains a major risk after cardiac surgery. Twelve perce... more Postoperative atrial fibrillation (POAF) remains a major risk after cardiac surgery. Twelve percent patients admitted to this unit postcardiac surgery experienced POAF, which led to hemodynamic instability, increased risk of stroke, and increased length of postoperative intensive care unit stay. Our aim was to decrease the incidence of POAF in the cardiothoracic intensive care unit by the end of April 2014. Design-Retrospective data analysis. Settings-Postcardiac surgery intensive care in a tertiary hospital. Postcardiac surgery patients. Intervention-A clinical practice guideline (CPG) was developed to promote early prevention and to improve adherence to POAF prophylaxis recommendations. Patient's charts were our key performance indicator. Primary outcome measure-Percentage of patients who developed episodes of POAF within the first 24 hours of cardiac surgery. Process measures-compliance with the newly developed CPG and early postoperative patient assessment. Balance measure-e...

Research paper thumbnail of Timing of Recombinant Factor VIIa Administration for Severe Bleeding in Cardiac Surgery: Does It Make Any Differences?

Anesthesia & Pain Research, 2019

Introduction: Perioperative severe bleeding remains a frequent complication in cardiac surgery wi... more Introduction: Perioperative severe bleeding remains a frequent complication in cardiac surgery with high incidence of morbidity and mortality. Recombinant activated factor VII (rVIIa) is administered for the management of many cases of severe bleeding in cardiac surgery with improvement of outcome. We hypothesize that there may be differences in the efficacy and safety of early versus late administration of rVIIa. Methods: A retrospective descriptive analytic study involved all patients who received rFVIIa in cardiac surgery department over 6 year's duration with a total number of 50 patients. The studied population was divided into two groups according to timing of rFVIIa administration, early group who received rVIIa within the first 2 hours of onset of bleeding (23 patients) and late group if rVIIa was given after 2hours of onset of bleeding (27 patients). Preoperative, intraoperative and postoperative data were collected and statistically analyzed. Results: There were no significant statistical demographic or surgical differences between the identified groups. Postoperatively we noted statistically significant lower postoperative blood loss (p =.001), blood transfusion (p=.02), Fresh frozen plasma P (p= .02), platelets transfusion (p= .02) and incidence of re-exploration (p=.02) in the early rVIIa administration group. There was no difference in the lengths of mechanical ventilation or hospital stay but length of ICU stay was significantly longer in the late rVIIa administration group. Conclusion: In this analysis, Early administration of rFVIIa in the management of severe bleeding following cardiac surgery was associated with decreased blood loss, decreased the need for blood and blood products transfusion and decreased Incidence of Re-exploration. Long-term safety remains unclear.

Research paper thumbnail of Comparison between Mannitol 20% and hypertonic saline 7.5% for cerebral resuscitation in severely head injured patients with intra-cranial hypertension

International journal of health sciences, 2011

Elevated intracranial pressure (ICP) represents the most important cause of morbidity and mortali... more Elevated intracranial pressure (ICP) represents the most important cause of morbidity and mortality in patients suffering from severe traumatic head injury. Early management of the elevated intracranial pressure is advantageous in preventing secondary brain insults and improving outcome. Infusion of hyperosmolar solutes is one of the modalities currently used for management of intracranial hypertension after severe head injury. Mannitol 20% is considered as the reference solute, but it has limitations and may fail to decrease critically elevated intracranial pressure. Hypertonic saline solutions have received renewed attention in clinical practice as osmotic agent for cerebral resuscitation. It may be more beneficial than other osmotic diuretics because they augment intravascular volume and cardiovascular performance in addition to reducing intracranial tension and improving cardiovascular elastance. This study compares the effect of 20% isovolume of mannitol with 7.5% hypertonic saline on intracranial pressure (ICP), hemodynamics and cardiac performance in patients with severe head injury and high intracranial pressure.

Research paper thumbnail of Preoperative hemoglobin concentration as an independent predictor for outcome after coronary artery bypass grafting

Journal of the Egyptian Society of Cardio-Thoracic Surgery, 2016

Preoperative anemia is accused for increased complications, morbidity and mortality following car... more Preoperative anemia is accused for increased complications, morbidity and mortality following cardiac surgery. Due to the nature of cardiac patients who usually have poor myocardium reserve and multiple concomitant comorbidities, it is difficult to identify the role of preoperative hemoglobin concentration in the postoperative outcome. Accordingly, correction of low hemoglobin level prior to cardiac surgery still is a matter of debate. Aim of the work: To determine the impact of preoperative hemoglobin concentration on postoperative outcome following coronary artery bypass grafting. Methods: Data were collected on all patients who underwent coronary artery bypass grafting surgery in our hospital in the last three years. Preoperative Anemia was defined as hemoglobin level below 12 gm. /dl. Accordingly, three groups were identified: low, normal and high preoperative hemoglobin. Postoperative bleeding, red blood cells transfused, myocardial injury, infection rate, lengths of ventilation, renal injury and length of stay in intensive care unit were recorded. Results: We recruited 804 patients in our study. Preoperative anemia were identified in 159 patients assigned in group I. Patients in this group had postoperative blood transfusion in 69% of patients and postoperative bleeding > One liter in 31.6% of patients with P-value of 0.006,0.096 respectively. It showed higher postoperative infection rate in 9.5% of patients (P-value 0.49) and higher length of stay in ICU in 43.3% of patients (P value 0.003). Group II were 481 patients, whom had HB (12.1-15 gm./dl) showed the shortest postoperative hospital stay in 56.1 % of patients, P value 0.0001. Group III, 164 patients had HB more than 15.1 gm. /dl. No cases of ICU readmission were recorded. Conclusion:-Preoperative hemoglobin level can be used as an indicator of outcome after cardiac surgery. Preoperative anemia should be optimized before coronary artery bypass grafting.

Research paper thumbnail of Role of dexmedetomidine infusion after coronary artery bypass grafting

The Cardiothoracic Surgeon, 2020

Background Postoperative pain has negative consequences on patients’ outcomes after cardiac surge... more Background Postoperative pain has negative consequences on patients’ outcomes after cardiac surgery. Routine management with opioid and or non-steroidal anti-inflammatory medications has several disadvantages. Dexmedetomidine is a selective α2 agonist used for sedation and analgesia. The use of dexmedetomidine for postoperative pain management and decreasing delirium and agitation in cardiac surgery patients is a matter of debate. Our objective was to determine the role of an early administration of dexmedetomidine in decreasing opioid use post-cardiac surgery and its effects on the quality of postoperative recovery. Results Medical records of 120 patients admitted to the cardiac surgery intensive care unit (CSICU) after coronary artery bypass grafting (CABG) in two cardiac centers between December 2015 and December 2016 were reviewed. Patients were divided into two groups. Group A included 55 patients who received dexmedetomidine in a dose of 0.2–0.4 mcg/kg/h on admission to CSICU,...

Research paper thumbnail of Perioperative management of COVID 19 patients undergoing coronary artery bypass surgery

Journal of Clinical Anesthesia, 2020

Highlights • COVID-19 represents a major challenge for healthcare systems globally and regionally... more Highlights • COVID-19 represents a major challenge for healthcare systems globally and regionally.• The complexity of the disease requires special considerations when cardiac surgery is imminent.• Worsening of the patients’ clinical condition because of COVID-19 association was not encountered in our series.• Healthcare providers might not endure cross-infection if strict protocol is followed.

Research paper thumbnail of Postoperative Cardiac Surgery Outcomes in a Statin-Native Population

Anesthesia, essays and researches

Statin utilization had been associated with improved survival after cardiac surgery. We aim to st... more Statin utilization had been associated with improved survival after cardiac surgery. We aim to study whether perioperative treatment with statin could be associated with increased postoperative complications. This was a retrospective, descriptive, single-center study. We analyzed morbidity after cardiac surgery as well as the outcome related to statin therapy in a tertiary cardiac center. A total of 202 consecutive patients were enrolled over 1 year after cardiac surgery. Patients were divided into two groups; Group I - statin users and Group II - nonusers. Measurements were baseline and follow-up laboratory markers for muscular injury including cardiac muscle and hepatic injuries and renal injuries. The incidence of rhabdomyolysis and elevation of liver enzymes did not differ between both groups. Postoperative atrial fibrillation was significantly lower in the statin group ( = 0.02). In addition, peak cardiac troponin and creatine kinase-MB did not differ significantly in the stati...

Research paper thumbnail of Rhabdomyolysis following Cardiac Surgery: A Prospective, Descriptive, Single-Center Study

BioMed research international, 2016

Purpose. Rhabdomyolysis (RML) following cardiac surgery and its relationship with acute kidney in... more Purpose. Rhabdomyolysis (RML) following cardiac surgery and its relationship with acute kidney injury (AKI) require investigation. Patients and Methods. All patients undergoing cardiac surgery in our hospital were enrolled in this prospective study during a 1-year period. To investigate the occurrence of RML and its association with AKI, all patients in the study underwent serial assessment of serum creatine kinase (CK) and myoglobin levels. Serial renal function, prior statin treatment, and outcome variables were recorded. Results. In total, 201 patients were included in the study: 185 men and 16 women with a mean age of 52.0 ± 12.4 years. According to the presence of RML (CK of ≥2,500 U/L), the patients were divided into Group I (RML present in 17 patients) and Group II (RML absent in 184 patients). Seven patients in Group I had AKI (41%) where 34 patients in group II had AKI (18.4%), P = 0.025. We observed a significantly longer duration of ventilation, length of stay in the ICU,...

Research paper thumbnail of Recombinant activated factor VIIa to treat refractory lower gastrointestinal hemorrhage in a patient with recently implanted mechanical valve: a case report

BMC Research Notes, 2014

Background: Bleeding is a common complication after cardiac surgery. However, lower gastrointesti... more Background: Bleeding is a common complication after cardiac surgery. However, lower gastrointestinal bleeding is not usually associated with this type of surgery. Case presentation: A 50-year-old man with a history of aortic regurgitation underwent elective mechanical valve replacement under cardiopulmonary bypass. He experienced a complicated intraoperative course involving unexplained cardiac arrest following induction of anesthesia. He also developed two episodes of massive lower gastrointestinal bleeding secondary to mucosal ischemia while convalescing in the cardiothoracic surgery intensive care unit. After unsuccessful attempts to control the bleeding, exhaustion of blood products, and consideration of the high risk of mortality associated with surgery and the possibility of early-and long-term surgical complications, the decision was made to administer two successive doses of recombinant activated factor VII at 60 mcg/kg. Hemostasis was achieved without adverse systemic or valvular effects. Conclusions: A favorable outcome was achieved after administration of recombinant activated factor VII, which controlled the patient's severe lower gastrointestinal bleeding. This outcome suggests the need to raise awareness about the use of this drug in dire circumstances when other conventional measures fail or are unsuitable.

Research paper thumbnail of Rhabdomyolysis following cardiac surgery: from prevalence to prevention

Research paper thumbnail of Role Of Recombinant Factor Viia In The Management Of Severe Perioperative Bleeding In Cardiac Surgery, Qatari Experience

Introduction: Intractable bleeding is one of common adverse events after cardiac surgeries. Recom... more Introduction: Intractable bleeding is one of common adverse events after cardiac surgeries. Recombinant activated factor VII (rVIIa) showed efficiency in controlling postoperative intractable bleeding (1). Its usage after cardiac surgeries should be more investigated. Patients and methods: - All patients received rVIIa post cardiac surgeries over a period of two years were included in a retrospective descriptive study. All patients were evaluated for base line laboratory results and comorbidities, operative details, dose of rVIIa received, total chest drains pre and post rVIIa administration, total blood and blood products given pre and post rVIIa, post rVIIa laboratory results, complications of rVIIa, length of stay in intensive care unit. Results: -. We recruited 19 patients with a mean age of 49±18 years who received RVIIa in a dose of 90 mcg/kg. Packed red blood cells transfusion post rVIIa administration was decreased from mean of 10±6 units to 3.7±1.7 units P<0.0001. Chest drains post rVIIa administration were decreased from median of 2000 ml and IQR of 1200 to median of 500 ml and IQR of 500 P<0.1 .No complications related to rVIIa administration were observed. Discussion: - The study highlight the following findings: Efficiency and safety of rVIIa in the control of intractable bleeding post cardiac surgeries. Usage of rVIIa saves blood bank resources, decreases the need of surgical reopening and decreases morbidity. More studies needed to elaborate clinical guidelines for the usage of rVIIa in the management of intractable bleeding post cardiac surgeries. Conclusion: - There is increase need for clinical guidelines for the usage of rVIIa post cardiac surgeries. In our experience at Qatar heart hospital recombinant activated factor VII is safe and efficient treatment to control intractable bleeding post cardiac surgeries. Reference: - (1) Conrad V. Bishop, William E.P. Renwick, Chris Hogan, Michael Haeusler, Annabel Tuckfield and James Tatoulis: Recombinant Activated Factor VII: Treating Postoperative Hemorrhage in Cardiac Surgery. Ann Thorac Surg 2006; 81:875-879.

Research paper thumbnail of ROLE OF RECOMBINANT FACTOR VIIa IN T HE MANAGEMENT OF SEVERE PERIOPERATIVE BLEEDING IN CARDIA C SURGERY, QATARI

Introduct ion: Intractable bleeding is one of common adverse events af ter cardiac surger ies . R... more Introduct ion: Intractable bleeding is one of common adverse events af ter cardiac surger ies . Recombinant act ivated factor VII (rVIIa) showed effic iency in control l ing postoperat ive intractable bleeding (1) . I ts usage af ter cardiac surger ies should be more invest igated. Pat ients and methods: Al l pat ients received rVIIa post cardiac surger ies over a per iod of two years were inc luded in a retrospect ive descr ipt ive s tudy. Al l pat ients were evaluated for base l ine laborator y resul ts and comorbidit ies , operat ive deta i l s , dose of rVIIa received, tota l chest drains pre and post rVIIa administrat ion, tota l b lood and blood products g iven pre and post rVIIa, post rVIIa laborator y resul ts , complicat ions of rVIIa, length of s tay in intensive care unit . Results : . We recruited 19 pat ients with a mean age of 49±18 years who received RVIIa in a dose of 90 mcg/kg. Packed red blood ce l l s t ransfus ion post rVIIa administrat ion was decreased from mea...

Research paper thumbnail of Post Cardiac Surgery Statins Related Morbidity

Qatar Foundation Annual Research Conference Proceedings Volume 2014 Issue 1, 2014

Introduction: The notion of the favorable outcome related to continuation of statins in the perio... more Introduction: The notion of the favorable outcome related to continuation of statins in the perioperative cardiac surger y settings had gained wide approbation,1 but the complications related to statins therapy in this period remains a major concern. Aim of the work: To study whether perioperative treatment with statins could be associated with increased post-operative complications in terms of increased liver enz ymes and rhabdomyol ysis with possible associated acute kidney injur y (AKI). Methodolog y : Prospective, obser vational study with pur posive sampling where we anal y z ed morbidit y af ter cardiac surger y as well as the outcome related to statins therapy in 202 consecutive patients over a period of one year. We collected perioperative individual data inc luding age, gender, race, Euro score, cardiopulmonar y bypass time (CPB), aor tic cross c lamp time (ACC), length of ventilation, length of stay in intensive care unit (ICU), and association of elevation of liver enz ymes, rhabdomyol ysis, AKI, post-operative atrial fibrillation (POAF), nosocomial infections and post-operative cardiac enz ymes. Patients divided into two groups; group I was statins users and group II was non-users. The groups were compared by t-test, or Mann-W hitney U test, as appropriate for inter val variables, and Chi square tests used for categorical variables. Data expressed as mean±SD or propor tions/percentages for inter val and categorical variables respectivel y. P<= 0.05 (two-tailed) was considered the statistical significant level. Results: Both groups were matched regarding the age, gender, body mass index, Euro score, preoperative liver enz ymes, creatinine, and creatine kinase. S tatins group did not show significant elevation in liver enz ymes, nosocomial infections or higher association of AKI. The incidence of rhabdomyol ysis and POAF were significantl y lower in the statins group (p=0.025&0.02 respectivel y). In addition, initial cardiac troponin and CK-MB were significantl y lower in the statins group (p=0.01&0.04 respectivel y). S tatins treated group had significant lower lengths of ventilation, stay in ICU and hospital (p=0.002, 00.05&0.001 respectivel y). Conc lusions: Therapy with statins before cardiac surgeries was not associated with high incidence of adverse events; moreover statins treated group had a favorable outcome regarding the POAF events and lengths of stay in ICU as well as hospital. Reference(S). Liakopoulos OJ, Kuhn EW, S lottosch I, Wassmer G&Wahlers T. Preoperative statins therapy for patients undergoing cardiac surger y. Cochrane Database S yst, 2012.Rev, 4. Acknowledgment: I am highl y indebted to all members of the depar tment of Cardiothoracic surger y depar tment, as well as medical research center, Hamad Medical Cor poration. Health and Biomedical

Research paper thumbnail of Role Of Recombinant Factor Viia In The Management Of Severe Perioperative Bleeding In Cardiac Surgery, Qatari Experience

Qatar Foundation Annual Research Conference Proceedings Volume 2014 Issue 1, 2014

Introduction: Intractable bleeding is one of common adverse events after cardiac surgeries. Recom... more Introduction: Intractable bleeding is one of common adverse events after cardiac surgeries. Recombinant activated factor VII (rVIIa) showed efficiency in controlling postoperative intractable bleeding (1). Its usage after cardiac surgeries should be more investigated. Patients and methods: - All patients received rVIIa post cardiac surgeries over a period of two years were included in a retrospective descriptive study. All patients were evaluated for base line laboratory results and comorbidities, operative details, dose of rVIIa received, total chest drains pre and post rVIIa administration, total blood and blood products given pre and post rVIIa, post rVIIa laboratory results, complications of rVIIa, length of stay in intensive care unit. Results: -. We recruited 19 patients with a mean age of 49±18 years who received RVIIa in a dose of 90 mcg/kg. Packed red blood cells transfusion post rVIIa administration was decreased from mean of 10±6 units to 3.7±1.7 units P<0.0001. Chest drains post rVIIa administration were decreased from median of 2000 ml and IQR of 1200 to median of 500 ml and IQR of 500 P<0.1 .No complications related to rVIIa administration were observed. Discussion: - The study highlight the following findings: Efficiency and safety of rVIIa in the control of intractable bleeding post cardiac surgeries. Usage of rVIIa saves blood bank resources, decreases the need of surgical reopening and decreases morbidity. More studies needed to elaborate clinical guidelines for the usage of rVIIa in the management of intractable bleeding post cardiac surgeries. Conclusion: - There is increase need for clinical guidelines for the usage of rVIIa post cardiac surgeries. In our experience at Qatar heart hospital recombinant activated factor VII is safe and efficient treatment to control intractable bleeding post cardiac surgeries. Reference: - (1) Conrad V. Bishop, William E.P. Renwick, Chris Hogan, Michael Haeusler, Annabel Tuckfield and James Tatoulis: Recombinant Activated Factor VII: Treating Postoperative Hemorrhage in Cardiac Surgery. Ann Thorac Surg 2006; 81:875-879.

Research paper thumbnail of Improving Incidence of Postoperative Atrial Fibrillation After Cardiac Surgery Using Simplified Clinical Practice Guidelines

Journal of intensive care medicine, Jan 8, 2016

Postoperative atrial fibrillation (POAF) remains a major risk after cardiac surgery. Twelve perce... more Postoperative atrial fibrillation (POAF) remains a major risk after cardiac surgery. Twelve percent patients admitted to this unit postcardiac surgery experienced POAF, which led to hemodynamic instability, increased risk of stroke, and increased length of postoperative intensive care unit stay. Our aim was to decrease the incidence of POAF in the cardiothoracic intensive care unit by the end of April 2014. Design-Retrospective data analysis. Settings-Postcardiac surgery intensive care in a tertiary hospital. Postcardiac surgery patients. Intervention-A clinical practice guideline (CPG) was developed to promote early prevention and to improve adherence to POAF prophylaxis recommendations. Patient's charts were our key performance indicator. Primary outcome measure-Percentage of patients who developed episodes of POAF within the first 24 hours of cardiac surgery. Process measures-compliance with the newly developed CPG and early postoperative patient assessment. Balance measure-e...

Research paper thumbnail of Timing of Recombinant Factor VIIa Administration for Severe Bleeding in Cardiac Surgery: Does It Make Any Differences?

Anesthesia & Pain Research, 2019

Introduction: Perioperative severe bleeding remains a frequent complication in cardiac surgery wi... more Introduction: Perioperative severe bleeding remains a frequent complication in cardiac surgery with high incidence of morbidity and mortality. Recombinant activated factor VII (rVIIa) is administered for the management of many cases of severe bleeding in cardiac surgery with improvement of outcome. We hypothesize that there may be differences in the efficacy and safety of early versus late administration of rVIIa. Methods: A retrospective descriptive analytic study involved all patients who received rFVIIa in cardiac surgery department over 6 year's duration with a total number of 50 patients. The studied population was divided into two groups according to timing of rFVIIa administration, early group who received rVIIa within the first 2 hours of onset of bleeding (23 patients) and late group if rVIIa was given after 2hours of onset of bleeding (27 patients). Preoperative, intraoperative and postoperative data were collected and statistically analyzed. Results: There were no significant statistical demographic or surgical differences between the identified groups. Postoperatively we noted statistically significant lower postoperative blood loss (p =.001), blood transfusion (p=.02), Fresh frozen plasma P (p= .02), platelets transfusion (p= .02) and incidence of re-exploration (p=.02) in the early rVIIa administration group. There was no difference in the lengths of mechanical ventilation or hospital stay but length of ICU stay was significantly longer in the late rVIIa administration group. Conclusion: In this analysis, Early administration of rFVIIa in the management of severe bleeding following cardiac surgery was associated with decreased blood loss, decreased the need for blood and blood products transfusion and decreased Incidence of Re-exploration. Long-term safety remains unclear.

Research paper thumbnail of Comparison between Mannitol 20% and hypertonic saline 7.5% for cerebral resuscitation in severely head injured patients with intra-cranial hypertension

International journal of health sciences, 2011

Elevated intracranial pressure (ICP) represents the most important cause of morbidity and mortali... more Elevated intracranial pressure (ICP) represents the most important cause of morbidity and mortality in patients suffering from severe traumatic head injury. Early management of the elevated intracranial pressure is advantageous in preventing secondary brain insults and improving outcome. Infusion of hyperosmolar solutes is one of the modalities currently used for management of intracranial hypertension after severe head injury. Mannitol 20% is considered as the reference solute, but it has limitations and may fail to decrease critically elevated intracranial pressure. Hypertonic saline solutions have received renewed attention in clinical practice as osmotic agent for cerebral resuscitation. It may be more beneficial than other osmotic diuretics because they augment intravascular volume and cardiovascular performance in addition to reducing intracranial tension and improving cardiovascular elastance. This study compares the effect of 20% isovolume of mannitol with 7.5% hypertonic saline on intracranial pressure (ICP), hemodynamics and cardiac performance in patients with severe head injury and high intracranial pressure.

Research paper thumbnail of Preoperative hemoglobin concentration as an independent predictor for outcome after coronary artery bypass grafting

Journal of the Egyptian Society of Cardio-Thoracic Surgery, 2016

Preoperative anemia is accused for increased complications, morbidity and mortality following car... more Preoperative anemia is accused for increased complications, morbidity and mortality following cardiac surgery. Due to the nature of cardiac patients who usually have poor myocardium reserve and multiple concomitant comorbidities, it is difficult to identify the role of preoperative hemoglobin concentration in the postoperative outcome. Accordingly, correction of low hemoglobin level prior to cardiac surgery still is a matter of debate. Aim of the work: To determine the impact of preoperative hemoglobin concentration on postoperative outcome following coronary artery bypass grafting. Methods: Data were collected on all patients who underwent coronary artery bypass grafting surgery in our hospital in the last three years. Preoperative Anemia was defined as hemoglobin level below 12 gm. /dl. Accordingly, three groups were identified: low, normal and high preoperative hemoglobin. Postoperative bleeding, red blood cells transfused, myocardial injury, infection rate, lengths of ventilation, renal injury and length of stay in intensive care unit were recorded. Results: We recruited 804 patients in our study. Preoperative anemia were identified in 159 patients assigned in group I. Patients in this group had postoperative blood transfusion in 69% of patients and postoperative bleeding > One liter in 31.6% of patients with P-value of 0.006,0.096 respectively. It showed higher postoperative infection rate in 9.5% of patients (P-value 0.49) and higher length of stay in ICU in 43.3% of patients (P value 0.003). Group II were 481 patients, whom had HB (12.1-15 gm./dl) showed the shortest postoperative hospital stay in 56.1 % of patients, P value 0.0001. Group III, 164 patients had HB more than 15.1 gm. /dl. No cases of ICU readmission were recorded. Conclusion:-Preoperative hemoglobin level can be used as an indicator of outcome after cardiac surgery. Preoperative anemia should be optimized before coronary artery bypass grafting.

Research paper thumbnail of Role of dexmedetomidine infusion after coronary artery bypass grafting

The Cardiothoracic Surgeon, 2020

Background Postoperative pain has negative consequences on patients’ outcomes after cardiac surge... more Background Postoperative pain has negative consequences on patients’ outcomes after cardiac surgery. Routine management with opioid and or non-steroidal anti-inflammatory medications has several disadvantages. Dexmedetomidine is a selective α2 agonist used for sedation and analgesia. The use of dexmedetomidine for postoperative pain management and decreasing delirium and agitation in cardiac surgery patients is a matter of debate. Our objective was to determine the role of an early administration of dexmedetomidine in decreasing opioid use post-cardiac surgery and its effects on the quality of postoperative recovery. Results Medical records of 120 patients admitted to the cardiac surgery intensive care unit (CSICU) after coronary artery bypass grafting (CABG) in two cardiac centers between December 2015 and December 2016 were reviewed. Patients were divided into two groups. Group A included 55 patients who received dexmedetomidine in a dose of 0.2–0.4 mcg/kg/h on admission to CSICU,...

Research paper thumbnail of Perioperative management of COVID 19 patients undergoing coronary artery bypass surgery

Journal of Clinical Anesthesia, 2020

Highlights • COVID-19 represents a major challenge for healthcare systems globally and regionally... more Highlights • COVID-19 represents a major challenge for healthcare systems globally and regionally.• The complexity of the disease requires special considerations when cardiac surgery is imminent.• Worsening of the patients’ clinical condition because of COVID-19 association was not encountered in our series.• Healthcare providers might not endure cross-infection if strict protocol is followed.

Research paper thumbnail of Postoperative Cardiac Surgery Outcomes in a Statin-Native Population

Anesthesia, essays and researches

Statin utilization had been associated with improved survival after cardiac surgery. We aim to st... more Statin utilization had been associated with improved survival after cardiac surgery. We aim to study whether perioperative treatment with statin could be associated with increased postoperative complications. This was a retrospective, descriptive, single-center study. We analyzed morbidity after cardiac surgery as well as the outcome related to statin therapy in a tertiary cardiac center. A total of 202 consecutive patients were enrolled over 1 year after cardiac surgery. Patients were divided into two groups; Group I - statin users and Group II - nonusers. Measurements were baseline and follow-up laboratory markers for muscular injury including cardiac muscle and hepatic injuries and renal injuries. The incidence of rhabdomyolysis and elevation of liver enzymes did not differ between both groups. Postoperative atrial fibrillation was significantly lower in the statin group ( = 0.02). In addition, peak cardiac troponin and creatine kinase-MB did not differ significantly in the stati...

Research paper thumbnail of Rhabdomyolysis following Cardiac Surgery: A Prospective, Descriptive, Single-Center Study

BioMed research international, 2016

Purpose. Rhabdomyolysis (RML) following cardiac surgery and its relationship with acute kidney in... more Purpose. Rhabdomyolysis (RML) following cardiac surgery and its relationship with acute kidney injury (AKI) require investigation. Patients and Methods. All patients undergoing cardiac surgery in our hospital were enrolled in this prospective study during a 1-year period. To investigate the occurrence of RML and its association with AKI, all patients in the study underwent serial assessment of serum creatine kinase (CK) and myoglobin levels. Serial renal function, prior statin treatment, and outcome variables were recorded. Results. In total, 201 patients were included in the study: 185 men and 16 women with a mean age of 52.0 ± 12.4 years. According to the presence of RML (CK of ≥2,500 U/L), the patients were divided into Group I (RML present in 17 patients) and Group II (RML absent in 184 patients). Seven patients in Group I had AKI (41%) where 34 patients in group II had AKI (18.4%), P = 0.025. We observed a significantly longer duration of ventilation, length of stay in the ICU,...

Research paper thumbnail of Recombinant activated factor VIIa to treat refractory lower gastrointestinal hemorrhage in a patient with recently implanted mechanical valve: a case report

BMC Research Notes, 2014

Background: Bleeding is a common complication after cardiac surgery. However, lower gastrointesti... more Background: Bleeding is a common complication after cardiac surgery. However, lower gastrointestinal bleeding is not usually associated with this type of surgery. Case presentation: A 50-year-old man with a history of aortic regurgitation underwent elective mechanical valve replacement under cardiopulmonary bypass. He experienced a complicated intraoperative course involving unexplained cardiac arrest following induction of anesthesia. He also developed two episodes of massive lower gastrointestinal bleeding secondary to mucosal ischemia while convalescing in the cardiothoracic surgery intensive care unit. After unsuccessful attempts to control the bleeding, exhaustion of blood products, and consideration of the high risk of mortality associated with surgery and the possibility of early-and long-term surgical complications, the decision was made to administer two successive doses of recombinant activated factor VII at 60 mcg/kg. Hemostasis was achieved without adverse systemic or valvular effects. Conclusions: A favorable outcome was achieved after administration of recombinant activated factor VII, which controlled the patient's severe lower gastrointestinal bleeding. This outcome suggests the need to raise awareness about the use of this drug in dire circumstances when other conventional measures fail or are unsuitable.

Research paper thumbnail of Rhabdomyolysis following cardiac surgery: from prevalence to prevention