Peter Rosseel - Academia.edu (original) (raw)
Papers by Peter Rosseel
Netherlands Heart Journal, 2018
Anesthesiology, Mar 16, 2017
Conflicting results have been reported concerning the effect of platelet transfusion on several o... more Conflicting results have been reported concerning the effect of platelet transfusion on several outcomes. The aim of this study was to assess the independent effect of a single early intraoperative platelet transfusion on bleeding and adverse outcomes in cardiac surgery patients. For this observational study, 23,860 cardiac surgery patients were analyzed. Patients who received one early (shortly after cardiopulmonary bypass while still in the operating room) platelet transfusion, and no other transfusions, were defined as the intervention group. By matching the intervention group 1:3 to patients who received no early transfusion with most comparable propensity scores, the reference group was identified. The intervention group comprised 169 patients and the reference group 507. No difference between the groups was observed concerning reinterventions, thromboembolic complications, infections, organ failure, and mortality. However, patients in the intervention group experienced less bl...
Ventilator-associated pneumonia in patients undergoing major
Members of the DECS study group (The Netherlands) Jaap J. Bredée , Wolfgang F. Buhre , Jan M. Die... more Members of the DECS study group (The Netherlands) Jaap J. Bredée , Wolfgang F. Buhre , Jan M. Dieleman , Diederik van Dijk , Lex A. van Herwerden , Cor J. Kalkman , Jan van Klarenbosch , Karel G. Moons , Hendrik M. Nathoe , Sandra C. Numan , Thomas H. Ottens , Kit C. Roes , Anne-Mette C. Sauer , Arjen J. Slooter , Dirk van Osch , Kirolos A. Jacob , Arno P. Nierich , Jacob J. Ennema , Peter M. Rosseel , Nardo J. van der Meer , Joost M. van der Maaten , Vlado Cernak , Jan Hofland , Robert J. van Thiel , Jan C. Diephuis , Ronald M. Schepp , Jo Haenen , Fellery de Lange , Christa Boer , Jan R. de Jong , Jan G. Tijssen 9
Authors/Task Force Members: Domenico Pagano (EACTS Chairperson) (UK), Milan Milojevic (Netherland... more Authors/Task Force Members: Domenico Pagano (EACTS Chairperson) (UK), Milan Milojevic (Netherlands), Michael I. Meesters (Netherlands), Umberto Benedetto (UK), Daniel Bolliger (Switzerland), Christian von Heymann (Germany), Anders Jeppsson (Sweden), Andreas Koster (Germany), Ruben L. Osnabrugge (Netherlands), Marco Ranucci (Italy), Hanne Berg Ravn (Denmark), Alexander B.A. Vonk (Netherlands), Alexander Wahba (Norway), Christa Boer (EACTA Chairperson) (Netherlands)
The Journal of Thoracic and Cardiovascular Surgery, 2017
Objective: The study aim was to investigate the long-term prognosis and risk factors of postperic... more Objective: The study aim was to investigate the long-term prognosis and risk factors of postpericardiotomy syndrome (PPS). Methods: We performed a single-center cohort study in 822 patients undergoing nonemergent valve surgery. Risk factors of PPS were evaluated using multivariable logistic regression analysis. We also compared the incidence of reoperation for tamponade at 1 year between patients with and without PPS. Main secondary outcomes were hospital stay and mortality. Results: Of the 822 patients, 119 (14.5%) developed PPS. A higher body mass index (odds ratio (OR) per point increase, 0.94; 95% confidence interval (CI), 0.89-0.99) was associated with a lower risk of PPS, whereas preoperative treatment for pulmonary disease without corticosteroids (OR, 2.55; 95% CI, 1.25-5.20) was associated with a higher risk of PPS. The incidence of reoperation for tamponade at 1 year in PPS versus no PPS was 20.9% versus 2.5% (OR, 15.49; 95% CI, 7.14-33.58). One-year mortality in PPS versus no PPS was 4.2% versus 5.5% (OR, 0.68; 95% CI, 0.22-2.08). Median hospital stay was 13 days (interquartile range, 9-18 days) versus 11 days (interquartile range, 8-15 days) (P ¼ .001), respectively. Conclusions: Despite longer hospital stays and more short-term reoperations for tamponade, patients with PPS had an excellent 1-year prognosis.
Journal of Cardiothoracic and Vascular Anesthesia, 2016
Increasing evidence suggests benefits from restrictive red blood cell transfusion (RBC) threshold... more Increasing evidence suggests benefits from restrictive red blood cell transfusion (RBC) thresholds in major surgery and critically ill patients. However, these benefits are not obvious in cardiac surgery patients with intraoperative anemia. The authors examined the association between uncorrected hemoglobin (Hb) levels and selected postoperative outcomes as well as the effects of RBCs. Cohort study with prospectively collected data from a cardiac surgery registry. A major cardiac surgical hospital within the Netherlands, which is also a referral center for Jehovah's Witnesses. Patients (23,860) undergoing cardiac surgery between 1997 and 2013. Comparisons were done in patients with intraoperative nadir Hb<8 g/dL and/or an Hb decrease≥50%. Comparison (A) between Jehovah's Witnesses (Witnesses) and matched non-Jehovah's Witnesses (non-Witnesses) transfused with 1 unit of RBC, and comparison (B) between patients given 1 unit of RBC intraoperatively versus matched non-transfused patients. Postoperative outcomes were myocardial infarction, renal replacement therapy, stroke, and death. With propensity matching, the authors optimized exchangeability of the compared groups. Adverse outcomes increased with a decreasing Hb both among Witnesses and among non-Witnesses. The incidence of postoperative complications did not differ between Witnesses and matched non-Witnesses who received RBC (adjusted odds ratio 1.44, 95% confidence interval 0.63-3.29). Similarly, postoperative complications did not differ between patients who received a red cell transfusion and matched patients who did not (adjusted odds ratio 0.94, confidence interval 0.72-1.23). Intraoperative anemia is associated with adverse outcomes after cardiac surgery, and a single RBC transfusion does not seem to influence these outcomes.
Critical Care Medicine, 2016
Objective: Cardiac surgery and postoperative admission to the ICU may lead to posttraumatic stres... more Objective: Cardiac surgery and postoperative admission to the ICU may lead to posttraumatic stress disorder and depression. Perioperatively administered corticosteroids potentially alter the risk of development of these psychiatric conditions, by affecting the hypothalamic-pituitary-adrenal axis. However, findings of previous studies are inconsistent. We aimed to assess the effect of a single dose of dexamethasone compared with placebo on symptoms of posttraumatic stress disorder and depression and healthrelated quality of life after cardiac surgery and ICU admission. Design: Follow-up study of a randomized clinical trial. Setting: Five Dutch heart centers. Patients: Cardiac surgery patients (n = 1,244) who participated in the Dexamethasone for Cardiac Surgery trial. Interventions: A single intraoperative IV dose of dexamethasone or placebo was administered in a randomized, double-blind way. Measurements and Main Results : Symptoms of posttraumatic stress disorder, depression, and health-related quality of life were assessed with validated questionnaires 1.5 years after
Journal of Cardiothoracic and Vascular Anesthesia, 2015
The American Journal of Cardiology, 1988
Dopexamine hydrochloride, a dopamine analog with specific beta 2 adrenergic and DA1 dopaminergic ... more Dopexamine hydrochloride, a dopamine analog with specific beta 2 adrenergic and DA1 dopaminergic receptor activity, was evaluated in a prospective study including 20 patients undergoing coronary artery bypass grafting. Shortly after admission to the intensive care unit, increasing doses of dopexamine hydrochloride (1.0, 2.0, 4.0, 6.0, 8.0 and 10.0 micrograms/kg/min) were administered as continuous infusion at 20-minute intervals. Hemodynamic monitoring revealed that dopexamine hydrochloride causes a significant decrease in systemic vascular resistance and a significant increase in cardiac output and heart rate, even at lower dose levels (1.0 micrograms/kg/min). At higher dose levels (greater than or equal to 2.0 micrograms/kg/min), adverse effects such as systolic hypertension and tachycardia were observed. Shunt fraction increased significantly during dopexamine hydrochloride administration, probably due to the increase in cardiac output. It is concluded that dopexamine hydrochloride is a potent vasodilating agent at lower dose levels and is of potential benefit to patients with compromised myocardial function after coronary artery bypass grafting. Higher dose levels may cause unwanted side effects, which might be explained by various mechanisms such as norepinephrine uptake inhibition.
Jehovah’s Witnesses (JW) do not permit transfusion. Many JWs are referred to our Hospital for car... more Jehovah’s Witnesses (JW) do not permit transfusion. Many JWs are referred to our Hospital for cardiac surgery. We show that cardiac surgery is very well possible in JW with good results. The experiences with Jehovah’s Witnesses led to the introduction of an ongoing patient blood management programme which greatly improved transfusion requirements in the non JW population without ever achieving the same Zero Transfusion rate as with JW, while we now adopt the same medical and technical approach in JW as well as non-JW. We recommend that all cardiosurgical patients be treated like JW. We postulate this might imply a change in attitude towards transfusion as well as change in sociological and psychological behaviour of the cardiosurgical team in and outside the Operating Theatre.
Anaesthesia, Jan 20, 2017
Prophylactic intra-operative administration of dexamethasone may improve short-term clinical outc... more Prophylactic intra-operative administration of dexamethasone may improve short-term clinical outcomes in cardiac surgical patients. The purpose of this study was to evaluate long-term clinical outcomes and cost effectiveness of dexamethasone versus placebo. Patients included in the multicentre, randomised, double-blind, placebo-controlled DExamethasone for Cardiac Surgery (DECS) trial were followed up for 12 months after their cardiac surgical procedure. In the DECS trial, patients received a single intra-operative dose of dexamethasone 1 mg.kg(-1) (n = 2239) or placebo (n = 2255). The effects on the incidence of major postoperative events were evaluated. Also, overall costs for the 12-month postoperative period, and cost effectiveness, were compared between groups. Of 4494 randomised patients, 4457 patients (99%) were followed up until 12 months after surgery. There was no difference in the incidence of major postoperative events, the relative risk (95%CI) being 0.86 (0.72-1.03); p...
Paediatric day case surgery was first described in 1909 by James Nicoll, who performed 8988 opera... more Paediatric day case surgery was first described in 1909 by James Nicoll, who performed 8988 operations as day case at the Royal Glasgow Hospital. Since then, day case surgery has continued to grow and now about 50% to 60% of paediatric surgery is performed as outpatients in most of the western countries like USA and UK. In India, the incidence of paediatric day case surgery is low, i.e., 35%. This is because of illiteracy, lack of proper transport facilities and unhygienic conditions at home.
Patient Blood Management in Cardiac Surgery, 2019
Evidence is accumulating that both perioperative anemia and packed red blood cell transfusions ar... more Evidence is accumulating that both perioperative anemia and packed red blood cell transfusions are associated with adverse outcomes after cardiac surgery. Jehovah’s Witnesses who categorically refuse blood products, while otherwise expecting the highest standards of medical care and full deployment of modern medical technology, constitute a particular challenge for cardiac surgery. Their cases are interesting because they provide additional material to evaluate blood conservation strategies and advantages and risks of blood transfusion in cardiac surgery.
Journal of Cardiothoracic and Vascular Anesthesia, 2019
Journal of Cardiothoracic and Vascular Anesthesia, 2019
This article reviews fellowship training in adult cardiac, thoracic, and vascular anesthesia and ... more This article reviews fellowship training in adult cardiac, thoracic, and vascular anesthesia and critical care from the perspective of European program initiators and educational leaders in these subspecialties together with current training fellows. Currently, the European Association of Cardiothoracic Anaesthesiology (EACTA) network has 20 certified fellowship positions each year in 10 hosting centers within 7 European countries, with 2 positions outside Europe (São Paulo, Brazil). Since 2009, 42 fellows have completed the fellowship training. The aim of this article is to provide an overview of the rationale, requirements, and contributions of the fellows, in the context of the developmental progression of the EACTA fellowship in adult cardiac, thoracic, and vascular anesthesia and critical care from inception to present. A summary of the program structure, accreditation of host centers, requirements to join the program, teaching and assessment tools, certification, and training requirements in transesophageal electrocardiography is outlined. In addition, a description of the current state of EACTA fellowships across Europe, and a perspective for future steps and challenges to the educational program, is provided.
Journal of Cardiothoracic and Vascular Anesthesia, 2009
The Role of Anesthesiology in Global Health, 2014
ABSTRACT Performing cardiac surgery and anesthesia in a low resource setting is highly relevant i... more ABSTRACT Performing cardiac surgery and anesthesia in a low resource setting is highly relevant in the context of the global burden of cardiac surgical disease, and its impact is even higher in developing countries in both the pediatric and adult population. Safely conducted cardiac surgery imposes very high demands on the required infrastructure and the resources; therefore it is only realistic in countries with a minimal level of primary and secondary health care. Certain middle income countries face significant constraints and variability their health care system therefore alternative and creative strategies may be required to conduct a cardiac surgical mission. In times of global economic crisis, these strategies may be useful in high resource settings as well. The deployment of a cardiac surgical mission or project by a hosting hospital or organisation in a middle income country (MIC) will be most successful if respect for the local context and creating a mutual benefit for host and visiting teams is part of the mission statement. Such a program will require considerable improvement and fine tuning of a selected hospital and a strategy adapted to the local context. Such a program requires an investment beyond the scope of medical tourism and should aim at - over the course of five to ten years - an autonomous cardiac surgery or anaesthesia department well sustainable within the local hospital. Strong cardiac anesthesia and intensive care will hinge on adequate hospital infrastructure and laboratory, imaging, cardiology and extracorporal circulation services. The clinical care is a major team effort, which will require expertise in the field of cardiac anesthesia and intensive care and preparedness by the host team to depart from routines and habits that may not be evidence based. Collaboration with a NGO that is knowledgeable in and experienced with the local context can be of considerable advantage. Last but not least a cardiac surgical project or mission should monitor closely the structure, processes and outcome (clinical, organizational and economical) of the project and include mechanisms for further improvement.
Netherlands Heart Journal, 2018
Anesthesiology, Mar 16, 2017
Conflicting results have been reported concerning the effect of platelet transfusion on several o... more Conflicting results have been reported concerning the effect of platelet transfusion on several outcomes. The aim of this study was to assess the independent effect of a single early intraoperative platelet transfusion on bleeding and adverse outcomes in cardiac surgery patients. For this observational study, 23,860 cardiac surgery patients were analyzed. Patients who received one early (shortly after cardiopulmonary bypass while still in the operating room) platelet transfusion, and no other transfusions, were defined as the intervention group. By matching the intervention group 1:3 to patients who received no early transfusion with most comparable propensity scores, the reference group was identified. The intervention group comprised 169 patients and the reference group 507. No difference between the groups was observed concerning reinterventions, thromboembolic complications, infections, organ failure, and mortality. However, patients in the intervention group experienced less bl...
Ventilator-associated pneumonia in patients undergoing major
Members of the DECS study group (The Netherlands) Jaap J. Bredée , Wolfgang F. Buhre , Jan M. Die... more Members of the DECS study group (The Netherlands) Jaap J. Bredée , Wolfgang F. Buhre , Jan M. Dieleman , Diederik van Dijk , Lex A. van Herwerden , Cor J. Kalkman , Jan van Klarenbosch , Karel G. Moons , Hendrik M. Nathoe , Sandra C. Numan , Thomas H. Ottens , Kit C. Roes , Anne-Mette C. Sauer , Arjen J. Slooter , Dirk van Osch , Kirolos A. Jacob , Arno P. Nierich , Jacob J. Ennema , Peter M. Rosseel , Nardo J. van der Meer , Joost M. van der Maaten , Vlado Cernak , Jan Hofland , Robert J. van Thiel , Jan C. Diephuis , Ronald M. Schepp , Jo Haenen , Fellery de Lange , Christa Boer , Jan R. de Jong , Jan G. Tijssen 9
Authors/Task Force Members: Domenico Pagano (EACTS Chairperson) (UK), Milan Milojevic (Netherland... more Authors/Task Force Members: Domenico Pagano (EACTS Chairperson) (UK), Milan Milojevic (Netherlands), Michael I. Meesters (Netherlands), Umberto Benedetto (UK), Daniel Bolliger (Switzerland), Christian von Heymann (Germany), Anders Jeppsson (Sweden), Andreas Koster (Germany), Ruben L. Osnabrugge (Netherlands), Marco Ranucci (Italy), Hanne Berg Ravn (Denmark), Alexander B.A. Vonk (Netherlands), Alexander Wahba (Norway), Christa Boer (EACTA Chairperson) (Netherlands)
The Journal of Thoracic and Cardiovascular Surgery, 2017
Objective: The study aim was to investigate the long-term prognosis and risk factors of postperic... more Objective: The study aim was to investigate the long-term prognosis and risk factors of postpericardiotomy syndrome (PPS). Methods: We performed a single-center cohort study in 822 patients undergoing nonemergent valve surgery. Risk factors of PPS were evaluated using multivariable logistic regression analysis. We also compared the incidence of reoperation for tamponade at 1 year between patients with and without PPS. Main secondary outcomes were hospital stay and mortality. Results: Of the 822 patients, 119 (14.5%) developed PPS. A higher body mass index (odds ratio (OR) per point increase, 0.94; 95% confidence interval (CI), 0.89-0.99) was associated with a lower risk of PPS, whereas preoperative treatment for pulmonary disease without corticosteroids (OR, 2.55; 95% CI, 1.25-5.20) was associated with a higher risk of PPS. The incidence of reoperation for tamponade at 1 year in PPS versus no PPS was 20.9% versus 2.5% (OR, 15.49; 95% CI, 7.14-33.58). One-year mortality in PPS versus no PPS was 4.2% versus 5.5% (OR, 0.68; 95% CI, 0.22-2.08). Median hospital stay was 13 days (interquartile range, 9-18 days) versus 11 days (interquartile range, 8-15 days) (P ¼ .001), respectively. Conclusions: Despite longer hospital stays and more short-term reoperations for tamponade, patients with PPS had an excellent 1-year prognosis.
Journal of Cardiothoracic and Vascular Anesthesia, 2016
Increasing evidence suggests benefits from restrictive red blood cell transfusion (RBC) threshold... more Increasing evidence suggests benefits from restrictive red blood cell transfusion (RBC) thresholds in major surgery and critically ill patients. However, these benefits are not obvious in cardiac surgery patients with intraoperative anemia. The authors examined the association between uncorrected hemoglobin (Hb) levels and selected postoperative outcomes as well as the effects of RBCs. Cohort study with prospectively collected data from a cardiac surgery registry. A major cardiac surgical hospital within the Netherlands, which is also a referral center for Jehovah's Witnesses. Patients (23,860) undergoing cardiac surgery between 1997 and 2013. Comparisons were done in patients with intraoperative nadir Hb<8 g/dL and/or an Hb decrease≥50%. Comparison (A) between Jehovah's Witnesses (Witnesses) and matched non-Jehovah's Witnesses (non-Witnesses) transfused with 1 unit of RBC, and comparison (B) between patients given 1 unit of RBC intraoperatively versus matched non-transfused patients. Postoperative outcomes were myocardial infarction, renal replacement therapy, stroke, and death. With propensity matching, the authors optimized exchangeability of the compared groups. Adverse outcomes increased with a decreasing Hb both among Witnesses and among non-Witnesses. The incidence of postoperative complications did not differ between Witnesses and matched non-Witnesses who received RBC (adjusted odds ratio 1.44, 95% confidence interval 0.63-3.29). Similarly, postoperative complications did not differ between patients who received a red cell transfusion and matched patients who did not (adjusted odds ratio 0.94, confidence interval 0.72-1.23). Intraoperative anemia is associated with adverse outcomes after cardiac surgery, and a single RBC transfusion does not seem to influence these outcomes.
Critical Care Medicine, 2016
Objective: Cardiac surgery and postoperative admission to the ICU may lead to posttraumatic stres... more Objective: Cardiac surgery and postoperative admission to the ICU may lead to posttraumatic stress disorder and depression. Perioperatively administered corticosteroids potentially alter the risk of development of these psychiatric conditions, by affecting the hypothalamic-pituitary-adrenal axis. However, findings of previous studies are inconsistent. We aimed to assess the effect of a single dose of dexamethasone compared with placebo on symptoms of posttraumatic stress disorder and depression and healthrelated quality of life after cardiac surgery and ICU admission. Design: Follow-up study of a randomized clinical trial. Setting: Five Dutch heart centers. Patients: Cardiac surgery patients (n = 1,244) who participated in the Dexamethasone for Cardiac Surgery trial. Interventions: A single intraoperative IV dose of dexamethasone or placebo was administered in a randomized, double-blind way. Measurements and Main Results : Symptoms of posttraumatic stress disorder, depression, and health-related quality of life were assessed with validated questionnaires 1.5 years after
Journal of Cardiothoracic and Vascular Anesthesia, 2015
The American Journal of Cardiology, 1988
Dopexamine hydrochloride, a dopamine analog with specific beta 2 adrenergic and DA1 dopaminergic ... more Dopexamine hydrochloride, a dopamine analog with specific beta 2 adrenergic and DA1 dopaminergic receptor activity, was evaluated in a prospective study including 20 patients undergoing coronary artery bypass grafting. Shortly after admission to the intensive care unit, increasing doses of dopexamine hydrochloride (1.0, 2.0, 4.0, 6.0, 8.0 and 10.0 micrograms/kg/min) were administered as continuous infusion at 20-minute intervals. Hemodynamic monitoring revealed that dopexamine hydrochloride causes a significant decrease in systemic vascular resistance and a significant increase in cardiac output and heart rate, even at lower dose levels (1.0 micrograms/kg/min). At higher dose levels (greater than or equal to 2.0 micrograms/kg/min), adverse effects such as systolic hypertension and tachycardia were observed. Shunt fraction increased significantly during dopexamine hydrochloride administration, probably due to the increase in cardiac output. It is concluded that dopexamine hydrochloride is a potent vasodilating agent at lower dose levels and is of potential benefit to patients with compromised myocardial function after coronary artery bypass grafting. Higher dose levels may cause unwanted side effects, which might be explained by various mechanisms such as norepinephrine uptake inhibition.
Jehovah’s Witnesses (JW) do not permit transfusion. Many JWs are referred to our Hospital for car... more Jehovah’s Witnesses (JW) do not permit transfusion. Many JWs are referred to our Hospital for cardiac surgery. We show that cardiac surgery is very well possible in JW with good results. The experiences with Jehovah’s Witnesses led to the introduction of an ongoing patient blood management programme which greatly improved transfusion requirements in the non JW population without ever achieving the same Zero Transfusion rate as with JW, while we now adopt the same medical and technical approach in JW as well as non-JW. We recommend that all cardiosurgical patients be treated like JW. We postulate this might imply a change in attitude towards transfusion as well as change in sociological and psychological behaviour of the cardiosurgical team in and outside the Operating Theatre.
Anaesthesia, Jan 20, 2017
Prophylactic intra-operative administration of dexamethasone may improve short-term clinical outc... more Prophylactic intra-operative administration of dexamethasone may improve short-term clinical outcomes in cardiac surgical patients. The purpose of this study was to evaluate long-term clinical outcomes and cost effectiveness of dexamethasone versus placebo. Patients included in the multicentre, randomised, double-blind, placebo-controlled DExamethasone for Cardiac Surgery (DECS) trial were followed up for 12 months after their cardiac surgical procedure. In the DECS trial, patients received a single intra-operative dose of dexamethasone 1 mg.kg(-1) (n = 2239) or placebo (n = 2255). The effects on the incidence of major postoperative events were evaluated. Also, overall costs for the 12-month postoperative period, and cost effectiveness, were compared between groups. Of 4494 randomised patients, 4457 patients (99%) were followed up until 12 months after surgery. There was no difference in the incidence of major postoperative events, the relative risk (95%CI) being 0.86 (0.72-1.03); p...
Paediatric day case surgery was first described in 1909 by James Nicoll, who performed 8988 opera... more Paediatric day case surgery was first described in 1909 by James Nicoll, who performed 8988 operations as day case at the Royal Glasgow Hospital. Since then, day case surgery has continued to grow and now about 50% to 60% of paediatric surgery is performed as outpatients in most of the western countries like USA and UK. In India, the incidence of paediatric day case surgery is low, i.e., 35%. This is because of illiteracy, lack of proper transport facilities and unhygienic conditions at home.
Patient Blood Management in Cardiac Surgery, 2019
Evidence is accumulating that both perioperative anemia and packed red blood cell transfusions ar... more Evidence is accumulating that both perioperative anemia and packed red blood cell transfusions are associated with adverse outcomes after cardiac surgery. Jehovah’s Witnesses who categorically refuse blood products, while otherwise expecting the highest standards of medical care and full deployment of modern medical technology, constitute a particular challenge for cardiac surgery. Their cases are interesting because they provide additional material to evaluate blood conservation strategies and advantages and risks of blood transfusion in cardiac surgery.
Journal of Cardiothoracic and Vascular Anesthesia, 2019
Journal of Cardiothoracic and Vascular Anesthesia, 2019
This article reviews fellowship training in adult cardiac, thoracic, and vascular anesthesia and ... more This article reviews fellowship training in adult cardiac, thoracic, and vascular anesthesia and critical care from the perspective of European program initiators and educational leaders in these subspecialties together with current training fellows. Currently, the European Association of Cardiothoracic Anaesthesiology (EACTA) network has 20 certified fellowship positions each year in 10 hosting centers within 7 European countries, with 2 positions outside Europe (São Paulo, Brazil). Since 2009, 42 fellows have completed the fellowship training. The aim of this article is to provide an overview of the rationale, requirements, and contributions of the fellows, in the context of the developmental progression of the EACTA fellowship in adult cardiac, thoracic, and vascular anesthesia and critical care from inception to present. A summary of the program structure, accreditation of host centers, requirements to join the program, teaching and assessment tools, certification, and training requirements in transesophageal electrocardiography is outlined. In addition, a description of the current state of EACTA fellowships across Europe, and a perspective for future steps and challenges to the educational program, is provided.
Journal of Cardiothoracic and Vascular Anesthesia, 2009
The Role of Anesthesiology in Global Health, 2014
ABSTRACT Performing cardiac surgery and anesthesia in a low resource setting is highly relevant i... more ABSTRACT Performing cardiac surgery and anesthesia in a low resource setting is highly relevant in the context of the global burden of cardiac surgical disease, and its impact is even higher in developing countries in both the pediatric and adult population. Safely conducted cardiac surgery imposes very high demands on the required infrastructure and the resources; therefore it is only realistic in countries with a minimal level of primary and secondary health care. Certain middle income countries face significant constraints and variability their health care system therefore alternative and creative strategies may be required to conduct a cardiac surgical mission. In times of global economic crisis, these strategies may be useful in high resource settings as well. The deployment of a cardiac surgical mission or project by a hosting hospital or organisation in a middle income country (MIC) will be most successful if respect for the local context and creating a mutual benefit for host and visiting teams is part of the mission statement. Such a program will require considerable improvement and fine tuning of a selected hospital and a strategy adapted to the local context. Such a program requires an investment beyond the scope of medical tourism and should aim at - over the course of five to ten years - an autonomous cardiac surgery or anaesthesia department well sustainable within the local hospital. Strong cardiac anesthesia and intensive care will hinge on adequate hospital infrastructure and laboratory, imaging, cardiology and extracorporal circulation services. The clinical care is a major team effort, which will require expertise in the field of cardiac anesthesia and intensive care and preparedness by the host team to depart from routines and habits that may not be evidence based. Collaboration with a NGO that is knowledgeable in and experienced with the local context can be of considerable advantage. Last but not least a cardiac surgical project or mission should monitor closely the structure, processes and outcome (clinical, organizational and economical) of the project and include mechanisms for further improvement.