Assessment of Post-Resuscitation Intestinal Injury and Timing of Bacterial Translocation in Swine Anaesthetized With Propofol-Based Total Intravenous Anaesthesia.

Introduction and objectives Bacterial translocation (BT) is the passage of viable bacteria or endotoxins from the gastrointestinal lumen to extra-luminal tissues and is usually observed after intestinal ischaemia-reperfusion injury. The aim of this study was to investigate post-resuscitation BT after cardiac arrest and resuscitation in a swine anaesthetized with propofol-based total intravenous anaesthesia. Materials and methods Eighteen female Landrace/Large White piglets were randomly divided into control (CON), cardiac arrest (CA) and cardiac arrest-cardiopulmonary resuscitation (CA-CPR) groups. In the CON group, the animals were only monitored for two hours. In the CA group, the animals were not resuscitated and underwent necropsy immediately after cardiac arrest. In the CA-CPR group, the animals were resuscitated until the return of spontaneous circulation (ROSC) and were monitored for two hours. The animals of the CON and CA-CPR groups underwent necropsy 24 hours later. Bacterial translocation was assessed by blood and tissue cultures and endotoxin measurement in the portal and systemic circulation. Malondialdehyde content calculation and histological analysis of the intestine were performed in order to estimate ischemia and reperfusion (I/R) tissue damage. Results  Malondialdehyde content, an indicator of oxidative stress, was significantly higher in the CA-CPR group compared to the CA in homogenized ileum (p=0.016). Malondialdehyde content in homogenized colon revealed significantly higher levels in the CA-CPR group compared to the CON (p=0.004) and the CA group (p=0.016). We found significantly higher levels of portal endotoxin in the CA-CPR group compared to the CON (p=0.026) and the CA group (p=0.026). The number of positive mesenteric lymph nodes cultures for E. coli was greater in the CA-CPR group, followed by the CA and CON groups, although the difference was not significant (67%, 33%, and 33%, respectively; p=0.407). Conclusions Malondialdehyde content and portal endotoxin levels do not increase during the cardiac arrest interval, but only after CPR and ROSC. Although the number of positive MLNs cultures was greater in the CA-CPR animals, no statistically significant differences were observed between the three groups due to the short monitoring period.

Distal Radial Access: A Review Article.

Transradial approach (TRA) for coronary angiography and interventions has been increasingly used over the last decades and has become the default strategy in the majority of catheterization laboratories worldwide. Recently, a novel transradial access site, the distal radial access (DRA), has been proposed as an alternative to traditional TRA. Several case reports and case series have been published on this new approach over the last year showing overall good success rates. Aim of this review is to present the possible benefits and drawbacks of DRA and offer guidance on its successful use.

Right arm distal transradial (snuffbox) access for coronary catheterization: Initial experience.

BACKGROUND: Distal transradial access (dTRA) by the snuffbox approach for coronary catheterization has emerged as an alternative to the classic forearm TRA with certain advantages and limitations.The aim of this study was to evaluate the effectiveness and safety of the dTRA exclusively from the right arm. METHODS: Forty-nine consecutive patients (31 males and 18 females, mean age 64 ± 12 years), who were candidates for coronary catheterization in two cath laboratory centers, regardless of the indication, were recruited. Right dTRA was exclusively used. Radial artery patency both at the forearm and at the snuffbox region was evaluated 24 h after successful hemostasis by triplex ultrasonography. All complications were recorded until 24 h after the procedure. RESULTS: The indication for catheterization was an acute coronary syndrome in 24.5%, stable coronary artery disease in 22.4%, and other reasons in 53.1%. The overall failure attempt incidence was 10.2% and the mean puncture time 3.9 ± 4.1 min. Angiography only was performed in 81.8% and angiography followed by percutaneous coronary intervention in 18.2% of the patients. Manual hemostasis was applied in 63.6% of the patients, which had a significantly shorter duration than device hemostasis (11 ± 7 versus 198 ± 42 min, p < 0.001). No distal or forearm radial artery occlusion was observed on triplex ultrasonography 24 h after successful hemostasis. No major complications were recorded. CONCLUSIONS: This two-center study, utilizing exclusively the right dTRA, provides further data regarding the snuffbox approach in an all-comers population. Further worldwide reports will elucidate new aspects of the technique.

"Single Arm-Double Access" for CTO Intervention.

To our knowledge, this is the first reported case of a dual-access approach for CTO intervention using transradial and ipsilateral transulnar access. Although retrograde CTO intervention is a challenging procedure, a single arm-double access approach seems to be a feasible alternative that may be useful in patients with limited access-site availability.

Distal Versus Traditional Radial Approach for Coronary Angiography.

PURPOSE: The aim of this study was to evaluate the efficacy and safety of distal radial (DR) versus traditional radial (TR) approach during coronary angiography. METHODS: Two hundred patients scheduled to undergo transradial coronary angiography were randomized between the two approaches. Primary endpoint of the study was switching to another access site due to inability of successful target artery cannulation. Secondary endpoints were time to cannulation, total procedure duration, number of attempts, number of skin punctures and duration of manual hemostasis. Secondary safety endpoints were the rate of moderate or severe spasm, arm hematoma EASY class III or more and radial artery occlusion at discharge. Quality of life endpoint was the patient's preference of cannulation method at 30 days. RESULTS: The primary endpoint was met in 30 patients (30%) from the DR group and 2 patients (2%) from the TR group (p < 0.001). The time of cannulation was longer in the DR group compared to the TR group (269 ±â€¯251 s vs 140 ±â€¯161 s, p < 0.001), but this did not affect the total procedural duration (925 ±â€¯896 s vs 831 ±â€¯424 s, p = 0.494). The number of attempts and the number of skin punctures were more in the DR group compared to the TR group (6.8 ±â€¯6.2 vs 3.4 ±â€¯4.5, p < 0.001 and 2.4 ±â€¯1.7 vs 1.6 ±â€¯1.2, p < 0.001, respectively). However, DR treated patients had faster manual hemostasis time compared to TR treated patients (568 ±â€¯462 s vs 841 ±â€¯574 s, p = 0.002). There were no differences recorded in the safety endpoints of moderate or severe spasm, EASY grade III or more radial hematomas or the incidence of radial artery occlusion after the procedure. Patients' preference to the randomized puncture sites was the same (79% vs 85%, p = 0.358). CONCLUSION: Distal radial approach is associated with lower successful cannulation rates and shorter manual hemostasis time compared to the traditional radial approach.

Strategies to increase the use of forearm approach during coronary angiography and interventions.

The aim of this article is to focus on the utilization of forearm approach for cardiac catheterization in challenging groups of patients. Radial and ulnar approaches have gained significant popularity among the majority of interventional cardiologists. Multiple studies have demonstrated the feasibility, safety and efficacy of forearm route for cardiac catheterization and have highlighted the significant reduction in bleeding complications by avoiding the puncture of the groin. In this review we present the strategies need to be followed in order to apply the forearm approach in challenging group of patients.

Hand Hematoma After Cardiac Catheterization Via Distal Radial Artery.

This is the first reported case of severe hand hematoma after cardiac catheterization through the distal radial artery, with the hematoma extending distally to the sheath insertion site. The distribution of the hematoma in our case is completely different compared to the hematomas observed after traditional radial catheterization, which used to extend to the forearm. Therefore, the traditional EASY classification may not apply to hematomas after catheterization through the distal radial artery.