A High-Fidelity Percutaneous Model Used to Demonstrate ECMO Cannulation.

Medical simulation provides a realistic environment for practitioners to experience a planned clinical event in a controlled educational setting. We established a simulation model composed of synthetic ballistic gelatin that provided an inexpensive high-fidelity model for our extracorporeal membrane oxygenation (ECMO) team members to develop, master, and maintain clinical skills necessary for percutaneous cervical or femoral cannulation. The simulation component includes a cervical torso or femoral percutaneous synthetic gelatin model that is attached to either a static fluid model or to the high-fidelity perfusion simulator. Either model can be accessed with ultrasound guidance, cannulated with appropriately sized cannula, and connected to an in situ ECMO circuit. This article explains how the model is made and connected to the simulator with the purpose of re-creating this high-fidelity experience at any institution.

Outcomes of open repair for chronic descending thoracic aortic dissection.

BACKGROUND: This study analyzed early and late outcomes after open repair of descending thoracic aortic aneurysms with chronic aortic dissection. METHODS: We retrospectively reviewed our cases of open repair of descending thoracic aortic aneurysms with chronic dissection from 1991 to 2011. Patient comorbid conditions and operative details were analyzed to determine risks for adverse outcome. Long-term survival and aortic reinterventions were analyzed. RESULTS: We repaired 519 patients with descending thoracic aortic aneurysms during the study period, and 209 (40%) had chronic dissection. Mean age was 59 years, with 74% (154 of 209) men. Previous ascending repair was performed in 41% (85 of 209), and the second-stage elephant trunk was performed in 10% (21 of 209). Adjunctive distal aortic perfusion with cerebral spinal fluid drainage was used in 90% (188 of 209) of patients, and circulatory arrest with bypass in 1% (3 of 209). The 30-day mortality was 8.6% (18 of 209). Immediate neurologic deficit occurred in 0.95% (2 of 209) and only with extent C resection. Delayed neurologic deficit occurred in 1.4% (3 of 209), 1 patient in each extent. Because 66% (2 of 3) of the patients with delayed neurologic deficit recovered function, permanent deficit occurred in 1.4% (3 of 209). Stroke occurred in 2.4% (5 of 209) and dialysis on discharge in 5% (11 of 211). The only risk factor for 30-day mortality was preoperative glomerular filtration rate of less than 60 mL/min (odds ratio, 4.2; p < 0.006). Survival at 5, 10, and 15 years was 72%, 60%, and 49%, respectively. Freedom from reoperation on the operated-on segment was 98%, 96.5%, 96.5%, and 96.5% at 5, 10, 15, and 20 years. CONCLUSIONS: Open repairs of chronic descending thoracic aortic aneurysm dissections can be performed with respectable morbidity and mortality. Neurologic deficit remains low with the use of adjuncts, and early deaths are directly related to preoperative renal status. Reintervention on the involved aortic segment is low. These results allow comparisons with endovascular repair for chronic aortic dissection.