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151. Atrial fibrillation detected initially during acute medical illness: A systematic review

Author

McIntyre, William F, primary, Um, Kevin J, additional, Cheung, Christopher C, additional, Belley-Côté, Emilie P, additional, Dingwall, Orvie, additional, Devereaux, Philip J, additional, Wong, Jorge A, additional, Conen, David, additional, Whitlock, Richard P, additional, Connolly, Stuart J, additional, Seifer, Colette M, additional, and Healey, Jeff S, additional

Published
2018
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155. Recommandation de pratique clinique de la Société canadienne de soins intensifs: utilisation de vasopressine et d’analogues de la vasopressine chez l’adulte en état critique souffrant de choc distributif.

Author

Honarmand, Kimia, Um, Kevin John, Belley-Côté, Emilie P., Alhazzani, Waleed, Farley, Chris, Fernando, Shannon M., Fiest, Kirsten, Grey, Donna, Hajdini, Edita, Herridge, Margaret, Hrymak, Carmen, Møller, Morten Hylander, Kanji, Salmaan, Lamontagne, François, Lauzier, François, Mehta, Sangeeta, Paunovic, Bojan, Singal, Rohit, Tsang, Jennifer Ly, and Wynne, Christine

Subjects
SHOCK (Pathology), CATASTROPHIC illness, CRITICAL care medicine, VASOPRESSIN
Abstract

Copyright of Canadian Journal of Anaesthesia / Journal Canadien d'Anesthésie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Published
2020
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158. Design and rationale of the atrial fibrillation occurring transiently with stress (AFOTS) follow-up cohort study

Author

McIntyre, William F., primary, Mendoza, Pablo A., additional, Belley-Côté, Emilie P., additional, Whitlock, Richard P., additional, Um, Kevin J., additional, Maystrenko, Natalie, additional, Devereaux, P.J., additional, Conen, David, additional, Wong, Jorge A., additional, Connolly, Stuart J., additional, and Healey, Jeff S., additional

Published
2018
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161. Dabigatran in patients with myocardial injury after non-cardiac surgery (MANAGE): an international, randomised, placebo-controlled trial

Author

Devereaux, P J, primary, Duceppe, Emmanuelle, additional, Guyatt, Gordon, additional, Tandon, Vikas, additional, Rodseth, Reitze, additional, Biccard, Bruce M, additional, Xavier, Denis, additional, Szczeklik, Wojciech, additional, Meyhoff, Christian S, additional, Vincent, Jessica, additional, Franzosi, Maria Grazia, additional, Srinathan, Sadeesh K, additional, Erb, Jason, additional, Magloire, Patrick, additional, Neary, John, additional, Rao, Mangala, additional, Rahate, Prashant V, additional, Chaudhry, Navneet K, additional, Mayosi, Bongani, additional, de Nadal, Miriam, additional, Iglesias, Pilar Paniagua, additional, Berwanger, Otavio, additional, Villar, Juan Carlos, additional, Botto, Fernando, additional, Eikelboom, John W, additional, Sessler, Daniel I, additional, Kearon, Clive, additional, Pettit, Shirley, additional, Sharma, Mukul, additional, Connolly, Stuart J, additional, Bangdiwala, Shrikant I, additional, Rao-Melacini, Purnima, additional, Hoeft, Andreas, additional, Yusuf, Salim, additional, Devereaux, P.J., additional, Bangdiwala, Shrikant I., additional, Connolly, Stuart, additional, Eikelboom, John, additional, Pogue, Janice, additional, Sessler, Daniel I., additional, Di Diodato, Sara, additional, Gasic, Zora, additional, Mastrangelo, Louise J., additional, Molnar, Sarah H., additional, Swanson, Jennifer L., additional, Tosh, Makayla L., additional, Wells, Jennifer R., additional, Diaz, Rafael, additional, Chow, Clara K., additional, Gonzales, Beatriz, additional, Vásquez, Skarlet, additional, Jansky, Petr, additional, Dušek, Radovan, additional, Meyhoff, Christian S., additional, Coriat, Pierre, additional, Wittmann, Maria, additional, Yonga, Gerald, additional, Mathur, Nandini, additional, Seletti, Elena, additional, Malaga, German, additional, Tumanan-Mendoza, Bernadette A., additional, Tagle, Maria Pamela A., additional, Biccard, Bruce M., additional, Alonso-Coello, Pablo, additional, Popova, Ekaterine, additional, Shields, Martin, additional, Le Manach, Yannick, additional, Moayyedi, Paul, additional, van Zanten, Sander, additional, Fleischmann, Edith, additional, Garg, Amit, additional, Karaye, Kamilu, additional, McFalls, Edward, additional, Sigamani, Alben, additional, Belley-Côté, Emilie, additional, Biedroń, Grzegorz, additional, Borges, Flavia, additional, Frosi Stella, Steffan, additional, Haarmark Nielsen, Christian, additional, Leong, Darryl P., additional, Spence, Jessica, additional, Tran, Allen, additional, Wawrzycka-Adamczyk, Katarzyna, additional, Yang, Stephen S., additional, Yung, Terence, additional, Wyse, D. George, additional, Cheng, Davy, additional, Johnstone, David E., additional, Wells, George A., additional, Joseph, Philip, additional, Patel, Ameen, additional, Gregus, Krysten, additional, Lawrence, Kelly, additional, Doharris, Lindsay, additional, Conen, David, additional, Cheung, Jason, additional, Douketis, Jim, additional, Wright, Douglas, additional, Wikkerink, Spencer, additional, Dechert, William, additional, Panju, Mohamed, additional, Azzam, Khalid, additional, Rapanos, Theodore, additional, Van Helder, Tomas, additional, Shroff, Anjali, additional, Hare, Jacqueline, additional, Kidane, Biniam, additional, Nguyen, Thang, additional, Leydier, Larissa, additional, Bayaraa, Vanessa, additional, Parlow, Joel, additional, DuMerton, Deborah A., additional, Thakrar, Amar, additional, Shelley, Jessica, additional, Deligne, Benoit, additional, Carling, Roberta Daila, additional, Mrkobrada, Marko, additional, Dresser, George K., additional, Jacka, Michael J., additional, Hornstein, David, additional, Winkelaar, Gerrit B., additional, Haider, Zoeb Hussain, additional, Lanjewar, Pravina Prashant, additional, Varughese, Valsamma, additional, Calton, Rajneesh, additional, Ahuja, Hemani, additional, George, Preetha, additional, Sharma, Ambika, additional, Bhatt, Keyur Sureshchandra, additional, Mangukiya, Dhaval Odhavajibhai, additional, Nandaniya, Karshan Vira, additional, Parekh, Viral Vasantrai, additional, Pillai, Ashok Bhaskaran, additional, Menon, Vidya P., additional, Desai, Sanjay Channappa, additional, Sidhu, Ravinder Singh, additional, Gupta, Sandeep Kumar, additional, George, Robbie K., additional, Gurunath, T.R., additional, Drummond, Leanne W., additional, Torborg, Alexandra M., additional, Küsel, Belinda S., additional, Naidoo, Prebashini, additional, Naidoo, Datshana P., additional, Rajah, Chantal, additional, Farina, Zane, additional, von Rahden, Richard Peter, additional, Gumede, Simphiwe, additional, Chishala, Chishala, additional, Coetzee, Ettienne, additional, Dyer, Robert A., additional, Diedericks, Johan, additional, Bielański, Piotr, additional, Kaczmarek, Bogusz, additional, Studzińska, Dorota, additional, Zaniewski, Maciej, additional, Libura, Marek Józef, additional, Zacharias-Nalichowski, Tomasz Mikołaj, additional, Sega, Aurelia A.S., additional, Salwa, Jakub, additional, Kózka, Mateusz, additional, Górka, Jacek, additional, Wludarczyk, Anna, additional, Nowak-Kózka, Ilona, additional, Grudzień, Paweł Szczepan, additional, Gucwa, Jaroslaw W., additional, Słowiaczek, Michał Piotr, additional, Dobosz, Paweł P.D., additional, Gögenur, Ismail, additional, Eriksen, Jens Ravn, additional, Borup, Tine, additional, Kirkegaard, Tove, additional, Isbye, Dan, additional, Sonne, Asger, additional, Rasmussen, Lars S., additional, Pedersen, Sofie, additional, Troensegaard, Hannibal, additional, Duus, Camilla L., additional, Halle, Benedikte M., additional, Gundel, Ossian N., additional, Bernholm, Katrine F., additional, Martinsen, Kristian Rønsholt, additional, Pedersen, Søren, additional, Itenov, Theis S., additional, Camio, Elena, additional, Vázquez, Carles, additional, Matarin, Silvia, additional, Cano, Esther, additional, Álvarez-García, Jesús, additional, India, Inmaculada, additional, González-Osuna, Aránzazu, additional, Vives, Marc, additional, Rosselló, Elena, additional, Serrano, Ana B., additional, Turiel, Maurizio, additional, Drago, Lorenzo, additional, Colombo, Chiara, additional, Marra, Federica, additional, Mos, Lucio, additional, Arteni, Franco, additional, Lembo, Rosalba, additional, Ortalda, Alessandro, additional, Passarani, Simonetta, additional, Mokini, Zhirajr, additional, Figueiredo, Estevao Lanna, additional, Werner, Gustavo Fonseca, additional, Petriz, Joao Luiz, additional, Maia, Lilia Nigro, additional, Bergo, Ricardo R., additional, Precoma, Dalton Bertolim, additional, Saraiva, José Francisco Kerr, additional, Vilamajo, Oscar Gomez, additional, Allegrini, Eduardo, additional, Benzadón, Mariano, additional, Parody, Maria Leonor, additional, Duronto, Ernesto A., additional, Ingaramo, Adrián C., additional, Parra, Gustavo Adolfo, additional, Novoa, Danny, additional, Miller, Scott A., additional, Thomas, Sabu, additional, Karlapudi, Sudhakar P., additional, Bourji, Mohamad H., additional, Banerjee, Subhash, additional, Gupta, Anita, additional, Opole, Isaac O., additional, Fischer, Michal, additional, Mendoza, Victor Lecaros, additional, Reyes, Eugenio Borja, additional, Pierson, Richard J., additional, Shields, Martin O., additional, Piriou, Vincent, additional, Zacharowski, Kai, additional, Rotta-Rotta, Aida, additional, Paper, Main, additional, Srinathan, Sadeesh K., additional, Rahate, Prashant, additional, Chaudhry, Navneet, additional, Mayosi, Bogani, additional, Paniagua Iglesias, Pilar, additional, and Sharma, Mike, additional

Published
2018
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162. Association of Vasopressin Plus Catecholamine Vasopressors vs Catecholamines Alone With Atrial Fibrillation in Patients With Distributive Shock

Author

McIntyre, William F., primary, Um, Kevin J., additional, Alhazzani, Waleed, additional, Lengyel, Alexandra P., additional, Hajjar, Ludhmila, additional, Gordon, Anthony C., additional, Lamontagne, François, additional, Healey, Jeff S., additional, Whitlock, Richard P., additional, and Belley-Côté, Emilie P., additional

Published
2018
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166. Atraumatic versus conventional lumbar puncture needles: a systematic review and meta-analysis

Author

Nath, Siddharth, primary, Koziarz, Alex, additional, Badhiwala, Jetan H, additional, Alhazzani, Waleed, additional, Jaeschke, Roman, additional, Sharma, Sunjay, additional, Banfield, Laura, additional, Shoamanesh, Ashkan, additional, Singh, Sheila, additional, Nassiri, Farshad, additional, Oczkowski, Wieslaw, additional, Belley-Côté, Emilie, additional, Truant, Ray, additional, Reddy, Kesava, additional, Meade, Maureen O, additional, Farrokhyar, Forough, additional, Bala, Malgorzata M, additional, Alshamsi, Fayez, additional, Krag, Mette, additional, Etxeandia-Ikobaltzeta, Itziar, additional, Kunz, Regina, additional, Nishida, Osamu, additional, Matouk, Charles, additional, Selim, Magdy, additional, Rhodes, Andrew, additional, Hawryluk, Gregory, additional, and Almenawer, Saleh A, additional

Published
2018
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171. Peri‐mortem arrhythmias in the non‐cardiac intensive care unit.

Author

Okaj, Iva, Vadakken, Maria E., Belley‐Côté, Emilie P., Lengyel, Alexandra P., Rai, Anand S., Suri, Rubani S., Healey, Jeff S., and McIntyre, William F.

Abstract

Background Aim Study design Results Conclusions Relevance to Clinical Practice Cardiovascular failure is recognized as a common final pathway at the end of life but there is a paucity of data describing terminal arrhythmias.We aimed to describe arrhythmias recorded peri‐mortem in critically ill patients.We enrolled intensive care unit patients admitted to two tertiary Canadian medico‐surgical centres. Participants wore a continuous electrocardiogram (ECG) monitor for 14 days, until discharge, removal or death. We recorded all significant occurrences of arrhythmias in the final hour of life.Among 39 patients wearing an ECG monitor at the time of death, 22 (56%) developed at least 1 terminal arrhythmia as adjudicated by an arrhythmia physician: 23% (n = 9) had ventricular fibrillation/polymorphic ventricular tachycardia, 18% (n = 7) had sinoatrial pauses, 15% (n = 6) had atrial fibrillation and 13% (n = 5) had high‐degree atrioventricular block. Five participants (13%) developed multiple arrythmias.Arrhythmias are common in dying critically ill patients. There is a roughly even distribution between ventricular arrhythmias, atrial fibrillation, sinus node dysfunction and atrioventricular block.The results of this study may be most useful for critically ill patients who are organ donation candidates. The appearance of arrhythmias may serve as a marker of change in clinical status for organ donation teams to plan mobilization efforts. In participants who are sedated or intubated, arrhythmias could be a surrogate marker for respiratory or neurologic changes. [ABSTRACT FROM AUTHOR]

Published
2024
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174. Vasopressor use following traumatic injury – A single center retrospective study

Author

Hylands, Mathieu, primary, Godbout, Marie-Pier, additional, Mayer, Sandeep K., additional, Fraser, William D., additional, Vanasse, Alain, additional, Leclair, Marc-André, additional, Turgeon, Alexis F., additional, Lauzier, François, additional, Charbonney, Emmanuel, additional, Trottier, Vincent, additional, Razek, Tarek S., additional, Roy, André, additional, D’Aragon, Frédérick, additional, Belley-Côté, Emilie, additional, Day, Andrew G., additional, Le Guillan, Soazig, additional, Sabbagh, Robert, additional, and Lamontagne, François, additional

Published
2017
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175. Vasopressor use following traumatic injury: protocol for a systematic review

Author

Hylands, Mathieu, primary, Toma, Augustin, additional, Beaudoin, Nicolas, additional, Frenette, Anne-Julie, additional, D'Aragon, Frederick, additional, Belley-Côté, Emilie, additional, Hylander, Morten, additional, Lauzier, François, additional, Siemieniuk, Reed Alexander, additional, Charbonney, Emmanuel, additional, Kwong, Joey, additional, Laake, Jon Henrik, additional, Guyatt, Gordon, additional, Vandvik, Per Olav, additional, Rochwerg, Bram, additional, Green, Robert, additional, Ball, Ian, additional, Scales, Damon, additional, Murthy, Srinivas, additional, Rizoli, Sandro, additional, Asfar, Pierre, additional, and Lamontagne, François, additional

Published
2017
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176. 559: THE DONATE-CONSENT STUDY

Author

D’Aragon, Frederick, primary, Yaworski, Amanda, additional, Frenette, Anne-Julie, additional, Oczkowski, Simon, additional, Rochwerg, Bram, additional, Belley-Côté, Emilie, additional, Lamontagne, François, additional, and Meade, Maureen, additional

Published
2016
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179. Left Atrial Appendage Occlusion: A Narrative Review.

Author

Alsagheir, Ali, Koziarz, Alex, Belley-Côté, Emilie P., and Whitlock, Richard P.

Abstract

Left atrial appendage occlusion (LAAO) is a proposed alternative to oral anticoagulation in reducing stroke in patients with atrial fibrillation. It is suggested that LAAO is most suitable in patients at increased risk of stroke or bleeding or with contraindication to pharmacologic intervention. Despite the increase in evidence evaluating LAAO, the relative safety and efficacy of the procedure remains uncertain. Presently, several ongoing randomized trials are comparing various devices to each other and to pharmacologic anticoagulation. The objectives of this narrative review were to present the evidence on percutaneous and surgical LAAO devices, review current guidelines, and summarize landmark trials. [ABSTRACT FROM AUTHOR]

Published
2019
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180. Reply to Cheseks et al.—Expert Opinions For Refractory Cardiac Arrest: Double Sequential External Defibrillation, Vector Change, and eCPR

Author

van Diepen, Sean, le May, Michel R., Alfaro, Patricia, Goldfarb, Michael J., Luk, Adriana, Mathew, Rebecca, Peretz-Larochelle, Maude, Rayner-Hartley, Erin, Russo, Juan J., Senaratne, Janek M., Ainsworth, Craig, Belley-Côté, Emilie, Fordyce, Christopher B., Kromm, Julie, Overgaard, Christopher B., Schnell, Gregory, and Wong, Graham C.

Published
2024
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181. Reply to Dorian and Dorian—Risk Assessment in Immediate vs Delayed Angiography After Out-of-Hospital Cardiac Arrest Without ST-Segment Elevation Decisions

Author

van Diepen, Sean, Le May, Michel R., Alfaro, Patricia, Goldfarb, Michael J., Luk, Adriana, Mathew, Rebecca, Peretz-Larochelle, Maude, Rayner-Hartley, Erin, Russo, Juan J., Senaratne, Janek M., Ainsworth, Craig, Belley-Côté, Emilie, Fordyce, Christopher B., Kromm, Julie, Overgaard, Christopher B., Schnell, Gregory, and Wong, Graham C.

Published
2024
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184. The effect of perioperative benzodiazepine administration on postoperative nausea and vomiting: a systematic review and meta-analysis of randomised controlled trials.

Author

Au, Emily, Zhao, Karen, Belley-Côté, Emilie, Song, Yuri, Al-Hazzani, Waleed, Sadeghirad, Behnam, Wang, Eugene, Young, Jack, Kashani, Hessam, Kavosh, Morvarid, Inami, Toru, Beaver, Chris, Kloppenburg, Shelley, Mazer, David, Jacobsohn, Eric, Um, Kevin, and Spence, Jessica

Subjects
*POSTOPERATIVE nausea & vomiting, *RANDOMIZED controlled trials
Abstract

Despite recent systematic reviews suggesting their benefit for postoperative nausea, vomiting, or both (PONV) prevention, benzodiazepines have not been incorporated into guidelines for PONV prophylaxis because of concerns about possible adverse effects. We conducted an updated meta-analysis to inform future practice guidelines. We included randomised controlled trials (RCTs) of all languages comparing benzodiazepines with non-benzodiazepine comparators in adults undergoing inpatient surgery. Our outcomes were postoperative nausea, vomiting, or both. We assessed risk of bias for RCTs using the Cochrane Risk of Bias tool. We pooled data using a random-effects model and assessed the quality of evidence for each outcome using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. We screened 31 413 abstracts and 950 full texts. We included 119 RCTs; 104 were included in quantitative synthesis. Based on moderate certainty evidence, we found that perioperative benzodiazepine administration reduced the incidence of PONV (52 studies, n =5086, relative risk [RR]: 0.77, 95% confidence interval [CI] 0.66–0.89; number needed to treat [NNT] 16; moderate certainty), postoperative nausea (55 studies, n =5916, RR: 0.72, 95% CI 0.62–0.83; NNT 21; moderate certainty), and postoperative vomiting (52 studies, n =5909, RR: 0.74, 95% CI 0.60–0.91; NNT 55; moderate certainty). Moderate quality evidence shows that perioperative benzodiazepine administration decreases the incidence of PONV. The results of this systematic review and meta-analysis will inform future clinical practice guidelines. The protocol for this systematic review was pre-registered with PROSPERO International Prospective Register of Systematic Reviews (CRD42022361088) and published in BMJ Open (PMID 31831540). [ABSTRACT FROM AUTHOR]

Published
2024
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185. Association of cardiac biomarkers with acute kidney injury after cardiac surgery: A multicenter cohort study

Author

Belley-Côté, Emilie P., primary, Parikh, Chirag R., additional, Shortt, Colleen R., additional, Coca, Steven G., additional, Garg, Amit X., additional, Eikelboom, John W., additional, Kavsak, Peter, additional, McArthur, Eric, additional, Thiessen-Philbrook, Heather, additional, Whitlock, Richard P., additional, Devarajan, Prasad, additional, Edelstein, Charles, additional, Passik, Cary, additional, Swaminathan, Madhav, additional, Patel, Uptal, additional, Zappitelli, Michael, additional, and Butrymowicz, Isabel, additional

Published
2016
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189. Projet ROSE: Récupération Objective de la fonction Systolique évaluée par Échocardiographie

Author

Farand, Paul, St-Cyr, Denise, Belley-Côté, Emilie-Prudence, Nguyen, Michel, Farand, Paul, St-Cyr, Denise, Belley-Côté, Emilie-Prudence, and Nguyen, Michel

Abstract

Résumé: Mise en contexte : Les infarctus antérieurs avec élévation du segment ST (IMAEST) causent fréquemment une dysfonction ventriculaire gauche. Une diminution de la fraction d’éjection du ventricule gauche (FeVG) est associée à une augmentation du risque d’accident vasculaire cérébral (AVC). Les lignes directrices recommandaient jusqu’à récemment (Classe I, niveau d’évidence C) l’anticoagulation des patients qui, après un IMAEST, étaient jugés à haut risque d’embolie systémique tels que les infarctus étendus ou de la paroi antérieure. Généralement, ces patients reçoivent une anticoagulation d’une durée de trois mois en combinaison avec une double thérapie antiplaquettaire pour au moins quatre semaines. Si les anomalies régionales de la contractilité se normalisaient avant trois mois, la durée de l’anticoagulation pourrait potentiellement être écourtée. La cinétique de récupération des infarctus antérieurs revascularisés par angioplastie primaire est mal décrite. Objectif : Chez des patients ayant subi un IMAEST de la paroi antérieure revascularisés par angioplastie primaire, évaluer si la FeVG et la récupération de l’akinésie antérieure et apicale est différente à un mois et trois mois post infarctus. Méthode : De façon prospective, nous avons recruté 42 patients présentant une FEVG de 45% ou moins et une akinésie de la paroi antérieure ou apicale lors de l’échocardiographie réalisée 48 heures post IMAEST. Des échocardiographies étaient obtenues à un mois et trois mois post IMAEST. Chaque échocardiographie était interprétée par deux cardiologues indépendants à l’aveugle des données cliniques. Résultats : Lorsque comparée à la FeVG à 48 heures post IMAEST, la FeVG à un mois s’était déjà améliorée de façon significative (38% à 42%, p=0.03). Il n’y avait pas d’amélioration significative supplémentaire entre un mois et trois mois (42% à 44%, p=NS). La dynamique des segments apicaux et antérieurs s’améliorait de façon significative entre 48 heures et un mois, mais au, Background: Anterior ST-elevation myocardial infarction (STEMI) frequently causes left ventricular dysfunction. Worsening left ventricular ejection fraction (LVEF) is associated a higher stroke rate. Prior guidelines recommended anticoagulation for patients after STEMI who are at high risk for systemic emboli and specified that large or anterior myocardial infarctions (MI) are part of that group (Class I, level of Evidence C). The 2013 Guidelines made it a Class IIB recommendation and restricted the recommendation to those with anterior or apical akinesia and dyskinesia. These patients are usually given three months of anticoagulation. If the regional wall motion abnormalities were to normalize earlier, the duration of anticoagulation could be shortened. However, the kinetics of recovery after an anterior MI revascularized with primary percutaneous intervention are not well described. Objective: To evaluate if LVEF and apical and anterior akinesia recuperation is different at one month and three months after STEMI in patients treated with primary percutaneous angioplasty. Methods: We prospectively recruited 42 patients who had a LVEF of 45% or less and apical or anterior akinesia on echocardiography at 48 hours post STEMI. Echocardiography was repeated one month and three months post STEMI. Each echocardiogram was interpreted by two different cardiologists who were blinded to clinical information. Results: When compared to 48 hours post STEMI, LVEF at one month had already improved significantly (38% to 42%, p=0.03) and there was no further significant improvement at three months (44%, p=NS). Anterior and apical akinesia decreased significantly between the 48 hours and one month echocardiograms, but also between one month and three months. Conclusion: Given that LVEF and anterior/apical akinesia improve significantly within the first post STEMI month, it may be worth re-evaluating the LVEF earlier in patients in whom the decision was made to start anticoag

Published
2015

191. La place des essais randomisés avec permutation de grappes pour les tests d’efficience comparée en anesthésie: plan de l’essai d’anesthésie cardiaque sans benzodiazépine pour la réduction du délirium postopératoire (étude B-Free).

Author

Spence, Jessica, Belley-Côté, Emilie, Lee, Shun Fu, Bangdiwala, Shrikant, Whitlock, Richard, LeManach, Yannick, Syed, Summer, Lamy, Andre, Jacobsohn, Eric, MacIsaac, Sarah, Devereaux, P. J., and Connolly, Stuart

Abstract

Increasingly, clinicians and researchers recognize that studies of interventions need to evaluate not only their therapeutic efficacy (i.e., the effect on an outcome in ideal, controlled settings) but also their real-world effectiveness in broad, unselected patient groups. Effectiveness trials inform clinical practice by comparing variations in therapeutic approaches that fall within the standard of care. In this article, we discuss the need for studies of comparative effectiveness in anesthesia and the limitations of individual patient randomized-controlled trials in determining comparative effectiveness. We introduce the concept of randomized cluster crossover trials as a means of answering questions of comparative effectiveness in anesthesia, using the design of the Benzodiazepine-Free Cardiac Anesthesia for Reduction in Postoperative Delirium (B-Free) trial (Clinicaltrials.gov identifier NCT03053869). [ABSTRACT FROM AUTHOR]

Published
2018
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192. L’administration de benzodiazépines pendant la chirurgie cardiaque chez l’adulte: évaluation de la pratique actuelle des anesthésiologistes canadiens exerçant en milieu universitaire.

Author

Spence, Jessica, Belley-Côté, Emilie, Devereaux, P. J., Whitlock, Richard, Um, Kevin, McClure, Graham, Lamy, Andre, LeManach, Yannick, Connolly, Stuart, and Syed, Summer

Abstract

Background: Benzodiazepines are commonly administered during cardiac surgery because of their limited effect on hemodynamics and presumed role in preventing intraoperative awareness. Recent concerns about an increased risk of delirium with benzodiazepines have resulted in decreased usage in the intensive care unit and in geriatric perioperative practice. Little is known, however, about current benzodiazepine usage in the setting of adult cardiac surgery.Methods: We contacted all academic anesthesia departments in Canada to identify practicing attending cardiac anesthesiologists; this group constituted our sampling frame. Information regarding participant demographics, benzodiazepine usage, type, dose, and other administration details were obtained by electronic survey. Responses were analyzed descriptively.Results: The survey was completed by 243/346 (70%) of cardiac anesthesiologists. Eleven percent of respondents do not administer benzodiazepines. Midazolam was the most commonly used benzodiazepine, with a mean (standard deviation) dose of 4.9 (3.8) mg given to an average patient. When respondents were asked the proportion of patients that they gave benzodiazepines, the response was bimodal. The most common considerations that influenced benzodiazepine use were patient age (73%), patient anxiety (63%), history of alcohol/drug/benzodiazepine use (60%), and the presence of risk factors for intraoperative awareness (44%).Conclusions: Benzodiazepine use is common among academic cardiac anesthesiologists in Canada. Nonetheless, heterogeneity exists between individual practices, suggesting clinical equipoise between restrictive and liberal administration of benzodiazepines for cardiac anesthesia. L'administration de benzodiazépines pendant la chirurgie cardiaque chez l'adulte: évaluation de la pratique actuelle des anesthésiologistes canadiens exerçant en milieu universitaire. [ABSTRACT FROM AUTHOR]

Published
2018
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193. Atrial fibrillation detected initially during acute medical illness: A systematic review

Author

McIntyre, William F, Um, Kevin J, Cheung, Christopher C, Belley-Côté, Emilie P, Dingwall, Orvie, Devereaux, Philip J, Wong, Jorge A, Conen, David, Whitlock, Richard P, Connolly, Stuart J, Seifer, Colette M, and Healey, Jeff S

Abstract

Objective: There is uncertainty about the incidence of and prognosis associated with atrial fibrillation that is documented for the first time in the setting of an acute stressor, such as surgery or medical illness. Our objective was to perform a systematic review of the incidence and long-term recurrence rates for atrial fibrillation occurring transiently with stress in the setting of acute medical illness.Data sources: Medline, Embase and Cochrane Central to September 2017.Study selection: We included retrospective and prospective observational studies, and randomised controlled trials. The population of interest included patients hospitalised for medical (i.e. non-surgical) illness who developed newly diagnosed atrial fibrillation. Studies were included if they included data on either the incidence of atrial fibrillation or the rate of atrial fibrillation recurrence in atrial fibrillation occurring transiently with stress patients following hospital discharge.Data extraction: Two reviewers collected data independently and in duplicate. We characterised each study’s methodology for ascertainment of prior atrial fibrillation history, atrial fibrillation during hospitalisation and atrial fibrillation recurrence after hospital discharge.Data synthesis: Thirty-six studies reported the incidence of atrial fibrillation. Ten used a prospective design and included a period of continuous electrocardiographic (ECG) monitoring. Atrial fibrillation incidence ranged from 1% to 44%, which was too heterogeneous to justify meta-analysis (I2=99%). In post-hocmeta-regression models, the use of continuous ECG monitoring explained 13% of the variance in atrial fibrillation incidence, while care in an intensive care unit explained none. Two studies reported the long-term rate of atrial fibrillation recurrence following atrial fibrillation occurring transiently with stress. Neither of these studies used prospective, systematic monitoring. Recurrence rates at 5 years ranged from 42% to 68%.Conclusions: The incidence of atrial fibrillation with medical illness may be as high as 44%, with higher estimates in reports using continuous ECG monitoring. Within 5 years following hospital discharge, atrial fibrillation recurrence is documented in approximately half of patients; however, the true rate may be higher.Protocol registration PROSPERO CRD42016043240

Published
2019
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198. The role of randomized cluster crossover trials for comparative effectiveness testing in anesthesia: design of the Benzodiazepine-Free Cardiac Anesthesia for Reduction in Postoperative Delirium (B-Free) trial

Author

Spence, Jessica, Belley-Côté, Emilie, Lee, Shun, Bangdiwala, Shrikant, Whitlock, Richard, LeManach, Yannick, Syed, Summer, Lamy, Andre, Jacobsohn, Eric, MacIsaac, Sarah, Devereaux, P., and Connolly, Stuart

Abstract

Increasingly, clinicians and researchers recognize that studies of interventions need to evaluate not only their therapeutic efficacy (i.e., the effect on an outcome in ideal, controlled settings) but also their real-world effectiveness in broad, unselected patient groups. Effectiveness trials inform clinical practice by comparing variations in therapeutic approaches that fall within the standard of care. In this article, we discuss the need for studies of comparative effectiveness in anesthesia and the limitations of individual patient randomized-controlled trials in determining comparative effectiveness. We introduce the concept of randomized cluster crossover trials as a means of answering questions of comparative effectiveness in anesthesia, using the design of the Benzodiazepine-Free Cardiac Anesthesia for Reduction in Postoperative Delirium (B-Free) trial (Clinicaltrials.gov identifier NCT03053869). De plus en plus, les cliniciens et chercheurs reconnaissent que les études sur des interventions doivent évaluer non seulement leur efficacité thérapeutique (c’est-à-dire l’effet sur un critère d’évaluation dans un cadre contrôlé, idéal), mais aussi son efficience dans la vraie vie sur de larges groupes de patients non sélectionnés. Les études sur l’efficience informent la pratique clinique en comparant des variations — entrant dans les normes de soins — dans les démarches thérapeutiques. Dans cet article, nous discutons de la nécessité d’avoir en anesthésie des études comparatives de l’efficience et des limites des essais contrôlés avec des patients randomisés individuellement pour la détermination de l’efficience comparative. Nous présentons le concept d’essais randomisés avec permutation (« crossover ») de grappes (« cluster ») comme moyen de répondre aux questions d’efficience comparative en anesthésie en utilisant le plan de l’essai d’anesthésie cardiaque sans benzodiazépine pour la réduction du délirium postopératoire (étude B-Free).

Published
2018
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199. Benzodiazepine administration during adult cardiac surgery: a survey of current practice among Canadian anesthesiologists working in academic centres

Author

Spence, Jessica, Belley-Côté, Emilie, Devereaux, P., Whitlock, Richard, Um, Kevin, McClure, Graham, Lamy, Andre, LeManach, Yannick, Connolly, Stuart, and Syed, Summer

Abstract

Benzodiazepines are commonly administered during cardiac surgery because of their limited effect on hemodynamics and presumed role in preventing intraoperative awareness. Recent concerns about an increased risk of delirium with benzodiazepines have resulted in decreased usage in the intensive care unit and in geriatric perioperative practice. Little is known, however, about current benzodiazepine usage in the setting of adult cardiac surgery. We contacted all academic anesthesia departments in Canada to identify practicing attending cardiac anesthesiologists; this group constituted our sampling frame. Information regarding participant demographics, benzodiazepine usage, type, dose, and other administration details were obtained by electronic survey. Responses were analyzed descriptively. The survey was completed by 243/346 (70%) of cardiac anesthesiologists. Eleven percent of respondents do not administer benzodiazepines. Midazolam was the most commonly used benzodiazepine, with a mean (standard deviation) dose of 4.9 (3.8) mg given to an average patient. When respondents were asked the proportion of patients that they gave benzodiazepines, the response was bimodal. The most common considerations that influenced benzodiazepine use were patient age (73%), patient anxiety (63%), history of alcohol/drug/benzodiazepine use (60%), and the presence of risk factors for intraoperative awareness (44%). Benzodiazepine use is common among academic cardiac anesthesiologists in Canada. Nonetheless, heterogeneity exists between individual practices, suggesting clinical equipoise between restrictive and liberal administration of benzodiazepines for cardiac anesthesia. L’administration de benzodiazépines pendant la chirurgie cardiaque chez l’adulte: évaluation de la pratique actuelle des anesthésiologistes canadiens exerçant en milieu universitaire Les benzodiazépines sont fréquemment administrées pendant la chirurgie cardiaque en raison de leur effet limité sur l’hémodynamie et de leur rôle présumé dans la prévention de l’éveil peropératoire. Des inquiétudes sont récemment apparues concernant un risque accru de délirium lors de l’administration de benzodiazépines; par conséquent, une réduction de leur utilisation à l’unité des soins intensifs et dans la pratique périopératoire gériatrique a été observée. Nous disposons toutefois de très peu de données concernant l’usage actuel de benzodiazépines dans le contexte de la chirurgie cardiaque chez l’adulte. Nous avons contacté tous les départements universitaires d’anesthésie au Canada afin d’identifier les anesthésiologistes cardiaques en pratique; ce groupe de praticiens a constitué notre cadre d’échantillonnage. Les renseignements concernant les données démographiques des patients, l’utilisation de benzodiazépines, leur type, leur posologie ainsi que les autres détails d’administration ont été obtenus par sondage électronique. Les réponses ont été analysées de façon descriptive. Le sondage a été complété par 243/346 (70 %) des anesthésiologistes cardiaques. Onze pour cent des répondants n’administrent pas de benzodiazépines. Le midazolam était l’agent le plus fréquemment utilisé, avec une dose moyenne (écart type) de 4,9 (3,8) mg administrée à un patient moyen. Lorsqu’on a demandé aux répondants à quel pourcentage de leurs patients ils administraient des benzodiazépines, la réponse obtenue était bimodale. Les considérations les plus fréquentes influençant l’utilisation de benzodiazépines était l’âge du patient (73 %), son niveau d’anxiété (63 %), ses antécédents concernant l’utilisation d’alcool/drogues/benzodiazépines (60 %), et la présence de facteurs de risque d’éveil peropératoire (44 %). L’utilisation de benzodiazépines est fréquente parmi les anesthésiologistes cardiaques travaillant en milieu universitaire au Canada. Toutefois, les pratiques individuelles sont hétérogènes, ce qui laisse à penser qu’il existe un équilibre clinique entre l’administration restrictive vslibérale des benzodiazépines en anesthésie cardiaque.

Published
2018
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200. Does Early Coronary Angiography Improve Survival After out-of-Hospital Cardiac Arrest? A Systematic Review With Meta-Analysis

Author

Welsford, Michelle, Bossard, Matthias, Shortt, Colleen, Pritchard, Jodie, Natarajan, Madhu K., and Belley-Côté, Emilie P.

Abstract

In patients with out-of-hospital cardiac arrest who achieve return of spontaneous circulation, coronary angiography (CAG) might improve outcomes. We conducted a systematic review and meta-analysis to elucidate the benefit and optimal timing of early CAG in comatose out-of-hospital cardiac arrest patients with return of spontaneous circulation.

Published
2018
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