Daily Anesthesiology Research Analysis

INTRODUCTION: Survival after out-of-hospital cardiac arrest (OHCA) remains poor, particularly for refractory ventricular fibrillation/ventricular tachycardia (VF/VT). Extracorporeal cardiopulmonary resuscitation (ECPR) improves outcomes when delivered within 60 minutes of low-flow time, although geographic constraints frequently extend this interval in rural settings. RESEARCH QUESTION/HYPOTHESIS: We hypothesized that a Helicopter-EMS (HEMS)-facilitated, hospital-based ECPR pathway could expand rural access while preserving clinical outcomes comparable to standard ground-transport ECPR. METHODS: The FaciLItated hospital-based ECPR via Helicopter Transport (FLIGHT-to-ECPR) Study is a single-center prospective observational cohort study (August 2021-December 2025). Adults (18-75 years) with refractory VF/VT OHCA meeting Minnesota Mobile Resuscitation Consortium eligibility criteria were included. The pathway used parallel EMS and Helicopter-EMS activation with intra-arrest mechanical-CPR transport to a hospital-based ECMO center. Outcomes were compared 1:1 with a matched cohort treated under the standard ground-transport ECPR protocol, matched on low-flow time. The primary outcome was survival to discharge with favorable neurologic status (CPC 1-2). RESULTS: Forty-five patients underwent FLIGHT activation; 27 (60%) received ECPR (veno-arterial ECMO during cardiac arrest). Mean age was 55.2±15.0 years; 83.7% were witnessed arrests and 69.0% received bystander CPR. Mean 9-1-1-to-hospital arrival time was 70.3±18.5 minutes; HEMS scene and flight times were 18.0±11.6 and 18.6±6.3 minutes, respectively. Among cannulated patients, low-flow time was 85.9±29.3 minutes. Overall favorable neurologic survival (CPC 1-2) was 33.3% (15/45): 25.9% (7/27) in cannulated patients and 44.4% (8/18) in non-cannulated patients achieving ROSC or meeting termination criteria. In matched ECPR patients (n=27/group), low-flow times were similar (85.9±29.3 vs. 87.1±29.2minutes; p= > 0.99), with identical favorable neurologic survival (25.9%; p= > 0.99). No differences were observed in cannulation performance, ECMO duration, or hospital length of stay. CONCLUSIONS: A HEMS-facilitated, hospital-based ECPR strategy is feasible and safely expands rural access to advanced resuscitation while preserving neurologic outcomes comparable to standard ground-transport ECPR. Geography alone need not preclude ECPR when systems are optimized to maintain timely reperfusion.

BACKGROUND: This study aims to compare the analgesic efficacy and procedural efficiency of pectoral (PECS II) blocks performed using artificial intelligence (AI)-integrated ultrasonography (USG) versus conventional USG in patients undergoing modified radical mastectomy (MRM). PATIENTS AND METHODS: Between November 2021 and March 2023, a total of 70 female patients scheduled for unilateral MRM under general anesthesia were included in this randomized study. The patients were randomly allocated into two groups: USG group (n = 35) and AI-USG group (n = 35). A fourth-year anesthesiology resident performed the PECS II blocks under the supervision of a senior anesthesiologist. The primary outcome was the postoperative pain score as assessed by Visual Analog Scale (VAS) at 12 hours. Secondary outcomes included pain scores at other postoperative time points, total opioid consumption, time first to rescue analgesia request within 24 hours, and the resident's skill development at the end of the study. RESULTS: The mean age was 55.3±11.4 (range, 35 to 75) years. Intraoperative remifentanil consumption was higher in USG group than in AI-USG group; however, the difference was not statistically significant (p > 0.05). The durations of anesthesia and surgery were shorter in AI-USG group (p = 0.005 and p = 0.008, respectively). A comparison of local anesthetic injection times between the first 35 and the last 35 patients revealed a statistically significant decrease in the USG group (4.0 min vs. 3.0 min, p = 0.014). The VAS pain scores in the post-anesthesia care unit were initially higher in the AI-USG group (p = 0.05); however, at 12 and 24 postoperative hours, VAS scores were significantly lower than those in the USG group (p = 0.005 and p < 0.001, respectively). There was no significant difference in total tramadol consumption via PCA during the first 24 hours postoperatively (p > 0.05). Surgeon satisfaction scores were lower in the AI-USG group (p = 0.037). CONCLUSION: Our study results suggest that AI-enhanced USG guidance is associated with improved analgesic outcomes and may offer clinical and educational advantages in the performance of PECS II blocks, particularly for residents in training. The integration of AI into routine USG-guided regional anesthesia practice holds promise for improving procedural consistency and supporting novice practitioners.

OBJECTIVES: Blood cultures are essential for guiding antimicrobial therapy, but contamination remains a major challenge, particularly when samples are drawn from central venous catheters (CVCs). Blood cultures obtained from CVCs, even when newly inserted, show higher contamination rates than those from peripheral venipuncture, likely due to translocation of skin bacteria during skin dilation and catheter insertion. In critically ill patients with suspected infection or difficult peripheral venous access, CVC insertion often coincides with the indication for blood culture sampling. We hypothesized that obtaining blood cultures directly from the initial central venous puncture before CVC insertion could reduce contamination without impairing true pathogen detection. DESIGN: Retrospective paired comparison study of blood culture sets obtained during CVC insertion: one sample from the initial puncture before, and one from the CVC wire hub after insertion. Microbiological isolates were categorized as contaminants or true pathogens and compared within corresponding sampling pairs. SETTING: Five surgical ICUs of a tertiary care university hospital. PATIENTS: Two hundred twenty-eight critically ill patients requiring CVC placement (from November 2024 to July 2025). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Initial central venous sampling was associated with lower contamination rates than catheter wire hub sampling (3.5% vs. 14.1%), corresponding to an absolute risk difference of -10.6 percentage points (95% CI, -25.6% to -5.4%) and a relative risk of 0.25 (95% CI, 0.12-0.53). The number of procedures with the initial puncture technique required to prevent one contamination was 10 (95% CI, 6-18), and the odds of contamination were significantly lower with initial central venous sampling (odds ratio, 0.22; 95% CI, 0.10-0.49; p < 0.001). Contaminants were mostly coagulase-negative staphylococci, Propionibacterium species, and Corynebacterium species. Detection of true pathogens, including Escherichia coli, Pseudomonas aeruginosa, Klebsiella species, and Staphylococcus aureus, was comparable between techniques. CONCLUSIONS: Initial central venous blood culture sampling before CVC insertion is a simple approach that does not generate additional costs and may reduce contamination while preserving accurate pathogen detection, thereby potentially improving diagnostic certainty and supporting antimicrobial stewardship.