Management of temporary epicardial pacing wires in the cardiac surgical patient

Temporary epicardial pacing wires are used after cardiothoracic surgery to maintain a stable cardiac rhythm. They must be distinguished from the more commonly encountered transvenous temporary pacing wires, which are often used in coronary care units for the same purpose. Patients with temporary epicardial pacing wires may be transferred to hospital wards where these wires are not usually encountered, such as COVID wards, the general intensive care unit, the coronary care unit or general surgical wards if a laparotomy was required in the early period following cardiac surgery. Serious complications may arise in managing patients with temporary epicardial pacing wires, which are well known in the cardiothoracic unit but not so well known elsewhere in the hospital. This article discusses the dangers associated with the management of temporary epicardial pacing wires in adult patients, some of which are common to temporary transvenous pacing wires and others are unique to temporary epicardial pacing wires.

Echocardiography in post-cardiac surgery

Echocardiography following cardiac surgery can be regarded as a subspecialty of critical care echocardiography, as it requires knowledge of the specifics of each surgical intervention and potential complications, as well as in-depth knowledge of cardiac anatomy and physiology. It has a significant overlap with intraoperative transoesophageal echocardiography (TOE) but they are not synonymous. This chapter outlines the general approach to evaluate the postoperative cardiac surgical patient using echocardiography, as well as specific considerations for common cardiac surgical procedures, and some of the potential pitfalls that exist. As there are increasing numbers of transcatheter/hybrid interventions now being undertaken, this chapter additionally includes a section on postcatheter complications. The final section addresses areas where echocardiography can be used to guide the use of extracorporeal support on the surgical cardiac intensive care unit.