Objective: Renal dysfunction and acute renal failure after coronary artery bypass grafting (CABG) are among the main causes of increased mortality and morbidity. A sternum-sparing concept of minimally invasive total coronary revascularization via anterior minithoracotomy (TCRAT) was introduced with promising early and midterm outcomes in multivessel coronary artery disease. There are limited data regarding renal complications in patients undergoing the TCRAT technique. The present study analyzed renal outcomes in TCRAT compared to CABG via full median sternotomy (FS). Methods: We analyzed the records of 227 consecutive TCRAT patients (from September 2021 to June 2023) and 228 consecutive FS patients (from January 2017 to December 2018) who underwent nonemergent CABG. Following propensity score matching, preoperative baseline characteristics—including age, sex, diabetes mellitus, arterial hypertension, left ventricular ejection fraction, EuroSCORE II, preoperative serum creatinine, estimated glomerular filtration rate (eGFR), serum urea, and pre-existing chronic renal insufficiency—were comparable between the TCRAT (n = 170) and the FS group (n = 170). The examined postoperative renal parameters and complications were serum creatinine, eGFR, and serum urea on the first postoperative day. Moreover, serum creatinine, eGFR and serum urea at the time of discharge, postoperative ARF, and hemodialysis were investigated. Additionally, the duration of operation, CPB time, aortic cross-clamp time, ICU and hospital stay, ECMO support, rethoracotomy and in-hospital mortality were analyzed. The parameters were compared between groups using a Student’s t-test or Mann–Whitney U test. Results: The duration of operation (332 ± 66 vs. 257 ± 61 min; p < 0.05), CPB time (161 ± 40 vs. 116 ± 38 min; p < 0.05), and aortic cross-clamp time (100 ± 31 vs. 76 ± 26; p < 0.05) were longer in the TCRAT group. ICU (1.8 ± 2.2 vs. 2.9 ± 3.6 days; p < 0.05) and hospital (10.4 ± 7.6 vs. 12.4 ± 7.5 days; p < 0.05) stays were shorter in the TCRAT group. There were no differences between groups with regard to the renal parameters examined. Conclusions: Despite a prolonged duration of operation, CPB time, and aortic cross-clamp time when using the TCRAT technique, no increase in renal complications were found. In addition, ICU and hospital stays in the TCRAT group were shorter compared to CABG via full median sternotomy.

Background: Point-of-care ultrasound (POCUS) is increasingly being used in prehospital emergency medicine. While physician-performed prehospital ultrasound is well established, evidence regarding the feasibility and diagnostic accuracy of paramedic-performed POCUS in real-world settings remains limited. Methods: We conducted a retrospective observational cohort study evaluating paramedic-performed POCUS following a structured, multimodal training program. Twenty-one certified paramedics performed handheld ultrasound examinations in prehospital emergencies using standardized protocols with an observation period of 24 months, starting from March 2023. Feasibility, utilization patterns, diagnostic accuracy, and perceived clinical impact were assessed using standardized documentation. Hospital diagnoses served as the reference standard, based on radiological, sonographic, and/or clinical documentation. Results: A total of 169 ultrasound examinations were performed on 144 patients. The overall diagnostic performance achieved a sensitivity of 87.9% and specificity of 92.7%. Diagnostic accuracy, defined as the concordance between prehospital POCUS-based working diagnoses and final in-hospital diagnoses, was particularly strong for lung ultrasound (pneumothorax, pulmonary edema, pneumonia and pleural effusion; sensitivity 91.7%, specificity 100%) and eFAST (sensitivity 100%, specificity 96.5%), while for the abdominal ultrasound examinations, the specificity was 70% and sensitivity was 71.43%. Ultrasound findings influenced logistical and clinical decision-making in a substantial proportion of missions, including changes in transport urgency (36.1%) and hospital destination (18.1%), whereas emergency room prealerts were avoided in 9.7% of cases. Training resulted in significantly more positive attitudes regarding feasibility, clinical relevance, and image of paramedic-performed ultrasound. Concerns regarding time delay and workload were markedly reduced. Conclusions: Paramedic-performed prehospital POCUS is feasible after structured training and can be integrated into routine prehospital care. Prospective studies should further assess the diagnostic accuracy, reliability, and clinical impact of paramedic-performed POCUS in the prehospital setting.