Rapid identification of possible vascular compromise in free flap reconstruction to minimize time to reoperation improves achieving free flap salvage. Subjective clinical assessment, often complemented with handheld Doppler, is the golden standard for flap monitoring; but this lacks consistency and may be variable. Non-invasive optical methods such as near-infrared spectroscopy (NIRS) and hyperspectral imaging (HSI) could facilitate objective flap monitoring. A systematic review was conducted to compare NIRS with HSI in detecting vascular compromise in reconstructive flap surgery as compared to standard monitoring. A literature search was performed using PubMed and Embase scientific database in August 2021. Studies were selected by two independent reviewers. Sixteen NIRS and five HSI studies were included. In total, 3662 flap procedures were carried out in 1970 patients using NIRS. Simultaneously; 90 flaps were performed in 90 patients using HSI. HSI and NIRS flap survival were 92.5% (95% CI: 83.3–96.8) and 99.2% (95% CI: 97.8–99.7). Statistically significant differences were observed in flap survival (p = 0.02); flaps returned to OR (p = 0.04); salvage rate (p < 0.01) and partial flap loss rate (p < 0.01). However, no statistically significant difference was observed concerning flaps with vascular crisis (p = 0.39). NIRS and HSI have proven to be reliable; accurate and user-friendly monitoring methods. However, based on the currently available literature, no firm conclusions can be drawn concerning non-invasive monitoring technique superiority

Objective: Myocardial damage occurs in up to 25% of coronavirus disease 2019 (COVID‐19) cases. While veno‐venous extracorporeal life support (V‐V ECLS) is used as respiratory support, mechanical circulatory support (MCS) may be required for severe cardiac dysfunction. This systematic review summarizes the available literature regarding MCS use rates, disease drivers for MCS initiation, and MCS outcomes in COVID‐19 patients. Methods: PubMed/EMBASE were searched until October 14, 2021. Articles including adults receiving ECLS for COVID‐19 were included. The primary outcome was the rate of MCS use. Secondary outcomes included mortality at follow‐up, ECLS conversion rate, intubation‐to‐cannulation time, time on ECLS, cardiac diseases, use of inotropes, and vasopressors. Results: Twenty‐eight observational studies (comprising both ECLS‐only populations and ECLS patients as part of larger populations) included 4218 COVID‐19 patients (females: 28.8%; median age: 54.3 years, 95%CI: 50.7–57.8) of whom 2774 (65.8%) required ECLS with the majority (92.7%) on V‐V ECLS, 4.7% on veno‐arterial ECLS and/or Impella, and 2.6% on other ECLS. Acute heart failure, cardiogenic shock, and cardiac arrest were reported in 7.8%, 9.7%, and 6.6% of patients, respectively. Vasopressors were used in 37.2%. Overall, 3.1% of patients required an ECLS change from V‐V ECLS to MCS for heart failure, myocarditis, or myocardial infarction. The median ECLS duration was 15.9 days (95%CI: 13.9–16.3), with an overall survival of 54.6% and 28.1% in V‐V ECLS and MCS patients. One study reported 61.1% survival with oxy‐right ventricular assist device. Conclusion: MCS use for cardiocirculatory compromise has been reported in 7.3% of COVID‐19 patients requiring ECLS, which is a lower percentage compared to the incidence of any severe cardiocirculatory complication. Based on the poor survival rates, further investigations are warranted to establish the most appropriated indications and timing for MCS in COVID‐19.

Background: QRISK is a cardiovascular risk prediction model used in the United Kingdom to guide statin prescribing and is a rare example of a clinically implemented model that has undergone regular updates. Successive QRISK versions have incorporated additional predictors and expanded target populations, but the contribution of these updates to model performance remains unclear. We evaluated the impact of QRISK updating by comparing the performance of QRISK I–IV. Methods: We performed temporal external validation and external validation of sex-specific QRISK I–IV models in ten observational healthcare databases, including the UK Clinical Practice Research Datalink (CPRD). Temporal external validation was conducted at 6-month intervals from 2007 to 2024 using adjusted original and fixed QRISK I and QRISK IV target cohorts, whereas external validation was performed during the original development periods of each QRISK version. Model discrimination, calibration, and net benefit were assessed. Results: Across ten databases, evaluation of different QRISK versions within the same study populations showed little effect of model updating on discrimination. Although successive QRISK versions demonstrated incremental improvements in discrimination when evaluated within their respective target populations, these improvements were substantially attenuated when applied to fixed target populations, suggesting that gains were largely attributable to differences in population composition rather than model updating. Calibration analyses generally indicated overestimation of cardiovascular risk, and net-benefit was negative across databases and QRISK versions. In CPRD, discrimination was similar to that reported in the original development studies, but calibration overestimated risk and net benefit remained negative. Conclusion: QRISK I-IV showed broadly stable predictive performance, suggesting sustained robustness of cardiovascular risk prediction despite substantial changes to model specification. Apparent gains in successive QRISK versions were driven primarily by broader population coverage, particularly expansion of the age range, rather than mitigation of performance drift, supporting continued use of QRISK alongside ongoing monitoring of performance and clinical utility.