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Journal of Extra-corporeal Technology

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https://www.readbyqxmd.com/read/29302124/extracorporeal-life-support-as-a-rescue-measure-for-managing-life-threatening-arrythmia-and-brugada-syndrome
#1
Asaad G Beshish, Allison Weinberg, Waseem Ostwani, Gabe E Owens
We describe the use of extracorporeal cardiopulmonary resuscitation (E-CPR) to transiently stabilize a 3-month-old patient who presented with ventricular tachyarrhythmias leading to spontaneous cardiac arrest. The patient required 4 days of extracorporeal life support (ECLS) where he was diagnosed with probable Brugada syndrome (BS). The patient was discharged home in stable condition after implantable cardioverter defibrillator placement. This case highlights the importance of early transfer to extracorporeal membrane oxygenation (ECMO) center in the setting of unexplained cardiac arrhythmia in a pediatric patient...
December 2017: Journal of Extra-corporeal Technology
https://www.readbyqxmd.com/read/29302123/bloodless-repair-for-a-3-6-kilogram-transposition-of-the-great-arteries-with-jehovah-s-witness-faith
#2
Jeffery L Burnside, Todd M Ratliff, Ashley B Hodge, Daniel Gomez, Mark Galantowicz, Aymen Naguib
Achieving pediatric cardiac surgery using cardiopulmonary bypass (CPB) without allogeneic blood transfusion is challenging. There are many clinical and economic factors that point to the importance of avoiding blood transfusions. In some instances, honoring patients or parents beliefs may be the reason for avoiding blood transfusions. For example, patients or parents of the Jehovah's Witness faith refuse blood transfusion based on their religious beliefs. Over the last decade, our institution has seen a steady increase in our pediatric Jehovah's Witness patient population...
December 2017: Journal of Extra-corporeal Technology
https://www.readbyqxmd.com/read/29302122/rvad-support-in-the-setting-of-submassive-pulmonary-embolism
#3
Antonio Salsano, Elena Sportelli, Guido Maria Olivieri, Nicola Di Lorenzo, Silvia Borile, Francesco Santini
Patients with submassive pulmonary embolism (PE), although normotensive, are characterized by right ventricular (RV) dysfunction and elevated levels of biomarkers of cardiac damage. The best treatment option in these cases is still a subject of debate and the use of thrombolysis in submassive PE remains controversial. A 57-year-old Caucasian male with unprovoked PE, normal blood pressure, and elevated troponin I values was referred to the cardiovascular department. In view of the presence of a right atrium thrombus, the patient underwent surgical embolectomy under extracorporeal circulation, with the extraction of a huge thrombus together with fragmented thrombi from both pulmonary arteries...
December 2017: Journal of Extra-corporeal Technology
https://www.readbyqxmd.com/read/29302121/use-of-a-modified-cardiopulmonary-bypass-circuit-for-suction-embolectomy-with-the-angiovac-device
#4
Cara M Michelson, Cornelius M Dyke, Douglas J Wick, Rory Guenther, Dylan Dangerfield, Matthew E Wiisanen
The AngioVac suction cannula and circuit were designed for the percutaneous removal of soft thrombus and emboli in procedures requiring extracorporeal circulatory support. We describe a modification of the AngioVac suction catheter and cardiopulmonary bypass (CPB) circuit to effectively remove thrombus while maintaining the ability to rapidly initiate full CPBs during a medical crisis. This article will discuss the design concepts of the modified circuit as well as procedural protocols and considerations. The design modifications of incorporating an oxygenator, reservoir, and bridge allow for an increased flexibility that allows adaption to veno-venous extracorporeal membrane oxygenation or full CPB support when required for oxygenation or hemodynamic support...
December 2017: Journal of Extra-corporeal Technology
https://www.readbyqxmd.com/read/29302120/a-dedicated-perfusion-electronic-medical-record-with-discrete-epic-integration
#5
James A Reagor
Enterprise electronic medical records (EMR) have largely become a standard since their use was mandated by The American Recovery and Reinvestment Act of 2009. However, perfusion departments have adopted true perfusion EMRs at various rates. In our efforts to integrate with the institutions EMR while enjoying the benefits of an EMR designed specifically for perfusion practice, we developed a discrete data integration solution between Epic and the Spectrum Medical VIPER Perfusion EMR. This report describes our perfusion EMR selection criteria, design challenges, and documentation process...
December 2017: Journal of Extra-corporeal Technology
https://www.readbyqxmd.com/read/29302119/teg-directed-transfusion-in-complex-cardiac-surgery-impact-on-blood-product-usage
#6
Kevin Fleming, Roberta E Redfern, Rebekah L March, Nathan Bobulski, Michael Kuehne, John T Chen, Michael Moront
Complex cardiac procedures often require blood transfusion because of surgical bleeding or coagulopathy. Thrombelastography (TEG) was introduced in our institution to direct transfusion management in cardiothoracic surgery. The goal of this study was to quantify the effect of TEG on transfusion rates peri- and postoperatively. All patients who underwent complex cardiac surgery, defined as open multiple valve repair/replacement, coronary artery bypass grafting with open valve repair/replacement, or aortic root/arch repair before and after implementation of TEG were identified and retrospectively analyzed...
December 2017: Journal of Extra-corporeal Technology
https://www.readbyqxmd.com/read/29302118/blood-and-blood-product-conservation-results-of-strategies-to-improve-clinical-outcomes-in-open-heart-surgery-patients-at-a-tertiary-hospital
#7
Junaid H Khan, Emily A Green, Jimmin Chang, Alexandria M Ayala, Marilyn S Barkin, Emily E Reinys, Jeffrey Stanton, Russell D Stanten
Blood product usage is a quality outcome for patients undergoing cardiac surgery. To address an increase in blood product usage since the discontinuation of aprotinin, blood conservation strategies were initiated at a tertiary hospital in Oakland, CA. Improving transfusion rates for open heart surgery patients requiring Cardiopulmonary bypass (CPB) involved multiple departments in coordination. Specific changes to conserve blood product usage included advanced CPB technology upgrades, and precise individualized heparin dose response titration assay for heparin and protamine management...
December 2017: Journal of Extra-corporeal Technology
https://www.readbyqxmd.com/read/29302117/an-in-vitro-study-comparing-the-gme-handling-of-two-contemporary-oxygenators
#8
Carl J Gisnarian, Angela Hedman, Kenneth G Shann
Gaseous microemboli (GME) are a potential complication of cardiopulmonary bypass (CPB). Though it is difficult to prove that GME is the only major cause of neurological deficits, it may increase the chance of post-operative cognitive dysfunction if not removed. The objectives of this research were to compare LivaNova-Sorin Inspire (Inspire) oxygenator with a Medtronic arterial filter to the Medtronic Fusion (Fusion) oxygenator with and without a Medtronic arterial filter based on each system's ability to handle GME...
December 2017: Journal of Extra-corporeal Technology
https://www.readbyqxmd.com/read/29302116/quantification-of-carbon-dioxide-removal-at-low-sweep-gas-and-blood-flows
#9
Juan de Villiers Hugo, Ajay S Sharma, Usaama Ahmed, Patrick W Weerwind
Advancement in oxygenator membrane technology has further expanded the boundaries in the clinical application of extracorporeal carbon dioxide removal (ECCO2R). Despite the advent of modern poly-4-methyl-1-pentene (PMP) membranes, limited information exists on the performance of these membranes at low sweep gas and blood flows. Moreover, physiological relationships for CO2 removal at these flows are less explored. Hence, CO2 removal was quantified in an in vitro setting using a PMP membrane oxygenator. ECCO2R was performed using a ...
December 2017: Journal of Extra-corporeal Technology
https://www.readbyqxmd.com/read/29302115/colloid-oncotic-pressure-monitoring-its-effects-in-cardiac-surgery
#10
Jeffrey B Chores, David W Holt
Hemodilution is a common perioperative practice. The deleterious effects of excessive hemodilution and subsequent edema formation have been well documented by numerous authors. Colloid oncotic pressure (COP) is a reliable clinical indicator of hemodilution in cardiac surgery. The intent of this study is to determine if a correlation exists between COP and various patient outcome variables. It would also be helpful to know if there is a particular COP value to avoid preventing or limiting patient morbidity. Blood samples from 61 adult patients (mean age = 70 years old) undergoing cardiopulmonary bypass surgery were collected for COP calculation and comparison...
December 2017: Journal of Extra-corporeal Technology
https://www.readbyqxmd.com/read/29302114/the-influence-of-intraoperative-autotransfusion-on-postoperative-hematocrit-after-cardiac-surgery-a-cross-sectional-study
#11
Andrew J Stasko, Alfred H Stammers, Linda B Mongero, Eric A Tesdahl, Samuel Weinstein
Utilization of intraoperative autotransfusion (IAT) during cardiac surgery with cardiopulmonary bypass (CPB) has been shown to reduce allogeneic red blood cell transfusion. Previous research has emphasized the benefits of using IAT in the intraoperative period. The present study was designed to evaluate the effects of using IAT on overall hematocrit (Hct) drift between initiation of CPB and the immediate postoperative period. We reviewed 3,225 adult cardiac procedures occurring between February 2016 and January 2017 at 84 hospitals throughout the United States...
December 2017: Journal of Extra-corporeal Technology
https://www.readbyqxmd.com/read/29302113/does-the-type-of-cardioplegic-technique-influence-hemodilution-and-transfusion-requirements-in-adult-patients-undergoing-cardiac-surgery
#12
Alfred H Stammers, Eric A Tesdahl, Linda B Mongero, Andrew J Stasko, Samuel Weinstein
During cardiac surgery, myocardial protection is performed using diverse cardioplegic (CP) solutions with and without the presence of blood. New CP formulations extend ischemic intervals but use high-volume, crystalloid-based solutions. The present study evaluated four commonly used CP solutions and their effect on hemodilution during cardiopulmonary bypass (CPB). Records from 16,670 adult patients undergoing cardiac surgery with CPB between February 2016 and January 2017 were reviewed. Patients were classified into one of four groups according to CP type: 4-1 blood to crystalloid (4:1), microplegia (MP), del Nido (DN) and histidine-tryptophan-ketoglutarate (HTK)...
December 2017: Journal of Extra-corporeal Technology
https://www.readbyqxmd.com/read/29302112/low-oxygen-delivery-as-a-predictor-of-acute-kidney-injury-during-cardiopulmonary-bypass
#13
Richard F Newland, Robert A Baker
Low indexed oxygen delivery (DO2i) during cardiopulmonary bypass (CPB) has been associated with an increase in the likelihood of acute kidney injury (AKI), with critical thresholds for oxygen delivery reported to be 260-270 mL/min/m2. This study aims to explore whether a relationship exists for oxygen delivery during CPB, in which the integral of amount and time below a critical threshold, is associated with the incidence of postoperative AKI. The area under the curve (AUC) with DO2i during CPB above or below 270 mL/min/m2 was calculated as a metric of oxygen delivery in 210 patients undergoing CPB...
December 2017: Journal of Extra-corporeal Technology
https://www.readbyqxmd.com/read/29302111/from-the-editor
#14
Julie Wegner
No abstract text is available yet for this article.
December 2017: Journal of Extra-corporeal Technology
https://www.readbyqxmd.com/read/28979047/retraction-notice
#15
(no author information available yet)
[This retracts the article on p. 79 in vol. 48, PMID: 27578898.].
September 2017: Journal of Extra-corporeal Technology
https://www.readbyqxmd.com/read/28979046/bloodless-repair-of-aortic-arch-with-dual-aortic-cannulation-in-a-jehovah-s-witness-patient
#16
Melinda S Valleley, Kimberly R Glogowski, Kim F Duncan, Andrea Dutoit, Corinna Hagedorn
Various methods for surgical repair of the aortic arch are described throughout the literature with many focused on cannulation techniques and degree of systemic cooling in an effort to reduce postoperative morbidities. Despite advancements in techniques, this surgery is still often associated with higher levels of blood loss and subsequent allogenic blood transfusions. Although blood products can be safely transfused to the majority of patients undergoing repair of the aortic arch, the complexity and risk is further multiplied when the patient is of Jehovah's Witness faith and refuses blood transfusions...
September 2017: Journal of Extra-corporeal Technology
https://www.readbyqxmd.com/read/28979045/left-ventricular-unloading-during-peripheral-extracorporeal-membrane-oxygenator-support-a-bridge-to-life-in-profound-cardiogenic-shock
#17
Paolo Centofanti, Matteo Attisani, Michele La Torre, Davide Ricci, Massimo Boffini, Andrea Baronetto, Erika Simonato, Alberto Clerici, Mauro Rinaldi
A limit of peripheral veno-arterial Extracorporeal Membrane Oxigenator (VA-ECMO) is the inadequate unloading of the left ventricle. The increase of end-diastolic pressure reduces the possibility of a recovery and may cause severe pulmonary edema. In this study, we evaluate our results after implantation of VA-ECMO and Transapical Left Ventricular Vent (TLVV) as a bridge to recovery, heart transplantation or long-term left ventricular assit devices (LVAD). From 2011 to 2014, 24 consecutive patients with profound cardiogenic shock were supported by peripheral VA-ECMO as bridge to decision...
September 2017: Journal of Extra-corporeal Technology
https://www.readbyqxmd.com/read/28979044/use-of-volatile-anesthetic-agent-in-extracorporeal-circuit-as-a-cause-of-break-in-polycarbonate-connector-lessons-learnt
#18
Deepak Gowda, K Rashmi, Naveen Pandarinathan, Neelam Desai
Mishaps, near misses, and lethal incidents are known to occur during cardiopulmonary bypass. We share one such rare case of break in polycarbonate connector because of the use of isoflurane in extracorporeal circuit and its successful management.
September 2017: Journal of Extra-corporeal Technology
https://www.readbyqxmd.com/read/28979043/heparin-effects-upon-the-glycocalyx-and-endothelial-cells
#19
REVIEW
Bruce D Spiess
Unfractionated heparin (UFH) is the most widely used injectable medication in the United States. UFH is a poly-dispersed, relatively impure combination of many polysaccharides known as a glycosaminoglycan. It is used as the primary anticoagulant for heart surgery as well as for active treatment of deep venous thrombosis, vascular thrombosis, stroke, and many other potentially catastrophic clotting syndromes. Many perfusionists and cardiac team members know little of the biology of UFH other than its use for cardiopulmonary bypass...
September 2017: Journal of Extra-corporeal Technology
https://www.readbyqxmd.com/read/28979042/cerebral-oximetry-and-autoregulation-during-cardiopulmonary-bypass-a-review
#20
REVIEW
Nousjka P A Vranken, Patrick W Weerwind, Nadia A Sutedja, Ervin E Ĺ everdija, Paul J C Barenbrug, Jos G Maessen
Postoperative neurological complications (PNCs) following cardiac surgery with cardiopulmonary bypass (CPB) is a detrimental complication, contributing to increased mortality rates and health care costs. To prevent intraoperative cerebral desaturations associated with PNC, continuous brain monitoring using near-infrared spectroscopy has been advocated. However, clear evidence for a defined desaturation threshold requiring intervention during CPB is still lacking. Since cerebral oximetry readings are nonspecific, cerebral tissue oxygenation values need to be interpreted with caution and in the context of all available clinical information...
September 2017: Journal of Extra-corporeal Technology
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