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Mohammed Al Disi, Abdullah Alsalemi, Yahya Alhomsi, Fayçal Bensaali, Abbes Amira, Guillaume Alinier
INTRODUCTION: Extracorporeal membrane oxygenation (ECMO) training programs employ real ECMO components, causing them to be extremely expensive while offering little realism in terms of blood oxygenation and pressure. To overcome those limitations, we are developing a standalone modular ECMO simulator that reproduces ECMO's visual, audio and haptic cues using affordable mechanisms. We present a central component of this simulator, capable of visually reproducing blood oxygenation color change using thermochromism...
September 7, 2018: Perfusion
Stephen M Spindel, Bobby Yanagawa, Javier Mejia, Matthew A Levin, Robin Varghese, Paul E Stelzer
INTRODUCTION: We report our initial surgical experience of intermittent upper and lower body retrograde perfusion during aortic repair under circulatory arrest. METHODS: Between 2007 and 2015, 148 consecutive patients underwent surgical aortic repair using moderate hypothermic circulatory arrest with intermittent upper and lower body retrograde perfusion. RESULTS: All patients underwent ascending aorta replacement; eight had hemiarch replacement (5...
September 5, 2018: Perfusion
Ryan Haughey, William Vernick, Jacob Gutsche, Krzysztof Laudanski
INTRODUCTION: Calcium channel blockers (CCBs) are a commonly prescribed medication that, at toxic levels, are capable of causing severe refractory hypotension, hypoxic respiratory failure and cardiotoxicity. There is little evidence currently guiding the approach to managing CCB overdose, particularly when combined with other antihypertensive agents. CASE REPORT: We describe the use of veno-venous extracorporeal membrane oxygenation (VV ECMO) in a previously healthy man following combined overdose with amlodipine and lisinopril in a suicide attempt...
September 3, 2018: Perfusion
Mustafa Zakkar, Emmanuel Lansac, Alain Wurtz, Emmanuel Brian
The role of concomitant aortic and pectus repair in Marfan patients remains controversial. We present our surgical technique for concomitant aortic repair of aortic root pathology and pectus correction. The concomitant surgery can be safely achieved in Marfan patients, thus, avoiding the need for a risky second stage operation.
August 23, 2018: Perfusion
Yuki Michinaga, Tamaki Takano, Takamitsu Terasaki, Souma Miyazaki, Noritoshi Kikuchi, Kenji Okada
INTRODUCTION: We have been developing a closed-circuit cardiopulmonary bypass (CPB) system ("Dihead CPB") for application during coronary artery bypass grafting (CABG) and valve surgery. To strive for minimal hemolysis during Dihead CPB, we compared the hemolysis caused by three different suction systems and performed a clinical study with the newly applied suction system. MATERIALS & METHODS: We evaluated the hemolysis caused by roller-pump suction, the SmartSuction® Harmony® and wall suction systems with respect to suction speed and compared the systems by means of in vitro studies...
August 19, 2018: Perfusion
Dwight D Harris, Alexis E Shafii, Maher Baz, Thomas A Tribble, Victor A Ferraris
INTRODUCTION: Tracheostomy has been utilized in combination with venovenous extracorporeal membrane oxygenation (VV-ECMO) to enable early spontaneous breathing and minimize sedation requirements. Tracheostomy has been previously reported to be safe in patients supported on VV-ECMO; however, the impact of tracheostomy on blood loss in VV-ECMO patients is unknown. METHODS: We analyzed VV-ECMO patients with and without tracheostomy over a 5-year period. In order to avoid other potential sources of blood loss not related to tracheostomy or ECMO-related blood loss, patients who underwent a recent surgery prior to ECMO or during ECMO (other than tracheostomy) were excluded...
August 19, 2018: Perfusion
Gunnar Malmqvist, Helena Claesson Lingehall, Micael Appelblad, Staffan Svenmarker
INTRODUCTION: In the literature addressing cardiopulmonary bypass (CPB) prime composition, there is a considerable lack of discussion concerning plasma osmolality changes induced by using a hyperosmolar prime. With this study, we try to determine the magnitude and temporal relationship of plasma osmolality changes related to the use of a hyperosmolar CPB prime. METHOD: In this prospective observational study performed in a university hospital setting, we enrolled thirty patients scheduled for elective coronary bypass surgery...
August 16, 2018: Perfusion
Dirk W Donker, Daniel Brodie, José P S Henriques, Michael Broomé
Short-term mechanical support by veno-arterial extracorporeal membrane oxygenation (VA ECMO) is more and more applied in patients with severe cardiogenic shock. A major shortcoming of VA ECMO is its variable, but inherent increase of left ventricular (LV) mechanical load, which may aggravate pulmonary edema and hamper cardiac recovery. In order to mitigate these negative sequelae of VA ECMO, different adjunct LV unloading interventions have gained a broad interest in recent years. Here, we review the whole spectrum of percutaneous and surgical techniques combined with VA ECMO reported to date...
August 16, 2018: Perfusion
Nigel E Drury, Angela Horsburgh, Rehana Bi, Robert G Willetts, Timothy J Jones
INTRODUCTION: Many techniques are available for cardioplegic arrest in children, but there is a lack of late phase clinical trials to guide practice. We surveyed paediatric cardiac surgeons and perfusionists to establish current practice and willingness to change within a clinical trial. METHODS: An online survey was sent to all consultant paediatric cardiac surgeons and chief perfusionists in paediatric centres in the UK and Ireland. Information was sought on cardioplegia type, composition, temperature, topical cooling, dosing for induction and maintenance, interval between doses, whether practice changed with patient age or complexity and whether respondents would be willing and able to use different cardioplegia solutions within a randomised trial...
August 10, 2018: Perfusion
Qin Li, Haiming Li, Liangshan Wang, Changcheng Liu, Songnan Li, Yingwei Chen, Yafei Zhang, Chengxiong Gu
OBJECTIVES: At present, there is no effective method of evaluating the electrophysiological changes in cardiac myocytes during off-pump coronary artery bypass grafting (OPCAB). Therefore, we preliminarily explored the relationship between electrophysiological characteristics and the changes in cardiac function of 24 patients undergoing OPCAB. METHODS: We used the CARTO3 system for epicardial electrophysiological mapping before surgery, during left anterior descending branch anastomosis, diagonal branch anastomosis and after surgery for 24 patients undergoing OPCAB...
August 2, 2018: Perfusion
Gethin Boyle, Agnieszka Kuffel, Kiran Parmar, Kirsty Gibson, Megan Smith, Aidan Grehan, Beverley J Hunt, David J Chambers
BACKGROUND: Cardiac surgery using cardiopulmonary bypass (CPB) is associated with a coagulopathy due to haemodilution, thrombocytopenia and platelet dysfunction and the activation of coagulation and fibrinolysis, despite the use of large doses of unfractionated heparin. Conventional red cell salvage may exacerbate post-operative bleeding as plasma containing haemostatic factors is discarded. We hypothesized that a novel cell salvage device (HemoSep) may attenuate haemostatic changes associated with red cell salvage...
August 1, 2018: Perfusion
Omar Mutlak, Mohammed Aslam, Nigel J Standfield
OBJECTIVES: The real mechanism for the development of the later stages of chronic venous insufficiency still remains unclear. Venous hypervolemia and microvascular ischemia have been reported to be the consequences of venous insufficiency. The aim of this study was to investigate the effects of induced venous hypovolemia by dorsiflexion exercise in patients with venous leg ulcers. METHODS: Thirty-six participants, all of whom had an ankle brachial pressure index between 0...
August 1, 2018: Perfusion
Terje Aass, Lodve Stangeland, Christian Arvei Moen, Atle Solholm, Geir Olav Dahle, David J Chambers, Malte Urban, Knut Nesheim, Rune Haaverstad, Knut Matre, Ketil Grong
INTRODUCTION: This experimental study compares myocardial function after prolonged arrest by St. Thomas' Hospital polarizing cardioplegic solution (esmolol, adenosine, Mg2+ ) with depolarizing (hyperkalaemic) St. Thomas' Hospital No 2, both administered as cold oxygenated blood cardioplegia. METHODS: Twenty anaesthetized pigs on tepid (34°C) cardiopulmonary bypass (CPB) were randomised to cardioplegic arrest for 120 min with antegrade, repeated, cold, oxygenated, polarizing (STH-POL) or depolarizing (STH-2) blood cardioplegia every 20 min...
July 30, 2018: Perfusion
Holger Budde, Joachim Riggert, Steffen Vormfelde, Theodor Tirilomis, Martin G Friedrich
BACKGROUND: Re-transfusion of autologous blood is an important aspect of intraoperative blood management. Hemolysis and platelet dysfunction due to turbulence in the blood suction system strongly impede later usage of suction blood for re-transfusion. The aim of this study was to analyze the effects of a novel surgical-blood suction system with an automatic control setup for minimization of turbulence in the blood flow. METHODS: We compared the turbulence-controlled suction system (TCSS) with a conventional suction system and untreated control blood in vitro...
July 27, 2018: Perfusion
Omar Ellouze, Julie Lamirel, Justine Perrot, Anis Missaoui, Theresa Daily, Serge Aho, Andranik Petrosyan, Pierre Gregoire Guinot, Oliver Bouchot, Belaid Bouhemad
INTRODUCTION: The use of extracorporeal life support (ECLS) is increasing worldwide, in particular for the management of refractory cardiac arrest, cardiogenic shock and post cardiopulmonary bypass ventricular failure. Extubation of patients under extracorporeal membrane oxygenation (ECMO) for respiratory failure is a growing practice for adult and pediatric patients, especially for lung transplantation candidates. Because of potential complications and, specifically, accidental arterial decannulation, extubation of patients under ECLS is not standard practice...
July 25, 2018: Perfusion
Maria Fedosova, Hans-Henrik Kimose, Jacob Raben Greisen, Peter Fast, Marie Storebjerg Gissel, Carl-Johan Jakobsen
INTRODUCTION: A clear advantage of blood versus crystalloid cardioplegia has not yet been observed in smaller population studies. The purpose of this article was to further investigate the clinical outcomes of blood versus crystalloid cardioplegia in a large propensity-matched cohort of patients who underwent cardiac surgery. METHODS: The study was a single-centre study. Data was withdrawn from the Western Denmark Heart Registry, which comprises a perfusion section for each procedure...
July 25, 2018: Perfusion
Paolo Meani, Thijs Delnoij, Giuseppe M Raffa, Nuccia Morici, Giovanna Viola, Alice Sacco, Fabrizio Oliva, Sam Heuts, Jan-Willem Sels, Rob Driessen, Paul Roekaerts, Martijn Gilbers, Elham Bidar, Rick Schreurs, Ehsan Natour, Leo Veenstra, Suzanne Kats, Jos Maessen, Roberto Lorusso
BACKGROUND: Left ventricular (LV) afterload increase with protracted aortic valve (AV) closure may represent a complication of veno-arterial extracorporeal membrane oxygenation (V-A ECMO). The aim of the present study was to assess the effects of an intra-aortic balloon pump (IABP) to overcome such a hemodynamic shortcoming in patients submitted to peripheral V-A ECMO. METHODS: Among 184 adult patients who were treated with peripheral V-A ECMO support at Medical University Center Maastricht Hospital between 2007 and 2018, patients submitted to IABP implant for protracted AV closure after V-A ECMO implant were retrospectively identified...
July 1, 2018: Perfusion
Virginie Fouilloux, Célia Gran, Christophe Guervilly, Jean Breaud, Fedoua El Louali, Pierre Rostini
INTRODUCTION: Medical and para-medical education is one of the key points of healthcare strategy. Training and education based on high-fidelity simulation is one of the gold standards in modern healthcare institutions. We describe a model of training dedicated to ICU nurses in charge of patients with ECMO. The aim of our educational tool was to teach ICU nurses ECMO basic knowledge and skills. METHODS: An ECMO Specialist Course Committee implemented the training programme...
July 1, 2018: Perfusion
Rasha Al-Bawardy, Kenneth Rosenfield, Jorge Borges, Michael N Young, Mazen Albaghdadi, Rachel Rosovsky, Christopher Kabrhel
BACKGROUND: Extracorporeal membrane oxygenation (ECMO) has been used to stabilize patients with massive pulmonary embolism though few reports describe this approach. We describe the presentation, management and outcomes of patients who received ECMO for massive pulmonary embolism (PE) in our pulmonary embolism response team (PERT) registry. METHODS: We enrolled a consecutive cohort of patients with confirmed PE for whom PERT was activated and selected patients treated with ECMO...
July 1, 2018: Perfusion
Juan Zhang, Fei Xu, Xiao-Bo Liu, Shao-Jie Bi, Qing-Hua Lu
BACKGROUND/AIM: Rho kinase is a downstream effector of Rho GTPase that is known to regulate various pathological processes. The aim of this study was to evaluate the regulation of Rho kinase activity in leukocytes in patients with ischemia/reperfusion (I/R) injury. PATIENTS AND METHODS: We investigated 38 patients with acute ST-segment elevation myocardial infarction (STEMI), 26 patients with atherosclerosis (AS) and 22 normal subjects. All patients underwent coronary angiography (CAG) and all STEMI patients received primary percutaneous coronary intervention (PPCI) of the left anterior descending artery (LAD) within 12 h after chest pain on-set...
July 1, 2018: Perfusion
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