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Perfusion

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https://www.readbyqxmd.com/read/28730947/safety-of-nitric-oxide-added-to-the-ecmo-circuit-a-pilot-study-in-children
#1
Roberto Chiletti, Steve Horton, Andrzej Bednarz, Robert Bartlett, Warwick Butt
We describe our experience of 30 consecutive children supported with ECMO and receiving 20 ppm of nitric oxide in the oxygenator of the ECMO circuit. Administration of nitric oxide into the ECMO circuit is safe and could potentially mitigate ischaemia reperfusion injury and end-organ dysfunction of children requiring mechanical support.
July 1, 2017: Perfusion
https://www.readbyqxmd.com/read/28703036/an-unusual-presentation-of-ischaemic-mitral-regurgitation-as-p2-prolapse
#2
David S Thompson, Prakash P Punjabi
A 54-year-old gentleman presented with pulmonary oedema secondary to anterolateral papillary muscle (PPM) rupture and acute mitral regurgitation subsequent to myocardial ischaemia (MI). Angiography revealed complete occlusion of the first obtuse marginal (OM1) branch of the circumflex coronary artery and a 70% occlusion of the left anterior descending (LAD) coronary artery. Operatively, unusual anatomy was noted; an accessory head was attached superiorly to the anterior lateral PPM. This gave rise to chordae that were subsequently attached to the posterior second (P2) scallop...
July 1, 2017: Perfusion
https://www.readbyqxmd.com/read/28699424/endovascular-repair-of-subclavian-artery-aneurysms-results-from-a-single-center-experience
#3
XiXiang Gao, LiQiang Li, YongQuan Gu, LianRui Guo, ShiJun Cui, LiXing Qi, JianXin Li, Jian Zhang
OBJECTIVE: To present our experience of the endovascular treatment of subclavian artery aneurysms (SAAs) and analyze the clinical manifestations, imaging findings and treatment outcomes. METHODS: In this retrospective study, nine patients with SAAs underwent endovascular stent placement in our center between July 2011 and June 2016. Clinical features, imaging findings, treatment outcomes and follow-up results of these SAA patients were retrospectively analyzed. RESULTS: Nine patients were diagnosed with SAAs by computer tomography angiography (CTA)...
July 1, 2017: Perfusion
https://www.readbyqxmd.com/read/28699395/scedosporium-apiospermum-infection-lethal-complication-after-extracorporeal-cardiopulmonary-resuscitation
#4
Yong Mei, Xufeng Chen, Kai Sun, Jinru Lv, Hao Sun, Jinsong Zhang
In recent years, the development of extracorporeal membrane oxygenation (ECMO) technology has led to its extensive use in clinical practice. In particular, ECMO can play an important role in cardiopulmonary resuscitation (CPR). The American Heart Association CPR guidelines recommend its use in patients with cardiac arrest due to reversible disorders, along with high-quality CPR. This is called extracorporeal cardiopulmonary resuscitation (ECPR). However, it is important to be aware of the possibility of infection-related complications...
July 1, 2017: Perfusion
https://www.readbyqxmd.com/read/28693359/coagulation-monitoring-correlation-with-heparin-dose-in-pediatric-extracorporeal-life-support
#5
Katie Moynihan, Kerry Johnson, Lahn Straney, Christian Stocker, Ben Anderson, Prem Venugopal, John Roy
OBJECTIVES: Extracorporeal Life Support (ECLS) risks thrombotic and hemorrhagic complications. Optimal anti-coagulation monitoring is controversial. We compared coagulation tests evaluating the heparin effect in pediatric ECLS. METHODS: A retrospective study of children (<18yrs) undergoing ECLS over 12 months in a tertiary pediatric intensive care unit (PICU). Variables included anti-Factor Xa activity (anti-Xa), activated partial thromboplastin time (aPTT), activated clotting time (ACT) and thromboelastogram (TEG(®)6s) parameters: ratio and delta reaction (R) times (the ratio and difference, respectively, between R times in kaolin assays with and without heparinase)...
July 1, 2017: Perfusion
https://www.readbyqxmd.com/read/28653554/the-role-of-simulation-to-support-donation-after-circulatory-death-with-extracorporeal-membrane-oxygenation-dcd-ecmo
#6
Mateusz Puślecki, Marcin Ligowski, Marek Dąbrowski, Maciej Sip, Sebastian Stefaniak, Tomasz Kłosiewicz, Łukasz Gąsiorowski, Marek Karczewski, Tomasz Małkiewicz, Małgorzata Ładzińska, Marcin Zieliński, Aleksander Pawlak, Bartłomiej Perek, Michael Czekajlo, Marek Jemielity
Maintaining the viability of organs from donors after circulatory death (DCD) for transplantation is a complicated procedure, from a time perspective in the absence of appropriate organizational capabilities, that makes such transplantation cases difficult and not yet widespread in Poland. We present the procedural preparation for Poland's first case of organ (kidney) transplantation from a DCD donor in which perfusion was supported by extracorporeal membrane oxygenation (ECMO). Because this organizational model is complex and expensive, we used advanced high-fidelity medical simulation to prepare for the real-life implementation...
June 1, 2017: Perfusion
https://www.readbyqxmd.com/read/28622752/microvascular-fluid-exchange-during-cpb-with-deep-hypothermia-circulatory-arrest-or-low-flow
#7
Bjørg Elvevoll, Paul Husby, Venny L Kvalheim, Lodve Stangeland, Arve Mongstad, Øyvind S Svendsen
OBJECTIVE: Use of deep hypothermic low-flow (DHLF) cardiopulmonary bypass (CPB) has been associated with higher fluid loading than the use of deep hypothermia circulatory arrest (DHCA). We evaluated whether these perfusion strategies influenced fluid extravasation rates and edema generation differently per-operatively. MATERIALS AND METHODS: Twelve anesthetized pigs, randomly allocated to DHLF (n = 6) or DHCA (n = 6), underwent 2.5 hours CPB with cooling to 20°C for 30 minutes (min), followed by 30 min arrested circulation (DHCA) or 30 min low-flow circulation (DHLF) before 90 min rewarming to normothermia...
June 1, 2017: Perfusion
https://www.readbyqxmd.com/read/28621588/perioperative-single-site-veno-venous-extracorporeal-co2-removal-for-minimally-invasive-giant-bulla-resection
#8
Bassam Redwan, Christian Biancosino, Felix Giebel, Gabriele Woebker, Michael Eberlein, Servet Boeluekbas
Giant pulmonary bullae are rare and surgical management of patients with severe emphysema and advanced chronic obstructive lung disease (COPD) presenting with giant bullae can be very challenging. Previously, perioperative, two-site, high-flow, veno-venous extracorporeal membrane oxygenation (ECMO) was successfully utilized during giant bulla resection. Here we report the perioperative application of single-site, low-flow extracorporeal CO2 removal (ECCO2R) for minimally invasive thoracoscopic giant bulla resection...
June 1, 2017: Perfusion
https://www.readbyqxmd.com/read/28610543/does-diathermy-smoke-contaminate-processed-salvaged-blood-in-cardiac-surgery
#9
Katherine R Hulme, Jon van den Burg
INTRODUCTION: A cell salvage device is used in cardiac surgery with the aim of reducing allogeneic blood transfusion. Suction of blood from the operating field used for the device is often accompanied by diathermy smoke. There is limited published research to know if this blood is then contaminated with clinically significant levels of harmful chemicals from this smoke. Postoperative cardiac surgery patients are already physiologically vulnerable, making the optimization of salvaged blood worth considering...
June 1, 2017: Perfusion
https://www.readbyqxmd.com/read/28592188/polymer-coated-cardiopulmonary-bypass-circuit-attenuates-upregulation-of-both-proteases-protease-inhibitors-and-platelet-degranulation-in-pigs
#10
Shoichi Suehiro, Kouji Shimizu, Kensuke Imai, Atsushi Niii, Kazuhiro Akeho, Hayato Nakata, Akane Yamaguchi, Ken-Ichi Matsumoto, Teiji Oda
INTRODUCTION: Interaction of blood with a cardiopulmonary bypass (CPB) circuit activates the coagulation-fibrinolysis, complement and kinin-kallikrein systems that are mainly supported by proteases and their inhibitors. METHODS: Biocompatibility of a new polymer-coated (SEC-coated) CPB circuit was globally evaluated and compared with that of a non-coated CPB circuit by quantitative proteomics, using isobaric tags for relative and absolute quantification labeling tandem mass spectrometry...
June 1, 2017: Perfusion
https://www.readbyqxmd.com/read/28592166/continuous-bilateral-thoracic-paravertebral-blockade-for-analgesia-after-cardiac-surgery-a-randomised-controlled-trial
#11
Geoff G Lockwood, Leilani Cabreros, Dorota Banach, Prakash P Punjabi
BACKGROUND: Continuous bilateral thoracic paravertebral blockade has been used for analgesia after cardiac surgery, but its efficacy has never been formally tested. METHOD: Fifty adult patients were enrolled in a double-blind, randomised, controlled study of continuous bilateral thoracic paravertebral infusion of 0.5% lidocaine (1 mg.kg(-1).hr(-1)) for analgesia after coronary surgery. Control patients received a subcutaneous infusion of lidocaine at the same rate through catheters inserted at the same locations as the study group...
June 1, 2017: Perfusion
https://www.readbyqxmd.com/read/28587512/accuracy-of-predicted-haemoglobin-concentration-on-cardiopulmonary-bypass-in-paediatric-cardiac-surgery-effect-of-different-formulae-for-estimating-patient-blood-volume
#12
Matthias Redlin, Wolfgang Boettcher, Frank Dehmel, Mi-Young Cho, Marian Kukucka, Helmut Habazettl
INTRODUCTION: When applying a blood-conserving approach in paediatric cardiac surgery with the aim of reducing the transfusion of homologous blood products, the decision to use blood or blood-free priming of the cardiopulmonary bypass (CPB) circuit is often based on the predicted haemoglobin concentration (Hb) as derived from the pre-CPB Hb, the prime volume and the estimated blood volume. We assessed the accuracy of this approach and whether it may be improved by using more sophisticated methods of estimating the blood volume...
June 1, 2017: Perfusion
https://www.readbyqxmd.com/read/28581351/refractory-cardiac-arrest-inferior-vena-cava-agenesis-and-extracorporeal-cardiopulmonary-resuscitation-a-demanding-combination
#13
Sébastien Colombier, Pierre Demondion, Nadia Bouabdallaoui, Guillaume Lebreton, Pascal Leprince
Inferior vena cava abnormalities or agenesis had to be suspected in front of technical difficulties during venous catheterization. In the setting of extracorporeal life support and during chest compressions, femoral vascular access is the easiest, most efficient and, perhaps, the first approach for a successful extracorporeal cardiopulmonary resuscitation. In the case of inferior vena cava agenesis leading to cannulation failure and/or complications, the use of the right internal jugular vein for salvage venous cannulation is a potential life-saving strategy...
June 1, 2017: Perfusion
https://www.readbyqxmd.com/read/28581343/postoperative-acute-kidney-injury-following-intraoperative-blood-product-transfusions-during-cardiac-surgery
#14
Bogdan A Kindzelski, Philip Corcoran, Michael P Siegenthaler, Keith A Horvath
INTRODUCTION: This study explored the nature of the association between intraoperative usage of red blood cell, fresh frozen plasma, cryoprecipitate or platelet transfusions and acute kidney injury. METHODS: A total of 1175 patients who underwent cardiac surgery between 2008 and 2013 were retrospectively analyzed. We assessed the association between: (1) preoperative patient characteristics and acute kidney injury, (2) intraoperative blood product usage and acute kidney injury, (3) acute kidney injury and 30-day mortality or re-hospitalization...
June 1, 2017: Perfusion
https://www.readbyqxmd.com/read/28578633/early-pulmonary-compliance-increase-during-cardiac-surgery-predicted-post-operative-lung-dysfunction
#15
Yann Sacuto, Thierry Sacuto
INTRODUCTION: Lung dysfunction following cardiac surgery is currently viewed as the consequence of atelectasis and lung injury. While the mechanism of atelectasis has been largely detailed, the pathogenesis of lung injury after cardiopulmonary bypass is still unclear. Based upon clinical and experimental studies, we hypothesized that lungs could be injured through a mechanical phenomenon. METHODS: We recorded pulmonary compliance at six key moments of a heart operation in 62 adult patients undergoing elective cardiac surgery...
June 1, 2017: Perfusion
https://www.readbyqxmd.com/read/28578622/modular-minimal-invasive-extracorporeal-circuits-another-step-toward-universal-applicability
#16
Aschraf El-Essawi, Mohammed Morjan, Ingo Breitenbach, Ahmed Bechri, Rene Brouwer, Wolfgang Harringer
INTRODUCTION: Safety concerns have been one of the main reasons opposing a wider acceptance of minimal invasive extracorporeal circuits (MiECC). Following an extensive experience and a multitude of modifications, we have set out to employ a modular MiECC as a universal extracorporeal circuit. METHODS: A total of 129 cardiac surgical procedures were performed by a single surgeon in 2013. Excluding procedures done under circulatory arrest or with the potential need of such, the MiECC was utilized in almost 90% of surgeries...
June 1, 2017: Perfusion
https://www.readbyqxmd.com/read/28578609/an-unusual-agent-for-an-unusual-localization-of-infective-endocarditis
#17
Jens Litmathe, Rene Fussen, Alexander Heinzel, Marguerite Müller, Christoph Sucker, Lachmandath Tewarie, Manuel Dafotakis
We report on a 32-year-old male patient with acute left-hemispheric stroke caused by embolism due to infective endocarditis affected from the HACEK group. Additionally, atypical findings from the transesophageal echocardiography (TEE) which showed fluttering structures belonging to the papillary muscle could be proven as infectious agents with the help of a glucose positron emission tomography (PET) scan. TEE controls showed increasing vegetation involving the mitral valve so that surgery became necessary. The current work reflects, in detail, the emergent clinical course of this young patient, suffering from both an unusual localization and an infrequent cause of endocarditis and focuses on an actual view to the literature...
June 1, 2017: Perfusion
https://www.readbyqxmd.com/read/28566014/assessing-the-culture-of-safety-in-cardiovascular-perfusion-attitudes-and-perceptions
#18
Chad Lawson, Megan Predella, Allison Rowden, Jamie Goldstein, Joseph J Sistino, David C Fitzgerald
INTRODUCTION: The Hospital Survey on Patient Safety Culture was developed by the Agency for Healthcare Research and Quality (AHRQ) to assess the culture of safety in hospitals. The purpose of this study was to identify specific domains of perfusion that are indicators of a high quality culture of safety. METHODS: Perfusionists were recruited to participate in the survey through email invitation through Perflist, Perfmail and LinkedIn. The survey consisted of 37 questions across six safety domains...
May 1, 2017: Perfusion
https://www.readbyqxmd.com/read/28535744/leukocyte-filtration-of-the-cardiotomy-suction-does-it-affect-systemic-leukocyte-activation-or-pulmonary-function
#19
Richard Issitt, Jon Ball, Indie Bilkhoo, Adnan Mani, Bronagh Walsh, David Voegeli
BACKGROUND: Cardiopulmonary bypass is thought to propagate a global systemic response through contact with the non-physiological surfaces of the extracorporeal circuit, leading to the stimulation of leukocytes, their adherence to endothelial cells and the release of cytotoxic molecules. This, in turn, has been shown to accelerate pulmonary injury. This study tested a new leukocyte-filtration system (RemoweLL) against a conventional system with no leukocyte-depleting capacity to determine the efficacy of the filtration system and its effects on pulmonary function...
May 1, 2017: Perfusion
https://www.readbyqxmd.com/read/28530132/development-of-a-high-fidelity-pressurized-porcine-beating-heart-simulator-for-cardiac-surgery-training
#20
Igo B Ribeiro, Janet M C Ngu, Gurinder Gill, Fraser D Rubens
BACKGROUND: Development of a high-fidelity cardiac surgery simulator (CSS) requires integration of a heart model with a mock cardiopulmonary bypass (CPB) circuit that can provide feedback to mimic the pathophysiology of cardiac surgery. However, the cost of commercially available simulators precludes regular use. We describe steps in the construction of a high-fidelity CSS that integrates a pulsatile paracorporeal ventricular-assist device (Pulse-VAD) and a commercially available CPB simulator...
May 1, 2017: Perfusion
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