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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
Tanee Chan, Moi Lin Ling, Siew Yan Teng, Kit Yi Chiu, Esther Magdalane James
INTRODUCTION: The association of Mycobacterium chimaera infection in patients undergoing cardiopulmonary bypass (CPB) with the use of heater-cooler units (HCU) has been reported in various literature. We described microbiological monitoring and the extent of microbiological contamination of HCUs utilized in our centre and strategies employed to reduce the high microbial load. METHODS: Since August 2016, we have been following the new Instructions for Use from the manufacturer for the cleaning and disinfection of three units of Stöckert 3T and four units of Stöckert 1T HCU at the National Heart Centre Singapore...
July 1, 2018: Perfusion
Julia Merkle, Anton Sabashnikov, Carolyn Weber, Georg Schlachtenberger, Johanna Maier, Anna Spieker, Kaveh Eghbalzadeh, Antje-Christin Deppe, Mohamed Zeriouh, Parwis B Rahmanian, Navid Madershahian, Christian Rustenbach, Yeong-Hoon Choi, Ferdinand Kuhn-Régnier, Oliver Liakopoulos, Thorsten Wahlers
OBJECTIVES: Stanford A acute aortic dissection (AAD) is a life-threatening emergency, typically occurring in older patients and requiring immediate surgical repair. The aim of this study was to evaluate early outcome and short- and long-term survival of patients under and above 65 years of age. METHODS: Two hundred and forty patients with Stanford A AAD underwent aortic surgical repair from January 2006 to April 2015 in our center. After statistical analysis and logistic regression analysis, Kaplan-Meier survival estimation was performed, with up to 9-year follow-up, comprising patients under and above 65 years of age...
July 1, 2018: Perfusion
Yujia Wang, Chunlin Ge, Junfeng Chen, Kun Tang, Jianjun Liu
BACKGROUND: Sevoflurane has been shown to protect against myocardial ischemia/reperfusion (I/R) injury in animals, while its cardioprotection is lost if the ischemic insult is too long. In this study, we proposed a prevailing hypothesis that GSK-3β inhibitor-mediated activation of GSK-3β/β-catenin signaling pathway provides additional cardioprotection in sevoflurane preconditioned rats following I/R injury. METHODS: Rats were subjected to treatment with TDZD-8, a GSK-3β inhibitor, 5 minutes prior to sevoflurane preconditioning and 30-minute ischemia and 120-minute reperfusion...
July 1, 2018: Perfusion
Jeffrey J Cies, Wayne S Moore, Nadji Giliam, Tracy Low, Adela Enache, Arun Chopra
BACKGROUND: The objective was to determine the alterations of daptomycin (DAP) in a contemporary neonatal/pediatric (1/4-inch) and adolescent/adult (3/8-inch) extracorporeal membrane oxygenation (ECMO) circuit including the Quadrox-i® oxygenator. METHODS: Quarter-inch and 3/8-inch, simulated, closed-loop, ECMO circuits were prepared with a Quadrox-i pediatric and Quadrox-i adult oxygenator and blood primed. A one-time dose of DAP was administered into the circuit and serial pre- and post-oxygenator concentrations were obtained at 0-5 minutes and 1, 2, 3, 4, 5, 6 and 24-hour time points...
June 1, 2018: Perfusion
Yong Li, Xiaogang Sun, Xiuhui Zhang, Yuchun Zhang, Guanghui Pang, Hongliang Ma
Deep hypothermia or circulation arrest is widely used during total aortic arch replacement. However, conventional procedures have high morbidity and mortality.1 We use the "branch-first" technique2,3 combined with clamping the distal aorta, incorporating a stented elephant trunk to avoid deep hypothermia and circulation arrest. This technique brings us closer to the goal of arch surgery without cerebral or visceral circulatory arrest and the morbidity of deep hypothermia. Early results are encouraging...
June 1, 2018: Perfusion
James A Reagor, Sean Clingan, Bradley T Kulat, Gregory S Matte, Jordan Voss, James S Tweddell
Hypoplastic left heart syndrome (HLHS) is a rare and severe congenital cardiac defect. Approximately 1000 infants are born with HLHS in the United States every year. Healthcare collaboratives over the last decade have focused on sharing patient experiences and techniques in an effort to improve outcomes. In 2010, cardiologists and patient families joined together to improve the care of HLHS patients by forming the National Pediatric Cardiology Quality Improvement Collaborative (NPC-QIC). Sixty-six of the approximately 110 institutions caring for patients with HLHS in the United States and Canada are now members of NPC-QIC...
June 1, 2018: Perfusion
Takeshi Goto, Tsubasa Tanabe, Takao Inamura, Minori Shirota, Koji Fumoto, Yoshiaki Saito, Wakako Fukuda, Ikuo Fukuda, Kazuyuki Daitoku, Masahito Minakawa
BACKGROUND: Venous drainage in cardiopulmonary bypass is a very important factor for safe cardiac surgery. However, the ideal shape of venous drainage cannula has not been determined. In the present study, we evaluated the effect of side-hole number under fixed total area and venous drainage flow to elucidate the effect of increasing the side-hole numbers. METHOD: Computed simulation of venous drainage was performed. Cannulas were divided into six models: an end-hole model (EH) and models containing four (4SH), six (6SH), eight (8SH), 10 (10SH) or 12 side-holes (12SH)...
June 1, 2018: Perfusion
Robert K Wise, Sherry M Waldhausen, Van T Nguyen, David A Palanzo, Larry D Baer
The use of ECMO for cardiovascular support continues to increase in the United States and around the world. It is not a benign endeavor as serious complications may occur. We present our experience of two second generation CentriMag® (Abbott formerly Thoratec Inc.) console failures that occurred while transporting the patients to other areas of the hospital. In each incident, the patients were immediately placed on back-up units and the transport continued. No patient complications could be attributed to the failures...
June 1, 2018: Perfusion
Jori Leenders, Ed Overdevest, Bart van Straten, Hanna Golab
INTRODUCTION: Postoperative delirium is the most common neurological complication of cardiac surgery. Hypoxia has been shown to increase the risk of postoperative delirium. The possibility to continuously monitor oxygen delivery (DO2 ) during cardiopulmonary bypass (CPB) offers an adequate approximation of the oxygen status in a patient. This study investigates the role of oxygen delivery during cardiopulmonary bypass in the incidence of postoperative delirium. METHODS: Three hundred and fifty-seven adult patients who underwent normothermic coronary artery bypass grafting (CABG) surgery were included in this retrospective study...
June 1, 2018: Perfusion
Alfred H Stammers, Eric A Tesdahl, Linda B Mongero, Andrew Stasko
INTRODUCTION: Myocardial protection is performed using diverse cardioplegic (CP) solutions with various combinations of chemical and blood constituents. Newer CP formulations that extend ischemic intervals may require greater asanguineous volume, contributing to hemodilution. METHODS: We evaluated intraoperative hemodilution and red blood cell (RBC) transfusion rates among three common CP solutions during cardiac valve surgery. Data from 5,830 adult cardiac primary valve procedures where either four-to-one blood CP (4:1), del Nido solution (DN) or microplegia (MP) was used at 173 United States surgical centers...
June 1, 2018: Perfusion
Payal K Gurnani, Allison Bohlmann, Robert J March
BACKGROUND: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) has been used as a bridge to cardiac recovery in patients following a major cardiac event. There is a lack of literature surrounding prolonged use of eptifibatide and optimal dosing during ECMO. This case report describes our experience with extended durations and standard dosing of eptifibatide in the setting of ECMO. CASE: A 40-year-old male with a history of Marfan's syndrome, aortic root and ascending aortic aneurysm status post a modified Bentall with a St...
June 1, 2018: Perfusion
Chenglong Li, Hong Wang, Nan Liu, Ming Jia, Haitao Zhang, Xiuming Xi, Xiaotong Hou
BACKGROUND: Early fluid expansion could prevent postoperative organ hypoperfusion. However, excessive fluid resuscitation adversely influences multiple organ systems. This retrospective, observational study aimed to investigate the relationship between early negative fluid balance and postoperative mortality in critically ill adult patients following cardiovascular surgery. METHODS: In total, 567 critically ill patients who had undergone cardiovascular surgery and whose intensive care unit length of stay (LOS) was more than 24 hours were enrolled...
June 1, 2018: Perfusion
Killian Patton-Rivera, James Beck, Kenmond Fung, Christine Chan, Matthew Beck, Hiroo Takayama, Koji Takeda
BACKGROUND: Patients requiring V-A ECMO who receive femoral cannulation have an associated risk of distal, lower-limb hypoperfusion and ischemia of the cannulated leg. This pilot study evaluated the usefulness of non-invasive lower-limb oximetry, using near-infrared reflectance spectroscopy (NIRS) to detect limb ischemia. METHODS: Between June 2016 and January 2017, 25 patients receiving femoral V-A ECMO were continuously monitored using the CASMED Fore-Sight Elite (CAS Medical Systems Inc...
May 1, 2018: Perfusion
Shelley Hancock, Curtis Froehlich, Veronica Armijo-Garcia, Andrew D Meyer
INTRODUCTION: Respiratory failure is the leading cause of mortality in individuals with congenital spine and rib deformities. We present a case report of a child with Jeune syndrome surviving respiratory failure using extracorporeal membrane oxygenation (ECMO). We also summarize thoracic insufficiency syndrome cases reported in the Extracorporeal Life Support Organization (ELSO) registry. CASE REPORT: A two-year-old male with a chest circumference less than a third percentile for age was admitted with influenza pneumonia developing a peak oxygenation index of 103...
May 1, 2018: Perfusion
Jared Arensdorf, Halle Petitt, David Holt
BACKGROUND: The major source of hemolysis during cardiopulmonary bypass (CPB) remains the cardiotomy suction.1 Previous research has shown that the combination of negative pressures and the massive air-blood interface exponentially increases hemolysis in suctioned blood. OBJECTIVE: This research aims to decrease hemolysis by eliminating the air-to-blood interface by implementing the Venturi effect to create powerful suction. This research effort hypothesizes that the Venturi suction will result in less hemolysis, indicated by lower plasma free hemoglobin levels (PFH) compared to current vacuum suction...
May 1, 2018: Perfusion
Guillaume Alinier, Ibrahim Fawzy Hassan, Abdullah Alsalemi, Mohammed Al Disi, Ali Ait Hssain, Ahmed Labib, Yahya Alhomsi, Fayçal Bensaali, Abbes Amira, Abdulsalam Saif Ibrahim
INTRODUCTION/AIM: The patient's condition and high-risk nature of extracorporeal membrane oxygenation (ECMO) therapy force clinical services to ensure clinicians are properly trained and always ready to deal effectively with critical situations. Simulation-based education (SBE), from the simplest approaches to the most immersive modalities, helps promote optimum individual and team performance. The risks of SBE are negative learning, inauthenticity in learning and over-reliance on the participants' suspension of disbelief...
May 1, 2018: Perfusion
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