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April 2016: Clinical Privilege White Paper
Donald S Likosky, Timothy A Dickinson, Theron A Paugh
Cardiac surgery accounts for between 15% and 20% of all blood product utilization in the United States. A body of literature suggests that patients who are exposed to even small quantities of blood have an increased risk of morbidity and mortality, even after adjusting for pre-operative risk. Despite this body of literature supporting a restrictive blood management strategy, wide variability in transfusion rates exist across institutions. Recent blood management guidelines have shed light on a number of potentially promising blood management strategies, including acute normovolemic hemodilution (ANH) and retrograde autologous priming (RAP)...
September 2016: Journal of Extra-corporeal Technology
Kathleen Jr Daly, Luigi Camporota, Nicholas A Barrett
BACKGROUND: The last decade has seen an increase in the number of centres able to provide venovenous extracorporeal membrane oxygenation (VV-ECMO) internationally across different health care systems. To support this growth, a variety of staffing arrangements have been adopted depending on local need and availability of resources, both in terms of manpower and finances to safely meet the complex needs of the patient and circuit management. AIM: The aim of the survey was to describe current staffing arrangements of care provision for adult patients on VV-ECMO, with a focus on understanding the professional roles and responsibilities of staff managing the circuit in order to inform further discussion around different approaches to staffing...
September 21, 2016: Nursing in Critical Care
Jamil Bashir, Lynn M Fedoruk, John Ofiesh, Shahzad S Karim, G Frank O Tyers
BACKGROUND: Injuries to cardiac and venous structures during pacemaker and defibrillator lead extraction are serious complications that have been studied poorly. The incidence of these injuries is unknown but likely underestimated. No systematic multicenter review of these injuries or their management has been undertaken. METHODS AND RESULTS: We interrogated our mandatory administrative database for all excimer laser extractions that sustained a cardiac or venous injury in the province of British Columbia...
September 2016: Circulation. Arrhythmia and Electrophysiology
Joseph E Tonna, Nicholas J Johnson, John Greenwood, David F Gaieski, Zachary Shinar, Joseph M Bellezo, Lance Becker, Atman P Shah, Scott T Youngquist, Michael P Mallin, James Franklin Fair, Kyle J Gunnerson, Cindy Weng, Stephen McKellar
PURPOSE: To characterize the current scope and practices of centers performing extracorporeal cardiopulmonary resuscitation (eCPR) on the undifferentiated patient with cardiac arrest in the emergency department. METHODS: We contacted all US centers in January 2016 that had submitted adult eCPR cases to the Extracorporeal Life Support Organization (ELSO) registry and surveyed them, querying for programs that had performed eCPR in the Emergency Department (ED ECMO)...
October 2016: Resuscitation
Ronald A Bronicki, Mark Hall
OBJECTIVES: The objectives of this review are to discuss the pathophysiology of the pro-inflammatory response to the cardiopulmonary bypass circuit, the impact of ischemia reperfusion injury on post-operative organ function, the compensatory anti-inflammatory response and the evidence for immune-modulatory strategies and their impact on outcomes. DATA SOURCE: MEDLINE, PubMed. CONCLUSION: Innovations such as the development of more biocompatible surfaces and miniaturized circuits, as well as the increasing expertise of surgeons, anesthesiologists and perfusionists has transformed cardiac surgery and the use of cardiopulmonary bypass into a relatively routine procedure with favorable outcomes...
August 2016: Pediatric Critical Care Medicine
Philip M Jones, Daniel Bainbridge, Michael W A Chu, Philip S Fernandes, Stephanie A Fox, Ivan Iglesias, Bob Kiaii, Ronit Lavi, John M Murkin
PURPOSE: Volatile anesthetics possess cardioprotective properties, but it is unknown if the cardioprotective effects extend equally to all members of the class. Although sevoflurane is a relatively newer anesthetic than isoflurane, its introduction into practice was not preceded by a head-to-head comparison with isoflurane in a trial focusing on clinically important outcomes. Our objective was to determine whether sevoflurane was non-inferior to isoflurane on a clinically important primary outcome in a heterogeneous group of adults undergoing cardiac surgery...
October 2016: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
Vishwas Malik, Ajay Kumar Jha, Poonam Malhotra Kapoor
Continuously growing patient's demand, technological innovation, and surgical expertise have led to the widespread popularity of minimally invasive cardiac surgery (MICS). Patient's demand is being driven by less surgical trauma, reduced scarring, lesser pain, substantially lesser duration of hospital stay, and early return to normal activity. In addition, MICS decreases the incidence of postoperative respiratory dysfunction, chronic pain, chest instability, deep sternal wound infection, bleeding, and atrial fibrillation...
July 2016: Annals of Cardiac Anaesthesia
T N Cohen, J S Cabrera, O D Sisk, K L Welsh, J H Abernathy, S T Reeves, D A Wiegmann, S A Shappell, A J Boquet
The objectives of this study were to identify the frequency and nature of flow disruptions in the operating room with respect to three cardiac surgical team members: anaesthetists; circulating nurses; and perfusionists. Data collected from 15 cases and coded using a human factors taxonomy identified 878 disruptions. Significant differences were identified in frequency relative to discipline type. Circulating nurses experienced more coordination disruptions (χ(2) (2, N = 110) = 7.136, p < 0.028) and interruptions (χ(2) (2, N = 427) = 29...
August 2016: Anaesthesia
Kazuma Okamoto, Mikihiko Kudo, Hideyuki Shimizu
Although minimally invasive cardiac surgery (MICS) via right minithoracotomy is attracting attention as a minimally invasive approach in cardiac surgery, it has not become a standard, routine approach for mitral valve repair. Although it has spread rapidly in Germany (43%) and USA (20.4%), the proportion of MICS in isolated mitral valve repair still comprises only 15.6% of mitral valve repair surgeries in Japan. For safe, assured introduction of MICS as a routine approach under quality control for good surgical and mid- and long-term results, surgeons experienced in mitral valve repair who perform at least 10 mitral valve repairs per year are necessary...
March 2016: Nihon Geka Gakkai Zasshi
Michael A DeVita, Clifton W Callaway, Charissa Pacella, Maria Mori Brooks, John Lutz, Susan Stuart
BACKGROUND: In the United States, organ donation after circulatory death (DCD) determination is increasing among those who are removed from life-sustaining therapy but is rare when death is unexpected. We created a program for uncontrolled DCD (uDCD). METHODS: A comprehensive program was created to train personnel to identify and respond quickly to potential donors after unexpected death. The process termed Condition T was implemented in the emergency department (ED) of 2 academic medical centers...
March 2016: Progress in Transplantation
Caetano Nigro Neto, Francesco De Simone, Luigi Cassara, Carlos Gustavo Dos Santos Silva, Thiago Augusto Azevedo Marãnhao Cardoso, Francesco Carco, Alberto Zangrillo, Giovanni Landoni
BACKGROUND: Recently, evidence of cardio-protection and reduction in mortality due to the use of volatile agents during cardiac surgery led to an increase in their use during cardiopulmonary bypass (CPB). These findings seem to be enhanced when the volatile agents are used during all the surgical procedure, including the CPB period. AIMS: Since the administration of volatile agents through CPB can be beneficial to the patients, we decided to review the use of volatile agents vaporized in the CPB circuit and to summarize some tricks and tips of this technique using our 10-year experience of Brazilian and Italian centers with a large volume of cardiac surgeries...
April 2016: Annals of Cardiac Anaesthesia
L S Lokshin
INTRODUCTION: Over the past 20 years, there are many studies, where great attention is paid to the gas and material embolism as the cause of cognitive impairment in patients undergoing surgery with cardiopulmonary bypass. PURPOSE: To identify the filter capacity of 4 extracorporeal circuits for removing gaseous microemboli in various interventions on the heart and aorta. MATERIAL AND METHODS: Work carried out on 60 patients operated on acquired heart and aorta under cardiopulmonary bypass...
September 2015: Anesteziologiia i Reanimatologiia
Kyriakos Anastasiadis, John Murkin, Polychronis Antonitsis, Adrian Bauer, Marco Ranucci, Erich Gygax, Jan Schaarschmidt, Yves Fromes, Alois Philipp, Balthasar Eberle, Prakash Punjabi, Helena Argiriadou, Alexander Kadner, Hansjoerg Jenni, Guenter Albrecht, Wim van Boven, Andreas Liebold, Fillip de Somer, Harald Hausmann, Apostolos Deliopoulos, Aschraf El-Essawi, Valerio Mazzei, Fausto Biancari, Adam Fernandez, Patrick Weerwind, Thomas Puehler, Cyril Serrick, Frans Waanders, Serdar Gunaydin, Sunil Ohri, Jan Gummert, Gianni Angelini, Volkmar Falk, Thierry Carrel
Minimal invasive extracorporeal circulation (MiECC) systems have initiated important efforts within science and technology to further improve the biocompatibility of cardiopulmonary bypass components to minimize the adverse effects and improve end-organ protection. The Minimal invasive Extra-Corporeal Technologies international Society was founded to create an international forum for the exchange of ideas on clinical application and research of minimal invasive extracorporeal circulation technology. The present work is a consensus document developed to standardize the terminology and the definition of minimal invasive extracorporeal circulation technology as well as to provide recommendations for the clinical practice...
May 2016: Interactive Cardiovascular and Thoracic Surgery
Smita I Negi, Mladen Sokolovic, Edward Koifman, Sarkis Kiramijyan, Rebecca Torguson, Joseph Lindsay, Itsik Ben-Dor, William Suddath, Augusto Pichard, Lowell Satler, Ron Waksman
BACKGROUND: Refractory cardiogenic shock (RCS) in acute myocardial infarction (AMI) is associated with high rates of mortality. Smaller ventricular assist devices, such as the intraaortic balloon pump, provide limited support. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) offers more robust mechanical ventricular support, but is not widely utilized by interventional cardiologists. This study aimed to evaluate the patient characteristics and outcomes of VA-ECMO with RCS in the setting of AMI...
February 2016: Journal of Invasive Cardiology
Jared P Beller, Joshua A Scheinerman, Leora B Balsam, Patricia Ursomanno, Abe DeAnda
OBJECTIVE: The purpose of this study was to compare operative strategies and patient outcomes in acute type A aortic dissection (ATAAD) repairs before and after the implementation of a multidisciplinary aortic surgery team. METHODS: Between May 2005 and July 2014, 101 patients underwent ATAAD repair at our institution. A dedicated multidisciplinary aortic surgery team (experienced aortic surgeon, perfusionists, cardiac anesthesiologists, nurses, and radiologists) was formed in 2010...
November 2015: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
Armindo Fernandes, Eric Laliberte, Karine Toledano, Philippe Demers
Cardiopulmonary bypass (CPB) is a common practice in our era. The medical technology used for cardiac surgery goes through rigorous testing to ensure its safety. Unfortunately, it is not fail proof. Oxygenator failures are a rare occurrence but may lead to catastrophic events. We present a case where the preparation for initiating CPB was complicated by an oxygenator defect. After thorough examination, the oxygenator was found leaking from the gas exhaust port suggesting a disruption in continuity of the fibers...
September 2015: Journal of Extra-corporeal Technology
Rachel Gambino, Bruce Searles, Edward M Darling
Despite the widespread use of vacuum-assisted venous drainage (VAVD) and case reports describing catastrophic incidents related to VAVD, there is a lack of data cataloging specific safety measures that individuals and institutions have incorporated into their VAVD practices for the prevention of these incidents. Therefore, the purpose of this study is to survey the perfusion community to gather data on VAVD practices, and to compare these current practices with literature recommendations and the American Society of ExtraCorporeal Technology (AmSECT) Standards and Guidelines...
September 2015: Journal of Extra-corporeal Technology
Robert C Groom
No abstract text is available yet for this article.
June 2015: Journal of Extra-corporeal Technology
Ervin E Ševerdija, Nousjka P A Vranken, Steven Teerenstra, Yuri M Ganushchak, Patrick W Weerwind
Previous studies showed that decreased cerebral saturation during cardiac surgery is related to adverse postoperative outcome. Therefore, we investigated the influence of intraoperative events on cerebral tissue saturation in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). A total of 52 adult patients who underwent cardiac surgery using pulsatile CPB were included in this prospective explorative study. Cerebral tissue oxygen saturation (SctO2) was measured in both the left and right cerebral hemisphere...
March 2015: Journal of Extra-corporeal Technology
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