Circulation
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Multicenter comparison of truncated biphasic shocks and standard damped sine wave monophasic shocks for transthoracic ventricular defibrillation. Transthoracic Investigators.
The most important factor for improving out-of-hospital ventricular fibrillation survival rates is early defibrillation. This can be achieved if small, lightweight, inexpensive automatic external defibrillators are widely disseminated. Because automatic external defibrillator size and cost are directly affected by defibrillation waveform shape and because of the favorable experience with truncated biphasic waveforms in implantable cardioverter-defibrillators, we compared the efficacy of a truncated biphasic waveform with that of a standard damped sine monophasic waveform for transthoracic defibrillation. ⋯ We found that 130-J biphasic truncated transthoracic shocks defibrillate as well as the 200-J monophasic damped sine wave shocks that are traditionally used in standard transthoracic defibrillators and result in fewer ECG abnormalities after the shock.
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Randomized Controlled Trial Comparative Study Clinical Trial
Randomized trial of recombinant platelet factor 4 versus protamine for the reversal of heparin anticoagulation in humans.
Protamine reverses heparin anticoagulation, but it can have important side effects. We compared the safety and effectiveness of intravenous recombinant platelet factor 4 (rPF4) as an alternative to protamine in a randomized blinded trial. ⋯ At the dose used in this study, rPF4 was well tolerated and reversed the anticoagulant effect of heparin. These data support its continued evaluation as an alternative to protamine after cardiac surgery.
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The use of the extracorporeal membrane oxygenator (ECMO) for postoperative cardiac patients has not resulted in the same high success rate as when ECMO is used for neonates with pulmonary hypertension or pulmonary failure. The reason for this is poorly understood. ⋯ This review suggests that the diagnosis of single ventricle, initiation of ECMO in the operating room or > 50 hours after surgery, and ECMO for > 208 hours are associated with patient nonsurvival. Noncardiac complications more frequently led to discontinuation of ECMO than did failure of the return of cardiac function.
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A transient increase in pulmonary vascular resistance can result in hemodynamic compromise after a Fontan operation. An interatrial fenestration is designed to maintain cardiac output in these circumstances but may result in severe hypoxemia and a vicious circle due to hypoxemia induced pulmonary vasoconstriction. Our aim was to determine whether inhaled nitric oxide (iNO), a selective pulmonary vasodilator, could be used to reduce pulmonary vascular resistance in desaturated patients (SaO2 < or = 85%) after a fenestrated Fontan operation. ⋯ iNO improved both oxygenation and TPG in desaturated patients after the fenestrated Fontan operation, possibly by counteracting hypoxemia-induced pulmonary vasoconstriction. A trial of iNO should be considered in clinically unstable desaturated patients after the fenestrated Fontan operation.
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A low cardiac output state can complicate the postoperative course of patients undergoing Fontan-type operations and tetralogy of Fallot repair. ⋯ Negative-pressure ventilation improves cardiac output in children after total cavopulmonary connection and tetralogy of Fallot repair and may prove to be an important therapeutic option in children with the low cardiac output state.