The Annals of thoracic surgery
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Many victims of accidental hypothermia have been successfully resuscitated with cardiopulmonary bypass, but questions remain regarding treatment indications and efficacy. To assess the role of cardiopulmonary bypass in resuscitation from hypothermia, a collective literature review was performed. Data on 68 hypothermic patients resuscitated with cardiopulmonary bypass were analyzed. ⋯ Tissue perfusion and oxygenation are maintained while rapid warming occurs. Cardiopulmonary bypass resuscitation is recommended for hypothermic patients in arrest and for patients with core temperatures lower than 25 degrees C, irrespective of rhythm. Patients in stable condition with temperatures between 25 degrees and 28 degrees C can be treated with cardiopulmonary bypass or conventional warming methods.
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Randomized Controlled Trial Clinical Trial
Heparin and antithrombin III levels during cardiopulmonary bypass: correlation with subclinical plasma coagulation.
The anticoagulant effect of heparin in the milieu of altered antithrombin III levels was investigated in adult (n = 7) and pediatric (n = 14) patients undergoing open heart operations. The pediatric patients were subdivided into a control group (n = 8) and an antithrombin III group (n = 6), which received 1,000 units of antithrombin III. The reduction in antithrombin III levels during cardiopulmonary bypass was obvious in patients of all ages, showing a greater reduction (although not statistically significant) in the pediatric patients. ⋯ This result may be related to the different actions of heparin when antithrombin III levels are reduced. Supplementation with antithrombin III succeeded in suppressing the activation of the coagulation cascade and resulted in no statistical change in fibrinopeptide A levels at any time. We conclude that heparin and (in some patients) antithrombin III levels are important variables for the inhibition of fibrin formation and the possible preservation of coagulation proteins.
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Gastrobronchial fistula is an extremely rare condition. A case of gastrobronchial fistula secondary to a benign gastric ulcer 9 years after esophagectomy and gastric pull-up for treatment of esophageal carcinoma is described. A review of the literature is provided.