The International journal of artificial organs
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Review
Generation, detection and prevention of gaseous microemboli during cardiopulmonary bypass procedure.
Neuropsychological injury after cardiopulmonary bypass (CPB) is one of the most serious and costly complications arising from the procedure. Gaseous microemboli (GME) have long been implicated as one of the principal causes. There are two major sources of GME: surgical and manual manipulation of the heart and arteries; and the components of the extracorporeal circuit, including the type of pump, different perfusion modes, the design of the oxygenator and reservoir, and the use of vacuum assisted venous drainage (VAVD), all of which have a great impact on the delivery of existing GME to the patients. ⋯ Improvements in perfusion equipment and in perfusion and surgical techniques have led to a dramatic reduction in the occurrence of GME during cardiac surgery. Although the clinical relevance of cerebral air embolization in causing neurological damage is unclear, every single person involved in perfusion and surgical technology should be aware of the risk of embolization and strictly regulate clinical behavior. Related research should also be done to improve the design of circuit components and clinical practice with a view to eliminating air bubbles during CPB procedure.
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Comparative Study
A comparison of the Niagara™ and Dolphin® catheters for continuous renal replacement therapy.
The choice of vascular access catheter may affect filter life during continuous renal replacement therapy (CRRT); specifically, a new surface-modified catheter has been reported to possibly prevent thrombosis and catheter malfunction. ⋯ The Niagara and Dolphin catheters appear to be broadly equivalent in terms of their impact on circuit life.
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Transfer of severely hypoxic patients is a high-risk procedure. Extracorporeal membrane oxygenation (ECMO) allows safe transport of these patients to tertiary care institutions. Our ECMO transportation program was instituted in 2004; here we report results after 5 years of activity. ⋯ ECMO effectively enabled high-risk ground transfer of severely hypoxic patients.