Artificial organs
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Drowning and near-drowning is often associated with severe hypothermia requiring active core rewarming. We performed rewarming by cardiopulmonary bypass(CPB). Between 1987 and 2007, 13 children (9 boys and 4 girls) with accidental hypothermia were rewarmed by extracorporeal circulation (ECC) in our institution. ⋯ In conclusion,drowning and near-drowning with severe hypothermia remains a challenging emergency. Rewarming by ECC provides efficient rewarming and full circulatory support. Although nearly half of the children may survive after rewarming by ECC, long-term outcome is limited by pulmonary and neurological complications.
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Randomized Controlled Trial Comparative Study
Evaluation of perfusion modes on vital organ recovery and thyroid hormone homeostasis in pediatric patients undergoing cardiopulmonary bypass.
The objectives of this study were: (i) to evaluate the effects of perfusion modes (pulsatile vs. nonpulsatile) on vital organs recovery and (ii) to investigate the influences of two different perfusion modes on the homeostasis of thyroid hormones in pediatric patients undergoing cardiopulmonary bypass (CPB) procedures. Two hundred and eighty-nine consecutive pediatric patients undergoing open heart surgery for repair of congenital heart disease were prospectively entered into the study and were randomly assigned to two groups: the pulsatile perfusion group (Group P, n = 208) and the nonpulsatile perfusion group (Group NP, n = 81). All patients received identical surgical, perfusional, and postoperative care. ⋯ FT(3) and FT(4) levels were reduced significantly further in the nonpulsatile group both during CPB and at 72 h postoperation. The results of this study confirm our opinion that pulsatile perfusion leads to better vital organ recovery and clinical outcomes in the early postoperative period as compared to nonpulsatile perfusion in pediatric patients undergoing CPB cardiac surgery. The plasma concentrations of thyroid hormones are dramatically reduced during and after CPB, but pulsatile perfusion seems to have a protective effect of thyroid hormone homeostasis compared to nonpulsatile perfusion.
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Randomized Controlled Trial
Pulsatile flow improves cerebral blood flow in pediatric cardiopulmonary bypass.
The objective of this study was to evaluate the effect of pulsatile flow on cerebral blood flow (CBF) in infants with the use of a mild hypothermic cardiopulmonary bypass (CPB). Thirty infants scheduled for open heart surgery were randomized to the pulsatile group (Group P, n = 15) and nonpulsatile group (Group NP, n = 15). In Group P, pulsatile perfusion was applied during the aortic cross-clamping period, whereas nonpulsatile perfusion was used in Group NP. ⋯ Additionally, PI and RI in Group P were significantly lower than those in Group NP (P < 0.05). However, there was no difference during T6. Pulsatile perfusion may increase CBF and decrease cerebral vascular resistance in the early period after mild hypothermic CPB.
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Comparative Study
Evaluation of HL-20 roller pump and Rotaflow centrifugal pump on perfusion quality and gaseous microemboli delivery.
The purpose of this study was to compare the HL-20 roller pump (Jostra USA, Austin, TX, USA) and Rotaflow centrifugal pump (Jostra USA) on hemodynamic energy production and gaseous microemboli (GME) delivery in a simulated neonatal cardiopulmonary bypass (CPB) circuit under nonpulsatile perfusion. This study employed a simulated model of the pediatric CPB including a Jostra HL-20 heart-lung machine (or a Rotaflow centrifugal pump), a Capiox BabyRX05 oxygenator (Terumo Corporation, Tokyo, Japan), a Capiox pediatric arterial filter (Terumo Corporation), and ¼-inch tubing. The total volume of the experimental system was 700mL (500mL for the circuit and 200mL for the pseudo neonatal patient). ⋯ Postpump total hemodynamic energy (THE) increased with increasing flow rates and decreasing temperatures in both circuits using these two pumps. The HL-20 roller pump delivered more THE than the Rotaflow centrifugal pump at all tested flow rates and temperature conditions. Results suggest the HL-20 roller pump delivers more GME than the Rotaflow centrifugal pump but produces more hemodynamic energy under nonpulsatile perfusion mode.
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Low birthweight (LBW) continues to be a high-risk factor in surgery for congenital heart disease. This risk is particularly very high in very low birthweight infants under 1500g and extremely LBW infants under 1000g. From January 2005 to December 2008, 33 consecutive LBW neonates underwent cardiac surgery in our clinic in keeping with the criteria for choice of surgery. ⋯ None of the cases showed a need for early reoperation. The acceptable early- and midterm mortality rates in this group suggest that these operations can be successfully performed. There is a need for further multicenter studies to evaluate these high-risk groups.