Perfusion
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During cardiopulmonary bypass, the perfusionist maintains physiological parameters laid down in protocols; this is his or her performance capability. In order to assess his or her performance we need to be able to analyse these physiological parameters objectively. We defined six parameters, pH, BE, PaCO2, PaO2, ACT and oesophageal temperature and gave them ideal values of 7.40+/-0.05, 0.0+/-2.5 mmol/l, 39.0+/-3.0 mmHg, 150+/-50 mmHg, 540+/-60 s and 37.2+/-0.2 degrees C, respectively. ⋯ We then analysed what percentage of our 100 patients fell within each score range for each of the six parameters. This is an efficient means in analysing whether the perfusionist abides by the protocols, what quality is supplied to the patient, does he or she react when he or she is faced with parameters that are out of range and finally advocating in-line blood gas monitoring. This is another step towards our goal of total quality management.
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An experiment to study the role of contact-activation leukocyte sequestration in the formation of ischaemia-reperfusion injury (I-R injury) was carried out. The study was conducted using light and electron microscopic analyses in an ovine cardiopulmonary bypass (CPB) model using a membrane oxygenator. Five adult sheep were used in the study. ⋯ Neither significant differences in the transpulmonary gradients of leukocytes nor a significant complement activation, expressed by C3a levels, was observed. The MDA level did not display a significant change related to lung reperfusion despite an increase in MDA after the start of CPB. These findings indicate that I-R injury during CPB may not be from complement-activation leukocyte sequestration, but from another source of oxygen free radicals related to CPB.