Perfusion
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Comparative Study Clinical Trial
ICU outcomes in adult cardiac surgery patients in relation to ultrafiltration type.
Ultrafiltration (UF) is used to ameliorate the deleterious effects of cardiopulmonary bypass (CPB) in cardiac surgery patients. There are two different methods; conventional ultrafiltration (CUF), performed during CPB, and modified ultrafiltration (MUF), performed after CPB is finished. It has not been established which is better, and controversy remains regarding the optimal UF strategy. ⋯ In the present study, with adult patients receiving elective cardiac surgery, the combined ultrafiltration group had a larger fluid removal. However, neither type of ultrafiltration nor amount of filtered volume was accompanied by different postoperative ICU clinical outcomes. Ultrafiltration was considered a safe and reliable technique, with no related complications.
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Serious pulmonary and cardiac failure may be treated with extracorporeal membrane oxygenation (ECMO) when conventional treatment fails. In some severely ill patients, it may be necessary to initiate ECMO at the local hospital and, thereafter, transport the patient back to the ECMO center. The aim of this study was to evaluate our experiences with transportation of patients on ECMO. ⋯ Time from departure to arrival at Rikshospitalet was a mean of 3.2 (0.50-5.10) hours for survivors versus 2.5 (0.5-4.40) for non-survivors, p=0.41. This study shows that ECMO can be successfully established at local hospitals, using an experienced team, and that transportation of patients on ECMO can be performed safely and without technical difficulties. Survival for this group of patients did not differ from patients treated at the ECMO center.
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Serious pulmonary failure may be treated with extracorporeal membrane oxygenation (ECMO) when other treatment has failed. The aim of this study was to analyze pre-operative risk factors of early mortality in patients who underwent either veno-arterial (VA) ECMO or veno-venous (VV) ECMO for pulmonary failure. We studied a total of 26 risk factors in 72 patients with severe pulmonary insufficiency treated with ECMO. ⋯ It is, however, difficult to predict outcome when initiating ECMO. In this analysis, only pre-operative serum creatinine levels correlated with survival. None of the other parameters, including those which were used to select patients for ECMO treatment, could significantly predict the outcome.
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Comparative Study Retracted Publication
Treating pulmonary hypertension post cardiopulmonary bypass in pigs: milrinone vs. sildenafil analog.
Procedures using cardiopulmonary bypass (CPB) and aortic cross-clamping are associated with a variable degree of ischemia/reperfusion of the lungs, leading to acute pulmonary hypertension (PHT). The purpose of this study was to compare the effects of the sildenafil analog (UK343-664), a phosphodiesterase type V(PDEV) inhibitor, with milrinone, a PDE type III inhibitor, in a porcine model of acute PHT following CPB. After the pigs were anesthetized, pressure-tipped catheters were placed in the right ventricle and carotid and pulmonary arteries. ⋯ After administration of the drugs, mean pulmonary artery pressure decreased in all 3 groups; however, only in the sildenafil-analog group did pulmonary vascular resistance(PVR) decrease by 35%, from 820 to 433 dynes . cm . sec(-5) at 5 minutes (p<0.05), and continued to be decreased at 10 minutes by 26% (P<0.05). Pulmonary selectivity was demonstrated with sildenafil-analog, because there were no similar changes in systemic vascular resistance(SVR) and no significant changes in systemic hemodynamics. Sildenafil-analog, a PDEV inhibitor, shows a promising role for managing the PVR increases that occur following CPB.