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.
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Randomized Controlled Trial Comparative Study Clinical Trial
Clinical evaluation of nine hollow-fibre membrane oxygenators.
In a comparative study we investigated the performance characteristics of nine hollow-fibre oxygenators. In a clinical setting, 10 units of each type of oxygenator were tested for oxygen exchange, transoxygenator pressure drop, heat exchanger performance and blood trauma. The oxygenators included are Maxima PRF Plus, Affinity, Forte, Affinity NT, Quantum, Optima, Capiox 1.8, Hilite and Quadrox. ⋯ Plasma free haemoglobin values were low in each oxygenator. There are no differences in platelet drop postoperatively. The influence on blood trauma of the higher pressure drop in some of the tested devices, in combination with the higher centrifugal pump revolutions needed to overcome this gradient, has to be studied with longer perfusion times.
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An investigation was conducted to determine whether adding albumin to the prime of the cardiopulmonary bypass circuit had any effect on postoperative weight gain. Patients undergoing non-emergency myocardial revascularization for coronary artery disease were divided into two groups. Group I (albumin) received 250 ml of 5% human albumin in their pump prime, whereas group II (control) served as controls. ⋯ No statistically significant differences could be found between the groups for any of the variables studied, including fluid intake during surgery and the first 24 h postoperation, urine output, fluid balance and postoperative weight gain. The authors conclude from this investigation that adding 250 ml of 5% human albumin to the pump prime has no effect on postoperative weight gain. The next step could be to examine the effect of using larger amounts of albumin or plasma volume expanders in the pump prime.