Perfusion
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Case Reports
PRIS may be diagnosed before ICU period for patients undergoing cardiopulmonary bypass.
There are many published articles on the clinical manifestations of propofol-related infusion syndrome (PRIS), but they are not the same in each case.(1)Moreover, PRIS is only encountered infrequently and, therefore, it may create a diagnostic challenge. Nearly all of the published articles on PRIS are related to the use of long-term (> 48 hour) propofol infusion with a dose range of at least 4-5 mg/kg/h. ⋯ Therefore, we suggest that any propofol administration (bolus or infusion) may result in such clinical symptoms, which may be the earliest indicators of PRIS. When those symptoms are observed on propofol administration during cardiopulmonary bypass (CPB), the perfusionist must alert both the anaesthesiologist and the surgeon to stop the propofol in order to prevent the patient from further adverse effects of PRIS.
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Heparin resistance (unresponsiveness to heparin) is characterized by the inability to reach acceptable activated clotting time values following a calculated dose of heparin. Up to 20% of the patients undergoing cardiothoracic surgery with cardiopulmonary bypass using unfractionated heparin (UFH) for anticoagulation experience heparin resistance. Although UFH has been the "gold standard" for anticoagulation, it is not without its limitations. ⋯ The safety and efficacy of the use of the direct thrombin inhibitor bivalirudin for anticoagulation during cardiac surgery has been reported. However, there have been no reports on the treatment of heparin resistance with bivalirudin during CPB. In this review, we report the favorable outcome of our single-center experience with the alternative use of bivalirudin in the management of anticoagulation of heparin unresponsive patients undergoing coronary artery bypass graft surgery.
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A 45-year-old patient in lung failure treated with veno-venous extracorporeal membrane oxygenation (VV ECMO) developed subsequent right heart failure and required cardiac support. We present a method of upgrading a VV ECMO to a hybrid system for simultaneous support for respiratory and cardiac failure.
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The purpose of this study was to evaluate the association between survival and the duration of conventional cardiopulmonary resuscitation (CCPR) prior to extracorporeal cardiopulmonary resuscitation (ECPR) and possible confounding factors. ⋯ More than half of all patients who received ECPR survived to 30 days. Longer duration CCPR was associated with reduced survival within 2 weeks, but not at 30 days.
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Case Reports
Extracorporeal membrane oxygenation for the treatment of adult sickle cell acute chest syndrome.
Sickle cell disease (SCD) is a hereditary haemoglobinopathy that results in polymerization of haemoglobin molecules and subsequent vaso-occlusion. A common cause of death in adults is acute chest syndrome (AChS) with resulting hypoxemic respiratory failure. ⋯ We present an adult SCD patient with severe respiratory failure due to AChS, successfully treated with VV-ECMO. We also discuss some of the technical challenges and considerations when using ECMO in the SCD patient.