Perfusion
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Electrical storm refers to a state of cardiac electrical instability characterized by multiple episodes of ventricular tachycardia (VT) or ventricular fibrillation (VF) within a relatively short period of time and is associated with increased mortality and morbidity. The management of electrical storm involves a variety of strategies, including sedation, anti-arrhythmic and electrolyte replacement as well as revascularization and electrical ablation. However, the management strategy in patients with refractory storm is less clear and may require more invasive approaches. We present a case of severe ventricular tachycardia storm refractory to conservative management that was managed with a HeartMate II left ventricular assist device.
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Despite advances in surgery and intensive care, mortality in acute mesenteric ischemia remains between 50% and 90%. In this study, we evaluated factors affecting mortality in acute arterial mesenteric ischemia. ⋯ High red cell distribution width and gamma glutamyl transpeptidase levels and anti-coagulant use are factors affecting mortality in arterial acute mesenteric ischemia. The assessment of these variables could help predict the extent of arterial acute mesenteric ischemia and the mortality associated with it.
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Clinical Trial
Experience with the Avalon® bicaval double-lumen veno-venous cannula for neonatal respiratory ECMO.
We report a single centre experience of neonatal respiratory ECMO using the Avalon® double-lumen venous cannula and compare it with reports in the literature. ⋯ The Avalon® dual-lumen veno-venous cannula can be used for respiratory ECMO in the neonatal population. However, as the incidence of right atrial perforation is not negligible, we suspended its used in this group of patients.
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Randomized Controlled Trial Multicenter Study Comparative Study
The use of balanced HES 130/0.42 during complex cardiac surgery; effect on blood coagulation and fluid balance: a randomized controlled trial.
Colloids and crystalloid are used during cardiac surgery for priming of the cardiopulmonary bypass (CPB) circuit. Colloids may decrease postoperative fluid balance because of their high oncotic pressure and low risk of fluid extravasation. On the other hand, colloids have been shown to impair blood coagulation. ⋯ After complex cardiac surgery, the use of balanced 6% HES130/0.42 solution for CPB circuit priming did not impair haemostasis measured by ROTEM®, but it increased the need for transfusions. Fluid balance after CPB was less positive in the HES group, but, on the 1POM, it was comparable between the groups.