Perfusion
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Venoarterial extracorporeal membrane oxygenation is widely used as mechanical circulatory support for severe heart failure. A major concern with this treatment modality is left ventricular distension due to inability to overcome the afterload created by the extracorporeal membrane oxygenation circuit. The present porcine study evaluates coronary circulation, myocardial perfusion and ventricular distension during venoarterial extracorporeal membrane oxygenation. ⋯ Coronary artery blood flow is maintained during venoarterial extracorporeal membrane oxygenation after cardiopulmonary bypass and cardioplegic arrest despite severely affected performance of the left ventricle. Myocardial perfusion decreases, however, presumably due to rapid development of myocardial tissue oedema.
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Review Multicenter Study
The use of extracorporeal membrane oxygenation in human immunodeficiency virus-positive patients: a review of a multicenter database.
We chose to evaluate the survival of extracorporeal membrane oxygenation among patients with human immunodeficiency virus in a multicenter registry. ⋯ Survival among patients with human immunodeficiency virus infection who receive extracorporeal membrane oxygenation was less than 40%. Infections before extracorporeal membrane oxygenation cannulation occurred more often in non-survivors. The receipt of renal replacement therapy, inotropic infusions, or cardiopulmonary resuscitation during extracorporeal membrane oxygenation was associated with worse outcome.
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Evidence for the ideal/best practice priming solution remains meagre and largely historical. The aim of this survey was to determine the constituents of contemporary priming solutions in adult open-heart centres across Australia. This would provide insight on the level of variation within current Australian priming practices and inform perfusionists of how their current priming methods compare to the spectrum of Australian practice. ⋯ Contemporary Australian priming practices show a marked level of conformity between units. Variation exists in the rationale for adding sodium bicarbonate, mannitol and albumin. Further investigations into the clinical effects of these additives are required to determine if the rationale for their addition is historical or judicious in this contemporary era of low prime volumes, physiological base solutions and coated bypass circuits.
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The aim of this study was to compare blood flow velocity changes in the middle cerebral artery before, during and after heart surgery with cardiopulmonary bypass for patients with and without postoperative cognitive dysfunction. ⋯ Middle cerebral artery's blood flow velocity was decreased after anaesthesia induction and during cardiopulmonary bypass for patients with postoperative cognitive dysfunction comparing with their blood flow velocity preoperatively. Blood flow velocity during bypass has diagnostic value for postoperative cognitive dysfunction. Brain biomarker glial fibrillary acidic protein is not helpful in diagnosing postoperative cognitive dysfunction.
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We aimed to investigate the risk factors affecting survival after extracorporeal membrane oxygenation use in pediatric postcardiotomy patients. ⋯ Parameters affecting mortality after extracorporeal membrane oxygenation support in pediatric postcardiotomy patient group were the presence of a syndrome, multiple runs of extracorporeal membrane oxygenation, and single-ventricular physiology. Timing of extracorporeal membrane oxygenation initiation, appropriate patient selection, appropriate reintervention or reoperation for patients with correctable pathology, the use of an appropriate cannulation strategy in single-ventricle patients, management of shunt flow, and appropriate interventions to reduce the incidence of complications play key roles in improving survival.