Perfusion
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Review Case Reports
The use of extracorporeal membrane oxygenation in pediatric patients with sickle cell disease.
Previous reports have described the use of extracorporeal membrane oxygenation (ECMO) for acute chest syndrome of sickle cell disease (SCD). However, there have been no reports of venoarterial (VA) ECMO for cardiac dysfunction in patients with SCD. We describe a patient with SCD and life-threatening cardiogenic shock who was successfully treated with VA ECMO. ⋯ Ten percent of SCD patients receiving VA ECMO experienced either a cerebral infarct or hemorrhage; our patient suffered a cerebrovascular accident while on ECMO, though she survived with good neurologic outcome. To our knowledge, this is the first report of a pediatric patient with SCD and cardiogenic shock successfully managed with VA ECMO. In conjunction with the ELSO registry review, this case report suggests that, while VA ECMO can be successfully used in patients with SCD and severe cardiovascular dysfunction, clinicians should also be aware of the potential for serious complications in this high-risk population.
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Pre-operative hypoalbuminaemia is associated with worse outcomes after non-cardiac surgery, but it has only recently been considered as a predictor of outcome in cardiac surgery. A multivariate analysis of data routinely collected from 400 patients undergoing cardiac surgery was undertaken, comprising pre-operative routine blood tests (serum concentrations of albumin, creatinine, alanine transaminase, alkaline phosphatase, bilirubin and haemoglobin, and white cell and platelet count), diabetic status, left ventricular function, gender, ethnicity, body mass index and age. Indices of outcome were death and length of stay (LoS) in cardiac intensive care and hospital. ⋯ L(-1)): these patients had longer intensive care and hospital stays and were more likely to die. Multivariate analysis revealed the best combination of predictors of length of hospital stay for the first 200 patients to be age, serum creatinine concentration, severe hypoalbuminaemia and diabetic state. However, in the second cohort of 200 patients, the same combination of predictors was not successful in predicting LoS in hospital.
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Randomized Controlled Trial
Immediate effects of individualized heparin and protamine management on hemostatic activation and platelet function in adult patients undergoing cardiac surgery with tranexamic acid antifibrinolytic therapy.
This randomized prospective study was initiated to clarify whether individualized heparin and protamine dosing has immediate effects on hemostatic activation and platelet function in adult cardiac surgery. ⋯ An individualized and stable heparin concentration and appropriate dosing of protamine can reduce thrombin generation and preserve platelet function, even in short-time CPB.
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Biocompatible circuits (BCC) are intended to decrease the activation of blood to the artificial cardiopulmonary bypass (CPB) surface. Typically, the coatings are made of various inert substances or molecules physiologically similar to endothelium. Thromboelastography (TEG) graphically represents clot formation, strength of clotting and fibrinolysis. TEG analysis was undertaken to determine if coagulation could be preserved by the BCC. ⋯ While not harmful, BCC are ineffective in preserving TEG coagulation parameters post CPB. Clinical findings support laboratory TEG results in that there were no differences in bleeding or transfusion requirements between groups.
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Comparative Study
Comparison between normothermic and mild hypothermic cardiopulmonary bypass in myocardial revascularization of patients with left ventricular dysfunction.
The aim of this study was to investigate whether normothermic bypass is superior to mild hypothermia in patients with poor left ventricular function. This was achieved by studying defibrillation rates, postoperative requirements of cardiac pacing or other morbidity issues and mortality in patients with left ventricular dysfunction operated upon for elective coronary revascularization. ⋯ Normothermia enables less requirement for defibrillation after aortic declamping and postoperative cardiac pacing in patients with left ventricular dysfunction, which may be interpreted as better myocardial protection under normothermic bypass. However, maintaining normothermia had no effect on postoperative stroke, postoperative atrial fibrillation, renal failure development and mortality.