Perfusion
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Multicenter Study Clinical Trial
Evaluation of coagulation factors and platelet function from an off-line modified ultrafiltration technique for post-cardiopulmonary bypass circuit blood recovery.
Modified ultrafiltration (MUF) is a technique that hemoconcentrates residual CPB circuit blood and the patient at the same time. Hemoconcentration and MUF are Class 1-A recommendations in the anesthesia and surgical blood conservation guidelines. This study evaluated the off-line MUF process of the Hemobag (HB, Global Blood Resources, Somers, CT, USA) to quantitate coagulation factor levels, platelet (PLT) count and function in one facility and cellular growth factor concentrations of the final product that were transfused to the patient in another facility In two cardiac surgery facilities, after decannulation, the extracorporeal circuit (ECC) blood from 22 patients undergoing cardiac surgery was processed with the HB device. ⋯ The findings are similar to trends reported in other studies utilizing conventional MUF and the HB. Functioning platelets remain in the final product, with growth factor concentrations similar to some methods employed to create platelet concentrates to enhance coagulation. Based on the ability of the HB off-line MUF procedure to concentrate circuit blood, the clinical utility of the HB device to decrease allogeneic blood product exposure should be evaluated in a prospective randomized clinical trial.
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Review Meta Analysis
Effects of retrograde autologous priming on blood transfusion and clinical outcomes in adults: a meta-analysis.
Reducing the priming volume is an effective means of decreasing hemodilution and blood transfusion during cardiopulmonary bypass (CPB). The patient's own blood was used to replace the crystalloid in the CPB circuit by retrograde autologous priming (RAP) in order to decrease the priming volume. Therefore, we performed a meta-analysis to investigate whether RAP could reduce blood transfusion and improve clinical outcomes. ⋯ Compared to conventional priming, RAP could reduce transfusion in adults significantly, but had no effect on clinical outcomes, comparing to conventional priming. Further studies involving RAP are expected to investigate if this technique is beneficial to the patient.
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Extracorporeal membrane oxygenation (ECMO) facilitates organ support in patients with refractory cardiorespiratory failure whilst disease-modifying treatments can be administered. Improvements to the ECMO process have resulted in its increased utilisation. However, iatrogenic injuries remain, with bleeding and thrombosis the most significant concerns. ⋯ Furthermore, there is limited research directly linking hyperoxaemia and platelet activation. These are areas that warrant investigation as definitive data regarding the nascence of these pathological processes may delineate and define the relative risk of supranormal oxygen tension. These data could then assist in defining optimal oxygenation practice, reducing the risks associated with extracorporeal support.
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Acute kidney injury (AKI) following cardiopulmonary bypass (CPB) is associated with increased mortality, requirement for dialysis, and longer intensive care unit (ICU) and hospital length of stay. Rewarming during CPB and poor oxygen delivery have been associated with AKI; however, the role of temperature management on AKI has not been clearly defined. This study aims to evaluate the role of hyperthermia during CPB and the temperature upon admission to the ICU on AKI following cardiac surgery, using the RIFLE (renal Risk, Injury, Failure, Loss of renal function and End-stage renal disease) criteria. ⋯ Variables found to be independent predictors of AKI included CPB hyperthermia (Odds ratio [OR] 1.03 per minute increase [95% confidence interval (CI) 1.01-1.05]; p = 0.01), ICU admission temperature ([OR] 1.44 per degree increase [(CI) 1.13-1.85]; p<0.001), minimum CPB haemoglobin ([OR] 0.83 per g/dL increase [(CI) 0.71-0.97]; p = 0.02), use of intra-aortic balloon pump ([OR] 2.69 [(CI) 1.24-5.82]; p = 0.01) and ICU readmission ([OR] 3.13 [(CI) 1.73-5.64]; p<0.001). Avoiding arterial outlet hyperthermia may help decrease AKI following cardiac surgery using CPB. Both intraoperative and postoperative temperature management strategies should be the focus of future randomised studies to determine optimal interventions.
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Case Reports
Complete neurological recovery after delayed onset resuscitation in a normothermic witnessed arrest.
Cardiac arrest following aortic dissection carries high morbidity and mortality, primarily due to poor neurological outcomes. Most efforts are directed towards perfusing vital organs and replenishing oxygen and adenosine triphosphate (ATP) stores during and immediately after arrest. Methods of reperfusion (including external cardiopulmonary resuscitation (CPR), open CPR, extracorporeal life support and ventricular assist devices) and other ATP preservation methods, such as pharmaceutical agents and hypothermia, are maximally beneficial only if started early during cardiac arrest. We describe a case of aortic rupture with arrest on the table which was re-perfused after 20 minutes, using cardiopulmonary bypass (CPB), but still managed to recover without neurological sequelae.