Perfusion
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Clopidogrel (Plavix) is an inhibitor of ADP-induced platelet aggregation, acting by direct inhibition of adenosine diphosphate (ADP) binding to its receptor and of the subsequent ADP-mediated activation of the glycoprotein GPIIb/IIIa complex. A common recommendation for coronary artery bypass surgery is to stop clopidogrel five to seven days before surgery.(1) Patients taking clopidogrel within five days of surgery are more likely to show an increase in post-operative bleeding, an increase need for blood products, and an increased chance for secondary operations to control bleeding. This paper presents an option which appears to decrease the adverse effects of clopidogrel for patients undergoing coronary artery bypass surgery within one to four days of stopping the use of clopidogrel. ⋯ No other donor blood products were required. Post-operative bleeding was minimal, and the need for a secondary operation due to bleeding was eliminated. The average stay in the cardiovascular intensive care unit(CICU) was 2.8 days, with an average hospital stay of 7.25 days.
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Simulation is a common training modality used in aviation, the nuclear industry and by many medical specialties. The adoption of simulation by introductory perfusion education for beginning students and continuing medical education by cardiovascular perfusion has not kept pace with other fields and this paper explores issues connected with simulation in other professions, including training as it currently exists, access to simulator technology, and what could be achieved by utilizing simulator technology.
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Randomized Controlled Trial
Effect of subzero-balanced ultrafiltration on postoperative outcome of patients after cardiopulmonary bypass.
To evaluate the effect of a new ultrafiltration technique - subzero-balanced ultrafiltration technique - on early postoperative outcomes of adult patients undergoing cardiac operations with cardiopulmonary bypass. ⋯ Subzero-balanced ultrafiltration during cardiopulmonary bypass can effectively decrease the patients' hospital morbidity and the volume of blood transfusion: it also may promote early postoperative recovery of patients. Routine application of subzero-balanced ultrafiltration during adult cardiac operations should not be necessary, but the technique should be compared to other techniques, e.g. MUF, in further studies.
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Low hematocrit level and transfusion may coexist during cardiopulmonary bypass and the actual impact of one on the outcome parameters may be counfounded or masked by the other. This study aims to determine the impact of the lowest hematocrit level during cardiopulmonary bypass on outcome parameters in non-transfused patients. ⋯ Our findings suggest that a lowest hematocrit level of < or = 21% during cardiopulmonary bypass has no adverse impact on outcome after isolated coronary surgery in non-transfused patients.
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The aim of this prospective, animal study was to compare brain tissue oxygen tension (PbtO(2)) with cerebral near infrared spectroscopy (NIRS) and mixed venous oxygen saturation (SVO(2)) during venoarterial extracorporeal membrane oxygenation (VA ECMO) in a porcine model. This was accomplished using twelve immature piglets with surgically implanted catheters placed in the superficial cerebral cortex to measure brain PbtO(2) and microdialysis metabolites. The NIRS sensor was placed overlying the forehead to measure cerebral regional saturation index (rSO(2)i) while SVO(2) was measured directly from the ECMO circuit. ⋯ Upon further analysis, these animals had significantly lower blood pressure (p=0.001), lower serum pH (p=0.01), and higher serum lactate (p=0.02). Additionally, in this subgroup, rSO(2)i correlated better with PbtO(2) (R(2)=0.76). These findings suggest that, in our ECMO model, rSO(2)i and SVO( 2) correlate reasonably well with each other, but not necessarily with brain PbtO(2) and that NIRS-derived rSO(2)i may more accurately reflect cerebral tissue hypoxia in sicker animals.