Perfusion
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Extracorporeal life support (ECLS) was established in a newborn infant diagnosed with severe respiratory failure secondary to complex congenital heart disease. After 4 days of ECLS support in the intensive care unit, the infant was brought to the operating room for repair of the primary lesion. Due to concerns related to recurrent respiratory failure associated with blood contact to a new extracorporeal circuit, the existing ECLS circuit was modified for use in the operating room. This report describes the circuit modification steps and challenges related to running a modified ECLS circuit for cardiopulmonary support during cardiac surgery.
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Randomized Controlled Trial Comparative Study
Effects of centrifugal and roller pumps on survival of autologous red cells in cardiopulmonary bypass surgery.
Either a roller pump or a centrifugal pump can be used in the extracorporeal circuit during surgery with cardiopulmonary bypass. In this study, we assessed the effect of these two pumps on the 24-h post-transfusion survival values of autologous red blood cells (RBC). ⋯ The 24-h post-transfusion survival values of autologous RBC, measured by the 51 disodium chromate/99m technetium double isotope procedure, were not significantly different, whether the roller pump or the centrifugal pump was used in the extracorporeal circuit using membrane oxygenators during cardiopulmonary surgical procedures.
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Randomized Controlled Trial Comparative Study
Anticoagulation management in patients undergoing open heart surgery by activated clotting time and whole blood heparin concentration.
To investigate the changes in perioperative anticoagulation management using a heparin-concentration-based system (HMS), and its effect on postoperative outcome. ⋯ The HMS system, by facilitating maintenance of a stable heparin concentration, and by determining an appropriate dose of protamine, is associated with reduced platelet consumption and does not increase AT-III consumption and postoperative bleeding.
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Case Reports
Leucocyte depletion in a drowning victim during rewarming with extracorporeal circulation may limit pulmonary oedema.
We report two drowning victims with hypothermic circulatory arrest who were resuscitated with the use of extracorporeal circulation (ECC). The first patient developed severe post-bypass pulmonary oedema and inspired us to use a leucocyte-depletion filter in the second patient to attenuate leucocyte-mediated pulmonary reperfusion injury. ⋯ Profound leucocyte-depletion by means of filtration may have contributed to limit leucocyte-mediated pulmonary reperfusion injury.
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This prospective large-animal study was performed to evaluate the contribution of arterio-venous extracorporeal lung assist (AV-ECLA) to pulmonary gas exchange in a porcine lavage-induced acute lung injury model. Fifteen healthy female pigs, weighing 50.3 +/- 3.8 kg (mean +/- SD), were included. After induction of general anaesthesia and controlled ventilation, an arterial line and a pulmonary artery catheter were inserted. ⋯ Under apnoeic oxygenation, variations of sweep-gas flow were performed every 20 min in order to evaluate the membrane lung's efficacy, in terms of carbon dioxide (CO2) removal and oxygen (O2) uptake. Although AV-ECLA is highly effective in eliminating CO2, if combined with apnoeic oxygenation, normocapnia was not achievable. AV-ECLA's contribution to oxygenation during severe hypoxemia was antagonized by a significant increase in the pulmonary shunt fraction.