Perfusion
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Due to the short supply of donor organs available, many patients decompensate or die while waiting for transplantation. Options for mechanical support for infants and pediatrics with congenital heart disease are limited because of the patient's size and device availability. Extracorporeal membrane oxygenation (ECMO) is the most common means of cardiac and respiratory support for these patients. ⋯ Converting the ECMO circuit to an open cardiopulmonary bypass system in the OR minimizes the patient's exposure to new circuitry, decreases further donor exposures and provides continuous support for patients in cardiac and/or respiratory failure. In addition, the ability to use modified ultrafiltration post-bypass aids in reducing extracellular fluid, increasing the hematocrit and improving hemodynamic stability following an extended duration of ECMO and bypass support. The integrity of the ECMO circuit is maintained and can be converted back to ECMO for support postoperatively if needed.
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Delays in initiating extracorporeal membrane oxygenation (ECMO) in the critically ill pediatric patient may lead to adverse outcomes. Maintaining a primed ECMO circuit can considerably reduce the initiation time. The predominant concerns precluding this practice are a decrease in oxygenator efficiency due to the saturation of microporous hollow fibers and compromised sterility when the oxygenator has been primed for 30 days. ⋯ After 6 hours of use, the average transfer values all decreased to 111.4+/-2.1 (@ 55% SvO2, p <0.05 versus control), 104.0+/-5.6 (@ 65% SvO2, p <0.05 versus control) and 88.4+/-3.2 (@ 75% SvO2, p <0.05 versus control). In conclusion, there was a decrease in the average oxygen transfer values for the test group after 6 hours versus the control. The modest loss of oxygen transfer ability observed can be considered acceptable due to the amount of surface area of the Minimax Plus oxygenator when used on a neonate, making it feasible to adopt the practice of prepriming the Minimax oxygenator for neonatal ECMO.
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Clinical Trial Controlled Clinical Trial
Use of a dynamic bubble trap in the arterial line reduces microbubbles during cardiopulmonary bypass and microembolic signals in the middle cerebral artery.
Neurological complications remain an important cause of morbidity and mortality of patients following cardiopulmonary bypass (CPB). Microemboli, as well as cerebral hypoperfusion, are the main postulated mechanisms. This study demonstrates that the insertion of a dynamic bubble trap (DBT) into the curcuit reduces microbubbles in the arterial line and microembolic signals (MES) in the middle cerebral arteries (MCAs). ⋯ After inclusion of a DBT, we could register, in the second group, 8496 microemboli proximal and 2915 distal of the DBT, corresponding to 89 MES per operation. The reduction rate of microbubbles in the tubing was 65.7%, corresponding to a reduction in MES of about 86.2%. We conclude that the insertion of a DBT in the arterial line of CPB circuit protects the cerebrovascular system from microembolic events, as demonstrated by lower MES counts.
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Comparative Study Clinical Trial
Comparison of hollow-fiber membrane oxygenators in terms of pressure drop of the membranes during normothermic and hypothermic cardiopulmonary bypass in neonates.
The objective of this study was to investigate the effects of two hollow-fiber membrane oxygenators, the Capiox SX10 and the Lilliput 901, on pressure drop of the membranes during normothermic and hypothermic cardiopulmonary bypass (CPB) in neonates. ⋯ These results suggest that the Capiox SX10 hollow-fiber membrane oxygenator produced significantly lower membrane pressure drops and pre- and post-oxygenator ECC during normothermic and hypothermic CPB. Thus, blood trauma with the Capiox during extracorporeal circulation may be significantly lower compared to the Lilliput. Further studies, including the level of complements, platelets, neutrophils and cytokines, with these oxygenators are warranted.
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The respective value of procalcitonin (PCT) and C-reactive protein (CRP) as markers of postoperative complications after coronary bypass surgery is unclear. Therefore, complications during one week after surgery were studied to evaluate the predictive role of PCT and CRP changes during the immediate postoperative period. ⋯ A postoperative serum PCT concentration of >0.5 ng/mL is highly suggestive of a postoperative complication. CRP changes do not contribute to predictive information.