European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
-
Eur J Cardiothorac Surg · Jan 1990
Accidental deep hypothermia with cardiopulmonary arrest: extracorporeal blood rewarming in 11 patients.
Sixteen patients (age 13-53 years) with accidental deep hypothermia have been rewarmed in our clinic during the last 10 years, 14 by femoro-femoral cardiopulmonary bypass (CPB) of whom 11 had a cardiopulmonary arrest (asystole in 5 and ventricular fibrillation in 6). On admission, the latter were clinically dead showing wide non-reactive pupils and being supported by ventilation and external heart massage. In the survivors, the mean length of cold exposure was 4.4 h (2-5.5 h) and mean arrest interval until initiation of CPB was 2.5 h (1.4-3.7 h). ⋯ All survivors became conscious during the first POD and resumed, their professional activity. We conclude that patients with accidental deep hypothermia and even prolonged cardiopulmonary arrest should be rewarmed and resuscitated rapidly by cardiopulmonary bypass. These measures are very promising particularly if the cause of accident and the circumstances suggest that cardiopulmonary arrest was induced by hypothermia alone without other asphyxiating mechanisms.
-
Eur J Cardiothorac Surg · Jan 1990
Randomized Controlled Trial Comparative Study Clinical TrialA comparative study of prostacyclin infusion given before and during cardiopulmonary bypass to assess the first pass effect of the circuit on platelet number and function.
Platelet damage during cardiopulmonary bypass (CPB), although proportional to the duration of bypass, may result in significant dysfunction after the initial contact with an extracorporeal circuit, the so-called 'first pass' phenomenon. The platelet sparing effect of prostacyclin (PGI2) infusion was studied in a double-blind randomized trial on male patients undergoing coronary artery bypass grafts to assess the effect of the 'first pass' through the CPB circuit. Prostacyclin infusion was begun before the onset of CPB or during CPB in two groups which were compared to a placebo control group. ⋯ We conclude, therefore, that the initial contact of platelets with the CPB circuit, in the absence of PGI2 did not irreversibly affect platelet function. In addition, the hypotensive action of PGI2 was easier to control once on bypass. It may therefore be preferable to delay PGI2 infusion until CPB has been established.
-
Eur J Cardiothorac Surg · Jan 1990
Thoracic injuries sustained by the survivors of the M1 (Kegworth) aircraft accident. The Nottingham, Leicester, Derby, Belfast Study Group.
On 8 January 1989, a Boeing 737 carrying 126 passengers and crew crashed onto the M1 motorway killing 39 passengers. Of 87 initial survivors, 74 had major injuries making this an unusual accident as most aircraft crashes result in very few severely injured survivors. This prompted the setting up of a major study group, the Nottingham, Leicester, Derby, Belfast Study Group (NLDB) to examine in detail the accident and its aftermath. ⋯ Twenty-three passengers sustained major chest trauma and all had major injury to other parts of the body. Five of these patients died within 12 h of admission. Various patterns of chest trauma emerged from this study, including an increasing incidence of rib fractures with age and a distinctive pattern of upper zone pulmonary contusion in younger patients.
-
Eur J Cardiothorac Surg · Jan 1990
Complement activation before, during and after cardiopulmonary bypass.
Plasma levels of the complement parent molecules C3, C4, and factor B and their split products, C3d, C4d, and Ba were measured in 12 patients undergoing cardiopulmonary bypass for coronary artery surgery. Alternative and common complement pathway activation, demonstrated by statistically significant rising levels of Ba (P less than 0.05), and C3d (P less than 0.05) and by elevated Ba:B (P less than 0.05) and C3d:C3 (P less than 0.05) ratios were found before the institution of cardiopulmonary bypass but following heparin administration suggesting that heparin may itself initiate alternative pathway activation. In addition, significant depletion of parent complement components and elevation of split product concentrations was seen during bypass suggesting classical and alternate pathway activation (P less than 0.01). This study clarifies the pathways of complement activation during bypass and presents evidence that heparin administration may initially activate the complement cascade.