Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · May 1997
ReviewHemostatic-endothelial interactions: a potential anticoagulant role of the endothelium in the pulmonary circulation during cardiac surgery.
The use of extracorporeal circulation during cardiopulmonary bypass (CPB) procedures is associated with significant morbidity and mortality. Exposure of blood to the foreign surface of the extracorporeal circuit results in activation of complement, kinin, fibrinolytic and coagulation systems as well as cellular mediators of inflammation. Without the use of anticoagulants, the extracorporeal circuit would clot; high-dose heparin prevents coagulation, but activation of the coagulation system and consequent thrombin generation still occur. ⋯ It was postulated that under these conditions, the hemostatic system may become activated and could contribute to pulmonary dysfunction in some patients after CPB. However, it appears that during CPB interactions among heparin, the hemostatic system, and the endothelium may exert a protective effect, at least against activation of the tissue factor coagulation pathway. In this article, the effect of CPB on the coagulation system, with particular reference to changes in coagulation proteins occurring in the pulmonary vasculature, are reviewed.
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Recent advances in surgical techniques and perfusion technology allow cardiac operations to be performed routinely with low mortality rates. However, patients undergoing cardiac operations with cardiopulmonary bypass (CPB) are still associated with bleeding disorders, thrombotic complications, massive fluid shifts, and the activation of blood components that are collectively known as the whole body inflammatory response. In this review, the effect of cardiopulmonary bypass on various humoral and cellular components of blood is examined. ⋯ These include surface modification of extracorporeal circuit, control of flow dynamics in the circuit, pharmacological intervention, and the use of extracorporeal devices to remove inflammatory mediators. Recent findings on the effects of heparin-coated circuits on inflammatory response and clinical outcome are reviewed. It appears that the causes of inflammatory response to cardiopulmonary bypass are multifactorial and that an integrated strategy is needed to control and eliminate the negative effects of CPB.
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The "chain of survival" is important in the resuscitation of a patient who has had a cardiac arrest. The provision of Basic Life Support (BLS) and Advanced Cardiac Life Support (ACLS) is essential in this "chain of survival." Both BLS and ACLS have undergone several revisions since their initial inception. This article reviews (1) the current established and investigational issues of cardiopulmonary resuscitation, (2) the incidence and outcomes of anesthesia-related cardiac arrest, (3) the use of cardiopulmonary bypass in resuscitation, and (4) cerebral protection during and after resuscitation.
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J. Cardiothorac. Vasc. Anesth. · May 1997
ReviewThe role of the pulmonary circulation in the regulation of coagulation and fibrinolysis in relation to major surgery.
Cardiac surgery and hip replacement surgery (HRS) are associated with serious cardiorespiratory and vascular complications. Activation of blood coagulation and fibrinolysis in the lung vasculature seem to play a key role in the pathophysiology of this process. This article reviews the results of several experimental and clinical studies within this field. ⋯ However, this clearing process, to obtain adequate blood flow and gas exchange, was shut down several hours after surgery by an antifibrinolytic activity (PAI-1). Thus, these studies indicated that bone surgery induces a substantial intraoperative hemostatic activation in the lung capillaries, which is the primary target organ for venous blood-borne bone-marrow debris. Soft-tissue surgery and vascular surgery seem to induce less systemic activation of coagulation and fibrinolysis.