ASAIO journal : a peer-reviewed journal of the American Society for Artificial Internal Organs
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Randomized Controlled Trial Clinical Trial
Clinical study of platelet function and coagulation/fibrinolysis with Duraflo II heparin coated cardiopulmonary bypass equipment.
This clinical study was performed to evaluate the effects of Duraflo II heparin coated cardiopulmonary bypass equipment on platelet and coagulation/fibrinolysis activation. Twenty-four patients undergoing coronary artery bypass grafting were assigned to two groups using either heparin coated (Duraflo group, n = 13) or uncoated equipment (control group, n = 11). In the Duraflo group, the cardiotomy reservoir was also coated with heparin. ⋯ Platelet loss and platelet activation, as measured by increases in plasma beta-thromboglobulin (beta-TG) and platelet factor 4 (PF4), in the Duraflo group (beta-TG:237 +/- 143 ng/ml, PF4:167 +/- 104 ng/ml at the end of cardiopulmonary bypass) were less than those in the control group (beta-TG:373 +/- 131 ng/ml, PF4:295 +/- 131 ng/ml at the end of cardiopulmonary bypass). No significant differences were found in thrombin-antithrombin III complex levels or alpha 2 plasmin inhibitor-plasmin complex levels between the groups. Therefore, the use of Duraflo II heparin coated equipment with a heparin coated cardiotomy reservoir suppressed platelet activation.
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The authors describe, to their knowledge, the first management of acute airway obstruction in a newborn infant using Extracorporeal Membrane Oxygenation (ECMO). The infant had a primary diagnosis of gram negative sepsis complicated by pulmonary hemorrhage resulting in a left main stem bronchus obstruction. Despite full ventilatory support, the infant could not be adequately oxygenated. ⋯ Airway management also included vigorous physiotherapy, suctioning, and bronchoscopy. The infant was successfully weaned from ECMO after 208 hours. The authors suggest that ECMO could be useful to manage life threatening airway obstruction in the neonate.