The Journal of extra-corporeal technology
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J Extra Corpor Technol · Dec 2008
Case ReportsMitral valve replacement in a patient with sickle cell disease using perioperative exchange transfusion.
Sickle cell disease is a genetic hemoglobinopathy in which a significant number of red blood cells carry hemoglobin-S as opposed to normal red blood cells that contain hemoglobin-A. Under certain conditions such as hypoxia, acidosis, and hypothermia, the red blood cells containing hemoglobin-S will sickle, leading to occlusion of the microvasculature. As such, patients with sickle cell disease present unique challenges during heart surgery using cardiopulmonary bypass (CPB). ⋯ However, a hemoglobin-S level < 30% is considered safe for conducting CPB. The following case report will discuss these challenges and present a patient with sickle cell disease undergoing a mitral valve repair. Management of this patient involved exchange transfusions both preoperatively and intraoperatively.
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J Extra Corpor Technol · Dec 2008
Use of recombinant factor VIIa (NovoSeven) in pediatric cardiac surgery.
Significant post-operative bleeding can be encountered in a small population of pediatric surgical patients requiring cardiopulmonary bypass (CPB). Recombinant factor VIIa (NovoSeven) has been advocated as a possible off-label rescue therapy for these individuals when conventional blood component therapy alone is inadequate. This study retrospectively evaluates rFVIIa administration for the treatment of severe bleeding in pediatric patients immediately after cardiac surgical procedures requiring CPB. ⋯ Trends in the improvement of bleeding disturbances were noted in the ICU in patients < 30 kg treated with rFVIIa, subsequent to blood component therapy. The rate of bleeding (mL/kg/h) was improved in patients < 30 kg for the first 2 hours in the ICU. For individuals > 30 kg, there was no apparent benefit from the administration of rFVIIa.
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J Extra Corpor Technol · Dec 2008
ReviewHemolysis in cardiac surgery patients undergoing cardiopulmonary bypass: a review in search of a treatment algorithm.
Hemolysis is a fact in all extracorporeal circuits, as shown in various studies by the increasing levels of plasma-free hemoglobin (PfHb) and decreasing levels of haptoglobin during and after cardiopulmonary bypass (CPB). Beside complete red blood cell (RBC) destruction or hemolysis, RBCs can also be damaged on a sublethal level, resulting in altered rheological properties. Increased levels of free RBC constituents together with an exhaust of their scavengers result in a variety of serious clinical sequela, such as increased systemic and pulmonary vascular resistance, altered coagulation profile, platelet dysfunction, renal tubular damage, and increased mortality. ⋯ These patients are especially susceptible to the toxic influences of unscavenged RBC constituents and the loss of rheologic properties of the RBCs. Considering the high percentage of neurologic and renal sequela in post-cardiotomy patients, all imbalances possibly contributing to these morbidities should be focused on and prevented, if not treated. Considering the severity of the consequences of RBC damage, the high incidence of this complication, and especially the lack of interventional strategies in cases of suspected or confirmed RBC damage, there may be a need for a treatment algorithm for this phenomenon.
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J Extra Corpor Technol · Dec 2008
Randomized Controlled Trial Clinical TrialEffects of modified ultrafiltration on coagulation as measured by the thromboelastograph.
Hemodilution during cardiopulmonary bypass (CPB) continues to be a cause of morbidity associated with coagulation dysfunction, bleeding, and allogeneic blood transfusion. Clot formation and strength have been shown to impact bleeding and transfusions. Strategies to reduce hemodilution may be negated based on the course of the cardiac procedure itself. ⋯ Estimated plasma loss from the cell salvage device was 477.6 mL greater in the no-MUF group. In primary adult cardiac procedures, MUF did not change coagulation values as measured by thromboelastography, number of allogeneic unit transfusions, or chest tube output at 24 hours postoperatively. There was a significant difference in autologous cell salvage units processed and end of procedure net fluid balance that benefited MUF subjects.
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J Extra Corpor Technol · Dec 2008
ReviewVacuum-assisted venous drainage and gaseous microemboli in cardiopulmonary bypass.
When conventional gravity siphon venous drainage cannot achieve satisfactory venous drainage during minimally invasive cardiac and neonatal surgeries, assisted venous drainage techniques are needed to ensure adequate flow. One assisted venous drainage technique, vacuum-assisted venous drainage (VAVD), the aid of a vacuum in the venous reservoir, is now widely used to augment venous drainage during cardiopulmonary bypass (CPB) procedures. VAVD permits the use of smaller venous cannulae, shorter circuit tubing, and lower priming and blood transfusion volumes, but increases risk of arterial gaseous microemboli and blood trauma. ⋯ With current ultrasound technology, it is possible to simultaneously detect and classify gaseous microemboli in the CPB circuit. In this article, we summarize the components, setup, operation, advantages, and disadvantages of VAVD techniques and clinical applications and describe the basic principles of microemboli detectors, such as the Emboli Detection and Classification (EDAC) Quantifier (Luna Innovations, Roanoke, VA) and Bubble Counter Clinical 200 (GAMPT, Zappendorf, Germany). These novel gaseous microemboli detection devices could help perfusionists locate the sources of entrained air, eliminate hidden troubles, and minimize the postoperative neurologic impairments attributed to gaseous microemboli in clinical practice.