The Journal of extra-corporeal technology
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J Extra Corpor Technol · Mar 2009
Comparative StudyIncreased accuracy in heparin and protamine administration decreases bleeding: a pilot study.
Three to 5 percent of the patients undergoing cardiac surgery are reoperated because of bleeding. When a surgical cause can be excluded, heparin/protamine mismatch may be considered. Insufficient reversal of heparin and overdosing of protamine may cause postoperative bleeding. ⋯ Satisfactory end ACT values were obtained in both groups. Using the Hemochron RxDx, we observed a significant reduction in postoperative blood loss, as well as the amount of heparin and initial doses of protamine used during CPB. Individual patient managed anticoagulation during cardiac surgery using dose/response curve techniques based on in vitro analysis of heparin and protamine seems to reduce bleeding.
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J Extra Corpor Technol · Mar 2009
ReviewNIRS: a standard of care for CPB vs. an evolving standard for selective cerebral perfusion?
Cerebral oximetry monitoring using near infrared spectroscopy (NIRS) is a potentially important modality for detection of cerebral ischemia. Despite several studies showing improvements in patient outcome with applied NIRS for cardiac surgery, there has been steady but not yet widespread adoption of this technique. However, for patients undergoing aortic arch surgery--a procedure in which direct interruption of flow to cerebral vessels is an inherent risk--a majority of high-volume centers are using cerebral NIRS on a routine basis. This review examines the rationale and efficacy of such applied neuromonitoring and consider factors instrumental in modifying clinical practice in evolving standards of care.
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J Extra Corpor Technol · Mar 2009
Case ReportsExtracorporeal membrane oxygenation for the management of respiratory failure caused by diffuse alveolar hemorrhage.
Extracorporeal membrane oxygenation (ECMO) was developed as a supportive therapy to treat severe respiratory failure. When conventional mechanical ventilation has failed or when there is not enough time to treat the pathology, ECMO has the potential to sustain life. In this report, successful use of ECMO to support an adult patient with antineutrophil cytoplasmic antibody (ANCA)-associated systemic vasculitides complicated by severe respiratory failure caused by diffuse alveolar hemorrhage will be discussed.
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J Extra Corpor Technol · Mar 2009
Case ReportsUse of a thrombelastograph platelet mapping assay for diagnosis of clopidogrel resistance: a case report.
A 62-year-old woman presented to the emergency department with sudden collapse, intractable ventricular fibrillation, and an inferior wall myocardial infarction (MI). An emergent cardiac catheterization showed a totally occluded right coronary artery (RCA). A bare-metal stent was placed in the stenosis, resulting in thrombolysis in myocardial infarction (TIMI)-III flow with 0% residual stenosis. ⋯ The assay confirmed the patient to be non-responsive to clopidogrel for the inhibition of platelet ADP receptors. In an attempt to increase ADP inhibition, the ADP antagonist was changed to ticlopidine. Further testing was confounded by the presence of abciximab; however, the patient has remained free of cardiac events.