The Journal of extra-corporeal technology
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J Extra Corpor Technol · Dec 2011
Technical description of the use of selective perfusion techniques during the Norwood procedure for hypoplastic left heart syndrome.
Since the introduction of the Norwood procedure for surgical palliation of hypoplastic left heart syndrome in 1983, refinements have been made to the original procedure to improve patient outcomes while still accomplishing the original goals of the procedure. One of these refinements has been the introduction of regional selective perfusion to limit the duration of circulatory arrest times and optimize the regional flow distribution. In this paper we describe our technique for performing selective cerebral and lower body perfusion during the Norwood procedure.
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J Extra Corpor Technol · Dec 2011
The prognostic value of using the duration of acute kidney injury in cardiac surgery: an example using two antifibrinolytics.
Previously, we reported that the addition of duration to the Acute Kidney Injury Network (AKIN) definition of acute kidney injury (AKI) is a marker for more severe kidney injury and predicts long-term mortality. We aimed to evaluate an example of the utility of adding AKI duration to the AKIN definition by comparing the historical use of aprotinin with Amicar. In a single-center observational study, we followed 4987 consecutive patients undergoing cardiac surgery between 2002 and 2007 for postsurgery AKI. ⋯ Patients receiving aprotinin had evidence of more advanced disease and comorbidity and were more likely to develop AKI and have longer durations of AKI than Amicar (p < .001): 7.0 +/- 11.5 vs. 3.8 +/- 6.0 days (p < .001). Nearest-neighbor propensity matching demonstrated aprotinin had significantly worse 5-year mortality compared with Amicar (relative risk [RR] = 2.09, 95% confidence interval [CI] = 1.65-2.65). AKI duration added to the AKIN definition of AKI may provide the necessary sensitivity and specificity for evaluating renal outcomes in clinical trials.
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J Extra Corpor Technol · Dec 2011
Case ReportsHypothermic cardiac arrest in the homeless: what can we do?
Accidental deep hypothermia with body temperature < 28 degrees C induces high mortality rates for neurological and cardiac complications. Although several reports described successful treatment of hypothermic arrest by extracorporeal membrane oxygenation (ECMO), the field of warming in the homeless is almost completely unquestioned although the malnutrition and the co-morbidities are usually believed as relevant risk factors for poor outcome. This article describes the experience of successful warming by ECMO in two homeless victims of unwitnessed cardiac arrest, who survived without neurological or cardiac complications. In conclusion, this is an initial experience and further research is required, although our results are appreciable in this high risk subset of population.
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J Extra Corpor Technol · Dec 2011
The correlation of fluid balance changes during cardiopulmonary bypass to mortality in pediatric and congenital heart surgery patients.
Edema acquired during the perioperative period has long been associated with increased mortality. Edema acquired during cardiopulmonary bypass (CPB) may contribute to this mortality. The intent of this retrospective study was to test the premise that edema in the form of a positive fluid balance change (FBC) acquired during CPB correlated to mortality. ⋯ Positive FBC patients tended to be in higher risk categories, weighed more, and had longer pump times (p < .05) with an adjusted odds ratio for mortality of 1.73 (1.01-2.96, 95% confidence interval). There is a correlation between edema acquired during CPB and increased mortality in pediatric and congenital heart surgery patients. The potential exists for the perfusionist to optimize the fluid balance changes while on CPB to reduce mortality rates.
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J Extra Corpor Technol · Dec 2011
Neonatal extracorporeal membrane oxygenation devices, techniques and team roles: 2011 survey results of the United States' Extracorporeal Life Support Organization centers.
In early 2011, surveys of active Extracorporeal Life Support Organization (ELSO) centers within the United States were conducted by electronic mail regarding neonatal Extracorporeal Membrane Oxygenation (ECMO) equipment and professional staff. Seventy-four of 111 (67%) U. S. centers listed in the ELSO directory as neonatal centers responded to the survey. ⋯ The use of extracorporeal cardiopulmonary resuscitation (ECPR) was reported by 53% of the responding centers with 82% of those centers using a crystalloid primed circuit to initiate ECPR. A cooling protocol was used by 77% of the centers which have an ECPR program. When these data are compared with surveys from 2002 and 2008 it shows that the use of silicone membrane oxygenators continues to decline, the use of centrifugal pumps continues to increase and ECMO personnel continues to be comprised of multidisciplinary groups of dedicated allied health care professionals.