The Journal of extra-corporeal technology
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J Extra Corpor Technol · Mar 2012
ReviewPerioperative fluid and electrolyte management in cardiac surgery: a review.
This article can be broken down into three sections. First is a review of extracellular fluid volume management and some of the key physiological principles involved. ⋯ In all these areas, there has been much academic endeavor. Sometimes this has generated more heat than light, and the lack of consensus in many areas serves to highlight the need for further work and better understanding.
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J Extra Corpor Technol · Mar 2012
Randomized Controlled TrialImpact of a phosphorylcholine-coated cardiac bypass circuit on blood loss and platelet function: a prospective, randomized study.
Platelet dysfunction due to cardiopulmonary bypass (CPB) surgery increases the risk of bleeding. This study analyzed the effect of a phosphorylcholine (PC)-coated CPB circuit on blood loss, transfusion needs, and platelet function. We performed a prospective, randomized study at Strasbourg University Hospital, which included 40 adults undergoing coronary artery bypass graft surgery (CABG) (n = 20) or mitral valve repair (n = 20) using CPB. ⋯ There was no difference in markers of platelet activation, thrombin generation, or transfusion needs between the two groups. Norepinephrine use was more frequent in the control group (63% vs. 33%) but not significantly. PC-coating of the CPB surface reduced early postoperative bleeding, especially in CABG patients, but had no significant effect on platelet function because of large interindividual variations that prevented the establishment of a causal relationship.
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J Extra Corpor Technol · Mar 2012
Controlled Clinical TrialTimely bolus insulin for glucose control during cardiopulmonary bypass.
Hyperglycemia during cardiopulmonary bypass (CPB) with glucose containing cardioplegia is common; normoglycemia is difficult to maintain and failure to do so may result in worse outcomes. The purpose of this quality improvement initiative was to show that a simple timely insulin bolus is more effective for glucose control during CPB with glucose containing cardioplegia than conventional (not standardized) glucose management in historical case-matched controls. A single bolus of insulin (.2 international units per kilogram; iu/kg) was administered, at the time of aortic cannulation, to 211 consecutive patients undergoing cardiac surgery with CPB and glucose containing cardioplegia. ⋯ Hyperglycemia in the first 6 hours in the intensive care unit was also significantly less frequent in the study group (5; 2.4%) than in the control group (14; 6.6%) (p = .03). Severe hypoglycemia (BG < 2.8 mmol/L; 50.4 mg/dL) occurred in one patient (.47%) in the timely bolus insulin group and five patients (2.3%) in the control group (p = .09). The timely bolus insulin method is more efficacious, but equally safe, in preventing hyperglycemia during CPB with glucose containing cardioplegia, compared with conventional (not standardized) insulin treatment in historical case-matched controls.
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J Extra Corpor Technol · Mar 2012
Understanding the delicate balance between bleeding and thrombosis: can we use it to our advantage?
Hemostasis remains an issue in cardiac surgery because many patients are preoperatively on platelet-inhibiting drugs, whereas other patients such as those with an evolving acute myocardial infarction present themselves in a more prothrombotic status. Classical laboratory tests such as activated partial thrombin time and plasma thromboplastin are poor in predicting blood loss and bleeding problems postcardiac surgery. This is explained by the fact that these tests are performed on plasma instead of on whole blood. Whole blood coagulation tests are superior in detecting coagulation deficits and bleeding because they take the cellular interaction in the coagulation cascade into account.