The Journal of extra-corporeal technology
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J Extra Corpor Technol · Dec 2014
Randomized Controlled TrialInfluence of Two Colloidal Extracorporeal Primes on Coagulation of Cardiac Surgical Patients: A Prospectively Randomized Open-Label Pilot Trial.
The search for the ideal priming fluid continues as more evidence is discovered about side effects of volume expanders. With the availability of modern, balanced hydroxyethyl starch (HES) solutions with less side effects than former HES solutions, we considered to replace our gelatin- (modified gelatin) based extracorporeal circuit prime for a HES (130/.42) prime. Therefore, we studied the influence of two colloidal priming fluids on postoperative coagulation in patients undergoing cardiac surgery. ⋯ We found no significant difference in colloid. osmotic pressure between the groups. In this trial, HES (130/.42) impairs coagulation significantly more compared with gelatin. These differences in influence on coagulation did not lead to a difference in blood loss or fluid balance, so clinical relevance could not be proven.
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J Extra Corpor Technol · Dec 2014
Interdisciplinary Simulation Using the Cardiopulmonary Bypass Simulator (CPBS)?
Interdisciplinary education offerings between students of cardiovascular science and nurse anesthesia are uncommon despite the collaborative nature of these disciplines. The dual purpose of this article is to describe a method for interdisciplinary simulation and to report survey responses provided by participants. ⋯ Statistically significant differences between baseline and final survey responses were observed in the total score and within the areas of competency and perception of cooperation. Emerging simulation technologies and novel combinations of existing devices can facilitate meaningful interdisciplinary educational opportunities for health science students.
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J Extra Corpor Technol · Dec 2014
Case ReportsThe Need to Develop Standardized Protocols for the Timing of Extracorporeal Membrane Oxygenation Initiation among Adult Patients in Cardiac Arrest: A Case Study.
The duration of time between cardiac arrest, cardiopulmonary resuscitation (CPR), and initiation of extracorporeal membrane oxygenation (ECMO) among refractory patients is correlated with mortality. The duration of conventional CPR (CCPR) beyond which ECMO support should not be offered due to poor outcomes is not established. This case study describes a patient with heart failure with recurrent episodes of ventricular tachycardia who had a witnessed cardiac arrest in a coronary care unit. ⋯ Despite aggressive medical therapy, ECMO support was discontinued 48 hours later following absence of electroencephalographic activity and no evidence of cardiac function ultimately leading to the patient's death. This case study illustrates the possibility that prolonged ischemia resulting from duration of CCPR and time to initiate ECPR may contribute to adverse clinical outcomes. Systems of care that might reduce delays in ECMO initiation and improve patient outcomes are discussed including: 1) development of standardized protocols to allow for rapid initiation of ECMO support; 2) systematic evaluation of parameters such as biomarkers that might identify patients at risk for cardiac arrest in settings where ECMO is readily available; and 3) assessment of patient criteria to define subsets of individuals among whom late institution of ECMO, an expensive and labor-intensive mode of circulatory support, might be futile.
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J Extra Corpor Technol · Dec 2014
Use of del Nido Cardioplegia for Adult Cardiac Surgery at the Cleveland Clinic: Perfusion Implications.
Cardiac arrest by cardioplegia provides a reproducible and safe method to induce and maintain electromechanical cardiac quiescence. Techniques of intraoperative myocardial protection are constantly evolving. For the past three decades, modified Buckberg cardioplegia solution has been used for adult cardiac surgery at the Cleveland Clinic. ⋯ Single-dose, cold blood del Nido cardioplegia can be delivered antegrade if the duration of the operation will be limited and if there is no significant coronary artery disease or aortic insufficiency that would limit the distribution of cardioplegia. The addition of del Nido cardioplegia to our cardioplegia armamentarium allows us to customize our myocardial protection strategies for different surgical needs. This article aims to provide information on technical aspects of del Nido cardioplegia in adult cardiac surgery and its use at the Cleveland Clinic in the adult surgical population.