The Journal of extra-corporeal technology
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J Extra Corpor Technol · Jun 2019
Predictors of Oxygenator Exchange in Patients Receiving Extracorporeal Membrane Oxygenation.
Thrombosis within the membrane oxygenator (MO) during extracorporeal membrane oxygenation (ECMO) can lead to sudden oxygenator dysfunction with deleterious effects to the patient. The purpose of this study was to identify predictors of circuit exchange during ECMO. This is a single-center, retrospective study of all patients who received ECMO at our institution from January 2010 to December 2015. ⋯ D-dimer (DD) (μg/mL) (mean difference -2.6; 95% confidence interval [CI]: -4.2 to -1.1; p = .001) increased significantly in the 3 days leading up to MO exchange, whereas fibrinogen (mg/dL) (mean difference 90.7; 95% CI: 41.8-139.6; p = .001), platelet (PLT) count (1,000/μL) (mean difference 23.3; 95% CI: 10.2-36.4; p = .001), and heparin dose (units/h) (mean difference 261.7; 95% CI: 46.3-477.1; p = .02) decreased. Increasing DD or decreasing fibrinogen, PLT count, or heparin dose may indicate an impending need for MO exchange in patients receiving ECMO. Early identification of these changes may help prevent sudden MO dysfunction.
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J Extra Corpor Technol · Jun 2019
Retrograde Autologous Priming Technique to Reduce Hemodilution during Cardiopulmonary Bypass in the Pediatric Cardiac Patient.
Blood conservation techniques during pediatric congenital heart surgery continue to be a vital strategy in reducing hemodilution during cardiopulmonary bypass. Development of mini circuits, retrograde autologous priming, modified ultrafiltration, and use of a cell saver are methods adopted by pediatric heart programs to limit transfusions. Excessive hemodilution may warrant the need for transfusion in the pediatric patient, which carries significant risks in the overall care of the patient. Retrograde autologous priming is a safe and effective way to limit the amount of hemodilution, and thereby reduce the need for transfusion.