The Journal of extra-corporeal technology
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J Extra Corpor Technol · Dec 2010
ReviewExtracorporeal life support for pandemic influenza: the role of extracorporeal membrane oxygenation in pandemic management.
The recent global threat of a severe pandemic influenza outbreak has suggested that extracorporeal life support will begin to play an evolving role in the care of critically ill influenza stricken patients. The highly communicable attributes of influenza could result in widespread infection and an associated increased need for advanced life support. ⋯ Protocol oriented planning, research analysis, and advanced technologies are critical factors in averting catastrophe. This review article details the epidemiology, diagnostic techniques, and interventions for the influenza A virus, including H1N1.
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J Extra Corpor Technol · Dec 2010
Is there an association between hyperglycemia and clinical outcome in adult patients receiving extracorporeal membrane oxygenation.
Perioperative hyperglycemia frequently develops in critically ill patients and has been associated with adverse outcome. In this study, we tried to identify whether hyperglycemia was associated with adverse outcome in adult patients receiving extracorporeal membrane oxygenation. From 2004 through 2008, 44 adult patients received extracorporeal membrane oxygenation. ⋯ There is no significant difference in the mortality of the two groups. Perioperative complications were also similar between the two groups. Glucose levels were not associated with mortality and complications in adult patients receiving extracorporeal membrane oxygenation.
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J Extra Corpor Technol · Sep 2010
Case ReportsMinimizing reperfusion injuries: successful resuscitation using eCPR after cardiac arrest on a post-operative Norwood patient.
In patients with hypoplastic left heart syndrome (HLHS), the left ventricle is too small to circulate adequate oxygenated blood. If left untreated, HLHS is fatal. A 3-staged palliative procedure ultimately leading to a single ventricle physiology is the preferred management strategy for HLHS in most pediatric cardiac centers in the United States. ⋯ To minimize reperfusion injury, immediate cooling, arterial/venous shunting, minimal calcium, and hemodilution strategies were used. Once paCO2/pvCO2 gradients were minimized, we instituted sweep gas and gradually increased fiO2 as pH normalized. The patient was successfully weaned from ECMO and discharged, eCPR was used successfully in the resuscitation of this patient and reperfusion injuries were minimized despite prolonged CPR.
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J Extra Corpor Technol · Jun 2010
The effect of the perioperative blood transfusion and blood conservation in cardiac surgery Clinical Practice Guidelines of the Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists upon clinical practices.
The 2007 Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists Clinical Practice Guideline for Perioperative Blood Transfusion and Blood Conservation in Cardiac Surgery was recently promulgated and has received much attention. Using a survey of cardiac anesthesiologists and perfusionists' clinical practice, we assessed the current practices of perfusion, anesthesia, and surgery, as recommended by the Guidelines and also determined the role the Guidelines had in changing these practices. Nontrainee members of the Society of Cardiovascular Anesthesiologists, the American Academy of Cardiovascular Perfusion, the Canadian Society of Clinical Perfusion, and the American Society of ExtraCorporeal Technology were surveyed using a standardized survey instrument that examined clinical practices and responses to the Guidelines. ⋯ Only four of 38 Guideline recommendations were reported by more than 5% of respondents to have been changed in response to the Guidelines. Wide variation in clinical practices of cardiac surgery was reported. Little change in clinical practices was attributed to the Society of Thoracic Surgeons/Society of Cardiovascular Anesthesiologists Guidelines.
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J Extra Corpor Technol · Jun 2010
Self-priming hemodynamic reservoir and inline flow meter for a cardiopulmonary bypass simulation.
Simulator exercises are used at Midwestern University to augment academic and laboratory training toward consolidating particular skills, increasing situation awareness, and preparing the student for practice within the team environment of an operating room. This paper describes an enhanced cardiopulmonary bypass simulator consisting of a self-priming hemodynamic reservoir that includes an inline flow meter. A typical cardiopulmonary bypass adult perfusion circuit was assembled using a roller pump console and integrated oxygenator/heat exchanger/reservoir and primed with 2 liters of water. ⋯ An inline flow meter was added to the bypass circuit and an analog to digital converter board was used to pass flow data into the computer-based simulation program. The use of an inclined hemodynamic reservoir bag proved to be self-priming and functional without problems over a wide range of flows tested. By including a reservoir with the mannequin, plus processing and displaying real-time flow data using the CPB-Sim simulation program, a higher fidelity and more realistic simulation experience was created.