The Journal of extra-corporeal technology
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J Extra Corpor Technol · Sep 2009
Gaseous microemboli in a pediatric bypass circuit with an unprimed venous line: an in vitro study.
Miniaturizing cardiopulmonary bypass (CPB) circuits to reduce hemodilution and allogenic blood product administration is common in cardiac surgery. One major concern associated with smaller CPB circuits is a possible increase in gaseous microemboli (GME) sent to the cerebral vasculature, which is exacerbated by vacuum-assisted venous drainage (VAVD). The use of VAVD has increased with smaller venous line diameter and venous cannulae. ⋯ Group 2 (57.33 +/- 25.01, p < .05) had significantly more microemboli than group 1 (5.33 +/- 3.21) at the post-oxygenator sensor. No other findings were statistically significant. The results suggest that, if an oxygenator and arterial filter with sufficient air handling capabilities are used, this method to reduce prime volume may not increase GME in the arterial line distal to the arterial filter.
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J Extra Corpor Technol · Jun 2009
Treatment of malperfusion during surgery for type A aortic dissection.
During surgery for acute type A aortic dissection, malperfusion may occur during cardiopulmonary bypass. Retrograde perfusion trough femoral cannulation is considered a predisposing factor. ⋯ A technique of epicardial ultrasound-guided direct cannulation of the dissected aorta's true lumen by a Seldinger technique may help in those cases. We describe the technique with particular interest to the epicardial ultrasound control and the type of arterial cannula to be inserted by the Seldinger technique.
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J Extra Corpor Technol · Mar 2009
Comparative StudyIncreased accuracy in heparin and protamine administration decreases bleeding: a pilot study.
Three to 5 percent of the patients undergoing cardiac surgery are reoperated because of bleeding. When a surgical cause can be excluded, heparin/protamine mismatch may be considered. Insufficient reversal of heparin and overdosing of protamine may cause postoperative bleeding. ⋯ Satisfactory end ACT values were obtained in both groups. Using the Hemochron RxDx, we observed a significant reduction in postoperative blood loss, as well as the amount of heparin and initial doses of protamine used during CPB. Individual patient managed anticoagulation during cardiac surgery using dose/response curve techniques based on in vitro analysis of heparin and protamine seems to reduce bleeding.
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J Extra Corpor Technol · Mar 2009
ReviewNIRS: a standard of care for CPB vs. an evolving standard for selective cerebral perfusion?
Cerebral oximetry monitoring using near infrared spectroscopy (NIRS) is a potentially important modality for detection of cerebral ischemia. Despite several studies showing improvements in patient outcome with applied NIRS for cardiac surgery, there has been steady but not yet widespread adoption of this technique. However, for patients undergoing aortic arch surgery--a procedure in which direct interruption of flow to cerebral vessels is an inherent risk--a majority of high-volume centers are using cerebral NIRS on a routine basis. This review examines the rationale and efficacy of such applied neuromonitoring and consider factors instrumental in modifying clinical practice in evolving standards of care.
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J Extra Corpor Technol · Mar 2009
Case ReportsExtracorporeal membrane oxygenation for the management of respiratory failure caused by diffuse alveolar hemorrhage.
Extracorporeal membrane oxygenation (ECMO) was developed as a supportive therapy to treat severe respiratory failure. When conventional mechanical ventilation has failed or when there is not enough time to treat the pathology, ECMO has the potential to sustain life. In this report, successful use of ECMO to support an adult patient with antineutrophil cytoplasmic antibody (ANCA)-associated systemic vasculitides complicated by severe respiratory failure caused by diffuse alveolar hemorrhage will be discussed.