The Journal of extra-corporeal technology
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J Extra Corpor Technol · Dec 2008
Case ReportsMitral valve replacement in a patient with sickle cell disease using perioperative exchange transfusion.
Sickle cell disease is a genetic hemoglobinopathy in which a significant number of red blood cells carry hemoglobin-S as opposed to normal red blood cells that contain hemoglobin-A. Under certain conditions such as hypoxia, acidosis, and hypothermia, the red blood cells containing hemoglobin-S will sickle, leading to occlusion of the microvasculature. As such, patients with sickle cell disease present unique challenges during heart surgery using cardiopulmonary bypass (CPB). ⋯ However, a hemoglobin-S level < 30% is considered safe for conducting CPB. The following case report will discuss these challenges and present a patient with sickle cell disease undergoing a mitral valve repair. Management of this patient involved exchange transfusions both preoperatively and intraoperatively.
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J Extra Corpor Technol · Sep 2008
North American neonatal extracorporeal membrane oxygenation (ECMO) devices and team roles: 2008 survey results of Extracorporeal Life Support Organization (ELSO) centers.
In early 2008, surveys of active extracorporeal membrane oxygenation (ECMO) centers in North America were conducted by electronic mail regarding neonatal ECMO equipment and professional staff. Eighty of 103 (78%) North American ECMO centers listed in the Extracorporeal Life Support Organization directory as neonatal centers responded to the survey. Of the responding centers, 82.5% routinely used roller pumps for neonatal ECMO, and the remaining 17.5% used centrifugal pumps. ⋯ At 54% of the responding centers, perfusionists were involved with the ECMO program, registered nurses were involved at 70% of the centers, and respiratory therapists were involved at 46% of the centers. Compared with a 2002 survey, silicone membrane use is declining, and the use of centrifugal blood pumps and coated ECMO circuits is becoming more apparent. ECMO teams are still multidisciplinary, made up of combinations of registered nurses, respiratory therapists, and perfusionists.
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J Extra Corpor Technol · Sep 2008
Review Case ReportsMethylene blue-induced methemoglobinemia during cardiopulmonary bypass? A case report and literature review.
The guanylate cyclase (GC) and inducible nitric oxide (iNOS) inhibitor methylene blue (MB) has been used in cardiac surgery patients for the treatment of a variety of conditions. Methylene blue has been successfully used for the prevention and treatment of vasoplegia syndrome (VS) in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). Vasoplegia syndrome occurs in up to 10% of cardiac surgery patients and is associated with poor clinical outcomes. ⋯ Troubleshooting the cause of the apparent desaturation and eventual diagnosis of a false indication of arterial oxygen desaturation and methemoglobinemia (MHgb) due to MB injection is described. Methemoglobinemia is explained as well as its presentation and treatment with MB. The importance of intraoperating room communication and knowledge of drug effects are discussed.
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J Extra Corpor Technol · Sep 2008
Case Reports Comparative StudyMeasurements of recirculation during neonatal veno-venous extracorporeal membrane oxygenation: clinical application of the ultrasound dilution technique.
Recirculation during dual lumen veno-venous (DLVV) extracorporeal membrane oxygenation (ECMO) is a dynamic event that results in a fraction of the oxygenated blood exiting the arterial lumen and immediately shunting back into the venous lumen. Excessive recirculation will result in suboptimal oxygen delivery to the patient. Ultrasound dilution is a technology that has been shown to rapidly quantify recirculation in veno-venous (VV) ECMO animal models. ⋯ The two were found to closely correlate (mean difference, .25% +/- 2.8%). Ultrasound dilution measurements of recirculation provided rapid monitoring data during a clinical VV ECMO procedure. Application of this technique could provide early data that will assist the clinician in guiding interventions to minimize recirculation.
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J Extra Corpor Technol · Jun 2008
Influence of intraoperative fluid volume on cardiopulmonary bypass hematocrit and blood transfusions in coronary artery bypass surgery.
A hematocrit (Hct) of less than 25% during cardiopulmonary bypass (CPB) and transfusion of homologous packed red blood cells (PRBC) are each associated with an increased probability of adverse events in cardiac surgery. Although the CPB circuit is a major contributor to hemodilution intravenous (IV) fluid volume may also significantly influence the level of hemodilution. The objective of this study was to explore the influence of asanguinous IV fluid volume on CPB Hct and intraoperative PRBC transfusion. ⋯ Patients that received a PRBC transfusion (n = 30) received a significantly higher volume of pre-CPB fluid than nontransfused patients (1800 vs. 1350 mL, p = .0039). These findings suggest that pre-CPB fluid volume can significantly contribute to hemodilutional anemia in cardiac surgery. Optimizing pre-CPB volume may preserve baseline Hct and help limit intraoperative hemodilution.