The Journal of extra-corporeal technology
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J Extra Corpor Technol · Dec 2008
ReviewVacuum-assisted venous drainage and gaseous microemboli in cardiopulmonary bypass.
When conventional gravity siphon venous drainage cannot achieve satisfactory venous drainage during minimally invasive cardiac and neonatal surgeries, assisted venous drainage techniques are needed to ensure adequate flow. One assisted venous drainage technique, vacuum-assisted venous drainage (VAVD), the aid of a vacuum in the venous reservoir, is now widely used to augment venous drainage during cardiopulmonary bypass (CPB) procedures. VAVD permits the use of smaller venous cannulae, shorter circuit tubing, and lower priming and blood transfusion volumes, but increases risk of arterial gaseous microemboli and blood trauma. ⋯ With current ultrasound technology, it is possible to simultaneously detect and classify gaseous microemboli in the CPB circuit. In this article, we summarize the components, setup, operation, advantages, and disadvantages of VAVD techniques and clinical applications and describe the basic principles of microemboli detectors, such as the Emboli Detection and Classification (EDAC) Quantifier (Luna Innovations, Roanoke, VA) and Bubble Counter Clinical 200 (GAMPT, Zappendorf, Germany). These novel gaseous microemboli detection devices could help perfusionists locate the sources of entrained air, eliminate hidden troubles, and minimize the postoperative neurologic impairments attributed to gaseous microemboli in clinical practice.
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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
Case ReportsArgatroban in short-term percutaneous ventricular assist subsequent to heparin-induced thrombocytopenia.
Heparin-induced thrombocytopenia paradoxically is a transient pro-thrombotic disorder triggered by heparin exposure. If not treated appropriately, it can be life threatening because of its related thromboembolic complications. In particular, it presents a unique challenge in patients needing extracorporeal life support, because anticoagulation is essential for safe management. This case report describes the safe, efficacious use of Argatroban during short-term support of a patient with a percutaneously inserted left ventricular assist TandemHeart device.