The Journal of extra-corporeal technology
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J Extra Corpor Technol · Mar 2005
Comparative StudyThrombelastograph (TEG) analysis of platelet gel formed with different thrombin concentrations.
Autologous blood transfusion is the safest and most successful way to decrease transfusion-related risks such as postoperative infections, allo-immunization, and short- and long-term immunosuppression. In addition, these fibrin sealants are known to provide coagulation support at the surgical site and act as an adjunct to the control of postoperative bleeding. The physical formation of autologous platelet fibrin gel clot is dependent on both the common pathway of the coagulation cascade and platelet activation. ⋯ The results showed that thrombin concentration did not affect the MA, tMA, CI, or angle as measured by the TEG analyzer. The null hypothesis was accepted. Based on a one-way analysis of variance test for MA, tMA, CI, and angle there was no significant statistical difference for the TEG samples in this experiment as reported with a 95% confidence interval.
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J Extra Corpor Technol · Dec 2004
Clinical TrialRetrograde autologous prime with shortened bypass circuits decreases blood transfusion in high-risk coronary artery surgery patients.
Previous studies have shown that minimizing the amount of hemodilution during open-heart surgery reduces the need for a blood transfusion. Transfusion increases a patient's medical risks and leads to increased costs. We used a shortened bypass circuit, primed with autologous blood in a retrograde fashion, to decrease red cell transfusion in high-risk patients. ⋯ The postbypass hematocrit was similar at 26.5 +/- 1.82% vs. 25.5 +/- 2.38%, and the discharge hematocrit was 30.8 +/- 3.33% and 31.2 +/- 3.04% in the control and study groups. respectively. Minimizing hemodilution by shortening the bypass circuit and performing retrograde autologous prime conserves the use of blood during routine coronary artery bypass surgery. These methods can be used for patients who are at greater risk for transfusion.
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J Extra Corpor Technol · Dec 2004
Case ReportsAnticoagulant monitoring techniques in a heparin-induced thrombocytopenia patient undergoing cardiopulmonary bypass using bivalirudin anticoagulant.
Heparin is widely used as the anticoagulant of choice for cardiopulmonary bypass. However, some patients exposed to heparin therapies develop heparin-induced thrombocytopenia (HIT). Severe complications of HIT-induced thrombosis may lead to end-organ dysfunction and death. ⋯ Cardiopulmonary bypass was initiated, and the patient's mitral valve was repaired using a 34-mm annuloplasty ring. The patient was successfully weaned from bypass. No complications or evidence of HIT exacerbation were noted in the postoperative course.
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J Extra Corpor Technol · Dec 2004
Case ReportsResuscitation of fat embolism syndrome with extracorporeal membrane oxygenation.
Embolization of marrow fat appears to be an inevitable consequence of long bone fractures. Pulmonary fat embolism (FE) with cardiovascular collapse is associated with a high mortality rate because of acute right ventricular failure and hypoxia. Immediate and appropriate resuscitation is required to prevent sudden death. ⋯ Herein, we describe the successful use of veno-venous (V-V) ECMO in a trauma patient who initially presented with fractures of the right ulna and femur. After surgery, the patient rapidly decompensated despite massive ventilatory support and was placed on ECMO. ECMO support lasted approximately 120 hours followed by an uneventful recovery and discharge 10 days later.
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J Extra Corpor Technol · Dec 2004
Impact of extracorporeal circuit prime volume reduction on whole blood sequestration during acute normovolemic hemodilution for adult cardiac surgery patients.
Acute normovolemic hemodilution (ANH) is a blood-conservation method in which whole blood (WB(ANH)) is sequestered into blood collection bags before the commencement of surgery. However, for cardiac surgery, extracorporeal circuit (ECC) priming techniques limit the amount of blood that may collected prior to the actual initiation of cardiopulmonary bypass (CPB). In this study, computational modeling was used to examine the effect of reducing extracorporeal "pump" prime volume (PPV) on WB(ANH) prior to the CPB. ⋯ In turn, increases in "excess hemoglobin" are associated with expansion of WB(ANH) volume. In conclusion, sequential PPV reduction from 2000 mL increases the volume of WB(ANH) that potentially may be sequestered prior to initiation of CPB. Therefore, the combination of PPV reduction with ANH may represent a useful blood conservation approach in adult patients undergoing cardiac surgery with CPB.