The Journal of extra-corporeal technology
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J Extra Corpor Technol · Sep 2004
End-tidal CO2 for prediction of cardiac output following weaning from cardiopulmonary bypass.
This prospective study included 32 patients undergoing cardiopulmonary bypass (CPB) for elective coronary artery bypass grafting correlates the respiratory end-tidal CO2 (ETCO2) during partial separation from CPB with cardiac output (CO) following weaning from CPB. After induction of general anesthesia, a pulmonary artery catheter was inserted for measurement of cardiac output by thermodilution. Patients were monitored using a 5-lead ECG, pulse oximeter, invasive blood pressure monitoring, rectal temperature probe, and end-tidal capnography. ⋯ Also, regression analysis of ETCO2 after complete weaning from bypass and post-bypass CO showed significant correlation (r = 0.6, p = .002). The correlation between ETCO2 and CO showed that an ETCO2 >30 mm Hg during partial CPB will always predict an adequate CO following weaning from CPB. An ETCO2 <30 mm Hg may denote either a low or a normal cardiac output and hence other predictive parameters such as SvO2 must be added.
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J Extra Corpor Technol · Sep 2004
Comparative StudyThe Hemochron Response RxDx heparin and protamine dosing system.
The use of dosing assays to calculate heparin and protamine dose requirements during cardiac surgery has been shown to significantly improve overall postoperative patient outcome. When patients are managed with an individualized dosing system, intraoperative and postoperative transfusion requirements and bleeding are reduced. The Hemochron RxDx system is widely used as a complement to traditional activated clotting time testing to optimize anticoagulation management. ⋯ The Response RxDx also offers expanded user options related to blood volume limits, expanded clotting time ranges for presetting default values, and flexibility in test sequence. Case records can be printed or downloaded to a PC via the HRDM data management program. The Hemochron Response RxDx represents a complete anticoagulation management system for the cardiac surgical patient.
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J Extra Corpor Technol · Sep 2004
Removal of glucose from the cardiopulmonary bypass prime: a prospective clinical audit.
To quantify our decision for the removal of glucose and the use of mannitol as a substitute osmotic agent in the cardiopulmonary bypass prime, we conducted a prospective clinical audit to evaluate the effects of this change on patient outcomes. Data were prospectively collected for 172 consecutive routine cardiac surgery patients. The first 85 patients (Surgeon A, 42 patients [Group 1], Surgeon B, 43 patients [Group 2]) received 1000 mL Plasmalyte 148 + 5% glucose as per institutional protocol. ⋯ Gp 4 [26], p < .05). No other results were found to be significant (except CPB plasma osmolality (Groups 2 and 4) and sodium concentration [Groups 1 and 3]). The results of our audit provide an evidence base to support our change in practice to utilize nonglucose primes.
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J Extra Corpor Technol · Sep 2004
Internet-based virtual classroom and educational management software enhance students' didactic and clinical experiences in perfusion education programs.
A challenge faced by many university-based perfusion education (PE) programs is the need for student clinical rotations at hospital locations that are geographically disparate from the main educational campus. The problem has been addressed through the employment of distance-learning environments. The purpose of this educational study is to evaluate the effectiveness of this teaching model as it is applied to PE. ⋯ Historically this has led to a disintegration of the presentation of theory, and a reduction in the quantity or quality of clinical experience opportunities. New PE models help to eliminate limitations and improve the quality of education especially in the face of economic challenges. Perfusion education students and faculty will have to work together to find computer-based offerings that are equivalent to traditional classroom methods.
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J Extra Corpor Technol · Sep 2004
A versatile extracorporeal circuit for use during repair of descending and thoracoabdominal aortic aneurysms in high-risk patients with cardiac and/or pulmonary dysfunction: a novel approach to a significant perfusion management dilemma.
The incidence of ischemic complications associated with repair of descending and thoracoabdominal aortic aneurysms has been significantly reduced by the use of distal aortic perfusion with moderate hypothermia, cerebral spinal fluid drainage, and segmental sequential clamping techniques. However, because the maintenance of proximal perfusion, the adequacy of left heart bypass (LHB), and the ability to ventilate patients on only one lung are all dependent on ventricular and pulmonary function, high-risk patients with descending and/or thoracoabdominal aortic aneurysms in the presence of cardiopulmonary insufficiency or instability present a difficult challenge for the surgical team. ⋯ Furthermore, converting a patient from closed LHB to traditional venoarterial cardiopulmonary bypass (CPB) is frequently difficult, especially when the perfusionist works without the benefit of extra personnel to assist during such crises. Consequently, a modified extracorporeal circuit was designed to provide closed LHB with desired therapeutic adjuncts while also satisfying the additional need for a rapid infusion device, a source of supplemental ventilation/oxygenation, and, if necessary, the ability to convert the patient to venoarterial CPB conveniently in the event of cardiac and/or pulmonary failure during surgery to repair descending and/or thoracoabdominal aortic aneurysms.