The Journal of extra-corporeal technology
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J Extra Corpor Technol · Mar 2004
North American neonatal extracorporeal membrane oxygenation (ECMO) devices: 2002 survey results.
In mid 2002, surveys of active extracorporeal membrane oxygenation (ECMO) centers in the United States and Canada were conducted via E-mail regarding neonatal equipment and personnel. Seventy-four out of 99 (75%) North American ECMO centers listed in the Extracorporeal Life Support Organization (ELSO) directory responded to the survey. Of the responding centers, 95% use roller pumps, and the remaining 5% use centrifugal pumps. ⋯ At 49% of the responding centers, perfusionists were involved with the ECMO program, registered nurses were involved at 84% of the centers, and respiratory therapists were involved at 61% of the centers, perfusion assistants were involved at one center (1%), and biomedical engineers were involved at one of the centers. When compared to a 1990 survey, a shift away from using bladder boxes and toward using air bubble detectors is apparent. But other than those two shifts, ECMO is done in much the same manner as it was done 12 years ago.
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J Extra Corpor Technol · Dec 2003
The effect of electrolyte imbalance on weaning from cardiopulmonary bypass: an experimental study.
An imbalance in electrolyte concentration during separation from cardiopulmonary bypass (CPB) may lead to a disruption in excitation-contraction coupling resulting in a failure to wean. The etiology of myocardial dysfunction is multifactorial, and includes alterations in acid-base balance, glucose metabolism, and cellular function. The purpose of this study was to assess the effect of hyperkalemia on myocardial function during separation from CPB. ⋯ No other measured variables correlated with hyperkalemia. In summary, hyperkalemia caused a significant decline in venous pH evidenced in the early separation period, but had no effect on other variables. Therefore, measurement of venous pH may be an early marker indicating myocardial dysfunction and dysrhythmia.
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J Extra Corpor Technol · Dec 2003
ReviewUse of aprotinin in patients undergoing deep hypothermic circulatory arrest: a review.
Hemostatic derangements continue to be a major clinical challenge during thoracic aortic surgery using deep hypothermic circulatory arrest despite advances in surgical and pharmacologic therapy. Aprotinin, a broad-based, nonspecific serine protease inhibitor has been advocated for prophylactic use in cardiac surgery to decrease perioperative blood loss and blood transfusions. ⋯ Currently, aprotinin is advocated for use in patients undergoing cardiopulmonary bypass in the course of coronary artery bypass graft surgery. A review of current studies is provided that examines aprotinin usage under deep hypothermic circulatory arrest.
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J Extra Corpor Technol · Sep 2003
Review Case ReportsUnique considerations for the spinal cord injured patient undergoing cardiac surgery utilizing cardiopulmonary bypass.
A 37-year-old male with mitral valve regurgitation presented for mitral valve replacement. He has been a C5 quadriplegic for 13 years. The patient had been discharged 2 months before to this admission after a complicated hospital course for Staphylococcus aureus infection of the left hip. ⋯ The problems associated with spinal cord injury present potential complications to this patient population. Numerous triggering mechanisms may lead to a variety of clinical complications. Consideration of a response/ treatment management plan for potential problems must be exercised by the surgical team.
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J Extra Corpor Technol · Sep 2003
Hand-held personal digital assistant program for the HEMOCHRON RxDx heparin and protamine dosing system.
The use of in vitro dosing assays for heparin and protamine during cardiac surgery has significantly improved overall postoperative patient outcome. The HEMOCHRON RxDx system (International Technidyne Corp, Edison, NJ) is widely used for anticoagulation management. Based on a series of consecutive in vitro tests, the RxDx system is used to quantify the patient's heparin requirement (heparin response test, HRT), measure the activated clotting time (ACT), calculate the blood heparin concentration and the required protamine dose (protamine response test, PRT), as well as determine the efficacy of heparin reversal (protamine dose assay, PDA-O). ⋯ Following protamine administration, the program calculates any additional protamine required to neutralize residual heparin using the data from a PDA-O test. The RxDx hand-held PDA is accurate, quick, simple, and easy to use, patient data are saved and can be retrieved. The inclusion of this rapid computing technology into the Hemochron RxDx system serves to expand the applications of the Hemochron RxDx system during cardiac interventions.