The Journal of extra-corporeal technology
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J Extra Corpor Technol · Dec 1998
Comparative StudyAssisted venous drainage, venous air, and gaseous microemboli transmission into the arterial line: an in-vitro study.
The objective of this study was to examine the interaction of cardiopulmonary bypass venous air with assisted venous drainage, focusing on its production of gaseous microemboli in the arterial line. An in-vitro recirculating cardiopulmonary bypass circuit containing fresh whole bovine blood was monitored with a pulsed-doppler microbubble detector. Air of specific amounts was injected into the venous line and gaseous microemboli counts were obtained distal to the arterial filter. ⋯ The air is subjected to a greater degree of negative pressure and, with centrifugal pump assisted drainage, is subjected to kinetic energy imparted by the cones or vanes of the pump. The kinetic energy from the centrifugal pump appears to break the air into small bubbles which become suspended in the blood, passing through the reservoir, oxygenator, and arterial filter. In a clinical setting, these bubbles would be passed into a patient's arterial system.
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J Extra Corpor Technol · Jun 1998
Comparative StudyHematological abnormalities in neonatal patients treated with extracorporeal membrane oxygenation (ECMO).
The physical process of extracorporeal membrane oxygenation (ECMO) results in derangement of the hemostatic mechanism, which may lead to increased morbidity, secondary to the disease process. The purpose of this study was to evaluate the hematological status of neonates undergoing ECMO therapy, and to evaluate coagulation tests in predicting hemorrhagic risk. Following Institutional Review Board approval, 30 patients undergoing ECMO treatment were retrospectively entered into this study. ⋯ TEG determination showed significant differences between groups on days 3 and 6 (p < 0.005), and 8 (p < 0.05). Derangements in hemostasis resulting from ECMO are profound, with methods of assessing coagulation complicated by both the variability in patient condition and lack of specificity of laboratory tests. Interpretation of TEG data has shown to be a valuable supplement for managing this challenging patient population.
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J Extra Corpor Technol · Jun 1997
Single hospital experience with emergency cardiopulmonary bypass using the portable CPS (Bard) system.
One hundred four patients were placed emergently on the Bard CPS portable femoro-femoral bypass system over a 4 year period. Thirty-two patients (31%) were discharged from the hospital. Seventy-six of these patients (73%) required emergency bypass following cardiac arrest, and twenty-eight patients (26%) were in cardiogenic shock or respiratory failure. ⋯ For the 19 patients receiving treatment only in the cardiovascular laboratory, the discharge rate was 26%. Of the 55 patients taken to the operating room for surgical correction, 24 (44%) were discharged from the hospital. No patients placed on bypass at an outlying hospital or treated using CPS within 72 hours of a previous open heart procedure survived.
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J Extra Corpor Technol · Mar 1997
Comparative StudyAdding hetastarch to the adult cardiopulmonary bypass prime does not affect patient outcomes.
Hespan (hetastarch), a synthetic colloid, is often used in priming cardiopulmonary bypass circuits. The purpose of this study is to determine the efficacy of adding hetastarch to the prime compared to adding no hetastarch. ⋯ There were no significant differences in change in lung compliance, weight gain, time on the ventilator, or length of stay in the intensive care unit. Adding colloids to the adult CPB prime does not improve patient outcomes over priming exclusively with crystalloids.
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J Extra Corpor Technol · Mar 1997
Blood anion gaps and venoarterial carbon dioxide gradients as risk factors in long-term extracorporeal support.
Increases in the blood anion gap (AG) and venoarterial carbon dioxide gradients [p(V-A)CO2] may indicate changes in intracellular acid concentration not demonstrated by blood gas measurements. This prospective study examines these two physiologic markers to determine their relationship to extracorporeal membrane oxygenation (ECMO) survival and duration in 100 patients. Serum electrolytes were drawn every 6 hours and the AG calculated. ⋯ Both mortality and survivors' ECMO time increase as one or both risk factors increase. Patients with increases in both risk factors have a mortality rate 8 times greater and survivors remain on ECMO almost twice as long as those without increased risk factors. Patients may benefit from a perfusion strategy that seeks to minimize the AG and p(V-A)CO2.