The Journal of extra-corporeal technology
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J Extra Corpor Technol · Jun 1996
Scavenging anesthetic gas from a membrane oxygenator during cardiopulmonary bypass.
Concerns remain about the acute and chronic effects on personnel of waste anesthetic gases in the operating room environment. This study demonstrates a simple and effective means of scavenging waste anesthetic gases when halogenated anesthetics are administered through the pump oxygenator during cardiopulmonary bypass. This technique safeguards workers' health by reducing ambient anesthetic levels below the National Institute for Occupational Safety and Health (NIOSH) recommended exposure limits.
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J Extra Corpor Technol · Dec 1995
Correlation of ACT as measured with three commercially available devices with circulating heparin level during cardiac surgery.
Automated activated clotting time (ACT) is utilized as the primary means of assessing anticoagulation status for cardiopulmonary bypass (CPB) procedures. Influences on the clotting cascade during CPB such as hypothermia, hemodilution, and platelet dysfunction are known to affect ACT. The recently introduced Thrombolytic Assessment System (TAS) has been reported to be less sensitive to changes in hemodilution and hypothermia during CPB than more conventional ACT devices. ⋯ Study results demonstrated a high correlation between the HemoTec and Hemochron (r = 0.99), increased heparin dose response on CPB compared to pre-CPB activity (p < 0.05), and a significant (p < 0.05) negative correlation between devices and patient hematocrit during CPB. Additionally, device correlation with anti-Xa assay during collection periods 2 and 3 showed negative correlations in each of the three devices evaluated. We conclude that all automated devices tested demonstrated an inability to predict circulating heparin at levels necessary for CPB, and that these discrepancies become magnified during CPB procedures.
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J Extra Corpor Technol · Sep 1995
Comparative Study Clinical TrialAccuracy of in-line venous saturation and hematocrit monitors in pediatric perfusion.
Cardiopulmonary bypass (CPB) in neonates and infants routinely employs lower blood flow rates (BFR), temperatures, and hematocrits (Hct) than those typically observed in adult CPB. The purpose of this study was to evaluate the accuracy of three devices available for continuous in-line measurement of venous oxygen saturation (SvO2) and Hct during pediatric CPB. Venous blood samples were obtained over a range of BFR, temperatures, and Hct and analyzed on a Corning 2500 Co-Oximeter and HematoStat C-70 centrifuge. ⋯ When comparing spun Hct to the CDI and Gish values, the CDI in-line monitor demonstrated a greater reliability to predict actual patient Hct (r > 0.90) than the Gish StatSat (r > 0.60). Residual analysis revealed that even though the Gish StatSat had higher calculated p values (p > 0.05) than the CDI 100 for interpreting Hct, it was shown to display more inconsistent and sporadic values over the ranges of BFR and temperature studied. It is concluded that the CDI 100 proved to be more accurate, reliable, and consistent than the Gish StatSat and the Bentley Oxysat devices in determining SvO2 and Hct over all evaluated parameters in this study.
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J Extra Corpor Technol · Sep 1995
Clinical TrialCoagulation monitoring during extracorporeal membrane oxygenation: the role of thrombelastography.
Patients undergoing extracorporeal membrane oxygenation (ECMO) are at an increased risk for developing coagulopathies due to the adverse effects of extracorporeal circulation on the hemostatic mechanism. Methods of determining causative factors of bleeding diathesis are often inconsistent and non-specific. ECMO patients require aggressive transfusion therapy with autogenic blood products to stabilize and maintain hemostasis. ⋯ Transfusion requirements (measured in ml/kg/ECMO hour) were the following: packed red blood cells--1.34 +/- 0.5; platelets--0.71 +/- 0.57; fresh frozen plasma--0.09 +/- 0.12; cryoprecipitate 0.05 +/- 0.05. Thrombelastograph profiles reflected hemostatic conditions that ranged from severe coagulopathies (DIC) to hypercoagulability. Interpretation of TEG profiles identified hemostatic abnormalities in 57 of 101 profiles (46.5%), with the most common etiology related to platelet dysfunction.(ABSTRACT TRUNCATED AT 250 WORDS)
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J Extra Corpor Technol · Dec 1994
Comparative Study Clinical TrialIn vitro evaluation of continuous mixed venous oxygen saturation and hematocrit monitors.
Four venous hemoglobin oxygen saturation monitors, two of which provide hemoglobin monitoring, were evaluated and compared to a performance standard (control) during cardiopulmonary bypass (CPB). The CDI 100 Hematocrit/Saturation Monitor, CDI 400, Cobe Hematocrit/Saturation Monitor, and the Baxter Bentley OxySat values were compared to the Radiometer Copenhagen OSM3 Hemoximeter and the Damon International Equipment Company Microbore Centrifuge Hematocrit. ⋯ Only the CDI 400 failed to correlate with the control. The hematocrit monitors, although useful as trending devices, demonstrated inaccuracies in measurements requiring further refinement.