ASAIO transactions / American Society for Artificial Internal Organs
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Improvements in percutaneous coronary angioplasty (PTCA) have broadened the scope of this therapy to higher risk patients. The authors used an extracorporeal membrane oxygenator (ECMO) system during seven PTCA procedures to provide rapid, safe, cardiopulmonary support for high-risk patients. Six patients underwent femoral cutdown and placement of arteriovenous cannulae before PTCA; one patient was cannulated percutaneously. ⋯ One patient died of retroperitoneal hemorrhage unrelated to the ECMO cannulation site. Six patients survived. This system can be rapidly deployed while providing satisfactory cardiopulmonary support.
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A simple, colorimetric protamine titration method was developed for rapid and precise estimation of the protamine dose required for clinical heparin reversal. The method employs azure A dye as the titration indicator, and has replaced the time consuming clotting assay in the conventional protamine titration method with a rapid colorimetric assay. ⋯ In a similar manner, the colorimetric assay can also be employed with a heparin titration procedure to quickly assess the heparin dose required for protamine reversal. This would allow physicians to exercise a quick and accurate heparin back-titration to patients who are overdosed with protamine.
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Neuro-selective current perception threshold (CPT) values quantify peripheral nerve (n) integrity and provide an index of adequate hemodialysis (HD). Evaluation of polyneuropathy (PN) by CPT correlates with nerve conduction testing (NCT). CPT is convenient, painless, and may be performed during HD. ⋯ CPTs consistent with CTS (sufficiently greater impairment of the median vs ulnar n) were observed in 31% of the hands with combined median and ulnar n CPT abnormalities, and 11% were identified with CTS by NCT. The unique ability of the CPT exam to quantify hyperesthesia may account for its superior CTS detection sensitivity. These findings demonstrate that repeated CPT determinations are consistent and are diagnostic for CTS.