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Excerpts from: Heart Surgery in America: Perfusion Dreams

Editor’s Note: This book is NOW over 99% written and moving into the Editing Phase! The title of the book is “The Tips of Spears- An Inside Look At Heart Surgery in America” It is a rendering of the reality, sometimes sad and at times funny, emotional, and clinical vignettes of the many different aspects…


How is Your Moral Compass Today?

Editor’s Note: Well it was a Friday morning with a pretty nondescript schedule. There was one heart on for the day , I am on call – and life is good. I got a text at about 8:30 AM, letting me know that the case was canceled, that the circuit was completely set up and…

Renee Editor

Perfusion Policies 101: Custodial Cardioplegia

Editor’s Note: Renee is a colleague I work with quite often.  She is an amazing perfusionist as well as administrator, mom, and just a decent all around human being. She has a pretty scathing wit- so beware.   She offered to share a policy on the administration of CUSTODIAL THK Cardioplegia.  This is a collaborative…

cover, cpb, bypass, hlm, syringe, sampling

The Left Ventricular Outflow Tract Changes in Size and Shape from Pre- to Post-Cardiopulmonary Bypass: Three-Dimensional Transesophageal Echocardiography

The LVOT is smaller and more elliptical after CPB. Patients with AS have a smaller LVOT compared with non-AS patients. LVOTa calculated using LVOTd underestimates the 3D LVOTa-plan by as much as 23% depending on patient type and timing of measurement. Accurate assessment of the LVOT requires 3D imaging.

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A Pumpless Microfluidic Neonatal Lung Assist Device for Support of Preterm Neonates in Respiratory Distress

These findings indicate that this LAD has a potential application as a biomimetic artificial placenta to support the respiratory needs of preterm neonates.


Mobile Extracorporeal Membrane Oxygenation Teams for Organ Donation After Circulatory Death

This article analyses a potential mobile team organization based on the hub-and-spoke model, which already exists and functions in Italy, by estimating the dimension of the controlled DCD phenomenon in Italy, coordination requirements, costs, personnel training, and education, and reporting a single center experience in Milan, Italy.


Severe Shivering on Venoarterial Extracorporeal Membrane Oxygenation-Raising the Circuit Temperature to Stop Rhabdomyolysis: A Case Report

This case demonstrates therapeutic hyperthermia to treat infection-induced severe shivering and rhabdomyolysis while on ECMO.


Cytokine Adsorption in Severe Acute Respiratory Failure Requiring Veno-Venous Extracorporeal Membrane Oxygenation

Therefore, our data suggest that cytokine adsorption might be beneficial in patients with severe ARDS requiring V-V ECMO support.


Intra-aortic balloon counterpulsation – Does it work?

Current research efforts predominantly focus on other active mechanical circulatory support devices making evidence-based approaches for possible final IABP niches more difficult.

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COVID-19 Testing, Surgical Prioritization, and Reactivation in a Congenital Cardiac Surgery Program

In summary, our institutional experience demonstrates that the implementation of universal COVID-19 screening, surgical prioritization, and eventual reactivation is feasible for congenital cardiac surgery programs.


Brain Magnetic Resonance Imaging in Adult Survivors of Extracorporeal Membrane Oxygenation

The results of the study suggest that subclinical cerebral lesions are commonly found in patients with ECMO support.

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Simple and Effective Blood Salvage Technique for Extracorporeal Membrane Oxygenation Circuit

We describe a simplified technique to salvage the blood in the ECMO circuit that requires no special equipment, is safe, and maximizes blood salvage.

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Leukoreduction in Ex Vivo Perfusion Circuits: Comparison of Leukocyte Depletion Efficiency with Leukocyte Filters

Our results suggest that the LG filter should not be used in ex vivo perfusion circuits for the purpose of leukodepletion. The BC2 filter can be used in EVP circuits with flow rates of less than 350 mL/min. Alternatively, perfusate may be leukodepleted before perfusion.


Intraaortic Balloon Pump vs Peripheral Ventricular Assist Device Use in the United States

Over the study period, the rate of pVAD use for cardiogenic shock significantly increased. Compared with IABP, pVAD use was associated with increased mortality, higher costs, and several AEs.


Combined Use of Rotational Thromboelastometry (Rotem) and Platelet Impedance Aggregometry (Multiplate Analyzer) in Cyanotic and Acyanotic Infants and Children Undergoing Cardiac Surgery With Cardiopulmonary Bypass: Subgroup Analysis of a Randomized Clinical Trial

This study showed that Rotem, but not Multiplate results, were associated with platelet transfusion in pediatric cardiac surgery with no intake of platelet inhibitors. The usefulness of combining these tests in platelet transfusion decision-making needs to be evaluated in larger populations.

cover, ecmo, ecls, oxy

Pathophysiology and Complications during Extracorporeal Circulation

We need to have a good knowledge of the pathophysiology and complications during extracorporeal circulation, as well as each component of the extracorporeal circulation system.


Effects of Cardiopulmonary Bypass Perfusion Temperature on Perioperative Renal Function In Adult Patients Undergoing Cardiac Surgery

CPB with moderate hypothermia for valvular heart surgeries can be performed safely in patients with adequate renal functional reserve.

simulation, cover, califia, training

Development and Evaluation of An Abbreviated Extracorporeal Membrane Oxygenation (ECMO) Course for Nonsurgical Physicians and Nurses

We developed an accelerated 1‐day ECMO course. Clinicians’ confidence and knowledge assessments improved and 88% of teams could successfully initiate venoarterial ECMO after the course.


Sublingual Microcirculation in Patients With SARS-Cov-2 Undergoing Veno-Venous Extracorporeal Membrane Oxygenation

Our results showed an altered sublingual microcirculation in patients receiving VV-ECMO for severe SARS-CoV-2 and suggest a potential contribution of endothelia dysfunction to determine microvascular alteration.


Impact of Intraoperative Cell Salvage on Concentrations of Antibiotics Used for Surgical Prophylaxis

Studies measuring the impact of IOCS on perioperative antibiotic concentrations are warranted.

Machine for cardiopulmonary bypass

Role Of Albumin In The Preservation Of Endothelial Glycocalyx Integrity And The Microcirculation: A Review

This review examines the physiological function of the endothelial glycocalyx and the role of human albumin in preserving glycocalyx integrity and the microcirculation.


Effect of Red Blood Cell Storage Duration on Major Postoperative Complications in Cardiac Surgery: A Randomized Trial

This clinical trial, which was stopped at its midpoint owing to enrollment constraints, supports neither the efficacy nor the futility of transfusing either younger or older RBC units.

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Del Nido Cardioplegia in Isolated Adult Coronary Artery Bypass Surgery

The current study revealed noninferior myocardial protection and clinical outcomes with DC versus BC in both routine and greater-risk patients undergoing isolated CABG.

The Lobster Tank

The COVID Wars: The Lobster Tanks… Inside Looking Out

Editor’s Note: It was that kind of day, here on the other side of the Savannah river.  When I came down here to assist at the first apex of the COVID-19 crisis, everything was shut down, and fear was palpable in the air.  More ubiquitous than the virus itself, was an apprehension of the organism’s…


Perfusion Art: “Access DENIED !”

Perfusion Art: “Access DENIED !” – Photographer: Frank Aprile, BBA, LP, CCP Equipment: Iphone 8+ Editing: Photoshop Narrative:   And….   The Cryptic Reality of COVID-19-   This is our Chief Cardiac Anesthesiologist- Truly a gatekeeper to ALL things deleterious to our outcomes.  My sincerest respect 🙂 Time & Place:  South of the Savanna River, 2020 About The…


Del Nido Microplegia Compared to Standard 1:4 Crystalloid Del Nido for Myocardial Protection

Editor’s Note: We had a fun discussion with a couple of our surgeons today regarding the use of Del Nido cardioplegia.  At this institution we have been deploying the microplegia version of Del Nido, and subsequently substituting Blood as the crystalloid component, delivering the primary dose in 1,200 ml aliquots, and then redosing at 60…

Japanes Art

Preoperative Functional Platelet Number Is Inversely Associated With 30-Day Mortality After Cardiac Surgery: A Retrospective Cohort Study

The preoperative functional platelet number had significant associations with 30-day mortality after cardiac surgery.