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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…

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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…

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Conventional Ultrafiltration During Elective Cardiac Surgery and Postoperative Acute Kidney Injury

Removal of weight-indexed CUF volumes > 32 mL/kg increased the risk for postoperative AKI development. Importantly, CUF volume removal of any amount did not mitigate allogeneic blood transfusion during elective cardiac surgery. Prospective studies are needed to validate these findings.

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Association Between Intraoperative Hyperoxia and Acute Kidney Injury After Cardiac Surgery: A Retrospective Observational Study

Intraoperative hyperoxia significantly was associated with the risk of AKI after cardiac surgery involving cardiopulmonary bypass.

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In Vitro Evaluation of Flow Distribution in All-Region Perfusion during the Norwood Operation

For all-region perfusion during the Norwood operation, primary CPB arterial flow should be divided to the head and coronary circulation with an independent pump delivering flow to the descending aorta. This should avoid cerebral over-circulation and insufficient flow to the lower body.

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Sustained Total All-Region (STAR) Perfusion: An Optimized Perfusion Strategy for Norwood Reconstruction

STAR perfusion allows the Norwood procedure to be completed with mild hypothermia and continuous perfusion to all vascular beds with reduced cardiopulmonary bypass as well as total operative times. This technique is successfully achieved with minimal changes to circuitry, minor modifications to heart-lung machine servoregulation and few additional cannulation disposables.

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Managing Massive Transfusion Protocol During Cardiopulmonary Bypass in the Setting of Penetrating Traumatic Injury

Ultimately, randomized multicenter trials are needed to further address optimal ratios of blood product transfusion during MTP in trauma patients on CPB.

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Practical Management of ECPELLA

ECMO and concomitant Impella support (ECPELLA) is increasingly being used to treat cardiogenic shock by maintaining systemic circulation and unloading the left ventricle. There are several pitfalls to maintaining ECPELLA, and one useful tool is the pulmonary artery pulsatility index. The clinical advantages of ECPELLA compared to conventional ECMO alone should be demonstrated in larger scale studies in the near future.

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Investigation of Myocardial Protection During Pediatric CPB: Practical Experience in 100 Chinese Hospitals

In conclusion, the essence of myocardial protection management during pediatric CPB was cardiac arrest induced by cardioplegia under systemic hypothermia. However, there is no uniform standard for the type of cardioplegia, or dosages. Therefore, well-designed multicenter randomized controlled trials are warranted to provide tangible evidence for myocardial protection of cardioplegia in pediatric CPB.

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Associations Between the Severity of Influenza Seasons and Mortality and Readmission Risks After Elective Surgical Aortic Valve Replacement and Coronary Artery Bypass Graft Surgery in Older Adults

Our large sample suggests that it is safe to perform elective major operations regardless of the severity of influenza seasons.

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Activated Clotting Time (ACT) for Monitoring of Low-Dose Heparin: Performance Characteristics in Healthy Adults and Critically Ill Patients

In heparin-spiked blood, ACT is sensitive to heparin at levels of ≥0.1 IU/ml heparin. In ICU-patients, ACT did not correlate with UFH dose or other established methods. Both systems were differently influenced by certain parameters.

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Outcomes of Multiple Runs of Extracorporeal Membrane Oxygenation: An analysis of the Extracorporeal Life Support Registry

Though the use of multiple runs of ECMO is growing, outcomes remain poor for most cohorts. Survival decreases with each additional run. Patients requiring additional runs for a pulmonary indication should be considered prime candidates. Renal complications on the first run significantly increases the risk of mortality on subsequent runs, and as such, careful consideration should be applied in these cases.

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Perfusion Art: “A Different Kind of Filter”

Perfusion Art: “A A Different Kind of Filter” Photographer: Frank Aprile Equipment: IPhone 10 ish Editing: Heavy Filters Narrative: Lunch Break- Selfie at Subway🙂 Time & Place:   2020: South of the Savannah About The Artist:  CCP Commentary: Chilling at a vendor table outside of Subway. Grabbing lunch before the next run

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Perfusion Art: “A Picture Within”

Perfusion Art: “A Picture Within” Photographer: Frank Aprile Equipment: IPhone 10 ish Editing: Heavy Filters Narrative: Taking a picture of them taking a picture 🙂 Time & Place:   2020: South of the Savannah About The Artist:  CCP Commentary: Reassessing VA ECMO Cannulation…

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Intraoperative Oxygen Concentration and Neurocognition after Cardiac Surgery: A Randomized Clinical Trial

In this randomized controlled trial, intraoperative normoxia did not reduce postoperative cognitive dysfunction when compared to intraoperative hyperoxia in older patients having cardiac surgery. Although the optimal intraoperative oxygenation strategy remains uncertain, the results indicate that intraoperative hyperoxia does not worsen postoperative cognition after cardiac surgery.

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Evaluation of Recirculation During Venovenous Extracorporeal Membrane Oxygenation Using Computational Fluid Dynamics Incorporating Fluid-Structure Interaction

We have developed a finite element computational fluid dynamics model incorporating fluid-structure interaction (FSI) that incorporates atrial deformation during atrial filling and emptying, with fluid flow solved using large eddy simulation. With this model, we have evaluated an extensive number of factors that could influence recirculation during two-site VV ECMO, and characterized their impact on recirculation, including cannula construction, insertion depth and orientation, VV ECMO configuration, circuit blood flow, and changes in volume, venous return, heart rate, and blood viscosity.

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Central Versus Peripheral Arterial Cannulation for Veno-Arterial Extracorporeal Membrane Oxygenation in Post-Cardiotomy Patients

Central cannulation for VA-ECMO provides antegrade flow without Harlequin’s syndrome, changes of arterial cannula site, and better 30 day survival. Complication rates regarding need for reexploration and transfusion requirements were similar.

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Aortic Flow Below and Visceral Circulation During Aortic Counterpulsation: Evaluation of An In Vitro Model

The presented mock circulation was reliable and gave values with high accuracy both at baseline and during mechanical assistance. This system allows evaluation of the mesenteric flow during IABP, under different clinical/hemodynamic conditions. Nonetheless, its translational potential needs to be further evaluated

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Clinical Characteristics and Outcomes of Adults with Peripheral Extracorporeal Membrane Oxygenation in A Developing Country: A Single Center 8-Year Retrospective Study

The mortality rate in our ECMO center was considerably higher than that in the international registry report. Improved team education, rigid patient selection criteria, and a reimbursement protocol should lead to ameliorated outcomes.

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Extracorporeal Life Support for Cardiogenic Shock with Either A Percutaneous Ventricular Assist Device or An Intra-Aortic Balloon Pump

Careful considerations are required before selecting an additional support to ECLS.

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Outcomes of Cardiac Surgery in Jehovah’s Witness Patients: A Review.

The use of a bloodless protocol for Jehovah’s Witnesses does not appear to significantly impact upon clinical outcomes when compared to non-Witness patients, and it has even been suggested that a bloodless approach could provide advantages to all patients undergoing cardiac surgery. Larger cohorts and research across multiple centres into the long term outcomes of these patients is required.

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Perioperative Cardioprotection: General Mechanisms and Pharmacological Approaches

This review presents the fundamental mechanisms of conditioning strategies and provides an overview of the most recent and relevant findings on different concepts achieving cardioprotection in the experimental setting, specifically emphasizing pharmacological approaches in the perioperative context.

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International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations

After discussion of the scoping reviews and the evidence update, the task force prioritized several topics for new systematic reviews.

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Pediatric Intensive Care Preparedness and ECMO Availability in Children With COVID-19: An International Survey

In conclusion, both the experience in managing patients and the availability of neonatal/pediatric ECMO in the centers the responders are working
seemed to increase physicians’ preparedness.

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Prompt Prediction of Fibrinogen Concentration During Cardiopulmonary Bypass: A Pilot Study

Our results indicate a strong correlation between fibrinogen activation and serum fibrinogen concentration. The maximum amplitude of activator f can estimate low fibrinogen concentration faster than traditional methods; this method quickly provides important information for anesthesia and hemostatic management in cardiac surgery.

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Efficacy and Safety of Corticosteroids Prophylaxis in Cardiac Surgery: A Protocol for Systematic Review and Meta-Analysis

This study will compare the efficacy of prophylactic corticosteroids for adults and children undergoing cardiac surgery with CPB. Due to the nature of the disease and intervention methods, randomized controlled trials may be inadequate, and we will carefully consider inclusion in high-quality, non-randomized controlled trials, but this may result in high heterogeneity and affect the reliability of the results.