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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…

Birds-eye view

A Retrospective Analysis of CO2 Derived Goal-Directed Perfusion Variables Under Normothermic Conditions: Do We Need to Re-Evaluate Threshold Values?

Because CO2 production during bypass depends on patient temperature, a different cutoff value, that may take into account the influence of demographic variables, should be determined during normothermic CPB.


No Bad Blood — Surviving Severe Anemia Without Transfusion

Physicians who accept the challenges of learning how to treat patients safely and successfully without the traditional safety net of blood transfusion may experience a new level of confidence and expanded opportunities for providing quality care for all patients.

cover, ecmo, ecls, oxy

Characteristics of Pediatric Extracorporeal Membrane Oxygenation Programs in the United States and Canada

The majority of pediatric ECMO centers have adopted the infrastructure recommendations from the Extracorporeal Life Support Organization. However, there remains broad variability of practice characteristics and organizational infrastructure for pediatric ECMO centers across the United States and Canada.


Protocol-Driven Daily Optimisation of Venovenous Extracorporeal Membrane Oxygenation Blood Flows: An Alternate Paradigm?

This staged approach to weaning VV ECMO allows us to fully utilise the “decoupling” of oxygenation and decarboxylation that is possible only during extracorporeal support.


A Novel Escalation from Veno-Venous Bypass to Veno-Venous ECMO During Orthotopic Liver Transplantation. A Case Report

this is the first documented case that extracorporeal CO2 removal (ECCO2R) is used to optimize the biochemistry profile intraoperatively during a LT.


Incidental Cannulation of Left Ventricular Thebesian Vein

The catheter moved during the procedure, inadvertently cannulating a Thebesian vein with contrast injection.


Mechanical Circulatory Support to Treat Pulmonary Embolism: Venoarterial Extracorporeal Membrane Oxygenation and Right Ventricular Assist Devices

For patients with massive pulmonary embolism who are not candidates for conventional interventions or whose conditions are refractory, mechanical circulatory support in the form of RVAD placement or ECMO may be considered. Larger comparative studies are needed.


Preoperative COVID-19 Testing for Cardiovascular Procedures in Endemic Areas Should be Mandatory

It is extremely important for patients, healthcare providers, and the community at large to aggressively test for COVID-19 in the preprocedural period when the infection is endemic.


COVID-19 and ECMO: An Unhappy Marriage of Endothelial Dysfunction and Hemostatic Derangements

It is the authors’ perspective that it is through the integration of diagnostic assessment of viscoelastic testing with dedicated management schemes, up to and including the titration of antifibrinolytic therapies, that unmasks the capacity of this technology to enhance clinical outcomes.

cover, blood, RBC

Unit-To-Unit Variability in The Deformability of Red Blood Cells

The present study has demonstrated that storage duration is only one of the factors, and seemingly not even the major one, affecting the PRBCs functionality.

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.

cover, lungs, pulmonary, pneumo

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.

cover, covid

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.

cover, ecmo, ecls, oxy

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.

cover, bloodgas, heart

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.