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Bicarb Alternatives: Sodium Acetate & Balanced Crystalloids

Editor’s Note:   Authorization for the contributions below were obtained from each contributor via email.  Please see comments section… THAM A a Buffer Tham Description Tham Solution (tromeThamine injection) is a sterile, non-pyrogenic 0.3 M solution of tromeThamine, adjusted to a pH of approximately 8.6 with glacial acetic acid. It is administered by intravenous injection, by…

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Platelet Aggregation in Whole Blood is Not Impaired by A Platelet-Sparing Leukoreduction Filter and Instead Depends Upon the Presence of Leukocytes

WB filtration results in platelet count reduction and leukocyte removal; however, platelet IA is not degraded by passage through the filter. Apparent declines in platelet IA responses can be fully attributed to the reduction in platelet count and the removal of leukocytes.

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Effect of 6% Hydroxyethyl Starch 130/0.4 on Inflammatory Response and Pulmonary Function in Patients Having Cardiac Surgery: A Randomized Clinical Trial

Our investigation found no significant difference in the concentrations of inflammatory markers and measures of pulmonary function between cardiac surgical patients who received 6% HES 130/0.4 versus 5% albumin.

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Optimizing Cerebral Perfusion and Hemodynamics During Cardiopulmonary Bypass Through Cannula Design Combining In Silico, In Vitro And In Vivo Input

From this we propose another easy-to-manufacture cannula design (opti2CAN) that decreases areas burdened by high WSS, while preserving physiological cerebral flow and favorable hemodynamics. With this novel cannula design, we propose a cannulation option to reduce neurological complications and the prevalence of stroke in high-risk patients after CPB.

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Balanced Forced-Diuresis as A Renal Protective Approach in Cardiac Surgery: Secondary Outcomes of Electrolyte Changes

Balanced forced-diuresis with the RG reduced AKI rates after on-pump cardiac surgery compared to controls. Although the RG group required higher doses of IV potassium replacement in the postoperative period, normal serum levels of potassium were maintained by appropriate intravenous potassium supplementation and the clinical outcomes between groups were similar.

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Early Motor Outcomes in Infants with Critical Congenital Heart Disease are Related to Neonatal Brain Development and Brain Injury

Neonatal brain development and injury are associated with fewer favourable early motor outcomes in infants with CCHD.

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Survey of Practice Pattern in Patients With Heparin-Induced Thrombocytopenia Requiring Cardiopulmonary Bypass

Most responding SCA and AmSECT members reported that their institution used a protocol or guideline for HIT/CPB cases, and most guidelines directed the use of bivalirudin as an alternative anticoagulant. Various other methods such as plasmapheresis are also being used with success in this patient population. Further research, including comparison studies of alternative anticoagulant strategies, is required to elucidate the best approach to these difficult cases.

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A Real-Time Analysis of Intraoperative Interruptions in Relation to Use of Simple Preventive Measures Including A Sign On The Door and A Checklist-Based Team Brief

Our findings revealed significantly reduced interruptions after a simple preventive measure including team brief and the placement of a warning sign for unnecessary door openings.

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Heparin Resistance — Clinical Perspectives and Management Strategies

Heparin resistance is suspected when more heparin than usual is needed to achieve a therapeutic range of activated partial-thromboplastin time. Management may include increasing the heparin dose, supplementing antithrombin III levels, and using direct thrombin inhibitors.

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Acute Kidney Injury During Extracorporeal Membrane Oxygenation: VA ECMO Versus VV ECMO

Although mortality rates related to AKI/severe AKI during VV ECMO are high, the occurrence of AKI/severe AKI during VA ECMO should be given greater attention, as these instances are considered strong indicators of patient deterioration and even death. Additional studies are needed to corroborate these findings.

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Prone Positioning in Postoperative Cardiac Surgery Patients: A Narrative Review

The aim of this article is to provide an overview of available literature, which seems to suggest the efficacy of prone positioning, and to make an in-depth analysis of the studies on this topic by evaluating the efficacy of this maneuver on hard endpoints.

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Perfusion Art: “Thoracic Park…”

Perfusion Art: “Thoracic Park…” Photographer: Frank Aprile, CCP, BBA, LP Equipment: I Phone 8+ Editing: Photoshop Narrative: End of a long day- TAVRs x 3 Time & Place:   2021- North of the Wabash River About The Artist:  CCP Commentary:  We dodged a bullet today. A very nice save. Couldn’t help but notice how much our equipment resembles mechanical versions of Apex predators…

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Comparison of the Effects of Ringer’s Lactate and 6% Hydroxyethyl Starch 130/0.4 on Blood Loss and Need for Blood Transfusion After Off-Pump Coronary Artery Bypass Graft Cardiac Surgery

Crystalloids (RL) provide similar outcomes to HES and can be used as substitutes to colloids during cardiac surgery. However, further large-scale multicenter studies with varied indications can be suggested to substantiate the equivalence of crystalloids to colloids in perioperative management.

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Postoperative Nadir Hemoglobin and Adverse Outcomes in Patients Undergoing On-Pump Cardiac Operation

Compared with the risks when nadir hemoglobin is 9.0 to 9.9 g/dL, the risk of composite adverse events increases when postoperative nadir hemoglobin is below 9.0 g/dL, whereas risk of death increases when nadir hemoglobin is below 7.0 g/dL.

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An Update From The Society of Thoracic Surgeons Workforce on Evidence-Based Surgery: Improving the Implementation of Clinical Practice Guidelines

Indirect evidence on the impact of CPGs may also be derived from observing temporal trends in practice patterns and outcomes before and after publication of CPGs. A better understanding of when, how, and how completely CPGs are implemented in various practice settings is currently lacking, and more research is needed to address existing hurdles in implementation of CPGs.

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Patient Blood Management and Blood Conservation – Complimentary Concepts and Solutions for Blood Establishments and Clinical Services in South Africa and Beyond

In this article, we hope to convey the message that PBM and blood conservation should not be seen as competing concepts, but rather complimentary strategies with the common goal of improving patient care. This offers opportunity to improve the culture of transfusion practices with relief to blood establishments and clinical services, not only in South Africa and LMICs, but everywhere. With the COVID-19 pandemic impacting blood supplies worldwide, this is an ideal time to call for educational interventions and awareness as an active strategy to improve transfusion practices, immed

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Elimination of CO2 Insufflation-Induced Hypercapnia in Open Heart Surgery Using an Additional Venous Reservoir

An additional venous reservoir for the evacuation of blood from the open surgical wound eliminates CO2 insufflation-induced hypercapnia in open heart surgery keeping PaCO2 and sweep gas flow constant. This prevents possible CO2-induced hyperperfusion of the brain and decreases the risk of cerebral particulate embolization during CO2 insufflation for de-airing in open heart surgery.

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Which Factors Have a Great Impact on Coagulopathy and Hemostatic Impairment after Cardiopulmonary Bypass in Cardiovascular Surgery? An Analysis Based on Rotational Thromboelastometry

In perioperative hemostatic management using ROTEM, attention should be given to the effects of these multiple factors.

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Non-Governmental Organizations Delivering Global Cardiac Surgical Care: A Quantitative Impact Assessment

NGOs effectively address the burden of cardiac surgical disease in LMICs and contribute to local capacity-building. Increased, more detailed, and standardized reporting of the impact and outcomes of NGOs is necessary to better understand annual cardiac surgical volume and to support local centers working towards independent services.

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High Socioeconomic Deprivation and Coronary Artery Bypass Grafting Outcomes: Insights from Michigan

Isolated CABG patients residing in the highest areas of socioeconomic deprivation differed with respect to demographic and clinical characteristics, and experienced worse short and long-term outcomes compared with those not in the top ADI decile.

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Cerebral Microemboli during Extracorporeal Life Support: A Single-Centre Cohort Study

Our results indicate that adult ECLS patients are continuously exposed to many gaseous and, frequently, to few solid cerebral microemboli. Prolonged cerebral microemboli formation may contribute to neurological morbidity related to ECLS treatment.

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Acute Kidney Injury and Extracorporeal Membrane Oxygenation: Review on Multiple Organ Support Options

The combination of CRRT and ECMO can be considered a form of multiple organ support therapy, but this approach still requires optimization in timing, set-up, anticoagulation, prescription and delivery. The aim of this report is to review the pathophysiology of AKI, the CRRT delivery, anticoagulation strategies and outcomes of patients with AKI treated with ECMO.

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Perfusion Art: “The DoorWay”

Perfusion Art: “The DoorWay” Photographer: Frank Aprile, CCP, BBA, LP Equipment: I Phone 8+ Editing: Photoshop Narrative: “What You Lookin At???” (Opening the Chest for CPB-) Time & Place:   A While Ago: West Texas About The Artist:  CCP Commentary:  Two Amazing Clinicians- in a class of their own 🙂 _______________________________________

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The Association of Matrix Metalloproteinases With Acute Kidney Injury Following CPB-Supported Cardiac Surgery

Although the pilot study may have limitations, it has demonstrated that the serum and urine levels of activity of MMP-2 and MMP-9 are associated with the clinical endpoint of AKI and appear to have earlier rising levels as compared with those of serum creatinine. Furthermore, in depth, exploration is underway with a larger sample size to attempt validation of the analytical performance and reproducibility of the assay for MMP-2 and MMP-9 to aid in earlier diagnosis of AKI following CPB-supported cardiac surgery.

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The Albumin-to-Fibrinogen Ratio Independently Predicts Acute Kidney Injury in Infants With Ventricular Septal Defect Undergoing Cardiac Surgery With Cardiopulmonary Bypass

This study demonstrated that a low AFR (<9.35) during CPB was an independent risk factor for AKI in VSD infants following cardiac surgery with CPB.