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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…

Japanes Art

Development of A Valve Type Semi-Closed Extracorporeal Circulation System

In Japan, perfusionists who work on other clinical tasks are involved in cardiopulmonary bypass. Moreover, the number of cases they can perform is limited. In view of this situation, valve type semi-closed extracorporeal circulation (VACC) was developed as a system that enables extracorporeal circulation (ECC) regardless of perfusionists’ experience.

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Comparison of Microcirculatory Perfusion in Obese and Non-Obese Patients Undergoing Cardiac Surgery with Cardiopulmonary Bypass

Microcirculatory perfusion did not differ between obese and lean patients the day before surgery. CPB decreased microcirculatory perfusion with 9% in both groups, but this was only significant in lean patients (p < 0.05). Three days following surgery, microcirculatory perfusion was restored in both groups. In conclusion, microcirculatory perfusion was equally disturbed during cardiac surgery with CPB in metabolically healthy obese patients compared to lean patients.

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Extracorporeal Circulation During On-Pump Cardiac Surgery: An Evaluation of The Energy Equivalent Pressure (EEP) Index Based on Waveforms Decomposition in Harmonics

It is thus demonstrated that the surplus energy provided by pulsatile flow remains moderate (of order 10 mmHg), but that it can be improved by changing the relative shapes of the pressure and flow waves.

capno

Nadir Oxygen Delivery During Pediatric Bypass as A Predictor of Acute Kidney Injury

The lowest suitable DO 2i during CPB in the present population undergoing pediatric cardiac surgery was 353 mL/min/m 2. And below this threshold, there was a high probability of inducing CS-AKI.

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Tethered Liquid Perfluorocarbon Coating for 72 Hour Heparin-Free Extracorporeal Life Support

We conclude that neither TLP nor standard of care is an efficacious solution to prevent coagulation disturbances during ECLS. Further testing of promising biomaterials for ECLS utilizing the model outlined here is warranted.

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Blood Cell Adhesion to Arterial Filters Analysis by Scanning Electron Microscopy and Real-Time PCR Assay: Observational Clinical Study in Cardiac Surgery Patients

There was adhesion of blood elements, especially nucleated platelets, on all arterial filters studied. Although the arterial filter worked as a safety device, that possibly prevented arterial embolisation, it may also have caused greater hyperfibrinolysis during cardiopulmonary bypass.

bubble sensor

Dynamics of Appearance and Decay of Gaseous Microemboli During In Vitro Extracorporeal Circulation

We demonstrated GME formation and decay dynamics during in vitro circulation in an ECLS system with blood and glycerol. GME counts were higher in blood, likely due to varying rheological properties. There were decreases in GME levels post membrane in both groups after GME injection, with the membrane lung effectively trapping the GME, and additional reduction 10 minutes after GME injection.

surgery

Functional Brain Isolation Technique for Stroke Prevention in Thoracic Endovascular Aortic Repair

To prevent embolic stroke during thoracic endovascular aortic repair, we have adopted the brain isolation technique since June 2014 in 9 selected high-risk patients (9/134: 6.7%) having ulcerated or protruding atheromas within the proximal aorta.

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Intraoperative Collection of Autologous Platelet-Rich Plasma from The Cardiopulmonary Bypass Circuit Upon Initiation of Extracorporeal Circulation

Autologous PRP can be safely collected by drawing blood from the CPB circuit, platelet count and aggregation ability significantly decreased after CPB including autologous PRP collection. Some improvement was detected in the number of the platelets count and platelet aggregation ability by administrating an autologous PRP even if autologous PRP is collected from CPB circuit.

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Six-Month Survival After Extracorporeal Membrane Oxygenation for Severe COVID-19

The present findings suggested that about half of adult patients with severe COVID-19–related ARDS can be managed successfully with ECMO with sustained results at six months. Decreased arterial pH before ECMO was associated significantly with early mortality. Therefore, the authors hypothesized that initiation of ECMO therapy before severe metabolic derangements subset may improve survival rates significantly in these patients. These results should be viewed in the light of a strict patient selection policy and may not be replicated in patients with advanced age or multiple comorbidities.

COVID-19 Task Force 20200224

VV ECMO Strategies for COVID-19, A Single Center Experience

Topics covered in this webinar included patient selection and management, cannulation preference, extracorporeal circuit design, staffing models and personal protective equipment.

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Extracorporeal Membrane Oxygenation Support in Severe COVID-19

The early outcomes presented here suggest that the judicious use of ECMO support in severe COVID-19 may be clinically beneficial.

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EACTA/SCA Recommendations for the Cardiac Anesthesia Management of Patients with Suspected or Confirmed COVID-19 Infection: An Expert Consensus from the European Association of Cardiothoracic Anesthesiology and Society of Cardiovascular Anesthesiologists with the endorsement from the Chinese Society of Cardiothoracic and Vascular Anesthesiology

Our document should be the basis of future Task Forces to develop a more comprehensive consensus considering new evidence uncovered during the COVID-19 pandemic.

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Bedside Allogeneic Erythrocyte Washing with a Cell Saver to Remove Cytokines, Chemokines, and Cell-derived Microvesicles: A Clinical Feasibility Study

Bedside erythrocyte washing was clinically feasible and greatly reduced concentrations of soluble factors thought to be associated with transfusion-related adverse reactions, increasing concentrations of cell-free hemoglobin while maintaining acceptable (less than 0.8%) hemolysis.

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Del Nido Cardioplegia in Coronary Artery Bypass Grafting Surgery: A Safe, Efficacious and Economic Alternative to St. Thomas Solution; An Experience from A Developing Nation

The del Nido cardioplegia was found to be efficacious, safe and more economical alternative to St. Thomas solution.

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Utilization of Thromboelastogram and Inflammatory Markers in the Management of Hypercoagulable State in Patients with COVID-19 Requiring ECMO Support

The results of this case report show successful management of a hypercoagulable state among COVID-19 patients requiring ECMO support by utilization of inflammatory markers and TEG.

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Clinical and Technical Limitations of Cerebral and Somatic Near-Infrared Spectroscopy as an Oxygenation Monitor

This narrative review explores those clinical and technical limitations and proposes solutions and alternatives in order to avoid some of those pitfalls.

perfusion timers

Estimation Model for Hypothermic Circulatory Arrest Time to Predict Risk in Total Arch Replacement

As with the actual hypothermic circulatory arrest time, the predicted hypothermic circulatory arrest time using our model detected significant factors associated with major adverse outcomes. These results indicated that this prediction model for hypothermic circulatory arrest time may be effective.

surgery with hands

Factors Associated with Acute Kidney Injury and Mortality During Cardiac Surgery

A history of hypertension was predictive of the development of CSA-AKI, and preoperative eGFR was an independent predictor of mortality in this cohort. Both factors are modifiable.

perfusion screen

Lessons Learned on A New Procedure: Nonsternotomy Minimally Invasive Pulmonary Embolectomy

The initial data was positive and suggested that this approach is safe and feasible. We now broaden our experience with another two patients who underwent this approach, and highlight a number of technical and management modifications that have been made to optimize the procedure.

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Complete Aortic Thrombosis in SARS-Cov-2 Infection

COVID-19 infection due to the SARS-CoV-2 virus has shown to be associated with a hypercoagulable state.

FAMASK

I Woke up Friday and I DIDN’T CARE

That’s my Son 🙂 Editor’s Note: It’s not that I stopped caring, stress just gets you to a point sometime where the typical flair and zest you have for life and the job we do- well sometimes you end up manufacturing the smiles and enthusiasm. Anyone reading the title would have to be discouraged. It…

Air-Bubbles

A CO2 PE during SGV Harvesting? WTF?

Editor’s Note: I had an interesting case the other day, here at hospital 56. It was an op cab – and it ended up being more than the original grafts that were advertised. This was a fairly routine patient presentation in terms of degree of difficulty, with a particular surgeon for whatever reason always works…

June-12-2020-Kash-BDay-3

A Locum’s ScrapBook: Unmasking COVID: Virtual Reality has BECOME our Economy.

Editor’s Note: – That is my family. Up there- I want to be able to say that a year from now… – We (or better stated) “I” have worn Masks for YEARS. – Today is a continuation of more than a years struggle in terms of trying to cope with an entirely innocuous yet devastatingly…