Antiphospholipid Syndrome and Cardiac Bypass: The Careful Balance between Clotting and Bleeding
We present a patient with APS undergoing coronary artery bypass grafting with cardiopulmonary bypass. We delineate our strategy for managing anticoagulation in the presence of this syndrome using the Hepcon Hemostasis Management System Plus (Medtronic, Inc. Minneapolis, MN) device by targeting whole blood heparin concentration to monitor anticoagulation.
Cerebral Oxygen Saturation (Rso2) During Cardiopulmonary Bypass (CPB) Measured Using the INVOS Oximeter Closely Correlates with Baseline Rso2
Our findings suggest that low baseline rSO2 in patients with high BNP due to cardiac and/or renal diseases is more likely to result from tissue edema causing alterations in optical pathlength and thus in calculated rSO2 values, not readily modifiable with CPB, rather than actual cerebral hemodynamic alterations readily modifiable with CPB. These may partly explain why the INVOS oximeter is a trend monitor requiring baseline measures.
The Inverse Relationship Between Endothelium-Dependent Vasodilation and Blood Pressure is Lost After Cardiopulmonary Bypass
These data suggest that the measurement of endothelium impairment after CPB may be more reflective of cardiovascular health than SBP alone.
ECMO Assistance during Mechanical Ventilation: Effects Induced on Energetic and Haemodynamic Variables
The new modules of the systemic circulation and ECMO support allowed the study of the effects induced by concomitant mechanical ventilation and circulatory support. Based on our clinical experience during the COVID-19 pandemic, numerical simulations may help clinicians with data analysis and treatment optimisation of patients requiring both mechanical ventilation and circulatory support.
Pump Flow Setting and Assessment of Unloading in Clinical Practice
If a left-sided Impella device is used, it should be run at the highest possible performance level during treatment while avoiding suction events. When combined with VA-ECMO, the Impella device should be run at a lower performance level, ensuring sufficient left ventricular emptying but avoiding suction.
Long-Term Cognitive Outcomes and Sleep in Adults After Extracorporeal Life Support
In this small retrospective case series, no significant differences were found in sleep or cognitive outcomes between extracorporeal life support and non–extracorporeal life support survivors.
Is There a Renoprotective Value to Leukodepletion During Heart Valve Surgery? A Randomized Controlled Trial (ROLO)
Leukocyte depletion during cardiopulmonary bypass does not significantly reduce the incidence of AKI after valvular heart surgery. Other methods to ameliorate renal dysfunction after cardiac surgery need to be investigated.
Antecedent ACE-Inhibition, Inflammatory Response, and Cardiac Surgery Associated Acute Kidney Injury
Chronic, long-term ACE-I treatment may influence the inflammatory response following CPB. On the other hand, this drug class apparently has neutral impact on perioperative renal outcomes.
Establish a Nomogram of Cardiac Postoperative Cognitive Dysfunction
This nomogram incorporating the CPB time, hypertension, WBC count, AST, and arrhythmia to predict the risk of c-POCD. The internal validation shows a good forecasting effect.
Changes in Coagulation and Fibrinolysis Systems During the Perioperative Period of Acute Type A Aortic Dissection
The changes in coagulation and fibrinolysis in the ATAAD group before surgery were very significant, which caused a large amount of fibrinogen and platelet consumption. Cardiopulmonary bypass (CPB) and a lower intraoperative core temperature exacerbated the coagulation and fibrinolysis disorder, and the pro-coagulant function of the platelets was activated after surgery. Maintaining the normal concentration of fibrinogen was helpful to correct the coagulation function disorder.
Physiological Basis of Extracorporeal Membrane Oxygenation and Extracorporeal Carbon Dioxide Removal in Respiratory Failure
In this review, we will present the physiological basis of gas exchange in ECMO and ECCO2R, and the implications of their interaction with native lung function. We will also discuss the rationale for their use in clinical practice, their current advances, and future directions.
Low vs Standardized Dose Anticoagulation Regimens for Extracorporeal Membrane Oxygenation: A Meta-Analysis
This meta-analysis confirms that LA is a feasible and safe anticoagulation strategy in patients supported by ECMO. Future studies should focus on the long-term benefits of LA compared with SA.
Preoperative Intra-Aortic Balloon Pumps in Cardiac Surgery: A Propensity Score Analysis
In patients undergoing isolated CABG surgery, preoperative IABP use was associated with increased 30-day mortality and adverse outcomes. Large randomised controlled trials are required to confirm our findings.
Successful Heart Transplantation Recovered From a Brain-Dead Donor on Veno-Arterial Extracorporeal Membrane Oxygenation Support
The present case reports the successful transplantation of a brain-dead donor heart recently recovered from pulmonary embolism induced acute right ventricular failure supported by VA-ECMO and represents a potential source of increased donor organs that would otherwise not be utilized.
Investigation of Air Bubble Properties: Relevance to Prevention of Coronary Air Embolism During Cardiac Surgery
These results suggest that detected intracardiac air represents residual “air,” with carbon dioxide already absorbed. Therefore, the use of conventional de‐airing procedures needs reconsideration: air and buoyant bubbles should be removed from the heart before they are expelled into the aorta; this requires timely and precise assessment with transesophageal echocardiography and effective collaboration between surgeons, anesthesiologists, and perfusionists.
Extracorporeal Membrane Oxygenation in Acute Respiratory Distress Syndrome: How Do We Expand Capacity in the COVID-19 Era?
As cases soar, more people require ECMO support, and triaged resource allocation becomes a reality: strategies to expand capacity are even more necessary.
Perfusion Art: “Davinci”
Perfusion Art: “ Davinci” Photographer: Frank Aprile, CCP, BBA, LP Equipment: I Phone 8+ Editing: Photoshop Narrative: A MidCab with Robotic IMA Harvest Time & Place: 2021: UpNORTH About The Artist: CCP Commentary: The symmetry on display here is amazing! Impressive watching such an intricate communication process-
We Asked the Experts: Autotransfusion for the Provision of Blood in Lower-and-Middle-Income Countries
Since this is a safe option with low risk of adverse events it is time for all LMICs to actively work toward ensuring accessibility to such low-cost devices and thus enable more severe-trauma patients to get blood products with the expectation of an increase in survival, given the challenges of bank-blood availability and safety.
Vancomycin Concentrations During Cardiopulmonary Bypass in Pediatric Cardiac Surgery: A Prospective Study
An AUCintra/MIC ⩾400 target was not reached in one-quarter of children undergoing heart surgery. Vancomycin peaked before the start of surgery and neonates were those with the lowest troughs. Vancomycin concentrations are affected by CPB hemodilution and by patients’ age and weight.
Minimally Invasive Versus Sternotomy for Mitral Surgery in the Elderly: A Systematic Review and Meta-Analysis
MIMVS in elderly patients is associated with lower postoperative complications, blood transfusion, shorter ICU, and hospital LOS, and longer cross-clamp and bypass times.
Extracorporeal Life Support for Cardiogenic Shock During Pregnancy and Postpartum: A Single Center Experience
VA ECMO can be employed successfully in obstetric patients with cardiogenic shock with appropriate patient selection. Further research is needed to determine if VA ECMO provides a survival advantage over traditional management strategies in this vulnerable population.
Basics of Extra Corporeal Membrane Oxygenation: A Pediatric Intensivist’s Perspective
This article is not intended to provide an in-depth overview of ECMO, but outlines the basic principles that a pediatric intensive care physician should know in order to manage a kid on ECMO support.
Extubate Before Venovenous Extracorporeal Membranous Oxygenation Decannulation or Decannulate While Remaining on the Ventilator? The EuroELSO 2019 Weaning Survey
The aim of this survey was to understand current VV ECMO and IMV weaning practices globally.
Comparison of 4-Factor Prothrombin Complex Concentrate with Frozen Plasma for Management of Hemorrhage During and After Cardiac Surgery: A Randomized Pilot Trial
This randomized clinical trial found that the study protocols were feasible. Adequately powered randomized clinical trials are warranted to determine whether PCC is a suitable substitute for FP for mitigation of bleeding in cardiac surgery.