Circuit Surfers

The Currents, Eddys & Riptides- of Open-Heart Surgery

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CEREBRAL PERFUSION

Retrograde Cerebral Perfusion PURPOSE: To provide an alternative method of cerebral protection during procedures which require the cessation of cardiopulmonary bypass.  To provide an alternative method of cerebral protection during procedures where no other means of aortic perfusion, and thus cerebral perfusion, can or will be performed.  To provide an adjunctive therapy for the management…

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CPS Support

CPS Support (Written with assistance from Thomas Doyle, MS, CCP) CPS used by EMS … Click to read article… An interesting paper on using expanding percutaneous cannulas with CPS. Click to read article… Procedure for CPS A.    Disposable Equipment: 1.  CPS Pack 2.  Percutaneous cannulae (arterial/venous) 3.  Membrane oxygenator with integral heat exchanger and holder.…

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VAD / ECMO Policy v. 1.0

Editor’s Note: This is a disclaimer: As with all material presented on this site,  please use your own judgement as to what you feel is clinically safe, vetted, and makes sense to you.  This blog is NOT peer reviewed or sanctioned by any perfusion associated review board or academic body. That is not to say…

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MicroCircuits & Rapping

MicroCircuits & Rapping (Click Here if you want to skip to a list of posts) In the last 5 months, our institution decided to get aggressive about reducing our transfusion rate, and the numbers of patients that had postoperative bleeding issues. Originally our aim was to reduce the circuit size and use the integrated microcircuits…

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Protamine Reaction v1

I.    DESCRIPTION: Following cardiopulmonary bypass with heparin anticoagulation, protamine sulfate is used to neutralize the effects of heparin and reverse anticoagulation.  Currently protamine is the only drug available in the United States that can be used for this purpose. Hexadimethrine bromide (Polybrene) and toluidine blue are for laboratory use only. II.    ADMINISTRATION: The method of…

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HIT

Heparin Induced Thrombocytopenia I.    DESCRIPTION: Heparin induced thrombocytopenia (HIT) and heparin induced thrombocytopenia thrombosis syndrome (HITTS) are immune mediated complications of heparin therapy.  An antibody, produced by the body upon initial exposure to     heparin, reacts with an antigen upon re-exposure or continuous exposure to heparin. HIT is characterized by a dramatic decrease in platelet…

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Cold Agglutinins v.1

I.    BACKGROUND: Hypothermic cardiopulmonary bypass with the use of cold blood cardioplegia carries with it the risk of red cell agglutination caused by unsuspected cold agglutinin disease.  Patients with this condition possess serum antibodies which become reactive at temperatures usually less than 30°C and are directed against an antigen of the human erythrocyte causing agglutination…

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AT3 Deficiency v.1

Antithrombin III (AT III) is a plasma glycoprotein with a molecular weight of 58,000 daltons.  AT III deficiency may be noticed when the patient’s activated clotting time (ACT) does not respond to heparin administration as would be expected when given a standard dosage.  Also can be confirmed by a laboratory value of the patient’s AT…

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Jehovah’s Witness v.1

JEHOVAH’S WITNESSES Jehovah’s Witness patients are at increased risk for morbidity and mortality associated with blood loss due to their refusal, on religious grounds, of both homologous blood transfusion and autologous blood that has been removed from  continuity with the body.  They believe that it is wrong to accept or receive any type of blood…

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Malignant Hyperthermia v 1

I.    PATHOPHYSIOLOGY: Malignant hyperthermia (MH) is a pharmacogenetic disorder characterized by a fulminant hypermetabolic reaction of skeletal muscle induced by volatile inhalational anesthetics, succinylcholine, and possibly stress and exercise.  Until the advent of dantrolene, the mortality rate was 65% but since the introduction of dantrolene in 1979, it has decreased to between 1 and 10%.…