Showing papers in "Perfusion in 2018"
TL;DR: Early LV decompression should be considered in patients with insufficient unloading of the LV to prevent intra-cardiac thrombus formation and management strategies for patients with femoral VA-ECMO support and severely impaired LV function must be reassessed.
Abstract: Introduction:Profoundly impaired left ventricular (LV) function in patients undergoing femoral veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) can result in intra-cardiac stasis and t...
58 citations
TL;DR: A retrospective pilot study evaluated the usefulness of non-invasive lower-limb oximetry, using near-infrared reflectance spectroscopy (NIRS) to detect limb ischemia and found advancements in NIRS technology seem to have improved its accuracy for continuous, non- invasive monitoring of regional tissue.
Abstract: Background:Patients requiring V-A ECMO who receive femoral cannulation have an associated risk of distal, lower-limb hypoperfusion and ischemia of the cannulated leg. This pilot study evaluated the...
56 citations
TL;DR: Major vascular complications, including limb and mesenteric ischemia as well as bleeding and hemorrhage, have been associated with IABP, however, the incidence of these complications was generally low and studies supported the use of sheathless balloon insertion to reduce the risk of complications.
Abstract: Background:The use of the intra-aortic balloon pump (IABP) as a support device remains controversial due to the fact that a number of studies have shown no benefit in end mortality whilst using thi...
51 citations
TL;DR: A strategy combining screening CT on admission with a heparin-free period of extracorporeal support was demonstrated to be safe in VV-ECMO patients and resulted in a better prognosis compared to similar cohorts in the literature.
Abstract: Rationale:Extracorporeal membrane oxygenation (ECMO) use has exploded over the last decade. However, it remains invasive and associated with significant complications, including tamponade, infectio...
51 citations
TL;DR: VAV ECMO is a feasible rescue strategy for a small proportion of patients with combined respiratory and cardiac failure secondary to septic shock with septic cardiomyopathy, and a detailed report of the experience with this technique is provided.
Abstract: Introduction:The role of extracorporeal support for patients with septic shock remains unclear.Methods:We conducted a retrospective analysis of our single-centre experience with veno-arterio-venous...
48 citations
TL;DR: Intraoperative blood product transfusions were independently associated with an increased odds of developing acute kidney injury following cardiac surgery.
Abstract: Introduction:This study explored the nature of the association between intraoperative usage of red blood cell, fresh frozen plasma, cryoprecipitate or platelet transfusions and acute kidney injury....
35 citations
TL;DR: Echocardiography plays a key role throughout the ECLS care, including patient selection, adequate placement of cannulas, monitoring, weaning and follow-up after decannulation.
Abstract: Extracorporeal life support (ECLS) is a mainstay of current practice in severe respiratory, circulatory or cardiac failure refractory to conventional management. The inherent complexity of different ECLS modes and their influence on the native pulmonary and cardiovascular system require patient-specific tailoring to optimize outcome. Echocardiography plays a key role throughout the ECLS care, including patient selection, adequate placement of cannulas, monitoring, weaning and follow-up after decannulation. For this purpose, echocardiographers require specific ECLS-related knowledge and skills, which are outlined here.
34 citations
TL;DR: PCRTO is a simple, safe and reversible alternative weaning method that may have a particular role in the assessment of patients who have marginal recovery and right heart failure and Prospective controlled studies are needed to establish the potential role of PCRTO.
Abstract: Background:There is a lack of consensus on the timing of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) liberation. VA-ECMO weaning usually consists of serial decrements until an idlin...
28 citations
TL;DR: A prototype simulator allows the simulation of common ECMO emergencies through innovative solutions that enhance the fidelity of ECMO SBE and reduce the requirement for suspension of disbelief from participants.
Abstract: Introduction/Aim:The patient’s condition and high-risk nature of extracorporeal membrane oxygenation (ECMO) therapy force clinical services to ensure clinicians are properly trained and always read...
28 citations
TL;DR: In this in vitro study, citric acid, sodium citrate and lactic acid were added to venous blood from seven healthy donors, obtaining concentrations of 9 mEQ/L, 12 mEq/L and 15 mEqu/L.
Abstract: Introduction:Citric acid infusion in extracorporeal blood may allow concurrent regional anticoagulation and enhancement of extracorporeal CO2 removal. Effects of citric acid on human blood thromboe...
24 citations
TL;DR: ROTEM™ as a functional viscoelastic analysis does not provide additional information to basic and comprehensive laboratory tests during vvECMO, and bleeding events cannot be predicted by the means of specific ROTem™ results.
Abstract: Introduction:Veno-venous extracorporeal membrane oxygenation (vvECMO) used for respiratory support is associated with clinical bleeding in at least one third of patients. Mechanisms promoting bleed...
TL;DR: It is indicated that early negative fluid balance is associated with lower postoperative mortality in critically ill patients following cardiovascular surgery and further prospective, randomized trials are needed to prove the benefits from the restrictive fluid management strategy.
Abstract: Background:Early fluid expansion could prevent postoperative organ hypoperfusion. However, excessive fluid resuscitation adversely influences multiple organ systems. This retrospective, observation...
TL;DR: ECMO procedures and location may contribute to acquired infection risk; however, acquired infection did not predict mortality in this study.
Abstract: Introduction:Our objectives are to (1) describe the pathogens, site, timing and risk factors for acquired infection during neonatal and pediatric ECMO and (2) explore the association between acquir...
TL;DR: In peripheral cannulation for minimally invasive cardiac surgery, body mass index, cannula size and operation time can be considered as risk factors for leg ischemia.
Abstract: Background:In peripheral cannulation for cardiopulmonary bypass, there is always a risk of ischemia in the extremities, caused by femoral artery cannulation. This report aimed to evaluate the outco...
TL;DR: A lowDO2i during cardiopulmonary bypass is significantly associated with the incidence of postoperative delirium in CABG patients, and patients of older age were more sensitive to a declined DO2i.
Abstract: Introduction:Postoperative delirium is the most common neurological complication of cardiac surgery. Hypoxia has been shown to increase the risk of postoperative delirium. The possibility to contin...
TL;DR: The use of UF during CPB resulted in significant increases in end-hematocrit, with the greatest benefit shown when volumes were under 2.5 L, and for most procedure types, UF was most effective at increasing the last hematocrit on CPB.
Abstract: Objective:Ultrafiltration (UF) during cardiopulmonary bypass (CPB) is a well-accepted method for hemoconcentration to reduce excess fluid and increase hematocrit, platelet count and plasma constitu...
TL;DR: V ECMO successfully manages patients with severe isolated lung injury, however, once patients develop AKI during VVECMO, they are likely to further develop multi-organ dysfunction, including hepatic and hematological complications, leading to inferior survival.
Abstract: Introduction:Patients who develop severe acute respiratory distress syndrome (ARDS) despite full medical management may require veno-venous extracorporeal membrane oxygenation (VV ECMO) to support ...
TL;DR: Therapeutic hypothermia during neonatal ECMO appears to be associated with intracranial hemorrhage, and no differences were observed between groups for hospital mortality or functional status at hospital discharge among survivors.
Abstract: Introduction:The use of therapeutic hypothermia during neonatal extracorporeal membrane oxygenation (ECMO) as a neurologic protective strategy has gained interest among clinicians despite limited d...
TL;DR: The manifestation of acute kidney injury exclusively in the HES group of patients raises doubts about the use of HES products in conjunction with cardiac surgery and lowers fluid loading during bypass and improves cardiac function in the early postoperative period.
Abstract: Introduction:The use of cardiopulmonary bypass (CPB) leads to increased fluid filtration and edema. The use of artificial colloids to counteract fluid extravasation during cardiac surgery is contro...
TL;DR: Flushing the bypass circuits with carbon dioxide before priming significantly decreased the number of gaseous microemboli in the priming solution.
Abstract: Introduction:The use of cardiopulmonary bypass is associated with a risk of neurocognitive deficit caused by gaseous microemboli. Flushing the empty bypass circuit with carbon dioxide, which is mor...
TL;DR: In patients undergoing heart surgery with CPB, the findings indicate that, whilst oxygenator exhaust concentrations were significantly associated with arterial concentrations of isoflurane, neither had any association with the BIS scores, whereas body temperature has moderate positive correlation.
Abstract: Introduction Bispectral index (BIS) and monitoring of end-tidal concentration may be associated with a reduction in the incidence of awareness during volatile-based general anaesthesia. An analogue of end-tidal concentration during cardiopulmonary bypass (CPB) is measuring exhausted isoflurane concentration from the oxygenator as an estimate to blood and, so, brain concentration. The aim of this study was to determine the relationships between oxygenator exhaust and blood concentrations of isoflurane and the BIS score during CPB when administering isoflurane into the sweep gas supply to the oxygenator. Methods Seventeen patients undergoing elective cardiac surgery using CPB and isoflurane with BIS monitoring were recruited in a single-centre university hospital. Isoflurane gas was delivered via a calibrated vaporiser at the beginning of anaesthetic induction. Radial arterial blood samples were collected after the initiation of CPB and before aortic cross-clamping, which were analysed for isoflurane by gas chromatography and mass spectrometry. The BIS score and the concentration of exhausted isoflurane from the oxygenator membrane, as measured by an anaesthetic gas analyser, were recorded at the time of blood sampling. Results The mean duration of anaesthetic induction to arterial blood sampling was 90 min (95%CI: 80,100). On CPB, the median BIS was 39 (range, 7-43) and the mean oxygenator exhaust isoflurane concentration was 1.24 ± 0.21%. No significant correlation was demonstrated between BIS with arterial isoflurane concentration (r=-0.19, p=0.47) or oxygenator exhaust isoflurane concentration (r=0.07, p=0.80). Mixed-venous blood temperature was moderately correlated to BIS (r=0.50, p=0.04). Oxygenator exhaust isoflurane concentration was moderately, positively correlated with its arterial concentration (r=0.64, p Discussion In conclusion, in patients undergoing heart surgery with CPB, the findings of this study indicate that, whilst oxygenator exhaust concentrations were significantly associated with arterial concentrations of isoflurane, neither had any association with the BIS scores, whereas body temperature has moderate positive correlation.
TL;DR: The following article reviews the current knowledge in pediatric HIT, especially in ECMO patients, and the alternative anticoagulation options in the presence of HIT.
Abstract: Heparin-induced thrombocytopenia (HIT) is a prothrombotic, immune-mediated complication of unfractionated heparin (UFH) and low molecular weight heparin therapy. HIT is characterized by moderate thrombocytopenia 5-10 days after initial heparin exposure, detection of platelet-activating anti-platelet factor 4/heparin antibodies and an increased risk of venous and arterial thrombosis. Extracorporeal membrane oxygenation (ECMO) is a form of mechanical circulatory support used in critically ill patients with respiratory or cardiac failure. Systemic anticoagulation is used to alleviate the thrombotic complications that may occur when blood is exposed to artificial surfaces within the ECMO circuit. Therefore, when HIT complicates patients on ECMO support, it is associated with a high thrombotic morbidity and mortality. The following article reviews the current knowledge in pediatric HIT, especially in ECMO patients, and the alternative anticoagulation options in the presence of HIT.
TL;DR: Because a variety of factors influence therapy, the indication for transfusion should be re-evaluated and adapted repeatedly on a case-by-case basis.
Abstract: Introduction: Increasing the hematocrit is considered to increase oxygen delivery to the patient, especially when hypoxic conditions exist and the patient may become more stable. The aim of this st...
TL;DR: The findings obtained from the study support the concept that sevoflurane preconditioning confers cardioprotection against myocardial I/R injury and GSK-3β/β-catenin signaling activation mediated by TDZD-8 as a novel target to prolong cardiop rotection by sev oflureane anaesthesia.
Abstract: Background:Sevoflurane has been shown to protect against myocardial ischemia/reperfusion (I/R) injury in animals, while its cardioprotection is lost if the ischemic insult is too long. In this stud...
TL;DR: Higher doses of intra-operative protamine relative to heparin are associated with greater risk of transfusion and post-operative bleeding.
Abstract: Introduction:Accurate dosing of protamine reversal following on-pump cardiac surgical procedures is challenging, with both excessive and inadequate administration recognised to increase bleeding ri...
TL;DR: A novel technique that combines peripheral VA-ECMO with off-pump insertion of a trans-apical LV venting cannula and a right ventricular decompression cannula is reported on.
Abstract: Cardiogenic shock and cardiac arrest are life-threatening emergencies that result in high mortality rates. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) via peripheral cannulation is an option for patients who do not respond to conventional therapies. Left ventricular (LV) distention is a major limitation with peripheral VA-ECMO and is thought to contribute to poor recovery and the inability to wean off VA-ECMO. We report on a novel technique that combines peripheral VA-ECMO with off-pump insertion of a trans-apical LV venting cannula and a right ventricular decompression cannula.
TL;DR: No patient died during transportation and five complications were reported only during the ECMO transports, and all of these were managed without compromising the patient’s safety.
Abstract: Introduction:Neonatal and pediatric ECMO is a high-risk procedure that should be performed only in expert centers. Children who are eligible for ECMO and are managed in hospitals without ECMO capab...
TL;DR: Monitoring brain and peripheral rSO2 is an easy-to-use method, well reflecting the hemodynamics during CA, however, only brain rSO1 reflects the CPR efforts and might be used as a potential quality indicator for CPR.
Abstract: Introduction:Relationship between regional tissue oxygenation (rSO2) and microcirculatory changes during cardiac arrest (CA) are still unclear. Therefore, we designed an experimental study to corre...
TL;DR: This specific application of CytoSorbTM was safe, feasible and contributed to the optimal management of simultaneous shocks in a 46-year-old male patient who died from a new onset fulminant septic shock two months after his initial cardiac surgery.
Abstract: Introduction:The acute surgical treatment of infective endocarditis (IE) carries a high risk of postoperative mortality. Most complications are linked to uncontrolled sepsis and inflammatory proces...
TL;DR: The use of a cell-saver and the processing of shed blood as an integral part of MiECC significantly reduces the systemic cytokine load and is recommended to reduce the perioperative inflammatory response.
Abstract: Objective:The postoperative systemic inflammatory response after cardiopulmonary bypass (CPB) is still an undesirable side-effect after cardiac surgery. It is most likely caused by blood contact wi...