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Benedict Kjaergaard, Jens Hedegaard Kristensen, Jesper Eske Sindby, Susanne de Neergaard, Bodil Steen Rasmussen
INTRODUCTION: In massive pulmonary embolism (PE) with circulatory collapse or with cardiac arrest, treatment can be difficult. Often, the diagnosis is unclear, and the time to treatment is crucial. Our institution has had an out-of-hospital team intended for the treatment of accidental hypothermia with extra corporeal membrane oxygenation (ECMO) since 2004. The team has occasionally been involved in patients suffering massive PE. METHODS: We were called to 38 patients with PE, but two were assessed as untreatable...
February 17, 2019: Perfusion
Stephen Gerfer, Georg Schlachtenberger, Kaveh Eghbalzadeh, Jens Wippermann, Thorsten Wahlers
Pericardial cysts are rare, abnormal, benign and usually congenital anomalies with an estimated incidence of 1:100.000 and are caused by an incomplete coalescence of foetal lacunae of pericardium development. The size of pericardial cysts varies from 1 to 5 cm and generally do not cause any symptoms. Pectus excavatum is one of the most frequent chest wall abnormalities with a caved-in appearance of the chest and mostly of unknown pathogenesis. We present a rare case of constrictive pericarditis with a huge pericardial cyst (11...
February 13, 2019: Perfusion
Samuel M Galvagno, Nirav G Shah, Christopher R Cornachione, Kristopher B Deatrick, Michael A Mazzeffi, Jay Menaker
INTRODUCTION: Diffuse alveolar damage is the histologic hallmark for the acute phase of acute respiratory distress syndrome and can occasionally present as diffuse alveolar hemorrhage. CASE REPORT: We report a patient with diffuse alveolar hemorrhage and acute respiratory distress syndrome requiring veno-venous extracorporeal life support for 210 days, who was successfully treated for a period of 130 consecutive days without intravenous anticoagulation. DISCUSSION: Although there are a few brief reports detailing long extracorporeal life support runs, the literature is largely devoid of data regarding long-term extracorporeal life support without full systemic anticoagulation...
February 11, 2019: Perfusion
Cheng Zhang, Baoying Meng, Keye Wu, Yiqun Ding
INTRODUCTION: The existing cardiopulmonary bypass tubing system has already been significantly improved in our hospital by reducing the priming volume; thus, we further employed a new cardiopulmonary bypass strategy in children based on a miniaturized cardiopulmonary bypass circuit. We aimed to compare the effectiveness of new and conventional strategies by analyzing the outcomes after congenital heart surgery. METHODS: We performed a database analysis of all patients undergoing congenital heart surgery with cardiopulmonary bypass at Shenzhen Children's Hospital from 1 May 2015 to 30 June 2017...
February 10, 2019: Perfusion
Tim Kaufeld, Eric Beckmann, Fabio Ius, Nurbol Koigeldiev, Wiebke Sommer, Bakr Mashaqi, Felix N Fleissner, Thierry Siemeni, Jacob Ono Puntigam, Jessica Kaufeld, Axel Haverich, Christian Kuehn
BACKGROUND: Venoarterial extracorporeal membrane oxygenation support is a well-established tool in the care of severe refractory cardiac and respiratory failure. The application of this support may serve as a bridge to transplant, recovery or to implantation of a ventricular assist device. Venoarterial extracorporeal membrane oxygenation support can be administered through an open surgical access via the common femoral or axillary artery or a percutaneous approach using Seldinger technique...
February 8, 2019: Perfusion
Ying Xu, Qin Gu
BACKGROUND: The Swan-Ganz catheter is a reliable method used to monitor hemodynamics in intensive care units. Pump-controlled retrograde trial off is a new weaning test for veno-arterial extracorporeal membrane oxygenation in recent years. The objective of this report is to describe a case in which pulmonary artery flotation catheter hemodynamic monitoring in combination with pump-controlled retrograde trial off was sufficient for veno-arterial extracorporeal membrane oxygenation weaning...
February 8, 2019: Perfusion
Chris Oscier, Chinmay Patvardhan, Florian Falter, Will Tosh, John Dunning, Pedro Catarino, Ravi DeSilva, Martin Besser, Kamen Valchanov
Central venoarterial extracorporeal membrane oxygenation has been used since the 1970s to support patients with cardiogenic shock following cardiac surgery. Despite this, in-hospital mortality is still high, and although rare, thrombus within the cardiac chambers or within the extracorporeal membrane oxygenation circuit is often fatal. Aprotinin is an antifibrinolytic available in Europe and Canada, though not currently in the United States. Due to historical safety concerns, use of aprotinin is generally limited and is commonly reserved for patients with the highest bleeding risk...
February 2, 2019: Perfusion
Andrelise Maria Nicoletti, Claudia Zamberlan, Raquel Christine Kruger Miranda, Clandio Marques, Cristina Bragança de Moraes
Perfusionists have a fundamental role in multi-professional teams involved in cardiopulmonary bypass procedures. The main objective of this study is to outline the profile of Brazilian perfusionists in the labor market by considering the evolution, current scenario, and future perspectives of this profession. Data from socio-demographic and professional profiles in active duty in Brazil were obtained through an electronic survey. The sample consisted of 157 perfusionists and showed that most of the professionals are female (58%), have up to 35 years of age (47...
January 31, 2019: Perfusion
Fumiya Yoneyama, Toru Okamura
Bidirectional Glenn procedure outcomes are very good; therefore, extracorporeal membrane oxygenation use as extracorporeal cardiopulmonary resuscitation is uncommon. We describe a 13-month-old female who required extracorporeal cardiopulmonary resuscitation for ventricular tachycardia provoked by transient myocarditis 6 months post-bidirectional Glenn procedure. After extracorporeal membrane oxygenation induction with cannulation on the cervical vessels, small skin incision was created on the subxiphoid area without sternotomy and the atrium was cannulated...
January 14, 2019: Perfusion
R Peter Alston, Michael Connelly, Christopher MacKenzie, George Just, Natalie Homer
BACKGROUND: Administering isoflurane 2.5% into the oxygenator during cardiopulmonary bypass results in no patient movement. However, doing so may result in an excessive depth of anaesthesia particularly, when hypothermia is induced. Bispectral index and arterial blood and oxygenator exhaust concentrations of volatile anaesthetics should be related to depth of anaesthesia. The primary aim of this study was to measure the depth of anaesthesia using bispectral index, resulting from administering isoflurane 2...
January 12, 2019: Perfusion
Virginie Fouilloux, Célia Gran, Olivier Ghez, Caroline Chenu, Fedoua El Louali, Bernard Kreitmann, Stéphane Le Bel
OBJECTIVES: Extracorporeal membrane oxygenation has become a gold standard in treatment of severe refractory circulatory and/or pulmonary failure. Those procedures require gathering of competences and material. Therefore, they are conducted in a limited number of reference centers. Emergent need for such treatments induces either hazardous transfers or a mobile pediatric extracorporeal membrane oxygenation team able to remote implantation and transportation. The aim of this work is not to focus on pediatric extracorporeal membrane oxygenation outcomes or indications, which have been extensively discussed in the literature...
January 12, 2019: Perfusion
Pavla Pokorná, Martin Šíma, Václav Vobruba, Martina Bašková, Lenka Posch, Ondřej Slanař
INTRODUCTION: Sufentanil is a potent analgesic drug used for pain management. A few studies describe the pharmacokinetics of sufentanil in neonates; however, no pharmacokinetic data about sufentanil during extracorporeal membrane oxygenation have been published yet. CASE REPORT: A 1-day-old neonate with moderate hypoxic-ischemic encephalopathy received veno-arterial extracorporeal membrane oxygenation support for refractory respiratory and circulatory failure. Sufentanil plasma concentrations were determined during both extracorporeal membrane oxygenation (n = 14) and non-extracorporeal membrane oxygenation (n = 17) period...
January 11, 2019: Perfusion
Nicole Y R Shrimpton
The Maquet Heater Unit 35 (HU35) is widely used to maintain patient body temperature during extracorporeal life support. Water is used as a medium for heat transfer though it also provides a medium for the growth of pathogens. Thus, the use of a heating unit presents a risk for transmission of water-borne pathogens in critically ill patients. Recently, a Mycobacterium chimaera outbreak in cardiac surgery has been linked to the production of bioaerosols by heater-cooler devices. Consequently, manufacturers have revised cleaning recommendations, with significant impact on staff, budget and environment...
January 11, 2019: Perfusion
Giuseppe M Raffa, Mariusz Kowalewski, Paolo Meani, Fabrizio Follis, Gennaro Martucci, Antonio Arcadipane, Michele Pilato, Jos Maessen, Roberto Lorusso
Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) has been used to deal with life-threatening complications as well as back-up or active cardiovascular support during high-risk procedures in patients undergoing transcatheter aortic valve implantation (TAVI). PubMed and MEDLINE electronic databases were searched in order to identify studies with emergency or prophylactic V-A ECMO application in association with TAVI procedures. From November 2012 to November 2017, 14 relevant studies were identified that included 5,115 TAVI patients of whom 102 (2%) required V-A ECMO (22 prophylactically, 66 as an emergency and 14 without a reported indication)...
January 11, 2019: Perfusion
Julia Merkle, Anton Sabashnikov, Lisa Liebig, Carolyn Weber, Kaveh Eghbalzadeh, Oliver Liakopoulos, Mohamed Zeriouh, Ferdinand Kuhn-Régnier, Thorsten Wahlers
OBJECTIVES: The aim of this study was to evaluate independent risk factors predictive for mortality of patients with Stanford A acute aortic dissection. METHODS: From January 2006 to March 2015, a total of 240 consecutive patients diagnosed with acute Stanford A acute aortic dissection underwent surgical aortic repair in our center. After analysis of pre- and perioperative variables, univariate logistic and multivariate logistic regression analyses were performed for mortality of patients...
January 11, 2019: Perfusion
Miroslav Durila, Tomas Smetak, Pavel Hedvicak, Jan Berousek
Coagulopathy and bleeding is a frequent phenomenon in patients on extracorporeal membrane oxygenation. The cause may be multifactorial and it may change over time. We present a case when bleeding was caused by hyperfibrinolysis induced by oxygenator. The diagnosis was established by comparing thromboelastometry result from blood obtained before and after oxygenator. Hyperfibrinolysis and bleeding could be successfully treated merely by oxygenator exchange.
January 11, 2019: Perfusion
Jessica G Y Luc, Steven R Meyer, William J Murtha, Gurmeet Singh
Legionella community-acquired pneumonia necessitating veno-venous extracorporeal membrane oxygenation for severe acute respiratory distress syndrome has been reported in adults. However, few options remain in cases of refractory hypoxemia on veno-venous extracorporeal membrane oxygenation. Herein, we describe adjunctive extended therapeutic hypothermia for refractory hypoxemia despite veno-venous extracorporeal membrane oxygenation for successful management of severe acute respiratory distress syndrome secondary to Legionella...
January 10, 2019: Perfusion
Richard Crook, Kyrie Wheeler
Sickle cell anaemia results from homozygosity of an A-T point mutation leading to a substitution of glutamic acid for valine at point 6 of the β-globin gene. A person with sickle cell trait inherits one normal and one mutated allele. Patients with sickle cell anaemia, and to a lesser extent sickle cell trait, have a wide spectrum of haemostatic abnormalities. Here we describe the problems faced in obtaining an accurate activated clotting time measurement, in a patient with sickle cell trait, prior to commencement of cardiopulmonary bypass for decannulation of Berlin Heart...
January 10, 2019: Perfusion
Filip De Somer, Hendrik Bernolet, Stefaan Bouchez, Thierry Bové
This study evaluates the efficiency of emergency programs used by three contemporary cell washers. Both time necessary to process a given amount of blood and quality of the processed blood are investigated. The Fresenius Kabi Smart, Haemonetics Elite and LivaNova Xtra were validated using bovine blood, with a starting hematocrit of 13% or 21%. For all devices, the pre-programmed emergency program was used. The total volume processed in the 13% hematocrit group was 358 ± 68 mL for Fresenius, 375 ± 308 mL for Haemonetics and 497 ± 87 mL for LivaNova...
January 10, 2019: Perfusion
Xing Hao, Junyan Han, Hui Zeng, Hong Wang, Guoli Li, Chunjing Jiang, Zhichen Xing, Yu Hao, Feng Yang, Xiaotong Hou
BACKGROUND: Cardiopulmonary bypass (CPB) during open-heart surgery triggers an inflammatory response that can cause significant morbidity and mortality. Human monocytes and regulatory T (Treg) cells are phenotypically and functionally heterogeneous and have been shown to play a significant role in the inflammatory dysfunction triggered by CPB. Glucocorticoids (GCs) have been widely administered for decades in patients undergoing CPB to reduce this inflammatory response. However, it has not been clearly established how routine prophylactic administration of glucocorticoids (GCs) affects monocyte and Treg subsets...
January 9, 2019: Perfusion
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