A Change of Heart: Perspectives on Patient Care and Technology

Bryon Moore has had a rich and varied career in EMS. He became an EMT in 1979 and received paramedic training at the fabled UCLA Daniel Freeman School for Paramedicine in 1982. He went on to be a paramedic in several systems before becoming the Northern California Clinical Coordinator for American Medical Response (AMR). Bryon then was attracted to helping develop and bring new resuscitation technology to market, working for a variety of medical device companies and launching new products globally. He’s currently VP of EMS Market Development for Defibtech, a company owned by Nihon Kohden, a leading medical device manufacturer. In 2009, Bryon fell ill from a virus that irreversibly damaged his heart. A heart transplant saved his life—and changed his perspective on life.Q: What originally attracted you to EMS? I was allegedly speeding in my '67 GTO on the way to classes at my local junior college. While fighting that ticket, my fellow court attendee talked about his progress toward a degree in fire science. Being 18, I thought it sounded cool, so I got my EMT certification and joined the fire department as a “part-paid” firefighter. Before I knew it, I was deep into an industry that I still love, nearly 40 years later. I really wanted to understand the “why” of what I was being taught in EMT II school. I was full of questions: Why give that many milligrams? Why is that drug the standard? And when I explained this frustration to a buddy, ...
Source: JEMS Special Topics - Category: Emergency Medicine Authors: Tags: EMS Insider Exclusive Articles Administration and Leadership Source Type: news

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Human body is intertwined collection of lives of Individual organs.We believe death occurs when brain dies , respiration stops and circulation ceases . Curiously ,when life ends , these organs  don’t die as a single unit . These three events can happen in any of the six possible permutations.Each organ takes different times to die after loss of life.It is like a crashed computer , where the mother board /RAM memory may be transferred to another and be functional . Out of these three , heart function appears to be supreme as it can function without the need of brain (Science of brain-death) and keep the body...
Source: Dr.S.Venkatesan MD - Category: Cardiology Authors: Tags: Heart transplantation donor heart transport transmedics Source Type: blogs
Abstract A 44-year-old male with ongoing chest pain and left ventricular ejection fraction 400 s: multiple argatroban bolus doses were required, along with accelerated up-titration of infusion dosing. Despite maintaining an ACT>484 s, clot formation was observed in the cardiotomy reservoir prior to separation. Subsequently, the patient developed severe disseminated intravascular coagulopathy, with both intra-cardiac and intravascular thrombi, requiring massive transfusion and continuous cell saving due to severe hemorrhage post cardiopulmonary bypass (CPB). The patient received a total of 105 units of plasma, 7...
Source: Perfusion - Category: Cardiovascular & Thoracic Surgery Authors: Tags: Perfusion Source Type: research
Lung transplantation is a lifesaving therapy for patients with end-stage lung disease, but donor shortage still represents a significant problem in the clinical practice. With the use of normothermic ex vivo lung perfusion (EVLP), the retrieved donor lungs are ventilated and perfused in an ex vivo circuit, allowing repair and extended assessment of marginal donor lungs before transplantation.1 Actual criteria used to evaluate lung suitability for transplantation during EVLP are lung function tests, radiographic and bronchoscopic findings and macroscopic assessment.
Source: The Journal of Heart and Lung Transplantation - Category: Transplant Surgery Authors: Tags: Original Clinical Science Source Type: research
Authors: Lv Y, Pang X, Jia PY, Jia DL Abstract OBJECTIVE: Indoleamine 2, 3-dioxygenase (IDO) can inhibit rejection of graft via inducing T cell apoptosis. CD40L monoclonal antibody (mAb) inhibits T cell activation. However, the effects of the combination of infusion of dendritic cell (DC) from IDO over-expressed donor mice and CD40L mAb on the treatment of graft rejection after heart transplantation have not been reported. MATERIALS AND METHODS: Allogeneic heart transplantation mouse model was established. Recipient mice were divided into three groups, including control group, IDO group (in which DC donors rece...
Source: European Review for Medical and Pharmacological Sciences - Category: Drugs & Pharmacology Tags: Eur Rev Med Pharmacol Sci Source Type: research
Authors: Laranjinha I, Matias P, Oliveira R, Casqueiro A, Bento MT, Carvalho AP, Adragão T, Jorge C, Bruges M, Birne R, Machado D, Weigert A Abstract INTRODUCTION:: After a kidney transplant, it is unknown whether the maintenance of a functioning hemodialysis arteriovenous access could have deleterious effects on renal grafts. We hypothesize that maintaining an arteriovenous access can deviate a significant proportion of the cardiac output from the renal graft. The aim of this study was to investigate whether a temporary closure of the arteriovenous access could lead to an increase in graft perfusion. ME...
Source: The Journal of Vascular Access - Category: Surgery Tags: J Vasc Access Source Type: research
Heart transplantation is the definitive treatment for end-stage heart failure. A shortage of donor hearts forced transplant programs to accept older donors and longer ischemic times. Previous studies have suggested that the administration of mesenchymal stem cells (MSCs) or their conditioned medium (CM) protects the heart against ischemia/reperfusion injury (IRI). We hypothesized that the preservation of donor hearts with a CM would protect the graft from IRI after prolonged storage in 15-month-old rats and investigated mRNA-changes attributable to CM.
Source: The Journal of Heart and Lung Transplantation - Category: Transplant Surgery Authors: Tags: Original Pre-Clinical Science Source Type: research
Abstract Heart transplantation remains the definitive management for end-stage heart failure refractory to medical therapy. While heart transplantation cases are increasing annually worldwide, there remains a deficiency in organ availability with significant patient mortality while on the waiting list. Attempts have therefore been made to expand the donor pool and improve access to available organs by recruiting donors who may not satisfy the standard criteria for organ donation because of donor pathology, anticipated organ ischemic time, or donation after circulatory death. "Ex vivo" heart perfusion (EV...
Source: Anesthesia and Analgesia - Category: Anesthesiology Authors: Tags: Anesth Analg Source Type: research
Consistent success in life-supporting porcine cardiac xenotransplantation, Published online: 05 December 2018; doi:10.1038/s41586-018-0765-zα1,3-galactosyltransferase-knockout pig hearts that express human CD46 and human thrombomodulin require non-ischaemic preservation with continuous perfusion and post-transplantation growth control to ensure long-term orthotopic function of the xenograft in baboons.
Source: Nature AOP - Category: Research Authors: Source Type: research
Abstract Donors after brain death (DBD) have been the major source of organ donation due to good perfusion of the organs. However, owing to the mismatch in demand and supply of the organ donors and recipients, donors after circulatory death (DCDDs) has increased recently all over the world. Kidneys, liver, and lungs are being used for transplantation from DCDDs. Recently, heart transplantation from DCDDs has been started, which is under the firestorm of scrutiny by the ethicists. The ethical dilemma revolves around the question whether the donors are actually dead when they are declared dead by cardiocirculatory d...
Source: Indian Heart J - Category: Cardiology Authors: Tags: Indian Heart J Source Type: research
Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is a well-established mode of mechanical circulatory support for patients with cardiopulmonary collapse. With rapid peripheral initiation, it can restore perfusion and oxygenation effectively, mitigate further end-organ injuries, and serve as a bridge to a more durable platform.1 In our experience, nearly 80% of patients who were rescued with VA-ECMO before transitioning to ventricular assist device (VAD) or heart transplantation were alive at 1  year.
Source: The Journal of Thoracic and Cardiovascular Surgery - Category: Cardiovascular & Thoracic Surgery Authors: Tags: Editorial Commentary Source Type: research
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