Learning about Journal Metrics.
Authors: Wong RK PMID: 31548733 [PubMed - in process] (Source: Journal of Extra-Corporeal Technology)
Source: Journal of Extra-Corporeal Technology - September 26, 2019 Category: Cardiovascular & Thoracic Surgery Tags: J Extra Corpor Technol Source Type: research

A Simple Scoring System to Predict Survival after Venoarterial Extracorporeal Membrane Oxygenation.
Authors: Worku B, Khin S, Gaudino M, Avgerinos D, Gambardella I, D'Ayala M, Ramasubbu K, Gulkarov I, Salemi A Abstract Patients undergoing consideration for venoarterial extracorporeal membrane oxygenation (VA ECMO) require an immediate risk profile assessment in the setting of incomplete or no information. A retrospective cohort study of 100 patients undergoing VA ECMO placement at three institutions was carried out. Variables strongly associated with survival to discharge were used to calculate a risk stratification score. Indications for VA ECMO support included postcardiotomy shock (24%), ischemic etiologies (3...
Source: Journal of Extra-Corporeal Technology - September 26, 2019 Category: Cardiovascular & Thoracic Surgery Tags: J Extra Corpor Technol Source Type: research

Impact of Pre-bypass Autologous Blood Collection on Blood Transfusion Rates.
Authors: Crosby AD, Sistino JJ Abstract Pre-bypass acute autologous donation (PAAD) is a method of blood conservation that reduces exposure of blood to the cardiopulmonary bypass (CPB) circuit and may prevent the contact activation of platelets and clotting factors. The purpose of this study was to evaluate the impact of PAAD on product transfusion rates in cardiac surgical patients. This is a retrospective study of patients undergoing cardiac surgery between 2015 and 2017 for either a coronary artery bypass (CABG), valve replacement, or a combined valve/CABG procedure. PAAD was performed by removing blood from the...
Source: Journal of Extra-Corporeal Technology - September 26, 2019 Category: Cardiovascular & Thoracic Surgery Tags: J Extra Corpor Technol Source Type: research

Perfusion Methods and Modifications to the Cardiopulmonary Bypass Circuit for Midline Unifocalization Procedures.
This study is used to determine whether the VSD can be closed during surgery. A collateral flow study circuit is also set up for first-time operations to measure the residual collateral flow after all of the MAPCAs have been harvested. Patients who require midline unifocalization will invariably require very lengthy periods of support on cardiopulmonary bypass. We have adapted our perfusion circuitry to prepare for the demands on the bypass circuit to meet the requirements of this patient population. Our institution has developed a systematic approach for the conduct of perfusion to best serve our patients presenting with ...
Source: Journal of Extra-Corporeal Technology - September 26, 2019 Category: Cardiovascular & Thoracic Surgery Tags: J Extra Corpor Technol Source Type: research

Lactated Ringer's as a Base Solution for del Nido Cardioplegia.
Authors: Kantathut N, Cherntanomwong P, Khajarern S, Leelayana P Abstract Unavailability of Plasma-Lyte A precludes the utility of traditional del Nido cardioplegia in many countries. This observational study aimed to evaluate myocardial preservation and clinical outcomes when using lactated Ringer's solution as the base solution for del Nido cardioplegia as compared with our institute's standard blood cardioplegia strategy. Eighty-nine adult patients underwent cardiac surgery for acquired heart disease from February 2017 to November 2017 either with del Nido cardioplegia (n = 44) or blood cardioplegia (n = 45). Cl...
Source: Journal of Extra-Corporeal Technology - September 26, 2019 Category: Cardiovascular & Thoracic Surgery Tags: J Extra Corpor Technol Source Type: research

Dermabond as a Novel Solution for Needle-Hole Repair in Arterial Cannula while on Extracorporeal Membrane Oxygenation Therapy.
Authors: Reisenauer JS, Neal JR, Joyce DL Abstract The annual incidence of extracorporeal membrane oxygenation (ECMO) for adult patients is increasing. Indications may vary from acute lung injury, ECMO-assisted cardiopulmonary resuscitation, to cardiac failure with an inability to wean from cardiopulmonary bypass. Complications may happen to the ECMO circuit, including cannula leaks from holes, cracks, or other damage, during the support period. Here, we present a novel solution for repairing a bleeding structural leak in the side of an arterial cannula. Dermabond was used to seal a small leak in the cannula likely...
Source: Journal of Extra-Corporeal Technology - September 26, 2019 Category: Cardiovascular & Thoracic Surgery Tags: J Extra Corpor Technol Source Type: research

Aquapheresis (AQ) in Tandem with Extracorporeal Membrane Oxygenation (ECMO) in Pediatric Patients.
This article describes the use of AQ in tandem with ECMO in a user-friendly and safe way to provide UF in children requiring cardiopulmonary support, with minimal flow and hemodynamic disturbance. PMID: 31548739 [PubMed - in process] (Source: Journal of Extra-Corporeal Technology)
Source: Journal of Extra-Corporeal Technology - September 26, 2019 Category: Cardiovascular & Thoracic Surgery Tags: J Extra Corpor Technol Source Type: research

Homemade Salvage Setup for a Catastrophic Heater/Cooler Failure on Cardiopulmonary Bypass.
In this report, we describe a homemade setup which was used as a desperate salvage measure to rewarm a 1-year-old baby on cardiopulmonary bypass for intracardiac repair, who was inadvertently cooled to 24°C because of a malfunctioning heater/cooler machine. PMID: 31548740 [PubMed - in process] (Source: Journal of Extra-Corporeal Technology)
Source: Journal of Extra-Corporeal Technology - September 26, 2019 Category: Cardiovascular & Thoracic Surgery Tags: J Extra Corpor Technol Source Type: research

A Quick Reference Tool for Goal-Directed Perfusion in Cardiac Surgery.
The objective of this study was to create a GDP reference tool that would allow perfusionists to quickly determine the lowest acceptable blood flow needed to provide a patient of any BSA with a satisfactory DO2 without the need for additional dedicated technology. We approached this problem by deriving a formula for flow (L/min), based on BSA, oxygen content of the blood, and a minimum DO2 of 280 mL·min-1m-2. A quick reference GDP chart was created based on the derived formula, requiring only the patient's BSA and hemoglobin level to determine a safe minimum flow rate. The proposed tool allows any cardiac surgery ce...
Source: Journal of Extra-Corporeal Technology - September 26, 2019 Category: Cardiovascular & Thoracic Surgery Tags: J Extra Corpor Technol Source Type: research

Introducing the Loop for Circuit Access during Extracorporeal Membrane Oxygenation: Feasibility and Safety.
Authors: Broman LM, Eriksson C, Frenckner B, Palmér K Abstract In extracorporeal membrane oxygenation (ECMO), blood is drained from the patient, and pumped through a membrane oxygenator/lung (ML) for gas exchange and then back to the patient. For monitoring blood gases, samples may be sampled downstream from the ML. This exposes the patient for embolization risk (air/clot) when the stopcocks are flushed. For safe sampling procedures, the Loop was introduced. It is a constant low-flow arteriovenous shunt (AVS) used preferably in venoarterial ECMO. It is composed of three different length and diameter three-wa...
Source: Journal of Extra-Corporeal Technology - September 26, 2019 Category: Cardiovascular & Thoracic Surgery Tags: J Extra Corpor Technol Source Type: research

JECT Authors: a Diverse, Highly Prized Group.
Authors: Wong RK PMID: 31239576 [PubMed - in process] (Source: Journal of Extra-Corporeal Technology)
Source: Journal of Extra-Corporeal Technology - June 28, 2019 Category: Cardiovascular & Thoracic Surgery Tags: J Extra Corpor Technol Source Type: research

Predictors of Oxygenator Exchange in Patients Receiving Extracorporeal Membrane Oxygenation.
Authors: Basken R, Cosgrove R, Malo J, Romero A, Patanwala A, Finger J, Kazui T, Khalpey Z, Mosier J Abstract Thrombosis within the membrane oxygenator (MO) during extracorporeal membrane oxygenation (ECMO) can lead to sudden oxygenator dysfunction with deleterious effects to the patient. The purpose of this study was to identify predictors of circuit exchange during ECMO. This is a single-center, retrospective study of all patients who received ECMO at our institution from January 2010 to December 2015. Changes in potential markers were compared on Day 3 vs. Day 0 before MO exchange. Of the 150 patients who receiv...
Source: Journal of Extra-Corporeal Technology - June 28, 2019 Category: Cardiovascular & Thoracic Surgery Tags: J Extra Corpor Technol Source Type: research

Improved Estimation of Total Blood Volume Can Provide a Reliable Prediction of Dilutional Hematocrit and Oxygen Delivery during Cardiopulmonary Bypass.
Authors: Lee MH, Gisnarian CJ, Shann KG Abstract Optimal oxygen delivery during cardiopulmonary bypass (CPB) for open heart surgery is crucial to protect organ function, improve outcomes, and reduce hospital stay. Effective preparation for optimal oxygen delivery during CPB is dependent on a reliable estimation of total blood volume (TBV) to accurately predict dilutional hematocrit (Hct) and calculate indexed oxygen delivery (iDO2). Unreliable estimation of TBV is a major reason for inaccurate prediction of dilutional Hct and iDO2. We performed a retrospective study of 113 patients who underwent cardiac surgery to ...
Source: Journal of Extra-Corporeal Technology - June 28, 2019 Category: Cardiovascular & Thoracic Surgery Tags: J Extra Corpor Technol Source Type: research

Improving Decreased Heater-Cooler Efficiency as a Result of Heater-Cooler Infection Control Strategy.
Authors: Blakey AK, Holt DW Abstract Heater-cooler units (HCUs) play a vital role in temperature management during cardiopulmonary bypass. In recent years, HCUs have been shown to play a significant role in the propagation of bacteria causing patient infection and significant harm. As a result, various institutions across the world have begun moving the HCU either far away or outside of the operative theater entirely. The purpose of this study was to examine the effect that the increased length of HCU water lines have on the ability of the device to heat and cool. We hypothesized that the increase in water line dis...
Source: Journal of Extra-Corporeal Technology - June 28, 2019 Category: Cardiovascular & Thoracic Surgery Tags: J Extra Corpor Technol Source Type: research

Gravity Venous Drainage and the 3/8-Inch Venous Line: What Would Poiseuille Do?
Authors: Datt B, Pourmoghadam KK, Munro HM, DeCampli WM Abstract The 1/2″ venous line has long been the drainage tubing diameter of choice for adult patients undergoing cardiac surgery. However, several programs use a smaller diameter venous line when used in conjunction with kinetic-assisted venous drainage or vacuum-assisted venous drainage. In 2014, our perfusion team made an institution-wide effort to miniaturize the cardiopulmonary bypass (CPB) circuit for children. One of our changes was the transition to a 3/8″ diameter venous line for drainage, even in our larger patients (up to 80 kg). We revie...
Source: Journal of Extra-Corporeal Technology - June 28, 2019 Category: Cardiovascular & Thoracic Surgery Tags: J Extra Corpor Technol Source Type: research

Platelet Refractoriness in a Pediatric ECMO Patient: A Case Report.
Authors: Gill M Abstract Thrombocytopenia is a life-threatening condition, the severity of which is exacerbated further if the patient requires anticoagulation and is refractory to platelet transfusion. This is the first report of an infant undergoing extracorporeal support with immune-mediated platelet refractoriness. A 19-month-old girl, with a complex cardiac history, required extracorporeal support because of deterioration 8 days post-cardiac surgery. The child suffered from ongoing thrombocytopenia, unresponsive to multiple platelet transfusions. An incremental rise in the platelet count was achieved following...
Source: Journal of Extra-Corporeal Technology - June 28, 2019 Category: Cardiovascular & Thoracic Surgery Tags: J Extra Corpor Technol Source Type: research

Management Strategies during a VA ECMO Run in a Neonate with E. Coli Septic Shock Masquerading as Hypoxic Ischemic Encephalopathy.
We present a challenging case of a full-term neonate with inotrope-resistant Escherichia coli septic shock, profound coagulopathy, hypoxic respiratory failure, and HIE requiring CH and venoarterial (VA) ECMO. We illustrate that family-centered decision-making, ECMO, primary team, and subspecialist support is critical to success. In addition, we share the strategic medical interventions concomitantly used with VA ECMO to aid in the survival of this high-risk infant such as continuous veno-venous hemofiltration with AN69 membrane for cytokine and fluid removal, prostaglandin use to relieve right ventricular strain in maligna...
Source: Journal of Extra-Corporeal Technology - June 28, 2019 Category: Cardiovascular & Thoracic Surgery Tags: J Extra Corpor Technol Source Type: research

A High-Fidelity Surgical Model and Perfusion Simulator Used to Demonstrate ECMO Cannulation, Initiation, and Stabilization.
This article explains the educational strategy, how the surgical pad is made, and the simulator connections so that any hospital can re-create this experience. PMID: 31239583 [PubMed - in process] (Source: Journal of Extra-Corporeal Technology)
Source: Journal of Extra-Corporeal Technology - June 28, 2019 Category: Cardiovascular & Thoracic Surgery Tags: J Extra Corpor Technol Source Type: research

Retrograde Autologous Priming Technique to Reduce Hemodilution during Cardiopulmonary Bypass in the Pediatric Cardiac Patient.
Authors: Hagedorn C, Glogowski K, Valleley M, McQuiston L, Consbruck K, Illustrations by Oyer A Abstract Blood conservation techniques during pediatric congenital heart surgery continue to be a vital strategy in reducing hemodilution during cardiopulmonary bypass. Development of mini circuits, retrograde autologous priming, modified ultrafiltration, and use of a cell saver are methods adopted by pediatric heart programs to limit transfusions. Excessive hemodilution may warrant the need for transfusion in the pediatric patient, which carries significant risks in the overall care of the patient. Retrograde autologous...
Source: Journal of Extra-Corporeal Technology - June 28, 2019 Category: Cardiovascular & Thoracic Surgery Tags: J Extra Corpor Technol Source Type: research

Introduction and Tributes.
Authors: Wong RK PMID: 30936581 [PubMed - in process] (Source: Journal of Extra-Corporeal Technology)
Source: Journal of Extra-Corporeal Technology - April 3, 2019 Category: Cardiovascular & Thoracic Surgery Tags: J Extra Corpor Technol Source Type: research

Massive Air Embolism Caused by a Central Venous Catheter During Extracorporeal Membrane Oxygenation.
Authors: Kumar A, Keshavamurthy S, Abraham JG, Toyoda Y Abstract Extracorporeal membrane oxygenation (ECMO) has become an integral treatment option for patients as a bridge to transplant, management of post cardiotomy cardiogenic shock, and for rescue after cardiopulmonary arrest. Significant strides in ECMO technology and management cannot, however, replace the importance of maintaining and following a comprehensive safety checklist. We herein report a case of massive air entrainment from an inadvertently disconnected port of a central venous catheter (CVC) in the neck which culminated in an airlock of the ECMO ci...
Source: Journal of Extra-Corporeal Technology - April 3, 2019 Category: Cardiovascular & Thoracic Surgery Tags: J Extra Corpor Technol Source Type: research

Effects of ECMO Simulations and Protocols on Patient Safety.
Authors: Thomas F, Chung S, Holt DW Abstract The use of extracorporeal membrane oxygenation (ECMO) has greatly increased over the years; however, the survival rate is only above 56%. There has been a drastic increase in ECMO centers and cases. ECMO has become a popular therapy route for patients with respiratory and cardiac complications; however, patient safety is a major concern. Perfusion and non-perfusion students from the University of Nebraska Medical Center were recruited to participate in three simulation trials. The trials consisted of five different tasks that are required for managing or preventing catas...
Source: Journal of Extra-Corporeal Technology - April 3, 2019 Category: Cardiovascular & Thoracic Surgery Tags: J Extra Corpor Technol Source Type: research

Flow Awareness as a New Safety Device for Cardiopulmonary Bypass.
Authors: Brolhorst J, Peterson B, Holt DW Abstract Safety devices such as bubble detectors and level detectors have been in use for more than 40 years and initially reduced the risks associated with gaseous emboli during cardiopulmonary bypass; however, the risks have not been eliminated. This research explored a new safety device designed to further reduce these risks: Flow Awareness Technology. This device visually alerts the perfusionist when the ratio of venous return does not equal the amount of arterial flow. To determine the efficacy of this device, 33 participants with no perfusion background were randomly ...
Source: Journal of Extra-Corporeal Technology - April 3, 2019 Category: Cardiovascular & Thoracic Surgery Tags: J Extra Corpor Technol Source Type: research

Bivalirudin Anticoagulation for an Infant with Hyperbilirubinemia and Elevated Plasma-Free Hemoglobin on ECMO.
We report a case of a 2-month-old male child who was placed on ECMO for severe acute respiratory distress syndrome. His ECMO course was complicated by severe hemolysis and hyperbilirubinemia, which precluded accurate monitoring of heparin activity. Bivalirudin was successfully used for anticoagulation in this patient. PMID: 30936585 [PubMed - in process] (Source: Journal of Extra-Corporeal Technology)
Source: Journal of Extra-Corporeal Technology - April 3, 2019 Category: Cardiovascular & Thoracic Surgery Tags: J Extra Corpor Technol Source Type: research

Microfluidic Point-of-Care Ecarin-Based Clotting and Chromogenic Assays for Monitoring Direct Thrombin Inhibitors.
Authors: Alouidor B, Sweeney RE, Tat T, Wong RK, Yoon JY Abstract Direct thrombin inhibitors (DTIs), such as bivalirudin and dabigatran, have maintained steady inpatient and outpatient use as substitutes for heparin and warfarin, respectively, because of their high bioavailability and relatively safe "on-therapy" range. Current clinical methods lack the capacity to directly quantify plasma DTI concentrations across wide ranges. At present, the gold standard is the ecarin clotting time (ECT), where ecarin maximizes thrombin activity and clotting time is evaluated to assess DTIs' anticoagulation capability....
Source: Journal of Extra-Corporeal Technology - April 3, 2019 Category: Cardiovascular & Thoracic Surgery Tags: J Extra Corpor Technol Source Type: research

Establishing a Ventilator-Heart Lung Machine Communication Bridge to Mitigate Errors when Weaning from Bypass.
The objective of this project was to create a redundant safety system of verbal and electronic communication to prevent failure to ventilate errors after cardiopulmonary bypass. This objective could be realized by building an electronic communication bridge directly between the HLM and ventilator. A software application was created to retrieve and interpret data from the pump and ventilator and trigger a programmed smart alarm. The software is able to interpret data from the pump and ventilator. When both are off simultaneously (defined as a pump flow of 0 L/min with a respiratory rate of 0 breaths/min), the application wi...
Source: Journal of Extra-Corporeal Technology - April 3, 2019 Category: Cardiovascular & Thoracic Surgery Tags: J Extra Corpor Technol Source Type: research

Non-Invasive Tissue Oximetry-An Integral Puzzle Piece.
Authors: Vranken NPA, Weerwind PW Abstract Non-invasive tissue oximetry is a monitoring method for continuous assessment of tissue oxygenation, which may aid in detection of hemodynamic instability and otherwise unnoticed hypoxia. Numerous studies focused on using non-invasive tissue oximetry intraoperatively, proposing its predictive value in relation to clinical outcome. Tissue oximetry may be part of standard monitoring practice for brain monitoring during cardiac surgery in many clinical centers; however, the monitoring method can be deployed in numerous clinical settings. This succinct overview aims to determi...
Source: Journal of Extra-Corporeal Technology - April 3, 2019 Category: Cardiovascular & Thoracic Surgery Tags: J Extra Corpor Technol Source Type: research

Perfusionist Manpower Survey.
Authors: Kulat B PMID: 30936590 [PubMed - in process] (Source: Journal of Extra-Corporeal Technology)
Source: Journal of Extra-Corporeal Technology - April 3, 2019 Category: Cardiovascular & Thoracic Surgery Tags: J Extra Corpor Technol Source Type: research

Health-Care Provider Burnout.
Authors: Lippy R PMID: 30936591 [PubMed - in process] (Source: Journal of Extra-Corporeal Technology)
Source: Journal of Extra-Corporeal Technology - April 3, 2019 Category: Cardiovascular & Thoracic Surgery Tags: J Extra Corpor Technol Source Type: research

Trauma on the Job: Lessons Learned in a Combat Hospital.
Authors: Kraft HS PMID: 30936592 [PubMed - in process] (Source: Journal of Extra-Corporeal Technology)
Source: Journal of Extra-Corporeal Technology - April 3, 2019 Category: Cardiovascular & Thoracic Surgery Tags: J Extra Corpor Technol Source Type: research

Data, data, data ….
Data, data, data…. J Extra Corpor Technol. 2018 Dec;50(4):215-216 Authors: Wegner J PMID: 30581227 [PubMed - in process] (Source: Journal of Extra-Corporeal Technology)
Source: Journal of Extra-Corporeal Technology - December 26, 2018 Category: Cardiovascular & Thoracic Surgery Tags: J Extra Corpor Technol Source Type: research

Impact of Hemolysis on Acute Kidney Injury and Mortality in Children Supported with Cardiac Extracorporeal Membrane Oxygenation.
Authors: Borasino S, Kalra Y, Elam AR, Carlisle O'Meara L, Timpa JG, Goldberg KG, Collins Gaddis JL, Alten JA Abstract Intravascular hemolysis with elevated plasma-free hemoglobin (PFH) complicates extracorporeal membrane oxygenation (ECMO). In 50 consecutive pediatric cardiac patients requiring ECMO, we sought to describe the relationship between PFH and clinical outcomes; primary outcomes were acute kidney injury (AKI) and prolonged (>14 days) renal replacement therapy (RRT). Median age was 35 days, median weight 3.9 kg, and median ECMO duration 4.2 days. Seventy-eight percent (39/50) weaned off ECMO; survival...
Source: Journal of Extra-Corporeal Technology - December 26, 2018 Category: Cardiovascular & Thoracic Surgery Tags: J Extra Corpor Technol Source Type: research

Is Conventional Bypass for Coronary Artery Bypass Graft Surgery a Misnomer?
We report average usage (categorical data) or median values (continuous data) at the center-level, along with the minimum and maximum across centers. Three thousand five hundred sixty-two patients were identified in the ANZCPR and 8,450 in PERForm. Substantial variation in equipment usage and CPB management practices existed (within and across registries). Open venous reservoirs were commonly used across both registries (nearly 100%), as were "all-but-cannula" biopassive surface coatings (>90%), whereas roller pumps were more commonly used in ANZCPR (ANZCPR: 85% vs. PERForm: 64%). ANZCPR participants had 640 m...
Source: Journal of Extra-Corporeal Technology - December 26, 2018 Category: Cardiovascular & Thoracic Surgery Tags: J Extra Corpor Technol Source Type: research

Association of Primary Hemodilution and Retrograde Autologous Priming with Transfusion in Cardiac Surgery: Analysis of the Perfusion Case Database of the Japanese Society of Extra-Corporeal Technology in Medicine.
Authors: Saito C, Kamei T, Kubota S, Yoshida K, Hibiya M, Hashimoto S Abstract It is important to avoid unnecessary blood cell transfusion. However, the associations of hemodilution and retrograde autologous priming with red blood cell transfusion during and after cardiopulmonary bypass (CPB) in cardiac surgery in Japan are currently unclear. We analyzed these associations using data for 3,090 adults from the Perfusion Case Database of the Japanese Society of Extra-Corporeal Technology in Medicine. Percent hemodilution was calculated by total priming volume and weight. Logistic regression models were used to adjust...
Source: Journal of Extra-Corporeal Technology - December 26, 2018 Category: Cardiovascular & Thoracic Surgery Tags: J Extra Corpor Technol Source Type: research

An Ethanol-Free Autologous Thrombin System.
Authors: Matuska AM, Klimovich MK, Chapman JR Abstract Thrombin is a coagulation protein of central importance to hemostasis and wound healing that can be sourced from human blood, bovine blood, and engineered cell lines. Only autologous thrombin lacks the risks of transmitting emergent pathogens or eliciting an immunogenic response. Previous commercial autologous thrombin devices require the use of high concentrations of ethanol to achieve thrombin stability, introducing cytotoxicity risks. A new point of care device for preparing an ethanol-free autologous thrombin serum was investigated. The ethanol-free autolog...
Source: Journal of Extra-Corporeal Technology - December 26, 2018 Category: Cardiovascular & Thoracic Surgery Tags: J Extra Corpor Technol Source Type: research

Potential Deleterious Interactions between Certain Chemical Compounds and a Thermoplastic Polyurethane Heat Exchanger Membrane Oxygenator.
Authors: Forsberg BC, Novick WM, Cervantes C, Lopez J, Cardarelli M Abstract Extracorporeal membrane oxygenation (ECMO) has become a powerful tool in the race to reverse failure to rescue events. Rapid implementation set the stage for the advent of the 30-day wet-priming storage as a standard practice. A recent alert regarding methylene blue (MB) unidirectional leach from patient's circulation through the oxygenator thermoplastic polyurethane (TPU) heat-exchanger membrane into the heater-cooler unit (HCU) water bath led us to believe that despite reassurances, the reverse process might be possible. To that effect, ...
Source: Journal of Extra-Corporeal Technology - December 26, 2018 Category: Cardiovascular & Thoracic Surgery Tags: J Extra Corpor Technol Source Type: research

Unplanned Autotransplantation for Complex Multi-Valve Replacement in a Super Morbid Obese Female: The Challenge of Intraoperative Decision Making.
This report discusses the intraoperative progression to an unplanned autotransplant for mitral valve repair while considering some decision making processes that cardiac surgeons make. PMID: 30581233 [PubMed - in process] (Source: Journal of Extra-Corporeal Technology)
Source: Journal of Extra-Corporeal Technology - December 26, 2018 Category: Cardiovascular & Thoracic Surgery Tags: J Extra Corpor Technol Source Type: research

Role of Methadone in Extracorporeal Membrane Oxygenation: Two Case Reports.
We describe two patients from the cardiac surgery intensive care unit at Cedars Sinai (Los Angeles, CA) on ECMO for over 30 days maintained on methadone. PMID: 30581234 [PubMed - in process] (Source: Journal of Extra-Corporeal Technology)
Source: Journal of Extra-Corporeal Technology - December 26, 2018 Category: Cardiovascular & Thoracic Surgery Tags: J Extra Corpor Technol Source Type: research

How to Manage Thrombocytopenia with ECLS: A Proposal of Clinical Reasoning Tools.
Authors: Koeltz A, Gendron N, Ajzenberg N, Longrois D Abstract Extracorporeal life support (ECLS) is increasingly used as a rescue therapy in patients with refractory cardiac/respiratory failure for temporary support or bridge to decision-making in both adult and pediatric patients. Complications such as bleeding and thrombosis remain major causes of morbidity and mortality in patients treated with ECLS. Hemostatic complications related to ECLS are multifactorial in patients with multiple organ dysfunctions and are incompletely characterized. Persisting thrombocytopenia and/or platelet dysfunction is the most frequ...
Source: Journal of Extra-Corporeal Technology - December 26, 2018 Category: Cardiovascular & Thoracic Surgery Tags: J Extra Corpor Technol Source Type: research

The Safe Addition of Nitric Oxide into the Sweep Gas of the Extracorporeal Circuit during Cardiopulmonary Bypass and Extracorporeal Life Support.
Authors: Bennett M, Thuys C, Augustin S, Schultz B, Bottrell S, Horton A, Bednarz A, Horton S Abstract Low cardiac output syndrome and the systemic inflammatory response are consequences of the cardiac surgical perioperative course. The mechanisms responsible are multifactorial, but recent studies have shown that nitric oxide (NO) may be a key component in mitigating some of these processes. Following on from literature reports detailing the use of inhaled NO added to the gas phase of the extracorporeal circuit, we set about developing a technique to perform this addition safely and efficiently. In the setting of c...
Source: Journal of Extra-Corporeal Technology - December 26, 2018 Category: Cardiovascular & Thoracic Surgery Tags: J Extra Corpor Technol Source Type: research

Instructions for Authors.
Authors: PMID: 30581237 [PubMed - in process] (Source: Journal of Extra-Corporeal Technology)
Source: Journal of Extra-Corporeal Technology - December 26, 2018 Category: Cardiovascular & Thoracic Surgery Tags: J Extra Corpor Technol Source Type: research

Extending the Reach with Social Media.
Authors: Wegner J PMID: 30250338 [PubMed - in process] (Source: Journal of Extra-Corporeal Technology)
Source: Journal of Extra-Corporeal Technology - September 28, 2018 Category: Cardiovascular & Thoracic Surgery Tags: J Extra Corpor Technol Source Type: research

Incidence of Cerebral Microemboli in Single-Dose vs. Multidose Cardioplegia in Adult Cardiac Surgery.
This study compared the incidence of microemboli during cardiac operations using conventional (multidose) and del Nido (single-dose) cardioplegia delivery. Transcranial Doppler ultrasonography was used to detect microemboli in bilateral middle cerebral arteries of 30 adult patients undergoing cardiac operations using CPB and aortic clamping. Multidose conventional blood cardioplegia (CBC) was used in 15 patients and single-dose del Nido cardioplegia (DNC) in 15. Manual count of microemboli during cross-clamp and during administration of cardioplegia was performed. Baseline preoperative characteristics were similar between ...
Source: Journal of Extra-Corporeal Technology - September 28, 2018 Category: Cardiovascular & Thoracic Surgery Tags: J Extra Corpor Technol Source Type: research

Use of Thromboelastography to Predict Thrombotic Complications in Pediatric and Neonatal Extracorporeal Membranous Oxygenation.
The objectives of this study were to investigate the correlation between thromboelastography (TEG) and conventional measures of anticoagulation, and to determine optimum values for citrated kaolin TEG R time (TEG RCK) and anti-Xa activity that would minimize both bleeding and thrombotic complications in pediatric and neonatal patients requiring extracorporeal membranous oxygenation (ECMO). A retrospective chart review of patients requiring veno-venous (VV) and venoarterial (VA) ECMO was performed. Combined medical and cardiac ICU within a single-center, tertiary care, freestanding, children's hospital. Non-pregnant patient...
Source: Journal of Extra-Corporeal Technology - September 28, 2018 Category: Cardiovascular & Thoracic Surgery Tags: J Extra Corpor Technol Source Type: research

Distal Perfusion Cannulation and Limb Complications in Venoarterial Extracorporeal Membrane Oxygenation.
Authors: Elmously A, Bobka T, Khin S, Afzal A, de Biasi AR, DeBois WJ, Guy TS, D'ayala M, Gulkarov I, Salemi A, Worku B Abstract The utility of distal perfusion cannula (DPC) placement for the prevention of limb complications in patients undergoing femoral venoarterial (VA) extracorporeal membrane oxygenation (ECMO) is poorly characterized. Patients undergoing femoral VA ECMO cannulation at two institutions were retrospectively assessed. Patients were grouped into those who did and those who did not receive a DPC at the time of primary cannulation. The primary outcome was any limb complication. Secondary outcomes i...
Source: Journal of Extra-Corporeal Technology - September 28, 2018 Category: Cardiovascular & Thoracic Surgery Tags: J Extra Corpor Technol Source Type: research

Bivalirudin Anticoagulation Dosing Protocol for Extracorporeal Membrane Oxygenation: A Retrospective Review.
The objective of this analysis was to assess if a comprehensive bivalirudin dosing and monitoring protocol effectively guides dose adjustments and monitoring of bivalirudin in patients during ECMO. Our analysis included 11 patients who received bivalirudin during ECMO therapy and had dosing managed using our hospital derived protocol. Patients treated over a 1-year period were included in this retrospective analysis. Clinical characteristics and changes in activated partial thromboplastin time (aPTT) were evaluated from medical records to determine the efficacy of the dosing protocol. ECMO was initiated for acute respirato...
Source: Journal of Extra-Corporeal Technology - September 28, 2018 Category: Cardiovascular & Thoracic Surgery Tags: J Extra Corpor Technol Source Type: research

Malposition of the Extracorporeal Membrane Oxygenation Venous Cannula in an Accessory Hepatic Vein.
We report a case of a refractory cardiogenic shock secondary to myocardial infarction in a 70-year-old patient requiring femoral venoarterial extracorporeal membrane oxygenation (VA-ECMO). At initial transesophageal echocardiography, the venous cannula tip was seen in the inferior vena cava (IVC), but not in right atrium. On day 8, ultrasonic examination identified that the end of the venous cannula was in the hepatic vein (HV). Despite such malposition, no disturbance in extracorporeal membrane oxygenation (ECMO) venous return was observed. Moving or replacing the cannula was considered a high-risk maneuver potentially re...
Source: Journal of Extra-Corporeal Technology - September 28, 2018 Category: Cardiovascular & Thoracic Surgery Tags: J Extra Corpor Technol Source Type: research

Recombinant Factor VIII Measurement in a Hemophilia A Patient Undergoing Cardiopulmonary Bypass-Supported Cardiac Surgery.
This report describes a staged perioperative approach to clinical hematologic management as applied to an 80-year-old male of O-positive blood type with mild Hem A, who underwent successful, uncomplicated coronary artery bypass graft surgery. Hematologic management primarily consisted of normalization of plasma factor VIII levels followed by standard care. Conventional laboratory methods and point-of-care-testing methods such as thromboelastography and heparin management assays were combined to guide patient care. Minimal blood loss and minimal hemodilution techniques were also used to achieve favorable outcomes. The thoro...
Source: Journal of Extra-Corporeal Technology - September 28, 2018 Category: Cardiovascular & Thoracic Surgery Tags: J Extra Corpor Technol Source Type: research

The Novel Use of a Low Prime Modified Ultrafiltration Apparatus in a 13-kg Jehovah's Witness Patient: A Case Report.
We describe a case in which we maintained an acceptable hematocrit level greater than 24%, considered the nadir below which the adverse effects of hemodilution can become evident. We performed this by the novel use of an intravenous warming device (enFlow, Vyaire Medical, Mettawa, IL) to reduce the prime volume of our MUF circuit by more than 50%. We present the case and discuss the advantages and disadvantages of using a low-prime MUF circuit. We were able to conduct "bloodless" CPB, with the use of acute normovolemic hemodilution, miniaturization of the CPB and MUF circuits. PMID: 30250345 [PubMed - in proc...
Source: Journal of Extra-Corporeal Technology - September 28, 2018 Category: Cardiovascular & Thoracic Surgery Tags: J Extra Corpor Technol Source Type: research

Bloodless Heart Surgery for an 11-kg Infant of the Jehovah's Witness Faith Undergoing Second Repair for Complete Atrioventricular Canal.
We report on our bloodless strategy for a 2-year old Jehovah's Witness with trisomy 21 and complete atrioventricular canal repair, who underwent atrial septal defect and ventricular septal defect patch closure, pulmonary artery debanding, and pulmonary arterioplasty. We modified our circuit to reduce our prime volume to approximately 10% of the EBV and removed 200 mL of the patient's blood before surgery as acute normovolemic hemodilution. We did not alter our institutional standards for transfusion of blood and blood products. The post cardiopulmonary bypass (CPB) hematocrit was 30%. We conclude that bloodless CPB surgery...
Source: Journal of Extra-Corporeal Technology - September 28, 2018 Category: Cardiovascular & Thoracic Surgery Tags: J Extra Corpor Technol Source Type: research