The Journal of ExtraCorporeal Technology最新文献

{"title":"Perfusion for the jehovah's Witness Patient: An Example of Protocol Variability","authors":"R. Raley, R. C. Split","doi":"10.1051/ject/1996284209","DOIUrl":"https://doi.org/10.1051/ject/1996284209","url":null,"abstract":"Several translated verses in the New and Old Testaments provide Jehovah's Witnesses with influential guidance when they are to undertake a surgical procedure. These patients refuse to accept homologous blood or its components for transfusion. They also refuse to accept autologous blood for re-transfusion if it has been isolated from the body. This case report communicates the perfusion protocol variations in equipment selection, hemostasis management. and religious respect that resulted in optimal cardiac surgery for a Jehovah's Witness.","PeriodicalId":309024,"journal":{"name":"The Journal of ExtraCorporeal Technology","volume":"662 ","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1996-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114003487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Simplified Solution to Eliminating Electrical Noise During Cardiac Surgery","authors":"Nicklett Johnston, M. Jessen, M. Zeidler","doi":"10.1051/ject/1996284205","DOIUrl":"https://doi.org/10.1051/ject/1996284205","url":null,"abstract":"Electrical noise will be present in the operating room even under ideal circumstances. The addition of the cardiopulmonary bypass machine to the other machinery in the operating room introduces one more source of electrical noise. Identifying and managing this interference may aid in reducing artifactual signals on the electrocardiogram (EKG) monitor.\u0000If electrical interference occurs during the onset of cardiopulmonary bypass, an uninterpretable rhythm pattern on the electrocardiogram monitor may be present.\u0000Adding an extra ground from the main pump head to the heater/cooler helps to reduce noise and, therefore, effectively diminishes pump-generated artifact on the EKG.","PeriodicalId":309024,"journal":{"name":"The Journal of ExtraCorporeal Technology","volume":"141 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1996-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116076807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comprehensive Intraaortic Balloon Counterpulsation, 2nd Edition","authors":"P. Stark","doi":"10.1051/ject/1996284213","DOIUrl":"https://doi.org/10.1051/ject/1996284213","url":null,"abstract":"","PeriodicalId":309024,"journal":{"name":"The Journal of ExtraCorporeal Technology","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1996-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126916882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Moderate Hypothermia with Low Flow Rate Cardiopulmonary Bypass in Congenital Heart Defect Surgery","authors":"H.-M. Huang, H. Cheng, D. Zhu, D. Chao, W. Ding, Z. Su","doi":"10.1051/ject/1996284181","DOIUrl":"https://doi.org/10.1051/ject/1996284181","url":null,"abstract":"Low flow rate perfusion has been recommended in profound hypothemric cardiopulmonary bypass (CPB) in recent years, but has not been used in moderate hypothermic CPB. In this report, 30 patients with congenital heart defects, from 2 to 11 years old and weighing 11.5 to 25 kg. were selected to be the subjects of moderate hypothermia with low flow rate perfusion. Once on CPB, a high flow rate of 2.27 ± 0.36 L/min/m2 was used to cool the patient to 25.6 ± 0.84°C rectal, 24.1 ± 1.32°C esophageal, and 23.8 ± 1.4°C tympanic temperature, followed by a low flow rate of 1.23 ± 0.09 Llmin/m2 until the main intracardiac repair was completed. Rewarming to a rectal temperature of 34.5–35.0°C was accomplished with a high flow rate of 2.70 ± 0.22 L/min/m2 until weaning. The total CPB, cross clamp, and low flow rate perfusion times were 95.4 ± 34.6 min, 51.4 ± 20.2 min, and 45.7 ± 22.4 min respectively. A second group of five patients from 1.5 to 4 years old and from 6 to 11 kg were operated on with profound hypothermic circulatory arrest. A high flow rate of 2.35 ± 0.43 L/min/m2 was used to cool the temperature to 19.3 ± 0.8°C rectal, 17.5 ± 2.2°C esophageal, and 17.8 ± 1.5°C tympanic, and then the circulation was temporarily arrested. The CPB and arrest time were 55.0 ± 10.7 min and 44.7 ± 3.8 min respectively. Among the patients under moderate hyperthermia with low flow rate perfusion, only one showed metabolic acidosis during cardiopulmonary bypass and received an extra 12 mEq sodium bicarbonate. After 27 to 99 min low flow rate perfusion. the venous oxygen saturation was still greater than 80% for each patient and lactate concentration did not increase. In contrast, among those cases using profound hypothermic circulatory arrest, the blood gas analysis after two min of rewarming demonstrated an obvious metabolic acidosis and increase in lactate concentration. An extra 9 to 24 mEq sodium bicarbonate was needed in each of five patients for acidosis correction. After the sodium bicarbonate administration, the blood gases returned to normal while the lactate concentration still increased progressively. The data from this study suggest that low flow rate perfusion may safely be used in moderate hyperthermic CPB as long as we monitor the oxygen saturation of returned venous blood, keeping it above 80%.","PeriodicalId":309024,"journal":{"name":"The Journal of ExtraCorporeal Technology","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1996-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128524554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Do Heparinase Thrombelastographs Predict Postoperative Bleeding?","authors":"P. C. Mashburn, J. Ecklund, J. Riley","doi":"10.1051/ject/1996284185","DOIUrl":"https://doi.org/10.1051/ject/1996284185","url":null,"abstract":"Postoperative hemorrhage is a major cause of morbidity and mortality in patients who undergo cardiopulmonary bypass (CPB). The thrombelastograph (TEG) is a viscoelastic whole blood test that measures clot dynamics from clot formation through clot lysis. Previous studies have shown that post-bypass TEGs are accurate predictors of postoperative bleeding.\u0000TEGs from heparinized blood reversed with heparinase may be employed during CPB to evaluate coagulation. CPB heparinase TEGs may allow for earlier recognition of patients who may bleed after bypass. Earlier TEG analysis would allow targeting of specific therapies to begin before the patient bleeds excessively. Fifty-four heparinase TEGs during warming and fifty-four native TEGs post-protamine administration were collected. Parameters evaluated were R, K, alpha angle, MA, MA60, coagulation index, activated clotting time. hematocrit, prothrombin time, partial thromboplastin time, thrombin time, fibrinogen concentration, platelet count, blood loss during and after CPB, and blood and blood product administration. Coagulation indexes for CPB heparinase TEGs that were less than -2 or heparinase TEGs that were fibrinolytic were 87% accurate in predicting patients with excessive intraoperative blood loss, but were not predictive of blood product administration. The sensitivity was 12.5% and the specificity was I 00% in predicting excessive intraoperative bleeding. Post-protamine coagulation index inversely correlated with intraoperative red blood cell administration (r=-0.403, p<0.05), but was not predictive. Patients with fibrinolytic TEGs required blood products to compensate for expected blood loss associated with the fibrinolytic state. Simultaneous routine coagulation tests did not correlate significantly with blood loss or blood product administration, nor were they predictive. The findings of this study suggest that the presence of fibrinolysis in either a heparinase TEG on bypass or a post-protamine TEG is the most important predictor of blood and blood product administration. But, since only 20% of the patients in the study exhibited fibrinolytic TEGs, a study that included a much larger sample of patients would need to be done to confirm this finding.","PeriodicalId":309024,"journal":{"name":"The Journal of ExtraCorporeal Technology","volume":"66 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1996-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124616780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of the Thrombelastograph Targeted Coagulation Assessment","authors":"A. S. Bonness, A. Stammers, S. Huffman, S. J. Ficek, C. Brady","doi":"10.1051/ject/1996284191","DOIUrl":"https://doi.org/10.1051/ject/1996284191","url":null,"abstract":"Extracorporeal circulation predisposes patients to hemorrhagic risk which may increase both homologous transfusion requirements and the need for pharmacological intervention. The aim of this study was to evaluate the efficacy of a new diagnostic coagulation assay utilizing the thrombelastograph (TEG).\u0000Following Institutional Review Board approval, blood was drawn from healthy, non-medicated volunteers and four in vitro coagulopathic conditions were created, which included: hyperfibrinolysis (100% lysis), hypofibrinogenemia (<50 mg/dl), and both qualitative (1000 ug/ml nitroglycerin) and quantitative (<50 K/mm3) platelet abnormalities. Each of these four blood samples was then divided among four vials that contained known quantities of either: aminocaproic acid, fresh frozen plasma (FFP), platelet concentrate, or heparinase, and TEG profiles were completed.\u0000Twenty-one samples were evaluated and the following results were obtained. Hyperfibrinolysis- 100% correction of fibrinolytic potential in the aminocaproic acid vial, but none in the other vials. Qualitative platelet dysfunction- significantly improved time to coagulation in the platelet vial but not in the FFP, heparinase or aminocaproic acid vials. Quantitative platelet dysfunction- no significant difference observed between any vials. Hypofibrinogenemia- significant improvement in the TEG index in the FFP vial (-2.7 ± 0.5) when compared to the aminocaproic acid ( -8.6 ± 2.5, p<.001), platelet (-6.5 ± 0.5, p<.01) and heparinase (-8.8 ± 2.5, p<.001) vials.\u0000We conclude that this coagulation assessment assay may help in identifying the specific source of bleeding during surgeries where hyperfibrinolysis, hypofibrinogenemia, or qualitative platelet dysfunctions are present.","PeriodicalId":309024,"journal":{"name":"The Journal of ExtraCorporeal Technology","volume":"58 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1996-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115087492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ECMO, Extracorporeal Cardiopulmonary Support in Critical Care","authors":"J. Toomasian","doi":"10.1051/ject/1996283158","DOIUrl":"https://doi.org/10.1051/ject/1996283158","url":null,"abstract":"","PeriodicalId":309024,"journal":{"name":"The Journal of ExtraCorporeal Technology","volume":"73 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1996-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127273065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Supplemental Use of Antithrombin Ill Concentrate in the Pediatric Patient","authors":"B. Cunningham, J. Ecklund, J. Riley","doi":"10.1051/ject/1996283147","DOIUrl":"https://doi.org/10.1051/ject/1996283147","url":null,"abstract":"Decreased AT-III levels during cardiopulmonary bypass (CPB) have been observed in pediatric patients and are attributable to hemodilution. Prebypass administration of AT-III to the pediatric patient has been shown to prevent decreases in serum AT-III levels and elevated fibrinopeptide A (FPA) levels before and after bypass. We compared the clinical outcome of patients receiving supplemental AT-III injectate to control patients. Patients with preoperative AT-III levels less than 80% received AT-III injectate prior to heparinization.\u0000A retrospective analysis of 149 patients (31 study patients vs. 118 controls) revealed that a greater percentage of patients receiving AT-III were cyanotic (p=0.001) and underwent more complex cardiac repairs (p=0.001). Compared to patients not receiving AT-III, surgeries were performed at lower temperatures (p=0.040) with longer CPB times (p=0.031) and circulatory arrest times (p=0.047). Baseline AT-III levels were significantly lower in the treated group (p<0.0001) but were significantly higher during CPB (p=0.0001). Total postoperative blood loss, blood product administration, rate of reoperation, total time in ICU and mortality proved not to be significantly different between the groups after adjusting for above covariates (p=NS). It appears that maintenance of higher AT-III levels did not affect the clinically measurable outcome variables associated with hemostasis.","PeriodicalId":309024,"journal":{"name":"The Journal of ExtraCorporeal Technology","volume":"4 3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1996-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128374044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Whole Body Extracorporeal Low Flow Hyperthermia in a Canine Model","authors":"J. St, MD Cyr, B. C. T Kelly, BS Linda M. Shecterle","doi":"10.1051/ject/1996283140","DOIUrl":"https://doi.org/10.1051/ject/1996283140","url":null,"abstract":"Whole body hyperthermia (WBH) has not gained significant clinical acceptance, though extensive experimentation since the early 1980's has revealed its potential merits in the treatment of various cancers, and currently WBH is in clinical feasibility trials for Acquired Immune Deficiency Syndrome (AIDS). Using a new device and methodology, could canines serve as an appropriate test model for this device and methodology? Five dogs underwent one treatment each or the 42°C whole body hyperthermia using a low flow veno-venous approach. All animals were kept at the desired temperature for 90 minutes. There were no clinically significant acute or long term sequlae. Every animal was subjected to necropsy. Findings of this study showed that the canine was an adequate model to assess the initial safety of this new device.","PeriodicalId":309024,"journal":{"name":"The Journal of ExtraCorporeal Technology","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1996-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115335730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hemochron vs. Hemotec Kaolin ACT Comparison with Aprotinin Use in Congenital Heart Surgery","authors":"J. Ecklund, M. McCall, R. Southworth, M. Blackwell, J. Riley","doi":"10.1051/ject/1996283123","DOIUrl":"https://doi.org/10.1051/ject/1996283123","url":null,"abstract":"Between July 1994 and January 1995, ten patients underwent reoperative cardiac surgery with cardiopulmonary bypass for correction of various congenital anomalies. The patients' ages ranged from 0.17 to 34 years. Aprotinin was used according to surgeon protocol (200 mg/m2 body surface area initial loading dose and in pump prime, and 50 mg/m2 hourly infusion). The purpose of this study was to compare the simultaneous ACT values obtained from the Hemotec cartridge and the Hemochron kaolin tube.\u0000A 3 ml blood sample was drawn and duplicate ACTs run at four time periods during the procedure: 2 ml in a prewarmed kaolin Hemochron tube and 0.4 ml in each well of a pre-warmed Hemotec cartridge. Information recorded at each time period included: event [pre-CPB, onCPB hypothermia, on-CPB rewarming, post-CPB], temperature, and ACT values from each machine. A total of 74 paired samples were analyzed. Two-way ANOV A was used to compare the values. Multiple comparison tests using the Bonferonni method were performed to maintain the Type I error rate at 0.05. Regression, correlation, and residual analyses were performed. Cohen's kappa statistic was used to assess the degree of agreement between the two devices.\u0000There was a statistically significant difference between the ACT values obtained between the two devices (p<.01); however, the correlation between the values was high and significant (r=0.841, p<.01). The Hemotec was an average of 86 seconds lower than the Hemochron. The kappa statistic was 0.688, which indicates good agreement. The differences between these two devices have been previously reported using the celite Hemochron tubes, and it appears that there is still a difference when both tubes contain kaolin. Differences in the method of clot detection, differences in sample volume, and differences in the adsorption of aprotinin may explain the differences observed in this study. The Hemochron kaolin ACT is an acceptable alternative to the Hemotec ACT for monitoring heparinization when aprotinin is in use in congenital heart surgery.","PeriodicalId":309024,"journal":{"name":"The Journal of ExtraCorporeal Technology","volume":"58 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1996-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129108467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}