The Annals of thoracic surgery
-
Extracorporeal membrane oxygenation circuits have recently been introduced for extracorporeal life support (ECLS) in adult patients in cardiogenic shock and have been shown to provide excellent oxygenation and hemodynamic support. Heparin coating of the extracorporeal circuit provides a more biocompatible surface, which has been shown to minimize early surface-induced complement activation and platelet dysfunction and hence may improve patient survival. This report reviews our experience with extracorporeal membrane oxygenation to treat postcardiotomy cardiogenic shock using minimal to no systemic heparinization in 23 patients. ⋯ Extracorporeal life support using an extracorporeal membrane oxygenation system provides excellent cardiac support with similar hospital survival rates as centrifugal mechanical support. Extracorporeal life support has complications unique to itself, but with time, these are likely to be overcome. Women and patients with persistent left ventricular dilatation are less likely to be weaned.
-
The present era of medicine is concerned to a large measure with cost containment and the advent of managed care. For these reasons the concept of reducing hospital stays with a concomitant reduction in hospital cost is very attractive. The role of fast track is to ensure that we are not placing the patient at any additional risk and in fact are improving recovery and patient well-being. ⋯ A fast-track protocol allows faster recovery and earlier discharge from both the intensive care unit and the hospital without apparent increased risk. Complicated patients can also be fast tracked, and the desire to do so may actually expedite recovery.
-
Comment Letter
Tranexamic acid use during coronary artery bypass grafting.
-
An interesting observation, ie, the coracoclavicular line (from the lower border of the coracoid process to the upper border of the medial head of the clavicle) was parallel to the subclavian vein catheter in bedside chest roentgenograms (anteroposterior view), prompted us to use this subclavian approach. After supine positioning of the patient with the arm alongside the body and the left shoulder elevated 10 to 15 degrees, the puncture point was selected 1.5 cm away from the point where the coracoclavicular line crossed inferior border of the clavicle on the skin. ⋯ In 205 attempts in adult patients, 95.6% patients had successful cannulation in first attempt without significant complication. This technique appears to be promising as it is based on observation and is guided by constant landmarks and precise direction.
-
In spite of modern cardiac surgical techniques, severe cardiogenic shock not responding to pharmacologic therapy and intraaortic balloon pumping develops in about 0.2% to 1.2% of patients undergoing cardiac operations. ⋯ The results justify the use of Thoratec assist device in patients with severe preoperative cardiogenic shock.