Perfusion
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Veno-venous extracorporeal membrane oxygenation has several advantages over veno-arterial support for patients with severe reversible respiratory failure. However, recirculation can limit oxygen delivery as pump flow increases. This could be ameliorated by placing the return catheter in the right ventricle instead of the central veins. We compared recirculation in veno-right ventricular support with that in conventional veno-venous support and its relationship with pump flow. ⋯ Recirculation can be dramatically reduced by returning blood into the right ventricle, which improves oxygen delivery to the lungs and the systemic circulation. The design of specialized catheters may facilitate percutaneous ventricular cannulation, improve safety and further reduce recirculation.
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Review Meta Analysis
Is there any difference between blood and crystalloid cardioplegia for myocardial protection during cardiac surgery? A meta-analysis of 5576 patients from 36 randomized trials.
To compare the efficacy of blood versus crystalloid cardioplegia for myocardial protection in patients undergoing cardiac surgery. ⋯ We found evidence that argues against any superiority in terms of hard outcomes between blood or crystalloid cardioplegia for myocardial protection during cardiac surgery.
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Cardiac power output has been shown to quantify cardiac reserve. Cardiac reserve is defined as the difference between basal and maximal cardiac performance. We compared cardiac power index to other commonly used hemodynamic parameters to validate its usefulness to stage heart failure patients and determine the optimal time for implantation of mechanical circulatory support. A retrospective study of twenty-eight heart failure patients implanted with mechanical circulatory support was analyzed at three levels of drug therapy. Subjects were further separated into two categories: survived versus deceased. Cardiac power index was the only statistically significant hemodynamic parameter that identified cardiac reserve (p<0.05) in this patient population. These results showed that a cardiac power index at or below 0.34 Watts/m(2) resulted in increased mortality rate, ninety days post-implantation. ⋯ Cardiac reserve was a determinant of post-device survival; therefore, these data suggest that device implantation should occur prior to the 0.34 Watts/m(2) threshold.
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Veno-venous extracorporeal membrane oxygenation (VV-ECMO) has been indicated in patients with severe refractory respiratory failure from various causes for more than 30 years, even for the small infant.(1) Improved outcome from using ECMO for respiratory failure has been reported worldwide, ranging from 15% to over 50% in recent reviews.(1,2) The rationale of this therapy is to allow time for the lungs to heal, minimizing further lung injury from positive pressure ventilation.(3,4) We describe a case of severe acute respiratory distress syndrome (ARDS) with extensive barotrauma supported by VV-ECMO for 96 days in a resource-limited center. This is likely the longest ECMO support ever reported in a child.
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This extension study investigated the association between preoperative cerebral blood flow (CBF) velocity and postoperative cognitive decline (POCD) at a three-month follow-up in patients who underwent cardiac surgery. Continuous transcranial Doppler ultrasound on both middle cerebral arteries (MCAs) was used preoperatively in 31 right-handed cardiac surgery patients at rest. ⋯ Moreover, the group with POCD had a significantly lower CBF velocity in the left than in the right MCA, whereas no difference between the left and right CBF velocity was found in the group without POCD. These preliminary findings suggest that reduced preoperative CBF velocity in the left MCA may represent an independent risk factor for cognitive decline in patients three months after surgery.