Perfusion
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To find out the risk factors influencing perioperative bleeding and use of blood products in cardiac surgery so that appropriate interventions can be selected for blood conservation, risk factors were analysed in 343 cardiac surgical patients, retrospectively, by multiple regression technique. The results showed that the factors related to postoperative bleeding were male gender, Higgins score, cardiopulmonary bypass (CPB) time, operation procedures, intraoperative blood loss and use of internal mammary artery (IMA) graft. Factors related to perioperative homologous blood transfusions were emergency surgery, preoperative haemoglobin level, Higgins score, intraoperative blood loss, operation time and operation procedures. ⋯ The incidence of homologous blood transfusion during the hospital stay was 58.9% for the entire series and 54.5% in the nonrevision patients. Emergency patients received significantly more blood transfusion (p = 0.0001). Perioperative blood loss and transfusions are still problems in cardiac surgery and certain patient groups in this study were identified as high risk; available blood conservation techniques, therefore, are recommended in these patients.
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Data relating to the activated clotting time response to a 4 mg/kg heparin loading dose were collected prospectively in 358 patients having cardiopulmonary bypass. After excluding patients with factors known to cause relative heparin resistance or sensitivity, the activated clotting time (ACT) loading dose response ratio (ACTLORR) was calculated retrospectively in 263 patients and found to correlate significantly (p = 0.0001) with the need for extra heparin administration during bypass. ⋯ Where the ACTLORR was between 4.0 and 5.0, it was far less predictive, with approximately 35% of patients requiring additional heparin. This study indicates that a large ACT response to the initial heparin loading dose (a high ACTLORR) is predictive of stable, adequate anticoagulation during the first 90 minutes of bypass, but that a low initial response is not necessarily associated with declining ACTs and the need for additional heparin administration.
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Of the many possible causes of air embolism occurring in patients undergoing cardiopulmonary bypass (CPB), human error due to the perfusionist or the surgeon accounts for the vast majority. This case, however, presents a previously unreported, but recognized, cause of air embolism, due to a technical problem encountered during the administration of blood cardioplegia. ⋯ A situation may then arise whereby air may be entrained and delivered to the patient. The management of massive air embolism is discussed, and recommendations are made to prevent such an occurrence happening in the future.
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Accidental hypothermia resulting from exposure is generally associated with frigid regions and not with the more temperate areas of the South. However, we present clinical experience from two cases in which the victims of motor vehicle accidents were exposed to the elements for prolonged periods and became profoundly hypothermic. The first patient was a 21-year-old male who was ejected from, and pinned under, his vehicle for approximately four hours in -15 degrees C ambient temperature. ⋯ The patient was discharged from the hospital on the seventh postoperative day. These cases are unique in that both were trauma patients with suspected internal injuries which required the avoidance of anticoagulation. Therefore, both cases utilized a Carmeda-bonded circuit without systemic anticoagulation.
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Randomized Controlled Trial Clinical Trial
The effect of low-dose epsilon-aminocaproic acid on patients following coronary artery bypass surgery.
The effect of low-dose epsilon-aminocaproic acid (EACA) on the postoperative course of 46 patients was studied. Patients undergoing coronary artery bypass grafting were randomly selected in two groups. Group 1 (20 patients) received 5 g EACA upon initiation of cardiopulmonary bypass (CPB). ⋯ After CPB, blood usage significantly differed: 2.2 +/- 1.7 (SD) units in Group 1 and 3.9 +/- 3.0 units in Group 2 (p = 0.033). Significant difference was also demonstrated in postoperative blood loss in the first 24 hours: 1610 +/- 531 ml in Group 1 versus 2025 +/- 804 ml in Group 2 (p = 0.043). Pre-CPB administration of low-dose EACA significantly decreases blood loss and blood usage in the postoperative period.