The Journal of extra-corporeal technology
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J Extra Corpor Technol · Jun 2005
Randomized Controlled Trial Clinical TrialCan lean body mass be used to reduce the dose of heparin and protamine for obese patients undergoing cardiopulmonary bypass?
Increasing numbers of obese patients are presenting for cardiac surgery. The convention for heparin dose dictates that a bolus of 300 IU heparin per kilogram of total body weight (TBW) is administered before CPB. During CPB, the activated clotting time (ACT) is maintained for longer than 480 seconds. ⋯ Additional heparin was administered as required to achieve target ACT > 400 s. Mean ACT results and total heparin doses were analyzed using unpaired two tailed t tests. Our results indicate that with care, a reduction of as much as 25% in the doses of heparin (p = 0.0001) and protamine can be achieved for a substantial number of patients classified as overweight or obese.
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J Extra Corpor Technol · Jun 2005
Case ReportsCardiopulmonary bypass in pregnancy: possible new role for the intra-aortic balloon pump.
Cardiopulmonary bypass (CPB) during pregnancy is associated with a maternal mortality similar to the nonpregnant population; however, fetal morbidity and mortality are high. Various strategies to improve fetal survival have been advocated. ⋯ In the first, the IABP was inserted after termination of a long bypass, specifically in an attempt to improve uterine perfusion and thereby relieve a profound fetal bradycardia. In the second, the IABP was used electively to provide pulsatile flow during the bypass period primarily to benefit fetal hemodynamics.
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J Extra Corpor Technol · Jun 2005
Cardiopulmonary bypass in conscious patients undergoing cardiac surgery.
This study was undertaken to evaluate the feasibility of thoracic epidural anesthesia as an alternative technique to general anesthesia in patients undergoing cardiac surgery under cardiopulmonary bypass. This prospective study was conducted in a tertiary referral hospital. Seventeen patients underwent cardiac surgical procedures requiring cardiopulmonary bypass without general anesthesia under thoracic epidural anesthesia from February to May 2004. ⋯ None of the patients required conversion to general anesthesia. There was no mortality or morbidity in this series and to our knowledge our series is the first such. Cardiac surgical procedures requiring cardiopulmonary bypass may be conducted under thoracic epidural anesthesia, without endotracheal general anesthesia.
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J Extra Corpor Technol · Mar 2005
Randomized Controlled Trial Clinical TrialCombination of acute preoperative plateletpheresis, cell salvage, and aprotinin minimizes blood loss and requirement during cardiac surgery.
Acute preoperative plateletpheresis (APP), cell salvage (CS) technique, and the use of aprotinin have been individually reported to be effective in reducing blood loss and blood component transfusion while improving hematological profiles in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). In this prospective randomized clinical study, the efficacy of these combined approaches on reducing blood loss and transfusion requirements was evaluated. Seventy patients undergoing primary coronary artery bypass grafting (CABG) were randomly divided into four groups: a control group (group I, n = 10) did not receive any of the previously mentioned approaches. ⋯ The requirements of packed red blood cells in the three approached groups (153+/-63, 105+/-178, 0+/-0 mL, respectively) also were reduced when compared with group I (343+/-118 mL, p < 0.05). In group I, six patients (6/10) received fresh-frozen plasma and three patients (3/10) received platelet transfusion, whereas no patients in the other three groups required fresh-frozen plasma and platelet. In conclusion, both plateletpheresis concomitant with cell salvage and aprotinin contribute to the improvement of postoperative hemostasis, and the combination of these two approaches could minimize postoperative blood loss and requirement.
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J Extra Corpor Technol · Mar 2005
Case ReportsExtracorporeal membrane oxygenation and CO2 removal in an adult after near drowning.
Near drowning is a common event among otherwise healthy young people. The development of ARDS in the setting may significantly increase mortality. ⋯ It may be especially successful in those victims with single organ injury. We report the use of ECMO in a young adult with ARDS and pneumonia after near drowning.