Patient Characteristics and Cardiac Surgical Outcomes at A Tertiary Care Hospital in Kenya, 2008-2017: A Retrospective Study
Awareness of demographic and peri-surgical factors that are predictors of complications is useful in guiding clinical decisions to reduce morbidity and mortality. Identification of co-morbidities as the most useful predictors of post-surgical complications suggests that patient characteristics may be a larger contributor to the incidence of complications than surgical practices.
Emergent Cardiopulmonary Bypass During Cesarean Delivery. A Case Report
Successful management of Cesarean Delivery complicated by emergent CPB and AVR requires meticulous multidisciplinary planning. This case also represents the volatility that can arise from severe aortic regurgitation during pregnancy.
Anticoagulation and Transfusion Management During Neonatal and Pediatric Extracorporeal Membrane Oxygenation: A Survey of Medical Directors in the United States
Compared with the 2013 pediatric population, extracorporeal membrane oxygenation center anticoagulation and blood transfusion approaches continue to vary widely. Most report continued use of heparin as their primary anticoagulant and follow a combination of monitoring assays with the majority using the antifactor Xa assay in their practices, a significant shift from prior results. Antithrombin activity levels and viscoelastic tests are followed by a growing number of centers. Platelet transfusion thresholds continue to vary widely. Future research is needed to establish optimal anticoagulation and blood transfusion management.
Perioperative Serum Free Hemoglobin and Haptoglobin Levels in Valvular and Aortic Surgery With Cardiopulmonary Bypass: Their Associations With Postoperative Kidney Injury
This study found that the perioperative increase of the free hemoglobin level and the decrease of the haptoglobin level had independent associations with the risk of pAKI.
Retrograde Autologous Priming During Cardiopulmonary Bypass Reduces Blood Transfusion Rate in Adult Cardiac Surgery: A Prospective Randomized Clinical Trial
In this experiment, the lowest HCT value during CPB in the study group was significantly higher and only 20% of patients received a blood transfusion. The overall transfusion rate and intraoperative transfusion volume of homologous PRBC units in the RAP group were lower than those in the standard priming group.
Cell Salvage in Trauma
Autotransfusion or cell salvage is markedly under utilized in trauma. Opportunities exist for significant blood savings if it is used more frequently. More research is clearly needed to assess the safety of autotransfusion in the traumatized patient.
Risk Factors for Vasoplegia after Coronary Artery Bypass and Valve Surgery
Patients with long CPB duration, preoperative use of ACE inhibitors or Angiotensin receptor blockers, and a history of renal failure requiring dialysis are under increased risk of vasoplegia. Vasoplegia necessitates large-scale studies for a better understanding of its risk factors.
Controversies in the Clinical Practice of Patient Blood Management
This special article focuses on the current evidence and controversies in the clinical practice of PBM and on emerging data related to specific PBM-related interventions in patients undergoing cardiac surgery. Strong evidence for many PBM-related interventions is limited because of missing studies or the poor quality of published findings and study endpoints.
Peripheral Cannulation for Extracorporeal Membrane Oxygenation Yields Superior Neurologic Outcomes in Adult Patients Who Experienced Cardiac Arrest Following Cardiac Surgery
Peripheral VA-ECMO allows for continuous CPR and systemic perfusion while obtaining vascular access. Compared to central cannulation, a peripheral cannulation strategy is associated with improved neurologic outcomes and decreased likelihood of anoxic brain death.
Cardiovascular Professional Societies Fall Short in Providing Impartial, Clear and Evidence-Based Guidelines
Why are there so many guidelines? What are the limitations of our current approach? How can we optimise guideline development to improve care of patients with cardiovascular disease?
Outcome and Cost of Nurse-led versus Perfusionist-led Extracorporeal Membrane Oxygenation
Use of a perfusionist-led ECMO model may be more cost-conscious in the context of low utilization, smaller case volume and shorter ECMO duration. However, once annual case volume exceeds 10 and mean ECMO duration exceeds 10 days, the nurse specialist-led model may be more cost-conscious.
Novel Application of Indocyanine Green Fluorescence Imaging for Real-Time Detection of Thrombus in A Membrane Oxygenator.
Under ICG imaging, the inside of the oxygenator was observed as a white area. A black dot suspected to be the thrombus appeared 6-8 hours after measurement initiation. The thrombus and the black dot on ICG imaging were finely matched in terms of morphology. Thus, we succeeded in real-time thrombus detection in an oxygenator using ICG imaging. The combined use of ICG imaging and conventional routine screening tests could compensate for each other's weaknesses and significantly improve the safety of ECMO.