Protamine Test Dose: Impact on Activated Clotting Time and Circuit Integrity
Regardless of the protamine test dosage, there is no reliable way to predict how a patient’s ACT will respond to a protamine test dose. Clot formation and circuit integrity is at risk when pump suction devices are continuously in use during PTD administration. Therefore, we strongly recommend that the direct recovery of mediastinal shed blood into the pump circuit be discontinued before any amount of protamine is administered to the patient.
Importance of High-Performing Teams in the Cardiovascular Intensive Care Unit
In surgery, recent initiatives have been adopted in the United States and worldwide, aiming to train surgical providers, from novices to senior levels, on important nontechnical skills, such as situational awareness, leadership, decision-making, communication, and teamwork.
Degradation of the Endothelial Glycocalyx Contributes to Metabolic Acidosis in Children Following Cardiopulmonary Bypass Surgery
Our data show that metabolic acidosis (increased strong ion gap) is associated with plasma concentration of heparan sulfate, a negatively charged glycosaminoglycan cleaved from the endothelial glycocalyx during cardiopulmonary bypass. In addition, cleavage of heparan sulfate was associated with renal dysfunction, capillary leak, and global markers of cardiovascular dysfunction. These data highlight the importance of designing translational therapies to protect the glycocalyx in cardiopulmonary bypass.
Blood Conservation and Hemostasis in Cardiac Surgery: A Survey of Practice Variation and Adoption of Evidence-Based Guidelines
The survey demonstrated widespread adoption of several best practices, including the tolerance of lower hemoglobin transfusion triggers, use of antifibrinolytics, minimization of hemodilution, and use of red cell salvage. The survey also confirms that gaps remain in preoperative anemia management and the use of transfusion algorithms supplemented with POC hemostasis testing. Serial use of this survey can be used to identify barriers to implementation and audit the effectiveness of interventions described in this article. This instrument could also help harmonize local, regional, and national efforts and become an essential component of an implementation strategy for PBM in cardiac surgery.
Rheumatic Heart Disease: The Role of Global Cardiac Surgery
In this review, we describe historical developments in the global response to RHD with a focus on regional, international, and political commitments to address the global burden of RHD. We discuss the surgical and clinical considerations to properly manage surgical RHD patients and describe the logistical needs to strengthen cardiac centers caring for RHD patients worldwide.
Serum Metabolic Profile of Postoperative Acute Kidney Injury Following Infant Cardiac Surgery with Cardiopulmonary Bypass
Moderate-to-severe AKI after infant cardiac surgery is associated with changes in the serum metabolome, including prominent changes to purine, methionine, and kynurenine/nicotinamide metabolism. A portion of infants with mild AKI demonstrated similar metabolic changes, suggesting a potential role for metabolic analysis in the evaluation of lower stage injury.
The Effect of Hemoadsorption on Rivaroxaban Blood Plasma Concentration in Emergency Cardiac Surgery
The evolution of the RBPC under hemoadsorption in vivo warrants a thorough investigation. Further clinical studies are required to assess the effectiveness and limitations of hemoadsorption to preclude a fatal bleeding event in patients with rivaroxaban in need of major emergency surgery.
Extracorporeal Multiorgan Support Including CO2-Removal with the Advanced Organ Support (ADVOS) System for COVID-19: A Case Report
Irrespective of the outcome we conclude that extracorporeal CO2 removal and multiorgan-support were feasible in this COVID-19-patient. Combined and less invasive approaches such as ADVOS might be considered in old-age-COVID-19 patients with MOF.
Extracorporeal Membrane Oxygenation-Induced Hemolysis: An In Vitro Study to Appraise Causative Factors
Our preliminary results suggested that the choice of anticoagulant and blood donor gender could be critical factors in hemolysis studies, and should be taken into account to improve testing reliability during ECMO.
Evaluation of Autologous Retransfusion from A Closed Suction Drainage System for Patient Blood Management in Elective Total Hip and Knee Replacement: A Two Cohort Study
Our study questions the effectiveness of postoperative autotransfusion as part of a patient blood management programme. In addition, the obvious signs of inflammatory reactions and coagulation activation raise safety concerns.
Platelets and Extra-Corporeal Membrane Oxygenation in Adult Patients: A Systematic Review and Meta-Analysis
Thrombocytopenia and platelet dysfunction are common in ECMO patients, regardless the type of ECMO mode. The underlying mechanisms are multifactorial, and understanding and management are still limited. Further research to design appropriate strategies and protocols for its monitoring, management, or prevention should be matter of thorough investigations.
A Survey of Patient Blood Management for Patients Undergoing Cardiac Surgery in Nine European Countries
PBM guidelines are not universally implemented in European cardiac surgery centres or countries, resulting in discrepancies in techniques and products used for a given clinical situation.