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  • 1
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    Online Resource
    The Effects of Continuous Blood Gas Monitoring During Cardiopulmonary Bypass: A Prospective, Randomized Study—Part II
    EDP Sciences ; 2000
    In:  The Journal of ExtraCorporeal Technology Vol. 32, No. 3 ( 2000-09), p. 129-137
    Details
    In: The Journal of ExtraCorporeal Technology, EDP Sciences, Vol. 32, No. 3 ( 2000-09), p. 129-137
    Abstract: The impact of blood gas management during cardiopulmonary bypass (CPB) on patient care has not been examined and remains controversial. The purpose of this study was to determine whether precise blood gas management during CPB influences patient outcome. Fifty-nine patients were enrolled in an Institutional Review Board-approved, prospective, randomized study. An in-line blood gas monitor (CDI 500) was placed into the arterial and venous lines for all patients. Blood gas monitoring in the control group was managed by intermittent sampling (every 20–30 min), while the treatment group was managed with continuous monitoring. Blood gas control and measured parameters were as follows: pH 7.40 ± 0.05, PaCO 2 40 ± 5 mmHg, PaO 2 200 ± 50 mmHg. The treatment group had the CDI 500 guide clinical decisions. Compared to the control group, the treatment group consisted of significantly more diabetic (7% vs. 47%, p ≤ 0.001), renal failure (3% vs. 13%, p ≤ 0.01), and chronic obstructive pulmonary disease patients (7% vs. 20%, p ≤ 0.01). Internal thoracic artery utilization was higher in treatment patients than control patients (67% vs. 95%, p ≤ 0.02). No other differences existed in demographic, pharmacological, surgical, or anesthetic parameters. In the perioperative period, the control group required antiarrythmic support more frequently than the treatment group (10% vs. 0%, p ≤ 0.05). Compared to the control group, the treatment group required antiarrythmic (18% vs. 10%, p ≤ 0.05) and cardiac glycoside therapy (11% vs. 0%, p ≤ 0.05) less frequently in the postoperative period. Although treatment patients required less intraoperative pacing and cardioversion and spent less time on mechanical ventilation, in the intensive care unit (ICU), and in the hospital than control patients, statistical significance was not achieved. In conclusion, the use of continuous, in-line blood gas monitoring resulted in improvement in a number of postoperative outcome variables, although ICU and hospital stay was not effected.
    Type of Medium: Online Resource
    ISSN: 0022-1058 , 2969-8960
    URL: Article
    DOI: 10.1051/ject/2000323129
    Language: English
    Publisher: EDP Sciences
    Publication Date: 2000
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  • 2
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    Dose Titration of Recombinant Factor VIIa Using Thromboelastograph Monitoring in a Child With Hemophilia and High Titer Inhibitors to Factor VIII: A Case Report and Brief Review
    EDP Sciences ; 2006
    In:  The Journal of ExtraCorporeal Technology Vol. 38, No. 3 ( 2006-9), p. 254-259
    Details
    In: The Journal of ExtraCorporeal Technology, EDP Sciences, Vol. 38, No. 3 ( 2006-9), p. 254-259
    Abstract: The administration of recombinant factor VIIa (rFVIIa) is complicated by a wide inter-subject variation in response, a short half-life, evolving indications for use, and the absence of a test that has been shown to correlate with clinical effect. This report describes a method used to titrate rFVIIa to thromboelastography (TEG) parameters in a difficult to manage hemophilic patient with high titer inhibition to factor VIII. The current concepts of monitoring rFVIIa administration in hemophiliacs and uncontrolled hemorrhage in cardiac surgery are briefly reviewed.
    Type of Medium: Online Resource
    ISSN: 0022-1058 , 2969-8960
    URL: Article
    DOI: 10.1051/ject/200638254
    Language: English
    Publisher: EDP Sciences
    Publication Date: 2006
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  • 3
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    Improved Outcomes During Cardiac Surgery: A Multifactorial Enhancement of Cardiopulmonary Bypass Techniques
    EDP Sciences ; 2005
    In:  The Journal of ExtraCorporeal Technology Vol. 37, No. 2 ( 2005-6), p. 165-172
    Details
    In: The Journal of ExtraCorporeal Technology, EDP Sciences, Vol. 37, No. 2 ( 2005-6), p. 165-172
    Abstract: Patients presenting for cardiac surgery with cardiopulmonary bypass (CPB) are more likely to have pre-existing comorbidities, which has resulted in a steady increase in the risk associated with CPB. The resulting challenge has mandated the optimization of perfusion care. The purpose of this study was to retrospectively evaluate the impact of a number of simultaneous, evidence based perfusion care changes on patient outcome. After Institutional Review Board approval, two groups of patients were compared. The control group ( n = 317) included all patients undergoing CPB in a 12-month period preceding a multifaceted change in perfusion techniques. The treatment group ( n = 259) included all patients undergoing CPB in the 12-month period after the changes, which included the incorporation of updated continuous blood gas monitoring, biocompatible circuitry, updated centrifugal blood propulsion, continuous autotransfusion technology, new generation myocardial protection instrumentation, plasmapheresis, topical platelet gel application, excluding hetastarch while increasing the use of albumin, viscoelastographic coagulation monitoring, and implementing a quantitative quality improvement program. After univariate analysis, propensity scoring and multiple conditional logistical regression were used to control for demographic, preoperative, operative, and postoperative parameters. Results of the primary endpoints revealed a lower mortality rate in the treatment group (4% vs. 9% [95% confidence interval 1.33, 7.72], p = 0.009), lower transfusion rate (51% vs. 59% [1.00, 2.11], p = 0.048), and lower complication rate (55% vs. 65% [1.06,2.19], p = 0.025) despite having similar predicted mortality (11 [2,22] vs. 11[3,22] , p = NS) and other preoperative and operative parameters. The lower mortality rate was concurrent with a trend towards a lower incidence of complications, consistent with the differences in primary outcomes. In conclusion, the patients treated after the implementation of a multifactorial improvement plan using evidence based changes in CPB care had decreased complication and mortality rates.
    Type of Medium: Online Resource
    ISSN: 0022-1058 , 2969-8960
    URL: Article
    DOI: 10.1051/ject/200537165
    Language: English
    Publisher: EDP Sciences
    Publication Date: 2005
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  • 4
    Online Resource
    Online Resource
    The Effects of Continuous Blood Gas Monitoring During Cardiopulmonary Bypass: A Prospective, Randomized Study—Part I
    EDP Sciences ; 2000
    In:  The Journal of ExtraCorporeal Technology Vol. 32, No. 3 ( 2000-09), p. 120-128
    Details
    In: The Journal of ExtraCorporeal Technology, EDP Sciences, Vol. 32, No. 3 ( 2000-09), p. 120-128
    Abstract: The use of continuous in-line blood gas management (CILBGM) is steeped in controversy concerning its potential utility and impact on patient outcomes. The purpose of this study was to determine whether the use of CILBGM results in improved quality of patient care. Fifty-nine patients were enrolled in a Institutional Review Board-approved, prospective, randomized study. An in-line blood gas monitor (CDI 500) was placed into the arterial and venous lines for all patients. Blood gas monitoring in the control group was managed by intermittent sampling (every 20–30 min), while the treatment group was managed with continuous monitoring. There were no differences between groups in preoperative, surgical, anesthetic, or perfusion variables. The accuracy of the in-line monitor was comparable to laboratory analysis for arterial blood gas parameters ( N = 160; pH bias = 0.00; PaCO 2 bias = −1.1 mmHg; and PaO 2 bias = 0.7 mmHg). There was less deviation from target values (pH = 7.40, PaCO 2 = 40 mmHg, PaO 2 = 150–200 mmHg) when in-line monitoring was used versus intermittent sampling (N = 784; pH deviation = 0.05 ± 0.03 vs. 0.03 ± 0.01, p 〈 0.0001; PaCO 2 deviation 44.0 ± 2.9 mmHg vs. 2.0 ± 0.9 mmHg, p 〈 0.0001; and PaO 2 deviation = 22.7 ± 16.9 mmHg vs. 11.7 ± 8.3 mmHg, p 〈 0.0001). In conclusion, the results of part I of this study demonstrate that the use of CILBGM results in more accurate blood gas management during CPB.
    Type of Medium: Online Resource
    ISSN: 0022-1058 , 2969-8960
    URL: Article
    DOI: 10.1051/ject/2000323120
    Language: English
    Publisher: EDP Sciences
    Publication Date: 2000
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  • 5
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    In Vitro Evaluation of the Medtronic™ Cardioplegia Safety System®
    EDP Sciences ; 2000
    In:  The Journal of ExtraCorporeal Technology Vol. 32, No. 1 ( 2000-03), p. 31-37
    Details
    In: The Journal of ExtraCorporeal Technology, EDP Sciences, Vol. 32, No. 1 ( 2000-03), p. 31-37
    Abstract: Myocardial preservation demands the precise and accurate delivery of cardioplegic solutions to provide nutritive delivery and metabolic waste removal. The purpose of this study was to evaluate the performance characteristics of the Medtronic® CSS™ Cardioplegia Safety System in an in vitro setting. The CSS™ was evaluated under the following conditions: blood to crystalloid ratios of 1:0, 1:1, 4:1, 8:1, 0:1; potassium concentrations of 10, 20, and 40 mEq L −1 ; volumetric delivery collection at 100, 250, 500, 750, and 990 mL/min; pressure accuracy at 100 and 300 mmHg; and system safety mechanisms. Measured and predicted values from the CSS were compared using one way ANOVA, with statistical significance accepted at p ≤ 0.05. The measured values for the tested ratios and volume collections were all within the manufacturer’s technical parameters. Potassium concentration results were all within expected values except at 100 mL/min, where the measured value of 17.1 ± 2.1 mmol was lower than the expected 20.0 ± 0.2 mmol ( p 〈 .034). As flow rates changed, the CSS line pressure error was constant (0.5 to 3.7%), and the only significant difference was observed at 100 mmHg, 500 mL/min (102.3 ± 1.7 vs. 100.0 ± 0.0 mmHg, P 〈 .003). The device performed accurately and reliably under all simulated safety conditions, including bubble detection, over pressurization and battery backup. In conclusion, the performance of the CSS was within the manufacturer’s specifications for the majority of the tested conditions and operated safely when challenged under varying conditions.
    Type of Medium: Online Resource
    ISSN: 0022-1058 , 2969-8960
    URL: Article
    DOI: 10.1051/ject/2000322031
    Language: English
    Publisher: EDP Sciences
    Publication Date: 2000
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  • 6
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    The effect of priming techniques of ultrafiltrators on blood rheology: an in vitro evaluation
    SAGE Publications ; 2001
    In:  Perfusion Vol. 16, No. 3 ( 2001-05), p. 221-228
    Details
    In: Perfusion, SAGE Publications, Vol. 16, No. 3 ( 2001-05), p. 221-228
    Abstract: The increased interest of using ultrafiltration during cardiopulmonary bypass (CPB) has mandated a re-evaluation of the hematological effects of this blood conservation process. ‘Rinse-free’ ultrafiltrators can be primed using either crystalloid or blood prior to use. It is unknown whether one priming technique results in superior results in ultrafiltration quality. An in vitro circuit was designed to evaluate the Sorin/COBE HC1400 ( n=6), the Lifestream HC70 ( n=6), and the Terumo/Sarns HC11 ( n=6). All test conditions were conducted at a blood flow rate of 250 ml/min and a transmembrane pressure of 250 mmHg. Samples were drawn and analyzed at four distinct time points for hematocrit, total protein, plasma free hemoglobin, interleukin-6 (IL-6), interleukin-8 (IL-8), and tumor necrosis factor-α (TNFα). The HC11 had significantly greater percent increases in hematocrit under the blood priming protocol (29.2 ± 7.9) than either the HC1400 (11.0 ± 7.8, p 〈 0.03) or the HC70 (11.9 ± 7.8, p 〈 0.04). When crystalloid priming was compared to blood priming, the HC1400 and HC70 produced significant percent increases in hematocrit and total protein levels. The HC1400 devices produced significantly less plasma free hemoglobin when primed with crystalloid rather than blood (43.6 ± 38.3 vs 21.3 ± 5.6, p 〈 0.01). There were no significant differences between devices or priming techniques for IL-6, IL-8 or TNF levels. In conclusion, the efficiency of the ultrafiltrators was elevated when primed with crystalloid before use. Cytokine levels were relatively unchanged with priming techniques, while plasma free hemoglobin levels were reduced with those devices previously primed with crystalloid.
    Type of Medium: Online Resource
    ISSN: 0267-6591 , 1477-111X
    URL: Article
    DOI: 10.1177/026765910101600308
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2001
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  • 7
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    An in vitro study of the effects of isoflurane on oxygen transfer
    SAGE Publications ; 2001
    In:  Perfusion Vol. 16, No. 4 ( 2001-07), p. 293-299
    Details
    In: Perfusion, SAGE Publications, Vol. 16, No. 4 ( 2001-07), p. 293-299
    Abstract: A common anesthetic technique utilized during cardiopulmonary bypass (CPB) includes the use of various inhalation agents, such as isoflurane. The purpose of this study was to evaluate the effects of this agent on oxygen transfer during CPB. An in vitro model was designed using bovine blood. Blood flow was held constant at 2 l/min, while gas flow was manipulated at 1 and 3 l/min. The percentage of inspired oxygen (FiO 2 ) was set at 50 and 100%, and isoflurane was manipulated to 1.0, 3.0 and 5.0%. Blood gas analysis, oxygen transfer, and inlet and outlet isoflurane concentrations were measured at each of the given conditions. A total of 12 trials with four oxygenators were conducted. In the four oxygenators used in our study, no significant differences in oxygenator performance were found. At conditions of 1 l/min gas flow, 50% FiO 2 and 1% isoflurane, there were no significant changes in O 2 transfer between baseline and measurements taken during isoflurane administration (100.18 ± 12.49 vs 102.35 ± 10.99 ml O 2 /min, p=0.8031). At 3 l/min gas flow, 100% FiO 2 and 5% isoflurane, no significant differences were found (142.35 ± 10.76 vs 154.04 ± 8.95 ml O 2 /min, p=0.1459). The only significant differences found for oxygen transfer were between 50 and 100% FiO 2 , all other conditions being set equal (102.35 ± 10.99 vs 137.68 ± 8.62 ml O 2 /min, p=0.0023). In conclusion, increasing concentrations of isoflurane up to 5% does not affect the efficiency of oxygen transfer in an in vitro circuit. Further studies are necessary to evaluate the effects in an in vivo setting.
    Type of Medium: Online Resource
    ISSN: 0267-6591 , 1477-111X
    URL: Article
    DOI: 10.1177/026765910101600405
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2001
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  • 8
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    Autologous Platelet Concentrate and Vacuum-Assisted Closure Device Use in a Nonhealing Total Knee Replacement
    EDP Sciences ; 2006
    In:  The Journal of ExtraCorporeal Technology Vol. 38, No. 1 ( 2006-3), p. 44-47
    Details
    In: The Journal of ExtraCorporeal Technology, EDP Sciences, Vol. 38, No. 1 ( 2006-3), p. 44-47
    Abstract: Following a total knee replacement surgery, a 51-year-old insulin-dependent patient presented with complications of impaired healing and postoperative trauma to the wound site. The inability of this leg wound to heal placed this patient at risk of amputation. Vacuum-assisted closure therapy was initiated at postoperative day 53; after 100 days of protracted wound history a series of treatments with topical platelet concentrates were added to the vacuum assisted closure therapy and conventional wound care therapy. The previous nonhealing wound presented with good granulation and margination that enabled a skin graft with good take on postoperative day 150.
    Type of Medium: Online Resource
    ISSN: 0022-1058 , 2969-8960
    URL: Article
    DOI: 10.1051/ject/200638044
    Language: English
    Publisher: EDP Sciences
    Publication Date: 2006
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  • 9
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    Use of the Quest Myocardial Protection System” (MPS) for Modified Ultrafiltration During Pediatric Cardiac Surgery
    EDP Sciences ; 2005
    In:  The Journal of ExtraCorporeal Technology Vol. 37, No. 2 ( 2005-6), p. 219-221
    Details
    In: The Journal of ExtraCorporeal Technology, EDP Sciences, Vol. 37, No. 2 ( 2005-6), p. 219-221
    Abstract: Modified ultrafiltration generally is considered a standard of care for treating children undergoing cardiopulmonary bypass for congenital heat surgery. Different methods, incorporating a variety of devices and technologies, have been described. The present report describes a technique of modified ultrafiltration using arterial-venous flow with the Quest Myocardial Protection System™ (MPS).
    Type of Medium: Online Resource
    ISSN: 0022-1058 , 2969-8960
    URL: Article
    DOI: 10.1051/ject/200537219
    Language: English
    Publisher: EDP Sciences
    Publication Date: 2005
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  • 10
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    Effect of Partial-Filling Autotransfusion Bowls on the Quality of Reinfused Product
    EDP Sciences ; 2001
    In:  The Journal of ExtraCorporeal Technology Vol. 33, No. 2 ( 2001-06), p. 80-85
    Details
    In: The Journal of ExtraCorporeal Technology, EDP Sciences, Vol. 33, No. 2 ( 2001-06), p. 80-85
    Abstract: Intraoperative autotransfusion is used in a variety of surgical procedures with the quantity of blood loss dependent upon numerous factors. These procedures may or may not produce a full autotransfusion bowl. The inadequate removal of contaminants has been correlated to the incomplete filling of bowls, resulting in a condition called “Salvaged Blood Syndrome.” The purpose of this study was to assess the quality of aspirated whole blood after processing with an autotransfusion system using various fill volumes and two wash volumes. An in vitro circuit was designed to mimic the mechanical effects of extracorporeal flow on blood. Twenty-four Baylor-style bowls were filled at 400 mL min −1 and washed at 300 mL min −1 . Two wash volumes, 1000 and 2000 mL, and three bowl volumes; low, mid, and full, were used in this study. The bowl volumes were determined by using red cell quantities of 60, 100, and 135 mL for the low-fill, mid-fill, and full bowls, respectively. Samples were drawn pre-autotransfusion and post-autotransfusion and analyzed for plasma-free hemoglobin, IL-8, white blood cell count, platelet count, albumin, and total protein. All data were analyzed using one-way analysis of variance (ANOVA) with significance accepted at p ≥ .05. Plasma-free hemoglobin levels and hematocrit were concentrated significantly ( p 〈 .05) as bowl volume increased. A significant difference in IL-8 levels was found in the wash volumes in the low-fill bowls ( p 〈 .02). Platelet count was significantly decreased between the full bowl with 1000 mL wash and the full bowl with 2000 mL wash ( p 〈 .0004). Total protein reduction was significantly less in the low-fill bowl with 1000 mL wash as compared to the other bowl treatments ( p 〈 .05). In conclusion, the quality of the washed product did not vary significantly between fill or wash volumes, with the exception of the low-fill bowl with 1000 mL wash.
    Type of Medium: Online Resource
    ISSN: 0022-1058 , 2969-8960
    URL: Article
    DOI: 10.1051/ject/200133280
    Language: English
    Publisher: EDP Sciences
    Publication Date: 2001
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