Alwardt CM, DeValeria PA, Sen A
… +5 more, Thunberg CA, Bhalla P, Blakeman S, D'Cunha J, Ravanbakhsh S
J Extra Corpor Technol
· 2022 Mar · PMID 36380830
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Extracorporeal life support, commonly referred to as extracorporeal membrane oxygenation (ECMO), is indicated when conventional medical and surgical measures fail to support a patient during cardiac or respiratory failur...Extracorporeal life support, commonly referred to as extracorporeal membrane oxygenation (ECMO), is indicated when conventional medical and surgical measures fail to support a patient during cardiac or respiratory failure. Increased use of ECMO in recent years has led to innovation that has improved safety in appropriate candidates. This has resulted in the application of novel approaches to complex surgical problems. Herein, we describe a simple, novel, and new-to-market ECMO circuit used for successful perioperative veno-venous ECMO support of a patient undergoing complex repair of a tracheoesophageal fistula. We believe that this circuit and its use for intra-and post-operative extracorporeal support provides a framework for safe and simple ECMO support in the future, including perioperative support for patients undergoing complicated and challenging thoracic procedures.
J Extra Corpor Technol
· 2022 Mar · PMID 36380829
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Extracorporeal life support is used in adult and pediatric patients for refractory cardiac and respiratory failure. The great arteries and veins of the neck and groin are often used for cannulation to extracorporeal memb...Extracorporeal life support is used in adult and pediatric patients for refractory cardiac and respiratory failure. The great arteries and veins of the neck and groin are often used for cannulation to extracorporeal membrane oxygenation (ECMO). Newer cannulation techniques use the subclavian or axillary arteries, in addition to synthetic grafts anastomosed in end-to-side fashion, from which the cannula is positioned. These newer techniques can prevent need for ligation and sacrifice of important major vessels that is often undertaken in "traditional" direct surgical cannulation strategies. To our knowledge this graft technique has not been performed in pediatric ECMO patients. We describe a case series of nine patients from 2012 to 2017 supported with venoarterial (V-A) ECMO utilizing a synthetic Gore-Tex "jump graft" sewn in an end-to-side fashion to the right carotid artery, for the arterial cannula insertion. Each patient's hospital course was reviewed with particular consideration given to disease process, site of cannulation, neurologic examination abnormalities noted during ECMO, computed tomography (CT) or magnetic resonance imaging (MRI) evidence of intracranial hemorrhage, and outcomes. Eight of nine patients were successfully cannulated utilizing this technique without neurologic complication. One suffered catastrophic intracerebral hemorrhage. This series is limited by small sample size and single center experience. Further work is needed to determine the advantages and disadvantages of utilizing a synthetic graft in pediatric V-A ECMO.
J Extra Corpor Technol
· 2022 Mar · PMID 36380828
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A diverse and equitable working environment is desirable. In 2011, a survey was distributed to all female perfusionists in the United States. This survey suggested that the female perfusionists share the same difficultie...A diverse and equitable working environment is desirable. In 2011, a survey was distributed to all female perfusionists in the United States. This survey suggested that the female perfusionists share the same difficulties as women in the labor force. The role of women in society in general is clearly changing. Female perfusionists have been part of that evolution. Promoting equality and respecting diversity are central to life today. A follow-up survey was distributed to evaluate the status and the change in gender stereotypes in the field of perfusion over the past 10 years. Women make up nearly half of the U.S. labor force and 35.7% of the present perfusion workforce in North America (1,077 certified women). Women make 82 cents for every dollar that men earn and this disparity widens for women with more education. The purpose of this survey was to poll women in perfusion to evaluate concerns and opinions in their careers and to compare to the 2011 survey results. In December 2021, a 39-question survey (surveymonkey.com, San Mateo, CA) was made available to all female perfusionists in North American via social media websites (Facebook.com, Perfusion.com, LinkedIn.com, Perflist, Perfmail, and FPP Listserv). There were 384 responses to the 2021 survey compared to the 538 responses in 2011. About 32.1% of the survey participants have been used in perfusion for more than 20 years; 37.6% have earned a master's degree compared to 2011, where 18.3% had master's level education; 72.5% are the financial providers for their family with 44.2% earning $101-150,000.00 and 40.3% greater than $200,000.00, which is a significant change from 2011; 61.5% consider themselves under moderate stress compared to 63.0% in 2011; 94.3% take call on a regular basis; and 74.1% feel they miss essential family functions because of their schedules. Similarly, 62.8% felt discriminated against because of gender compared to 50.9% in 2011. This survey suggests that the female perfusionists have shown to be assertive (72% are the primary financial supporter of their families) and competent in the field of cardiovascular perfusion (nearly 40% have masters degrees). Further analysis is needed to discern whether female perfusionists are treated with comparable respect as their male colleagues when 50.0% report some discrimination or harassment in their workplace.
Goto T, Yaguchi S, Ogasawara J
… +7 more, Kato N, Irie J, Ichikawa H, Nishiya Y, Ishizawa Y, Nomura O, Hanada H
J Extra Corpor Technol
· 2022 Mar · PMID 36380827
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The optimal timing for initiating extracorporeal membrane oxygenation (ECMO) after starting mechanical ventilation has yet to be clarified. We report herein the cases of two patients with coronavirus disease 2019 (COVID-...The optimal timing for initiating extracorporeal membrane oxygenation (ECMO) after starting mechanical ventilation has yet to be clarified. We report herein the cases of two patients with coronavirus disease 2019 (COVID-19) acute respiratory distress syndrome (ARDS) who were successfully managed with an early ECMO induction strategy. Case 1 involved a 64-year-old man admitted in respiratory distress with polymerase chain reaction-confirmed COVID-19. On day 5 at hospital, he was intubated, but oxygenation remained unimproved despite mechanical ventilation treatment with high positive end-expiratory pressure (PEEP) (PaO/FiO [P/F] ratio, 127; Respiratory ECMO Survival Prediction [RESP] score, 4). ECMO was initiated 4 hours after intubation, and stopped on day 16 at hospital. The patient was discharged from hospital on day 36. Case 2 involved a 49-year-old man who had been admitted 8 days prior. He was intubated on hospital on day 2. High PEEP mechanical ventilation did not improve oxygenation (P/F ratio, 93; RESP score, 7). ECMO was stopped on hospital on day 7 and he was discharged from hospital on day 21. The strategy of early initiation of ECMO in these two cases may have minimized the risk of ventilation-related lung injury and contributed to the achievement of favorable outcomes.
Emani S, Emani VS, Diallo FB
… +5 more, Dutta P, Matte GS, Nathan M, Ibla JC, Emani SM
J Extra Corpor Technol
· 2022 Mar · PMID 36380826
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Thromboelastography (TEG) can predict bleeding in pediatric patients undergoing cardiac surgery. We hypothesized that results obtained from TEG5000 correlate with the new point-of-care TEG6S system and that TEG6S rewarmi...Thromboelastography (TEG) can predict bleeding in pediatric patients undergoing cardiac surgery. We hypothesized that results obtained from TEG5000 correlate with the new point-of-care TEG6S system and that TEG6S rewarming maximum amplitude (MA) is associated with surrogate endpoints for perioperative bleeding in pediatric patients who underwent complex cardiac surgery. We describe a retrospective study of pediatric (≤18 years) patients who underwent complex cardiac surgery on cardiopulmonary bypass. Citrate whole-blood samples were used to compared TEG5000 vs.TEG6S and TEG6S-FLEV (with fibrinogen measurement) vs. Clauss-fibrinogen methods. TEG6S parameters obtained during rewarming were compared to the surrogate endpoints for perioperative bleeding using linear regression analysis. Among 100 patients, 225 TEG5000 vs.TEG6S comparisons and 54 TEG6S-FLEV were analyzed. Good correlation was observed for all parameters comparing TEG5000 to TEG6S and TEG6S-FLEV to the Clauss-fibrinogen method (Pearson r ≥ .7). Similar to rewarming TEG5000 MA, rewarming TEG6S MA was the only parameter independently associated with risk for perioperative bleeding (median [interquartile range {IQR}] in bleeding vs. nonbleeding patients: 35 [29, 48] vs. 37 [32, 55]; = .02). A platelet transfusion calculator was developed based on TEG6S results by determining the relationship between platelet transfusion volume (mL/kg) and percent change in MA using linear regression analysis. TEG6S is a good alternative point-of-care method to analyze a patient's coagulation profile and it is comparable to TEG5000 in pediatric patients undergoing cardiac surgery on cardiopulmonary bypass. Lower TEG6S MA during rewarming is associated with increased risk for perioperative bleeding. TEG analysis during rewarming may be useful in customizing platelet transfusion therapy by reducing the risk of bleeding while minimizing excessive blood product transfusions.
J Extra Corpor Technol
· 2022 Mar · PMID 36380825
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Apnea test must be performed to confirm brain death in patients meet clinical criteria. But the increment of carbon dioxide is generally not achievable because of the diminished production of carbon dioxide and additiona...Apnea test must be performed to confirm brain death in patients meet clinical criteria. But the increment of carbon dioxide is generally not achievable because of the diminished production of carbon dioxide and additional sweep in extra corporeal membrane oxygenation (ECMO). We report three children with congenital heart disease treated with ECMO and had brain death during follow-up. All met clinical criteria but apnea test cannot be achieved in classical way because of prolonged duration and hemodynamic compromise. Therefore, we used external carbon dioxide to achieve desired levels of oxygen and carbon dioxide safely. Because of the lack of protocols for pediatric patients on ECMO, apnea test with exogenous carbon dioxide may be a reliable and rapid test in such patients. Especially cardiac patients, in whom classical apnea test can cause rapid deterioration, exogenous carbon dioxide may serve as an alternative.
Rutto A, Koech P, Korir A
… +2 more, Groom R, White R
J Extra Corpor Technol
· 2022 Mar · PMID 36380824
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Standards and guidelines for cardiopulmonary bypass have been established by various professional societies. They serve as an instrument to guide safe and effective patient care. We conducted a survey of practicing perfu...Standards and guidelines for cardiopulmonary bypass have been established by various professional societies. They serve as an instrument to guide safe and effective patient care. We conducted a survey of practicing perfusionists in Kenya to learn about their background, education, current clinical practice and about their knowledge, and attitude regarding standards and guidelines. Two multiple-choice surveys were distributed to all known practicing perfusionist in Kenya using SurveyMonkey (San Mateo, CA). Multiple-choice questions related to professional background, training, annual procedure volume, staffing models, clinical practices, the use of safety devices, and the use of checklists were included in the questionnaires. The survey also inquired about familiarity with American and European perfusion practice standards and guidelines and opinions on establishing standards in Kenya. Responses were received from 12 perfusionists practicing at 10 centers. Professional backgrounds included anesthesia nursing, clinical officers, and critical care nursing. Sixty-seven percent (8/12) received formal training and 33% (4/12) trained primarily through clinical instruction. Of those that received formal training, 63% (5/8) received 1-2 years of training, 25% (2/8) <1 year but more than 6 months, and 12.5% (1/8) received 6 months of formal training. The median clinical experience was 5 years (range 1-22). The median annual case load was 54 (range 0-100). Use of safety devices was reported as follows: level sensor 75% (9/12), air bubble detector 17% (2/12), one-way vent valves 67% (8/12), continuous venous oxygen saturation monitoring 25% (3/12), and gas supply analyzers 33% (4/12). More than one-third of the respondents had no knowledge of the American and European perfusion practice standards, and nearly two-thirds were aware of or had read them. This survey provides contextual information about perfusion practice in Kenya in 2021. There was consensus among perfusionists to develop standards and practice guidelines for Kenya.
J Extra Corpor Technol
· 2022 Mar · PMID 36380823
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Near-infrared spectroscopy (NIRS) is a non-invasive clinical tool allowing for real-time, continuous measurement of regional tissue oxygenation (rSO); though predominantly used for neuromonitoring, it also has the potent...Near-infrared spectroscopy (NIRS) is a non-invasive clinical tool allowing for real-time, continuous measurement of regional tissue oxygenation (rSO); though predominantly used for neuromonitoring, it also has the potential for early detection of hemodynamic compromise in the patients on extracorporeal life support (ECLS). The authors present two cases of neonates for whom continuous monitoring of multisite rSO with NIRS provided the first indication of a significant compromise in hemodynamic status from catastrophic hemorrhagic complications while on ECLS ahead of conventional ECLS monitoring parameters. Routine NIRS monitoring of neonates on ECLS has utility for ongoing assessment of hemodynamic status and can be used for early detection of complications leading to impaired tissue perfusion.
J Extra Corpor Technol
· 2022 Mar · PMID 36380822
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Extracorporeal Membrane Oxygenation (ECMO) was first used in the 1970s. Its use is increasingly common in critical care and perioperative settings and has gained newfound prominence during COVID-19. To guide future resea...Extracorporeal Membrane Oxygenation (ECMO) was first used in the 1970s. Its use is increasingly common in critical care and perioperative settings and has gained newfound prominence during COVID-19. To guide future research, we conducted a bibliometric analysis of ECMO literature. Thomson Reuters Web of Science was searched to March 7, 2021. Articles were ranked by total number of citations. Data was extracted from the 100 most cited papers relevant to ECMO for study design, topic, author, year, and institution. Journal impact factor for 2019 and Eigenfactor scores were also recorded. Our search retrieved a total of 18,802 articles. Median number of citations for the top 100 articles was 220 (range 157-1,819). These were published in 34 journals, with first authors originating from 15 countries. The had the highest number of articles (n = 9) while publications had the most citations (n = 3,191). Use of ECMO was most commonly observed in cardiogenic shock or acute respiratory distress syndrome. United States had the greatest article output (n = 49). With 10 publications, 2013 was the most prolific year. Using linear regression, when controlled for time since publication, there was no statistically significant relationship between 2019 journal impact factor and number of article citations ( = .09). Top articles in the ECMO literature are of considerable impact and quality. As the United States produced the bulk of the prominent evidence base, and most data were regarding respiratory issues, outsized advances in ECMO may be possible within the United States during the COVID-19 era.
J Extra Corpor Technol
· 2022 Mar · PMID 36380821
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Blood product usage is an important outcome for patients undergoing cardiac surgery. In 2015, our center made a concerted effort with multiple departments to focus on reducing transfusion rates in surgical patients requi...Blood product usage is an important outcome for patients undergoing cardiac surgery. In 2015, our center made a concerted effort with multiple departments to focus on reducing transfusion rates in surgical patients requiring cardiopulmonary bypass (CPB). Specific changes included an upgrade of the oxygenator in mid-2015 and, in early 2016, implementation of a hemostasis management system (HMS) that used heparin dose-response titration assays for heparin and protamine management. A retrospective chart review demonstrated significant decreases in the quarterly average of patients receiving packed red blood cells (PRBCs) from a baseline of 26.7% to 22.7% following the oxygenator upgrade ( = .021) and from 22.7% to 8.8% following implementation of the HMS ( = .0017). Platelet usage decreased from an average of 50.5% during the baseline and oxygenator upgrade periods to 22.2% following implementation of the HMS ( < .0001). Usage of fresh frozen plasma (FFP) decreased from an average of 28.2% of cases during the baseline and oxygenator upgrade periods to 10.4% during 2016, and cryoprecipitate usage decreased from 38.5% to 15.4%. Heparin usage averaged 56,903 units before implementation of the HMS, decreasing to an average of 43,796 units following HMS implementation ( < .0001). During the same time periods, protamine usage averaged 340.3 mg and 183.2 mg, respectively. Because improvements achieved during quality initiatives may revert back to their pre-intervention state once the assessment period is over, we performed a second retrospective analysis to determine whether the improvements achieved were maintained during the 48 months following the initial study. During 2017-2020, quarterly average usage of blood products was as follows: PRBCs, 11.9%; platelets, 14.7%; FFP, 6.2%; and cryoprecipitate, 11.5%. Quarterly, average use of heparin and protamine were 31,556 ± 2,757 units and 189 ± 113 mg, respectively. These findings indicate that the improvements achieved were not limited to the duration of the initial quality initiative.
Yang S, Williams B, Kaczorowski D
… +1 more, Mazzeffi M
J Extra Corpor Technol
· 2022 Jun · PMID 35928342
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Disseminated intravascular coagulation (DIC) is a life-threatening hematologic derangement characterized by dysregulated thrombin generation and excessive fibrinolysis. However, DIC is poorly characterized in the extraco...Disseminated intravascular coagulation (DIC) is a life-threatening hematologic derangement characterized by dysregulated thrombin generation and excessive fibrinolysis. However, DIC is poorly characterized in the extracorporeal membrane oxygenation (ECMO) population, and the underlying mechanisms are not well understood. Several mechanisms contribute to DIC in ECMO, including consumption of coagulation factors, acquired von Willebrand's syndrome leading to thrombocytopenia, and hyperfibrinolysis. There are few case reports of DIC in adult ECMO patients. Most are in the context of venoarterial ECMO, which is typically used in the setting of cardiogenic shock and cardiac arrest. These disease states themselves are known to be associated with DIC, liver failure, impaired anticoagulant mechanisms, and increased fibrinolysis. We present an unusual case of a 74-year-old man who developed overt DIC during veno-venous (VV) ECMO. DIC resulted in clinical bleeding and severe hypofibrinogenemia requiring massive cryoprecipitate transfusion of 87 pooled units. When the patient was decannulated from ECMO, his platelet count and fibrinogen concentration improved within 24 hours, suggesting that ECMO was a proximate cause of his DIC.
O'Meara C, Timpa J, Peek G
… +4 more, Sindelar M, Ross J, Raper J, Byrnes JW
J Extra Corpor Technol
· 2022 Jun · PMID 35928341
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Nitric oxide (NO) incorporation into the sweep gas of the extracorporeal life support (ECLS) circuit has been proposed as a strategy to ameliorate the insults caused by the systemic inflammatory response. This technical...Nitric oxide (NO) incorporation into the sweep gas of the extracorporeal life support (ECLS) circuit has been proposed as a strategy to ameliorate the insults caused by the systemic inflammatory response. This technical study describes circuit modifications allowing nitric oxide to be incorporated into the circuit and describing and validating the oxygenator sweep flow rates necessary to achieve consistent safe delivery of the therapy. For patients requiring sweep rates less than 2 L/min, a simplified setup, incorporating a pressure relief valve/low flow meter in the gas delivery line, was placed in line between the blender/NO injector module and the NO sampling port/oxygenator. This setup allows titration of sweep to low flows without the need to blend in CO while maintaining the manufacturer recommendation of a minimum 2 L/min of sweep gas to safely deliver NO without nitric dioxide (NO) buildup. This setup was tested three times at three different FiO rates and eleven different desired low sweep flows to test for reproducibility and safety to build an easy-to-follow chart for making gas flow changes. For patients requiring oxygenator sweep rates greater than 2 L/min, the pressure relief valve/low flow meter apparatus is not needed. Maintaining consistent sweep rate and nitric oxide delivery is required in order to utilize this therapy in ECLS. We demonstrated gas delivery across all flow rates. There were no issues delivering 20 parts per million of NO and negligible NO detection. The results from testing this setup were used to provide the specialist a chart at which to set the low flow meter to produce the desired flow rate at which the patient needs. This has been used clinically on 15 ECLS patients with success.
Broadwin M, Palmeri M, Kelting T
… +4 more, Groom R, Robich M, Lucas FL, Kramer R
J Extra Corpor Technol
· 2022 Jun · PMID 35928338
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Small increases in serum creatinine postoperatively reflect an acute kidney injury (AKI) that likely occurred during cardiopulmonary bypass (CPB). Maintaining adequate oxygen delivery (DO) during CPB, known as GDP (goal-...Small increases in serum creatinine postoperatively reflect an acute kidney injury (AKI) that likely occurred during cardiopulmonary bypass (CPB). Maintaining adequate oxygen delivery (DO) during CPB, known as GDP (goal-directed perfusion), improves outcomes. Whether GDP improves outcomes of patients at high risk for acute renal failure (ARF) is unknown. Forty-seven adult patients undergoing cardiac surgery with CPB utilizing GDP with Cleveland Clinic Acute Renal Failure Score of 3 or greater were compared with a matched cohort of patients operated upon using a flow-directed strategy. CPB flow in the GDP cohort was based on a DO goal of 260 mL/min/m. Serum creatinine values were used to determine whether postoperative AKI occurred according to AKIN (Acute Kidney Injury Network) guidelines. We examined the distribution of all variables using proportions for categorical variables and means (standard deviations) for continuous variables and compared treatment groups using tests for categorical variables and tests for differences in distributions for continuous and count variables. We used inverse probability of treatment weighting to adjust for treatment selection bias. In adjusted models, GDP was not associated with a decrease in AKI (odds ratio [OR]: .97; confidence interval [CI]: .62, 1.52), but was associated with higher odds of ARF (OR: 3.13; CI: 1.26, 7.79), mortality (OR: 3.35; CI: 1.14, 9.89), intensive care unit readmission (OR: 2.59; CI: 1.31, 5.15), need for intraoperative red blood cell transfusion (OR: 2.02; CI: 1.26, 3.25), and postoperative platelet transfusion (OR: 1.78; CI: 1.05, 3.01) when compared with the historic cohort. In patients who are at high risk for postoperative renal failure, GDP was not associated with a decrease in AKI when compared to the historical cohort managed traditionally by determining CPB flows based on body surface area. Surprisingly, the GDP cohort performed significantly worse than the retrospective control group in terms of ARF, mortality, intensive care unit readmission, and RBC and platelet transfusions.
Iwanowski I, Böckhaus J, Richardt P
… +3 more, Kutschka I, Hanekop GG, Friedrich MG
J Extra Corpor Technol
· 2022 Jun · PMID 35928337
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Blood hemolysis caused by mechanical impact is a serious problem in medicine. In addition to the heart-lung machine (artificial surfaces, flow irritating connection points) which contributes to hemolysis, blood suction a...Blood hemolysis caused by mechanical impact is a serious problem in medicine. In addition to the heart-lung machine (artificial surfaces, flow irritating connection points) which contributes to hemolysis, blood suction and surgical suction devices are influencing factors. Goal of our research is to develop best flow optimizing suction geometry that represents the best compromise between all influencing effects. Based on data that negative pressure and turbulence have a negative impact on blood components, 27 surgical suction tips have been examined for acoustic stress and negative pressure behavior. Furthermore, a dimensionless factor was introduced to assess the overall performance of the suction tips investigated.
J Extra Corpor Technol
· 2022 Jun · PMID 35928336
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Hematologic complications are a source of morbidity and mortality for patients receiving extracorporeal membrane oxygenation (ECMO) support. There is no consensus strategy for monitoring anticoagulation for children supp...Hematologic complications are a source of morbidity and mortality for patients receiving extracorporeal membrane oxygenation (ECMO) support. There is no consensus strategy for monitoring anticoagulation for children supported with ECMO. This study evaluated a novel measurement of anticoagulation for children on ECMO. This was a single-center observational study of children supported with ECMO from 2015 to 2020. Each patient's current unfractionated heparin dose was multiplied by the current antithrombin III (AT) level to obtain a novel anticoagulation value, the heparin-antithrombin product (HAP). This value was compared with the heparin dose, AT, and activated clotting time (ACT) to predict anti-Xa value using linear correlation and decision tree methods. Data were obtained from 128 patients supported with ECMO. The HAP value was more highly correlated with anti-Xa level than heparin dose, AT level, and ACT. This correlation was highest in the neonatal population ( = .7). The variable importance metrics from the regression tree and random forest models both identified the HAP value as the most influential predictor variable for anti-Xa value. The HAP value is more highly correlated with the anti-Xa level than heparin dose, AT level, or ACT. Further research is needed to evaluate the effectiveness of the HAP value as a measurement of anticoagulation for children on ECMO.
Nagashima K, Inoue T, Nakanaga H
… +3 more, Matsuyama S, Geshi E, Tabata M
J Extra Corpor Technol
· 2022 Jun · PMID 35928335
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It has been reported that a single-dose cardioplegia interval is useful, but the safe interval doses are not clear. We aimed to investigate the impact of the cardioplegia interval on myocardial protection using the modif...It has been reported that a single-dose cardioplegia interval is useful, but the safe interval doses are not clear. We aimed to investigate the impact of the cardioplegia interval on myocardial protection using the modified St. Thomas solution. We included consecutive isolated minimally invasive mitral valvuloplasty procedures ( = 229) performed at a hospital and medical center from January 2014 to December 2020. We compared postoperative peak creatine kinase MB and creatine kinase levels and other indicators between the short (Group S, = 135; maximum myocardial protection interval <60 minutes) and long (Group L, = 94; maximum myocardial protection interval ≥60 minutes) interval groups. Propensity score matching was used to adjust for confounders between the two groups. After propensity score matching, Groups S and L contained 47 patients each. Groups S and L did not differ significantly in peak creatine kinase MB (45.8 ± 26.3 IU/L and 41.5 ± 27.9 IU/L, respectively; = .441) and creatine kinase levels (1,133 ± 567 IU/L and 1,100 ± 916 IU/L, respectively; = .837) after admission to the intensive care unit on the day of surgery based on propensity score matching. In multivariate analysis, a cardioplegia dosing interval ≥60 minutes was not significantly associated with the maximum creatine kinase MB level after admission to the intensive care unit on the day of surgery ( = .354; 95% confidence interval: -1.67 to 4.65). Using the antegrade modified St. Thomas solution, the long interval dose method is useful and safe in minimally invasive mitral valvuloplasty.
J Extra Corpor Technol
· 2022 Jun · PMID 35928334
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Pediatric patients undergoing cardiopulmonary bypass (CPB) require adequate anticoagulation to combat hemostatic activation. Heparin is used to bind and catalyze antithrombin III (ATIII) that works to inhibit clot format...Pediatric patients undergoing cardiopulmonary bypass (CPB) require adequate anticoagulation to combat hemostatic activation. Heparin is used to bind and catalyze antithrombin III (ATIII) that works to inhibit clot formation. To dose heparin, a weight-based (WB) or patient-specific concentration-based (PSCB) method can be used. The WB protocol calculates the dose based on the patients' weight and uses an activated clotting time (ACT) test to ensure anticoagulation. The ACT has limitations during CPB especially for pediatric patients who have immature hemostatic systems. The PSCB method predicts the patients' response to heparin by projecting a heparin dose-response (HDR) curve. Some investigators have found benefit to using the PSCB method but further investigation into how well the HDR predicts the heparin response is needed. A literature review was conducted for studies that looked at heparin management strategies in pediatric CPB patients between 1992 and 2020. Articles that focused on pediatric physiology, heparin management strategies, and anticoagulation were included. Articles older than 1990 were excluded. The literature review highlights that utilizing the PSCB approach more adequately anticoagulated patients. The WB protocol was found to have several flaws due to its reliance on the ACT, especially in infants. The results show that further investigation is needed to understand why there is benefit to using the PSCB approach. Observing the association between the HDR curve and subsequent heparin concentrations could determine how accurately it predicts the patients' response to heparin and why there is benefit to using this method.