scholarly journals 2019 EACTS/EACTA/EBCP guidelines on cardiopulmonary bypass in adult cardiac surgery: a tool to better clinical practice

2020 ◽  
Vol 57 (2) ◽  
pp. 207-209 ◽  
Author(s):  
Robert A Baker ◽  
Aleksandar Nikolic ◽  
Francesco Onorati ◽  
R Peter Alston
Keyword(s):  
Cardiac Surgery ◽  
Clinical Practice ◽  
Cardiopulmonary Bypass ◽  
Adult Cardiac Surgery

Air Embolism on Cardiopulmonary Bypass

2019 ◽  
pp. 160-165
Author(s):  
Aaron Hudson ◽  
Ryan Hood
Keyword(s):  
Cardiac Surgery ◽  
Clinical Practice ◽  
Cardiopulmonary Bypass ◽  
Sudden Death ◽  
Air Embolism ◽  
Cardiac Surgical Procedures ◽  
Daily Basis ◽  
Team Members ◽  
Cardiac Surgeons ◽  
Almost All

The danger associated with air embolism in cardiac surgery has been well established for over 125 years. In the first volume of Annals of Surgery, published in 1885, long preceding the era of cardiac surgery and the use of extracorporeal circulatory techniques, Dr. Nicholas Senn alluded to the ensuing calamity caused by air embolism: “I intend on this occasion to call your attention to one of the most dreaded and, I may add, one of the most uncontrollable causes of sudden death—I allude to air-embolism.”1,2 Since the advent of modern cardiac surgery, much attention has been focused on the prevention of air embolism by cardiac surgeons, anesthesiologists, and perfusionists alike. Indeed, all three team members are critically responsible for the safe conduct of thousands of cardiac surgical procedures occurring on a daily basis worldwide. While the morbidity and mortality of massive air embolism is exceedingly high, most believe that with appropriate training and unwavering vigilance during clinical practice, almost all massive air emboli can be prevented.3

scholarly journals Blood Lactate Level as Predictor of Early Outcome after Cardiac Surgery under Cardiopulmonary Bypass

2018 ◽  
Vol 13 (2) ◽  
pp. 50-54
Author(s):  
Md Abul Kalam Azad ◽  
Md Abul Quashem ◽  
Md Rezaul Karim ◽  
Md Kamrul Hasan
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Blood Lactate ◽  
Lactate Level ◽  
Prolonged Mechanical Ventilation ◽  
Blood Lactate Level ◽  
Binary Logistic Regression Analysis ◽  
Early Outcome ◽  
Icu Transfer ◽  
Adult Cardiac Surgery

We examined the hypothesis that high blood lactate level in ICU patient after adult cardiac surgery under cardiopulmonary bypass is associated with early adverse outcome. The objective of this study was to evaluate whether blood lactate level after cardiac surgery is predictor of the early outcome after adult cardiac surgery under CPB. In this prospective observational study total 100 patients were enrolled who underwent elective cardiac surgery under CPB as per inclusion and exclusion criteria. Blood lactate levels > 3mmol/ L 6 hours after ICU transfer were present in 57(57%) patients. The binary logistic regression analysis showed that blood lactate level 6 hours after ICU transfer is an independent predictor for prolonged mechanical ventilation time (OR 2.417, 95% CI 1.272 - 4.596, p = .007), prolonged ICU stay (OR 1.562, 95% CI 1.181 - 2.067, p = .002), neurological deficit (OR 2.432, 95% CI 1.539 - 3.843, p = .001), pulmonary complication (OR 1.301, 95% CI 1.011 - 1.676, p = .041), arrhythmia (OR 1.444, 95% CI 1.102 - 1.893, p = .008), renal dysfunction (OR 1.838, 95% CI 1.352 - 2.497, p = .001) and mortality (OR 1.822, 95% CI 1.123- 2.955, p = .015). In conclusion, blood lactate level 6 hours after ICU transfer is an independent risk factor for worse outcomes in adult patients including mortality after cardiac surgery under CPB.University Heart Journal Vol. 13, No. 2, July 2017; 50-54

Safe time limits of aortic cross-clamping and cardiopulmonary bypass in adult cardiac surgery

Perfusion ◽  
2009 ◽  
Vol 24 (5) ◽  
pp. 297-305 ◽  
Author(s):  
Juha Nissinen ◽  
Fausto Biancari ◽  
Jan-Ola Wistbacka ◽  
Timo Peltola ◽  
Pertti Loponen ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Time Limits ◽  
Adult Cardiac Surgery

scholarly journals Leukocyte depletion during cardiopulmonary bypass in routine adult cardiac surgery

2011 ◽  
Vol 12 (2) ◽  
pp. 207-212 ◽  
Author(s):  
J. F. M. Bechtel ◽  
S. Muhlenbein ◽  
W. Eichler ◽  
M. Marx ◽  
H.-H. Sievers
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Leukocyte Depletion ◽  
Adult Cardiac Surgery

scholarly journals Del Nido Cardioplegia Versus Cold Blood Cardioplegia in Adult Cardiac Surgery: Protocol for a Randomized Controlled Trial

10.2196/17826 ◽  
2020 ◽  
Vol 9 (7) ◽  
pp. e17826
Author(s):  
Jessica Garcia-Suarez ◽  
Javier Garcia Fernandez ◽  
Sergio Sanz ◽  
Daniel Martinez Lopez ◽  
Leticia Reques ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Myocardial Protection ◽  
Primary Outcome ◽  
Retrospective Studies ◽  
Adult Patients ◽  
Blood Cardioplegia ◽  
Cardioplegia Solution ◽  
Adult Cardiac Surgery

Background The use of cardioplegia solutions as a myocardial protection technique is essential during cardiac surgery with cardiopulmonary bypass. The del Nido cardioplegia solution (DNS) has been widely used as a myocardial preservation technique for pediatric patients undergoing cardiac surgery with cardiopulmonary bypass. Its unique pharmacological features have created growing interest for adult cardiac surgery, especially for elderly patients or those with ventricular dysfunction who are more prone to ischemia-reperfusion injury. Ever since its implementation, several retrospective studies have been published to validate the efficacy, safety, and efficiency of DNS in adult patients undergoing coronary revascularization, valve replacement, or combined procedures. Recently, a meta-analysis based on nine retrospective studies was published claiming the noninferiority of DNS compared to other conventional cardioplegia solutions. Few prospective randomized studies have been conducted whose primary outcome was the assessment of DNS clinical efficacy compared to other solutions commonly used in adult patients. Objective The aim of this randomized clinical trial is to assess the benefits of DNS compared to Cardi-Braun blood cardioplegia solution in clinical and biochemical terms regarding myocardial protection during adult cardiac surgery. Methods This is the protocol of a controlled, randomized, single-center clinical trial carried out at the Puerta de Hierro Majadahonda University Hospital in Spain. A total of 474 participants over the age of 18 years undergoing elective cardiac surgery with cardiopulmonary bypass will be assigned to groups by simple randomization to receive either DNS or Cardi-Braun blood cardioplegia solution. The primary outcome will be the differences between groups in myocardial protection in biochemical terms (ie, perioperative troponin levels) and clinical terms (ie, presence of the composite variable acute cardiovascular event). The clinical trial will be carried out under conditions of respect for the fundamental rights of the person and the ethical principles that affect biomedical research with human beings, as well as in accordance with international recommendations contained in the Declaration of Helsinki and its subsequent revisions. Results The inclusion process started in 2018. Data cleaning and analyses are expected to take place in the fall of 2020 and the results are expected in January 2021. Conclusions This study is particularly relevant as it will be one of the first to analyze the clinical effects of del Nido cardioplegia on the basis of direct myocardial protection parameters. In light of published studies, carrying out prospective studies based on primary clinical objectives with a larger sample, high-risk patients, and longer cardiopulmonary bypass times continues to be necessary. We believe that our study addresses an important gap in the knowledge of del Nido cardioplegia in adult patient cardiac surgery and will be able to clarify the possible benefits of this method in a large population of patients undergoing these procedures. Trial Registration European Union Drug Regulating Authorities Clinical Trials Database (EudraCT) 2017-005144-14; https://www.clinicaltrialsregister.eu/ctr-search/search?query=2017-005144-14+; ClinicalTrials.gov NCT04094168; https://clinicaltrials.gov/ct2/show/NCT04094168 International Registered Report Identifier (IRRID) DERR1-10.2196/17826

scholarly journals Do continuous forms of intra-operative ultrafiltration enhance recovery after adult cardiac surgery with cardiopulmonary bypass? A protocol for systematic review and meta-analysis of randomized controlled trials

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Joel Bierer ◽  
David Horne ◽  
Roger Stanzel ◽  
Mark Henderson ◽  
Leah Boulos ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
High Risk ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Inflammatory Syndrome ◽  
Adult Cardiac Surgery

Abstract Background Cardiac surgery with cardiopulmonary bypass (CPB) is associated with a systemic inflammatory syndrome that adversely impacts cardiopulmonary function and can contribute to prolonged postoperative recovery. Intra-operative ultrafiltration during CPB is a strategy developed by pediatric cardiac specialists, aiming to dampen the inflammatory syndrome by removing circulating cytokines and improving coagulation profiles during the cardiac operation. Although ultrafiltration is commonly used in the pediatric population, it is not routinely used in the adult population. This study aims to evaluate if randomized evidence supports the use of continuous intra-operative ultrafiltration to enhance recovery for adults undergoing cardiac surgery with CPB. Methods This systematic review and meta-analysis will include randomized controlled trials (RCT) that feature continuous forms of ultrafiltration during adult cardiac surgery with CPB, specifically assessing for benefit in mortality rates, invasive ventilation time and intensive care unit length of stay (ICU LOS). Relevant RCTs will be retrieved from databases, including MEDLINE, Embase, CENTRAL and Scopus, by a pre-defined search strategy. Search results will be screened for inclusion and exclusion criteria by two independent persons with consensus. Selected RCTs will have study demographics and outcome data extracted by two independent persons and transferred into RevMan. Risk of bias will be independently assessed by the Revised Cochrane Risk-of-Bias (RoB2) tool and studies rated as low-, some-, or high- risk of bias. Meta-analyses will compare the intervention of continuous ultrafiltration against comparators in terms of mortality, ventilation time, ICU LOS, and renal failure. Heterogeneity will be measured by the χ2 test and described by the I2 statistic. A sensitivity analysis will be completed by excluding included studies judged to have a high risk of bias. Summary of findings and certainty of the evidence, determined by the GRADE approach, will display the analysis findings. Discussion The findings of this systematic review and meta-analysis will summarize the evidence to date of continuous forms of ultrafiltration in adult cardiac surgery with CPB, to both inform adult cardiac specialists about this technique and identify critical questions for future research in this subject area. Systematic review registration This systematic review and meta-analysis is registered in PROSPERO CRD42020219309 (https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020219309). 

scholarly journals Analysis of online gas monitoring CDI 500® and SYSTEM M-M4®. Are they comparable tools for clinical perfusion practice?

2019 ◽  
pp. 21-27 ◽  
Author(s):  
Maria Luz Recio ◽  
Maria Carmen Santos ◽  
Carlos Casado ◽  
Juan Carlos Santos
Keyword(s):  
Cardiac Surgery ◽  
Clinical Practice ◽  
Cardiopulmonary Bypass ◽  
Prospective Observational Study ◽  
Venous Blood ◽  
Blood Gases ◽  
Reliable Data ◽  
Direct Evaluation ◽  
Two Samples ◽  
Evaluation Of Data

Objective: to compare the data obtained from the CDI500® and Spectrum M4® to assess the reliability of the results and their impact on cardiopulmonary bypass. Methods: a prospective observational study of patients undergoing cardiac surgery with CPB was conducted between January-2017 and February-2018. The data provided by CDI and M4 was collected. Arterial and venous blood gases taken from Radiometer ABL90 Flex® were used as control. With the first sample, the data of both analyzers were adjusted. A minimum of two samples and a maximum of four were made. Results: 100 patients and 292 samples (32% women) with a mean age of 65.2 ± 11.5 years were studied. The parameters of the CDI and M4 practically did not present significant differences after the first adjustment, and without affecting the clinical practice, except in the bicarbonate and the excess of base where CDI does not adjust to the values. The analysis was done with the Bland/Altman charts, the PCO2 and PO2 were better measured by the CDI while Hto, Hb and SvO2 by M4, which was corroborated comparing the error percentages less than ± 5% in both systems, the significant differences being in the five parameters. Conclusions: both systems provide reliable data, although they require a previous calibration. The M4 allows direct evaluation of data to help a goal directed perfusion.

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