Temperature Outcomes without heater cooler units in adult patients supported with extracorporeal membrane oxygenation: A retrospective cohort study.

Introduction: Heater-cooler units (HCUs) are frequently incorporated into extracorporeal membrane oxygenation (ECMO) circuits to help maintain patient normothermia. However, these devices may be associated with increased cost and infection risk. This study describes our institution's experience managing adult ECMO patients without the routine use of in-circuit HCUs.

Distal Perfusion Cannulation and Limb Complications in Venoarterial Extracorporeal Membrane Oxygenation.

The utility of distal perfusion cannula (DPC) placement for the prevention of limb complications in patients undergoing femoral venoarterial (VA) extracorporeal membrane oxygenation (ECMO) is poorly characterized. Patients undergoing femoral VA ECMO cannulation at two institutions were retrospectively assessed. Patients were grouped into those who did and those who did not receive a DPC at the time of primary cannulation.

Incidence, risk factors, and prognostic impact of re-exploration for bleeding after cardiac surgery: A retrospective cohort study.

Background: Postoperative re-exploration for bleeding (RB) is a frequent complication following cardiac surgery. We aim to assess incidence, risk factors, and prognostic significance of RB in a large cohort of cardiac patients.

Materials And Methods: We reviewed prospectively collected data for all patients who underwent cardiac surgery at our institution from 2007 to 2015.

Extracorporeal Membrane Oxygenation as a Bridge through Chemotherapy in B-Cell Lymphoma.

A 41-year-old female presented with a large anterior mediastinal mass adjacent to the heart. Biopsy demonstrated lymphoma. Upon administration of chemotherapy, she developed cardiogenic shock requiring a 5-day course of extracorporeal membrane oxygenation (ECMO) as a bridge through her treatment.

Variability in End-Organ Perfusion with Femoral-Femoral Venoarterial Extracorporeal Membrane Oxygenation: Aortographic Evidence.

In femoral-femoral venoarterial extracorporeal membrane oxygenation (VA-ECMO), the outflow of oxygenated blood from the circuit enters the aorta in retrograde fashion. As a result, variability in end-organ oxygenation (e.g.

Nonischemic Postoperative Seizure Does Not Increase Mortality After Cardiac Surgery.

Background: Postoperative seizure (PS) is an infrequent, yet distressing, complication after cardiac surgery. We wished to determine the prognostic significance of these complicated neurologic events.

Methods: The Weill Cornell Medical College Department of Cardiothoracic Surgery database and the New York State Department of Health Database were reviewed to identify all patients having PS after cardiac surgery between January 1, 2008, and December 31, 2011.

Blood conservation strategies in cardiac surgery: more is better.

Objectives: Recent data show that up to 50% of heart procedures require blood transfusion, which can have adverse long- and short-term outcomes for the patient. This led to the updated 2011 Society of Thoracic Surgery (STS)/Society of Cardiovascular Anesthesiologists (SCA) guidelines in an attempt to adopt more effective blood conservation techniques. We present our results after the implementation of a more aggressive strategy for intraoperative blood conservation in cardiac surgery.

Regional variation in arterial saturation and oxygen delivery during venoarterial extracorporeal membrane oxygenation.

Unlabelled: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) can be lifesaving in patients with cardiopulmonary collapse. However, observation studies have implied that oxygenated blood does not pass in a retrograde fashion from the VA-ECMO circuit to the aortic root and arch when the femoral artery (FA) is used. This study aims at accurately measuring the oxygen saturation in various arteries during VA-ECMO through different cannula sites.

Improved environmental impact with diversion of perfusion bypass circuit to municipal solid waste.

The project goal was to reduce waste disposal volume, costs and minimize the negative impact that regulated waste treatment and disposal has on the environment. This was accomplished by diverting bypass circuits from the traditional regulated medical waste (RMW) to clear bag waste, or municipal solid waste (MSW). To qualify circuits to be disposed of through MSW stream, the circuits needed to be void of any free-flowing blood and be "responsibly clear.

A novel method for percutaneous insertion of a right ventricular assist device.

Right heart failure is a rare but often fatal complication both in the pre- and postoperative setting. Right heart support with a ventricular assist device inserted in the operating room through median sternotomy can be a time-consuming procedure that requires a reoperation for removal. In cases of urgent need of right heart support, a percutaneous technique option may be of benefit.

2010 John H. Gibbon Lecture. Just say yes!

Advancing anything requires change and a new method. It can be a challenge to bring about the change that you believe in. This change however requires you to plan and say no to the old way of doing things.

Heparin sensitivity test for patients requiring cardiopulmonary bypass.

Anticoagulation for the open heart surgery patient undergoing cardiopulmonary bypass (CPB) is achieved with the use of heparin. The industry standard of activated clotting time (ACT) was used to measure the effect of heparin. The commonly acceptable target time of anticoagulation adequacy is 480 seconds or greater.

Cardiopulmonary bypass in patients with pre-existing coagulopathy.

Patients with pre-existing coagulopathies who undergo surgical interventions are at increased risk for bleeding complications. This risk is especially true in cardiac surgical procedures with cardiopulmonary bypass (CPB) because of the necessity for heparinization and the use of the extracorporeal circuits, which have destructive effects on most of the blood components. In this review, cases of cardiac surgeries in patients with certain pre-existing coagulopathies are summarized, which could shed a light on future managements of such patients undergoing cardiac procedures with CPB.

Negative fluid displacement: an alternative method to assess patency of arterial line cannulation.

Optimal flow rate with minimal pressure gradient is the goal of arterial cannulation for cardiopulmonary bypass (CPB). Misplacement of the arterial cannula or vascular pathology can lead to hemolysis or intimal damage with subsequent aortic dissection. The risk of dissection with aortic cannulation is low, 0.

Diagnosis and treatment of heparin-induced thrombocytopenia.

Heparin-induced thrombocytopenia (HIT) is a major side effect secondary to the administration of heparin. This syndrome is serious and potentially life threatening. This response is the result of antibodies formed against the platelet factor 4 (PF4)/heparin complex.

The effects of platelet inhibitors on blood use in cardiac surgery.

Platelet inhibition via glycoprotein (GP) IIb/IIIa receptor antagonists has greatly reduced the need for emergent cardiac surgery. However, this change has come at a cost to both the patient and the cardiac surgical team in terms of increased bleeding risk. Current guidelines for patients requiring coronary artery bypass surgery include: 1) cessation of GP IIb/IIIa inhibitor; 2) delay of surgery for up to 12 h if abciximab, tirofiban, or eptafibitide is used; 3) utilization of ultrafiltration via zero balance technique; 4) maintenance of standard heparin dosing despite elevated bleeding times; and 5) transfusion of platelets as needed, rather than prophylactically.

MAST system: a new condensed cardiopulmonary bypass circuit for adult cardiac surgery.

There have been many refinements in cardiopulmonary bypass (CPB) techniques over the past few decades specific to design, materials and function. Despite these improvements, use of the standard length circuit tubing and pump oxygenator alter cellular, biochemical and rheological properties by inducing a systemic inflammatory response, persisting well into the early postoperative phase. We have designed a new condensed CPB circuit, the MAST system, where the oxygenator and the pumps are brought closer to the operating table (within 30 inches) with the help of a series of telescopic swivel steel poles to which they are attached.

Isolated extra-corporeal coronary perfusion circuit for use during off-pump coronary artery bypass grafting.

Cardiovascular surgery would not have developed into its present form without the heart-lung machine. In coronary artery bypass grafting (CABG), cardiopulmonary bypass allows accurate, all site, complete revascularization in a way convenient to the surgeon. The aim of this circuit is to find new ways to reduce invasiveness of CABG and to create new basis conditions for successful coronary bypass grafting on the beating heart.

Perfusion method for thoracoabdominal aneurysm repair using the open distal technique.

Challenges related to perfusion support of thoracoabdominal aneurysm repair include maintenance of distal aortic perfusion, rapidity of fluid resuscitation, and avoidance of both hypothermia and excessive hemodilution. Using available technology, we have devised a circuit and protocol that addresses these issues. To accomplish such support a bypass circuit consisting of 3/8 inch tubing connected to a centrifugal pump and low-prime heat exchanger was constructed.

Retrograde autologous priming for cardiopulmonary bypass: a safe and effective means of decreasing hemodilution and transfusion requirements.

Objectives: The obligatory hemodilution resulting from crystalloid priming of the cardiopulmonary bypass circuit represents a major risk factor for blood transfusion in cardiac operations. We therefore examined whether retrograde autologous priming of the bypass circuit would result in decreased hemodilution and red cell transfusion.

Methods: Sixty patients having first-time coronary bypass were prospectively randomized to cardiopulmonary bypass with or without retrograde autologous priming.

Comprehensive multimodality blood conservation: 100 consecutive CABG operations without transfusion.

Background: Despite the recent introduction of a number of technical and pharmacologic blood conservation measures, bleeding and allogeneic transfusion remain persistent problems in open heart surgical procedures. We hypothesized that a comprehensive multimodality blood conservation program applied algorithmically on the basis of bleeding and transfusion risk would provide a maximum, cost-effective, and safe reduction in postoperative bleeding and allogeneic blood transfusion.

Methods: One hundred consecutive patients undergoing coronary artery bypass grafting were prospectively enrolled in a risk factor-based multimodality blood conservation program (MMD group).

Open heart operations without transfusion using a multimodality blood conservation strategy in 50 Jehovah's Witness patients: implications for a "bloodless" surgical technique.

Background: Blood transfusion persists as an important risk of open heart operations despite the recent introduction of a variety of new pharmacologic agents and blood conservation techniques as independent therapies. A comprehensive multimodality blood conservation program was developed to minimize this risk.

Study Design: To provide a strategy for operating without transfusion, this program was prospectively applied to 50 adult patients who are Jehovah's Witnesses and have undergone open heart operation at our institution since 1992.