The Safe Addition of Nitric Oxide into the Sweep Gas of the Extracorporeal Circuit during Cardiopulmonary Bypass and Extracorporeal Life Support.

Low cardiac output syndrome and the systemic inflammatory response are consequences of the cardiac surgical perioperative course. The mechanisms responsible are multifactorial, but recent studies have shown that nitric oxide (NO) may be a key component in mitigating some of these processes. Following on from literature reports detailing the use of inhaled NO added to the gas phase of the extracorporeal circuit, we set about developing a technique to perform this addition safely and efficiently.

Activated clotting time (ACT).

The standard assay for monitoring anticoagulation during extracorporeal life support (ECLS) is the activated clotting time (ACT) test, with celite, kaolin, and glass beads being the most commonly used activators to initiate contact activation. The point-of-care ACT test has been the preferred test in catheterization labs and cardiac theatres because it has a number of advantages over laboratory tests (Spinler et al., Ann Pharmacother 39(7-8):1275-1285, 2005): Shorter time between sampling and results.

Integrated Oxygenator FX05.

In recent years, there has been a trend to incorporate arterial filters into cardiopulmonary bypass (CPB) oxygenators. The FX oxygenators are the first examples of integrating a filter around the fibers of the oxygenator. To assess the efficacy of the FX05 oxygenator, in comparison with our existing CPB setup (RX05 oxygenator + arterial filter), we randomly assigned 40 patients undergoing CPB, with calculated flows <1.

Centrifugal pump inlet pressure site affects measurement.

During extracorporeal life support (ECLS), blood is exposed to a myriad of unphysiological factors that can affect outcome. One aspect of this is the sub-atmospheric pressure generated by the ECLS pump and imparted to blood elements along the pump inlet line. This pressure can be measured on the inlet line close to the pump head by adding a connector, or at the venous cannula connection site.

The use of extracorporeal life support in the treatment of influenza-associated myositis/rhabdomyolysis.

A 13-year-old girl presented to the emergency department with fatigue, headaches and muscle stiffness after returning from a family camping trip. Within 24 h, she was transferred to ICU with general oedema and low saturations, where she had a cardio-respiratory arrest and was placed on veno-arterial extracorporeal membrane oxygenation (ECMO). The patient was successfully supported with ECMO for profound myocardial dysfunction and haemofiltration for rhabdomyolysis and acute renal failure.

New technology increases perioperative haemoglobin levels for paediatric cardiopulmonary bypass: what is the benefit?

Increasing perioperative haemoglobin level by reducing priming volume and maintaining a safe cardiopulmonary bypass (CPB) system is the aim of every perfusionist. In this study, we have compared the two membrane oxygenators and pump systems used for paediatric bypass at the Royal Children's Hospital on a regular basis since 1988. We looked at all patients who had the Cobe VPCML (Cobe Laboratories, Denver, CO, USA) and Terumo RX-05 (Terumo Corporation, Tokyo, Japan) oxygenators used for flows from 800 mL/min up to the maximum rated flow for the respective oxygenator from January 2002 until March 2004.