{"title":"Scientific Articles of Interest","authors":"Rick G. Smith","doi":"10.1051/ject/200739210","DOIUrl":"https://doi.org/10.1051/ject/200739210","url":null,"abstract":"","PeriodicalId":309024,"journal":{"name":"The Journal of ExtraCorporeal Technology","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2007-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126683200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Retrospective surveys of perfusion practice and experience have provided valuable information for all clinicians and disciplines involved in open heart surgery. The most recent national survey, this time from Charriere et al. in France, represents another such survey. A distinguishing aspect of their report was the very high response rate (86%) from 57 centers performing 34,496 cardiopulmonary bypass (CPB) cases in 2005. This was perhaps because of involvement of a governmental advisory agency in the original solicitation and, secondarily, persistent follow-up by the authors to re-solicit initial non-responders. Like previous surveys cited in their report (1–5), they sought information on several known complications associated with CPB. Besides providing data on incident rates, they also gathered patient outcome information in four categories: (i) no injury; (ii) injury without permanent sequelae but increased length of hospital stay; (iii) injury with permanent sequelae; and (iv) death. These categories have been used in prior surveys and allow for some general comparisons on trends for specific incidents with the caveat that subtle differences in the wording of questions or descriptors on a questionnaire can significantly alter responses. For example, Charriere et al. describe “coagulation of the circuit,” whereas earlier surveys described this complication as “disseminated intravascular coagulopathy,” “consumption coagulopathy,” or more broadly, “coagulation problems” or “coagulation problems following bypass.” These differences urge caution for readers in making direct comparisons or conclusions relative to the earlier reports. In another example, comparison of results for “oxygenator failure” presents similar pitfalls in analysis caused by wording differences. Failure to transfer gas is one manifestation under this broad category, as is the development of a membrane leak, both of which have been described as “oxygenator failure.” Perhaps more important, in all surveys over the last four decades [except that of Jenkins et al. (4)], the incidence of adverse patient outcome for this complication was either zero or negligible. For another well-known complication, gas embolism from the CPB circuit, analysis is less equivocal, and in this survey, the news is good: the overall incidence rate was 8 of 30,512 cases, or 0.26 incidents per 1000 cases, and the incidence rate for an adverse patient outcome was 0.13 per 1000 cases. These data indicate a decline in the overall incidence rate ranging from 1.14 to 0.68 per 1000 cases (mean, 0.84) from four earlier surveys (1–3, 5) posing nearly identical questions on this complication. Examining the incidence of adverse patient outcome for gas embolism, the earlier surveys reported incident rates ranging from a high of 0.41 per 1000 in the 1970s (1) to 0.03 per 1000 (mean, 0.19 per 1000) in the survey of Mejak et al. (5). How can we account for the apparent decline in this particular complication? I
{"title":"Invited Commentary: RE: A Retrospective Survey of Monitoring/Safety Devices and Incidents of Cardiopulmonary Bypass for Cardiac Surgery in France","authors":"M. Kurusz","doi":"10.1051/ject/200739158","DOIUrl":"https://doi.org/10.1051/ject/200739158","url":null,"abstract":"Retrospective surveys of perfusion practice and experience have provided valuable information for all clinicians and disciplines involved in open heart surgery. The most recent national survey, this time from Charriere et al. in France, represents another such survey. A distinguishing aspect of their report was the very high response rate (86%) from 57 centers performing 34,496 cardiopulmonary bypass (CPB) cases in 2005. This was perhaps because of involvement of a governmental advisory agency in the original solicitation and, secondarily, persistent follow-up by the authors to re-solicit initial non-responders. Like previous surveys cited in their report (1–5), they sought information on several known complications associated with CPB. \u0000 \u0000Besides providing data on incident rates, they also gathered patient outcome information in four categories: (i) no injury; (ii) injury without permanent sequelae but increased length of hospital stay; (iii) injury with permanent sequelae; and (iv) death. These categories have been used in prior surveys and allow for some general comparisons on trends for specific incidents with the caveat that subtle differences in the wording of questions or descriptors on a questionnaire can significantly alter responses. For example, Charriere et al. describe “coagulation of the circuit,” whereas earlier surveys described this complication as “disseminated intravascular coagulopathy,” “consumption coagulopathy,” or more broadly, “coagulation problems” or “coagulation problems following bypass.” These differences urge caution for readers in making direct comparisons or conclusions relative to the earlier reports. In another example, comparison of results for “oxygenator failure” presents similar pitfalls in analysis caused by wording differences. Failure to transfer gas is one manifestation under this broad category, as is the development of a membrane leak, both of which have been described as “oxygenator failure.” Perhaps more important, in all surveys over the last four decades [except that of Jenkins et al. (4)], the incidence of adverse patient outcome for this complication was either zero or negligible. \u0000 \u0000For another well-known complication, gas embolism from the CPB circuit, analysis is less equivocal, and in this survey, the news is good: the overall incidence rate was 8 of 30,512 cases, or 0.26 incidents per 1000 cases, and the incidence rate for an adverse patient outcome was 0.13 per 1000 cases. These data indicate a decline in the overall incidence rate ranging from 1.14 to 0.68 per 1000 cases (mean, 0.84) from four earlier surveys (1–3, 5) posing nearly identical questions on this complication. Examining the incidence of adverse patient outcome for gas embolism, the earlier surveys reported incident rates ranging from a high of 0.41 per 1000 in the 1970s (1) to 0.03 per 1000 (mean, 0.19 per 1000) in the survey of Mejak et al. (5). \u0000 \u0000How can we account for the apparent decline in this particular complication? I","PeriodicalId":309024,"journal":{"name":"The Journal of ExtraCorporeal Technology","volume":"150 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2007-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115168113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Our classic article for this issue is a now historic 1972 report by Dr. Kantrowitz summarizing his research team’s success to demonstrate ventricular assist with artificial devices, diaphragms, aortic balloons, and orthotopic donor hearts (1). He weaves remarkable case reports into the article to illustrate what are now most certainly pioneering endeavors. Dr. Kantrowitz discusses the evolution of the mechanical cardiac assist (MCA) and counterpulsation prior to 1972. It is appropriate that we reflect on Dr. Kantrowiz’ contributions to our Journal since there are two article regarding IABP in this issue. Our classic article is one of three interesting contributions that the Kantrowitz team made to JECT in the 1970s (1–3). A keyword search of JECT for intra-aortic balloon pumping yielded only six articles, so the current IABP articles are welcomed and relevant to the newly updated perfusionist Scope of Practice Section 2.1.2. . The use of the IABP for MCA is an important aspect in the care of heart failure patents with which perfusionists should be familiar (4). Building on the work of Moulopoulos, et al. (5) and working at the same time as many other international researchers in the 1960s, Adrian Kantrowitz came to be referred to as the “father of intra-aortic balloon pumping”, probably because of his early success to help commercialize a pumping device and to form a 1970s Who’s-Who in cardiac surgery, multi-institutional research, and information-sharing group. The on-line Sixth Edition Columbia Encyclopedia lists Dr. Kantrowitz’s accomplishments as a physician and inventor (multiple patent holder) of a plastic heart valve, a heart lung machine, an internal pacemaker, and an auxiliary left ventricle. As well, Dr. Kantrowitz performed the first implantation of a partial mechanical heart in a human, the second human cardiac transplant, and pioneered motion pictures of the inside of the human heart. On a personal note, 1972 was the year I entered perfusion school and during my research class work, my classmates and I had the opportunity to visit Dr. Kantrowitz’s lab in Detroit. Dr. Kantrowitz, his research staff and his administrator-wife spent a great deal of time with us and gave us a lasting memory by allowing us to use the drive system (Kantrowitz Phase-Shift Balloon Pump) pictured in this issue’s classic article. In the 1950–1960s, Kantrowitz referred to diastolic augmentation as “arterial pressure delay” or “phase-shift pumping” while others coined the term “counterpulsation”. Not only is Dr. Kantrowitz a pioneer, surgeon, and inventor, but he is a motivating and effective teacher. Today, Dr. Kantrowitz continues to influence the ventricularassist industry with his Dynamic Aortic Patch . The third article contributed to JECT from the Kantrowitz team (3) is an interesting piece of research (a classic in its own right) that documents that counterpulsation prepares the myocardium to protect it from a forthcoming infarct, which is
{"title":"Classic Pages of the Journal of ExtraCorporeal Technology","authors":"J. Riley","doi":"10.1051/ject/200739201","DOIUrl":"https://doi.org/10.1051/ject/200739201","url":null,"abstract":"Our classic article for this issue is a now historic 1972 report by Dr. Kantrowitz summarizing his research team’s success to demonstrate ventricular assist with artificial devices, diaphragms, aortic balloons, and orthotopic donor hearts (1). He weaves remarkable case reports into the article to illustrate what are now most certainly pioneering endeavors. Dr. Kantrowitz discusses the evolution of the mechanical cardiac assist (MCA) and counterpulsation prior to 1972. It is appropriate that we reflect on Dr. Kantrowiz’ contributions to our Journal since there are two article regarding IABP in this issue. \u0000 \u0000Our classic article is one of three interesting contributions that the Kantrowitz team made to JECT in the 1970s (1–3). A keyword search of JECT for intra-aortic balloon pumping yielded only six articles, so the current IABP articles are welcomed and relevant to the newly updated perfusionist Scope of Practice Section 2.1.2. . The use of the IABP for MCA is an important aspect in the care of heart failure patents with which perfusionists should be familiar (4). \u0000 \u0000Building on the work of Moulopoulos, et al. (5) and working at the same time as many other international researchers in the 1960s, Adrian Kantrowitz came to be referred to as the “father of intra-aortic balloon pumping”, probably because of his early success to help commercialize a pumping device and to form a 1970s Who’s-Who in cardiac surgery, multi-institutional research, and information-sharing group. The on-line Sixth Edition Columbia Encyclopedia lists Dr. Kantrowitz’s accomplishments as a physician and inventor (multiple patent holder) of a plastic heart valve, a heart lung machine, an internal pacemaker, and an auxiliary left ventricle. As well, Dr. Kantrowitz performed the first implantation of a partial mechanical heart in a human, the second human cardiac transplant, and pioneered motion pictures of the inside of the human heart. \u0000 \u0000On a personal note, 1972 was the year I entered perfusion school and during my research class work, my classmates and I had the opportunity to visit Dr. Kantrowitz’s lab in Detroit. Dr. Kantrowitz, his research staff and his administrator-wife spent a great deal of time with us and gave us a lasting memory by allowing us to use the drive system (Kantrowitz Phase-Shift Balloon Pump) pictured in this issue’s classic article. \u0000 \u0000In the 1950–1960s, Kantrowitz referred to diastolic augmentation as “arterial pressure delay” or “phase-shift pumping” while others coined the term “counterpulsation”. Not only is Dr. Kantrowitz a pioneer, surgeon, and inventor, but he is a motivating and effective teacher. Today, Dr. Kantrowitz continues to influence the ventricularassist industry with his Dynamic Aortic Patch . \u0000 \u0000The third article contributed to JECT from the Kantrowitz team (3) is an interesting piece of research (a classic in its own right) that documents that counterpulsation prepares the myocardium to protect it from a forthcoming infarct, which is ","PeriodicalId":309024,"journal":{"name":"The Journal of ExtraCorporeal Technology","volume":"127 2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2007-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129835931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"From The Editor","authors":"A. Stammers","doi":"10.1051/ject/200537132","DOIUrl":"https://doi.org/10.1051/ject/200537132","url":null,"abstract":"","PeriodicalId":309024,"journal":{"name":"The Journal of ExtraCorporeal Technology","volume":"22 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2005-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131865716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
As is the tradition of the first issue of the New Year we include the abstracts from the upcoming International Meeting of the American Society of Extra-Corporeal Technology (AmSECT). This month AmSECT will hold its 43rd meeting at the Hilton Riverside Hotel in New Orleans, Louisiana, USA, and once again, individuals from all over the globe will travel to America to partake in the scientific discussions and social gatherings of the convention. Trying to describe the meeting to an individual who has never before attended AmSECT is a daunting task. No other perfusion-oriented meeting can boast of the diversity in subject content, nor breadth of presenters, that is seen at AmSECT. The format of the meeting parallels what one would encounter at large surgical or anesthesia meeting where multiple sessions are conducted concurrently. One might ask why not conduct the meeting as a ‘single auditorium’ session, as is the modus operandi of most meetings. It is always easier, and more economical, to conduct a meeting with a single plenary session as the primary venue. Some meetings may also include small breakout sessions that are focused on single topic subjects. Such informal settings are comfortable and allow participants the opportunity to discuss issues on a more personal level. However, there are drawbacks related to limitations such as a finite number of attendees and limited subject content. Another feature of AmSECT International is the ability of practitioners to view the developing technologies at the manufacturers exhibits. These exhibits serve as the epicenter for discussion as well as a place for renewing old friendships and for developing new ones. As perfusionists we are a technology driven group who rely heavily on industry to invest in the development of new products, ultimately with the goal of improving the conduct of cardiopulmonary bypass for improving patient care. Few medical specialties have developed consociational relationships with industry sources such as those seen between perfusionists and the companies marketing cardiopulmonary devices. Although most perfusionists will attempt to select their devices based upon an evidenced based approach, the economic advances of partnering with a single, or few, companies almost makes this impossible. Because of this economic benefit many of us become sequestered from those companies whom we do little or no business, and it is only the aggressive product manager or representative who gambles by expending a fraction of his or her precious time on less devoted customers. Meetings such as AmSECT provide perfusionists with the opportunity to visit all the major manufacturers of cardiopulmonary equipment and compare products that are not readily seen in our clinical practices. Opportunities for product review are few and far between and shrinking CME and industry budgets will further complicate this effect. Of course, the value of knowledge can never be over appreciated. Hippocrates in Law IV re
{"title":"AmSECT and the Meetings of the Minds","authors":"","doi":"10.1051/ject/200537004","DOIUrl":"https://doi.org/10.1051/ject/200537004","url":null,"abstract":"As is the tradition of the first issue of the New Year we include the abstracts from the upcoming International Meeting of the American Society of Extra-Corporeal Technology (AmSECT). This month AmSECT will hold its 43rd meeting at the Hilton Riverside Hotel in New Orleans, Louisiana, USA, and once again, individuals from all over the globe will travel to America to partake in the scientific discussions and social gatherings of the convention. Trying to describe the meeting to an individual who has never before attended AmSECT is a daunting task. No other perfusion-oriented meeting can boast of the diversity in subject content, nor breadth of presenters, that is seen at AmSECT. The format of the meeting parallels what one would encounter at large surgical or anesthesia meeting where multiple sessions are conducted concurrently. One might ask why not conduct the meeting as a ‘single auditorium’ session, as is the modus operandi of most meetings. It is always easier, and more economical, to conduct a meeting with a single plenary session as the primary venue. Some meetings may also include small breakout sessions that are focused on single topic subjects. Such informal settings are comfortable and allow participants the opportunity to discuss issues on a more personal level. However, there are drawbacks related to limitations such as a finite number of attendees and limited subject content. Another feature of AmSECT International is the ability of practitioners to view the developing technologies at the manufacturers exhibits. These exhibits serve as the epicenter for discussion as well as a place for renewing old friendships and for developing new ones. As perfusionists we are a technology driven group who rely heavily on industry to invest in the development of new products, ultimately with the goal of improving the conduct of cardiopulmonary bypass for improving patient care. Few medical specialties have developed consociational relationships with industry sources such as those seen between perfusionists and the companies marketing cardiopulmonary devices. Although most perfusionists will attempt to select their devices based upon an evidenced based approach, the economic advances of partnering with a single, or few, companies almost makes this impossible. Because of this economic benefit many of us become sequestered from those companies whom we do little or no business, and it is only the aggressive product manager or representative who gambles by expending a fraction of his or her precious time on less devoted customers. Meetings such as AmSECT provide perfusionists with the opportunity to visit all the major manufacturers of cardiopulmonary equipment and compare products that are not readily seen in our clinical practices. Opportunities for product review are few and far between and shrinking CME and industry budgets will further complicate this effect. Of course, the value of knowledge can never be over appreciated. Hippocrates in Law IV re","PeriodicalId":309024,"journal":{"name":"The Journal of ExtraCorporeal Technology","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2005-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128376297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Joseph Deptula, Sherrie K Fogg, K. Glogowski, K. Fenton, Duncan F. Kim
The Terumo Baby-RX™, a new-generation low prime oxygenator, recently has entered the perfusion market in North America. This oxygenator is designed exclusively for neonates and infants and has the smallest priming volume of any clinically available oxygenator. The BABY-RX™ also is treated with X Coating™, Terumo’s biocompatible, hydrophilic polymer surface coating that reduces platelet adhesion and protein denaturation. The oxygenator has a blood flow range of 0.1 to 1500 mL/min and operates with a minimum reservoir volume of 15 mL. A 3.2-kg patient, status post-Stage 1 Norwood, Palliation was placed on cardiopulmonary support after thrombus formation within the modified Blalock-Taussig shunt during a general surgery procedure. The extended support circuit incorporated the Baby-RX™ oxygenator for 17.5 hours. The oxygenator performed well over this time period at flows of 600–800 mL/min, sweep rates of 100–300 mL/min, FiO2 of 30–40%, and ACTs of 140–200 seconds. There were no indices of oxygenator failure noted within the time frame of support. After placement of a new systemic to pulmonary shunt, the patient was removed from support and the oxygenator drained of residual blood. No evidence of fiber damage or clot formation was noted. The patient had a successful support run without complications related to cardiopulmonary support.
{"title":"Extended Support With the Terumo BABY-RX™ Oxygenator","authors":"Joseph Deptula, Sherrie K Fogg, K. Glogowski, K. Fenton, Duncan F. Kim","doi":"10.1051/ject/2004364364","DOIUrl":"https://doi.org/10.1051/ject/2004364364","url":null,"abstract":"The Terumo Baby-RX™, a new-generation low prime oxygenator, recently has entered the perfusion market in North America. This oxygenator is designed exclusively for neonates and infants and has the smallest priming volume of any clinically available oxygenator. The BABY-RX™ also is treated with X Coating™, Terumo’s biocompatible, hydrophilic polymer surface coating that reduces platelet adhesion and protein denaturation. The oxygenator has a blood flow range of 0.1 to 1500 mL/min and operates with a minimum reservoir volume of 15 mL. A 3.2-kg patient, status post-Stage 1 Norwood, Palliation was placed on cardiopulmonary support after thrombus formation within the modified Blalock-Taussig shunt during a general surgery procedure. The extended support circuit incorporated the Baby-RX™ oxygenator for 17.5 hours. The oxygenator performed well over this time period at flows of 600–800 mL/min, sweep rates of 100–300 mL/min, FiO2 of 30–40%, and ACTs of 140–200 seconds. There were no indices of oxygenator failure noted within the time frame of support. After placement of a new systemic to pulmonary shunt, the patient was removed from support and the oxygenator drained of residual blood. No evidence of fiber damage or clot formation was noted. The patient had a successful support run without complications related to cardiopulmonary support.","PeriodicalId":309024,"journal":{"name":"The Journal of ExtraCorporeal Technology","volume":"52 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2004-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124607295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
B. Arnrich, A. Albert, J. Walter, F. Schön, M. Rothe, J. Ennker, K. Schneider, C. Ullmann, T. Walther, S. Dhein, F. Mohr, M. Kostelka
. Methods: We investigated in 10 patients undergoing off-pump coronary revascularization intra-and postoperatively the change in markers of contact activation (FXII, C3a), coagulation (FXIII, Fab 1/2), inflammatory response (elastase, IL-6, procalcitonin), astroglial damage (S-100b, MMST), and myocardial ischemia (CK, CK-MB, TropT) and compared the data with 10 on-pump CABG patients. Results: Most interestingly we found no group differences in FXII, which plays a major role in contact activation after exposition of blood to foreign surfaces of the extracorporeal circuit. C3a as representative of the alternative pathway of complement activation showed only weak statistical difference. Coagulation and cerebral markers remained nearly unaffected with at least a more concise increase of Fab 1/2 after on-pump surgery. Inflammatory response could not be detected by IL-6
{"title":"33rd International Meeting of the German Society for Cardiovascular Engineering","authors":"B. Arnrich, A. Albert, J. Walter, F. Schön, M. Rothe, J. Ennker, K. Schneider, C. Ullmann, T. Walther, S. Dhein, F. Mohr, M. Kostelka","doi":"10.1051/ject/2004363286","DOIUrl":"https://doi.org/10.1051/ject/2004363286","url":null,"abstract":". Methods: We investigated in 10 patients undergoing off-pump coronary revascularization intra-and postoperatively the change in markers of contact activation (FXII, C3a), coagulation (FXIII, Fab 1/2), inflammatory response (elastase, IL-6, procalcitonin), astroglial damage (S-100b, MMST), and myocardial ischemia (CK, CK-MB, TropT) and compared the data with 10 on-pump CABG patients. Results: Most interestingly we found no group differences in FXII, which plays a major role in contact activation after exposition of blood to foreign surfaces of the extracorporeal circuit. C3a as representative of the alternative pathway of complement activation showed only weak statistical difference. Coagulation and cerebral markers remained nearly unaffected with at least a more concise increase of Fab 1/2 after on-pump surgery. Inflammatory response could not be detected by IL-6","PeriodicalId":309024,"journal":{"name":"The Journal of ExtraCorporeal Technology","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2004-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132432003","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The use of dosing assays to calculate heparin and protamine dose requirements during cardiac surgery has been shown to significantly improve overall postoperative patient outcome. When patients are managed with an individualized dosing system, intraoperative and postoperative transfusion requirements and bleeding are reduced. The Hemochron® RxDx® system is widely used as a complement to traditional activated clotting time testing to optimize anticoagulation management. The system consists of the heparin response test, the protamine response test, and the protamine dose assay. All are modifications of the activated clotting time using either Celite® (Celite Corporation, Santa Barbara, CA) or kaolin as the activator. Dosing is calculated manually using earlier version Hemochron instruments (model 801) or automatically with the Hemochron 8000 or with the early versions of the Hemochron® Response and the personal digital assistant (PDA) RxDx calculator. Missing from available user options is an automated RxDx system for the Response. A study was conducted at four clinical sites to compare recently developed Response RxDx software, which eliminates the need for the PDA RxDx calculator, to the existing Hemochron 8000 RxDx and to the Response-PDA RxDx systems. Similar to the current system, the operator inputs the patient’s height, weight, and gender, and the software automatically calculates the blood volume. Using the clotting times determined on the Response, bolus heparin and protamine doses and any additional heparin and protamine requirements are calculated automatically. Data were collected from 76 patients, of which, 64 patients were on pump, 11 patients were off pump, and 1 patient was converted from off to on pump. The Response estimated blood volume calculations showed a correlation coefficient of 0.989 when compared with available systems. A good correlation was also observed for the bolus heparin (r = 0.925) and protamine doses (r = 0.900) with equivalence confirmed by a paired student’s t test. These data confirm that the Response RxDx system yields results that are identical (P > 0.05) to those obtained using the Hemochron 8000 RxDx or Response-PDA RxDx calculator. The Response RxDx also offers expanded user options related to blood volume limits, expanded clotting time ranges for presetting default values, and flexibility in test sequence. Case records can be printed or downloaded to a PC via the HRDM data management program. The Hemochron Response RxDx represents a complete anticoagulation management system for the cardiac surgical patient.
{"title":"The Hemochron® Response RxDx® Heparin and Protamine Dosing System","authors":"Stacy A. Jaryno, M. Zucker, F. Laduca","doi":"10.1051/ject/2004363258","DOIUrl":"https://doi.org/10.1051/ject/2004363258","url":null,"abstract":"The use of dosing assays to calculate heparin and protamine dose requirements during cardiac surgery has been shown to significantly improve overall postoperative patient outcome. When patients are managed with an individualized dosing system, intraoperative and postoperative transfusion requirements and bleeding are reduced. The Hemochron® RxDx® system is widely used as a complement to traditional activated clotting time testing to optimize anticoagulation management. The system consists of the heparin response test, the protamine response test, and the protamine dose assay. All are modifications of the activated clotting time using either Celite® (Celite Corporation, Santa Barbara, CA) or kaolin as the activator. Dosing is calculated manually using earlier version Hemochron instruments (model 801) or automatically with the Hemochron 8000 or with the early versions of the Hemochron® Response and the personal digital assistant (PDA) RxDx calculator. Missing from available user options is an automated RxDx system for the Response. A study was conducted at four clinical sites to compare recently developed Response RxDx software, which eliminates the need for the PDA RxDx calculator, to the existing Hemochron 8000 RxDx and to the Response-PDA RxDx systems. Similar to the current system, the operator inputs the patient’s height, weight, and gender, and the software automatically calculates the blood volume. Using the clotting times determined on the Response, bolus heparin and protamine doses and any additional heparin and protamine requirements are calculated automatically. Data were collected from 76 patients, of which, 64 patients were on pump, 11 patients were off pump, and 1 patient was converted from off to on pump. The Response estimated blood volume calculations showed a correlation coefficient of 0.989 when compared with available systems. A good correlation was also observed for the bolus heparin (r = 0.925) and protamine doses (r = 0.900) with equivalence confirmed by a paired student’s t test. These data confirm that the Response RxDx system yields results that are identical (P > 0.05) to those obtained using the Hemochron 8000 RxDx or Response-PDA RxDx calculator. The Response RxDx also offers expanded user options related to blood volume limits, expanded clotting time ranges for presetting default values, and flexibility in test sequence. Case records can be printed or downloaded to a PC via the HRDM data management program. The Hemochron Response RxDx represents a complete anticoagulation management system for the cardiac surgical patient.","PeriodicalId":309024,"journal":{"name":"The Journal of ExtraCorporeal Technology","volume":"38 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2004-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133832052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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