Perfusion-Uk最新文献

Background: Medical mission trips address the global burden of cardiac disease, particularly in Sub-Saharan Africa, where limited access to cardiac surgery exacerbates challenges faced by affected individuals. However, a lack of literature exists on the experiences of perfusionists involved in these missions, despite their crucial role in delivering cardiac surgery services. Therefore, the purpose of this descriptive study was to evaluate the experiences of cardiovascular perfusionists involved in philanthropic cardiac surgery in low-income countries.Methods: A descriptive survey research design was conducted among perfusionists who have participated in cardiac mission trips. The survey link was distributed in February 2024 via the Liv Perfusion LLC social media account. The survey included questions regarding years of experience, countries visited, adequacy of equipment and personnel, language and cultural barriers, and establishment of long-term care.Results: A total of 23 respondents completed the survey, 15 of which were included in the study. All of the survey takers were perfusionists with a mean clinical experience of 10.67 ± 7.96 years and 67% held a master's degree. All of the survey respondents were either very satisfied or satisfied with their cardiac mission trip experience. Despite high satisfaction, 60% reported language differences, and 40% reported cultural barriers and legal restrictions as significant challenges in their delivery of care. Additionally, 67% reported having adequate medical equipment and 80% reported having adequate personnel during the mission trip.Conclusion: In summary, cardiovascular perfusionists reported high satisfaction with philanthropic cardiac missions but faced challenges such as language barriers, and cultural and legal constraints. Addressing these issues could improve mission effectiveness and patient care in low-income countries.

Extracorporeal Membrane Oxygenation (ECMO) use is associated with substantial psychiatric morbidity in patients and their families. This systematic review and meta-analysis quantifies the prevalence of post-traumatic stress disorder (PTSD), anxiety, and depression among ECMO survivors and their families. Included studies enrolled patients on ECMO or their families and reported at least one trauma-related psychopathology. Of 1767 screened studies, 55 were included (5146 participants): 50 in adult ECMO survivors, one in pediatric ECMO survivors, and four in families of ECMO patients (two adult, two pediatric.). The pooled prevalence of PTSD was 19% in adult ECMO survivors, 20% in pediatric ECMO survivors, 25% in families of adult ECMO patients, and 21% in families of pediatric ECMO patients. The pooled prevalence of anxiety was 30% in adult ECMO survivors, 8% in pediatric ECMO survivors, 67% in families of adult ECMO patients, and 46% in families of pediatric ECMO patients. The pooled prevalence of depression was 24% in adult ECMO survivors, 8% in pediatric ECMO survivors, 50% in families of adult ECMO patients, and 32% in families of pediatric ECMO patients. This meta-analysis demonstrates a high prevalence of trauma-related psychopathologies surrounding ECMO use, highlighting the need for interventions to improve post-ECMO outcomes.

Background: Post-cardiopulmonary bypass (CPB) blood processing is an important component of blood management during cardiac surgery. Purpose: The purpose of this study is to evaluate several methods of processing post-CPB residual blood.Research Design: Using a multi-institutional national database (SpecialtyCare Operative Procedural rEgistry [SCOPE]), 77,591 cardiac surgical operations performed in adults (>18 years) between January 2017 and September 2022 were reviewed.Study Sample: Blood processing methods included: Cell washing (CW, n = 63,592), Ultrafiltration (UF, n = 6286), Whole blood (WB, n = 3749), Hemobag (HB, n = 2480), and No processing (NO, n = 1484). The primary outcome was intraoperative post-CPB allogenic red blood cell (RBC) transfusion.Data Analysis: Group differences in RBC transfusion were assessed using a Bayesian mixed-effects logistic regression model controlling for multiple operative variables.Results: Across blood processing groups, patients had similar ages, body mass index and surgical procedures performed as well as preoperative hematocrit and nadir operative hematocrit. Median hematocrit change from last-in-operating room to first-in-ICU were highest in UF and HB groups (3.0 [IQR = 2.0-4.8] and 2.5 [IQR = 0.4-5.0]), respectively. The model-predicted probability of intraoperative post-CPB RBC transfusion was lowest in the HB group (0.79% [95% CrI = 0.37%-1.26%]), and highest in NO group (2.12% [95% CrI = 1.47%-2.82%]). Relative to CW, the odds of RBC transfusion for HB cases were reduced by half (OR = 0.5 [95% CrI = 0.28-0.89], statistical reliability = 99.1%), while odds for NO were 1.41 greater (OR = 1.41 [95% CrI = 1.03-1.93], statistical reliability = 98.2%).Conclusions: Post-CPB blood processing affects the likelihood for both receiving an intraoperative post-CPB RBC transfusion and for hematocrit change, with HB use resulting in the lowest predicted risk for transfusion, and NO the highest.

Background: In the world of academia, traditional lecturing has been the most common pedagogical approach for centuries. However, it can create an environment for students to be passive learners in the classroom. Alternatively, active learning is a pedagogical approach intended to encourage students to engage with content in manners which have been associated with improved exam performance, final course grades, clinical reasoning skills, and critical thinking skills. Given that perfusion is inherently a profession where didactic information must be applied in practice, the implementation of active learning in didactic courses is worth considering. Although active learning is practiced in perfusion education through participation in simulations and clinical rotations, there are no easily identifiable active learning resources available to supplement didactic perfusion courses. In response, written active learning activities were specifically designed for didactic perfusion courses.

Methods: The activities were designed based on the format for guided inquiry worksheets, the incorporation of the learning cycle, and the implementation of process oriented guided inquiry learning (POGIL) strategies. Key concepts were identified, learning objectives were specified, and models (figures or tables of data) were created as targets of engagement and analysis. Following each model, questions and prompts are given to guide students through identifying, understanding, and exploring the concepts incorporated in the activity as well as opportunities to apply the newly gained knowledge and understanding.

Results: Ten active learning activities have been developed based on the methods summarized above.

Conclusion: While the purposes of this paper are to inform the perfusion community of active learning and to share guidelines on how to create active learning activities for didactic perfusion courses, the goals of the activities are to provide examples to perfusion educators and to guide students in understanding basic perfusion concepts in a clinically relevant manner. It is recommended that perfusion students complete these activities alongside their didactic perfusion courses.

Extracorporeal perfusion systems utilized in open-heart surgeries with cardiopulmonary bypass can affect multiple body systems. The primary adverse effects of Extracorporeal Perfusion Systems (EPS) on the hematological system include postoperative bleeding and coagulation issues. The aim of this study is to evaluate the effects of on-pump time and cross-clamp duration on total platelet count (PLT) and platelet indices in open-heart surgeries performed using cardiopulmonary bypass. This evaluation is achieved by comparing PLT, mean platelet volume (MPV), platelet distribution width (PDW), and plateletcrit (PCT) before and after surgery. For this study, the laboratory results of a total of 392 patients who underwent open-heart surgery with cardiopulmonary bypass at the Department of Cardiovascular Surgery, Istanbul University Cerrahpaşa Institute of Cardiology, between 2017 and 2018 were retrospectively analyzed. The stepwise multiple linear regression model, in which postoperative PLT was the dependent variable and other parameters were independent variables, revealed that the main determinants of the significant change in postoperative PLT were the duration of device use, along with preoperative PLT and PDW. Our results indicate that on-pump time, along with preoperative PLT and PDW values, is the primary determinants of changes in PLT and PCT in open-heart surgeries with cardiopulmonary bypass. Considering the patient's preoperative platelet count and PDW values in such surgeries may be useful in preventing postoperative adverse events.

We present the case of a 74-year-old female patient with a 50 mm ascending aortic aneurysm who underwent ascending aorta replacement. During routine open heart surgery, suboptimal flow in the cardiopulmonary bypass circuit, led to the discovery of a type B aortic dissection with substantial flow in the false lumen. Conservative management was chosen, focusing on blood pressure control in the ICU. Despite an initial uneventful recovery the patient developed malperfusion syndrome prompting consideration of endovascular repair. Following a temporary improvement, malperfusion symptoms recurred, leading to a successful endovascular repair, with complete thrombosis of the false lumen.

Severe accidental hypothermia can lead to cardiac arrest. The most efficient method of resuscitating and warming is by ECMO (Extracorporeal Membrane Oxygenation). While the convention is to use VA ECMO (Veno Arterial ECMO), using VV ECMO (Veno Venous ECMO) in which the blood is returned directly into the right ventricle could be an alternative and lead to conversion to life sustaining cardiac rhythm. In this article we present our case series of ECMO for resuscitation of accidental hypothermia complicated by cardiac arrest. We used VV ECMO for 4 patients; in 3 of them ROSC (Return of Spontaneous Circulation) was successfully achieved. We also discuss the potential advantages of VV ECMO and VA ECMO in this setting and present our algorithm for management.

We report the case of a 72-year-old male patient who presented with a progressive aortic arch aneurysm. To reduce surgical trauma, we planned the procedure using an upper partial sternotomy with continuous cardiac perfusion and moderate hypothermia. Two vents were inserted to provide sufficient relief to the heart during perfusion. The heart was perfused continuously under flow and pressure control. To treat the aneurysm, a Vascutec™ Thoraflex Hybrid prosthesis was implanted. Despite the minimally invasive approach of partial sternotomy and beating heart combined with moderate hypothermia, the procedure was performed safely, quickly and without complications. The operation required precise pre-planning of the anatomy, outstanding surgical expertise and excellent interdisciplinary cooperation with the anaesthetist and clinical perfusionist.

Purpose: Research on the safety and efficacy of del Nido cardioplegia in adult patients with reduced left ventricular ejection fraction (LVEF) is limited. We evaluated the effect of del Nido cardioplegia on early outcomes of cardiac surgery in this cohort.

Methods: PubMed, Scopus, and the Cochrane Central Register of Controlled Trials were searched through August 2024 to conduct a meta-analysis comparing del Nido to other cardioplegia in adult patients with reduced LVEF (≤50%). Primary endpoint was early mortality, and secondary endpoints included morbidities, aortic cross-clamp time and postoperative LVEF before discharge. A random-effect model was used to estimate the pooled effect size.

Results: Seven studies met our eligibility criteria, including three propensity score-matched studies with a total of 1160 patients. Conventional blood cardioplegia was used exclusively as a control solution in the included studies. The incidence of early mortality was similar between the del Nido and control groups, with a pooled odds ratio of 0.94 [95% confidence interval: 0.52; 1.71] (p = .822). Postoperative stroke (p = .680), renal failure (p = .832), atrial fibrillation (p = .412), and aortic cross-clamp time (p = .153) were also comparable between the two groups. Postoperative LVEF was significantly higher in the del Nido group compared to the control group, with a standardized mean difference of 0.52 [95% confidence interval: 0.07; 0.96] (p = .034).

Conclusions: In adult patients with reduced LVEF undergoing cardiac surgery, del Nido cardioplegia provides comparable mortality and morbidity rates compared to conventional blood cardioplegic solutions, with the potential to offer protective effects on myocardial function.