SURVEY: VAVD- When does Negative Pressure = a NEGATIVE Result?

Editor’s Note: I recently had an interesting discussion with my colleague, Dennis, regarding whether we measured negative pressures on the venous line when using Vacuum Assisted Venous Drainage (VAVD) during the conduct of perfusion at our particular clinical site.  I was frank in my answer (no pun) and said- it wasn’t something that I have […]

Factor X Inhibition? Cardiac Health Supplements / Polyphenol Compounds & Considerations Regarding Hemostasis…

Editor’s Note:   Had an unusual presentation of unexpected post op bleeding the other day with a patient that had no concomitant coagulation issues nor other co-existing disease states that would possibly contribute or amplify post CPB hemostasis. Normally I would write this off as the “the less-than-extraordinary transcendence of damage to general hemostasis” that […]

Perfusion Policies 101: Anticoagulation Reversal

Renee Toth, BS, CCP   Editor’s Note: Renee is a colleague I work with quite often.  She is an amazing perfusionist as well as administrator, mom, and just a decent all around human being. She has a pretty scathing wit- so beware.  She offered to share a policy she has worked on for a quite […]

Management of weaning from cardiopulmonary bypass after cardiac surgery

Editor’s Note: Oddly enough, I was searching for some information regarding observed hypotensive states post CPB- associated with pump blood reinfusion, when I came upon this very cogent and well written article.  So I diverted my attention for the time being, to sharing this resource. Ill get back to the previous search later 🙂 Enjoy […]

Heater/Cooler Survey Results are In!

  Editor’s Note: Well… I started this survey back in the Fall of last year. (Click image above to view or take the survey) Since then I have been at 4 other institutions and have had the opportunity to observe how my colleagues addressed this issue.  No footprint changes regarding the relative position of the […]

Perfusion Polices 101: Malignant Hyperthermia

Editor’s Note: PERFUSION POLICIES 101 Welcome to PERFUSION POLICIES 101. This will be a continuing series provided to assist your programs with that one puzzle piece we all run into now and then- that one time that an unexpected patient condition may give you pause… The intention here is to disseminate some basic recipes that […]

Perfusion Policies 101: HyperKalemia

Editor’s Note: PERFUSION POLICIES 101 Welcome to PERFUSION POLICIES 101.  This will be a continuing series provided to assist your programs with that one puzzle piece we all run into now and then- that one time that an unexpected patient condition may give you pause… The intention here is to disseminate some basic recipes that […]

Perfusion Policies 101: Gas Embolism

Editor’s Note: PERFUSION POLICIES 101 Welcome to PERFUSION POLICIES 101.  This will be a continuing series provided to assist your programs with that one puzzle piece we all run into now and then- that one time that an unexpected patient condition may give you pause… The intention here is to disseminate some basic recipes that […]

Perfusion Policies 101: Cold Agglutinins

Editor’s Note: PERFUSION POLICIES 101 Welcome to PERFUSION POLICIES 101.  This will be a continuing series provided to assist your programs with that one puzzle piece we all run into now and then- that one time that an unexpected patient condition may give you pause… The intention here is to disseminate some basic recipes that […]

IMPORTANT SAFETY NOTICE: RE; Heater Cooler Mediated Infections

Editor’s Note: I received this email from Bryan Lich, President of Perfusion.com, and I felt it was important enough to disseminate to the readership and hopefully together we can work to solve this issue.  The content of the letter is below in it’s entirety. Below is a survey to try to gather a consensus on […]

Heater Cooler Survey!

“I encourage all of you to take this survey, the issue at hand is primarily for the purpose of patient protection FIRST, and and how we adjust to it is obviously reactionary- but must be proactive and simply cannot be ignored or sidestepped” Editor’s Note: I’m sure all  of us are equally concerned regarding the surge […]

The Heater Cooler Conundrum: Has the Sky Fallen?

“If anyone has a chart or list/table that compares all of the current Heater Coolers, that would go a long way to helping institutions make informed choices as to selecting systems that have the smallest potential footprint regarding impact on laminar flow in the OR, as well as the least amount of potential pt. exposure […]

Surgical (operative) Air: A Historical Perspective

Editor’s Note: I was reviewing some data related to the accidental de-priming of the MPS Microplegia delivery system, when in the process, I came up upon this very good article relating to the evolution of the body of knowledge concerning accidental introduction of air to the patient during surgery.  It is a fascinating read, and well worth […]

Why is my Patient Bleeding? A Snapshot of Hemostasis, Part II

Click on image to view source article Editor’s Note: We have all revisted this pathway intensively throughout our careers, and of course, we have all been clinically challenged by open-heart cases that test our fundamental understanding of coagulation theory in real time, at a level that certainly reflects a fairly deep dive into esoteric hematology. So i am keeping it simple, and found […]

Perfusion Policies 101: Angiomax

Editor’s Note: The use of alternatives to heparin in terms of managing anicoagulation doesn’t come up often.  It’s easy to get a bit rusty when it comes to using exotic agents such as Ancrod (Hirudin), Angiomax and similar agents. So here is a brief refresher, and as always- a disclaimer here:  Use this information with […]

Desmospressin: A Primer on DDAVP

<img class="alignnone size-full wp-image-32561" src="https://i2.wp.com/circuit.perfusion.com/wp-content/uploads/2016/07/1 20 mg prednisone.jpg?resize=529%2C167″ alt=”1″ srcset=”https://i2.wp.com/circuit.perfusion.com/wp-content/uploads/2016/07/1.jpg?w=787 787w, https://i2.wp.com/circuit.perfusion.com/wp-content/uploads/2016/07/1.jpg?resize=300%2C95 300w, https://i2.wp.com/circuit.perfusion.com/wp-content/uploads/2016/07/1.jpg?resize=768%2C243 768w” sizes=”(max-width: 529px) 100vw, 529px” data-recalc-dims=”1″ /> Click on image to view source article = Desmopressin Desmopressin acetate (DDAVP) is a synthetic analog of vasopressin and like ADH, epinephrine, and insulin, releases a variety of hemostatically active substances from vascular endothelium.  […]

Centrifugal vs. Rollerhead Pump? Which is Safer?

“Overall, I like centrifugals, although I do worry if the necessity to hand crank comes up- most systems have been so shortened- getting the awkward and cumbersome centrifugal hand-crank positioned is in most cases- nearly impossible.” Editor’s Note: I got the following email this morning: Dear Staff, Very early morning greetings from Vermont. I am […]

Unexpected Air: An ECMO Discussion

Editor’s Note: I was on FB and was visiting the Malaysian Perfusion Page, monitoring a discussion regarding venous air entrainment in an ECMO circuit, and the efforts made to save the patient.  This a true emergency, and with a closed system, much more difficult to resolve. The discussion however is what captured my interest because […]

International CQI: Vaporizer Obstructing O2 Q

Editors Note: This is a new Section. We are trying to develop a database of common or not-so-common problems encountered by perfusionists during CPB. Please join us by clicking the Link Above if you have had any sort of unusual event you would like to share. Please email details if you feel that your story […]

Synchronized vs. Unsynchronized Cardioversion

Courtesy of ACLS-Algotithms.com  (Click image to view site) Editor’s Note: It’s funny how you can go an entire career doing something (CPB) and hear the same thing every day, but actually not evaluate what it means.  Yes, I have taken ACLS and studied the electrophysiology of the heart. So anyway, we have just taken off the […]

TEG vs ROTEM? A Brief Comparison AND a Survey?

Click image above to take ROTEM Survey 🙂 Editor’s Note: I was asked by a reader to do an article on thromboelastograms.  Wasn’t sure what approach to take in this regards so decided to do a brief intro and switch the focus in particular to a comparison and differentiation between the two prevalent systems, the TEG and the […]

An ECMO in OMAN: FB Discussion

Editor’s Note: I saw this discussion on the Perfusion.com Group FB page, and thought it merited a post here on ‘Surfes– to demonstrate how effective new media communication can be in real time. Please feel free to add to the discussion 🙂 Frank = Saleh Al Harthy Yesterday at 9:36am · Al Amarat, Oman – […]

Angiomax: Use and Dosing Regimen

Editor’s Note: The use of alternatives to heparin in terms of managing anicoagulation doesn’t come up often.  So many of us get a bit rusty when it comes to using exotic agents such as Ancrod (Hirudin), Angiomax and similar agents. So here is a brief refresher, and as always- a disclaimer here:  Use this information […]

Cairo, Egypt: Case Study: AVR with Antiphospholipid Syndrome

Editor’s Note: I saw this post of Ramy’s FB page (or maybe one of the perfusion groups on FB) and reached out to Ramy to submit this as a case study.  He has graciously forwarded the case study and I thank you Ramy. Feel free to leave comments in the comments section- Happy Saturday 🙂 […]

Plz Donate: Intervention Doesn’t Stop AFTER the Operation…

“This would make the realistic GoFundMe goal approximately $10,800- a sum that represents less than the purchase price of a used car…” Click Image Above to Donate 🙂 Editor’s Note: I was checking FB the other day, and spotted a compelling story on the page of a long distance friend (as well as colleague on this […]

International CQI: USA: Total Oxygenator Failure

Operation: ACB x 3. Pt. Data 70 years old Gender: Male 71 inches 79 Kilograms 1.94 BSA Baseline Hematocrit- 44% Pertinant Hx: Unremarkable. No coagulopathic issues No other issues-  patient appeared to be  robust and healthy. Plan: ACB x 3:  Mild Hypothermia- 34 degrees C.. Prime Constituents: 300 ml  Normosol 5,000 units heparin 37.5 g […]

Using Occlusive Foley Catheters to Control Excessive Tumor-Related Bleeding

Dr.Harinder Singh Bedi = = The lowly Foley to the rescue – It was the 4th case . A meticulous  total arterial off pump bypass and and two hectic mitral and tricuspid valve repairs – the 2nd had required some extra  time as it was a young lad and I wanted to avoid a valve […]

From Japan [ 11 ] Have a Safe Pump Run! “Taigaijyunkan anzen”

Facebook Thread Authored By: Hiroyuki Kuromitsu (Hiro) Editor’s Note: My friend Hiro has a Japanese Perfusion FB group page- perfusionist.JP founded by Hiroyuki Kuromitsu (Hiro) a Japanese perfusionist. I was on his site when I saw a very interesting object hanging on a Japanes pump.  So naturally… I had to ask… What is it- and WHAT […]

CPB Techniques for ESRD/Hemodyalisis on Pt Awaiting Renal TX

Dr.Harinder Singh Bedi = = I have a 56 year old patient in ESRD on hemodialysis with a left radial AV fistula . He was being planned for renal transplant and was discovered to have critical and diffuse CAD- so being taken up for CABG . Plan so far : 1. avoid LIMA because of […]

Protamine

Protamine Protamine, a polycationic protein derived from salmon milt, possess strong alkalinity because of an amino acid composition consisting of 67% arginine.  In its natural state, the numerous positive charges on the protamine molecule bind with the negatively charged phosphate groups of the nucleoprotein material of salmon sperm.  Heparin, a polyanion, binds ionically to protamine […]

The First Ever Artificial Heart Transplantation in Azerbaijan

Editor’s Note: A FB friend and colleague of mine, Cuneyt Imamoglu, from Baku, Azerbaijan, shared the story below of the ground breaking procedure performed for the first time in Azerbaijan. Cuneyt is very active on-line promoting perfusion dialogue and education. Thank you for sharing this Cuneyt 🙂 Frank   The first ever artificial heart transplantation […]

HAS THIS HAPPENED TO YOU ? H2O Outlet Deformity on Oxygenator:

Click on image to enlarge Have you seen this happen before?  This is my 3rd time.  Plz respond in the comments section below- or send an email privately to ecclog@gmail.com to share your experience and identify if this is indeed a common issue. Editors Note: We are developing a database of common or not-so-common problems […]

The TEG (Thromboelastogram)

Editor’s Note: Recently we began employing the TEG routinely for all of our open-heart procedures.  Now I am relatively familiar with the concept, having discussed and written about it before.  However there is an array of numbers and categories that come with the TEG analysis that I wasn’t certain about, so to clear it up […]

JASECT 2014: A Japanese Perfusion Art Gallery

Click to view image Editor’s Note: I sent out a post on FB to get more people from the international perfusion community- to consider participating in the perfusion art gallery.  Here is one response: Dear Mr. Frank Aprile Please find attached a picture. This picture was taken by Takuma Douguchi. Please let me know if […]

An International Perfusion CQI Registry: American, Asian, European, ALL Countries are Invited.

To Join the International Perfusion CQI Registry-  cick image above Editors Note: This is a new platform for Quality Improvement. We are trying to develop a database of common or not-so-common problems encountered by perfusionists during CPB.  We are inviting perfusionists, groups, and institutional participation to develop a universal platform for identifying areas of concern […]

VAD’s & Device Availability List

A ventricular assist device (VAD) is a mechanical circulatory device that is used to partially or completely replace the function of a failing heart. Some VADs are intended for short term use, typically for patients recovering from heart attacks or heart surgery, while others are intended for long-term use (months to years and in some […]

Perfusion Glitches: Deprimed Cardioplegia Line

Click Image Above to Add a “Glitch” to the Perfusion Database … Editors Note: This is a new Section. We are trying to develop a database of common or not-so-common problems encountered by perfusionists during CPB. Please join us by clicking the Link Above if you have had any sort of unusual event you would […]

AT3 Deficiency

Antithrombin III (AT III) is a plasma glycoprotein with a molecular weight of 58,000 daltons.  AT III deficiency may be noticed when the patient’s activated clotting time (ACT) does not respond to heparin administration as would be expected when given a standard dosage.  Also can be confirmed by a laboratory value of the patient’s AT […]

Art from Japan [ 10 ] JASECT

Click to view image Editor’s Note: I sent out a post on FB to get more people from the international perfusion community- to consider participating in the perfusion art gallery.  Here is one response: Dear Mr. Frank Aprile Please find attached a picture. This picture was taken by Takuma Douguchi. Please let me know if […]

Cold Agglutinins

Literature: Click image to view source article Cold Agglutinins in Cardiac Surgery: Management of Myocardial Protection and Cardiopulmonary Bypass CAs are autoantibodies to RBC antigens [3], which can causesystemic thrombosis and hemolysis. The cause of these CAs maybe primary/idiopathic, or more commonly, secondary to an infectiveprocess (eg, mycoplasma, human immunodeficiency virus) or alymphoproliferative disorder [2]. […]

On CPB- Heparin Protocol Survey

Editor’s Note: I received a note from a perfusionist the other day regarding heparin administration, and how it has become regulated at their institution.  It was significant enough- in terms of it’s implications of our ability to manage patients on bypass for me to pass on the concern, and as well- develop a survey to […]

Heparin: Factors Affecting & it’s Effects [Reprint]

HEPARIN ONSET: Maximal at 1 minute past atrial delivery: Measured at radial artery.  Note:  10-20% reduction in svr without affecting c.o. and or h.r. LUNG VS MUCOSAL: Mucosal requires larger doses- but can be reversed with 25-30% less protamine:  greater postoperative blood loss associated with mucosal heparin- speculated to result from lower molecular weight & […]

Hybrid OR [3] Day 1 Debut

In Technicolor or Black & White ? Editor’s Note: Over the past year or so, a Hybrid room as been under construction, here in West Texas.  Being very close to one of the cardiac operating rooms- during this process, the sounds of drilling and hammering mix in with Pink Floyd, Annie Lennox, some “ya-done-me-wrong” Texas […]

A Discussion from Japan [ 9 ] An Adult ECMO Circuit

Facebook Thread Authored By:  Hiroyuki Kuromitsu (Hiro) Editor’s Note: Once again, just checking early morning news and chatter on Facebook, and another interesting discussion rears it’s head.  This discussion can be found on this Japanese FB group- https://www.facebook.com/groups/perfusionist.JP/ This thread was started by one of our Japanese colleagues, Hiroyuki Kuromitsu (Hiro) And… The Discussion… Any […]

Jehovah’s Witness & Open Heart Bypass

Jehova’s Winesses:  A Background Jehovah’s Witnesses believe that the Bible prohibits ingesting blood and that Christians should therefore not accept blood transfusions or donate or store their own blood for transfusion.[1] Watch Tower Society publications teach that the Witnesses’ refusal of transfusions of whole blood or its four primary components—red cells, white cells, platelets and […]

Hybrid OR [1] The Genesis of

Meet Andrea…  One part of the beginning of the process- Editor’s Note: Over the past year or so, a Hybrid room as been under construction, here in West Texas.  Being very close to one of the cardiac operating rooms- during this process, the sounds of drilling and hammering mix in with Pink Floyd, Annie Lennox, […]

Perfusion Glitches: Loss of Vacuum VAVD : Request for Your Opinions

Click Image Above to Add a “Glitch” to the Perfusion Database … Editors Note:  This is a new Section.  We are trying to develop a database of common or not-so-common problems encountered by perfusionists during CPB. Please join us by clicking the Link Above if you have had any sort of unusual event you would […]

Coagulation Issues: Fibrinolysis & HIT: Helpful Graphics

Fibrinolysis Fibrinolysis is the dissolution of the clot formation process involving the plasma protein plasminogen.  This system of enzymes dissolves blood clots by the lysis of fibrin.  Fibrinolysis plays a role as well in other biological processes such as tissue repair, macrophage activation and function, ovulation, and embryo implantation.  Fibrinolysis is mediated by plasmin and […]

Heparin: Factors Affecting & it’s Effects

HEPARIN ONSET: Maximal at 1 minute past atrial delivery: Measured at radial artery.  Note:  10-20% reduction in svr without affecting c.o. and or h.r. LUNG VS MUCOSAL: Mucosal requires larger doses- but can be reversed with 25-30% less protamine:  greater postoperative blood loss associated with mucosal heparin- speculated to result from lower molecular weight & […]

A Thesis from Japan [ 8 ] Pediatric Q Rates ?

Presentation authored by:  Hiroyuki Kuromitsu (Hiro) Editor’s Note: Hiro Kuromitsu is very active as a Japanese perfusionist, and has been an on-line FaceBook friend for quite some time.  He will be presenting a paper on Pediatric Flow Rates / CPB at the 21st Annual Meeting of the Asian Society for Cardiovascular and Thoracic Surgery in […]