A Locum’s ScrapBook: Modifying the ECC for Antegrade Cerebral Protection

Editor’s Note: To view the entire “Locum’s ScrapBook” series- click here My life is Family First and then Perfusion.  I take BOTH very seriously. I switched from staff perfusionist to becoming a Locum’s traveler to make sure my kids and family would have a solid place to call home.  I travel because it puts me in […]

Perfusion Policies 101: Oxygenator Changeout

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: Nitric Oxide

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 […]

The Physics of Negative Pressure

Editor’s Note: We all deal with the concepts of positive and negatives pressures, and certainly pay attention to those values during the course of a bypass run, or ECMO, or a myriad of other perfusion modalities. This is a rather insightful and esoteric view of the basic perfusion principle that we both respect and fear- […]

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 […]

LPM: A Student’s Perspective- ECMO

“I realized that I learned what a vast difference it is to move from doing a case in the OR, to following up on a patient on a daily basis and monitoring their care.” Editor’s Note: This is a continuation of a series with our newest associate editor, Shayla Johnson, who is currently enrolled in a […]

Welcome to HIPEC!

2 Cone Heads 🙂 Editor’s Note: I had an opportunity to assist and learn how to do a HIPEC procedure.  This was an extraordinary experience, and this perfusion group in Iowa should definitely be recognized for the advanced perfusion techniques they do routinely, that many of us have never had the opportunity to be a part […]

Some Thoughts about Pump Configuration and Design: Collin Green

“Admittedly there are machines today where the arterial pump can be re-positioned closer to the table and sometimes higher but to the best of my knowledge sucker and cardioplegia pumps tend to stay on the machine base.“ Editor’s Note: I would like to introduce you to a perfusionist that contacted me recently and is the […]

The ‘Third Space’–Fact or Fiction?

“While I was familiar with the concept of “third spacing”, I needed to clarify the implied “first”, and “second” spaces.” Editor’s Note: Back quite a while ago, I was really into publications, and the academic side of cardiac perfusion and education.  Part of what we do involves some major fluid shifts within the patient as […]

How to Calculate EBL with Cell Savers

“It was simple- but in theory is consistent with other ways I have used to extrapolate that mysterious number we always come up with- that is sometime just barely a step away from ‘home cooking’.”   Editor’s Note: Well, I was @ a new venue, doing a locum’s gig- and ran into an interesting formula/calculation […]

Modified Ultrafiltration During Cardiopulmonary Bypass

“MUF following separation from extracorporeal circulation (ECC) provides well known advantages in children with improvements in the hemodynamic, pulmonary, coagulation and other organs functions.” Editor’s Note: Please consider the fact that I am NOT a pediatric perfusionist, so this article may be too rudimentary for you Peds guys out there 🙂 Nevertheless- this post began […]

LPM: A Student’s Perspective- Dialysis

“Once the basic pump set-up is learned, there are so many other additional instruments and methods that also need to be understood.” Editor’s Note: This is a continuation of a new series with a guest blogger who is currently enrolled in a perfusion program.  I am impressed that as a perfusion student she has the initiative […]

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 […]

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 – […]

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 🙂 […]

Pressors; Q; or Volume?

Editor’s Note: Well I was surfing the perfusio.com FB perfusion group, when I came across a continuing dialogue on when and why to adjust pressure using flow, vasopressors, or volume… So it seemed to be a pretty advanced thread- and I thought I would share it to see if anyone else wanted to join in? Pressors; […]

PICU Nursing: Honing Your ECMO Skills

Editor’s Note: So I was @ Women’s & Children’s Hospital – here in West Texas, doing some platelet gel cases, when I decided to drop by the PICU to visit friends I hadn’t seen in awhile. The PICU staff was pretty thin- so I asked where everybody was- and found out they were conducting an ECMO wet […]

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 […]

From Italy [ 7 ] Reshaping the Heart

Editor’s Note: Once again, just checking early morning news and chatter on Facebook, and another interesting link rears it’s head.   I found this article on an Italian perfusion FB page by CardioPeople- an Italian resource- very well organized, and very professional. Link:  https://www.facebook.com/universita.campobasso They provided an English version of the above cited topic- so […]

From Italy [ 6 ] Mitral Prosthesis, Implantation on the Beating Heart

Editor’s Note: Once again, just checking early morning news and chatter on Facebook, and another interesting link rears it’s head.   I found this article on an Italian perfusion FB page by CardioPeople- an Italian resource- very well organized, and very professional.  http://www.cardiopeople-network.com/social/index.php?do=%2Fpages%2F10%2F They provided an English version of the above cited topic- so I […]

Writers & Bloggers Wanted :

Hi- Wanted to see if there are any perfusionists out there that like to write- or want to write about their perfusion experiences? Perfusionists from all corners of the World are invited to participate … Writing / blogging is basically taking taking your point of view on aspects of perfusion and sharing it with others […]

Myocardial Ischemia: The Best Timing for Engaging CPB for Revascularization

Editors Note: Having been in the field for awhile, and being an STS data coordinator, the timing of surgery for patients suffering from an acute evolving myocardial infarction (AEMI) has always intrigued me. The STS data form is very specific in tracking these intervals, and I am naturally curious as to what the impact on […]

A Unique Case Review:

Authored by Steve Sutton, LP, CCP Editor’s Note: Steve Sutton is well known and highly regarded into today’s Perfusion community.  He is a strong proponent for advancing Perfusion education and in pursuing that goal,  he has given numerous presentations at some of the most  premier Perfusion meetings held each year. Along with his dedication to […]

Adequacy of Perfusion:

Adequacy of Perfusion:  By Steve Sutton, LP, CCP Editor’s Note: Steve Sutton is well known and highly regarded into today’s Perfusion community.  He is a strong proponent for advancing Perfusion education and in pursuing that goal,  he has given numerous presentations at some of the most  premier Perfusion meetings held each year. Along with his […]

And Then Comes Sunday …

24 Hours… of ECMO New Beginnings   (To view the entire “Day In The Life” series Click Here) Jesse Shipman struggles to do a stretch during a therapy session with occupational therapist Megan Taylor at TrustPoint Hospital in Lubbock, Texas Tuesday, June 12, 2011. (Miranda Grubbs/ Lubbock Avalanche-Journal) To view the entire “Day In The […]

H1N1- ARDS- & ECMO (Current Literature)

Editors Note: A big thank you to Marianne Veir Pilger, CCP, and her colleague John @ Meriter Hospital in Madison, Wisconsin for helping out so quickly and hooking us up with the below listed articles on ECMO management for ARDS and H1N1. This is something we are all facing- so I hope it helps. Again- […]

CNS & CPB

CNS & CPB The major postoperative neurological complication associated with open-heart surgery and cardiopulmonary bypass is stroke, which is defined as a sudden onset of a focal deficit of the central nervous system lasting longer than 24 hours.  While this clinical finding occurs in approximately 1-5% of cardiac surgery patients, 70% of cerebrovascular sequelae occur […]

Letters From the Philippines: Improving O2 Transfer?

Editor’s Note: Hi Guys, I got this letter from a Filipino  perfusionist via FaceBook.  If any of you have any engineering insights into the mechanics of increasing Oxygenator surface area for improving O2/CO2 exchange , can you send replies to Kevin Tabamo’s FB page? Thanks ! = = 🙂 Frank Click image to respond directly […]

Letters From Pakistan: Questions on the CardioHelp System

Click image to view manufacturer’s information on this product- Editor’s Note: Hi Guys, I got this letter from a Pakistani perfusionist via LinkedIn.  If any of you have any Experience using the CardioHelp System, can you send replies here to ‘Surfers? I have no experience with the device, so it would be inappropriate for me […]

Intracardiac Shunts

Principles of Intracardiac Shunts Significant hypoxemia can result from right-to-left intracardiac shunting through a patent foramen ovale, an atrial septal defect or a ventricular septal defect. Pulmonary embolus, congenital heart disease and pericardial tamponade are well-recognized causes of right-to-left shunting. With the continued presence of a congenital defect of the cardiac septum or great vessels […]

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]. […]

HELP ! Looking for Medos Oxygenators

Editor’s Note: I received an email today regarding the Medos pediatric oxygenator: “Frank, browsing for a supply of pediatric oxy’s and found your post on the Medos oxygenator system. I used this once eons ago in Italy- worked superbly. I want to try to get some for a big project. Any contacts out there?” Jeffrey […]

Letter To ‘Surfers: Protocols & ECC Setups ?

Editor’s Note: I received an email today regarding ECC setups and institutional protocols.  If you have any suggestions or written protocols, perhaps you could share them with Ryan ? Hello Frank,  I sent a post to you back in June that you entitled, ‘Is Perfusion a Dead Language?’. I am happy to say that I […]

A Quick Guide to Changing Out the Terumo FX15 / 25 Oxygenator

Editor’s Note: I had an early Op-Cab and was looking at a primed circuit that I had set up the day before- for a case that was also an Op-Cab.  It was primed with Normal Saline, no meds, and would have been fine to use on our patient today. I decided to go ahead and […]

Ventricular Hypertrophy & Perfusion

LVH :  Photo by:  Srinivas Rao @ Gruppo dei Perfusionisti!!! Ventricular Hypertrophy & Perfusion Subendocardial Q Determinants While subendocardial and sub-epicardial layers have the same determinants for blood flow, subendocardial layers are at greater risk from ischemia and infarction.  The deeper subendocardium is subjected to greater wall tension which then expresses as a metabolic requirement […]

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 […]

Perfusion Techniques: Parallel Oxygenators

Perfusion Techniques: Parallel Oxygenators  _____Click image to enlarge Perfusionist:  Randy Ransom, CCP Equipment:  FX25 Terumo Oxygenators x 2 / Tubing and “Y” connectors Issues:  None Narrative:  Large Patient:  Preoperative adjustment: Bumped up the ECC capacity  to 2 oxygenators setup as a parallel circuit. Time & Place:   2013 About The Perfusionist:  CCP Click to Donate Click […]

Circuit Surfers is 2 Years Old !

Why?  Cuz I think cool pictures are part of our lives … 2 Years … Wow !  Never really thought it would go this long- or that it went by so fast. First of all- Thanks all of you for joining and reading.  Slowly you guys started trusting or at least enjoying the site- and […]

From South Korea: A Very Cool Peds Perfusion Video

Editor’s Note: Was checking out some perfusion Facebook groups, and came across a very cool perfusion video from  Lee Jinkwon (a South Korean perfusionist). Here is his introduction: Lee Jinkwon “Hello, My name is Lee Jinkwon. South Korea, Sejong general Hospital Congenital cardiac sugery team, Perfusionist.. I introduce to our Neonate circuit. We use to […]

Career Perfusionist: [13] The Extracorporeal Circuit

The Extracorporeal Circuit Diversion of blood from the operative site, via an extracorporeal circuit (ECC) is necessary to proceed with open heart surgery .  Vascular access leading to the right side of the heart (venous) and ejecting from the left side of the heart (arterial) is shunted from the patient to the heart lung machine. […]

VAD / ECMO Policy: Generic & Universal

Editor’s Note: This is a disclaimer: As with all material presented on this site,  please use your own judgement as to what you feel is clinically safe, vetted, and makes sense to you.  This blog is NOT peer reviewed or sanctioned by any perfusion associated review board or academic body. That is not to say […]

Writers & Bloggers Wanted : Want to Write a Post?

  Editor’s Note: I wanted to see if there are any perfusionists out there that like to write- or want to write about their perfusion experiences? Perfusionists from all corners of the World are invited to participate … Writing / blogging is basically taking taking your point of view on aspects of perfusion and sharing […]

Deep Hypothermia: Antegrade & Retrograde Cerebral Perfusion

Editor’s Note: Deep Hypothermic Circulatory Arrest (DHCA), is a concept discussed here in this forum, as well as a significant perfusion event when it comes to the horizon. Obviously an issue for aortic dissections, transections, or congenital malformations that require a surgical approach and repair that can only be accomplished by intermittent or momentary cessation […]

Deep Hypothermia: Rapid Cooling & Nitroglycerine

Editor’s Note: Deep Hypothermic Circulatory Arrest (DHCA), is a concept discussed here in this forum, as well as a significant perfusion event when it comes to the horizon. Obviously an issue for aortic dissections, transections, or congenital malformations that require a surgical approach and repair that can only be accomplished by intermittent or momentary cessation […]

The “Hot Shot” : A Layman’s Approach to Myocardial Protection

A Salient Point from a Perfusionist: “I will give one good example of how a warm/hot shot worked for us. We finished up a normal 4 banger and before doing the proximals with the cross clamp on we routinely give a short hot shot, actually its room temperature shot, but I digress. The clamp was […]

A Bridge to Transplant? How About a BRIDGE to Medicare?

1/2 a year shy of 65- MEDICARE hasn’t kicked in yet… STRANDED ON THE TARMAC Day:1 Day + Day + ACCESS… DENIED ! Day + Day + Day + Day + Day + Day + Epilog … RIP Click to Enlarge You Figure It Out …

From Italy [ 5 ] Transcatheter Aortic Valve Implantation

Editor’s Note: Once again, just checking early morning news and chatter on Facebook, and another interesting video link rears it’s head.  This video can be found below- or on the FB group Care of heart  founded by Manoj Sharma  an Indian perfusionist that I have interacted with occasionally online. Now this video is in Italian- so if […]