Bicarb Alternatives: Sodium Acetate & Balanced Crystalloids

Editor’s Note:   Authorization for the contributions below were obtained from each contributor via email.  Please see comments section… THAM A a Buffer Tham Description Tham Solution (tromeThamine injection) is a sterile, non-pyrogenic 0.3 M solution of tromeThamine, adjusted to a pH of approximately 8.6 with glacial acetic acid. It is administered by intravenous injection, by […]

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.  […]

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 […]

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 […]

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 […]

Right Ventricular Function

Right Ventricle The right ventricle is one of four chambers (two atria and two ventricles) in the human heart. It receives deoxygenated blood from the right atrium via the tricuspid valve, and pumps it into the pulmonary artery via the pulmonary valve and pulmonary trunk. It is triangular in form, and extends from the right […]

Letters To ‘Surfers: From China: Pediatric Priming Solutions ?

(Click Image to Enlarge) Editor’s Note: I got this question regarding pediatric priming protocols from a perfusionist in China. My pediatric experience is limited to ECMO- so I defer to the more experienced pediatric perfusionists out there to help formulate an informed response 🙂 Leave your answers or suggestions in the “Comments” section plz? Frank […]

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 & […]

Protamine Reaction

“It binds to heparin to form a stable ion pair which does not have anticoagulant activity; on its own, protamine has a weak anticoagulant effect.”   Protamine sulfate is a drug that reverses the anticoagulant effects of heparin by binding to it. Protamine was originally isolated from the sperm of salmon and other species of […]

Malignant Hyperthermia

Editor’s Note: Just a brief primer on Malignant Hyperthermia, should the need ever arise to place a patient on CPB who has been diagnosed with this condition. It is an unusual co-morbidity and should be approached and treated with an abundance of clinical respect and caution.  Any insight or recommendations from readers would be greatly […]