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 […]

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 […]

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 […]

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 […]

Aortic Stenosis

Aortic Stenosis Rheumatic heart disease and calcification deposits due to age (senile calcific aortic stenosis) are the most common pathologic conditions associated with aortic stenosis.  Congenital malformations such as a bicuspid aortic valve with a small annulus, or unicuspid valve usually develop symptoms at an early age but occasionally surface in later years.  Calcification of […]

Cardiac Blood Flow & O2 Consumption

“The major vessels of the coronary circulation are the left main coronary that divides into left anterior descending and circumflex branches, and the right main coronary artery.” Source: Cardiovascular Physiology Concepts Richard E. Klabunde, PhD The major vessels of the coronary circulation are the left main coronary that divides into left anterior descending andcircumflex branches, and the right main coronary artery. […]

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 […]

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 […]

Intracardiac Pressures

Intracardiac Pressures = Right ventricular systolic pressure Right ventricular systolic pressure (RVSP) can be easily assessed in most subjects who present some degree of tricuspid regurgitation. The velocity recorded across the regurgitant jet corresponds to the right ventricular-right atrial gradient (RV-RA ΔP), so that, this value added to mean right atrial pressure (RAP) represents the […]

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 […]

Mitral Insufficiency

Mitral Insufficiency Six anatomical components must mesh synchronously to insure proper function of the mitral valve.  Disruption of the kinetic interrelationship between the left ventricular wall, the left atrial wall, valve leaflets, annulus, chordae tendineae, and papillary muscles, may lead to dysfunction of the valve.  Chronic mitral valve insufficiency (regurgitation) most often results from rheumatic […]

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 […]

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]. […]

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 & […]

The A1C : “Say Hello To My Little Friend…”

Glycosylated Hemoglobin Called also hemoglobin A1c. Hemoglobin A with a glucose moiety attached to the amino terminal valine of the beta chain. This type of hemoglobin is made at a slow constant rate during the life span of the erythrocyte. Increased levels correlate with glucose intolerance in diabetes. With adequate insulin treatment, levels return to […]

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 […]