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Biomedical subjects

R K Firmin

Publications and source records attributed to R K Firmin.

At least 73 records · Page 4Linked to original sources
PubMed1992

UK experience in neonatal extracorporeal membrane oxygenation.

Extracorporeal membrane oxygenation (ECMO) is a life support technique capable of supporting pulmonary, cardiac, or cardiopulmonary function. It has proved most successful in neonatal respiratory failure. We report the initial UK experience with a survival rate of 80% in 15 neonates (gestations 36-41 weeks, birth weights 2690-3990 g) whose condition exceeded American criteria for ECMO treatment for a prolonged period before referral. Ages at referral varied from 11 to 240 hours and the duration of bypass required varied from 30 to 240 hours respectively.

Costs and Cost Analysis↗
PubMed1990

Thoracic injuries sustained by the survivors of the M1 (Kegworth) aircraft accident. The Nottingham, Leicester, Derby, Belfast Study Group.

On 8 January 1989, a Boeing 737 carrying 126 passengers and crew crashed onto the M1 motorway killing 39 passengers. Of 87 initial survivors, 74 had major injuries making this an unusual accident as most aircraft crashes result in very few severely injured survivors. This prompted the setting up of a major study group, the Nottingham, Leicester, Derby, Belfast Study Group (NLDB) to examine in detail the accident and its aftermath. This paper is part of that work and is an initial survey of the thoracic injuries sustained by the 87 survivors. Twenty-three passengers sustained major chest trauma and all had major injury to other parts of the body. Five of these patients died within 12 h of admission. Various patterns of chest trauma emerged from this study, including an increasing incidence of rib fractures with age and a distinctive pattern of upper zone pulmonary contusion in younger patients.

Accidents, Aviation↗
PubMed1988

A rare anomaly of the aortic arch complex.

A six-month-old girl presented with heart failure. Cardiac catheterisation showed a ventricular septal defect and an anomaly of the aortic arch complex, which is a challenge to embryologic theory.

Aorta, Thoracic↗
PubMed1988

Cerebral function analysis during deep hypothermia and total circulatory arrest in infant lambs.

Deep hypothermia with total circulatory arrest is an important technique in the surgical treatment of complex congenital heart defects. However, the clinical use of this technique has been accompanied by occasional postoperative neurological abnormalities. Twenty new born lambs (four groups of five) were subjected to deep hypothermia (15 degrees C) and circulatory arrest for 30 min, 45 min, 60 min and 90 min respectively. Their brain electrical response was monitored by means of the Cerebral Function Analysing Monitor (CFAM), which produces a detailed analysis of the electroencephalogram amplitude and analyses the frequency of the waveforms into standard, beta, alpha, theta, and delta bands. After induction of circulatory arrest both the voltage and frequency recordings became isoelectric within 30-180 seconds and remained flat for the duration of the arrest. During the rewarming phase of the latency of time to initial appearance of electrical activity and continuous CFAM recording showed a good correlation with the duration of arrest and also a significant increase (p less than or equal to 0.001) when the circulatory arrest was maintained beyond 45 min. These findings suggest an increasing risk of neurologic damage when the arrest period is longer than 45 min.

Animals↗
PubMed1988

Management of a patient with Wilms's tumour extending into the right heart chambers: a case report and a review of other published reports.

Wilms's tumours that extend by direct intravascular spread into the right side of the heart are rare. A case of such a tumour was diagnosed by ultrasound. A one stage resection was performed on cardiopulmonary bypass and with profound hypothermic circulatory arrest. It was followed by adjunctive chemotherapy and radiotherapy. The child was alive and tumour free 18 months later. A review of 17 other similar cases indicated that multimodal treatment is justified in patients with extensive intravascular spread of Wilms's tumours.

Cardiopulmonary Bypass↗
PubMed1985

Changes in the respiratory gas tensions of a pneumonectomy space and their application to the diagnosis of bronchopleural fistula.

The oxygen (pO2) and carbon dioxide (pCO2) gas tensions of a pneumonectomy space were studied in an animal model. The 2 gases were measured in a standard blood gas analyser. The space gas pO2 and pCO2 equilibrated to a steady state within 48 hours of thoracotomy (pO2 mean 53.9 +/- 9.3 SD torr; pCO2 mean 44.8 +/- 9.9 SD torr). In the presence of a bronchopleural fistula (BPF), the pO2 rose significantly (mean pO2 118.4 +/- 13.2 SD torr; p less than 0.001). The space pCO2 usually fell, but the response was inconsistent (mean pCO2 33.6 +/- 16.4 SD; p = NS). A further rise in space pO2 could sometimes be induced by allowing the animals to breathe 100% oxygen by face mask. Data from 4 clinical cases of BPF support the concept that measurement f the space gas pO2 could be used as a bedside test for BPF.

Animals↗
PubMed1985

Sympathoadrenal function during cardiac operations in infants with the technique of surface cooling, limited cardiopulmonary bypass, and circulatory arrest.

The sympathoadrenal response to surface cooling, limited cardiopulmonary bypass, and deep hypothermic circulatory arrest was investigated in 22 infants undergoing correction of congenital heart defects. Surface cooling to 26 degrees C was associated with a significant rise in plasma epinephrine and norepinephrine levels. Both levels fell during the period of core cooling on bypass, presumably because of hemodilution. Following the period of circulatory arrest there was a rise in both catecholamine levels that correlated nonlinearly with the duration of circulatory arrest. The catecholamine levels remained high after rewarming until the chest was closed. The results suggest that this type of surgical procedure produces severe sympathoadrenal stress. The extremely high values found in the postarrest period in some patients, who had had a long period of arrest (greater than 40 minutes), may indicate hypoxic stress. The biological effect of high circulating plasma catecholamines during hypothermia is difficult to assess. The heart rate response to plasma catecholamine levels tended to diminish on cooling in our patients.

Cardiopulmonary Bypass↗