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At least 433 records · Page 24Linked to original sources
PubMed1986

Selected blood coagulation parameters during extracorporeal circulation.

We investigated selected coagulation parameters in 13 patients who had undergone open heart surgery with extracorporeal circulation (ECC). During ECC factor XIIa increased considerably to 38%. This may lead to intravascular coagulation, which is however inhibited during ECC by the administered heparin. The C1-inhibitor activity decreased to 12% during ECC, this decrease was considerably greater and lasted longer than the decrease of the C1-inhibitor concentration, which declined to 59%. The levels of the other coagulation factors I, II, V, VII, X, XII, antithrombin III, alpha 2-antiplasmin and platelets decreased to 50-60%. The latter was predominantly due to hemodilution at the beginning of ECC. We assume that the critical period for the coagulation system in ECC appears when ECC is discontinued. At this point we have a high factor XIIa level and a low C1-inhibitor activity so that intravascular coagulation (DIC) may occur because then the inhibitory effect of heparin is neutralized by protamine.

Adult↗
PubMed1980

Technical aspects in the management of the meconium aspiration syndrome with extracorporeal circulation.

Sixteen neonatal patients diagnosed as having the meconium aspiration syndrome were selected for management with extracorporeal circulation with a membrane oxygenator (ECMO) with 8 survivors over 4 yr. All patients weighed greater than 2 kg. Each was placed in the 100% mortality group according to a Neonatal Pulmonary Insufficiency Index (NPII) based on hourly pH and FiO2 determinations. The typical patient course on ECMO was stabilization for the first 12 hr then improvement on high bypass flow rates for 12-24 hr to maintain a pAO2 for 50-60 mm Hg with minimal ventilator settings with an FiO2 of 0.3-0.4. Bypass flow rates were reduced to maintain adequate pAO2 with similar ventilator settings for another 24 hr. Survivors were taken off bypass and decannulated while on similar ventilator settings. Nonsurvivors did stabilize or improve but usually exhibited symptoms of intracranial hemorrhage by 48 hr. Intracranial hemorrhage appeared to be related to the degree of prebypass acidosis. Successful ECMO support reduced the expected mortality from severe meconium aspiration from 100% to 50%. Early institution of ECMO, before acidosis worsens, seems to be indicated to reduce the morbidity of conventional ventilator management and to prevent intracranial hemorrhage from severe prebypass acidosis. Long term followup indicates that these patients have progressed satisfactorily according to developmental testing for as long as 4 yr.

Catheterization↗
PubMed1995

Continuous blood density measurements and volume changes during extracorporeal circulation in patients undergoing cardiac surgery.

The changes of blood volume and transcapillary fluid shifts during extracorporeal circulation (ECC) was examined using continuous measurements of blood density by the mechanical oscillator technique. Sixteen patients (1 female, 15 male) with a mean age of 61.4 years (+/- 7.6 years, 47-70 years) undergoing coronary artery bypass surgery were included in this study. The equipment for continuous measurement of the blood density (DPRT by Paar/Austria) was installed at the arterial line of the heart-lung bypass. Higher-precision discrete measurements of some parameters used the DMA 55 equipment produced by the Paar company. Measurements were taken at 37 degrees C. In 11 patients the transcapillary volume loss (difference of total volume between beginning and end of ECC) during heart-lung bypass (mean observation period of 55 min (+/- 16 min, 28-82 min) was found to be 870 ml/m2 body surface area (BSA) (+/- 360 ml, 290-1560 ml/m2) by the dilution method using the priming solution at the beginning and 500 ml lactated Ringer's solution added at the end of the ECC. The calculated volume shift using the "double density method", which takes into account blood density, plasma density, and hematocrit, amounted to 830 ml/m2 BSA (+/- 200 ml, 450-1210 ml/m2). The density of the transcapillary volume loss into the interstitial layer was calculated and found to be 1.0026 g/ml (+/- 0.0017 g/ml, 1.0003-1.0063 g/ml). A significant difference of transcapillary volume shift correlated with the administered catecholamine (dopamine, dobutamine) dosage postoperatively. Without catecholamine this difference was 260 ml/m2 BSA, with 3 microns/kg/min dopamine it rose to > 500 ml/m2 BSA.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed2005

[Resection of the trachea with extracorporeal circulation as a simultaneous procedure during coronary artery bypass grafting--a case report].

The authors describe their surgical management of a female patient with a symptomatic coronary artery disease, who had developed a postintubation stenosis of the trachea. The patient sufferred from a rest dyspnoea with stridor. The unusual combination of the both cardiac and tracheal disorders were managed employing a one-step cardio-thoracic surgical procedure. The tracheal resection was conducted in the extracorporeal circulation condition together with the myocardial revascularization. The case shows how, in indicated cases, availability of the extracorporeal circulation can widen a spectrum and limits of the standard chest surgery.

Aged↗
PubMed1994

[Monitoring of electroencephalogram during the operation under the extracorporeal circulation].

Generally speaking, it is difficult to know the occurrence of brain complication until the patient becomes awake from anesthesia. But if we can detect the occurrence of of brain complication during the operation, we can start its therapy even during the operation. In order to detect the occurrence of brain complication during the operation under extracorporeal circulation (ECC), we monitored intraoperative electroencephalogram (EEG). Since June 1992, forty-two patients were operated on using ECC. Usual ECC was applied in 39 cases (Group-A), and circulatory arrest with retrograde cerebral perfusion was applied in remaining three cases (Group-B). We studied the amplitude of EEG using actual value (by Fujimori method), and compressed EEG acquired by slow-paper-feed recording. In terms of the frequency of EEG, we studied compressed spectral array (CSA). In Group-A, there was no brain complication identified after operation. Actual values of amplitude were 23 +/- 4.0 microV (before ECC), 19 +/- 4.0 microV (during ECC), 23 +/- 4.9 microV (after ECC). There was a significant decrease (p < 0.001) of amplitude during ECC compared with that before ECC. The ratio of amplitude during ECC to that before ECC (D/B ratio) was 0.82 +/- 0.16. The ratio of amplitude after ECC to that before ECC (A/B ratio) was 1.01 +/- 0.15. According to compressed EEG, it was observed that the amplitude changes following the up-down of esophageal temperature. In CSA, influence of esophageal temperature on the power spectrum of alpha and delta wave band was recognized. In Group-B, there was one brain complication identified after operation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

[Variations in plasma protein components during extracorporeal circulation].

In this research we have determined the behaviour of proteic plasmatic pattern and some enzymes during extracorporeal circulation and we noted a constant increase of albumin and of the ratio Alb/Glob. We observed also variations of some enzymes. Our opinion according other AA. is that this changes are determined principally by the large dose of heparin necessary during the C.E.C.

Alanine Transaminase↗
PubMed1963

HAEMATOLOGY AND THE EXTRACORPOREAL CIRCULATION.

The experience gained in the investigation of 100 cases of cardiac surgery treated by use of extracorporeal circulation has shown that certain simple laboratory tests suffice to detect induced defects in the blood and to guide therapy. These tests have been devised to detect the level of circulating heparin during perfusion; the presence of residual heparin following perfusion; the existence of a qualitative or quantitative fibrinogen deficiency; excessive fibrinolysis. Any of the latter three abnormalities alone or together have caused excessive immediate post-operative blood loss. Specific therapy has not been found to be necessary unless severe bleeding occurs.

Anemia↗
PubMed1975

Blood platelets and extracorporeal circulation; kinetic studies on dogs on cardiopulmonary bypass.

Platelet kinetics and functions were studied in dogs during extracorporeal circulation. A transient platelet sequestration in the liver occurs during the bypass. This reversible disappearance is accompanied by a loss of the ability of platelets to adhere or aggregate. The platelets which return to the circulation have normal functions and a normal life span. The irreversible damage is mainly due to the direct blood-gas interface. Impairment of lung function by platelet aggregates is discussed and the importance of an in vivo model to study the factors which affect the platelets, such as antiaggregating agents, is pointed out.

Animals↗
PubMed1989

Defibrotide in extracorporeal circulation on healthy rabbits.

Defibrotide, a partially depolymerized DNA fraction obtained from mammalian lung, was found to have significant antithrombotic and fibrinolytic activities. On the basis of this evidence defibrotide could be of clinical value during hemoperfusive treatment. The present study was designed to evaluate the biological tolerance of this technique in a model of extracorporeal circulation, using an original Silastic apparatus, with defibrotide (0.83 mg/kg-1/min-1 after a 50 mg/kg-1 bolus injection) and heparin (0.66 IU/kg-1/min-1 after a 400 IU/kg-1 bolus injection) in ten rabbits (Group 1) and heparin only in ten others (Group 2, control group). In this study defibrotide produced a significantly lower pressure inside the circuit compared to the control group and gave a protective effect against those pathological changes which appeared during extracorporeal circulation and that may be considered omens of a state of shock. However the use of defibrotide in addition to heparin seemed to have a poor effect on platelet and leukocyte count alterations during application of this technique.

Animals↗
PubMed1975

The hemostatic mechanism after open-heart surgery. I. Studies on plasma coagulation factors and fibrinolysis in 512 patients after extracorporeal circulation.

Blood coagulation screening profiles were performed in 512 patients who underwent open-heart surgery with extracorporeal circulation. Severe coagulation disorders were found in 29 (5.6 per cent) patients. The most common abnormalities were low one-stage prothrombin time (PT) activities and impaired whole blood clot retractions. In the majority of patients the discrepancy between low PT's and normal or only slightly depressed factor II, V, VII, and X activities was explained by the presence of an inhibitor of the extrinsic system. Eight patients demonstrated the heparin rebound phenomenon but only 1 bled excessively. The pattern of severe hepatic dysfunction was found in 4 and severe depression of vitamin K-dependent factors due to oral anticoagulants in 2. Two had disseminated intravascular coagulation. Seventeen patients with normal coagulation screening profiles bled excessively postoperatively. Of these, 2 had moderate thrombocytopenia associated with a marked platelet functional abnormality. Revision of the wound in 13 revealed a surgical hemostatic defect and in 2 the cause of bleeding could not be determined.

Blood Coagulation Disorders↗
PubMedDate not supplied

Heparin free long-term extracorporeal circulation using bioactive surfaces.

As already shown, a single bolus injection of heparin is sufficient to perform extracorporeal circulation (ECC) for long-term lung support if bioactive surfaces (HBS) are used. In the present study whether complete avoidance of systemic heparinization using HBS is possible was studied. Seven conscious sheep (50-60 kg) underwent venovenous bypass under standardized conditions using a Maxima capillary membrane oxygenator. Drug administration, surgery, and other conditions, such as priming volume and blood flow rates, were identical in all experiments. All blood contacting surfaces (oxygenator, catheters, etc.) were HBS. The ECC periods were set for 24 hr (n = 3) and 5 days (n = 4). At no time was heparin administered. No complications occurred in any experiment. Partial thromboplastin time, activated clotting time, and other coagulation parameters remained within physiologic ranges. Platelets did not drop below 80% of baseline values, and hemolysis rates were negligible. Blood gas data and other vital parameters were normal during the entire ECC period. Results show that HBS can be applied to long-term ECC, without the necessity for heparin administration.

Animals↗
PubMed2006

Extracorporeal circulation with low systemic heparinization during lung transplantation.

BACKGROUND: Some lung transplantation (LT) recipients suffer from pulmonary hypertension and right ventricular dysfunction or failure requiring extracorporeal circulation (ECC) to avoid catastrophic complications during surgery. The extracorporeal support usually requires systemic heparinization which is potentially associated with important side effects. We performed eight LT using preheparinized ECC circuits and an oxygenator associated with a lower level of systemic heparinization without evidence of perioperative complications. PATIENTS AND METHODS: From May 2002 to May 2005, 8 patients (5 men and 3 women) of mean age 22.5 +/- 9.5 years underwent bilateral sequential lung transplantation (BSLT) for cystic fibrosis (n = 6) or idiopathic pulmonary fibrosis (n = 2). All procedures were performed with ECC through a femoro-femoral veno-arterial bypass with preheparinized circuits and an oxygenator. RESULTS: No intraoperative mortality occurred. The mean ECC time was 147.8 +/- 31.3 minutes and the mean heparin administered was 3525 +/- 969.16 UI. No coagulopathy or thrombotic events were observed perioperatively. CONCLUSIONS: Our study confirmed the efficacy and safety of prehepanized circuits and oxygenator for femoro-femoral veno-arterial bypass during LT for patients with severe pulmonary hypertension requiring ECC.

Adult↗
PubMed2006

[Usefulness of transesophageal echocardiography during myocardial revascularization surgery without extracorporeal circulation].

OBJECTIVE: Intraoperative transesophageal echocardiography can be a highly useful monitoring technique during myocardial revascularization surgery when extracorporeal circulation (ECC) is not being used. Transesophageal echocardiography provides real-time images on both volume status and segmental myocardial contractility without interfering with the surgical field. PATIENTS AND METHODS: A total of 25 patients undergoing myocardial revascularization by sternotomy without ECC were monitored by transesophageal echocardiography during surgery. RESULTS: The 18 men and 7 women studied had a mean (SD) age of 71.3 (8) years. A third of them had hypertension and diabetes, 3 had suffered a cerebrovascular accident, and 2 had renal failure. Nine patients had a history of acute myocardial infarction and 3 had undergone angioplasty. Baseline echocardiograms on all patients established that 6 had a low ejection fraction (<30%). Twelve had altered segmental contractility, which was transient in 11 cases. Six patients had improved ejection fraction at the final assessment. Transesophageal electrocardiography also monitored volume status and the effects of inotropic drugs and beta-blockers in 83% of the patients. CONCLUSION: Transesophageal electrocardiography is a minimally invasive, safe, and precise way to directly monitor the beating heart in real time during myocardial revascularization without ECC. Image quality is good.

Adrenergic beta-Antagonists↗
PubMed2004

INO-1001 a novel poly(ADP-ribose) polymerase (PARP) inhibitor improves cardiac and pulmonary function after crystalloid cardioplegia and extracorporal circulation.

Poly(ADP-ribose) polymerase (PARP) activation plays a key role in free radical-induced injury in the context of systemic inflammation and ischemia/reperfusion. In the present preclinical study, we investigated the effects of INO-1001, a novel PARP inhibitor, on cardiac and pulmonary function during reperfusion in an experimental model of cardioplegic arrest and extracorporal circulation. Twelve anesthetized dogs underwent hypothermic cardiopulmonary bypass. After 60 min of hypothermic cardiac arrest, reperfusion was started after application of either saline vehicle (control, n = 6), or INO-1001 (1 mg/kg), a potent PARP inhibitor (n = 6). Biventricular hemodynamic variables were measured by combined pressure-volume-conductance catheters. Coronary and pulmonary blood flow and vasodilative responses to acetylcholine and sodium nitroprusside as well as pulmonary gas exchange were also determined. The administration of INO-1001 led to a significantly better recovery of left and right ventricular systolic function (P < 0.05) after 60 min of reperfusion. Coronary blood flow was also significantly higher in the INO-1001 group (P < 0.05). Although the vasodilative response to sodium nitroprusside was similar in both groups, acetylcholine resulted in a significantly greater increase in coronary and pulmonary blood flow in the INO-1001 group (P < 0.05). Pulmonary function in terms of alveolar arterial oxygen difference was better preserved in the INO-1001-treated group (P < 0.05). Thus, PARP inhibition improves the recovery of myocardial and endothelial function after hypothermic cardiac arrest and reduces pulmonary injury associated with extracorporal circulation.

Acetylcholine↗
PubMedDate not supplied

Intracardiac operations with extracorporeal circulation under acupuncture anaesthesia.

The method and clinical materials of 107 cases of direct vision intracardiac operation with extracorporeal circulation under acupuncture anaesthesia, together with a preliminary consideration of selection of patients, are reported. The most obvious benefit of acupuncture anaesthesia is the marked reduction or the absence of various post-operative respiratory symptoms and complications. Improvements on surgical technique for better result of acupuncture anaesthesia are discussed. It is stressed that further investigations for better analgesic effect are obligatory.

Acupuncture Therapy↗
PubMed1975

[Anoxic myocardial lesions in man, developed during extracorporeal circulation, studied by electron microscopy].

Anoxemic changes of the myocardium were examined at 20 patients operated on in extracorporal circulation. At a mild degree hypothermia (30 degrees C) morphological changes appear after a 20 minutes period of anoxaemia. Damage to the myocard of irreversible character could be revealed after an anoxaemic period of 43--55 minutes. An intermitting perfusion of the coronary arteries delayes the formation of the lesions, although in cases of ligation of the aorta for 90 minutes severe mitochondrial changes and deformation of cells were seen. The best method for protecting the myocard is an isotherm perfusion of the coronary arteries. Clinical and laboratory findings show that necrosis of the myocard has a focal character and may play a part in formation of postoperative lesions.

Cardiac Surgical Procedures↗
PubMed2001

Low dose systemic heparinization combined with heparin-coated extracorporeal circulation. Effects related to platelets.

BACKGROUND: A heparin coated cardiopulmonary bypass system combined with full and low dose systemic heparinization in coronary bypass surgery was investigated in a prospective, randomised study. Roller pumps, coronary suction and an open cardiotomy reservoir were used. METHODS: One hundred and nineteen patients were divided into 3 groups: group A (n=39) had a standard uncoated extracorporeal circulation (ECC)-set and systemic heparin was given in an initial dose of 400 IE/kg body weight. During ECC activated clotting time (ACT) was kept at = or >480 sec. Group B (n=42) had the same ECC-set completely coated with low molecular weight heparin, i.v. heparin was administered in the same dose as in group A, ACT was again kept at = or >480 sec. Group C (n=38) had the same coated ECC set as group B, but i.v. heparin was reduced to 150 IE/kg and during ECC ACT was maintained of = or >240 sec. RESULTS: Platelet decrease was significantly less in both groups utilizing coated circuitry as compared to control group A. Activation of thrombocytes as marked by b-thromboglobulin (not PF4) was significantly decreased in patients treated with coated circuits combined with low dose systemic heparinization and postoperative bleeding was significantly reduced. CONCLUSIONS: We conclude that in heparin coated extracorporeal circulation combined with either full dose or reduced systemic heparinization compared to uncoated circuits platelet count reduction is significantly less. Platelet activation as marked by b-thromboglobulin and postoperative blood loss are decreased with coated equipment and low i.v. heparinization.

Adult↗