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Results for “Extracorporeal Circulation”

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PubMed1990

[Serum levels of oxacillin and cephalothin in patients with extracorporeal circulation during surgery].

The authors investigated the oxacillin and cephalotine serum levels in patients operated under conditions of extracorporeal circulation. They found that the time for which the patients are adequately protected against staphylococcal infection is in oxacillin cca 180 mins. and in cephalotine 150 mins. after administration of the first dose of antibiotic. They recommend to administer a second dose of the antibiotic along with protamine sulphate after removal of the aortal cannula to obtain a maximum concentration of the antibiotic in the newly formed blood clots. If the surgical operation lasts longer, they recommend to administer the antibiotic in the given time interval regardless of the operation and to administer a third dose when removing the cannula. The authors investigated a total of 30 patients. In one case they encountered an early and in another case a urinary infection.

Adolescent↗
PubMed1988

Complement activation by extracorporeal circulation: effects of precoating a membrane oxygenator circuit with human whole blood.

In an in vitro study of extracorporeal circulation (ECC), uncoated oxygenators (UC), oxygenators precoated with whole human blood (CN) and oxygenators precoated with blood and then rinsed with Ringer's acetate (CR) all significantly (p less than 0.001) activated the initial and terminal parts of the complement cascade. After 60 min C3 activation had increased by 692% (UC), 750% (CN) and 393% (CR), and terminal complement complex (TCC) concentrations by 194% (UC), 215% (CN) and 273% (CR). C3 activation was significantly (p less than 0.05) less in the CR than in the other groups. There was no statistical intergroup difference in increase of TCC concentration. Complement activation was accompanied by a significant drop in neutrophil counts, which was uninfluenced by coating or rinsing. The observed dissociation of the complement cascade shows that assessment of activation products from both parts is necessary for evaluation of total complement activation. The study suggests that protein precoating may improve biocompatibility of ECC.

Biocompatible Materials↗
PubMed1995

[Evaluation of serum granulocyte colony stimulating factor and granulocyte counts in patients with extracorporeal circulation].

To clarify the physiologic roles of granulocyte colony stimulating factor (G-CSF) in increasing granulocyte after extracorporeal circulation (ECC). The serum levels of G-CSF, C3a, granulocyte elastase and granulocyte count were examined in 26 patients undergone open heart surgery. These patients were divided into two groups, the long perfusion group (11 patients) and the short perfusion group (15 patients). Granulocyte increased immediately after ECC and reached maximum 48 hours after ECC in both groups. C3a showed significant increase at the end of ECC and decreased rapidly after ECC in both group. G-CSF showed high levels 3 and 6 hours after ECC in the short perfusion group and moderate increase prolonged until 48 hours after ECC in the long perfusion group. Granulocyte elastase showed high levels 6 hours after ECC and decreased to the normal value 48 hours after ECC in the short perfusion group, and high levels prolonging until 48 hours after ECC in the long perfusion group. Increase of granulocyte count might be affected with increase of compliment (C3a) and G-CSF at the early and late phase after ECC, respectively. Granulocyte elastase increased differently by the duration of perfusion time.

Adult↗
PubMed1999

[Severe digestive complications after heart surgery using extracorporeal circulation].

PURPOSE: To determine the incidence, circumstances of occurrence and evolution of gastrointestinal complications after cardiac surgery with extracorporeal circulation (ECC). METHODS: Retrospective chart study of gastrointestinal complications in 6.281 patients undergoing ECC between january 1994 and December 1997. RESULTS: Sixty patients developed 68 gastrointestinal complications (1%). Complications included: upper gastrointestinal bleeding (n = 23), intestinal ischemia (n = 19), cholecystitis (n = 7), pancreatitis (n = 6), and paralytic ileus (n = 16). The incidence of these complications was low after coronary artery (0.4%) or valvular surgery (0.8%) and high after cardiac transplantation (6%) and after surgery for acute aortic dissection (9%). Compared with a control population, patients with gastrointestinal complication had a higher Parsonnet score (29 +/- 15 vs 13 +/- 12 points; P = 0.002), were more frequently operated upon as an emergency (40/60, 66% vs 1120/6221, 18%; P = 0.01), underwent ECC of longer duration (114 +/- 66 vs 74 +/- 42 min; P = 0.01), and presented more frequently with low cardiac output after surgery (45/60, 75% vs 435/6221, 7%; P = 0.001). The mortality rate after gastrointestinal complications was 52%. The major factor associated with mortality was the occurrence of sepsis (OR = 38.7). Other factors were: renal failure (OR = 7.9), age > 75 yr (OR = 3.5), mechanical ventilation for more than seven days (OR = 2.7), associated cerebral damage (OR = 3.9). CONCLUSION: Gastrointestinal complications after ECC occur in high risk surgical patients. These complications are frequently associated with other complications leading to a high mortality rate.

Adult↗
PubMed2004

Myocardial revascularization surgery without extracorporeal circulation minimizes postoperative bleeding and the need for transfusion.

OBJECTIVE: To compare myocardial revascularization (MR) with and without extracorporeal circulation (ECC) in regard to postoperative bleeding and the need for blood and hemoderivate transfusion. METHODS: From November 2001 to February 2002, 186 patients undergoing myocardial revascularization were assessed, excluding those who underwent associated procedures. The patients were divided into 2 groups as follows: group A -- comprising 116 patients undergoing MR with ECC; and group B -- comprising 69 patients undergoing MR without ECC. Both groups were comparable in regard to pre- and intraoperative characteristics, except for the greater number of distal anastomoses (P=0.0004) in group A, and greater prothrombin activity (P=0.04) and INR (P=0.03) in group B. To avoid discrepancies between the groups, 140 patients with statistically similar characteristics were selected. RESULTS: Studying the paired groups, both the total bleeding volume in 24 hours (P=0.001) and the bleeding volume indexed for body surface (P=0.004) were greater in group A (609.6 +/- 395.8 mL; 331.8 +/- 225.8 mL/m2, respectively) than in group B (437.2 +/- 315 mL; 241 +/- 173.9 mL/m2, respectively). Although the need for transfusion was not significantly different between the groups (P=0.1), the amount of erythrocyte concentrate transfused was greater in group A (P=0.01). No statistical difference was observed in regard to transfusion of other hemocomponents and the need for surgical review of hemostasis. CONCLUSION: Myocardial revascularization without ECC was more advantageous than MR with ECC in regard to smaller postoperative blood loss and a lesser need for transfusion of erythrocyte concentrate. The repercussions of this finding may be innumerable, particularly in regard to minimization of morbid factors and hospital costs.

Adult↗
PubMed2001

Heparin-coated extracorporeal circulation with full and low dose heparinization: comparison of thrombin related coagulatory effects.

Thrombin related coagulatory effects of a heparin-coated cardiopulmonary bypass system combined with full and low dose systemic heparinization were investigated in a prospective, randomized study in coronary bypass surgery patients. One hundred nineteen patients were divided into 3 groups. Group A (n = 39) had a standard uncoated extracorporeal circulation (ECC) set, and systemic heparin was administered in an initial dose of 400 IU/kg body weight. During ECC activated clotting time (ACT) was maintained at > or =480 s. Group B (n = 42) had the same ECC set completely coated with low molecular weight heparin. Intravenous heparin was given in the same dose as in Group A, and ACT was kept at the same level. Group C (n = 38) had the same coated ECC set as Group B, but intravenous heparin was reduced to 150 IU/kg, and during ECC, ACT was set to be > or =240 s. The same ECC components were used in all 3 groups including roller pumps, coronary suction, and an open cardiotomy reservoir. Thrombin generation as indicated by F1/F2 was significantly elevated at an ECC duration >60 min if heparin-coated ECC combined with low dose systemic heparinization was employed. Complexed thrombin (TAT) was significantly elevated after administration of protamine. Release of D-dimers indicating fibrinolysis was not significantly different between groups. Signs of clinical thromboembolism, i.e., postoperative neurological deficit, occurred in 2 patients in Group A and 1 patient in Group C. We conclude that heparin-coated extracorporeal circulation combined with reduced systemic heparinization intraoperatively leads to significantly increased thrombin generation, but not to increased fibrinolysis.

Adult↗
PubMed2002

[The influence of factor VII deficiency on cardiac operations with extracorporeal circulation].

During preoperative blood coagulation testing the factor VII (FVII) deficiency was found in two patients. No liver disease or cardiac insufficiency was found. No history of bleeding episodes existed. The latent (mild) deficiency of the FVII was diagnosed. The treatment with vitamin K (Vitacon) was administered in order to exclude vitamin K deficiency. The treatment showed no impact on the level of the FVII. Mixing study corrected the deficit (normal PT was found). Both patients underwent cardiac surgery with extracorporeal circulation. The epsilon-aminocapronic acid and fresh frozen plasma were used to prevent bleeding. The postoperative bleeding was compared to average of the year. No difference was found. The patients with mild FVII deficiency may safely undergo cardiac surgery with extracorporeal circulation.

Aged↗
PubMed1992

Treatment of recurrent in transit metastases from cutaneous melanoma by isolation perfusion in extracorporeal circulation with interleukin-2 and lymphokine activated killer cells. A pilot study.

Chemoresistant melanoma cells are known to be susceptible in vitro to lymphokine activated killer (LAK) cells. To obtain a high LAK/tumour cell ratio in vivo and avoid systemic toxicity due to interleukin-2 (IL-2), we used IL-2 plus LAK cells in the treatment of in transit melanoma metastases of the limbs by isolation perfusion (IP). In vivo immunological modifications induced by this immunotherapeutic approach were also analysed. Six patients previously treated with IP in extracorporeal circulation with tumour cytotoxic drugs and presently relapsing or not responding, were submitted to locoregional adoptive therapy consisting of 5 days systemic administration of IL-2 (Proleukin, EuroCetus) (9-12 x 10(6) IU/m2/day c.i.). Autologous LAK cells were derived from leukapheresis and subsequent in vitro stimulation with IL-2; LAK cells were then given along with IL-2 (120-2400 IU/ml of perfusion priming) to the affected limb by IP. In addition, 7-16 x 10(9) LAK cells were administered by systemic infusion the day after together with IL-2 (9-12 x 10(6) IU/m2/day) by c.i. for 5 days. All patients concluded the treatment without major toxicity. The analysis of circulating lymphocytes obtained from extracorporeal circuit at different times revealed rapid disappearance of LAK cells, suggesting their extravasation and/or endothelial adhesion in perfused tissues. Clinical responses included four partial and one complete response; another patient had stable disease. All patients are presently alive. Follow-up after IP ranges from 8 to 22 months.

Adult↗
PubMed2000

Extracorporeal circulation can induce hypotension by both blood-material contact and pump-induced platelet aggregation.

OBJECTIVE: Use of extracorporeal systems in cardiopulmonary bypass and dialysis induces vascular reactions, which can lead to hypotension and lung edema. METHODS: To study the contribution of blood-material contact and use of a roller pump, as well as prevention of their adverse effects, we perfused a rat hind leg with a tube connecting a carotid and a femoral artery. RESULTS: Autoperfusion of an uncoated tube caused a fall of aortic pressure and femoral resistance to 66% +/- 16% and 76% +/- 15%, respectively, of their initial values within 2 hours, whereas in control animals without a shunt, these variables hardly changed (to 94% +/- 2.8% and 99% +/- 2.8%, respectively). Lung water content became significantly higher than that found in control animals (79.4% +/- 1.50% versus 77. 0% +/- 1.67%). If we coated the tube with albumin, these changes were largely prevented. When the coated tube was placed in a roller pump, aortic pressure and femoral resistance immediately fell to 79% +/- 17.2% and 63% +/- 13.5%, respectively, whereas lung water content did not increase. The vasodilation was caused by platelet aggregation and could be prevented with aurintricarboxylic acid, which inhibits shear-induced platelet aggregation by blocking the binding of von Willebrand factor to platelet glycoprotein Ib receptors. CONCLUSIONS: Extracorporeal circulation may induce hypotension and lung edema by means of blood-material contact. Hypotension can be prevented by coating the system with albumin but can still result from pump-induced platelet aggregation.

Animals↗
PubMedDate not supplied

[Central hemodynamics, gas exchange, and gas oxygen-transporting function in combined anesthesia using xenon during operations under extracorporeal circulation].

The advantages of xenon include its good hemodynamic profile and possible cardioprotective properties. The investigation was undertaken to study central hemodynamics, lung gas exchange, and blood oxygen-transporting function in xenon anesthesia in patients operated on under extracorporeal circulation (EC). Fifteen patients aged 41-69 years operated on for coronary heart disease were examined. The severity of the patients' baseline status corresponded to NYHA functional classes I to IV. The duration of an operation was 251 +/- 10 min; that of EC was 97 +/- 5 min; aortic ligation lasted 59 +/- 3 min. After induction of anesthesia with propofol via concentration-regulated infusion (CRI) and with fentanyl, delivery of xenon was initiated at concentrations of 47 +/- 1 to 52.5 +/- 1%, which was mixed with oxygen. Propofol CRI was used during EC. After the latter, xenon was inhaled at concentrations of 47.7 +/- 1 to 53.3 +/- 1%. The mean arterial pressure (BP(mean)), heart rate (HR), and cardiac index (CI) remained unchanged during xenon anesthesia in the preperfusion period. After EC during xenon anesthesia, CI significantly rose with a moderate increase in HR without inotropic support. BP(mean) was moderately, but statistically significantly decreased. Prior to and following EC, there were no changes in the values of blood oxygen-transporting function.

Adult↗
PubMed1992

[Evolution of the blood levels of propofol administered by continuous perfusion during extracorporeal circulation].

The pharmacokinetics of propofol administered in continuous infusion was studied in 10 patients without left ventricular insufficiency during extracorporeal circulation (ECC) with hemodilution, for aortocoronary bypass. After a dosage of 1.5 mg.kg-1 during anaesthetic induction, the blood level was 4,800 micrograms.l-1. Under continuous infusion levels remained very high: they decreased by 40% during EEC induction and rose more than 10% when artificial ventilation started again. These modifications can be explained by physiological variations induced by EEC (non pulsated flow, redistribution, vasoconstriction, hemodilution, hypothermia) and they lead to adapt dosages in this type of anaesthesia.

Aged↗
PubMedDate not supplied

Carotid endarterectomy under hypothermic extracorporeal circulation: a method of brain protection for special patients.

This study was undertaken to evaluate the efficacy of hypothermic extracorporeal circulation for cerebral protection in 17 patients having simultaneous carotid endarterectomy and cardiac operations. The cardiopulmonary by-pass (CPB) was conducted using total hemodilution. The body temperature was cooled to 25 degrees C and the heart was arrested with cardioplegic solution. The carotid endarterectomy was performed first followed by the cardiac operation. No neurological or cardiac complications occurred. These results support the reliability of hypothermic cardiopulmonary bypass as a method of providing cerebral protection during simultaneous cardiac and carotid surgical procedures.

Aged↗
PubMed1985

Activation of granular cells during extracorporeal circulation--comparison between bubble-, membrane and hollowfiber oxygenators.

Summarizing our data we can say, that some hematologic disorders during extracorporeal circulation can be diminished by the use of new oxygenator types like the membrane and the Hollowfiber oxygenator. This correlates to the results of other research teams. In contrast to that the activation of the complement cascade is caused by the three systems in a similar way. Although we know, that the activation of the complement systems is only one of numerous reasons for postoperative pulmonary complications, we still must regard this as an important factor, so that the aim of further investigations should be to reduce complement activation during long term ECC.

Adult↗
PubMed1988

Isoflurane elimination via a bubble oxygenator during extracorporeal circulation.

It has been suggested that inhalational anesthetics should be discontinued at least 15 minutes prior to termination of extracorporeal circulation (ECC) to avoid myocardial depression. However, data regarding elimination of inhalation agents via a bubble oxygenator from hypothermic, hemodiluted patients have not been previously reported. The washout of isoflurane (ISF) from ten cardiac surgical patients using mass spectrometry was studied. The mean baseline oxygenator exhaust concentration of ISF was 0.85% prior to termination of ECC. Oxygenator concentration of ISF decreased to less than 0.05% in 8.8 +/- 2.5 minutes. Eight of ten patients had ISF washout curves best characterized by a one-compartment model, with a mean time constant of 1.94 minutes. Therefore, 95% washout of ISF should occur in 5.8 minutes (three time constants). It is suggested that ISF may be used closer to the termination of ECC than previously recommended without fear of significant myocardial depression.

Aged↗
PubMed1997

[Resuscitation of a near-drowning patient by the use of a portable extracorporeal circulation device].

We report on a 21-year old patient who nearly drowned in cold water under inexplicable circumstances. About 1/2 hour later he was found with cardiac arrest. Immediate cardiopulmonary resuscitation remained unsuccessfully but was continued. After transportation to the nearest hospital a core temperature of 26.1 degrees C was recorded. A team of our hospital arrived 2 1/2 hours after start of cardiopulmonary resuscitation. After introducing a femo-femoral bypass the patient was rapidly rewarmed and oxygenated using a portable extracorporeal circulation and membrane oxygenation. Defibrillation succeeded at a core temperature of 34.4 degrees C. A severe ARDS developed the same day which was successfully treated by membrane oxygenation. 41 days later the patient left the hospital fully recovered.

Adult↗
PubMed2007

Administration of brain natriuretic peptide improves cardiac function following operations using extracorporeal circulation in an animal model.

The critical phase during cardiosurgical procedures is weaning the diseased heart from the ECC (extracorporeal circulation). Post-ischaemic heart failure sometimes requires the administration of inotropic and/or vasconstrictive agents. The natriuretic peptides influence pre- and after-load through their natriuretic, diuretic and vasodilating actions. To date, there are only a few reports describing the therapeutic effect of BNP (brain natriuretic peptide) administration during cardiosurgical procedures. The aim of the present study was to evaluate the effect of BNP administration following ECC in an animal model. Surgery was performed on 20 pigs using ECC. A 30-min ischaemic episode was simulated. Following de-clamping, BNP was administered to the BNP group (n=10) by an i.v. (intravenous) bolus at 0.3 microg x kg(-1) of body weight x min(-1), followed by an infusion at a rate of 0.015 microg x kg(-1) of body weight x min(-1) for 60 min. The animals in the control group (n=10) received a saline solution instead of BNP. Haemodynamic and clinical chemistry parameters as well as the amount of catecholamines that were required were measured. All of the animals in the BNP group had a significantly better cardiac output and cardiac index at the end of the experiment. Seven out of 10 animals from the control group required catecholamines, whereas only one animal from the BNP group did. Creatine kinase levels were significantly lower in the BNP group. Systemic vascular resistance was markedly lower in the BNP group. In conclusion, administration of BNP is highly effective in treating post-ischaemic heart failure following ECC. Haemodynamics are greatly improved, and there is almost no need for pharmacological support.

Animals↗