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An Adjusted Calculation Model Allows for Reduced Protamine Doses without Increasing Blood Loss in Cardiac Surgery.

https://arctichealth.org/en/permalink/ahliterature284260
Source
Thorac Cardiovasc Surg. 2016 Sep;64(6):487-93
Publication Type
Article
Date
Sep-2016
Author
Gunilla Kjellberg
Ulrik Sartipy
Jan van der Linden
Emelie Nissborg
Gabriella Lindvall
Source
Thorac Cardiovasc Surg. 2016 Sep;64(6):487-93
Date
Sep-2016
Language
English
Publication Type
Article
Keywords
Aged
Anticoagulants - administration & dosage - adverse effects
Blood Coagulation - drug effects
Blood Coagulation Tests
Blood Loss, Surgical - prevention & control
Body Height
Body Weight
Cardiac Surgical Procedures - adverse effects
Cardiopulmonary Bypass - adverse effects
Computer simulation
Drug Dosage Calculations
Female
Heparin - administration & dosage - adverse effects
Heparin Antagonists - administration & dosage - adverse effects
Humans
Male
Middle Aged
Models, Biological
Postoperative Hemorrhage - etiology - prevention & control
Protamines - administration & dosage - adverse effects
Sweden
Time Factors
Treatment Outcome
Abstract
Background Heparin dosage for anticoagulation during cardiopulmonary bypass (CPB) is commonly calculated based on the patient's body weight. The protamine-heparin ratio used for heparin reversal varies widely among institutions (0.7-1.3?mg protamine/100 IU heparin). Excess protamine may impair coagulation. With an empirically developed algorithm, the HeProCalc program, heparin, and protamine doses are calculated during the procedure. The primary aim was to investigate whether HeProCalc-based dosage of heparin could reduce protamine use compared with traditional dosages. The secondary aim was to investigate whether HeProCalc-based dosage of protamine affected postoperative bleeding. Patients and Methods We consecutively randomized 40 patients into two groups. In the control group, traditional heparin and protamine doses, based on body weight alone, were given. In the treatment group, the HeProCalc program was used, which calculated the initial heparin bolus dose from weight, height, and baseline activated clotting time and the protamine dose at termination of CPB. Results We analyzed the results from 37 patients, after exclusion of three patients. Equal doses of heparin were given in both groups, whereas significantly lower mean doses of protamine were given in the treatment group versus control group (211?±?56 vs. 330?±?61?mg, p?
PubMed ID
26270199 View in PubMed
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An Alaskan experience with cardiopulmonary bypass in resusitating patients with profound hypothermia and cardiac arrest.

https://arctichealth.org/en/permalink/ahliterature5226
Source
Alaska Med. 1984 Apr-Jun;26(2):31-3
Publication Type
Article

Anesthetic management for cardiac transplantation in North America--1986 survey.

https://arctichealth.org/en/permalink/ahliterature234662
Source
J Cardiothorac Anesth. 1987 Oct;1(5):429-37
Publication Type
Article
Date
Oct-1987
Author
F A Hensley
D E Martin
D R Larach
M E Romanoff
Author Affiliation
Department of Anesthesia, Pennsylvania State University College of Medicine, Hershey 17033.
Source
J Cardiothorac Anesth. 1987 Oct;1(5):429-37
Date
Oct-1987
Language
English
Publication Type
Article
Keywords
Anesthesia, General - methods - statistics & numerical data
Canada - epidemiology
Cardiopulmonary Bypass - statistics & numerical data
Heart Transplantation - statistics & numerical data
Humans
Preanesthetic Medication - statistics & numerical data
Preoperative Care - statistics & numerical data
Time Factors
United States - epidemiology
Abstract
Cardiac transplantation has become an established part of the therapy of end-stage heart disease. The number of cardiac transplants performed, as well as the number of centers performing them, has increased dramatically in the past 2 years. A paucity of literature on the anesthetic management of patients undergoing cardiac transplantation prompted this survey of 46 United States and Canadian institutions. The report summarizes the perioperative anesthetic management of a total of 1,273 transplant recipients in 34 institutions. Generally, similar anesthetic techniques and agents were used. One notable exception was the percentage of institutions using perioperative pulmonary artery catheter monitoring. As determined from this survey, right ventricular failure remains the leading cause of inability to terminate cardiopulmonary bypass in this patient population. Further, in surveyed institutions, cardiac transplantation expends more physician as well as hospital resources per patient than coronary artery bypass surgery.
PubMed ID
2979112 View in PubMed
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Anticoagulation management during cardiopulmonary bypass: a survey of 54 North American institutions.

https://arctichealth.org/en/permalink/ahliterature144769
Source
J Thorac Cardiovasc Surg. 2010 Jun;139(6):1665-6
Publication Type
Article
Date
Jun-2010

Are intraoperative precursor events associated with postoperative major adverse events?

https://arctichealth.org/en/permalink/ahliterature108590
Source
J Thorac Cardiovasc Surg. 2014 May;147(5):1499-504
Publication Type
Article
Date
May-2014
Author
Christine R Herman
Jean-François Légaré
Adrian Levy
Karen J Buth
Roger Baskett
Author Affiliation
Division of Cardiac Surgery, Dallhousie University, Halifax, Nova Scotia, Canada; Department of Community Health and Epidemiology, Dallhousie University, Halifax, Nova Scotia, Canada. Electronic address: cherman@dal.ca.
Source
J Thorac Cardiovasc Surg. 2014 May;147(5):1499-504
Date
May-2014
Language
English
Publication Type
Article
Keywords
Aged
Blood Loss, Surgical - mortality
Cardiopulmonary Bypass
Coronary Artery Bypass - adverse effects - mortality
Female
Heart Valve Prosthesis Implantation - adverse effects - mortality
Humans
Incidence
Male
Middle Aged
Nova Scotia - epidemiology
Postoperative Complications - epidemiology - mortality - surgery
Prevalence
Quality Improvement
Quality Indicators, Health Care
Registries
Reoperation
Retrospective Studies
Risk factors
Time Factors
Treatment Outcome
Abstract
Precursor events are undesirable events that can lead to a subsequent adverse event and have been associated with postoperative mortality. The purpose of the present study was to determine whether precursor events are associated with a composite endpoint of major adverse cardiac events (MACE) (death, acute renal failure, stroke, infection) in a low- to medium-risk coronary artery bypass grafting, valve, and valve plus coronary artery bypass grafting population. These events might be targets for strategies aimed at quality improvement.
The present study was a retrospective cohort design performed at the Queen Elizabeth Health Science Centre. Low- to medium-risk patients who had experienced postoperative MACE were matched 1:1 with patients who had not experienced postoperative MACE. The operative notes, for both groups, were scored by 5 surgeons to determine the frequency of 4 precursor events: bleeding, difficulty weaning from cardiopulmonary bypass, repair or regrafting, and incomplete revascularization or repair. A univariate comparison of =1 precursor events in the matched groups was performed.
A total of 311 MACE patients (98.4%) were matched. The primary outcome occurred more frequently in the MACE group than in the non-MACE group (33% vs 24%; P = .015). The incidence of the individual events of bleeding and difficulty weaning from cardiopulmonary bypass was significantly higher in the MACE group. Those patients with a precursor event in the absence of MACE also appeared to have a greater prevalence of other important postoperative outcomes.
Patients undergoing cardiac surgery who are exposed to intraoperative precursor events were more likely to experience a postoperative MACE. Quality improvement techniques aimed at mitigating the consequences of precursor events might improve the surgical outcomes for cardiac surgical patients.
PubMed ID
23870157 View in PubMed
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Are we doing everything we can to conserve blood during bypass? A national survey.

https://arctichealth.org/en/permalink/ahliterature172391
Source
Perfusion. 2005 Sep;20(5):237-41
Publication Type
Article
Date
Sep-2005
Author
D. Belway
F D Rubens
D. Wozny
B. Henley
H J Nathan
Author Affiliation
Division of Perfusion Services, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
Source
Perfusion. 2005 Sep;20(5):237-41
Date
Sep-2005
Language
English
Publication Type
Article
Keywords
Blood Loss, Surgical - prevention & control
Blood Transfusion, Autologous - methods - utilization
Canada
Cardiopulmonary Bypass - methods
Centrifugation
Data Collection
Filtration
Humans
Leukocyte Reduction Procedures
Abstract
Despite major advances in biomaterial research and blood conservation, bleeding is still a common complication after cardiopulmonary bypass and cardiac surgery remains a major consumer of blood products. Although the underlying mechanisms for these effects are not fully established, two proposed major etiologies are the hemodilution associated with the use of the heart-lung machine and the impact of reinfusion of shed cardiotomy blood. Therapeutic strategies that primarily encompass the use of devices or technologies to overcome these effects may result in improved clinical outcomes.
To determine the extent to which 1) lipid/leukocyte filtration and centrifugal processing of cardiotomy blood, and 2) modified ultrafiltration (MUF) are currently applied in adult cardiac surgery in Canada.
A questionnaire was mailed to the chief perfusionist at all adult cardiac surgical centers in Canada, addressing details regarding the frequency of use of cardiotomy blood processing and MUF.
All questionnaires (36, 100%) were completed and returned. With regards to cardiotomy blood management, in 21 centers (58%), no specific processing steps were utilized exclusive of the integrated cardiotomy reservoir filter. Of the remaining centers, two (6%) reported using lipid/leukocyte filtration and 15 (42%) reported washing their cardiotomy blood. Three centers (8%) reported using MUF at the end of CPB.
Despite growing concern about the potential detrimental effects of cardiotomy blood, few centers in Canada routinely manage this blood with additional filtration and/or centrifugal processing prior to reinfusion. Similarly, MUF, demonstrated to be effective in the pediatric population, has not seen popular application in adult cardiac surgical practice.
PubMed ID
16231618 View in PubMed
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Arrhythmias in off-pump coronary artery bypass grafting and the antiarrhythmic effect of regional ischemic preconditioning.

https://arctichealth.org/en/permalink/ahliterature183703
Source
J Cardiothorac Vasc Anesth. 2003 Aug;17(4):459-64
Publication Type
Article
Date
Aug-2003
Author
Zhong-Kai Wu
Tiina Iivainen
Erkki Pehkonen
Jari Laurikka
Matti R Tarkka
Author Affiliation
Department of Surgery, Tampere University Hospital, Tampere, Finland.
Source
J Cardiothorac Vasc Anesth. 2003 Aug;17(4):459-64
Date
Aug-2003
Language
English
Publication Type
Article
Keywords
Adult
Aged
Anastomosis, Surgical
Arrhythmias, Cardiac - etiology - metabolism - physiopathology
Atrial Fibrillation - etiology - metabolism - physiopathology
Biological Markers - blood
Cardiopulmonary Bypass
Circadian Rhythm - physiology
Coronary Artery Bypass
Coronary Vessels - surgery
Creatine Kinase - metabolism
Creatine Kinase, MB Form
Electrocardiography
Female
Finland - epidemiology
Heart Rate - physiology
Humans
Incidence
Ischemic Preconditioning, Myocardial - adverse effects
Isoenzymes - metabolism
Male
Middle Aged
Myocardial Ischemia - metabolism - physiopathology - therapy
Prospective Studies
Recurrence
Statistics as Topic
Tachycardia, Supraventricular - etiology - metabolism - physiopathology
Tachycardia, Ventricular - etiology - metabolism - physiopathology
Time Factors
Treatment Failure
Ventricular Premature Complexes - etiology - metabolism - physiopathology
Abstract
The authors sought to establish whether regional ischemic preconditioning (IP) reduces ischemic reperfusion arrhythmias in patients who undergo off-pump coronary artery bypass grafting (OPCAB).
A controlled, randomized, prospective study.
A university hospital.
Thirty-two patients with left anterior descending coronary artery (LAD) or 2-vessel heart disease (including LAD) who were to undergo OPCAB were randomized into an IP and a control group.
IP was induced by occluding the LAD twice for a 2-minute period followed by 3-minute LAD reperfusion before bypass grafting of the first coronary vessel.
Twenty-four-hour electrocardiography was recorded from the preoperative day to the second postoperative day. The heart rate (HR) was significantly elevated after surgery. Supraventricular extrasystole (SVES) events were similar before and after surgery. The incidence of patients with ventricular extrasystole (VES), supraventricular tachycardia (SVT), atrial fibrillation (AF), and ventricular tachycardia (VT) was significantly increased after the operation. Ventricular arrhythmias occurred mostly during anastomosis and the early reperfusion period and recovered 2 hours after reperfusion. Supraventricular tachyarrhythmias were mostly encountered 24 hours after reperfusion. IP significantly suppressed HR elevation, SVT, and VT after surgery. SVES, VES, and AF episodes were similar between the groups.
Arrhythmia was a common phenomenon during and after an OPCAB procedure. The present IP protocol significantly suppressed HR elevation, the episodes of SVT, and the incidence of VT after surgery.
PubMed ID
12968233 View in PubMed
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The Best Bypass Surgery Trial: rationale and design of a randomized clinical trial with blinded outcome assessment of conventional versus off-pump coronary artery bypass grafting.

https://arctichealth.org/en/permalink/ahliterature165955
Source
Contemp Clin Trials. 2007 Jul;28(4):540-7
Publication Type
Article
Date
Jul-2007
Author
Christian H Møller
Birte Østergaard Jensen
Christian Gluud
Mario J Perko
Jens T Lund
Lars Willy Andersen
Jan Kyst Madsen
Pia Hughes
Daniel A Steinbrüchel
Author Affiliation
Department of Cardiothoracic Surgery, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. christian.01.moeller@rh.hosp.dk
Source
Contemp Clin Trials. 2007 Jul;28(4):540-7
Date
Jul-2007
Language
English
Publication Type
Article
Keywords
Aged
Cardiopulmonary Bypass
Cause of Death
Coronary Angiography
Coronary Artery Bypass
Coronary Artery Bypass, Off-Pump
Denmark
Endpoint Determination
Female
Follow-Up Studies
Humans
Male
Middle Aged
Outcome Assessment (Health Care)
Postoperative Complications - mortality
Quality of Life
Research Design
Risk factors
Single-Blind Method
Abstract
Recent trials suggest that off-pump coronary artery bypass grafting (OPCAB) reduces the risk of mortality and morbidity compared with conventional coronary artery bypass grafting (CCAB) using cardiopulmonary bypass. Patients with a moderate- to high-risk of complications after CCAB may have additional benefit from OPCAB.
The Best Bypass Surgery Trial is a randomized, single center trial comparing the effects of OPCAB versus CCAB. The inclusion criteria are 3 vessel coronary heart disease affecting one of the marginal arteries, age>54 years, and EuroSCORE>or=5. The primary composite outcome measure consists of all-cause mortality, myocardial infarction, stroke, cardiac arrest, cardiogenic shock, and cardiac revascularization procedure. Follow up involves collection of data of mortality and morbidity via linkage to public registers, quality of life assessment at 3 and 12 months postoperatively and angiographic control at 12 months. The sample size of 330 patients was based on an estimated 75% one-year event free rate of the primary outcome measure in the OPCAB arm and 60% in the control arm with alpha=.05 and beta=.20. Accordingly, the trial will be able to detect an absolute risk reduction of 15% or a relative risk reduction of 37.5%. The median follow-up time is scheduled to 3 years.
Enrollment started in April 2002 and ended March 2006.
The results may have implications on the treatment modality of moderate- to high-risk patients scheduled for coronary artery bypass grafting.
PubMed ID
17188581 View in PubMed
Less detail

The cardiac surgery program at the Royal Columbian Hospital: review of the first fiscal year.

https://arctichealth.org/en/permalink/ahliterature219722
Source
Can J Surg. 1993 Dec;36(6):541-5
Publication Type
Article
Date
Dec-1993
Author
L M Fedoruk
K M Stewart
R I Hayden
Author Affiliation
Department of Cardiac Sciences, Royal Columbian Hospital, New Westminster, BC.
Source
Can J Surg. 1993 Dec;36(6):541-5
Date
Dec-1993
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Blood Transfusion - statistics & numerical data
British Columbia - epidemiology
Budgets
Cardiac Surgical Procedures - economics - organization & administration - statistics & numerical data
Cardiopulmonary Bypass - adverse effects - economics - mortality - statistics & numerical data
Coronary Artery Bypass - adverse effects - economics - mortality - statistics & numerical data
Emergencies - epidemiology
Female
Hospital Units - economics - organization & administration - statistics & numerical data
Humans
Intra-Aortic Balloon Pumping - statistics & numerical data
Length of Stay - statistics & numerical data
Male
Middle Aged
Organizational Objectives
Reoperation - statistics & numerical data
Surgical Procedures, Elective - statistics & numerical data
Time Factors
Treatment Outcome
Abstract
From a budgetary viewpoint, the authors summarize the operative experience of the cardiac surgery program at the Royal Columbian Hospital during its first fiscal year of operation. The program was funded for 250 cardiopulmonary bypass (CPB) procedures: $16,800 per CPB procedure ($4.2 million for the program). The 250 CPB procedures were performed on 248 patients. The 30-day operative mortality was 2%. Thirty patients (12.1%) underwent a second operation for complications or delayed primary closure of the sternum, or both; the complications included aortic prosthetic perivalvular leaks in 2 patients. Eight patients (3.2%) required insertion of an intra-aortic balloon pump preoperatively to stabilize their condition; 10 others (4.0%) required intra-aortic balloon pump insertion at surgery to correct low-cardiac-output syndrome. Blood products were needed for 149 (59.6%) of the 250 CPB procedures. The average hospital stay was 10.4 days for noncoronary procedures and 9.0 days for coronary procedures.
PubMed ID
8258135 View in PubMed
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[Cardiopulmonary bypass duration as predictor of immediate results after cardiac surgery].

https://arctichealth.org/en/permalink/ahliterature266621
Source
Khirurgiia (Mosk). 2015;(5):4-13
Publication Type
Article
Date
2015
Author
Yu V Belov
A I Katkov
I A Vinokurov
A V Stonogin
R N Komarov
Source
Khirurgiia (Mosk). 2015;(5):4-13
Date
2015
Language
English
Russian
Publication Type
Article
Keywords
Adult
Aged
Cardiac Surgical Procedures - adverse effects - methods
Cardiopulmonary Bypass - adverse effects - methods
Female
Heart Valve Diseases - surgery
Humans
Male
Middle Aged
Moscow
Outcome Assessment (Health Care)
Postoperative Complications - classification - epidemiology - etiology
Retrospective Studies
Risk factors
Time Factors
Abstract
It was analyzed the results of treatment of 152 patients who underwent heart valve surgery. Depending on cardiopulmonary bypass (CPB) duration patients were divided into 4 groups: the 1st--up to 90 min, the 2nd--90-120 min, the 3rd--120-180 min, the 4th--more than 180 min. Severity of initial comorbidities was comparable in all groups. It was revealed that CPB duration effects on intraoperative blood loss, incidence of acute renal failure, encephalopathy, use of inotropic and angiotonic support (p
PubMed ID
26271316 View in PubMed
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111 records – page 1 of 12.