International Perfusion Association

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IPA

Day: March 20, 2024

ECMO 123

Scrutinizing Mechanical Circulatory Support in Cardiogenic Shock: Have We Jumped the Gun?

This article examines the efficacy of mechanical circulatory support (MCS) systems, like veno-arterial extracorporeal membrane oxygenation (V-A ECMO) and Impella devices, in treating cardiogenic shock (CS). Despite their increasing use and endorsement in ESC and AHA/ACC guidelines based on observational studies, the article highlights a critical gap: the lack of clear mortality benefit from randomized controlled trials. This gap calls for a reassessment of the current evidence supporting MCS in CS, suggesting that enthusiasm for these technologies might have outpaced their proven clinical value. The article advocates for a careful reflection on the existing evidence to better understand the role of MCS in CS management.

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March 20, 2024
Pedi Pump

Perfusion Techniques for an 800 g Premature Neonate Undergoing Arterial Switch Procedure for Transposition of the Great Arteries

This article highlights the groundbreaking success in utilizing cardiopulmonary bypass (CPB) techniques for congenital heart surgery in premature neonates weighing less than 1000 g. Focusing on a case of a 28-week-old, 800 g neonate with transposition of the great arteries, the study discusses the challenges and innovations in perfusion techniques. Miniaturization of the CPB circuit, careful management of patient-to-circuit ratios, pharmacological distribution volumes, pressure gradients, and meticulous physiological environment control were key to mitigating risks such as volume shifts, electrolyte imbalance, and intracranial hemorrhage. This report underscores the feasibility and critical adjustments needed for successful CPB in extremely low birth weight neonates.

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March 20, 2024
Vasopressin

Prospective Randomized Double-Blind Study to Evaluate the Superiority of Vasopressin Versus Norepinephrine in the Management of Patients at Renal Risk Undergoing Cardiac Surgery with Cardiopulmonary Bypass (NOVACC Trial)

The NOVACC trial, a multicentre, randomized, double-blind study, evaluates vasopressin against norepinephrine for patients at renal risk during cardiac surgery with cardiopulmonary bypass. Targeting the reduction of cardiac surgery-associated acute kidney injury (CS-AKI) and its associated morbidity and healthcare costs, the study is based on preliminary findings suggesting vasopressin’s potential to lower CS-AKI incidence and post-operative atrial fibrillation. With the primary endpoint being the occurrence of acute kidney injury and death, and secondary endpoints including a range of post-operative complications and medico-economic costs, the trial aims to demonstrate vasopressin’s effectiveness in reducing CS-AKI, mortality, and medical expenses.

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March 20, 2024
MAP Study

Mean Arterial Pressure (MAP) Trial: Study Protocol for a Multicentre, Randomized, Controlled Trial to Compare Three Different Strategies of Mean Arterial Pressure Management during Cardiopulmonary Bypass

The MAP Trial is a pioneering multicentre, randomized, controlled study comparing three strategies for managing mean arterial pressure (MAP) during cardiopulmonary bypass (CPB) in heart surgery. It challenges the traditional “standard MAP” of 50-60 mmHg by introducing a “high MAP” (70-80 mmHg) and a “patient-tailored MAP” approach, aiming to optimize organ perfusion. The study’s primary goal is to identify the most effective MAP management technique by measuring serum lactate peaks as indicators of tissue hypoxia. Secondary outcomes include intraoperative oxygenation parameters and major postoperative complications, contributing to enhanced cardiac surgery results.

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March 20, 2024

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