International Perfusion Association

Category: Blood

Cytocaine CPB

Removal of Cytokines During Cardiac Surgery (RECCAS): A Randomised Controlled Trial

This randomized controlled trial evaluates the efficacy of intraoperative haemoadsorption (HA) using CytoSorb® during cardiac surgery with cardiopulmonary bypass (CPB). The primary focus was on reducing interleukin-6 (IL-6) levels post-surgery. Despite a significant reduction in cytokine levels within the HA device during surgery, there was no difference in IL-6 levels between the treatment and control groups upon ICU admission or during the ICU stay. Some haemodynamic benefits, such as reduced fluid and fibrinogen requirements and shorter need for renal replacement therapy, were observed, though these did not translate into improved clinical outcomes like ICU length of stay or mortality rates. The study underscores the need for further large-scale trials to refine patient selection and HA application strategies.

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ECMO Scale

Novel Risk Scoring Model to Predict the Implementation of Veno-Arterial Extracorporeal Membrane Oxygenation in Patients With Acute Myocarditis

This study introduces the Korean Acute Myocarditis (KAM) score, a predictive model for assessing the likelihood of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) use in acute myocarditis. Analyzing data from 841 patients across seven Korean hospitals, eight clinical parameters were identified as predictors, including cardiac arrest and left ventricular ejection fraction <40%. The KAM score demonstrated excellent discriminant ability, supporting its potential to guide timely interventions and improve patient outcomes.

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Cold Platelets

Delayed Cold-Stored vs. Room Temperature Stored Platelet Transfusions in Bleeding Adult Cardiac Surgery Patients—A Randomized Multicentre Pilot Study (PLTS-1)

This study investigates the feasibility of using delayed cold-stored platelets (DCSP) compared to standard room-temperature platelets (RTP) in bleeding cardiac surgery patients. DCSP, stored initially at 22°C and then refrigerated, may address platelet supply challenges by extending shelf life and enhancing hemostatic activity. The multicentre pilot aims to assess recruitment, adherence, and product availability to inform a future definitive trial. The trial could improve transfusion logistics and patient outcomes.

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Transfusion 102

The Effects of Blood Cell Salvage on Transfusion Requirements After Decannulation from Veno-Venous Extracorporeal Membrane Oxygenation: An Emulated Trial Analysis

This study investigates the impact of blood cell salvage (BCS) during veno-venous extracorporeal membrane oxygenation (VV-ECMO) decannulation on transfusion needs. Using an emulated trial with 841 patients, the results showed BCS reduced transfusions of packed red blood cells (PRBC) and increased hemoglobin levels without affecting inflammatory or coagulation markers. These findings suggest BCS is an effective strategy for minimizing transfusion-related complications in VV-ECMO decannulation.

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Ratatulli

A New Protocol for Removal of the Endothelium from the Perfused Rat Hind-Limb Preparation

This study introduces a novel method for selectively removing endothelial cells from rat hind-limb arteries using a high flow/air bubbles/high flow protocol. The technique effectively removes endothelium from larger arteries without damaging smooth muscle cells, arterioles, or capillaries. It enhances vascular reactivity, as shown by increased contractile responses to a,β-methylene ATP. This method provides a model for investigating vascular function with and without endothelial influence.

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Transfusion Blood Cardiac Surgery

A Systematic Approach to Reduce Blood Transfusions in Acute Type A Aortic Dissection Surgery

This clinical study evaluates a systematic approach to reducing blood transfusions in patients undergoing acute type A aortic dissection (ATAAD) surgery. Techniques included Liu’s aortic root repair, moderate hypothermia circulatory arrest, and the use of a centrifugal pump in cardiopulmonary bypass. Among 326 patients, 53.37% avoided transfusions. Transfusion-free patients had lower mortality (1.72% vs. 9.21%) and complications. The findings support transfusion-free ATAAD surgeries for selected cases.

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Sodium CPB

Relation Between Serum Sodium Trajectory and Survival in Septic Patients with Cardiopulmonary Bypass Surgery

This study examined the impact of serum sodium trajectory on 30-day mortality in septic patients after cardiopulmonary bypass (CPB) surgery using the MIMIC-IV database. Among 1,038 patients, serum sodium trajectories were classified into three groups, with higher levels linked to increased mortality. Elevated fluctuations, even within normal sodium ranges, were associated with adverse outcomes. These findings highlight the need for close monitoring and sodium management in critically ill patients undergoing CPB.

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HGB AKI 2024

Association Between Plasma-Free Haemoglobin and Postoperative Acute Kidney Injury in Paediatric Cardiac Surgery: A Prospective Observational Study

This study investigates the link between plasma-free haemoglobin (PFH) and acute kidney injury (AKI) in children undergoing cardiopulmonary bypass (CPB) during cardiac surgery. Among 179 participants, 41% developed AKI. Peak PFH concentrations were significantly higher in patients with AKI, but multivariable analysis showed CPB duration and patient age, rather than PFH, as primary risk factors. This emphasizes CPB time management in mitigating AKI risk.

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Hemaglobin 2024

Association Between Perioperative Hemoglobin Decrease and Outcomes of Transfusion in Patients Undergoing On-Pump Cardiac Surgery: An Observational Study From Two Chinese Heart Centers

This study analyzed 8186 adult patients undergoing cardiac surgery to examine the impact of perioperative hemoglobin decrease (ΔHb) on red blood cell transfusion outcomes. Patients with greater hemoglobin decreases (≥50%) were found to have higher risks of complications like mortality and organ failure. Transfusions helped in some cases but became harmful when exceeding four units. The findings underscore the importance of careful transfusion management in cardiac surgery.

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WBC ECMO

Increased White Blood Cell Count is Associated with an Increased Demand for Unfractionated Heparin During Veno-Arterial Extracorporeal Oxygenation in Lung Transplantation

This retrospective study investigated whether increased white blood cell (WBC) counts correlate with higher unfractionated heparin (UFH) dosage needs during veno-arterial extracorporeal membrane oxygenation (V-A ECMO) in lung transplantation. Among 27 patients, those with elevated WBC counts (above 10.2 × 10³/μL) required higher UFH doses to maintain targeted clotting times. The findings suggest WBC count could help determine optimal UFH dosing during surgery.

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