Low-Volume Acute Normovolemic Hemodilution Does Not Reduce Allogeneic Red Blood Cell Transfusion in Cardiac Surgery in the Modern Era of Patient Blood Management: A Propensity Score-Matched Cohort Study

February 2, 2024 No Comments

In a retrospective cohort study of 542 elective cardiac surgery patients, acute normovolemic hemodilution (ANH) did not significantly reduce perioperative red blood cell transfusion rates compared to controls. This suggests that in the context of modern patient blood management practices, the benefits of ANH in minimizing transfusion requirements may be less significant than previously thought.

Effects of Albumin and Crystalloid Priming Strategies on Red Blood Cell Transfusions in On-Pump Cardiac Surgery: A Network Meta-Analysis

January 20, 2024 No Comments

In on-pump cardiac surgery, a network meta-analysis revealed that crystalloid priming strategies are associated with fewer perioperative red blood cell (RBC) transfusions compared to albumin priming, although the difference in postoperative blood loss between the two was not statistically significant. The study suggests that while albumin priming might reduce postoperative blood loss, its use leads to more RBC transfusions and a higher blood management burden, indicating the need for careful consideration of its application in this context.

Trends in the Use of Recombinant Activated Factor VII and Prothrombin Complex Concentrate in Heart Transplant Patients in Virginia

January 16, 2024 No Comments

The study investigated the use of procoagulant factors during heart transplants in Virginia and their potential link to postoperative thrombosis. It found a decrease in the use of off-label recombinant activated factor VII (rFVIIa) but an increase in off-label prothrombin complex concentrate (PCC) use, with rFVIIa associated with a higher risk of thrombosis, although patients receiving it were more critically ill, which may have influenced the results.

Multi-Method Investigation of Blood Damage Induced by Blood Pumps in Different Clinical Support Modes

January 14, 2024 No Comments

This study investigates the impact of different operational modes of an extracorporeal blood pump (CentriMag) on blood flow patterns and the associated risks of bleeding, thrombosis, and hemolysis using computational fluid dynamics and hemocompatibility models. It finds that venous-arterial (V-A) ECMO mode results in the highest risk of these complications, with heart failure (HF) mode being the least risky, largely due to variations in flow patterns affecting cell and protein functions.

Effects of Blood Transfusion, Cardiopulmonary Bypass Time, and Bypassed Vessels on Mortality Following Isolated and Combined Coronary Artery Bypass Grafting

January 4, 2024 No Comments

This study analyzed 677 patients to investigate the correlation between the number of bypassed vessels, cardiopulmonary bypass duration, blood transfusion requirements, revision rates, and mortality in coronary artery bypass grafting surgeries. Results indicated that higher revision rates were associated with six-vessel bypasses, longer bypass and cross-clamp times, increased blood transfusions, and mortality, with specific blood thinners affecting transfusion needs and mortality outcomes.

The Effect of Perioperative Antithrombin Supplementation on Blood Conservation and Postoperative Complications After Cardiopulmonary Bypass Surgery: A Systematic Review, Meta-Analysis and Trial Sequential Analysis

January 4, 2024 No Comments

This meta-analysis investigated the effect of perioperative antithrombin (AT) supplementation on patients undergoing cardiopulmonary bypass (CPB) surgery, analyzing 13 randomized controlled trials with 996 participants. The study found that perioperative AT did not significantly reduce postoperative blood loss or the need for blood transfusions, and it was associated with increased in-hospital mortality and acute kidney injury incidence.

Early Blood Clot Detection Using Forward Scattering Light Measurements Is Not Superior to Delta Pressure Measurements

January 3, 2024 No Comments

This study investigates the use of forward scattered light (FSL) measurements for early blood clot detection in extracorporeal membrane oxygenators, a method potentially superior to the current standard of monitoring pressure differences (ΔP) which fails to detect smaller, early-stage clots. Despite several modifications, FSL measurements were unable to reliably detect clots in an in vitro test circuit, whereas the current clinical gold standard of pressure measurements successfully detected fulminant clot formation in multiple experiments.

Using Cardiohelp, Quadrox, and Nautilus Extracorporeal Membrane Oxygenators as Vascular Access for Hemodialysis, Continuous Renal Replacement Therapy, and Plasmapheresis: A Brief Technical Report

January 2, 2024 No Comments

This technical report details methods for performing dialytic therapies, such as intermittent hemodialysis (iHD) and continuous renal replacement therapy (CRRT), safely and effectively through an ECMO circuit, eliminating the need for a separate dialysis catheter in patients with acute kidney injury (AKI) and end-stage renal disease (ESRD). It outlines the connection of these kidney replacement therapies to various oxygenators and discusses performing plasmapheresis alongside ECMO and iHD or CRRT, emphasizing the technique’s safety as it doesn’t require modifications to ECMO cannulas/tubing.

Percutaneous Debulking of Tricuspid Valve Infective Endocarditis Vegetations Using a Large Bore Manual Aspiration Device – AlphaVac

December 31, 2023 No Comments

While most infectious endocarditis cases are managed medically, non-responsive patients or those with complications like septic emboli may need mechanical interventions such as AngioVac, which has limitations like the need for a perfusionist and large-bore accesses. The AlphaVac system, omitting the motor element, offers a simpler alternative for manual percutaneous aspiration of tricuspid valve vegetations, as demonstrated in two reported cases.

Protamine Dose to Neutralize Heparin at the Completion of Cardiopulmonary Bypass Can be Reduced Significantly Without Affecting Post-Operative Bleeding

December 27, 2023 No Comments

The study investigated reducing the protamine-to-heparin ratio (P-to-H) from 1:1 to 0.9:1 and 0.8:1 in cardiac surgery patients to determine its effect on post-operative bleeding. Results showed a significant reduction in the actual protamine dose without an increase in post-op bleeding, suggesting that a ratio as low as 0.75:1 might be sufficient for effective neutralization of heparin.