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Predictive Value of Trendelenburg Position

Predictive Value of Trendelenburg Position and Carotid Ultrasound for Fluid Responsiveness in Patients on VV-ECMO with Acute Respiratory Distress Syndrome in the Prone Position

This study evaluates the effectiveness of Trendelenburg position and carotid ultrasound in predicting fluid responsiveness in VV-ECMO patients with ARDS in the prone position. Findings reveal that carotid corrected flow time (FTcBaseline) and stroke volume index variation (ΔSVITrend) are accurate and non-invasive predictors. These methods outperform traditional markers like pulse pressure variation, enhancing fluid management strategies in critical care.

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January 2, 2025
Myxoma Leg

A Firing Cannon: Bilateral Lower Limb Ischemia as a Manifestation of Cardiac Myxoma

This article presents a rare case of a 33-year-old woman with a left atrial myxoma, a benign cardiac tumor, causing bilateral lower limb ischemia due to systemic embolization. The patient’s myxoma, identified as the source of emboli, was successfully excised through open-heart surgery. The case underscores the critical need for timely surgical intervention to prevent potentially fatal complications such as stroke. Postoperative outcomes were excellent, with the patient resuming normal activities.

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December 28, 2024
Traditional vs. Modified Ringer Lactate-Based del Nido Cardioplegia

Traditional vs. Modified Ringer Lactate-Based del Nido Cardioplegia: Impacts on Clinical Outcomes in Coronary Artery Bypass Grafting

This prospective, randomized, and blinded study compared the impacts of traditional Plasma-Lyte A-based del Nido cardioplegia (PL DN) and a modified Ringer’s lactate-based formulation (LR DN) on clinical outcomes in patients undergoing coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB). Results showed that while both formulations had similar effects on several clinical parameters, PL DN offered superior myocardial protection, as indicated by lower postoperative cardiac enzyme levels and reduced need for epinephrine.

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December 26, 2024
Fluid Management in Adult Patients Undergoing Venoarterial Extracorporeal Membrane Oxygenation: A Scoping Review

Fluid Management in Adult Patients Undergoing Venoarterial Extracorporeal Membrane Oxygenation: A Scoping Review

This review explores fluid management in patients supported by venoarterial extracorporeal membrane oxygenation (VA-ECMO). It highlights the lack of evidence for optimal fluid strategies, comparing liberal vs. restrictive approaches, or types like crystalloids and albumin. Fluid overload negatively affects survival and kidney outcomes, emphasizing the need for precise strategies. The study calls for rigorous research to determine effective fluid resuscitation approaches and improve clinical outcomes.

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December 24, 2024
A Technique Avoiding Cardioplegia Delivery Complications: A Case Using Systemic Hyperkalemia Cardiopulmonary Bypass Combined with Circulatory Arrest

A Technique Avoiding Cardioplegia Delivery Complications: A Case Using Systemic Hyperkalemia Cardiopulmonary Bypass Combined with Circulatory Arrest

This case study details a novel approach to avoid cardioplegia delivery complications during a high-risk redo mitral valve replacement. The 75-year-old patient, with severe mitral regurgitation and mild aortic regurgitation, underwent minimally invasive surgery using systemic hyperkalemia and circulatory arrest. The method eliminated the need for aortic cross-clamping, achieving effective myocardial protection and an uneventful recovery, despite complex surgical challenges.

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December 24, 2024
Failure to Oxygenate During Cardiopulmonary Bypass: Treatment Options and Intervention Algorithm

Failure to Oxygenate During Cardiopulmonary Bypass: Treatment Options and Intervention Algorithm

This study addresses the critical issue of oxygenator failure during cardiopulmonary bypass (CPB), a rare but high-risk event. It explores protocols and techniques for addressing oxygenator malfunction, including traditional oxygenator change-outs and alternative approaches like arterial and venous piggyback methods. The authors emphasize the need for institutional preparation, including written protocols and routine emergency drills, and propose a venous piggyback technique as a safer first-line response to improve patient outcomes.

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December 23, 2024
Lung ECMO

Enhancing Lung Transplantation with ECMO: A Comprehensive Review of Mechanisms, Outcomes, and Future Considerations

Lung transplantation (LTx) is a transformative solution for patients with end-stage lung disease, but it comes with significant challenges, including limited donor availability and severe post-operative complications. This review focuses on the role of Extracorporeal Membrane Oxygenation (ECMO) in overcoming these hurdles and improving patient outcomes across all phases of the transplant process.

ECMO, initially developed for cardiac surgery, has become an essential tool in lung transplantation, particularly for its ability to provide cardiopulmonary support. Its applications span the preoperative, intraoperative, and postoperative stages, making it integral to modern LTx practices.

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December 22, 2024
Perfusion Ladder

Development of a Professional Advancement Model for Perfusionists

The article introduces a Professional Advancement Model (PAM) tailored for perfusionists to address high turnover and enhance retention. Drawing from PAM frameworks in other healthcare professions like nursing and advanced practice providers, the author proposes a four-tier system: Perfusionist I through IV. Progression is determined by points earned in categories such as leadership, clinical excellence, education, and service, alongside experience requirements. The PAM offers structured career growth, salary increments, and institutional benefits, serving as a retention strategy and professional growth tool for perfusionists.

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December 22, 2024
Milrinone

Interaction of Milrinone with Extracorporeal Life Support

This study investigates the interactions between milrinone, a phosphodiesterase inhibitor used in critically ill patients, and extracorporeal life support (ECLS) systems, specifically extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT). Ex vivo experiments demonstrated that milrinone exhibits negligible interaction with ECMO circuits but is rapidly cleared (99% within two hours) by CRRT circuits. These findings suggest that while ECMO dosing adjustments are unnecessary, CRRT requires tailored dosing. Future studies incorporating patient physiology are recommended to refine dosing strategies.

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December 22, 2024
Del Nido vs Hyper

Outcomes of Del Nido and Hyperkalemic Blood Cardioplegia in Adult Cardiac Surgery with Prolonged Aortic Cross-Clamp Times

This study compares the effectiveness of Del Nido cardioplegia (DNC) and hyperkalemic blood cardioplegia (HKB) in adult cardiac surgery with prolonged aortic cross-clamp times. In a retrospective cohort of 388 patients, findings revealed no significant differences in clinical outcomes or myocardial protection, as assessed by troponin profiles. However, DNC required fewer doses, had longer ischemic intervals, and was associated with higher rates of spontaneous rhythm recovery, suggesting logistical and procedural benefits.

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December 21, 2024
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