Warm cardiac surgery with continuous blood cardioplegia using a potassium                 infusion pump

Fried, David W; Leo, Joseph J.; Mattioni, Gabriel J.; Mohamed, Hasratt; Zombolas, Theodore L; Weiss, Steven J.

doi:10.1177/026765919701200104

Cited by 2 publications

(2 citation statements)

References 4 publications

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“…Total pump time was 122 minutes, and cross-clamp time was 66 minutes. A total of 3100 mL microplegia (7) was delivered through a 4:1 ratio (blood:crystalloid). Two units of homologous blood were used, because there was some blood loss in the field when venous cannulation was attempted.…”

Section: H Mohamed Et Almentioning

confidence: 99%

Massive Carbon Dioxide Gas Embolism: A Near Catastrophic Situation Averted by Use of Cardiopulmonary Bypass

Mohamed¹,

Zombolas²,

Schultz³

et al. 2009

J Extra Corpor Technol

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Endovascular vein harvesting is used as a less invasive method when compared to the standard open surgical method of dissecting and procurement of the greater saphenous vein. The benefits include smaller incision, decreased blood loss, less pain, decreased transfusion, decreased risk of infection and enhanced epidermal cosmetics. However, endovascular vein harvesting does have a learning curve to master the technique and although endovascular vein harvesting is the preferred standard of practice over the open surgical technique, it does have inherent potential complications. During endovascular vein harvesting, there is a potential for the patient’s circulatory system to collapse which can be identified initially through hemodynamic monitoring, blood gas results, and vigilance through clinical observation. The suspected source of the crisis was confirmed when the surgeon cannulated the right atrium, where a massive gas source that (appeared pressurized) escaped upon incision of the right atrial appendage. Cardiopulmonary bypass (CPB) was utilized to support the patient and rectify the impending catastrophic event. Once full CPB was attained, we achieved hemodynamic stability and eventually all blood gases were normalized. Massive CO2 embolism is a life threatening emergency which must be identified and corrected instantaneously. CPB was the modality used to salvage this situation. Attention to the set-up of the EVH equipment, use of the transesophageal echocardiography, cerebral cximetry, vigilance and cooperation of all disciplines in the OR are definite recommendations to prevent such an occurrence. Experience gained by the perfusion team with a previous case was applied and helped to solve the immediate problems presented in this case.

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Section: H Mohamed Et Almentioning

confidence: 99%

Massive Carbon Dioxide Gas Embolism: A Near Catastrophic Situation Averted by Use of Cardiopulmonary Bypass

Mohamed¹,

Zombolas²,

Schultz³

et al. 2009

J Extra Corpor Technol

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“…It has been indicated that using titration CP delivery can aid a more rapid return of myocardial contractility, in addition to reducing crystalloid volume and systemic potassium levels. 15,16 Variations in CP delivery parameters, including blood source viscosity, temperature, infusion pressure and blood to crystalloid ratio, may affect CP volume delivery distal to simulated stenotic lesions. The purpose of this study was twofold: to quantify CP delivery in an in vitro model that simulated coronary atherosclerotic lesions; and to quantify CP volume washout of commercially available CP systems.…”

Section: Introductionmentioning

confidence: 99%

Cardioplegia flow dynamics in an in vitro model

et al. 1999

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The flow of fluids in extracorporeal circuits does not conform to conventional Poiseuille mechanics which confounds calculating cardioplegia (CP) flow distribution. The purpose of this study was to quantify CP flow dynamics in a model simulating coronary atherosclerosis across varying sized restrictions. An in vitro preparation was designed to assess hydraulic fluid movement across paired restrictions of 51, 81 and 98% lumen reductions. Volume data were obtained at variable flow, temperature, viscosity and pressure conditions. CP delivered through 14- and 18-gauge (GA) conduits at 8 degrees C and 100 mmHg infusion pressure revealed that both four to one and crystalloid CP solutions had significantly less total percentage flow through the 14-GA conduit, p < 0.0001 and p < 0.001, respectively. Overall, 4:1 CP exhibited the most favorable fluid dynamics at 8 degrees C in that it delivered the highest percentages of total CP flow through the smaller lumen conduit. At both 8 degrees C and 37 degrees C delivery, blood CP resulted in the least homogeneous fluid distribution at all delivery parameters. The results in relation to blood viscosity indicate that, although the 8 degrees C blood CP had a significantly greater viscosity than 37 degrees C blood CP, it did not produce an effect in fluid distribution. These data show that increasing the cardioplegic solution hematocrit causes an inhomogeneous fluid distribution regardless of delivery temperature or infusion pressure.

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Warm cardiac surgery with continuous blood cardioplegia using a potassium infusion pump

Cited by 2 publications

References 4 publications

Massive Carbon Dioxide Gas Embolism: A Near Catastrophic Situation Averted by Use of Cardiopulmonary Bypass

Massive Carbon Dioxide Gas Embolism: A Near Catastrophic Situation Averted by Use of Cardiopulmonary Bypass

Cardioplegia flow dynamics in an in vitro model

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