Abdul Qadeer Khan |  |
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Dear Perfusionists
Hello
I am a cardiac perfusionist from Karachi, Paksitan. I am looking for cardiac perfusionists or perfusion Organizations from
Afghanistan
Bangladesh
Bhutan
Ira
n
India
Maldives
Nepal
Sirilanka
r>Kindly contact me any perfusionist or their organizations at qadeerkhanperfusionist@hotmail.com. I will be obliged.
Thanks
Abdul Qadeer Khan July 22, 2010 08:51 pm - Pakistan |
umesh khan | |
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Hi. I am a perfusionist. We were using pvc helix coils for cooling of blood cardioplegia solution. Now few companies are coming with aluminium helix coils. I think I read somewhere that they causes raise in aluminium level in blood after surgery. Is it true? Any reference in Journal? Is there any difference between laminated aluminium coil and non-laminated coil? Which one is better: PVC/HDEP/Copper/Aluminium helix coil for this purpose? Please ...Please mail me to my email umeshkhanperf at the rate of gmail dot com. Thank you very much. June 16, 2010 10:43 am - Nepal |
m_hemmati | |
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hi
i am a Iranian perfusionist and like to link you blog
i writ the phone program in java applet, it cat calculate several formula of CPB for perfusionist very easy and fast,
if you are want to have that program send the massege for me,
that program is free and can calculate BSA, flow rate , kind of oxygenator and them information ,... that can accept in first international Iranian perfusion congress and take the award
thank and sorry about my poor language skill May 21, 2010 07:36 pm - iran - tehran |
m_hemmati | |
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hi
i am a Iranian perfusionist and like to link you blog
i writ the phone program in java applet, it cat calculate several formula of CPB for perfusionist very easy and fast,
if you are want to have that program send the massege for me,
that program is free and can calculate BSA, flow rate , kind of oxygenator and them information ,... that can accept in first international Iranian perfusion congress and take the award
thank and sorry about my poor language skill May 21, 2010 07:35 pm - iran - tehran |
Decio Elias | |
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According to the world statistics the number of neonatal ECMO cases has dropped during the last few years. This is a consequence of improvements on neonatal care delivered in the intensive care units.
More and more sick babies are entering ECMO programs and this has substantially influenced the morbidity and mortality.
As perfusionists and ECMO specialists we must be prepared to manage more severely ill patients during our ECMO runs.
ECMO programs have identified this suplemental need and are designing new updating on their training programs for the years to come. February 11, 2010 11:16 am - Brazil |
AmSECT's PWOB committee | |
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Greetings. This letter is intended for both perfusionists and student perfusionists alike. AmSECT is currently expanding the goals of the subcommittee, Perfusion Without Borders. Perfusion Without Borders, PWOB, was established to create links between members of the perfusion community
and a selection of reputable non-profit cardiac missions groups serving in foreign locations around the world. Some of the goals that we have set for this new group are
* a database of creditable missions groups with biographies and contact information
* a database of volunteer perfusionists with resumes and volunteer interests
* a "wish list" of hardware and disposables requested by volunteer organizations as well as an inventory of hardware and disposables that are available for donation
* information and protocols directly related to the volunteer process and cardiac medical missions and
* assistance specifically directed towards student perfusionists who are interested in using medical missions as an educational opportunity.
Cardiac medical missions is, in fact, an educational opportunity for perfusionists of all backgrounds. PWOB would like to encourage all members of the world-wide perfusion community to consider cardiac medical missions
as an excellent opportunity to enrich their professional experience. Towards that end, AmSECT would like to collect any information that you might have regarding cardiac missions groups with which you are currently engaged, which you have worked with in the past, or with which you are indirectly familiar. If you are aware of any non-profit, 501 (c)(3)registered or unregistered, medical missions group or individual surgeon which routinely performs free-of-charge open-heart cardiac surgeries for
patients in need in unsupported foreign communities, would you please relay any contact information that you may have regarding that group or individual to the following address: sniders@summa-health.org
PWOB is very grateful for any help that you can offer. If you have an interest in cardiac missions, we encourage you to check our website frequently. Likewise, if you are interested in receiving periodic updates on missions activity and upcoming trips, please consider forwarding your contact email information to: sniders@summa-health.org
Thank you very much for your interest!
PWOB Committee
March 26, 2009 12:29 pm - USA |
Fred Colbert | |
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A few colleagues very timely remember us that using a low operating volumes at adult flow rates can significantly increase the number of bubbles exiting the venous
reservoir. This resulted in the advice of adding an extra 200cc in the venous reservoir, which represents a small increase in total volume (patient + prime). The resulted low increase in hemodilution would then be well worth.
We should be aware that the level of venous reservoir is usually a function of arterial flow and the perfusionist´s experience, according to the old time rule of 15 seconds. This means that the venous reservoir should have enough volume to assure a high level of safety to the patient. For a 1 liter/min arterial flow, the "level" (better saying volume) in the oxygenator should usually be 250 ml (1/4) considering the 15 seconds rule of thumb. This means that in case of any mechanical problem that interferes with arterial flow, the perfusionist will have 15 seconds to take an appropriate measure. This has been known as the "response time", meaning the time that a perfusionist needs to detect a problem and reduce arterial flow to buy more time to definitely correct the existing problem. Coincidently this level also works as a protector against air bubbles entering the venous blood being pumped out to the arterial line.
A well trained perfusionist using modern well designed oxygenators can reduce "response time" to 10 seconds without increasing the risks of massive air emboli to the patient in front of an emergency situation. This is to say that it is reasonable to keep a venous reservoir with a volume of 533 ml (500 ml) for a 80kg patient with an arterial flow of 3,200 ml/min (40 ml/kg/min). Levels in the venous reservoir lower than this are unnecessary and certainly increases risks involved (reduces safety) and certainly produce more air microbubbles.
In conclusion, the 10 seconds "response time" is just a volume corresponding to 1/6 of the arterial flow. June 5, 2008 11:00 am - England |
Maria Helena | |
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There are a few perfusionists that still have difficulties to conduct CPB is small body weight adults without having to resource to blood products transfusion. Experience and a few reports have shown that for small patients the lines (arterial and venous) can have 3/8" diameter and can be much shorter than the usual, provided the shortening does not interfere with the surgical requirements. The oxygenator is a key point in the circuit and we must choose a small device to be able to add a minimum prime volume, without sacrificing safety. A small circuit such as this can easily be fully primed with a little less than one liter of crystalloid solutions. For patients with a BSA lower than 1.7 M2 an initial prime volume may reach 1,000-1,200 ml, including the arterial filter.
Adding RAP to our protocol will reduce the crystalloid volume to an acceptable level without compromising efficacy or surgical needs.
In North America, the Hemobag device has been added to the protocol of CPB and has been shown superior results when compared to blood savers because the device (Hemobag) discards only excess of crystalloids and saves cells and plasma (coagulation factors). Modified ultrafiltration can be of great use in these small adults. The association of these techniques can certainly reduce the requirements of blood products during and immediately after cardiopulmonary bypass in small adults. May 28, 2008 01:31 pm - Rio de Janeiro, Brazil |
Eugene Smith | |
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Prime volume and surface area available for blood contact are two major considerations in modern cardiopulmonary bypass (CPB).
Lower priming volumes and small circuits have gained the race against older standards because their combination allows a lower incidence of transfusion of blood products and minimizes the inflammatory systemic body reaction to CPB.
We should not, however, forget perfusion time. Even when using a small foreign surface circuit, perfusion time will be another variable involved in the production and the intensity of the systemic inflammatory reaction. The protein and cellular systems involved in the production of the inflammatory reaction are stimulated and activated very soon after starting CPB. In my judgement one or two hours of CPB should have the same effect on the inflammatory mediators, regardless the surface area to which blood is exposed.
April 21, 2008 10:24 am - New Zeland |
Anastopoulos K. Kantor | |
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Cocaine is presently the most abused major stimulant used in the United States. Drug addict has spread among yougsters and cocaine has become the drug most frequently involved in emergency department visits. It is not a new drug of abuse, however it is now considered the top of the line of "recreational" substances. Very often cocaine is part of mixture with alcohol, heroin and other dangerous cocktails.
There is a common myth that cocaine is not addictive because it lacks the physical withdrawal symptoms seen in alcohol or heroin addicted individuals. However, the substance has powerful psychological addictive properties.
Among several complications, cocaine includes the strong stimulation of the sympathetic nervous response. Arterial hypertension, angina and myocardial infarction and failure have all been minutiously describe in cocaine users.
An episode of severe heart failure produced by cocaine can be very difficult to manage with medical resources and will not unusually ends as a fatal complication.
The following abstract relates what is possibly the first use of ECMO to rescue a patient presenting with an episode of severe heart failure resistant to conventional medical management:
Cocaine is an increasing cause of admission in the emergency room. The widespread abuse of this drug during the last decade in the USA is now widely emerging in Europe. Because of its various cardio-vascular complications, cocaine is one of the most death-related drugs known at this time. The following report describes the dramatic case of a young man polydrug addict presenting at our institution with life-threatening acute heart failure that developed shortly after his very first cocaine intake. Because of the lack of response to intensive medical treatment, we decided to perform a percutaneous extracorporeal circulation membranous oxygenation (ECMO) that allowed survival and rapid left ventricular function recovery. This report highlights cocaine as a rising trigger of acute heart failure in young people and is, to the best of our knowledge, the first report that illustrates ECMO as an effective hemodynamic support in the course of fulminant cocaine-induced cardiomyopathy.
De Vroey F, Plein D, Vercauteren S, Castadot M, Bettendorf P. Rescue extracorporeal circulation as bridge to recovery in fulminant cocaine-induced heart failure.
Int J Cardiol. 2008 Mar 10 [Epub ahead of print]
April 9, 2008 11:21 am - Greece |
Perfline | |
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There have been recent reports regarding several episodes of water-to-blood leaks in blood cardioplegia units. These incidents have prompted all of us to review our safety protocols and make sure that every heat exchanger is fully tested before use, regardless of being part of an integrated oxygenator or any other device inserted in the cardiopulmonary bypass circuit.
Heat exchangers in general are built of two materials: metal (stainless steel, aluminium) and plastic polymers (polyester, polyurethane). Metal can be made as thin as possible to improve conductance, but must be thick enough to resist to pressures exerted on both sides. Usually pressures in the water path are higher than in the blood path which determines a water to the blood direction of a leak.
Manufacturers have their own protocol to test the integrity of every heat exchanger produced before the final procedures to deliver to end users.
In the USA, the FDA recommends testing the heat exchangers using water and subjecting the device to 1,5 times the maximum recommended pressure for six hours to determine fi a water to blood leak will occur.
Water to blood leak is a dreadful complication capable to produce hemolysis, interstitial fluid accumulation, sepsis, and multiple organ failure.
Hamilton et cols have reported an excellent revision of heat exchangers tests and risks:
Testing of heat exchangers in membrane oxygenators using air pressure. Hamilton C, Seidler R, Kind R, Tosok J, Upterfofel J. Perfusion 2006;21:105-107 April 6, 2008 11:31 am - Rio de Janeiro, Brazil |
Perfline | |
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Synthetic heparin becomes a reality.
The pursuit of a synthetic version of heparin, free of animal materials and made with stricter quality controls, is gaining more attention as awareness grows that the anticoagulant can be easily contaminated during the process of biological extraction.
Researchers at Rensselaer Polytechnic Institute and University of North Carolina at Chapel Hill have discovered an alternative way to produce heparin. Their findings could enable the current supply of heparin, now extracted from porcine tissues, to be replaced or supplemented by the synthetic version.
Heparin, as we know, is a complex carbohydrate used to prevent blood coagulation during medical procedures and treatments such as hemodyalisis, cardiopulmonary bypass coronary artery stenting, and many others.
The researchers reported that they have synthetically prepared heparin in quantities large enough for use in human medical treatments by engineering recently discovered heparin biosynthetic enzymes. These discoveries will enable the researchers to effectively replace a variable raw material - heparin derived from processed animal organs -- with a synthetic material -- synthetic heparin -- and have the same therapeutic result.
After determining the molecular structure of complex carbohydrates such as heparin, the researchers established a structure-activity relationship that may reveal lead compounds for new drug development. The research team has developed a large-scale process involving the engineered enzymes and co-factor recycling that can be applied to synthesize the heparin and other heparin-based structures that regulate cell growth and may have applications in wound healing or cancer treatment.
A provisional patent request was filed and the whole work was supported by the National Institutes of Health and the American Heart Association.
March 26, 2008 10:37 am - Rio de Janeiro, Brazil |
Perfline | |
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Cardiopulmonary bypass (CPB) has been used to assist cardiac surgery for more than 50 yr since its introduction 1953. Technological improvements with CPB and other advances over the last half century have allowed the benefits of cardiac surgery to be extended to older patients with a greater burden of comorbidity. Neurologic complications are of particular concern because of their impact on duration of hospitalization, mortality, health care costs, and quality of life.
Both gross air bubbles and gaseous microemboli have been the subject of several studies, and efforts have been directed at elimination of both types of microemboli. Gross air embolism has been practically eliminated from CPB practice and in our days it is reported only occasionally. However, elimination of gaseous microemboli from conventional CPB has proved more difficult.
Neurologic deficits after coronary artery bypass grafting (CABG) still represent the most devastating complication. The mechanisms contributing to neurologic complications are multifactorial and comprise hemodynamic fluctuations, cerebral embolization (atherosclerotic plaque, air, fat, and platelet aggregates), cerebral hyperthermia, and other inflammatory and neurohumoral derangements associated with surgery. Gaseous microemboli has been implicated as the most common cause of neurologic complications.
The EDAC® QUANTIFIER (Emboli Detection and Classification) blood circuit monitor uses advanced ultrasound technology to non-invasively count and classify gaseous emboli in the extracorporeal bypass circuit. Employing highly sophisticated algorithms, the EDAC® QUANTIFIER device simultaneously monitors up to three locations, detects individual gaseous emboli at rates up to at least 1,000 per second, identifies gaseous emboli from 10 microns in diameter to up to 12.7mm (1/2") in diameter and instantly reports relevant data to the user. Results are displayed on-screen for real-time feedback to immediately adjust tubing and pumps as needed. It has been pointed that the use of EDAC may be considered is one of the most reliable methods destined to verify the efficacy of a given gaseous microemboli protocol and, at the same time, evaluate eventual changes to reduce the amount of gas introduced into the cerebral circulation during CPB.
Note: EDAC Quantifier: http://www.lunamedicalproducts.com/edac.htm
March 25, 2008 10:23 am - Rio de Janeiro / Brazil |
Perfline | |
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The search for a small CPB circuit for use in neonates continues. Charette and coworkers reported on a 180 ml capacity system that has offered excellent results. Starting on 1999, the authors began using a circuit which could be primed with 172 ml. This allowed a decrease in intraoperative hemodilution and a higher perioperative hematocrit. Their circuit was used for patients less than 5.1 kg. The authors used a 1/4" tubing for the arterial roller (0.82 ml/inch), 3/16" tubing (0.45 ml/inch) for the venous line, and 1/8" (0.20 ml/inch) tubing for the arterial line. No arterial filter was interposed in the circuits to maintain the lowest possible prime volume. The authors obtained a decreased use of exogenous blood, less contact activation, less intense intraoperative inflammation, and reduced costs. By replacing a few components the prime could be further reduced to 122 ml.
Now it is possible to use a circuit with a less than 1:1 ratio between the neonate´s blood volume (about 250 ml) and priming volume.
Ref. Charette K et cols. Perfusion 2007;22;327.
March 12, 2008 11:10 am - Rio de Janeiro, Brazil |
Perfline | |
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Neonatal perfusion has some particularities that can produce or avoid complications depending on how they are handled. Systemic heparinization is still a debatable question. A 3 kg newborn has a total blood volume of about 250 ml. If we administer heparin in a dose of 4 mg/kg and use a blood prime of 300 ml, the prime will contain additional heparin (5 mg/100ml blood). Total circulating heparin, after starting CPB will be 12 + 15 = 27 mg. This corresponds to a circulating heparin of 9 mg/kg, even considering that the total blood volume (perfusate) increased from 250 ml to 550 ml.
It has been well described that excess heparin contributes to an increased postbypass blood loss.
In our experience immediate postoperative blood loss in neonates is still a problem, sometimes difficult to manage. We would like to be aware of some other protocols to manage systemic heparinization during neonatal CPB. March 10, 2008 07:55 pm - Rio de Janeiro, Brazil |
Perfline | |
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Baxter International Co had to recall several lots of porcine heparin because of a possibly related increased incidence of mortality and morbidity among patients treated with the drug.
The manufacturer and the FDA identified this heparin as "contaminated" by an unidentified substance in a proportion of 20%.
The chinese plant that manufactures the gross product and sells to Baxter has no explanation for the contamination. The Wall Street Journal reports that the Shenzhen Hepalink plant (China) has been inspected and approved nine times in recent years by government health authorities, including the U.S. Food and Drug Administration, China's drug watchdog and German regulators. Buyers have done their own audits 25 times. To track a process that starts with crude heparin extracted from pig intestines, the company keeps more than 300 pages of data for each batch to "ensure traceability of each lot," Shenzhen Hepalink Chairman Li says.
To date there has been about 20 deaths and 800 severe reactions reported to the FDA in the USA and another unknown number of similar occurrences in German.
As China has grown to be the larger manufacturer of pharmaceutical products, it is possible that other countries have also imported heparin from the same manufacturer.
A few years ago, bovine heparin was abandoned because of risks of transmission of a spongiform encephalytis.
We should be aware of these happenings and double check the heparin we administer to our patients.
March 10, 2008 07:55 pm - Rio de Janeiro, Brazil. |
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