1. Our experience of cardiopulmonary bypass in total arch replacement with open stent graft
- Author
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Naoya Hamada, Hiroyuki Nishi, Daizo Kato, Masatoshi Mukumoto, Hirota Hamatsu, Shinya Tachibana, Miwa Masui, Shuhei Kurashige, Tatsuto Ozaki, Yusaku Ohata, and Toshiki Takahashi
- Subjects
Clotting factor ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,030204 cardiovascular system & hematology ,Thromboelastography ,Surgery ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Platelet transfusion ,030228 respiratory system ,Blood product ,law ,Anesthesia ,Hemostasis ,medicine ,Cardiopulmonary bypass ,Aprotinin ,Aminocaproic acid ,business ,circulatory and respiratory physiology ,medicine.drug - Abstract
Over the past decade, there have been many advances in the management of bleeding in children undergoing heart surgery. These advances have included changes in surgery, anesthesiology, and cardiopulmonary bypass (CPB). Surgeons routinely use hemostatic agents instilled directly at the site of bleeding in the form of gels and sponges (1). Anesthesiologists are using newer drugs such as factor VIIa (2) and older drugs such as aminocaproic acid, which have resurfaced after the recall of aprotinin (1). Anesthesiologists are monitoring the clotting process with thromboelastography, which is more dynamic than traditional clotting tests such as prothrombin time (3). Cardiopulmonary bypass circuits have become smaller and more biocompatible leading to decreased contact activation of the inflammatory response and potentially mitigating CPB’s effects on hemostasis. Perfusionists routinely use various forms of ultrafiltration in an attempt to hemoconcentrate red blood cells and clotting factors during (conventional ultrafiltration) and immediately after (modified ultrafiltration [MUF]) CPB. We recently introduced a change in our blood product transfusion practice in an attempt to decrease volume shifts during the MUF process and promote earlier hemostasis. Instead of administering all of the blood products intravenously after CPB and MUF, we changed to administering blood products during MUF, directly into the MUF circuit. This article describes a retrospective study of this change in practice.
- Published
- 2018
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