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1.	Arthursson, Henrik, et al. (författare) Cerebral oxygenation and autoregulation during rewarming on cardiopulmonary bypass 2023 Ingår i: Perfusion. - : Sage Publications. - 0267-6591 .- 1477-111X. ; 38:3, s. 523-529 Tidskriftsartikel (refereegranskat)abstract Background Rewarming on cardiopulmonary bypass (CPB) is associated with increased metabolic demands; however, it remains unclear whether cerebral autoregulation is affected during this phase. This RCT aims to describe the effects of 20% supranormal, compared to normal CPB flow, on monitoring signs of inadequate perfusion, oxygenation, and disturbed cerebral autoregulation, during the rewarming phase of CPB. Method Thirty two patients scheduled for coronary artery bypass grafting were allocated to a Control group (n = 16) receiving a CPB pump flow corresponding to preoperatively measured cardiac output, and an Intervention group (n = 16) receiving the corresponding CPB pump flow increased by 20% during rewarming. Cerebral Oximetry Index (COx) was calculated with the aid of Near Infrared Spectroscopy. Results Twenty five patients were included in the data. Results show a median COx value of 0.0 (IQR -0.33-0.5) (Control) and 0.0 (IQR -0.15-0.25) (Intervention), respectively; p = .85 with individual variations within groups. The median cerebral perfusion pressure (CPP) was 55 (52-58) (Control) and 61 (54-66) mmHg (Intervention); p = .08. No significant difference in rSO2 values was observed between the groups (58.5% (50-61) versus 64% (58-68); p = .06). Conclusion The present study showed no difference between increased and normal CPB pump flow with respect to cerebral autoregulation during rewarming. Large variations in cerebral autoregulation were seen at individual level.
2.	Bjursten, Henrik, et al. (författare) Particle separation using ultrasound can be used with human shed mediastinal blood. 2005 Ingår i: Perfusion. - : SAGE Publications. - 1477-111X .- 0267-6591. ; 20:1, s. 39-43 Tidskriftsartikel (refereegranskat)abstract Shed mediastinal blood collected by cardiotomy suction has been shown to be a large contributor to lipid microemboli ending up in different organs. The aim of this study was to test the separation efficiency on human shed blood of a new separation method developed to meet this demand. METHODS: Shed mediastinal blood collected from the pericardial cavity of 13 patients undergoing cardiac surgery with cardiopulmonary bypass was collected. The blood was processed in an eight-channel parallel PARSUS separator, and separation efficiency was determined. RESULTS: Erythrocyte recovery, in terms of a separation ratio, varied between 68% and 91%. Minor electrolyte changes took place, where levels of sodium increased and levels of potassium and calcium decreased. CONCLUSION: This study demonstrates that PARSUS technology can be used on human shed mediastinal blood with good separation efficiency. The technology is, thereby, suggested to have future clinical relevance.
3.	Blohme, L, et al. (författare) Alternatives for arterial inflow in open surgical descending and thoracoabdominal aortic repair 2016 Ingår i: Perfusion. - : SAGE Publications. - 1477-111X .- 0267-6591. ; 31:4, s. 316-319 Tidskriftsartikel (refereegranskat)abstract Surgical repair of the descending and thoracoabdominal aorta is regularly performed with the support of extracorporeal circulation. Femoral artery cannulation is the standard for arterial inflow, but presents, along with extremity hypoperfusion, the risk of embolization and malperfusion with retrograde aortic perfusion. There are alternatives for arterial inflow to avoid the drawbacks of the standard approach while accommodating different perfusion strategies. Ideally, with a broadened perfusion armamentarium, the choice of arterial inflow could be individualized to provide safe and efficient extracorporeal circulation.
4.	Blomquist, Sten, et al. (författare) Clinical experience with a novel endotoxin adsorbtion device in patients undergoing cardiac surgery. 2009 Ingår i: Perfusion. - : SAGE Publications. - 1477-111X .- 0267-6591. ; 24:1, s. 13-17 Tidskriftsartikel (refereegranskat)abstract Endotoxaemia is thought to occur in cardiac surgery using extracorporeal circulation (ECC) and a positive correlation has been proposed between the magnitude of endotoxaemia and risk for postoperative complications. We studied the effects of a new endotoxin adsorber device (Alteco(R) LPS adsorber) in patients undergoing cardiac surgery with ECC, with special reference to safety and ease of use. Fifteen patients undergoing coronary artery bypass and/or valvular surgery were studied. In 9 patients, the LPS Adsorber was included in the bypass circuit between the arterial filter and the venous reservoir. Flow through the adsorber was started when the aorta was clamped and stopped at the end of perfusion. Flow rate was kept at 150 ml/min. Six patients served as controls with no adsorber in the circuit. Samples were taken for analysis of endotoxin, TNFalpha, IL-1ss and IL-6 as well as complement factors C3, C4 and C1q. Whole blood coagulation status was evaluated using thromboelastograpy (TEG) and platelet count. No adverse events were encountered when the adsorber was used in the circuit. Blood flow through the device was easily monitored and kept at the desired level. Platelet count decreased in both groups during surgery. TEG data revealed a decrease in whole blood clot strength in the control group while it was preserved in the adsorber group. Endotoxin was detected in only 2 patients and IL-1ss in 4 patients. IL-6 decreased in both groups whereas no change in TNF concentrations was found. C3 fell in both groups, but no changes wer found in C4 and C1q. The Alteco(R) LPS adsorber can be used safely and is easy to handle in the bypass circuit. No complications related to the use of the adsorber were noted. The intended effects of the adsorber, i.e. removal of endotoxin from the blood stream could not be evaluated in this study, presumably due to the small number of patients and the relatively short perfusion times.
5.	Braatz, E, et al. (författare) Will high-dose heparin affect blood loss and inflammatory response in patients undergoing cardiopulmonary bypass? 2021 Ingår i: Perfusion. - : SAGE Publications. - 1477-111X .- 0267-6591. ; 36:1, s. 63-69 Tidskriftsartikel (refereegranskat)abstract We performed a randomized study to investigate if a high versus a standard dose of heparin dose during cardiopulmonary bypass could affect intra- and post-operative bleeding and reduce the inflammatory response. Methods: A total of 30 patients undergoing elective coronary artery bypass grafting were randomized into high or standard dose of heparin during cardiopulmonary bypass. Blood loss was documented peri- and post-operatively, and interleukin-6, tumor necrosis factor-α, and C3 were measured in conjunction with cardiopulmonary bypass. Results: Data from 29 patients were analyzed after exclusion of one patient. The mean initial bolus and total heparin doses were 43,000 ± 5,800 IU versus 35,000 ± 4,100 IU, (p < 0.001), and 58,000 ± 9,500 IU versus 45,000 ± 7,900 IU, (p < 0.001) in the intervention and the control group, respectively. The median intra-operative bleeding was 150 mL (interquartile range 100-325) in the control versus 225 mL (IQR 200-350) in the intervention group, p = 0.15. The median chest tube blood loss 12 hour post-operatively was 300 mL (interquartile range 250-385) in the control versus 450 mL (IQR 315-505) in the intervention group, p = 0.029. There was no significant difference between the control group and the intervention group during cardiopulmonary bypass for the measured inflammatory markers interleukin-6 (p = 0.98), tumor necrosis factor-α (p = 0.72), or C3 (p = 0.13). Conclusion: This small study showed a small increase of post-operative bleeding associated with higher heparin dosage in conjunction with cardiopulmonary bypass but did not demonstrate an effect of heparin on the inflammatory response to cardiopulmonary bypass.
6.	Broman, Lars Mikael, et al. (författare) Pressure and flow properties of cannulae for extracorporeal membrane oxygenation I : return (arterial) cannulae 2019 Ingår i: Perfusion. - : SAGE PUBLICATIONS LTD. - 0267-6591 .- 1477-111X. ; 34, s. 58-64 Tidskriftsartikel (refereegranskat)abstract Adequate extracorporeal membrane oxygenation support in the adult requires cannulae permitting blood flows up to 6-8 L/minute. In accordance with Poiseuille's law, flow is proportional to the fourth power of cannula inner diameter and inversely proportional to its length. Poiseuille's law can be applied to obtain the pressure drop of an incompressible, Newtonian fluid (such as water) flowing in a cylindrical tube. However, as blood is a pseudoplastic non-Newtonian fluid, the validity of Poiseuille's law is questionable for prediction of cannula properties in clinical practice. Pressure-flow charts with non-Newtonian fluids, such as blood, are typically not provided by the manufacturers. A standardized laboratory test of return (arterial) cannulae for extracorporeal membrane oxygenation was performed. The aim was to determine pressure-flow data with human whole blood in addition to manufacturers' water tests to facilitate an appropriate choice of cannula for the desired flow range. In total, 14 cannulae from three manufacturers were tested. Data concerning design, characteristics, and performance were graphically presented for each tested cannula. Measured blood flows were in most cases 3-21% lower than those provided by manufacturers. This was most pronounced in the narrow cannulae (15-17 Fr) where the reduction ranged from 27% to 40% at low flows and 5-15% in the upper flow range. These differences were less apparent with increasing cannula diameter. There was a marked disparity between manufacturers. Based on the measured results, testing of cannulae including whole blood flows in a standardized bench test would be recommended.
7.	Broman, Lars Mikael, et al. (författare) Pressure and flow properties of cannulae for extracorporeal membrane oxygenation II : drainage (venous) cannulae 2019 Ingår i: Perfusion. - : SAGE PUBLICATIONS LTD. - 0267-6591 .- 1477-111X. ; 34, s. 65-73 Tidskriftsartikel (refereegranskat)abstract The use of extracorporeal life support devices such as extracorporeal membrane oxygenation in adults requires cannulation of the patient's vessels with comparatively large diameter cannulae to allow circulation of large volumes of blood (>5 L/min). The cannula diameter and length are the major determinants for extracorporeal membrane oxygenation flow. Manufacturing companies present pressure-flow charts for the cannulae; however, these tests are performed with water. Aims of this study were 1. to investigate the specified pressure-flow charts obtained when using human blood as the circulating medium and 2. to support extracorporeal membrane oxygenation providers with pressure-flow data for correct choice of the cannula to reach an optimal flow with optimal hydrodynamic performance. Eighteen extracorporeal membrane oxygenation drainage cannulae, donated by the manufacturers (n = 6), were studied in a centrifugal pump driven mock loop. Pressure-flow properties and cannula features were described. The results showed that when blood with a hematocrit of 27% was used, the drainage pressure was consistently higher for a given flow (range 10%-350%) than when water was used (data from each respective manufacturer's product information). It is concluded that the information provided by manufacturers in line with regulatory guidelines does not correspond to clinical performance and therefore may not provide the best guidance for clinicians.
8.	Broman, L. M., et al. (författare) Pressure and flow properties of dual-lumen cannulae for extracorporeal membrane oxygenation 2020 Ingår i: Perfusion. - : SAGE Publications Ltd. - 0267-6591 .- 1477-111X. Tidskriftsartikel (refereegranskat)abstract Introduction: In the last decade, dual-lumen cannulae have been increasingly applied in patients undergoing extracorporeal life support. Well-performing vascular access is crucial for efficient extracorporeal membrane oxygenation support; thus, guidance for proper cannulae size is required. Pressure–flow charts provided by manufacturers are often based on tests performed using water, rarely blood. However, blood is a shear-thinning and viscoelastic fluid characterized by different flow properties than water. Methods: We performed a study evaluating pressure–flow curves during standardized conditions using human whole blood in two commonly available dual-lumen cannulae used in neonates, pediatric, and adult patients. Results were merged and compared with the manufacturer’s corresponding curves obtained from the public domain. Results: The results showed that using blood as compared with water predominantly influenced drainage flow. A 10-80% higher pressure-drop was needed to obtain same drainage flow (hematocrit of 26%) compared with manufacturer’s water charts in 13-31 Fr bi-caval dual-lumen cannulae. The same net difference was found in cavo-atrial cannulae (16-32 Fr), where a lower drainage pressure was required (Hct of 26%) compared with the manufacturer’s test using blood with an Hct of 33%. Return pressure–flow data were similar, independent whether pumping blood or water, to the data reported by manufacturers. Conclusion: Non-standardized testing of pressure–flow properties of extracorporeal membrane oxygenation dual-lumen cannulae prevents an adequate prediction of pressure–flow results when these cannulae are used in patients. Properties of dual-lumen cannulae may vary between sizes within same cannula family, in particular concerning the drainage flow.
9.	Broman, LM (författare) When antithrombin substitution strikes back 2020 Ingår i: Perfusion. - : SAGE Publications. - 1477-111X .- 0267-6591. ; 35:1_suppl, s. 34-37 Tidskriftsartikel (refereegranskat)abstract Commercially available products used for antithrombin supplementation, for example, in extracorporeal life support, may contain latent antithrombin, a hyper-stable strongly procoagulative and anti-angiogenic residue. Latent antithrombin is associated with severe thrombosis in the critically ill. In the manufacturing process of fractionated antithrombin from plasma, heat treatment, citrate, and freeze drying speed up the transformation of native antithrombin to latent antithrombin. Manufacturers are not required to assess and report the latent antithrombin content of their products. When reported, the latent antithrombin fractions in their product range from <1% to 40% of total antithrombin compared with <3% in the healthy adult and less in children. The aims of this work were (1) to convey increased awareness to clinicians who may experience defaulted, expected effect after antithrombin supplementation in, for example, heparin anticoagulation during extracorporeal life support and (2) to urge manufacturers to assess and disclose latent antithrombin content in their products.
10.	Chew, Michelle (författare) Does modified ultrafiltration reduce the systemic inflammatory response to cardiac surgery with cardiopulmonary bypass? 2004 Ingår i: Perfusion. - : SAGE Publications. - 1477-111X .- 0267-6591. ; 19 Suppl 1, s. 57-60 Tidskriftsartikel (refereegranskat)abstract Cardiopulmonary bypass (CPB) is associated with an accumulation of total body water and a systemic inflammatory response syndrome (SIRS), which, in turn, is associated with organ dysfunction and postoperative morbidity. It has been suggested that modified ultrafiltration (MUF) may be capable of reducing SIRS and improving clinical outcome by filtering out the inflammatory mediators generated during CPB. This paper reviews the data regarding the use of MUF in paediatric and adult settings. Specifically, three issues will be considered: 1) Does MUF improve clinical outcome? 2) Does MUF reduce the systemic inflammatory response to cardiac surgery with CPB? 3) Is MUF more effective than conventional ultrafiltration in improving clinical outcome?
11.	Corderfeldt, Anna, et al. (författare) Non-invasive and invasive measurement of skeletal muscular oxygenation during isolated limb perfusion 2023 Ingår i: Perfusion-Uk. - : SAGE Publications. - 0267-6591. ; 38:5, s. 1019-1028 Tidskriftsartikel (refereegranskat)abstract Background: Isolated limb perfusion (ILP) is a regional surgical treatment for localized metastatic disease. High doses of chemotherapeutic agents are administered within an extracorporeal circulated isolated extremity, treating the metastasis, while systemic toxicity is avoided. To our knowledge, indexed oxygen supply/demand relationship during ILP has not previously been described. Our aim was to measure and describe oxygen metabolism, specifically oxygen delivery, consumption, and extraction, in an isolated leg/arm during ILP. Also investigate whether invasive oxygenation measurement during ILP correlates and can be used interchangeable with the non-invasive method, near infrared spectroscopy (NIRS). Methods: Data from 40 patients scheduled for ILP were included. At six time points blood samples were drawn during the procedure. DO2, VO2, and O2ER were calculated according to standard formulas. NIRS and hemodynamics were recorded every 10 min. Results: For all observations, the mean of DO2 was 190 +/- 59 ml/min/m(2), VO2 was 35 +/- 8 ml/min/m(2), and O2ER was 21 +/- 8%. VO2 was significantly higher in legs compared to arms (38 +/- 8 vs. 29 +/- 7 ml/min/m(2), p=0.02). Repeated measures showed a significant decrease in DO2 in legs (209 +/- 65 to 180 +/- 66 ml/min/m(2), p=<0.01) and in arms (252 +/- 72 to 150 +/- 57 ml/min/m(2), p=<0.01). Significant increase in O2ER in arms was also found (p=0.03). Significant correlation was detected between NIRS and venous extremity oxygen saturation (SveO(2)) (r(rm)=0.568, p=<. 001, 95% CI 0.397-0.701). When comparing SveO(2) and NIRS using a Bland-Altman analysis, the mean difference (bias) was 8.26 +/- 13.03 (p=<. 001) and the limit of agreement was - 17.28-33.09, with an error of 32.5%. Conclusion: DO2 above 170 ml/min/m(2) during ILP kept O2ER below 30% for all observations. NIRS correlates significant to SveO(2); however, the two methods do not agree sufficiently to work interchangeable.
12.	Cvetkovic, M, et al. (författare) International survey of neuromonitoring and neurodevelopmental outcome in children and adults supported on extracorporeal membrane oxygenation in Europe 2023 Ingår i: Perfusion. - : SAGE Publications. - 1477-111X .- 0267-6591. ; 38:2, s. 245-260 Tidskriftsartikel (refereegranskat)abstract Adverse neurological events during extracorporeal membrane oxygenation (ECMO) are common and may be associated with devastating consequences. Close monitoring, early identification and prompt intervention can mitigate early and late neurological morbidity. Neuromonitoring and neurocognitive/neurodevelopmental follow-up are critically important to optimize outcomes in both adults and children. Objective: To assess current practice of neuromonitoring during ECMO and neurocognitive/neurodevelopmental follow-up after ECMO across Europe and to inform the development of neuromonitoring and follow-up guidelines. Methods: The EuroELSO Neurological Monitoring and Outcome Working Group conducted an electronic, web-based, multi-institutional, multinational survey in Europe. Results: Of the 211 European ECMO centres (including non-ELSO centres) identified and approached in 23 countries, 133 (63%) responded. Of these, 43% reported routine neuromonitoring during ECMO for all patients, 35% indicated selective use, and 22% practiced bedside clinical examination alone. The reported neuromonitoring modalities were NIRS ( n = 88, 66.2%), electroencephalography ( n = 52, 39.1%), transcranial Doppler ( n = 38, 28.5%) and brain injury biomarkers ( n = 33, 24.8%). Paediatric centres (67%) reported using cranial ultrasound, though the frequency of monitoring varied widely. Before hospital discharge following ECMO, 50 (37.6%) reported routine neurological assessment and 22 (16.5%) routinely performed neuroimaging with more paediatric centres offering neurological assessment (65%) as compared to adult centres (20%). Only 15 (11.2%) had a structured longitudinal follow-up pathway (defined followup at regular intervals), while 99 (74.4%) had no follow-up programme. The majority ( n = 96, 72.2%) agreed that there should be a longitudinal structured follow-up for ECMO survivors. Conclusions: This survey demonstrated significant variability in the use of different neuromonitoring modalities during and after ECMO. The perceived importance of neuromonitoring and follow-up was noted to be very high with agreement for a longitudinal structured follow-up programme, particularly in paediatric patients. Scientific society endorsed guidelines and minimum standards should be developed to inform local protocols.
13.	Di Nardo, M, et al. (författare) A narrative review of the technical standards for extracorporeal life support devices (pumps and oxygenators) in Europe 2018 Ingår i: Perfusion. - : SAGE Publications. - 1477-111X .- 0267-6591. ; 33:7, s. 553-561 Tidskriftsartikel (refereegranskat)abstract This review summarizes the European rules to control the market when introducing new products. In particular, it shows all the steps to achieve the European Conformity (CE Mark), a certification that all new medical products must achieve before being used in Europe. Extracorporeal membrane oxygenation (ECMO) devices are exposed to the same procedures. Hereby, we present some regulatory issues regarding pumps and oxygenators, providing technical details as released by the manufacturers on their websites and information charts.
14.	Donker, D. W., et al. (författare) Echocardiography in extracorporeal life support : A key player in procedural guidance, tailoring and monitoring 2018 Ingår i: Perfusion. - : Sage Publications. - 0267-6591 .- 1477-111X. ; 33:1_suppl, s. 31-41 Tidskriftsartikel (refereegranskat)abstract Extracorporeal life support (ECLS) is a mainstay of current practice in severe respiratory, circulatory or cardiac failure refractory to conventional management. The inherent complexity of different ECLS modes and their influence on the native pulmonary and cardiovascular system require patient-specific tailoring to optimize outcome. Echocardiography plays a key role throughout the ECLS care, including patient selection, adequate placement of cannulas, monitoring, weaning and follow-up after decannulation. For this purpose, echocardiographers require specific ECLS-related knowledge and skills, which are outlined here.
15.	Donker, Dirk W., et al. (författare) Left ventricular unloading during veno-arterial ECMO : a review of percutaneous and surgical unloading interventions 2019 Ingår i: Perfusion. - : Sage Publications. - 0267-6591 .- 1477-111X. ; 34:2, s. 98-105 Forskningsöversikt (refereegranskat)abstract Short-term mechanical support by veno-arterial extracorporeal membrane oxygenation (VA ECMO) is more and more applied in patients with severe cardiogenic shock. A major shortcoming of VA ECMO is its variable, but inherent increase of left ventricular (LV) mechanical load, which may aggravate pulmonary edema and hamper cardiac recovery. In order to mitigate these negative sequelae of VA ECMO, different adjunct LV unloading interventions have gained a broad interest in recent years. Here, we review the whole spectrum of percutaneous and surgical techniques combined with VA ECMO reported to date.
16.	El-Essawi, A, et al. (författare) Minimized perfusion circuits: an alternative in the surgical treatment of Jehovah's Witnesses 2013 Ingår i: Perfusion. - : SAGE Publications. - 1477-111X .- 0267-6591. ; 28:1, s. 47-53 Tidskriftsartikel (refereegranskat)abstract Jehovah’s Witnesses present a challenge to cardiac surgeons, as quality of care is not only defined by mortality and morbidity, but also by the avoidance of blood transfusions. Over the last years, minimized perfusion circuits (MPC) have contributed substantially to the achievement of this goal in our clinic. Presented is a retrospective analysis of our experience. Methods: Twenty-nine Jehovah’s Witnesses, aged 69 ± 10 years, have undergone cardiac surgery with a MPC in our institution since 2005. The ROCsafe (Reservoir Optional Circuit) MPC was used in most of these patients (n=27) as it offers the unique possibility of a speedy integration of a reservoir in the event of a major air leak, thereby, negligating any safety concerns. Results: There was no in-hospital or 30-day postoperative mortality. Mean ICU stay was 1.6 ± 2 days with a mean intubation time of 11.3 ± 9.1 hrs. Postoperative complications included one myocardial infarction with accompanying low cardiac output, one stroke, one transient delirium, one idiopathic thrombocytopenia and three re-operations (one sternal infection, one postoperative bleeding and one delayed tamponade). The mean postoperative hospital stay was 9.9 ± 2.3 days. Mean decrease in hemoglobin was 2.1 ± 1.3 g/dl during cardiopulmonary bypass and 3.4 ±1.4 g/dl at discharge. The lowest postoperative hemoglobin level was 9.3 ±1.8 (Range 6-12.9). Conclusions: These encouraging results emphasize the role MPCs can play in optimizing the quality of patient care. We hope that this report can serve as a stimulus for similar experiences.
17.	Engström, Gunnar, et al. (författare) Fat reduction in pericardial suction blood by spontaneous density separation : an experimental model on human liquid fat versus soya oil 2003 Ingår i: Perfusion. - : SAGE Publications. - 0267-6591 .- 1477-111X. ; 18:1, s. 39-45 Tidskriftsartikel (refereegranskat)abstract Pericardial suction blood (PSB) contains mediastinal liquid wound fat with an embolic potential to cause brain damage after cardiopulmonary bypass (CPB). The aims were to measure how fat separates spontaneously from blood by density and how temperature and fat surface adhesion affect the results under experimental conditions. Human liquid fat was heat-extracted from retrieved pericardial fat tissue of coronary artery bypass graft (CABG) patients ( n=10). Human fat or soya oil, 5% and 10%, respectively, were mixed with postoperatively shed mediastinal blood ( n=20). The mixture was loaded into a temperature-controlled (37°C, 20°C, 10°C) vertical separation column. At 1, 2.5, 5 and 10 minutes, the blood was collected in five fractions, representing layers of density separation, followed by centrifugation. Human fat solidified at 8°C. Soya oil remained liquid below 0°C. Soya oil separated fast in water, but was slower in blood. At 10 minutes and 37°C 73±6% of added soya oil was found in the top 20% fraction. Human fat at 37°C behaved similarly to soya oil, with 58-2% separation at 10 minutes. However, at lower temperatures the density separation became less efficient ( p<0.001), whereas human fat more effectively adhered to the walls of the column, which added to the removal. In total, 66%-78% of the human fat was removed, depending on temperature. In conclusion, fat in PSB can be reduced by simple density separation and surface adhesion while it is temporarily retained from the CPB circuit.
18.	Eyjolfsson, Atli, et al. (författare) Comparison between transcranial Doppler and coulter counter for detection of lipid micro embolization from mediastinal shed blood reinfusion during cardiac surgery. 2011 Ingår i: Perfusion. - : SAGE Publications. - 1477-111X .- 0267-6591. ; 26:5, s. 519-523 Tidskriftsartikel (refereegranskat)abstract INTRODUCTION: Lipid micro embolization (LME) from re-transfused shed blood has been postulated to be a potential reason for short- and long-term cognitive dysfunction after cardiac surgery. The purpose of this investigation was to evaluate if transcranial Doppler (TCD) has the capacity to detect LME. METHODS: Thirteen patients undergoing cardiopulmonary bypass surgery were investigated. Each patient's cerebral circulation was monitored with transcranial Doppler during the first two minutes after re-transfusion of shed blood and blood was simultaneously sampled and characterised by a Coulter counter. RESULTS: Strong correlation was found between embolic loads, as measured by transcranial Doppler and Coulter counter (r=0.79, P<0.005). CONCLUSIONS: This pilot study shows that non-invasive monitoring by transcranial Doppler could be a potential tool to monitor LME during cardiopulmonary bypass surgery.
19.	Falk, L, et al. (författare) Differential hypoxemia and the clinical significance of venous drainage position during extracorporeal membrane oxygenation 2023 Ingår i: Perfusion. - : SAGE Publications. - 1477-111X .- 0267-6591. ; 38:4, s. 818-825 Tidskriftsartikel (refereegranskat)abstract Differential hypoxemia (DH) has been recognized as a clinical problem during veno-arterial extracorporeal membrane oxygenation (VA ECMO) although its features and consequences have not been fully elucidated. This single center retrospective study aimed to investigate the clinical characteristics of patients manifesting DH as well as the impact of repositioning the drainage point from the inferior vena cava (IVC) to the superior vena cava to alleviate DH. All patients (>15 years) commenced on VA ECMO at our center between 2009 and 2020 were screened. Of 472 eligible patients seven were identified with severe DH. All patients had the drainage cannula tip in the IVC or at the junction between the IVC and right atrium. The mean peripheral capillary saturation increased from 54 (±6.6) to 86 (±6.6) %, ( p = <0.001) after repositioning of the cannula. Pre-oxygenator saturation increased from 62 (±8.9) % prior to adjustment to 74 (±3.7) %, ( p = 0.016) after repositioning. Plasma lactate tended to decrease within 24 h after adjustment. Five patients (71%) survived ECMO treatment, to discharge from hospital, and were alive at 1-year follow-up. Although DH has been described in several studies, the condition has not been investigated in a clinical setting comparing the effect on upper body saturation before and after repositioning of the drainage cannula. This study shows that moving the drainage zone into the upper part of the body has a marked positive effect on upper body saturation in patients with DH.
20.	Falk, L, et al. (författare) Differential hypoxemia during venoarterial extracorporeal membrane oxygenation 2019 Ingår i: Perfusion. - : SAGE Publications. - 1477-111X .- 0267-6591. ; 34:1_suppl, s. 22-29 Tidskriftsartikel (refereegranskat)abstract Venoarterial extracorporeal membrane oxygenation, indicated for severe cardio-respiratory failure, may result in anatomic regional differences in oxygen saturation. This depends on cannulation, hemodynamic state, and severity of respiratory failure. Differential hypoxemia, often discrete, may cause clinical problems in peripheral femoro-femoral venoarterial extracorporeal membrane oxygenation, when the upper body is perfused with low saturated blood from the heart and the lower body with well-oxygenated extracorporeal membrane oxygenation blood. The key is to diagnose and manage fulminant differential hypoxemia, that is, a state that may develop where the upper body is deprived of oxygen. We summarize physiology, assessment of diagnosis, and management of fulminant differential hypoxemia during venoarterial extracorporeal membrane oxygenation. A possible solution is implantation of an additional jugular venous return cannula. In this article, we propose an even better solution, to drain the venous blood from the superior vena cava. Drainage from the superior vena cava provides superiority to venovenoarterial configuration in terms of physiological rationale, efficiency, safety, and simplicity in clinical circuit design.
21.	Ferrari, Gabriele, 1984-, et al. (författare) Long-term results of percutaneous coronary intervention in no-touch vein grafts are significantly better than in conventional vein grafts 2024 Ingår i: Perfusion. - London : Sage Publications. - 0267-6591 .- 1477-111X. Tidskriftsartikel (refereegranskat)abstract Introduction: Conventional vein grafts have a high risk of thrombosis and early atherosclerosis. Percutaneous coronary intervention (PCI) in conventional vein grafts is associated with a higher incidence of late adverse cardiac events. The aim of this study was to evaluate the long-term results after PCI in saphenous vein grafts (SVG) harvested with the no-touch technique compared to the conventional technique. Methods: This was a single-center, retrospective, cohort study, based on data from the Swedeheart register. The inclusion criterion was individuals who underwent CABG using different vein graft techniques between January 1992 and July 2020, and who required a PCI in SVGs between January 2006 and July 2020. The primary end point was long-term in-stent restenosis. The secondary endpoints were long-term major adverse cardiac events (MACE) and 1-year re-hospitalization rates. The associations between the graft types and the endpoints were evaluated using the Fine and Gray competing-risk regression analysis. Results: The study included 346 individuals (67 no-touch, 279 conventional). The mean clinical follow-up time was 6.4 years with a standard deviation of 3.7 years. The long-term in-stent restenosis rate for the no-touch grafts was 3.2% compared to 18.7% for the conventional grafts (p <.01), with a subdistribution hazard ratio (SHR) of 0.16 (p =.010). The long-term MACE rate was 27.0% in the no-touch group and 48.3% in the conventional group (p <.01) with a SHR of 0.53 (p =.017). The short-term results were similar in both groups. Conclusions: Percutaneous coronary intervention in a no-touch vein graft was associated with statistically significantly fewer in-stent restenoses and MACE at long-term follow-up compared to a conventional SVG. © The Author(s) 2024.
22.	Haraldsen, Pernille, et al. (författare) Sevoflurane anesthesia during acute right ventricular ischemia in pigs preserves cardiac function better than propofol anesthesia. 2016 Ingår i: Perfusion. - : SAGE Publications. - 1477-111X .- 0267-6591. Tidskriftsartikel (refereegranskat)abstract The intention of the present study was to evaluate possible cardioprotective properties of inhalation anesthesia with sevoflurane.
23.	Hjarpe, A. K., et al. (författare) Epoprostenol for the treatment of increasing oxygenator pressure drop during cardiopulmonary bypass. A case report 2018 Ingår i: Perfusion-Uk. - : SAGE Publications. - 0267-6591. ; 33:3, s. 228-231 Tidskriftsartikel (refereegranskat)abstract A change of oxygenator during cardiopulmonary bypass is a technically high-risk procedure with potential for a serious adverse event for the patient. This case report describes a case of increased pressure drop and pre-oxygenator blood pressure during cardiopulmonary bypass successfully treated with pre-oxygenator-administered epoprostenol.
24.	Hjarpe, A. K., et al. (författare) Risk factors and treatment of oxygenator high-pressure excursions during cardiopulmonary bypass 2023 Ingår i: Perfusion-Uk. - : SAGE Publications. - 0267-6591. ; 38:1, s. 156-164 Tidskriftsartikel (refereegranskat)abstract Introduction: A high-pressure excursion (HPE) is a sudden increase in oxygenator inlet pressure during cardiopulmonary bypass (CPB). The aims of this study were to identify factors associated with HPE, to describe a treatment protocol utilizing epoprostenol in severe cases, and to assess early outcome in HPE patients. Methods: Patients who underwent cardiac surgery with cardiopulmonary bypass at Sahlgrenska University Hospital 2016-2018 were included in a retrospective observational study. Pre- and post-operative data collected from electronic health records, local databases, and registries were compared between HPE and non-HPE patients. Factors associated with HPE were identified with logistic regression models. Results: In total, 2024 patients were analyzed, and 37 (1.8%) developed HPE. Large body surface area (adjusted Odds Ratio (aOR): 1.43 per 0.1 m(2); 95% confidence interval (CI): 1.16-1.76, p < 0.001), higher hematocrit during CPB (aOR: 1.20 per 1%; (1.09-1.33), p < 0.001), acute surgery (aOR: 2.98; (1.26-6.62), p = 0.018), and previous stroke (aOR: 2.93; (1.03-7.20), p = 0.027) were independently associated with HPE. HPE was treated with hemodilution (n = 29, 78.4%), and/or extra heparin (n = 23, 62.2%), and/or epoprostenol (n = 12, 32.4%). No oxygenator change-out was necessary. While there was no significant difference in 30-day mortality (2.7% vs 3.2%, p = 1.0), HPE was associated with a higher perioperative stroke rate (8.1% vs 1.8%, aOR 5.09 (1.17-15.57), p = 0.011). Conclusions: Large body surface area, high hematocrit during CPB, previous stroke and acute surgery were independently associated with HPE. A treatment protocol including epoprostenol appears to be a safe option. Perioperative stroke rate was increased in HPE patients.
25.	Högevold, H. E., et al. (författare) Effects of heparin coating on the expression of CD11b, CD11c and CD62L by leucocytes in extracorporeal circulation in vitro 1997 Ingår i: Perfusion. - : SAGE Publications. - 0267-6591 .- 1477-111X. ; 12:1, s. 9-20 Tidskriftsartikel (refereegranskat)abstract Leucocyte adhesion molecules are involved in the leucocyte-endothelial interaction and in the activation of coagulation and binding of complement and endotoxin. Thus, they are important in inflammation, systemic acute phase reaction, ischaemia reperfusion injury and resistance against infections. The expression of the adhesion molecules CD11b, CD11c and CD62L on leucocytes and changes in plasma products of neutrophil activation (myeloperoxidase, lactoferrin) and complement activation (C3bc, SC5b-9 (TCC)) were examined in an extracorporeal circulation (ECC) model and the effects of Carmeda bioactive surface (CBAS) heparin coating (n = 7) of the circuits were compared to uncoated control circuits (n = 5). In this model, new 'unactivated' cells mobilized from the bone marrow could not interfere with descriptive measures of cell activation as seen in in vivo studies. In the control group, CD11b and CD11c were upregulated on monocytes and granulocytes during ECC, whereas CD62L was downregulated. Heparin coating reduced the increase in CD11b and CD11c on granulocytes (p < 0.02 at 2 h), but the delayed increase in CD11c on monocytes and the delayed downregulation of CD62L on granulocytes and monocytes did not reach statistical significance. Further, heparin coating also reduced the initial decrease in the absolute cell counts of monocytes and granulocytes (p = 0.01 at 2 h), reflecting reduced adhesion to the oxygenator/tubing. The increases in plasma myeloperoxidase, lactoferrin, C3bc and TCC were lower in the heparin-coated group compared to the control group. The increases in plasma myeloperoxidase and lactoferrin correlated significantly to the increase in CD11b (r = 0.71, p = 0.02 and r = 0.64, p = 0.05, respectively) and CD11c (r = 0.72, p = 0.008 and r = 0.72, p = 0.008, respectively) on granulocytes, suggesting interacting regulatory pathways in the process of neutrophil adhesion, activation and degranulation. Thus, in this in vitro ECC model, heparin coating of oxygenator/tubing sets reduced leucocyte activation and leucocyte adhesion-related phenomena.

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