This study evaluated the impact of antegrade cerebral perfusion (ACP) at 25°C on cerebral oxygenation and serum creatinine in 61 newborns and children undergoing aortic arch reconstruction. Cerebral and somatic oxygenation as measured by near-infrared spectroscopy was well-preserved during and after surgery for all patients. Peak postoperative serum creatinine levels were normal and complications such as seizures, neurological deficits, or need for dialysis were low. The results suggest ACP at 25°C provides adequate cerebral and somatic protection for newborns and children undergoing arch reconstruction.
The field of perfusion is becoming increasingly demanding both clinically and didactically. As the patient population continues to present with a variety of complex health issues, there is a greater need than ever for the Pefusionist to develop new techniques for patient care while on Cardiopulmonary Support. Ascending Aortic Arch dissections (AAAD), with its current mortality rates of 10%-15% with significant neurological complications associated, still remains a difficult case for Perfusionist’s to manage effectively. The most widely used technique during this type of repair surgery, is hypothermic circulatory arrest (HCA). Although this remains a premier technique, there continues to be a high reported incidence of neurological deficit post HCA. In order to address and limit this issue, the advent of selective cerebral perfusion is slowly gaining acceptance. This new technique has been shown to not only decrease the time of exposure of blood to a foreign surface, but limit the patient duration on full cardiopulmonary support. The most notable aspect of this technique; is it allows the surgeon to begin repairs immediately, since the process cools the brain only, while keeping the rest of body at moderate-mild hypothermic levels.
The field of perfusion is becoming increasingly demanding both clinically and didactically. As the patient population continues to present with a variety of complex health issues, there is a greater need than ever for the Pefusionist to develop new techniques for patient care while on Cardiopulmonary Support. Ascending Aortic Arch dissections (AAAD), with its current mortality rates of 10%-15% with significant neurological complications associated, still remains a difficult case for Perfusionist’s to manage effectively. The most widely used technique during this type of repair surgery, is hypothermic circulatory arrest (HCA). Although this remains a premier technique, there continues to be a high reported incidence of neurological deficit post HCA. In order to address and limit this issue, the advent of selective cerebral perfusion is slowly gaining acceptance. This new technique has been shown to not only decrease the time of exposure of blood to a foreign surface, but limit the patient duration on full cardiopulmonary support. The most notable aspect of this technique; is it allows the surgeon to begin repairs immediately, since the process cools the brain only, while keeping the rest of body at moderate-mild hypothermic levels.
Noncardiac surgery (NCS) is associated with a considerable risk of adverse cardiac events among individuals with coronary artery or aortic valve disease
"The real benefit to the patient [of echocardiography] is not the technical skill, but rather the application of intellectual input... information, communication and teamwork are essential" Jos Roelandt, 1993
Of all the imaging techniques used in intensive care, echocardiography has come to the fore, in particular due to its accessibility, immediate availability and applicability as a point-of-care technique, thereby removing the risks of transportation of the critically ill. Over the preceding 20 years evidence has continued to emerge for its extended use in the acute/emergency setting, to the extent that it is now included in national and international guidelines relating to the universal definition of myocardial infarction, as well as in shock pathways, and as an adjunctive technique in advanced life support. Its potential scope is huge, with applications relating to monitoring, cardiac pathophysiology and coronary perfusion as well as its more evident use to define cardiac anatomy.
The three main uses of ultrasound to interrogate the heart relate to the way in which the technique is used: first, as an extension to the clinical examination using binary questions and 2D imaging only (focused cardiac ultrasound, FoCUS) which forms the basis of 'basic' techniques. Second, incorporating the full range of echocardiographic techniques for diagnostic capability (echocardiography), and third, selective application of the full range of techniques in order to answer specific questions raised in the critical care/emergency arena (targeted echocardiography). This includes speckle strain/strain-rate to determine abnormalities of myocardial function suggestive of myocarditis, calculation of myocardial electromechanical efficiency in order to maximise cardiac output, recognition of parameters that suggest restrictive right ventricular physiology, with the requirement for modification of ventilatory techniques and parameters, detection of myocardial ischaemia, estimation of LVEDP and LAP, and its application in the institution, monitoring and weaning of mechanical circulatory support.
Advances in Automated CPR
A/Prof Marcus Ong
Consultant, Senior Medical Scientist
& Director of Research
Department of Emergency Medicine
Singapore General Hospital
Noncardiac surgery (NCS) is associated with a considerable risk of adverse cardiac events among individuals with coronary artery or aortic valve disease
"The real benefit to the patient [of echocardiography] is not the technical skill, but rather the application of intellectual input... information, communication and teamwork are essential" Jos Roelandt, 1993
Of all the imaging techniques used in intensive care, echocardiography has come to the fore, in particular due to its accessibility, immediate availability and applicability as a point-of-care technique, thereby removing the risks of transportation of the critically ill. Over the preceding 20 years evidence has continued to emerge for its extended use in the acute/emergency setting, to the extent that it is now included in national and international guidelines relating to the universal definition of myocardial infarction, as well as in shock pathways, and as an adjunctive technique in advanced life support. Its potential scope is huge, with applications relating to monitoring, cardiac pathophysiology and coronary perfusion as well as its more evident use to define cardiac anatomy.
The three main uses of ultrasound to interrogate the heart relate to the way in which the technique is used: first, as an extension to the clinical examination using binary questions and 2D imaging only (focused cardiac ultrasound, FoCUS) which forms the basis of 'basic' techniques. Second, incorporating the full range of echocardiographic techniques for diagnostic capability (echocardiography), and third, selective application of the full range of techniques in order to answer specific questions raised in the critical care/emergency arena (targeted echocardiography). This includes speckle strain/strain-rate to determine abnormalities of myocardial function suggestive of myocarditis, calculation of myocardial electromechanical efficiency in order to maximise cardiac output, recognition of parameters that suggest restrictive right ventricular physiology, with the requirement for modification of ventilatory techniques and parameters, detection of myocardial ischaemia, estimation of LVEDP and LAP, and its application in the institution, monitoring and weaning of mechanical circulatory support.
Advances in Automated CPR
A/Prof Marcus Ong
Consultant, Senior Medical Scientist
& Director of Research
Department of Emergency Medicine
Singapore General Hospital
Outcome After Procedures for Retained Blood Syndrome in Coronary SurgeryPaul Molloy
OBJECTIVES:
Incomplete drainage of blood from around the heart and lungs can lead to retained blood syndrome (RBS) after cardiac sur-
gery. The aim of this study was to assess the incidence of and the outcome after procedures for RBS in patients undergoing isolated coronary artery bypass grafting (CABG)-
SOLACI Coverage: AHA 2012 Congress. Dr. Esteban Lopez-de-Sa . PILOT trial: El estudio piloto de dos niveles de hipotermia en los sobrevivientes comatosos tras un paro cardiaco fuera del hospital. Find more presentations on our web http://solaci.org/es/aha_2012.php
2017 Barcelona. Acute Cardiac Unloading and Recovery Working Group Meeting.
The Impella ventricular assist device support experience at Texas Children's Hospital.
Survival after cardiac arrest is poor but some therapies can make a difference. This presentation discusses the evidence for therpauetic hypothermia, normoxia, management of blood pressure and early cardiac catherterisation. It also makes the case that these might be elements of a bundle of care.
Background: Arterial stiffness is an independent predictor of cardiovascular disease. Independent of aging and other cardiovascular risk factors, arterial stiffness increases from the proximal to the distal arterial compartments. The overall aim of this work is to establish a longitudinal mechanical mapping of the arterial tree in healthy individuals.
Methods: We report preliminary data quantifying stiffness of the abdominal aorta (AAA), common carotid artery (CCA) and brachial artery (BA) in adolescents. In group-1 subjects (from Melbourne, Australia), cine-loops of the AAA and CCA B-mode data were digitally recorded, whereas in group-2 (from Montreal, Canada), cine-loops of the CCA and BA B-mode data were acquired at the same clinical evaluation. Arterial wall elastic moduli (EIBM) were estimated off-line using our proprietary non-invasive imaging-based biomarker algorithm(ImBioMark).
Remote Ischaemic Conditioning: A Paper Review & Uses in Paramedic Practicebgander23
A 2 part presentation. Part 1 reviews a paper on the long-term clinical outcomes of STEMI patients undergoing remote ischaemic perconditioning prior to primary percutaneous coronary intervention. The 2nd part looks at how this technique can be used in Paramedic practice.
Fragmented QRS Complex is associated with the Left Ventricular Remodeling in ...submissionclinmedima
A total of 140 patients with AMI were enrolled. Accoridng to the presence of fQRS in presenting electrocardiogram. The patients were divided into fQRS group and NonfQRS group. Real-time three-dimensional echocardiograph parameters measured in-hospital and 6-month follow-up period were collected.