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Management of Amniotic Fluid Embolism (AFE) using anticoagulation-free ECMO

Abstract Amniotic fluid embolism (AFE) is a critical obstetric complication characterized by the entry of amniotic fluid and its components into maternal circulation during parturition, leading to acute cardiopulmonary failure,..

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ECMO in Pregnancy: Analysis of Indications, Management and Outcomes

Abstract Extracorporeal membrane oxygenation (ECMO) has become a critical rescue therapy for pregnant and peripartum patients experiencing life-threatening cardiac or respiratory failure that is refractory to standard treatments. Pregnancy induces..

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Towards goal-directed perfusion – Part I: Developing physiology-inspired mathematical framework using high-resolution paediatric CPB data

Abstract Background During cardiopulmonary bypass (CPB), goal-directed perfusion (GDP) seeks to match oxygen delivery to metabolic demand, but the dynamics of oxygen extraction and intraoperative oxygen demand remain poorly understood,..

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Endo-Aortic Balloon Occlusion versus Transthoracic Clamping in Minimally Invasive Mitral Valve Surgery

Abstract Objectives The present study compared the clinical outcome between endo-aortic balloon occlusion (EABO) and transthoracic clamping (TTC) in patients undergoing minimally invasive mitral valve surgery (MIMVS). Methods All patients..

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Optimizing Extracorporeal Membrane Oxygenation Gas Exchange: Key Insights for Clinical Management

Abstract This review examines the role of extracorporeal membrane oxygenation (ECMO) in the management of severe acute respiratory distress syndrome (ARDS), emphasizing its contribution to lung-protective ventilation through optimizing oxygenation..

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Ice Water Drowning Survival After 147-Minute Submersion and 7 °C Hypothermic Circulatory Arrest

Abstract Background Young patients may survive accidental deep hypothermia with prolonged asystolic circulatory arrest because of protective effects of cold. Case Summary An 8-year-old boy fell through pond ice and..

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The Use of Tris-hydroxymethyl Aminomethane in Patients Following Cardiac Surgery: A Retrospective Investigation

Abstract Objectives To compare the metabolic and hemodynamic parameters of cardiac surgery patients following the receipt of tris-hydroxymethyl aminomethane (THAM) or sodium bicarbonate alone for the treatment of postoperative metabolic..

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Mean arterial pressure difference before and during cardiopulmonary bypass: what should be the ideal mean perfusion pressure?

Abstract Objectives: The difference between mean arterial pressure (MAP) before cardiopulmonary bypass (CPB) and mean perfusion pressure (MPP) during CPB is thought to be a strong predictor of acute kidney injury..

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Progress of extracorporeal centrifugal pumps for mechanical circulatory supports

Abstract This review traces the evolution of centrifugal blood pumps in mechanical circulatory support (MCS) systems. Initially met with concerns over blood damage and thrombus formation, centrifugal pumps have become..

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Delayed Sternal Closure Following Complex Cardiac Surgery in Neonates

Abstract Background Delayed sternal closure (DSC) is a well-established management strategy following complex congenital cardiac surgery that is used to mitigate postoperative hemodynamic and respiratory instability. It is mostly used..

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Targeting the contributors to vasorelaxation during vasoplegia from cardiopulmonary bypass

Abstract Vasoplegia, a syndrome of noncardiogenic, non-hypovolaemic vasodilatory hypotension is a common complication of cardiac surgery utilising cardiopulmonary bypass. Vasopressor-sparing strategies have been increasingly used in the management of vasoplegia..

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Effectiveness and safety of bivalirudin anticoagulation therapy in adult patients receiving extracorporeal membrane oxygenation: A systematic review and meta-analysis

Abstract Background:  Compared to heparin, there is limited evidence of the benefits of bivalirudin in the patients with extracorporeal membrane oxygenation (ECMO). Methods:  We searched for studies comparing bivalirudin anticoagulation..

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Von Willebrand factor in Ecmo: a dynamic modulator of hemorrhage and thrombosis

Abstract Von Willebrand factor (vWF) orchestrates hemostasis through platelet activation, factor VIII stabilization, and inflammatory modulation, with emerging evidence highlighting its shear-dependent conformational dynamics as a critical regulator of thrombus..

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Hemolysis Index and Cardiopulmonary Bypass Time as Predictors of Cardiac Surgery-associated Acute Kidney Injury: An Observational Cohort Study

Abstract Objectives Acute kidney injury (AKI) is a common and serious complication of cardiac surgery, often linked to the use and duration of cardiopulmonary bypass (CPB). The Hemolysis Index (HI)..

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A Landscape Analysis of Pediatric and Congenital Heart Disease Services in Africa

Abstract Background There is geographic disparity in the provision of Pediatric and Congenital Heart Disease (PCHD) services; Africa accounts for only 1% of global cardiothoracic surgical capacity. Methods We conducted..

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Prediction of acute lung injury/acute respiratory distress syndrome after cardiopulmonary bypass in infants by monitoring femoral oxygen saturation

Abstract To investigate the feasibility of regional oxygen saturation (rSO2) monitoring for preventing acute lung injury (ALI)/acute respiratory distress syndrome (ARDS) caused by cardiopulmonary bypass (CPB) in infants undergoing ventricular..

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Implementing lean six sigma to optimize emergency extracorporeal cardiopulmonary resuscitation process management

Abstract Objective The aim of this study is to evaluate the effectiveness of lean six sigma management in optimizing the emergency extracorporeal cardiopulmonary resuscitation (ECPR) rescue process. Methods The existing..

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Innovations in Risk Assessment, Monitoring, and Management in Cardiothoracic and Vascular Anesthesia

Abstract As the perioperative care in cardiothoracic and vascular anesthesia continues to evolve, more emphasis is being placed on developing innovative methods for risk assessment and early detection of operative..

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Cell-free hemoglobin is associated with microcirculatory perfusion disturbances and acute kidney injury in rats on extracorporeal membrane oxygenation

Abstract Background Extracorporeal membrane oxygenation (ECMO) is a life-saving treatment, but carries a high risk of complications such as acute kidney injury (AKI). A contributor to AKI is hemolysis, which..

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Optimising cardiac surgery outcomes in people with diabetes: the OCTOPuS pilot feasibility study

Abstract Background Surgical outcomes are worse in people with diabetes, in part, because of the effects of hyperglycaemia, obesity and other comorbidities. Two important uncertainties in the management of people..

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Optimizing Tranexamic Acid Use in Adult Cardiac Surgery: From Rationale to Clinical Practice

Abstract  (TXA) has emerged as a cornerstone in blood conservation strategies for cardiac surgery. This comprehensive review synthesizes current evidence on TXA's efficacy, safety, and optimal use in various cardiac..

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How I Do It: Donation After Circulatory Death With Normothermic Regional Perfusion in Small Babies

Abstract Background: The gold standard for treatment of patients with end-stage heart failure remains . Time spent on the active waiting list, notably for  patients, contributes to alarmingly high mortality. Donation after..

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Liberal or restrictive transfusion for veno-arterial extracorporeal membrane oxygenation patients: a target trial emulation using the OBLEX study data

Abstract Background The optimal transfusion threshold for patients undergoing venoarterial extracorporeal membrane oxygenation (VA-ECMO) remains uncertain. Methods We used data from OBLEX (ClinicalTrials.gov: NCT03714048), an international, prospective, observational study conducted..

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Assessment of Renal Vein Flow Index by Transesophageal Echocardiography: Precision, Variability, and Association with Cardiac Index During Cardiac Surgery

Abstract Objectives Cardiac surgery-associated acute kidney injury (CSA-AKI) is a frequent and important complication often attributed to decreased kidney blood flow. Ultrasound measurement of renal  has been associated with adverse cardiac..

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Sarcoplasmic reticulum-mitochondria microdomains: hugging and kissing in the heart

Abstract Endoplasmic reticulum (ER)-mitochondrial (ER-Mito) interface, termed mitochondrial-ER contacts (MERCs), plays significant roles in the maintenance of bioenergetics and basal cell functions via the exchange of lipids, Ca2+, and reactive..

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Description and Management of Cardiac Arrests in Congenital Cardiac Patients Undergoing Cardiac Surgery, Cardiac Catheterization, and Cardiac Imaging

Abstract Objective To describe cardiac arrest during anesthesia care provided by a pediatric cardiac anesthesiologist in patients with congenital heart disease and identify predictors of outcome. Design Retrospective chart review...

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Extracorporeal CPR Performance Metrics in Adult In-Hospital Cardiac Arrest: A Stepwise and Evidence-Based Appraisal of the VA-ECMO Implementation Process

Abstract Extracorporeal cardiopulmonary resuscitation (ECPR) is an established intervention for select patients experiencing refractory cardiac arrest. Among modifiable predictors of survival and neurologic recovery during ECPR implementation, timely restoration of..

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Anticoagulation Monitoring During Extracorporeal Membrane Oxygenation: A Narrative Review

Abstract The advancement of  has introduced a new dimension to managing patients who do not respond to conventional treatment of severe .  (ECMO) is a specialized temporary life support that serves as a..

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Early alpha power in the frontal lobe area can predict delirium after cardiac surgery

Abstract Background Delirium is a common postoperative complication in patients undergoing cardiac surgery and is associated with prolonged hospitalization and persistent cognitive impairment. This study aimed to assess the predictive..

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Analysis of Risk Factors for Heparin Resistance During Cardiac Surgery: Does Antithrombin Deficiency Cause Heparin Resistance?

Abstract Objectives To determine whether heparin resistance (HR) occurring during  (CPB) is associated with  (antithrombin III) activity. Design Retrospective review of data collected prospectively in a single center. Setting A tertiary referral..

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