Abstract Brain death, also commonly referred to as death by neurologic criteria, has been considered a legal definition of death for decades. Its determination involves many considerations and subtleties. In this review, we discuss the philosophy and history of brain death, its clinical determination, and special considerations. We discuss performance..
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Abstract Two equations have been developed from multi-frequency measurements of blood impedance Zb for a simultaneous electrical online estimation of changes in blood hematocrit ΔH [%] and temperatures ΔT [K] in cardiopulmonary bypass (CPB). Zb of fixed blood volumes at varying H and T were measured by an impedance analyzer and changes in blood conductivity σb and relative permittivity εb computed. Correlation analysis were based on..
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Abstract OBJECTIVES: We aimed to investigate whether there are differences in outcome for pediatric patients when extracorporeal life support (ECLS) is initiated on-hours compared with off-hours. DESIGN: Retrospective cohort study. SETTING: Ten-year period (2009–2018) in United States centers, from the Extracorporeal Life Support Organization registry. PATIENTS: Pediatric (>30 d and..
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Abstract Objective To assess preoperative hemoglobin and perioperative red blood cell transfusion in children undergoing cardiac surgery after the implementation of a preoperative patient blood management (PBM) clinic with oral iron supplementation. Design A retrospective analysis. Setting A single tertiary hospital. Participants Patients who underwent cardiac surgery with cardiopulmonary bypass..
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Abstract Background: Extracorporeal circuit coating has been shown to improve coagulation derangements during pediatric cardiopulmonary bypass (CPB). This study compared platelet function and hemostasis activation in pediatric cardiac surgery conducted with nonheparin coating (Balance; Medtronic, Minneapolis, MN) versus heparin-based coating (Carmeda; Medtronic) circuits. Methods: A prospective, randomized, double-center trial was conducted in..
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Abstract Objective The objective of this study was to audit current patient blood management practice in children throughout cardiac surgery and paediatric intensive care unit (PICU) admission. Design This was a prospective observational cohort study. Setting This was a single-centre study in the cardiac operating room (OR) and PICU in..
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Abstract OBJECTIVES The aim of this study was to evaluate if a ‘protective’ (low-tidal/low-frequency) ventilation strategy can shorten the postoperative ventilation time and minimize acute lung injury in children with congenital heart disease (CHD) undergoing repair with cardiopulmonary bypass (CPB). METHODS This is a single-centre prospective, interventional study, including..
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Abstract Significant progress has been made in neonatal cardiopulmonary bypass (CPB) over the years. At Penn State Health Children’s Hospital, we have established a multidisciplinary research team that brings clinicians, engineers, scientists, research nurses, neuromonitoring technicians, perfusionists, and students from various departments to help reduce adverse outcomes following CPB in..
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Abstract Veno-arterial extra-corporeal membrane oxygenation (VA ECMO) in children is often established by cannulation of the right carotid artery and the right internal jugular vein. Cerebral infarction which is sometimes seen in such cases may be secondary to an incomplete circle of Willis. We present 3 cases with VA ECMO..
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Abstract Pediatric cardiac surgery induces an increased oxidative stress (OS) response. Increased OS is associated with poor neurologic outcomes in neonatal populations with similar patterns of brain injury. We investigated OS and brain injury in infants undergoing heart surgery. Patients 6 months or younger, undergoing cardiac surgery with or without..
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