Publications (2)3.74 Total impact
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ABSTRACT: The aim of this study was to determine whether the use of fresh frozen plasma (FFP) in the infant pump prime can avoid dilution of fibrinogen, decrease the need for blood product transfusion after bypass, and decrease exposure to donor blood products. Twenty infants weighing less than 8 kg were prospectively randomized to receive either 1 U of FFP (10 patients) or no FFP (10 patients) in the pump prime. Mean age (4.2 +/- 2.8 months), weight (4.3 +/- 1.1 kg), total prime volume (641 +/- 96 ml), cardiopulmonary bypass time, cross-clamp time, lowest temperature on bypass, and preoperative coagulation parameters did not differ between the two groups. At the end of bypass, the mean fibrinogen level was significantly higher in the FFP than the no FFP group (123 +/- 20 versus 58 +/- 17 mg/dL; p < 0.0001), whereas the mean platelet count did not differ (60 +/- 25 versus 52 +/- 26 K/mm(3); p = 0.5). Patients in the FFP group received significantly fewer units of cryoprecipitate (0.4 +/- 0.8 versus 2.0 +/- 0.9 U/patient; p < 0.001), and had a mean total donor exposure of 4.1 +/- 1.5 U/patient versus 5.4 +/- 1.4 U/patient in the no FFP group (p = 0.06). The mean chest tube output over the first 24 hours did not differ between groups. The use of FFP in the pump prime significantly limited dilutional hypofibrinogenemia, decreased the transfusion of cryoprecipitate after bypass, and tended to decrease the overall mean patient exposure to blood products.The Annals of Thoracic Surgery 03/2004; 77(3):983-7; discussion 987. · 3.74 Impact Factor
Article: Ventricular function determination during extracorporeal membrane oxygenation (ECMO) following Norwood operation: a case report.[show abstract] [hide abstract]
ABSTRACT: Extracorporeal membrane oxygenation has been used successfully to support both cardiac and pulmonary function following Stage I Norwood operation. Determination of the return of native cardiac function and pulmonary function can be easily accomplished because of the single ventricle physiology. The pulmonary function can be assessed while on full flow ECMO by isolating the membrane oxygenator gas compartment, allowing evaluation of native pulmonary gas exchange through the modified Blalock-Taussig shunt. Cardiac output can be calculated by using the following oxygen delivery equation: Total O2 delivery = ECMO oxygen delivery + ventricular oxygen delivery. The ventricular O2 saturation used in the formula for oxygen delivery is same as the mixed venous O2 saturation returning to the ECMO pump because of the large atrial communication following the Norwood operation. A 3.2 kilogram patient was placed on a pediatric ECMO circuit utilizing a heparin-coated centrifugal pump and a microporous membrane oxygenate after failure to wean from bypass because of a low oxygen saturation and poor ventricular function. On day 1 of support, the systemic arterial oxygen saturation was 100% and matched the ECMO arterial saturation. On day 2 of the support, the patient's arterial saturation decreased to 96%, and the ECMO mixed venous saturation was 87%. Using the oxygen delivery formula, the ventricular cardiac output was calculated to be 175 mL/min, with an ECMO flow of 400 mL/min for a total cardiac output of 575 mL/min. The native ventricular contribution was, therefore, 30% of total cardiac output. Calculation of cardiac output would normally require a left ventricular sample in a patient with biventricular physiology. The single ventricle physiology in the post-operative Norwood patient makes this calculation a useful tool for assessing return of ventricular function in these patients.The Journal of extra-corporeal technology 07/2002; 34(2):148-50.