scholarly journals Analysis of Dynamic Changes in Cognitive Workload During Cardiac Surgery Perfusionists′ Interactions With the Cardiopulmonary Bypass Pump

2020 ◽  
pp. 001872082097629
Author(s):  
Lauren R. Kennedy-Metz ◽  
Roger D. Dias ◽  
Rithy Srey ◽  
Geoffrey C. Rance ◽  
Heather M. Conboy ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Heart Surgery ◽  
Time Windows ◽  
Open Heart Surgery ◽  
Real Life ◽  
Skin Incision ◽  
Cognitive Workload ◽  
Dynamic Changes ◽  
Pump Operation

Objective This novel preliminary study sought to capture dynamic changes in heart rate variability (HRV) as a proxy for cognitive workload among perfusionists while operating the cardiopulmonary bypass (CPB) pump during real-life cardiac surgery. Background Estimations of operators’ cognitive workload states in naturalistic settings have been derived using noninvasive psychophysiological measures. Effective CPB pump operation by perfusionists is critical in maintaining the patient’s homeostasis during open-heart surgery. Investigation into dynamic cognitive workload fluctuations, and their relationship with performance, is lacking in the literature. Method HRV and self-reported cognitive workload were collected from three Board-certified cardiac perfusionists ( N = 23 cases). Five HRV components were analyzed in consecutive nonoverlapping 1-min windows from skin incision through sternal closure. Cases were annotated according to predetermined phases: prebypass, three phases during bypass, and postbypass. Values from all 1min time windows within each phase were averaged. Results Cognitive workload was at its highest during the time between initiating bypass and clamping the aorta (preclamp phase during bypass), and decreased over the course of the bypass period. Conclusion We identified dynamic, temporal fluctuations in HRV among perfusionists during cardiac surgery corresponding to subjective reports of cognitive workload. Not only does cognitive workload differ for perfusionists during bypass compared with pre- and postbypass phases, but differences in HRV were also detected within the three bypass phases. Application These preliminary findings suggest the preclamp phase of CPB pump interaction corresponds to higher cognitive workload, which may point to an area warranting further exploration using passive measurement.

scholarly journals Pre-operative and peri operative predictors of acute renal failure after cardiac surgery

2019 ◽  
Vol 6 (3) ◽  
pp. 756
Author(s):  
Praveen Dhaulta ◽  
Vikas Panwar
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Ejection Fraction ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Clinical Variable ◽  
Open Heart ◽  
Multiple Variables

Background: Acute kidney injury (AKI) is one of the most serious complications during the postoperative period of cardiac surgery. Multiple variables predict the ARF after cardiac surgery. Objective of this study was to evaluate the significance of pre and peri-operative variables which may help in predicting the chances of developing ARF after cardiac surgery.Methods: This study was an observational, prospective study conducted among patients who were scheduled to undergo open heart surgery under cardiopulmonary bypass.Results: In total, 50 patients who underwent open-heart surgery, ARF was seen in 5 patients, with the incidence rate of 10%. Acute renal failure was present in one patient with ejection fraction <35, 2 patients had ejection fraction between 35 to 50 and 2 patients with ejection fraction >50. It was seen in 4 patients with 1-2 hrs of cardiopulmonary bypass and in 1 patient with >2 hrs of cardiopulmonary bypass. ARF was also seen in 4 patients with hematocrit between 22-26% and in 1 patient with >26%.Conclusions: The study provided a clinical variable score that can predict ARF after open-heart surgery. The score enhances the accuracy of prediction by accounting for the effect of all major risk factors of ARF.

The systemic inflammatory response syndrome following cardiac surgery: different expression of proinflammatory cytokines and procalcitonin in patients with and without multiorgan dysfunctions

Perfusion ◽  
2002 ◽  
Vol 17 (2) ◽  
pp. 103-109 ◽  
Author(s):  
Armin Sablotzki ◽  
Ivar Friedrich ◽  
Jörg Mühling ◽  
Marius G Dehne ◽  
Jan Spillner ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Systemic Inflammatory Response Syndrome ◽  
Inflammatory Response ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Multiple Organ ◽  
Systemic Inflammatory Response ◽  
Apache Ii Score ◽  
Organ Dysfunctions

Cardiopulmonary bypass is associated with an injury that may cause pathophysiological changes in the form of systemic inflammatory response syndrome (SIRS) or multiple organ dysfunction syndrome (MODS). In the present study, we investigated the inflammatory response of patients with multiple organ dysfunctions following open-heart surgery. Plasma levels of cytokines (IL-1β, IL-6, IL-8, IL-18) and procalcitonin (PCT) were measured on the first four postoperative days in 12 adult male patients with SIRS and two or more organ dysfunctions after myocar-dial revascularization (MODS group), and 15 patients without organ dysfunctions (SIRS group). All cytokines (except IL-1β) and PCT were significantly elevated in MODS patients, with peak values at the first two postoperative days. The results of our study show a different expression of members of the IL-1 family following extracorporeal circulation. For the first time, we can document that IL-18 is involved in the inflammatory response and the initiation of the MODS following cardiopulmonary bypass. In addition to APACHE-II score, PCT, IL-8, and IL-18 may be used as parameters for the prognosis of patients with organ dysfunctions after cardiac surgery. Furthermore, it must be noted that the duration of the surgical procedure is one of the most important factors for the initiation of the inflammatory response.

scholarly journals Impact of some intraoperative factors on wound infection in cardiac surgery

2021 ◽  
Vol 20 (1) ◽  
pp. 36-43
Author(s):  
A. V. Stepin
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Wound Infection ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Wound Infections ◽  
Open Heart ◽  
Postoperative Wound ◽  
Sternal Infection ◽  
Mammary Arteries

Relevanc. Surgical Site Infection (SSI) after open heart surgery is a significant problem in clinical, social, and economic aspect which causes the need to identification of the preferred procedures for successful prevention of the SSI.Objectives. To determine risk of the SSI in cardiac surgery depending on complexity of intervention, using of cardiopulmonary bypass (CBP) and use of both internal mammary arteries (IMA).Methods. Prospective observations study from 2010 to 2019 in cardiac surgery department of the Ural Institute of Cardiology, where in total 4993 open heart surgery procedures were consecutively performed. All SSI cases were recorded up to 90 days after surgery. The analysis was performed to identify risk of cardiopulmonary bypass (CPB), bilateral IMA grafting and combined procedures on the risk of the postoperative wound infection.Results. During the investigation period, total 220 cases of the SSI (4,5%) have been registered of the 4993 patients undergoing open heart surgery. It included 42 cases of deep sternal infection (0,9%) and 178 cases of superficial infection (3,6%). The main pathogen identified was Staphylococcus epidermidis (56,4%). During the hospital period, 151 cases (66,5%) of SSI have been detected, with the median time to detection of the complication 6 days. The relative mortality risk in deep sternal infection group was 4,4 times higher than in the group without SSI (HR 4,6, 95 % CI 1,5-13,9, p=0,003624). CABG increases the relative risk of SSI in compare with non-CABG procedures (OR 3,086169; 95%CI 1,281 – 7,437), while the complexity of the operation (combined versus isolated interventions) does not significantly increase the risk (OR 0.972283; 95% CI: 0.696 - 1.359). The incidence of SSI in the group of in situ BIMA grafting was 8.8%, significantly increasing the likelihood of the SSI in compare to those with SIMA (OR 2.167983, 95% CI 1.463 - 3.212; p =0,000057). CBP significantly increases the risk of postoperative wound infections (OR 1.523890, 95% CI 1.149 - 2.022, p = 0.001742).Conclusions. Refusal of cardiopulmonary bypass, simultaneous procedures and bilateral coronary artery bypass does not allow completely to avoid postoperative wound infections. Nevertheless, the technical features of the preparations and use of grafts, including skeletonization, prevention of coagulation and the preference for sequential composite CABG, can reduce the risk associated with the type of the open heart surgery.

Carbon dioxide field flooding techniques for open heart surgery: monitoring and minimizing potential adverse effects

Perfusion ◽  
2000 ◽  
Vol 15 (2) ◽  
pp. 151-153 ◽  
Author(s):  
Edward M Nadolny ◽  
Lars G Svensson
Keyword(s):  
Carbon Dioxide ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Adverse Effects ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Open Heart ◽  
Blood Gas

The use of carbon dioxide for displacement of air in cardiac surgery can have potential adverse effects on blood gas strategies. Presented is a method of monitoring carbon dioxide in the cardiopulmonary bypass circuit and limiting the potential for severe hypercarbia during cardiopulmonary bypass.

scholarly journals Circulating S100B and Adiponectin in Children Who Underwent Open Heart Surgery and Cardiopulmonary Bypass

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Alessandro Varrica ◽  
Angela Satriano ◽  
Alessandro Frigiola ◽  
Alessandro Giamberti ◽  
Guido Tettamanti ◽  
...  
Keyword(s):  
Adipose Tissue ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Neurological Disorders ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Serum Levels ◽  
S100b Protein ◽  
Perioperative Monitoring ◽  
A Prospective Study

Background. S100B protein, previously proposed as a consolidated marker of brain damage in congenital heart disease (CHD) newborns who underwent cardiac surgery and cardiopulmonary bypass (CPB), has been progressively abandoned due to S100B CNS extra-source such as adipose tissue. The present study investigated CHD newborns, if adipose tissue contributes significantly to S100B serum levels.Methods. We conducted a prospective study in 26 CHD infants, without preexisting neurological disorders, who underwent cardiac surgery and CPB in whom blood samples for S100B and adiponectin (ADN) measurement were drawn at five perioperative time-points.Results. S100B showed a significant increase from hospital admission up to 24 h after procedure reaching its maximum peak(P<0.01)during CPB and at the end of the surgical procedure. Moreover, ADN showed a flat pattern and no significant differences(P>0.05)have been found all along perioperative monitoring. ADN/S100B ratio pattern was identical to S100B alone with the higher peak at the end of CPB and remained higher up to 24 h from surgery.Conclusions. The present study provides evidence that, in CHD infants, S100B protein is not affected by an extra-source adipose tissue release as suggested by no changes in circulating ADN concentrations.

Specific requirements for bloodless cardiopulmonary bypass in neonates and infants; a review

Perfusion ◽  
2010 ◽  
Vol 25 (4) ◽  
pp. 237-243 ◽  
Author(s):  
Hanna D Golab ◽  
Johanna JM Takkenberg ◽  
Ad JJC Bogers
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Heart Surgery ◽  
Pediatric Patients ◽  
Survival Rates ◽  
Open Heart Surgery ◽  
Acceptable Level ◽  
Open Heart ◽  
Neonates And Infants ◽  
Safe Performance

A miniaturized cardiopulmonary bypass circuit enables the safe performance, in selected pediatric patients, of bloodless open heart surgery. As the latest survival rates in neonatal and infant cardiac surgery have become satisfactory, investigators have concentrated upon the improvement of existing procedures. Institutional guidelines and multidisciplinary efforts undertaken in the pre- and postoperative periods are of great importance, concerning bloodless CPB and should be seriously pursued by all involved caregivers. This review reflects upon the selective, most relevant requirements for success of asanguinous neonatal and infant CPB: acceptable level of hemodilution during the CPB, patient preoperative hematocrit value and volume of CPB circuit. We present an assessment of practical measures that were also adapted in our institution to achieve an asanguinous CPB for neonatal and infant patients.

Delayed Development of Malignant Hyperthermia Following Cardiopulmonary Bypass

2017 ◽  
Vol 22 (1) ◽  
pp. 95-99 ◽  
Author(s):  
Stephen Hall Sams ◽  
Stephen Revilla ◽  
David Lawrence Stahl
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Malignant Hyperthermia ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Signs And Symptoms ◽  
Life Threatening ◽  
Cardiac Intensive Care ◽  
High Index Of Suspicion ◽  
Post Cardiac Surgery

Malignant hyperthermia (MH) is a rare but potentially life-threatening disorder encountered during general anesthesia. The use of cardiopulmonary bypass during cardiac surgery can obscure many of the cardinal signs and symptoms of MH. The development of postoperative MH following cardiac surgery is rare, but anesthesiologists and intensivists must maintain a high index of suspicion in order to make a prompt diagnosis. Initiation and tailored maintenance of MH therapy must also consider the complex physiologic changes of patients in the immediate post–cardiac surgery period. In this article, we present a case of the development of postoperative MH in the cardiac intensive care unit after elective open heart surgery with cardiopulmonary bypass.

scholarly journals Management of COVID-19 Patient in Cardiac Surgery with Cardiopulmonary Bypass.

2021 ◽  
Vol 5 (1) ◽  
pp. 779-783
Author(s):  
Alfred Ibrahimi ◽  
Saimir Kuci ◽  
Ervin Bejko ◽  
Stavri Llazo ◽  
Marsela Goga ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Respiratory Failure ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Laboratory Findings ◽  
Early Intubation ◽  
History Of ◽  
High Doses ◽  
Respiratory Assistance

Introduction; The diagnosis of COVID-19 is quite challenging due to the inconsistent correlation between laboratory findings, radiological imaging, and the clinical picture and contact history of the patient. The patients who underwent cardiac surgery with cardiopulmonary bypass (CPB) face double risk because CBP triggers an intense inflammatory response and the leading cause of mortality in COVID-19 patients is “cytokine storm”. In our institution 15 confirmed cases operated on with open-heart surgery. 9 cases isolated CABG, 4 cases valvular combined with CABG, and 1 valvular disease. Materials and method; All patients undergoing elective or urgent cardiac surgery at “Mother Theresa” ’s Hospital from 11 March to 30 November 2020 were included in this study. Patients diagnosed with COVID-19 infection via positive throat swab taken due to clinical suspicion postoperatively were reviewed. Patients characteristics, type of intervention, date of COVID-19 diagnosis. Results: 9 patients (72%) normal recovery, no respiratory failure, only 3-5 days of fever (max 39,4). 3 of them a moderate respiratory failure. 3 patients with severe respiratory failure. Only 3 deaths (26,6%). Recommendation: It's important to a preoperative screening for COVID-19 patients. The outcome of cardiac surgical patients who contracted COVID-19 infection perioperatively is extremely poor. Aggressive respiratory assistance (early intubation), high doses of corticosteroids, and anticoagulation, better results.

scholarly journals Cardiopulmonary Bypass Induced Hematological Changes in Patients Undergoing Cardiac Surgery

2016 ◽  
Vol 30 (2) ◽  
pp. 53-57 ◽  
Author(s):  
Md Aftabuddin ◽  
Nivesh Rajbhandhari ◽  
Md Zillur Rahman ◽  
Nadira Islam ◽  
Omar Sadeuque Khan
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Heart Surgery ◽  
Inflammatory Responses ◽  
Complete Blood Count ◽  
Open Heart Surgery ◽  
International Normalized Ratio ◽  
Elective Cardiac Surgery ◽  
Almost All ◽  
Hematological Changes

Cardiopulmonary bypass (CPB) assisted open heart surgery have become a frequent surgical procedures in almost all major heart surgeries. However,growing evidence indicates that anemia, coagulation derangements, platelet dysfunction and inflammatory responses are common in patients undergoing CPB aided cardiac surgery. The aim of the present study was to characterize CPB induced hematologic changes in patients undergoing cardiac surgery. A total of sixty three patients undergoing elective cardiac surgery in the department of Cardiac Surgery, BSMMU, Dhaka, Bangladesh, were prospectively randomized into the present study: 33 of which underwent CPB aided cardiac surgery (CPB-aided) and the rest 30 patients underwent cardiac surgery without CPB (CPB non-aided). Complete blood count together with Hb%, prothrombin time (PT) and International normalized ratio (INR) was determined preoperatively and on 1st, 3rd and 7th postoperative days (POD). The TC of WBC was significantly higher in CPB aided patients than that of CPB non-aided patients on 1st POD. When comparison was done, total count of RBC, platelets & Hb% were significantly lower in CPB aided patients compared to patients underwent cardiac surgery without CPB on the 7th POD. Additionally, PT and INR were higher in CPB aided cardiac patients compared to that of CPB non-aided patients on the 7th POD. The lower levels of Hb% and TC of RBC following CPB-aided cardiac surgery may be due to excessive hemolysis because of mechanical force during extra-corporal circulation. The observed significant leucocytosis in the present CPB aided cardiac surgery patients on 1st POD may support the notion that CPB induces a systemic inflammatory response following cardiac surgery. Further studies are required to evaluate the mechanisms of CPB- induced hematological changes following major cardiac surgery.Bangladesh Heart Journal 2015; 30(2) : 53-57

scholarly journals Effect of Cardiopulmonary Bypass on Postoperative Nutrition of Cardiac Surgery Patients

1970 ◽  
Vol 38 (2) ◽  
pp. 53-55
Author(s):  
Suman Nazmul Hosain ◽  
Sayeda Jarina Akter ◽  
Haroon Rasheed ◽  
Fazle Maruf ◽  
Nasiruddin Ahmed
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Heart Surgery ◽  
Critical Role ◽  
Open Heart Surgery ◽  
Whole Body ◽  
Calorie Intake ◽  
Open Heart ◽  
Postoperative Nutrition ◽  
Daily Food

Introduction: Nutrition is an important factor for recovery following cardiac surgery. Most patients loose appetite and have reduced nutrition following cardiac surgery. Several factors including pain, anxiety, medications, whole body inflammatory response, Cardiopulmonary bypass (CPB) have role in postoperative anorexia and reduced nutrition. Objective: Objective of this study is to find out the role of CPB in postoperative anorexia and nutrition. Methodology: This prospective study was conducted at NICVD. 30 randomly selected adult patients who had undergone open heart surgical procedures were compared to same number of closed heart surgery patients. The daily food intake was calculated from the ICU data-sheets and calorie value obtained. The values were compared between the open and closed heart surgery patients. Results: It was noted that the open heart surgery patients took significantly less amount of food and calorie compared to the closed heart surgery patients. Conclusion: Open heart surgery is a situation where post operative nutrition plays a very significant role in patient's recovery. But unfortunately there is a tendency of the patient's taking low calorie intake for various reasons. This may have a critical role postoperatively. So adequate measures should be adopted to ensure proper postoperative nutrition following open heart surgery.   DOI: 10.3329/bmj.v38i2.3574 Bangladesh Medical Journal 38(2) 2009 53-55

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