scholarly journals Adult cardiopulmonary bypass in Australian and New Zealand public hospitals: A survey of practice

2020 ◽  
Vol 48 (6) ◽  
pp. 465-472
Author(s):  
Simon J Pattullo ◽  
David M Samson
Keyword(s):  
New Zealand ◽  
Cardiopulmonary Bypass ◽  
Point Of Care ◽  
Human Albumin ◽  
Public Hospitals ◽  
Cell Saver ◽  
Coagulation Testing ◽  
Acute Normovolaemic Haemodilution ◽  
A Cell ◽  
Residual Blood

A telephone survey of cardiac anaesthetists and perfusionists at the 29 public hospitals providing adult cardiac surgical services in Australia and New Zealand was carried out between December 2019 and January 2020. The aim was to investigate current practice with regard to selected contentious elements of anaesthetic and perfusion management during cardiopulmonary bypass; primarily relating to bypass circuit priming, blood conservation methods and point-of-care coagulation testing. There was a 100% response rate. The average number of adult public cardiopulmonary bypass cases per hospital was 508 (160–1400). For cardiopulmonary bypass cases, ten hospitals (34%) routinely used a cell saver and the remainder used a cell saver selectively. Residual blood remaining in the cardiopulmonary bypass circuit was processed using a cell saver routinely in four hospitals (14%) and selectively in 23 (79%). Acute normovolaemic haemodilution was rarely used. Retrograde autologous priming was used routinely in seven hospitals (24%) and selectively in 16 (55%). All hospitals had access to point-of-care coagulation testing. The majority of hospitals targeted an activated clotting time of 480 s (range 400–500 s) prior to commencing cardiopulmonary bypass. There was marked geographic variation in access to fibrinogen concentrate. The cardiopulmonary bypass circuit prime solution was primarily a balanced crystalloid in most hospitals; however, there was significant variation regarding the addition of human albumin, mannitol, sodium bicarbonate and other medications. Many of the interventions examined were used on a case-by-case basis. These findings support the need for further research to define more evidence-based practice of these interventions.

scholarly journals Antibody Responses in Cats Following Primary and Annual Vaccination against Feline Immunodeficiency Virus (FIV) with an Inactivated Whole-Virus Vaccine (Fel-O-Vax® FIV)

Viruses ◽  
2021 ◽  
Vol 13 (3) ◽  
pp. 470
Author(s):  
Mark Westman ◽  
Dennis Yang ◽  
Jennifer Green ◽  
Jacqueline Norris ◽  
Richard Malik ◽  
...  
Keyword(s):  
Antibody Response ◽  
Virus Vaccine ◽  
Point Of Care ◽  
Primary Vaccination ◽  
Antibody Responses ◽  
Blood Samples ◽  
Study Results ◽  
Elisa Testing ◽  
Primary Antibody Response ◽  
Residual Blood

Although the antibody response induced by primary vaccination with Fel-O-Vax® FIV (three doses, 2–4 weeks apart) is well described, the antibody response induced by annual vaccination with Fel-O-Vax® FIV (single dose every 12 months after primary vaccination) and how it compares to the primary antibody response has not been studied. Residual blood samples from a primary FIV vaccination study (n = 11), and blood samples from cats given an annual FIV vaccination (n = 10), were utilized. Samples from all 21 cats were tested with a commercially available PCR assay (FIV RealPCRTM), an anti-p24 microsphere immunoassay (MIA), an anti-FIV transmembrane (TM; gp40) peptide ELISA, and a range of commercially available point-of-care (PoC) FIV antibody kits. PCR testing confirmed all 21 cats to be FIV-uninfected for the duration of this study. Results from MIA and ELISA testing showed that both vaccination regimes induced significant antibody responses against p24 and gp40, and both anti-p24 and anti-gp40 antibodies were variably present 12 months after FIV vaccination. The magnitude of the antibody response against both p24 and gp40 was significantly higher in the primary FIV vaccination group than in the annual FIV vaccination group. The differences in prime versus recall post-vaccinal antibody levels correlated with FIV PoC kit performance. Two FIV PoC kits that detect antibodies against gp40, namely Witness® and Anigen Rapid®, showed 100% specificity in cats recently administered an annual FIV vaccination, demonstrating that they can be used to accurately distinguish vaccination and infection in annually vaccinated cats. A third FIV PoC kit, SNAP® Combo, had 0% specificity in annually FIV-vaccinated cats, and should not be used in any cat with a possible history of FIV vaccination. This study outlines the antibody response to inactivated Fel-O-Vax® FIV whole-virus vaccine, and demonstrates how best to diagnose FIV infection in jurisdictions where FIV vaccination is practiced.

Effects of gelatine and medium molecular weight starch as priming fluid in cardiopulmonary bypass - a randomised controlled trial

Perfusion ◽  
2007 ◽  
Vol 22 (1) ◽  
pp. 57-61 ◽  
Author(s):  
WW Yap ◽  
D. Young ◽  
V. Pathi
Keyword(s):  
Intraocular Pressure ◽  
Cardiopulmonary Bypass ◽  
Blood Loss ◽  
Controlled Trial ◽  
Artery Bypass ◽  
Human Albumin ◽  
Fluid Replacement ◽  
Blood Profile ◽  
Post Cardiopulmonary Bypass ◽  
Randomised Controlled

Perioperative volume replacement after cardiopulmonary bypass is complicated by post-bypass systemic inflammatory process. The aim of this study was to assess the effects of using two different colloid solutions as priming fluids in cardiopulmonary bypass. The study's primary end point was to measure the amount of fluid replacement needed during and post-cardiopulmonary bypass; blood loss, change in blood profile and intraocular pressure were secondary end points, used as measures of plasma oncotic pressures. Patients undergoing coronary artery bypass grafting were recruited. Both patients and surgeons were blinded to receive either Gelofusine® or Voluven® as priming fluids. At fixed intervals during cardiopulmonary bypass, the patients had their intraocular pressures measured. Intra and postoperative fluid replacement was in the form of 4.5% human albumin and the amount was recorded for each subject. The result did not show any significant differences in the amount of fluid needed to be replaced, in blood loss or in blood profile between the two groups. However, it showed an increase in intraocular pressure in both groups once cardiopulmonary bypass commenced. The average intraocular pressure was higher in the Gelofusine ® group compared to the Voluven® group. The significant increase in intraocular pressure measurements in the Gelofusine® group compared to the Voluven® group support the hypothesis that Voluven maintains the plasma oncotic pressure better and reduces fluid shift. Perfusion (2007) 22, 57—62.

Remote Mentoring of Point-of-Care Ultrasound Skills to Inexperienced Operators Using Multiple Telemedicine Platforms: Is a Cell Phone Good Enough?

2018 ◽  
Vol 37 (11) ◽  
pp. 2517-2525 ◽  
Author(s):  
Andrew Smith ◽  
Reuben Addison ◽  
Peter Rogers ◽  
Jordan Stone-McLean ◽  
Sarah Boyd ◽  
...  
Keyword(s):  
Cell Phone ◽  
Point Of Care ◽  
Point Of Care Ultrasound ◽  
A Cell

National quality improvement indicators project: an initial descriptive study

2021 ◽  
pp. 0310057X2110278
Author(s):  
Daniel P Ramsay ◽  
Phillip Quinn ◽  
Veronica Gin ◽  
Timothy D Starkie ◽  
Robert A Fry ◽  
...  
Keyword(s):  
Quality Improvement ◽  
New Zealand ◽  
Respiratory Distress ◽  
Postoperative Nausea ◽  
Postoperative Nausea And Vomiting ◽  
Public Hospitals ◽  
Nausea And Vomiting ◽  
Post Anaesthesia Care Unit ◽  
National Quality ◽  
Anaesthesia Care

Background Anaesthesia Quality Improvement New Zealand developed a set of five quality improvement indicators pertaining to postoperative nausea and vomiting, pain, respiratory distress, hypothermia and a prolonged post-anaesthesia care unit stay. This study sought to assess the proportion of eligible institutions that were able to measure and provide data on these indicators, produce an initial national estimate of these, and a measure of variability in the quality improvement indicators across hospitals in New Zealand. Methods All public hospitals that provide a representative to Anaesthesia Quality Improvement New Zealand were eligible for inclusion. Participating institutions were required to provide the number and proportion of patients with each of the five quality improvement indicators over a continuous 2-week period between 1 June 2019 and 25 October 2019. The overall percentage of patients and the median percentage with each outcome were calculated. Results A total of 79.2% of eligible hospitals participated. The median incidence of the indicators ranged from 1.67% for respiratory distress to 6.31% for prolonged post-anaesthesia care unit stay. The indicator with the largest interquartile range was hypothermia and the smallest was respiratory distress (13.48 and 2.29, respectively). A large variation was seen for prolonged post-anaesthesia care unit stay, hypothermia, pain and postoperative nausea and vomiting. Conclusion The majority of eligible institutions were able to measure and provide data on the quality improvement indicators. There was a low rate of respiratory distress with low variability. A large amount of variability was observed in the other indicators. Future studies are needed to explore the nature of this variability.

Point‐of‐care ultrasound in rural New Zealand: Safety, quality and impact on patient management

2018 ◽  
Vol 26 (5) ◽  
pp. 342-349 ◽  
Author(s):  
Garry Nixon ◽  
Katharina Blattner ◽  
Marara Koroheke‐Rogers ◽  
Jillian Muirhead ◽  
Wendy L. Finnie ◽  
...  
Keyword(s):  
New Zealand ◽  
Patient Management ◽  
Point Of Care ◽  
Point Of Care Ultrasound

P869 Blood salvage during cesarean section: minimizing the risks of cell free fetal DNA transfusion using a cell-saver system

2009 ◽  
Vol 107 ◽  
pp. S659-S659
Author(s):  
C. Osswald ◽  
C. Rusterholz ◽  
O. Lapaire ◽  
B. Stroetz ◽  
M. Peev ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Cell Saver ◽  
Blood Salvage ◽  
Fetal Dna ◽  
Cell Free Fetal Dna ◽  
A Cell

Comparison of three plasma expanders used as priming fluids in cardiopulmonary bypass patients

Perfusion ◽  
1998 ◽  
Vol 13 (5) ◽  
pp. 297-303 ◽  
Author(s):  
Izaak Tigchelaar ◽  
Rolf CG Gallandat Huet ◽  
Piet W Boonstra ◽  
Willem van Oeveren
Keyword(s):  
Cardiopulmonary Bypass ◽  
Osmotic Pressure ◽  
Hydroxyethyl Starch ◽  
Half Life ◽  
Human Albumin ◽  
Colloid Osmotic Pressure ◽  
Low Molecular Weight ◽  
Postoperative Phase ◽  
Total Blood ◽  
Plasma Substitute

Ten per cent low molecular weight hydroxyethyl starch is a plasma substitute only recently used as priming solution in an extracorporeal circuit, in contrast to human albumin and gelatin. To evaluate the effect of priming solutions on haemodynamics and colloid osmotic pressure, we studied 36 patients elected for cardiopulmonary bypass (CPB). They were randomly assigned to 2.5% hydroxyethyl starch, 3% gelatin or 4% human albumin priming solution. Total blood loss (perioperative + intensive care unit period) was higher in the gelatin group than in the albumin and hydroxyethyl starch groups. During CPB, the colloid osmotic pressure was best preserved in the gelatin group, although no excessively low colloid osmotic pressures were measured in the other two groups. Due to the extended half-life and the additional postoperative colloid administration, the hydroxyethyl starch group had a higher colloid osmotic pressure in the postoperative phase. We conclude that, next to human albumin, 2.5% hydroxyethyl starch is a safe CPB priming solution additive and is effective as plasma substitute. Its somewhat longer half-life requires adaptation of the routine protocol for transfusion of colloids and blood products.

scholarly journals A rapid and affordable point of care test for antibodies against SARS-CoV-2 based on hemagglutination and artificial intelligence interpretation

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Vanessa Redecke ◽  
Kazuki Tawaratsumida ◽  
Erin T. Larragoite ◽  
Elizabeth S. C. P. Williams ◽  
Vicente Planelles ◽  
...  
Keyword(s):  
Test Performance ◽  
Learning Algorithm ◽  
Point Of Care ◽  
Method Comparison ◽  
High Specificity ◽  
Turnaround Time ◽  
Analysis Tool ◽  
Point Of Care Test ◽  
Specificity And Sensitivity ◽  
A Cell

AbstractDiagnostic tests that detect antibodies (AB) against SARS-CoV-2 for evaluation of seroprevalence and guidance of health care measures are important tools for managing the COVID-19 pandemic. Current tests have certain limitations with regard to turnaround time, costs and availability, particularly in point-of-care (POC) settings. We established a hemagglutination-based AB test that is based on bi-specific proteins which contain a dromedary-derived antibody (nanobody) binding red blood cells (RBD) and a SARS-CoV-2-derived antigen, such as the receptor-binding domain of the Spike protein (Spike-RBD). While the nanobody mediates swift binding to RBC, the antigen moiety directs instantaneous, visually apparent hemagglutination in the presence of SARS-CoV-2-specific AB generated in COVID-19 patients or vaccinated individuals. Method comparison studies with assays cleared by emergency use authorization demonstrate high specificity and sensitivity. To further increase objectivity of test interpretation, we developed an image analysis tool based on digital image acquisition (via a cell phone) and a machine learning algorithm based on defined sample-training and -validation datasets. Preliminary data, including a small clinical study, provides proof of principle for test performance in a POC setting. Together, the data support the interpretation that this AB test format, which we refer to as ‘NanoSpot.ai’, is suitable for POC testing, can be manufactured at very low costs and, based on its generic mode of action, can likely be adapted to a variety of other pathogens.

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