Introduction: Despite significant advances in the materials, components and techniques used for extracorporeal life support in recent years, the management of anticoagulation in ECMO remains controversial, the objective of this protocol is to develop an update for anticoagulation and its control for infants ECMO.
Development: Unfractionated heparin is the drug of choice for anticoagulation in ECMO. The heparin dose used in pediatrics have been mostly adapted from the experience in adults without a corresponding validation, as well as limiting the absence of randomized clinical trials in children. After the assessment of the patient and a possible correction of coagulopathies, prior to establishment of ECMO, as well as decide the administration of a heparin bolus of 50-100 IU/kg of body weight at the time prior to cannulation. At 5-10’ of beginning ECMO a ACT control is made, if the value is greater than 300 sg, ACT is repeated at 30-60’. Once the ACT is less than 300, an infusion starts between 10-20 IU/kg/h, in the absence of major bleeding. Controls will be carried out every 30’ to stabilize the ACT in the chosen range. For the control, the ACT will be used, mainly, and the APTT, with better results the higher the child's age, although the anti-Xa test is the only laboratory test that shows a strong correlation with the heparin dose administered in ECMO.
Objective: to compare the data obtained from the CDI500® and Spectrum M4® to assess the reliability of the results and their impact on cardiopulmonary bypass.
Methods: a prospective observational study of patients undergoing cardiac surgery with CPB was conducted between January-2017 and February-2018. The data provided by CDI and M4 was collected. Arterial and venous blood gases taken from Radiometer ABL90 Flex® were used as control. With the first sample, the data of both analyzers were adjusted. A minimum of two samples and a maximum of four were made.
Results: 100 patients and 292 samples (32% women) with a mean age of 65.2 ± 11.5 years were studied. The parameters of the CDI and M4 practically did not present significant differences after the first adjustment, and without affecting the clinical practice, except in the bicarbonate and the excess of base where CDI does not adjust to the values. The analysis was done with the Bland/Altman charts, the PCO2 and PO2 were better measured by the CDI while Hto, Hb and SvO2 by M4, which was corroborated comparing the error percentages less than ± 5% in both systems, the significant differences being in the five parameters.
Conclusions: both systems provide reliable data, although they require a previous calibration. The M4 allows direct evaluation of data to help a goal directed perfusion.
Objective: to assess the relationship between oxygen delivery during cardiopulmonary bypass and the incidende of acute kidney injury in the immediate postoperative period of patients undergoing cardiac surgery, as well as to identify possible risk factors.
Methods: A retrospective observational study of patients undergoing cardiac surgery
scheduled between May 2016 and February 2018 was carried out in which the M-M4 System was used for online blood gases. Patients with preoperative diagnosis of chronic renal failure were excluded. For the oxigen delivery, the average of all M4 records was made.
Results: 133 patients (35.3% women) with a mean age of 64.9 ± 10.9 years were studied. The incidence of acute kidney injury was 18.8% (AKI I: 12%; AKI II: 3%; AKI III: 3.8%). There was no correlation between acute kidney injury and O2 delivery (251 ± 43 vs 247 ± 52, ns), if there was a difference when patients needed renal replacement therapy (251 ± 43 vs 198 ± 18, p = 0.04). There was a significant increase risk in diabetes; HTA; pulmonary arterial hypertension; chronic atrial fibrilation; red blood cell concentrate and blood products administration in the operating room; redo for bleeding; high lactic acid and glycemia post cardiopulmonary bypass; prolonged pump and ischemia times; and combined surgery.
Conclusions: There was no direct relationship between O2 delivery and acute kidney injury, although there was a significantly lower O2 delivery in patients who needed postoperative renal replacement therapy.
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