Adjusted calculation model of heparin management during cardiopulmonary bypass in obese patients

Vienne, Matthias; Haas, Emmanuel; Wipf, Thibaut; Grunebaum, Lélia; Lévy, François; Sattler, Laurent; Minh, Tam Hoang; Séverac, François; Tacquard, Charles; Collange, Olivier; Mertès, Paul-Michel; Steib, A.

doi:10.1097/eja.0000000000000784

Cited by 5 publications

(3 citation statements)

References 27 publications

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“…An initial unfractioned heparin dosage of about 250 units pro-kilo, calculated based on ideal body weight (IBW) 21 is administered during the before re-perfusion: 1 / 3 of the total dose is injected during the agonal period, to prevent peri-mortem vascular thrombosis, potentially impeding reperfusion, while the remaining 2 / 3 after cannulation, to prevent catheter and intracircuit thrombosis. 22 According to the law, if the patient is at In this visual summary, main monitorings to be fulfilled on potential donor, on extracorporeal system, and on blood during EISOR, and reperfusion settings.…”

Section: Extracorporeal System and Re-perfusion Settingsmentioning

confidence: 99%

EISOR Delivery: Regional experience with sharing equipe, equipment & expertise to increase cDCD donor pool in time of pandemic

et al. 2022

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Donation after circulatory death (DCD) programs are expanding in Europe, in the attempt to expand donors pool. Even in controlled DCD donors, however, a protracted warm ischemia time occurring in the perimortem period might damage organs, making these unsuitable for transplantation. Implementing a strategy of extracorporeal interval support for organ retrieval (EISOR), a regional reperfusion with normothermic, oxygenated blood provides a physiologic environment allowing extensive assessment of potential grafts, and potentially promotes recovery of native function. Here we report the results of a multi-center retrospective cohort study including 29 Maastricht Category III controlled DCD donors undergoing extracorporeal support in a regional DCD/EISOR Training Center, and in the network of referring In-Training Centers, under the liaison of the regional Transplant Coordination Center during COVID-19 pandemic, between March 2020 and November 2021. The study aims to understand whether a mobile, experienced EISOR team implementing a consistent technique and sharing its equipe, expertise and equipment in a regional network of hospitals, might be effective and efficient in implementing the regional DCD program activity even in a highly stressed healthcare system.

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Section: Extracorporeal System and Re-perfusion Settingsmentioning

confidence: 99%

EISOR Delivery: Regional experience with sharing equipe, equipment & expertise to increase cDCD donor pool in time of pandemic

et al. 2022

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“…The majority of studies retrieved concerned the cardiovascular (n = 14) [9][10][11][12][13][14][15][16][17][18][19][20][21][22], respiratory (n = 7) [23][24][25][26][27][28][29], and neurological (n = 9) [30][31][32][33][34][35][36][37] systems. Two pertained to point-of-care testing [38,39]. These were tabulated according to theme (Tables 1, 2, 3, 4, 5, 6, 7, 8, 9, hereafter).…”

Section: Resultsmentioning

confidence: 99%

“…Obesity is associated with physiological and anthropometric changes that alter the pharmacokinetics of most drugs. As our focus was on intraoperative monitoring, we included two studies (Table 9 ) [ 38 , 39 ] which looked at point-of-care testing and heparin dosing in obesity. In the context of extracorporeal circulation, point-of-care testing (activated clotting time) did not reliably detect the excessively high plasma heparin concentrations often achieved in the obese patient dosed according to total body weight.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative Monitoring of the Obese Patient Undergoing Surgery: A Narrative Review

et al. 2021

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With the increasing prevalence of obesity in the population, anaesthetists must confidently manage both the pathophysiological and technical challenges presented in bariatric and non-bariatric surgery. The intraoperative period represents an important opportunity to optimise and mitigate risk. However, there is little formal guidance on what intraoperative monitoring techniques should be used in this population. This narrative review collates the existing evidence for intraoperative monitoring devices in the obese patients. Although a number of non-invasive blood pressure monitors have been tested, an invasive arterial line remains the most reliable monitor if accurate, continuous monitoring is required. Goal-directed fluid therapy is recommended by clinical practice guidelines, but the methods tested to assess this had guarded applicability to the obese population. Transcutaneous carbon dioxide (CO 2 ) monitoring may offer additional benefit to standard capnography in this population. Individually titrated positive end expiratory pressure (PEEP) and recruitment manoeuvres improved intraoperative mechanics but yielded no benefit in the immediate postoperative period. Depth of anaesthesia monitoring appears to be beneficial in the perioperative period regarding recovery times and complications. Objective confirmation of reversal of neuromuscular blockade continues to be a central tenet of anaesthesia practice, particularly relevant to this group who have been characterised as an “at risk” extubation group. Where deep neuromuscular blockade is used, continuous neuromuscular blockade is suggested. Both obesity and the intraoperative context represent somewhat unstable search terms, as the clinical implications of the obesity phenotype are not uniform, and the type and urgency of surgery have significant impact on the intraoperative setting. This renders the generation of summary conclusions around what intraoperative monitoring techniques are suitable in this population highly challenging.

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Identifying optimal heparin management during cardiopulmonary bypass in Chinese people: a retrospective observational comparative study

Gan

Yang

Mei

et al. 2019

J Thromb Thrombolysis

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Adjusted calculation model of heparin management during cardiopulmonary bypass in obese patients

Abstract: ClinicalTrials.gov identifier: NCT02675647.

Cited by 5 publications

References 27 publications

EISOR Delivery: Regional experience with sharing equipe, equipment & expertise to increase cDCD donor pool in time of pandemic

EISOR Delivery: Regional experience with sharing equipe, equipment & expertise to increase cDCD donor pool in time of pandemic

Intraoperative Monitoring of the Obese Patient Undergoing Surgery: A Narrative Review

Identifying optimal heparin management during cardiopulmonary bypass in Chinese people: a retrospective observational comparative study

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