Effect of two different colloid priming strategies in infants weighing less than 5 kg undergoing on-pump cardiac surgeries

An optimized perfusate for enhanced rat ex vivo lung perfusion and lung transplant models

Although Steen's solution plays a crucial role in maintaining vascular oncotic pressure and reducing pulmonary edema due to its high concentration of human serum albumin during ex vivo lung perfusion (EVLP), it incurs high costs and potential immune responses in rat models. In our preliminary research, donor lungs perfused with Steen's solution exhibited significant lung injury post transplantation, likely due to a strong immune response elicited by the high concentration of xenogenic proteins upon reperfusion. This study explores a low-cost and efficient perfusate composition for use in rat EVLP and lung transplant models. The modified perfusate employed in this study uses artificial colloids as the primary component, with an albumin concentration of only 2%, demonstrating comparable physiological parameters, metabolic levels, and pathological changes to those of Steen's solution during EVLP. Moreover, the modified composition exhibited good biocompatibility in transplantation, with minimal lung injury. In summary, the proposed perfusate offers a safer and more economical alternative for establishing rat EVLP and lung transplant models, facilitating the advancement of related research.

Practical training concept for perfusionists at the heart and diabetes center Nordrhein-Westfalen

BackgroundIncreasing regulations and requirements of advisory bodies, in particular the Joint Federal Committee and the Medical Service of the health insurance funds, make it necessary to employ only demonstrably well-trained perfusionists. The minimum requirement for this staff is EBCP certification. Currently there is limited availability of such specialists on the German market. Therefore, the qualification of young people in this area is of central importance. The aim of this paper is to strengthen the training of perfusionists at our centre, to standardise the process and to provide the respective student with a "roadmap" to their internship.Material & MethodsThe structure is based on a rough division of the 24 weeks of internship. This is described in detail in the following and is backed up with the learning objectives for the respective time periods.ResultsAt our centre, practical training has been standardized and clear responsibilities have been defined. Furthermore, as a centre of maximum care in the field of cardiac surgery, we can offer students the necessary number of perfusions in just six months to meet the requirements of the ECBP for practical training. According to this concept, 20 perfusionists have been successfully trained in the last 8 years. All of them have passed the exams and have been certified according to EBCP.ConclusionThe aim of the practical semester is for the student to be in a position at the end of the semester to independently supervise simple cardiac surgery procedures with the aid of the Extra- Corporal Circulation (ECC) and to carry this out in accordance with the currently valid guidelines and directives (1-8) and the departmental procedural instructions based on them. Great emphasis is placed to the students becoming aware of their competence to act, knowing their limits and being able to assess when these limits have been reached and the involvement of experienced colleagues is necessary to ensure patient safety.

Evaluating the Impact of Cardiopulmonary Bypass Priming Fluids on Bleeding After Pediatric Cardiac Surgery: A Systematic Review and Meta-Analysis

OBJECTIVES

Cardiopulmonary bypass (CPB) predisposes young children to coagulopathy. The authors evaluated possible effects of CPB priming fluids on perioperative bleeding in pediatric cardiac surgery.

DESIGN

Meta-analysis and systematic review of previously published studies.

SETTING

Each study was conducted in a surgical center or intensive care unit.

PARTICIPANTS

Studies investigating patients <18 years without underlying hematologic disorders were included.

INTERVENTIONS

The authors evaluated randomized controlled trials (RCTs) published between 1980 and 2020 on MEDLINE, EMBASE, PubMed, and CENTRAL databases. The primary outcome was postoperative bleeding; secondary endpoints included blood product transfusion, mortality, and safety.

MEASUREMENTS AND MAIN RESULTS

Twenty eligible RCTs were analyzed, with a total of 1,550 patients and a median of 66 patients per study (range 20-200). The most frequently assessed intervention was adding fresh frozen plasma (FFP) to the prime (8/20), followed by albumin (5/20), artificial colloids (5/20), and blood-based priming solutions (3/20). Ten studies with 771 patients evaluated blood loss at 24 hours in mL/kg and were included in a meta-analysis. Most of them investigated the addition of FFP to the priming fluid (7/10). No significant difference was found between intervention and control groups, with a mean difference of -0.13 (-2.61 to 2.34), p = 0.92, I² = 69%. Further study endpoints were described but their reporting was too heterogeneous to be quantitatively analyzed.

CONCLUSIONS

This systematic review of current evidence did not show an effect of different CPB priming solutions on 24-hour blood loss. The analysis was limited by heterogeneity within the dataset regarding population, type of intervention, dosing, and the chosen comparator, compromising any conclusions.