Session 3: Innovative Solutions To Common Perfusion Challenges Using Oxygen Manipulation

  1. Raymond PD, Marsh NA. Alterations to haemostasis following cardiopulmonary bypass and the relationship of these changes to neurocognitive morbidity. Blood Coagul Fibrinolysis. 2001 Dec;12(8):601-18.
  2. Floyd TF, Shah PN, Price CC, et al. Clinically Silent Cerebral Ischemic Events After Cardiac Surgery: Their Incidence, Regional Vascular Occurrence, and Procedural Dependence. Ann Thorac Surg 2006; 81(6):2160-2166.
  3. Borger MA, Feindel CM. Cerebral emboli during cardiopulmonary bypass: effect of perfusionist interventions and aortic cannulas. J Extra Corpor Technol 2002; 34(1):29-33.
  4. Habib RH, Zacharias A, Schwann TA, et al. Adverse effects of low hematocrit during cardiopulmonary bypass in the adult: should current practice be changed? J Thorac Cardiovasc Surg 2003; 125(6):1438-50.
  5. Habib, R. H., A. Zacharias, et al. (2005). “Role of hemodilutional anemia and transfusion during cardiopulmonary bypass in renal injury after coronary revascularization: implications on operative outcome.” Crit Care Med 33(8): 1749-56.
  6. Karkouti, K., W. S. Beattie, et al. (2005). “Hemodilution during cardiopulmonary bypass is an independent risk factor for acute renal failure in adult cardiac surgery.” J Thorac Cardiovasc Surg 129(2): 391-400.
  7. Ranucci, M., F. Romitti, et al. (2005). “Oxygen delivery during cardiopulmonary bypass and acute renal failure after coronary operations.” Ann Thorac Surg 80(6): 2213-20.
  8. Habler O, Kleen M, Kemming G, Zwissler B. Hyperoxia in extreme hemodilution. Eur Surg Res 2002; 34(1-2):181-7.
  9. Kemming GI, Meisner FG, Kleen M, et al. Hyperoxic ventilation at the critical haematocrit. Resuscitation 2003; 56(3):289-97.
  10. Kemming GI, Meisner FG, Meier J, et al. Hyperoxic ventilation at the critical hematocrit: effects on myocardial perfusion and function. Acta Anaesthesiol Scand 2004; 48(8):951-9.
  11. Meier J, Kemming G, Meisner F, et al. Hyperoxic ventilation enables hemodilution beyond the critical myocardial hemoglobin concentration. Eur J Med Res 2005; 10(11):462-8.
  12. Brasel, K., D. McRitchie, and P. Dellinger, Canadian Association of General Surgeons and American College of Surgeons Evidence Based Reviews in Surgery. 21: the risk of surgical site infection is reduced with perioperative oxygen. Can J Surg, 2007. 50(3): p. 214-6.
  13. Dexter F, Kern FH, Hindman BJ, Greeley WJ. The brain uses mostly dissolved oxygen during profoundly hypothermic cardiopulmonary bypass. Ann Thorac Surg 1997; 63(6):1725-9. 14. Nollert G et al. J Thorac Cardiovasc Surg 1999.
  14. Pearl JM, Thomas DW, Grist G, Duffy JY, Manning PB. Hyperoxia for management of acid-base status during deep hypothermia with circulatory arrest. Ann Thorac Surg 2000 Sep; 70(3):751-5.
  15. Bauer V, Bauer F. Reactive oxygen species as mediators of tissue protection and injury. Gen Physiol Biophys 1999; 18 Spec No:7-14.
  16. Hyperbaric Oxygen Therapy; Michael Neumeister, MD, FRCSC, FACS, Program Director, Assistant Professor, Department of Surgery, Division of Plastic Surgery, Southern Illinois University School of Medicine, http://www.emedicine.com/plastic/topic526.htm
  17. National Oceanic and Atmospheric Administration (NOAA) Diving Manual for Science and Technology, 4th Edition; U.S. Department of Commerce, Technology Administration, National Technical Information Service, Springfield, Virginia 22161
  18. U.S Navy Diving Manual, NAVSHIPS 0994-001-9010. Washington, DC: Dept. of the Navy, 1991.
  19. Guo S, Counte MA, Romeis JC. Hyperbaric oxygen technology: an overview of its applications, efficacy, and cost-effectiveness. Int J Technol Assess Health Care 2003; 19(2):339-46.
  20. Bennett M, Jepson N, Lehm J. Hyperbaric oxygen therapy for acute coronary syndrome. Cochrane Database Syst Rev 2005(2):CD004818.
  21. Floyd TF, Shah PN, Price CC, et al. Clinically Silent Cerebral Ischemic Events After Cardiac Surgery: Their Incidence, Regional Vascular Occurrence, and Procedural Dependence. Ann Thorac Surg 2006; 81(6):2160-2166.
  22. FREE RADICALS AND REACTIVE OXYGEN SPECIES, GREGORY B. BULKLEY, http://www.cosmos-club.org/web/journals/2002/bulkley.html
  23. Becker LB, New concepts in reactive oxygen species and cardiovascular reperfusion physiology. Cardiovascular Research 61 (2004);461-470
  24. Ihnken K, Morita K, Buckberg GD, Young HH. Studies of hypoxemic/reoxygenation injury with aortic clamping: XI. Cardiac advantages of normoxemic versus hyperoxemic management during cardiopulmonary bypass. J Thorac Cardiovasc Surg 1995; 110(4 Pt 2):1255-64.
  25. KH Polderman, Crit Care Med 2009 37:7(Suppl), S188
  26. DeFoe GR, Ross CS, Olmstead EM, et al. Lowest hematocrit on bypass and adverse outcomes associated with coronary artery bypass grafting. Northern New England Cardiovascular Disease Study Group. Ann Thorac Surg 2001;71:769-76.
  27. Grist G. Should Perfusionists Use a Transfusion Trigger on Cardiopulmonary Bypass? AmSECT Today, November/December 2009, 12(6): pgs 4-5,13.

 

One Thought on “Session 3: Innovative Solutions To Common Perfusion Challenges Using Oxygen Manipulation”

  1. Charlie Krumholz
    April 13, 2017 at 11:00 am

    Gary,
    Thank you very much for this very clear explanation of these mechanisms. I have been an advocate of hyperoxia for some time since a meeting in New York city during which Carl Bocchio (sp?) talked about diving and nitrogen. I still do not pretend to understand everything I need to know about reactive oxygen species and inflammatory mediators. We have cut our blood use to 10% for intra-operative and post-operative transfusion in 2015 and 2016 for 478 patients on CPB…adult. I use hyperoxia, small prime (800ccs),VAVD, less fluid by Anesthesia and hemoconcentration on 70% of my patients. Stroke was 1.5% in 2015, 0.8% mortality for CABG, 1.4% mortality for all 478 patients. It has gone up since then, but AKI was 2.8% in 2015, down from 7% in 2012. So far this year transfusion has risen dramatically. Still, our nadir hematocrit is over 26% so we will see what AKI does this year. Cheers! This is fantastic. Charlie

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Perfusion Theory is an educational platform for the Oxygen Pressure Field Theory (OPFT). August Krogh’s theoretical concept of the oxygen pressure field is explained and then applied to clinical applications in perfusion practice.

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