bluuebunny/crossref_metadata_2025 huggingface dataset:
Prediction of Carbon Emissions from Natural and Human Systems Based on Correlation Analysis and Logistic Models
Authors: Lu Yiyi
Published: July 2023

With the increasing trend of global warming and the growing emphasis on carbon reduction programs at home and abroad, there is an urgent need to propose solutions to prevent the greenhouse effect. In order to solve such problems, exploring and predicting the trend of carbon dioxide emissions is essential to better establish targeted carbon reduction programs. By analyzing the relationship among carbon emissions, human and natural systems, the relationship between factors such as economic level status, resident population, road passenger traffic, and vegetation carbon sequestration capacity and carbon emissions is studied in five characteristic regions of China, and the predicted results are verified by carbon emission release.
Study on the Distribution and Source of Heavy Metal Pollution in Surface Sediments of Huanghua Habor
Authors: Huo Yongwei
Published: July 2023

In order to study the pollution characteristics of heavy metals in surface sediments of Huanghua Sea area, the concentrations of organic carbon, sulfide, petroleum, Hg, Cu, Pb, Zn, Cr, Cd and As in surface sediments of 15 stations in Huanghua Sea area were analyzed, and their sources and ecological risks were evaluated. The results show that all the elements in the sediments can meet the quality standard of a class of Marine sediments. The coefficient of variation of heavy metals ranged from 18.71% to 37.69%, indicating that the distribution of heavy metals among all stations was relatively uniform and the dispersion was small. The correlation of Pb, Cr and As in heavy metals is good, which indicates that these elements have homology. The results of ground accumulation index Igeo calculated by the average value of sediments in shallow sea of China show that Hg and Cd of surface sediments in Huanghua Sea are pollution-free to light-moderate pollution, and the pollution of Cd and Hg is more serious. The evaluation of potential ecological risk coefficient shows that the potential risk index RI of Huanghua Port area ranges from 112.78 to 449.89, all of which are greater than 110, belonging to moderate to strong ecological risk, in which the contribution values of Cd and Hg are greater than 90%, which also indicates that Cd and Hg are the main ecological risk factors in Huanghua Sea area.
Study on Diversity of Culturable Bacteria in Maize Field Soil under Pesticide Stress
Authors: Lv Chang-xu , Chen Juan , Guo Zong-ming , Yu Bin , Zhang Yue-Hua
Published: July 2023

The effects of pesticide application on the diversity of culturable bacteria in the soil of corn farmland in Sanjiang Plain were studied, and the bacteria capable of degrading acetochloramine in the soil samples were screened. In the black soil of corn farmland where “ethyldiazine 86” was applied, the experimental group and the control group were set, and the culturable bacteria in the soil samples of the two groups were cultured and screened by coating plate method. The 16S rRNA gene sequences and morphological characteristics were analyzed to determine the species of bacteria. Selective medium was designed to screen pesticide degrading bacteria. 19481 strains of culturable bacteria were cultured in the experiment, including 7854 strains in the experimental group and 11627 strains in the control group. A total of 65 strains were screened, purified and preserved, including 16 strains of phosphorus solubilizing bacteria, 9 strains of nitrogen fixing bacteria and 4 strains of pesticide degrading bacteria. The community structure of soil bacteria was mainly composed of Pseudomonas, Pantoea and Bacillus, and the dominant bacterium was Pseudomonas. The four pesticide-degrading bacteria were all Pseudomonas migulae. Long-term application of pesticides can reduce the number of culturable-bacteria in the soil, and the bacteria richness is also decreased. This study provides a theoretical basis for understanding the bacterial diversity of pesticide residue soil, protection and sustainable utilization of black soil.
Research on the Impact of Industrial enterprises Participation in the Peak shaving Auxiliary Service Market on Carbon Dioxide Emission
Authors: Sun Shuang , Zhang Xuesen , Zhu Xiangbo , Duan Tingting
Published: July 2023

With the advancement of the construction of new power systems, industrial enterprises participation in the peak shaving auxiliary service market is increasing. This paper proposes a model to estimate the impact of industrial enterprises participation in the peak shaving auxiliary service market on carbon dioxide emission, and designs a blockchain-based platform architecture to ensure the credibility of transaction of the aggregation trade. The simulation results indicate that most enterprises in the magnesia park use electricity during normal and valley hours. Transferring electricity consumption from peak hours to flat and low periods will reduce carbon dioxide emissions. Moreover, a blockchain-based aggregation platform architecture is an attractive measure too. Besides, the carbon dioxide emission factor of the power grid and the production proportion of primary energy show an opposite trend.
Evaluation and Analysis of the Status Quo and Impact Degree of Mine Geological Environment in Heilongjiang Province
Authors: Chen Lei , Xu Bo
Published: July 2023

To identify the geological and environmental problems and hazards of significant mines in Heilongjiang Province and put forward specific countermeasures for mine geological environmental protection and treatment and restoration, the issue of the unclear geological environment due to mine mining was solved. Through data collection, remote sensing interpretation, on-site investigation, and other working methods, the causes and impacts of mine geological and environmental problems were analyzed, and the results were achieved: ① the production status of critical mines in the province was investigated; ② Find out the impact of mine production on the geological environment;③ The degree of the geological, environmental impact of the mine was analyzed, and specific prevention and control measures were proposed.
A Comprehensive Evaluation Study on the Ecological Conservation Model of Saihanba, China and Its Application in the Asia-Pacific Regions
Authors: Xu Guoli , In Wong Cora Un , Lin Ngan Lei
Published: July 2023

The key of this paper is to extract several representative characteristic indicators and establish the ecosystem characteristic index system of Saihanba by collecting and preprocessing the data in Saihanba area for a comprehensive evaluation. A gray correlation model was used to calculate the correlation degree and rank the cities based on the characteristic indicators, with Beijing as the central point and extended to Xinjiang, Japan and other regions. Through the integration of the data from the official website and books, the data of the representative ecological aspects of the Saihanba was obtained and divided into 12 characteristic indicators to build the characteristic indicator system of the Saihanba ecological environment, and the maximum characteristic value and CR value were solved by using the hierarchical analysis method to assign values to the indicators and obtain the weight vector of each indicator. Based on the principal component analysis, the correlation matrix between the indicators was established to determine the importance of the factors, and finally, a comprehensive comparison and analysis of the changes in environmental conditions before and after the restoration of the Saihanba was performed. Based on the multivariate nonlinear regression fitting bias and optimization and TOPSIS comprehensive evaluation method to assess the importance of the indicators, it can be concluded that Saihanba played an important role in the fight against sandstorms in Beijing; through the evaluation model, the in-depth analysis of environmental indicators in Xinjiang region and Japan, the impact of the ecological model on environmental conditions in different regions was derived, which has positive implications for the promotion of similar ecological reserves.
Soft Sensor Modeling Method for Sulfur Recovery Process Based on Long Short-Term Memory Artificial Neural Network (LSTM)
Authors: Tan Qing , Li Bolun
Published: July 2023

In the process of sulfur recovery, H2S and SO2 concentrations reflect the effectiveness and reliability of the recovery process. However, the concentration of H2S and SO2 in the process of sulfur recovery is difficult to be measured by online analysis instrument, so the soft sensing modeling method is often used to analyze the system. Because SRU system has strong nonlinear characteristics and dynamic process characteristics,traditional soft sensing modeling methods are often limited in use. Long Short-Term Memory (LSTM)Artificial neural networks show strong ability in processing nonlinear data and dynamic data. Therefore, LSTM soft sensing method is used in this paper to systematically analyze the sulfur recovery process.
Development of Comprehensive Acquisition Software for Measurement While Drilling Data Based on VUE Coal Mine
Authors: Zhang Jungang , Chen Guo , Liu Ruitao , Yang Yongping , Chen Xiang
Published: July 2023

For the current coal mine directional drilling MWD equipment and system are independent of each other, resulting in different forms of MWD data at the bottom of the hole, forming data islands; Based on the B/S system architecture mode, by comparing the measurement while drilling mode and measurement data format, the requirement module of data comprehensive acquisition system is analyzed; the background database of the integrated collection system is set up to develop the development of the integrated collection system of directional drilling while drilling data in coal mine. The verification shows that the data acquisition system can meet the unified collection and processing of various MWD data, the overall analysis and evaluation function, and achieve real-time data upload. It provides data network transmission guarantee for directional drilling data supervision platform in coal mine, and improves the intelligent level of coal mine drilling.
Combination of Acute Preoperative Plateletpheresis, Cell Salvage, and Aprotinin Minimizes Blood Loss and Requirement During Cardiac Surgery
Authors: Li Shu , Ji Hongwen , Lin Jing , Lenehan Eric , Ji Bingyang , Liu Jinping , Liu Jin , Long Cun , Crane Terry A.
Published: July 2023

Acute preoperative plateletpheresis (APP), cell salvage (CS) technique, and the use of aprotinin have been individually reported to be effective in reducing blood loss and blood component transfusion while improving hematological profiles in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). In this prospective randomized clinical study, the efficacy of these combined approaches on reducing blood loss and transfusion requirements was evaluated. Seventy patients undergoing primary coronary artery bypass grafting (CABG) were randomly divided into four groups: a control group (group I, n = 10) did not receive any of the previously mentioned approaches. An APP and CS group (group II, n = 20) experienced APP in which preoperative platelet-rich plasma was collected and reinfused after reversal of heparin, along with the cell salvage technique throughout surgery. The third group (group III, n = 22) received aprotinin in which 5,000,000 KIU Trasylol was applied during surgery, and a combination group (group IV, n = 18) was treated with all three approaches, i.e., APP, CS, and aprotinin. Compared with group I (896 ± 278 mL), the postoperative total blood loss was significantly reduced in groups II, III, and IV (468 ± 136,388 ± 122,202 ± 81 mL, respectively, p < 0.05). The requirements of packed red blood cells in the three approached groups (153 ± 63,105 ± 178,0 ± 0 mL, respectively) also were reduced when compared with group I (343 ± 118 mL, p < 0.05). In group I, six patients (6/10) received fresh-frozen plasma and three patients (3/10) received platelet transfusion, whereas no patients in the other three groups required fresh-frozen plasma and platelet. In conclusion, both plateletpheresis concomitant with cell salvage and aprotinin contribute to the improvement of postoperative hemostasis, and the combination of these two approaches could minimize postoperative blood loss and requirement.
Improved Outcomes During Cardiac Surgery: A Multifactorial Enhancement of Cardiopulmonary Bypass Techniques
Authors: Trowbridge Cody C. , Stammers Alfred H. , Wood G. Craig , Murdock James D. , Klayman Myra , Yen Bianca R. , Woods Edward , Gilbert Christian
Published: July 2023

Patients presenting for cardiac surgery with cardiopulmonary bypass (CPB) are more likely to have pre-existing comorbidities, which has resulted in a steady increase in the risk associated with CPB. The resulting challenge has mandated the optimization of perfusion care. The purpose of this study was to retrospectively evaluate the impact of a number of simultaneous, evidence based perfusion care changes on patient outcome. After Institutional Review Board approval, two groups of patients were compared. The control group (n= 317) included all patients undergoing CPB in a 12-month period preceding a multifaceted change in perfusion techniques. The treatment group (n= 259) included all patients undergoing CPB in the 12-month period after the changes, which included the incorporation of updated continuous blood gas monitoring, biocompatible circuitry, updated centrifugal blood propulsion, continuous autotransfusion technology, new generation myocardial protection instrumentation, plasmapheresis, topical platelet gel application, excluding hetastarch while increasing the use of albumin, viscoelastographic coagulation monitoring, and implementing a quantitative quality improvement program. After univariate analysis, propensity scoring and multiple conditional logistical regression were used to control for demographic, preoperative, operative, and postoperative parameters. Results of the primary endpoints revealed a lower mortality rate in the treatment group (4% vs. 9% [95% confidence interval 1.33, 7.72],p= 0.009), lower transfusion rate (51% vs. 59% [1.00, 2.11],p= 0.048), and lower complication rate (55% vs. 65% [1.06,2.19],p= 0.025) despite having similar predicted mortality (11 [2,22] vs. 11[3,22],p= NS) and other preoperative and operative parameters. The lower mortality rate was concurrent with a trend towards a lower incidence of complications, consistent with the differences in primary outcomes. In conclusion, the patients treated after the implementation of a multifactorial improvement plan using evidence based changes in CPB care had decreased complication and mortality rates.
Oxygenator Exhaust Capnography for Prediction of Arterial Carbon Dioxide Tension During Hypothermic Cardiopulmonary Bypass
Authors: Baraka Anis , El-Khatib Mohamad , Muallem Eva , Jamal Salim , Haroun-Bizri Sania , Aouad Marie
Published: July 2023

Continuous monitoring and control of arterial carbon dioxide tension (PaCO2) during cardiopulmonary bypass (CPB) is essential. A reliable, accurate, and inexpensive system is not currently available. This study was undertaken to assess whether the continuous monitoring of oxygenator exhaust carbon dioxide tension (PexCO2) can be used to reflect PaCO2during CPB. A total of 33 patients undergoing CPB for cardiac surgery were included in the study. During normothermia (37°C) and stable hypothermia (31°C), the values of PexCO2from the oxygenator exhaust outlet were monitored and compared simultaneously with the PaCO2values. Regression and agreement analysis were performed between PexCO2and temperature corrected-PaCO2and temperature uncorrected-PaCO2. At normothermia, a significant correlation was obtained between PexCO2and PaCO2(r = 0.79;p< 0.05); there was also a strong agreement between PexCO2and PaCO2with a gradient of 3.4 ± 1.9 mmHg. During stable hypothermia, a significant correlation was obtained between PexCO2and the temperature corrected-PaCO2(r = 0.78;p< 0.05); also, there was a strong agreement between PexCO2and temperature corrected-PaCO2with a gradient of 2.8 ± 2.0 mmHg. During stable hypothermia, a significant correlation was obtained between PexCO2and the temperature uncorrected-PaCO2(r = 0.61;p< 0.05); however, there was a poor agreement between PexCO2and the temperature uncorrected-PaCO2with a gradient of 13.2 ± 3.8 mmHg. Oxygenator exhaust capnography could be used as a mean for continuously monitoring PaCO2during normothermic phase of cardiopulmonary bypass as well as the temperature-corrected PaCO2during the stable hypothermic phase of CPB.
Embol-X Intra-Aortic Filtration System: Capturing Particulate Emboli in the Cardiac Surgery Patient
Authors: Sobieski Michael A. , Pappas Patroklos S. , Tatooles Antone J. , Slaughter Mark S.
Published: July 2023

We sought to evaluate the effectiveness of using an intra-aortic filtration system for the prevention of particulate emboli transport and the minimization of significant postoperative complications associated with particulate emboli. Between October of 2000 and October 2001, a total of 146 patients were enrolled at Advocate Christ Medical Center as part of the multi-institutional randomized trial (1289 patients at 22 centers). A total of 74 patients (51%) received the Embol-X intra-aortic filter and 72 patients (49%) were enrolled in the control group. Patients were evaluated for neurological deficit, myocardial infarction, renal insufficiency/failure, limb ischemia, and death at 12-hour, 24-hour, 72-hour, 7-day, and 30-day postoperative intervals. All filters received histological examination for particulate matter. Particulate matter was isolated in 70 (94.5%) of the filters successfully deployed. There was no statistically significant difference in the device related events between the filter and conventional cannulation groups (9/74 = 12.1% vs. 7/72 = 9.7%). Although not clinically evident, the primary event for both groups was ascending aortic intimal tears. There was one death in each of the groups not related to the filter or cannula used. The use of the Embol-X intra-aortic filter system has proven to be a safe and effective means to reduce the introduction of particulate emboli into the systemic circulation. Clearly, the reduction of particulate matter by as much as 95% justifies its use in cardiac surgery patients identified with an increased preoperative embolic risk.
Variations in Battery Life of a Heart—Lung Machine Using Different Pump Speeds, Pressure Loads, Boot Material, Centrifugal Pump Head, Multiple Pump Usage, and Battery Age
Authors: Marshall Cornelius , Hargrove Martin , O’Donnell Aonghus , Aherne Thomas
Published: July 2023

Electrical failure during cardiopulmonary bypass (CPB) has previously been reported to occur in 1 of every 1500 cases. Most heart—lung machine pump consoles are equipped with built-in battery back-up units. Battery run times of these devices are variable and have not been reported. Different conditions of use can extend battery life in the event of electrical failure. This study was designed to examine the run time of a fully charged battery under various conditions of pump speed, pressure loads, pump boot material, multiple pump usage, and battery life. Battery life using a centrifugal pump also was examined. The results of this study show that battery life is affected by pump speed, circuit pressure, boot stiffness, and the number of pumps in service. Centrifugal pumps also show a reduced drain on battery when compared with roller pumps. These elements affect the longevity and performance of the battery. This information could be of value to the individual during power failure as these are variables that can affect the battery life during such a challenging scenario.
Transfusion-Free Cardiopulmonary Bypass in Jehovah’s Witness Patients Weighing Less Than 5 kg
Authors: Boettcher Wolfgang , Merkle Frank , Huebler Michael , Koster Andreas , Schulz Fritz , Kopitz Michael , Kuppe Hermann , Lange Peter , Hetzer Roland
Published: July 2023

Performing cardiac surgery on pediatric Jehovah’s Witness patients is a great challenge for the surgical team and especially for the perfusionist. Jehovah’s Witnesses reject blood transfusions on the grounds of their literal interpretation of passages of the Bible. In accordance with this belief, Jehovah’s Witnesses feel that it is also forbidden to retransfuse autologous blood that has been separated from their own circulatory system. We report the use of cardiopulmonary bypass (CPB) during open-heart surgery in three infants with a body weight of 4.5 kg, 3.5 kg, and 3.1 kg, respectively, without transfusion of blood components. A small-volume CPB circuit with a priming volume of 200 mL, including the arterial line filter, was designed to decrease the degree of hemodilution. A dedicated pediatric heart lung machine console with remote pump heads and intensive blood conservation efforts allowed the operation without the use of donor blood. The CPB circuits were primed with crystalloid solution only. The procedures were performed in normothermia or in moderate hypothermia. Pre-CPB hemoglobin levels were 10.8 g/dL, 10.6 g/dL, and 8.5 g/dL. The hemoglobin concentrations measured during CPB ranged from 5.9 to 6.5 g/dL, 6.4 to 6.8 g/dL, and 5.5 to 5.9 g/dL, respectively. The patients did not receive any blood or blood products during their entire hospital stay.
A Prospective Comparison of the Platelet Sequestration Ability of Three Autotransfusion Devices
Authors: Scholz Mary , Serrick Cyril , Noel Dionne , Singh Onkar , Melo Arthur
Published: July 2023

Although current autotransfusion devices have platelet sequestration capabilities, each has a unique technology to achieve the final platelet product. The purpose of this study was to assess the quality and quantity of platelets sequestered by three different autotransfusion devices. The three commercially available autotransfusion devices evaluated were Fresenius C.A.T.S (closed spiral chamber), Cobe BRAT 2 (Baylor bowl), and Haemonetic Cell Saver 5 (Latham bowl). Platelet sequestration was preformed in the automatic mode following the manufacturer’s recommended sequestration protocols. The total number of platelets sequestered, percent recovery, and percent platelet function were assessed. Each device behaved similarly. There was a 2- to 3-fold increase in platelet count compared with baseline with only approximately 50–60% recovery, whereas there was approximately a 10% decrease in platelet function after processing compared with baseline. No statistical difference was noted in platelet function between the respective machines. However, there was a significant loss of platelet function observed with the actual process regardless of autotransfusion device used.
The Coronary Baroreflex in Humans
Authors: Kincaid K. , Ward M. , Nair U. , Hainsworth R. , Drinkhill M.
Published: July 2023

Previous studies have identified the presence of coronary baroreceptors in animal models. We set up a study to explore the presence of coronary baroreceptors in humans, which was performed with isolated, graded aortic root perfusion in patients during cardiopulmonary bypass. With ethical approval 12 patients with normal coronary arteries, aged 58–75 (mean 69) years undergoing mitral valve surgery were recruited to the study with informed consent. Those with aortic valve incompetence, coronary, or peripheral artery disease and diabetes mellitus were excluded. They were randomized to have their coronary perfusion pressure set low at 50 mmHg for 90 seconds and then adjusted high to 80 mmHg for 90 seconds (group L–H) or the reverse sequence (group H–L). Average arterial pressure and approximately constant systemic flow over 30-second periods were used to calculate vascular resistance (SVR). The first six experiments followed initiation of cardiopulmonary bypass and aortic clamping but before the delivery of cold blood cardioplegia; the blood temperature for these experiments was kept at 32°C. The remaining six were conducted prior to removal of the aortic cross clamp at 37°C. Coronary sinus blood samples were analyzed to exclude myocardial ischemia. Coronary sinus blood samples showed insignificant variation in oxygen saturation, lactate, and troponin T. Three patients were excluded because of unstable blood pressure. In the (L–H) group SVR reduced in 4 of 4 remaining patients (mean −9.4%, range −3.9 to −19.6%). In the (H–L) group SVR increased in three patients (mean +2.0%, range 1.1 to 3.7%) but decreased in two (−8.9% and −15.8%). These preliminary results, although not statistically different, suggest the presence of coronary baroreceptors in humans. The reflex vascular responses are similar to those previously reported in animal models.
The Use of Hydroxy-Ethyl Starch Sedimentation for Autologous Buffy Coat Preparation
Authors: Gannon Timothy , McConnell Kristen , Riley Jeffrey
Published: July 2023

The use of hydroxy-ethyl starch (HES) has been used in the cord blood banking industry for the separation of blood into its individual components. The focus of this study is to examine whether the use of HES is feasible in obtaining a buffy coat for the use in the construction of platelet gels. Blood was collected from seven canines into anticoagulant citrate dextrose at a ratio of 1:8. A sample of whole blood was used to obtain initial cell counts and a base line Thrombelastograph® (TEG®). 6% Hespan was added to the whole blood and allowed to sediment for 60 minutes. Cell counts and TEG®s were performed on the resulting layers: red blood cells (RBCs), buffy coat (BC), and plasma. The results of this study (see Table 1) suggest that the gravity sedimentation of whole blood with HES can significantly reduce the RBCs in the BC and plasma layers while increasing the platelet count in the plasma layer. These data also suggest that HES does not affect the clotting capabilities of the BC and plasma layers.
Update on Pediatric Perfusion Practice in North America: 2005 Survey
Authors: Groom Robert C. , Froebe Shane , Martin Janine , Manfra Michael J. , Cormack John E. , Morse Catherine , Taenzer Andreas H. , Quinn Reed D.
Published: July 2023

The devices and techniques used for pediatric cardiopulmonary bypass (CPB) undergo continuous change. New techniques and clinical comparisons of devices are frequently reported in the literature; however, information about the extent to which these techniques and devices are adopted into clinical practice at pediatric heart centers are not well described. We conducted a mail survey of North American pediatric cardiac surgery centers to gain perspective on the extent to which various devices and techniques were used for CPB along with program demographic data. In January 2005, surveys were mailed to 180 North American open heart centers. The survey was nearly identical in format and content to three earlier surveys completed in 1989, 1994, and 1999, with the exception that new questions were added to address new techniques and devices that have emerged over the years. Responses were received from 76 hospitals, for an overall response rate of 42%. Of the responding centers, 53 were performing pediatric open heart surgery and 23 were not. Twenty centers performed only pediatric open heart surgery, and 33 performed both pediatric and adult open heart surgery. The mean pediatric annual caseload of responding centers was 195 procedures/yr (range, 20–650 procedures/yr; median, 154 procedures/yr). A total of 9943 pediatric open heart procedures were performed at responding centers in 2004. Most of the centers surveyed reported use of an open venous reservoir system (88%), use of roller pumps (90%), and use of arterial line filtration (98%). Most centers used circuits that have surface treatments with heparin or some other surface-modifying agent (74%). There has been an increase in the use of all types of safety devices. Modified ultrafiltration is used at 75% of the centers surveyed. Centers reported an increase in the availability of all types of cardiac support devices including extracorporeal membrane oxygenation for postcardiotomy cardiac support (90%). This survey provides an overview of clinical practice in 2004. The series of surveys document the historical progression of clinical practice over the past 16 years. Practice surveys may also be useful for identifying gaps between evidence-based knowledge and clinical practice. These surveys document the diffusion of innovation related to CPB during the past 16 years and areas of variation in practice that need further study.
A Primer on Randomized Controlled Trials
Authors: Likosky Donald S.
Published: July 2023

Randomized Clinical Trials are held as the gold standard for quantifying the effect of an intervention across two or more groups. In such a trial an intervention is randomly allocated to one of two groups. The benefit of such a trial lies in its ability to establish nearly comparable groups of subjects in all manner except for the effect of the intervention. As such, the effect of a given intervention may be attributed solely to the intervention and not to any other extraneous factor. In the following editorial, we will discuss several issues that are important for understanding how to conduct and interpret randomized trials: choosing the study population, choosing the comparison group, choosing your outcome, study design, data analysis, and issues of inference. This editorial is intended to make the reader an educated consumer of such trial designs.
Whole Blood Cardioplegia (Minicardioplegia) Reduces Myocardial Edema After Ischemic Injury and Cardiopulmonary Bypass
Authors: McCann Ulysses G. , Lutz Charles J. , Picone Anthony L. , Searles Bruce , Gatto Louis A. , Dilip Karikehalli A. , Nieman Gary F.
Published: July 2023

While blood:crystalloid cardioplegia is the clinical standard for patients undergoing cardiopulmonary bypass (CPB), it has been postulated that whole blood minicardioplegia may benefit the severely injured heart by reducing cardioplegic volume, thereby reducing myocardial edema. To test this hypothesis, we compared the cardioprotection of a popular 4:1 blood:crystalloid cardioplegia to whole blood minicardioplegia (WB) in a porcine model of acute myocardial ischemia. Yorkshire pigs (n = 20) were placed on atriofemoral bypass and subjected to 30 minutes of global normothermic ischemia. Animals were randomized to receive either 4:1 cold cardioplegia (n = 10) or WB cold cardioplegia (n = 10) delivered antegrade continuously for 90 minutes. Baseline (BL) echocardiographic determination of left ventricular mass (LVM) was compared within groups for cardiac edema (%) measured by histologic morphometrics. All (100%) animals receiving WB were successfully weaned off CPB, whereas only 40% of animals receiving 4:1 were successfully weaned off CPB. Cardiac edema percentage (p < .004) and LVM (p < .05) were significantly decreased in the WB group compared with 4:1. WB cardioplegia increases the number of hearts successfully weaned from CPB and decreases cardiac edema in our porcine model of acute myocardial ischemia. This finding implies whole blood cardioplegia may be more protective in a select group of patients undergoing extended CPB time by decreasing myocardial edema.
A Primer on Reviewing and Synthesizing Evidence
Authors: Likosky Donald S.
Published: July 2023

In this editorial, I shall describe methods commonly used for synthesizing evidence and review some contemporary examples of how this methodology has been applied to the peer-reviewed literature. It is my hope that the reader will find this interesting, but more importantly useful as you find yourself reading the evermore voluminous medical literature.
Electronic Data Processing: The Pathway to Automated Quality Control of Cardiopulmonary Bypass
Authors: Newland R. F. , Baker R. A. , Stanley R.
Published: July 2023

Electronic data collection during cardiac surgery creates an enormous data source that has many potential applications. After the introduction of the Stockert Data Management System (DMS; Munich, Germany) to our perfusion practice, we recognized that the data could be used for the purpose of quality control (QC). Our aim was to create an automated technique of data analysis and feedback for cardiopulmonary bypass (CPB) procedures. Using visual basic programming, we created a process by which data from the DMS is analyzed and processed in a Microsoft Access database after a CPB procedure. The processing is designed to transfer the collected data to a research database and create a number of CPB quality indicator (QI) parameters, such as mean arterial pressure being less than 40 mmHg for more than 5 minutes or a venous saturation of less than 60% for more than 5 minutes. In the event of QI parameter detection, a QC report is generated and e-mailed to the senior perfusionist and the perfusionist performing the procedure. The introduction of electronic data collection and subsequent development of electronic data processing techniques has enabled us to transfer the data into a readily accessible database and create a data set of perfusion variables and quality indicators for CPB procedures. This data set may be used for immediate automated QC feedback after CPB procedures and direction of performance improvement initiatives through retrospective or prospective data analysis as part of a continuous quality improvement process.
Modification of a Biventricular Assist Device to Facilitate Preservative Infusion and Organ Recovery in a Nonheart-Beating Donor
Authors: Angona Ron , Abt Peter , Younan Duraid , Massey Todd , Marvin Michael , Kashyap Randeep , Richards Dan , Jones Karen , Queschenbach James , Zand Martin , Jain Ashok , Orloff Mark , Bozorgzadeh Adel
Published: July 2023

A 46-year-old patient supported by a biventricular assist device (BiVAD) was transferred to our institution for evaluation for heart transplant. The patient was found to have a large intracranial hemorrhage with profound deterioration of neurologic status. The poor prognosis prompted the decision to withdraw care and pursue organ donation. Because the patient did not meet brain death criteria, nonheart-beating donor organ donation was pursued. After the termination of care, the BiVAD was modified: the left side to provide organ preservative solution and the right side to allow drainage. Eight liters of cold University of Wisconsin solution were pumped systemically over 10 minutes, the donor was drained, and the liver was harvested. This technique expedited donor perfusion by eliminating the need to cannulate, minimizing ischemic time for the liver. Although the recipient outcome was poor, and retransplantation was eventually necessary, we believe it was most likely not attributable to the quality of organ preservation. This report discusses the technical aspects of this potentially beneficial procedure.
Hemoglobin Test Result Variability and Cost Analysis of Eight Different Analyzers During Open Heart Surgery
Authors: Patel Kirti P. , Hay Gary W. , Cheteri Mahesh Keitheri , Holt David W.
Published: July 2023

The purpose of this study was to compare the variation in hemoglobin (Hgb) values among various point-of-care (POC) analyzers available on the market. Eight analyzers (Gem 3000, ABL 720, ABL 77, Rapidpoint 405, IL 682, GemOPL, Hb 201+, and manual/centrifugation) were compared with the Hgb values from the Beckman Coulter LH750. A total of 72 patient samples were analyzed on each test instrument. The samples were obtained after intubation, after heparinization, during cardiopulmonary bypass, and after protamine administration. Four of the samples were excluded from the study because of delayed sample analysis. The calculated mean differences of reference test method Hgb (mean ± SD) for all samples (n = 68) were Gem 3000 = 1.431 ± 0.396 g/dL; ABL 720 = −0.224 ± 0.240 g/dL; ABL 77 = 0.341 ± 0.578 g/dL; Rapidpoint 405 = 0.001 ± 0.205 g/dL; IL 682 = −0.137 ± 0.232 g/dL; GemOPL = 0.774 ± 0.427 g/dL; Hb 201+ = 0.110 ± 0.524 g/dL; and manual/centrifugation = 0.547 ± 0.499 g/dL. Cumulative results indicated that the bias in Hgb values from the Gem 3000, ABL720, ABL 77, IL 682, GemOPL, and the manual method were statistically significant (p < .05), compared with the Coulter LH750. Additionally, only the Rapidpoint 405 and Hb 201+ most closely matched the values from the Coulter LH750 (p > .05). Some of the methodologies have previously been shown to be affected during hemodilution, hypoproteinemia, and/or after blood transfusion. There is variability among methodologies, which can give rise to statistically different Hgb values, and one should consider the “ideal” instrument based on this and many other factors. Based on our results, the rank order of closest approximation to the Coulter LH750 measurement was Rapidpoint 405, Hb 201+, IL 682, ABL 720, ABL 77, manual/centrifugation, GemOPL, and Gem 3000.
Autotransfusion Management During and After Cardiopulmonary Bypass Alters Fibrin Degradation and Transfusion Requirements
Authors: Wiefferink Alice E.C.M. , Weerwind Patrick W. , van Heerde Waander , Teerenstra Steven , Noyez Luc , de Pauw Ben E. , Brouwer René M.H.J.
Published: July 2023

The coagulation-fibrinolytic profile during cardiopulmonary bypass (CPB) has been widely documented. However, less information is available on the possible persistence of these alterations when autotransfusion is used in management of perioperative blood loss. This study was designed to explore the influence of autotransfusion management on intravascular fibrin degradation and postoperative transfusions. Thirty patients, undergoing elective primary isolated coronary bypass grafting, were randomly allocated either to a control group (group A; n = 15) or an intervention group (group B; n = 15) in which mediastinal and residual CPB blood was collected and processed by a continuous autotransfusion system before re-infusion. Intravascular fibrin degradation as indicated by D-dimer generation was measured at five specific intervals and corrected for hemodilution. In addition, chest tube drainage and need for homologous blood were monitored. D-dimer generation increased significantly during CPB in group A, from 312 to 633 vs. 291 to 356 ng/mL in group B (p = .001). The unprocessed residual blood (group A) revealed an unequivocal D-dimer elevation, 4131 ± 1063 vs. 279 ± 103 ng/mL for the processed residual in group B (p < .001). Consequently, in the first post-CPB period, the intravascular fibrin degradation was significantly elevated in group A compared with group B (p = .001). Twenty hours postoperatively, no significant difference in D-dimer levels was detected between both groups. However, a significant intra-group D-dimer elevation pre- vs. postoperative was noticed from 312 to 828 ng/mL in group A and from 291 to 588 ng/mL in group B (p < .01 for both). Postoperative chest tube drainage was higher in the patients from group A, which also had the highest postoperative D-dimer levels. Patients in group A perceived a higher need for transfusions of red cells suspensions post-operatively. These data clearly indicate that autotransfusion management during and after CPB suppresses early postoperative fibrin degradation.
Preliminary Analysis of Perfusionists’ Strategies for Managing Routine and Failure Mode Scenarios in Cardiopulmonary Bypass
Authors: Power Gerald , Miller Anne
Published: July 2023

Cardiopulmonary bypass (CPB) is a complex task requiring high levels of practitioner expertise. Although some education standards exist, few are based on an analysis of perfusionists’ problem-solving needs. This study shows the efficacy of work domain analysis (WDA) as a framework for analyzing perfusionists’ conceptualization and problem-solving strategies. A WDA model of a CPB circuit was developed. A high-fidelity CPB simulator (Manbit) was used to present routine and oxygenator failure scenarios to six proficient perfusionists. The video-cued recall technique was used to elicit perfusionists’ conceptualization strategies. The resulting recall transcripts were coded using the WDA model and analyzed for associations between task completion times and patterns of conceptualization. The WDA model developed was successful in being able to account for and describe the thought process followed by each participant. It was also shown that, although there was no correlation between experience with CPB and ability to change an oxygenator, there was a link between the between specific thought patterns and the efficiency in undertaking this task. Simulators are widely used in many fields of human endeavor, and in this research, the attempt was made to use WDA to gain insights into the complexities of the human thought process when engaged in the complex task of conducting CPB. The assumption that experience equates with ability is challenged, and rather, it is shown that thought process is a more significant determinant of success when engaged in complex tasks. WDA analysis in combination with a CPB simulator may be used to elucidate successful strategies for completing complex tasks.
Are There Benefits to a Fresh Whole Blood vs. Packed Red Blood Cell Cardiopulmonary Bypass Prime on Outcomes in Neonatal and Pediatric Cardiac Surgery?
Authors: Valleley Melinda S. , Buckley Klayton W. , Hayes Kylie M. , Fortuna Randall R. , Geiss Dale M. , Holt David W.
Published: July 2023

Techniques for pediatric cardiac surgery requiring cardiopulmonary bypass (CPB) have significantly improved over the years. The use of fresh whole blood (FWB) and pre-bypass ultrafiltration (PBUF) has been suggested as means for improving perioperative and postoperative outcomes. It is the intent of this study to show that fresh whole blood along with PBUF will result in balanced CPB prime that can offer a reduction in blood product exposures and blood loss along with improving several measured postoperative outcomes. After institutional review board approval, a retrospective review was conducted on 100 patients to analyze the benefits of FWB and PBUF on outcomes in neonatal and pediatric cardiac surgery. Data analysis included preoperative and CPB data, perioperative inotrope and blood product exposure, and postoperative blood loss and blood product exposure measured for up to a 12-hour period in the intensive care unit (ICU). The three groups compared were FWB prime vs. packed red blood cell (PRBC) prime, <5 kg FWB prime vs. <5 kg PRBC prime, and 5+ kg FWB prime and 5+ kg PRBC prime. Cumulative blood product exposures for the FWB prime group found 62% received one blood exposure for the operative and postoperative period (p < .0001). The majority of patients who received a PRBC prime (64%) received three or more cumulative exposures (p < .0003). The <5 kg FWB group also received significantly less cumulative blood exposure, with 64% receiving just one exposure. Comparatively, 85% of the <5 kg PRBC patients received three or more blood product exposures perioperatively and postoperatively (p < .0001). Perioperative inotrope and postoperative blood loss did not differ among the groups. Outcomes for intraoperative death, intraoperative extubation, delayed sternal closure, and mediastinal reexploration were also not statistically different. The results of this study found that FWB leads to significantly less blood exposure, specifically in the <5-kg population. Finally, the use of PBUF is an effective method for achieving a balanced, physiologic prime. Future research would be helpful in determining which specific patient populations would receive the greatest benefit from FWB and PBUF.
Non-Activated Autologous Platelet-Rich Plasma for the Prevention of Inguinal Wound-Related Complications After Endovascular Repair of Abdominal Aortic Aneurysms
Authors: Saratzis Nikolaos , Saratzis Athanasios , Melas Nikolaos , Kiskinis Dimitrios
Published: July 2023

The endovascular repair (EVAR) of abdominal aortic aneurysms (AAAs) usually involves the surgical exposure and catheterization of the femoral arteries. Several inguinal surgical wound-related complications have been reported postoperatively. The aim of this report was to evaluate the safety and efficacy of intraoperative application of autologous platelet-rich plasma (PRP) for the prevention of wound-related complications in AAA EVAR. The authors conducted a patient- and assessor-blinded controlled trial involving 100 subjects undergoing EVAR of an AAA. PRP was produced using an autologous platelet separator and was applied, without prior thrombin activation, in 50 patients eligible for inclusion. The results were compared with a control group of 50 patients who underwent AAA EVAR within the same time period. The primary outcome was the difference in postoperative hospital stay. Secondary outcomes included subjective assessment of wound healing and wound-related complications. Age, sex, and other comorbidities related to wound healing were not significantly different between cases and controls. One patient treated with PRP developed a unilateral wound infection with lymphorrhea, and two patients developed a bi-lateral superficial infection. Twelve patients within the control group developed a wound-related complication. The postoperative hospitalization was significantly lower in the PRP group. The overall surgical wound-related complications rate was also significantly lower in the PRP group. Application of non-thrombin-activated PRP seems to prevent major postoperative wound-related complications (p= .026) and shorten postoperative hospital stay duration after femoral artery exposure and catheterization for AAA EVAR (mean, 4.48 ± 0.48 vs. 6.14 ± 0.39 days).
Evaluation of the i-STAT Point-of-Care Analyzer in Critically Ill Adult Patients
Authors: Steinfelder-Visscher Jacoline , Teerenstra Steven , Klein Gunnewiek Jacqueline M.T. , Weerwind Patrick W.
Published: July 2023

Point-of-care analyzers may benefit therapeutic decision making by reducing turn-around-time for samples. This is especially true when biochemical parameters exceed the clinical reference range, in which acute and effective treatment is essential. We therefore evaluated the analytical performance of the i-STAT point-of-care analyzer in two critically ill adult patient populations. During a 3-month period, 48 blood samples from patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) and 42 blood samples from non-cardiac patients who needed intensive care treatment were analyzed on both the i-STAT analyzer (CPB and non-CPB mode, respectively) and our laboratory analyzers (RapidLab 865/Sysmex XE-2100 instrument). The agreement analysis for quantitative data was used to compare i-STAT to RapidLab for blood gas/electrolytes and for hematocrit with the Sysmex instrument. Point-of-care electrolytes and blood gases had constant deviation, except for pH, pO2, and hematocrit. A clear linear trend in deviation of i-STAT from RapidLab was noticed for pH during CPB (r = 0.32, p = .03) and for pO2 > 10 kPa during CPB (r = −0.59, p < .0001 when 10 < pO2 <30 kPa) and in the intensive care unit (r = −0.61, p < .001 when 10 < pO2 <30 kPa). In the normal pO2 range (10.6 < pO2 <13.3 kPa), the performance of the i-STAT was comparable to the RapidLab. In contrast to hematocrit measured during CPB, hematocrit using the non-CPB mode in the non-cardiac intensive care population showed an underestimation up to 2.2% (p < .0001) in the hematocrit range below 25% (n = 11) using the i-STAT. The i-STAT analyzer is suitable for point-of-care testing of electrolytes and blood gases in critically ill patients, except for high pO2. However, the discrepancy in hematocrit bias shows that accuracy established in one patient population cannot be automatically extrapolated to other patient populations, thus stressing the need for separate evaluation.