bluuebunny/crossref_metadata_2025 huggingface dataset:
Uzbek folk ecology – formation of the foundations of ecological culture in elementary school students
Authors: Jobborova Gulnoza
Published: August 2023

This article shows the results of the research, the uniqueness of pedagogical methods in forming a positive attitude towards the environment among primary school pupils, as well as the necessary recommendations for forming a positive attitude towards the environment among primary school pupils. Providing environmental education to students in educational institutions, raising a sense of respect for nature and the environment in them, a careful attitude and a sense of responsibility for it, issues related to environmental education of primary school students are highlighted, historical experience, traditions and rituals of the Uzbek people, and folk language reflected in his work: proverbs, sayings, quick sayings, riddles, songs, verses, recitations are among them. Also, as evidenced by the historical and ethnographic material, the ancestors of the Uzbek people felt themselves together with nature. Environmental conditions have been consistently studied by them, knowledge and experience in this regard has been developed and deepened. The unique information of Uzbek folklore reveals the organic unity of man and nature and its meaning, customs and ceremonies of the Uzbek people, as well as folk oral creativity: proverbs, proverbs, quick sayings, riddles, songs are aimed at forming the foundations of ecological culture.
Fauna symbols in Uzbek and English cultural spaces
Authors: Khakimova S. I.
Published: August 2023

In this article, we focus on one of the most efficient expressive language tool, namely, a symbol. In dictionaries, the word “symbol” is determined as follows: 1) an object, character, event that is used instead of another object in a symbolic condition; 2) a sign, number, letter that has a fixed meaning in science such as mathematics, chemistry and so on. However, our interest is directed to a language symbol, specifically, animalistic symbols whose meaning cannot be deducted from the literal definitions, but refers instead to a figurative meaning that is known only through conventional use. Conceptual meanings of the symbols are expressed through linguistic units like words, yet its social or extra-linguistic meaning is based on experiences in a daily life. Furthermore, the study includes symbols which reflect the linguocultural aspects of English language by comparing them with the Uzbek ones, being highly associated with the cultural, religious and historical ties.
Chronic tubulointerstitial nephritis in children: New approaches to diagnosis and treatment
Authors: Akhmatova Yu. A. , Akhmatov A. , Yuldashev B. A. , Ruzikulov N. Ya.
Published: August 2023

A survey of 120 children with HTIN, aged from 4 to 15 years, was conducted. Taking into account the clinical variant of HTIN, all patients were divided into 2 groups: group 1 –52 (43%) children with recurrent form of HTIN and group 2 -68 (57%) patients with latent HTIN. Among them, there were 65 boys (54%), 55 girls (46%). The conducted studies have shown that with the development of rHTIN and lHTIN, an important mechanism of damage to interstitial kidney tissue, the development of clinical symptoms and the course of the disease is both a metabolic disorder leading to structural shifts at the level of various elements of the nephron and changes in the functional state of the kidneys, and instability of the cytomembranes of tubular cells. The analysis of the results of the study showed that the method of treatment proposed by the authors is the most effective way of treating HTIN, due to accelerated recovery, both clinical and laboratory parameters of the disease and indicators of protein metabolism, as well as in relation to the restoration of the functional state of the kidneys, which leads to a reduction in the length of hospital stay, a reduction in the number of relapses of exacerbation, prevention complications of the chronic process. All this contributes to preventing the development of disability and reducing the number of child deaths from CRF.
Climate conditions, hydrogeology and meliorative conditions of serozem -grass soils of mirzaabad district, sirdaryo region
Authors: Makhkamova Dilafruz , Nabiyeva Gulchekhra , Abdushukurova Zamira , Iskhakova Shoira , Abdujabbarovna Aziza
Published: August 2023

This in the article Mirzaabad district of Sirdarya region serozem -meadow determining the current state of soil fertility and land reclamation, as well as their effective use events about data given.
Thermodynamics of Carbon (IV)-Oxide adsorption on NaA Zeolite obtained by modification of angren kaolin
Authors: Oydinov Muxlis , Abdulxayev Tolibjon , Kokhkharov Mirzihid , Abdurakhmonov Eldor , Rakhmatkarieva Firuza
Published: August 2023

Purification of natural gas from carbon dioxide is extremely important for the gas processing industry of Uzbekistan. Type A zeolites are the most suitable for this purpose. The patterns of water adsorption in the NaA zeolite have been considered. It was found that an appreciable amount of water is adsorbed in β-cavities. The carbon dioxide molecule is somewhat larger than the water molecule and, therefore, at room temperature it is unable to penetrate into the β-cavities through the six-membered oxygen windows of 2.6 Å diameter and form there ion-molecule clusters with sodium cations. However, the cations themselves can migrate from the β-cavities to the α-cavities under the influence of adsorbing molecules.
Automation of the single-track study for L-PBF additive manufacturing processes (for AlSi10Mg powder)
Authors: Ripetskiy A. V. , Brykin V. A. , Mikhailova E. V. , Temicheva N. Yu. , Sitnikov S.A.
Published: August 2023

When using a new powder material in each individual selective laser melting unit, the process engineer has to conduct process development works (PDW) to find the optimal combination of process parameters. The results of the PDW are analysed manually by the process engineer without the use of process decision support tools. Due to the expanding technological capabilities of the equipment and the available range of material properties, the possible set of parameters is also expanding, complicating the already non-trivial process of searching for printing process parameters. In order to reduce the PDW time, in this paper we proposed a rapid analysis tool to select individual experimental results with single welded tracks of AlSi10Mg powder. The process of conducting the experiment on domestic equipment was reviewed and the efficiency of the automation tool was investigated in comparison with the traditional manual selection approach. It is concluded that it is possible to apply the developed tool for materials and installations of additive manufacturing not considered in the study.
ESG-lending in the Russian economy
Authors: Korobeynikov Dmitry , Korobeynikova Olga , Dugina Tatiana , Shaldokhina Svetlana , Peters Irina
Published: August 2023

The purpose of the article is to consider the current state of ESG lending in the Russian economy, the features of ESG rating of Russian financial companies and approaches to potential borrowers, and to identify the most relevant areas for the development of ESG lending to Russian companies. Despite the fact that Russian companies and the Russian economy are under sanctions and the opportunities to enter foreign markets are significantly limited, ESG remains relevant. An analysis of ESG practices in the banking sector conducted in 2022 by Expert RA showed that only large credit institutions follow the ESG concept. More than 50% of the top 20 banks have implemented KPIs for ESG indicators in their lending and investment processes. In the practice of Russian banks, ESG-assessment of credit risks includes indicators of default probability, analysis and evaluation of portfolios in terms of industry/geographical concentrations, exposure limits, borrowing strategies, scenario analysis and/or stress testing. It is concluded that Russian companies in the financial sector use ESG approache for their own strategic development and for lending to their clients, and that government support is required for the ESG transformation of the banking sector.
Application of calibrated vehicle dynamic indicators in city traffic management
Authors: Loktionova Alina , Novikov Aleksandr , Shevtsova Anastasia
Published: August 2023

The number of registered vehicles in the Russian Federation is increasing every year, and the traffic flows of cities consist mainly of cars. The car fleet of the Russian Federation has undergone significant changes in recent decades. In particular, passenger vehicles, their power and design parameters are improving every year. These changes affect the system and the process of movement of cars in the traffic flow. This article defines the parameters that affect the functioning of urban traffic flows and, in a mathematical way, on their basis, found dynamic indicators for a conditional “calibrated” car.
Place attachment and the expression of thematic imageries in an urban kampung in Surakarta, Indonesia
Authors: Krismawanti K. , Nursanty Eko
Published: August 2023

Place attachment refers to the inherent strength that enhances the desirability and likability of a particular location among both residents and visitors, thereby leading to social and economic benefits while also increasing competitiveness. This research endeavor aims to explore and comprehend the positive emotional connection between individuals or communities and their surroundings by examining thematic mural images that are created and painted on the walls of urban settlements. Through the utilization of qualitative research methods such as field surveys, in-depth interviews, questionnaires, and mapping techniques in an Indonesian kampung, this study seeks to analyze the interplay between the artist's creativity, the depicted imageries, the social-cultural objectives, and the economic advantages associated with place attachment. The findings of this study highlight that the strong emotional bond between the community and the location is greatly influenced by factors such as shared identity, the distinctiveness of the place, and its appeal. This research significantly contributes to the ongoing discussions surrounding place-making, city branding, and the competitive advantage of cities.
Economic integration of South Caucasus countries: Current potential and main directions
Authors: Bayramova Laman
Published: August 2023

The South Caucasus region, comprising Armenia, Azerbaijan, and Georgia, has witnessed significant political and economic developments in recent years. This article explores the current potential and main directions for economic integration among these countries. First, the article examines the economic landscape of the South Caucasus, highlighting the unique strengths and challenges faced by each country. It analyzes key sectors such as energy, agriculture, tourism, and manufacturing, and explores the potential for cross-border collaboration and trade. The article then delves into the existing frameworks for economic integration in the region, including the Eurasian Economic Union, the Commonwealth of Independent States, and bilateral trade agreements. It evaluates the benefits and limitations of these frameworks and discusses the potential for deeper integration among South Caucasus countries. Next, the article explores the main drivers of economic integration in the region. It discusses the role of infrastructure development, including transportation and energy networks, in facilitating trade and connectivity. It also examines the importance of institutional reforms, harmonization of regulations, and investment promotion to foster economic cooperation. Finally, the article identifies key recommendations for policymakers and stakeholders to realize the potential of economic integration in the South Caucasus. Overall, this article provides a comprehensive overview of the current potential and main directions for economic integration among South Caucasus countries. It highlights the importance of regional cooperation and outlines strategies to harness the economic opportunities that integration can bring.
Vacuum-Assisted Venous Drainage: To Air or Not To Air, That Is the Question. Has the Bubble Burst?
Authors: Willcox Timothy W.
Published: August 2023

Assisted venous drainage is a recent development in cardiopulmonary bypass (CPB) and was introduced to overcome limitations in achieving adequate blood flow through small diameter cannulas used in minimally invasive surgery. The more common application, vacuum assisted venous drainage (VAVD) is now widely used in both adult and pediatric CPB. During a clinical investigation into pharmacological cerebral protection at Green Lane Hospital, we repeatedly observed evidence of emboli in the right common carotid artery following both entrainment of air into the venous line, and also, reductions in the blood level of the hard-shell venous reservior. We subsequently embarked upon a series of in vitro experiments designed to identify sources of emboli from the CPB circuit, and to evaluate the ability of CPB circuit components to remove air entrained into the venous line under conditions of both gravity and vacuum assisted venous drainage. Initial experiments revealed design features of certain hard-shell venous reservoirs that generated gaseous emboli. In further studies using adult circuits, entrainment of air into the venous line under conditions of conventional gravity venous drainage resulted in emboli distal to the arterial filter. When these studies were repeated using VAVD, arterial line emboli increased eight to tenfold. Initial experiments with a pediatric circuit showed similar findings. Cerebral emboli during CPB have been positively correlated with increasing neurocognitive deficits. The application of VAVD has been employed clinically without any significant redesign of the components of the CPB circuit. While VAVD may be efficacious in certain scenarios, a thorough understanding of its influence on CPB is essential. Advantages must be balanced against potential hazards. The safe use of VAVD necessitates refinement of perfusion techniques, judicious choice of application, and further development of the CPB circuit.
Cerebral Emboli During Cardiopulmonary Bypass: Effect of Perfusionist Interventions and Aortic Cannulas
Authors: Borger Michael A. , Feindel Christopher M.
Published: August 2023

Neuropsychological impairment is a very common complication of cardiopulmonary bypass (CPB). The principal cause of postoperative cognitive impairment is thought to be cerebral microemboli during CPB. We recently investigated the effects of perfusionist interventions and aortic cannulation techniques on cerebral emboli production during coronary bypass (CABG) surgery. Patients undergoing isolated CABG were monitored with continuous transcranial Doppler ultrasonography of the middle cerebral artery. Perfusionist interventions were defined as injections of drugs into the CPB circuit or acquisition of blood samples from the CPB circuit. Patients were randomized to receive either standard cannulation of the ascending aorta or cannulation of the distal aortic arch. Cerebral emboli were detected in all patients. The number of emboli per minute was markedly higher during perfusionist interventions than during other time periods. Patients with increased perfusionist interventions had worse neuropsychological outcomes. Cannulation of the distal aortic arch, with placement of the cannula tip beyond the cerebral vessels, resulted in significantly less cerebral emboli than cannulation of the ascending aorta. Perfusionist interventions are a common source of cerebral microemboli during CPB, and may contribute to postoperative neuropsychological impairment. Care should be taken to minimize the introduction of air into the bypass circuit during CPB. Provided it is performed safely, distal aortic arch cannulation is a useful technique for reducing cerebral emboli during cardiac surgery.
Laboratory Evaluation of the Pressure Flow Characteristics of Venous Cannulas During Vacuum-Assisted Venous Drainage
Authors: Humphries Keri , Sistino Joseph J.
Published: August 2023

Vacuum-assisted venous drainage (VAVD) is frequently used to increase venous return through smaller venous cannula and reduced venous line size. The purpose of this study is to determine the maximal flow rates achieved through various venous cannula with varying amounts of negative pressure applied during VAVD. The first test circuit consisted of 25 different venous cannulae connected to 3/8 inner diameter tubing on the positive side of a centrifugal pump. Flows through the cannula were measured at a line pressure of 20, 40, 60, and 80 mmHg. The second circuit consisted of the test cannula connected to 3/8-in inner diameter tubing, a hard-shell venous reservoir, and flow probe placed on the venous line. Using a vacuum regulator and venous line pressure monitor, flow rates were measured through each cannula at −20, −40, −60, and −80 mmHg of vacuum. The results show a mean correlation of 0.989 between the two methods of flow measurement (p < .001). Mean flow rates were established at 40 and 80 mmHg using both methods. For each 40 mmHg increase using vacuum, blood flow was increased by 42.08 ± 0.09%. These data have been incorporated into a chart to allow the perfusionist to identify the negative pressure necessary to achieve venous return when using specific venous cannula during VAVD.
Isolated Limb Perfusion: A Literature Review
Authors: Schaadt Jennifer , Crowley Richard , Miller Danielle , Kavanah Maureen
Published: August 2023

Through patient education, biological research, and technological advances, the rate of many cancers in the United States of America is declining. However, the incidence of melanoma is rising steadily, as are the efforts and resources allocated to its treatment. Isolated limb perfusion, ILP, is a standard of care for treating recurrent malignant melanoma confined to a limb. Although an extracorporeal procedure, only a small percentage of perfusionists are experienced regarding ILP’s indications and performance techniques. Use of ILP may increase as the incidence of melanoma increases. This two-part review is designed to familiarize the perfusionist with the procedure and the disease it treats. Part I reviews the history of isolated limb perfusion, the diagnosis and classification of malignant melanoma, and the applicability of ILP in its treatment. Part II details a procedural overview and technical considerations of the therapy from the perfusionist perspective. The review concludes with patient selection, outcomes, and the future of ILP as well as other applications for the hyperthermic regional delivery of chemotherapy using extracorporeal technology.
Impella: A Miniaturized Cardiac Support System in an Era of Minimal Invasive Cardiac Surgery
Authors: Vercaemst Leen , Vandezande Eddy , Janssens Patrick , Yvan Taverniers , Peter Demuylder , Meyns Bart
Published: August 2023

In modern coronary bypass surgery, new objectives have been set based upon a minimal invasive approach: beating heart surgery is the new trend to follow, although this might not be feasible in more complex cases. In these cases, the beating heart could be supported by a mechanical device, preferably a device with minimal invasive features to fit in this new approach. For this purpose, two intravascular blood pumps were developed: the Intracardiac Pump LV for left ventricular support and the Intracardiac pump RV for right ventricular support. (Impella Cardiotechnik, Aachen, Germany) The Impella pumps are rotary blood pumps of the axial flow type and produce 4.2 L/min at physiological pressure differences and a rotational speed of 32,500 rotations/min. These micropumps can widen the indications of beating heart surgery by sustaining hemodynamic stability and protecting the heart from warm ischemia. The current concept is aimed at bridging a procedure. Therefore, the proof of safe duration of usage has not been extended beyond 6 hours. As the pump-flow is based on standard pressure-flow curves for each so-called “performance level” (resulting from in-vitro experiments), an investigation was conducted to compare this relationship in the in-vitro trials with the findings in pumpsupported patients undergoing coronary bypass surgery. It could be concluded that the intracardiac pump is efficacious in assisting coronary bypass surgery.
How Does the Age of a Blood Sample Affect It’s Activated Clotting Time? Comparison of Eight Different Devices
Authors: Searles Bruce , Nasrallah Fadi , Darling Edward , Yarcusko Sarah
Published: August 2023

Monitoring activated clotting time (ACT) during extracorporeal procedures is virtually universal. The ACT test is usually performed immediately following blood collection. However, certain situations may occur that delay rapid measurement. It is unknown how an aged blood sample affects the ACT measurement. It is hypothesized that the ACT will be affected as a blood sample ages. Multiple blood samples were taken from six patients undergoing cardiopulmonary bypass (CPB). Samples were divided into two groups, heparinized (H) and unheparinized (UH). ACT/HMT tests were performed with each sample on eight devices (Array Actalyke, Gem PCL, Hemochron Jr. Signature, Hemochron Response, Hemochron 801, Hemotec HMS, Rapidpoint Coag, and Sonoclot II) at three different sample ages [<60 s (fresh blood), 10 min, and 15 min after sample collection. ACT/HMT results of aged samples (10 min and 15 min after sample collection] were compared to ACT/HMT results for fresh blood using a repeated measures analyses of variance (ANOVA) with Student’s–Newman-Keuls post hoc test. In the unheparinized group, no device produced an ACT significantly different from the fresh sample counterpart at the 10 min time point. At the 15 min time point, the Hemochron 801 produced a significantly lower average ACT when compared to the fresh sample. (120±25 vs. 135±15 s). In the heparinized group, the Actalyke device produced results with 10 and 15 min aged blood that were significantly longer than fresh blood sample results (ACT <60 s = 426±66, 10 min = 457±82, 15 min = 450±68 s, p< .05). No other device produced significant differences for either time period. Based on this limited sample population, it seems that accurate ACT may be performed on blood samples up to 15 min old in many devices.
Comparison of Five Point-of-Care Prothrombin and Activated Partial Thromboplastin Time Devices Based on Age of Blood Sample
Authors: Searles Bruce , Nasrallah Fadi , Graham Susan , Lajara Ribana Blanco
Published: August 2023

Delays in processing statium (STAT) blood samples have led to the production of an increasing number of point-of-care tests. Product inserts recommend measuring blood samples immediately after procurement, suggesting that delays may invalidate the test results. We studied the effect of the age of blood samples on point-of-care (POC) prothrombin time (PT) and an activated partial thromboplastin time (aPTT) result. Informed consent was obtained from 11 patients undergoing cardiopulmonary bypass (CPB). Blood samples (40 mL) were taken from each patient. Each blood sample was used to perform five PT tests and six aPTT tests on five POC devices (Gem PCL, Hemochron 801, Hemochron Jr. Signature, Hemochron Response, Rapidpoint Coag) at three different sample ages [<60 s (fresh blood), 10 and 18 min after sample collection]. Blood samples were procured in a plastic syringe devoid of air bubbles, which was left undisturbed between tests but was gently agitated before initiating the 10- and 18-min tests. For tests requiring citrated whole blood, a fraction of each sample was anticoagulated (3.8% citrate) at each age. Statistical analysis was used for comparison of test results for fresh blood to aged samples (10 and 18 min). Test values were recorded as International Normalized Ratio (INR) and seconds for PT and aPTT, respectively. Two devices, the Hemochron 801 and Hemochron response showed statistically, although not clinically, significant variation in PT test results when the samples were aged to 10 and 18 minutes. As for aPTT results, Hemochron 801, Hemochron response, Hemochron Jr. signature, and Gem PCL showed statistically significant variation at 18 minutes. One device (Hemochron 801) reported results with 10-min aged blood that were statistically different from fresh blood. None of the aPTT tests results from any device produced results with aged blood that were clinically different from fresh blood. This study suggests that, in the tests evaluated, blood samples that have aged 10 or 18 min will produce clinically relevant aPTT and PT results, respectively.
Trillium™-Coated Oxygenators in Adult Open-Heart Surgery: A Prospective Randomized Trial
Authors: Dickinson Timothy , Mahoney C. B. , Simmons Mark , Marison Angela , Polanski Paul
Published: August 2023

This randomized, prospective clinical trial examines the impact of the use of Trillium™ biopassive surface coating on clinical outcomes after cardiopulmonary bypass (CPB) that may be induced by contact of blood elements with foreign surfaces. The study consisted of 98 consecutive patients randomly assigned to either a CPB circuit that consisted of a Trillium-coated Affinity open reservoir oxygenator or a CPB circuit with an uncoated Affinity open reservoir oxygenator. The operative procedure performed on all 98 patients consisted of either coronary artery bypass graft (CABG), valve, or a combination of the two. Exclusion criteria consisted of patients who presented to the operating room in circulatory arrest. Trillium biopassive surface coating resulted in improved clinical outcomes and fewer adverse events when compared to the control group. Significantly, fewer patients required no blood products (18.3% in the control group vs. 32.7% in the treatment group), even though the control group had a significantly higher pre-bypass hematocrit. Postoperative atrial fibrillation (24.5% vs. 16.3%) and reoperation for bleeding (10.2% vs. 4.1%) showed a much lower incidence in the Trillium group. Significance was not reached because of the small sample size resulting in low power. Trillium circuits result in improved patient outcomes in the treatment group when compared to the control circuit group.
A Reusable Training Circuit for Cardiopulmonary Bypass
Authors: Millette Guy , Weerasena Nihal , Cornel Garry , Broecker Lothar
Published: August 2023

At the turn of the millennium, perfusion teaching programs are faced with significant difficulties. The number of students in pediatric perfusion training has increased, and more importantly, the number of pediatric open-heart procedures has decreased because of a variety of reasons. Hence, they could barely satisfy the minimum requirements of pediatric cases established by the teaching programs. The idea of “a teaching circuit” that could reproduce and simulate cardiopulmonary bypass was designed. The trainee is able to manipulate the cardiopulmonary bypass circuit according to patient responses, to perform perfusion related-maneuvers in establishing and maintaining hemodynamic stability. The aim of this study was to simulate a patient on CPB, maintain stability during varying clinical situations, and then to wean the patient off CPB. The equipment used was reusable and nonsterile.
Comparison of Blood Gas and Electrolyte Test Results from the Gem-Premier and the ABL-70 versus a Conventional Laboratory Analyzer
Authors: Walton Howard G. , Boucher David M. , Marroquin Rafael
Published: August 2023

Blood gas analyzers serve a critical role in providing information that reflects patient homeostasis. This study was undertaken to evaluate the accuracy, reliability, consistency, and bias of the Radiometer ABL-70 point of care blood gas analyzer. Thirty samples were gathered for analysis of pH, pCO2, pO2, sodium, potassium, sodium bicarbonate, and base excess. Twenty-nine samples were gathered for hematocrit, 31 for ionized calcium, and 33 for venous pO2 and saturations. The data were compared with the Gem-Premier point of care analyzer and the hospital blood gas machine and electrolyte analyzer. There was statistical significance between the pH, pCO2, sodium, potassium, calcium, hematocrit, and venous pO2 and saturations when comparing the ABL-70 with the Gem-Premier. When comparing the ABL-70 with the Corning 278/270 blood gas machine/Co-Ox, the AVL-9180, and the Dimension XL, there was statistical significance seen between the pH, pCO2, pO2, sodium, calcium, hematocrit, and base excess. Although this statistical significance was observed between the ABL-70 and the other analyzers, the significance was not of clinical importance. The ABL-70 demonstrated acceptable accuracy, reliability, consistency, and bias.
Quality of Red Blood Cells Using Autotransfusion Devices: A Comparative Analysis
Authors: Serrick Cyril J. , Scholz Mary , Melo Arthur , Singh Onkar , Noel Dionne
Published: August 2023

Cell salvage devices are routinely used to process and wash red blood cells (RBCs) shed during surgical interventions. Although the principle theory of cell saving is the same, the actual process to achieve this is very different from one device to another. The purpose of this study was to compare the quality of washed, concentrated RBC produced by five very different cell-saving devices, specifically the Cobe BRAT 2, Medtronic Sequestra 1000, Haemonetics Cell Saver 5, Medtronic Autolog, and the Fresenius CATS. Reservoir and washed red blood cells were analyzed for hematocrit (Hct), platelets (PLT), leukocytes (WBC), potassium (K+), heparin, plasma-free hemoglobin (PFH), RBC mass recovery and recovery rate. The Haemonetics and BRAT 2 had the highest RBC recovery. All devices adequately removed heparin and potassium. The Medtronic Autolog had the highest removal of platelets and PFH; whereas, the BRAT had the lowest. Although the Autolog had the highest leukocyte removal, leukocytes were not adequately washed out by any of the autotransfusion devices. In conclusion, although all cell- saving devices use the same theory of centrifugation, the actual quality of the washed RBC product differs widely from one device to another.
Maintaining Adequate Anticoagulation on Extracorporeal Membrane Oxygenation Therapy: Hemochron Junior Low Range versus Hemochron 400
Authors: Colby Christopher E. , Sheehan Arlene , Benitz William , Van Meurs Krisa , Halamek Louis P. , Moss R. Lawrence
Published: August 2023

Extracorporeal membrane oxygenation (ECMO) therapy requires that patients be anticoagulated to prevent clotting and thrombotic complications. There are several bedside whole blood microcoagulation systems available to determine activated clotting time (ACT) levels. Many ECMO centers use Hemochron (International Technidyne, Edison, NJ) products to determine ACT levels. During the study period, we used the Hemochron 400 and then changed to the Hemochron Junior Low Range. There were two specific aims of this study. First, to determine if there was a difference in ACT levels measured by these two distinct Hemochron products both marketed for the use in ECMO therapy. Second, to determine if the differing ACT levels produced by these two devices affected clinical outcomes. We compared ACT levels between two devices on 70 paired blood specimens obtained from four neonatal ECMO patients receiving heparin. A retrospective review of 77 ECMO patients was performed to analyze frequency of circuit emergencies and length of ECMO circuit life while using the two products. In lower ACT ranges, the Hemochron Jr. LR consistently yielded higher ACT values than the Hemochron 400. In higher ACT ranges, the Hemochron Jr. LR consistently yielded lower ACT values than the Hemochron 400. Without calibration, after changing devices, this discrepancy led to shorter circuit life and more circuit clotting complications. After calibration and adjustment in target ACT values, there was a trend toward longer circuit life, and there were fewer clotting complications. There is a difference in the ACT values produced by Hemochron 400 and Hemochron Jr. LR. Failure to calibrate target ACT levels after changing machines may lead to shorter circuit life and more clotting complications.
The Neurologic Sequelae of Cardiopulmonary Bypass-Induced Cerebral Hyperthermia and Cerebroprotective Strategies
Authors: Scheffer Todd , Sanders D. Bradford
Published: August 2023

Cerebral hyperthermia during the rewarming phase of cardiopulmonary bypass (CPB) is associated with adverse outcomes. Cerebral hyperthermia can exacerbate a preexisting injury prior to rewarming, and may be damaging in itself. Temperature and cerebral metabolic rate (CMRO2) play a vital role in cerebral autoregulation. Therefore, hyperthermia can have a strong impact on cerebral oxygen transfer, and neurologic outcome. Glutamate levels can increase during cerebral hyperthermia, leading to eventual cell death. Rapid rewarming decreases jugular venous hemoglobin saturation, creating a mismatch between cerebral oxygen consumption and delivery. With these ill effects in mind, cerebral protection during CPB is imperative. Special attention should be given during rewarming to prevent these harmful outcomes. Pharmacologic agents such as sodium nitroprusside can be used to assist the rewarming process. Temperature management is the key component during the rewarming phase of CPB in the prevention of cerebral hyperthermia.
The Effect of Electrolyte Imbalance on Weaning from Cardiopulmonary Bypass: An Experimental Study
Authors: Stammers Alfred H. , Mills Nancy , Kmiecik Scott A. , Petterson Craig M. , Liu Jun-Li , Nichols Jeffery D. , Kohtz Ryan J. , Zheng Hong , Hock Lynette M.
Published: August 2023

An imbalance in electrolyte concentration during separation from cardiopulmonary bypass (CPB) may lead to a disruption in excitation–contraction coupling resulting in a failure to wean. The etiology of myocardial dysfunction is multifactorial, and includes alterations in acid-base balance, glucose metabolism, and cellular function. The purpose of this study was to assess the effect of hyperkalemia on myocardial function during separation from CPB. A porcine model (n = 5) of hypothermic (32°C) CPB was used where hyperkalemia [K+ (6.5 ± 1.0)] was created before weaning. A 3-minute weaning process was initiated once normothermia was achieved. Mixed venous and arterial samples were obtained during CPB, weaning, and 10 minutes postbypass. Samples were assayed for [K+], [Ca++], glucose, pH, CPK-MB, and lactic acid levels. Hyperkalemia resulted in the generation of severe arrhythmias in all animals. During the immediate prewean period, there was a significant correlation between venous [K+] and pH (p < .01, r2 = .891). Arterial pH did not change during the weaning or post-CPB period, while venous pH declined significantly throughout the same period (7.35 ± 0.75 to 7.20 ± 0.17, p < .05). No other measured variables correlated with hyperkalemia. In summary, hyperkalemia caused a significant decline in venous pH evidenced in the early separation period, but had no effect on other variables. Therefore, measurement of venous pH may be an early marker indicating myocardial dysfunction and dysrhythmia.
Use of Aprotinin in Patients Undergoing Deep Hypothermic Circulatory Arrest: A Review
Authors: Huffman-Egger Suzanne
Published: August 2023

Hemostatic derangements continue to be a major clinical challenge during thoracic aortic surgery using deep hypothermic circulatory arrest despite advances in surgical and pharmacologic therapy. Aprotinin, a broad-based, nonspecific serine protease inhibitor has been advocated for prophylactic use in cardiac surgery to decrease perioperative blood loss and blood transfusions. Its efficacy has been documented in several studies throughout the United States and Europe. Currently, aprotinin is advocated for use in patients undergoing cardiopulmonary bypass in the course of coronary artery bypass graft surgery. A review of current studies is provided that examines aprotinin usage under deep hypothermic circulatory arrest.
The Society of Thoracic Surgeons, The Society of Cardiovascular Anesthesiologists, and The American Society of ExtraCorporeal Technology: Clinical Practice Guidelines for Cardiopulmonary Bypass—Temperature Management during Cardiopulmonary Bypass
Authors: Engelman Richard , Baker Robert A. , Likosky Donald S. , Grigore Alina , Dickinson Timothy A. , Shore-Lesserson Linda , Hammon John W.
Published: August 2023

To improve our understanding of the evidence-based literature supporting temperature management during adult cardiopulmonary bypass, The Society of Thoracic Surgeons, the Society of Cardiovascular Anesthesiology and the American Society of ExtraCorporeal Technology tasked the authors to conduct a review of the peer-reviewed literature, including 1) optimal site for temperature monitoring, 2) avoidance of hyperthermia, 3) peak cooling temperature gradient and cooling rate, and 4) peak warming temperature gradient and rewarming rate. Authors adopted the American College of Cardiology/American Heart Association method for development clinical practice guidelines, and arrived at the following recommendation.
Vacuum-Assisted Venous Drainage: A 2014 Safety Survey
Authors: Gambino Rachel , Searles Bruce , Darling Edward M.
Published: August 2023

Despite the widespread use of vacuum-assisted venous drainage (VAVD) and case reports describing catastrophic incidents related to VAVD, there is a lack of data cataloging specific safety measures that individuals and institutions have incorporated into their VAVD practices for the prevention of these incidents. Therefore, the purpose of this study is to survey the perfusion community to gather data on VAVD practices, and to compare these current practices with literature recommendations and the American Society of ExtraCorporeal Technology (AmSECT) Standards and Guidelines. In September 2014, a survey was distributed via PerfList and PerfMail, and by direct e-mail to members of the New York State Society of Perfusionists, targeting certified clinical perfusionists in New York State. Survey topics pertaining to VAVD practice included 1) equipment, 2) pressure monitoring and alarms, 3) protocols, checklists, and documentation, and 4) VAVD-related incidents. Of ∼200 certified clinical perfusionists who live and/or work in New York State (NYS), 88 responded (42%). Most respondents (90.1%) report they use VAVD. Of these, 87.3% report that they monitor VAVD pressure, with 51.6% having audible and visual alarms for both positive and excessive negative pressures. At the institutional level, 61.2% of respondents reported that there is a protocol in place at for their team limiting negative pressure in the reservoir, 28.4% document VAVD pressure in the pump record, and AmSECT’s three recommended VAVD checklist items are met with 53.7%, 55.1%, and 33.8% compliance. In conclusion, the results of this study reveal that the use of VAVD has increased and has become nearly universal in 2014. There is high compliance to some of the literature recommendations and AmSECT Standards and Guidelines, however, there are still some gaps between current practices and these recommendations. Continued improvement, both at the individual and institutional levels, will help to improve patient safety by preventing untoward events from occurring while using VAVD.
A Novel Method to Detect an Oxygenator Defect Prior to Cardiopulmonary Bypass Initiation
Authors: Fernandes Armindo , Laliberte Eric , Toledano Karine , Demers Philippe
Published: August 2023

Cardiopulmonary bypass (CPB) is a common practice in our era. The medical technology used for cardiac surgery goes through rigorous testing to ensure its safety. Unfortunately, it is not fail proof. Oxygenator failures are a rare occurrence but may lead to catastrophic events. We present a case where the preparation for initiating CPB was complicated by an oxygenator defect. After thorough examination, the oxygenator was found leaking from the gas exhaust port suggesting a disruption in continuity of the fibers. This was found by the vigilance of the perfusionist and a creative method to quickly assess the integrity of the oxygenation device. We describe a simple technique to help diagnose an oxygenator leak.
Heart Failure in Thyrotoxic Cardiomopathy: Extracorporeal Membrane Oxygenation Treatment for Graves’ Disease
Authors: Allencherril Joseph , Birnbaum Itamar
Published: August 2023

Thyrotoxicosis-induced cardiomyopathy and consequent heart failure is one of the most grave complications of uncontrolled hyperthyroidism. In such patients, early recognition of thyrotoxicosis, and directed antithyroid therapy can lead to rapid normalization of left ventricular function. Herein, we present a case of a 29-year-old male with Graves’ disease who developed heart failure with severe deterioration of left ventricular function and eventually, circulatory collapse. Height and weight of the patient were 1.8 m and 84 kg, respectively. The patient was placed on venoarterial extracorporeal membrane oxygenation for immediate circulatory support, with restoration of cardiac function after 6 days.
Perfusion Electronic Record Documentation Using Epic Systems Software
Authors: Riley Jeffrey B. , Justison George A.
Published: August 2023

The authors comment on Steffens and Gunser’s article describing the University of Wisconsin adoption of the Epic anesthesia record to include perfusion information from the cardiopulmonary bypass patient experience. We highlight the current-day lessons and the valuable quality and safety principles the Wisconsin-Epic model anesthesia-perfusion record provides.
Arterial Limb Microemboli during Cardiopulmonary Bypass: Observations from a Congenital Cardiac Surgery Practice
Authors: Matte Gregory S. , Connor Kevin R. , Liu Hua , DiNardo James A. , Faraoni David , Pigula Frank
Published: August 2023

Gaseous microemboli (GME) are known to be delivered to the arterial circulation of patients during cardiopulmonary bypass (CPB). An increased number of GME delivered during adult CPB has been associated with brain injury and postoperative cognitive dysfunction. The GME load in children exposed to CPB and its consequences are not well characterized. We sought to establish a baseline of arterial limb emboli counts during the conduct of CPB for our population of patients requiring surgery for congenital heart disease. We used the emboli detection and counting (EDAC) device to measure GME activity in 103 consecutive patients for which an EDAC machine was available. Emboli counts for GME <40 μ and >40 μ were quantified and indexed to CPB time (minutes) and body surface area (BSA) to account for the variation in patient size and CPB times. Patients of all sizes had a similar embolic burden when indexed to bypass time and BSA. Furthermore, patients of all sizes saw a three-fold increase in the <40 μ embolic burden and a five-fold increase in the >40 μ embolic burden when regular air was noted in the venous line. The use of kinetic venous-assisted drainage did not significantly increase arterial limb GME. Efforts for early identification and mitigation of venous line air are warranted to minimize GME transmission to congenital cardiac surgery patients during CPB.
Novel Applications of Modified Ultrafiltration and Autologous Priming Techniques to Reduce Blood Product Exposure on ECMO
Authors: Neal James R. , Blau Caitlin L. , Cornelius Amanda M. , Pike Roxann B. , Dearani Joseph A. , Mora Bassem N.
Published: August 2023

Patients needing the assistance of extracorporeal membrane oxygenation (ECMO) are at risk of hemodilution and, in some instances, may require exposure to large amounts of allogeneic blood products. Patient outcomes can be improved by taking steps to reduce transfusions and hemodilution. Currently, modified ultrafiltration (MUF) is used across the world to reduce hemodilution after cardiopulmonary bypass (CPB). Another common technique during bypass initiation is autologous priming. By applying modified versions of these techniques, ECMO patients may potentially benefit. Usually, patients requiring immediate transition from CPB to ECMO are not stable enough to tolerate MUF. Through alterations of the CPB and ECMO circuit tubing, MUF can be performed once on ECMO. Another technique to potentially lower the transfusion requirements for ECMO patients is a complete circuit blood transfer during an ECMO circuit exchange. While selective component changes are preferred if possible, occasionally a complete circuit change must be done. To minimize hemodilution or prevent priming with blood products, the original ECMO circuit's blood can be transferred to the new ECMO circuit before connecting to the patient. Both of these techniques, in our opinion, helped to reduce the number of transfusions that our ECMO patients have seen during these critical time periods.
A Modified EXIT-to-ECMO with Optional Reservoir Circuit for Use during an EXIT Procedure Requiring Thoracic Surgery
Authors: Matte Gregory S. , Connor Kevin R. , Toutenel Nathalia A. , Gottlieb Danielle , Fynn-Thompson Francis
Published: August 2023

A 34 year old mother with a history of polyhydraminos and premature rupture of membranes presented for an ex utero intrapartum treatment (EXIT) procedure to deliver her 34 week gestation fetus. The fetus had been diagnosed with a large cervical mass which significantly extended into the right chest. The mass compressed and deviated the airway and major neck vessels posteriorly. Imaging also revealed possible tumor involvement with the superior vena cava and right atrium. The plan was for potential extracorporeal membrane oxygenation (ECMO) during the EXIT procedure (EXIT-to-ECMO) and the potential for traditional cardiopulmonary bypass (CPB) for mediastinal tumor resection. A Modified EXIT-To-ECMO with Optional Reservoir (METEOR) circuit was devised to satisfy both therapies. A fetal airway could not be established during the EXIT procedure and so the EXIT-to-ECMO strategy was utilized. The fetus was then delivered and transferred to an adjoining operating room (OR). Traditional cardiopulmonary bypass with a cardiotomy venous reservoir (CVR) was utilized during the establishment of an airway, tumor biopsy and partial resection. The patient was eventually transitioned to our institution's standard ECMO circuit and then transferred to the intensive care unit. The patient was weaned from ECMO on day of life (DOL) eight and had a successful tumor resection on DOL 11. The patient required hospitalization for numerous interventions including cardiac surgery at 4 months of age. She was discharged to home at 5 months of age.