The Experts below are selected from a list of 1815 Experts worldwide ranked by ideXlab platform
Christopher M Feindel - One of the best experts on this subject based on the ideXlab platform.
-
Cerebral emboli during cardiopulmonary bypass: effect of Perfusionist interventions and aortic cannulas.
The journal of extra-corporeal technology, 2002Co-Authors: Michael A Borger, Christopher M FeindelAbstract: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.
-
neuropsychologic impairment after coronary bypass surgery effect of gaseous microemboli during Perfusionist interventions
The Journal of Thoracic and Cardiovascular Surgery, 2001Co-Authors: Michael A Borger, Charles M Peniston, Richard D Weisel, Marie Vasiliou, Robin Green, Christopher M FeindelAbstract:Abstract Objective: Neuropsychologic impairment is a common complication of coronary bypass surgery. Cerebral microemboli during cardiopulmonary bypass are the principal cause of cognitive deficits after coronary bypass grafting. We have previously demonstrated that the majority of cerebral emboli occur during Perfusionist interventions (ie, during the injection of air into the venous side of the cardiopulmonary bypass circuit). The purpose of this study was to determine whether an increase in Perfusionist interventions is associated with an increased risk of postoperative cognitive impairment. Methods: Patients undergoing elective coronary artery bypass grafting (n = 83) underwent a battery of neuropsychologic tests preoperatively and 3 months postoperatively. Patients were divided into 2 groups according to the median value of Perfusionist interventions during cardiopulmonary bypass. Group 1 patients (n = 42) had fewer than 10 Perfusionist interventions, and group 2 patients (n = 41) had 10 or more interventions. Results: The 2 groups of patients were similar for all preoperative, intraoperative, and postoperative variables, with the exception of longer cardiopulmonary bypass times in group 2 patients ( P Conclusions: Introduction of air into the cardiopulmonary bypass circuit by Perfusionists, resulting in cerebral microembolization, may contribute to postoperative cognitive impairment. (J Thorac Cardiovasc Surg 2001; 121:743-9)
-
Neuropsychologic impairment after coronary bypass surgery: effect of gaseous microemboli during Perfusionist interventions.
The Journal of thoracic and cardiovascular surgery, 2001Co-Authors: Michael A Borger, Charles M Peniston, Richard D Weisel, Marie Vasiliou, Robin Green, Christopher M FeindelAbstract:Neuropsychologic impairment is a common complication of coronary bypass surgery. Cerebral microemboli during cardiopulmonary bypass are the principal cause of cognitive deficits after coronary bypass grafting. We have previously demonstrated that the majority of cerebral emboli occur during Perfusionist interventions (ie, during the injection of air into the venous side of the cardiopulmonary bypass circuit). The purpose of this study was to determine whether an increase in Perfusionist interventions is associated with an increased risk of postoperative cognitive impairment. Patients undergoing elective coronary artery bypass grafting (n = 83) underwent a battery of neuropsychologic tests preoperatively and 3 months postoperatively. Patients were divided into 2 groups according to the median value of Perfusionist interventions during cardiopulmonary bypass. Group 1 patients (n = 42) had fewer than 10 Perfusionist interventions, and group 2 patients (n = 41) had 10 or more interventions. The 2 groups of patients were similar for all preoperative, intraoperative, and postoperative variables, with the exception of longer cardiopulmonary bypass times in group 2 patients (P <.001). Group 2 patients had lower mean scores on 9 of 10 neuropsychologic tests, with 3 (Rey Auditory Verbal Learning, Digit Span, and Visual Span) being statistically significant. Group 2 patients had worse cognitive test scores, even when controlling for increased bypass times. Group 2 patients had a nonsignificant trend toward an increased prevalence of neuropsychologic impairment 3 months postoperatively. Introduction of air into the cardiopulmonary bypass circuit by Perfusionists, resulting in cerebral microembolization, may contribute to postoperative cognitive impairment.
-
Cerebral microemboli during cardiopulmonary bypass: increased emboli during Perfusionist interventions
The Annals of thoracic surgery, 1999Co-Authors: Ruth L. Taylor, Michael A Borger, Richard D Weisel, Ludwig Fedorko, Christopher M FeindelAbstract:Abstract Background . Microemboli to the cerebral circulation occur during cardiopulmonary bypass (CPB) and can contribute to postoperative neurologic dysfunction. Cerebral microemboli are known to occur during specific surgical interventions, but the source of a large proportion of emboli remains unexplained. We investigated whether interventions by the Perfusionist could account for the appearance of cerebral microemboli. Methods . Transcranial Doppler ultrasonography was used to continuously monitor the middle cerebral artery of 18 patients undergoing coronary artery bypass grafting. The CPB circuit consisted of a softshell venous reservoir, a hollow-fiber membrane oxygenator, and a 32-μm arterial filter. The mean embolic rate was calculated for three time periods: (1) during surgical interventions (aortic cannulation and decannulation, cross-clamp application and removal, CPB start and end, and start of cardiac ejection); (2) during Perfusionist interventions (blood sampling and drug administration into the venous reservoir); and (3) during baseline (all other time periods during CPB). Results . Microemboli were detected in all patients (mean ± standard deviation, 207 ± 142 per patient, median, 132). The number of emboli per minute was significantly ( p Conclusions . Interventions by the Perfusionist account for a large proportion of previously unexplained cerebral microemboli during CPB. These emboli likely represent air bubbles that are not eliminated by the arterial line filter. Although further studies of additional types of CPB circuits are required, we believe that air in the venous reservoir should be avoided whenever possible to minimize the risk of neurologic injury.
Lex Tepaske - One of the best experts on this subject based on the ideXlab platform.
-
instrumentarium van de klinisch Perfusionist
Critical Care, 2009Co-Authors: Lex Tepaske, Jacqueline Den BandtbloemzaadAbstract:In het vorige nummer van Critical Care hebben we uitvoerig het ontstaan van perfusie en met name de hart-longmachine besproken. In dit artikel gaan we dieper in op de werkzaamheden van de klinisch Perfusionist. We kijken naar de verschillende apparaten die de Perfusionist kan bedienen en beschrijven in het kort in welke setting u deze apparaten kunt tegenkomen.
-
de wereld van de Perfusionist
Critical Care, 2009Co-Authors: Lex TepaskeAbstract:Bij operaties aan het hart is het prettig om het hart stil te kunnen leggen. Tijdens deze periode moet het bloed blijven stromen en voorzien worden van zuurstof. Dit wordt gedaan door de Perfusionist via perfusie. In dit artikel gaan we in op het ontstaan en de werking van perfusie.
Brad E. Vazales - One of the best experts on this subject based on the ideXlab platform.
-
A simple and safe technique of left ventricular venting.
The Annals of thoracic surgery, 1992Co-Authors: Edward F. Lundy, Craig J. Gassmann, Lawrence I. Bonchek, Ricky G. Smith, Mark W. Burlingame, Brad E. VazalesAbstract:Left ventricular venting has many physiologic and practical benefits. A venting technique is described that employs a simple, closed system which allows the Perfusionist to monitor left ventricular distention. By monitoring the left ventricular volume the Perfusionist can regulate the degree of negative pressure on the vent and thus reduce the chance of air entering the heart.
Costa, Eduardo Tavares - One of the best experts on this subject based on the ideXlab platform.
-
Brazilian Perfusionists And Arterial Roller Pump Adjustment: Comparison Between Static And Dynamic Calibration Method.
2015Co-Authors: Vieira Junior, Francisco Ubaldo, Antunes Nilson, Johannes Dantas De ,medeiros Júnior, Vieira, Reinaldo Wilson, Elio Barreto De ,carvalho Filho, Reis Junior, José Evaldo Cavalcante, Costa, Eduardo TavaresAbstract:Roller pumps play an important role in extracorporeal circulation. However, occlusion of the rollers should be adequately performed and this can be adjusted mainly by two methods: static and dynamic. To investigate how the Brazilian Perfusionists adjust arterial roller pumps in their services and evaluate the application of a Device to Assist Calibration (DAC) that facilitates roller adjustment by the dynamic calibration method. We installed a roller pump with accessories to perform adjustment by drop rate (static calibration) and dynamic calibration methods during the XXVIII Brazilian Congress of Extracorporeal Circulation. Perfusionists were asked to adjust the roller pump according to the procedure they usually do in their service. After each adjustment pressure was measured by dynamic calibration method with DAC. The research was approved by the Research Ethics Committee of UNICAMP, Nº 1144/2010. There were 56 Perfusionists in this study. Pressure average of 56 measurements of dynamic calibration was 434 ± 214 mmHg; 76% of measurements were within the recommended range for the use of the dynamic calibration method (between 150 and 500 mmHg). Brazilian Perfusionists tend to adjust roller pumps with less occlusive settings. The amplitudes of the dynamic calibration pressure tend to be smaller for more experienced Perfusionists because their skills increase with time. The device can be used by the Perfusionist to adjust roller pumps with greater accuracy and mainly repeatability in few minutes.26205-1
-
Brazilian Perfusionists and arterial roller pump adjustment: comparison between static and dynamic calibration method
Sociedade Brasileira de Cirurgia Cardiovascular, 2015Co-Authors: Vieira Junior, Francisco Ubaldo, Antunes Nilson, Johannes Dantas De ,medeiros Júnior, Vieira, Reinaldo Wilson, Elio Barreto De ,carvalho Filho, Reis Junior, José Evaldo Cavalcante, Costa, Eduardo TavaresAbstract:INTRODUCTION: Roller pumps play an important role in extracorporeal circulation. However, occlusion of the rollers should be adequately performed and this can be adjusted mainly by two methods: static and dynamic. OBJECTIVE: To investigate how the Brazilian Perfusionists adjust arterial roller pumps in their services and evaluate the application of a Device to Assist Calibration (DAC) that facilitates roller adjustment by the dynamic calibration method. METHODS: We installed a roller pump with accessories to perform adjustment by drop rate (static calibration) and dynamic calibration methods during the XXVIII Brazilian Congress of Extracorporeal Circulation. Perfusionists were asked to adjust the roller pump according to the procedure they usually do in their service. After each adjustment pressure was measured by dynamic calibration method with DAC. The research was approved by the Research Ethics Committee of UNICAMP, Nº 1144/2010. RESULTS: There were 56 Perfusionists in this study. Pressure average of 56 measurements of dynamic calibration was 434 ± 214 mmHg; 76% of measurements were within the recommended range for the use of the dynamic calibration method (between 150 and 500 mmHg). CONCLUSION: Brazilian Perfusionists tend to adjust roller pumps with less occlusive settings. The amplitudes of the dynamic calibration pressure tend to be smaller for more experienced Perfusionists because their skills increase with time. The device can be used by the Perfusionist to adjust roller pumps with greater accuracy and mainly repeatability in few minutes.INTRODUÇÃO: Bombas de roletes desempenham um papel importante na circulação extracorpórea. No entanto, a oclusão dos roletes das bombas deve ser realizada de forma adequada e estas podem ser ajustadas, principalmente por dois métodos: estático e dinâmico. OBJETIVO: Investigar como os Perfusionistas brasileiros ajustam as bombas de rolete arterial em seus serviços e testar o uso de um Dispositivo Auxiliar de Calibração que facilita o ajuste pelo método de calibração dinâmica. MÉTODOS: Foi instalada uma bomba de roletes com os acessórios necessários para a realização de sua calibração pelos métodos de velocidade de queda (calibração estática) e calibração dinâmica durante o XXVIII Congresso Brasileiro de Circulação Extracorpórea. Foi solicitado aos Perfusionistas que ajustassem uma bomba de roletes conforme procedimento normalmente utilizado em seu serviço. Após cada regulagem, foi medida a respectiva pressão pelo método de calibração dinâmica com o auxílio do dispositivo. O projeto foi aprovado pelo Comitê de Ética em Pesquisa da UNICAMP, sob Nº 1144/2010. RESULTADOS: Participaram da pesquisa 56 Perfusionistas. A média das 56 medidas de pressão de calibração dinâmica foi 434 ± 214 mmHg; 76% das medidas realizadas ficaram no intervalo preconizado para o uso da técnica de calibração dinâmica (entre 150 e 500 mmHg). CONCLUSÃO: Os Perfusionistas brasileiros tendem a calibrar bombas de roletes com ajustes menos oclusivos. As amplitudes das medidas de pressão de calibração dinâmica tendem a ser menores para Perfusionistas mais experientes. O dispositivo pode ser utilizado por Perfusionistas para ajustar bombas de roletes com maior precisão e, principalmente, repetitividade e em alguns minutos.20521
Frank Merkle - One of the best experts on this subject based on the ideXlab platform.
-
Comparison of a perfusion simulator to a clinical operating room: evaluation of eye tracking data and subjective perception. A pilot study.
Perfusion, 2020Co-Authors: Cynthia Pawelke, Frank Merkle, Dino Kurtovic, Sina Gierig, Gisela Müller-plathAbstract:With the aim of evaluating the perfusion simulator at the German Heart Center Berlin, similarity between simulation and clinical operation room (OR) was investigated regarding subjective perception and eye movement. Eight Perfusionists performed an operation on the heart-lung machine (HLM) wearing eye tracking glasses, each in real OR and simulator. The three most important phases for Perfusionists (going on bypass, cardioplegia administration and coming off bypass) were considered. Additional to eye tracking data as objective measure, questionnaires were completed, and interviews conducted afterwards. The structure of simulator and real OR is perceived as basically the same. Yet there are differences in the HLM-models used and the temporal sequence. Different perception of both situations is reported in interviews and reflected in significant differences in the rating scales (NASA-TLX) on three of six subscales. In eye tracking data, certain AOIs could be identified for the individual phases, both in OR and simulator-an indication of fundamental similarity. However, differences regarding the proportions of the individual AOIs, especially in the first and third phase, are leading to the assumption that the simulator, and especially the simulation process, is only valid to a limited extent regarding subjective perception and eye tracking data. The use of the simulator for (advanced) training is accepted and explicitly requested by Perfusionists. Yet further research is needed to identify the decisive factors (like simulation duration or additional tasks) for a valid execution in the simulator. Furthermore, a larger sample size should be regarded to allow statistical analysis.
-
Simulation-based training of critical events during cardiopulmonary bypass: importance of a critical events checklist.
Perfusion, 2020Co-Authors: Frank Merkle, Volkmar Falk, Dino Kurtovic, Andreas Matschke, Benjamin Haupt, Christoph StarckAbstract:Objectives:Evaluation of critical events training for clinical Perfusionists is necessary to improve this educational approach. Critical events checklists are effective in reducing clinical complic...
-
Simulation in perfusion: evaluating the efficacy of a specific training with eye-tracking.
Perfusion, 2020Co-Authors: Sina Gierig, Frank Merkle, Cynthia Pawelke, Gisela Müller-plathAbstract:Background:With the aim of integrating simulation training into the training of Perfusionists, we examined whether the participants were able to transfer a specific learning content to the same and...
-
from pump technicians to qualified health personnel the evolution of the Perfusionist profession
Interactive Cardiovascular and Thoracic Surgery, 2010Co-Authors: Frank MerkleAbstract:Dear Ladies and Gentlemen, The invention of a new profession is often linked to an evolution in science and technology. While the first experts on the application of extracorporeal circulation were recruited from laboratory technicians or physicians w1x, the subsequent evolution to a profession underwent several stages w2x. As in the US, the majority of cardiovascular Perfusionists in Europe today have a formal education, although this varies between countries w3x. The compentencies necessary to safely operate a heart–lung-machine and the related equipment are widespread. The expected future developments would seem to make the academic training of cardiovascular Perfusionists especially desirable w4x. As wide variation concerning the education and training of cardiovascular Perfusionists exists in Europe, an overseeing body regulating this education process was deemed necessary. The European Board of Cardiovascular Perfusion was founded in 1991 in order to unite European Perfusionists in their desire for equality of standards in both their training and in their professional status w5x. For this purpose, a democratic organization with representatives from the perfusion societies of all European countries which, at that time were members of the European Community (EC) or the European Free Trade Association (EFTA) was initiated. Supporting organizations of the European Board of Cardiovascular Perfusion include the European Association for Cardio-Thoracic Surgery (EACTS), the European Society for Cardio-Vascular Surgery (ESCVS) and the European Association for Cardio-Thoracic Anaesthesiologists (EACTA). The objectives of the European Board of Cardiovascular Perfusion are to:
-
Which competencies are necessary for clinical perfusion in Germany? Interviews with Perfusionists.
Perfusion, 2007Co-Authors: Frank MerkleAbstract:Background: The professional education of cardiovascular Perfusionists in Germany and the expertise required for successful practice have not often been studied. Here, the necessary skills for clinical cardiovascular Perfusionists are described.Method: The prerequisites for the practice of the profession, expected future developments and the question of the positioning of a future professional Perfusionist training within the educational system were discussed with ten experienced Perfusionists. These individuals were interviewed in a semi-standardized fashion following an interview manual and the interviews were evaluated using qualitative research methods.Results: The professional skills currently required of Perfusionists correspond to the list of activities published by the German Society of Cardiovascular Enginering. New areas are knowledge of management and, increasingly, social competence and self-management skills. Future tasks for Perfusionists will be more diversified than at present.Conclusion: ...