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Cardiac dysrhythmia management in the radiology department
Published in William H. Bush, Karl N. Krecke, Bernard F. King, Michael A. Bettmann, Radiology Life Support (Rad-LS), 2017
Asystole occurring in a procedural setting may in fact be profound bradycardia secondary to overwhelming parasympathetic tone,10 as distinct from asystole occurring as a result of, for example, myocardial infarction. Obviously the former has a much better prognosis and, although it is tempting to use atropine first because of this, epinephrine is a better initial choice for asystole. Not only will epinephrine accelerate any sinus activity potentially present, but it is also the one drug that preferentially preserves cerebral and coronary blood flow during cardiac arrest and CPR.15,23 Since asystole is a fatal ‘rhythm’, giving high doses (1.0–1.5 mg) of epi-nephrine is a ‘no-lose’ approach.34 Frequent use of epinephrine is advocated,10’15 and it can be given IV or by ET every few minutes while CPR is in progress. As with any cardiopulmonary emergency, detailed attention to the airway and adequacy of ventilation/oxygenation are of paramount importance in order to provide adequate tissue oxygenation and to facilitate respiratory correction of metabolic acidosis, both of which will improve the environment of the myocardium and favor successful conversion. Bicarbonate administration should ideally be guided by arterial blood gas determination.
Clinical Workflows Supported by Patient Care Device Data
Published in John R. Zaleski, Clinical Surveillance, 2020
Because the cardiovascular and respiratory systems of the patient are depressed during this postoperative stage, they require help in providing the body and all of its sub systems with oxygenated blood. One way to ensure that enough oxygen is received by the body is to ventilate the patient on high levels of pure oxygen. As the patient’s cardiovascular and respiratory systems regain their natural function, the amount of oxygen is reduced. Pulse oximetry is used and calibrated against arterial blood-gas (ABG) oxygenation measurements several times to verify the accuracy of these non-invasive pulse oximetry measurements.
Medical Applications of Fiber-Optic Sensors
Published in Krzysztof Iniewski, Ginu Rajan, Krzysztof Iniewski, Optical Fiber Sensors, 2017
For some analysis, pulse oximetry (described in later section) can be used, but such noninvasive technologies cannot replace arterial blood gas analysis as they cannot detect a high pO2 or define a safe lower saturation limit and cannot differentiate between various dyshemoglobinemias (abnormal hemoglobin derivatives that are incapable of binding O2).61
Parameters of high-frequency jet ventilation using a mechanical lung model
Published in Journal of Medical Engineering & Technology, 2022
Evgeni Kukuev, Evgeny Belugin, Dafna Willner, Ohad Ronen
Another limitation was posed by the inability to measure expiratory gases on an open-ventilation system lung model. Gas exchange in high-frequency jet ventilation is complex and its efficacy should always confirmed through evaluation of arterial blood gases. Ventilatory gases are a mixture of inspiratory and expiratory gases. Generally, during high-frequency jet ventilation, only oxygen and air are in use. About half of the inspiratory gas is derived from the air surrounding the patient’s head, through the Venturi effect [14]. While end-tidal carbon-dioxide (etCO2) monitoring is possible with high-frequency jet ventilation, it may not accurately reflect PaCO2; therefore, ventilatory parameters should be modified based on arterial blood gas analysis. In light of the poor overall understanding of high-frequency jet ventilation physics, in-vivo and human studies with supplemental measurements of arterial blood gases should be conducted to determine effects of ventilator settings on CO2 elimination, and intrathoracic pressure.
Management of out-of hospital cardiac arrest patients with extracorporeal cardiopulmonary resuscitation in 2021
Published in Expert Review of Medical Devices, 2021
Christopher Gaisendrees, Matias Vollmer, Sebastian G Walter, Ilija Djordjevic, Kaveh Eghbalzadeh, Süreyya Kaya, Ahmed Elderia, Borko Ivanov, Stephen Gerfer, Elmar Kuhn, Anton Sabashnikov, Heike a Kahlert, Antje C Deppe, Axel Kröner, Navid Mader, Thorsten Wahlers
Patients on VA-ECMO require close cardiorespiratory monitoring to ensure adequate end-organ perfusion. Monitoring should include hemodynamic monitoring with continuous mean arterial pressure measurements by cannulating the right brachial or radial artery electrocardiography, peripheral oxygen saturation, and repeated arterial blood gas analysis to ensure adequate gas exchange. Following OHCA, these strategies do not differ significantly from postoperative VA – ECMO implantation. Details are beyond the scope of this article and discussed elsewhere in detail [41]. In patients undergoing eCPR, two aspects need to be addressed in-depth: neuromonitoring and monitoring of coagulation.
Comparison of mechanical cardiopulmonary support strategies during lung transplantation
Published in Expert Review of Medical Devices, 2020
Noah Weingarten, Dean Schraufnagel, Gilman Plitt, Anthony Zaki, Kamal S. Ayyat, Haytham Elgharably
VA ECMO’s effects depend on whether cannulas are inserted peripherally or centrally. In peripheral cannulation, the venous cannula is placed in a peripheral vein and advanced into the inferior vena cava or right atrium. Blood is returned to a peripheral artery, such as the femoral artery, and flows retrograde to the aorta allowing oxygenated blood to perfuse the heart and brain. Risks include distal limb ischemia and differential oxygenation of upper and lower body. Limb ischemia is experienced by 12–25% of patients with femoral artery cannulation, though its risk can be reduced with the placement of a distal perfusion cannula – typically a 6 to 8 Fr cannula placed percutaneously in the superficial femoral artery and connected to the main arterial cannula’s side port with extension tubing and an intervening stopcock. The distal perfusion cannula facilitates perfusion to the distal limb [44–46]. Limb ischemia may also be prevented with central cannulation, whereby venous blood is drained from the right atrium and returned to the ascending aorta. Differential upper body hypoxemia, known as Harlequin syndrome, is at risk of occurring in the setting of respiratory failure and peripheral cannulation. It occurs when poorly oxygenated blood pumped by the left heart perfuses aortic arch branches and coronary arteries, while blood oxygenated by the ECMO circuit primarily perfuses the lower extremities. It is diagnosed with the finding of hypoxic oxygen saturations on arterial blood gas from the right radial artery. This potentially fatal condition may be treated by several adjustments to the ECMO circuit including the addition of a venous inflow cannula to the upper extremity [47]. Central cannulation enables the placement of larger cannulas that permit higher flow rates. One study comparing rates of deep vein thromboses and peripheral wound complications such as groin infections among 103 patients undergoing double LT for pulmonary hypertension found lower rates in central relative to peripheral cannulation [46]. This study did not find increased rates of bleeding, infection or re-operation between these two groups, which have each been cited as risks of central cannulation [43,46].