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The tube above it (obscured by the surgeon on the right) is the venous cannula (receives blood from the body). The patient's heart is stopped and the aorta is cross-clamped. The patient's head (not seen) is at the bottom. Emergency bypass surgery for the treatment of an acute myocardial infarction (MI) is less common than PCI or thrombolysis.
The main reason for the acute phase of ischemia-reperfusion injury is oxygen deprivation and, therefore, arrest of generation of ATP (cellular energy currency) by mitochondria oxidative phosphorylation. Tissue damage due to the general energy deficit during ischemia is followed by reperfusion (increase of oxygen level) when the injury is enhanced.
The patients cannula are attached to an ECMO circuit with blood flow targets of 3Lmin −1 and oxygen blood flow of 3L min −1 commenced. An arterial blood gas is used to assess for successful oxygenation and metabolic improvement following the commencement of ECMO.
ECMO should be performed only by clinicians with training and experience in its initiation, maintenance, and discontinuation. ECMO insertion is typically performed in the operating room setting by a cardiothoracic surgeon. ECMO management is commonly performed by a registered nurse, respiratory therapist, or a perfusionist.
Oxygen therapy is often useful in chronic hypoxemia caused by conditions such as severe COPD or cystic fibrosis. [3] [1] Oxygen can be delivered via nasal cannula, face mask, or endotracheal intubation at normal atmospheric pressure, or in a hyperbaric chamber. [4] [5] It can also be given through bypassing the airway, such as in ECMO therapy.
Remote ischemic conditioning (RIC) is an experimental medical procedure that aims to reduce the severity of ischaemic injury to an organ such as the heart or the brain, most commonly in the situation of a heart attack or a stroke, or during procedures such as heart surgery when the heart may temporary suffer ischaemia during the operation, by triggering the body's natural protection against ...
Reperfusion is the restoration of blood flow to an organ or tissue after having been blocked, and may refer to: Reperfusion injury , tissue damage caused when blood supply returns to the tissue Reperfusion therapy , the medical treatment that restores blood flow through blocked arteries, typically after a heart attack
The Lund protocol utilises a roller pump, blood-based perfusate, and an ECMO ventilator. Red blood cells account for 14% of the Steen perfusate–that is, haematocrit level is kept at 14%. [ 14 ] The Lund protocol achieves a complete target flow, which is 100% of the cardiac output.