The PerfWeb Podcast

A review of ECMO (Extracorporeal Membrane Oxygenation) usage and outcome before, during, and post-COVID. Hosted by Thomas DiSalvio with cohost Joe Basha.

Discussions about the use of Goal Directed Perfusion and balancing the needs of the surgeon and the needs of the patient. Using DO2i as a tool to determine perfusion adequacy and justify flows, temperature, and transfusions. Hosted by Joe Basha with co-host Thomas Desalvio.

Transfusions carry risks, anemia causes morbidities: Discussions surrounding the use of transfusions, transfusion management, and when transfusions are just a necessity. Discussions about liberal vs. restrictive transfusion thresholds and outcomes. Hosted by Joe Basha, CCP, and Thomas Disalvio.

Understanding the Physics of Intra-Aortic Balloon Pumps. Learn the 8 phases of the cardiac cycle and how to accurately time the IABP. IABP, Impella, and ECMO; when are they appropriate to use? "Mastering Intra-Aortic Balloon Pumps: Decoding the Physics and Timing for Optimal Cardiac Support" Welcome to our channel, where we delve into the fascinating world of cardiovascular physiology! In this comprehensive video, we invite you to embark on an enlightening journey to understand the physics of Intra-Aortic Balloon Pumps (IABP) and explore the critical role they play in supporting the cardiac cycle. 🫀 Understanding the 8 Phases of the Cardiac Cycle 🫀 We begin by demystifying the cardiac cycle, the rhythmic dance that orchestrates every heartbeat. Through clear and concise explanations, we explore the intricacies of each of the eight phases, from atrial contraction and isovolumetric contraction to ventricular ejection and isovolumetric relaxation. This knowledge serves as a solid foundation to comprehend the mechanisms behind the IABP's operation. 💡 Decoding the Physics of Intra-Aortic Balloon Pumps 💡 Next, we dive into the core of this video, as we decipher the physics behind Intra-Aortic Balloon Pumps. Gain insights into the principles that govern the IABP's actions, how it augments cardiac function, and its impact on aortic pressure and coronary perfusion. Through engaging animations and real-life examples, we illustrate these concepts to ensure you grasp the underlying physics. 🎯 Accurate Timing: The Key to Effective IABP Assistance 🎯 Timing is everything when it comes to IABP therapy. In this segment, we share invaluable tips and techniques on how to accurately time the IABP to the cardiac cycle. Discover the synchronization methods and the art of selecting the optimal inflation and deflation points, maximizing the device's assistance to the heart and enhancing patient outcomes. 📈 Mastering IABP: Clinical Applications and Future Trends 📈 Beyond the basics, we explore the clinical applications of IABPs, including its use in cardiogenic shock, unstable angina, and high-risk cardiac surgeries. Moreover, we provide an overview of the latest advancements in IABP technology, shedding light on potential future trends and innovations in this life-saving field.

Emily Foreman, CCP reviews her peer-reviewed publication on RAPP as a transfusion management procedure. In this YouTube video, Emily Foreman, CCP presents the findings of a paper published towards the end of 2021. The paper is titled "To Wrap or Not to Wrap." The purpose of the study was a quality improvement project to determine if wrapping during cardiac surgeries was beneficial for their patients. The speaker explains that their institution has a low prime bypass circuit and a strict anesthesia preoperative protocol. They analyzed about 40 different data points on each patient and examined reported benefits and possible negative consequences of wrapping during cardiac surgeries. They conducted a retrospective study by comparing two groups of patients: those who were wrapped during surgery and those who were not. They looked at various factors, including red blood cell transfusion index, oxygen delivery, postoperative acute kidney injury, albumin administration, ventilator times, ICU length of stay, and 30-day mortality. The speaker presents their original theories, such as the belief that wrapping may negatively impact acute kidney injury incidence and reduce oxygen delivery. However, their analysis revealed that wrapping did not have a statistically significant impact on most of the studied parameters. The only notable finding was a higher post-operative albumin administration in the wrapped group. The conclusion drawn from the study was that wrapping during cardiac surgeries was not beneficial in their patient population, considering their specific preoperative fluid administration protocols and prime circuit. They also mention the need for further research, particularly in cases involving condensed circuits. Overall, the study did not support the idea that wrapping was advantageous for their patients, and the speaker highlights the limitations and challenges they faced during the analysis.

RAPP is a technique utilized to minimize hemodilution-associated anemia on cardiopulmonary bypass. Risks associated with RAPP include hypotension, acute hypovolemic shock, and hypo-perfusion. The program will explore the data supporting RAPP and explore the limitations of the data.

Pulsatile perfusion: What are the benefits, and do they outweigh the risks? The program will examine the use of pulsatile perfusion. Physiologic pulse pressure and circuit limitations will be discussed.

SARS-CoV-2 Versus Influenza-associated Acute Respiratory Distress Syndrome Requiring Veno-venous Extracorporeal Membrane Oxygenation Support.

CRRT, CVVH is a useful tool for managing patients with fluid, electrolyte, metabolite and acid-base imbalance. Patients on ECMO requiring CVVH may benefit by integrating the CRRT into the ECMO circuit versus having a line placed in a central vein. We will discuss the advantages and potential risks associated with integrating the CRRT machine into the ECMO circuit.

A simplified approach to mini mitral surgery: No clamp, no fib, just a-rest. The use of Port Access is expensive and prolonged Ventricular Fibrillation is potentially damaging to the heart. We propose a simplified approach to minimally invasive mitral valve surgery that maintains coronary perfusion and provides a relaxed, quiet heart.