CPB case report: Management of Antiphospholipid …Fanny Lange DESS PEC UdM, CPC, B.ScPerfusionistin...
Transcript of CPB case report: Management of Antiphospholipid …Fanny Lange DESS PEC UdM, CPC, B.ScPerfusionistin...
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Fanny Lange DESS PEC UdM, CPC, B.ScPerfusionist in Montreal Sacre-Cœur HospitalEducational Clinical Coordinator (MSCH)
CPB case report: Management of AntiphospholipidSyndrome with the HMS Plus system.
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Disclosure
Financially supported my presence here
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q I was raised by two medical parents, and by many‘’old timer’’ in the perfusion world
q Even after 10 years, every single day before a surgery, I still physically goand visit my patients… or I call the wonderfull nurse to get my bedtimestory when I’m home!
The reason why I’m a really good girl…
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But not everything is seen during school!
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q Eric caught the 1st ‘’jackpot’’…
August 19th, 2017
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Let’s overlook the syndrome!
IF YOU HAVE ONE MAJOR RESUME TO READ, THIS IS THE ONE…
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Let’s overlook the syndrome!
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Let’s overlook the syndrome!
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Let’s overlook the syndrome!
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What a big mess!
https://image.slidesharecdn.com/antiphospholipidsyndrome-141014120624-conversion-gate01/95/antiphospholipid-syndrome-19-638.jpg?cb=1413290258
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How do we translate this to CPB:
q Ideally maintain normothermia
q Omit antifibrinolytic use during cardiac surgery… At least without the ROTEM system
q Use cell-saver before and after the cpb period
q Be prepared to transfuse anykind blood products
q Pre and post membrane monitoring in CPB circuit
q No retro-autologous priming of the CPB circuit
q Early given and secured level of anticoagulation with Heparin
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Many techniques for the ‘’safe’’ anticoagulation level
q Use an excess of heparin (≈ 5 mg/kg) and run your ACT ≥ 999sec(Kaolin = ok/Celite= less affected)
OR
q Run Anti-Xa around ≥ 4u/ml during the cpb period ( … possible labissues…)
OR
q Run HMS Plus – heparin concentration tests ≥ 3-4 u/ml (2,2-3mg/kg)
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What a chance: Alex caught the 2nd one!
I was SO ready that time!
October 5th, 2017
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Welcome aboard!
q We purchased the HMS Plus system a yearago
q We learned through time to use it
q Because of the two APS we had to get on board!
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HMS Plus in action: Clinical cases Presentation
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HMS Plus in action: Clinical cases Presentation
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HMS Plus in action: Clinical cases Presentation
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HMS Plus in action: Clinical cases Presentation
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Conclusion:
q Young expertise in our center
q Evidence based approach definitly helped
q HMS Plus was used with the Heparin concentration test in both cases
q No significant events during both CPB periods
q Sufficient anticoagulation maintained
q NO OBSERVED CLOT IN BOTH CIRCUITS
q GOOD LUCK to all of you now!
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Acknowledgments:
q The CSCP organizers
AND