Vascular anatomical considerations and clinical decision making during insertion of the Avalon® Elite Dual Lumen single-site veno-venous ECMO cannula in children weighing less than 20 kg.

The correct selection and placement of a single-site Avalon® Elite Dual Lumen Cannula for veno-venous extracorporeal membrane oxygenation (ECMO) in children weighing less than 20 kg is dependent on both the mechanical characteristics of the catheter, including length and diameter, as well as the unique vascular anatomic considerations of the patient. This manuscript describes the development of a clinical strategy, over a four-year period from 2012-2016, for cannula selection to reduce the risk of migration and malposition in 20 critically ill children weighing less than 20 kg who presented for veno-venous ECMO.

Thrombelastograph (TEG) analysis of platelet gel formed with different thrombin concentrations.

Autologous blood transfusion is the safest and most successful way to decrease transfusion-related risks such as postoperative infections, allo-immunization, and short- and long-term immunosuppression. In addition, these fibrin sealants are known to provide coagulation support at the surgical site and act as an adjunct to the control of postoperative bleeding. The physical formation of autologous platelet fibrin gel clot is dependent on both the common pathway of the coagulation cascade and platelet activation. Platelet gel can help provide control of intraoperative and postoperative bleeding. The Thrombelastograph Hemostasis Analyzer (TEG) measures the viscoelastic properties of a clot as it forms. Based on the information that the TEG provides, it promises to be a good choice for point of care measurement of the integrity of thrombus formed by platelet gels. Bovine blood from a single donor was sequestered into platelet-rich plasma and was made into platelet gel using calcium and three different concentrations of thrombin. The platelet gel samples were then analyzed with the TEG analyzer. The results for MA, tMA, CI, and angle were recorded and statistical analysis was performed to accept or reject the null hypothesis, which is: There is no difference between TEG parameters when analyzing platelet gels formed with calcium chloride, platelet-rich plasma and three different concentrations of thrombin A one-way analysis of variance test was performed between thrombin concentrations for MA (p = 0.19), tMA (p = 0.443), CI (p = 0.257), and angle (p = 0.323). The results showed that thrombin concentration did not affect the MA, tMA, CI, or angle as measured by the TEG analyzer. The null hypothesis was accepted. Based on a one-way analysis of variance test for MA, tMA, CI, and angle there was no significant statistical difference for the TEG samples in this experiment as reported with a 95% confidence interval.

Quantifying platelet gel coagulation using Sonoclot and Thrombelastograph hemostasis analyzer.

Little in vitro research exists discussing platelet gel composition and the resulting strength and degradation characteristics using point-of-care technologies. There must be a quantifiable way of determining the structural integrity of the resulting formed platelet gel thrombus. The Thrombelastograph Hemostasis Analyzer (TEG) and Sonoclot measure the elasticity of a clot as it forms and subsequently degrades naturally. The objective of this study was to determine the application of TEG and Sonoclot technologies as point-of-care devices for technicians using platelet gel therapy. The collected bovine blood was anticoagulated with CPD and processed using a previously published plasma sequestration protocol, using normal saline as a wash solution. The resulting platelet-rich plasma was stored in a sequestration bag in a water bath to maintain the blood temperature at 37 degrees C. Sequestered bovine platelet-rich plasma was made into platelet gel using three different thrombin concentrations. A total of 30 experiments were performed on the platelet gel product using both the TEG and the Sonoclot. We discovered that 6 of the Sonoclot tests and 15 of the TEG tests were valid. None of the TEG clot signatures and nine of the Sonoclot signatures were discovered to be invalid. A chi2 test was performed on the resultant data. The value of the chi2 test was calculated to be 12.86, which translated into a p value of less than 0.001. Despite the vast use and growing popularity of platelet gels, a method in which to quantify platelet gels has yet to be reported. There remains a possibility that gels formed with different concentrations of components may prove useful in different areas of surgery or their uses may expand to a broader spectrum of medicine. However, technology to quantify platelet gels must first be standardized. On the basis of the data collected in this study, it was determined that the TEG and the Sonoclot are not equally capable of analyzing platelet gel clots. The TEG is a valid means for analysis, whereas the Sonoclot provided unreliable analysis based on a Chi-squared test.