Eugen Varlan was advised as a stager reseacher in scientific laboratory of cardiosurgery of Cardiology Institute In 1995 and in few months (November 1995) sucessfully performed extracorporeal circulation in cardiac surgery operations. During 22 years he performed above 3500 extracorporeal circulations in the majority cases of paediatric cardiac surgery (radical correction of Tetralogy Fallot, radical correction of Atrioventricular Canal, mitral and tricuspidal annuloplastic, Glenn and Fontan operations with extracorporeal circulation assistance, switch correction of Transposition of Grand vessels, Mustard operation, Norwood correction) and, of course, assistance at all adult operations and ECMO. By his insistence the method of modified ultrafiltration (see his publications in” Art of Surgery”- journal of Moldavian Surgery Society) was introduced In practice in the Republic of Moldova. He wish to see the “Hospital for Sick Children “ in Great Ormond Street where Martin Elliot introduced this revolutionary method.
Both severities of cardiac surgery and technical features of extracorporeal circulation circuit demands blood transfusion from donors, which involves a number of risks for the patient, especially with low body weight. Priming of the cardiopulmonary bypass circuit with patients\' own blood [retrograde autologous priming (RAP)] is a technique used to limit haemodilution and reduce transfusion requirements. \r\nPurpose: to explore the possibilities of reducing the volume of homologous blood transfusion in pediatric cardiac surgery.\r\nMaterial and methods: the study included 250 children (131 boys, 119 girls)with congenital heart disease, operated on heart under CPB, weighting less than 20kg (20.45 ± 3.15) and 3.4 ± 1.7 years average age, who were divided into experimental (125 children) and control group (125children). In the control group conventional CPB was performed (supplementing the priming with red blood cells), while in study group CPB was started after RAP via aortic cannula with recuperation till 45 % of “priming”. The hematocrit (Hct), lactate (Lac) levels at two perioperative time-points, and intraoperative and postoperative blood usage were recorded. There were no significant differences in CPB time, aortic cross-clamp time between groups. Cell Saver wasn’t used in both groups (is not effective in children cardio surgery).\r\nResults: No hospital lethality occurred in the study and no surgical hemostasis was performed. Blood loss accounted for 6.2 ml/kg /24h. Postoperative transfusion of homologous blood (erythrocyte mass) as needed 73 children, that make up only 29,2% of the whole study group. Amongst children who received transfusion on pump, the number of homologous units of packed red blood cells was less in the RAP group than that in the standard priming group intraoperatively and perioperatively (0.54 ± 0.17 vs. 1.48 ± 0.68 units, P = 0.03; 0.94 ± 0.54 vs. 1.69 ± 0.69 units, P = 0.15). There were no significant differences in CPB time, aortic clamp, and Lac value between the two groups (P>0.05). Clinical outcomes were similar with respect to pulmonary, renal and hepatic function, length of ICU stay and hospital stay.\r\nConclusions: “priming” minimalisation and autologous blood priming, ultrafiltration, could diminish the necessity of perioperative homologous blood transfusion in infant cardiac surgery.\r\n
Dr Neil Bodagh is an academic foundation year 2 doctor currently based at Barts Health NHS Trust. He completed his foundation year 1 training at Barking, Havering and Redbridge NHS Trust which is where this project was undertaken. Dr Fahad Farooqi is a consultant cardiologist based at the Barking Havering and Redbridge NHS Trust.
High quality discharge summaries facilitate safe transfer of care by communicating relevant clinical information to GPs after hospital discharge. This is especially important in complex clinical syndromes such as chronic heart failure where multidisciplinary teams are required to effectively co-ordinate community care and minimise the risk of re-hospitalisation.rnThe quality of heart failure discharge summaries issued by the two District General Hospitals within our Trust was assessed. We tested the effectiveness of a discharge summary checklist intended to improve documentation. All issued discharge summaries following unplanned hospital admissions with a primary diagnosis of heart failure were identified over a 3 month period using Hospital Episodes Statistics data. The content of each discharge summary was objectively assessed using a point based scoring technique. Junior doctors working on a single ward were exposed to a checklist poster providing guidance on composing a quality heart failure discharge summary (n=24). Their performance was compared against doctors working on other wards who were not exposed to the checklist (n=84).rnA total of 164 discharge summaries were assessed. In the ward exposed to the discharge summary checklist poster the mean discharge summary score was 6.1 +/- 0.59. In the wards that weren\'t exposed to the checklist, the mean discharge summary score was significantly poorer 2.7 +/- 0.19 (p<0.001).rnOur study demonstrates that the provision of a checklist was associated with a statistically significant improvement in the quality of heart failure discharge summaries issued by our Trust. This intervention was simple to implement at minimal cost and potentially helps junior doctors communicate more effectively with primary care.rn