Papers by Joshua Blessing
The journal of extra-corporeal technology, 2017
The goal of this chart review was to investigate the use of down-sized cardiopulmonary bypass (CP... more The goal of this chart review was to investigate the use of down-sized cardiopulmonary bypass (CPB) circuits for obese patients. The effects of transitioning from larger to smaller oxygenators, reservoirs, and arteriovenous tubing loops were evaluated through a retrospective review of 2,816 adult non-congenital procedure perfusion records. This technique report and case series is a continuation of our original prescriptive CPB circuit quality improvement project. An algorithm was derived to adjust body surface area (BSA) to lower body mass index (BMI) to provide down-sized extracorporeal circuit components capable of meeting the metabolic needs of the patient. As a result of using smaller circuits, decreased priming volumes led to significantly increased hemoglobin (HB) nadirs (p < .05) leading to significant decreases in homologous donor blood product exposures (p < .05). Patients with large BSAs were supported safely with smaller circuits by using lean body mass (LBM)-adjust...
We appreciate Mr. Myers’ letter because it adds to the discussion of our article and is interesti... more We appreciate Mr. Myers’ letter because it adds to the discussion of our article and is interesting. We respect his personal concerns regarding the publication. Our article is not the first retrospective study to associate lower priming volumes with higher nadir hemoglobin levels and less allogeneic blood use. We cited and discussed those references in the article (1). It is true, in any institution, “excessive hemodilution can be a manageable risk factor if addressed by reliable staff education, common sense, team work and the cooperation of all professions involved in cardiac surgery.” Regarding internal validity, multiple variables, and the weaknesses of retrospective studies, Mr. Myers restates in his letter what we admonished in the article. As months went by, our team was able to safely select the use of smaller circuits in a greater percentage of our patient population. In addition to the small significant increase in nadir hemoglobin, we reported a significant reduction in t...
UNLABELLED The goal of this cardiopulmonary bypass (CPB) quality improvement initiative was to ma... more UNLABELLED The goal of this cardiopulmonary bypass (CPB) quality improvement initiative was to maximize hemoglobin nadir concentration by minimizing hemodilution and, in turn, eliminating allogeneic blood product transfusion. The effects of transitioning from "one-size-fits-all" to "right-sized" oxygenators, reservoirs, and arterial-venous tubing loops were evaluated through a 2-year retrospective review of 3852 patient perfusion records. Using a sizing algorithm, derived from manufacturers' recommendations, we were able to create individualized "right-sized" extracorporeal circuits based on patient body surface area, cardiac index, and target blood flows. Use of this algorithm led to an increase in the percent of algorithm-recommended smaller oxygenators being used from 39% to 63% (p < .01) and an increase in average hemoglobin nadir from 8.38 to 8.76 g/dL (p < .01). Decreased priming volumes led to increased hemoglobin nadir and decreases in...
The Journal of extra-corporeal technology, 2014
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Papers by Joshua Blessing