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Svenmarker, Staffan
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Publications (10 of 16) Show all publications
Malmqvist, G., Claesson Lingehall, H., Appelblad, M. & Svenmarker, S. (2019). Cardiopulmonary bypass prime composition: beyond crystalloids versus colloids. Perfusion, 34(2), 130-135
Open this publication in new window or tab >>Cardiopulmonary bypass prime composition: beyond crystalloids versus colloids
2019 (English)In: Perfusion, ISSN 0267-6591, E-ISSN 1477-111X, Vol. 34, no 2, p. 130-135Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: In the literature addressing cardiopulmonary bypass (CPB) prime composition, there is a considerable lack of discussion concerning plasma osmolality changes induced by using a hyperosmolar prime. With this study, we try to determine the magnitude and temporal relationship of plasma osmolality changes related to the use of a hyperosmolar CPB prime.

METHOD: In this prospective observational study performed in a university hospital setting, we enrolled thirty patients scheduled for elective coronary bypass surgery. Plasma osmolality was analysed on eight occasions. A hyperosmolar CPB prime was used.

RESULTS: Analyses of the perioperative plasma osmolality on eight occasions gave the following results: the preoperative osmolality level was normal (297±4 mOsm/kg); a significant increase to 322±17 mOsm/kg (p<0.001) was observed at the commencement of CPB and remained elevated after 30 minutes (310±4 mOsm/kg) and throughout the procedure (309±4 mOsm/kg); the osmolality level returned to 291±5 mOsm/kg on day 1 postoperatively and remained normal the following day (291±6 mOsm/kg).

CONCLUSIONS: Use of hyperosmolar CPB prime resulted in a dramatic and instant elevation of the plasma osmolality. Rapid changes in plasma osmolality are associated with organ dysfunction (e.g. osmotic demyelination syndrome), therefore, effects on plasma osmolality related to the CPB prime composition should be recognised. Influence on organ function and clinical outcome warrants further investigations. - Clinical Trials.gov (NCT03060824). Changes in Plasma Osmolality Related to the Use of Cardiopulmonary Bypass With Hyperosmolar Prime. URL: https://clinicaltrials.gov/ct2/show/NCT03060824?term=cpb&cond=osmolality&rank=1.

Place, publisher, year, edition, pages
Sage Publications, 2019
Keywords
cardiac surgery, cardiopulmonary bypass, osmolality, osmolarity, priming solutions
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-151324 (URN)10.1177/0267659118793249 (DOI)000458887400006 ()30114960 (PubMedID)
Available from: 2018-08-31 Created: 2018-08-31 Last updated: 2019-04-16Bibliographically approved
Svenmarker, S., Hannuksela, M. & Haney, M. (2018). A retrospective analysis of the mixed venous oxygen saturation as the target for systemic blood flow control during cardiopulmonary bypass. Perfusion, 33(6), 453-462
Open this publication in new window or tab >>A retrospective analysis of the mixed venous oxygen saturation as the target for systemic blood flow control during cardiopulmonary bypass
2018 (English)In: Perfusion, ISSN 0267-6591, E-ISSN 1477-111X, Vol. 33, no 6, p. 453-462Article in journal (Refereed) Published
Abstract [en]

Objectives: The patient's body surface area serves as the traditional reference for the determination of systemic blood flow during cardiopulmonary bypass (CPB). New strategies refer to different algorithms of oxygen delivery. This study reports on the mixed venous oxygen saturation (SvO2) as the target for systemic blood flow control. We hypothesise that an SvO2>75% (S(v)O(2)75) is associated with better preservation of renal function and improved short-term survival.

Methods: This retrospective, 10-year, observational study analysed 6945 consecutive cardiac surgical cases requiring CPB. Endpoints included rates of acute kidney injury (AKI) and short-term survival, also the estimated glomerular filtration rate ((e)GFR), lactate levels and blood transfusions.

Results: Seventy-seven percent of the patients attained the S(v)O(2)75 target. For this group, the median SvO2 was 78.1 (5.8) %, with a mean oxygen delivery of 331 (78) ml/min per m(2) body surface area. Overall incidence of AKI levels (I-III): 7.5% - 2.6% - 0.6%. Incidence of (e)GFR (<50%): 3.9%, increasing to 6% for haemoglobin levels <80 g/L (p<0.001). Red cell transfusion was more frequent (p<0.001) within this group (30.6%) compared to levels >100 g/L (0.3%). Further, women (52.8%) were transfused more often than men (14.6%). Lactate level at weaning from CPB was 1.3 (0.7) mmol/L. The S(v)O(2)75 target demonstrated a relative risk reduction of 22.5% (p=0.032) for AKI (I), increasing to 32.3% (p=0.026) for procedures extending >90 minutes. In addition, the risk for death 90-days postop was lower (p=0.039).

Conclusion: The S(v)O(2)75 target showed a decreased risk for postoperative AKI and prolonged short-term survival. Good clinical outcomes were also linked to measures of lactate and the (e)GFR. However, anaemia remains a risk factor for AKI.

Place, publisher, year, edition, pages
Sage Publications, 2018
Keywords
acute kidney injury, blood flow control, cardiopulmonary bypass, lactate, mixed venous oxygen saturation, survival
National Category
Anesthesiology and Intensive Care Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-151546 (URN)10.1177/0267659118766437 (DOI)000442397500008 ()29623766 (PubMedID)
Available from: 2018-09-11 Created: 2018-09-11 Last updated: 2019-05-22Bibliographically approved
Smulter, N., Lingehall, H. C., Gustafson, Y., Olofsson, B., Engström, K. G., Appelblad, M. & Svenmarker, S. (2018). Disturbances in Oxygen Balance During Cardiopulmonary Bypass: A Risk Factor for Postoperative Delirium. Journal of Cardiothoracic and Vascular Anesthesia, 32(2), 684-690
Open this publication in new window or tab >>Disturbances in Oxygen Balance During Cardiopulmonary Bypass: A Risk Factor for Postoperative Delirium
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2018 (English)In: Journal of Cardiothoracic and Vascular Anesthesia, ISSN 1053-0770, E-ISSN 1532-8422, Vol. 32, no 2, p. 684-690Article in journal (Refereed) Published
Abstract [en]

Objective: The aim of this study was to determine risk factors for postoperative delirium after cardiac surgery, specifically associated with the conduct of cardiopulmonary bypass (CPB).

Design: Prospective observational study.

Setting: Heart Centre, University Hospital.

Participants: The study included 142 patients aged 70 years and older scheduled for elective cardiac surgery with CPB.

Interventions: Risk factor analysis comprised information collected from the hospital clinical and CPB dedicated databases in addition to the medical chart. Delirium was diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision criterion using the Mini Mental State Examination and the Organic Brain Syndrome scale.

Measurements and Main Results: Assessments of delirium diagnosis were executed preoperatively and on the following first and fourth postoperative days. Delirium occurred in 55% (78/142) of the patients. Patients with delirium were identified with significantly higher body weight and body surface area preoperatively, accompanied with longer CPB time, higher positive fluid balance per CPB, and lower systemic pump flow related to body surface area. Furthermore, the duration of the mixed venous oxygen saturation (SvO2) below 75% was significantly longer during CPB. The result from the multivariable logistic regression analysis included the duration of SvO2 below 75%, fluid balance per CPB and patient age as independent risk factors for postoperative delirium.

Conclusions: The influence of the SvO2 level during CPB, fluid balance, and patient age should be recognized as risk factors for postoperative delirium after cardiac surgery in patients 70 years and older.

Place, publisher, year, edition, pages
Saunders Elsevier, 2018
Keywords
cardiac surgery, cardiopulmonary bypass, mixed venous oxygen saturation, postoperative delirium, risk factors
National Category
Nursing Cardiac and Cardiovascular Systems Respiratory Medicine and Allergy Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:umu:diva-144659 (URN)10.1053/j.jvca.2017.08.035 (DOI)000429083200014 ()29153931 (PubMedID)
Available from: 2018-02-09 Created: 2018-02-09 Last updated: 2019-05-22Bibliographically approved
Johagen, D., Svenmarker, P., Jonsson, P. & Svenmarker, S. (2017). A microscopic view of gaseous microbubbles passing a filter screen. International Journal of Artificial Organs, 40(9), 498-502
Open this publication in new window or tab >>A microscopic view of gaseous microbubbles passing a filter screen
2017 (English)In: International Journal of Artificial Organs, ISSN 0391-3988, E-ISSN 1724-6040, Vol. 40, no 9, p. 498-502Article in journal (Refereed) Published
Abstract [en]

Purpose: The aim of this study was to investigate the filtration efficacy of a 38-µm 1-layer screen filter based on Doppler registrations and video recordings of gaseous microbubbles (GME) observed in a microscope.

Methods: The relative filtration efficacy (RFE) was calculated from 20 (n = 20) sequential bursts of air introduced into the Plasmodex® primed test circuit.

Results: The main findings indicate that the RFE decreased (p = 0.00), with increasing flow rates (100-300 mL/min) through the filter screen. This reaction was most accentuated for GME below the size of 100 µm, where counts of GME paradoxically increased after filtration, indicating GME fragmentation. For GME sized between 100-250 µm, the RFE was constantly >60%, independently of the flow rate level. The video recording documenting the GME interactions with the screen filter confirmed the experimental findings.

Conslusions: The 38-µm 1-layer screen filter investigated in this experimental setup was unable to trap gaseous microbubbles effectively, especially for GME below 100 µm in size and in conjunction with high flow rates.

Place, publisher, year, edition, pages
Wichtig Publishing, 2017
Keywords
cardiopulmonary bypass, filtration, gaseous microemboli
National Category
Other Medical Engineering Medical Laboratory and Measurements Technologies
Identifiers
urn:nbn:se:umu:diva-141491 (URN)10.5301/ijao.5000602 (DOI)000413064400004 ()28574103 (PubMedID)
Available from: 2017-11-20 Created: 2017-11-20 Last updated: 2019-05-20Bibliographically approved
Hällgren, O., Svenmarker, S. & Appelblad, M. (2017). Implementing a Statistical Model for Protamine Titration: Effects on Coagulation in Cardiac Surgical Patients. Journal of Cardiothoracic and Vascular Anesthesia, 31(2), 516-521
Open this publication in new window or tab >>Implementing a Statistical Model for Protamine Titration: Effects on Coagulation in Cardiac Surgical Patients
2017 (English)In: Journal of Cardiothoracic and Vascular Anesthesia, ISSN 1053-0770, E-ISSN 1532-8422, Vol. 31, no 2, p. 516-521Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: To implement a statistical model for protamine titration. DESIGN: Prospective randomized trial. SETTING: University hospital. PARTICIPANTS: Sixty (n = 30+30) patients scheduled for elective coronary artery bypass surgery were randomly assigned to 2 groups. INTERVENTIONS: Protamine dose calculated according to an algorithm established from a statistical model or to a fixed protamine-heparin dose ratio (1:1). MEASUREMENTS AND MAIN RESULTS: Both groups demonstrated comparable patient demographics and intraoperative data. Coagulation effects were evaluated using rotational thromboelastometry. Using the statistical model reduced (p<0.01) the protamine dose from 426±43 mg to 251±66 mg, followed by significantly (p<0.01) shorter intrinsic clotting time (208±29 seconds versus 244±52 seconds) and stronger clot firmness (p = 0.01), and effects on indices of extrinsic or fibrinogen coagulation pathways were insignificant. Test of residual heparin was negative in all patients after protamine administration, aligned with insignificant (p = 0.27) intergroup heparinase-verified clotting time differences. CONCLUSIONS: The statistical model for protamine titration is clinically feasible and protects the patient from exposure to excessive doses of protamine, with advantageous effects on coagulation as measured using rotational thromboelastometry. Significance regarding clinical outcome is yet to be defined.

Keywords
cardiac surgery, cardiopulmonary bypass, heparin, protamine, statistical model
National Category
Clinical Medicine
Identifiers
urn:nbn:se:umu:diva-134742 (URN)10.1053/j.jvca.2016.07.018 (DOI)000400794400018 ()27712970 (PubMedID)
Available from: 2017-05-11 Created: 2017-05-11 Last updated: 2019-05-22Bibliographically approved
Axelsson, B., Häggmark, S., Svenmarker, S., Johansson, G., Gupta, A., Tyden, H., . . . Haney, M. (2016). Effects of Combined Milrinone and Levosimendan Treatment on Systolic and Diastolic Function During Postischemic Myocardial Dysfunction in a Porcine Model. Journal of Cardiovascular Pharmacology and Therapeutics, 21(5), 495-503
Open this publication in new window or tab >>Effects of Combined Milrinone and Levosimendan Treatment on Systolic and Diastolic Function During Postischemic Myocardial Dysfunction in a Porcine Model
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2016 (English)In: Journal of Cardiovascular Pharmacology and Therapeutics, ISSN 1074-2484, E-ISSN 1940-4034, Vol. 21, no 5, p. 495-503Article in journal (Refereed) Published
Abstract [en]

It is not known whether there are positive or negative interactions on ventricular function when a calcium-sensitizing inotrope is added to a phosphodiesterase inhibitor in the clinical setting of acute left ventricular (LV) dysfunction. We hypothesized that when levosimendan is added to milrinone treatment, there will be synergetic inotropic and lusitropic effects. This was tested in an anesthetized porcine postischemic global LV injury model, where ventricular pressures and volumes (conductance volumetry) were measured. A global ischemic injury was induced by repetitive left main stem coronary artery occlusions. Load-independent indices of LV function were assessed before and after ventricular injury, after milrinone treatment, and finally after addition of levosimendan to the milrinone treatment. Nonparametric, within-group comparisons were made. The protocol was completed in 12 pigs, 7 of which received the inotrope treatment and 5 of which served as controls. Milrinone led to positive lusitropic effects seen by improvement in tau after myocardial stunning. The addition of levosimendan to milrinone further increased lusitropic state. The latter effect could however not be attributed solely to levosimendan, since lusitropic state also improved spontaneously in time-matched controls at the same rate during the corresponding period. When levosimendan was added to milrinone infusion, there was no increase in systolic function (preload recruitable stroke work) compared to milrinone treatment alone. We conclude that in this model of postischemic LV dysfunction, there appears to be no clear improvement in systolic or diastolic function after addition of levosimendan to established milrinone treatment but also no negative effects of levosimendan in this context.

Place, publisher, year, edition, pages
Sage Publications, 2016
Keywords
cardiac pharmacology, cardioactive agents, experimental and clinical heart failure, ischemia-reperfusion injury
National Category
Anesthesiology and Intensive Care Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-116180 (URN)10.1177/1074248416628675 (DOI)000382567800008 ()26837238 (PubMedID)1940-4034 (Electronic) 1074-2484 (Linking) (ISBN)
Available from: 2016-02-09 Created: 2016-02-09 Last updated: 2019-05-22Bibliographically approved
Johagen, D. & Svenmarker, S. (2016). The scientific evidence of arterial line filtration in cardiopulmonary bypass. Perfusion, 31(6), 446-457
Open this publication in new window or tab >>The scientific evidence of arterial line filtration in cardiopulmonary bypass
2016 (English)In: Perfusion, ISSN 0267-6591, E-ISSN 1477-111X, Vol. 31, no 6, p. 446-457Article in journal (Refereed) Published
Abstract [en]

Background: The indication for arterial line filtration (ALF) is to inhibit embolisation during cardiopulmonary bypass. Filtration methods have developed from depth filters to screen filters and from a stand-alone component to an integral part of the oxygenator. For many years, ALF has been a standard adopted by a majority of cardiac centres worldwide. The following review aims to summarize the available evidence in support for ALF and report on its current practice in Europe. Method: The principles and application of ALF in Europe was investigated using a survey conducted in 2014. The scientific evidence for ALF was examined by performing a systematic literature search in six different databases, using the following search terms: Cardiopulmonary bypass AND filters AND arterial. The primary endpoint was protection against cerebral injury verified by the degree of cerebral embolisation or cognitive tests. The secondary endpoint was improvement of the clinical outcome verified elsewise. Only randomised clinical trials were considered. Results: The response rate was 31% (n=112). The great majority (88.5%) of respondents were using ALF, following more than 10 years of experience. Integrated arterial filtration was used by 55%. Of respondents not using ALF, fifty-four percent considered starting using integrated arterial filtration. The systematic literature database search returned 180 unique publications where 82 were specifically addressing ALF in cardiopulmonary bypass. Only four out of the 82 identified publications fulfilled our inclusion criteria. Of these, three were more than 20 years old and based on the use of bubble oxygenation. Conclusion: ALF is a standard implemented in a majority of cardiopulmonary bypass procedures in Europe. The level of scientific evidence available in support of current arterial line filtration methods in cardiopulmonary bypass is, however, poor. Large, well-designed, randomised trials are warranted.

National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-126509 (URN)10.1177/0267659115616179 (DOI)000382956000002 ()26607840 (PubMedID)
Available from: 2016-10-27 Created: 2016-10-10 Last updated: 2019-05-20Bibliographically approved
Ödling Davidsson, F., Johagen, D., Appelblad, M. & Svenmarker, S. (2015). Reversal of Heparin After Cardiac Surgery: Protamine Titration Using a Statistical Model. Journal of Cardiothoracic and Vascular Anesthesia, 29(3), 710-714
Open this publication in new window or tab >>Reversal of Heparin After Cardiac Surgery: Protamine Titration Using a Statistical Model
2015 (English)In: Journal of Cardiothoracic and Vascular Anesthesia, ISSN 1053-0770, E-ISSN 1532-8422, Vol. 29, no 3, p. 710-714Article in journal (Refereed) Published
Abstract [en]

Objective: To establish a statistical model for determination of protamine dose in conjunction with cardiopulmonary bypass. Design: Prospective.

Setting: University hospital.

Participants: Ninety consecutive cardiac surgical patients.

Interventions: None.

Measurements and Main Results: A series of clinically oriented variables were introduced into a statistical model for projection of the protamine dose after cardiopulmonary bypass. The following significant predictors were identified using multivariable regression analysis: The patient's body surface area, the administered dose of heparin, heparin clearance, and the preoperative platelet count. The statistical model projected the protamine dose within 3 +/- 23 mg of the point-of-care test used as reference.

Conclusion: Protamine dosing based on statistical modeling represents an alternative to point-of-care tests.

Keywords
cardiac surgery, cardiopulmonary bypass, protamine, heparin, point-of-care testing, statistical modeling
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-106499 (URN)10.1053/j.jvca.2014.12.006 (DOI)000355643500025 ()
Available from: 2015-07-16 Created: 2015-07-14 Last updated: 2018-06-07Bibliographically approved
Svenmarker, S., Häggmark, S., Johansson, G., Axelsson, B., Wiklund, U. & Haney, M. (2014). Regional changes in cerebral blood flow oxygenation can indicate global changes in cerebral blood flow during coronary artery occlusion in juvenile pigs. Physiological Measurement, 35(7), 1439-1450
Open this publication in new window or tab >>Regional changes in cerebral blood flow oxygenation can indicate global changes in cerebral blood flow during coronary artery occlusion in juvenile pigs
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2014 (English)In: Physiological Measurement, ISSN 0967-3334, E-ISSN 1361-6579, Vol. 35, no 7, p. 1439-1450Article in journal (Refereed) Published
Abstract [en]

Near infrared spectroscopy (NIRS) is a widely employed method for assessment of regional cerebral oxygenation (R(c)StO(2)). RcStO(2) values are expected to vary with changes in the relative amount of oxyhaemoglobin. The present experimental study aimed to assess the response of RcStO(2) to controlled alterations of carotid blood flow (CQ). Landrace pigs were anesthetized followed by surgical preparation. Cyclic variations in cardiac output were accomplished by intermittently occluding the main stem of the left coronary artery. A flow measurement probe for assessing CQ was placed around the left carotid artery. One NIRS probe was placed on the left ipsilateral forehead to assess regional cerebral oximetry. Simultaneous registration of CQ and RcStO(2) was conducted. There was a strong correlation for variation in CQ and RcStO(2) signal values. Based on coherence analysis the fraction of power of the RcStO(2) that was coherent with the CQ signal reached 0.84 - 0.12 (P < 0.05) for frequencies lower than 0.1 Hz. The agreement of the sampleto- sample co-variation, as assessed by the Pearson correlation coefficient, was 0.83 +/- 0.08 (P < 0.05). One explanatory component for variations in cerebral oxygenation verified by NIRS should be attributed to variations in the cerebral blood flow.

Place, publisher, year, edition, pages
IOP Publishing, 2014
Keywords
cerebral oxygenation, near infrared spectroscopy, blood flow, measurement, non-invasive monitoring
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:umu:diva-91373 (URN)10.1088/0967-3334/35/7/1439 (DOI)000338476000018 ()
Available from: 2014-08-14 Created: 2014-08-04 Last updated: 2018-06-07Bibliographically approved
Svenmarker, S., Häggmark, S., Östman, M., Holmgren, A. & Näslund, U. (2013). Central venous oxygen saturation during cardiopulmonary bypass predicts 3-year survival. Interactive Cardiovascular and Thoracic Surgery, 16(1), 21-26
Open this publication in new window or tab >>Central venous oxygen saturation during cardiopulmonary bypass predicts 3-year survival
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2013 (English)In: Interactive Cardiovascular and Thoracic Surgery, ISSN 1569-9293, E-ISSN 1569-9285, Vol. 16, no 1, p. 21-26Article in journal (Refereed) Published
Abstract [en]

Long-term survival after cardiac surgery is determined by a number of different risk factors. Central venous oxygen saturation (SvO2) measures the balance between oxygen delivery and demand. SvO2 levels in the intensive care situation are reported to be associated with patient outcome. The present report explores the connection between SvO2 during cardiopulmonary bypass (CPB) and survival after cardiac surgery. Retrospective analysis of one thousand consecutive cardiac surgical patients was undertaken. SvO2 during CPB was monitored online. Registry data combining specific risk factors with SvO2 were selected for Kaplan-Meier and Cox regression analysis to examine the influence on 30-day and 3-year survivals. Nine-hundred and thirty-two patient records were eligible for analysis. SvO2 below 75% during CPB was associated with significantly shorter 30-day and 3-year survivals. Based on Kaplan-Meier statistics, the survival rate decreased by 3.1% (98.1-95.0), P = 0.011 and 6.1% (92.7-86.6), P = 0.003, respectively. The influence of SvO2 on 3-year survival remained statistically significant after controlling for a series of risk factors in the Cox regression analysis. Patients with SvO2 < 75% carried a 2-fold (odds ratio 2.1) increased relative risk of shortened 3-year survival (P = 0.003). Other risk factors statistically significantly associated with 3-year survival were age, gender, duration of CPB, blood temperature, hypertension, haematocrit and type of surgical procedure. We report decreased 30-day and 3-year survival expectancy for patients experiencing SvO2 lower than 75% during CPB.

Keywords
Survival, Cardiopulmonary bypass, Venous oxygen saturation, Systemic blood flow
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-64238 (URN)10.1093/icvts/ivs363 (DOI)000312652900007 ()
Available from: 2013-01-29 Created: 2013-01-21 Last updated: 2018-06-08Bibliographically approved
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