Anas Alatas

Prakasa SA, Alatas A

Sari EK, Alatas A, Kusuma H

Made Ryan Kharmayani, R. Soenarto, Anas Alatas, Muhammad Arza Putra

Application of cardiopulmonary bypass (CPB) in cardiac surgery may cause systemic inflammatory reactions, possibly causing clinical sequelae and multiple organ failures such as systolic or diastolic dysfunction, regional or global left ventricle or right ventricle low contractility, and the function of vascular tone. The use of drugs (i.e., corticosteroids) and the ultrafiltration method during the CPB application has been known to prevent or minimize the complication of CPB in cardiac surgery. One of the non-pharmacological approaches to minimize those inflammatory responses is the modified ultrafiltration (MUF) technique. Theoretically, this is due to ultrafiltration which may reduce the interstitial fluid and inflammatory mediator. MUF can be used to counteract inflammatory responses in pediatric cardiac surgery. This ultrafiltration method became a recommended procedure in minimally invasive surgery and conventional open-heart surgery. However, studies about effectiveness in adults are limited. In this case series, the MUF technique was used in three patients who underwent valvular heart surgery with a CPB machine. Following the application of the CPB, the MUF technique is performed for 10 min at a speed of no more than 10% full flow. Hemodynamic measurements and interleukin-6 (IL-6) levels were taken during surgery and 24 h post-CPB. At 24 h post-CPB, the vasoactive inotropic score and duration of mechanical support use were less than 20 and 18–24 h, respectively, and the IL-6 level ranged from 7.22 to 14.22 pg/mL. The cardiac index increased, ranging from 2.43 to 3.47 L/min/m2, and pulmonary vascular resistance decreased, ranging from 78 to 146 dyne s/cm5.

A. R. Tantri, Anas Alatas, Reza Surya Dharma

BACKGROUND: The femoral vein cannulation is essential for vascular access and finding it by just relying on the femoral artery pulsation can be challenging in a certain condition. V technique is a new technique to identify the femoral vein’s cannulation site based on topographic anatomy without relying on femoral artery pulsation. AIM: This study was aimed to compare V technique and arterial palpation technique accuracies in identifying the femoral vein’s cannulation site. METHODS: This study was a cross-sectional study on 115 adult patients aged 18–65 years old with body mass index 18–25 kg/m2 who underwent elective surgery in Cipto Mangunkusumo National General Hospital on February-March 2020. After ethical approval and informed consent, the distance of the femoral vein’s cannulation site identified by both techniques with the skin projection of the femoral vein diameter identified by ultrasonography (USG) were compared in all subjects. Accuracy was defined when the femoral vein’s cannulation sites identified by both techniques were within the skin projection of femoral vein diameter identified by USG. Data were collected and analyzed using SPSS ver 20. RESULTS: The accuracy of the V technique in determining the femoral vein’s cannulation site was 93.9%, while the accuration of the femoral artery pulsation technique was 96.5%. Mcnemar analysis showed no difference in both techniques’ accuracy (p = 0.549). There was a statistically significant positive correlation between the distance of the femoral vein cannulation site predicted by both techniques with the skin projection of the femoral vein midpoint (r = 0.548; p < 0.001). CONCLUSION: V technique’s accuracy was not significantly different from the femoral artery pulsation palpation technique’s accuracy in identifying the femoral vein cannulation site.

K. Ferdiana, A. Ramlan, R. Soenarto, Anas Alatas

BACKGROUND Coagulopathy is a serious COVID-19 complication that requires rapid diagnosis and anticoagulation. This study aimed to determine the role of coagulation examination using thromboelastography (TEG) on the decision-making time of anticoagulant therapy in COVID-19 patients and its clinical outcomes. METHODS A prospective observational study was conducted in Cipto Mangunkusumo Hospital, Indonesia, from October 2020 to March 2021. We consecutively recruited moderate and severe COVID-19 patients in the high and intensive care units. Turnaround time, time to anticoagulant therapy decision, and clinical outcomes (length of stay and 30-day mortality) were compared between those who had a TEG examination in addition to the standard coagulation profile examination (thrombocyte count, PT, APTT, D-dimer, and fibrinogen) and those who had only a standard coagulation profile laboratory examination. RESULTS Among 100 moderate to severe COVID-19 patients recruited, 50 patients had a TEG examination. The turnaround time of TEG was 45 (15–102) min versus 82 (19–164) min in the standard examination (p<0.001). The time to decision was significantly faster in the TEG group than the standard group (75 [42–133] min versus 184 [92–353] min, p<0.001). The turnaround time was positively correlated with time to decision (r = 0.760, p<0.001). However, TEG did not improve clinical outcomes such as length of stay (10.5 [3–20] versus 9 [2–39] days) and 30-day mortality (66% versus 64%). CONCLUSIONS The TEG method significantly enables quicker decision-making time for moderate to severe coagulation disorder in COVID-19 patients.