1,536 results on '"Extracorporeal membrane oxygenation"'
Search Results
302. Extracorporeal Respiratory Support With a Miniature Integrated Pediatric Pump-Lung Device in an Acute Ovine Respiratory Failure Model.
- Author
-
Wei, Xufeng, Sanchez, Pablo G., Liu, Yang, Claire Watkins, A., Li, Tieluo, Griffith, Bartley P., and Wu, Zhongjun J.
- Subjects
- *
HEART assist devices , *EXTRACORPOREAL membrane oxygenation , *RESPIRATORY insufficiency , *MAMMAL physiology , *PEDIATRIC cardiology - Abstract
Respiratory failure is one of the major causes of mortality and morbidity all over the world. Therapeutic options to treat respiratory failure remain limited. The objective of this study was to evaluate the gas transfer performance of a newly developed miniature portable integrated pediatric pump-lung device (PediPL) with small membrane surface for respiratory support in an acute ovine respiratory failure model. The respiratory failure was created in six adult sheep using intravenous anesthesia and reduced mechanical ventilation at 2 breaths/min. The PediPL device was surgically implanted and evaluated for respiratory support in a venovenous configuration between the right atrium and pulmonary artery. The hemodynamics and respiratory status of the animals during support with the device gas transfer performance of the PediPL were studied for 4 h. The animals exhibited respiratory failure 30 min after mechanical ventilation was reduced to 2 breaths/min, indicated by low oxygen partial pressure, low oxygen saturation, and elevated carbon dioxide in arterial blood. The failure was reversed by establishing respiratory support with the PediPL after 30 min. The rates of O2 transfer and CO2 removal of the PediPL were 86.8 and 139.1 mL/min, respectively. The results demonstrated that the PediPL (miniature integrated pump-oxygenator) has the potential to provide respiratory support as a novel treatment for both hypoxia and hypercarbia. The compact size of the PediPL could allow portability and potentially be used in many emergency settings to rescue patients suffering acute lung injury. [ABSTRACT FROM AUTHOR]
- Published
- 2016
- Full Text
- View/download PDF
303. Automatic Control of Veno-Venous Extracorporeal Lung Assist.
- Author
-
Kopp, Ruedger, Bensberg, Ralf, Stollenwerk, Andre, Arens, Jutta, Grottke, Oliver, Walter, Marian, and Rossaint, Rolf
- Subjects
- *
LUNG transplantation , *PULMONARY gas exchange , *ARTIFICIAL blood circulation , *ADULT respiratory distress syndrome , *AEROBIC capacity - Abstract
Veno-venous extracorporeal lung assist ( ECLA) can provide sufficient gas exchange even in most severe cases of acute respiratory distress syndrome. Commercially available systems are manually controlled, although an automatically controlled ECLA could allow individualized and continuous adaption to clinical requirements. Therefore, we developed a demonstrator with an integrated control algorithm to keep continuously measured peripheral oxygen saturation and partial pressure of carbon dioxide constant by automatically adjusting extracorporeal blood and gas flow. The ' SmartECLA' system was tested in six animal experiments with increasing pulmonary hypoventilation and hypoxic inspiratory gas mixture to simulate progressive acute respiratory failure. During a cumulative evaluation time of 32 h for all experiments, automatic ECLA control resulted in a peripheral oxygen saturation ≥90% for 98% of the time with the lowest value of 82% for 15 s. Partial pressure of venous carbon dioxide was between 40 and 49 mm Hg for 97% of the time with no value <35 mm Hg or >49 mm Hg. With decreasing inspiratory oxygen concentration, extracorporeal oxygen uptake increased from 68 ± 25 to 154 ± 34 mL/min ( P < 0.05), and reducing respiratory rate resulted in increasing extracorporeal carbon dioxide elimination from 71 ± 37 to 92 ± 37 mL/min ( P < 0.05). The ' SmartECLA' demonstrator allowed reliable automatic control of the extracorporeal circuit. Proof of concept could be demonstrated for this novel automatically controlled veno-venous ECLA circuit. [ABSTRACT FROM AUTHOR]
- Published
- 2016
- Full Text
- View/download PDF
304. Cytokine adsorption in a patient with severe coronavirus disease 2019 related acute respiratory distress syndrome requiring extracorporeal membrane oxygenation therapy: A case report
- Author
-
Achim Lother, Christoph Benk, Dawid L. Staudacher, Marina Rieder, Christoph Bode, Alexander Supady, Daniel Duerschmied, and Timm Zahn
- Subjects
2019-20 coronavirus outbreak ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,medicine.medical_treatment ,Biomedical Engineering ,Medicine (miscellaneous) ,Bioengineering ,General Medicine ,Acute respiratory distress ,Biomaterials ,Cytokine ,Immunology ,medicine ,Extracorporeal membrane oxygenation ,business - Published
- 2020
305. Is anticoagulation with bivalirudin comparable to heparin for pediatric extracorporeal life support? Results from a high‐volume center
- Author
-
Michael A. Lahart, Ahmed S. Said, Emily L. Burns, Matthew T. Douds, Aaron M. Abarbanell, and Matthew R. Schill
- Subjects
Male ,endocrine system ,Adolescent ,Critical Illness ,0206 medical engineering ,Biomedical Engineering ,Medicine (miscellaneous) ,Hemorrhage ,Bioengineering ,02 engineering and technology ,030204 cardiovascular system & hematology ,Intensive Care Units, Pediatric ,Extracorporeal ,Biomaterials ,03 medical and health sciences ,Extracorporeal Membrane Oxygenation ,0302 clinical medicine ,Blood product ,Intensive care ,Humans ,Medicine ,Bivalirudin ,Child ,Blood Coagulation ,Retrospective Studies ,Drug Substitution ,Heparin ,business.industry ,Anticoagulants ,Infant ,Thrombosis ,General Medicine ,Hirudins ,020601 biomedical engineering ,Peptide Fragments ,Recombinant Proteins ,Stroke ,Child, Preschool ,Life support ,Anesthesia ,Female ,Fresh frozen plasma ,business ,Hospitals, High-Volume ,medicine.drug ,Discovery and development of direct thrombin inhibitors - Abstract
There is a paucity of data regarding the use of direct thrombin inhibitors such as bivalirudin for children on extracorporeal life support (ECLS). We sought to compare the outcomes of children on ECLS anticoagulated with bivalirudin versus heparin. Patients transitioned from heparin to bivalirudin were treated as a separate group. A single-institution, retrospective review of all consecutive children (neonate to 18 years) placed on ECLS in the cardiac or pediatric intensive care units was performed (June 2018-December 2019). Data collected included demographics, anticoagulation strategy, number of circuit interventions, blood product use on ECLS, survival to decannulation, and survival to discharge. Fifty-four children were placed on ECLS for a total of 56 runs. Demographics and venovenous versus venoarterial ECLS were similar. The bivalirudin group had longer median duration of support compared to the heparin group--11.0 days [IQR 6.2, 23.1] versus 3.3 days [2.1, 6.2], P < .001. Patients switched from heparin to bivalirudin had a similar duration of support (10.3 days [8.3, 18.3]) as those on bilvalirudin alone. However, there was no difference in red blood cell, fresh frozen plasma, or platelet transfusions. There was no difference in the number of circuit interventions, survival to decannulation or discharge. The freedom to first circuit intervention was longer with bivalirudin compared to heparin. Our data suggest that even with longer pediatric ECLS runs on bivalirudin, there were no differences in the outcomes between the heparin and bivalirudin groups, with longer freedom from first circuit intervention with bivalirudin. While this is the largest reported series comparing children on ECLS anticoagulated with heparin versus bivalirudin, larger studies are needed to determine the optimal anticoagulation strategy for this diverse and complicated group of children.
- Published
- 2020
306. The effect of hyperoxia on inflammation and platelet responses in an ex vivo extracorporeal membrane oxygenation circuit
- Author
-
Margaret R. Passmore, John F. Fraser, Aidan Burrell, Maximilian V. Malfertheiner, Kiran Shekar, Sainath Raman, Mahe Bouquet, Jacky Y. Suen, Talvin J Lee, Katrina K Ki, Charles McDonald, E. Wood, Chris H H Chan, Sacha Rozencwajg, and Daman Langguth
- Subjects
Blood Platelets ,Platelet Aggregation ,medicine.medical_treatment ,0206 medical engineering ,Biomedical Engineering ,Medicine (miscellaneous) ,Bioengineering ,Inflammation ,02 engineering and technology ,Hyperoxia ,030204 cardiovascular system & hematology ,Pharmacology ,medicine.disease_cause ,Severity of Illness Index ,Biomaterials ,Superoxide dismutase ,03 medical and health sciences ,Extracorporeal Membrane Oxygenation ,0302 clinical medicine ,Leukocytes ,medicine ,Extracorporeal membrane oxygenation ,Humans ,Whole blood ,biology ,business.industry ,General Medicine ,020601 biomedical engineering ,Oxidative Stress ,Neutrophil elastase ,biology.protein ,medicine.symptom ,business ,Oxidative stress ,Ex vivo - Abstract
Use of extracorporeal membrane oxygenation (ECMO) is expanding, however it is still associated with significant morbidity and mortality. Activation of inflammatory and innate immune responses and hemostatic alterations contribute to complications. Hyperoxia may play a role in exacerbating these responses. Nine ex vivo ECMO circuits were tested using fresh healthy human whole blood, with two oxygen levels: 21% inspired fraction of oxygen (FiO ; mild hyperoxia; n=5) and 100% FiO (severe hyperoxia; n=4). Serial blood samples were taken for analysis of platelet aggregometry, leukocyte activation, inflammatory and oxidative stress markers. ECMO resulted in reduced adenosine diphosphate- (p
- Published
- 2020
307. Outcomes and factors associated with early mortality in pediatric postcardiotomy veno‐arterial extracorporeal membrane oxygenation
- Author
-
Jinping Liu, Shengwen Guo, Peiyao Zhang, Jinxiao Hu, Ju Zhao, Yixuan Li, Yuanyuan Tong, Zhengyi Feng, Liting Bai, and Yu Jin
- Subjects
Male ,medicine.medical_specialty ,Adolescent ,Transposition of Great Vessels ,medicine.medical_treatment ,0206 medical engineering ,Biomedical Engineering ,Medicine (miscellaneous) ,Bioengineering ,02 engineering and technology ,030204 cardiovascular system & hematology ,Biomaterials ,03 medical and health sciences ,Extracorporeal Membrane Oxygenation ,Postoperative Complications ,0302 clinical medicine ,Risk Factors ,Extracorporeal membrane oxygenation ,Humans ,Medicine ,Weaning ,Hospital Mortality ,Cardiac Surgical Procedures ,Child ,Adverse effect ,Retrospective Studies ,business.industry ,Cardiogenic shock ,Infant, Newborn ,Acute kidney injury ,Infant ,General Medicine ,Acute Kidney Injury ,Length of Stay ,Prognosis ,medicine.disease ,020601 biomedical engineering ,Heart Arrest ,Cardiac surgery ,surgical procedures, operative ,Great arteries ,Child, Preschool ,Anesthesia ,Cohort ,Female ,business - Abstract
Mortality and morbidity of children received veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support after cardiac surgery remain high despite remarkable advances in medical management and devices. The purpose of this study was to describe outcomes and risk factors of applying VA-ECMO in the surgical pediatric population. We retrospectively analyzed 85 consecutive pediatric patients (aged
- Published
- 2020
308. Venoarterial extracorporeal membrane oxygenation for postcardiotomy cardiogenic shock—A six‐year service evaluation
- Author
-
James Barnard, Lee Feddy, M. Charlesworth, Julian Barker, Laura Head, Miguel Torres García, Rajamiyer Venkateswaran, and Alan Ashworth
- Subjects
Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,0206 medical engineering ,Shock, Cardiogenic ,Biomedical Engineering ,Medicine (miscellaneous) ,Bioengineering ,02 engineering and technology ,030204 cardiovascular system & hematology ,law.invention ,Tertiary Care Centers ,Biomaterials ,03 medical and health sciences ,Extracorporeal Membrane Oxygenation ,Postoperative Complications ,0302 clinical medicine ,Risk Factors ,law ,Intensive care ,Hemofiltration ,medicine ,Cardiopulmonary bypass ,Extracorporeal membrane oxygenation ,Humans ,Hospital Mortality ,Cardiac Surgical Procedures ,Aged ,Retrospective Studies ,business.industry ,Cardiogenic shock ,Age Factors ,General Medicine ,Middle Aged ,medicine.disease ,020601 biomedical engineering ,Intensive care unit ,Cardiac surgery ,Survival Rate ,Treatment Outcome ,Cardiothoracic surgery ,Anesthesia ,Female ,business ,Program Evaluation - Abstract
Only a small number of English hospitals provide postcardiotomy venoarterial extracorporeal membrane oxygenation (VA-ECMO) and there are doubts about its efficacy and safety. The aim of this service evaluation was to determine local survival rates and report on patient demographics. This was a retrospective service evaluation of prospectively recorded routine clinical data from a tertiary cardiothoracic center in the United Kingdom offering services including cardiac and thoracic surgery, heart and lung transplantation, venovenous extracorporeal membrane oxygenation (VV-ECMO) for respiratory failure, and all types of mechanical circulatory support. In six years, 39 patients were supported with VA-ECMO for refractory postcardiotomy cardiogenic shock (PCCS). We analyzed survival data and looked for associations between survival rates and patient characteristics. The intervention was venoarterial-ECMO in patients with PCCS either following weaning from cardiopulmonary bypass or following a trial of inotropes and intra-aortic balloon counterpulsation on the intensive care unit. 30-day, hospital discharge, 1-year and 2-year survivals were 51.3%, 41%, 37.5%, and 38.5%, respectively. The median (IQR [range]) duration of support was 6 (4-9 [1-35]) days. Nonsurvival was associated with advanced age, shorter intensive care length of stay, and the requirement for postoperative hemofiltration. Reasonable survival rates can be achieved in selected patients who may have been expected to have a worse mortality without VA-ECMO. We suggest postoperative VA-ECMO should be available to all patients undergoing cardiac surgery be it in their own center or through an established pathway to a specialist center.
- Published
- 2020
309. Impact of high mechanical shear stress and oxygenator membrane surface on blood damage relevant to thrombosis and bleeding in a pediatric ECMO circuit
- Author
-
Shigang Wang, Bartley P. Griffith, Tieluo Li, Jiafeng Zhang, Zengsheng Chen, Katherin Arias, Zhongjun J. Wu, and Wenji Sun
- Subjects
Blood Platelets ,medicine.medical_specialty ,medicine.medical_treatment ,0206 medical engineering ,Biomedical Engineering ,Medicine (miscellaneous) ,Hemorrhage ,Bioengineering ,Platelet Membrane Glycoproteins ,02 engineering and technology ,030204 cardiovascular system & hematology ,Fibrinogen ,Article ,Biomaterials ,03 medical and health sciences ,Extracorporeal Membrane Oxygenation ,0302 clinical medicine ,Von Willebrand factor ,Cell-Derived Microparticles ,Internal medicine ,medicine ,Extracorporeal membrane oxygenation ,Humans ,Platelet ,Platelet activation ,Child ,Oxygenator ,Oxygenators, Membrane ,biology ,Chemistry ,Thrombosis ,General Medicine ,Platelet Activation ,020601 biomedical engineering ,Healthy Volunteers ,Platelet Glycoprotein GPIb-IX Complex ,Hemostasis ,Cardiology ,biology.protein ,Stress, Mechanical ,GPVI ,medicine.drug - Abstract
OBJECTIVE: The roles of the large membrane surface of the oxygenator and the high mechanical shear stress (HMSS) of the pump in the ECMO circuit were examined under a pediatric support setting. METHODS: A clinical centrifugal pump and a pediatric oxygenator were used to construct the ECMO circuit. An identical circuit without the oxygenator was constructed for comparison. Fresh human blood was circulated in the two circuits for 4 hours under the identical pump speed and flow. Blood samples were collected hourly for blood damage assessment, including platelet activation, generation of platelet-derived microparticles (PDMP), losses of key platelet hemostasis receptors (glycoprotein (GP) Ibα (GPIbα) and GPVI) and high molecular weight multimers (HMWM) of von Willebrand factor (VWF) and plasma free hemoglobin (PFH). Platelet adhesion on fibrinogen, VWF and collagen was further examined. RESULTS: The levels of platelet activation and generation of PDMP and PFH exhibited an increasing trend with circulation time while the expression levels of GPIbα and GPVI receptors on the platelet surface decreased. Correspondingly, the platelets in the blood samples exhibited increased adhesion capacity to fibrinogen and decreased adhesion capacities on VWF and collagen with circulation time. Loss of HMWM of VWF occurred in both circuits. No statistically significant differences were found in all the measured parameters for blood damage and platelet adhesion function between the two circuits. CONCLUSIONS: The results indicate that HMSS from the pump played a dominant role in blood damage associated with ECMO and the impact of the large surface of the oxygenator on blood damage was insignificant.
- Published
- 2020
310. Extracorporeal life support during and after bilateral sequential lung transplantation in patients with pulmonary artery hypertension
- Author
-
Guido Frascaroli, Giampiero Dolci, Massimo Baiocchi, Alessio Campisi, Sara Mazzarra, Andrea Dell’Amore, Saverio Pastore, and Stefano Congiu
- Subjects
Male ,medicine.medical_treatment ,Medicine (miscellaneous) ,02 engineering and technology ,030204 cardiovascular system & hematology ,law.invention ,0302 clinical medicine ,law ,pulmonary hypertension ,Medicine ,Hospital Mortality ,Pulmonary Arterial Hypertension ,Cardiopulmonary Bypass ,Incidence ,General Medicine ,Middle Aged ,Treatment Outcome ,surgical procedures, operative ,Female ,Lung Transplantation ,Adult ,medicine.medical_specialty ,0206 medical engineering ,Biomedical Engineering ,Primary Graft Dysfunction ,Bioengineering ,Extracorporeal ,Biomaterials ,Young Adult ,03 medical and health sciences ,Extracorporeal Membrane Oxygenation ,medicine.artery ,Cardiopulmonary bypass ,Extracorporeal membrane oxygenation ,Humans ,Lung transplantation ,Retrospective Studies ,Postoperative Care ,Intraoperative Care ,business.industry ,extracorporeal support technique ,medicine.disease ,020601 biomedical engineering ,Pulmonary hypertension ,Surgery ,cardiopulmonary bypass ,extracorporeal membrane oxygenation ,lung transplantation ,Life support ,Pulmonary artery ,business ,Follow-Up Studies - Abstract
The use of extracorporeal membrane oxygenator instead of standard cardiopulmonary bypass during lung transplantation is debatable. Moreover, recently, the concept of prolonged postoperative extracorporeal membrane oxygenator (ECMO) support has been introduced in many transplant centers to prevent primary graft dysfunction (PGD) and improve early and long-term results. The objective of this study was to review the results of our extracorporeal life support strategy during and after bilateral sequential lung transplantation (BSLT) for pulmonary artery hypertension. We review retrospectively our experience in BSLT for pulmonary artery hypertension between January 2010 and August 2018. A total of 38 patients were identified. Nine patients were transplanted using cardiopulmonary bypass (CPB), in eight cases CPB was followed by a prolonged ECMO (pECMO) support, 14 patients were transplanted on central ECMO support, and seven patients were transplanted with central ECMO support followed by a pECMO assistance. The effects of different support strategies were evaluated, in particular in-hospital morbidity, mortality, incidence of PGD, and long-term follow-up. The use of CPB was associated with poor postoperative results and worse long-term survival compared with ECMO-supported patients. Predictive preoperative factors for the need of intraoperative CPB instead of ECMO were identified. The pECMO strategy had a favorable effect to mitigate postoperative morbidity and mortality, not only in intraoperative ECMO-supported patients, but even in CPB-supported cases. In our experience, ECMO may be considered as the first choice circulatory support for lung transplantation. Sometimes, in very complex cases, CBP is still necessary. The pECMO strategy is very effective to reduce incidence of PGD even in CPB-supported patients.
- Published
- 2020
311. Clinical outcomes of venoarterial extracorporeal life support in 462 patients: Single‐center experience
- Author
-
Varvara Pavlova, Itcvr, Harald C. Eichstaedt, Jerry Easo, Alexander Weymann, Michel Pompeu Barros de Oliveira Sá, Ilgiz Zagitov, Arjang Ruhparwar, Konstantin Zhigalov, Dmitrii Safonov, Juergen Ennker, and Ahmad Alofesh
- Subjects
Male ,endocrine system ,medicine.medical_specialty ,medicine.medical_treatment ,Medizin ,Shock, Cardiogenic ,Biomedical Engineering ,Medicine (miscellaneous) ,Bioengineering ,Single Center ,Extracorporeal ,Biomaterials ,Extracorporeal Membrane Oxygenation ,Postoperative Complications ,medicine ,Humans ,Hospital Mortality ,Cardiopulmonary resuscitation ,Cardiac Surgical Procedures ,Adverse effect ,Shock, Surgical ,Survival rate ,Aged ,business.industry ,Cardiogenic shock ,General Medicine ,Middle Aged ,medicine.disease ,Sternotomy ,Cardiopulmonary Resuscitation ,Cardiac surgery ,Survival Rate ,Treatment Outcome ,Life support ,Anesthesia ,Female ,business - Abstract
This study aims to investigate the outcomes of venoarterial extracorporeal life support (VA-ECLS) in a large single-center patient cohort regarding survival and adverse events. Between June 2009 and March 2019, 462 consecutive patients received VA-ECLS. The mean age was 66.2 ± 11.9 years. Two patient groups were identified: Group 1-patients with ECLS due to postcardiotomy shock (PCS) after cardiac surgery (PCS, n = 357); Group 2-patients with ECLS due to cardiogenic shock (CS) without previous surgery (nonPCS, n = 105). The primary end point was overall in-hospital survival, while secondary end points were adverse events during the study period. Overall, the in-hospital survival rate was 26%. There was no statistically significant difference between the groups: 26.3% for PCS and 24.8% for nonPCS, respectively (P > .05). Weaning from VA-ECLS was possible in 44.3% for PCS and in 29.5% for nonPCS (P = .004). The strong predictors of overall mortality were postoperative hepatic dysfunction (OR = 14.362, 95%CI = 1.948-105.858), cardiopulmonary resuscitation > 30 minutes (OR = 6.301, 95%CI = 1.488-26.673), bleeding with a need for revision (OR = 2.123, 95%CI = 1.343-3.355), and previous sternotomy (OR = 2.077, 95%CI = 1.021-4.223). Despite its low survival rates, VA-ECLS therapy is the last resort and the only lifesaving option for patients in refractory CS. In contrast, there is still a lack of evidence for VA-ECLS in PCS patients. Future studies are warranted to evaluate the outcomes of VA-ECLS therapy after cardiac surgery.
- Published
- 2020
312. Evaluation of an autoregulatory ECMO system for total respiratory support in an acute ovine model
- Author
-
Jiafeng Zhang, Zachary B. K. Berk, Douglas Tran, Zhongjun J. Wu, Robert G. Conway, Tieluo Li, and Bartley P. Griffith
- Subjects
Male ,medicine.medical_treatment ,0206 medical engineering ,Biomedical Engineering ,Medicine (miscellaneous) ,Hemodynamics ,Bioengineering ,02 engineering and technology ,030204 cardiovascular system & hematology ,Article ,Artificial lung ,Biomaterials ,03 medical and health sciences ,Extracorporeal Membrane Oxygenation ,0302 clinical medicine ,Fuzzy Logic ,Extracorporeal membrane oxygenation ,medicine ,Animals ,Respiratory system ,Oxygenator ,Sheep ,Respiratory distress ,business.industry ,General Medicine ,Oxygenation ,020601 biomedical engineering ,surgical procedures, operative ,Respiratory failure ,Anesthesia ,business - Abstract
Extracorporeal membrane oxygenation (ECMO) has become a mainstay of therapy for patients suffering from severe respiratory failure. Ambulatory ECMO systems aim to provide long-term out-of-hospital respiratory support. As a patient’s activity level changes, the required level of ECMO support varies with oxygen consumption and metabolic fluctuations. To compensate for such changes, an Auto-Regulatory ECMO system (AR-ECMO) has been developed and its performance was evaluated as a proof-of-concept in an acute ovine model. The AR-ECMO system consists of a regular ECMO circuit and an electromechanical control system. A custom fuzzy-logic control algorithm was implemented to adjust the blood flow and sweep gas flow of the ECMO circuit to meet the varying respiratory demand by utilizing two noninvasive sensors for venous oxyhemoglobin saturation and the oxygenator exhaust gas CO2 concentration. Disturbance responses of the AR-ECMO to induced acute respiratory distress were assessed for six hours in four juvenile sheep cannulated with a veno-pulmonary artery ECMO configuration, including acute ventilator shutoff, ventilator step-change (off-on-off), and forced desaturation. All sheep survived for the study duration. The AR-ECMO system was able to respond and maintain stable hemodynamics and physiological blood gas contents (SpO(2) = 96.3 % ± 4.29, pH = 7.44 ± 0.09, pCO(2) = 38.9 ± 9.9 mmHg, and pO(2) =237.9 ± 123.6 mmHg) during simulated respiratory distress. Acceptable correlation between oxygenator exhaust gas CO(2) and oxygenator outlet pCO(2) were observed (R(2)= 0.84). In summary, the AR-ECMO system successfully maintained physiologic control of peripheral oxygenation and carbon dioxide over the study period, utilizing only measurements taken directly from the ECMO circuit. The range of system response necessitates an adaptable system in the setting of variable metabolic demands. The ability of this system to respond to significant disturbances in ventilator support is encouraging. Future work to evaluate our AR-ECMO system in long-term, awake animal studies is necessary for further refinement.
- Published
- 2020
313. Extracorporeal carbon dioxide removal requirements for ultraprotective mechanical ventilation: Mathematical model predictions
- Author
-
Kai Harenski, Dominique Pouchoulin, Jacques Goldstein, and John K Leypoldt
- Subjects
medicine.medical_specialty ,ARDS ,medicine.medical_treatment ,0206 medical engineering ,Biomedical Engineering ,Medicine (miscellaneous) ,Bioengineering ,02 engineering and technology ,mechanical ventilation ,030204 cardiovascular system & hematology ,Models, Biological ,Biomaterials ,03 medical and health sciences ,Extracorporeal Membrane Oxygenation ,0302 clinical medicine ,Permissive hypercapnia ,Main Text Articles ,Internal medicine ,medicine ,Humans ,Normocapnia ,carbon dioxide removal ,Tidal volume ,Mechanical ventilation ,Main Text Article ,extracorporeal ,Chemistry ,physiological simulation ,General Medicine ,Carbon Dioxide ,medicine.disease ,Respiration, Artificial ,020601 biomedical engineering ,Blood ,Breathing ,Cardiology ,Arterial blood ,medicine.symptom ,Hypercapnia ,mathematical model - Abstract
Extracorporeal carbon dioxide (CO2 ) removal (ECCO2 R) facilitates the use of low tidal volumes during protective or ultraprotective mechanical ventilation when managing patients with acute respiratory distress syndrome (ARDS); however, the rate of ECCO2 R required to avoid hypercapnia remains unclear. We calculated ECCO2 R rate requirements to maintain arterial partial pressure of CO2 (PaCO2 ) at clinically desirable levels in mechanically ventilated ARDS patients using a six-compartment mathematical model of CO2 and oxygen (O2 ) biochemistry and whole-body transport with the inclusion of an ECCO2 R device for extracorporeal veno-venous removal of CO2 . The model assumes steady state conditions. Model compartments were lung capillary blood, arterial blood, venous blood, post-ECCO2 R venous blood, interstitial fluid and tissue cells, with CO2 and O2 distribution within each compartment; biochemistry included equilibrium among bicarbonate and non-bicarbonate buffers and CO2 and O2 binding to hemoglobin to elucidate Bohr and Haldane effects. O2 consumption and CO2 production rates were assumed proportional to predicted body weight (PBW) and adjusted to achieve reported arterial partial pressure of O2 and a PaCO2 level of 46 mmHg at a tidal volume of 7.6 mL/kg PBW in the absence of an ECCO2 R device based on average data from LUNG SAFE. Model calculations showed that ECCO2 R rates required to achieve mild permissive hypercapnia (PaCO2 of 46 mmHg) at a ventilation frequency or respiratory rate of 20.8/min during mechanical ventilation increased when tidal volumes decreased from 7.6 to 3 mL/kg PBW. Higher ECCO2R rates were required to achieve normocapnia (PaCO2 of 40 mmHg). Model calculations also showed that required ECCO2R rates were lower when ventilation frequencies were increased from 20.8/min to 26/min. The current mathematical model predicts that ECCO2R rates resulting in clinically desirable PaCO2 levels at tidal volumes of 5-6 mL/kg PBW can likely be achieved in mechanically ventilated ARDS patients with current technologies; use of ultraprotective tidal volumes (3-4 mL/kg PBW) may be challenging unless high mechanical ventilation frequencies are used.
- Published
- 2019
314. Outcomes after extracorporeal membrane oxygenation support in COVID‐19 and non‐COVID‐19 patients
- Author
-
G. R. Scott Budinger, Samuel Kim, James M. Walter, Ankit Bharat, Alexandra Klonis, Adwaiy Manerikar, Azad S. Karim, Chitaru Kurihara, Mark Saine, Vanessa Hoppner, Satoshi Watanabe, Viswajit Kandula, Rafael Garza-Castillon, Kalvin Lung, David D. Odell, Catherine A Gao, and Richard G. Wunderink
- Subjects
ARDS ,Time Factors ,Coronavirus disease 2019 (COVID-19) ,medicine.medical_treatment ,Biomedical Engineering ,Medicine (miscellaneous) ,Bioengineering ,Hemorrhage ,V‐V ECMO ,outcomes ,Extracorporeal ,Biomaterials ,Extracorporeal Membrane Oxygenation ,COVID‐19 ,circulatory support devices ,medicine ,Extracorporeal membrane oxygenation ,Lung transplantation ,Humans ,In patient ,Late initiation ,Retrospective Studies ,Respiratory Distress Syndrome ,Main Text ,artificial organs ,business.industry ,COVID-19 ,General Medicine ,medicine.disease ,surgical procedures, operative ,Anesthesia ,business ,Thrombotic complication - Abstract
Background Veno‐venous extracorporeal membrane oxygenation (V‐V ECMO) support is increasingly used in the management of COVID‐19‐related acute respiratory distress syndrome (ARDS). However, the clinical decision‐making to initiate V‐V ECMO for severe COVID‐19 still remains unclear. In order to determine the optimal timing and patient selection, we investigated the outcomes of both COVID‐19 and non‐COVID‐19 patients undergoing V‐V ECMO support. Methods Overall, 138 patients were included in this study. Patients were stratified into two cohorts: those with COVID‐19 and non‐COVID‐19 ARDS. Results The survival in patients with COVID‐19 was statistically similar to non‐COVID‐19 patients (p = .16). However, the COVID‐19 group demonstrated higher rates of bleeding (p = .03) and thrombotic complications (p, The survival in patients with COVID‐19 was statistically similar compared to non‐COVID‐19 patients, but the mortality of COVID‐19 patients who had been on a ventilator for longer than 7 days prior to the initiation of ECMO approached 100%.
- Published
- 2021
315. Is extracorporeal life support evidence‐based medicine? Not yet
- Author
-
Daniele Orso, Sara Scapol, and Tiziana Bove
- Subjects
Biomaterials ,Evidence-Based Medicine ,Extracorporeal Membrane Oxygenation ,Biomedical Engineering ,Humans ,Medicine (miscellaneous) ,Bioengineering ,General Medicine ,Respiratory Insufficiency ,Retrospective Studies - Published
- 2022
316. Percutaneous oxygenated right ventricular assist device for pulmonary embolism: A case series.
- Author
-
Lee TML, Bianchi P, Kourliouros A, Price LC, and Ledot S
- Subjects
- Humans, Treatment Outcome, Prosthesis Implantation, Heart-Assist Devices, Extracorporeal Membrane Oxygenation, Pulmonary Embolism, Heart Failure surgery, Ventricular Dysfunction, Right
- Abstract
Acute right ventricular (RV) failure following massive pulmonary embolism (PE) can have significant hemodynamic consequences and is the mode of death. Temporary mechanical circulatory support can provide tissue perfusion required while thrombectomy or lysis-aimed therapies act to relieve the thrombotic obstruction. Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) has conventionally been the first line MCS. A more selective approach to RV support has been advocated in the form of an extracorporeal right ventricular assist device (RVAD) as it mitigates some of the shortcomings of V-A ECMO. We present the first case series of four patients who received fully percutaneous RVAD, with an integrated oxygenator forming an Oxy-RVAD, for selective right heart support following massive PE, including the application of single-access dual-lumen right atrium to pulmonary artery cannula. All patients achieved RV recovery and were successfully weaned from oxy-RVAD support within 5-10 days demonstrating the feasibility of selective percutaneous right heart support in managing these challenging patients., (© 2022 International Center for Artificial Organ and Transplantation (ICAOT) and Wiley Periodicals LLC.)
- Published
- 2023
- Full Text
- View/download PDF
317. Hemostatic alterations during extracorporeal membrane oxygenation in ovine veno-venous and veno-arterial models.
- Author
-
Gao S, Zhang Y, Peng R, Yan S, Teng Y, Qi J, Cheng G, Yu D, Liu G, Xu Q, Cai X, Zhou Z, and Ji B
- Subjects
- Male, Animals, Sheep, Blood Coagulation, Anticoagulants therapeutic use, Extracorporeal Membrane Oxygenation adverse effects, Hemostatics, Thrombosis etiology
- Abstract
Background: Extracorporeal membrane oxygenation (ECMO) has salvaged many people's life during global pandemics. However, ECMO is associated with a high incidence of hemostatic complications. This study aims to explore the effects of the ECMO system on the coagulation system in the healthy ovine ECMO model., Methods: Ten healthy male sheep were included. Five received the veno-arterial ECMO and five received the veno-venous ECMO. Heparin was infused for systemic anticoagulation and was adjusted according to the activated clotting time. Blood routine tests, coagulation factors, anticoagulation proteins, and fibrinolysis markers were tested at the baseline and every 24 h. After weaning, the pump heads were dissected to explore thrombosis., Results: Platelets decreased in the first 72 h and returned to the baseline at the 120th hour. The neutrophils increased in the first 24 h and returned to the baseline at the 48th hour. Factors II, VII, and X decreased in the first 24 h and gradually increased, while factors VIII, IX, XI, and XII decreased in the first 24 h and remained at a low level. The baseline antithrombin was 73.2 ± 14.4% and reduced to 42.6 ± 9.9% at the 168th hour. Pathology showed seven sheep developed thrombus, but no clinically relevant bleeding or thrombosis events occurred., Conclusions: The study explored hemostatic alterations during ECMO in healthy animal models, which eliminated the confounding under critically ill conditions. The study may provide insights into ECMO hemostatic disorders and aid the design of optimal therapeutic strategies., (© 2022 International Center for Artificial Organ and Transplantation (ICAOT) and Wiley Periodicals LLC.)
- Published
- 2023
- Full Text
- View/download PDF
318. The impact of preservation and recovery of renal function on survival after veno-arterial extracorporeal life support: A retrospective cohort study.
- Author
-
Prasad A, Brehm C, and Singbartl K
- Subjects
- Humans, Shock, Cardiogenic, Retrospective Studies, Kidney physiology, Extracorporeal Membrane Oxygenation, Acute Kidney Injury
- Abstract
Background: Veno-arterial extracorporeal life support (V-A ECLS) has become a cornerstone in the management of critical cardiogenic shock, but it can also precipitate organ injury, e.g., acute kidney injury (AKI). Available studies highlight the effect of non-cardiac organ injury on patient outcomes. Only very little is known about the impact of non-cardiac organ recovery on patient survival. AKI occurs frequently during cardiogenic shock and carries a poor prognosis. We have developed descriptive models to hypothesize on the role of AKI severity versus that of recovery of renal function for patient survival., Methods: Retrospective, observational study including 175 patients who were successfully decannulated from V-A ECLS. We assessed AKI severity using the "Kidney Disease: Improving Global Outcomes" (KDIGO) criteria. We defined recovered or preserved renal function (RPRF) prior to decannulation from V-A ECLS as 0 (AKI with no improvement) or 1 (no AKI or AKI with improvement). We classified patient outcomes as alive or dead at hospital discharge., Results: 78% (n = 138) of all patients survived hospital discharge of which 38% (n = 67) never developed AKI. After adjusting for shock severity and non-renal organ injury, RPRF emerged as an independent predictor of survival in both the overall cohort [OR (95% CI) - 4.11 (1.72-9.79)] and the AKI-only sub-cohort [OR (95% CI) - 5.18 (1.8-14.92)]. Neither maximum KDIGO stage nor KDIGO stage at the end of V-A ECLS was independently associated with survival., Conclusions: Our model identifies RPRF, but not AKI severity, as an independent predictor of hospital survival in patients undergoing V-A ECLS for cardiogenic shock. We hypothesize that recovered or preserved non-cardiac organ function during V-A ECLS is crucial for patient survival., (© 2022 International Center for Artificial Organ and Transplantation (ICAOT) and Wiley Periodicals LLC.)
- Published
- 2023
- Full Text
- View/download PDF
319. Influence of confirmed viral infection on adult acute fulminant myocarditis supported with extracorporeal membrane oxygenation.
- Author
-
Kuo LP, Tsai MT, Wang YC, Hsu CH, Lin WH, Wang WM, Shih CJ, Yang PN, Hu YN, and Roan JN
- Subjects
- Adult, Humans, Retrospective Studies, Treatment Outcome, Virus Diseases, Extracorporeal Membrane Oxygenation, Myocarditis diagnosis, Myocarditis therapy, Myocarditis virology
- Abstract
Background: The impact of etiologies of acute fulminant myocarditis (AFM), which requires extracorporeal membrane oxygenation (ECMO), on clinical outcomes remains unknown. This study aimed to investigate the risk factors for ECMO weaning and mortality among patients with AFM due to viral etiologies in a tertiary referral medical center., Methods: We included 33 adults with AFM who received ECMO and were admitted between January 2002 and January 2021. General demographics, laboratory data, echocardiography findings, and long-term outcomes were analyzed for confirmed viral etiology and unconfirmed etiology groups., Results: The overall hospital survival rate was 54.5%. The age, sex, severity of the hemodynamic condition, and cardiac rhythm were similar between the two groups. Multivariate Cox regression analysis revealed that a confirmed viral etiology (HR 4.201, 95% CI 1.061-16.666), peri-ECMO renal replacement therapy (RRT) (HR 9.804, 1.140-83.333) and a high positive end-expiratory pressure (PEEP) in the ventilator settings at 24 h after ECMO (HR 1.479, 1.020-2.143) were significant prognostic factors for in-hospital mortality. Peri-ECMO RRT was also a significant negative prognostic factor for successful ECMO weaning (OR 0.061, 0.006-0.600) in the multivariate logistic model., Conclusions: Among AFM patients receiving ECMO support, RRT use was associated with a decreased chance of survival to ECMO weaning. Multiple organ dysfunction and a high PEEP were also predictive of a lower chance of hospital survival. Those with a confirmed diagnosis of viral myocarditis may require more medical attention due to the higher risk of hospital mortality than those without a definite diagnosis., (© 2022 International Center for Artificial Organ and Transplantation (ICAOT) and Wiley Periodicals LLC.)
- Published
- 2023
- Full Text
- View/download PDF
320. Impact of volute design features on hemodynamic performance and hemocompatibility of centrifugal blood pumps used in ECMO.
- Author
-
Li Y, Wang H, Xi Y, Sun A, Deng X, Chen Z, and Fan Y
- Subjects
- Humans, Hemolysis, Hemodynamics, Stress, Mechanical, Equipment Design, Heart-Assist Devices adverse effects, Extracorporeal Membrane Oxygenation
- Abstract
Background: The centrifugal blood pump volute has a significant impact on its hemodynamic performance hemocompatibility. Previous studies about the effect of volute design features on the performance of blood pumps are relatively few., Methods: In the present study, the computational fluid dynamics (CFD) method was utilized to evaluate the impact of volute design factors, including spiral start position, volute tongue radius, inlet height, size, shape and diffuser pipe angle on the hemolysis index and thrombogenic potential of the centrifugal blood pump., Results: Correlation analysis shows that flow losses affect the hemocompatibility of the blood pump by influencing shear stress and residence time. The closer the spiral start position of the volute, the better the hydraulic performance and hemocompatibility of the blood pump. Too large or too small volute inlet heights can worsen hydraulic performance and hemolysis, and higher volute inlet height can increase the thrombogenic potential. Small volute sizes exacerbate hemolysis and large volute sizes increase the thrombogenic risk, but volute size does not affect hydraulic performance. When the diffuser pipe is tangent to the base circle of the volute, the best hydraulic performance and hemolysis performance of the blood pump is achieved, but the thrombogenic potential is increased. The trapezoid volute has poor hydraulic performance and hemocompatibility. The round volute has the best hydraulic and hemolysis performance, but the thrombogenic potential is higher than that of the rectangle volute., Conclusion: This study found that the hemolysis index shows a significant correlation with spiral start position, volute size, and diffuser pipe angle. Thrombogenic potential exhibits a good correlation with all the studied volute design features. The flow losses affect the hemocompatibility of the blood pump by influencing shear stress and residence time. The finding of this study can be used to guide the optimization of blood pump for improving the hemodynamic performance and hemocompatibility., (© 2022 International Center for Artificial Organ and Transplantation (ICAOT) and Wiley Periodicals LLC.)
- Published
- 2023
- Full Text
- View/download PDF
321. The role of extracorporeal membrane oxygenation in adult kidney transplant patients: A qualitative systematic review of literature.
- Author
-
Reid TD, Kratzke I, Dayal D, Raff L, Serrano P, Kumar A, Boddie O, Zendel A, Gallaher J, Carlson R, Boone J, Charles AG, and Desai CS
- Subjects
- Humans, Adult, Tissue Donors, Retrospective Studies, Kidney Transplantation adverse effects, Extracorporeal Membrane Oxygenation adverse effects
- Abstract
Background: A paucity of evidence exists regarding the risks and benefits of Extracorporeal Membrane Oxygenation (ECMO) in adult kidney transplantation., Methods: This was a systematic review conducted from Jan 1, 2000 to April 24, 2020 of adult kidney transplant recipients (pre- or post- transplant) and donors who underwent veno-arterial or veno-venous ECMO cannulation. Death and graft function were the primary outcomes, with complications as secondary outcomes., Results: Twenty-three articles were identified that fit inclusion criteria. 461 donors were placed on ECMO, with an overall recipient 12-month mortality rate of 1.3% and a complication rate of 61.5%, the majority of which was delayed graft function. Fourteen recipients were placed on ECMO intraoperatively or postoperatively, with infection as the most common indication for ECMO. The 90-day mortality rate for recipients on ECMO was 42.9%, with multisystem organ failure and infection as the ubiquitous causes of death. 35.7% of patients experienced rejection within 6 months of decannulation, yet all were successfully treated., Conclusions: ECMO use in adult kidney transplantation is a useful adjunct. Recipient morbidity and mortality from donors placed on ECMO mirrors that of recipients from standard criteria donors. The morbidity and mortality of recipients placed on ECMO are also similar to other patient populations requiring ECMO., (© 2022 International Center for Artificial Organ and Transplantation (ICAOT) and Wiley Periodicals LLC.)
- Published
- 2023
- Full Text
- View/download PDF
322. Innovative experimental animal models for real-time comparison of antithrombogenicity between two oxygenators using dual extracorporeal circulation circuits and indocyanine green fluorescence imaging.
- Author
-
Sakurai H, Fujiwara T, Ohuchi K, Hijikata W, Inoue Y, Maruyama O, Tahara T, Yokota S, Tanaka Y, Takewa Y, Mizuno T, and Arai H
- Subjects
- Animals, Swine, Indocyanine Green, Equipment Design, Oxygenators, Models, Animal, Optical Imaging, Oxygenators, Membrane adverse effects, Extracorporeal Membrane Oxygenation methods, Thrombosis etiology
- Abstract
Background: Antithrombogenicity of extracorporeal membrane oxygenation (ECMO) devices, particularly oxygenators, is a current problem, with numerous studies and developments underway. However, there has been limited progress in developing methods to accurately compare the antithrombogenicity of oxygenators. Animal experiments are commonly conducted to evaluate the antithrombogenicity of devices; however, it is challenging to maintain a steady experimental environment. We propose an innovative experimental animal model to evaluate different devices in a constant experimental environment in real-time., Methods: This model uses two venous-arterial ECMO circuits attached to one animal (one by jugular vein and carotid artery, one by femoral vein and artery) and real-time assessment of thrombus formation in the oxygenator by indocyanine green (ICG) fluorescence imaging. Comparison studies were conducted using three pigs: one to compare different oxygenators (MERA vs. CAPIOX) (Case 1), and two to compare antithrombotic properties of the oxygenator (QUADROX) when used under different hydrodynamic conditions (continuous flow vs. pulsatile flow) (Cases 2 and 3)., Results: Thrombi, visualized using ICG imaging, appeared as black dots on a white background in each oxygenator. In Case 1, differences in the site of thrombus formation and rate of thrombus growth were observed in real-time in two oxygenators. In Case 2 and 3, the thrombus region was smaller in pulsatile than in continuous conditions., Conclusions: We devised an innovative experimental animal model for comparison of antithrombogenicity in ECMO circuits. This model enabled simultaneous evaluation of two different ECMO circuits under the same biological conditions and reduced the number of sacrificed experimental animals., (© 2022 International Center for Artificial Organ and Transplantation (ICAOT) and Wiley Periodicals LLC.)
- Published
- 2023
- Full Text
- View/download PDF
323. Prediction of successful veno-venous extracorporeal life support liberation using the oxygen challenge test.
- Author
-
Misselbrook GP, Kanji H, Thiara S, Ronco JJ, Kalan S, Chen L, and Sidhu A
- Subjects
- Humans, Oxygen, Lung, Ventilators, Mechanical, Retrospective Studies, Respiratory Insufficiency, Extracorporeal Membrane Oxygenation methods
- Abstract
Background: The oxygen challenge test (OCT) is an underutilized measure of lung recovery, easily performed prior to proceeding with a trial-off V-V ECLS as part of a weaning algorithm. Evidence-based thresholds for OCT results which support continuing with V-V ECLS weaning are lacking, making interpretation of these tests challenging in clinical practice., Methods: We performed a retrospective review of patients commenced on V-V ECLS as a bridge-to-recovery at Vancouver General Hospital from 2015-2019. The absolute PaO
2 post-OCT and change in PaO2 proportional to incremental FiO2 change on the ventilator (∆PaO2 ) were evaluated as predictive screening metrics for identifying conditions favorable for successful trial-off of V-V ECLS., Results: An optimal cut-off of PaO2 ≥ 240 mm Hg post-OCT (AUC 0.77) and ∆PaO2 ≥ 250 mm Hg (AUC 0.76) was identified as a threshold for predicting successful trials-off. A total of 26 and 24 patients achieved post-OCT PaO2 and ∆PaO2 thresholds, and 100% of these patients were liberated successfully from ECLS during their admission., Conclusions: The OCT can serve as an effective screen of shunt reduction and native lung recovery which can be used alongside other measures of ventilation to assess for suitability of liberation from V-V ECLS prior to a trial-off. Achieving a PaO2 ≥ 240 mm Hg post-OCT is a strong prognostic indicator for successful liberation from V-V ECLS during ICU admission., (© 2022 International Center for Artificial Organ and Transplantation (ICAOT) and Wiley Periodicals LLC.)- Published
- 2023
- Full Text
- View/download PDF
324. Intestinal Conditioning After Cardiac Arrest: The Use of Normothermic Extracorporeal Membrane Oxygenation in the Non-Heart-Beating Animal Model.
- Author
-
Guo, Mingxiao, Yao, Danhua, Li, Linlin, Lu, Chunlei, Li, Yousheng, and Li, Jieshou
- Subjects
- *
EXTRACORPOREAL membrane oxygenation , *INTESTINE transplantation , *ARTIFICIAL blood circulation , *INTESTINAL mucosa , *GASTROINTESTINAL mucosa - Abstract
The effect of normothermic extracorporeal membrane oxygenation (NECMO) on small bowel preservation in a clinically relevant large animal model of expected donation after cardiac death (eDCD) was evaluated. Thirty domestic crossbred donor pigs were divided into five groups. The first group served as the live donation (LD) group, the second group served as the donation after cardiac death (DCD) group, and the remaining were further assigned into three subgroups: E1 group (1 h NECMO support), E3 group (3 h NECMO support), and E5 group (5 h NECMO support). Pathology, electron microscopy, energy metabolism, cell apoptosis, and tight junction (TJ) protein expression level of intestinal mucosa and the level of plasma d-lactic acid were evaluated in normal, cardiac death and at the end of extracorporeal support, respectively. The mean arterial pressure and PaO2 were maintained over 60 and 267 mm Hg during NECMO support, respectively. One hour of extracorporeal support could improve the energy status in intestines of the DCD group. Although the histologic damage and apoptosis of the E1 group had no significant difference with those of the LD and DCD groups ( P > 0.05), the levels of intestinal mucosa TJ protein decreased ( P < 0.05), and plasma d-lactic acid increased progressively ( P < 0.05). With the extension of extracorporeal support, the degree of intestinal mucosa damage and intestinal permeability gradually increased, as well as the content of adenosine triphosphate in intestinal mucosa. The normothermic extracorporeal support for 1 h in DCD is beneficial for improving the energy status and viability of the bowel. However, the integrity of intestinal mucosa was destroyed gradually as extracorporeal support time went by. And the activation of intestinal epithelial apoptosis and hyperoxia might be the factors that lead to intestinal mucosa injury. [ABSTRACT FROM AUTHOR]
- Published
- 2016
- Full Text
- View/download PDF
325. The Impact of Renal Failure and Renal Replacement Therapy on Outcome During Extracorporeal Membrane Oxygenation Therapy.
- Author
-
Antonucci, Elio, Lamanna, Irene, Fagnoul, David, Vincent, Jean‐Louis, De Backer, Daniel, and Silvio Taccone, Fabio
- Subjects
- *
KIDNEY failure , *EXTRACORPOREAL membrane oxygenation , *ARTIFICIAL blood circulation , *MEMBRANE oxygenators , *THERAPEUTICS ,TREATMENT of acute kidney failure - Abstract
Acute kidney injury (AKI) is common in patients treated with veno-arterial (VA-) or veno-venous (VV-) extracorporeal membrane oxygenation (ECMO). In this setting, the use of continuous renal replacement therapy (CRRT) can help to optimize fluid status but may also negatively impact on patients' outcome. In contrast, the relationship between AKI, CRRT, and survival in critically ill adult patients receiving ECMO is not well defined. The institutional ECMO database ( n = 162) from November 2008 to December 2013, excluding patients with ICU survival <24 hours was reviewed. Demographics, co-morbidities, and concomitant therapies for all patients were collected. AKI was defined according to the Acute Kidney Injury Network (AKIN) criteria. ICU mortality was noted. Data were retrieved for 135 patients (79 with VA-ECMO and 56 with VV-ECMO). Of these, 95 developed AKI, 63 (47%) of whom required CRRT; thus three groups of patients were identified: (a) no AKI; (b) AKI without CRRT (AKINOCRRT); and (c) CRRT with AKI (AKICRRT). AKINOCCRT patients were more likely to have preexisting heart disease, to be more severely ill, and to be treated with VA-ECMO than those without AKI. AKICRRT patients were also more likely to be treated with VA-ECMO, had more organ dysfunction at the time of ECMO insertion, and needed more transfusions and inotropic agents than patients without AKI. ICU mortality was 53% (72/135) and was similar in the three groups, even when different AKI stages or VA/VV-ECMO were analyzed separately. In this study, the use of CRRT was not associated with an increased mortality in an adult population of patients treated with ECMO, even after adjustment for confounders. [ABSTRACT FROM AUTHOR]
- Published
- 2016
- Full Text
- View/download PDF
326. Peripheral Veno-Arterial Extracorporeal Membrane Oxygenation as a Bridge to Decision for Pediatric Fulminant Myocarditis.
- Author
-
Okada, Noritaka, Murayama, Hiroomi, Hasegawa, Hiroki, Kawai, Satoru, Mori, Hiromitsu, and Yasuda, Kazushi
- Subjects
- *
EXTRACORPOREAL membrane oxygenation , *ARTIFICIAL blood circulation , *TREATMENT of myocarditis , *TREATMENT of cardiomyopathies , *PEDIATRIC cardiology - Abstract
It is essential to establish an appropriate initial treatment strategy for pediatric fulminant myocarditis. We reviewed eight cases of pediatric fulminant myocarditis that required extracorporeal membrane oxygenation (ECMO) from 2012 to 2015. The median age was 8 years (range 3 months-13 years), and the median body surface area was 0.89 m2 (range 0.35-1.34 m2). Peripheral veno-arterial ECMO was initially applied, and we evaluated whether heart decompression was sufficient. If the pump flow was insufficient, central cannulation was performed via median sternotomy (central ECMO). The need for subsequent ventricular assist device (VAD) support was determined 72 h after ECMO initiation. Six patients were bridged to recovery using peripheral ECMO support only (for 3-11 days), whereas two required VAD support. One patient was switched to central ECMO before VAD implantation. Three patients died of multiorgan failure, even though cardiac function recovered in two of those patients. The duration from hospital arrival to ECMO initiation was shorter in the survival (3.3 ± 1.3 h; range 1.6-4.7 h) than in the nonsurvival group (32 ± 28 h; range 0.7-55 h). Peripheral ECMO can be useful as a bridge to decision for pediatric fulminant myocarditis, which is frequently followed by a successful bridge to recovery. It is important to determine whether ECMO support should be initiated before organ dysfunction advances to preserve organ function, which provides a better bridge to subsequent VAD therapy and heart transplant or recovery. [ABSTRACT FROM AUTHOR]
- Published
- 2016
- Full Text
- View/download PDF
327. Therapeutic Plasma Exchange-Does Age Matter? A Single-Center Study.
- Author
-
Brunetta Gavranić, Bruna, Bašić‐Jukić, Nikolina, and Kes, Petar
- Subjects
- *
EXTRACORPOREAL membrane oxygenation , *ANTICOAGULANTS , *BLOOD coagulation , *BLOOD plasma , *HEMATOLOGIC agents , *HEMOSTASIS - Abstract
Therapeutic plasma exchange ( TPE) is an extracorporeal blood purification technique designed for the removal of substances with large molecular weight from the plasma. However, it is not commonly performed in children and the elderly because of concern of potential complications. The Department of Nephrology at Zagreb University Hospital Centre's database (8335 procedures, 981 patients) was retrospectively analyzed from 1982 to 2011 to record indications, applications, and safety of TPE use in children (≤18 years), adults (>18 and <65 years), and elderly patients (≥65 years). Indications, blood access, replacement fluid, and anticoagulation during TPE differed among age groups. Significantly more complications were recorded in the youngest and eldest patients compared with the adults (12.2% and 12.7% vs. 9.9%, respectively), while the severity of complications did not differ significantly among the age groups. Our results indicate that TPE may be performed relatively safely in all age groups when the patients' differences are acknowledged prior to prescribing the procedure. [ABSTRACT FROM AUTHOR]
- Published
- 2016
- Full Text
- View/download PDF
328. Role of Intra-Aortic Balloon Pump and Extracorporeal Membrane Oxygenation in Early Graft Failure After Cardiac Transplantation.
- Author
-
Loforte, Antonio, Murana, Giacomo, Cefarelli, Mariano, Jafrancesco, Giuliano, Sabatino, Mario, Martin Suarez, Sofia, Pilato, Emanuele, Pacini, Davide, Grigioni, Francesco, Bartolomeo, Roberto Di, and Marinelli, Giuseppe
- Subjects
- *
HEART transplantation , *TRANSPLANTATION of organs, tissues, etc. , *EXTRACORPOREAL membrane oxygenation , *ARTIFICIAL blood circulation , *INTRA-aortic balloon counterpulsation - Abstract
Early graft failure (EGF) is a major risk factor for death after heart transplantation (Htx). We investigated the predictive risk factors for moderate-to-severe EGF requiring an intra-aortic balloon pump (IABP) or extracorporeal membrane oxygenation (ECMO) circulatory support as treatment after Htx. Between January 2000 and December 2014, 412 consecutive adult patients underwent isolated Htx at our institution. Moderate and severe EGF were defined as the need for IABP and ECMO support, respectively, within 24 h after Htx. All available recipient and donor variables were analyzed to assess the risk of EGF occurrence. Overall, moderate-to-severe EGF occurred in 46 (11.1%) patients. Twenty-nine (63.04%) patients required peripheral or central ECMO support in the treatment of severe EGF and 17 (36.9%) patients required IABP support for the treatment of moderate EGF. The predictive risk factors for moderate-to-severe EGF in recipients, as assessed by logistic regression analysis, were a preoperative transpulmonary gradient > 12 mm Hg (odds ratio [OR] 5.2; P = 0.023), a preoperative inotropic score > 10 (OR 8.5; P = 0.0001), and preoperative ECMO support (OR 4.2; P = 0.012). For donors, the predictive risk factor was a donor score ≥ 17 (OR 8.3; P = 0.006). The absence of EGF was correlated with improved long-term survival: 94% at 1 year and 81% at 5 years without EGF versus 76% and 36% at 1 year ( P < 0.001), and 70% and 28% at 5 years ( P < 0.001) with EGF requiring IABP and ECMO support, respectively. In-hospital weaned and survived patients after IABP or ECMO treatment for moderate-to-severe EGF had a similar 5-year conditional survival rate as transplant patients who had not suffered EGF: 88% without EGF versus 84% with EGF treated with mechanical circulatory support devices ( P = 0.08). The occurrence of EGF is a multifactorial deleterious event that depends on donor and recipient profiles. IABP and ECMO support are reliable treatment strategies, depending on the grade of EGF. Furthermore, surviving patients treated with IABP or ECMO have the same long-term conditional survival rate as patients who have not suffered EGF. [ABSTRACT FROM AUTHOR]
- Published
- 2016
- Full Text
- View/download PDF
329. Systematic Venoarterial Extracorporeal Membrane Oxygenation After Surgical Correction of Post-Infarction Ventricular Septal Defect.
- Author
-
Pozzi, Matteo, Lantelme, Pierre, and Obadia, Jean‐François
- Subjects
- *
EXTRACORPOREAL membrane oxygenation , *ARTIFICIAL blood circulation - Abstract
A letter to the editor is presented about systematic venoarterial extracorporeal membrane oxygenation after surgical correction of post-infarcton ventricular septal defect.
- Published
- 2016
- Full Text
- View/download PDF
330. Comparison of a New Miniaturized Extracorporeal Membrane Oxygenation System With Integrated Rotary Blood Pump to a Standard System in a Porcine Model of Acute Lung Injury.
- Author
-
Pilarczyk, Kevin, Heckmann, Jens, Lyskawa, Kathrin, Strauß, Andreas, Haake, Nils, Wiese, Ingo, Jakob, Heinz, Kamler, Markus, and Pizanis, Nikolaus
- Subjects
- *
EXTRACORPOREAL membrane oxygenation , *ADULT respiratory distress syndrome treatment , *MEMBRANE oxygenators , *ARTIFICIAL respiration , *PULMONARY gas exchange - Abstract
Extracorporeal membrane oxygenation (ECMO) is used for severe acute respiratory distress syndrome. However, available ECMO systems are large and not well designed for fast delivery, emergency implantation, and interhospital transfer. Therefore, a new miniaturized oxygenator with integrated rotary blood pump (ILIAS) was developed and compared with a standard ECMO system in a large animal model. Acute lung injury was induced with repeated pulmonary saline lavage in 14 pigs until PaO2/ FiO2-ratio was <100 mm Hg with a positive-end-expiratorypressure of 5 mbar. Pigs were assigned to the following three groups: group 1 (n = 4): control group with conventional ventilation; group 2 (n = 5): standard vv-ECMO; group 3 (n = 5): vv-ILIAS. Gas exchange, hemodynamics, hemolysis, and coagulation activation were examined over a period of 8 h. No device failed during the observation period. PaCO2 decreased from 59.40 ± 4.14 mm Hg to 48.62 ± 4.50 mm Hg after 1 h in the ILIAS group compared with an improvement of PaCO2 from 48.86 ± 7.45 to 40.10 ± 6.02 in the conventional ECMO group (P = not significant [n.s.]). ARDS-induced respiratory acidosis was controlled promptly with a pH of 7.2 ± 0.1 at baseline increasing to 7.4 ± 0.1 in both study groups after 60 min of ECMO support. Mean carbon dioxide transfer was comparable between the conventional ECMO and ILIAS (211.36 ±78.39 mL/min vs. 219.99 ± 76.72 mL/min, P = n.s.). PaO2/FiO2 increased from 118.4 ± 15.5 mm Hg to 179.1 ± 72.4 mm Hg in the ILIAS group compared with an improvement of oxygenation from 107.1 ± 24.9 mm Hg to 179.0 ± 45.7 mm Hg in the standard ECMO group (P = n.s.). Mean oxygen transfer was calculated with 136.09 ± 30.25 mL/min for the ILIAS and 129.05 ± 36.28 mL/min for the standard ECMO. Hemodynamic instability or significant activation of the plasmatic coagulation was not observed. However, hemolysis was significantly higher in the ILIAS group compared with the conventional ECMO. As the ILIAS prototype provided excellent gas exchange with hemodynamic stability comparable with a standard ECMO system, we believe this study serves as a proof of concept. Further development and design modifications (optimized rotation speed and surface coating of rotor) are already done and another experiment is projected to reduce hemolysis and platelet consumption for clinical application. [ABSTRACT FROM AUTHOR]
- Published
- 2016
- Full Text
- View/download PDF
331. 13C Breath Tests Are Feasible in Patients With Extracorporeal Membrane Oxygenation Devices.
- Author
-
Bednarsch, Jan, Menk, Mario, Malinowski, Maciej, Weber‐Carstens, Steffen, Pratschke, Johann, and Stockmann, Martin
- Subjects
- *
BREATH tests , *EXTRACORPOREAL membrane oxygenation , *HEART failure patients , *MEMBRANE oxygenators , *LIVER function tests - Abstract
Temporary extracorporeal membrane oxygenation (ECMO) has been established as an essential part of therapy in patients with pulmonary or cardiac failure. As physiological gaseous exchange is artificially altered in this patient group, it is debatable whether a 13C-breath test can be carried out. In this proof of technical feasibility report, we assess the viability of the 13C-breath test LiMAx (maximum liver function capacity) in patients on ECMO therapy. All breath probes for the test device were obtained directly via the membrane oxygenator. Data of four patients receiving liver function assessment with the 13C-breath test LiMAx while having ECMO therapy were analyzed. All results were compared with validated scenarios of the testing procedures. The LiMAx test could successfully be carried out in every case without changing ECMO settings. Clinical course of the patients ranging from multiorgan failure to no sign of liver insufficiency was in accordance with the results of the LiMAx liver function test. The 13C-breath test is technically feasible in the context of ECMO. Further evaluation of 13C-breath test in general would be worthwhile. The LiMAx test as a 13C-breath test accessing liver function might be of particular predictive interest if patients with ECMO therapy develop multiorgan failure. [ABSTRACT FROM AUTHOR]
- Published
- 2016
- Full Text
- View/download PDF
332. Accumulation of Multipotent Progenitor Cells on Polymethylpentene Membranes During Extracorporeal Membrane Oxygenation.
- Author
-
Lehle, Karla, Friedl, Lucas, Wilm, Julius, Philipp, Alois, Müller, Thomas, Lubnow, Matthias, and Schmid, Christof
- Subjects
- *
PROGENITOR cells , *EXTRACORPOREAL membrane oxygenation , *ENDOTHELIAL cells , *MESENCHYMAL stem cells , *FLOW cytometry - Abstract
Multipotent progenitor cells were mobilized during pediatric extracorporeal membrane oxygenation ( ECMO). We hypothesize that these cells also adhered onto polymethylpentene ( PMP) fibers within the membrane oxygenator ( MO) during adult ECMO support. Mononuclear cells were removed from the surface of explanted PMP- MOs ( n = 16). Endothelial-like outgrowth and mesenchymal-like cells were characterized by flow cytometric analysis using different surface markers. Spindle-shaped attaching cells were identified early, but without proliferative activity. After long-term cultivation palisading type or cobblestone-type outgrowth cells with high proliferative activity appeared and were characterized as (i) leukocytoid CD45+/ CD31+ ( CD133+/ VEGFR-II+/ CD90+/ CD14+/ CD146dim/ CD105dim); (ii) endothelial-like CD45−/ CD31+ ( VEGF-RII+/ CD146+/ CD105+/ CD133−/ CD14−/ CD90−); and (iii) mesenchymal-like cells CD45−/ CD31− ( CD105+/ CD90+/ CD133dim/ VEGFR-II−/ CD146−/ CD14−). The distribution of the cell populations depended on the MO and cultivation time. Endothelial-like cells formed capillary-like structures and did uptake Dil-acetylated low-density lipoprotein. Endothelial- and mesenchymal-like cells adhered on the surface of PMP- MOs. Further research is needed to identify the clinical relevance of these cells. [ABSTRACT FROM AUTHOR]
- Published
- 2016
- Full Text
- View/download PDF
333. 12th. International Conference on Pediatric Mechanical Circulatory Support Systems and Pediatric Cardiopulmonary Bypass.
- Subjects
- *
EXTRACORPOREAL membrane oxygenation , *CARDIOPULMONARY bypass , *CONGENITAL heart disease , *THERAPEUTICS - Abstract
The article presents abstracts on medical topics which include the extracorporeal membrane oxygenation for congenital heart disease, the history of cardiopulmonary bypass, and the infant jarvik 2015 ventricular assist device.
- Published
- 2016
- Full Text
- View/download PDF
334. Predictors of Acute Renal Failure During Extracorporeal Membrane Oxygenation in Pediatric Patients After Cardiac Surgery.
- Author
-
Lv, Lin, Long, Cun, Liu, Jinping, Hei, Feilong, Ji, Bingyang, Yu, Kun, Hu, Qiang, Hu, Jinxiao, Yuan, Yuan, and Gao, Guodong
- Subjects
- *
ACUTE kidney failure in children , *ACUTE kidney failure , *EXTRACORPOREAL membrane oxygenation , *MEMBRANE oxygenators , *OXYGENATORS - Abstract
Acute renal failure ( ARF) is associated with increased mortality in pediatric extracorporeal membrane oxygenation ( ECMO). The aim of this study was to identify predictors of ARF during ECMO in pediatric patients after cardiac surgery. A retrospective study analyzed 42 children (≤15 years) after cardiac surgery requiring venous-arterial ECMO between December 2008 and December 2014 at Fuwai Hospital. ARF was defined as ≥300% rise in serum creatinine ( SCr) concentration from baseline or application of dialysis. Multivariate logistic regression was performed to identify the predictors of ARF during ECMO. A total of 42 children (age, interquartile range [ IQR], 13.0 [7.2-29.8] months; weight, IQR, 8.5 [6.7-11.0] kg) after cardiac surgery requiring ECMO were included in this study. The total survival rate was 52.4%, and the incidence of ARF was 40.5%. As the result of univariate analysis, ECMO duration, cardiopulmonary resuscitation, maximum free hemoglobin ( FHB) during ECMO, lactate level, and mean blood pressure before initiation of ECMO were entered in multiple logistic regression analysis. In multiple logistic regression analysis, FHB during ECMO ( OR 1.136, 95% CI 1.023-1.261) and lactate level before initiation of ECMO ( OR 1.602, 95% CI 1.025-2.502) were risk factors for ARF during ECMO after pediatric cardiac surgery. There was a linear correlation between maximum SCr and maximum FHB ( Pearson's r = 0.535, P = 0.001). Maximum SCr during ECMO has also a linear correlation with lactate level before initiation of ECMO ( Pearson's r = 0.342, P = 0.044). Increased FHB during ECMO and high lactate level before initiation of ECMO were risk factors for ARF during ECMO in pediatric patients after cardiac surgery. [ABSTRACT FROM AUTHOR]
- Published
- 2016
- Full Text
- View/download PDF
335. Ischemic Postconditioning and Nitric Oxide Administration Failed to Confer Protective Effects in a Porcine Model of Extracorporeal Cardiopulmonary Resuscitation.
- Author
-
Psotova, Hana, Ostadal, Petr, Mlcek, Mikulas, Kruger, Andreas, Janotka, Marek, Vondrakova, Dagmar, Svoboda, Tomas, Hrachovina, Matej, Taborsky, Ludek, Dudkova, Vlasta, Strunina, Svitlana, Kittnar, Otomar, and Neuzil, Petr
- Subjects
- *
NITRIC oxide , *CARDIOPULMONARY resuscitation , *CARDIAC arrest , *ARTIFICIAL implants , *EXTRACORPOREAL membrane oxygenation - Abstract
The protective effects of ischemic postconditioning ( IPC) and nitric oxide ( NO) administration have been demonstrated in several ischemic scenarios. However, current evidence regarding the effect of IPC and NO in extracorporeal cardiopulmonary resuscitation remains lacking. Fifteen female swine (body weight 45 kg) underwent veno-arterial extracorporeal membrane oxygenation ( ECMO) implantation; cardiac arrest-ventricular fibrillation was induced by rapid ventricular pacing. After 20 min of cardiac arrest, blood flow was restored by increasing the ECMO flow rate to 4.5 L/min. The animals (five per group) were then randomly assigned to receive IPC (three cycles of 3 min ischemia and reperfusion), NO (80 ppm via oxygenator), or mild hypothermia ( HT; 33.0°C). Cerebral oximetry and aortic blood pressure were monitored continuously. After 90 min of reperfusion, blood samples were drawn for the measurement of troponin I, myoglobin, creatine-phosphokinase, alanine aminotransferase, neuron-specific enolase, cystatin C, and reactive oxygen metabolite ( ROM) levels. Significantly higher blood pressure and cerebral oxygen saturation values were observed in the HT group compared with the IPC and NO groups ( P < 0.05). The levels of troponin I, myoglobin, creatine phosphokinase, and alanine aminotransferase were significantly lower in the HT group ( P < 0.05); levels of neuron-specific enolase, cystatin C, and ROM were not significantly different. IPC and NO were comparable in all monitored parameters. The results of the present study indicate that IPC and NO administration are not superior interventions to HT for the maintenance of blood pressure, cerebral oxygenation, organ protection, and suppression of oxidative stress following extracorporeal cardiopulmonary resuscitation. [ABSTRACT FROM AUTHOR]
- Published
- 2016
- Full Text
- View/download PDF
336. Acute Myocardial Infarction Complicated by Cardiogenic Shock: An Algorithm-Based Extracorporeal Membrane Oxygenation Program Can Improve Clinical Outcomes.
- Author
-
Unai, Shinya, Tanaka, Daizo, Ruggiero, Nicholas, Hirose, Hitoshi, and Cavarocchi, Nicholas C.
- Subjects
- *
EXTRACORPOREAL membrane oxygenation , *CARDIOGENIC shock , *MYOCARDIAL infarction complications , *HEALTH outcome assessment , *ACUTE coronary syndrome , *CARDIAC surgery - Abstract
Extracorporeal membrane oxygenation ( ECMO) in our institution resulted in near total mortality prior to the establishment of an algorithm-based program in July 2010. We hypothesized that an algorithm-based ECMO program improves the outcome of patients with acute myocardial infarction complicated with cardiogenic shock. Between March 2003 and July 2013, 29 patients underwent emergent catheterization for acute myocardial infarction due to left main or proximal left anterior descending artery occlusion complicated with cardiogenic shock (defined as systolic blood pressure <90 mm Hg despite multiple inotropes, with or without intra-aortic balloon pump, lactic acidosis). Of 29 patients, 15 patients were treated before July 2010 ( Group 1, old program), and 14 patients were treated after July 2010 ( Group 2, new program). There were no significant differences in the baseline characteristics, including age, sex, coronary risk factors, and left ventricular ejection fraction between the two groups. Cardiopulmonary resuscitation prior to ECMO was performed in two cases (13%) in Group 1 and four cases (29%) in Group 2. ECMO support was performed in one case (6.7%) in Group 1 and six cases (43%) in Group 2. The 30-day survival of Group 1 versus Group 2 was 40 versus 79% ( P = 0.03), and 1-year survival rate was 20 versus 56% ( P = 0.01). The survival rate for patients who underwent ECMO was 0% in Group 1 versus 83% in Group 2 ( P = 0.09). In Group 2, the mean duration on ECMO was 9.8 ± 5.9 days. Of the six patients who required ECMO in Group 2, 100% were successfully weaned off ECMO or were bridged to ventricular assist device implantation. Initiation of an algorithm-based ECMO program improved the outcomes in patients with acute myocardial infarction complicated by cardiogenic shock. [ABSTRACT FROM AUTHOR]
- Published
- 2016
- Full Text
- View/download PDF
337. Long-Term Mechanical Circulatory Support in Pediatric Patients.
- Author
-
Sandica, Eugen, Blanz, Ute, Mime, Lotfi Ben, Schultz‐Kaizler, Ursula, Kececioglu, Deniz, Haas, Nikolaus, Kirchner, Guenther, Knyphausen, Edzard, Lauenroth, Volker, and Morshuis, Michiel
- Subjects
- *
CHILD patients , *HEART assist devices , *EXTRACORPOREAL membrane oxygenation , *HEART transplantation , *SURVIVAL analysis (Biometry) - Abstract
This retrospective study reviews our results regarding the long-term support in pediatric patients using two ventricular assist systems between January 2008 and April 2014. We implanted the Berlin Heart EXCOR in 29 patients (median age 3.4 years [interquartile range ( IQR) 0.2-16.5], median weight 13 kg [ IQR 4.2-67.2]). Twenty-two patients (75.8%) received a left ventricular assist device. Three patients (10.3%) had single-ventricle physiology. One patient (3.4%) had mechanical mitral valve prosthesis. The HeartWare System was implanted in nine patients. The median age was 15.6 years ( IQR 12.2-17.9), and the median weight was 54.9 kg ( IQR 27.7-66). In the Berlin Heart group, the median support time was 65 days ( IQR 4-619), with 3647 days of cardiac support. Nineteen patients (65.5%) were transplanted, six patients (20.7%) recovered, one patient (3.4%) is on support, and three patients (10.3%) died on support. Survival rate was 89.7%. Fourteen blood pumps had been exchanged. Four patients (13.8%) had local signs of infection, and three patients (10.3%) had neurological complications. In the HeartWare group, the median support time was 180 days ( IQR 1-1124), with 2839 days of cardiac support. Four patients (44.4%) had local signs of infection, and three (33.3%) had neurological complications. Eight patients (88.9%) have been transplanted, and one patient (11.1%) died on support. Survival rate was 88.9%. Excellent survival is possible after long-term mechanical circulatory support in patients with two- and single-ventricle physiology with a low rate of adverse events. [ABSTRACT FROM AUTHOR]
- Published
- 2016
- Full Text
- View/download PDF
338. Ventricular Assist Device in Single-Ventricle Heart Disease and a Superior Cavopulmonary Anastomosis.
- Author
-
Niebler, Robert A., Shah, Tejas K., Mitchell, Michael E., Woods, Ronald K., Zangwill, Steven D., Tweddell, James S., Berger, Stuart, and Ghanayem, Nancy S.
- Subjects
- *
HEART ventricle diseases , *HEART assist devices , *CARDIOPULMONARY system physiology , *SURGICAL anastomosis , *EXTRACORPOREAL membrane oxygenation - Abstract
Our objective is to describe the use of a ventricular assist device ( VAD) in single-ventricle patients with circulatory failure following superior cavopulmonary anastomosis ( SCPA). We performed a retrospective chart review of all single-ventricle patients supported with a VAD following SCPA. Implantation techniques, physiologic parameters while supported, medical and surgical interventions postimplant, and outcomes were reviewed. Four patients were supported with an EXCOR Pediatric ( Berlin Heart Inc., The Woodlands, TX, USA) following SCPA for a median duration of 10.5 days (range 9-312 days). Selective excision of trabeculae and chords facilitated apical cannulation in all patients without inflow obstruction. There were two pump exchanges in the one patient supported for 312 days. Two patients were evaluated by cardiac catheterization while supported. Three of four patients were successfully bridged to transplantation. One patient died while supported. All patients had significant bleeding at the time of transplantation, and one required posttransplant extracorporeal membrane oxygenation with subsequent full recovery. VAD support can provide a successful bridge to transplantation in patients with single-ventricle circulation following SCPA. A thorough understanding of the challenges encountered during this support is necessary for successful outcomes. [ABSTRACT FROM AUTHOR]
- Published
- 2016
- Full Text
- View/download PDF
339. Effect of the Pulsatile Extracorporeal Membrane Oxygenation on Hemodynamic Energy and Systemic Microcirculation in a Piglet Model of Acute Cardiac Failure.
- Author
-
Itoh, Hideshi, Ichiba, Shingo, Ujike, Yoshihito, Douguchi, Takuma, Obata, Hideaki, Inamori, Syuji, Iwasaki, Tatsuo, Kasahara, Shingo, Sano, Shunji, and Ündar, Akif
- Subjects
- *
EXTRACORPOREAL membrane oxygenation , *ARTIFICIAL blood circulation , *MICROCIRCULATION , *HEART failure , *HEMODYNAMICS , *PIGLETS , *LABORATORY swine - Abstract
The objective of this study was to compare the effects of pulsatile and nonpulsatile extracorporeal membrane oxygenation (ECMO) on hemodynamic energy and systemic microcirculation in an acute cardiac failure model in piglets. Fourteen piglets with a mean body weight of 6.08 ± 0.86 kg were divided into pulsatile ( N = 7) and nonpulsatile ( N = 7) ECMO groups. The experimental ECMO circuit consisted of a centrifugal pump, a membrane oxygenator, and a pneumatic pulsatile flow generator system developed in-house. Nonpulsatile ECMO was initiated at a flow rate of 140 mL/kg/min for the first 30 min with normal heart beating, with rectal temperature maintained at 36°C. Ventricular fibrillation was then induced with a 3.5-V alternating current to generate a cardiac dysfunction model. Using this model, we collected the data on pulsatile and nonpulsatile groups. The piglets were weaned off ECMO at the end of the experiment (180 min after ECMO was initiated). The animals did not receive blood transfusions, inotropic drugs, or vasoactive drugs. Blood samples were collected to measure hemoglobin, methemoglobin, blood gases, electrolytes, and lactic acid levels. Hemodynamic energy was calculated using the Shepard's energy equivalent pressure. Near-infrared spectroscopy was used to monitor brain and kidney perfusion. The pulsatile ECMO group had a higher atrial pressure (systolic and mean), and significantly higher regional saturation at the brain level, than the nonpulsatile group (for both, P < 0.05). Additionally, the pulsatile ECMO group had higher methemoglobin levels within the normal range than the nonpulsatile group. Our study demonstrated that pulsatile ECMO produces significantly higher hemodynamic energy and improves systemic microcirculation, compared with nonpulsatile ECMO in acute cardiac failure. [ABSTRACT FROM AUTHOR]
- Published
- 2016
- Full Text
- View/download PDF
340. Extracorporeal Life Support Bridge to Ventricular Assist Device: The Double Bridge Strategy.
- Author
-
Marasco, Silvana F., Lo, Casey, Murphy, Deirdre, Summerhayes, Robyn, Quayle, Margaret, Zimmet, Adam, and Bailey, Michael
- Subjects
- *
EXTRACORPOREAL membrane oxygenation , *ARTIFICIAL blood circulation , *ARTIFICIAL hearts , *LEFT heart ventricle , *HEART assist devices - Abstract
In patients requiring left ventricular assist device ( LVAD) support, it can be difficult to ascertain suitability for long-term mechanical support with LVAD and eventual transplantation. LVAD implantation in a shocked patient is associated with increased morbidity and mortality. Interest is growing in the utilization of extracorporeal life support ( ECLS) as a bridge-to-bridge support for these critically unwell patients. Here, we reviewed our experience with ECLS double bridging. We hypothesized that ECLS double bridging would stabilize end-organ dysfunction and reduce ventricular assist device ( VAD) implant perioperative mortality. We conducted a retrospective review of prospectively collected data for 58 consecutive patients implanted with a continuous-flow LVAD between January 2010 and December 2013 at The Alfred Hospital, Melbourne, Victoria, Australia. Twenty-three patients required ECLS support pre- LVAD while 35 patients underwent LVAD implantation without an ECLS bridge. Preoperative morbidity in the ECLS bridge group was reflected by increased postoperative intensive care duration, blood loss, blood product use, and postoperative renal failure, but without negative impact upon survival when compared with the no ECLS group. ECLS stabilization improved end-organ function pre- VAD implant with significant improvements in hepatic and renal dysfunction. This series demonstrates that the use of ECLS bridge to VAD stabilizes end-organ dysfunction and reduces VAD implant perioperative mortality from that traditionally reported in these 'crash and burn' patients. [ABSTRACT FROM AUTHOR]
- Published
- 2016
- Full Text
- View/download PDF
341. Potential Danger of Pre-Pump Clamping on Negative Pressure-Associated Gaseous Microemboli Generation During Extracorporeal Life Support-An In Vitro Study.
- Author
-
Wang, Shigang, Chin, Brian J., Gentile, Frank, Kunselman, Allen R., Palanzo, David, and Ündar, Akif
- Subjects
- *
EXTRACORPOREAL membrane oxygenation , *ARTIFICIAL blood circulation , *ARTIFICIAL hearts , *HEMATOCRIT , *HEART assist devices - Abstract
The objectives of this study were to investigate the relationship between revolution speed of a conventional centrifugal pump and negative pressure at the inlet of the pump by clamping the tubing upstream of the pump, and to verify whether negative pressure leads to gaseous microemboli ( GME) production in a simulated adult extracorporeal life support ( ECLS) system. The experimental circuit, including a Maquet Rotaflow centrifugal pump and a Medos Hilite 7000 LT polymethyl-pentene membrane oxygenator, was primed with packed red blood cells (hematocrit 35%). Negative pressure was created in the circuit by clamping the tubing upstream of the pump for 10 s, and then releasing the clamp. An emboli detection and classification quantifier was used to record GME volume and count at pre-oxygenator and post-oxygenator sites, and pressure and flow rate data were collected using a custom-based data acquisition system. All trials were conducted at 36°C at revolution speeds of 2000-4000 rpm (500 rpm increment). The flow rates were 1092.5-4708.4 mL/min at the revolution speeds of 2000-4000 rpm. Higher revolution speed generated higher negative pressure at the pre-pump site when clamping the tubing upstream of the pump (−108.3 ± 0.1 to −462.0 ± 0.5 mm Hg at 2000-4000 rpm). Moreover, higher negative pressure was associated with a larger number and volume of GME at pre-oxygenator site after de-clamp ( GME count 10 573 ± 271 at pre-oxygenator site at 4000 rpm). The results showed that there was a potential danger of delivering GME to the patient when clamping pre-pump tubing during ECLS using a centrifugal pump. Our results warrant further clinical studies to investigate this phenomenon. [ABSTRACT FROM AUTHOR]
- Published
- 2016
- Full Text
- View/download PDF
342. Improved Outcome of Cardiac Extracorporeal Membrane Oxygenation in Infants and Children Using Magnetic Levitation Centrifugal Pumps.
- Author
-
Luciani, Giovanni Battista, Hoxha, Stiljan, Torre, Salvatore, Rungatscher, Alessio, Menon, Tiziano, Barozzi, Luca, and Faggian, Giuseppe
- Subjects
- *
EXTRACORPOREAL membrane oxygenation , *CONGENITAL heart disease in children , *HEART failure in children , *CONGENITAL heart disease , *ARTIFICIAL blood circulation , *HEART assist devices , *THERAPEUTICS - Abstract
Extracorporeal membrane oxygenation ( ECMO) has traditionally been and, for the most part, still is being performed using roller pumps. Use of first-generation centrifugal pumps has yielded controversial outcomes, perhaps due to mechanical properties of the same and the ensuing risk of hemolysis and renal morbidity. Latest-generation centrifugal pumps, using magnetic levitation (ML), exhibit mechanical properties which may have overcome limitations of first-generation devices. This retrospective study aimed to assess the safety and efficacy of veno-arterial ( V- A) ECMO for cardiac indications in neonates, infants, and children, using standard ( SP) and latest-generation ML centrifugal pumps. Between 2002 and 2014, 33 consecutive neonates, infants, and young children were supported using V- A ECMO for cardiac indications. There were 21 males and 12 females, with median age of 29 days (4 days-5 years) and a median body weight of 3.2 kg (1.9-18 kg). Indication for V- A ECMO were acute circulatory collapse in ICU or ward after cardiac repair in 16 (49%) patients, failure to wean after repair of complex congenital heart disease in 9 (27%), fulminant myocarditis in 4 (12%), preoperative sepsis in 2 (6%), and refractory tachy-arrhythmias in 2 (6%). Central cannulation was used in 27 (81%) patients and peripheral in 6. Seven (21%) patients were supported with SP and 26 (79%) with ML centrifugal pumps. Median duration of support was 82 h (range 24-672 h), with 26 (79%) patients weaned from support. Three patients required a second ECMO run but died on support. Seventeen (51%) patients required peritoneal dialysis for acute renal failure. Overall survival to discharge was 39% (13/33 patients). All patients with fulminant myocarditis and with refractory arrhythmias were weaned, and five (83%) survived, whereas no patient supported for sepsis survived. Risk factors for hospital mortality included lower (<2.5 kg) body weight ( P = 0.02) and rescue ECMO after cardiac repair ( P = 0.03). During a median follow-up of 34 months (range 4-62 months), there were three (23%) late deaths and two late survivors with neurological sequelae. Weaning rate (5/7 vs. 21/26, P = NS) and prevalence of renal failure requiring dialysis (4/7 vs. 13/26, P = NS) were comparable between SP and ML ECMO groups. Patients supported with ML had a trend toward higher hospital survival (1/7 vs. 12/26, P = 0.07) and significantly higher late survival (0/7 vs. 10/26, P = 0.05). The present experience shows that V- A ECMO for cardiac indications using centrifugal pumps in infants and children yields outcomes absolutely comparable to international registry ( ELSO) data using mostly roller pumps. Although changes in practice may have contributed to these results, use of ML centrifugal pumps appears to further improve end-organ recovery and hospital and late survival. [ABSTRACT FROM AUTHOR]
- Published
- 2016
- Full Text
- View/download PDF
343. Is Implantation of a Left Ventricular Assist Device in Patients With Critical or Impending Cardiogenic Shock an Absolute Contraindication? Looking Back at Our Past Experience Trying to Identify Contraindicative Risk Factors.
- Author
-
Dell'Aquila, Angelo Maria, Schneider, Stefan R.B., Risso, Paolo, Welp, Henryk, Glockner, David G., Alles, Sebastian, Sindermann, Jürgen R., and Scherer, Mirela
- Subjects
- *
CARDIOGENIC shock , *EXTRACORPOREAL membrane oxygenation , *MECHANICAL hearts , *POSTPERICARDIOTOMY syndrome , *DEATH rate , *HEMODYNAMICS , *THERAPEUTICS - Abstract
Poor survival has been demonstrated after ventricular assist device ( VAD) implantation for Interagency Registry for Mechanically Assisted Circulatory Support ( INTERMACS) profile 1 and 2 patients compared with more stable levels. However, risk factors within this high-risk cohort have not been determined so far. The aim of the present study was to identify risk factors associated with this very high mortality rate. Between February 1993 and January 2013, 298 patients underwent VAD implantation in our institution. One hundred nine patients were in INTERMACS level 1 and 49 patients were in INTERMACS level 2 and were therefore defined as hemodynamically critical (overall 158 patients). Assist devices implanted were: HVAD HeartWare n = 18; Incor n = 11; VentrAssist n = 2; DeBakey n = 22; and pulsatile systems n = 105. After cumulative support duration of 815.35 months, Kaplan- Meier analysis revealed a survival of 63.9, 48.8, and 40.3% at 1, 6, and 12 months, respectively. Cox regression analyses identified age > 50 ( P = 0.001, odds ratio [OR] 2.48), white blood cell count > 13.000/μL ( P = 0.01, OR 2.06), preoperative renal replacement therapy ( P = 0.001, OR 2.63), and postcardiotomy failure ( P < 0.001, OR 2.79) as independent predictors of mortality. Of note, last generation VADs were not associated with significantly better 6-month survival ( P = 0.59). Patients without the aforementioned risk factors could yield a survival of 79.2% at 6 months. This single-center experience shows that VAD implantation in hemodynamically unstable patients generally results in poor early outcome, even in third-generation pumps. However, avoiding the aforementioned risk factors could result in improved outcome. [ABSTRACT FROM AUTHOR]
- Published
- 2015
- Full Text
- View/download PDF
344. Effects of Cardiopulmonary Support With a Novel Pediatric Pump-Lung in a 30-Day Ovine Animal Model.
- Author
-
Liu, Yang, Sanchez, Pablo G., Wei, Xufeng, Watkins, Amelia C., Niu, Shuqiong, Wu, Zhongjun J., and Griffith, Bartley P.
- Subjects
- *
CARDIOPULMONARY bypass , *HEART transplantation , *EXTRACORPOREAL membrane oxygenation , *LUNG transplantation , *MECHANICAL ventilators - Abstract
The scarcity of donor organs has led to the development of devices that provide optimal long-term respiratory or cardiopulmonary support to bridge recipients as they wait for lung and/or heart transplantation. This study was designed to evaluate the 30-day in vivo performance of the newly developed pediatric pump-lung ( PediPL) for cardiopulmonary support using a juvenile sheep model. The PediPL device was placed surgically between the right atrium and descending aorta in eight sheep (25.4-31.2 kg) and evaluated for 30 days. Anticoagulation was maintained with continuous heparin infusion (activated clotting time 150-200 s). The flow rate was measured continually, and gas transfer was measured daily. Plasma free hemoglobin, platelet activation, hematologic data, and blood biochemistry were assessed twice a week. Sheep were euthanized after 30 days. The explanted devices were examined for gross thrombosis. Six sheep survived for 30-32 days. During the study, the oxygen transfer rate of the devices was 54.9 ± 13.2 mL/min at a mean flow rate of 1.14 ± 0.46 L/min with blood oxygen saturation of 95.4% ± 1.7%. Plasma free hemoglobin was 8.2 ± 3.7 mg/dL. Platelet activation was 5.35 ± 2.65%. The animals had normal organ chemistries except for surgery-related transient alterations in kidney and liver function. Although we found some scattered thrombi on the membrane surfaces of some explanted devices during the necropsy, the device function and performance did not degrade. The PediPL device was capable of providing cardiopulmonary support with long-term reliability and good biocompatibility over the 30-day duration and offers the potential option for bridging pediatric patients with end-stage heart or lung disease to heart and/or lung transplantation. [ABSTRACT FROM AUTHOR]
- Published
- 2015
- Full Text
- View/download PDF
345. Upcoming Meetings.
- Subjects
- *
ARTIFICIAL blood circulation , *EXTRACORPOREAL membrane oxygenation - Published
- 2021
- Full Text
- View/download PDF
346. Upcoming Meetings.
- Subjects
- *
ARTIFICIAL blood circulation , *EXTRACORPOREAL membrane oxygenation - Published
- 2021
- Full Text
- View/download PDF
347. Generation of microbubbles in extracorporeal life support and assessment of new elimination strategies
- Author
-
S. Günther, F. König, Jinchi Chen, Christian Hagl, N. Thierfelder, and Frank Born
- Subjects
Materials science ,Membrane oxygenator ,0206 medical engineering ,Biomedical Engineering ,Medicine (miscellaneous) ,Peristaltic pump ,Bioengineering ,02 engineering and technology ,Inflow ,030204 cardiovascular system & hematology ,Biomaterials ,03 medical and health sciences ,Extracorporeal Membrane Oxygenation ,0302 clinical medicine ,Pressure ,Embolism, Air ,Humans ,Oxygenator ,Oxygenators, Membrane ,Equipment Design ,General Medicine ,Centrifugal pump ,020601 biomedical engineering ,ddc ,Volume (thermodynamics) ,Microbubbles ,Outflow ,Biomedical engineering - Abstract
Occurrence of microbubbles (MB) is a major problem during venoarterial extracorporeal life support (ECLS) with partially severe clinical complications. The aim of this study was to establish an in vitro ECLS setup for the generation and detection of MB. Furthermore, we assessed different MB elimination strategies. Patient and ECLS circuit were simulated using reservoirs, a centrifugal pump, a membrane oxygenator, and an occluder (modified roller pump). The system was primed with a glycerin solution of 44%. Three different revolution speeds (2500, 3000, and 3400 rpm) were applied. For MB generation, the inflow line of the pump was either statically or dynamically (15 rpm) occluded. A bubble counter was used for MB detection. The effectiveness of the oxygenator and dynamic bubble traps (DBTs) was evaluated in regard to MB elimination capacities. MB generation was highly dependent on negative pressure at the inflow line. Increasing revolution speeds and restriction of the inflow led to increased MB activity. The significant difference between inflow and outflow MB volume identified the centrifugal pump as a main source. We could show that the oxygenator's ability to withhold larger MB is limited. The application of one or multiple DBTs leads to a significant reduction in MB count and overall gas volume. The application of DBT can significantly reduce the overall gas volume, especially at high flow rates. Moreover, large MB can effectively be broken down for faster absorption. In general, the incidence of MBs is significantly dependent on pump speed and restriction of the inflow. The centrifugal pump was identified as a major source of MB generation.
- Published
- 2019
348. Impact of Istanbul Symposiums and Artificial Organs on education and training of young clinicians and the outcomes of congenital heart surgery patients in Turkey
- Author
-
Akif Ündar
- Subjects
Heart Defects, Congenital ,medicine.medical_specialty ,Cardiopulmonary Bypass ,Turkey ,business.industry ,General surgery ,Treatment outcome ,Biomedical Engineering ,MEDLINE ,Medicine (miscellaneous) ,Bioengineering ,General Medicine ,Congresses as Topic ,Biomaterials ,Extracorporeal Membrane Oxygenation ,Treatment Outcome ,Humans ,Medicine ,Artificial Organs ,Cardiac Surgical Procedures ,business - Published
- 2019
349. Accumulations of von Willebrand factor within ECMO oxygenators: Potential indicator of coagulation abnormalities in critically ill patients?
- Author
-
Lars Krenkel, Karla Lehle, Michael Gruber, Maik Foltan, Thomas Mueller, Alois Philipp, Andre Bredthauer, Clemens Birkenmaier, and Tamara Steiger
- Subjects
Adult ,Male ,medicine.medical_specialty ,Oxygenators ,Critical Illness ,medicine.medical_treatment ,Biomedical Engineering ,Medicine (miscellaneous) ,Bioengineering ,von Willebrand factor ,thrombogenesis ,shear stress ,Biomaterials ,Von Willebrand factor ,Main Text Articles ,hemic and lymphatic diseases ,Internal medicine ,Extracorporeal membrane oxygenation ,Humans ,Medicine ,Platelet ,SOFA score ,Blood Coagulation ,Aged ,Oxygenators, Membrane ,Main Text Article ,biology ,liver dysfunction ,business.industry ,Critically ill ,Thrombosis ,Equipment Design ,General Medicine ,extracorporeal membrane oxygenation ,Middle Aged ,Platelet Activation ,Coagulation ,biology.protein ,Cardiology ,Female ,Liver dysfunction ,business ,circulatory and respiratory physiology - Abstract
Clot formation within membrane oxygenators (MOs) remains a critical problem during extracorporeal membrane oxygenation (ECMO). The composition of the clots—in particular, the presence of von Willebrand factor (vWF)—may be an indicator for prevalent nonphysiological flow conditions, foreign body reactions, or coagulation abnormalities in critically ill patients. Mats of interwoven gas exchange fibers from randomly collected MOs (PLS, Maquet, Rastatt, Germany) of 21 patients were stained with antibodies (anti‐vWF and anti‐P‐selectin) and counterstained with 4′,6‐diamidino‐2‐phenylindole. The extent of vWF‐loading was correlated with patient and technical data. While 12 MOs showed low vWF‐loadings, 9 MOs showed high vWF‐loading with highest accumulations close to crossing points of adjacent gas fibers. The presence and the extent of vWF‐fibers/“cobwebs,” leukocytes, platelet–leukocyte aggregates (PLAs), and P‐selectin‐positive platelet aggregates were independent of the extent of vWF‐loading. However, the highly loaded MOs were obtained from patients with a significantly elevated SOFA score, severe thrombocytopenia, and persistent liver dysfunction. The coagulation abnormalities of these critically ill patients may cause an accumulation of the highly thrombogenic and elongated high‐molecular‐weight vWF multimers in the plasma which will be trapped in the MOs during the ECMO therapy.
- Published
- 2019
350. Technical feasibility of umbilical cannulation in midgestation lambs supported by the EXTra‐uterine Environment for Neonatal Development (EXTEND)
- Author
-
Marcus G. Davey, Matthew A. Hornick, William H. Peranteau, Grace Hwang, Ali Y. Mejaddam, Jiancheng Han, Patrick E. McGovern, Alan W. Flake, and Emily A. Partridge
- Subjects
Male ,Incubators, Infant ,0206 medical engineering ,Biomedical Engineering ,Medicine (miscellaneous) ,Bioengineering ,02 engineering and technology ,030204 cardiovascular system & hematology ,Umbilical cord ,Umbilical vein ,Catheterization ,Umbilical Cord ,Biomaterials ,03 medical and health sciences ,Extracorporeal Membrane Oxygenation ,0302 clinical medicine ,medicine.artery ,medicine ,Animals ,Humans ,Sheep, Domestic ,Fetus ,business.industry ,Hemodynamics ,Infant, Newborn ,Gestational age ,Umbilical artery ,Equipment Design ,General Medicine ,020601 biomedical engineering ,Cannula ,medicine.anatomical_structure ,Animals, Newborn ,In utero ,Infant, Extremely Premature ,Anesthesia ,Breathing ,Feasibility Studies ,Premature Birth ,business - Abstract
EXTEND (EXTra-uterine Environment for Neonatal Development) is a novel system for supporting extremely premature infants that replicates in utero conditions by maintaining a sterile fluid environment and providing gas exchange via a pumpless arteriovenous oxygenator circuit connected to the umbilical vessels. Target gestational age (GA) for EXTEND support in human infants is 23-27 weeks, when immature lungs are most susceptible to injury in the setting of air ventilation. We previously demonstrated physiologic support of premature lambs cannulated at 105-117 days GA (lungs developmentally analogous to the 23-27 week GA human infant) for up to 28 days on EXTEND. In the present study, we sought to determine the technical feasibility of umbilical vessel cannulation in 85-96 days GA lambs delivered to EXTEND at weights equivalent to the 23-27 week GA human infant (500-850 g). Five preterm lambs were cannulated at 85-96 days GA (term 145 days) and supported on EXTEND for 4-7 days. All lambs underwent umbilical artery and umbilical vein cannulation. Circuit flows and pressures were monitored continuously, and blood gases were obtained at regular intervals for assessment of oxygen parameters. Systemic pH and lactate were measured at least once daily. Mean body weight at cannulation was 641 ± 71 g (range 480-850 g). All lambs were cannulated successfully (cannula size varied from 8 to 12 Fr), and mean survival on EXTEND was 140 ± 7 hours. Mean circuit flow was 213 ± 15 mL/kg*min, mean pH was 7.37 ± 0.01, and mean lactate was 1.6 ± 0.2 mmol/L. During the initial 120 hours after EXTEND cannulation, there were no significant differences between 85-96 days GA lambs and 105-117 days GA lambs in weight-adjusted circuit flows, oxygen delivery, pH, or lactate levels. This study demonstrates successful umbilical cord cannulation and adequate circuit flows and oxygen delivery in midgestation lambs size-matched to the 23-27 week GA human fetus, which represents an important step in the translation of EXTEND to clinical practice.
- Published
- 2019
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.