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Shelley Hancock, Curtis Froehlich, Veronica Armijo-Garcia, Andrew D Meyer
INTRODUCTION: Respiratory failure is the leading cause of mortality in individuals with congenital spine and rib deformities. We present a case report of a child with Jeune syndrome surviving respiratory failure using extracorporeal membrane oxygenation (ECMO). We also summarize thoracic insufficiency syndrome cases reported in the Extracorporeal Life Support Organization (ELSO) registry. CASE REPORT: A two-year-old male with a chest circumference less than a third percentile for age was admitted with influenza pneumonia developing a peak oxygenation index of 103...
May 1, 2018: Perfusion
Jared Arensdorf, Halle Petitt, David Holt
BACKGROUND: The major source of hemolysis during cardiopulmonary bypass (CPB) remains the cardiotomy suction.1 Previous research has shown that the combination of negative pressures and the massive air-blood interface exponentially increases hemolysis in suctioned blood. OBJECTIVE: This research aims to decrease hemolysis by eliminating the air-to-blood interface by implementing the Venturi effect to create powerful suction. This research effort hypothesizes that the Venturi suction will result in less hemolysis, indicated by lower plasma free hemoglobin levels (PFH) compared to current vacuum suction...
May 1, 2018: Perfusion
Guillaume Alinier, Ibrahim Fawzy Hassan, Abdullah Alsalemi, Mohammed Al Disi, Ali Ait Hssain, Ahmed Labib, Yahya Alhomsi, Fayçal Bensaali, Abbes Amira, Abdulsalam Saif Ibrahim
INTRODUCTION/AIM: The patient's condition and high-risk nature of extracorporeal membrane oxygenation (ECMO) therapy force clinical services to ensure clinicians are properly trained and always ready to deal effectively with critical situations. Simulation-based education (SBE), from the simplest approaches to the most immersive modalities, helps promote optimum individual and team performance. The risks of SBE are negative learning, inauthenticity in learning and over-reliance on the participants' suspension of disbelief...
May 1, 2018: Perfusion
John P Scott, Johnny C Hong, Nathan E Thompson, Ronald K Woods, George M Hoffman
We describe the case of a 4-year-old male with a past medical history significant for nephrotic syndrome, short-bowel syndrome and fulminant hepatic failure status post (s/p) liver transplant (LT) who developed early post-transplant allograft dysfunction (hyperbilirubinemia, coagulopathy) and septic shock requiring central extracorporeal membrane oxygenation (ECMO). He remained on ECMO for 85 hours before he was decannulated without event and later underwent repeat LT. This case highlights the potential of central ECMO to provide the circulatory output necessary to reverse distributive shock physiology in patients with sepsis and hepatic dysfunction following LT...
May 1, 2018: Perfusion
Vittorio Scaravilli, Luca Di Girolamo, Eleonora Scotti, Mattia Busana, Osvaldo Biancolilli, Patrizia Leonardi, Andrea Carlin, Caterina Lonati, Mauro Panigada, Antonio Pesenti, Alberto Zanella
INTRODUCTION: Citric acid infusion in extracorporeal blood may allow concurrent regional anticoagulation and enhancement of extracorporeal CO2 removal. Effects of citric acid on human blood thromboelastography and aggregometry have never been tested before. METHODS: In this in vitro study, citric acid, sodium citrate and lactic acid were added to venous blood from seven healthy donors, obtaining concentrations of 9 mEq/L, 12 mEq/L and 15 mEq/L. We measured gas analyses, ionized calcium (iCa++ ) concentration, activated clotting time (ACT), thromboelastography and multiplate aggregometry...
May 1, 2018: Perfusion
Juan Lehoux, Zachary Hena, Megan McCabe, Giles Peek
Aluminium phosphide (AP) is a pesticide used against rodents and insects. Exposure of AP to water releases phosphine gas. Phosphine is a highly toxic mitochondrial poison to which there is no known antidote. We report a case of a 3-year-old female with accidental home exposure to AP, which resulted in cardiac arrest, who was successfully supported with extracorporeal membrane oxygenation (ECMO).
May 1, 2018: Perfusion
Endre Nemeth, Szabolcs Szigeti, Tamas Varga, Laszlo Daroczi, Zoltan Barati, Bela Merkely, Janos Gal
INTRODUCTION: The acute surgical treatment of infective endocarditis (IE) carries a high risk of postoperative mortality. Most complications are linked to uncontrolled sepsis and inflammatory processes. Cytokine haemoadsorption is an extracorporeal technique which has benefits reported in haemodynamic stability and inflammatory response. CASE REPORT: A 46-year-old male patient underwent emergency cardiac surgery due to progressive IE. Postcardiotomy cardiogenic shock associated with cardiac surgery required the implantation of venoarterial (VA)-ECMO...
May 1, 2018: Perfusion
Matteo Di Nardo, Leen Vercaemst, Justyna Swol, Nicholas Barret, Fabio S Taccone, Maximilian V Malfertheiner, Lars M Broman, Federico Pappalardo, Jan Belohlavek, Thomas Mueller, Roberto Lorusso, Margherita Lonero, Mirko Belliato
This review summarizes the European rules to control the market when introducing new products. In particular, it shows all the steps to achieve the European Conformity (CE Mark), a certification that all new medical products must achieve before being used in Europe. Extracorporeal membrane oxygenation (ECMO) devices are exposed to the same procedures. Hereby, we present some regulatory issues regarding pumps and oxygenators, providing technical details as released by the manufacturers on their websites and information charts...
April 1, 2018: Perfusion
Gui-Zhen Yang, Fu-Shan Xue, Ya-Yang Liu, Hui-Xian Li, Qing Liu, Xu Liao
INTRODUCTION: The available evidence shows that perioperative oral thyroid hormone can significantly attenuate the postoperative decline in the serum hormone level and improve postoperative hemodynamic and prognostic parameters. However, there has been no study assessing the effects of preoperative oral different-dose thyroid hormone on serum hormone levels and myocardial ischemia-reperfusion injury (IRI) after cardiac surgery. METHODS: Forty-eight healthy Wistar rats, aged 35 days, were randomly allocated into six groups: Group BC, Group C and four pretreatment groups in which the rats were given levothyroxine-sodium of 10 μg, 20 μg, 40 μg and 80 μg/100 g...
April 1, 2018: Perfusion
Gardner Yost, Geetha Bhat, Patroklos Pappas, Antone Tatooles
INTRODUCTION: The neutrophil to lymphocyte ratio (NLR) has proven to be a robust predictor of mortality in a wide range of cardiovascular diseases. This study investigated the predictive value of the NLR in patients supported by extracorporeal membrane oxygenation (ECMO) systems. METHODS: This study included 107 patients who underwent ECMO implantation for cardiogenic shock. Median preoperative NLR was used to divide the cohort, with Group 1 NLR <14.2 and Group 2 with NLR ≥14...
April 1, 2018: Perfusion
Gui-Zhen Yang, Fu-Shan Xue, Hui-Xian Li, Ya-Yang Liu
No abstract text is available yet for this article.
April 1, 2018: Perfusion
Justyna Swol, Christopher Marschall, Justus T Strauch, Thomas A Schildhauer
INTRODUCTION: Increasing the hematocrit is considered to increase oxygen delivery to the patient, especially when hypoxic conditions exist and the patient may become more stable. The aim of this study was to evaluate the relationship between hematocrit and hospital mortality via subgroup analyses of trauma and non-trauma patients. METHODS: The hospital length of stay (LOS) and LOS in the intensive care unit (ICU) and hospital after extracorporeal life support (ECLS) treatment of 81 patients were analyzed and compared...
April 1, 2018: Perfusion
Ø S Svendsen, M Farstad, A Mongstad, R Haaverstad, P Husby, V L Kvalheim
No abstract text is available yet for this article.
April 1, 2018: Perfusion
Vaclav Vobruba, Jiri Votruba, Jan Bělohlávek, Tomas Grus, Pavel Leden, Tomas Zaoral, Jan Hřídel
INTRODUCTION: Lung agenesis is a rare disorder with a variable, but potentially very bad clinical course. It necessitates complex clinical management, especially in life-threatening situations. CASE REPORT: We describe a case of a 6-month-old girl with right lung agenesis who required venovenous extracorporeal membrane oxygenation (VV-ECMO) due to pneumonia complicated by exacerbated previously diagnosed left main bronchus stenosis. The stenosis was resolved by endobronchial intervention and X-ray-guided stent insertion, which enabled weaning from ECMO and was aimed at preventing such a life-threatening respiratory failure in the future...
April 1, 2018: Perfusion
Katherine Cashen, Ron Reeder, Heidi J Dalton, Robert A Berg, Thomas P Shanley, Christopher J L Newth, Murray M Pollack, David Wessel, Joseph Carcillo, Rick Harrison, J Michael Dean, Robert Tamburro, Kathleen L Meert
INTRODUCTION: Our objectives are to (1) describe the pathogens, site, timing and risk factors for acquired infection during neonatal and pediatric ECMO and (2) explore the association between acquired infection and mortality. METHODS: Secondary analysis of prospective data collected by the Collaborative Pediatric Critical Care Research Network between December 2012 and September 2014. Clinical factors associated with acquired infection were assessed with multivariable Cox regression...
April 1, 2018: Perfusion
Molly E Bryant, William L Regan, Francis Fynn-Thompson, David Hoganson, Viviane G Nasr, Katherine Zaleski, Katie Faella, Gregory S Matte
INTRODUCTION: Comparison of two pediatric cases at our institution that utilized bivalirudin for anticoagulation on cardiopulmonary bypass (CPB); a bilateral lung transplant (BLT) and a ventricular assist device (VAD) implantation. METHODS: The same bivalirudin protocol was utilized in both cases with an initial bolus of 1 mg/kg administered by the anesthesia team, a 50 mg bolus in the pump prime at the time of the initial patient bolus and an initial infusion rate of 2...
April 1, 2018: Perfusion
Nicholaos Mansolas, Aishah Qureshi, Eleanor Edwards, Sibo Wan, Xin Yi Ng, Meera Patel, R Peter Alston
No abstract text is available yet for this article.
April 1, 2018: Perfusion
Cory J Toomasian, Salvatore R Aiello, Benjamin L Drumright, Terry C Major, Robert H Bartlett, John M Toomasian
INTRODUCTION: Cardiopulmonary bypass (CPB) is known to cause a systemic inflammatory and immune response. OBJECTIVE: An in-vitro model of cardiotomy suction was designed to quantify the effects of incrementally increased air-blood exposure on leucocyte marker CD11b and cytokine activation in two common anticoagulants, heparin and citrate. METHODS: Fresh human blood was exposed to increasing amounts of air flow for ten minutes. Leucocyte and cytokine levels were measured prior to and after ten minutes of air flow...
April 1, 2018: Perfusion
Xinghai Hao, Yang Lu, Zhu Zhang, Ming Jia
We report a 58-year-old acute myocardial infarction patient with dissecting intramyocardial hematoma (DIH) disguised as a ventricular pseudoaneurysm. DIH with a flexuous and narrow channel in the myocardium was confirmed during the operation, which extended deeply into the periphery of the ventricular wall. This DIH connected with the left ventricle via a narrow-necked flexuous channel of the myocardial defect and looked like a bulged sac surrounded by a thin wall of myocadium. No pericardium effusion was seen...
April 1, 2018: Perfusion
Jeffrey L Burnside, Todd M Ratliff, Ann Salvator, Ashley B Hodge
The desired use of the HPH Jr. is optimal due to the low priming volume; however, the lower rate of volume removal necessitates utilization of a larger hemofilter. Larger hemofilters carry a higher prime volume, which is impactful in the pediatric setting. Pediatric cardiac surgery patients under 18 kilograms requiring cardiopulmonary bypass were randomly assigned to one of two study groups. Group 1 (coated) contained an HPH Jr. hemofilter that was primed with the addition of 25% albumin and heparin. Group 2 (non-coated) contained an HPH Jr...
April 1, 2018: Perfusion
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