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Philippe Portran, Flavie Lavigne, Matthias Jacquet-Lagreze, Jean-Luc Fellahi
INTRODUCTION: The discontinuation of venoarterial extracorporeal membrane oxygenation (VA ECMO) is a critical step in patient recovery. To reduce risks, weaning trials must be performed to buttress this important decision. However, a successful weaning trial does not preclude the possibility of complications. CASE REPORT: Here, we report a case of sudden multiple organ failure in a heart transplant patient, occurring after a successful ECMO weaning trial. We finally diagnosed a rare post-surgical complication of bicaval orthotopic heart transplantation, a severe stenosis of the inferior vena cava (IVC) that had been masked by the post-operative ECMO...
November 3, 2018: Perfusion
Kamran Hassani, Alireza Karimi, Ali Dehghani, Ali Tavakoli Golpaygani, Hamed Abdi, Daniel M Espino
OBJECT: Mitral regurgitation (MR) is a condition in which the mitral valve does not prevent the reversal of blood flow from the left ventricle into the left atrium. This study aimed at numerically developing a model to mimic MR and poor leaflet coaptation and also comparing the performance of a normal mitral valve to that of the MR conditions at different gap junctions of 1, 3 and 5 mm between the anterior and posterior leaflets. RESULTS: The results revealed no blood flow to the left ventricle when a gap between the leaflets was 0 mm...
November 3, 2018: Perfusion
Aschraf El-Essawi, Ingo Breitenbach, Benjamin Haupt, Rene Brouwer, Mohammed Morjan, Wolfgang Harringer
OBJECTIVE: The positive impact of minimally invasive extracorporeal circuits (MiECC) on patient outcome is expected to be most evident in patients with limited physiologic reserves. Nevertheless, most studies have limited their use to low-risk patients undergoing myocardial revascularization. As such, there is little evidence to their benefit outside this patient population. We, therefore, set out to explore their potential benefit in octogenarians undergoing aortic valve replacement (AVR) with or without concomitant myocardial revascularization...
November 3, 2018: Perfusion
Zongmei Wen, Yang Jin, Xuemei Jiang, Meng Sun, Nazzarena Arman, Tao Wen, Xin Lv
INTRODUCTION: Extracellular histones have been recently identified as damage-associated molecular-pattern (DAMP) molecules involved with the pathogenesis of various inflammatory diseases. This study intended to investigate whether extracellular histones can indicate the prognosis in critically ill patients supported by extracorporeal membrane oxygenation (ECMO) therapy. METHODS: A total of 56 patients undergoing ECMO were analysed retrospectively. Median concentrations of extracellular histones in patients before ECMO were assessed and used to divide the patients into two groups (Group 1 <48 µg/ml and Group 2 ⩾48 µg/ml)...
October 29, 2018: Perfusion
Mohammed Al Disi, Abdullah Alsalemi, Yahya Alhomsi, Fayçal Bensaali, Abbes Amira, Guillaume Alinier
Patients under the error-prone and complication-burdened extracorporeal membrane oxygenation (ECMO) are looked after by a highly trained, multidisciplinary team. Simulation-based training (SBT) affords ECMO centers the opportunity to equip practitioners with the technical dexterity required to manage emergencies. The aim of this article is to review ECMO SBT activities and technology followed by a novel solution to current challenges. ECMO simulation: The commonly-used simulation approach is easy-to-build as it requires a functioning ECMO machine and an altered circuit...
October 19, 2018: Perfusion
Ting Liu, Zhen Qin, Ming Luo, Zhao-Xia Tan, Ji-Yue Xiong, Gang-Jian Gu, Xiang Yu, Qi Li, Rong-Hua Zhou
BACKGROUND AND OBJECTIVE: A multi-discipline cardiac and cardiopulmonary bypass (CPB) team simulation scenario was established to compare three different de-airing approaches dealing with massive air embolism in CPB, so as to formulate a standardized procedure to handle this adverse acute event more proficiently and ensure clinical safety. METHOD: A simulation-based clinical CPB massive air embolism scenario was developed by a cardiac and CPB team. Study Objects: Five licensed perfusionists and five CPB trainees were matched randomly into five pairs...
October 19, 2018: Perfusion
Mosaad El Banna, Luis Geraldes, Julia Grapsa, Cristiana Ramalhao, Santhi Adigopula, Ahmad Edris, Safieeldin Ghazala, Ashley Alwood, Jacques Kobersy
A 90-year-old female patient presented to the emergency department with abdominal pain. Computed tomography (CT) set the suspicion of a cardiac tumor in the right heart chambers. We describe the presentation, the differential diagnosis and the decision for management of the patient.
October 5, 2018: Perfusion
Adrian C Mattke, Anthony Black, Prem Venugopal
No abstract text is available yet for this article.
October 5, 2018: Perfusion
Mohammed Al Disi, Abdullah Alsalemi, Yahya Alhomsi, Fayçal Bensaali, Abbes Amira, Guillaume Alinier
INTRODUCTION: Extracorporeal membrane oxygenation (ECMO) training programs employ real ECMO components, causing them to be extremely expensive while offering little realism in terms of blood oxygenation and pressure. To overcome those limitations, we are developing a standalone modular ECMO simulator that reproduces ECMO's visual, audio and haptic cues using affordable mechanisms. We present a central component of this simulator, capable of visually reproducing blood oxygenation color change using thermochromism...
September 7, 2018: Perfusion
Stephen M Spindel, Bobby Yanagawa, Javier Mejia, Matthew A Levin, Robin Varghese, Paul E Stelzer
INTRODUCTION: We report our initial surgical experience of intermittent upper and lower body retrograde perfusion during aortic repair under circulatory arrest. METHODS: Between 2007 and 2015, 148 consecutive patients underwent surgical aortic repair using moderate hypothermic circulatory arrest with intermittent upper and lower body retrograde perfusion. RESULTS: All patients underwent ascending aorta replacement; eight had hemiarch replacement (5...
September 5, 2018: Perfusion
Ryan Haughey, William Vernick, Jacob Gutsche, Krzysztof Laudanski
INTRODUCTION: Calcium channel blockers (CCBs) are a commonly prescribed medication that, at toxic levels, are capable of causing severe refractory hypotension, hypoxic respiratory failure and cardiotoxicity. There is little evidence currently guiding the approach to managing CCB overdose, particularly when combined with other antihypertensive agents. CASE REPORT: We describe the use of veno-venous extracorporeal membrane oxygenation (VV ECMO) in a previously healthy man following combined overdose with amlodipine and lisinopril in a suicide attempt...
September 3, 2018: Perfusion
Mustafa Zakkar, Emmanuel Lansac, Alain Wurtz, Emmanuel Brian
The role of concomitant aortic and pectus repair in Marfan patients remains controversial. We present our surgical technique for concomitant aortic repair of aortic root pathology and pectus correction. The concomitant surgery can be safely achieved in Marfan patients, thus, avoiding the need for a risky second stage operation.
August 23, 2018: Perfusion
Yuki Michinaga, Tamaki Takano, Takamitsu Terasaki, Souma Miyazaki, Noritoshi Kikuchi, Kenji Okada
INTRODUCTION: We have been developing a closed-circuit cardiopulmonary bypass (CPB) system ("Dihead CPB") for application during coronary artery bypass grafting (CABG) and valve surgery. To strive for minimal hemolysis during Dihead CPB, we compared the hemolysis caused by three different suction systems and performed a clinical study with the newly applied suction system. MATERIALS & METHODS: We evaluated the hemolysis caused by roller-pump suction, the SmartSuction® Harmony® and wall suction systems with respect to suction speed and compared the systems by means of in vitro studies...
August 19, 2018: Perfusion
Dwight D Harris, Alexis E Shafii, Maher Baz, Thomas A Tribble, Victor A Ferraris
INTRODUCTION: Tracheostomy has been utilized in combination with venovenous extracorporeal membrane oxygenation (VV-ECMO) to enable early spontaneous breathing and minimize sedation requirements. Tracheostomy has been previously reported to be safe in patients supported on VV-ECMO; however, the impact of tracheostomy on blood loss in VV-ECMO patients is unknown. METHODS: We analyzed VV-ECMO patients with and without tracheostomy over a 5-year period. In order to avoid other potential sources of blood loss not related to tracheostomy or ECMO-related blood loss, patients who underwent a recent surgery prior to ECMO or during ECMO (other than tracheostomy) were excluded...
August 19, 2018: Perfusion
Prakash P Punjabi
No abstract text is available yet for this article.
November 2018: Perfusion
Geoffrey Lockwood
No abstract text is available yet for this article.
October 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...
October 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...
October 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...
October 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).
October 2018: Perfusion
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