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Extracorporeal perfusion

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https://www.readbyqxmd.com/read/28101622/-use-of-vasopressors-and-inotropics-in-cardiogenic-shock
#1
H Lemm, S Dietz, M Janusch, M Buerke
Vasoactive drugs and inotropic agents are important for the hemodynamic management of cardiogenic shock. In this article the use of different vasoactive and ionotropic drugs in cardiogenic shock is presented. Hemodynamic management during cardiogenic shock occurs after initial moderate volume delivery by dobutamine to increase inotropism. If adequate perfusion pressures are not achieved norepinephrine is administered. If a sufficient increase in cardiac performance can still not be achieved by the treatment, administration of levosimendan or phosphodiesterase (PDE) inhibitors may be necessary...
January 18, 2017: Herz
https://www.readbyqxmd.com/read/28093811/routine-use-of-distal-arterial-perfusion-in-pediatric-femoral-venoarterial-extracorporeal-membrane-oxygenation
#2
Christine A Schad, Brian P Fallon, Julie Monteagudo, Shunpei Okochi, Eva W Cheung, Nicholas J Morrissey, Angela V Kadenhe-Chiweshe, Gudrun Aspelund, Steven Stylianos, William Middlesworth
Lower-extremity ischemia is a significant complication in children on femoral venoarterial extracorporeal membrane oxygenation (VA ECMO). Our institution currently routinely uses distal perfusion catheters (DPCs) in all femoral arterial cannulations in attempts to reduce ischemia. We performed a single-center, retrospective review of pediatric patients supported with femoral VA ECMO from January 2005 to November 2015. The outcomes of patients with prophylactic DPC placement at cannulation (prophylactic DPC) were compared to a historical group with DPCs placed in response only to clinically evident ischemic changes (reactive DPC)...
January 2017: Artificial Organs
https://www.readbyqxmd.com/read/28093803/novel-ecg-synchronized-pulsatile-ecls-system-with-various-heart-rates-and-cardiac-arrhythmias-an-in-vitro-study
#3
Shigang Wang, Shannon B Spencer, Allen R Kunselman, Akif Ündar
The objective of this study is to evaluate electrocardiography (ECG)-synchronized pulsatile flow under varying heart rates and different atrial and ventricular arrhythmias in a simulated extracorporeal life support (ECLS) system. The ECLS circuit consisted of an i-cor diagonal pump and console, an iLA membrane ventilator, and an 18 Fr arterial cannula. The circuit was primed with lactated Ringer's solution and packed red blood cells (hematocrit 35%). An ECG simulator was used to trigger pulsatile flow and to generate selected cardiac rhythms...
January 2017: Artificial Organs
https://www.readbyqxmd.com/read/28074817/extracorporeal-membrane-oxygenation-for-refractory-cardiac-arrest
#4
REVIEW
Steven A Conrad, Peter T Rycus
Extracorporeal cardiopulmonary resuscitation (ECPR) is the use of rapid deployment venoarterial (VA) extracorporeal membrane oxygenation to support systemic circulation and vital organ perfusion in patients in refractory cardiac arrest not responding to conventional cardiopulmonary resuscitation (CPR). Although prospective controlled studies are lacking, observational studies suggest improved outcomes compared with conventional CPR when ECPR is instituted within 30-60 min following cardiac arrest. Adult and pediatric patients with witnessed in-hospital and out-of-hospital cardiac arrest and good quality CPR, failure of at least 15 min of conventional resuscitation, and a potentially reversible cause for arrest are candidates...
January 2017: Annals of Cardiac Anaesthesia
https://www.readbyqxmd.com/read/28074808/demonstration-of-blood-flow-by-color-doppler-in-the-femoral-artery-distal-to-arterial-cannula-during-peripheral-venoarterial-extracorporeal-membrane-oxygenation
#5
K G Suresh Rao, T Muralikrishna, K R Balakrishnan
In spite of distal perfusion of the limb using a cannula, the limb can have ischemic events if there is an undetected kink or clot anywhere in the line or thrombus in the artery. There are several ways to monitor and assess the limb ischemia. Monitoring for clinical signs of limb ischemia like temperature change and pallor is reliable and mandatory. We report a method where we used color Doppler to document the blood flow. Curvilinear vascular probe of an echo machine is used to identify the flow in the distal femoral artery of the lower limb...
January 2017: Annals of Cardiac Anaesthesia
https://www.readbyqxmd.com/read/28063605/extracorporeal-membrane-oxygenation-in-massive-pulmonary-embolism
#6
Elena V Dolmatova, Kasra Moazzami, Thomas P Cocke, Elie Elmann, Pranay Vaidya, Arthur F Ng, Kumar Satya, Rajeev L Narayan
BACKGROUND: Extracorporeal Membrane Oxygenation (ECMO) has been suggested for cardiopulmonary support in patients with massive pulmonary embolism (PE) refractory to other treatment or as bridging to embolectomy. The survival benefit from ECMO in patients with massive PE remains unclear. METHODS: Here, we describe 5 cases in which ECMO was used as cardiopulmonary support following massive near-fatal pulmonary embolism. RESULTS: The overall mortality in patients with massive PE that received ECMO support was 40%...
January 4, 2017: Heart & Lung: the Journal of Critical Care
https://www.readbyqxmd.com/read/28030441/does-permissive-hypoxaemia-during-extracorporeal-membrane-oxygenation-cause-long-term-neurological-impairment-a-study-in-patients-with-h1n1-induced-severe-respiratory-failure
#7
Bernhard Holzgraefe, Christin Andersson, Håkan Kalzén, Viktor von Bahr, Mikael Mosskin, Elna-Marie Larsson, Kenneth Palmér, Björn Frenckner, Anders Larsson
BACKGROUND: The Extracorporeal Life Support Organisation accepts permissive hypoxaemia in adult patients during extracorporeal membrane oxygenation (ECMO). The neurological long-term outcome of this approach has not yet been studied. OBJECTIVES: We investigated the prevalence of brain lesions and cognitive dysfunction in survivors from the Influenza A/H1N1 2009 pandemic treated with permissive hypoxaemia during ECMO for severe acute respiratory distress syndrome (ARDS)...
February 2017: European Journal of Anaesthesiology
https://www.readbyqxmd.com/read/28018896/factors-influencing-neurodevelopment-after-cardiac-surgery-during-infancy
#8
REVIEW
Hedwig Hubertine Hövels-Gürich
Short- and long-term neurodevelopmental (ND) disabilities with negative impact on psychosocial and academic performance, quality of life, and independence in adulthood are known to be the most common sequelae for surviving children after surgery for congenital heart disease (CHD). This article reviews influences and risk factors for ND impairment. For a long time, the search for independent risk factors was focused on the perioperative period and modalities of cardiopulmonary bypass (CPB). CPB operations to ensure intraoperative vital organ perfusion and oxygen supply with or without circulatory arrest or regional cerebral perfusion bear specific risks...
2016: Frontiers in Pediatrics
https://www.readbyqxmd.com/read/28009947/root-replacement-for-graft-infection-using-an-all-biologic-xenopericardial-conduit
#9
Sabina P W Guenther, Angela Reichelt, Sven Peterss, Maximilian Luehr, Erik Bagaev, Christian Hagl, Maximilian A Pichlmaier, Nawid Khaladj
BACKGROUND: The management of graft infection following ascending aortic replacement (AAR) and/or aortic valve replacement (AVR) with destruction of the root remains a challenge. Besides technical issues, the choice of graft material is controversial. The study aim was to investigate the initial results of aortic root replacement (ARR) as redo-surgery for infection using the xenopericardial all-biologic conduit (BioIntegral) as an alternative to a homograft or prosthetic material. METHODS: Between February 2013 and January 2015, a total of 18 consecutive patients (16 males, two females; mean age 61 ± 14 years) were reoperated on for infection at a mean of 55 ± 61 months (range: 3 to 219 months) following previous AVR (n = 6), supracoronary aortic replacement (SAR, n = 2), AVR + SAR (n = 1), root replacement (n = 7), and root reconstruction (n = 2)...
July 2016: Journal of Heart Valve Disease
https://www.readbyqxmd.com/read/28006944/regional-tissue-oximetry-reflects-changes-in-arterial-flow-in-porcine-chronic-heart-failure-treated-with-venoarterial-extracorporeal-membrane-oxygenation
#10
P Hála, M Mlček, P Ošťádal, D Janák, M Popková, T Bouček, S Lacko, J Kudlička, P NeuŽil, O Kittnar
Venoarterial extracorporeal membrane oxygenation (VA ECMO) is widely used in treatment of decompensated heart failure. Our aim was to investigate its effects on regional perfusion and tissue oxygenation with respect to extracorporeal blood flow (EBF). In five swine, decompensated low-output chronic heart failure was induced by long-term rapid ventricular pacing. Subsequently, VA ECMO was introduced and left ventricular (LV) volume, aortic blood pressure, regional arterial flow and tissue oxygenation were continuously recorded at different levels of EBF...
December 22, 2016: Physiological Research
https://www.readbyqxmd.com/read/27998838/emergency-percutaneous-implantation-of-veno-arterial-extracorporeal-membrane-oxygenation-in-the-catheterisation-laboratory
#11
Tomaz Goslar, Rihard Knafelj, Peter Radsel, Misa Fister, Alenka Golicnik, Klemen Steblovnik, Vojka Gorjup, Marko Noc
AIMS: Our aim was to describe our protocol for emergency percutaneous implantation of femoral veno-arterial extracorporeal membrane oxygenation (VA ECMO) in the catheterisation laboratory and to compare its effectiveness and safety with implantation in the intensive care unit and the operating room. METHODS AND RESULTS: Our retrospective observational study enrolled 56 consecutive patients undergoing VA ECMO implantation in the catheterisation laboratory (n=23), the intensive care unit (n=8) and the operating room (n=25)...
December 20, 2016: EuroIntervention
https://www.readbyqxmd.com/read/27984315/effect-of-pulsatility-on-microcirculation-in-patients-treated-with-extracorporeal-cardiopulmonary-resuscitation-a-pilot-study
#12
Petra Krupičková, Michal Huptych, Zuzana Mormanová, Tomáš Bouček, Tomáš Belza, Ondřej Šmíd, Aleš Král, Hana Skalická, Aleš Linhart, Jan Bělohlávek
The effect of pulsatile blood flow on microcirculation during extracorporeal cardiopulmonary resuscitation (ECPR) is not elucidated, therefore we designed an observational study comparing sublingual microcirculation in refractory cardiac arrest patients with spontaneously pulsatile or low/non-pulsatile blood flow following treatment with ECPR. Microcirculation was assessed with Sidestream Dark Field technology in 12 cardiac arrest patients treated with ECPR and 12 healthy controls. Microcirculatory images were analyzed offline in a blinded fashion and consensual parameters were determined for the vessels ≤ 20 μm...
December 13, 2016: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/27977885/soluble-adhesion-molecules-during-ex-vivo-lung-perfusion-are-associated-with-post-transplant-primary-graft-dysfunction
#13
Kohei Hashimoto, Marcelo Cypel, Hyunhee Kim, Tiago N Machuca, Daisuke Nakajima, Manyin Chen, Michael K Hsin, Ricardo Zamel, Sassan Azad, Thomas K Waddell, Mingyao Liu, Shaf Keshavjee
Ex vivo lung perfusion (EVLP) enables assessment of marginal donor lungs for transplantation. We aimed to discover biomarkers in EVLP perfusate that could predict development of primary graft dysfunction (PGD). From September 2008 to August 2013, 100 clinical EVLP were performed. Eleven patients developed PGD grade 3 within 72 h after transplant. Non-PGD group consisted of 34 patients without PGD grade 3. Non-bilateral lung transplants or transplant after extracorporeal life support were excluded from analyses...
December 15, 2016: American Journal of Transplantation
https://www.readbyqxmd.com/read/27925235/quantification-of-operational-learning-in-minimal-invasive-extracorporeal-circulation
#14
Kyriakos Anastasiadis, Polychronis Antonitsis, Christos Asteriou, Helena Argiriadou, Apostolos Deliopoulos, Dimitrios Konstantinou, Vassilios Grosomanidis, Paschalis Tossios
Minimal invasive extracorporeal circulation (MiECC) has initiated important new efforts within science and technology towards a more physiologic perfusion. In this study, we aim to investigate the learning curve of our center regarding MiECC. We studied a series of 150 consecutive patients who underwent elective coronary artery bypass grafting by the same surgical team during the initial phase of MiECC application. Patients were randomly assigned into two groups. Group A (n = 75) included patients operated on MiECC, while group B (n = 75) included patients operated with conventional cardiopulmonary bypass (cCPB)...
December 7, 2016: Artificial Organs
https://www.readbyqxmd.com/read/27916176/functional-assessment-and-transplantation-of-the-donor-heart-after-circulatory-death
#15
Simon J Messer, Richard G Axell, Simon Colah, Paul A White, Marian Ryan, Aravinda A Page, Barbora Parizkova, Kamen Valchanov, Christopher W White, Darren H Freed, Euan Ashley, John Dunning, Martin Goddard, Jayan Parameshwar, Christopher J Watson, Thomas Krieg, Ayyaz Ali, Steven Tsui, Stephen R Large
BACKGROUND: After a severe shortage of brain-dead donors, the demand for heart transplantation has never been greater. In an attempt to increase organ supply, abdominal and lung transplant programs have turned to the donation after circulatory-determined death (DCD) donor. However, because heart function cannot be assessed after circulatory death, DCD heart transplantation was deemed high risk and never adopted routinely. We report a novel method of functional assessment of the DCD heart resulting in a successful clinical program...
December 2016: Journal of Heart and Lung Transplantation
https://www.readbyqxmd.com/read/27903207/direct-cerebral-perfusion-and-cooling-in-experimental-cardiac-arrest
#16
Rinaldo Bellomo, Bruno Marino, Peter Angelopoulos, Scott Carson, Glenn Eastwood, Junko Kosaka, Naoya Iguchi, Andrew Hilton, Clive May
BACKGROUND: Cerebral protection is a key priority during cardiac arrest (CA). However, current approaches are suboptimal. OBJECTIVE: To test whether direct perfusion and cooling of the anterior cerebral circulation by means of cerebral vessel cannulation and extracorporeal membrane oxygenation (ECMO) increases cerebral oxygenation and induces cerebral hypothermia during CA. METHODS: We performed proof-of-concept animal experiments in sheep...
2016: Critical Care and Resuscitation: Journal of the Australasian Academy of Critical Care Medicine
https://www.readbyqxmd.com/read/27897967/an-observational-study-of-donor-ex-vivo-lung-perfusion-in-uk-lung-transplantation-develop-uk
#17
Andrew Fisher, Anders Andreasson, Alexandros Chrysos, Joanne Lally, Chrysovalanto Mamasoula, Catherine Exley, Jennifer Wilkinson, Jessica Qian, Gillian Watson, Oli Lewington, Thomas Chadwick, Elaine McColl, Mark Pearce, Kay Mann, Nicola McMeekin, Luke Vale, Steven Tsui, Nizar Yonan, Andre Simon, Nandor Marczin, Jorge Mascaro, John Dark
BACKGROUND: Many patients awaiting lung transplantation die before a donor organ becomes available. Ex vivo lung perfusion (EVLP) allows initially unusable donor lungs to be assessed and reconditioned for clinical use. OBJECTIVE: The objective of the Donor Ex Vivo Lung Perfusion in UK lung transplantation study was to evaluate the clinical effectiveness and cost-effectiveness of EVLP in increasing UK lung transplant activity. DESIGN: A multicentre, unblinded, non-randomised, non-inferiority observational study to compare transplant outcomes between EVLP-assessed and standard donor lungs...
November 2016: Health Technology Assessment: HTA
https://www.readbyqxmd.com/read/27867655/veno-arterial-extracorporeal-membrane-oxygenation-va-ecmo-in-postcardiotomy-cardiogenic-shock-how-much-pump-flow-is-enough
#18
COMMENT
Federico Pappalardo, Andrea Montisci
Post-cardiotomy cardiogenic shock (PCCS) is a complication of heart surgery associated with a poor prognosis: veno-arterial extracorporeal membrane oxygenation (VA ECMO) ensures end-organ perfusion while fully replacing heart and lung function, though it is associated with unsatisfactory results. Few studies have identified reliable predictors of poor prognosis early in the course of extracorporeal support. A recent study showed the strong prognostic power of urine output in the first 24 hours of VA ECMO in predicting early and late mortality of PCCS...
October 2016: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/27862035/does-an-open-recirculation-line-affect-the-flow-rate-and-pressure-in-a-neonatal-extracorporeal-life-support-circuit-with-a-centrifugal-or-roller-pump
#19
Shigang Wang, Shannon B Spencer, Karl Woitas, Kristen Glass, Allen R Kunselman, Akif Ündar
The objective of this study is to evaluate the impact of an open or closed recirculation line on flow rate, circuit pressure, and hemodynamic energy transmission in simulated neonatal extracorporeal life support (ECLS) systems. The two neonatal ECLS circuits consisted of a Maquet HL20 roller pump (RP group) or a RotaFlow centrifugal pump (CP group), Quadrox-iD Pediatric oxygenator, and Biomedicus arterial and venous cannulae (8 Fr and 10 Fr) primed with lactated Ringer's solution and packed red blood cells (hematocrit 35%)...
November 15, 2016: Artificial Organs
https://www.readbyqxmd.com/read/27856841/hemolysis-generation-from-a-novel-linear-positive-displacement-blood-pump-for-cardiopulmonary-bypass-on-a-six-kilogram-piglet-a-preliminary-report
#20
D Scott Lawson, Derek Eilers, Suzanne Osorio Lujan, Maria Bortot, James Jaggers
BACKGROUND: Current blood pumps used for cardiopulmonary bypass generally fall into two different pump design categories; non-occlusive centrifugal pumps and occlusive, positive-displacement roller pumps. The amount of foreign surface area of extracorporeal circuits correlates with post-operative morbidity due to systemic inflammation, leading to a push for technology that reduces the amount of foreign surfaces. Current roller pumps are bulky and the tubing forms an arc in the pumping chamber (raceway), positioning the inlet 360 degrees from the outlet, making it very difficult to place the pump closer to the patient and to efficiently reduce tubing length...
November 16, 2016: Perfusion
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