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Extracorporeal perfusion

Jason Q Alexander, Claire Ostertag-Hill, Peter Alden, Jesse Manunga, Jess Titus, Elliot Stephenson, Kasia Hryniewicz-Czeneszew, Timothy Sullivan
No abstract text is available yet for this article.
August 2016: Journal of Vascular Surgery
Andreas M Fichter, Lucas M Ritschl, Andrea Rau, Claudia Schwarzer, Achim von Bomhard, Stefan Wagenpfeil, Klaus-Dietrich Wolff, Thomas Mücke
The warm ischaemia time of microvascular free flaps is limited. Incalculable events, such as lack of adequate recipient vessels or intraoperative medical emergencies, can lead to prolonged ischaemia and potentially to flap loss. In this study, critically perfused ischaemic or congested flaps were temporarily perfused with an extracorporeal perfusion system until anastomosis could be commenced. Temporary extracorporeal perfusion was performed in 8 radial forearm flaps for 147 ± 52 (range 77-237) minutes. Flap perfusion was assessed using Indocyanine Green fluorescence angiography and combined laser Doppler flowmetry and remission spectroscopy...
September 23, 2016: Journal of Cranio-maxillo-facial Surgery
S Sachin, M C Rajesh, E K Ramdas
Surgical removal of the kidney tumor outside the body, (ex vivo renal bench surgery) followed by auto transplantation is an emerging and often done procedure to reconstruct the urinary tract. It possesses immense challenges to both the anesthesiologists and the surgeons. The risks are multiplied if you are performing the surgery on a solitary functioning kidney. Here, we are describing the anesthetic management of 70-year-old male post nephrectomy patient undergoing renal auto transplantation by bench surgery...
September 2016: Anesthesia, Essays and Researches
J H Kang, B H Choi, K M Moon, Y M Park, K H Yang, J H Ryu, C W Chu
It is well known that the quality of organs retrieved from brain-dead donors (DBDs) is better than those retrieved from circulatory death donors. However, in situations of organ retrieval from marginal DBDs, who are unstable despite intensive care, transplantation outcomes are not good. Organ ischemia is the most important determining factor in decreased organ quality in circulatory death donors and in some DBDs. Extracorporeal membrane oxygenation (ECMO) for management of DBDs can be an emergency countermeasure...
September 2016: Transplantation Proceedings
Mohamed Ghalayini, Pierre-Yves Brun, Pascal Augustin, Elise Guivarch, Marie Pierre Dilly, Sophie Provenchere, Pierre Mordant, Yves Castier, Philippe Montravers, Dan Longrois
Competitive flows syndrome result in severe regional hypoxemia when the deoxygenated flow from the native left ventricle (LV) competes with oxygenated flow from extracorporeal life support (ECLS) pump with potentially severe consequences for the cerebral and coronary circulations. Fast correction of hypoxemia could be obtained by decreasing native LV flow by infusion of a short-acting beta-blocker (esmolol). Our purpose was to retrospectively review the efficacy of esmolol in this situation and hypothesize on the potential mechanisms of action and the associated risks...
September 2016: Journal of Extra-corporeal Technology
Elisa Damiani, Alex Dyson, Lucia Zacchetti, Abele Donati, Mervyn Singer
BACKGROUND: Hypoxemia may compromise cell metabolism and organ function. Supplemental oxygen (O2) at high concentrations may prove ineffective, and issues relating to hyperoxia, barotrauma, mechanical ventilation, and extracorporeal oxygenation are well documented. Old reports suggest the potential safety and efficacy of alternative routes for O2 administration, such as intravenous or intestinal. We re-explored these routes in rat models of hypoxemia. METHODS: Hypoxemia was induced in spontaneously breathing, anesthetized rats by breathing a hypoxic gas mix (FiO2 0...
December 2016: Intensive Care Medicine Experimental
Zhao-Yang Lu, Rui-Lin Li, Hong-Sheng Zhou, Jing-Juan Huang, Zhi-Xiao Su, Jia Qi, Lan Zhang, Yue Li, Yi-Qin Shi, Chang-Ning Hao, Jun-Li Duan
Therapeutic ultrasound (TUS) has been demonstrated to improve endothelial nitric oxide synthase (eNOS) activity, which played a crucial role in the regulation of angiogenesis. Diabetes Mellitus (DM) impairs eNOS activity. We tested the hypothesis that DM may retard unilateral hindlimb ischemia-induced angiogenesis by inhibiting eNOS in high-fat diet (HFD)/streptozocin (STZ) induced diabetic mice, and that TUS may reverse DM-related impairment of angiogenesis. C57BL/6 mice were allocated to four groups: (A) mice were fed standard diet (control); (B) mice were fed standard diet and treated with TUS (control+TUS); (C) type-2 DM mice were induced by HFD/STZ (diabetic); and (D) type-2 DM mice and treated with TUS (dabetic+TUS)...
2016: American Journal of Translational Research
Wan Qin, Meredith A Roberts, Xiaoli Qi, Charles E Murry, Ying Zheng, Ruikang K Wang
In this study, we propose a novel implementation of optical coherence tomography-based angiography combined with ex vivo perfusion of fixed hearts to visualize coronary microvascular structure and function. The extracorporeal perfusion of Intralipid solution allows depth-resolved angiographic imaging, control of perfusion pressure, and high-resolution optical microangiography. The imaging technique offers new opportunities for microcirculation research in the heart, which has been challenging due to motion artifacts and the lack of independent control of pressure and flow...
October 7, 2016: Physics in Medicine and Biology
Ahmed R El-Nahas, Mohamed M Elsaadany, Diaa-Eldin Taha, Ahmed M Elshal, Mohamed Abo El-Ghar, Amani M Ismail, Essam A Elsawy, Hazem H Saleh, Ehab W Wafa, Amira Awadalla, Tamer S Barakat, Khaled Z Sheir
OBJECTIVE: To evaluate the protective effects of selenium with vitamins A, C and E (selenium ACE, i.e. antioxidants), verapamil (calcium channel blocker), and losartan (angiotensin receptor blocker) against extracorporeal shockwave lithotripsy (ESWL)-induced renal injury. PATIENTS AND METHODS: A randomised controlled trial was conducted between August 2012 and February 2015. Inclusion criteria were adult patients with a single renal stone (<2 cm) suitable for ESWL...
September 30, 2016: BJU International
Robert Kraemer, Heiko Sorg, Vinzent Forstmeier, Karsten Knobloch, Eirini Liodaki, Felix Hagen Stang, Peter Mailaender, Tobias Kisch
Elucidation of the precise mechanisms and therapeutic options of extracorporeal shock wave therapy (ESWT) is only at the beginning. Although immediate real-time effects of ESWT on cutaneous hemodynamics have recently been described, the dose response to different ESWT energies in cutaneous microcirculation has never been examined. Thirty-nine Sprague-Dawley rats were randomly assigned to three groups that received either focused high-energy shock waves (group A: total of 1000 impulses, 10 J) to the lower leg of the hind limb, focused low-energy shock waves (group B: total of 300 impulses, 1 J) or placebo shock wave treatment (group C: 0 impulses, 0 J) using a multimodality shock wave delivery system (Duolith SD-1 T-Top, Storz Medical, Tägerwilen, Switzerland)...
September 20, 2016: Ultrasound in Medicine & Biology
Levi Bassin, David Bell
The key to aortic surgery is protection of the brain, heart, spinal cord, and viscera. For operations involving the aortic arch, the focus is on cerebral protection, while for pathology involving the descending thoracic aorta, the focus is on spinal protection. Optimal cerebral and spinal protection requires an extensive knowledge of the operative steps and an understanding of the cardiopulmonary bypass modalities that are possible. A bloodless field is required when operating on the aorta. As a result, periods of ischemia to the central nervous system and end-organ viscera are often unavoidable...
September 2016: Best Practice & Research. Clinical Anaesthesiology
Kathleen Jr Daly, Luigi Camporota, Nicholas A Barrett
BACKGROUND: The last decade has seen an increase in the number of centres able to provide venovenous extracorporeal membrane oxygenation (VV-ECMO) internationally across different health care systems. To support this growth, a variety of staffing arrangements have been adopted depending on local need and availability of resources, both in terms of manpower and finances to safely meet the complex needs of the patient and circuit management. AIM: The aim of the survey was to describe current staffing arrangements of care provision for adult patients on VV-ECMO, with a focus on understanding the professional roles and responsibilities of staff managing the circuit in order to inform further discussion around different approaches to staffing...
September 21, 2016: Nursing in Critical Care
Christopher Lotz, Norbert Roewer, Ralf M Muellenbach
Mechanical ventilation is the most commonly used form of respiratory support to restore or maintain adequate gas exchange. However, mechanical ventilation does not provide a physiological form of breathing. Neither does it provide an optimal ventilation / perfusion ratio due to passive movement of the diagphragm favoring the non-dependent parts of the lung. Furthermore, patients are in danger of ventilator-associated/induced lung injury (VALI/VILI). Hence, lung protective ventilation is mandatory in patients with an acute respiratory distress syndrome (ARDS) and should likewise be used in the operating room...
September 2016: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
Christopher Lotz, Norbert Roewer, Ralf M Muellenbach
Circulatory support represents an integral part within the treatment of the critically ill patient. Sophisticated pharmacologic regimens help to maintain systemic perfusion pressure by increasing vascular tone as well as mediating positive inotropic effects. Besides the administration of catecholamines and phosphodiesterase-III-inhibitors, in particular the administration of levosimendan represents a promising alternative during low-cardiac-output. Nevertheless, sufficient evidence demonstrating a survival benefit for any pharmacologic regimen is nonexistent...
September 2016: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
Tetsuro Uchida, Azumi Hamasaki, Atsushi Yamashita, Ken Nakamura, Jun Hayashi, Satoko Funata, Seigo Gomi, Mitsuaki Sadahiro
BACKGROUND: The open stent grafting, in other words "frozen elephant trunk (FET)" technique has been played an important role in surgical treatment of extensive thoracic aortic pathologies. J Graft Open Stent Graft (JOSG) was a new Japan-made commercially available product. We have recently introduced this attractive device as an alternative to self-made open stent graft. PATIENTS: Twenty consecutive patients underwent aortic arch replacement using the JOSG as a FET in our institution...
September 2016: Kyobu Geka. the Japanese Journal of Thoracic Surgery
Raúl J Gazmuri, Christopher L Kaufman, Alvin Baetiong, Jeejabai Radhakrishnan
BACKGROUND: Several characteristics of the ventricular fibrillation (VF) waveform have been found predictive of successful defibrillation and hypothesized to reflect the myocardial energy state. In an open-chest swine model of VF, we modeled "average CPR" using extracorporeal circulation (ECC) and assessed the time course of coronary blood flow, myocardial metabolism, and myocardial structure in relation to the amplitude spectral area (AMSA) of the VF waveform without artifacts related to chest compression...
2016: PloS One
Zhao-Yang Lu, Rui-Lin Li, Hong-Sheng Zhou, Jing-Juan Huang, Jia Qi, Zhi-Xiao Su, Lan Zhang, Yue Li, Yi-Qin Shi, Chang-Ning Hao, Jun-Li Duan
We examined the hypothesis that therapeutic ultrasound (TUS) treatment would rescue the hypertension-related inhibition of ischemia-induced angiogenesis. TUS protects against endothelial dysfunction, but it is little known that the effect of TUS treatment on angiogenesis inhibited by hypertension. 20-week-old male spontaneously hypertensive rats (SHRs) and Wistar-Kyoto rats (WKYs) were randomly allocated to 4 groups: SHR; TUS treated SHR (SHR-TUS); WKY and TUS treated WKY (WKY-TUS). After undergoing excision of the left femoral artery, the ischemic skeletal muscles were treated with extracorporeal TUS for 9 minutes of daily exposure (frequency of 1 MHz, intensity of 0...
2016: American Journal of Translational Research
Amir Faravan, Nooredin Mohammadi, Alireza Alizadeh Ghavidel, Mohammad Zia Toutounchi, Ameneh Ghanbari, Mehran Mazloomi
INTRODUCTION: Standards have a significant role in showing the minimum level of optimal optimum and the expected performance. Since the perfusion technology staffs play an the leading role in providing the quality services to the patients undergoing open heart surgery with cardiopulmonary bypass machine, this study aimed to assess the standards on how Iranian perfusion technology staffs evaluate and manage the patients during the cardiopulmonary bypass process and compare their practice with the recommended standards by American Society of Extracorporeal Technology...
2016: Journal of Cardiovascular and Thoracic Research
Rolando Claure-Del Granado, Ravindra L Mehta
BACKGROUND: Fluid overload is frequently found in acute kidney injury patients in critical care units. Recent studies have shown the relationship of fluid overload with adverse outcomes; hence, manage and optimization of fluid balance becomes a central component of the management of critically ill patients. DISCUSSION: In critically ill patients, in order to restore cardiac output, systemic blood pressure and renal perfusion an adequate fluid resuscitation is essential...
August 2, 2016: BMC Nephrology
Piotr M Kasprzak, Reinhard Kobuch, Christof Schmid, Reinhard Kopp
We report successful endovascular repair of a 61-year-old man treated for a 7.1-cm excentric aortic arch aneurysm by in situ stent graft fenestration for the brachiocephalic trunk and the left common carotid artery. Cerebral perfusion during the intervention was maintained by pump-driven extracorporal bypass to the right common carotid artery and to the left axillary artery provided with a left carotid-subclavian bypass. After 5 years of follow-up, the aortic arch in situ revascularization is still patent, the aneurysm excluded, and no endoleak detectable, although endovascular reintervention with distal aortic stent graft extension due to dilatation of the descending aorta was required...
July 25, 2016: Journal of Vascular Surgery
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