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Ecmo simulation

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https://www.readbyqxmd.com/read/28863039/extracorporeal-membrane-oxygenation-for-end-stage-interstitial-lung-disease-with-secondary-pulmonary-hypertension-at-rest-and-exercise-insights-from-simulation-modeling
#1
Scott Chicotka, Daniel Burkhoff, Marc L Dickstein, Matthew Bacchetta
Interstitial lung disease (ILD) represents a collection of lung disorders with a lethal trajectory with few therapeutic options with the exception of lung transplantation. Various extracorporeal membrane oxygenation (ECMO) configurations have been used for bridge to transplant (BTT), yet no optimal configuration has been clearly demonstrated. Using a cardiopulmonary simulation, we assessed different ECMO configurations for patients with end-stage ILD to assess the physiologic deficits and help guide the development of new long-term pulmonary support devices...
August 31, 2017: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/28815092/zinc-chloride-smoke-inhalation-induced-severe-acute-respiratory-distress-syndrome-first-survival-in-the-united-states-with-extended-duration-five-weeks-therapy-with-high-dose-corticosteroids-in-combination-with-lung-protective-ventilation
#2
Hafiz Mahboob, Robert Richeson Iii, Robert McCain
Zinc chloride smoke bomb exposure is frequently seen in military drills, combat exercises, metal industry works, and disaster simulations. Smoke exposure presents with variety of pulmonary damage based on the intensity of the exposure. Smoke induced severe acute respiratory distress syndrome (ARDS) is often fatal and there are no standard treatment guidelines. We report the first survival of smoke induced severe ARDS in the United States (US) with prolonged use of high dose steroids (five weeks) and lung protective ventilation alone...
2017: Case Reports in Critical Care
https://www.readbyqxmd.com/read/28810931/a-comprehensive-regional-clinical-and-educational-ecpr-protocol-decreases-time-to-ecmo-in-patients-with-refractory-out-of-hospital-cardiac-arrest
#3
Brian Grunau, Sarah Carrier, Jamil Bashir, William Dick, Luke Harris, Robert Boone, Dan Kalla, Frank Scheuermeyer, Brian Twaites, Ron Straight, James Abel, Ken McDonald, Ruth MacRedmond, David Agulnik, Joe Finkler, Jeanne MacLeod, Jim Christenson, Anson Cheung
OBJECTIVE: Extracorporeal membrane oxygenation within CPR (ECPR) may improve survival for refractory out-of-hospital cardiac arrest (OHCA). We developed a prehospital, emergency department (ED), and hospital-based clinical and educational protocol to improve the key variable of time-to-ECPR (TTE). METHODS: In a single urban health region we involved key prehospital, clinical, and administrative stakeholders over a 2-year period, to develop a regional ECPR program with destination to a single urban tertiary care hospital...
August 16, 2017: CJEM
https://www.readbyqxmd.com/read/28674057/population-pharmacokinetics-and-dose-optimization-of-teicoplanin-during-venoarterial-extracorporeal-membrane-oxygenation
#4
Jin Wi, Hayeon Noh, Kyoung Lok Min, Seungwon Yang, Byung Hak Jin, Jongsung Hahn, Soo Kyung Bae, Jiseon Kim, Min Soo Park, Donghoon Choi, Min Jung Chang
The pharmacokinetics (PK) of drugs are known to be significantly altered in patients receiving extracorporeal membrane oxygenation (ECMO). However, clinical studies of the PK of drugs administered during ECMO are scarce, and the proper dosing adjustment has yet to be established. We developed a population PK model for teicoplanin, investigated covariates influencing teicoplanin exposure, and suggested an optimal dosing regimen for ECMO patients. Samples for PK analysis were collected from 10 adult patients, and a population PK analysis and simulations were performed to identify an optimal teicoplanin dose needed to provide a >50% probability of target attainment at 72 h using a trough concentration target of >10 μg/ml for mild to moderate infections and a trough concentration target of >15 μg/ml for severe infections...
September 2017: Antimicrobial Agents and Chemotherapy
https://www.readbyqxmd.com/read/28653554/the-role-of-simulation-to-support-donation-after-circulatory-death-with-extracorporeal-membrane-oxygenation-dcd-ecmo
#5
Mateusz Puślecki, Marcin Ligowski, Marek Dąbrowski, Maciej Sip, Sebastian Stefaniak, Tomasz Kłosiewicz, Łukasz Gąsiorowski, Marek Karczewski, Tomasz Małkiewicz, Małgorzata Ładzińska, Marcin Zieliński, Aleksander Pawlak, Bartłomiej Perek, Michael Czekajlo, Marek Jemielity
Maintaining the viability of organs from donors after circulatory death (DCD) for transplantation is a complicated procedure, from a time perspective in the absence of appropriate organizational capabilities, that makes such transplantation cases difficult and not yet widespread in Poland. We present the procedural preparation for Poland's first case of organ (kidney) transplantation from a DCD donor in which perfusion was supported by extracorporeal membrane oxygenation (ECMO). Because this organizational model is complex and expensive, we used advanced high-fidelity medical simulation to prepare for the real-life implementation...
June 1, 2017: Perfusion
https://www.readbyqxmd.com/read/28621839/evaluation-of-hemodynamic-performance-of-a-combined-ecls-and-crrt-circuit-in-seven-positions-with-a-simulated-neonatal-patient
#6
Elizabeth Profeta, Kaitlyn Shank, Shigang Wang, Christian O'Connor, Allen R Kunselman, Karl Woitas, John L Myers, Akif Ündar
As it is common for patients treated with extracorporeal life support (ECLS) to subsequently require continuous renal replacement therapy (CRRT), and neonatal patients encounter limitations due to lack of access points, inclusion of CRRT in the ECLS circuit could provide advanced treatment for this population. The objective of this study was to evaluate an alternative neonatal ECLS circuit containing either a Maquet RotaFlow centrifugal pump or Maquet HL20 roller pump with one of seven configurations of CRRT using the Prismaflex 2000 System...
June 16, 2017: Artificial Organs
https://www.readbyqxmd.com/read/28609315/the-role-of-extracorporeal-membrane-oxygenation-simulation-training-at-extracorporeal-life-support-organization-centers-in-the-united-states
#7
Mark F Weems, Philippe S Friedlich, Lara P Nelson, Alyssa J Rake, Laura Klee, James E Stein, Theodora A Stavroudis
INTRODUCTION: Extracorporeal membrane oxygenation (ECMO) requires a multidisciplinary healthcare team. The Extracorporeal Life Support Organization publishes training guidelines but leaves specific requirements up to each institution. Simulation training has shown promise, but it is unclear how many institutions have incorporated simulation techniques into ECMO training to date. METHODS: We sent an electronic survey to ECMO coordinators at Extracorporeal Life Support Organization sites in the United States...
August 2017: Simulation in Healthcare: Journal of the Society for Simulation in Healthcare
https://www.readbyqxmd.com/read/28557862/quantification-of-postmembrane-gaseous-microembolization-during-venoarterial-extracorporeal-membrane-oxygenation
#8
York Jiao, Keith E Gipson, Pramod Bonde, Abeel Mangi, Robert Hagberg, David J Rosinski, Jeffrey B Gross, Robert B Schonberger
Prolonged use of venoarterial extracorporeal membrane oxygenation (VA ECMO) may be complicated by end-organ dysfunction. Although gaseous microemboli (GME) are thought to damage end organs during cardiopulmonary bypass, patient exposures to GME have not been well characterized during VA ECMO. We therefore performed an observational study of GME in adult VA ECMO patients, with correlation to clinical events during routine patient care. After institutional review board (IRB) approval, we used two Doppler probes to detect GME noninvasively in extracorporeal membrane oxygenation (ECMO) circuits on four patients for 15 hours total while also recording patient care events...
May 23, 2017: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/28499654/hybrid-extracorporeal-membrane-oxygenation-using-avalon-elite-double-lumen-cannula-ensures-adequate-heart-brain-oxygen-supply
#9
Ju Zhao, Dongfang Wang, Cherry Ballard-Croft, Jingkun Wang, Po-Lin Hsu, Matthew Bacchetta, Joseph B Zwischenberger
BACKGROUND: Differential hypoxia exists in peripheral venoarterial (VA) extracorporeal membrane oxygenation (ECMO) patients with compromised lungs, causing hypoxic damage to heart or brain. We proposed an Avalon Elite (Maquet, Rastatt, Germany) double lumen cannula-based hybrid ECMO to add a venovenous (VV) blood flow into the pulmonary circulation onto the existing VA ECMO circuit to increase oxygen saturation in the left ventricle and ascending aorta, mitigating heart/brain hypoxia...
September 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28384599/the-effect-of-veno-venous-ecmo-on-the-pharmacokinetics-of-ritonavir-darunavir-tenofovir-and-lamivudine
#10
Mohamed A Ghazi Suliman, Kayode Ogungbenro, Christos Kosmidis, Alan Ashworth, Julian Barker, Anita Szabo-Barnes, Andrew Davies, Lee Feddy, Igor Fedor, Tim Hayes, Sarah Stirling, Ignacio Malagon
INTRODUCTION: To our knowledge, there is no published data on the pharmacokinetic (PK) profile of antiretroviral (ART) drugs on patients undergoing extracorporeal membrane oxygenation (ECMO) therapy. We present PK analyses of Ritonavir, Darunavir, Lamivudine and Tenofovir in a patient with HIV who required veno-venous ECMO (VV ECMO). METHODS: Plasma concentrations for Ritonavir, Darunavir, Tenofovir and Lamivudine were obtained while the patient was on ECMO following pre-emptive dose adjustments...
March 12, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28319522/a-numerical-simulation-comparing-a-cavopulmonary-assist-device-and-va-ecmo-for-failing-fontan-support
#11
Po-Lin Hsu, Dongfang Wang, Cherry Ballard-Croft, Dawei Xiao, Joseph B Zwischenberger
A cavopulmonary assist device (CPAD) has been developed for failing Fontan support. This CPAD pumps blood from superior/inferior vena cavae to pulmonary artery. In this study, we compared failing Fontan support with CPAD versus VA ECMO in silico. A numerical lumped-parameter circulatory system model was used to simulate Fontan circulation. Failing Fontan was simulated by increased pulmonary resistance. Central venous pressure (CVP), mean pulmonary arterial pressure (mPAP), left atrial pressure (LAP), and univentricular outflow (CO) were simulated and compared to published clinical data...
March 17, 2017: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/28262284/flow-mixing-during-peripheral-veno-arterial-extra-corporeal-membrane-oxygenation-a-simulation-study
#12
M C Stevens, F M Callaghan, P Forrest, P G Bannon, S M Grieve
Peripheral veno-arterial extra-corporeal membrane oxygenation (ECMO) is an artificial circulation that supports patients with severe cardiac and respiratory failure. Differential hypoxia during ECMO support has been reported, and it has been suggested that it is due to the mixing of well-perfused retrograde ECMO flow and poorly-perfused antegrade left ventricle (LV) flow in the aorta. This study aims to quantify the relationship between ECMO support level and location of the mixing zone (MZ) of the ECMO and LV flows...
April 11, 2017: Journal of Biomechanics
https://www.readbyqxmd.com/read/28169848/efficacy-of-flow-monitoring-during-ecmo
#13
Aditya Badheka, Sara E Stucker, Joseph W Turek, Madhavan L Raghavan
The hypothesis that blood flow monitoring could serve as an effective early indicator of distal obstruction during extracorporeal membrane oxygenation (ECMO) was tested under controlled experimental conditions. The ECMO circuit typically includes (or could be easily modified to include) a shunt that bifurcates from the main line returning a small amount of blood to the pump with access points for drug infusions. Distal circuit obstructions in the oxygenator and beyond will result in an increased diversion of flow from the distal line to the shunt...
July 2017: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/28134658/flow-rate-through-pigtail-catheter-used-for-left-heart-decompression-in-an-artificial-model-of-extracorporeal-membrane-oxygenation-circuit
#14
Won Ho Kim, Tae Hee Hong, Joung Hun Byun, Jong Woo Kim, Sung Hwan Kim, Sung Ho Moon, Hyun Oh Park, Jun Young Choi, Jun Ho Yang, In Seok Jang, Chung Eun Lee, Jeong Hee Yun
In refractory cardiogenic shock, veno-arterial extracorporeal membrane oxygenation (ECMO) can be initiated. Although left heart decompression can be accomplished by insertion of a left atrial (LA) or left ventricular (LV) cannula using a percutaneous pigtail catheter, the venting flow rate according to catheter size and ECMO flow rate is unknown. We developed an artificial ECMO circuit. One liter saline bag with its pressure set to 20 mm Hg was connected to ECMO to mimic LV failure. A pigtail catheter was inserted into the 1 L saline bag to simulate LV unloading...
May 2017: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/27815558/in-vitro-effects-of-an-extracorporeal-membrane-oxygenation-circuit-on-the-sequestration-of-%C3%AF%C2%B5-aminocaproic-acid
#15
Deborah Wagner, Miguel Caraballo, John Waldvogel, Yuki Peterson, Duxin Sun
OBJECTIVE: To assess the in vitro effects of drug sequestration in extracorporeal membrane oxygenation (ECMO) on ϵ-aminocaproic acid (EACA) concentrations. METHODS AND DESIGN: This in vitro study will determine changes in EACA concentration over time in ECMO circuits. A pediatric dose of 2,500 mg was administered to whole expired blood in the simulated pediatric ECMO circuit. Blood samples were collected at 0, 30, 60, 360 and 1440-minute intervals after initial administration equilibration from three different sites of the circuit: pre-oxygenator (PRE), post-oxygenator (POST) and PVC tubing (PVC) to determine the predominant site of drug loss...
April 2017: Perfusion
https://www.readbyqxmd.com/read/27746030/simulation-for-neonatal-extracorporeal-membrane-oxygenation-teams
#16
REVIEW
Lindsay Johnston, Gary Oldenburg
Extracorporeal membrane oxygenation (ECMO) is a highly technical and complex method of life support. Patient and circuit emergencies on ECMO are rare, but in these cases, prompt and correct actions to address the crisis are needed to prevent morbidity and mortality. ECMO simulation programs have gained popularity in recent years, as they provide a standardized educational experience for all members of the inter-professional care team. In addition to providing a context in which to solidify knowledge of ECMO support, participants are also able to focus on vital technical and behavioral skills that are not highlighted in other training methodologies...
November 2016: Seminars in Perinatology
https://www.readbyqxmd.com/read/27314826/pharmacokinetics-and-safety-of-micafungin-in-infants-supported-with-extracorporeal-membrane-oxygenation
#17
Julie Autmizguine, Christoph P Hornik, Daniel K Benjamin, Kim L R Brouwer, Susan R Hupp, Michael Cohen-Wolkowiez, Kevin M Watt
BACKGROUND: Candida is a leading cause of infection in infants on extracorporeal membrane oxygenation (ECMO). Optimal micafungin dosing is unknown in this population because ECMO can alter drug pharmacokinetics (PK). METHODS: To characterize micafungin pharmacokinetics and safety in infants on ECMO, we conducted an open-label pharmacokinetics trial. Infants on ECMO either received intravenous micafungin 4 mg/kg every 24 h for invasive candidiasis prophylaxis or 8 mg/kg every 24 h when a fungal infection was suspected or confirmed...
November 2016: Pediatric Infectious Disease Journal
https://www.readbyqxmd.com/read/27093507/simulation-based-assessment-of-ecmo-clinical-specialists
#18
James J Fehr, Mark Shepard, Mary E McBride, Mary Mehegan, Kavya Reddy, David J Murray, John R Boulet
OBJECTIVE: The aims of the study were (1) to create multiple scenarios that simulate a range of urgent and emergent extracorporeal membrane oxygenation (ECMO) events and (2) to determine whether these scenarios can provide reliable and valid measures of a specialist's advanced skill in managing ECMO emergencies. DESIGN: Multiscenario simulation-based performance assessment was performed. SETTING: The study was conducted in the Saigh Pediatric Simulation Center at St...
June 2016: Simulation in Healthcare: Journal of the Society for Simulation in Healthcare
https://www.readbyqxmd.com/read/27086941/venous-cannula-positioning-in-arterial-deoxygenation-during-veno-arterial-extracorporeal-membrane-oxygenation-a-simulation-study-and-case-report
#19
Mattias Lindfors, Björn Frenckner, Ulrik Sartipy, Anna Bjällmark, Michael Broomé
Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is indicated in reversible life-threatening circulatory failure with or without respiratory failure. Arterial desaturation in the upper body is frequently seen in patients with peripheral arterial cannulation and severe respiratory failure. The importance of venous cannula positioning was explored in a computer simulation model and a clinical case was described. A closed-loop real-time simulation model has been developed including vascular segments, the heart with valves and pericardium...
January 2017: Artificial Organs
https://www.readbyqxmd.com/read/26384794/extracorporeal-membrane-oxygenation-credentialing-where-do-we-stand
#20
Sydne Muratore, Greg Beilman, Ranjit John, Melissa Brunsvold
BACKGROUND: No guidelines exist for credentialing extracorporeal membrane oxygenation (ECMO) physicians despite variable training backgrounds. We aim to identify national patterns of institutional credentialing for ECMO physicians. METHODS: Program directors from 173 US ECMO centers were surveyed regarding credentialing, recertification, training elements, and barriers. RESULTS: Response rate was 42% (73/173). ECMO credentialing for physicians was required in 66% of responding ECMO centers...
October 2015: American Journal of Surgery
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