The International journal of artificial organs
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Extracorporeal membrane oxygenation (ECMO) was used to achieve temporary artificial support in cardiac and pulmonary function in 22 patients from 1987 to September 1990. Standard indications were postcardiotomy cardiogenic shock (n = 4), neonatal (n = 1) and adult respiratory distress syndrome (n = 4). ECMO was also used for extended indications, such as graft failure following heart (n = 11) or lung transplantation (n = 2). ⋯ This series illustrates the results with ECMO in emergency situations, in patients under immunosuppressive protocols, or in patients with advanced lung failure requiring almost complete artificial gas exchange. In such complex situations, ECMO does provide stabilization until additional therapeutic measures are in effect. ECMO cannot be recommended for postoperative cardiogenic shock but short-term ECMO support is an accepted method in most cases with graft failure or pulmonary failure or other origin.
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Hemodialysis is a powerful tool for extracorporeal CO2 removal, because CO2 can be eliminated both as gas and as bicarbonate with blood flow rates as low as 10-15 ml/kg/min. An unsolved problem remains, however: how to make up for the bicarbonate loss. ⋯ CO2 removal was quantitatively the same as during routine acetate hemodialysis and could not be increased using other organic acids. b) NaOH alone, through theoretically the best substitute for NaHCO3, had serious side effects and led to an increase in pulmonary artery pressure. c) with TRIS at a rate of 5 mmol/min, all metabolic CO2 could be removed for up to seven hours without clinical side effects, but not for longer periods. We conclude that a combination treatment for realkalinisation has to be worked out to compensate for the bicarbonate loss.