The International journal of artificial organs
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Comparative Study
Recirculation during veno-venous extra-corporeal membrane oxygenation--a simulation study.
Veno-venous ECMO is indicated in reversible life-threatening respiratory failure without life-threatening circulatory failure. Recirculation of oxygenated blood in the ECMO circuit decreases efficiency of patient oxygen delivery but is difficult to measure. We seek to identify and quantify some of the factors responsible for recirculation in a simulation model and compare with clinical data. ⋯ Simulations suggest that recirculation is a significant clinical problem in veno-venous ECMO in agreement with clinical data. Due to the difficulties in measuring recirculation and interpretation of the venous oxygen saturation in the ECMO drainage blood, flow settings and cannula positioning should rather be optimized with help of arterial oxygenation parameters. Simulation may be useful in quantification and understanding of recirculation in VV-ECMO.
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The objective of this work was to conduct pre-clinical feasibility studies to determine if a highly efficient, active-mixing, adult extracorporeal carbon dioxide removal (ECCO2R) system can safely be translated to the pediatric population. The Hemolung Respiratory Assist System (RAS) was tested in vitro and in vivo to evaluate its performance for pediatric veno-venous applications. ⋯ The Hemolung RAS was found to have gas exchange and pumping capabilities relevant to patients weighing 3-25 kg. Seven-day animal studies in juvenile sheep demonstrated that veno-venous extracorporeal support could be used safely and effectively with no significant adverse reactions related to device operation.
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Case Reports
Low-flow veno-venous extracorporeal CO2 removal: first clinical experience in lung transplant recipients.
Low-flow extracorporeal CO2 removal devices are easy to setup and manage and may provide valuable ventilation support. ⋯ Our data suggest that this new device is effective in removing CO2 and stabilizing the pH.
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Comparative Study
Influence of different oxygenator types on changing frequency, infection incidence, and mortality in ARDS patients on veno-venous ECMO.
Veno-venous extracorporeal membrane oxygenation (vv-ECMO) is pivotal in the treatment of patients suffering from acute respiratory distress syndrome (ARDS). Comparative data with different oxygenator models have not yet been reported. The aim of this retrospective investigation was therefore to assess whether different oxygenator types might influence changing frequency, infection incidence, and mortality in patients on vv-ECMO. ⋯ The PMP oxygenator membranes showed benefits with regards to changing frequency, but not infection incidence, length of ICU stay, and length of ECMO therapy. There was a trend towards a lower ICU mortality in patients with PMP oxygenators.
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Extracorporeal membrane oxygenation (ECMO) has been effective in the treatment of H1N1-induced ARDS across the globe. However, the evidence supporting the use of ECMO in ARDS is still being collected. The intention of this study was to add a piece of puzzle to the growing body of evidence on the use of ECMO in ARDS patients. ⋯ Our results confirm the usefulness of ECMO treatment in patients with H1N1-induced ARDS.