Artificial organs
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The objective of this investigation is to describe recent changes made in extracorporeal life support (ECLS) technology in the US Postal survey to directors and coordinators of all 125 US ECLS centers identified by Extracorporeal Life Support Organization as of November 2010, with follow-up of nonrespondents. Spearman coefficients were used to correlate the method of updating knowledge of ECLS technology with the likelihood of changing technology, and to correlate decision-making hierarchy with the likelihood of changing equipment. The response rate was 75% representing 34 states, and the majority of respondents were ECLS coordinators (56.6%). ⋯ Forty-six percent of respondents that changed oxygenators cited that the primary reason for changing was "clinical preference/experience," while the other half was split between "FDA approval" and "Research results." In 40% of centers, a multidisciplinary group made decisions on changing technology. This survey indicates that over one-half of ECLS centers implemented new technology within the past 3 years. Knowledge of ECLS technology and safe operation of ECLS circuit components is essential in preventing some of the mechanical complications.
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Clinical Trial
Counterpulsation with symphony prevents retrograde carotid, aortic, and coronary flows observed with intra-aortic balloon pump support.
A counterpulsation device (Symphony) is being developed to provide long-term circulatory support for advanced heart failure (HF) patients. In acute animal experiments, flow waveform patterns in the aortic, carotid, and coronary arteries were compared during Symphony and intra-aortic balloon pump (IABP) support. Human data were examined for similarities. ⋯ Counterpulsation with an IABP via aortic volume displacement produces retrograde flows during rapid balloon deflation that reduces total flow. Counterpulsation with Symphony via volume removal eliminates retrograde flow and improves total flow more than that achieved with IABP. The Symphony may provide long-term hemodynamic benefits in HF patients.
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Children with heart failure unresponsive to medical therapy are left with few options for survival. Ventricular assist devices (VADs) are life-saving options for such patients, allowing for bridge to transplantation or cardiac recovery. Retrospective review of cases from May 2006 to October 2010 was undertaken. ⋯ Survival for pediatric patients of all ages is excellent using current device technology with a majority of patients being successfully bridged to transplantation. Morbidity is acceptably low considering the severity of illness. Significant challenges exist with long-term extracorporeal support due to lack of donor availability and the high incidence of preformed alloantibodies especially in the failing single ventricle.