Artificial organs
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Single-lumen cannula venovenous (VV) extracorporeal membrane oxygenation (ECMO) is a special extracorporeal life support (ECLS) technique used for neonatal and pediatric refractory hypoxemia. This is an alternative flow rate ECLS that consists of successive clamping on the drainage and the injection lines. Currently, the Armand-Trousseau's pediatric intensive care unit remains the only pediatric ECMO center proposing this partial assistance. ⋯ Our experience shows that this technique is as efficient and less invasive than two cannulas ECMO. The single-lumen cannula VV ECMO is a simple and safe ECLS support used for neonatal or pediatric refractory hypoxemia. Because this is a partial assistance, it is a promising ECLS support.
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A novel pulsatile rotary flow pump has been used in clinical extracorporeal life support (ECLS) in Europe. The objective of this study is to evaluate the Medos Deltastream DP3 diagonal pump (Medos Medizintechnik AG, Stolberg, Germany) in a simulated pediatric ECLS system. The ECLS circuit consisted of a Medos Hilite 800LT hollow fiber membrane oxygenator (Medos Medizintechnik AG), a Medos Deltastream DP3 diagonal pump, a 10Fr Terumo TenderFlow Pediatric Arterial Cannula (Terumo Corporation, Tokyo, Japan), and an arterial/venous tubing. ⋯ The results showed that the Medos Deltastream DP3 can generate effective pulsatile flow without backflow, provide higher flow rates and pressures than nonpulsatile flow, and then create surplus hemodynamic energy and more total hemodynamic energy than nonpulsatile flow. Pulsatility increased with increased speed differential values and flow rates, while the oxygenator pressure drop increased at an acceptable level. The Medos Deltastream DP3 diagonal pump can provide adequate quality of pulsatility without backflow, and generate more hemodynamic energy under pulsatile mode in a simulated pediatric ECLS system.
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Biography Historical Article
Oliver Murray Wrong, MD, FRCP (London and Edinburgh): a giant of nephrology (1925-2012).
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The operation of cardiopulmonary bypass procedure requires an advanced skill in both physiological and mechanical knowledge. We developed a virtual patient simulator system using a numerical cardiovascular regulation model to manage perfusion crisis. This article evaluates the ability of the new simulator to prevent perfusion crisis. ⋯ Typical blood pressure (BP) changes (hypertension, stable, and hypotension) were reproducible using a combination of four control parameters that can be estimated from changes in patient physiology, BP, and blood volume. This simulation model is a useful educational tool to learn the recognition and management skills of extracorporeal circulation. Identification method for control parameter can be applied for diagnosis of heart failure.
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Randomized Controlled Trial Comparative Study
Comparison of the effects of three cell saver devices on erythrocyte function during cardiopulmonary bypass procedure--a pilot study.
Cell salvage devices are routinely used to process red blood cells (RBCs) shed during cardiac surgery. The purpose of this study was to evaluate three commercially available cell saver (CS) devices in terms of erythrocyte function and the quality of washed RBCs during cardiopulmonary bypass (CPB). Thirty patients undergoing CPB were randomly allocated to three CS devices: Group C (Cell Saver 5+; Haemonetics, n = 10), Group M (autolog; Medtronic, n = 10), and Group F (CATS; Fresenius HemoCare, n = 10). ⋯ Group F provided the maximum concentration of Hct (P = 0.021; 0.046) and Hb (P = 0.008; 0.013). In addition, Groups C (P = 0.035) and M (P = 0.038) had a higher removal of fHb (ΔfHb), differing significantly with Group F. In conclusion, CS devices use the same theory of centrifugation; however, based on different designs, the function of the washed erythrocyte and undesirable content removal efficiency differs widely from one device to another.