Artificial organs
-
Multicenter Study Comparative Study
Comparative study of five types of IABP balloons in terms of incidence of balloon rupture and other complications: a multi-institutional study.
The Multi-Institutional IABP Balloon Study Group in Japan (14 institutions) conducted a retrospective nonrandomized study to elucidate the incidence and type of IABP balloon-related complications relative to design and durability of five different clinically available balloons: TMP (n = 960), Kontron (n = 943). Datascope (n = 485), Mansfield (n = 226), and Aries (n = 189) balloons. A total of 2,803 patients (1,973 males, 830 females, mean age 62.1 years) spent a total of 243,856 h on the pump. ⋯ They included lower limb ischemia (61 cases), hematoma (11 cases), extensive dissection (6 cases), perforation (5 cases), entrapment without balloon rupture (3 cases), and mesenteric infarction (3 cases). The incidence of rupture, other major complications, and total complications, respectively, for each balloon was 0, 2.7, and 2.7 for TMP, 1.6, 4.3, and 5.9% for Kontron, 4.1, 1.9, and 6.0% for Datascope, 1.3, 2.7, and 4.0% for Mansfield, and 5.8, 3.7, and 9.5% for Aries. In conclusion, the TMP balloon demonstrates a significantly lower rate of rupture while the incidence of other complications for the 5 balloons is not significantly different.
-
Case Reports
Emergency cardiopulmonary bypass support in patients with cardiac arrest caused by myocardial infarction.
Emergency percutaneous cardiopulmonary bypass support (PCPS) was instituted in 3 patients with acute myocardial infarction in cardiac arrest refractory to conventional resuscitation measures. All had severe double or triple vessel disease. Percutaneous transluminal coronary angioplasty (PTCA) was performed in 1 patient and PTCA and directional coronary atherectomy (DCA) were performed in the other 2 patients on combined intraaortic balloon pumping (IABP) and PCPS. ⋯ Time on IABP ranged from 10 days to 2 weeks. These 2 patients died of pneumonia or multiorgan failure after 1.5 months. In conclusion, emergency PCPS is a powerful resuscitative tool that may stabilize the condition of patients in cardiac arrest to allow for definitive intervention.
-
Urinary excretion of selected markers for renal injury, as well as urinary excretion rates of the thromboxane metabolite, 11-keto-thromboxane B2 (11k-TXB2), was studied in 36 male patients undergoing coronary bypass surgery using cardiopulmonary bypass (CPB). In all patients, excretion of both tubular (N-acetyl-beta-D-glucosaminidase [beta NAG]; alpha 1-microglobulin [alpha 1-MG]) and glomerular markers (albumin [Alb]; transferrin [Trf]; immunoglobulin G [IgG]) sharply increased on Day 1 after CPB, and they remained elevated throughout the observation period of 5 days. Urinary excretion rates of 11k-TXB2 markedly increased on Day 1 after surgery, and they rapidly decreased thereafter. ⋯ Furthermore, no correlation between urinary excretion of 11k-TXB2 and any of the urinary markers for renal injury could be detected. Our data do not strengthen the hypothesis that acute renal injury observed during CPB is related to exaggerated thromboxane biosynthesis in these patients. Monitoring of urinary markers for incipient renal damage, particularly excretion of beta NAG, might be of additional diagnostic value for detection of otherwise subclinical renal injury in patients undergoing CPB.
-
We examined whether pyridoxalated hemoglobin-polyoxyethylene conjugate (PHP) could be life-relievable for carbon monoxide (CO) intoxication. Toxic gas (O2, 5.0%; CO2, 16.0%; CO, 1.8%; and N2, 77.2%) was inhaled by rabbits anesthetized with urethane and the following parameters were measured: blood pressure, arterial and venous Po2, Pco2, pH, and carboxyhemoglobin (COHb). When mean blood pressure reached 0 or 20 mm Hg as an index after inhalation of the toxic gas, the toxic gas was switched to air; intravenous infusion of physiological saline or PHP (1.2 g/20 ml/kg/30 min) was simultaneously initiated. ⋯ All 6 animals in the PHP group survived and each parameter recovered. PHP accelerated recovery from high COHb concentrations, low arterial and venous Po2, reduction of arterial and venous Pco2, and elevations of pH and blood pressure. These results suggest that PHP treatment during the early stage of CO intoxication is life-saving and effective in facilitating the recovery of various functions.
-
The effects of pyridoxalated hemoglobin polyoxyethylene conjugate (PHP) and stroma-free hemoglobin (SFH) on vascular responsiveness to various vasoactive substances were examined in isolated perfused rat kidneys. The kidneys isolated from rats were perfused with 6% PHP, 6% SFH, and 6% hydroxyethylstarch (HES) solution at a constant flow rate. Vascular responsiveness to acetylcholine (ACh), nitroglycerin (NG), norepinephrine (NE), and angiotensin-II (ANG-II) was examined by measuring the perfusion pressure (PP). ⋯ NE and ANG-II induced an increase in PP in all groups, but NE-induced and ANG-II-induced responses in the PHP-perfused and SFH-perfused groups were significantly larger than those in the HES-perfused group. L-NMMA did not alter vascular responsiveness to NE and ANG-II. These results indicate that PHP and SFH do not inhibit EDRF induced by ACh, but hemoglobin moiety per se does augment the vascular responsiveness to NE and ANG-II in the isolated perfused rat kidney.