Perfusion
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Comparative Study Clinical Trial
Comparison of hollow-fiber membrane oxygenators in terms of pressure drop of the membranes during normothermic and hypothermic cardiopulmonary bypass in neonates.
The objective of this study was to investigate the effects of two hollow-fiber membrane oxygenators, the Capiox SX10 and the Lilliput 901, on pressure drop of the membranes during normothermic and hypothermic cardiopulmonary bypass (CPB) in neonates. ⋯ These results suggest that the Capiox SX10 hollow-fiber membrane oxygenator produced significantly lower membrane pressure drops and pre- and post-oxygenator ECC during normothermic and hypothermic CPB. Thus, blood trauma with the Capiox during extracorporeal circulation may be significantly lower compared to the Lilliput. Further studies, including the level of complements, platelets, neutrophils and cytokines, with these oxygenators are warranted.
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Comparative Study
Performance of polymethyl pentene oxygenators for neonatal extracorporeal membrane oxygenation: a comparison with silicone membrane oxygenators.
To review the performance of polymethyl pentene versus silicone oxygenators in terms of efficiency in priming and oxygenation, oxygenator resistance, requirements for coagulation proteins and consumption of blood products, for neonatal extracorporeal membrane oxygenation (ECMO) patients. ⋯ Small PMP oxygenators (Medos Hilite 800 LT) provide adequate gas exchange and offer technical advantages in terms of more efficient priming, reduced haemodynamic resistance and better control and preservation of coagulation proteins than silicone oxygenators.
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To report a single case of oxygenator failure caused by clot embolism originating from the bladder; and to discuss some preventative options. ⋯ There is a need for improvement in the design of small oxygenators and ECMO circuits. Adjustment of the coagulation parameters and lowering the tolerance towards clots in the circuit by electively changing them may reduce the incidence of sudden unexpected oxygenator failure. However, using a slightly larger Medos oxygenator may gain valuable time needed to arrange an oxygenator/circuit change.
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The respective value of procalcitonin (PCT) and C-reactive protein (CRP) as markers of postoperative complications after coronary bypass surgery is unclear. Therefore, complications during one week after surgery were studied to evaluate the predictive role of PCT and CRP changes during the immediate postoperative period. ⋯ A postoperative serum PCT concentration of >0.5 ng/mL is highly suggestive of a postoperative complication. CRP changes do not contribute to predictive information.
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Routine administration of large amounts of pain and sedative medication is common to critically ill pediatric patients undergoing extracorporeal membrane oxygenation (ECMO) for cardiopulmonary failure. It has been our experience that pediatric patients are the most difficult age group in which to achieve an ideal pain and sedative control due to the narrow margin of safety. The purpose of this study was to determine the general practice guideline used for pain and anxiolytic pharmacotherapy for pediatric patients at ECMO centers. ⋯ Of the 46 responding centers (including telephone follow-ups), 37 (80%) centers had an active pediatric ECMO programs for patients with severe respiratory failure. Fentanyl was the most commonly used pain medication and continuous infusion, administered directly to the patient, was preferred. Subjective effectiveness of various pharmacological agents was variable without clear consensus; however, midazolam was considered to be the most effective agent used.