ASAIO journal : a peer-reviewed journal of the American Society for Artificial Internal Organs
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The placement of peritoneal catheters by non-surgeons was facilitated by a percutaneous laparoscopic technique ("Y-tec"). We have developed a catheter implantation system that is simpler to use, is less expensive initially and per procedure, and provides greatly enhanced peritoneal visualization. The core of the system is a 4 mm diameter Verres needle, which has a protective spring loaded obturator. ⋯ This method uses the safest mode of blind peritoneal entry and permits thorough peritoneal inspection, even without insufflation. The needle and cannula are reusable, which minimizes cost. The technique is simple, and early results with inexperienced operators are encouraging.
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The authors have developed a venovenous extracorporeal lung support technique with an original single lumen cannula to avoid the carotid ligation of venoarterial extracorporeal membrane oxygenation (ECMO). During a 5 year period, the authors have used the technique in 107 neonates (weight: 3.045 +/- 0.6 1 kg; gestational age: 38.1 +/- 2.2 weeks). All of the neonates had severe respiratory failure despite maximal conventional treatment and the same indications as those for ECMO. ⋯ The mean duration of bypass was 117.8 +/- 83.9 hr, and 91 of the 107 (85%) neonates were weaned from AREC. The technical complications were less important than those associated with venoarterial ECMO. The authors conclude that AREC is as effective as venoarterial ECMO and is easier to use.
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The hemodynamic and metabolic adaptations to exercise in five calves implanted with the Utah-100 total artificial heart (TAH) were investigated. The outputs of the left and right ventricles (LCO, RCO) were measured with a cardiac output monitoring and diagnostic unit (COMDU). Arterial and venous oxygen content (CaO2, CvO2) and blood lactate levels (Lac) were measured by blood gas analysis and enzymatic methods. ⋯ During exercise, there was a positive correlation between DO2, EO2, and VO2. The blood pH, BE, SBE, and lactate levels were within normal ranges, and the IMA exceeded 1.5, denoting that tissue perfusion was adequate and anaerobic metabolism did not occur. This study implies that Utah-100 TAH animals could physiologically accommodate to exercise with an intensity of up to 1.8 mph for 30 min by increasing cardiac preload, cardiac output, oxygen delivery, and oxygen extraction rate, and by decreasing systemic and pulmonary vascular resistance without transition to anaerobic metabolism.
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Extracorporeal membrane oxygenation (ECMO) for adult post cardiotomy cardiogenic shock has had limited success. The efficacy of a heparin bonded ECMO system was tested in 11 patients (eight men, three women; mean age: 63 +/- 8 years), all of whom were in post cardiotomy shock refractory to inotropes and intra-aortic balloon pumping (IABP). The system consisted of a right atrial-to-aortic loop using a hollow fiber oxygenator driven by a vortex pump. ⋯ Eight (73%) patients were weaned from ECMO. Five (45.4%) of these are alive and have been discharged home with a mean follow-up of 317 +/- 76 days (range: 179-416 days). This heparin-free ECMO system allows rapid and simple deployment and provides effective short-term cardiopulmonary support.
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The authors evaluated the efficacy of treatment by extracorporeal perfusion on experimental canine septic shock. Canine septic shock was produced by intravenous infusion of Escherichia coli endotoxin and treated by three techniques: no treatment (Sham), hemoperfusion over Polymyxin B immobilized fiber (PMX), and plasma perfusion over anion exchange resin (Resin). The 24 hr survival rates of the Sham, PMX, and Resin groups were 0%, 80%, and 40%, respectively. ⋯ In addition, blood endotoxin levels in the PMX group were significantly lower, resulting in a significant suppression of TNF release. In the Resin group, some parameters were significantly better than those of the Sham group, but the efficacy of this treatment was less than that of the PMX treatment. Hemoperfusion over Polymyxin B immobilized fibers can detoxify circulatory endotoxin, resulting in improvement of systemic and organic disorders caused by sepsis.