ASAIO journal : a peer-reviewed journal of the American Society for Artificial Internal Organs
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Between June 1986 and October 1995, 81 patients were emergently resuscitated with a portable extracorporeal life support (ECLS) system. Venoarterial perfusion was achieved using a centrifugal pump (BioMedicus; Medtronic, Anaheim, CA) and a hollow fiber oxygenator (BARD in 56 patients; Medtronic heparin-bonded MAXIMA, [MAXIMA, Medtronic, Minneapolis, MN] in the last 25 patients. The ECLS system was used at various locations in the hospital with the setup, priming, and initiation of perfusion done by ECLS trained intensive care unit nurses. ⋯ The ECLS system permitted an additional therapeutic surgical intervention in 45 cases. Patients who had a surgically remediable problem were more likely to survive. Prolongation of cardiopulmonary resuscitation beyond 30 mins before initiation of ECLS correlated with a decreased likelihood of survival.
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While the use of the centrifugal vortex ECMO pump as an alternative to a roller-occlusion pump offers distinct advantages, unacceptable hemolysis may occur during its use in newborn infants. The authors studied 87 consecutive neonatal patients with respiratory failure supported with venoarterial ECMO using a centrifugal vortex pump. Baseline mean plasma free hemoglobin level for all patients during the first 48 hours of bypass was 31.3 +/- 3.1 md/dl. ⋯ Mean plasma free hemoglobin decreased to baseline values following pump head change. The authors could not determine any factors that distinguish the infants who developed hemolysis from those who did not. Changing only the pump head provides a simple approach to hemolysis during use of the centrifugal vortex pump on newborn infants.
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The annual ELSO Registry Report for 1995 is presented. Fourteen thousand patients treated with extracorporeal life support are reported, 11,000 are newborn infants with respiratory failure (80% survived). ⋯ In 1993, the number of annual case reached a plateau of approximately 1500-1800 cases per year. The survival rate is gradually improving in pediatric and adult respiratory cases.