ASAIO journal : a peer-reviewed journal of the American Society for Artificial Internal Organs
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In this review, we summarize the history of tracheal reconstruction and replacement as well as progress in current tracheal substitutes. In Part 1, we cover the historical highlights of grafts, flaps, tube construction, and tissue transplants and address the progress made in tracheal stenting as a means of temporary tracheal support. ⋯ We conclude Part 2 with a summary of recent efforts toward generating a bioengineered trachea. Finally, we provide an algorithm on the spectrum of options available for tracheal replacement.
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We compared the morbidity of patients with meconium aspiration syndrome (MAS) with that in patients with all other respiratory conditions treated with extracorporeal membrane oxygenation (ECMO) (no MAS). If ECMO for MAS was associated with a lower complication rate, then relaxed ECMO entry criteria could be considered. A retrospective review was performed of all patients in the national extracorporeal life support (ELSO) registry from 1989 to 2004. ⋯ Overall, MAS patients had a significantly lower number of complications per patient in each category versus no-MAS patients. These results indicate that regardless of type of ECMO, there are fewer complications on ECMO in MAS versus no-MAS patients. These data support the consideration of relaxed ECMO entry criteria for MAS.
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Anticoagulation for extracorporeal life support (ECLS) is routinely achieved using heparin, which can be difficult in patients suspected of having heparin-induced thrombocytopenia. We describe a case series of five patients in which we used argatroban, a direct thrombin inhibitor, as an alternative to heparin for systemic anticoagulation during ECLS in patients suspected to have heparin-induced thrombocytopenia. Argatroban was used to achieve target systemic anticoagulation for activate clotting times between 210 and 230. ⋯ Argatroban dosage ranged from 0.2 to 3.5 microg/kg/min. Activated clotting times showed good agreement with aPTT. In conclusion, we illustrate that argatroban is a reasonable alternative to heparin anticoagulation for patients requiring ECLS.