ASAIO journal : a peer-reviewed journal of the American Society for Artificial Internal Organs
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Multicenter Study
Antimicrobial prophylaxis and infection surveillance in extracorporeal membrane oxygenation patients: a multi-institutional survey of practice patterns.
The goal of this study was to characterize antimicrobial prophylaxis and infection surveillance practices at centers treating patients with extracorporeal membrane oxygenation (ECMO). A 37-question web-based survey was sent to all ECMO coordinators and directors at Extracorporeal Life Support Organization (ELSO) participating centers. Data were reported by center. ⋯ There is significant variation in the antibiotic choices and duration of prophylaxis, regardless of whether the center has a protocol or not. Almost half of centers (49%, 64/132) perform routine surveillance cultures but at variable intervals. There is significant heterogeneity in antibiotic prophylaxis and infection surveillance practice patterns among ELSO centers.
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Controlled Clinical Trial
Addition of acetylsalicylic acid to heparin for anticoagulation management during pumpless extracorporeal lung assist.
Pump-driven extracorporeal membrane oxygenation (ECMO) or pumpless arterio-venous interventional lung assist (iLA) is associated with possible complications, mainly consisting of bleeding or thrombosis/clotting by cellular deposits on the membrane or extracorporeal circuit surfaces, which may reduce gas-exchange capacity. In this study, we report our experiences with the addition of low-dose acetylsalicylic acid (ASA 1.5 mg/kg body weight/d) to heparin for anticoagulation of a pumpless low-resistance gas-exchange membrane (Novalung GmbH, Talheim, Germany). We assessed changes in coagulation parameters and the demand for transfusion of blood components. ⋯ The use of membranes per patient (membrane/patient ratio) tended to be decreased in patients treated with ASA (1.12 ± 0.34) in comparison with control (1.33 ± 0.62, p = 0.157). In the ASA group, one patient died due to multiple organ failure, whereas in the control group, five patients died. We conclude that supplementation of low-dose ASA during pumpless extracorporeal lung support is safe and might preserve the function of oxygen transfer.
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Correct placement of the Avalon Elite Bicaval Dual Lumen catheter (Avalon Laboratories, LLC, CA) for single-site venovenous extracorporeal membrane oxygenation (VV ECMO) is safe using image guidance. Using this technique, 26 of 27 patients (96%) had uneventful placement of the cannula in the right internal jugular vein. ⋯ As proficiency improves, TEE at the bedside provides an excellent standard of care. Double-lumen ECMO catheters can be effectively placed under image guidance with minimal need for repositioning.
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Extracorporeal membrane oxygenation can achieve sufficient gas exchange in severe acute respiratory distress syndrome. A highly integrated extracorporeal membrane oxygenator (HEXMO) was developed to reduce filling volume and simplify management. Six female pigs were connected to venovenous HEXMO with a total priming volume of 125 ml for 4 hours during hypoxemia induced by a hypoxic inspired gas mixture. ⋯ The plasmatic coagulation was only mildly activated without significant platelet consumption. The HEXMO prototype provided sufficient gas exchange to prevent hypoxemia. This proof of concept study supports further development and design modifications to increase performance and to reduce coagulation activation for potential long-term application.
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Comparative Study
Left ventricular mechanical support with Impella provides more ventricular unloading in heart failure than extracorporeal membrane oxygenation.
The Impella microaxial-flow pump can directly unload left ventricle (LV) in cases of acute heart failure. Extracorporeal membrane oxygenation (ECMO) is widely used for circulatory support. Although the clinical effectiveness of ECMO has been demonstrated, insufficient LV loading reduction may not be advantageous for myocardial recovery. ⋯ The PV area, which is a measure of ventricular unloading and is correlated with myocardial oxygen consumption, decreased more with Impella than with ECMO. Successful defibrillation was achieved more effectively while under Impella support. Superior ventricular unloading with the Impella device may provide higher recovery potential to damaged hearts than ECMO and may have a significant impact not only on intensive care of patients with heart failure but also on resuscitation.