ASAIO journal : a peer-reviewed journal of the American Society for Artificial Internal Organs
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Early mobility is associated with improved outcomes in critically ill patients with acute respiratory failure. The Avalon Elite Bicaval Dual-Lumen cannula provides support for extracorporeal membrane oxygenation through a single cannula in the internal jugular position in the neck, avoiding femoral cannulation. ⋯ Placement of the Avalon bicaval cannula poses a potential risk of intracardiac placement and right ventricular rupture as a result of the flexibility of the guidewire. We present our endovascular technique for Avalon bicaval cannula placement with fluoroscopic guidance to prevent inadvertent intracardiac placement.
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Currently, nonpulsatile selective cerebral perfusion for cerebroprotection against thoracic aortic aneurysm is used in clinical settings. We performed synchrotron radiation microangiography to determine the effects on selective cerebral perfusion modulation by pulsatile flow. We established cerebral perfusion at normothermia and severe hypothermia in anesthetized rats, during which cerebral angiography was performed. ⋯ The angiographic scores, an indicator of vessel count, for nonpulsatile and pulsatile flow at normothermia were 0.198 ± 0.013 vs. 0.258 ± 0.010 (p < 0.001) and those at severe hypothermia were 0.158 ± 0.017 vs. 0.214 ± 0.015 (p < 0.01), respectively. In comparison with nonpulsatile flow, the relative internal carotid artery diameters during pulsatile flow with and without L-NAME were 98.50 ± 1.7% vs. 114.96 ± 4.6%, respectively, during severe hypothermia. These results show that pulsatile flow is effective in increasing blood vessel diameter, number of vessels, and perfusion distribution range in the rat model and that it was more effective at normothermia during nitric oxide production.
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Case Reports
Octreotide for left ventricular assist device-related gastrointestinal hemorrhage: can we stop the bleeding?
Left ventricular support devices (LVADs) are associated with a propensity toward gastrointestinal bleeding. A postulated mechanism is related to gastrointestinal arteriovenous malformations secondary to nonpulsatile flow. We describe a case of LVAD-related, gastrointestinal bleeding successfully treated with a combination of subcutaneous and intramuscular depot formulations of octreotide.
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Left ventricular assist devices (LVADs) are an effective therapy for patients with advanced heart failure, increasing patient survival and quality of life. Left ventricular assist devices are associated with the risks of bleeding and thrombosis. We used lactate dehydrogenase (LDH) and brain natriuretic peptide (BNP) as biomarkers for developing a thrombosis risk index. ⋯ The TRI retrospectively was able to accurately predict patients with impending device thrombosis. Indexed rise in BNP and LDH in LVAD patients may be useful to identify early device dysfunction and possible future thrombosis. Fibrinogen and D-dimer assays are currently being evaluated in these patients for their possible inclusion and added value to the TRI.
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Despite heparin coating and systemic anticoagulation, thrombotic clot formation is a serious complication in extracorporeal membrane oxygenation (ECMO). We describe our first results of visualization of thrombotic deposits in ECMO devices using advanced multidetector computed tomography (MDCT). A bioline-coated polymethylpentene membrane oxygenator (MO) after 8 days of ECMO treatment (device 1) and a factory-sealed MO serving as an internal quality control (device 2) were analyzed with three-dimensional (3D) visualization volume rendering technique (VRT) using a 0.6 mm3 voxel isotropic MDCT dataset. ⋯ Device 2 showed no signs of clot formation in MDCT using the same VRT settings. It was demonstrated that MDCT with VRT is able to detect thrombotic deposits in ECMO devices under ex vivo conditions. MDCT allows direct visualization of the actual thrombus load of a used ECMO device as well as the quantification of the thrombus volume and could, therefore, play a significant role in better understanding the oxygenator thrombosis in modern ECMO treatment.