ASAIO journal : a peer-reviewed journal of the American Society for Artificial Internal Organs
-
Oxygenator thrombosis is a serious complication in extracorporeal membrane oxygenation (ECMO) and may necessitate a system exchange. Coagulation and fibrinolysis parameters, flow dynamics, and gas transfer performance are currently used to evaluate the degree of oxygenator thrombosis, but there is no technical approach for direct visualization and quantification of thrombotic deposits within the membrane oxygenator (MO). We used multidetector computed tomography (MDCT) with three-dimensional postprocessing to assess the incidence of oxygenator thrombosis, to quantify thrombus extent, and to localize clot distribution. ⋯ There was no correlation between clot volume and ECMO support time or aPTT. Clot formation within the MO is a common finding in ECMO despite adequate systemic anticoagulation. The clinical significance of thrombus formation and its influence on gas exchange capacity and hemostatic complications have to be addressed in further studies.
-
During veno-venous extracorporeal membrane oxygenation (VV-ECMO) support, optimization of oxygenation can be achieved by therapeutic interventions on both patient physiological variables and adjustment of ECMO settings. Based on the physiology of oxygen delivery during VV-ECMO support, we established the mathematical relationship between the variables which define the oxygenation state: hemoglobin (Hb), extracorporeal blood flow (ECBF), cardiac output (Q), and systemic oxygen consumption (VO2). ⋯ Despite the same value of SaO2, the DO2 resulting from the different combinations of Hb and ECBF progressively decreases with decreasing Hb. By demonstrating the quantitative relationship between Hb and ECBF as determinants of oxygenation during VV-ECMO support, this mathematical model could provide a theoretical basis for a rational approach to strategies to optimize oxygenation in patients on VV-ECMO.
-
Venoarterial extracorporeal life support (VA-ECLS) is a lifesaving circulatory support in hemodynamic collapse induced by miscellaneous etiologies. However, survival rates vary among etiologies. To investigate the therapeutic effectiveness of VA-ECLS in hemodynamic collapse induced by fulminant cardiomyopathy (CM), a retrospective chart review of 14 patients was conducted, among the 294 adults receiving VA-ECLS in a single institution from April 2006 to April 2013. ⋯ All of the 10 survivors, including the five experiencing dialysis-dependent acute renal failure, had their cardiac and renal function return to normal within 6 months after the episode. The VA-ECLS was a practical therapeutic option in fulminant CM. It could provide expeditious hemodynamic support and preserve organ viability essential to recovery.