ASAIO journal : a peer-reviewed journal of the American Society for Artificial Internal Organs
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To test the feasibility, safety, and efficacy of partial extracorporeal CO2 removal (PECCO2R) using a standard continuous renal replacement (CRRT) device with a pediatric oxygenation membrane introduced into the circuit in a serial manner. In this retrospective single-center study, we have studied mechanically ventilated patients with persistent significant respiratory acidosis and acute renal failure requiring ongoing CRRT. Sixteen patients were treated with our PECCO2R device. ⋯ Partial extracorporeal CO2 removal treatment had no effect on oxygenation. No complication was observed. Our PECCO2R approach based on the simple introduction of a pediatric extracorporeal membrane oxygenation membrane into the circuit of a standard CRRT device is easy to implement, safe, and efficient to improve respiratory acidosis.
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Cardiac output (CO) assessment is important in treating patients with heart failure. Durable left ventricular assist devices (LVADs) provide essentially all CO. In currently used LVADs, estimated device flow is generated by a computerized algorithm. ⋯ Left ventricular assist device flow generally trends with measured CO, but large variability exists, hence flow measures should not be assumed to equal with CO. Clinicians should take into account variables such as high CO, BP, and opening of the aortic valve when interpreting LVAD flow readout. Direct flow sensors incorporated in the LVAD system may allow for better estimation.
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Echocardiography is the standard to assess heart function although obtaining transesophageal echocardiography (TEE) on an emergent basis may be limited by its availability. A transoral miniaturized hemodynamic TEE (hTEE) probe (ImaCor Inc.) was developed to provide direct visualization of the heart, and we hypothesized that the probe could provide hemodynamic information useful for patient management. Data from 2011 to 2012 was retrospectively collected. ⋯ The indications for probe insertion were hemodynamic instability (n = 32), ECMO weaning (n = 10), VAD alarm (n = 1), tamponade (n = 14), pulmonary embolism (n = 2), and intra-aortic balloon pump wean (n = 2). In all 61 cases, we were successfully able to diagnose and treat the etiology of instability based on the hTEE findings. Utilization of the hTEE probe successfully diagnosed and aided therapy in all patients with hemodynamic instability refractory to initial therapy and provides a valuable tool to aid clinicians in the management of postoperative hemodynamics.
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Unfractionated heparin (UFH) is required in children on extracorporeal life support (ECLS) to maintain circuit patency. When high-dose UFH is inadequate to maintain an anticoagulant effect, the addition of antithrombin concentrate (ATC) is considered. The objective of this study was to review clinical experience giving 1,000 units (U) of ATC to patients on ECLS and UFH anticoagulation. ⋯ Mean anti-Xa level pre- and post-AT administration was 0.23 and 0.41 U/ml, respectively. There were no associated acute adverse events. The administration of high-dose ATC decreases UFH dose requirements.
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Implantation of rotary blood pumps is an established treatment for end-stage heart failure. Anticoagulation is routinely used for reducing pump thrombosis, but this severe complication still occurs in 5-8% of patients. In 105 patients, the sound produced by the left ventricular assist device HeartWare HVAD was prospectively and sequentially recorded. ⋯ Analysis of the acoustic spectrum of the HVAD pump can be used as a reliable method to detect pump thrombosis. The appearance of third harmonics indicates the presence of thrombotic particles independently of previous baseline measurements. The goal of this study is to define and validate such a method.