ASAIO journal : a peer-reviewed journal of the American Society for Artificial Internal Organs
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Extracorporeal circulation (ECC) is an invaluable tool in lung transplantation (lutx). More than the past years, an increasing number of centers changed their standard for intraoperative ECC from cardiopulmonary bypass (CPB) to extracorporeal membrane oxygenation (ECMO) - with differing results. This meta-analysis reviews the existing evidence. ⋯ These data indicate a benefit of the intraoperative use of ECMO as compared with CPB during lung transplant procedures regarding short-term outcome (ICU stay). There was no statistically significant effect regarding blood transfusion needs or long-term outcome. The superiority of ECMO in lutx patients remains to be determined in larger multi-center randomized trials.
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This study aimed to investigate the effectiveness of near-infrared spectroscopy (NIRS) monitoring for the early detection of limb ischemia in patients who were placed on veno-arterial extracorporeal membrane oxygenation (VA-ECMO) via femoral artery. We prospectively used NIRS monitoring for the early detection of limb ischemia in 28 adult patients, who were supported with peripheral VA-ECMO between August 2013 and August 2014 (NIRS group). A decision to perform distal perfusion catheterization was made in accordance with the regional oxygen saturation (rSO2) values provided by the NIRS system. ⋯ No patient underwent fasciotomy in the NIRS group, while 13.9% did in the control group (p = 0.040). We think that NIRS monitoring is a useful and reliable method for the early detection of limb ischemia in patients undergoing peripheral VA-ECMO. Its application may allow timely correction of perfusion deficits and the prevention of compartment syndrome and limb complications.
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Comparative Study
A Numerical Simulation Comparing a Cavopulmonary Assist Device and VA ECMO for Failing Fontan Support.
A cavopulmonary assist device (CPAD) has been developed for failing Fontan support. This CPAD pumps blood from superior/inferior vena cavae (SVC/IVC) to pulmonary artery. In this study, we compared failing Fontan support with CPAD versus veno-arterial extracorporeal membrane oxygenation (VA ECMO) in silico. ⋯ Veno-arterial extracorporeal membrane oxygenation provided partial Fontan assistance with low pump flows. Blood went through pulmonary circulation with CPAD whereas VA ECMO bypassed pulmonary circulation and diminished univentricular blood flow (0.8 L/min). This in silico study demonstrated that CPAD preserved heart/lung function whereas VA ECMO had very low univentricular flow, potentially leading to thrombosis or univentricular atrophy.
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Extracorporeal CO2 removal (ECCO2R) is promoted with attributes like "safe" and "less invasive" compared with (high-flow) venovenous extracorporeal membrane oxygenation (ECMO) systems. With our experience in coagulation disorders during ECMO therapy with this observational study, we for the first time prospectively evaluate hemolysis and coagulation disorders during ECCO2R. Eight consecutive patients with predominant hypercapnic respiratory failure were treated with the Hemolung respiratory assist system (Alung-Technologies, Pittsburg, PA). ⋯ Six of seven patients required transfusion of red blood cells. Our observation shows that even low-flow extracorporeal lung support is associated with relevant clinical bleeding symptoms, blood cell injury, development of acquired von Willebrand syndrome and need for transfusion. In our opinion, it therefore is too early to quote ECCO2R "safe" and "less invasive."
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Right ventricular failure (RVF) may still occur despite the benefits of minimally invasive left ventricular assist device (MI-LVAD) implantation. Our center strategy aims to avoid aggressive postoperative inotrope use by using mechanical support to facilitate right ventricle recovery and adaptation. We herein report first outcomes of patients with minimally invasive temporary right ventricular assist device (MI-t-RVAD) support for RVF during MI-LVAD implantation. ⋯ The 30 day survival was 80%. Our results confirm safety and feasibility of MI-t-RVAD support for acute RVF in the setting of MI-LVAD implantation. The potential benefits of this strategy are more stable hemodynamics in the first postoperative days that usually are crucial for LVAD patients and reduced inotrope requirement.