ASAIO journal : a peer-reviewed journal of the American Society for Artificial Internal Organs
-
Cardiopulmonary failure because of drowning with accidental hypothermia (AH) remains a major task for emergency care physicians. In this case series, we describe our experience in nine patients with cardiopulmonary failure after drowning with AH less than 35°C, who were provided on an emergency basis with extracorporeal life support (ECLS) system or extracorporeal membrane oxygenation (ECMO). Conservative rewarming methods are not considered for this study. ⋯ Cause of death was severe neurologic damage in six patients and cardiac failure in one patient. The use of ECLS/ECMO is a therapy option for a small range of patients with cardiopulmonary failure because of drowning with AH. Nevertheless, the interval of preclinical rescue remains extensively long.
-
We previously described a highly efficient extracorporeal CO2 removal technique called respiratory electrodialysis (R-ED). Respiratory electrodialysis was composed of a hemodiafilter and a membrane lung (ML) positioned along the extracorporeal blood circuit, and an electrodialysis (ED) cell positioned on the hemodiafiltrate. The ED regionally increased blood chloride concentration to convert bicarbonate to CO2 upstream the ML, thus enhancing ML CO2 extraction (VCO2ML). ⋯ Subsequently, VCO2ML increased from 27 ± 1.7 to 91.3 ± 1.5 ml/min (0 vs. 8 A, p < 0.001). Respiratory electrodialysis is efficient in increasing VCO2ML of an extracorporeal circuit featuring an ML perfused by hemodiafiltrate. During R-ED, the VCO2ML can be significantly enhanced by increasing the ED current.
-
Case Reports
Prolonged Maintenance of VV ECMO for 104 Days with Native Lung Recovery in Acute Respiratory Failure.
Recently, extracorporeal membrane oxygenation (ECMO) support has been increasingly applied in acute respiratory failure. The ECMO brings some advantages for enhancing the capacity of lung regeneration. Thus, the timing of determining irreversibility of the injured lung could be delayed. ⋯ In this case, the initial empirical treatment showed no response within 4 weeks with ECMO support but the patient did not want a lung transplantation. With prolonged maintenance of the ECMO, related ethical issues arose, such as how long should the applied ECMO be maintained. Hence, there was a discussion that was centered on the timing of determining futility and ethical issues, while applying the ECMO in acute respiratory failure.
-
The use of left ventricular assist devices (LVADs), implantable pumps used to supplement cardiac output, has become an increasingly common and effective treatment for advanced heart failure. Although modern continuous-flow LVADs improve quality of life and survival more than medical management of heart failure, device malfunction remains a common concern. Improved noninvasive methods for assessment of LVAD function are needed to detect device complications. ⋯ Peak frequency values measured in vivo were found to correlate strongly with both predicted values and in vitro measurements (r > 0.999). Plots of the area under the acoustic spectrum curve, obtained by integrating over 50 Hz increments, showed strong correlations between in vivo and in vitro measurements (r > 0.966). Device thrombosis was found to be associated with reduced LVAD acoustic amplitude in two patients who underwent surgical device exchange.
-
End-stage lung disease (ESLD) causes progressive hypercapnia and dyspnea and impacts quality of life. Many extracorporeal support (ECS) configurations for CO2 removal resolve symptoms but limit ambulation. An ovine model of pumpless ECS using subclavian vessels was developed to allow for ambulatory support. ⋯ In animals with induced hypercapnia, PaCO2 increased to 73.9 ± 15.1. At maximum sweep gas flow, CO2 removal was 3.4 ± 0.4 ml/kg/min and PaCO2 decreased to 49.1 ± 6.7 mm Hg. Subclavian AV access is effective in lowering PaCO2 and respiratory rate and is potentially an effective ambulatory destination therapy for ESLD patients.