ASAIO journal : a peer-reviewed journal of the American Society for Artificial Internal Organs
-
Miniaturized bypass circuits, including the Kids D100 oxygenator and the D130 arterial filter, were specially designed to reduce blood transfusions in small infants undergoing cardiac surgery. This study compared the number of blood product transfusions and short-term outcome between patients younger than 1 year undergoing cardiac surgery with a conventional and a miniaturized bypass circuit, after controlling for baseline characteristics and surgical complexity by 1:1 matching. Adjusted odds ratios (ORs) and 95% confidence intervals for exposure to transfusions and to any additional transfusion were estimated from binary and polytomous regression models. ⋯ The use of the miniaturized circuit required a lower priming volume, 265.5 vs. 432.4 mL, p < 0.001, fewer packed red blood cell (PRBC) transfusions, 1.4 vs. 2.0 U, p < 0.001, and fewer platelet transfusions on the day of surgery, 57.7% vs. 76.4%, p < 0.001. After adjustment for the use of antifibrinolytics, the ultrafiltration rate, and the year of surgery, the use of the miniaturized circuit was independently related to a reduced risk of additional PRBC transfusions, OR 0.04 (0.01, 0.13), and exposure to platelet transfusions, OR 0.78 (0.63, 0.96). Short-term outcome was similar.
-
Comparative Study
Retrospective hemolysis comparison between patients with centrifugal biventricular assist and left ventricular assist devices.
Little is known about the hemolysis rate in the case of concomitant implantation of two continuous flow pumps for the treatment of biventricular heart failure. We present a retrospective study comparing the hemolysis parameters in patients supported with one implantable centrifugal pump of the type HeartWare HVAD used as a left ventricular assist device (LVAD) and with two pumps as a biventricular assist device (BiVAD). A total of 20 consecutive patients who received HeartWare BiVAD (n = 10) and LVAD (n = 10) support at our institution between September 2009 and September 2010 were examined. ⋯ There were no differences in LDH, plasma-free hemoglobin (fHB), or total bilirubin levels postoperatively for up to 6 months. Only the haptoglobin level was lower in BiVAD recipients up to 3 months after surgery: 2nd week (63.5 [range: 8-237] mg/dl vs. 151 [range: 11-263] mg/dl, p = 0.05), 5th week (67 [range: 8-196] mg/dl vs. 215 [range: 56-292] mg/dl, p = 0.046), and after 3rd month (42 [range: 8-205] mg/dl vs. 220 [range: 157-256] mg/dl, p = 0.048). Our retrospective analysis of BiVAD HeartWare and LVAD HeartWare recipients showed a lack of a clinically important degree of hemolysis when two centrifugal HeartWare pumps are used for biventricular support.
-
Case Reports
Challenges during repeat extracorporeal life support in a patient with pulmonary alveolar proteinosis.
Extracorporeal life support (ECLS) is used to support patients with pulmonary alveolar proteinosis (PAP) both during acute illness and during lung lavage therapies. We report the challenges encountered while providing ECLS for respiratory failure to a 12-year-old girl with PAP who had previously received ECLS as a toddler for a prior episode of respiratory failure due to PAP. She was placed on venovenous-arterial (VVA) ECLS and subsequently switched to venovenous (VV) ECLS with drainage from the right femoral vein and reinfusion by a long cannula placed into the right atrium. Our case illustrates standard cannulation may not be possible for children requiring a second ECLS course and the importance of considering alternative modes of cannulation and ECLS support when conventional methods are not possible.
-
Extracorporeal membrane oxygenation (ECMO) is a lifesaving therapy, which has been used for the support of children with a broad range of diseases. Two pumps of differing mechanisms have been used to generate the extracorporeal flow: roller-head pumps and centrifugal pumps. Seven patients supported during ECMO with Levitronix Centrimag (Centrimag group [CG]) were matched to 14 patients supported with Stockert-Shiley SIII (Stockert-Shiley group [SSG]) at a single institution from July 2007 to July 2009. ⋯ In this population of cardiac patients requiring ECMO support, more hemolysis occurred in the SSG, a roller-head pump supported group, when compared with the CG, a centrifugal pump supported group. Differences in circuit life did not reach statistical significance. This pilot study contrasts with past studies, which have demonstrated more hemolysis occurring with centrifugal pumps when compared with roller-head pumps.
-
A 17-year-old male high school football player treated by polymyxin B-immobilized fiber (PMX-F) hemoperfusion for mild-moderate septic shock caused by osteitis pubis is described in this study. He was admitted for inguinal pain, gait disturbance, and high fever (40.6°C). His white blood cell (WBC) count and C-reactive protein (CRP), endotoxin, and procalcitonin (PCT) levels were significantly elevated. ⋯ The inguinal pain diminished, and the patient's blood pressure increased to 112/76 mm Hg. He was discharged on day 10 after admission. This case reflects association of PMX-F with decreased endotoxin, PCT, and CRP, suggesting the association of PMX-F with clinical improvement in mild-moderate sepsis in a young athlete.