ASAIO journal : a peer-reviewed journal of the American Society for Artificial Internal Organs
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Cardiopulmonary bypass (CPB) devices and techniques have continuously evolved. We have conducted surveys that chronicle the changes in CPB devices and techniques used at North American pediatric cardiac surgery centers since 1989. The aim of this article is to describe trends in cardiopulmonary bypass device use during cardiac surgery and changes in the devices used for extracorporeal life support (ECLS) following cardiac surgery for pediatric patients. ⋯ ECLS systems comprised of hollow fiber oxygenators and centrifugal pumps for are gradually replacing the classical ECLS circuit, servo regulated roller pumps and silicone rubber membranes. Nearly 40% of centers use these alternate components in their ECLS systems. Costs, utility, safety and measurable benefit to the patient should guide decisions related to device selection.
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Blood gas management during hypothermic cardiopulmonary bypass may be corrected by pH stat or alpha stat strategy. The pH stat philosophy is to maintain the blood pH constant at any temperature. Carbon dioxide must be introduced to the oxygenator in order to maintain the pH and pCO2 during hypothermic cardiopulmonary bypass. ⋯ Results from several studies favor the pH stat strategy during neonatal cardiopulmonary bypass. This strategy increases tissue oxygenation and cerebral blood flow while cooling. Data also suggest that pH stat management results in better outcomes with shorter ventilation times and intensive care unit stays after pediatric cardiac surgery.
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Comparative Study
Optimization of the circuit configuration of a pulsatile ECLs: an in vivo experimental study.
An extracorporeal life support system (ECLS) with a conventional membrane oxygenator requires a driving force for the blood to pass through hollow fiber membranes. We hypothesized that if a gravity-flow hollow fiber membrane oxygenator is installed in the circuit, the twin blood sacs of a pulsatile ECLS (the Twin-Pulse Life Support, T-PLS) can be placed downstream of the membrane oxygenator. This would increase pump output by doubling pulse rate at a given pumpsetting rate while maintaining effective pulsatility. ⋯ Pump output was higher in the parallel circuit at 40, and 50 BPM pump-setting rates (3.1 +/- 0.2, 3.7 +/- 0.2 L/min vs. 2.2 +/- 0.1 and 2.5 +/- 0.1 L/min, respectively, p =0.01). Either parallel or serial circuit configuration of T-PLS generates effective pulsatility. As for the pump out, the parallel circuit configuration provides higher flow than the serial circuit configuration by doubling the pulse rate at a given pump-setting rate.
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Comparative Study
Clinical outcomes of 84 children with congenital heart disease managed with extracorporeal membrane oxygenation after cardiac surgery.
The purpose of our research was to study the clinical outcomes of children with congenital heart disease (CHD) requiring extracorporeal membrane oxygenation (ECMO) support after cardiac surgery at a tertiary care children's hospital. Retrospective review of all patients with CHD who required postcardiotomy ECMO between January 2001 and September 2004 (45 months) was undertaken. Various outcome predictors were tested for any association with survival to hospital discharge using univariate analysis. ⋯ ECMO support results in improved outcomes in patients who suffered hemodynamic collapse post cardiac surgery. Underlying cardiac lesion, age, weight, gender, initial arterial pH, location of ECMO initiation, need for hemofiltration and placement of ECMO after active ongoing cardiopulmonary resuscitation did not increase the mortality risk. Initial arterial serum lactate level and inability to wean off by 6 days were strongly correlated with nonsurvival.
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We describe a 2 year-old girl with end-stage dilated cardiomyopathy in whom extracorporeal membrane oxygenation (ECMO) was used for mechanical cardiac assistance. After 4 weeks, ECMO-related complications necessitated change to a Berlin Heart Left Ventricular Assist Device (LVAD), and she received a successful cardiac transplant after a total of 106 days on mechanical cardiac support.