ASAIO journal : a peer-reviewed journal of the American Society for Artificial Internal Organs
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In infants with hypertrophic obstructive cardiomyopathy (HOCM) on extracorporeal membrane oxygenation (ECMO), conventional treatment with inotropes, fluid restriction, and diuretics may be detrimental. This case reports an infant of a diabetic mother with HOCM on ECMO illustrating beneficial effects of beta adrenergic blockade and increased fluid administration.
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Comparative Study
Arteriovenous extracorporeal carbon dioxide removal: a mathematical model and experimental evaluation.
To explore the feasibility and operating limits of arteriovenous extracorporeal CO2 removal (AVCO2R) for support of acute respiratory failure, the authors developed a mathematical model to simulate (AVCO2R), evaluate the effects of several parameters used in its application, and predict the feasibility and necessary conditions for total CO2 removal. The mathematical model incorporated compartments representing blood, pulmonary alveoli, pulmonary capillaries, peripheral tissues and capillaries, and an extracorporeal gas exchange device. The model was validated against an animal model of extracorporeal CO2 removal. ⋯ The mathematical model was used to determine operating parameters for total CO2 removal. Relationships between extracorporeal blood flow, device diffusing capacity, and device gas sweep flow were established for CO2 removal at various levels of CO2 production. These simulations indicate that it is possible to achieve total CO2 removal using an extracorporeal shunt fraction of 10%-15% of cardiac output, a device diffusing capacity of 0.5 ml x min(-1) x torr(-1) (kg body weight)(-1), and a gas:blood flow of 5 or greater.
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Comparative Study
Use of extracorporeal life support for adult patients with respiratory failure and sepsis.
Traditionally, adult sepsis has been considered a contraindication to extracorporeal life support (ECLS). The objective of this study was to review the authors' institutional experience with a subgroup of adult patients requiring ECLS for severe respiratory failure and sepsis. Hospital records from 100 consecutive adult patients with respiratory failure placed on ECLS between 1990 and 1996 were retrospectively reviewed. ⋯ Neither group differed in organ dysfunction (incidence or type), frequency of respiratory recovery, or survival. Neither sepsis nor positive blood cultures were independently predictive of mortality. Sepsis and positive blood cultures do not adversely affect outcome in adult patients with respiratory failure requiring ECLS.
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Editorial Historical Article
Food and Drug Administration control of medical devices: an inescapable intrusion and stimulus for adaptation.