ASAIO journal : a peer-reviewed journal of the American Society for Artificial Internal Organs
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The authors used quantitative gamma scintigraphy to evaluate the influence of nitric oxide gas on platelet and neutrophil deposition in Cobe Duo microporous oxygenators during cardiopulmonary bypass (CPB). The effects of nitric oxide gas on circulating platelet and neutrophil counts and platelet function also were assessed. Animals were prepared by standard methods. ⋯ Neutrophil adhesion tended to be lower, and circulating platelet and neutrophil counts tended to be higher with nitric oxide gas infusion. Results of in vitro aggregometry studies using rabbit platelets indicate that the class V phosphodiesterase inhibitor zaprinast can strongly enhance the inhibitory effects of nitric oxide. The authors conclude nitric oxide gas is a promising platelet sparing agent in the setting of CPB.
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Randomized Controlled Trial Clinical Trial
Clinical study of platelet function and coagulation/fibrinolysis with Duraflo II heparin coated cardiopulmonary bypass equipment.
This clinical study was performed to evaluate the effects of Duraflo II heparin coated cardiopulmonary bypass equipment on platelet and coagulation/fibrinolysis activation. Twenty-four patients undergoing coronary artery bypass grafting were assigned to two groups using either heparin coated (Duraflo group, n = 13) or uncoated equipment (control group, n = 11). In the Duraflo group, the cardiotomy reservoir was also coated with heparin. ⋯ Platelet loss and platelet activation, as measured by increases in plasma beta-thromboglobulin (beta-TG) and platelet factor 4 (PF4), in the Duraflo group (beta-TG:237 +/- 143 ng/ml, PF4:167 +/- 104 ng/ml at the end of cardiopulmonary bypass) were less than those in the control group (beta-TG:373 +/- 131 ng/ml, PF4:295 +/- 131 ng/ml at the end of cardiopulmonary bypass). No significant differences were found in thrombin-antithrombin III complex levels or alpha 2 plasmin inhibitor-plasmin complex levels between the groups. Therefore, the use of Duraflo II heparin coated equipment with a heparin coated cardiotomy reservoir suppressed platelet activation.
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The authors describe, to their knowledge, the first management of acute airway obstruction in a newborn infant using Extracorporeal Membrane Oxygenation (ECMO). The infant had a primary diagnosis of gram negative sepsis complicated by pulmonary hemorrhage resulting in a left main stem bronchus obstruction. Despite full ventilatory support, the infant could not be adequately oxygenated. ⋯ Airway management also included vigorous physiotherapy, suctioning, and bronchoscopy. The infant was successfully weaned from ECMO after 208 hours. The authors suggest that ECMO could be useful to manage life threatening airway obstruction in the neonate.
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Clinical Trial Controlled Clinical Trial
Use of two-dimensional and contrast echocardiography for venous cannula placement in venovenous extracorporeal life support.
The objective of this study was to determine the efficacy of two-dimensional and contrast echocardiograms to identify venous cannula position. Sequential sampling of 20 infants was evaluated by contrast echocardiography after meeting institutional criteria for extracorporeal life support. Each infant was placed on venovenous extracorporeal life support using a double-lumen cannula. ⋯ Mixed venous saturations decreased, which indicated less recirculation when the orientation of the tip of the cannula was toward the lateral wall in those who required repositioning. The authors conclude that two-dimensional and contrast echocardiography aid in the positioning of the venovenous cannula. Satisfactory position is approximately 5 mm from the tricuspid valve, with orientation toward the lateral wall of the right atrium.
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In Japan, liver transplantation from brain dead donors has not yet started. The authors present the first report of a clinical experience with a child with fulminant hepatic failure in whom the combined treatment of plasma exchange and continuous hemodiafiltration using a high-performance polymethylmethacrylate membrane was used successfully to sustain life for a period of as long as 54 days before liver transplantation from a living donor could be performed. The combination of plasma exchange and continuous hemodiafiltration appeared to maintain blood coagulation and level of consciousness effectively. Although the combined use of plasma exchange and continuous hemodiafiltration is still unsatisfactory as an artificial liver support, the authors suggest that this technique may be useful to support the life of a child who awaits liver transplantation.