ASAIO transactions / American Society for Artificial Internal Organs
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Comparative Study
In vitro evaluation of a pyridoxalated hemoglobin polyoxyethylene conjugate in reversing cell sickling.
In sickle cell disease (SCD) microcirculatory blockage by red blood cells (RBC) occurs because of their low oxygen concentration, which results in both sickling and painful crises. Pyridoxalated hemoglobin polyoxyethylene (PHP), developed from human RBC hemoglobin (Hb) by chemical modification as an oxygen carrier, was evaluated in vitro for its ability to reverse cell sickling. PHP solutions of 6 or 8 g % Hb and a P50 of 20 mmHg were evaluated. ⋯ A novel artificial capillary system (ACS) modeling the dynamics of the microcirculation of the body was used. With the ACS plugged with deoxygenated cells, perfusion with oxygenated cell-PHP solutions was significantly more efficient in reversing the blockage than oxygenated saline and Hespan solutions. PHP reverses cell sickling by its effective delivery of oxygen.
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Mechanical ventricular assist devices (VADs) have led to survival in patients who develop postcardiotomy cardiogenic shock (PCCS) refractory to conventional therapies. To elicit determinants of survival, the authors reviewed records of 26 patients at our institution who required Pierce-Donachy VADs for PCCS. Thirteen patients were weaned from ventricular assistance (50%), nine (34.6%) achieved long-term survival, and 17 died. ⋯ Perioperative myocardial infarction and renal failure were found to be univariate determinants of survival. Inadequate cardiac output and biventricular failure preclude weaning from mechanical circulatory assistance. Survival is associated with the expeditious establishment of assist pumping, and with the avoidance of irreversible perioperative myocardial injury and renal failure.