ASAIO transactions / American Society for Artificial Internal Organs
-
To perform low blood flow extracorporeal CO2 removal (ECCO2R), the authors developed a device for extracorporeal circulation (ECC) equipped with a dialyzer for the elimination of CO2 as bicarbonate. The major problem with this method was the decrease in blood pH. To control blood pH and clarify the limit of CO2 elimination using this method, a study with apneic dogs was performed. ⋯ The CO2 was converted to bicarbonate using systemic infusion of trihydroxy-methylamino methane (THAM), and the generated bicarbonate was removed by hemodialysis. Blood flow rate in the ECC was 15 ml/kg/min, and the duration of ECC was 5 hr. During ECC, the hemodynamic parameters of the dogs were stable, and the PaCO2 remained at about 90 mmHg with a PaO2 above 350 mmHg; CO2 elimination from the airway was negligible.
-
A simple, colorimetric protamine titration method was developed for rapid and precise estimation of the protamine dose required for clinical heparin reversal. The method employs azure A dye as the titration indicator, and has replaced the time consuming clotting assay in the conventional protamine titration method with a rapid colorimetric assay. ⋯ In a similar manner, the colorimetric assay can also be employed with a heparin titration procedure to quickly assess the heparin dose required for protamine reversal. This would allow physicians to exercise a quick and accurate heparin back-titration to patients who are overdosed with protamine.
-
Improvements in percutaneous coronary angioplasty (PTCA) have broadened the scope of this therapy to higher risk patients. The authors used an extracorporeal membrane oxygenator (ECMO) system during seven PTCA procedures to provide rapid, safe, cardiopulmonary support for high-risk patients. Six patients underwent femoral cutdown and placement of arteriovenous cannulae before PTCA; one patient was cannulated percutaneously. ⋯ One patient died of retroperitoneal hemorrhage unrelated to the ECMO cannulation site. Six patients survived. This system can be rapidly deployed while providing satisfactory cardiopulmonary support.