ASAIO transactions / American Society for Artificial Internal Organs
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Term or near term newborns whose severity of cardiac or respiratory failure makes them candidates for extracorporeal membrane oxygenation (ECMO) are often too unstable to be safely transported to an ECMO-competent center. Faced with a large military and civilian referral population that is distributed across the entire continental United States, the authors have addressed this dilemma by developing a transportable ECMO system that can be taken to the referring hospital in a small transport aircraft. This system was on hand, but was not required, to stabilize and transport the infant in question in four cases. ⋯ The remaining 12 infants were stabilized and transported successfully on ECMO over distances ranging from 17 to 1,437 miles, with 11 of these being long distance air transports. Four patients are long-term survivors. The authors conclude that a properly configured and managed ECMO system can effectively stabilize and transport even extremely ill neonates if the pertinent physiologic and aeromedical considerations are addressed.
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Of 11 patients who underwent emergency resuscitation from cardiac arrest using a system of percutaneous cardiopulmonary support (CPS), two (18%) were long-term survivors. Percutaneous cardiopulmonary support was instituted without complication in all patients, with flows ranging from 1.8 to 5.5 L/min; the average duration of support was 304.3 min. All four patients who underwent emergency surgery (two coronary revascularization, one mitral valve revascularization, one mitral valve replacement with coronary revascularization, and one primary left ventricular assist device insertion) died. ⋯ Cardiopulmonary support can be instituted, resulting in excellent stabilization in patients with cardiac arrest. Survivors tended to be young and not have atherosclerotic cardiovascular disease (ASCVD) as their primary diagnosis. Neither length of cardiac arrest before CPS nor time on support correlated with a poor outcome.(ABSTRACT TRUNCATED AT 250 WORDS)
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Emergency cardiopulmonary support (CPS) was instituted in 53 consecutive patients for acute life threatening pathologies. Indications for CPS deployment were: cardiac arrest, 60% (n = 32); cardiogenic shock, 20.4% (n = 11), supported angioplasty, 13% (n = 7); and adult respiratory distress syndrome, 5.6% (n = 3). Cardiopulmonary support was successfully deployed in 51 of the 53 patients (96%), resulting in a mean blood pressure greater than or equal to 60 mmHg, CO greater than or equal to 3-5 L/min, and partial pressure of oxygen greater than or equal to 100 mmHg, with venous oxygen saturation greater than or equal to 60%. ⋯ The overall survival using the CPS system is 59% short-term (greater than 24 hrs.), and 33% long-term (greater than 30 days). In conclusion, the CPS system is a potent and effective resuscitative tool. It requires transfer to other treatment modalities for survival in most cases.
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Cannulas used for extracorporeal circulating devices are made in many shapes and sizes. Side hole placement, length, and wall thickness can make the pressure-flow characteristics of catheters with similar French sizes quite different in their actual performance. ⋯ The M-numbers for commonly used catheters that are placed by extrathoracic dissections are determined. Clinical situations are presented that demonstrate applications of the M-number.