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Li P, Mei X, Ge W, Wu T, Zhong M, Huan N, Jiang Q, Hsu PL, Steinseifer U, Dong N, Zhang L. A comprehensive comparison of the in vitro hemocompatibility of extracorporeal centrifugal blood pumps. Front Physiol 2023; 14:1136545. [PMID: 37228828 PMCID: PMC10204736 DOI: 10.3389/fphys.2023.1136545] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 04/20/2023] [Indexed: 05/27/2023] Open
Abstract
Purpose: Blood damage has been associated with patients under temporary continuous-flow mechanical circulatory support. To evaluate the side effects caused by transit blood pumping, in vitro hemocompatibility testing for blood damage in pumps is considered a necessary reference before clinical trials. Methods: The hemocompatibility of five extracorporeal centrifugal blood pumps was investigated comprehensively, including four commercial pumps (the Abbott CentriMag, the Terumo Capiox, the Medos DP3, and the Medtronic BPX-80) and a pump in development (the magAssist MoyoAssist®). In vitro, hemolysis was tested with heparinized porcine blood at nominal operating conditions (5 L/min, 160 mmHg) and extreme operating conditions (1 L/min, 290 mmHg) using a circulation flow loop. Hematology analyses concerning the blood cell counts and the degradation of high-molecular-weight von Willebrand factor (VWF) during 6-h circulation were also evaluated. Results: Comparing the in vitro hemocompatibility of blood pumps at different operations, the blood damage was significantly more severe at extreme operating conditions than that at nominal operating conditions. The performance of the five blood pumps was arranged in different orders at these two operating conditions. The results also demonstrated superior hemocompatibility of CentriMag and MoyoAssist® at two operating conditions, with overall low blood damage at hemolysis level, blood cell counts, and degradation of high-molecular-weight VWF. It suggested that magnetic bearings have an advantage in hemocompatibility compared to the mechanical bearing of blood pumps. Conclusion: Involving multiple operating conditions of blood pumps in in vitro hemocompatibility evaluation will be helpful for clinical application. In addition, the magnetically levitated centrifugal blood pump MoyoAssist® shows great potential in the future as it demonstrated good in vitro hemocompatibility.
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Affiliation(s)
- Ping Li
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xu Mei
- Artificial Organ Technology Lab, Biomanufacturing Centre, School of Mechanical and Electrical Engineering, Soochow University, Suzhou, China
| | - Wanning Ge
- Artificial Organ Technology Lab, Biomanufacturing Centre, School of Mechanical and Electrical Engineering, Soochow University, Suzhou, China
| | - Tingting Wu
- Artificial Organ Technology Lab, Biomanufacturing Centre, School of Mechanical and Electrical Engineering, Soochow University, Suzhou, China
| | - Min Zhong
- Artificial Organ Technology Lab, Biomanufacturing Centre, School of Mechanical and Electrical Engineering, Soochow University, Suzhou, China
| | - Nana Huan
- Artificial Organ Technology Lab, Biomanufacturing Centre, School of Mechanical and Electrical Engineering, Soochow University, Suzhou, China
| | - Qiubo Jiang
- Artificial Organ Technology Lab, Biomanufacturing Centre, School of Mechanical and Electrical Engineering, Soochow University, Suzhou, China
| | - Po-Lin Hsu
- Artificial Organ Technology Lab, Biomanufacturing Centre, School of Mechanical and Electrical Engineering, Soochow University, Suzhou, China
| | - Ulrich Steinseifer
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Helmholtz Institute, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Nianguo Dong
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liudi Zhang
- Artificial Organ Technology Lab, Biomanufacturing Centre, School of Mechanical and Electrical Engineering, Soochow University, Suzhou, China
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Duy Nguyen BT, Nguyen Thi HY, Nguyen Thi BP, Kang DK, Kim JF. The Roles of Membrane Technology in Artificial Organs: Current Challenges and Perspectives. MEMBRANES 2021; 11:239. [PMID: 33800659 PMCID: PMC8065507 DOI: 10.3390/membranes11040239] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 03/20/2021] [Accepted: 03/20/2021] [Indexed: 02/07/2023]
Abstract
The recent outbreak of the COVID-19 pandemic in 2020 reasserted the necessity of artificial lung membrane technology to treat patients with acute lung failure. In addition, the aging world population inevitably leads to higher demand for better artificial organ (AO) devices. Membrane technology is the central component in many of the AO devices including lung, kidney, liver and pancreas. Although AO technology has improved significantly in the past few decades, the quality of life of organ failure patients is still poor and the technology must be improved further. Most of the current AO literature focuses on the treatment and the clinical use of AO, while the research on the membrane development aspect of AO is relatively scarce. One of the speculated reasons is the wide interdisciplinary spectrum of AO technology, ranging from biotechnology to polymer chemistry and process engineering. In this review, in order to facilitate the membrane aspects of the AO research, the roles of membrane technology in the AO devices, along with the current challenges, are summarized. This review shows that there is a clear need for better membranes in terms of biocompatibility, permselectivity, module design, and process configuration.
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Affiliation(s)
- Bao Tran Duy Nguyen
- Department of Energy and Chemical Engineering, Incheon National University, Incheon 22012, Korea; (B.T.D.N.); (H.Y.N.T.); (B.P.N.T.)
| | - Hai Yen Nguyen Thi
- Department of Energy and Chemical Engineering, Incheon National University, Incheon 22012, Korea; (B.T.D.N.); (H.Y.N.T.); (B.P.N.T.)
| | - Bich Phuong Nguyen Thi
- Department of Energy and Chemical Engineering, Incheon National University, Incheon 22012, Korea; (B.T.D.N.); (H.Y.N.T.); (B.P.N.T.)
| | - Dong-Ku Kang
- Department of Chemistry, Incheon National University, Incheon 22012, Korea
| | - Jeong F. Kim
- Department of Energy and Chemical Engineering, Incheon National University, Incheon 22012, Korea; (B.T.D.N.); (H.Y.N.T.); (B.P.N.T.)
- Innovation Center for Chemical Engineering, Incheon National University, Incheon 22012, Korea
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Berdajs D, von Segesser LK, Maisano F, Milano G, Ferrari E. Performance characteristics of the new Eurosets magnetically suspended centrifugal pump. Perfusion 2020; 36:183-189. [PMID: 32567504 DOI: 10.1177/0267659120931990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The aim was to evaluate the performance of a newly developed magnetically suspended centrifugal pump head intended for use as a ventricular assistance device with a newly developed extracorporeal membrane oxygenator setup. METHODS In an experimental setup, an extracorporeal membrane oxygenator circuit was established in three calves with a mean weight of 68.2 ± 2.0 kg. A magnetically levitated centrifugal pump was tested, along with a newly designed extracorporeal membrane oxygenator console, at three different flow ranges: (a) 0.0 to 5.2 L/min, (b) 0.0 to 7.1 L/min, and (c) 0.0 to 6.0 L/min. For each setup, the animals were supported by a circuit for 6 h. Blood samples were collected just before caridiopulmonary bypass (CPB) after 10 min on bypass and after 1, 2, 5, and 6 h of perfusion for hemolysis determination and biochemical tests. Values were recorded for blood pressure, mean flow, and pump rotational speed. Analysis of variance was used for repeated measurements. RESULTS Mean pump flows achieved during the three 6 h pump runs for the three pump heads studied were as follows: (a) flow range 0.0 to 5.2 L/min, 3.6 ± 1.5 L/min, (b) flow range 0.0 to 7.1 L/min, 4.9 ± 1.3 L/min, and (c) flow range 0.0 to 6.0 L/min, 3.8 ± 1.5 L/min. Blood trauma, evaluated by plasma hemoglobin and lactate dehydrogenase levels, did not help in detecting any significant hemolysis. Thrombocytes and white blood cell count profiles showed no significant differences between the groups at the end of the 6 h perfusion. At the end of testing, no clot deposition was found in the oxygenator, and there was no evidence of peripheral emboli. CONCLUSION The results suggest that the newly developed magnetically suspended centrifugal pump head provides satisfactory hydrodynamic performance in an acute perfusion scenario without increasing hemolysis.
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Affiliation(s)
- Denis Berdajs
- Department of Cardiac Surgery, University Hospital of Basel, Basel, Switzerland
| | - Ludwig K von Segesser
- Department of Surgery and Anesthesiology, Cardio-Vascular Research, Lausanne, Switzerland
| | - Francesco Maisano
- Department of Cardiac Surgery, University Hospital of Zurich, Zurich, Switzerland
| | - Guiseppina Milano
- Department of Surgery and Anesthesiology, Cardio-Vascular Research, Lausanne, Switzerland
| | - Enrico Ferrari
- Department of Surgery and Anesthesiology, Cardio-Vascular Research, Lausanne, Switzerland
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Abstract
Since the use of continuous flow blood pumps as ventricular assist devices is standard, the problems with haemolysis have increased. It is mainly induced by shear stress affecting the erythrocyte membrane. There are many investigations about haemolysis in laminar and turbulent blood flow. The results defined as threshold levels for the damage of erythrocytes depend on the exposure time of the shear stress, but they are very different, depending on the used experimental methods or the calculation strategy. Here, the results are resumed and shown in curves. Different models for the calculation of the strengths of erythrocytes are discussed. There are few results reported about tests of haemolysis in blood pumps, but some theoretical approaches for the design of continuous flow blood pumps according to low haemolysis have been investigated within the last years.
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Affiliation(s)
- Inge Köhne
- Department for Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
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5
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Noszczyk-Nowak A, Michałek M, Janiszewski A, Kurosad A, Sławuta A, Cepiel A, Pasławska U. Analysis of Haematological and Biochemical Blood Parameters After Electrical Cardioversion of Atrial Fibrillation in Dogs. J Vet Res 2018; 62:109-112. [PMID: 29978135 PMCID: PMC5957469 DOI: 10.1515/jvetres-2018-0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 03/09/2018] [Indexed: 11/15/2022] Open
Abstract
Introduction Electrical cardioversion is a therapeutic procedure used to convert various types of arrhythmias back to sinus rhythm. It is used to restore the sinus rhythm in dogs with atrial fibrillation. The effect of the electrical energy used during cardioversion on red blood cells (RBC) is not fully understood. Studies on humans reported lysis of RBC following electrical cardioversion. Similar studies have not been carried out on dogs. The aim of the study was to assess the effect of electrical cardioversion on chosen RBC parameters. Material and Methods The study was carried out on 14 large and giant breed dogs weighing from 30 to 84 kg with lone atrial fibrillation (lone AF). Electrical cardioversion was carried out under general anaesthesia by biphasic shock with 70-360 J of energy. Blood was collected at T0 - during atrial fibrillation, prior to cardioversion, and at T1 - 30 min after electrical cardioversion. Complete blood counts as well as total and direct bilirubin concentrations were evaluated. A maximum output of 360 J was used. Results In all cases, electrical cardioversion was effective, and no significant changes in the number of RBC and RBC indices were noted. Similarly, there were no statistically significant differences in the levels of total and direct bilirubin. Conclusion Electrical cardioversion in dogs led neither to statistically nor clinically significant RBC lysis.
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Affiliation(s)
- Agnieszka Noszczyk-Nowak
- Department of Internal Medicine and Clinic of Diseases of Horses, Dogs, and Cats, Faculty of Veterinary Medicine, Wrocław University of Environmental and Life Sciences,50-366Wrocław, Poland
| | - Marcin Michałek
- Department of Internal Medicine and Clinic of Diseases of Horses, Dogs, and Cats, Faculty of Veterinary Medicine, Wrocław University of Environmental and Life Sciences,50-366Wrocław, Poland
- E-mail:
| | - Adrian Janiszewski
- Centre for Experimental Diagnostics and Biomedical Innovations, 50-366, Wrocław, Poland
| | - Agnieszka Kurosad
- Department of Internal Medicine and Clinic of Diseases of Horses, Dogs, and Cats, Faculty of Veterinary Medicine, Wrocław University of Environmental and Life Sciences,50-366Wrocław, Poland
| | - Agnieszka Sławuta
- Department of Cardiology, Kłodzko County Hospital, 57-300Kłodzko, Poland
| | - Alicja Cepiel
- Department of Internal Medicine and Clinic of Diseases of Horses, Dogs, and Cats, Faculty of Veterinary Medicine, Wrocław University of Environmental and Life Sciences,50-366Wrocław, Poland
| | - Urszula Pasławska
- Department of Internal Medicine and Clinic of Diseases of Horses, Dogs, and Cats, Faculty of Veterinary Medicine, Wrocław University of Environmental and Life Sciences,50-366Wrocław, Poland
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6
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Analysis of haematological and biochemical blood parameters after electrical cardioversion of atrial fibrillation in dogs. J Vet Res 2018. [DOI: 10.2478/jvetres-2018-0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Introduction
Electrical cardioversion is a therapeutic procedure used to convert various types of arrhythmias back to sinus rhythm. It is used to restore the sinus rhythm in dogs with atrial fibrillation. The effect of the electrical energy used during cardioversion on red blood cells (RBC) is not fully understood. Studies on humans reported lysis of RBC following electrical cardioversion. Similar studies have not been carried out on dogs. The aim of the study was to assess the effect of electrical cardioversion on chosen RBC parameters.
Material and Methods
The study was carried out on 14 large and giant breed dogs weighing from 30 to 84 kg with lone atrial fibrillation (lone AF). Electrical cardioversion was carried out under general anaesthesia by biphasic shock with 70–360 J of energy. Blood was collected at T0 – during atrial fibrillation, prior to cardioversion, and at T1 – 30 min after electrical cardioversion. Complete blood counts as well as total and direct bilirubin concentrations were evaluated. A maximum output of 360 J was used.
Results
In all cases, electrical cardioversion was effective, and no significant changes in the number of RBC and RBC indices were noted. Similarly, there were no statistically significant differences in the levels of total and direct bilirubin.
Conclusion
Electrical cardioversion in dogs led neither to statistically nor clinically significant RBC lysis.
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Okan Y, Sertac H, Erkut O, Taner K, Selen OI, Firat AH, Nihat C, Pelin A, Halime E, Alper G. Initial Clinical Experiences With Novel Diagonal ECLS System in Pediatric Cardiac Patients. Artif Organs 2017; 41:717-726. [DOI: 10.1111/aor.12977] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 05/03/2017] [Accepted: 05/10/2017] [Indexed: 01/27/2023]
Affiliation(s)
- Yildiz Okan
- Department of Pediatric Cardiovascular Surgery; Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital; Istanbul Turkey
| | - Haydin Sertac
- Department of Pediatric Cardiovascular Surgery; Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital; Istanbul Turkey
| | - Ozturk Erkut
- Department of Pediatric Cardiology; Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital; Istanbul Turkey
| | - Kasar Taner
- Department of Pediatric Cardiology; Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital; Istanbul Turkey
| | - Onan I. Selen
- Department of Pediatric Cardiovascular Surgery; Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital; Istanbul Turkey
| | - Altin H. Firat
- Department of Pediatric Cardiovascular Surgery; Siyami Ersek Thoracic and Cardiovascular Surgery Education and Research Hospital; Istanbul Turkey
| | - Cine Nihat
- Department of Pediatric Cardiovascular Surgery; Kartal Koşuyolu Yüksek İhtisas Education and Research Hospital; Istanbul Turkey
| | - Ayyildiz Pelin
- Department of Pediatric Cardiology; Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital; Istanbul Turkey
| | - Erkan Halime
- Pediatric Perfusion; Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital; Istanbul Turkey
| | - Guzeltas Alper
- Department of Pediatric Cardiology; Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital; Istanbul Turkey
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Raiten JM, Wong ZZ, Spelde A, Littlejohn JE, Augoustides JG, Gutsche JT. Anticoagulation and Transfusion Therapy in Patients Requiring Extracorporeal Membrane Oxygenation. J Cardiothorac Vasc Anesth 2017; 31:1051-1059. [DOI: 10.1053/j.jvca.2016.08.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Indexed: 11/11/2022]
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Poh CL, Chiletti R, Zannino D, Brizard C, Konstantinov IE, Horton S, Millar J, d’Udekem Y. Ventricular assist device support in patients with single ventricles: the Melbourne experience†. Interact Cardiovasc Thorac Surg 2017; 25:310-316. [DOI: 10.1093/icvts/ivx066] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Accepted: 01/30/2017] [Indexed: 11/13/2022] Open
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Fujiwara T, Sakota D, Ohuchi K, Endo S, Tahara T, Murashige T, Kosaka R, Oi K, Mizuno T, Maruyama O, Arai H. Optical Dynamic Analysis of Thrombus Inside a Centrifugal Blood Pump During Extracorporeal Mechanical Circulatory Support in a Porcine Model. Artif Organs 2017; 41:893-903. [DOI: 10.1111/aor.12862] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 07/07/2016] [Accepted: 08/19/2016] [Indexed: 12/25/2022]
Affiliation(s)
- Tatsuki Fujiwara
- Department of Cardiovascular Surgery; Tokyo Medical and Dental University Graduate School of Medical and Dental Sciences
| | - Daisuke Sakota
- Health Research Institute, National Institute of Advanced Industrial Science and Technology (AIST)
| | - Katsuhiro Ohuchi
- Department of Advanced Surgical Technology Research and Development; Tokyo Medical and Dental University
| | - Shu Endo
- Center for Experimental Animals, Tokyo Medical and Dental University
| | - Tomoki Tahara
- Faculty of Medicine; Tokyo Medical and Dental University
| | - Tomotaka Murashige
- Graduate School of Science and Technology; Tokyo University of Science; Ibaraki Japan
| | - Ryo Kosaka
- Health Research Institute, National Institute of Advanced Industrial Science and Technology (AIST)
| | - Keiji Oi
- Department of Cardiovascular Surgery; Tokyo Medical and Dental University Graduate School of Medical and Dental Sciences
| | - Tomohiro Mizuno
- Department of Cardiovascular Surgery; Tokyo Medical and Dental University Graduate School of Medical and Dental Sciences
| | - Osamu Maruyama
- Health Research Institute, National Institute of Advanced Industrial Science and Technology (AIST)
| | - Hirokuni Arai
- Department of Cardiovascular Surgery; Tokyo Medical and Dental University Graduate School of Medical and Dental Sciences
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11
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Thiara A, Hoel T, Kristiansen F, Karlsen H, Fiane A, Svennevig J. Evaluation of oxygenators and centrifugal pumps for long-term pediatric extracorporeal membrane oxygenation. Perfusion 2016; 22:323-6. [DOI: 10.1177/0267659107086270] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: Two extracorporeal membrane oxygenation (ECMO) circuits for children under 10 kg were evaluated and compared for plasma leakage, hemolysis, blood transfusions, and durability. Methods: Group A ( n = 20) was supported by ECMO circuits with the Minimax oxygenator and the Biomedicus centrifugal pump. Group B ( n = 10) was supported by ECMO circuits with the Lilliput 2 ECMO oxygenator and the Rotaflow centrifugal pump. Results: ECMO circuit durability, as measured by oxygenator lifespan, was significantly better in Group B than in Group A (p = 0.04). There was significantly lower hemolysis, measured by plasma free hemoglobin, in Group B ( p = 0.019), and patients in Group B had significantly less need for antithrombin III transfusion ( p = 0.004). No plasma leakage was observed in Group B oxygenators, but plasma leakage was observed in all Group A oxygenators. Conclusion: The combination of a Rotaflow centrifugal pump and Lilliput 2 ECMO oxygenator in pediatric ECMO circuits improved durability and reduced circuit-induced hemolysis. This improvement may be due to the low priming volume, the oxygenator's plasma leakage resistance, the suspended rotor of the centrifugal pump, or a combination of these factors. Perfusion (2007) 22, 323—326.
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Affiliation(s)
- A.P.S. Thiara
- Department of Thoracic and Cardiovascular Surgery, Rikshospitalet-Radiumhospitalet Medical Center, Oslo, Norway,
| | - T.N. Hoel
- Department of Thoracic and Cardiovascular Surgery, Rikshospitalet-Radiumhospitalet Medical Center, Oslo, Norway
| | - F. Kristiansen
- Department of Thoracic and Cardiovascular Surgery, Rikshospitalet-Radiumhospitalet Medical Center, Oslo, Norway
| | - H.M. Karlsen
- Department of Thoracic and Cardiovascular Surgery, Rikshospitalet-Radiumhospitalet Medical Center, Oslo, Norway
| | - A.E. Fiane
- Department of Thoracic and Cardiovascular Surgery, Rikshospitalet-Radiumhospitalet Medical Center, Oslo, Norway
| | - J.L. Svennevig
- Department of Thoracic and Cardiovascular Surgery, Rikshospitalet-Radiumhospitalet Medical Center, Oslo, Norway
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Omar HR, Mirsaeidi M, Socias S, Sprenker C, Caldeira C, Camporesi EM, Mangar D. Plasma Free Hemoglobin Is an Independent Predictor of Mortality among Patients on Extracorporeal Membrane Oxygenation Support. PLoS One 2015; 10:e0124034. [PMID: 25902047 PMCID: PMC4406730 DOI: 10.1371/journal.pone.0124034] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 03/02/2015] [Indexed: 11/17/2022] Open
Abstract
Background Hemolysis is common in all extracorporeal circuits as evident by the elevated plasma free hemoglobin (PFHb) level. We investigated whether increased hemolysis during extracorporeal membrane oxygenation (ECMO) is an independent mortality predictor. Methods We performed a retrospective observational study of consecutive subjects who received ECMO at a tertiary care facility from 2007-2013 to investigate independent predictors of in-hospital mortality. We examined variables related to patient demographics, comorbidities, markers of hemolysis, ECMO characteristics, transfusion requirements, and complications. 24-hour PFHb> 50 mg/dL was used as a marker of severe hemolysis. Results 154 patients received ECMO for cardiac (n= 115) or pulmonary (n=39) indications. Patients’ mean age was 51 years and 75.3% were males. Compared to nonsurvivors, survivors had lower pre-ECMO lactic acid (p=0.026), lower 24-hour lactic acid (p=0.023), shorter ECMO duration (P=0.01), fewer RBC transfusions on ECMO (p=0.008) and lower level of PFHb 24-hours post ECMO implantation (p=0.029). 24-hour PFHb> 50 mg/dL occurred in 3.9 % versus 15.5% of survivors and nonsurvivors, respectively, p=0.002. A Cox proportional hazard analysis identified PFHb> 50 mg/dL 24-hours post ECMO as an independent predictor of mortality (OR= 3.4, 95% confidence interval: 1.3 – 8.8, p= 0.011). Conclusion PFHb> 50 mg/dL checked 24-hour post ECMO implantation is a useful tool to predict mortality. We propose the routine checking of PFHb 24-hours after ECMO initiation for early identification and treatment of the cause of hemolysis.
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Affiliation(s)
- Hesham R Omar
- Department of Internal Medicine, Mercy Medical Center, Clinton, Iowa, United States of America
| | - Mehdi Mirsaeidi
- Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of Illinois at Chicago, Chicago, IL, United States of America
| | - Stephanie Socias
- Department of Research, Florida Gulf-to-Bay Anesthesiology Associates, Tampa, Florida, United States of America
| | - Collin Sprenker
- Department of Research, Florida Gulf-to-Bay Anesthesiology Associates, Tampa, Florida, United States of America
| | - Christiano Caldeira
- Department of Cardiothoracic Surgery, Florida Advanced Cardiothoracic Surgery, Tampa, Florida, United States of America
| | - Enrico M Camporesi
- University of South Florida, FGTBA and TEAMHealth, Tampa, Florida, United States of America
| | - Devanand Mangar
- Department of Anesthesia, Tampa General Hospital, FGTBA, TEAMHealth, Tampa, Florida, United States of America
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Armignacco P, Garzotto F, Bellini C, Neri M, Lorenzin A, Sartori M, Ronco C. Pumps in wearable ultrafiltration devices: pumps in wuf devices. Blood Purif 2015; 39:115-24. [PMID: 25659605 DOI: 10.1159/000368943] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The wearable artificial kidney (WAK) is a device that is supposed to operate like a real kidney, which permits prolonged, frequent, and continuous dialysis treatments for patients with end-stage renal disease (ESRD). Its functioning is mainly related to its pumping system, as well as to its dialysate-generating and alarm/shutoff ones. A pump is defined as a device that moves fluids by mechanical action. In such a context, blood pumps pull blood from the access side of the dialysis catheter and return the blood at the same rate of flow. The main aim of this paper is to review the current literature on blood pumps, describing the way they have been functioning thus far and how they are being engineered, giving details about the most important parameters that define their quality, thus allowing the production of a radar comparative graph, and listing ideal pumps' features.
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15
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Xie A, Phan K, Tsai YC, Yan TD, Forrest P. Venoarterial extracorporeal membrane oxygenation for cardiogenic shock and cardiac arrest: a meta-analysis. J Cardiothorac Vasc Anesth 2014; 29:637-45. [PMID: 25543217 DOI: 10.1053/j.jvca.2014.09.005] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To evaluate the effect of extracorporeal membrane oxygenation (ECMO) on survival and complication rates in adults with refractory cardiogenic shock or cardiac arrest. DESIGN Meta-analysis. SETTING University hospitals. PARTICIPANTS One thousand one hundred ninety-nine patients from 22 observational studies. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Observational studies published from the year 2000 onwards, examining at least 10 adult patients who received ECMO for refractory cardiogenic shock or cardiac arrest were included. Pooled estimates with 95% confidence intervals were calculated based on the Freeman-Tukey double-arcsine transformation and DerSimonian-Laird random-effect model. Survival to discharge was 40.2% (95% confidence intervals [CI], 33.9-46.7), while survival at 3, 6, and 12 months was 55.9% (95% CI, 41.5-69.8), 47.6% (95% CI, 25.4-70.2), and 54.4% (95% CI, 36.6-71.7), respectively. Survival up to 30 days was higher in cardiogenic shock patients (52.5%, 95% CI, 43.7%-61.2%) compared to cardiac arrest (36.2%, 95% CI, 23.1%-50.4%). Concurrently, complication rates were particularly substantial for neurologic deficits (13.3%, 95% CI, 8.3-19.3), infection (25.1%, 95%CI, 15.9-35.5), and renal impairment (47.4%, 95% CI, 30.2-64.9). Significant heterogeneity was detected, although its levels were similar to previous meta-analyses that only examined short-term survival to discharge. CONCLUSIONS Venoarterial ECMO can improve short-term survival in adults with refractory cardiogenic shock or cardiac arrest. It also may provide favorable long-term survival at up to 3 years postdischarge. However, ECMO also is associated with significant complication rates, which must be incorporated into the risk-benefit analysis when considering treatment. These findings require confirmation by large, adequately controlled and standardized trials with long-term follow-up.
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Affiliation(s)
- Ashleigh Xie
- The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia; University of New South Wales, Sydney, Australia
| | - Kevin Phan
- The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia; University of New South Wales, Sydney, Australia
| | - Yi-Chin Tsai
- Department of Cardiothoracic Surgery, Prince Charles Hospital, Brisbane, Australia
| | - Tristan D Yan
- The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia; Department of Cardiothoracic Surgery; University of Sydney, Sydney, Australia.
| | - Paul Forrest
- Cardiothoracic Anesthesia and Perfusion, Royal Prince Alfred Hospital, Sydney, Australia; University of Sydney, Sydney, Australia
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16
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Katz JN, Jensen BC, Chang PP, Myers SL, Pagani FD, Kirklin JK. A multicenter analysis of clinical hemolysis in patients supported with durable, long-term left ventricular assist device therapy. J Heart Lung Transplant 2014; 34:701-9. [PMID: 25582036 DOI: 10.1016/j.healun.2014.10.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 10/03/2014] [Accepted: 10/28/2014] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND Despite the beneficial effects of mechanical circulatory support (MCS), the majority of patients ultimately will have an adverse event. Although hemolysis is common among temporary devices, the incidence and clinical significance of hemolysis in patients managed with long-term, durable left ventricular assist device (LVAD) therapy is largely unknown. METHODS Data were obtained from the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS). All adults who received a continuous-flow LVAD (CF-LVAD) between June 2006 and March 2012 were included. A hemolytic event was defined as a plasma-free hemoglobin >40 mg/dl in association with clinical signs of hemolysis occurring at least 72 hours after LVAD implant. Descriptive statistics, time-dependent analyses and multivariable modeling were employed for statistical purposes. RESULTS A total of 4,850 patients followed for a mean of 11.1 months comprised the final study population. There were 340 hemolytic events in 260 patients. Freedom from hemolysis was 97% at 3 months, 94% at 1 year and 91% at 2 years. Mean time from implant to first hemolysis event was 7.4 months. Younger age (<60 years) was independently associated with greater hemolysis (p < 0.001). Thrombotic device malfunction, device exchange and mortality were all significantly higher after hemolysis, with the greatest risk for each occurring within 6 months. CONCLUSIONS Hemolysis is not a rare event after CF-LVAD implantation and is associated with an early increase in morbidity and death. Future study should focus on other device and implant characteristics that may lead to hemolytic events, as well as appropriate strategies for managing affected patients.
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Affiliation(s)
- Jason N Katz
- Division of Cardiology, UNC Center for Heart and Vascular Care, Chapel Hill, North Carolina.
| | - Brian C Jensen
- Division of Cardiology, UNC Center for Heart and Vascular Care, Chapel Hill, North Carolina; McAllister Heart Institute, University of North Carolina, Chapel Hill, North Carolina
| | - Patricia P Chang
- Division of Cardiology, UNC Center for Heart and Vascular Care, Chapel Hill, North Carolina
| | - Susan L Myers
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Francis D Pagani
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - James K Kirklin
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
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17
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Abstract
The role for temporary and durable mechanical circulatory support is rapidly expanding. As the use of these technologies continues to grow, the emergency physician has an increasing opportunity to participate in the advancement of these potentially life-saving technologies. This review discusses the current role of the intra-aortic balloon pump in cardiogenic shock, describes the complications and management strategies for the critically ill patient with a left ventricular assist device, and explores the emerging role of ECMO in the emergency department for patients presenting in refractory cardiogenic shock and cardiac arrest.
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Affiliation(s)
- John C Greenwood
- Division of Pulmonary & Critical Care Medicine, University of Maryland School of Medicine, 110 South Paca Street, 2nd Floor, Baltimore, MD 21201, USA.
| | - Daniel L Herr
- Critical Care Service, Cardiac Surgery ICU, Shock Trauma Center, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD 21201, USA
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18
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Hemolysis in Pediatric Patients Receiving Centrifugal-Pump Extracorporeal Membrane Oxygenation. Crit Care Med 2014; 42:1213-20. [DOI: 10.1097/ccm.0000000000000128] [Citation(s) in RCA: 104] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bottrell S, Bennett M, Augustin S, Thuys C, Schultz B, Horton A, Horton S. A comparison study of haemolysis production in three contemporary centrifugal pumps. Perfusion 2014; 29:411-6. [PMID: 24406272 DOI: 10.1177/0267659113509000] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
One challenge in providing extracorporeal circulation is to supply optimal flow while minimising adverse effects, such as haemolysis. To determine if the recent generation constrained vortex pumps with their inherent design improvements would lead to reduced red cell trauma, we undertook a study comparing three devices. Utilizing a simulated short-term ventricular assist circuit primed with whole human blood, we examined changes in plasma free haemoglobin values over a six-day period. The three pumps investigated were the Maquet Rotaflow, the Levitronix PediVAS and the Medos Deltastream DP3.This study demonstrated that all three pumps produced low levels of haemolysis and are suitable for use in a clinical environment. The Levitronix PediVAS was significantly less haemolytic than either the Rotaflow (p<0.05) or the DP3 (p<0.05). There was no significant difference in plasma free haemoglobin between the Rotaflow and the DP3 (p=0.71).
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Affiliation(s)
- S Bottrell
- Perfusion Department, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - M Bennett
- Perfusion Department, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - S Augustin
- Perfusion Department, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - C Thuys
- Perfusion Department, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - B Schultz
- Perfusion Department, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - A Horton
- Perfusion Department, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - S Horton
- Perfusion Department, Royal Children's Hospital, Melbourne, Victoria, Australia Department of Paediatrics, Melbourne University, Melbourne, Victoria, Australia
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20
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Palanzo DA, Baer LD, El-Banayosy A, Wang S, Ündar A, Pae WE. Choosing a Pump for Extracorporeal Membrane Oxygenation in the USA. Artif Organs 2014; 38:1-4. [DOI: 10.1111/aor.12215] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- David A. Palanzo
- Heart and Vascular Institute, Penn State Milton S. Hershey Medical Center; Penn State Hershey College of Medicine, Penn State Hershey Children's Hospital; Hershey PA USA
| | - Larry D. Baer
- Heart and Vascular Institute, Penn State Milton S. Hershey Medical Center; Penn State Hershey College of Medicine, Penn State Hershey Children's Hospital; Hershey PA USA
| | - Aly El-Banayosy
- Heart and Vascular Institute, Penn State Milton S. Hershey Medical Center; Penn State Hershey College of Medicine, Penn State Hershey Children's Hospital; Hershey PA USA
| | - Shigang Wang
- Departments of Pediatrics, Surgery and Bioengineering, Pediatric Cardiovascular Research Center; Penn State Hershey College of Medicine, Penn State Hershey Children's Hospital; Hershey PA USA
| | - Akif Ündar
- Departments of Pediatrics, Surgery and Bioengineering, Pediatric Cardiovascular Research Center; Penn State Hershey College of Medicine, Penn State Hershey Children's Hospital; Hershey PA USA
| | - Walter E. Pae
- Heart and Vascular Institute, Penn State Milton S. Hershey Medical Center; Penn State Hershey College of Medicine, Penn State Hershey Children's Hospital; Hershey PA USA
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21
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Lafçı G, Budak AB, Yener AÜ, Cicek OF. Use of Extracorporeal Membrane Oxygenation in Adults. Heart Lung Circ 2014; 23:10-23. [DOI: 10.1016/j.hlc.2013.08.009] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2013] [Revised: 08/15/2013] [Accepted: 08/20/2013] [Indexed: 10/26/2022]
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22
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Palanzo DA, El-Banayosy A, Stephenson E, Brehm C, Kunselman A, Pae WE. Comparison of hemolysis between CentriMag and RotaFlow rotary blood pumps during extracorporeal membrane oxygenation. Artif Organs 2013; 37:E162-6. [PMID: 23981131 DOI: 10.1111/aor.12158] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The purpose of this investigation was to compare the hemolysis levels for patients on extracorporeal membrane oxygenation (ECMO) incorporating two different rotary blood pumps (CentriMag [CMAG] and RotaFlow [RF]) in identical circuits otherwise. The difference between the two pumps is the cost. One is 20-30 times less expensive than the other. A retrospective analysis of all patients placed on ECMO from June 2008 through May 2012 was done to evaluate hemolysis. Daily plasma hemoglobin (pHb), lactate dehydrogenase (LDH), and lactate levels were collected on all patients. Values were compared between those patients who received a CMAG and those who received an RF. Patients had to be on ECMO for more than 2 days to be included in the study. Linear mixed effects models were fit to the data to assess differences over time for each continuous outcome. Forty patients were placed on ECMO incorporating CMAG, whereas 40 patients received an RF. There were no significant statistical differences between CMAG and RF groups when comparing days on support (8.7 ± 5.0; 8.4 ± 5.7), age (44.8 ± 18.3; 46.1 ± 16.0), body surface area (2.03 ± 0.36; 1.96 ± 0.31), gender (male: 58%, female: 42%; male: 55%, female: 45%), etiology, type of support (veno-arterial [VA)]: 78%, veno-venous [VV)]: 22%; VA: 82%, VV: 18%) and pre-ECMO LDH levels (4004.0 ± 3583.2; 3603.7 ± 3354.1). There were also no significant differences between the CMAG and RF groups when comparing the mean values for daily pHb levels (5.7 ± 3.6; 5.7 ± 4.2), lactate levels (2.8 ± 1.9; 3.0 ± 2.1), and LDH levels (2656.3 ± 1606.8; 2688.6 ± 1726.1) or daily lactate, LDH, and pHb levels for the first 10 days of support. From our investigation, there is no difference between the CMAG and the RF blood pumps in regard to the creation of hemolysis during ECMO. The difference in cost of the devices does not correlate with the performance and outcomes.
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Affiliation(s)
- David A Palanzo
- Heart and Vascular Institute, Penn State Milton S. Hershey Medical Center, Penn State Hershey College of Medicine, Penn State Hershey Children's Hospital, Hershey, PA, USA
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Fujiwara T, Nagaoka E, Watanabe T, Miyagi N, Kitao T, Sakota D, Mamiya T, Shinshi T, Arai H, Takatani S. New generation extracorporeal membrane oxygenation with MedTech Mag-Lev, a single-use, magnetically levitated, centrifugal blood pump: preclinical evaluation in calves. Artif Organs 2013; 37:447-56. [PMID: 23489176 DOI: 10.1111/aor.12006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We have evaluated the feasibility of a newly developed single-use, magnetically levitated centrifugal blood pump, MedTech Mag-Lev, in a 3-week extracorporeal membrane oxygenation (ECMO) study in calves against a Medtronic Bio-Pump BPX-80. A heparin- and silicone-coated polypropylene membrane oxygenator MERA NHP Excelung NSH-R was employed as an oxygenator. Six healthy male Holstein calves with body weights of about 100 kg were divided into two groups, four in the MedTech group and two in the Bio-Pump group. Under general anesthesia, the blood pump and oxygenator were inserted extracorporeally between the main pulmonary artery and the descending aorta via a fifth left thoracotomy. Postoperatively, both the pump and oxygen flow rates were controlled at 3 L/min. Heparin was continuously infused to maintain the activated clotting time at 200-240 s. All the MedTech ECMO calves completed the study duration. However, the Bio-Pump ECMO calves were terminated on postoperative days 7 and 10 because of severe hemolysis and thrombus formation. At the start of the MedTech ECMO, the pressure drop across the oxygenator was about 25 mm Hg with the pump operated at 2800 rpm and delivering 3 L/min flow. The PO2 of the oxygenator outlet was higher than 400 mm Hg with the PCO2 below 45 mm Hg. Hemolysis and thrombus were not seen in the MedTech ECMO circuits (plasma-free hemoglobin [PFH] < 5 mg/dL), while severe hemolysis (PFH > 20 mg/dL) and large thrombus were observed in the Bio-Pump ECMO circuits. Plasma leakage from the oxygenator did not occur in any ECMO circuits. Three-week cardiopulmonary support was performed successfully with the MedTech ECMO without circuit exchanges. The MedTech Mag-Lev could help extend the durability of ECMO circuits by the improved biocompatible performances.
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Affiliation(s)
- Tatsuki Fujiwara
- Department of Cardiovascular Surgery, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
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24
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Kotani Y, Honjo O, Davey L, Chetan D, Guerguerian AM, Gruenwald C. Evolution of Technology, Establishment of Program, and Clinical Outcomes in Pediatric Extracorporeal Membrane Oxygenation: The “SickKids” Experience. Artif Organs 2013; 37:21-8. [DOI: 10.1111/aor.12032] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | | | | | | | - Anne-Marie Guerguerian
- Division of Critical Care Medicine; The Hospital for Sick Children, University of Toronto; Toronto; Ontario; Canada
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25
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Sobieski MA, Giridharan GA, Ising M, Koenig SC, Slaughter MS. Blood Trauma Testing of CentriMag and RotaFlow Centrifugal Flow Devices: A Pilot Study. Artif Organs 2012; 36:677-82. [DOI: 10.1111/j.1525-1594.2012.01514.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Raval JS, Wearden PD, Orr RA, Kiss JE. Plasma exchange in a 13-year-old male with acute intravascular hemolysis and acute kidney injury after placement of a ventricular assist device. J Clin Apher 2012; 27:274-7. [DOI: 10.1002/jca.21236] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Accepted: 05/21/2012] [Indexed: 01/26/2023]
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Sidebotham D, Allen SJ, McGeorge A, Ibbott N, Willcox T. Venovenous extracorporeal membrane oxygenation in adults: practical aspects of circuits, cannulae, and procedures. J Cardiothorac Vasc Anesth 2012; 26:893-909. [PMID: 22503344 DOI: 10.1053/j.jvca.2012.02.001] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Indexed: 01/19/2023]
Affiliation(s)
- David Sidebotham
- Cardiothoracic Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand.
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28
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Pokersnik JA, Buda T, Bashour CA, Gonzalez-Stawinski GV. Have changes in ECMO technology impacted outcomes in adult patients developing postcardiotomy cardiogenic shock? J Card Surg 2012; 27:246-52. [PMID: 22372761 DOI: 10.1111/j.1540-8191.2011.01409.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Extracorporeal membrane oxygenation (ECMO) technology has undergone several advancements over the last decade. We sought to compare current ECMO technology to older ones to determine how these technological improvements have impacted outcomes in patients suffering from postcardiotomy cardiogenic shock (PCS). Between 2005 and 2010, 49 patients received ECMO as support for PCS following elective cardiac surgery. Patients were divided into three groups. Group 1 (Gp 1, n = 11) patients received a Biomedicus pump with an Affinity oxygenator, Group 2 (Gp 2, n = 11) patients received a Biomedicus pump with a Quadrox D oxygenator, and Group 3 (Gp 3, n = 27) patients received a Rotaflow pump with a Quadrox D oxygenator. Groups were compared with regards to adverse events and ability to wean. Adverse event analysis showed no statistically significant difference between groups in incidence of stroke (p = 0.08), renal failure (p = 0.88), or bleeding requiring reexploration (p = 0.10). Changes in technology did little to improve weaning rates from ECMO (Gp 1 = 63.6%, Gp 2 = 45.5%, and Gp 3 = 55.6%). Similar trends were detected in hospital survival (Gp 1 = 27.3%, Gp 2 = 27.3%, and Gp 3 = 33.3%). Technology did impact oxygenator durability with Gp 1 requiring seven (63.6%) oxygenator exchanges compared to zero (0.0%) in Gp 2 and two (7.4%) in Gp 1. While advancements in ECMO technology have resulted in improved oxygenator durability, outcomes in patients requiring such support for PCS continue to be poor.
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Affiliation(s)
- Julie A Pokersnik
- Department of Perfusion Services, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
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29
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Retrieval of critically ill adults using extracorporeal membrane oxygenation: an Australian experience. Intensive Care Med 2011; 37:824-30. [PMID: 21359610 DOI: 10.1007/s00134-011-2158-8] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Accepted: 10/30/2010] [Indexed: 01/21/2023]
Abstract
PURPOSE A retrieval program was developed in New South Wales (NSW), Australia to provide extracorporeal membrane oxygenation support (ECMO) for the safe transport of adults with severe, acute respiratory or cardiac failure. We describe the development and results of this program and the impact of the 2009 H1N1 epidemic on this service. METHODS An observational study of all patients who were retrieved on ECMO support in NSW, from March 1, 2007 to June 1, 2010, was carried out. RESULTS Forty adult patients were retrieved on ECMO support (median age 34 years). The indications for retrieval were respiratory in 38 patients (of whom 16 were confirmed or suspected H1N1 cases) and cardiac in 2 patients. Two other patients died after referral but before ECMO support could be established. Patients were transported by road (n = 26, 65%), medical retrieval jet (n = 10, 25%) and helicopter (n = 4, 10%). The median retrieval distance was 250 km (range 12-1,960 km). Thirty-four patients (85%) survived to hospital discharge. Survival for respiratory indications was 87% (33/38 patients) and 50% (1/2 patients) for cardiac indications. There were no deaths or major morbidity associated with these retrievals. CONCLUSIONS Patients with very severe respiratory failure, which was considered to preclude conventional ventilation for safe transfer to tertiary centres, were managed by an ECMO referral and retrieval program in NSW and had a high rate of survival. This program also enhanced the capacity of the state to respond to a surge in demand for ECMO support due to the H1N1 epidemic, although the role of ECMO in respiratory failure is not yet well defined.
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Abstract
Despite optimization of standard medical therapy, some patients with chronic heart failure will deteriorate to the point that they require hospitalization for intravenous therapies and inpatient monitoring. Once the condition is recognized, the therapeutic goals are to reverse hemodynamic derangements, correct metabolic abnormalities, and provide symptomatic relief. Achievement of these goals requires individualized care and a familiarity with the risks and benefits of particular therapies.
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Affiliation(s)
- John Lynn Jefferies
- Cardiomyopathy and Heart Failure, Cardiovascular Genetics Service, Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA.
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31
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Clark JB, Guan Y, McCoach R, Kunselman AR, Myers JL, Undar A. An investigational study of minimum rotational pump speed to avoid retrograde flow in three centrifugal blood pumps in a pediatric extracorporeal life support model. Perfusion 2011; 26:185-90. [PMID: 21227983 DOI: 10.1177/0267659110394712] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
During extracorporeal life support with centrifugal blood pumps, retrograde pump flow may occur when the pump revolutions decrease below a critical value determined by the circuit resistance and the characteristics of the pump. We created a laboratory model to evaluate the occurrence of retrograde flow in each of three centrifugal blood pumps: the Rotaflow, the CentriMag, and the Bio-Medicus BP-50. At simulated patient pressures of 60, 80, and 100 mmHg, each pump was evaluated at speeds from 1000 to 2200 rpm and flow rates were measured. Retrograde flow occurred at low revolution speeds in all three centrifugal pumps. The Bio-Medicus pump was the least likely to demonstrate retrograde flow at low speeds, followed by the Rotaflow pump. The CentriMag pump showed the earliest transition to retrograde flow, as well as the highest degree of retrograde flow. At every pump speed evaluated, the Bio-Medicus pump delivered the highest antegrade flow and the CentriMag pump delivered the least.
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Affiliation(s)
- Joseph B Clark
- Department of Pediatrics, Penn State Hershey Pediatric Cardiovascular Research Center, Penn State Hershey, 500 University Drive, Hershey, PA 17033, USA.
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Sivarajan VB, Best D, Brizard CP, Shekerdemian LS, D'Udekem Y, Horton SB, Butt W. Improved outcomes of paediatric extracorporeal support associated with technology change. Interact Cardiovasc Thorac Surg 2010; 11:400-5. [DOI: 10.1510/icvts.2010.239210] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Srivastava MC, Ramani GV, Garcia JP, Griffith BP, Uber PA, Park MH. Veno-venous extracorporeal membrane oxygenation bridging to pharmacotherapy in pulmonary arterial hypertensive crisis. J Heart Lung Transplant 2010; 29:811-3. [DOI: 10.1016/j.healun.2010.02.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2009] [Revised: 01/26/2010] [Accepted: 02/04/2010] [Indexed: 10/19/2022] Open
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Yulong Guan, Xiaowei Su, McCoach R, Kunselman A, El-Banayosy A, Ündar A. Mechanical performance comparison between RotaFlow and CentriMag centrifugal blood pumps in an adult ECLS model. Perfusion 2010; 25:71-6. [DOI: 10.1177/0267659110365366] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction: Centrifugal blood pumps have been widely adopted in conventional adult cardiopulmonary bypass and circulatory assist procedures. Different brands of centrifugal blood pumps incorporate distinct designs which affect pump performance. In this adult extracorporeal life support (ECLS) model, the performances of two brands of centrifugal blood pump (RotaFlow blood pump and CentriMag blood pump) were compared. Methods: The simulated adult ECLS circuit used in this study included a centrifugal blood pump, Quadrox D membrane oxygenator and Sorin adult ECLS tubing package. A Sorin Cardiovascular® VVR® 4000i venous reservoir (Sorin S.p.A., Milan, Italy) with a Hoffman clamp served as a pseudo-patient. The circuit was primed with 900ml heparinized human packed red blood cells and 300ml lactated Ringer’s solution (total volume 1200 ml, corrected hematocrit 40%). Trials were conducted at normothermia (36°C). Performance, including circuit pressure and flow rate, was measured for every setting analyzed. Results: The shut-off pressure of the RotaFlow was higher than the CentriMag at all measurement points given the same rotation speed (p < 0.0001). The shut-off pressure differential between the two centrifugal blood pumps was significant and increased given higher rotation speeds (p < 0.0001). The RotaFlow blood pump has higher maximal flow rate (9.08 ± 0.01L/min) compared with the CentriMag blood pump (8.37 ± 0.02L/min) (p < 0.0001). The blood flow rate differential between the two pumps when measured at the same revolutions per minute (RPM) ranged from 1.64L/min to 1.73L/min. Conclusions: The results obtained in this experiment demonstrate that the RotaFlow has a higher shut-off pressure (less retrograde flow) and maximal blood flow rate than the CentriMag blood pump. Findings support the conclusion that the RotaFlow disposable pump head has a better mechanical performance than the CentriMag. In addition, the RotaFlow disposable pump is 20-30 times less expensive than the CentriMag.
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Affiliation(s)
- Yulong Guan
- Penn State Hershey Pediatric Cardiovascular Research Center, Department of Pediatrics, Penn State College of Medicine, Penn State Children's Hospital, Hershey, Pennsylvania, USA
| | - Xiaowei Su
- Penn State Hershey Pediatric Cardiovascular Research Center, Department of Pediatrics, Penn State College of Medicine, Penn State Children's Hospital, Hershey, Pennsylvania, USA
| | - Robert McCoach
- Penn State Hershey Pediatric Cardiovascular Research Center, Department of Pediatrics, Penn State College of Medicine, Penn State Children's Hospital, Hershey, Pennsylvania, USA
| | - Allen Kunselman
- Public Health Sciences, Penn State Milton S. Hershey Medical Center, Penn State Hershey College of Medicine, Penn State Hershey Children's Hospital, Hershey, Pennsylvania, USA
| | - Aly El-Banayosy
- Heart and Vascular Institute, Penn State Milton S. Hershey Medical Center, Penn State Hershey College of Medicine, Penn State Children's Hospital, Hershey, Pennsylvania, USA
| | - Akif Ündar
- Penn State Hershey Pediatric Cardiovascular Research Center, Department of Pediatrics, Penn State College of Medicine, Penn State Children's Hospital, Hershey, Pennsylvania, USA, Department of Surgery, Penn State Milton S. Hershey Medical Center, Penn State Hershey College of Medicine, Penn State Children's Hospital, Hershey, Pennsylvania, USA, Department of Bioengineering, Penn State Milton S. Hershey Medical Center, Penn State Hershey College of Medicine, Penn State Children's Hospital, Hershey,
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Sidebotham D, McGeorge A, McGuinness S, Edwards M, Willcox T, Beca J. Extracorporeal Membrane Oxygenation for Treating Severe Cardiac and Respiratory Disease in Adults: Part 1—Overview of Extracorporeal Membrane Oxygenation. J Cardiothorac Vasc Anesth 2009; 23:886-92. [DOI: 10.1053/j.jvca.2009.08.006] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2009] [Indexed: 01/23/2023]
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36
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Sidebotham D, McGeorge A, McGuinness S, Edwards M, Willcox T, Beca J. Extracorporeal membrane oxygenation for treating severe cardiac and respiratory failure in adults: part 2-technical considerations. J Cardiothorac Vasc Anesth 2009; 24:164-72. [PMID: 19875307 DOI: 10.1053/j.jvca.2009.08.002] [Citation(s) in RCA: 127] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2009] [Indexed: 12/25/2022]
Affiliation(s)
- David Sidebotham
- Department of Anesthesiology and Cardiothoracic Intensive Care, Auckland City Hospital, Park Road, Grafton, Auckland, New Zealand.
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Regelungs- und Sicherheitskonzepte für extrakorporale Systeme zur Lungenunterstützung / Automatic control and safety concepts for extracorporeal lung support. ACTA ACUST UNITED AC 2009; 54:289-97. [DOI: 10.1515/bmt.2009.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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39
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Plasma Exchange During Cardiopulmonary Bypass in Patients With Severe Hemolysis in Cardiac Surgery. ASAIO J 2009; 55:78-82. [DOI: 10.1097/mat.0b013e31819099f8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Fiser RT, Morris MC. Extracorporeal cardiopulmonary resuscitation in refractory pediatric cardiac arrest. Pediatr Clin North Am 2008; 55:929-41, x. [PMID: 18675027 DOI: 10.1016/j.pcl.2008.04.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The purpose of this article is to discuss the indications for extracorporeal cardiopulmonary resuscitation (ECPR), physiologic and mechanical issues that arise in patients managed with ECPR, and optimal patient selection for ECPR. ECPR can provide very good outcomes for some children who, in all likelihood, would otherwise have died. Having the capability to routinely offer ECPR represents an enormous institutional commitment of people and resources. For ECPR to be successful, it must be rapidly deployed, patients must be selected with care, and consistently excellent conventional CPR must take place while awaiting ECPR.
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Affiliation(s)
- Richard T Fiser
- University of Arkansas for Medical Science, Little Rock, AR 72202-3591, USA.
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Russo P, Wheeler A, Russo J, Tobias JD. Use of a ventricular assist device as a bridge to transplantation in a patient with single ventricle physiology and total cavopulmonary anastomosis. Paediatr Anaesth 2008; 18:320-4. [PMID: 18315638 DOI: 10.1111/j.1460-9592.2008.02435.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Mechanical circulatory support can be used to manage acute and chronic cardiac failure in both adult and pediatric patients. Traditionally, extracorporeal membrane oxygenation (ECMO) has been the most common form of mechanical circulatory support in children. However, more recently, in cases of pure ventricular dysfunction, ventricular assist devices (VADs) have offered specific advantages over ECMO, including better ventricular recovery, reduced anticoagulation requirements, decreased use of blood products and decreased cost. We present the use of a VAD in an adolescent with single-ventricle physiology, who could not be weaned from cardiopulmonary bypass (CPB) after undergoing a revision of a modified Fontan operation. Gas exchange was provided by the patient's lungs while the centrifugal VAD was used successfully to support the circulation as a bridge, first to a totally implantable pulsatile VAD and subsequently to heart transplantation.
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Affiliation(s)
- Pierantonio Russo
- Department of Cardiothoracic Surgery, University of Missouri, Columbia, MO, USA
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Karl TR, Horton SB, Brizard C. Postoperative support with the centrifugal pump ventricular assist device (VAD). Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2006:83-91. [PMID: 16638552 DOI: 10.1053/j.pcsu.2006.02.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Centrifugal pump left ventricular assist device is a useful adjunct in pediatric cardiac surgery, as a bridge to recovery, or in some cases, to transplantation. This form of circulatory support may not have the universal applicability of extracorporeal membrane oxygenation, but it is equally or more effective in properly selected patients. The technology for centrifugal pump support is now quite standardized, and the advantages well documented. In this chapter we discuss the problems of indications, case selection, technical aspects of the circuit, and general clinical management. Results since 1989 are also presented.
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Affiliation(s)
- Tom R Karl
- Pediatric Cardiac Surgery, University of California-San Francisco, 513 Parnassus Ave, S-549, San Francisco, CA 94143, USA.
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Ruperez M, López-Herce J, Sánchez C, García C, García E, Del Francisco CJ. Comparison of a Tubular Pulsatile Pump and a Volumetric Pump for Continuous Venovenous Renal Replacement Therapy in a Pediatric Animal Model. ASAIO J 2005; 51:372-5. [PMID: 16156301 DOI: 10.1097/01.mat.0000169112.40062.0e] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
We compare the efficacy of a tubular pulsatile pump and a conventional volumetric pump (IVAC 571), connected to a neonatal hemofiltration circuit with an FH22 filter, for continuous renal replacement therapy in 54 Maryland pigs weighing 8-16 kg. Three different flow rates (30 ml/min in 12 cases, 15 ml/min in 22 cases, and 5 ml/min in 20 cases) were used over a 2-hour period. Hemofiltration and hemodiafiltration were performed, and measurements of ultrafiltrate flow, circuit pressures, heart rate, blood pressure, temperature, urea, creatinine, total proteins, Na, K, Cl, hematocrit, and hemolysis parameters (aspartate transaminase, lactic dehydrogenase, haptoglobin, indirect bilirubin, free hemoglobin) were made. There were no differences in ultrafiltrate flow between the two pumps. Ultrafiltrate volume was significantly higher with higher flows (p < 0.01). The technique was well tolerated by all pigs. When each blood flow was analyzed separately, cross-filter pressure drop was significantly higher in the volumetric pump than in the tubular pulsatile pump (p < 0.05). No significant differences in heart rate, blood pressure, or analytical determinations were seen between the two pumps. We conclude that pulsatile and volumetric pumps can be uses as an alternative to roller pumps for continuous venovenous renal replacement therapy in neonates and infants.
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Affiliation(s)
- Marta Ruperez
- Pediatric Intensive Care Unit, Gregorio Marañón University Hospital, Madrid, Spain
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