1
|
van Kaam P, Stehouwer M. Sudden pump stop may cause air release in oxygenators, ' The Hammer Effect ': An in vitro evaluation. Perfusion 2024:2676591241244961. [PMID: 38584486 DOI: 10.1177/02676591241244961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
BACKGROUND Oxygenators, as used in cardiopulmonary bypass (CPB) circuits, are components with good air removal properties. However, under some conditions the semipermeable characteristics of hollow fibers allow air to accidentally enter the blood side of the CPB circuit. This may occur when a fluid in motion is stopped suddenly by which the rapid change in momentum may cause a relative negative pressure drop, the so-called hammer effect. The hammer effect is not yet described in literature related to CPB. The aim of this in vitro study was to reproduce the hammer effect. METHODS The in vitro setup consisted of a CPB circuit with a fully occluded roller pump and one of four test oxygenators. The hammer test was performed by a sudden pump stop. The pressure wave was measured and after the test the residual air present in the oxygenator was forced into the arterial line and measured with a bubble detector. RESULTS We showed that a sudden pump stop could lead to the hammer effect, represented as a relative negative pressure drop in the arterial line. This hammer effect resulted in air release through the semipermeable fibers as we showed in two of the four tested brands of oxygenators. CONCLUSIONS We conclude that the hammer effect may occur before connection of the CPB system to the patient, and this may result in air release into the arterial blood side of the oxygenator. The hammer effect can be caused by clamping of the tubing in combination with a centrifugal pump, or by suddenly stopping the roller pump. With this study we would like to raise awareness of the hammer effect.
Collapse
Affiliation(s)
- Paul van Kaam
- Department of Extracorporeal Circulation, Sint Antonius Ziekenhuis Chirurgie, Nieuwegein, Netherlands
| | - Marco Stehouwer
- Department of Extracorporeal Circulation, UMC Utrecht, Utrecht, Netherlands
| |
Collapse
|
2
|
Deininger MM, Benner CF, Strudthoff LJ, Leonhardt S, Bruells CS, Marx G, Bleilevens C, Breuer T. Post-Mortem Extracorporeal Membrane Oxygenation Perfusion Rat Model: A Feasibility Study. Animals (Basel) 2023; 13:3532. [PMID: 38003149 PMCID: PMC10668677 DOI: 10.3390/ani13223532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 11/11/2023] [Accepted: 11/14/2023] [Indexed: 11/26/2023] Open
Abstract
The development of biomedical soft- or hardware frequently includes testing in animals. However, large efforts have been made to reduce the number of animal experiments, according to the 3Rs principle. Simultaneously, a significant number of surplus animals are euthanized without scientific necessity. The primary aim of this study was to establish a post-mortem rat perfusion model using extracorporeal membrane oxygenation (ECMO) in surplus rat cadavers and generate first post vivo results concerning the oxygenation performance of a recently developed ECMO membrane oxygenator. Four rats were euthanized and connected post-mortem to a venous-arterial ECMO circulation for up to eight hours. Angiographic perfusion proofs, blood gas analyses and blood oxygenation calculations were performed. The mean preparation time for the ECMO system was 791 ± 29 s and sufficient organ perfusion could be maintained for 463 ± 26 min, proofed via angiographic imaging and a mean femoral arterial pressure of 43 ± 17 mmHg. A stable partial oxygen pressure, a 73% rise in arterial oxygen concentration and an exponentially increasing oxygen extraction ratio up to 4.75 times were shown. Considering the 3Rs, the established post-mortal ECMO perfusion rat model using surplus animals represents a promising alternative to models using live animals. Given the preserved organ perfusion, its use could be conceivable for various biomedical device testing.
Collapse
Affiliation(s)
- Matthias Manfred Deininger
- Department of Intensive and Intermediate Care, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany; (G.M.); (T.B.)
- Department of Anesthesiology, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany;
| | - Carl-Friedrich Benner
- Medical Information Technology, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, 52074 Aachen, Germany; (C.-F.B.); (S.L.)
| | - Lasse Johannes Strudthoff
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany;
| | - Steffen Leonhardt
- Medical Information Technology, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, 52074 Aachen, Germany; (C.-F.B.); (S.L.)
| | - Christian Simon Bruells
- Department of Anesthesia, Intensive and Emergency Medicine, Marien Kliniken, 57072 Siegen, Germany;
| | - Gernot Marx
- Department of Intensive and Intermediate Care, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany; (G.M.); (T.B.)
| | - Christian Bleilevens
- Department of Anesthesiology, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany;
| | - Thomas Breuer
- Department of Intensive and Intermediate Care, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany; (G.M.); (T.B.)
| |
Collapse
|
3
|
Das S, Das D, Dutta N, Sharma M, Koley R. Use of cardiopulmonary bypass machine in intensive care unit as a short term mechanical circulatory support for recovery of cardiac function. Perfusion 2023; 38:1652-1658. [PMID: 36134458 DOI: 10.1177/02676591221129740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Extracorporeal Membrane Oxygenation (ECMO) is used as a bridge to recovery of cardiac function following completion of congenital cardiac surgeries where there is failure to wean from cardiopulmonary bypass (CPB) or severe low cardiac output states in the post operative periods. Although ECMO is a well-established form of mechanical circulatory support, the associated cost can be a huge financial burden on families. We are an ECMO center and use the same in post operative congenital cardiac surgeries for mechanical cardiovascular support if needed. However, a significant proportion of the children, whom we operate, are funded by government aides. The resources are limited in such circumstances. If needed, we use the same CPB circuit and cannulae used in the Operating Room (OR) and support them at a significantly lower cost compared to ECMO. METHODS We report our experience of using conventional CPB machine as a short-term bridge to recovery of cardiac function in Intensive Care Unit where there was limitation of funds. Essentially same CPB circuit with roller pump is retained, by omitting cardiotomy suckers. We use D901 Lilliput 1 Oxygenator (Sorin, Italy) for children <5 kg and D902 Lilliput 2 (Sorin, Italy) Oxygenator for children >5 Kg. RESULTS We supported nine patients on CPB between March 2019 and December 2021. During this time, 1392 congenital cardiac surgeries were performed. We could wean off three patients (33.3%) and discharge two patients (22.2%). Our support time ranged from 21 h to 60 h with a median of 48 h. Beyond 48 h of support, we experienced several CPB induced complications in our cohort. CONCLUSION In resource-limited settings, conventional CPB machines can be used for short-term cardiac support. Although results may not be comparable to using ECMO, some patients can be definitely salvaged, who would otherwise die in the absence of institution of mechanical circulatory support.
Collapse
Affiliation(s)
| | - Debasis Das
- Department of Cardiac Surgery, NH Narayana Superspeciality Hospital, Howrah, India
| | - Nilanjan Dutta
- Department of Cardiac Surgery, NH Narayana Superspeciality Hospital, Howrah, India
| | - Manish Sharma
- Department of Cardiac Anesthesiology, NH Narayana Superspeciality Hospital, Howrah, India
| | - Rangan Koley
- Department of Cardiac Anesthesiology, NH Narayana Superspeciality Hospital, Howrah, India
| |
Collapse
|
4
|
Omlor AJ, Caspari S, Omlor LS, Jungmann AM, Krawczyk M, Schmoll N, Mang S, Seiler F, Muellenbach RM, Bals R, Lepper PM. Comparison of Serial and Parallel Connections of Membrane Lungs against Refractory Hypoxemia in a Mock Circuit. Membranes (Basel) 2023; 13:809. [PMID: 37887981 PMCID: PMC10608735 DOI: 10.3390/membranes13100809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 09/13/2023] [Accepted: 09/21/2023] [Indexed: 10/28/2023]
Abstract
Extracorporeal membrane oxygenation (ECMO) is an important rescue therapy method for the treatment of severe hypoxic lung injury. In some cases, oxygen saturation and oxygen partial pressure in the arterial blood are low despite ECMO therapy. There are case reports in which patients with such instances of refractory hypoxemia received a second membrane lung, either in series or in parallel, to overcome the hypoxemia. It remains unclear whether the parallel or serial connection is more effective. Therefore, we used an improved version of our full-flow ECMO mock circuit to test this. The measurements were performed under conditions in which the membrane lungs were unable to completely oxygenate the blood. As a result, only the photometric pre- and post-oxygenator saturations, blood flow and hemoglobin concentration were required for the calculation of oxygen transfer rates. The results showed that for a pre-oxygenator saturation of 45% and a total blood flow of 10 L/min, the serial connection of two identical 5 L rated oxygenators is 17% more effective in terms of oxygen transfer than the parallel connection. Although the idea of using a second membrane lung if refractory hypoxia occurs is intriguing from a physiological point of view, due to the invasiveness of the solution, further investigations are needed before this should be used in a wider clinical setting.
Collapse
Affiliation(s)
- Albert J. Omlor
- Department of Internal Medicine V—Pneumology, Allergology and Intensive Care Medicine, University Hospital of Saarland, 66424 Homburg, Germany
| | - Stefan Caspari
- Department of Internal Medicine V—Pneumology, Allergology and Intensive Care Medicine, University Hospital of Saarland, 66424 Homburg, Germany
| | - Leonie S. Omlor
- Department of Anaesthesiology and Critical Care, University Hospital of Saarland, 66424 Homburg, Germany
| | - Anna M. Jungmann
- Department of Internal Medicine V—Pneumology, Allergology and Intensive Care Medicine, University Hospital of Saarland, 66424 Homburg, Germany
| | - Marcin Krawczyk
- Department of Internal Medicine II, University Hospital of Saarland, 66424 Homburg, Germany
- Laboratory of Metabolic Liver Diseases, Department of General, Transplant and Liver Surgery, Centre for Preclinical Research, Medical University of Warsaw, 02091 Warsaw, Poland
| | - Nicole Schmoll
- Department of Internal Medicine V—Pneumology, Allergology and Intensive Care Medicine, University Hospital of Saarland, 66424 Homburg, Germany
| | - Sebastian Mang
- Department of Internal Medicine V—Pneumology, Allergology and Intensive Care Medicine, University Hospital of Saarland, 66424 Homburg, Germany
| | - Frederik Seiler
- Department of Internal Medicine V—Pneumology, Allergology and Intensive Care Medicine, University Hospital of Saarland, 66424 Homburg, Germany
| | - Ralf M. Muellenbach
- Department of Anaesthesiology and Critical Care, Campus Kassel of the University of Southampton, 34125 Kassel, Germany
| | - Robert Bals
- Department of Internal Medicine V—Pneumology, Allergology and Intensive Care Medicine, University Hospital of Saarland, 66424 Homburg, Germany
- Helmholtz Institute for Pharmaceutical Research Saarland (HIPS), Helmholtz Centre for Infection Research (HZI), 66123 Saarbrücken, Germany
| | - Philipp M. Lepper
- Department of Internal Medicine V—Pneumology, Allergology and Intensive Care Medicine, University Hospital of Saarland, 66424 Homburg, Germany
| |
Collapse
|
5
|
Abstract
When employing minimal invasive extracorporeal circulation (MiECC), the removal of bubbles in the circuit is important to prevent air embolism. We investigated the bubble removal performance of the FHP oxygenator with a pre-filter and compared it with that of four oxygenators, including the Fusion oxygenator, Quadrox oxygenator, Inspire oxygenator, and FX oxygenator. A closed test circuit filled with an aqueous glycerin solution was used. Air injection (10 mL) was performed prior to the oxygenator, and the number and volume of the bubbles were measured at the inlet and outlet of each oxygenator. At the inlet of the five oxygenators, there were no significant differences in the total number of bubbles detected. At the outlet, bubbles were classified into two groups according to the bubble size: ≥100 μm and <100 μm. Tests were performed at pump flow rates of 4 and 5 L/min. For bubbles ≥100 μm, which are considered clinically detrimental, the FHP was the lowest number and volume of bubbles at both pump flow rates compared to the other oxygenators. Regarding the bubbles <100 μm, the number of bubbles was higher in the FHP than those in others; however, the volume of bubbles was significantly lower at 4 L/min and tended to be lower at 5 L/min. The use of the FHP with the pre-filter removed more bubbles ≥100 μm in the circuit than that by the other oxygenators.
Collapse
Affiliation(s)
- Mitsuru Ishida
- Department of Medical Engineering, RinggoldID:%2083943Nerima Hikarigaoka Hospital, Nerima-ku, Japan
| | - Sho Takahashi
- Department of Medical Engineering, RinggoldID:%2083943Nerima Hikarigaoka Hospital, Nerima-ku, Japan
| | - Homare Okamura
- Department of Cardiovascular Surgery, RinggoldID:%2083943Nerima Hikarigaoka Hospital, Nerima-ku, Japan
| |
Collapse
|
6
|
Strudthoff LJ, Focke J, Hesselmann F, Kaesler A, Martins Costa A, Schlanstein PC, Schmitz-Rode T, Steinseifer U, Steuer NB, Wiegmann B, Arens J, Jansen SV. Novel Size-Variable Dedicated Rodent Oxygenator for ECLS Animal Models-Introduction of the "RatOx" Oxygenator and Preliminary In Vitro Results. Micromachines (Basel) 2023; 14:800. [PMID: 37421033 DOI: 10.3390/mi14040800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/22/2023] [Accepted: 03/24/2023] [Indexed: 07/09/2023]
Abstract
The overall survival rate of extracorporeal life support (ECLS) remains at 60%. Research and development has been slow, in part due to the lack of sophisticated experimental models. This publication introduces a dedicated rodent oxygenator ("RatOx") and presents preliminary in vitro classification tests. The RatOx has an adaptable fiber module size for various rodent models. Gas transfer performances over the fiber module for different blood flows and fiber module sizes were tested according to DIN EN ISO 7199. At the maximum possible amount of effective fiber surface area and a blood flow of 100 mL/min, the oxygenator performance was tested to a maximum of 6.27 mL O2/min and 8.2 mL CO2/min, respectively. The priming volume for the largest fiber module is 5.4 mL, while the smallest possible configuration with a single fiber mat layer has a priming volume of 1.1 mL. The novel RatOx ECLS system has been evaluated in vitro and has demonstrated a high degree of compliance with all pre-defined functional criteria for rodent-sized animal models. We intend for the RatOx to become a standard testing platform for scientific studies on ECLS therapy and technology.
Collapse
Affiliation(s)
- Lasse J Strudthoff
- Institute of Applied Medical Engineering, Department of Cardiovascular Engineering, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany
| | - Jannis Focke
- Institute of Applied Medical Engineering, Department of Cardiovascular Engineering, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany
| | - Felix Hesselmann
- Institute of Applied Medical Engineering, Department of Cardiovascular Engineering, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany
| | - Andreas Kaesler
- Institute of Applied Medical Engineering, Department of Cardiovascular Engineering, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany
| | - Ana Martins Costa
- Department of Biomechanical Engineering, Faculty of Engineering Technologies, University of Twente, 7522 LW Enschede, The Netherlands
| | - Peter C Schlanstein
- Institute of Applied Medical Engineering, Department of Cardiovascular Engineering, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany
| | - Thomas Schmitz-Rode
- Institute of Applied Medical Engineering, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany
| | - Ulrich Steinseifer
- Institute of Applied Medical Engineering, Department of Cardiovascular Engineering, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany
| | - Niklas B Steuer
- Institute of Applied Medical Engineering, Department of Cardiovascular Engineering, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany
| | - Bettina Wiegmann
- Department for Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, 30625 Hanover, Germany
- Lower Saxony Center for Biomedical Engineering, Implant Research and Development (NIFE), 30625 Hanover, Germany
- German Center for Lung Research (DLZ), 30625 Hanover, Germany
| | - Jutta Arens
- Institute of Applied Medical Engineering, Department of Cardiovascular Engineering, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany
- Department of Biomechanical Engineering, Faculty of Engineering Technologies, University of Twente, 7522 LW Enschede, The Netherlands
| | - Sebastian V Jansen
- Institute of Applied Medical Engineering, Department of Cardiovascular Engineering, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany
| |
Collapse
|
7
|
van Minnen O, Oude Lansink-Hartgring A, Hoffmann RF, van den Bergh WM. Risk factors for elective and emergency oxygenator exchanges during veno-venous extracorporeal membrane oxygenation. Perfusion 2023:2676591231168642. [PMID: 36995209 DOI: 10.1177/02676591231168642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
BACKGROUND Despite systemic anticoagulation and antithrombotic surface coating, oxygenator dysfunction remains one of most common technical complications of Extracorporeal membrane oxygenation (ECMO). Several parameters have been associated with an oxygenator exchange, but no guidelines for when to perform an exchange are published. An exchange, especially an emergency exchange, has a risk of complications. Therefore, a delicate balance between oxygenator dysfunction and the exchange of the oxygenator exists. This study aimed to identify risk factors and predictors for elective and emergency oxygenator exchanges. METHODS This observational cohort study included all adult patients supported with veno-venous extracorporeal membrane oxygenation (V-V ECMO). We compared patients' characteristics and laboratory values of patients with and without an oxygenator exchange and between an elective and emergency exchange, defined as an exchange outside office hours. Risk factors for an oxygenator exchange were identified with cox regression analyses, and risk factors for an emergency exchange were identified with logistic regression analyses. RESULTS We included forty-five patients in the analyses. There were twenty-nine oxygenator exchanges in nineteen patients (42%). More than a third of the exchanges were emergency exchanges. Higher partial pressure of carbon dioxide (PaCO2), transmembrane pressure difference (ΔP), and hemoglobin (Hb) were associated with an oxygenator exchange. Lower lactate dehydrogenase (LDH) was the only risk factor for an emergency exchange. CONCLUSION Oxygenator exchange is frequent during V-V ECMO support. PaCO2, ΔP and Hb were associated with an oxygenator exchange and lower LDH with the risk of an emergency exchange.
Collapse
Affiliation(s)
- Olivier van Minnen
- Department of Critical Care of the University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | | | - Roland F Hoffmann
- Department of Cardiothoracic Surgery, Section Extracorporeal Circulation of the University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Walter M van den Bergh
- Department of Critical Care of the University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| |
Collapse
|
8
|
Alabdullh HA, Pflaum M, Mälzer M, Kipp M, Naghilouy-Hidaji H, Adam D, Kühn C, Natanov R, Niehaus A, Haverich A, Wiegmann B. Biohybrid lung Development: Towards Complete Endothelialization of an Assembled Extracorporeal Membrane Oxygenator. Bioengineering (Basel) 2023; 10:bioengineering10010072. [PMID: 36671644 PMCID: PMC9854558 DOI: 10.3390/bioengineering10010072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/20/2022] [Accepted: 12/30/2022] [Indexed: 01/07/2023]
Abstract
Towards the establishment of a long-term lung-assist device to be used both as a bridge and as an alternative to lung transplantation according to final destination therapy, we develop the biohybrid lung (BHL) on the technical basis of contemporary extracorporeal membrane oxygenation (ECMO). Here, to overcome the significant drawbacks of ECMO, in particular the missing hemocompatibility of the artificial surfaces, all blood-contacting areas need to be endothelialized sufficiently. In continuation of our recent accomplishments, demonstrating the feasibility of establishing a physiological acting endothelial cell (EC) monolayer on the hollow fiber membranes (HFMs) of the ECMO in vitro, the next step towards BHL translation is the endothelialization of the complete oxygenator, consisting of HFMs and the surrounding housing. Therefore, we assessed EC seeding inside our model oxygenator (MOx), which simulated the conditions in the assembled HFM oxygenators in order to identify the most important factors influencing efficient endothelialization, such as cell seeding density, cell distribution, incubation time and culture medium consumption. Overall, upon adjusting the concentration of infused ECs to 15.2 × 104/cm2 and ensuring optimal dispersion of cells in the MOx, viable and confluent EC monolayers formed on all relevant surfaces within 24 h, even though they comprised different polymers, i.e., the fibronectin-coated HFMs and the polysulfone MOx housing. Periodic medium change ensured monolayer survival and negligible apoptosis rates comparable to the reference within the assembled system. By means of these results, revealing essential implications for BHL development, their clinical translation is coming one step closer to reality.
Collapse
Affiliation(s)
- Hussam Almesto Alabdullh
- Department for Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, 30625 Hannover, Germany
- Lower Saxony Center for Biomedical Engineering, Implant Research and Development (NIFE), Stadtfelddamm 34, 30625 Hannover, Germany
| | - Michael Pflaum
- Department for Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, 30625 Hannover, Germany
- Lower Saxony Center for Biomedical Engineering, Implant Research and Development (NIFE), Stadtfelddamm 34, 30625 Hannover, Germany
| | - Marisa Mälzer
- Department for Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, 30625 Hannover, Germany
- Lower Saxony Center for Biomedical Engineering, Implant Research and Development (NIFE), Stadtfelddamm 34, 30625 Hannover, Germany
| | - Marcel Kipp
- Department for Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, 30625 Hannover, Germany
- Lower Saxony Center for Biomedical Engineering, Implant Research and Development (NIFE), Stadtfelddamm 34, 30625 Hannover, Germany
| | - Hossein Naghilouy-Hidaji
- Department for Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, 30625 Hannover, Germany
- Lower Saxony Center for Biomedical Engineering, Implant Research and Development (NIFE), Stadtfelddamm 34, 30625 Hannover, Germany
| | - Denise Adam
- Department for Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, 30625 Hannover, Germany
- Lower Saxony Center for Biomedical Engineering, Implant Research and Development (NIFE), Stadtfelddamm 34, 30625 Hannover, Germany
| | - Christian Kühn
- Department for Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, 30625 Hannover, Germany
- Lower Saxony Center for Biomedical Engineering, Implant Research and Development (NIFE), Stadtfelddamm 34, 30625 Hannover, Germany
- German Center for Lung Research (DZL), Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Russlan Natanov
- Department for Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, 30625 Hannover, Germany
| | - Adelheid Niehaus
- Department for Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, 30625 Hannover, Germany
| | - Axel Haverich
- Department for Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, 30625 Hannover, Germany
- Lower Saxony Center for Biomedical Engineering, Implant Research and Development (NIFE), Stadtfelddamm 34, 30625 Hannover, Germany
- German Center for Lung Research (DZL), Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Bettina Wiegmann
- Department for Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, 30625 Hannover, Germany
- Lower Saxony Center for Biomedical Engineering, Implant Research and Development (NIFE), Stadtfelddamm 34, 30625 Hannover, Germany
- German Center for Lung Research (DZL), Carl-Neuberg-Str. 1, 30625 Hannover, Germany
- Correspondence:
| |
Collapse
|
9
|
Sakurai H, Fujiwara T, Ohuchi K, Hijikata W, Inoue Y, Maruyama O, Tahara T, Yokota S, Tanaka Y, Takewa Y, Mizuno T, Arai H. Innovative experimental animal models for real-time comparison of antithrombogenicity between two oxygenators using dual extracorporeal circulation circuits and indocyanine green fluorescence imaging. Artif Organs 2023; 47:77-87. [PMID: 35957489 DOI: 10.1111/aor.14380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 07/08/2022] [Accepted: 08/02/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Antithrombogenicity of extracorporeal membrane oxygenation (ECMO) devices, particularly oxygenators, is a current problem, with numerous studies and developments underway. However, there has been limited progress in developing methods to accurately compare the antithrombogenicity of oxygenators. Animal experiments are commonly conducted to evaluate the antithrombogenicity of devices; however, it is challenging to maintain a steady experimental environment. We propose an innovative experimental animal model to evaluate different devices in a constant experimental environment in real-time. METHODS This model uses two venous-arterial ECMO circuits attached to one animal (one by jugular vein and carotid artery, one by femoral vein and artery) and real-time assessment of thrombus formation in the oxygenator by indocyanine green (ICG) fluorescence imaging. Comparison studies were conducted using three pigs: one to compare different oxygenators (MERA vs. CAPIOX) (Case 1), and two to compare antithrombotic properties of the oxygenator (QUADROX) when used under different hydrodynamic conditions (continuous flow vs. pulsatile flow) (Cases 2 and 3). RESULTS Thrombi, visualized using ICG imaging, appeared as black dots on a white background in each oxygenator. In Case 1, differences in the site of thrombus formation and rate of thrombus growth were observed in real-time in two oxygenators. In Case 2 and 3, the thrombus region was smaller in pulsatile than in continuous conditions. CONCLUSIONS We devised an innovative experimental animal model for comparison of antithrombogenicity in ECMO circuits. This model enabled simultaneous evaluation of two different ECMO circuits under the same biological conditions and reduced the number of sacrificed experimental animals.
Collapse
Affiliation(s)
- Hironobu Sakurai
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tatsuki Fujiwara
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Katsuhiro Ohuchi
- Center for Experimental Animals, Tokyo Medical and Dental University, Tokyo, Japan
| | - Wataru Hijikata
- School of Engineering, Tokyo Institute of Technology, Tokyo, Japan
| | - Yusuke Inoue
- Advanced Medical Engineering Research Center, Asahikawa Medical University, Asahikawa, Japan
| | - Osamu Maruyama
- Health and Medical Research Institute, National Institute of Advanced Industrial Science and Technology (AIST), Tsukuba, Japan
| | - Tomoki Tahara
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Sachie Yokota
- Faculty of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yui Tanaka
- School of Engineering, Tokyo Institute of Technology, Tokyo, Japan
| | - Yoshiaki Takewa
- Advanced Medical Engineering Research Center, Asahikawa Medical University, Asahikawa, Japan
| | - Tomohiro Mizuno
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hirokuni Arai
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| |
Collapse
|
10
|
Chopski SG, Govender K, May A, Garven E, Stevens RM, Tchantchaleishvili V, Throckmorton AL. Novel hybrid total artificial heart with integrated oxygenator. J Card Surg 2022; 37:5172-5186. [PMID: 36403254 PMCID: PMC9812888 DOI: 10.1111/jocs.17210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 10/30/2022] [Accepted: 11/01/2022] [Indexed: 11/21/2022]
Abstract
There continues to be an unmet therapeutic need for an alternative treatment strategy for respiratory distress and lung disease. We are developing a portable cardiopulmonary support system that integrates an implantable oxygenator with a hybrid, dual-support, continuous-flow total artificial heart (TAH). The TAH has a centrifugal flow pump that is rotating about an axial flow pump. By attaching the hollow fiber bundle of the oxygenator to the base of the TAH, we establish a new cardiopulmonary support technology that permits a patient to be ambulatory during usage. In this study, we investigated the design and improvement of the blood flow pathway from the inflow-to-outflow of four oxygenators using a mathematical model and computational fluid dynamics (CFD). Pressure loss and gas transport through diffusion were examined to assess oxygenator design. The oxygenator designs led to a resistance-driven pressure loss range of less than 35 mmHg for flow rates of 1-7 L/min. All of the designs met requirements. The configuration having an outside-to-inside blood flow direction was found to have higher oxygen transport. Based on this advantageous flow direction, two designs (Model 1 and 3) were then integrated with the axial-flow impeller of the TAH for simulation. Flow rates of 1-7 L/min and speeds of 10,000-16,000 RPM were analyzed. Blood damage studies were performed, and Model 1 demonstrated the lowest potential for hemolysis. Future work will focus on developing and testing a physical prototype for integration into the new cardiopulmonary assist system.
Collapse
Affiliation(s)
- Steven G. Chopski
- BioCirc Research Laboratory, School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, Pennsylvania, USA
| | - Krianthan Govender
- BioCirc Research Laboratory, School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, Pennsylvania, USA
| | - Alexandra May
- Department of Bioengineering, McGowan Institute for Regenerative Medicine, Swanson School of Engineering, University, Pittsburgh, Pennsylvania, USA
| | - Ellen Garven
- BioCirc Research Laboratory, School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, Pennsylvania, USA
| | - Randy M. Stevens
- College of Medicine, St. Christopher’s Hospital for Children, Drexel University, Philadelphia, Pennsylvania, USA
| | | | - Amy L. Throckmorton
- BioCirc Research Laboratory, School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, Pennsylvania, USA
| |
Collapse
|
11
|
Vedula EM, Isenberg BC, Santos J, Lai W, Lewis DJ, Sutherland D, Roberts TR, Harea GT, Wells C, Teece B, Urban J, Risoleo T, Solt D, Leazer S, Chung K, Sukavaneshvar S, Batchinsky AI, Borenstein JT. Multilayer Scaling of a Biomimetic Microfluidic Oxygenator. ASAIO J 2022; 68:1312-9. [PMID: 36194101 DOI: 10.1097/MAT.0000000000001647] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Extracorporeal membrane oxygenation (ECMO) has been advancing rapidly due to a combination of rising rates of acute and chronic lung diseases as well as significant improvements in the safety and efficacy of this therapeutic modality. However, the complexity of the ECMO blood circuit, and challenges with regard to clotting and bleeding, remain as barriers to further expansion of the technology. Recent advances in microfluidic fabrication techniques, devices, and systems present an opportunity to develop new solutions stemming from the ability to precisely maintain critical dimensions such as gas transfer membrane thickness and blood channel geometries, and to control levels of fluid shear within narrow ranges throughout the cartridge. Here, we present a physiologically inspired multilayer microfluidic oxygenator device that mimics physiologic blood flow patterns not only within individual layers but throughout a stacked device. Multiple layers of this microchannel device are integrated with a three-dimensional physiologically inspired distribution manifold that ensures smooth flow throughout the entire stacked device, including the critical entry and exit regions. We then demonstrate blood flows up to 200 ml/min in a multilayer device, with oxygen transfer rates capable of saturating venous blood, the highest of any microfluidic oxygenator, and a maximum blood flow rate of 480 ml/min in an eight-layer device, higher than any yet reported in a microfluidic device. Hemocompatibility and large animal studies utilizing these prototype devices are planned. Supplemental Visual Abstract, http://links.lww.com/ASAIO/A769.
Collapse
|
12
|
Wahl T, Stokes A, Varner C, Zeybek B, Bardia A. Alterations in Pre/Post Oxygenator Flows Due to Fibrin Deposition in the CardioHelp System-A Case Report. J Extra Corpor Technol 2022; 54:239-241. [PMID: 36742210 PMCID: PMC9891478 DOI: 10.1182/ject-239-241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 08/15/2022] [Indexed: 02/07/2023]
Abstract
We present a 62-year-old patient with COVID-19 pneumonia on Veno-venous (VV) Extracorporeal Membrane Oxygenation (ECMO) with unique perturbations to pre and post oxygenator pressures due to fibrin deposition in despite being on a Heparin/Bivalirudin infusion and activated Partial Thromboplastin Time (aPTT) within therapeutic range of 60-80 seconds. On Day 8 of ECMO support, it was noticed that flows steadily decreased despite unchanged RPMs. Unlike typical blood flow to circuit pressure relationships, the circuit pressures did not correlate with the observed decreased flow. The Delta Pressure (ΔP) was not elevated. The patient's vitals were stable. On inspection post change-out, clots were noted in the oxygenator outlets. Oxygenator clots are usually associated with increased ΔP. In this scenario, clots in the oxygenator blocked 1 of the 4 outlets in the oxygenator causing the flow, pressures, and ΔP to drop consecutively. Due to reduced flow, the ΔP was not elevated despite extensive clots. The fibrin clot location in the CardioHelp ECMO circuit may lead to unexpected pressure and flow alterations. Sole reliance on ΔP as a marker for oxygenator clots may be misleading. Careful monitoring and timely diagnosis of coagulation status may lead to changes in anticoagulation goals and meaningfully impact patient outcomes.
Collapse
Affiliation(s)
- Tyler Wahl
- Division of Perfusion Medicine, Yale New Haven Hospital, New Haven, Connecticut; and
- Address correspondence to: Tyler Wahl, MHS, CCP, Yale New Haven Hospital, 495 Totoket Rd Northford, CT 06472. E-mail:
| | - Angela Stokes
- Division of Perfusion Medicine, Yale New Haven Hospital, New Haven, Connecticut; and
| | - Caleb Varner
- Division of Perfusion Medicine, Yale New Haven Hospital, New Haven, Connecticut; and
| | - Burak Zeybek
- Department of Anesthesiology, Yale School of Medicine, New Haven, Connecticut
| | - Amit Bardia
- Department of Anesthesiology, Yale School of Medicine, New Haven, Connecticut
| |
Collapse
|
13
|
Hendrix RHJ, Debeuckelaere G, Degezelle K, Lenaerts L, Verbelen T, Weerwind PW. Clinical evaluation of the novel Capiox NX19 adult oxygenator-a multicenter study. Perfusion 2022; 38:734-739. [PMID: 35348392 PMCID: PMC10102914 DOI: 10.1177/02676591221078942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The novel Capiox NX19 adult oxygenator is, compared to its predecessors, improved with enhanced air removal technology, a polymer heat exchanger and smaller, innovative hollow fibers resulting in a surface area reduction and a lower priming volume. The aim of this study was to evaluate the NX19 oxygenator performance in a clinical setting. METHODS A prospective multicenter study was performed involving three large European university hospitals. The Capiox NX19 (n = 150) performance was assessed during adult cardiopulmonary bypass and involved gaseous microemboli handling and gas transfer efficiency. The heat exchanger performance was evaluated separately in vitro. RESULTS The heat exchanger performance factors were 0.80 ± 0.03 and 0.58 ± 0.04 at pump flow rates of 3 L/min and 6 L/min, respectively. After priming, residual post-oxygenator gaseous microemboli count and volume were decreased by 91% and 93.7%, respectively. The gas compartment pressure was 6.0 ± 2.5 mmHg, while the O2 transfer was 69 ± 30 mL/min/m2 and the CO2 transfer 73 ± 34 mL/min/m2. The O2 gradient was 44 ± 19 mmHg/LPM and the O2 diffusing capacity 0.38 ± 0.14 mL/min/mmHg. The shunt fraction was 0.19 ± 0.13, whereas oxygenator resistance and shear stress were 10.5 ± 3.7 mmHg/LPM and 5.1 ± 3.1 dyn/cm2, respectively. CONCLUSION This multicenter study displayed good clinical safety and performance of the NX19 oxygenator.
Collapse
Affiliation(s)
- Rik H J Hendrix
- Department of Cardiothoraxic Surgery, 199236Maastricht University Medical Centre, Maastricht, Netherlands
| | - Gerdy Debeuckelaere
- Department of Extra-corporeal Circulation, 60202University Hospital Antwerp, Edegem, Belgium
| | - Karlien Degezelle
- Department of Perfusion Technology, 60182University Hospitals Leuven, Leuven, Belgium
| | - Lieven Lenaerts
- Department of Perfusion Technology, 60182University Hospitals Leuven, Leuven, Belgium
| | - Tom Verbelen
- Department of Cardiac Surgery, 60182University Hospitals Leuven, Leuven, Belgium
| | - Patrick W Weerwind
- Department of Cardiothoraxic Surgery, 199236Maastricht University Medical Centre, Maastricht, Netherlands
| |
Collapse
|
14
|
Tamura T, Mori A, Ishii A, Nishiwaki K. The equilibrated blood sevoflurane concentrations show a rapid decrease after switching from ventilation for the human lung to cardiopulmonary bypass. Nagoya J Med Sci 2022; 84:163-168. [PMID: 35392015 PMCID: PMC8971030 DOI: 10.18999/nagjms.84.1.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 07/12/2021] [Indexed: 11/08/2022]
Abstract
Volatile anesthetics (VAs) protect myocardial cells during cardiovascular surgeries, including cardiopulmonary bypass (CPB). In CPB, blood is gradually transferred from the body to a CPB unit until the target cardiac index is achieved, following which human lung (HL) ventilation is stopped. This pilot study aimed to evaluate changes in the blood sevoflurane concentrations 5 min after the start of CPB when its delivery to the oxygenator began after HL ventilation with sevoflurane was completed. Six patients were recruited and participated in this study. For each patient, the equilibrated blood sample, collected 20 min after starting the delivery of 1.7% sevoflurane (HL group), and another blood sample, collected 5 min after starting the CPB, were analyzed using gas chromatography equipped with a flame ionization detector. The mean (± standard deviation) sevoflurane concentrations in the HL and 5 min after starting CPB groups were 58.6 ± 4.7 and 14.5 ± 5.0 μg/ml, respectively (P < 0.01). In conclusion, the equilibrated blood sevoflurane concentrations showed a rapid decrease when switching from sevoflurane ventilation for the HL to CPB unless it was introduced to the oxygenator until completion of the switch.
Collapse
Affiliation(s)
- Takahiro Tamura
- Department of Anesthesiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Atsushi Mori
- Department of Perioperative Management System, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akira Ishii
- Department of Legal Medicine and Bioethics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kimitoshi Nishiwaki
- Department of Anesthesiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| |
Collapse
|
15
|
Yildirim F, Amanvermez Senarslan D, Yersel S, Bayram B, Taneli F, Tetik O. Systemic inflammatory response during cardiopulmonary bypass: Axial flow versus radial flow oxygenators. Int J Artif Organs 2022; 45:278-283. [PMID: 35098782 DOI: 10.1177/03913988221075043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The objective of this study was to investigate the inflammatory effects of different oxygenator flow pattern types in patients undergoing coronary artery bypass graft surgery with cardiopulmonary bypass. METHODS We designed this randomized, single-blind, prospective study of patients with coronary artery disease. We compared the systemic inflammatory effects of oxygenators with two types of flow: axial flow and radial flow. Therefore, we divided the patients into two groups: 24 patients in the axial group and 28 patients in the radial group. IL-1, IL-6, IL-10, and TNF-α were examined for cytokine activation leading to a systemic inflammatory reaction. The samples were collected at three different time intervals: T1, T2, and T3 (T1 was taken before cardiopulmonary bypass, T2 just 1 h after CPB onset, and T3 was taken 24 h after the surgery). RESULTS There were no significant differences in demographic characteristics between the two groups. We observed that there were notably lower levels of humoral inflammatory response parameters (IL-1, IL-6, and TNF-α) in the radial flow oxygenator group than in the axial flow group at the specific sampling times. For IL-10, there was no significant difference for any time period. CONCLUSION It might be advantageous to use a radial-flow-patterned oxygenator to limit the inflammatory response triggered by the oxygenators in cardiopulmonary bypass.
Collapse
Affiliation(s)
- Funda Yildirim
- Cardiovascular Surgery, Manisa Celal Bayar University, Manisa, Turkey
| | | | - Seyhmus Yersel
- Manisa Celal Bayar University, Manisa, Turkey.,Munich Heart Center, Munich, Germany
| | - Barıs Bayram
- Cardiovascular Surgery, Manisa Celal Bayar University, Manisa, Turkey
| | - Fatma Taneli
- Biochemistry, Manisa Celal Bayar University, Manisa, Turkey
| | - Omer Tetik
- Cardiovascular Surgery, Manisa Celal Bayar University, Manisa, Turkey
| |
Collapse
|
16
|
Steuer NB, Schlanstein PC, Hannig A, Sibirtsev S, Jupke A, Schmitz-Rode T, Kopp R, Steinseifer U, Wagner G, Arens J. Extracorporeal Hyperoxygenation Therapy (EHT) for Carbon Monoxide Poisoning: In-Vitro Proof of Principle. Membranes (Basel) 2021; 12:membranes12010056. [PMID: 35054581 PMCID: PMC8779470 DOI: 10.3390/membranes12010056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 12/28/2021] [Indexed: 11/23/2022]
Abstract
Carbon monoxide (CO) poisoning is the leading cause of poisoning-related deaths globally. The currently available therapy options are normobaric oxygen (NBO) and hyperbaric oxygen (HBO). While NBO lacks in efficacy, HBO is not available in all areas and countries. We present a novel method, extracorporeal hyperoxygenation therapy (EHT), for the treatment of CO poisoning that eliminates the CO by treating blood extracorporeally at elevated oxygen partial pressure. In this study, we proof the principle of the method in vitro using procine blood: Firstly, we investigated the difference in the CO elimination of a hollow fibre membrane oxygenator and a specifically designed batch oxygenator based on the bubble oxygenator principle at elevated pressures (1, 3 bar). Secondly, the batch oxygenator was redesigned and tested for a broader range of pressures (1, 3, 5, 7 bar) and temperatures (23, 30, 37 °C). So far, the shortest measured carboxyhemoglobin half-life in the blood was 21.32 min. In conclusion, EHT has the potential to provide an easily available and effective method for the treatment of CO poisoning.
Collapse
Affiliation(s)
- Niklas B. Steuer
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Helmholtz Institute, Medical Faculty, RWTH Aachen University, Pauwelsstraße 20, 52074 Aachen, Germany; (P.C.S.); (A.H.); (U.S.); (G.W.); (J.A.)
- Correspondence: ; Tel.:+49-241-80-88764
| | - Peter C. Schlanstein
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Helmholtz Institute, Medical Faculty, RWTH Aachen University, Pauwelsstraße 20, 52074 Aachen, Germany; (P.C.S.); (A.H.); (U.S.); (G.W.); (J.A.)
| | - Anke Hannig
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Helmholtz Institute, Medical Faculty, RWTH Aachen University, Pauwelsstraße 20, 52074 Aachen, Germany; (P.C.S.); (A.H.); (U.S.); (G.W.); (J.A.)
| | - Stephan Sibirtsev
- Fluid Process Engineering (AVT.FVT), RWTH Aachen University, Forckenbeckstraße 51, 52074 Aachen, Germany; (S.S.); (A.J.)
| | - Andreas Jupke
- Fluid Process Engineering (AVT.FVT), RWTH Aachen University, Forckenbeckstraße 51, 52074 Aachen, Germany; (S.S.); (A.J.)
| | - Thomas Schmitz-Rode
- Institute of Applied Medical Engineering, Helmholtz Institute, Medical Faculty, RWTH Aachen University, Pauwelsstraße 20, 52074 Aachen, Germany;
| | - Rüdger Kopp
- Department of Intensive Care Medicine, Medical Faculty, RWTH Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany;
| | - Ulrich Steinseifer
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Helmholtz Institute, Medical Faculty, RWTH Aachen University, Pauwelsstraße 20, 52074 Aachen, Germany; (P.C.S.); (A.H.); (U.S.); (G.W.); (J.A.)
| | - Georg Wagner
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Helmholtz Institute, Medical Faculty, RWTH Aachen University, Pauwelsstraße 20, 52074 Aachen, Germany; (P.C.S.); (A.H.); (U.S.); (G.W.); (J.A.)
| | - Jutta Arens
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Helmholtz Institute, Medical Faculty, RWTH Aachen University, Pauwelsstraße 20, 52074 Aachen, Germany; (P.C.S.); (A.H.); (U.S.); (G.W.); (J.A.)
- Department of Biomechanical Engineering, Faculty of Engineering Technology, University of Twente, De Horst 2, 7522LW Enschede, The Netherlands
| |
Collapse
|
17
|
Smith NJ, Nance BA, Durham LA, McAlarnen LA, Bishop EA, Zundel MT. Extracorporeal Membrane Oxygenator Failure in a Patient With Gestational Trophoblastic Neoplasm: Possible Mechanisms and Considerations in Critical Care. J Cardiothorac Vasc Anesth 2021; 36:2583-2587. [PMID: 34649807 DOI: 10.1053/j.jvca.2021.09.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 09/22/2021] [Accepted: 09/27/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Nathan J Smith
- Department of Surgery, Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, WI.
| | - Beth A Nance
- Department of Anesthesiology, Division of Critical Care Anesthesia, Medical College of Wisconsin, Milwaukee, WI
| | - Lucian A Durham
- Department of Surgery, Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Lindsey A McAlarnen
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Erin A Bishop
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - M Tracy Zundel
- Department of Anesthesiology, Division of Critical Care Anesthesia, Medical College of Wisconsin, Milwaukee, WI
| |
Collapse
|
18
|
Santos J, Vedula EM, Lai W, Isenberg BC, Lewis DJ, Lang D, Sutherland D, Roberts TR, Harea GT, Wells C, Teece B, Karandikar P, Urban J, Risoleo T, Gimbel A, Solt D, Leazer S, Chung KK, Sukavaneshvar S, Batchinsky AI, Borenstein JT. Toward Development of a Higher Flow Rate Hemocompatible Biomimetic Microfluidic Blood Oxygenator. Micromachines (Basel) 2021; 12:888. [PMID: 34442512 PMCID: PMC8398684 DOI: 10.3390/mi12080888] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 07/18/2021] [Accepted: 07/24/2021] [Indexed: 01/05/2023]
Abstract
The recent emergence of microfluidic extracorporeal lung support technologies presents an opportunity to achieve high gas transfer efficiency and improved hemocompatibility relative to the current standard of care in extracorporeal membrane oxygenation (ECMO). However, a critical challenge in the field is the ability to scale these devices to clinically relevant blood flow rates, in part because the typically very low blood flow in a single layer of a microfluidic oxygenator device requires stacking of a logistically challenging number of layers. We have developed biomimetic microfluidic oxygenators for the past decade and report here on the development of a high-flow (30 mL/min) single-layer prototype, scalable to larger structures via stacking and assembly with blood distribution manifolds. Microfluidic oxygenators were designed with biomimetic in-layer blood distribution manifolds and arrays of parallel transfer channels, and were fabricated using high precision machined durable metal master molds and microreplication with silicone films, resulting in large area gas transfer devices. Oxygen transfer was evaluated by flowing 100% O2 at 100 mL/min and blood at 0-30 mL/min while monitoring increases in O2 partial pressures in the blood. This design resulted in an oxygen saturation increase from 65% to 95% at 20 mL/min and operation up to 30 mL/min in multiple devices, the highest value yet recorded in a single layer microfluidic device. In addition to evaluation of the device for blood oxygenation, a 6-h in vitro hemocompatibility test was conducted on devices (n = 5) at a 25 mL/min blood flow rate with heparinized swine donor blood against control circuits (n = 3). Initial hemocompatibility results indicate that this technology has the potential to benefit future applications in extracorporeal lung support technologies for acute lung injury.
Collapse
Affiliation(s)
- Jose Santos
- Draper, Cambridge, MA 02139, USA; (J.S.); (W.L.); (B.C.I.); (D.J.L.); (D.L.); (D.S.); (C.W.); (B.T.); (P.K.); (J.U.); (T.R.); (A.G.)
| | - Else M. Vedula
- Draper, Cambridge, MA 02139, USA; (J.S.); (W.L.); (B.C.I.); (D.J.L.); (D.L.); (D.S.); (C.W.); (B.T.); (P.K.); (J.U.); (T.R.); (A.G.)
| | - Weixuan Lai
- Draper, Cambridge, MA 02139, USA; (J.S.); (W.L.); (B.C.I.); (D.J.L.); (D.L.); (D.S.); (C.W.); (B.T.); (P.K.); (J.U.); (T.R.); (A.G.)
| | - Brett C. Isenberg
- Draper, Cambridge, MA 02139, USA; (J.S.); (W.L.); (B.C.I.); (D.J.L.); (D.L.); (D.S.); (C.W.); (B.T.); (P.K.); (J.U.); (T.R.); (A.G.)
| | - Diana J. Lewis
- Draper, Cambridge, MA 02139, USA; (J.S.); (W.L.); (B.C.I.); (D.J.L.); (D.L.); (D.S.); (C.W.); (B.T.); (P.K.); (J.U.); (T.R.); (A.G.)
| | - Dan Lang
- Draper, Cambridge, MA 02139, USA; (J.S.); (W.L.); (B.C.I.); (D.J.L.); (D.L.); (D.S.); (C.W.); (B.T.); (P.K.); (J.U.); (T.R.); (A.G.)
| | - David Sutherland
- Draper, Cambridge, MA 02139, USA; (J.S.); (W.L.); (B.C.I.); (D.J.L.); (D.L.); (D.S.); (C.W.); (B.T.); (P.K.); (J.U.); (T.R.); (A.G.)
| | - Teryn R. Roberts
- Autonomous Reanimation and Evacuation (AREVA) Research Program, The Geneva Foundation, Brooks City Base, San Antonio, TX 78006, USA; (T.R.R.); (G.T.H.); (A.I.B.)
| | - George T. Harea
- Autonomous Reanimation and Evacuation (AREVA) Research Program, The Geneva Foundation, Brooks City Base, San Antonio, TX 78006, USA; (T.R.R.); (G.T.H.); (A.I.B.)
| | - Christian Wells
- Draper, Cambridge, MA 02139, USA; (J.S.); (W.L.); (B.C.I.); (D.J.L.); (D.L.); (D.S.); (C.W.); (B.T.); (P.K.); (J.U.); (T.R.); (A.G.)
| | - Bryan Teece
- Draper, Cambridge, MA 02139, USA; (J.S.); (W.L.); (B.C.I.); (D.J.L.); (D.L.); (D.S.); (C.W.); (B.T.); (P.K.); (J.U.); (T.R.); (A.G.)
| | - Paramesh Karandikar
- Draper, Cambridge, MA 02139, USA; (J.S.); (W.L.); (B.C.I.); (D.J.L.); (D.L.); (D.S.); (C.W.); (B.T.); (P.K.); (J.U.); (T.R.); (A.G.)
| | - Joseph Urban
- Draper, Cambridge, MA 02139, USA; (J.S.); (W.L.); (B.C.I.); (D.J.L.); (D.L.); (D.S.); (C.W.); (B.T.); (P.K.); (J.U.); (T.R.); (A.G.)
| | - Thomas Risoleo
- Draper, Cambridge, MA 02139, USA; (J.S.); (W.L.); (B.C.I.); (D.J.L.); (D.L.); (D.S.); (C.W.); (B.T.); (P.K.); (J.U.); (T.R.); (A.G.)
| | - Alla Gimbel
- Draper, Cambridge, MA 02139, USA; (J.S.); (W.L.); (B.C.I.); (D.J.L.); (D.L.); (D.S.); (C.W.); (B.T.); (P.K.); (J.U.); (T.R.); (A.G.)
| | - Derek Solt
- Thrombodyne, Inc., Salt Lake City, UT 84103, USA; (D.S.); (S.S.)
| | - Sahar Leazer
- Department of Medicine, F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA; (S.L.); (K.K.C.)
| | - Kevin K. Chung
- Department of Medicine, F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA; (S.L.); (K.K.C.)
| | | | - Andriy I. Batchinsky
- Autonomous Reanimation and Evacuation (AREVA) Research Program, The Geneva Foundation, Brooks City Base, San Antonio, TX 78006, USA; (T.R.R.); (G.T.H.); (A.I.B.)
| | - Jeffrey T. Borenstein
- Draper, Cambridge, MA 02139, USA; (J.S.); (W.L.); (B.C.I.); (D.J.L.); (D.L.); (D.S.); (C.W.); (B.T.); (P.K.); (J.U.); (T.R.); (A.G.)
| |
Collapse
|
19
|
Zakhary B, Sheldrake J, Pellegrino V. Extracorporeal membrane oxygenation and V/Q ratios: an ex vivo analysis of CO 2 clearance within the Maquet Quadrox-iD oxygenator. Perfusion 2021; 35:29-33. [PMID: 32397880 DOI: 10.1177/0267659120906767] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
While hypercapnia is typically well treated with modern membrane oxygenators, there are cases where respiratory acidosis persists despite maximal extracorporeal membrane oxygenation support. To better understand the physiology of gas exchange within the membrane oxygenator, CO2 clearance within an adult Maquet Quadrox-iD oxygenator was evaluated at varying blood CO2 tensions and V/Q ratios in an ex vivo extracorporeal membrane oxygenation circuit. A closed blood-primed circuit incorporating two Maquet Quadrox-iD oxygenators in series was attached to a Maquet PLS Rotaflow pump. A varying blend of CO2 and air was connected to the first oxygenator to provide different levels of pre-oxygenator blood CO2 levels (PvCO2) to the second oxygenator. Varying sweep gas flows of 100% O2 were connected to the second oxygenator to provide different V/Q ratios. Exhaust CO2 was directly measured, and then VCO2 and oxygenator dead space fraction (VD/VT) were calculated. VCO2 increased with increasing gas flow rates with plateauing at V/Q ratios greater than 4.0. Exhaust CO2 increased with PvCO2 in a linear fashion with the slope of the line decreasing at high V/Q ratios. Oxygenator dead space fraction varied with V/Q ratio-at lower ratios, dead space fraction was 0.3-0.4 and rose to 0.8-0.9 at ratios greater than 4.0. Within the Maquet Quadrox-iD oxygenator, CO2 clearance is limited at high V/Q ratios and correlated with elevated oxygenator dead space fraction. These findings have important implications for patients requiring high levels of extracorporeal membrane oxygenation support.
Collapse
Affiliation(s)
- Bishoy Zakhary
- Division of Pulmonary and Critical Care Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Jayne Sheldrake
- Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, Melbourne, VIC, Australia
| | - Vincent Pellegrino
- Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, Melbourne, VIC, Australia
| |
Collapse
|
20
|
Rochow N, Fusch C, Selvaganapathy PR. Reply to the "Comment on 'A Pumpless Microfluidic Neonatal Lung Assist Device for Support of Preterm Neonates in Respiratory Distress'" by Li Wang, Fang Li, Zhichun Feng, Yuan Shi. Adv Sci (Weinh) 2021; 8:2100831. [PMID: 34194955 PMCID: PMC8224426 DOI: 10.1002/advs.202100831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Indexed: 06/13/2023]
Affiliation(s)
- Niels Rochow
- Paracelsus Medical UniversityNurembergGermany
- Department of PediatricsUniversity Hospital NurembergGermany
| | - Christoph Fusch
- Department of PediatricsMcMaster UniversityHamiltonONL8S 4L7Canada
- Paracelsus Medical UniversityNurembergGermany
- Department of PediatricsUniversity Hospital NurembergGermany
| | | |
Collapse
|
21
|
Sakurai H, Fujiwara T, Ohuchi K, Hijikata W, Inoue Y, Seki H, Tahara T, Yokota S, Ogata A, Mizuno T, Arai H. Novel application of indocyanine green fluorescence imaging for real-time detection of thrombus in a membrane oxygenator. Artif Organs 2021; 45:1173-1182. [PMID: 34037247 DOI: 10.1111/aor.13999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/17/2021] [Accepted: 05/11/2021] [Indexed: 12/31/2022]
Abstract
Extracorporeal membrane oxygenation (ECMO) plays an important role in the coronavirus disease 2019 (COVID-19) pandemic. Management of thrombi in ECMO is generally an important issue; especially in ECMO for COVID-19 patients who are prone to thrombus formation, the thrombus formation in oxygenators is an unresolved issue, and it is very difficult to deal with. To prevent thromboembolic complications, it is necessary to develop a method for early thrombus detection. We developed a novel method for detailed real-time observation of thrombi formed in oxygenators using indocyanine green (ICG) fluorescence imaging. The purpose of this study was to verify the efficacy of this novel method through animal experiments. The experiments were performed three times using three pigs equipped with veno-arterial ECMO comprising a centrifugal pump (CAPIOX SL) and an oxygenator (QUADROX). To create thrombogenic conditions, the pump flow rate was set at 1 L/min without anticoagulation. The diluted ICG (0.025 mg/mL) was intravenously administered at a dose of 10 mL once an hour. A single dose of ICG was 0.25mg. The oxygenator was observed with both an optical detector (PDE-neo) and the naked eye every hour after measurement initiation for a total of 8 hours. With this dose of ICG, we could observe it by fluorescence imaging for about 15 minutes. Under ICG imaging, the inside of the oxygenator was observed as a white area. A black dot suspected to be the thrombus appeared 6-8 hours after measurement initiation. The thrombus and the black dot on ICG imaging were finely matched in terms of morphology. Thus, we succeeded in real-time thrombus detection in an oxygenator using ICG imaging. The combined use of ICG imaging and conventional routine screening tests could compensate for each other's weaknesses and significantly improve the safety of ECMO.
Collapse
Affiliation(s)
- Hironobu Sakurai
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tatsuki Fujiwara
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Katsuhiro Ohuchi
- Department of Advanced Surgical Technology Research and Development, Tokyo Medical and Dental University, Tokyo, Japan
| | - Wataru Hijikata
- School of Engineering, Tokyo Institute of Technology, Tokyo, Japan
| | - Yusuke Inoue
- Advanced Medical Engineering Research Center, Asahikawa Medical University, Asahikawa, Japan
| | - Haruna Seki
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tomoki Tahara
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Sachie Yokota
- Faculty of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Asato Ogata
- Faculty of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tomohiro Mizuno
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hirokuni Arai
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| |
Collapse
|
22
|
Gimbel AA, Hsiao JC, Kim ES, Lewis DJ, Risoleo TF, Urban JN, Borenstein JT. A high gas transfer efficiency microfluidic oxygenator for extracorporeal respiratory assist applications in critical care medicine. Artif Organs 2021; 45:E247-E264. [PMID: 33561881 DOI: 10.1111/aor.13935] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 01/10/2021] [Accepted: 02/05/2021] [Indexed: 12/15/2022]
Abstract
Advances in microfluidics technologies have spurred the development of a new generation of microfluidic respiratory assist devices, constructed using microfabrication techniques capable of producing microchannel dimensions similar to those found in human capillaries and gas transfer films in the same thickness range as the alveolar membrane. These devices have been tested in laboratory settings and in some cases in extracorporeal animal experiments, yet none have been advanced to human clinical studies. A major challenge in the development of microfluidic oxygenators is the difficulty in scaling the technology toward high blood flows necessary to support adult humans; such scaling efforts are often limited by the complexity of the fabrication process and the manner in which blood is distributed in a three-dimensional network of microchannels. Conceptually, a central advantage of microfluidic oxygenators over existing hollow-fiber membrane-based configurations is the potential for shallower channels and thinner gas transfer membranes, features that reduce oxygen diffusion distances, to result in a higher gas transfer efficiency defined as the ratio of the volume of oxygen transferred to the blood per unit time to the active surface area of the gas transfer membrane. If this ratio is not significantly higher than values reported for hollow fiber membrane oxygenators (HFMO), then the expected advantage of the microfluidic approach would not be realized in practice, potentially due to challenges encountered in blood distribution strategies when scaling microfluidic designs to higher flow rates. Here, we report on scaling of a microfluidic oxygenator design from 4 to 92 mL/min blood flow, within an order of magnitude of the flow rate required for neonatal applications. This scaled device is shown to have a gas transfer efficiency higher than any other reported system in the literature, including other microfluidic prototypes and commercial HFMO cartridges. While the high oxygen transfer efficiency is a promising advance toward clinical scaling of a microfluidic architecture, it is accompanied by an excessive blood pressure drop in the circuit, arising from a combination of shallow gas transfer channels and equally shallow distribution manifolds. Therefore, next-generation microfluidic oxygenators will require novel design and fabrication strategies to minimize pressure drops while maintaining very high oxygen transfer efficiencies.
Collapse
Affiliation(s)
| | | | - Ernest S Kim
- Bioengineering Division, Draper, Cambridge, MA, USA
| | | | | | | | | |
Collapse
|
23
|
Darby JRT, Berry MJ, Quinn M, Holman SL, Bradshaw EL, Jesse SM, Haller C, Seed M, Morrison JL. Haemodynamics and cerebral oxygenation of neonatal piglets in the immediate ex utero period supported by mechanical ventilation or ex utero oxygenator. J Physiol 2021; 599:2751-2761. [PMID: 33745149 DOI: 10.1113/jp280803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 03/15/2021] [Indexed: 12/29/2022] Open
Abstract
KEY POINTS The margin of human viability has extended to the extremes of gestational age (<24 weeks) when the lungs are immature and ventilator-induced lung injury is common. Artificial placenta technology aims to extend gestation ex utero in order to allow the lungs additional time to develop prior to entering an air-breathing environment. We compared the haemodynamics and cerebral oxygenation of piglets in the immediate period post-oxygenator (OXY) transition against both paired in utero measures and uniquely against piglets transitioned onto mechanical ventilation (VENT). Post-transition, OXY piglets became hypotensive with reduced carotid blood flow in comparison with both paired in utero measures and VENT piglets. The addition of a pump to the oxygenator circuit may be required to ensure haemodynamic stability in the immediate post-transition period. ABSTRACT Gestational age at birth is a major predictor of wellbeing; the lower the gestational age, the greater the risk of mortality and morbidity. At the margins of human viability (<24 weeks gestation) immature lungs combined with the need for early ventilatory support means lung injury and respiratory morbidity is common. The abrupt haemodynamic changes consequent on birth may also contribute to preterm-associated brain injury, including intraventricular haemorrhage. Artificial placenta technology aims to support oxygenation, haemodynamic stability and ongoing fetal development ex utero until mature enough to safely transition to a true ex utero environment. We aimed to characterize the impact of birth transition onto either an oxygenator circuit or positive pressure ventilation on haemodynamic and cerebral oxygenation of the neonatal piglet. At 112 days gestation (term = 115 days), fetal pigs underwent instrumentation surgery and transitioned onto either an oxygenator (OXY, n = 5) or ventilatory support (VENT, n = 8). Blood pressure (BP), carotid blood flow and cerebral oxygenation in VENT piglets rose from in utero levels to be significantly higher than OXY piglets post-transition. OXY piglet BP, carotid blood flow and carotid oxygen delivery (DO2 ) decreased from in utero levels post-transition; however, cerebral regional oxygen saturation (rSO2 ) was maintained at fetal-like levels. OXY piglets became hypoxaemic and retained CO2 . Whether OXY piglets are able to maintain cerebral rSO2 under these conditions for a prolonged period is yet to be determined. Improvements to OXY piglet oxygenation may lie in maintaining piglet BP at in utero levels and enhancing oxygenator circuit flow.
Collapse
Affiliation(s)
- Jack R T Darby
- Early Origins of Adult Health Research Group, Health and Biomedical Innovation, UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Mary J Berry
- Centre for Translational Physiology, University of Otago, Wellington, New Zealand.,Department of Paediatrics and Child Health, University of Otago, Wellington, New Zealand
| | - Megan Quinn
- Early Origins of Adult Health Research Group, Health and Biomedical Innovation, UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Stacey L Holman
- Early Origins of Adult Health Research Group, Health and Biomedical Innovation, UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Emma L Bradshaw
- Early Origins of Adult Health Research Group, Health and Biomedical Innovation, UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Sarah M Jesse
- Early Origins of Adult Health Research Group, Health and Biomedical Innovation, UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Christoph Haller
- Univeristy of Toronto and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mike Seed
- Univeristy of Toronto and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Janna L Morrison
- Early Origins of Adult Health Research Group, Health and Biomedical Innovation, UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| |
Collapse
|
24
|
Abstract
Extra Corporeal membrane oxygenation (ECMO) is one of the most advanced forms of life support therapy in the Intensive Care Unit. It relies on the principle where an external artificial circuit carries venous blood from the patient to a gas exchange device (oxygenator) within which blood becomes enriched with oxygen and has carbon dioxide removed. The blood is then returned to the patient via a central vein or an artery. The goal of ECMO is to provide a physiologic milieu for recovery in refractory cardiac/respiratory failure. The technology is not a definitive treatment for a disease, but provides valuable time for the body to recover. In that way it can be compared to a bridge, where patients are initiated on ECMO as a bridge to recovery, bridge to decision making, bridge to transplant or bridge to diagnosis. The use of this modality in children is not backed by a lot of randomized controlled trials, but the use has increased dramatically in our country in last 10 years. This article is not intended to provide an in-depth overview of ECMO, but outlines the basic principles that a pediatric intensive care physician should know in order to manage a kid on ECMO support.
Collapse
Affiliation(s)
- Shubhadeep Das
- Department of Pediatric Cardiac Intensive Care, NH Narayana Superspeciality Hospital, Howrah, West Bengal, India
| | - Sandip Gupta
- Department of Pediatric Intensive Care, Aster CMI Hospital, Bangalore, Karnataka, India
| | - Debasis Das
- Department of Cardiac Surgery, NH Narayana Superspeciality Hospital, Howrah, West Bengal, India
| | - Nilanjan Dutta
- Department of Cardiac Surgery, NH Narayana Superspeciality Hospital, Howrah, West Bengal, India
| |
Collapse
|
25
|
Srey R, Rance G, Handrahan J, Smith T, Leissner KB, Zenati MA. Fraction of expired oxygen: an additional safety approach to monitor oxygen delivery to the heart lung machine oxygenator. Perfusion 2021; 37:331-333. [PMID: 33739181 DOI: 10.1177/02676591211001594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Monitoring oxygen delivery to the oxygenator of a heart lung machine (HLM) is typically accomplished with an O2 analyzer connected to the gas inflow line. It is assumed when the FiO2 is greater than 21% that oxygen is being delivered to the oxygenator. However, this assumption is imperfect because the connection of the inflow line to the oxygenator is downstream from the O2 analyzer. FiO2 monitoring will not alert the perfusionist if the inflow line is not actually connected to the oxygenator. Measuring the fraction of expired oxygen (FEO2) is a more reliable way of monitoring O2 delivery. METHODS An O2 analyzer was placed on the scavenging line that is attached to the exhaust port of oxygenator (FEO2). RESULTS Whenever the FiO2 is greater than 21%, and the inflow line is properly connected, the FEO2 exiting the oxygenator is greater than 21%. The FEO2 falls to 21% when the inflow line is not functioning. CONCLUSION Monitoring the FEO2 is a more reliable way to verify O2 delivery to an oxygenator. An alarm can be set on the FEO2 monitor to alert the perfusionist if the FEO2 falls below a predetermined threshold so any issue with O2 delivery will always be recognized.
Collapse
Affiliation(s)
- Rithy Srey
- Division of Cardiac Surgery, Veterans Affairs Boston Healthcare System, Boston, MA, USA
| | - Geoffrey Rance
- Division of Cardiac Surgery, Veterans Affairs Boston Healthcare System, Boston, MA, USA
| | - John Handrahan
- Division of Cardiac Surgery, Veterans Affairs Boston Healthcare System, Boston, MA, USA
| | - Trevor Smith
- Division of Cardiac Surgery, Veterans Affairs Boston Healthcare System, Boston, MA, USA
| | - Kay B Leissner
- Department of Anesthesiology and Critical Care Medicine, Veterans Affairs Boston Healthcare System, Boston, MA, USA
| | - Marco A Zenati
- Division of Cardiac Surgery, Veterans Affairs Boston Healthcare System, Boston, MA, USA.,Harvard Medical School, Cambridge, MA, USA
| |
Collapse
|
26
|
Nakamura Y, Nakakita T, Yamamoto K, Kamada A, Iguchi S, Umimoto K. Utility of gas inlet pressure monitoring in extracorporeal membrane oxygenation. Int J Artif Organs 2020; 44:332-339. [PMID: 33949236 DOI: 10.1177/0391398820962122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Purpose: Condensation that clogs the hollow fibers of the oxygenation and accumulation of plasma leaks reduces oxygenated lung capacity. In this study, artificial We evaluated whether monitoring changes in lung gas inlet pressure was a way to predict these complications. METHODS Changes in gas inlet pressure and oxygenation capacity of three different prostheses (BIOCUBE6000, EXCELUNG PRIME, and Capiox-LX) Evaluated the relationship. When simulating plasma leakage using BIOCUBE6000, sodium dodecyl sulfate (SDS) (1%, 0.1%, A solution of 0.01%, and RO water) reduced surface tension. During 120 minutes of circulation, changes in gas inlet pressure and leakage from the membrane into the gas flow path The amount of fluid was measured. RESULTS There was a significant negative correlation between the gas inlet pressure changes and the oxygenation capacity of all three oxygenators (BIOCUBE6000: R2 = 0.957, EXCELUNG PRIME: R2 = 0.946, Capiox-LX: R2 = 0.878). After 120 min of SDS solution circulation using the BIOCUBE6000, both the gas inlet pressure and the volume of fluid leaking from the membrane into the gas flow path increased in proportion to the SDS solution concentration: RO water (0.56 ± 0.11 mmHg and 16.67 mL ± 0.94 mL), 0.01% SDS (0.98 ± 0.11 mmHg and 23.3 ± 0.47 mL,) 0.1% SDS (1.64 ± 0.21 mmHg and 29.0 ± 1.63 mL), and 1%SDS (14.3 ± 0.27 mmHg and 36.7 ± 0.47 mL) (n = 3). CONCLUSION This study confirmed that monitoring the gas inlet pressure changes of an oxygenator during ECMO is clinically useful.
Collapse
Affiliation(s)
- Yuki Nakamura
- Osaka Electro-Communication University - Shijonawate Campus, Shijonawate, Japan
| | - Takafumi Nakakita
- Osaka Electro-Communication University - Shijonawate Campus, Shijonawate, Japan
| | - Kazuhiko Yamamoto
- Osaka Electro-Communication University - Shijonawate Campus, Shijonawate, Japan
| | - Aki Kamada
- Osaka Electro-Communication University - Shijonawate Campus, Shijonawate, Japan
| | - Shinichi Iguchi
- Osaka Electro-Communication University - Shijonawate Campus, Shijonawate, Japan
| | - Koichi Umimoto
- Osaka Electro-Communication University - Shijonawate Campus, Shijonawate, Japan
| |
Collapse
|
27
|
Verbelen T, Halwes M, Meyns B. First in vivo assessment of RAS-Q technology as lung support device for pulmonary hypertension. Int J Artif Organs 2020; 44:243-250. [PMID: 32907461 PMCID: PMC8041442 DOI: 10.1177/0391398820954217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Objectives: To assess the in vivo hemodynamic effects on the pressure overloaded right ventricle of RAS-Q® technology, the world’s first gas exchanger with a fully integrated compliance. Methods: In six acute in vivo trials RAS-Q was implanted in sheep between the pulmonary artery and left atrium. Right ventricular pressure overload was induced by pulmonary artery banding. Pressures and flows were recorded in baseline, moderate and severe pulmonary hypertension conditions. In one trial, RAS-Q was benchmarked against the pediatric Quadrox-i®. Results: With 1.00 and 1.17 L/min, RAS-Q delivered 31% and 39% of the total cardiac output in moderate and severe pulmonary hypertension, respectively. Pulmonary artery pressures and mean pulmonary artery pressure/mean arterial blood pressure ratio successfully decreased, implying a successful right ventricular unloading. Cardiac output was restored to normal levels in both pulmonary hypertension conditions. With both devices in parallel, RAS-Q provided three times higher flow rates and a 10 times higher pressure relief, compared to the pediatric Quadrox-i. Conclusion: A gas exchanger with a fully integrated compliance better unloads the right ventricle compared to a non-compliant gas exchanger and it can restore cardiac output to normal levels in cases of severe pulmonary hypertension.
Collapse
Affiliation(s)
- Tom Verbelen
- Department of Cardiac Surgery, University Hospitals Leuven and Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | | | - Bart Meyns
- Department of Cardiac Surgery, University Hospitals Leuven and Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| |
Collapse
|
28
|
Condello I, Moscarelli M, Santarpino G, Fattouch K, Nasso G, Speziale G. Water condensation from gas outlet of oxygenator. J Card Surg 2020; 35:2039-2040. [PMID: 32652821 DOI: 10.1111/jocs.14841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 06/26/2020] [Accepted: 06/26/2020] [Indexed: 11/30/2022]
Abstract
Condensation and water loss from gas output of the cardiopulmonary bypass (CPB) oxygenator has been the study object of several research. However, little is known about the propagation of the condensation formed at the level of oxygenator and how potentially it can contaminate the surrounding environment. We aimed to document the moment of formation of the 'gas steam' derived from the CPB oxygenator during cardiac surgery with thermography imaging. Thermographic camera is a device that creates an image using infrared radiation, similar to a common camera that forms an image using visible light. The brightest (warmest) parts of the image are customarily colored white, the intermediate temperatures reds and yellows, and the dimmest (coolest) parts black. Thermal image captures the condensation phenomenon around the oxygenator perimeter with the same color/temperature code (yellow) of gas outlet. The use of aspiration at the level of the gas outlet could also favor the elimination of the condensation, improve gas exchanges, and potentially reduce the spread of hazardous substances in the operating room.
Collapse
Affiliation(s)
- Ignazio Condello
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, Bari, Italy
| | - Marco Moscarelli
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, Bari, Italy.,Department of Cardiac Surgery, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Giuseppe Santarpino
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, Bari, Italy.,Department of Cardiac Surgery, Paracelsus Medical University, Nuremberg, Germany.,Cardiac Surgery Unit, Department of Experimental and Clinical Medicine, "Magna Graecia" University of Catanzaro, Catanzaro, Italy
| | - Khalil Fattouch
- Department of Cardiac Surgery, Maria Eleonora Hospital, GVM Care & Research, Palermo, Italy
| | - Giuseppe Nasso
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, Bari, Italy
| | - Giuseppe Speziale
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, Bari, Italy
| |
Collapse
|
29
|
Cies JJ, Moore WS, Giliam N, Low T, Marino D, Deacon J, Enache A, Chopra A. Oxygenator impact on voriconazole in extracorporeal membrane oxygenation circuits. Perfusion 2020; 35:529-533. [PMID: 32627659 DOI: 10.1177/0267659120937906] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
INTRODUCTION To determine the oxygenator impact on alterations of voriconazole in a contemporary neonatal/pediatric (1/4 inch) and adolescent/adult (3/8 inch) extracorporeal membrane oxygenation circuit including the Quadrox-i® oxygenator. METHODS Simulated closed-loop extracorporeal membrane oxygenation circuits (1/4 and 3/8 inch) were prepared with a Quadrox-i pediatric and Quadrox-i adult oxygenator and blood primed. In addition, 1/4- and 3/8-inch circuits were also prepared without an oxygenator in series. A one-time dose of voriconazole was administered into the circuits, and serial pre- and post-oxygenator concentrations were obtained at 5 minutes, 1, 2, 3, 4, 5, 6, and 24 hour time points. Voriconazole was also maintained in a glass vial and samples were taken from the vial at the same time periods for control purposes to assess for spontaneous drug degradation. RESULTS For the 1/4-inch circuit, there was an approximate mean of 64-67% voriconazole loss with the oxygenator in series and mean of 15-20% voriconazole loss without an oxygenator in series at 24 hours. For the 3/8-inch circuit, there was an approximate mean of 44-51% voriconazole loss with the oxygenator in series and a mean of 8-12% voriconazole loss without an oxygenator in series at 24 hours. The reference voriconazole concentrations remained relatively constant during the entire study period demonstrating that the drug loss in each size of the extracorporeal membrane oxygenation circuit with or without an oxygenator was not a result of spontaneous drug degradation. CONCLUSION This ex vivo investigation demonstrated substantial voriconazole loss within an extracorporeal membrane oxygenation circuit with an oxygenator in series with both sizes of the Quadrox-i oxygenator at 24 hours and no significant voriconazole loss in the absence of an oxygenator. Further evaluations with multiple dose in vitro and in vivo investigations are needed before specific voriconazole dosing recommendations can be made for clinical application with extracorporeal membrane oxygenation.
Collapse
Affiliation(s)
- Jeffrey J Cies
- The Center for Pediatric Pharmacotherapy LLC, Pottstown, PA, USA.,Drexel University College of Medicine, Philadelphia, PA, USA
| | - Wayne S Moore
- The Center for Pediatric Pharmacotherapy LLC, Pottstown, PA, USA
| | - Nadji Giliam
- St. Christopher's Hospital for Children, Philadelphia, PA, USA
| | - Tracy Low
- St. Christopher's Hospital for Children, Philadelphia, PA, USA
| | - Daniel Marino
- St. Christopher's Hospital for Children, Philadelphia, PA, USA
| | - Jillian Deacon
- St. Christopher's Hospital for Children, Philadelphia, PA, USA
| | - Adela Enache
- Atlantic Diagnostic Laboratories, Bensalem, PA, USA
| | - Arun Chopra
- The Center for Pediatric Pharmacotherapy LLC, Pottstown, PA, USA.,NYU Langone Medical Center, New York, NY, USA.,NYU School of Medicine, New York, NY, USA
| |
Collapse
|
30
|
Hugo JDV, Yeung A, Weerwind PW. To Purge or Not to Purge. J Extra Corpor Technol 2020; 52:22-6. [PMID: 32280141 DOI: 10.1182/ject-1900022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 02/24/2020] [Indexed: 11/20/2022]
Abstract
To remove gaseous microemboli (GME) using an oxygenator with an integrated arterial filter, it is recommended by some manufacturers to purge the oxygenator as an additional safety feature while on bypass. In this in vitro study, we evaluated whether purging of oxygenators with an integrated arterial filter is efficient in reducing GME. Five different types of commercially available contemporary oxygenators with an integrated arterial filter based on progressive filter filtration (1), cascade filtration (1), screen filtration (2), or self-venting (1) were tested for their efficiency in removing GME while keeping the purge line open or closed. A bubble counter was used for pre- and post-oxygenator GME signaling, from which the filter efficiency was computed. Freshly drawn heparinized porcine blood was used at blood flow rates of 3 and 5 L/min. Three units of each oxygenator were tested with its specific reservoir at a fixed volume level of 1,500 mL. GME load was introduced into the venous line at 1,000 mL air/min. Measurements started as soon as GME were detected by the pre-oxygenator probe and then continued for 1 minute. There was no statistically significant difference in filter efficiency between the purged and non-purged groups for specific oxygenators. At a blood flow of 3 L/min, the average filter efficiency stayed approximately invariable when comparing the non-purged and purged groups, where 89.1-88.2% indicated the largest difference between the groups. At a blood flow rate of 5 L/min, the filter efficiency changed in one screen filter group from an average of 55.7% in the non-purged group to 42.4% in the purged group. Other filter efficiencies at the blood flow rate of 5 L/min for non-purged compared with purged groups were, respectively, 98.0 vs. 98.0% (screen filtration), 88.6 vs. 85.8% (self-venting filtration), 82.8 vs. 75.5% (progressive filter filtration), and 65.4 vs. 65.1% (cascade filtration). Based on these results, purging while confronted with continuous GME challenge did not result in an increased filter efficiency.
Collapse
|
31
|
Hendrix RH, Yeung AK, Ganushchak YM, Weerwind PW. The effect of flow and pressure on the intra oxygenator flow path of different contemporary oxygenators: an in vitro trial. Perfusion 2020; 35:658-663. [PMID: 32056504 PMCID: PMC7536508 DOI: 10.1177/0267659119899883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Introduction: This study analyzed the effect of different flows and pressures on the
intraoxygenator flow path in three contemporary oxygenators and its
consequences for oxygen transfer efficiency. Methods: In an experimental setup, intraoxygenator flow path parameters were analyzed
at post-oxygenator pressures of 150, 200, and 250 mm Hg and at flows ranging
from 2 L/min to the oxygenators’ maximum permitted flow, with and without
pulsatility. The oxygen gradient and the oxygen transfer per minute and per
100 mL blood were calculated using previously collected clinical data and
compared with the flow path parameters. Results: Increasing pressure did not affect the flow path parameters, whereas
pulsatile flow led to significantly increased dynamic oxygenator blood
volumes. Increased flow resulted in decreased values of the flow path
parameters in all oxygenators, indicating increased flow through short
pathways in the oxygenator. In parallel, oxygen transfer/100 mL blood
decreased in all oxygenators (average 2.5 ± 0.4 to 2.4 ± 0.3 mL/dL,
p > 0.001) and the oxygen gradient increased from 229 ± 45 to
287 ± 29 mm Hg, p > 0.001, indicating decreased oxygen transfer
efficiency. Oxygen transfer/min increased (101 ± 15 to
143 ± 20 mL/min/m2, p > 0.001), however, due to the
increased flow through the oxygenator. Conclusion: Varying trans-membrane oxygenator pressures did not lead to changes in the
intraoxygenator flow path, while an increased flow exhibited lower flow path
parameters resulting in less efficient use of the gas exchange compartment.
The latter was confirmed by a decrease in O2 transfer efficiency
during higher blood flows.
Collapse
Affiliation(s)
- Rik Hj Hendrix
- Department of Extra-Corporeal Circulation, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Alexander Ks Yeung
- Department of Extra-Corporeal Circulation, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Yuri M Ganushchak
- Department of Extra-Corporeal Circulation, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Patrick W Weerwind
- Department of Extra-Corporeal Circulation, Maastricht University Medical Centre, Maastricht, The Netherlands
| |
Collapse
|
32
|
Alston RP, Kitchen C, McKenzie C, Homer N. A Comparison of the Arterial Blood Concentration of Isoflurane During Cardiopulmonary Bypass Between 2 Polypropylene Oxygenators. J Cardiothorac Vasc Anesth 2019; 34:1184-1190. [PMID: 31548106 DOI: 10.1053/j.jvca.2019.08.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 08/09/2019] [Accepted: 08/14/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The primary objective was to compare arterial blood concentration of isoflurane during cardiopulmonary bypass (CPB) between 2 polypropylene oxygenators of different designs. Secondary objectives were to compare levels of Bispectral Index Score (BIS) during CPB between the 2 oxygenators and to examine the relationships between oxygenator exhaust and arterial blood concentrations of isoflurane and BIS. DESIGN Single, blinded, randomized control trial. SETTING Teaching hospital. PARTICIPANTS Twenty-five patients undergoing cardiac surgery with CPB. INTERVENTIONS Subjects were randomly assigned (1:1) to Inspire 8F (Sorin) or Affinity Fusion (Medtronic) oxygenators. MEASUREMENTS AND MAIN RESULTS The mean arterial blood concentration in the Inspire 8F (Sorin) group was 59 (standard deviation [SD] 23) µg/mL, compared with 53 (SD 17) µg/mL in the Affinity Fusion (Medtronic) group with a nonsignificant mean difference of 6 (95% confidence interval = -11, 22) µg/mL (t[23] = 0.676, p = 0.50). No significant difference in BIS was found between the groups (p = 0.896). Moderate and strong, negative correlations respectively, were found between arterial and oxygenator exhaust correlations and BIS (r = -0.472, p < 0.05; r = -0.812, p < 0.001). A strong, positive correlation was found between arterial and exhaust isoflurane concentration (r = 0.810, p < 0.0005). CONCLUSIONS No significant difference in arterial blood concentration of isoflurane or BIS was found between the Inspire 8F (Sorin) and Affinity Fusion (Medtronic) oxygenators. A significant positive correlation was found between arterial blood and oxygenator exhaust concentrations of isoflurane, as well as significant negative correlations between both arterial and oxygenator exhaust concentrations of isoflurane and BIS.
Collapse
Affiliation(s)
- R Peter Alston
- Department of Anaesthesia, Critical Care and Pain Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK.
| | - Cathy Kitchen
- School of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Christopher McKenzie
- Department of Anaesthesia, Critical Care and Pain Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Natalie Homer
- Clinical Research Facility Mass Spectrometry Core Centre for Cardiovascular Research, Queens Medical Research Institute, University of Edinburgh, Edinburgh, UK
| |
Collapse
|
33
|
Majewski MB, Lee R, Chabot D, McGee E, LeVan P. Hypoxemia on Cardiopulmonary Bypass Caused by a Patient's Oxygen Consumption Exceeding the Capacity of a Membrane Oxygenator. J Cardiothorac Vasc Anesth 2019; 33:2521-2524. [PMID: 30940495 DOI: 10.1053/j.jvca.2019.02.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 02/11/2019] [Accepted: 02/12/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Michael B Majewski
- Department of Anesthesiology, Loyola University Medical Center, Maywood, IL.
| | - Rebecca Lee
- Department of Anesthesiology, Loyola University Medical Center, Maywood, IL
| | | | - Edwin McGee
- Loyola University Medical Center, Maywood, IL
| | - Pierre LeVan
- Department of Anesthesiology, Loyola University Medical Center, Maywood, IL
| |
Collapse
|
34
|
Alston RP, Connelly M, MacKenzie C, Just G, Homer N. The depth of anaesthesia associated with the administration of isoflurane 2.5% during cardiopulmonary bypass. Perfusion 2019; 34:392-398. [PMID: 30638148 DOI: 10.1177/0267659118822946] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Administering isoflurane 2.5% into the oxygenator during cardiopulmonary bypass results in no patient movement. However, doing so may result in an excessive depth of anaesthesia particularly, when hypothermia is induced. Bispectral index and arterial blood and oxygenator exhaust concentrations of volatile anaesthetics should be related to depth of anaesthesia. The primary aim of this study was to measure the depth of anaesthesia using bispectral index, resulting from administering isoflurane 2.5% into the oxygenator during cardiopulmonary bypass, and secondary aims were to examine the relationships between blood and oxygenator exhaust isoflurane concentrations and bispectral index. METHODS Arterial and mixed-venous blood samples were aspirated at three time points during cardiopulmonary bypass and measured for isoflurane concentration using mass spectrometry. Simultaneously, oxygenator exhaust isoflurane concentration, nasopharyngeal temperature and bispectral index were recorded. RESULTS When averaged across the three time points, all patients had a bispectral index score below 40 (binomial test, p < 0.001). There were no significant correlations between bispectral index score and arterial or mixed-venous blood isoflurane concentrations (r = -0.082, p = 0.715; r = -0.036, p = 0.874) and oxygenator exhaust gas concentration of isoflurane (r = -0.369, p = 0.091). CONCLUSION When 2.5% isoflurane was administered into the sweep gas supply to the oxygenator during cardiopulmonary bypass, all patients experienced a bispectral index score less than 40 and no significant relationship was found between either arterial or mixed-venous blood or oxygenator exhaust concentrations of isoflurane and bispectral index.
Collapse
Affiliation(s)
- R Peter Alston
- 1 Department of Anaesthesia, Critical Care and Pain Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Michael Connelly
- 2 School of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, UK.,3 Intensive Care Unit, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Christopher MacKenzie
- 4 Department of Anaesthesia and Critical Care, School of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, UK
| | - George Just
- 5 Mass Spectrometry Core, Edinburgh Clinical Research Facility, Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, UK
| | - Natalie Homer
- 5 Mass Spectrometry Core, Edinburgh Clinical Research Facility, Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, UK
| |
Collapse
|
35
|
Durila M, Smetak T, Hedvicak P, Berousek J. Extracorporeal membrane oxygenation-induced fibrinolysis detected by rotational thromboelastometry and treated by oxygenator exchange. Perfusion 2019; 34:330-333. [PMID: 30632877 DOI: 10.1177/0267659118824218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Coagulopathy and bleeding is a frequent phenomenon in patients on extracorporeal membrane oxygenation. The cause may be multifactorial and it may change over time. We present a case when bleeding was caused by hyperfibrinolysis induced by oxygenator. The diagnosis was established by comparing thromboelastometry result from blood obtained before and after oxygenator. Hyperfibrinolysis and bleeding could be successfully treated merely by oxygenator exchange.
Collapse
Affiliation(s)
- Miroslav Durila
- 1 Department of Anaesthesiology and Intensive Care Medicine, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Tomas Smetak
- 2 Department of Cardiovascular Surgery, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Pavel Hedvicak
- 2 Department of Cardiovascular Surgery, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Jan Berousek
- 1 Department of Anaesthesiology and Intensive Care Medicine, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| |
Collapse
|
36
|
Benstoem C, Bleilevens C, Borchard R, Stoppe C, Goetzenich A, Autschbach R, Breuer T. Retrospective Analysis of Air Handling by Contemporary Oxygenators in the Setting of Cardiac Surgery. Ann Thorac Cardiovasc Surg 2018; 24:230-237. [PMID: 29998925 PMCID: PMC6197996 DOI: 10.5761/atcs.oa.18-00019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Purpose: Cardiac surgery with the use of extracorporeal circulation is associated with a significant risk for gaseous microemboli (GME) despite excellent surgical techniques and highest operative standards. GME are associated with postoperative neurocognitive dysfunction and negative clinical outcome. This study determines whether oxygenator design has influence on perioperative outcome after cardiac surgery. Methods: Three different oxygenator models with integrated arterial filter (HiliteAF 7000, Fusion Affinity, and Synthesis) were retrospectively evaluated in 55 patients undergoing elective cardiac surgery with the use of extracorporeal circulation. The two-channel ultrasound bubble counter BCC200 was used to detect GME in real time. Results: All three oxygenators differ in terms of structural specifications and have different rates of number and volume GME reduction. The Fusion Affinity had the lowest arterial GME volume (1.81 µL ± 0.23 µL), which was statistically significant compared to the Synthesis (3.37 µL ± 0.71 µL, p = 0.014). However, the Synthesis had lower absolute numbers at the venous GME count (31771 µL ± 6579 µL) versus the Fusion Affinity (49304 µL ± 8196 µL). However, with regard to clinical outcome after cardiac surgery (duration of invasive and non-invasive mechanical ventilation, incidence of delirium, stroke, acute renal failure, or new myocardial infarction), we found no differences between groups. Conclusion: Despite significant differences in the design specifications, all oxygenators eliminated relevant GME volumes safely.
Collapse
|
37
|
Abstract
Extracorporeal Membrane Oxygenation (ECMO) is a resource intensive, life-preserving support system that has seen ever-expanding clinical indications as technology and collective experience has matured. Clinicians caring for patients who develop pulmonary failure secondary to cardiac failure can find themselves in unique situations where traditional ECMO may not be the ideal clinical solution. Existing paracorporeal ventricular assist device (VAD) technology or unique patient physiologies offer the opportunity for thinking "outside the box." Hybrid ECMO approaches include splicing oxygenators into paracorporeal VAD systems and alternative cannulation strategies to provide a staged approach to transition a patient from ECMO to a VAD. Alternative technologies include the adaptation of ECMO and extracorporeal CO2 removal systems for specific physiologies and pediatric aged patients. This chapter will focus on: (1) hybrid and alternative approaches to extracorporeal support for pulmonary failure, (2) patient selection and, (3) technical considerations of these therapies. By examining the successes and challenges of the relatively select patients treated with these approaches, we hope to spur appropriate research and development to expand the clinical armamentarium of extracorporeal technology.
Collapse
Affiliation(s)
- Timothy M Maul
- Department of Cardiac Surgery, Nemours Children's Hospital, Orlando, FL, United States.,Department of Biomedical Engineering, University of Pittsburgh, Pittsburgh, PA, United States
| | - Jennifer S Nelson
- Department of Cardiac Surgery, Nemours Children's Hospital, Orlando, FL, United States
| | - Peter D Wearden
- Department of Cardiac Surgery, Nemours Children's Hospital, Orlando, FL, United States.,Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| |
Collapse
|
38
|
Stanzel RDP, Henderson M. Is There a Relationship between Pressure Gradients through Contemporary Oxygenators and Immune Cell Proliferation during Cardiopulmonary Bypass? A Pilot Study. J Extra Corpor Technol 2017; 49:160-167. [PMID: 28979039 PMCID: PMC5621579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 06/11/2017] [Indexed: 06/07/2023]
Abstract
There have been many advances in the perfusion equipment used for cardiopulmonary bypass (CPB) surgery. A key component, the membrane oxygenator, has had a number of modifications in recent years and a recent clinical evaluation demonstrated disparity in various aspects of device performance. One difference among oxygenators, which to-date has received little attention, was the impact on the patient's immune cells, with some oxygenators producing a significantly greater increase in immune cell numbers after cross clamp. Such increases in immune cell proliferation may contribute to the development of a systemic inflammatory response (SIR), which has been demonstrated to have a negative impact on patient outcomes. Although factors contributing to immune cell proliferation during CPB are recognized to be multi-factorial, the goal of the current communication was to perform an ad hoc analysis of these raw data for evidence that pressure gradients through an oxygenator contributes to this outcome. Despite the observation that higher-pressure gradient oxygenators appeared to associate with increased immune cell proliferation, no correlation was detected in this analysis. This finding, however, provides further evidence for the complex nature of inflammation during CPB, which deserves ongoing discussion and investigation.
Collapse
Affiliation(s)
- Roger D P Stanzel
- Cardiovascular Perfusion, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Mark Henderson
- Cardiovascular Perfusion, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| |
Collapse
|
39
|
Daniel JM, Bernard PA, Skinner SC, Bhandary P, Ruzic A, Bacon MK, Ballard HO. Hollow Fiber Oxygenator Composition Has a Significant Impact on Failure Rates in Neonates on Extracorporeal Membrane Oxygenation: A Retrospective Analysis. J Pediatr Intensive Care 2017; 7:7-13. [PMID: 31073461 DOI: 10.1055/s-0037-1599150] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 01/22/2017] [Indexed: 10/20/2022] Open
Abstract
In extracorporeal life support (ECLS), there are two main types of oxygenators in clinical use for neonates: polymethylpentene (PMP) hollow fiber and polypropylene (PP) hollow fiber. A retrospective study was performed on neonates ( n = 44) who had undergone ECLS for noncardiac indications from 2009 to 2015. Between the two groups (PMP n = 21, PP n = 23), the PP oxygenators failed 91% of the time, whereas the PMP oxygenators failed 43% of the time ( p < 0.05). Analysis suggests PMP oxygenators are less prone to failure than PP oxygenators, and they require fewer number of oxygenator changes during a neonatal ECLS.
Collapse
Affiliation(s)
- John M Daniel
- Division of Neonatology, Department of Pediatrics, University of Kentucky, Lexington, Kentucky, United States
| | - Philip A Bernard
- Division of Pediatric Critical Care, Department of Pediatrics, University of Kentucky, Lexington, Kentucky, United States
| | - Sean C Skinner
- Division of Pediatric Surgery, Department of Surgery, University of Kentucky, Lexington, Kentucky, United States
| | - Prasad Bhandary
- Division of Neonatology, Department of Pediatrics, University of Kentucky, Lexington, Kentucky, United States
| | - Ana Ruzic
- Division of Pediatric Surgery, Department of Surgery, University of Kentucky, Lexington, Kentucky, United States
| | - Matthew K Bacon
- Division of Pediatric Critical Care, Department of Pediatrics, University of Kentucky, Lexington, Kentucky, United States
| | - Hubert O Ballard
- Division of Neonatology, Department of Pediatrics, University of Kentucky, Lexington, Kentucky, United States
| |
Collapse
|
40
|
Abstract
Cardiopulmonary bypass (CPB) provides a bloodless field for cardiac surgery. It incorporates an extracorporeal circuit to provide physiological support in which venous blood is drained to a reservoir, oxygenated and sent back to the body using a pump. Team effort between surgeon, perfusionist and anaesthesiologist is paramount for the successful use of CPB. However, it also has its share of complications and strategies to reduce these complications are the area of the current research.
Collapse
Affiliation(s)
- Manjula Sarkar
- Department of Anaesthesia, Seth G. S. Medical College, Mumbai, Maharashtra, India
| | - Vishal Prabhu
- Department of Anaesthesia, Seth G. S. Medical College, Mumbai, Maharashtra, India
| |
Collapse
|
41
|
Ramakrishna H, Gutsche JT, Evans AS, Patel PA, Weiner M, Morozowich ST, Gordon EK, Riha H, Shah R, Ghadimi K, Zhou E, Fernadno R, Yoon J, Wakim M, Atchley L, Weiss SJ, Stein E, Silvay G, Augoustides JGT. The Year in Cardiothoracic and Vascular Anesthesia: Selected Highlights From 2015. J Cardiothorac Vasc Anesth 2015; 30:1-9. [PMID: 26847747 DOI: 10.1053/j.jvca.2015.09.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Indexed: 12/14/2022]
Affiliation(s)
| | - Jacob T Gutsche
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Adam S Evans
- Icahn School of Medicine, Mount Sinai Hospital, New York, NY
| | - Prakash A Patel
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Menachem Weiner
- Icahn School of Medicine, Mount Sinai Hospital, New York, NY
| | | | - Emily K Gordon
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Hynek Riha
- Department of Anesthesiology and Intensive Care Medicine, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Ronak Shah
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Kamrouz Ghadimi
- Department of Anesthesiology and Critical Care, Duke University, Durham, NC
| | - Elizabeth Zhou
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Rohesh Fernadno
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jeongae Yoon
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Mathew Wakim
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Lance Atchley
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Stuart J Weiss
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Erica Stein
- Department of Anesthesiology, Ohio State University, Columbus, OH
| | - George Silvay
- Icahn School of Medicine, Mount Sinai Hospital, New York, NY
| | - John G T Augoustides
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
| |
Collapse
|
42
|
Okahara S, Tsuji T, Ninomiya S, Miyamoto S, Takahashi H, Soh Z, Sueda T. Hydrodynamic characteristics of a membrane oxygenator: modeling of pressure-flow characteristics and their influence on apparent viscosity. Perfusion 2014; 30:478-83. [PMID: 25467939 DOI: 10.1177/0267659114562101] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The viscosity obtained from pressure-flow characteristics of an oxygenator may help to detect factors that change oxygenator resistance. The objective of this study was to model pressure-flow characteristics of a membrane oxygenator with an integrated arterial filter and to quantify their influence on apparent viscosity of non-Newtonian fluids. One Newtonian fluid (glycerin solution) and two non-Newtonian fluids (whole bovine blood and a human red blood cell suspension) were perfused through an oxygenator and their pressure-flow characteristics examined systematically. Four resistance parameters for the pressure gradient characteristics approximation equation were obtained by the least squares method from the relational expression of pressure-flow characteristics and viscosity. For all three fluids, a non-linear flow to pressure change was observed with a coefficient of determination of almost 1 by exponential approximation. The glycerin solution had a higher pressure gradient (10-70%) than the other fluids; the apparent viscosity of the non-Newtonian fluids was around 35% lower than the static one measured by a torsional oscillation viscometer. Overall, our study demonstrated that the influence on the apparent viscosity of non-Newtonian fluids can be quantified by pressure gradient differences in a membrane oxygenator with an integrated arterial filter.
Collapse
Affiliation(s)
- S Okahara
- Department of System Cybernetics, Graduate School of Engineering, Hiroshima University, Hiroshima, Japan Department of Clinical Engineering, Hiroshima University Hospital, Hiroshima, Japan
| | - T Tsuji
- Department of System Cybernetics, Institute of Engineering, Hiroshima University, Hiroshima, Japan
| | - S Ninomiya
- Department of Clinical Engineering, Hiroshima International University, Hiroshima, Japan
| | - S Miyamoto
- Department of Clinical Engineering, Hiroshima University Hospital, Hiroshima, Japan
| | - H Takahashi
- Department of Clinical Engineering, Hiroshima University Hospital, Hiroshima, Japan
| | - Z Soh
- Department of System Cybernetics, Institute of Engineering, Hiroshima University, Hiroshima, Japan
| | - T Sueda
- Department of Cardiovascular Surgery, Hiroshima University Hospital, Hiroshima, Japan
| |
Collapse
|
43
|
Myers GJ. Understanding Off-Label Use and Reference Blood Flows in Modern Membrane Oxygenators. J Extra Corpor Technol 2014; 46:192-196. [PMID: 26357784 PMCID: PMC4566827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Accepted: 08/07/2014] [Indexed: 06/05/2023]
Abstract
This editorial will address two issues that are still a source of global controversy and confusion in present day perfusion practice. Membrane oxygenators are designed and tested to a set of stringent flow standards prior to their release from every manufacturer. But how well do we know the iatrogenic consequences of pushing these devices beyond their maximum rated limits? In addition, how well do we know the meaning of the term 'AAMI Reference Flow' as it relates to the Manufacturers Maximum Rated Flow?
Collapse
|
44
|
Potger KC, McMillan D, Ambrose M. Air Transmission Comparison of the Affinity Fusion Oxygenator with an Integrated Arterial Filter to the Affinity NT Oxygenator with a Separate Arterial Filter. J Extra Corpor Technol 2014; 46:229-238. [PMID: 26357789 PMCID: PMC4566832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 08/06/2014] [Indexed: 06/05/2023]
Abstract
Arterial filters used in the extracorporeal circuit (ECC) have been shown to minimize cerebral injury by capturing particulate matter and microbubbles. We clinically use the Affinity NT oxygenator with an Affinity arterial filter attached ("Affinity system"). The new Affinity Fusion oxygenator ("Fusion") incorporates integrated arterial filtering. Our aim was to determine if the Fusion oxygenator was as safe as the Affinity system in terms of relative microbubble transmission of introduced air. A recirculating in vitro circuit primed with blood was used to compare the Fusion with the Affinity system. Microbubbles were detected using a GAMPT BC100 Doppler in the oxygenator-arterial filter outflow line. Measurements were taken 1 minute before and 3 minutes after bolusing 30 mL air proximal to the venous reservoir while altering pump flow rates (3 L/min; 5 L/min). Both the Fusion and Affinity system transmitted microbubbles during air injection. Microbubble volume transmitted at 5 L/min pump flow was significantly greater than at 3 L/min in both systems. The Fusion tended to transmit fewer bubbles, less bubble volume, and smaller sized bubbles than the Affinity system. Under the parameters of this in vitro study, the Affinity Fusion oxygenator with an integrated arterial filter is as safe as the Affinity NT oxygenator with a separate arterial filter in terms of microbubble transmission. However, more research is needed to confirm this study's findings and generalizability to the clinical environment. As both oxygenator-arterial filter systems transmitted microbubbles during air introduction, it is important to develop strategies to minimize microbubble entry into the ECC.
Collapse
|
45
|
Özyüksel A, Ersoy C, Akçevin A, Türkoğlu H, Çiçek AE, Kahraman A, Kayhan B, Cantürk E. Cost-effective usage of membrane oxygenators in extracorporeal membrane oxygenation in infants. Perfusion 2014; 30:239-42. [PMID: 24965913 DOI: 10.1177/0267659114540025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Although the poly-methylpentene (PMP) oxygenators have significant advantages in ECMO implementation, their usage may be limited in some situations, which may be related to economic constraints. In this report, we aimed to emphasize our cost-effective usage of a membrane oxygenator at the ECMO setup. We implemented ECMO with eight Capiox® FX05 or Baby RX05 hollow-fiber membrane oxygenators in five neonatal patients. The average ECMO duration was 121 hours (ranging from 41 to 272 hours). Following the termination of the ECMO, the system was broken down into its components for macroscopic analysis. Neither gross blood clots nor plasma leakage were observed in any of the components. The integration of a centrifugal pump and a separate hollow-fiber oxygenator may provide a cost-effective ECMO implementation setup with no adverse effects which may be an encouraging alternative for the low cost usage of ECMO in neonates.
Collapse
Affiliation(s)
- A Özyüksel
- Department of Cardiovascular Surgery, Medipol University, Istanbul, Turkey
| | - C Ersoy
- Department of Cardiovascular Surgery, Medipol University, Istanbul, Turkey
| | - A Akçevin
- Department of Cardiovascular Surgery, Medipol University, Istanbul, Turkey
| | - H Türkoğlu
- Department of Cardiovascular Surgery, Medipol University, Istanbul, Turkey
| | - A E Çiçek
- Department of Cardiovascular Surgery, Medipol University, Istanbul, Turkey
| | - A Kahraman
- Department of Cardiovascular Surgery, Medipol University, Istanbul, Turkey
| | - B Kayhan
- Department of Cardiovascular Surgery, Medipol University, Istanbul, Turkey
| | - E Cantürk
- Department of Cardiovascular Surgery, Medipol University, Istanbul, Turkey
| |
Collapse
|
46
|
Abstract
Introduction: The conduct of cardiopulmonary bypass surgery requires the use of equipment and devices like the oxygenator. The oxygenator comes in different makes and each manufacturer customizes the carrier or ‘holder’ of this device specific to their design. Aim: This paper presents an innovation designed to overcome the need to purchase a different holder for every oxygenator thereby cutting the cost. Materials and Methods: A sheet of iron measuring 1.9 cm (width) × 0.1 cm (thickness) was used to design the holder circular main frame. Another sheet measuring 2 cm (width) × 0.6 cm (thickness) × 24 cm (length) was used to construct a V-shaped handle with the arms of the V attached to the main frame 7 cm apart. At the narrow base of the handle is a latch requiring two 13-gauge screws to attach the holder to the heart-lung machine. Within the circumference of the main frame are four T-shaped side arms which grip the oxygenator; located at 2, 5, 7 and 11 O’clock positions. The stem of the T consist of a 0.6 cm (thickness) × 13 cm (length) rod drilled through the main frame. The cross of the T consists of variable lengths of the same sheet as the mainframe attached to the stem by a screw mechanism. At the base of the T, is attached a circular handle (4 cm in diameter) made of 0.4 cm iron rod. Result: An oxygenator holder which weighs 1.75 kg with a total length of 54 cm (the diameter of the mainframe is 30 cm). Its advantages include (i) affordability, (ii) materials are locally accessible, (iii) versatility (iv) reproducibility. The disadvantages include, (i) it requires some time to fit, (ii) caution is required in fitting the oxygenator to avoid breakage, (iii) a spanner is required to lock the latch. Conclusion: The concept of a universal holder is pertinent, especially in resource poor environments to avoid purchasing a new holder whenever the usual oxygenator common to the centre is unavailable. This device is amenable to further modifications to meet the unforeseen challenges.
Collapse
Affiliation(s)
- Sunday Adoga Edaigbini
- Department of Surgery, Division of Cardiothoracic Surgery, Ahmadu Bello University/ABU Teaching Hospital, Zaria, Kaduna State, Nigeria
| | - Ibrahim Zira Delia
- Department of Surgery, Division of Cardiothoracic Surgery, Ahmadu Bello University/ABU Teaching Hospital, Zaria, Kaduna State, Nigeria
| | - Muhammad Balarabe Aminu
- Department of Surgery, Division of Cardiothoracic Surgery, Ahmadu Bello University/ABU Teaching Hospital, Zaria, Kaduna State, Nigeria
| |
Collapse
|
47
|
Simsek E, Karapinar K, Bugra O, Tulga Ulus A, Sarigul A. Effects of albumin and synthetic polypeptide-coated oxygenators on IL-1, IL-2, IL-6, and IL-10 in open heart surgery. Asian J Surg 2013; 37:93-9. [PMID: 24210839 DOI: 10.1016/j.asjsur.2013.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2013] [Revised: 07/16/2013] [Accepted: 09/23/2013] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND In this study, we have tried to demonstrate the effects of coating style used in oxygenators on various hematologic and clinical parameters. MATERIALS AND METHODS Twenty-seven patients were included in the study, who had undergone operations because of elective coronary artery disease. Albumin-coated oxygenator was used in Group I. In Group II, a synthetic polypeptide-coated oxygenator was used. C1-inhib (complement), C3c, C4, interleukins (IL-1β, IL2, IL-6, IL-10), and tumor necrosis factor alpha (TNF-α) levels were examined at four different time intervals. Hemoglobin, hematocrit, leukocyte and platelet counts, drainage, and transfused blood volumes were analyzed. RESULTS Albumin levels were significantly lower in Group I than those in Group II 5 minutes after the removal of the cross-clamp. Twenty-four hours after the surgery, Group I patients also had a significantly higher white blood cell count compared to Group II patients. TNF-α levels in Group I were always expressed in considerably higher amounts than those in Group II. IL-6 levels were significantly higher in Group I, but IL-10 levels were observed to be higher in Group II (p < 0.05). CONCLUSION Synthetic polypeptide-coated advanced technology, which employed oxygenators, had an important attenuator effect on acute phase reactants and also on the inflammatory response.
Collapse
Affiliation(s)
- Erdal Simsek
- Department of Cardiovascular Surgery, Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey.
| | - Kasim Karapinar
- Department of Cardiovascular Surgery, Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Onursal Bugra
- Department of Cardiovascular Surgery, İzzet Baysal University, Bolu, Turkey
| | - Ahmet Tulga Ulus
- Department of Cardiovascular Surgery, Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Ali Sarigul
- Department of Cardiovascular Surgery, Necmettin Erbakan University, Konya, Turkey
| |
Collapse
|
48
|
Bronson SL, Riley JB, Blessing JP, Ereth MH, Dearani JA. Prescriptive patient extracorporeal circuit and oxygenator sizing reduces hemodilution and allogeneic blood product transfusion during adult cardiac surgery. J Extra Corpor Technol 2013; 45:167-172. [PMID: 24303598 PMCID: PMC4557535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Accepted: 08/19/2013] [Indexed: 06/02/2023]
Abstract
UNLABELLED The goal of this cardiopulmonary bypass (CPB) quality improvement initiative was to maximize hemoglobin nadir concentration by minimizing hemodilution and, in turn, eliminating allogeneic blood product transfusion. The effects of transitioning from "one-size-fits-all" to "right-sized" oxygenators, reservoirs, and arterial-venous tubing loops were evaluated through a 2-year retrospective review of 3852 patient perfusion records. Using a sizing algorithm, derived from manufacturers' recommendations, we were able to create individualized "right-sized" extracorporeal circuits based on patient body surface area, cardiac index, and target blood flows. Use of this algorithm led to an increase in the percent of algorithm-recommended smaller oxygenators being used from 39% to 63% (p < .01) and an increase in average hemoglobin nadir from 8.38 to 8.76 g/dL (p < .01). Decreased priming volumes led to increased hemoglobin nadir and decreases in allogeneic blood transfusion (p = .048). Patients with similar body surface areas who previously were exposed to larger oxygenators, reservoirs, and arterial-venous loops were now supported with smaller circuits as a result of the use of the right-sized algorithm. Adjustments to the algorithm were made for unique patients and procedural situations including age, gender, and length and type of procedure. Larger heat exchanger surface area oxygenators were used for circulatory arrest procedures as a result of the need for increased heat exchange capability. Despite the generally higher costs of smaller circuits, reduced transfusion-related expenditures and decreased exposure risks justify the use of smaller circuit components. This quality improvement initiative demonstrated that as an integral part of a multidisciplinary, multimodal blood conservation effort, the use of the "right-sized" circuit algorithm can help to elevate hemoglobin nadir during CPB and eliminate allogeneic blood transfusions to patients undergoing CPB. KEYWORDS cardiopulmonary bypass, oxygenator, perfusion index, extracorporeal circuit, hemodilution.
Collapse
|
49
|
Lahanas A, Argerakis PW, Johnson KA, Burdan ML, Ozdirik JE. A retrospective comparison of blood transfusion requirements during cardiopulmonary bypass with two different small adult oxygenators. Perfusion 2013; 28:541-5. [PMID: 23804956 DOI: 10.1177/0267659113492835] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A low haematocrit during cardiopulmonary bypass (CPB) is associated with adverse outcomes and often results in homologous blood transfusions. Oxygenators with improved venous reservoir designs aid in reducing the priming volume. Recently, we changed our small adult oxygenator model from the D905 EOS oxygenator (Dideco, Mirandola, Italy) to the Capiox FX1540 (Terumo Corporation, Tokyo, Japan). We conducted a retrospective study of 42 patents to evaluate the impact of the Capiox FX 1540 on blood transfusion requirements in small patients (body surface area (BSA) up to 1.8 m(2)). The D905 EOS group had a lower minimum intraoperative haematocrit than the FX1540 group (20 ± 3 v 22 ± 4, p = 0.029) with 73% of the patients receiving intraoperative blood transfusions compared with 30% in the FX 1540 group (p = 0.012). Patients in the D905 EOS group received one blood transfusion more during CPB than the FX 1540 patients (p = 0.002). The haematocrits at the end of CPB and in the early postoperative period were identical in both groups. The postoperative ventilation time, length of stay in the intensive care unit and postoperative chest drain bleeding were similar in both groups. In conclusion, the Capiox FX1540 was effective in reducing intraoperative packed red cell transfusions.
Collapse
Affiliation(s)
- A Lahanas
- Prince of Wales Hospital, Sydney, Australia
| | | | | | | | | |
Collapse
|
50
|
Abstract
The extracorporeal membrane oxygenation circuit is made of a number of components that have been customized to provide adequate tissue oxygen delivery in patients with severe cardiac and/or respiratory failure for a prolonged period of time (days to weeks). A standard extracorporeal membrane oxygenation circuit consists of a mechanical blood pump, gas-exchange device, and a heat exchanger all connected together with circuit tubing. Extracorporeal membrane oxygenation circuits can vary from simple to complex and may include a variety of blood flow and pressure monitors, continuous oxyhemoglobin saturation monitors, circuit access sites, and a bridge connecting the venous access and arterial infusion limbs of the circuit. Significant technical advancements have been made in the equipment available for short- and long-term extracorporeal membrane oxygenation applications. Contemporary extracorporeal membrane oxygenation circuits have greater biocompatibility and allow for more prolonged cardiopulmonary support time while minimizing the procedure-related complications of bleeding, thrombosis, and other physiologic derangements, which were so common with the early application of extracorporeal membrane oxygenation. Modern era extracorporeal membrane oxygenation circuitry and components are simpler, safer, more compact, and can be used across a wide variety of patient sizes from neonates to adults.
Collapse
|