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Sample records for membrane oxygenation ecmo

  1. Extracorporeal membrane oxygenation (ECMO)

    African Journals Online (AJOL)

    Extracorporeal membrane oxygenation (ECMO) is increasingly being employed in South African intensive care units for the management of patients with refractory hypoxaemia and for haemodynamic support, particularly following cardiothoracic procedures. ECMO is expensive, however, and there is a danger that this ...

  2. Extracorporeal membrane oxygenation (ECMO) | Richards ...

    African Journals Online (AJOL)

    Extracorporeal membrane oxygenation (ECMO) is increasingly being employed in South African intensive care units for the management of patients with refractory hypoxaemia and for haemodynamic support, particularly following cardiothoracic procedures. ECMO is expensive, however, and there is a danger that this ...

  3. Neonatal respiratory extracorporeal membrane oxygenation (ECMO) referrals.

    LENUS (Irish Health Repository)

    El-Khuffash, A

    2011-03-01

    Extracorporeal membrane oxygenation (ECMO) is a complex technique for providing life support in neonatal respiratory failure. T UK Collaborative ECMO trial demonstrated cost-effectiveness and substantial improvements in neurological morbidity and mortality. Currently, infants requiring ECMO in Ireland are referred to one of various centres in the UK and Scandinavia. We aimed to review the number of infants referred from Ireland for respiratory ECMO. All infants with a non-cardiac condition referred from Ireland for ECMO were reviewed for diagnosis and outcomes. Eleven infants required ECMO between June 2006 and January 2009 and were referred to the Scandinavian team for ECMO transport although one infant improved and did not require ECMO following the arrival of the team. Four infants died: one infant died prior to arrival of the ECMO team, 3 infants had fatal diagnoses and one infant with congenital diaphragmatic hernia received pre-op ECMO. The median (inter-quartile range) gestational age was 39.7 (38.3-40.7) weeks and birth weight of 3.7 (3.2-4.0) kg. The median age at the decision to transfer for ECMO was 13h (4-123) and the team arrived at 23 h (12-132). All infants had a normal cranial ultrasound and echo prior to ECMO and 2 infants had an abnormal MRI post-ECMO. The time on ECMO was 9 days (3-17) and total length of hospital stay was 32 d (23-36). There were no pre-ECMO clinical or biochemical

  4. Rehabilitation following intracerebral haemorrhage secondary to extracorporeal membrane oxygenation (ECMO).

    Science.gov (United States)

    Kilsby, Amanda; Buddha, Sandeep

    2013-05-24

    Extracorporeal membrane oxygenation (ECMO) was first used in adults with severe respiratory failure in the 1970s. Its use has been steadily increasing since the 1990s after a trial demonstrated improved survival. There are currently seven centres in the UK offering ECMO to adults. Neurological complications are often picked up within the first few days of initiating ECMO. Intracerebral haemorrhage is a well recognised complication and it is the leading cause of death in infants on ECMO and rates of 9-18.9% in adults have been reported. We report a 52-year-old woman admitted in severe type 1 respiratory failure in January 2012. She was transferred to a tertiary centre and suffered bitemporal and right parietal haemorrhages on ECMO in late February. She was repatriated to our unit for rehabilitation in April 2012. Her rehabilitation needs represent the complexity of this patient group with multiple medical, behavioural and physical challenges.

  5. Short and Long Term Studies in Neonates treated with Extracorporeal Membrane Oxygenation (ECMO)

    NARCIS (Netherlands)

    M.N. Hanekamp (Manon)

    2005-01-01

    textabstractExtracorporeal membrane oxygenation (ECMO) is a technique for providing life support in severe but potentially reversible cardiorespiratory failure. The technique oxygenates blood outside the body, obviating the need for gas exchange in the lungs and, if necessary, provides

  6. Systemic inflammatory response syndrome (SIRS) after extracorporeal membrane oxygenation (ECMO): Incidence, risks and survivals.

    Science.gov (United States)

    Thangappan, Karthik; Cavarocchi, Nicholas C; Baram, Michael; Thoma, Brandi; Hirose, Hitoshi

    2016-01-01

    Systemic inflammatory response syndrome (SIRS) is frequently observed after extracorporeal membrane oxygenation (ECMO) decannulation; however, these issues have not been investigated well in the past. Retrospective chart review was performed to identify post-ECMO SIRS phenomenon, defined by exhibiting 2/3 of the following criteria: fever, leukocytosis, and escalation of vasopressors. The patients were divided into 2 groups: patients with documented infections (Group I) and patients with true SIRS (Group TS) without any evidence of infection. Survival and pre-, intra- and post-ECMO risk factors were analyzed. Among 62 ECMO survivors, 37 (60%) patients developed the post-ECMO SIRS phenomenon, including Group I (n = 22) and Group TS (n = 15). The 30-day survival rate of Group I and TS was 77% and 100%, respectively (p = 0.047), although risk factors were identical. SIRS phenomenon after ECMO decannulation commonly occurs. Differentiating between the similar clinical presentations of SIRS and infection is important and will impact clinical outcomes. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. Extracorporeal membrane oxygenation (ECMO as salvage treatment for pulmonary Echinococcus granulosus infection with acute cyst rupture

    Directory of Open Access Journals (Sweden)

    Sören L. Becker

    2017-11-01

    Full Text Available Extracorporeal membrane oxygenation (ECMO has been used successfully for the treatment of patients with respiratory failure due to severe infections. Although rare, parasites can also cause severe pulmonary disease. Tapeworms of the genus Echinococcus give rise to the development of cystic structures in the liver, lungs, and other organs. Acute cyst rupture leads to potentially life-threatening infection, and affected patients may deteriorate rapidly. The case of a young woman from Bulgaria who was admitted to hospital with severe dyspnoea, progressive chest pain, and haemoptysis is described. Computed tomography of the chest was pathognomonic for cystic echinococcosis with acute cyst rupture. Following deterioration on mechanical ventilation, she was cannulated for veno-venous ECMO. The patient’s condition improved considerably, and she was weaned successfully from ECMO and mechanical ventilation. Following lobectomy of the affected left lower lobe, the patient was discharged home in good condition. This appears to be the first report of the successful use of ECMO as salvage treatment for a severe manifestation of a helminthic disease. Due to recent migration to Western Europe, the number of patients presenting with respiratory failure due to pulmonary echinococcosis with cyst rupture is likely to increase. Keywords: Extracorporeal membrane oxygenation (ECMO, Infection, Echinococcosis, Echinococcus granulosus, Hydatid disease, Infection

  8. Management of intracranial hemorrhage in adult patients on extracorporeal membrane oxygenation (ECMO)

    DEFF Research Database (Denmark)

    Fletcher-Sandersjöö, Alexander; Thelin, Eric Peter; Bartek, Jiri

    2017-01-01

    BACKGROUND: Intracranial hemorrhage (ICH) is a common complication in adults treated with extracorporeal membrane oxygenation (ECMO). The aim of this study was to identify predictors of outcome and investigate intervention strategies following ICH development in ECMO-treated adult patients. METHODS.......036), presence of intraparenchymal hematoma (IPH) (p = 0.049), IPH volume (p = 0.002), presence of intraventricular hemorrhage (p = 0.001), subarachnoid hemorrhage Fisher grade (p...), 63% (n = 10) had favorable neurological outcome (GOS 4-5) after six months. Five patients were surgically treated for their ICH, some with dire hemorrhagic consequences, however one patient made a complete recovery. CONCLUSIONS: ICH in adult ECMO patients is associated with a high mortality rate...

  9. Autopsy findings in patients on postcardiotomy extracorporeal membrane oxygenation (ECMO).

    Science.gov (United States)

    Rastan, A J; Lachmann, N; Walther, T; Doll, N; Gradistanac, T; Gommert, J F; Lehmann, S; Wittekind, C; Mohr, F W

    2006-12-01

    To assess the clinical sensitivity of causes of death, concomitant diseases and postoperative complications including thromboembolic events in ECMO patients. Between January 2000 and December 2004 154/202 patients (76.2%) died after postcardiotomy ECMO circulatory support. Autopsy was performed in 78 (50.6%) consecutive patients. Clinical and post-mortem data were prospectively recorded and compared concerning causes of death and postoperative complications including venous and arterial thromboembolisms and significant comorbidities. Mean age was 62.1+/-11.3 years, ejection fraction was 43.4+/-17.3%. 39.7% were emergency operations including acute coronary syndrome in 25.6% and preoperative cardiogenic shock in 28.2%. Successful ECMO weaning rate was 43.6%. Mean postoperative survival was 11.3 days. Premortem unknown concomitant diseases were found in 63 patients (80.8%) with clinical relevance in 9 patients (11.5%). Clinically unrecognized postoperative complications were found in 59 patients (75.6%) including acute cerebral infarction (n=7), acute bowel ischemia (1), intestinal perforation (3), pneumonia (4), venous thrombus formation (25) and systemic thromboembolic events (24). Clinically based causes of death were cardiac in 62.8%, multi-organ failure in 10.3%, cerebral in 5.1%, respiratory in 10.3%, fatal pulmonary embolism in 2.6%, technical in 5.1%, and others in 3.8%. Unexpected causes of death were found by autopsy in 22 patients (28.2%) including myocardial infarction (n=5), acute heart failure (4), fatal pulmonary embolism (2), pneumonia (2), ARDS (1), lung bleeding (1), fatal cerebrovascular event (4) and multiorgan failure (3). In ECMO patients major discrepancies between clinical and post-mortem examination were found. The true incidence of thromboembolic events is highly underestimated by clinical evaluation.

  10. Management of intracranial hemorrhage in adult patients on extracorporeal membrane oxygenation (ECMO: An observational cohort study.

    Directory of Open Access Journals (Sweden)

    Alexander Fletcher-Sandersjöö

    Full Text Available Intracranial hemorrhage (ICH is a common complication in adults treated with extracorporeal membrane oxygenation (ECMO. The aim of this study was to identify predictors of outcome and investigate intervention strategies following ICH development in ECMO-treated adult patients.We conducted a retrospective review of adult patients (≥18 years who developed an ICH during ECMO treatment at the Karolinska University Hospital (Stockholm, Sweden between September 2005 and May 2017. Outcome was assessed by 30-day mortality and Glasgow Outcome Scale (GOS after 6 months. The statistical analysis was supplemented by a case series of patients who were surgically treated for an ICH.Sixty-five patients developed an ICH during ECMO treatment. 30-day mortality was 74% (n = 48, and was significantly associated with low level of consciousness at ICH diagnosis (p = 0.036, presence of intraparenchymal hematoma (IPH (p = 0.049, IPH volume (p = 0.002, presence of intraventricular hemorrhage (p = 0.001, subarachnoid hemorrhage Fisher grade (p<0.001, hydrocephalus (p<0.001, midline shift (p = 0.026 and absent basal cisterns (p<0.001. Among the 30-day survivors (n = 17, 63% (n = 10 had favorable neurological outcome (GOS 4-5 after six months. Five patients were surgically treated for their ICH, some with dire hemorrhagic consequences, however one patient made a complete recovery.ICH in adult ECMO patients is associated with a high mortality rate. Outcome predictors can help to identify patients where ICH treatment is indicated. Treating a patient with an ICH during ECMO represents an intricate balance between pro- and anticoagulatory demands. Furthermore, surgical treatment is associated with several risks but may be indicated in life-threatening lesions. Prospective studies are warranted.

  11. Myocardial protection of early extracorporeal membrane oxygenation (ECMO) support for acute myocardial infarction with cardiogenic shock in pigs.

    Science.gov (United States)

    Zhu, Gang-jie; Sun, Li-na; Li, Xing-hai; Wang, Ning-fu; Wu, Hong-hai; Yuan, Chen-xing; Li, Qiao-qiao; Xu, Peng; Ren, Ya-qi; Mao, Bao-gen

    2015-09-01

    The aim of this study was to explore myocardial protection of early extracorporeal membrane oxygenation (ECMO) support for acute myocardial infarction with cardiogenic shock in pigs. 24 male pigs (34.6 ± 1.3 kg) were randomly divided into three groups-control group, drug therapy group, and ECMO group. Myocardial infarction model was created in drug therapy group and ECMO group by ligating coronary artery. When cardiogenic shock occurred, drugs were given in drug therapy group and ECMO began to work in ECMO group. The pigs were killed 24 h after cardiogenic shock. Compared with in drug therapy group, left ventricular end-diastolic pressure in ECMO group decreased significantly 6 h after ligation (P myocardial infarct size of ECMO group did not reduce significantly, but myocardial enzyme and troponin-I decreased significantly. Compared with drug therapy, ECMO improves left ventricular diastolic function, and may improve systolic function. ECMO cannot reduce myocardial infarct size without revascularization, but may have positive effects on ischemic areas by avoiding further injuring.

  12. ASAP ECMO: Antibiotic, Sedative and Analgesic Pharmacokinetics during Extracorporeal Membrane Oxygenation: a multi-centre study to optimise drug therapy during ECMO

    Directory of Open Access Journals (Sweden)

    Shekar Kiran

    2012-11-01

    Full Text Available Abstract Background Given the expanding scope of extracorporeal membrane oxygenation (ECMO and its variable impact on drug pharmacokinetics as observed in neonatal studies, it is imperative that the effects of the device on the drugs commonly prescribed in the intensive care unit (ICU are further investigated. Currently, there are no data to confirm the appropriateness of standard drug dosing in adult patients on ECMO. Ineffective drug regimens in these critically ill patients can seriously worsen patient outcomes. This study was designed to describe the pharmacokinetics of the commonly used antibiotic, analgesic and sedative drugs in adult patients receiving ECMO. Methods/Design This is a multi-centre, open-label, descriptive pharmacokinetic (PK study. Eligible patients will be adults treated with ECMO for severe cardiac and/or respiratory failure at five Intensive Care Units in Australia and New Zealand. Patients will receive the study drugs as part of their routine management. Blood samples will be taken from indwelling catheters to investigate plasma concentrations of several antibiotics (ceftriaxone, meropenem, vancomycin, ciprofloxacin, gentamicin, piperacillin-tazobactum, ticarcillin-clavulunate, linezolid, fluconazole, voriconazole, caspofungin, oseltamivir, sedatives and analgesics (midazolam, morphine, fentanyl, propofol, dexmedetomidine, thiopentone. The PK of each drug will be characterised to determine the variability of PK in these patients and to develop dosing guidelines for prescription during ECMO. Discussion The evidence-based dosing algorithms generated from this analysis can be evaluated in later clinical studies. This knowledge is vitally important for optimising pharmacotherapy in these most severely ill patients to maximise the opportunity for therapeutic success and minimise the risk of therapeutic failure. Trial registration ACTRN12612000559819

  13. Saline lavage with substitution of bovine surfactant in term neonates with meconium aspiration syndrome (MAS) transferred for extracorporeal membrane oxygenation (ECMO): a pilot study

    Science.gov (United States)

    Möller, Jens C; Kohl, Martina; Reiss, Irwin; Diederich, Wiebke; Nitsche, Esther M; Göpel, Wolfgang; Gortner, Ludwig

    1999-01-01

    Background: Meconium aspiration syndrome (MAS) is still a condition associated with a high mortality, and many patients require extracorporeal membrane oxygenation (ECMO) as rescue therapy. Beneficial effects of surfactant and perflubron lavage have been reported. However, pure surfactant supplementation has not been proven to be beneficial in the most severe forms of MAS. This study was performed to demonstrate an improvement in oxygenation in neonates transferred for ECMO and fulfilling ECMO criteria with a saline lavage and surfactant resupplementation. Methods: Twelve newborns with MAS [gestational age 36–40 weeks, mean birth weight 3200 g, age 4–16 h, oxygenation index (OI) > 40] transferred for ECMO therapy were treated with saline lavage (5–10 cm3/kg body weight, as long as green colored retrieval was observed) and resupplementation with bovine surfactant (Alveofact, Boehringer, Ingelheim, Germany). The OI at admission and 3 h after this procedure was compared using the t-test for paired samples. ECMO was available as rescue therapy at all times. Results: The OI decreased from 49.4 (SD ± 13.3) to 27.4 (SD ± 7.3), P meconium by extensive lavage is feasible as long as 16 h after birth even in infants considered for ECMO therapy; it might reduce the necessity of ECMO. PMID:11056719

  14. The effect of temperature on the QTc interval in the newborn infant receiving extracorporeal membrane oxygenation (ECMO).

    Science.gov (United States)

    Horan, Marie; Edwards, A David; Firmin, Richard K; Ablett, Tiena; Rawson, Hilary; Field, David

    2007-04-01

    To explore the changes in the QTc interval during mild hypothermia in neonates receiving extracorporeal membrane oxygenation (ECMO). Twenty seven neonates (median gestation 40 weeks; range 33-41 weeks) enrolled in a pilot study of mild hypothermia were studied during the first five days of ECMO. The first group (N=7) were maintained at 37 degrees C throughout the study period. Subsequent groups (N=5) were cooled to 36 degrees C, 35 degrees C and 34 degrees C respectively for twenty four hours and the final group to 34 degrees C for forty eight hours before being rewarmed to 37 degrees C. Using a 24 h digital monitor, the QT and QTc intervals were recorded continuously during the cooling and rewarming period and validated using standard 12 lead electrocardiograms. Patients were carefully assessed clinically and routine biochemistry (including magnesium and calcium) laboratory tests measured pre ECMO and at timed intervals during cooling and rewarming. The mean difference between the continuous digital and 12 lead ECG values for QTc was -13.3 ms. During the first 24 h of cooling, the mean (95th centile) values for the digitally measured QTc interval at 37 degrees C=431(506) milliseconds (ms); 36 degrees C=459(521) ms; 35 degrees C=445(516) ms; 34 degrees C=465(531) ms; 34 degrees C for 48 h=466(521) ms. During this period overall QTc increased by 3.12 ms (95% confidence intervals 6.17 to 0.84; p=0.04) for each degree fall in body temperature. During rewarming, there was no significant relationship between QTc and temperature change. No serious arrhythmias were during cooling. Using univariate analysis, no relationship was found between QTc and electrolytes, heart rate and blood pressure. QTc shows significant variability in individuals, and only a small proportion of this can be explained by rectal temperature. Mild hypothermia was not associated with serious cardiac arrhythmias.

  15. Influence of volume replacement with colloids versus crystalloids in neonates on venoarterial extracorporeal membrane oxygenation on fluid retention, fluid balance, and ECMO runtime.

    Science.gov (United States)

    Vrancken, Sabine L; Heijst, Arno Fvan; Zegers, Miranda; der Staak, Frans Hvan; Liem, K Djien; van Heijst, Arno F; van der Staak, Frans H

    2005-01-01

    In this retrospective study, we compared the effects of colloid versus crystalloid fluid replacement on the clinical signs of capillary leakage syndrome in 30 neonates with pulmonary hypertension due to meconium aspiration syndrome on venoarterial membrane oxygenation (VA-ECMO). Before 2000, 15 neonates received volume replacement with a pasteurized plasma protein solution (3.8% albumin); after 2000, 15 neonates received normal saline. Patient characteristics and pre-ECMO values did not differ between the two groups. Total fluid balance was also equal. Diuretic use was significantly higher in the colloid group (p runtime (p < 0.05). Serum colloid osmotic pressure, albumin, urea nitrogen, and creatinine were significantly higher in the colloid group (p < 0.0001, < 0.0001, < 0.001, and < 0.05, respectively). Duration of VA-ECMO, of artificial ventilation after ECMO treatment, and the mortality rate did not differ between the two groups. We conclude that volume replacement with crystalloids in neonates on VA-ECMO aggravated the edema in a preexisting situation of capillary leakage syndrome, whereas volume replacement with colloids could impair the kidney function.

  16. Fetal MR lung volumetry in congenital diaphragmatic hernia (CDH): prediction of clinical outcome and the need for extracorporeal membrane oxygenation (ECMO).

    Science.gov (United States)

    Kilian, A K; Büsing, K-A; Schuetz, E-M; Schaible, T; Neff, K W

    2009-09-01

    Despite the ultrasound (US) based lung-to-head ratio (LHR) and first results of fetal lung volume (FLV) determination in magnetic resonance imaging (MRI), there is no reliable prenatal parameter for the clinical course and outcome of fetuses with congenital diaphragmatic hernia (CDH), in particular for the need of extracorporeal membrane oxygenation (ECMO). MR FLV measurement was evaluated in 36 fetuses with CDH using T2-weighted half-Fourier acquisition single-shot turbo spin echo (HASTE) imaging. FLV and liver herniation, respectively, were correlated with survival and the need for ECMO therapy. A total of 18 healthy fetuses served as controls. MR FLV measurement was applied to predict survival and the need for neonatal ECMO therapy and to assess liver herniation as a prognostic parameter. On MRI there was a highly significant correlation of the FLV and patients' survival (p=0.0001) and ECMO requirement, respectively (p=0.0029). Compared to normal controls mean FLV in infants who died was 10% (9.4+/-5.8 ml) and 32% in surviving infants (25+/-9.7 ml). Liver herniation significantly decreased lung volume and negatively impacted clinical outcome (pCDH patients. MR FLV measurements are also valuable to identify patients who may benefit from ECMO therapy. Upward liver herniation is the most important additional prognostic parameter.

  17. Management of Alveolar Proteinosis by Bronchopulmonary lavage under Extra Corporeal Membrane Oxygenation (ECMO

    Directory of Open Access Journals (Sweden)

    Tahereh Parsa

    2015-12-01

    Full Text Available Normal 0 false false false EN-US X-NONE AR-SA The gold standard of treating Pulmonary Alveolar Proteinosis (PAP is bronchopulmonary lavage (BPL. We describe a rare case of BPD for PAP, who underwent ECMO due to hypoventilation in the setting of one lung ventilation. First, the clinical course of the patient is presented; furthermore, the biomolcular basis of PAP and new treatment approaches is discussed. /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin-top:0cm; mso-para-margin-right:0cm; mso-para-margin-bottom:10.0pt; mso-para-margin-left:0cm; line-height:115%; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman","serif"; mso-fareast-font-family:Calibri; mso-bidi-font-family:"B Nazanin";} Normal 0 false false false EN-US X-NONE AR-SA  

  18. Centrifugal pumps and hemolysis in pediatric extracorporeal membrane oxygenation (ECMO) patients: An analysis of Extracorporeal Life Support Organization (ELSO) registry data.

    Science.gov (United States)

    O'Brien, Ciaran; Monteagudo, Julie; Schad, Christine; Cheung, Eva; Middlesworth, William

    2017-06-01

    It is currently unclear whether centrifugal pumps cause more hemolysis than roller pumps in extracorporeal membrane oxygenation (ECMO) circuits. The aim of this study was to help answer that question in pediatric patients. A limited deidentified data set was extracted from the international multicenter Extracorporeal Life Support Organization (ELSO) registry comprising all reported ECMO runs for patients 18years or younger between 2010 and 2015. Logistic regression was used to evaluate a possible association between hemolysis and pump type, controlling for patient demographics, circuit factors, and complications. 14,776 ECMO runs for 14,026 patients had pump type recorded. Centrifugal pumps were employed in 60.4% of ECMO circuits. Hemolysis was a reported complication for 1272 (14%) centrifugal pump runs and for 291 (5%) roller pump runs. 1755 (20%) centrifugal pump runs reported kidney injury as compared to 797 (14%) roller pump runs. In the full logistic regression, the odds of hemolysis were significantly greater for runs using centrifugal pumps (OR 3.3, 95% CI 2.9-3.8, ppumps was associated with increased rates of hemolysis, hyperbilirubinemia, and kidney injury. Retrospective cohort study. Level III. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. Extracorporeal membrane oxygenation

    Science.gov (United States)

    Extracorporeal membrane oxygenation (ECMO) is a treatment that uses a pump to circulate blood through an artificial lung back into the bloodstream of a very ill baby. This system provides heart-lung bypass support ...

  20. Mechanical ventilation during extracorporeal membrane oxygenation

    OpenAIRE

    Schmidt, Matthieu; Pellegrino, Vincent; Combes, Alain; Scheinkestel, Carlos; Cooper, D Jamie; Hodgson, Carol

    2014-01-01

    The timing of extracorporeal membrane oxygenation (ECMO) initiation and its outcome in the management of respiratory and cardiac failure have received considerable attention, but very little attention has been given to mechanical ventilation during ECMO. Mechanical ventilation settings in non-ECMO studies have been shown to have an effect on survival and may also have contributed to a treatment effect in ECMO trials. Protective lung ventilation strategies established for non-ECMO-supported re...

  1. Extracorporeal membrane oxygenation (ECMO) assisted cardiopulmonary resuscitation or uncontrolled donation after the circulatory determination of death following out-of-hospital refractory cardiac arrest-An ethical analysis of an unresolved clinical dilemma.

    Science.gov (United States)

    Dalle Ave, Anne L; Shaw, David M; Gardiner, Dale

    2016-11-01

    The availability of extracorporeal membrane oxygenation (ECMO) assisted cardiopulmonary resuscitation (E-CPR), for use in refractory out-of hospital cardiac arrest (OHCA), is increasing. In parallel, some countries have developed uncontrolled donation after circulatory determination of death (uDCDD) programs using ECMO to preserve organs for transplantation purposes. When facing a refractory OHCA, how does the medical team choose between initiating ECMO as part of an E-CPR protocol or ECMO as part of a uDCDD protocol? To answer these questions we conducted a literature review on E-CPR compared to uDCDD protocols using ECMO and analyzed the raised ethical issues. Our analysis reveals that the inclusion criteria in E-CPR and uDCDD protocols are similar. There may be a non-negligible risk of including patients in a uDCDD protocol, when the patient might have been saved by the use of E-CPR. In order to avoid the fatal error of letting a saveable patient die, safeguards are necessary. We recommend: (1) the development of internationally accepted termination of resuscitation guidelines that would have to be satisfied prior to inclusion of patients in any uDCDD protocol, (2) the choice regarding modalities of ongoing resuscitation during transfer should be focused on the primary priority of attempting to save the life of patients, (3) only centers of excellence in life-saving resuscitation should initiate or maintain uDCDD programs, (4) E-CPR should be clinically considered first before the initiation of any uDCDD protocol, and (5) there should be no discrimination in the availability of access to E-CPR. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  2. Motor performance after neonatal extracorporeal membrane oxygenation: a longitudinal evaluation

    NARCIS (Netherlands)

    Cammen-Zijp, M.H. van der; Janssen, A.J.W.M.; Raets, M.M.; Rosmalen, J. van; Govaert, P.; Steiner, K.; Gischler, S.J.; Tibboel, D.; Heijst, A.F.J. van; Ijsselstijn, H.; et al.,

    2014-01-01

    OBJECTIVE: To assess longitudinally children's motor performance 5 to 12 years after neonatal extracorporeal membrane oxygenation (ECMO) and to evaluate associations between clinical characteristics and motor performance. METHODS: Two hundred fifty-four neonatal ECMO survivors in the Netherlands

  3. Nosocomial transmission of Cupriavidus pauculus during extracorporeal membrane oxygenation.

    Science.gov (United States)

    Stovall, S H; Wisdom, C; McKamie, W; Ware, W; Dedman, H; Fiser, R T

    2010-01-01

    Patients undergoing extracorporeal membrane oxygenation (ECMO) are at increased risk of infection. We present the first known report of nosocomial infection with Cupriavidus pauculus attributable to contamination from ECMO equipment and describe the measures taken to halt subsequent infections. A cluster of infections in ECMO patients should prompt team members to consider contamination of equipment with environmental pathogens as a possible cause.

  4. Laboratory and clinical predictors of 30-day survival for patients on Extracorporeal Membrane Oxygenation (ECMO): 8-Year experience at Albert Einstein College of Medicine, Montefiore Medical Center.

    Science.gov (United States)

    Francischetti, Ivo M B; Szymanski, James; Rodriguez, Daniel; Heo, Moonseong; Wolgast, Lucia R

    2017-08-01

    Survival of patients on ECMO has remained stable in every population. Laboratory values predictors of survival are required to improve patient care. Clinical Looking Glass software was used to assess Electronic Medical Records (EMRs) of patients at Albert Einstein College of Medicine, Montefiore Medical Center (2007-2014). Our population comprises of 166 adults and was divided in survivors and non-survivors, within 30days. Indications for ECMO were cardiac (65%), respiratory (25%) and infectious diseases (<10%). Eighty six patients (51.8%) survived the procedure. Gender, body weight, ejection fraction, diastolic blood pressure, and socio-economic status did not differ among survivors and non-survivors. In contrast, younger patients (45yo vs 55yo, p=0.0001) and higher systolic blood pressure (115mmHg vs 103mmHg, p=0.025) have favorable outcome. Univariate analysis shows that pre-cannulation values for creatinine (p=0.0003), chloride (p=0.009), bicarbonate (p=0.015) and pH (p=0.03) have prognostic value. Post-cannulation aPTT, pH, platelet and lymphocyte counts also have discriminative power. Notably, multiple logistic regressions for Multivariate Analysis identified chloride (OR 1.07; 95% CI 1.02-1.13; p=0.004), pH (OR 3.35; 95% CI 1.89-5.9; p<0.0001) and aPTT (OR 0.98; 95% CI 0.976-0.998; p=0.024) as independent risk factors for 30-day mortality. These results imply that pre-existing renal conditions and hemostatic dysregulation contribute to poor outcome. Finally, patients on VV-ECMO have increase odds of survival (OR 1.88; 95% CI 1.06-3.34; p=0.029). Laboratory markers identified herein may guide the management of patients on ECMO. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. ECMO - Safety and efficacy

    International Nuclear Information System (INIS)

    Koul, B.L.

    1991-05-01

    Three adult patient with severe acute respiratory failure were treated with a conventional high flow veno-venous extracorporeal membrane oxygenation (ECMO), using heparin coated ECMO system and low dose of heparin (Study 1). Two patients survived and are living a normal life. The third patient died of candida sepsis. In study 2, 6 healty pigs were subjected to 24 hours of veno-right ventricular ECMO. The veno-right ventricular ECMO substituted the total lung function of the animals at extracorporeal blood flows amounting to 80 of the total cardiac output. In study 3, 6 pigs were subjected to 18 hours of total veno-arterial ECMO. All the animals died within 4 hours of weaning from ECMO. Thus 18 hours of total veno-arterial ECMO is 100% fatal in healthy pigs on account of irreversible ischemic pulmonary damage. In another study, 6 pigs were subjected to 18 hour partial veno-arterial ECMO during which 25% of the cardiac output was diverted through the pulmonary artery to the lungs (study 4). 6 hours after weaning from ECMO, a slight but significant decrease in arterial oxygen tension, a significant increase in the pulmonary vascular resistance (mean = 76%) and a slight increase in the pulmonary clearance of 99m Tc-DPTA was observed. Thus 25% right cardiac output is the border-line safe pulmonary blood flow needed for presevation of adequate lung function during 18 hours of veno-arterial ECMO at normothermia in healthy pigs. 6 healthy pigs were subjected to 24 hours of heparin free total veno-right centricular ECMO, using Carmeda heparin coated system (study 5). Deterioration in the arterial blood gases and in the pulmonary hemodynamics was not clinically significant. Total platelet count and plasma free hemoglobin remained unaffected. The heparin coated surface thus inhibits both the coagulation cascade and the platelet activation during a 24 hour heparin free ECMO in healty pigs. (116 refs.)

  6. Circulação extracorpórea por membrana (ECMO em recém-nascido com insuficiência respiratória por síndrome de aspiração meconial: efeitos da administração de surfactante exógeno Extracorporeal membrane oxygenation (ECMO in a neonate with respiratory distress due to meconium aspiration syndrome: Effect of the administration of exogenous surfactant

    Directory of Open Access Journals (Sweden)

    João Gilberto Maksoud-Filho

    2001-06-01

    Full Text Available OBJETIVO: apresentar a evolução clínica de recém-nascido portador de insuficiência respiratória grave neonatal secundária à Sindrome de Aspiração Meconial tratado por Circulação Extracorpórea por Membrana, ou, conforme o termo consagrado em língua inglesa, ECMO (Extracorporeal Membrane Oxygenation, o efeito do uso de surfactante exógeno neste caso e os custos do procedimento. MÉTODOS: Descrição de um caso de Síndrome de Aspiração Meconial, tratado na UCINE (Unidade de Cuidados Intensivos Neonatais do Instituto da Criança Prof. Pedro de Alcantara, Hospital das Clínicas da Universidade de São Paulo. RESULTADOS: O suporte extracorpóreo teve a duração de 5 dias, sem complicações clínicas ou mecânicas. Surfactante exógeno de origem porcina foi administrado no 4o dia, após o quê observamos uma melhora significativa na complacência pulmonar. O recém-nascido pôde então ser rapidamente decanulado. Os custos do tratamento foram compatíveis com a realidade nacional em relação a um recém-nascido criticamente enfermo. CONCLUSÕES: a ECMO é indicada em casos de insuficiência respiratória neonatal que não respondam a outros tratamentos existentes. Deve ser disponível em Unidades de Tratamento Intensivo (UTIs neonatais de hospitais terciários e ser empregada conforme critérios bem estabelecidos. A utilização de surfactante exógeno aparentemente antecipou a retirada da ECMO e, portanto, deve ser considerada em casos semelhantes. Os custos do tratamento justificam a organização de Equipes de ECMO nessas UTIs.OBJECTIVES: to present the clinical outcome of a newborn with severe respiratory distress secondary to meconium aspiration syndrome and treated by extracorporeal membrane oxygenation (ECMO; and to present the effect of the use of exogenous surfactant in this case and the cost of the procedure. METHODS: Case report of a newborn with meconium aspiration syndrome and treated at the neonatal ICU of the

  7. Evaluation of furosemide regimens in neonates treated with extracorporeal membrane oxygenation

    NARCIS (Netherlands)

    M.M.J. van der Vorst (Maria); E.D. Wildschut (Enno); R.J.M. Houmes (Robert Jan); S.J. Gischler (Saskia); J.E. Kist-Van Holthe (Joana); J. Burggraaf (Jacobus); A.J. van der Heijden (Bert); D. Tibboel (Dick)

    2006-01-01

    textabstractIntroduction: Loop diuretics are the most frequently used diuretics in patients treated with extracorporeal membrane oxygenation (ECMO). In patients after cardiopulmonary bypass (CPB) surgery, the use of continuous furosemide infusion is increasingly documented. Because ECMO and CPB are

  8. Diagnosis-related deterioration of lung function after extracorporeal membrane oxygenation.

    NARCIS (Netherlands)

    M. Spoel (Marjolein); R. Laas (Roxanne); S.J. Gischler (Saskia); W.C.J. Hop (Wim); D. Tibboel (Dick); J.C. de Jongste (Johan); H. IJsselstijn (Hanneke)

    2012-01-01

    textabstractThe aim of the study was to assess lung function longitudinally after neonatal extracorporeal membrane oxygenation (ECMO), and to identify any effects of diagnosis and perinatal characteristics. 121 neonatal ECMO-treated children (70 with meconium aspiration

  9. Acceptance and transfer to a regional severe respiratory failure and veno-venous extracorporeal membrane oxygenation (ECMO) service: predictors and outcomes.

    Science.gov (United States)

    Gillon, S A; Rowland, K; Shankar-Hari, M; Camporota, L; Glover, G W; Wyncoll, D L A; Barrett, N A; Ioannou, N; Meadows, C I S

    2018-02-01

    The use of extracorporeal membrane oxygenation for respiratory failure is high risk and resource intensive. In England, five centres provide this service and patients who are referred have four possible outcomes: declined transfer due to perceived futility; accepted in principle but remain at the referring centre with ongoing surveillance; retrieved using conventional ventilation; or retrieved on extracorporeal support. The decision-making process leading to these outcomes has not previously been examined. We evaluated referrals to one centre and identified factors associated with each decision outcome. Five hundred and sixty-four patients were analysed from January 2012 to October 2015. One hundred and fifty-seven patients were declined; multivariate analysis demonstrated associated factors to be: age (odds ratio (95% confidence interval) 1.05 (1.04-1.07)); immunocompromise (4.95 (2.58-9.67)); lactate (1.11 (1.01-1.22)); duration of ventilation (1.08 (1.04-1.14)); and cardiac failure (3.22 (1.04-10.51)). Factors associated with the decision to retrieve an accepted patient were: plateau pressure (1.05 (1.01-1.10)); ratio of arterial oxygen partial pressure to fractional inspired oxygen (0.89 (0.85-0.93)); partial pressure of carbon dioxide in arterial blood (1.13 (1.03-1.25)); and the absence of non-pulmonary infection (0.31 (0.15-0.61)). Only pH was independently associated with the decision to transfer on extracorporeal support (0.020 (0.002-0.017)). Six-month survival in the declined, non-retrieved, conventionally retrieved and extracorporeal-retrieved groups was 16.6%, 71.1%, 76.7% and 72.1%, respectively, substantially supporting the decision-making model. Survival in the accepted group exceeds that reported previously. However, a proportion of those declined do survive and some remotely managed patients die. This suggests the approach does not account for some important survival-determining factors. © 2017 The Association of Anaesthetists of Great Britain

  10. Mechanical ventilation during extracorporeal membrane oxygenation.

    Science.gov (United States)

    Schmidt, Matthieu; Pellegrino, Vincent; Combes, Alain; Scheinkestel, Carlos; Cooper, D Jamie; Hodgson, Carol

    2014-01-21

    The timing of extracorporeal membrane oxygenation (ECMO) initiation and its outcome in the management of respiratory and cardiac failure have received considerable attention, but very little attention has been given to mechanical ventilation during ECMO. Mechanical ventilation settings in non-ECMO studies have been shown to have an effect on survival and may also have contributed to a treatment effect in ECMO trials. Protective lung ventilation strategies established for non-ECMO-supported respiratory failure patients may not be optimal for more severe forms of respiratory failure requiring ECMO support. The influence of positive end-expiratory pressure on the reduction of the left ventricular compliance may be a matter of concern for patients receiving ECMO support for cardiac failure. The objectives of this review were to describe potential mechanisms for lung injury during ECMO for respiratory or cardiac failure, to assess the possible benefits from the use of ultra-protective lung ventilation strategies and to review published guidelines and expert opinions available on mechanical ventilation-specific management of patients requiring ECMO, including mode and ventilator settings. Articles were identified through a detailed search of PubMed, Ovid, Cochrane databases and Google Scholar. Additional references were retrieved from the selected studies. Growing evidence suggests that mechanical ventilation settings are important in ECMO patients to minimize further lung damage and improve outcomes. An ultra-protective ventilation strategy may be optimal for mechanical ventilation during ECMO for respiratory failure. The effects of airway pressure on right and left ventricular afterload should be considered during venoarterial ECMO support of cardiac failure. Future studies are needed to better understand the potential impact of invasive mechanical ventilation modes and settings on outcomes.

  11. ECMO in CDH: Is there a role?

    Science.gov (United States)

    Kays, David W

    2017-06-01

    Despite wide use and decades of experience, survival of congenital diaphragmatic hernia (CDH) patients treated with extra-corporeal membrane oxygenation (ECMO), as reported by the extra-corporeal life support organization (ELSO), remains unchanged at 50%. High-survival rates both with and without utilizing ECMO have been reported, fueling questions about the utility of ECMO support in this difficult population. This review looks at data from the Congenital Diaphragmatic Hernia Study Group and individual center reports, to evaluate the role of ECMO in CDH, focusing on defining the patients most likely to benefit, and discussing how those benefits can best be achieved. These data show that ECMO improves survival in those CDH patients who are most severely affected, but potential complications of ECMO delivery outweigh benefit in patients with less severely affected. Improved results can be expected by minimizing ECMO complications, and by improving rates of CDH repair in patients that require ECMO. Copyright © 2017 Elsevier Inc. All rights reserved.

  12. Femoro-femoral versus atrio-aortic extracorporeal membrane oxygenation: selecting the ideal cannulation technique.

    Science.gov (United States)

    Saeed, Diyar; Stosik, Hanna; Islamovic, Merima; Albert, Alexander; Kamiya, Hiroyuki; Maxhera, Bujar; Lichtenberg, Artur

    2014-07-01

    Veno-arterial extracorporeal membrane oxygenation (ECMO) may be implanted using peripheral ECMO (pECMO) or central ECMO (cECMO) cannulation techniques. The aim of this study was to compare the outcome between these two cannulation techniques. A retrospective study was performed at Düsseldorf University Hospital from October 2009 through June 2011. Inclusion criteria were patients with veno-arterial ECMO support ≥24 h. Various pre- and postimplantation variables were investigated including postimplantation hemodynamic and ECMO parameters, oxygenation/ventilation parameters at 3, 6, 12, 24, 48, 72 h, as well as renal and liver function tests at first and third postoperative days following implantation. Outcome data of patients receiving pECMO were compared with those who received cECMO. The inclusion criteria were met by 37 patients (25 pECMO and 12 cECMO). There were no significant differences in baseline characteristics between these two groups except for younger age in pECMO patients (P=0.005). All postimplantation variables were comparable between the two groups except for higher PO2 and lower PCO2 values at the 3rd hour postimplantation in patients with pECMO (P=0.007 and 0.01, respectively). Eleven (44%) of the pECMO patients required re-exploration for bleeding versus 100% of patients with cECMO (P=0.01). Ischemic leg complication was observed in four pECMO and three cECMO patients. Thirty-day mortality in patients with pECMO and cECMO was 60% versus 67%, respectively (P=1.00). In this study, no particular oxygenation/ventilation, hemodymanic, or end-organ function advantage was observed with either cannulation technique. However, more bleeding and resternotomy complications were observed in cECMO patients. Copyright © 2014 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

  13. Simulation training for extracorporeal membrane oxygenation

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    Roberta Brum

    2015-01-01

    Full Text Available Background: Extracorporeal membrane oxygenation (ECMO is a complex treatment. Despite this, there are a lack of training programs designed to develop relevant clinical and nonclinical skills required for ECMO specialists. The aim of the current study was to describe the design, implementation and evaluation of a 1-day simulation course for delivering training in ECMO. Methods: A 1-day simulation course was developed with educational and intensive care experts. First, the delegates received a lecture on the principles of simulation training and the importance of human factors. This was, followed by a practical demonstration and discussion of the ECMO circuit, console components, circuit interactions effects and potential complications. There were then five ECMO simulation scenarios with debriefing that covered technical and nontechnical issues. The course culminated in a knowledge-based assessment. Course outcomes were assessed using purpose-designed questionnaires. Results: We held 3 courses with a total of 14 delegates (9 intensive care nurses, 3 adult intensive care consultants and 2 ECMO technicians. Following the course, 8 (57% gained familiarity in troubleshooting an ECMO circuit, 6 (43% increased their familiarity with the ECMO pump and circuit, 8 (57% perceived an improvement in their communication skills and 7 (50% perceived an improvement in their leadership skills. At the end of the course, 13 (93% delegates agreed that they felt more confident in dealing with ECMO. Conclusions: Simulation-training courses may increase knowledge and confidence in dealing with ECMO emergencies. Further studies are indicated to determine whether simulation training improves clinical outcomes and translates to reduced complication rates in patients receiving ECMO.

  14. Craniotomy during ECMO in a severely traumatized patient

    NARCIS (Netherlands)

    Friesenecker, B. E.; Peer, R.; Rieder, J.; Lirk, P.; Knotzer, H.; Hasibeder, W. R.; Mayr, A. J.; Dünser, M. W.

    2005-01-01

    Extracorporeal membrane oxygenation (ECMO) can be a last resort treatment in acute respiratory distress syndrome after thoracic trauma. However, co-existent brain trauma is considered to be a contra-indication for ECMO. This is the first report on successful craniotomy under ECMO treatment in a

  15. Changes in thyroid hormone concentrations during neonatal extracorporeal membrane oxygenation

    NARCIS (Netherlands)

    Leeuwen, L. (L.); A.F.J. van Heijst (Arno); J.M. van Rosmalen (Joost); Y.B. de Rijke (Yolanda); L.W.J.E. Beurkens (Leonardus); D. Tibboel (Dick); E.L.T. van den Akker (Erica); H. IJsselstijn (Hanneke)

    2017-01-01

    textabstractObjective: Thyroid hormone concentrations can be disturbed during critical illness. Our aim was to determine changes in thyroid hormone concentrations during neonatal extracorporeal membrane oxygenation (ECMO). Study Design: We included 21 ECMO-treated neonates. Age-specific s.d. scores

  16. Deterioration of exercise capacity after neonatal extracorporeal membrane oxygenation

    NARCIS (Netherlands)

    M.H.M. van der Cammen-van Zijp (Monique); S.J. Gischler (Saskia); W.C.J. Hop (Wim); J.C. de Jongste (Johan); D. Tibboel (Dick); H. IJsselstijn (Hanneke)

    2011-01-01

    textabstractExtracorporeal membrane oxygenation (ECMO) provides life support in acute reversible cardiorespiratory failure. Assessment of long-term morbidity is essential to confirm survival advantage. This study aimed to assess exercise capacity in the first 12 yrs of life after neonatal ECMO, and

  17. Veno-Venous Extracorporeal Membrane Oxygenation for Continuous Renal Replacement in a Neonate with Propionic Acidemia.

    Science.gov (United States)

    Gander, Jeffrey W; Rhone, Erika T; Wilson, William G; Barcia, John P; Sacco, Melissa J

    2017-03-01

    The usual indications for extra corporeal membrane oxygenation (ECMO) are for respiratory or cardiac failure. Although continuous renal replacement therapy (CRRT) is frequently used when patients are on ECMO, the need for CRRT as the primary indication for ECMO is rare. A case of a neonate placed onto veno-venous ECMO for the use of CRRT to treat hyperammonemia from propionic acidemia is presented.

  18. Ecmo y ecmo mobile. soporte gardio respiratorio avanzado

    Directory of Open Access Journals (Sweden)

    Dr. G. Rodrigo Díaz

    2011-05-01

    Full Text Available ECMO (Extracorporeal Membrane Oxygenation es un sistema de soporte vital extracorpóreo en falla pulmonar catastrófica, insuficiencia cardiaca aguda y reanimación de uso cada vez más común. En Chile se ha implementado en distintos centros, con resultados comparables al registro internacional. Cuando el candidato a ser sometido está demasiado inestable como para ser transportado a un hospital que cuente con ECMO, la canulación antes del traslado permite la estabilización y posterior transporte al centro de ECMO. Los resultados en los pacientes transportados son similares a los casos generados en el mismo lugar. En el siguiente artículo revisaremos las definiciones en soporte extracorpóreo, indicaciones y contraindicaciones, los resultados esperables y las experiencias internacionales y propia de Clínica Las Condes en ECMO y ECMO Mobile.

  19. Cerebral aspects of neonatal extracorporeal membrane oxygenation: a review.

    NARCIS (Netherlands)

    Mol, A.C. de; Liem, K.D.; Heijst, A.F.J. van

    2013-01-01

    Background: Neonatal extracorporeal membrane oxygenation (ECMO) is a lifesaving therapeutic approach in newborns suffering from severe, but potentially reversible, respiratory insufficiency, mostly complicated by neonatal persistent pulmonary hypertension. However, cerebral damage, intracerebral

  20. Prolonged Extracorporeal Membrane Oxygenation Support for Acute Respiratory Distress Syndrome

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    Wen-Je Ko

    2006-01-01

    Full Text Available When all conventional treatments for respiratory failure in patients with acute respiratory distress syndrome (ARDS have failed, extracorporeal membrane oxygenation (ECMO can provide a chance of survival in these desperately ill patients. A 49-year-old male patient developed septic shock and progressive ARDS after liver abscess drainage. Venovenous ECMO was given due to refractory respiratory failure on postoperative day 6. Initially, two heparin-binding hollow-fiber microporous membrane oxygenators in parallel were used in the ECMO circuit. Twenty-two oxygenators were changed in the first 22 days of ECMO support because of plasma leak in the oxygenators. Each oxygenator had an average life of 48 hours. Thereafter, a single silicone membrane oxygenator was used in the ECMO circuit, which did not require change during the remaining 596 hours of ECMO. The patient's tidal volume was only 90 mL in the nadir and less than 300 mL for 26 days during the ECMO course. The patient required ECMO support for 48 days and survived despite complications, including septic shock, ARDS, acute renal failure, drug-induced leukopenia, and multiple internal bleeding. This patient received an unusually long duration of ECMO support. However, he survived, recovered well, and was in New York Heart Association functional class I-II, with a forced expiratory volume in 1 second of 81% of the predicted level 18 months later. In conclusion, ECMO can provide a chance of survival for patients with refractory ARDS. The reversibility of lung function is possible in ARDS patients regardless of the severity of lung dysfunction at the time of treatment.

  1. Neuropsychological Follow-up After Neonatal ECMO

    NARCIS (Netherlands)

    Schiller, R.M.; Madderom, M.J.; Reuser, J.J.C.M.; Steiner, K.; Gischler, S.J.; Tibboel, D.; Heijst, A.F.J. van; Ijsselstijn, H.

    2016-01-01

    OBJECTIVE: To assess the longitudinal development of intelligence and its relation to school performance in a nationwide cohort of neonatal extracorporeal membrane oxygenation (ECMO) survivors and evaluate predictors of outcome at 8 years of age. METHODS: Repeated measurements assessed intelligence

  2. Neuropsychological Follow-up After Neonatal ECMO

    NARCIS (Netherlands)

    R.M. Schiller (Raisa); M.J. Madderom (Marlous); J.J.C.M. Reuser (Jolanda); K. Steiner (Katerina); S.J. Gischler (Saskia); D. Tibboel (Dick); A.F.J. van Heijst (Arno); H. IJsselstijn (Hanneke)

    2016-01-01

    markdownabstractOBJECTIVE: To assess the longitudinal development of intelligence and its relation to school abstract performance in a nationwide cohort of neonatal extracorporeal membrane oxygenation (ECMO) survivors and evaluate predictors of outcome at 8 years of age. METHODS: Repeated

  3. Central extracorporeal membrane oxygenation requiring pulmonary arterial venting after near-drowning.

    Science.gov (United States)

    Kimura, Mitsutoshi; Kinoshita, Osamu; Fujimoto, Yoshifumi; Murakami, Arata; Shindo, Takahiro; Kashiwa, Koichi; Ono, Minoru

    2014-02-01

    Extracorporeal membrane oxygenation (ECMO) is an effective respiratory and circulatory support in patients in refractory cardiogenic shock or cardiac arrest. Peripheral ECMO sometimes requires left heart drainage; however, few reports state that pulmonary arterial (PA) venting is required during ECMO support. We present a case of a 14-year-old boy who required PA venting during ECMO support after resuscitation from near-drowning in freshwater. A biventricular assist device with an oxygenator implantation was intended on day 1; however, we were unable to proceed because of increasing of pulmonary vascular resistance from the acute lung injury. Central ECMO with PA venting was then performed. On day 13, central ECMO was converted to biventricular assist device with an oxygenator, which was removed on day 16. This case suggests that PA venting during ECMO support may be necessary in some cases of respiratory and circulatory failure with high pulmonary vascular resistance after near-drowning.

  4. Cupriavidus pauculus bacteremia in a child on extracorporeal membrane oxygenation.

    Science.gov (United States)

    Uzodi, Adaora S; Schears, Gregory J; Neal, James R; Henry, Nancy K

    2014-01-01

    We report a case of bacteremia secondary to Cupriavidus pauculus in a 15-month-old boy on extracorporeal membrane oxygenation (ECMO). The source of the organism was water in the thermoregulator reservoir. The child responded well to cefepime and ciprofloxacin, a delayed oxygenator change out and replacement of the thermoregulator reservoir with a unit that was cleaned and decontaminated with sodium hypochlorite. Isolation of Cupriavidus pauculus from a patient on ECMO support should raise suspicion of the reservoir as a source.

  5. Kinetics of Procalcitonin in Pediatric Patients on Extracorporeal Membrane Oxygenation.

    Science.gov (United States)

    Bobillo, Sara; Rodríguez-Fanjul, Javier; Solé, Anna; Moreno, Julio; Balaguer, Mònica; Esteban, Elisabeth; Cambra, Francisco José; Jordan, Iolanda

    2018-01-01

    To assess the kinetics of procalcitonin (PCT) and C-reactive protein (CRP) in pediatric patients who required extracorporeal membrane oxygenation (ECMO) and to analyze its relationship with morbidity and mortality. Prospective observational study including pediatric patients who required ECMO. Both PCT and CRP were sequentially drawn before ECMO (P0) and until 72 hours after ECMO. A total of 40 patients were recruited. Two cohorts were established based on the value of the P0 PCT (>10 ng/mL). Comparing the kinetics of PCT and CRP in these cohorts, the described curves were the expected for each clinical situation. The cutoff for P0 PCT to predict multiple organ dysfunction syndrome was 2.55 ng/mL (sensibility 83%, specificity 100%). Both PCT and CRP did not predict risk of neurologic sequelae or mortality in any group. Procalcitonin does not seem to be modified by ECMO and could be a good biomarker of evolution.

  6. The impact of severity of initial illness, determined by SOFA score, and presence of anemia on outcomes among patients requiring Extra Corporal Membrane Oxygenation (ECMO) support: A single center experience.

    Science.gov (United States)

    Elabbassi, Wael; Aila, Farah Al; Chowdhury, Mohammed Andaleeb; Najib, Ahmed; Zaid, H; Michelin, M; Nooryani, Arif Al

    ECMO provides respiratory and circulatory support in critically ill patients. In our study, we report on a single center experience with ECMO and aim to identify the prognostic markers for survival to discharge from hospital. A registry was maintained on all patients who underwent ECMO implantation from September 2012 till January 2016 at a single institution. The collected data was analyzed to identify baseline characteristics, outcomes including clinical variables predictive of poor outcome. A total of 29 patients underwent ECMO implantation. The average age of patients was 42±18years. 59% were males (N=17). 19 cases had a cardiac indication for ECMO (66%) while 10 cases had a pulmonary indication (34%). On univariate analysis; presence of Multi-organ failure, SOFA score more than 18 and hemoglobin less than 10g/dl at baseline and after ECMO removal were associated with increased 30day mortality. Pearson correlation with 30day mortality showed a positive correlation with MOF (+0.562, p=0.002) and SOFA score >18 (+0.448, p=0.015) and a negative correlation with anemia (-0.507, p=0.005). 15 out of the total 29 patients (52%) died within 30days of admission. Patients with MOF (log rank: 10.926, p=0.001), SOFA score >18 (log rank: 7.758, p=0.005) and hemoglobin <10g/dl (log rank: 5.595, p=0.018) had decreased survival on 30day follow up. Although the use of ECMO as a last line in the treatment of critical patients refractory to conventional treatment measures constitutes an important improvement in their care; with 48% overall survival; patient selection and timing of ECMO initiation remains challenging. Patients who already had signs of MOF and a high SOFA score portended a poor response. Similarly for anemic patients. Hence the importance of consideration for ECMO use earlier in course of illness rather than later. Screening and aggressive treatment of anemia in those patients may help improve the outcomes. Copyright © 2017. Published by Elsevier B.V.

  7. Extracorporeal membrane oxygenation, an anesthesiologist′s perspective: Physiology and principles. Part 1

    Directory of Open Access Journals (Sweden)

    Chauhan Sandeep

    2011-01-01

    Full Text Available Extracorporeal membrane oxygenation (ECMO is an adaptation of conventional cardiopulmonary bypass techniques to provide cardiopulmonary support. ECMO provides physiologic cardiopulmonary support to aid reversible aspects of the disease process and to allow recovery. ECMO does not provide treatment of the underlying disease. The indications for ECMO support have expanded from acute respiratory failure to acute cardiac failure refractory to conventional treatments from wide patient subsets involving neonates to adults. Vascular access for ECMO support is either percutaneous through a single-site, dual-lumen bicaval cannula or transthoracic via separate cannulas. The modes of support are either veno-venous or veno-arterial ECMO. In this article, the physiologic aspects of ECMO support are outlined.

  8. Severe myocardial injury and extracorporeal membrane oxygenation following perinatal asphyxia

    Directory of Open Access Journals (Sweden)

    P. Benson Ham

    2015-05-01

    Full Text Available Perinatal asphyxia is a common cause of morbidity and mortality in the newborn and is associated with myocardial injury in a significant proportion of cases. Biomarkers, echocardiography, and rhythm disturbances are sensitive indicators of myocardial ischemia and may predict mortality. We present a case of severe myocardial dysfunction immediately after delivery managed with extracorporeal membrane oxygenation (ECMO and discuss the role of cardiac biomarkers, echocardiography, electrocardiography, and ECMO in the asphyxiated newborn.

  9. Motor performance in five-year-old extracorporeal membrane oxygenation survivors: A population-based study

    NARCIS (Netherlands)

    M.W.G. Nijhuis-van der Sanden (Maria); M.H.M. van der Cammen-van Zijp (Monique); A.J.W.M. Janssen (Anjo); J.J.C.M. Reuser (Jolanda); P. Mazer (Petra); A.F.J. van Heijst (Arno); S.J. Gischler (Saskia); D. Tibboel (Dick); L.A. Kollee

    2009-01-01

    textabstractIntroduction: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is a cardio-pulmonary bypass technique to provide life support in acute reversible cardio-respiratory failure when conventional management is not successful. Most neonates receiving ECMO suffer from meconium

  10. Triiodothyronine facilitates weaning from extracorporeal membrane oxygenation by improved mitochondrial substrate utilization

    Energy Technology Data Exchange (ETDEWEB)

    Files, Matthew D.; Kajimoto, Masaki; Priddy, Colleen M.; Ledee, Dolena R.; Xu, Chun; Des Rosiers, Christine; Isern, Nancy G.; Portman, Michael A.

    2014-03-20

    Extracorporeal membrane oxygenation (ECMO) provides a bridge to recovery after myocardial injury in infants and children, yet morbidity and mortality remain high. Weaning from the circuit requires adequate cardiac contractile function, which can be impaired by metabolic disturbances induced either by ischemia-reperfusion and / or by ECMO.

  11. Successful Left-Heart Decompression during Extracorporeal Membrane Oxygenation in an Adult Patient by Percutaneous Transaortic Catheter Venting

    Directory of Open Access Journals (Sweden)

    Tae Hee Hong

    2015-06-01

    Full Text Available Venoarterial extracorporeal membrane oxygenation (VA ECMO is widely used in patients with cardiogenic shock. Insufficient decompression of the left ventricle (LV is considered a major factor preventing adequate LV recovery. A 40-year-old male was diagnosed with acute myocardial infarction, and revascularization was performed using percutaneous stenting. However, cardiogenic shock occurred, and VA ECMO was initiated. Severe LV failure developed, and percutaneous transaortic catheter venting (TACV was incorporated into the venous circuit of VA ECMO under transthoracic echocardiography guidance. The patient was successfully weaned from VA ECMO. Percutaneous TACV is an effective, relatively noninvasive, and rapid method of LV decompression in patients undergoing VA ECMO.

  12. Extracorporeal membrane oxygenation: current clinical practice, coding, and reimbursement.

    Science.gov (United States)

    Schuerer, Douglas J E; Kolovos, Nikoleta S; Boyd, Kayla V; Coopersmith, Craig M

    2008-07-01

    Extracorporeal membrane oxygenation (ECMO) is a technique for providing life support for patients experiencing both pulmonary and cardiac failure by maintaining oxygenation and perfusion until native organ function is restored. ECMO is used routinely at many specialized hospitals for infants and less commonly for children with respiratory or cardiac failure from a variety of causes. Its usage is more controversial in adults, but select medical centers have reported favorable findings in patients with ARDS and other causes of severe pulmonary failure. ECMO is also rarely used as a rescue therapy in a small subset of adult patients with cardiac failure. This article will review the current uses and techniques of ECMO in the critical care setting as well as the evidence supporting its usage. In addition, current practice management related to coding and reimbursement for this intensive therapy will be discussed.

  13. Successful application of venoarterial-venous extracorporeal membrane oxygenation in the reversal of severe cardiorespiratory failure.

    Science.gov (United States)

    Umei, Nao; Ichiba, Shingo; Ujike, Yoshihito; Tsukahara, Kouhei

    2015-06-08

    Typical configurations of extracorporeal membrane oxygenation (ECMO) include venovenous (VV) and venoarterial (VA) configurations; however, other configurations of ECMO may be necessary in certain situations. We performed VA ECMO for a 71-year-old man who experienced refractory hypoxaemia associated with a brief cardiac arrest after resection of the small intestine showing necrosis. As the cardiac function improved, the patient showed a complication of poor oxygenation in the upper body due to insufficient respiratory function. Therefore, we performed VA-venous ECMO, which further improved his cardiac function and allowed him to be converted to VV ECMO. It is very important to consider different configuration strategies of ECMO by adjusting the patient's cardiopulmonary conditions appropriately. 2015 BMJ Publishing Group Ltd.

  14. Microcirculatory assessment of patients under VA-ECMO

    NARCIS (Netherlands)

    A. Kara (Atila); S. Akin (Sakir); D. dos Reis Miranda (Dinis); A. Struijs (Ard); K. Caliskan (Kadir); R.J. van Thiel (Robert); E.A. Dubois; de Wilde, W. (Wouter); F. Zijlstra (Felix); D.A.M.P.J. Gommers (Diederik); C. Ince (Can)

    2016-01-01

    textabstractBackground: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is an effective technique for providing emergency mechanical circulatory support for patients with cardiogenic shock. VA-ECMO enables a rapid restoration of global systemic organ perfusion, but it has not been found

  15. Microcirculatory assessment of patients under VA-ECMO

    NARCIS (Netherlands)

    Kara, Atila; Akin, Sakir; Dos Reis Miranda, Dinis; Struijs, Ard; Caliskan, Kadir; van Thiel, Robert J.; Dubois, Eric A.; de Wilde, Wouter; Zijlstra, Felix; Gommers, Diederik; Ince, Can

    2016-01-01

    Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is an effective technique for providing emergency mechanical circulatory support for patients with cardiogenic shock. VA-ECMO enables a rapid restoration of global systemic organ perfusion, but it has not been found to always show a

  16. Morphometric analysis of the lung vasculature after extracorporeal membrane oxygenation treatment for pulmonary hypertension in newborns.

    NARCIS (Netherlands)

    Heyst, A.F.J. van; Haasdijk, R.; Groenman, F.; Staak, F.H.J.M. van der; Hulsbergen-van de Kaa, C.A.; Krijger, R.R. de; Tibboel, D.

    2004-01-01

    Persistent pulmonary hypertension in the newborn (PPHN) is characterised by increased medial and adventitial thickness in the lung vasculature. This study describes morphometry of lung vasculature after extracorporeal membrane oxygenation (ECMO) in newborns with PPHN, due to meconium aspiration

  17. Continuous Renal Replacement Therapy Applications on Extracorporeal Membrane Oxygenation Circuit.

    Science.gov (United States)

    Yetimakman, Ayse Filiz; Tanyildiz, Murat; Kesici, Selman; Kockuzu, Esra; Bayrakci, Benan

    2017-06-01

    Continuous venovenous hemofiltration or hemodiafiltration is used frequently in pediatric patients, but experience of continuous renal replacement therapy (CRRT) application on extracorporeal membrane oxygenation (ECMO) circuit is still limited. Among several methods used for applying CRRT on ECMO patients, we aim to share our experience on inclusion of a CRRT device in the ECMO circuit which we believe is easier and safer to apply. The data were collected on demographics, outcomes, and details of the treatment of ECMO patients who had CRRT. During the study period of 3 years, venous cannula of ECMO circuit before pump was used for CRRT access for both the filter inlet and outlet of CRRT machine to minimize the thromboembolic complications. The common indication for CRRT was fluid overload. CRRT was used in 3.68% of a total number of patients admitted and 43% of patients on ECMO. The patients have undergone renal replacement therapy for periods of time ranging between 24 h and 25 days (260 h mean). The survival rate of this group of patients with multiorgan failure was 33%. Renal recovery occurred in all of the survivors. Complications such as electrolyte imbalance, hypothermia, and bradykinin syndrome were easily managed. Adding a CRRT device on ECMO circuit is a safe and effective technique. The major advantages of this technique are easy to access, applying CRRT without extra anticoagulation process, preventing potential hemodynamic disturbances, and increased clearance of solutes and fluid overload using larger hemofilter.

  18. Extracorporeal Membrane Oxygenation as a Bridge to Lung Transplantation in the United States: A Multicenter Survey.

    Science.gov (United States)

    Tsiouris, Athanasios; Budev, Marie M; Yun, James J

    2017-12-14

    The clinical use of extracorporeal membrane oxygenation (ECMO) as a bridge to lung transplantation (LTx) has greatly increased in recent years. However, clinical practices for ECMO as a bridge to LTx vary widely between LTx centers. To better define the current practice of ECMO as a bridge to LTx, we surveyed pre-LTx ECMO practices among all adult LTx programs in the United States. All US LTx centers were surveyed (n = 57) between January and December 2014. Responses were received from 33 of 57 centers (58%). Of 33 responding centers, six (18%) performed ≥50 LTxs per year (defined as high volume) and two (6%) performed bridge to LTx. Of these 22 centers, 18 (82%) successfully used venovenous (VV) ECMO as a bridge to LTx using the dual-lumen Avalon cannula. Patient >65 years of age was judged an ECMO contraindication in 15/33 (45%) of responding centers, but 12/33 (36%) centers, including the six high-volume centers, had no official age cutoff for ECMO candidacy. There was no consensus on the maximum acceptable duration of pre-LTx ECMO therapy; although 18/33 (55%) of programs had no defined maximal duration of ECMO pre-LTx, 10/33 (30%) considered >10 days on ECMO support contraindicated. Our survey suggests that in the United States, ECMO is used frequently pre-LTx, particularly VV ECMO at high-volume centers. However, criteria for ECMO initiation, age eligibility, bedside care, and maximum duration of support varied significantly between survey respondents.

  19. Blood Transfusion Strategies in Patients Undergoing Extracorporeal Membrane Oxygenation

    Directory of Open Access Journals (Sweden)

    Hyoung Soo Kim

    2017-02-01

    Full Text Available Extracorporeal membrane oxygenation (ECMO is frequently associated with bleeding and coagulopathy complications, which may lead to the need for transfusion of multiple blood products. However, blood transfusions are known to increase morbidity and mortality, as well as hospital cost, in critically ill patients. In current practice, patients on ECMO receive a transfusion, on average, of 1-5 packed red blood cells (RBCs/day, with platelet transfusion accounting for the largest portion of transfusion volume. Generally, adult patients require more transfusions than neonates or children, and patients receiving venovenous ECMO for respiratory failure tend to need smaller transfusion volumes compared to those receiving venoarterial ECMO for cardiac failure. Observation studies have reported that a higher transfusion volume was associated with increased mortality. To date, the evidence for transfusion in patients undergoing ECMO is limited; most knowledge on transfusion strategies was extrapolated from studies in critically ill patients. However, current data support a restrictive blood transfusion strategy for ECMO patients, and a low transfusion trigger seems to be safe and reasonable.

  20. Risk factors for nosocomial infections in patients receiving extracorporeal membrane oxygenation supportive therapy.

    Science.gov (United States)

    Sun, Geqin; Li, Binfei; Lan, Haili; Wang, Juan; Lu, Lanfei; Feng, Xueqin; Luo, Xihua; Yan, Haizhong; Mu, Yuejing

    2017-11-22

    The aim of this study was to analyze risk factors for nosocomial infection (NI) in patients receiving extracorporeal membrane oxygenation (ECMO) support. Clinical NI data were collected from patients who received ECMO support therapy, and analyzed retrospectively. Among 75 ECMO patients, 20 were found to have developed NI (infection rate 26.7%); a total of 58 pathogens were isolated, including 43 strains of gram-negative bacteria (74.1%) and 15 strains of gram-positive bacteria (25.9%). Multi-drug resistant strains were highly concentrated and were mainly shown to be Acinetobacter baumannii, Pseudomonas aeruginosa, and coagulase-negative staphylococci. Incidence of NI was related to the duration of ECMO support therapy and the total length of hospital stay, and the differences were statistically significant (P<.05). A prolonged period of ECMO support extended the hospital stay, but it did not increase the mortality rate. However, an elevated level of lactic acid increased the mortality rate in this study population. ECMO-associated secondary NIs correlated significantly with the length of hospital stay and with the duration of ECMO support. Therefore, to reduce the incidence of ECMO-associated NIs, preventive strategies that aim to shorten the duration of ECMO support therapy and avoid lengthy hospitalization should be applied, wherever possible. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

  1. Histopathologic Findings in Lungs of Patients Treated With Extracorporeal Membrane Oxygenation.

    Science.gov (United States)

    Lee, Hee Eun; Yi, Eunhee S; Rabatin, Jeffrey T; Bohman, J Kyle; Roden, Anja C

    2017-12-20

    The outcome of extracorporeal membrane oxygenation (ECMO) might be influenced by its complications. Only limited information is available regarding the pathologic consequences of ECMO, especially in the era of modern ECMO technology. We studied the histopathologic findings in autopsy lungs of patients treated with ECMO compared with those without ECMO. Autopsy files were queried for cases with ECMO. An age- and sex-matched control group comprised of patients who died in the ICU without acute respiratory distress syndrome, pneumonia, or ECMO was compared with patients with ECMO for cardiac reason. Histopathology and medical records were reviewed. Seventy-six patients treated with ECMO (38 men; median age, 40 years) and 47 control patients (23 men; median age, 45 years) were included. Common histologic pulmonary findings in the ECMO group were pulmonary hemorrhage (63.2%), acute lung injury (60.5%), thromboembolic disease (47.4%), calcifications (28.9%), vascular changes (21.1%), and hemorrhagic infarct (21.1%). Pulmonary hemorrhage was associated with longer ECMO duration (median, 7.0 vs 3.5 months; P = .014), acute lung injury with venovenous ECMO (91.7% vs 54.7%; P = .039) and longer ECMO (6.0 vs 4.0 months; P = .044), and pulmonary calcifications with infants (50.0% vs 22.4%; P = .024). Patients with ECMO for cardiac reasons (n = 60) more frequently showed pulmonary hemorrhage (P < .001), diffuse alveolar damage (P = .044), thromboembolic disease (P = .004), hemorrhagic infarct (P = .002), pulmonary calcifications (P = .002), and vascular changes (P = .001) than patients in the non-ECMO group. Some findings are suspected to be associated with the patient's underlying disease, whereas others might be related to ECMO. Our results provide a better understanding of ECMO-related lung disease and might help to prevent it. Copyright © 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

  2. Serial plasma concentrations of atrial natriuretic peptide, plasma renin activity, aldosterone, and antidiuretic hormone in neonates on extracorporeal membrane oxygenation.

    NARCIS (Netherlands)

    Semmekrot, B.A.; Pesman, G.J.; Span, P.N.; Sweep, C.G.J.; Heyst, A.F.J. van; Monnens, L.A.H.; Bor, M. van de; Tanke, R.B.; Staak, F.H.J.M. van der

    2002-01-01

    To obtain information on water and salt regulating hormones and volume homeostasis during neonatal extracorporeal membrane oxygenation (ECMO), serial determinations of atrial natriuretic peptide (ANP), plasma renin activity (PRA), aldosterone (Aldo), antidiuretic hormone (ADH), colloid-osmotic

  3. Superior vena cava drainage improves upper body oxygenation during veno-arterial extracorporeal membrane oxygenation in sheep.

    Science.gov (United States)

    Hou, Xiaotong; Yang, Xiaofang; Du, Zhongtao; Xing, Jialin; Li, Hui; Jiang, Chunjing; Wang, Jinhong; Xing, Zhichen; Li, Shuanglei; Li, Xiaokui; Yang, Feng; Wang, Hong; Zeng, Hui

    2015-02-20

    Differential hypoxia is a pivotal problem in patients with femoral veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) support. Despite recognition of differential hypoxia and attempts to deliver more oxygenated blood to the upper body, the mechanism of differential hypoxia as well as prevention strategies have not been well investigated. We used a sheep model of acute respiratory failure that was supported with femoral VA ECMO from the inferior vena cava to the femoral artery (IVC-FA), ECMO from the superior vena cava to the FA (SVC-FA), ECMO from the IVC to the carotid artery (IVC-CA) and ECMO with an additional return cannula to the internal jugular vein based on the femoral VA ECMO (FA-IJV). Angiography and blood gas analyses were performed. With IVC-FA, blood oxygen saturation (SO₂) of the IVC (83.6 ± 0.8%) was higher than that of the SVC (40.3 ± 1.0%). Oxygen-rich blood was drained back to the ECMO circuit and poorly oxygenated blood in the SVC entered the right atrium (RA). SVC-FA achieved oxygen-rich blood return from the IVC to the RA without shifting the arterial cannulation. Subsequently, SO₂ of the SVC and the pulmonary artery increased (70.4 ± 1.0% and 73.4 ± 1.1%, respectively). Compared with IVC-FA, a lesser difference in venous oxygen return and attenuated differential hypoxia were observed with IVC-CA and FA-IJV. Differential venous oxygen return is a key factor in the etiology of differential hypoxia in VA ECMO. With knowledge of this mechanism, we can apply better cannula configurations in clinical practice.

  4. Extracorporeal membrane oxygenation after intravenous injection of paraffin oil

    DEFF Research Database (Denmark)

    Pasgaard, Thomas; Huynh, Anh-Nhi Thi; Gjedsted, Jakob

    2016-01-01

    We present a rare cause of acute respiratory distress syndrome (ARDS) due to an accidental intravascular injection of paraffin oil. While there is no specific therapy, we decided to support the patient with veno-venous extracorporeal membrane oxygenation (V-V ECMO) to allow the ARDS to resolve....... A previously healthy 30-year-old man was admitted to the Emergency Department with acute onset respiratory distress following an injection with paraffin oil for cosmetic purposes. In 36 hours, the patient developed severe ARDS and respiratory support with V-V ECMO was initiated. The patient was successfully...

  5. Oxygen transport membrane

    DEFF Research Database (Denmark)

    2015-01-01

    The present invention relates to a novel composite oxygen transport membrane as well as its preparation and uses thereof.......The present invention relates to a novel composite oxygen transport membrane as well as its preparation and uses thereof....

  6. The Use of Extracorporeal Membrane Oxygenation in the Surgical Repair of Bronchial Rupture

    Directory of Open Access Journals (Sweden)

    Ju-Hee Park

    2016-02-01

    Full Text Available Extracorporeal membrane oxygenation (ECMO has been used successfully in critically ill patients with traumatic lung injury and offers an additional treatment modality. ECMO is mainly used as a bridge treatment to delayed surgical management; however, only a few case reports have presented the successful application of ECMO as intraoperative support during the surgical repair of traumatic bronchial injury. A 38-year-old man visited our hospital after a blunt chest trauma. His chest imaging showed hemopneumothorax in the left hemithorax and a finding suspicious for left main bronchus rupture. Bronchoscopy was performed and confirmed a tear in the left main bronchus and a congenital tracheal bronchus. We decided to provide venovenous ECMO support during surgery for bronchial repair. We successfully performed main bronchial repair in this traumatic patient with a congenital tracheal bronchus. We suggest that venovenous ECMO offers a good option for the treatment of bronchial rupture when adequate ventilation is not possible.

  7. Successful weaning from 65-day extracorporeal membrane oxygenation therapy in influenza-associated acute respiratory distress syndrome.

    Science.gov (United States)

    Buchtele, Nina; Schellongowski, Peter; Bojic, Andja; Hermann, Alexander; Robak, Oliver; Lamm, Wolfgang; Staudinger, Thomas

    2016-07-04

    Data on prolonged extracorporeal membrane oxygenation (ECMO) usage in influenza associated acute respiratory distress syndrome (ARDS) are lacking. Furthermore, no consensus exists on when to terminate ECMO treatment in refractory cases. This report highlights additional treatment measures and complications in prolonged ECMO therapy and discusses associated ethical burdens. We report on a 64-year-old man with confirmed H1N1 influenza virus infection who was successfully weaned from 65-day ECMO treatment with an excellent outcome. Our experience suggests that prolonged ECMO therapy may be provided as long as only 1-organ failure exists and no lung fibrosis occurs. Active physical therapy, facilitated by ECMO treatment, is crucial and should be performed as early as possible.

  8. A safe procedure for connecting a continuous renal replacement therapy device into an extracorporeal membrane oxygenation circuit.

    Science.gov (United States)

    Suga, Natsumi; Matsumura, Yosuke; Abe, Ryuzo; Hattori, Noriyuki; Nakada, Taka-Aki; Oda, Shigeto

    2017-06-01

    Patients receiving extracorporeal membrane oxygenation (ECMO) often require continuous renal replacement therapy (CRRT). The intra-circuit pressure of adult ECMO usually deviates from the physiological range. We investigated the use of CRRT connected to an ECMO circuit with physiological intra-circuit pressures (0-150 mmHg, defined as the "safety range") using an in vitro experiment involving a water-filled ECMO circuit. The intra-circuit pressure pre-pump, post-pump, and post-oxygenator were measured while varying the height of the pump or ECMO flow. The bypass conduit pressure and distance from the post-oxygenator port were measured to find the "safety point", where the bypass pressure remained within the safety range. Both drainage and return limbs of the CRRT machine were connected to the safety point and the inlet and outlet pressures of the hemofilter were recorded while varying the ECMO and CRRT flow. The pre-pump pressure only remained within the safety range for heights >75 cm (ECMO flow = 4 L/min) or ECMO flow machine safely under physiological pressures in adult patients receiving ECMO.

  9. The organ preservation and enhancement of donation success ratio effect of extracorporeal membrane oxygenation in circulatory unstable brain death donor.

    Science.gov (United States)

    Fan, Xiaoli; Chen, Zhiquan; Nasralla, David; Zeng, Xianpeng; Yang, Jing; Ye, Shaojun; Zhang, Yi; Peng, Guizhu; Wang, Yanfeng; Ye, Qifa

    2016-10-01

    Between 2010 and 2013, we recorded 66 cases of failed organ donation after brain death (DBD) due to the excessive use of the vasoactive drugs resulting in impaired hepatic and/or renal function. To investigate the effect of extracorporeal membrane oxygenation (ECMO) in donor management, ECMO was used to provide support for DBD donors with circulatory and/or respiratory failure from 2013 to 2015. A retrospective cohort study between circulatory non-stable DBD with vasoactive drugs (DBD-drug) and circulatory non-stable DBD with ECMO (DBD-ECMO) was designed to compare the transplant outcomes. A total of 19 brain death donors were supported by ECMO. The incidence rate of post-transplant liver primary non-function (PNF) was 10% (two of 20) in DBD-drug group and zero in DBD-ECMO group. Kidney function indicators, including creatinine clearance and urine production, were significantly better in DBD-ECMO group, as well as the kidney delayed graft function (DGF) rate was found to be decreased by the use of ECMO in our study. Donation success rate increased steadily from 47.8% in 2011 to 84.6% in 2014 after the ECMO intervention. The use of ECMO in assisting circulatory and respiratory function of DBD can reduce liver and kidney injury from vasoactive drugs, thereby improving organ quality and reducing the organ discard rates. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  10. Management benefits and safety of computed tomography in patients undergoing extracorporeal membrane oxygenation therapy: experience of a single centre

    International Nuclear Information System (INIS)

    Jepson, S.L.; Harvey, C.; Entwisle, J.J.; Peek, G.J.

    2010-01-01

    Aim: To evaluate the benefits and logistical safety of computed tomography (CT) imaging in patients undergoing extracorporeal membrane oxygenation (ECMO) therapy in a single institution. Materials and methods: Over a period of 25 months, 134 patients (80 neonates, 19 children, and 35 adults) underwent ECMO therapy at this institution. The imaging of these patients was reviewed to identify patients who had undergone CT imaging whilst on ECMO. Patient notes were retrospectively reviewed. CT findings and subsequent decisions were analysed to assess the benefit of CT imaging. Complications arising due to the logistics of performing the scan were analysed to assess the safety of performing CT in ECMO patients. Results: Of 134 patients, 14 (10%) had a total of 15 CT examinations whilst undergoing ECMO therapy. Indications for CT included new neurology, increased respiratory demand, and increasing requirement for high ECMO flows. There were no major complications and two minor complications associated with the logistics of performing a CT examination on an ECMO patient. Significant findings resulted from 73.3% (11/15) of the CT examinations, and in all 15 examinations information was provided that was used in making further management decisions, including, in some cases, withdrawal of ECMO therapy. Conclusion: With an experienced team, CT imaging of patients on ECMO can be performed safely. CT provides valuable information for subsequent management of patients undergoing ECMO therapy.

  11. Transfusion Associated Hyperkalemia and Cardiac Arrest in an Infant after Extracorporeal Membrane Oxygenation

    Directory of Open Access Journals (Sweden)

    Do Wan Kim

    2015-05-01

    Full Text Available Cardiac arrest associated with hyperkalemia during red blood cell transfusion is a rare but fatal complication. Herein, we report a case of transfusion-associated cardiac arrest following the initiation of extracorporeal membrane oxygenation support in a 9-month old infant. Her serum potassium level was increased to 9.0 mEq/L, soon after the newly primed circuit with pre-stored red blood cell (RBC was started and followed by sudden cardiac arrest. Eventually, circulation was restored and the potassium level decreased to 5.1 mEq/L after 5 min. Extracorporeal membrane oxygenation (ECMO priming is a relatively massive transfusion into a pediatric patient. Thus, to prevent cardiac arrest during blood-primed ECMO in neonates and infants, freshly irradiated and washed RBCs should be used when priming the ECMO circuit, to minimize the potassium concentration. Also, physicians should be aware of all possible complications associated with transfusions during ECMO.

  12. Neurodevelopmental, educational and behavioral outcome at 8 years after neonatal ECMO: a nationwide multicenter study

    NARCIS (Netherlands)

    Madderom, M.J.; Reuser, J.J.C.M.; Utens, E.M.; Rosmalen, J. van; Raets, M.; Govaert, P.; Steiner, K.; Gischler, S.J.; Tibboel, D.; Heijst, A.F.J. van; Ijsselstijn, H.

    2013-01-01

    PURPOSE: Reporting neurodevelopmental outcome of 8-year-old children treated with neonatal extracorporeal membrane oxygenation (ECMO). METHODS: In a follow-up study in 135 8-year-old children who received neonatal ECMO between 1996 and 2001 we assessed intelligence (Revised Amsterdam Intelligence

  13. Venovenous Extracorporeal Membrane Oxygenation as a Treatment for Obesity Hypoventilation Syndrome

    OpenAIRE

    Umei, Nao; Ichiba, Shingo

    2017-01-01

    The mortality rate for respiratory failure resulting from obesity hypoventilation syndrome is high if it requires ventilator management. We describe a case of severe acute respiratory failure resulting from obesity hypoventilation syndrome (BMI, 60.2 kg/m2) successfully treated with venovenous extracorporeal membrane oxygenation (VV-ECMO). During ECMO management, a mucus plug was removed by bronchoscopy daily and 18 L of water was removed using diuretics, resulting in weight loss of 24 kg. Th...

  14. Complicated Pulmonary Pseudocyst Following Traumatic Lung Injury Rescued by Extracorporeal Membrane Oxygenation

    Directory of Open Access Journals (Sweden)

    Sung Bum Park

    2014-08-01

    However, we experienced a case of a delayed complicated pulmonary pseudocyst in a 17-year-old boy following severe traumatic acute respiratory distress syndrome rescued by Veno-venous extracorporeal membrane oxygenation (ECMO. In this case, the pseudocyst appeared on the 12th day after trauma and transformed into an infected cyst. Veno-venous ECMO was successfully maintained for 20 days without anticoagulation.

  15. Non-intubated recovery from refractory cardiogenic shock on percutaneous VA-extracorporeal membrane oxygenation

    OpenAIRE

    van Houte, J; Donker, D W; Wagenaar, L J; Slootweg, A P; Kirkels, J H; van Dijk, D

    2015-01-01

    We report on the use of percutaneous femoral veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in a fully awake, non-intubated and spontaneously breathing patient suffering from acute, severe and refractory cardiogenic shock due to a (sub)acute anterior myocardial infarction. Intensified heart failure therapy was closely monitored with a pulmonary artery catheter and allowed gradual weaning off the ECMO support without additional invasive measures, notably without mechanical ventila...

  16. Extracorporeal Membrane Oxygenation in Diffuse Alveolar Hemorrhage Secondary to Systemic Lupus Erythematosus

    Science.gov (United States)

    Claudio, Christine Pacheco; Charbonney, Emmanuel; Durand, Madeleine; Kolan, Christophe; Laskine, Mikhael

    2014-01-01

    Diffuse alveolar hemorrhage (DAH) is a rare and potentially deadly complication of systemic lupus erythematosus (SLE). We report two adult cases where extracorporeal membrane oxygenation (ECMO) was used as rescue therapy for severe respiratory failure in this setting. We discuss the risk related to coagulation disturbance and the need for the circuit anticoagulation in this particular setting. We also briefly discuss the clinical problem of lack of knowledge on the bioavailability of the immunosuppressive treatment with the use of ECMO. We think that ECMO should be used as rescue therapy in patients with DAH caused by SLE, but strategies for anticoagulation require further precision. PMID:24578757

  17. Trends in U.S. Extracorporeal Membrane Oxygenation Use and Outcomes: 2002-2012.

    Science.gov (United States)

    McCarthy, Fenton H; McDermott, Katherine M; Kini, Vinay; Gutsche, Jacob T; Wald, Joyce W; Xie, Dawei; Szeto, Wilson Y; Bermudez, Christian A; Atluri, Pavan; Acker, Michael A; Desai, Nimesh D

    2015-01-01

    This study evaluates contemporary trends in the use and outcomes of adult patients undergoing extracorporeal membrane oxygenation (ECMO) in U.S. hospitals. All adult discharges in the Nationwide Inpatient Sample database during the years 2002-2012 that included ECMO were used to estimate the total number of U.S. ECMO hospitalizations (n = 12,407). Diagnostic codes were used to group patients by indication for ECMO use into postcardiotomy, heart transplant, lung transplant, cardiogenic shock, respiratory failure, and cardiopulmonary failure. A Mann-Kendall test was used to examine trends over time using standard statistical techniques for survey data. We found that ECMO use increased significantly from 2002-2012 (P = 0.003), whereas in-hospital mortality rate fluctuated without a significant difference in trend over time. No significant trend was observed in overall ECMO use from 2002-2007, but the use did demonstrate a statistically significant increase from 2007-2012 (P = 0.0028). The highest in-hospital mortality rates were found in the postcardiotomy (57.2%) and respiratory failure (59.2%) groups. Lung and heart transplant groups had the lowest in-hospital mortality rates (44.10% and 45.31%, respectively). The proportion of ECMO use for postcardiotomy decreased from 56.9% in 2002 to 37.9% in 2012 (P = 0.026) and increased for cardiopulmonary failure from 3.9% to 11.1% (P = 0.026). We concluded that ECMO use in the United States increased between 2002 and 2012, driven primarily by increase in national ECMO use beginning in 2007. Mortality rates remained high but stable during this time period. Though there were shifts in relative ECMO use among patient groups, absolute ECMO use increased for all indications over the study period. Copyright © 2015. Published by Elsevier Inc.

  18. Nosocomial Infection in Adult Patients Undergoing Veno-Arterial Extracorporeal Membrane Oxygenation.

    Science.gov (United States)

    Kim, Gwan Sic; Lee, Kyo Seon; Park, Choung Kyu; Kang, Seung Ku; Kim, Do Wan; Oh, Sang Gi; Oh, Bong Suk; Jung, Yochun; Kim, Seok; Yun, Ju Sik; Song, Sang Yun; Na, Kook Joo; Jeong, In Seok; Ahn, Byoung Hee

    2017-04-01

    Data on the frequency of nosocomial infections during extracorporeal membrane oxygenation (ECMO) in adult populations remain scarce. We investigated the risk factors for nosocomial infections in adult patients undergoing venoarterial ECMO (VA-ECMO) support. From January 2011 to December 2015, a total of 259 patients underwent ECMO. Of these, patients aged 17 years or less and patients undergoing ECMO for less than 48 hours were excluded. Of these, 61 patients diagnosed with cardiogenic shock were evaluated. Mean patient age was 60.6 ± 14.3 years and 21 (34.4%) patients were female. The mean preoperative Sequential Organ Failure Assessment (SOFA) score was 8.6 ± 2.2. The mean duration of ECMO support was 6.8 ± 7.4 days. The rates of successful ECMO weaning and survival to discharge were 44.3% and 31.1%, respectively. There were 18 nosocomial infections in 14 (23.0%) patients. These included respiratory tract infections in 9 cases and bloodstream infections in a further 9. In multivariate analysis, independent predictors of infection during ECMO were the preoperative creatinine level (hazard ratio [HR], 2.176; 95% confidence interval [CI], 1.065-4.447; P = 0.033) and the duration of ECMO support (HR, 1.400; 95% CI, 1.081-1.815; P = 0.011). A higher preoperative creatinine level and an extended duration of ECMO support are risk factors for infection. Therefore, to avoid the development of nosocomial infections, strategies to shorten the length of ECMO support should be applied whenever possible. © 2017 The Korean Academy of Medical Sciences.

  19. The Impact of Venoarterial and Venovenous Extracorporeal Membrane Oxygenation on Cerebral Metabolism in the Newborn Brain.

    Directory of Open Access Journals (Sweden)

    Aaron J Reitman

    Full Text Available Extracorporeal membrane oxygenation (ECMO is an effective therapy for supporting infants with reversible cardiopulmonary failure. Still, survivors are at risk for long-term neurodevelopmental impairments, the cause of which is not fully understood.To elucidate the effects of ECMO on the newborn brain. We hypothesized that the cerebral metabolic profile of neonates who received ECMO would differ from neonates who did not receive ECMO. To address this, we used magnetic resonance spectroscopy (1H-MRS to investigate the effects of venoarterial and venovenous ECMO on cerebral metabolism.41 neonates treated with ECMO were contrasted to 38 age-matched neonates.All 1H-MRS data were acquired from standardized grey matter and white matter regions of interest using a short-echo (TE = 35 milliseconds, point-resolved spectroscopy sequence (PRESS and quantitated using LCModel. Metabolite concentrations (mmol/kg were compared across groups using multivariate analysis of covariance. Elevated creatine (p = 0.002 and choline (p = 0.005 concentrations were observed in the grey matter among neonates treated with ECMO relative to the reference group. Likewise, choline concentrations were elevated in the white matter (p = 0.003 while glutamate was reduced (p = 0.03. Contrasts between ECMO groups revealed lower osmolite concentrations (e.g. myoinositol among the venovenous ECMO group.Neonates who underwent ECMO were found to have an abnormal cerebral metabolic profile, with the pattern of abnormalities suggestive of an underlying inflammatory process. Additionally, neonates who underwent venovenous ECMO had low cerebral osmolite concentrations as seen in vasogenic edema.

  20. The ethics of extracorporeal membrane oxygenation in brain-dead potential organ donors.

    Science.gov (United States)

    Dalle Ave, Anne L; Gardiner, Dale; Shaw, David M

    2016-05-01

    Organ-preserving extracorporeal membrane oxygenation (OP-ECMO) is defined as the use of extracorporeal support for the primary purpose of preserving organs for transplantation, rather than to save the patient's life. This paper discusses the ethics of using OP-ECMO in donation after brain determination of death (DBDD) to avoid the loss of organs for transplantation. We review case reports in the literature and analyze the ethical issues raised. We conclude that there is little additional ethical concern in continuing OP-ECMO in patients already on ECMO if they become brain dead. The implementation of OP-ECMO in hemodynamically unstable brain-dead patients is ethically permissible in certain clinical situations but requires specific consent from relatives if the patient's wish to donate is not clear. If no evidence of a patient's wish to donate is available, OP-ECMO is not recommended. In countries with presumed consent legislation, failure to opt out should be considered as a positive wish to donate. If a patient is not-yet brain-dead or is undergoing testing for brain death, OP-ECMO is not recommended. Further research on OP-ECMO is needed to better understand the attitudes of professionals, families, and lay people to ensure agreement on key ethical issues. © 2016 Steunstichting ESOT.

  1. Logistics and safety of extracorporeal membrane oxygenation in medical retrieval.

    Science.gov (United States)

    Burns, Brian J; Habig, Karel; Reid, Cliff; Kernick, Paul; Wilkinson, Chris; Tall, Gary; Coombes, Sarah; Manning, Ron

    2011-01-01

    This article reviews the logistics and safety of extracorporeal membrane oxygenation (ECMO) medical retrieval in New South Wales, Australia. We describe the logistics involved in ECMO road and rotary-wing retrieval by a multidisciplinary team during the H1N1 influenza epidemic in winter 2009 (i.e., June 1 to August 31, 2009). Basic patient demographics and key retrieval time lines were analyzed. There were 17 patients retrieved on ECMO, with their ages ranging from 22 to 55 years. The median weight was 110 kg. Four critical events were recorded during retrieval, with no adverse outcomes. The retrieval distance varied from 20.8 to 430 km. There were delays in times from retrieval booking to both retrieval tasking and retrieval team departure in 88% of retrievals. The most common reasons cited were "patient not ready" 23.5% (4/17); "vehicle not available," 23.5% (4/17); and "complex retrieval," 41.2% (7/17). The median time (hours:minutes) from booking with the medical retrieval unit (MRU) to tasking was 4:35 (interquartile range [IQR] 3:27-6:15). The median time lag from tasking to departure was 1:00 (IQR 00:10-2:20). The median stabilization time was 1:30 (IQR 1:20-1:55). The median retrieval duration was 7:35 (IQR 5:50-10:15). The process of development of ECMO retrieval was enabled by the preexistence of a high-volume experienced medical retrieval service. Although ECMO retrieval is not a new concept, we describe an entire process for ECMO retrieval that we believe will benefit other retrieval service providers. The increased workload of ECMO retrieval during the swine flu pandemic has led to refinement in the system and process for the future.

  2. Extracorporeal membrane oxygenation in a Scottish intensive care unit.

    Science.gov (United States)

    Berryman, Sean

    2010-01-01

    I reflected on the training I had on an extraordinary treatment for profound respiratory failure. The result of training enabled us to successfully treat a young female with the influenza A virus with extracorporeal membrane oxygenation (ECMO). I report the positive outcome that occurred, while continuing to run a busy general intensive care unit (ICU). She was the first of six patients who were all successfully treated with ECMO. Ten trained and experienced critical care nurses and two doctors attended the ECMO training course provided by the national centre in the UK. Five patients had already received ECMO therapy in the Scottish specialist unit (over the period of 8 years). As our Scottish specialist unit purchased exactly the same equipment as the national centre, it was easier for the multidisciplinary team to utilize their new-found knowledge and treat future patients with ECMO. With the predicted swine flu (H1N1) pandemic and the subsequent demand for critical care beds, funding was obtained to facilitate ECMO training. The potential need for increased provision of ECMO therapies was highlighted by recent events in Australia and New Zealand. Their most recent winter produced 68 patients requiring ECMO, whereas the previous year had manifested only three. Using our new equipment and adapted protocols from the national centre, we used these new skills to treat our first patient in October 2009. Johns' reflective practice tool was used to evaluate the care provided. Our patient was on ECMO for 9 days. She went on to make a remarkable recovery and was discharged from the ICU 1 week after ECMO was discontinued. She was discharged to the cardiothoracic high-dependency unit, where she was successfully rehabilitated. We were able to successfully treat a young lady, while providing the care for all other patients. This was a complex treatment, one that uses many resources including time and finance. Now that we have all the equipment, the necessary training and the

  3. Local experience with extracorporeal membrane oxygenation in children with acute fulminant myocarditis.

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    Botao Ning

    Full Text Available To analyze the clinical effect of extracorporeal membrane oxygenation (ECMO in children with acute fulminant myocarditis, we retrospectively analyzed the data of five children with acute fulminant myocarditis in the intensive care unit (ICU at the Affiliated Children's Hospital, Zhejiang University from February 2009 to November 2012. The study group included two boys and three girls ranging in age from 9 to 13 years (median 10 years. Body weight ranged from 25 to 33 kg (mean 29.6 kg. They underwent extracorporeal membrane oxygenation (ECMO through a venous-arterial ECMO model with an average ECMO supporting time of 89.8 h (40-142 h. Extracorporeal circulation was established in all five children. After treatment with ECMO, the heart rate, blood pressure, and oxygen saturation were greatly improved in the four children who survived. These four children were successfully weaned from ECMO and discharged from hospital machine-free, for a survival rate of 80% (4/5. One child died still dependent on the machine. Cause of death was irrecoverable cardiac function and multiple organ failure. Complications during ECMO included three cases of suture bleeding, one case of acute hemolytic renal failure and suture bleeding, and one case of hyperglycemia. During the follow-up period of 4-50 months, the four surviving children recovered with normal cardiac function and no abnormal functions of other organs. The application of ECMO in acute fulminant myocarditis, even in local centers that experience low incidence of this disease, remains an effective approach. Larger studies to determine optimal timing of placement on ECMO to guide local centers are warranted.

  4. Clinical and billing review of extracorporeal membrane oxygenation.

    Science.gov (United States)

    Blum, James M; Lynch, William R; Coopersmith, Craig M

    2015-06-01

    Extracorporeal membrane oxygenation (ECMO) is a temporary technique for providing life support for cardiac dysfunction, pulmonary dysfunction, or both. The two forms of ECMO, veno-arterial (VA) and veno-venous (VV), are used to support cardiopulmonary and pulmonary dysfunction, respectively. Historically, ECMO was predominantly used in the neonatal and pediatric populations, as early adult studies failed to improve outcomes. ECMO has become far more common in the adult population because of positive results in published case series and clinical trials during the 2009 influenza A(H1N1) pandemic in 2009 to 2010. Advances in technology that make the technique much easier to implement likely fueled the renewed interest. Although exact criteria for ECMO are not available, patients who are good candidates are generally considered to be relatively young and suffering from acute illness that is believed to be reversible or organ dysfunction that is otherwise treatable. With the increase in the use in the adult population, a number of different codes have been generated to better identify the method of support with distinctly different relative value units assigned to each code from a very simple prior coding scheme. To effectively be reimbursed for use of the technique, it is imperative that the clinician understands the new coding scheme and works with payers to determine what is incorporated into each specific code.

  5. Venovenous Extracorporeal Membrane Oxygenation in Intractable Pulmonary Insufficiency: Practical Issues and Future Directions

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    T. S. R. Delnoij

    2016-01-01

    Full Text Available Venovenous extracorporeal membrane oxygenation (vv-ECMO is a highly invasive method for organ support that is gaining in popularity due to recent technical advances and its successful application in the recent H1N1 epidemic. Although running a vv-ECMO program is potentially feasible for many hospitals, there are many theoretical concepts and practical issues that merit attention and require expertise. In this review, we focus on indications for vv-ECMO, components of the circuit, and management of patients on vv-ECMO. Concepts regarding oxygenation and decarboxylation and how they can be influenced are discussed. Day-to-day management, weaning, and most frequent complications are covered in light of the recent literature.

  6. Right ventricular metabolism during venoarterial extracorporeal membrane oxygenation in immature swine heart in vivo.

    Science.gov (United States)

    Kajimoto, Masaki; Ledee, Dolena R; Isern, Nancy G; Portman, Michael A

    2017-04-01

    Venoarterial extracorporeal membrane oxygenation (VA-ECMO) provides hemodynamic rescue for patients encountering right or left ventricular (RV or LV) decompensation, particularly after surgery for congenital heart defects. ECMO, supported metabolically by parenteral nutrition, provides reductions in myocardial work and energy demand and, therefore, enhances functional recovery. The RV must often assume systemic ventricular pressures and function on weaning from VA-ECMO. However the substrate utilization responses of the RV to VA-ECMO or stimulation are unknown. We determined RV and LV substrate utilization response to VA-ECMO in immature swine heart. Mixed-breed male Yorkshire pigs (33-49 days old) underwent normal pressure volume loading (control, n = 5) or were unloaded by VA-ECMO (ECMO, n = 10) for 8 h. Five pigs with ECMO received intravenous thyroid hormone [triiodothyronine (T 3 )] to alter substrate utilization. Carbon 13 ( 13 C)-labeled substrates (lactate and medium-chain and long-chain fatty acids) were systemically infused as metabolic tracers. Analyses by nuclear magnetic resonance showed that both ventricles have similar trends of fractional 13 C-labeled substrate contributions to the citric acid cycle under control conditions. VA-ECMO produced higher long-chain fatty acids and lower lactate contribution to the citric acid cycle via inhibition of pyruvate dehydrogenase, whereas T 3 promoted lactate metabolism in both ventricles. However, these metabolic shifts were smaller in RV, and RV fatty acid contributions showed minimal response to perturbations. Furthermore, VA-ECMO and T 3 also achieved high [phosphocreatine]/[ATP] and low [NADH]/[NAD + ] in LV but not in RV. These data suggest that the RV shows decreased ability to modify substrate utilization and achieve improvements in energy supply/demand during VA-ECMO. NEW & NOTEWORTHY We showed that the right ventricle unloaded by venoarterial extracorporeal membrane oxygenation (VA-ECMO) has diminished

  7. Lessons learned from extracorporeal membrane oxygenation as a bridge to lung transplantation

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    Vladimir Shumaster

    2014-05-01

    Full Text Available Extracorporeal membrane oxygenation (ECMO has been used infrequently as a bridge to lung transplantation due to lack of consensus and data regarding the benefits of such a strategy. We present data from the United Network of Organ Sharing (UNOS database on the outcomes of patients bridged to lung transplantation with ECMO. We used the UNOS database to analyze data between January 1, 2000 and December 31, 2011. During this time 14,263 lung transplants were performed, of which 143 (1.0% were bridged using ECMO. Patients on ECMO as a bridge to lung transplantation were compared to those transplanted without prior ECMO support. Demographics, survival rates, complications, and rejection episodes were compared between the two groups. The 30-day, 6-month, 1-year, 3-year, and 5-year survival rates were 69%, 56%, 48%, 26%, and 11%, respectively, for the ECMO bridge group and 95%, 88%, 81%, 58%, and 38% respectively, for the control group (p ≤ 0.01. The ECMO group incurred higher rate of postoperative complications, including airway dehiscence (4% vs. 1%, p ≤ 0.01, stroke (3% vs. 2%, p ≤ 0.01, infection (56% vs. 42%, p ≤ 0.01, and pulmonary embolism (10% vs. 0.6%, p ≤ 0.01. The length of hospital stay was longer for the ECMO group (41 vs. 25 days, p ≤ 0.01, and they were treated for rejection more often (49% vs. 36%, p = 0.02. The use of ECMO as a bridge to lung transplantation is associated with significantly worse survival and more frequent postoperative complications. Therefore, we advocate very careful patient selection and cautious use of ECMO.

  8. Novel Applications of Modified Ultrafiltration and Autologous Priming Techniques to Reduce Blood Product Exposure on ECMO.

    Science.gov (United States)

    Neal, James R; Blau, Caitlin L; Cornelius, Amanda M; Pike, Roxann B; Dearani, Joseph A; Mora, Bassem N

    2016-03-01

    Patients needing the assistance of extracorporeal membrane oxygenation (ECMO) are at risk of hemodilution and, in some instances, may require exposure to large amounts of allogeneic blood products. Patient outcomes can be improved by taking steps to reduce transfusions and hemodilution. Currently, modified ultrafiltration (MUF) is used across the world to reduce hemodilution after cardiopulmonary bypass (CPB). Another common technique during bypass initiation is autologous priming. By applying modified versions of these techniques, ECMO patients may potentially benefit. Usually, patients requiring immediate transition from CPB to ECMO are not stable enough to tolerate MUF. Through alterations of the CPB and ECMO circuit tubing, MUF can be performed once on ECMO. Another technique to potentially lower the transfusion requirements for ECMO patients is a complete circuit blood transfer during an ECMO circuit exchange. While selective component changes are preferred if possible, occasionally a complete circuit change must be done. To minimize hemodilution or prevent priming with blood products, the original ECMO circuit's blood can be transferred to the new ECMO circuit before connecting to the patient. Both of these techniques, in our opinion, helped to reduce the number of transfusions that our ECMO patients have seen during these critical time periods.

  9. The use of extracorporeal membrane oxygenation in blunt thoracic trauma: A study of the Extracorporeal Life Support Organization database.

    Science.gov (United States)

    Jacobs, Jordan V; Hooft, Nicole M; Robinson, Brenton R; Todd, Emily; Bremner, Ross M; Petersen, Scott R; Smith, Michael A

    2015-12-01

    Reports documenting the use of extracorporeal membrane oxygenation (ECMO) after blunt thoracic trauma are scarce. We used a large, multicenter database to examine outcomes when ECMO was used in treating patients with blunt thoracic trauma. We performed a retrospective analysis of ECMO patients in the Extracorporeal Life Support Organization database between 1998 and 2014. The diagnostic code for blunt pulmonary contusion (861.21, DRG International Classification of Diseases-9th Rev.) was used to identify patients treated with ECMO after blunt thoracic trauma. Variations of pre-ECMO respiratory support were also evaluated. The primary outcome was survival to discharge; the secondary outcome was hemorrhagic complication associated with ECMO. Eighty-five patients met inclusion criteria. The mean ± SEM age of the cohort was 28.9 ± 1.1 years; 71 (83.5%) were male. The mean ± SEM pre-ECMO PaO2/FIO2 ratio was 59.7 ± 3.5, and the mean ± SEM pre-ECMO length of ventilation was 94.7 ± 13.2 hours. Pre-ECMO support included inhaled nitric oxide (15 patients, 17.6%), high-frequency oscillation (10, 11.8%), and vasopressor agents (57, 67.1%). The mean ± SEM duration of ECMO was 207.4 ± 23.8 hours, and 63 patients (74.1%) were treated with venovenous ECMO. Thirty-two patients (37.6%) underwent invasive procedures before ECMO, and 12 patients (14.1%) underwent invasive procedures while on ECMO. Hemorrhagic complications occurred in 25 cases (29.4%), including 12 patients (14.1%) with surgical site bleeding and 16 (18.8%) with cannula site bleeding (6 patients had both). The rate of survival to discharge was 74.1%. Multivariate analysis showed that shorter duration of ECMO and the use of venovenous ECMO predicted survival. Outcomes after the use of ECMO in blunt thoracic trauma can be favorable. Some trauma patients are appropriate candidates for this therapy. Further study may discern which subpopulations of trauma patients will benefit most from ECMO. Therapeutic

  10. Venovenous Extracorporeal Membrane Oxygenation as a Treatment for Obesity Hypoventilation Syndrome

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    Nao Umei

    2017-01-01

    Full Text Available The mortality rate for respiratory failure resulting from obesity hypoventilation syndrome is high if it requires ventilator management. We describe a case of severe acute respiratory failure resulting from obesity hypoventilation syndrome (BMI, 60.2 kg/m2 successfully treated with venovenous extracorporeal membrane oxygenation (VV-ECMO. During ECMO management, a mucus plug was removed by bronchoscopy daily and 18 L of water was removed using diuretics, resulting in weight loss of 24 kg. The patient was weaned from ECMO on day 5, extubated on day 16, and discharged on day 21. The fundamental treatment for obesity hypoventilation syndrome in morbidly obese patients is weight loss. VV-ECMO can be used for respiratory support until weight loss has been achieved.

  11. Salvage intraosseous thrombolysis and extracorporeal membrane oxygenation for massive pulmonary embolism

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    Luke Cameron Northey

    2015-01-01

    Full Text Available Intraosseous access is an alternative route of pharmacotherapy during cardiopulmonary resuscitation. Extracorporeal membrane oxygenation (ECMO provides cardiac and respiratory support when conventional therapies fail. This case reports the use of intraosseous thrombolysis and ECMO in a patient with acute massive pulmonary embolism (PE. A 34-year-old female presented to the emergency department with sudden onset severe shortness of breath. Due to difficulty establishing intravenous access, an intraosseous needle was inserted into the left tibia. Echocardiography identified severe right ventricular dilatation with global systolic impairment and failure, indicative of PE. Due to the patient′s hemodynamic compromise a recombinant tissue plasminogen activator (Alteplase bolus was administered through the intraosseous route. After transfer to the intensive care unit, venous-arterial ECMO was initiated as further therapy. The patient recovered and was discharged 36 days after admission. This is the first report of combination intraosseous thrombolysis and ECMO as salvage therapy for massive PE.

  12. Extracorporeal membrane oxygenation for life-threatening asthma refractory to mechanical ventilation: analysis of the Extracorporeal Life Support Organization registry

    OpenAIRE

    Yeo, Hye Ju; Kim, Dohyung; Jeon, Doosoo; Kim, Yun Seong; Rycus, Peter; Cho, Woo Hyun

    2017-01-01

    Background The use of extracorporeal membrane oxygenation (ECMO) in cases of near-fatal asthma (NFA) has increased, but the benefits and potential complications of this therapy have yet to be fully investigated. Methods Cases were extracted from the Extracorporeal Life Support Organization Registry between March 1992 and March 2016. All patients with a diagnosis of asthma (according to the International Classification of Diseases 9th edition), who also received ECMO, were extracted. Exclusion...

  13. Successful application of extracorporeal membrane oxygenation due to pulmonary hemorrhage secondary to granulomatosis with polyangiitis

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    Hohenforst-Schmidt W

    2013-07-01

    Full Text Available Wolfgang Hohenforst-Schmidt,1 Arndt Petermann,2 Aikaterini Visouli,3 Paul Zarogoulidis,4 Kaid Darwiche,5 Ioanna Kougioumtzi,6 Kosmas Tsakiridis,3 Nikolaos Machairiotis,6 Markus Ketteler,2 Konstantinos Zarogoulidis,4 Johannes Brachmann11II Medical Clinic, Coburg Clinic, University of Wuerzburg, Coburg, Germany; 2Division of Nephrology, Coburg Clinic, University of Wuerzburg, Coburg, Germany; 3Cardiothoracic Surgery Department, “Saint Luke” Private Hospital, Thessaloniki, Greece; 4Pulmonary Department, “G Papanikolaou” General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece; 5Department of Interventional Pneumology, Ruhrlandklinik, West German Lung Center, University Hospital, University of Duisburg-Essen, Essen, Germany; 6Surgery Department (National Health System, University General Hospital of Alexandroupolis, Alexandroupolis, GreeceAbstract: Extracorporeal membrane oxygenation (ECMO is increasingly applied in adults with acute refractory respiratory failure that is deemed reversible. Bleeding is the most frequent complication during ECMO support. Severe pre-existing bleeding has been considered a contraindication to ECMO application. Nevertheless, there are cases of successful ECMO application in patients with multiple trauma and hemorrhagic shock or head trauma and intracranial hemorrhage. ECMO has proved to be life-saving in several cases of life-threatening respiratory failure associated with pulmonary hemorrhage of various causes, including granulomatosis with polyangiitis (Wegener’s disease. We successfully applied ECMO in a 65-year-old woman with acute life-threatening respiratory failure due to diffuse massive pulmonary hemorrhage secondary to granulomatosis with polyangiitis, manifested as severe pulmonary-renal syndrome. ECMO sustained life and allowed disease control, together with plasmapheresis, cyclophosphamide, corticoids, and renal replacement therapy. The patient was successfully weaned from ECMO

  14. Point-of-Care Ultrasound-Guided Percutaneous Cannulation of Extracorporeal Membrane Oxygenation: Make it Simple.

    Science.gov (United States)

    Ahn, Hong Joon; Lee, Jun Wan; Joo, Ki Hyuk; You, Yeon Ho; Ryu, Seung; Lee, Jin Woong; Kim, Seung Whan

    2017-12-30

    Cannulation of the great vessels is required for extracorporeal membrane oxygenation (ECMO). Currently, there is no guideline for optimal imaging modalities during percutaneous cannulation of ECMO. The purpose of this study was to describe percutaneous cannulation guided by point-of-care ultrasound (POCUS) for ECMO and compare it with fluoroscopy and landmark guidance. Three groups (POCUS-, fluoroscopy-, and landmark-guided) of percutaneous cannulation for ECMO were analyzed retrospectively in a tertiary academic hospital. In the POCUS-guided group, visual confirmation of guidewire and cannula by ultrasound in both the access and return cannula were essential for successful cannulation. Fluoroscopy- and landmark-guided groups were cannulated with the conventional technique. A total of 128 patients were treated by ECMO during the study period, of which 94 (73.4%) cases were venoarterial ECMO. This included 56 cases of extracorporeal cardiopulmonary resuscitation. Also, there were 30 (23.4%) cases of venovenous ECMO and 4 (3.1%) cases of venoarteriovenous ECMO. A total of 71 (55.5%) patients were cannulated under POCUS guidance, and 43 (33.6%) patients were cannulated under fluoroscopy guidance and 14 (10.9%) patients were cannulated by landmark guidance. No surgical cut downs were required. Misplacement of cannula occurred in 3 (2.3%) cases. All three occurred in the landmark-guided group. POCUS-guided cannulation is comparable to fluoroscopy-guided cannulation in terms of avoiding cannula misplacement. In our experience, POCUS-guided cannulation is a useful strategy over fluoroscopy- and landmark-guided cannulation during peripheral ECMO. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. Impact of Heart Transplantation on Survival in Patients on Venoarterial Extracorporeal Membrane Oxygenation at Listing in France.

    Science.gov (United States)

    Jasseron, Carine; Lebreton, Guillaume; Cantrelle, Christelle; Legeai, Camille; Leprince, Pascal; Flecher, Erwan; Sirinelli, Agnes; Bastien, Olivier; Dorent, Richard

    2016-09-01

    Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used as a short-term circulatory support in patients with refractory cardiogenic shock providing a bridge to long-term mechanical circulatory support or transplantation. In France, a higher priority status is granted to transplant candidates on VA-ECMO than to those on long-term mechanical circulatory support. This study aimed to evaluate the impact of transplantation as primary therapy on survival in patients on VA-ECMO at listing. This was a retrospective analysis of data from the French national registry CRISTAL including all patients (n = 866) newly registered on the waiting list for heart transplantation between January 2010 and December 2011. We compared outcomes of 80 patients on VA-ECMO at listing to outcomes of the comparison group. In the VA-ECMO group, a Cox proportional hazard model with transplantation as a time dependent variable was used to evaluate the effect of transplantation on survival. Patients on VA-ECMO were more often on ventilator and dialysis and had a higher bilirubin level than other candidates. One-year overall survival rate was lower in candidates from the study group (52.2%) compared with comparison group (75.5%), (P < 0.01). One-year posttransplant survival was 70% in the VA-ECMO group and 81% in comparison group (P = 0.06). In the VA-ECMO group, transplantation was associated with a lower risk of mortality (hazard ratio, 0.44; 95% confidence interval, 0.2-0.9). Transplantation provides a survival benefit in listed patients on VA-ECMO even if posttransplant survival remains inferior than for patients without VA-ECMO. Transplantation may be considered to be an acceptable primary therapy in selected patients on VA-ECMO.

  16. Application of the Age, Creatinine, and Left Ventricular Ejection Fraction Score for Patients on Extracorporeal Membrane Oxygenation.

    Science.gov (United States)

    Tsai, Tsung-Yu; Tsai, Feng-Chun; Fan, Pei-Chun; Chang, Chih-Hsiang; Lin, Chan-Yu; Chang, Wei-Wen; Lee, Shen-Yang; Hsu, Hsiang-Hao; Tian, Ya-Chung; Fang, Ji-Tseng; Yang, Chih-Wei; Chen, Yung-Chang

    2017-02-01

    Patients on extracorporeal membrane oxygenation (ECMO) usually have high mortality rate and poor outcome. Age, Creatinine, and Left Ventricular Ejection Fraction (ACEF) score is an easy-calculating score and provides good performance on mortality prediction in patients undergoing cardiac operations or percutaneous coronary intervention, but it has not been applied to patients on ECMO before. In this study, we aimed to use ACEF score obtained within 1 week of ECMO support for in-hospital mortality prediction in patients on ECMO due to severe myocardial failure. This study reviewed the medical records of 306 patients on ECMO at a specialized intensive care unit (CVSICU) in a tertiary-care university hospital between March 2002 and December 2011, and 105 patients on veno-arterial ECMO due to severe myocardial failure were enrolled. Demographic, clinical, and laboratory variables were retrospectively collected as survival predictors. The overall mortality rate was 47.6%. The most frequent condition requiring ICU admission was postcardiotomy cardiogenic shock. Multiple logistic regression analysis indicated that post-ECMO ACEF score, Sequential Organ Failure Assessment score, and troponin I on day 1 of ECMO support were independent risk factors for in-hospital mortality. Using the area under the receiver operating characteristic curve (AUROC), the post-ECMO ACEF score indicated a good discriminative power (AUROC 0.801 ± 0.042). Finally, cumulative survival rates at 6-month follow-up differed significantly (P  2.22. After ECMO treatment due to severe myocardial failure, post-ECMO ACEF score provides an easy-calculating method with a reproducible evaluation tool with excellent prognostic abilities in these patients. © 2016 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

  17. Antifungal Extraction by the Extracorporeal Membrane Oxygenation Circuit.

    Science.gov (United States)

    Watt, Kevin M; Cohen-Wolkowiez, Michael; Williams, Duane C; Bonadonna, Desiree K; Cheifetz, Ira M; Thakker, Dhiren; Benjamin, Daniel K; Brouwer, Kim L R

    2017-09-01

    Invasive candidiasis is common and often fatal in patients supported with extracorporeal membrane oxygenation (ECMO), and treatment relies on optimal antifungal dosing. The ECMO circuit can extract drug and decrease drug exposure, placing the patient at risk of therapeutic failure. This ex vivo study determined the extraction of antifungal drugs by the ECMO circuit. Fluconazole and micafungin were studied separately in three closed-loop circuit configurations to isolate the impact of the oxygenator, hemofilter, and tubing on circuit extraction. Each circuit was primed with human blood, and flow was set to 1 L/min. Drug was dosed to achieve therapeutic concentrations. Each antifungal was added to a separate tube of blood to serve as a control. Serial blood samples were collected over 24 hours and concentrations were quantified with a validated assay. Drug recovery was calculated at each time point: (C t /C i )*100, with C t and C i the concentrations at time = t and 1 minute, respectively. After 24 hours of recirculation, mean recovery of fluconazole in the ECMO circuit (95-98%) and controls (101%) was high. In contrast, mean recovery of micafungin was dependent on the time and circuit configuration. Recovery at 4 hours was only 46% when a hemofilter was in-line but was much higher when the hemofilter was removed (91%). By 24 hours, however, micafungin recovery was low in all circuit configurations (26-43%), regardless of the presence of a hemofilter, as well as in the controls (57%). In conclusion, these results suggest that micafungin is extracted by the ECMO circuit, which may result in decreased drug exposure in vivo.

  18. A National Perspective on ECMO Utilization Use in Patients with Burn Injury.

    Science.gov (United States)

    Nosanov, Lauren B; McLawhorn, Melissa M; Vigiola Cruz, Mariana; Chen, Jason H; Shupp, Jeffrey W

    2017-12-27

    Extracorporeal membranous oxygenation (ECMO) has become an increasingly utilized used strategy to support patients in cardiac and cardiopulmonary failure. The Extracorporeal Life Support Organization reports adult survival rates between 40 and 50%. Utilization Use and outcomes for burned patients undergoing ECMO are poorly understood. The National Burn Repository (version 8.0) was queried for patients with International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9) procedure codes for ECMO. Demographics, comorbidities, mechanism, injury details, and clinical outcomes were recorded. ECMO patients were matched one-to-one to those not requiring ECMO based on age, gender, TBSA, and inhalation injury. Group comparisons were made utilizing using χ2 and Mann-Whitney U tests. Thirty ECMO-treated burn patients were identified. Patients were predominantly male (80.0%) and Caucasian (63.3%) with mean age 38.9 ± 20.3 years. The majority were flame injuries (80.0%) of moderate size (17.0 ± 18.7% TBSA), affecting predominantly upper limbs and trunk. Inhalation injury was reported in 26.7%. Respiratory failure was reported in nine, acute respiratory distress syndrome in three, and pneumonia in nine. Fourteen patients survived to discharge. The ECMO cohort had significantly higher rates of cardiovascular comorbidities, concomitant major thoracic trauma, pneumonia, acute renal failure, and sepsis than non-ECMO patients (P < .05). Ventilator usage, intesive care unit (ICU) length of stay, and mortality were also significantly higher in those treated by ECMO (P < .05). Although burn patients placed on ECMO have significantly higher rates of morbidity and mortality than those not requiring ECMO, the mortality rate is equivalent to patients reported by Extracorporeal Life Support Organization. ECMO is a viable option for supporting critically injured burn patients.

  19. U.S. and International In-Hospital Costs of Extracorporeal Membrane Oxygenation: a Systematic Review.

    Science.gov (United States)

    Harvey, Michael J; Gaies, Michael G; Prosser, Lisa A

    2015-08-01

    The in-hospital costs of extracorporeal membrane oxygenation (ECMO) have not been well established. To evaluate the in-hospital costs of ECMO technology in both US and non-US settings for all patient types. Systematic review of English-language articles, using the PubMed, Embase, Web of Science and EconLit databases. Searches consisted of the terms 'ECMO' AND 'health expenditures' or 'resource use' or 'costs' or 'cost analysis' or 'cost(-)effectiveness' or 'cost(-)benefit' or 'cost(-)utility' or 'economic(-)evaluation' or 'economic' or 'QALY' or 'cost per quality-adjusted life year'. Only full scientific research articles were included. The exclusion criteria included papers that focused on pumpless ECMO, simulation training or decision support systems; papers that did not include human subjects or were not written in English; papers that did not mention ECMO, costs, economics or resource utilization; and papers that included only outside-hospital, infrastructure capital or device capital costs. Data extraction was completed by one author, using predefined criteria. From the database searches, 1371 results were returned, 226 records underwent a full review and 18 studies were included in the final review. Three papers studied adult populations, two studied adult and paediatric populations, five studied only paediatric populations, one studied a paediatric and neonatal population, and the remaining seven exclusively examined ECMO in neonatal populations. The sample sizes ranged from 8 to 8753 patients. ECMO for respiratory conditions was the most common diagnosis category, followed by congenital diaphragmatic hernia (CDH) and then cardiac conditions. Most papers (n = 14) used retrospective cost collection. Only eight papers stated the perspective of the cost analysis. The results show a large variation in the cost of ECMO over multiple cost categories (e.g., range of total in-hospital costs of treatment: USD 42,554-537,554 [in 2013 values]). In the U.S.A., the

  20. Mechanical Ventilation during Extracorporeal Membrane Oxygenation in Patients with Acute Severe Respiratory Failure

    Directory of Open Access Journals (Sweden)

    Zhongheng Zhang

    2017-01-01

    Full Text Available Conventionally, a substantial number of patients with acute respiratory failure require mechanical ventilation (MV to avert catastrophe of hypoxemia and hypercapnia. However, mechanical ventilation per se can cause lung injury, accelerating the disease progression. Extracorporeal membrane oxygenation (ECMO provides an alternative to rescue patients with severe respiratory failure that conventional mechanical ventilation fails to maintain adequate gas exchange. The physiology behind ECMO and its interaction with MV were reviewed. Next, we discussed the timing of ECMO initiation based on the risks and benefits of ECMO. During the running of ECMO, the protective ventilation strategy can be employed without worrying about catastrophic hypoxemia and carbon dioxide retention. There is a large body of evidence showing that protective ventilation with low tidal volume, high positive end-expiratory pressure, and prone positioning can provide benefits on mortality outcome. More recently, there is an increasing popularity on the use of awake and spontaneous breathing for patients undergoing ECMO, which is thought to be beneficial in terms of rehabilitation.

  1. Extracorporeal membrane oxygenation after protracted ventricular fibrillation cardiac arrest: case report and discussion.

    Science.gov (United States)

    Abu-Laban, Riyad B; Migneault, David; Grant, Meghan R; Dhingra, Vinay; Fung, Anthony; Cook, Richard C; Sweet, David

    2015-03-01

    Extracorporeal membrane oxygenation (ECMO) is a method to provide temporary cardiac and respiratory support to critically ill patients. In recent years, the role of ECMO in emergency departments (EDs) for select adults has increased. We present the dramatic case of a 29-year-old man who was placed on venoarterial ECMO for cardiogenic shock and respiratory failure following collapse and protracted ventricular fibrillation cardiac arrest in our ED. Resuscitation efforts prior to ECMO commencement included 49 minutes of virtually continuous cardiopulmonary resuscitation (CPR), 11 defibrillations, administration of numerous medications, including a thrombolytic agent, while CPR was ongoing, percutaneous coronary intervention and stenting for a mid-left anterior descending coronary artery dissection and thrombotic occlusion, inotropic support, and intra-aortic balloon pump counterpulsation. Over the next 48 hours following ECMO commencement, the patient's cardiorespiratory function rapidly improved, and he was discharged home 9 days after admission with no neurologic sequelae. The history, indications, and increasing role of ECMO in a range of conditions, including cardiac arrest, are reviewed.

  2. Mechanical Ventilation during Extracorporeal Membrane Oxygenation in Patients with Acute Severe Respiratory Failure.

    Science.gov (United States)

    Zhang, Zhongheng; Gu, Wan-Jie; Chen, Kun; Ni, Hongying

    2017-01-01

    Conventionally, a substantial number of patients with acute respiratory failure require mechanical ventilation (MV) to avert catastrophe of hypoxemia and hypercapnia. However, mechanical ventilation per se can cause lung injury, accelerating the disease progression. Extracorporeal membrane oxygenation (ECMO) provides an alternative to rescue patients with severe respiratory failure that conventional mechanical ventilation fails to maintain adequate gas exchange. The physiology behind ECMO and its interaction with MV were reviewed. Next, we discussed the timing of ECMO initiation based on the risks and benefits of ECMO. During the running of ECMO, the protective ventilation strategy can be employed without worrying about catastrophic hypoxemia and carbon dioxide retention. There is a large body of evidence showing that protective ventilation with low tidal volume, high positive end-expiratory pressure, and prone positioning can provide benefits on mortality outcome. More recently, there is an increasing popularity on the use of awake and spontaneous breathing for patients undergoing ECMO, which is thought to be beneficial in terms of rehabilitation.

  3. Pathogens and outcomes in pediatric septic shock patients supported by extracorporeal membrane oxygenation.

    Science.gov (United States)

    Chang, Tu-Hsuan; Wu, En-Ting; Lu, Chun-Yi; Huang, Shu-Chien; Yang, Tzu-I; Wang, Ching-Chia; Chen, Jong-Min; Lee, Ping-Ing; Huang, Li-Min; Chang, Luan-Yin

    2017-08-04

    Refractory septic shock is the leading cause of mortality in children. There is limited evidence to support extracorporeal membrane oxygenation (ECMO) use in pediatric septic shock. We described the etiology and outcomes of septic patients in our institution and attempted to find predictive factors. We retrospectively reviewed 55 pediatric patients with septic shock who required ECMO support in a tertiary medical center from 2008 to 2015. Septic shock was defined as culture proved or clinical suspected sepsis with hypotension or end-organ hypoperfusion. ECMO would be applied when pediatric advanced life support steps were performed thoroughly without clinical response. Patient's demographics, laboratory parameters before and after ECMO, and outcomes were analyzed. Among 55 children with ECMO support, 31% of them survived on discharge. For 25 immunocompromised patients, causal pathogens were found in 17 patients: 7 due to bacteremia, 9 with preexisting virus infections and one with invasive fungal infection. Among 30 previously healthy patients, causal pathogens were found in 18 patients: 10 due to bacteremia (the most common was pneumococcus), 7 with preexisting virus infections including influenza (n = 4), adenovirus (n = 2), RSV, and 1 patient had mixed virus and bacterial infections. Predictive factors associated with death were arterial blood gas pH, CO 2 and Glasgow Coma Scale (p shock had high mortality rate and ECMO could be used as a rescue modality, and SOFA score could be applied to predict outcomes. Copyright © 2017. Published by Elsevier B.V.

  4. Predictors of mortality in patients successfully weaned from extracorporeal membrane oxygenation.

    Directory of Open Access Journals (Sweden)

    Wei-Wen Chang

    Full Text Available PURPOSE: Extracorporeal membrane oxygenation (ECMO has been utilized for critically ill patients, such as those with life-threatening respiratory failure or post-cardiotomy cardiogenic shock. This study compares the predictive value of Acute Physiology, Age, and Chronic Health Evaluation II (APACHE II, Sequential Organ Failure Assessment (SOFA, and Organ System Failure (OSF obtained on the first day of ECMO removal, and the Acute Kidney Injury Network (AKIN stages obtained at 48 hours post-ECMO removal (AKIN(48-hour in terms of hospital mortality for critically ill patients. METHODS: This study reviewed the medical records of 119 critically ill patients successfully weaned from ECMO at the specialized intensive care unit of a tertiary-care university hospital between July 2006 and October 2010. Demographic, clinical, and laboratory data were collected retrospectively as survival predictors. RESULTS: Overall mortality rate was 26%. The most common condition requiring ECMO support was cardiogenic shock. By using the areas under the receiver operating characteristic (AUROC curve, the Sequential Organ Failure Assessment (SOFA score displayed good discriminative power (AUROC 0.805±0.055, p13. CONCLUSIONS: Following successful ECMO weaning, the SOFA score proved a reproducible evaluation tool with good prognostic abilities.

  5. Issues to resolve with the use of extracorporeal membrane oxygenation during interfacility transportation.

    Science.gov (United States)

    Burgueño, P; González, C; Sarralde, A; Gordo, F

    2018-03-01

    Extracorporeal membrane oxygenation (ECMO) support is indicated in patients who are refractory to treatment, those with cardiogenic shock or respiratory failure and those with exacerbations eligible for heart and lung transplantation. Physician experience and quantity of necessary resources are reasons why regionalization could benefit patients of this kind, establishing ECMO reference centers and integrating a transportation network specialized in ECMO. This type of transportation is a challenge for healthcare systems and physicians, given its greater complexity, requiring a multidisciplinary and inter-territorial approach. ECMO transportation is safer than without mechanical support, though there are currently no criteria for starting such therapy in patients being transferred. Criteria of lesser severity might be necessary for these patients. The training and specialization of the team in extracorporeal support therapies, interfacility transport and the systemization of transfer can improve the outcomes. There are no studies on the conditions that must be met by the transportation media, although space and stability are important characteristics. Air transfer with ECMO is an increasingly frequent option. Although there are data on its safety, there are none on the physiology of patients undergoing ECMO at high altitudes. Such information could be of help in the indication and management of this type of transportation. Copyright © 2018 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

  6. Insensible water loss through adult extracorporeal membrane oxygenation circuit: an in vitro study.

    Science.gov (United States)

    Li Li, Chang; Oi Yan, Tam; Ming Chit Arthur, Kwan; Hoi Ping, Shum; King Chung Kenny, Chan; Wing Wa, Yan

    2014-01-01

    Patients on extracorporeal membrane oxygenation (ECMO) are critically ill, and fluid balance need to be managed as accurately as possible. Previous studies have focused on insensible water loss through neonatal ECMO circuit and showed that water loss through the ECMO circuit was correlated with the sweep-gas flow rates. Current study is the first study focusing on insensible water loss through adult ECMO circuit. An in vitro extracorporeal circuit consisting of Jostra Quadrox D membrane oxygenator and centrifugal pump was primed with normal saline. The amount of water loss through the ECMO circuit was found to be linearly correlated with the sweep-gas flow rate and fluid temperature. For every liter per minute of sweep-gas flow at 37°C, 0.046 ml/min of water will be lost, and for every change of fluid temperature by 1°C, water content loss will be changed by 0.0026 ml/min by multiple linear regression (R = 0.996). The average daily water loss for every liter per minute of sweep-gas flow at 33, 34, 35, 36, 37, 38, and 39°C were 51.3, 55, 58.8, 62.5, 66.2, 70.0, and 73.7 ml/day, respectively.

  7. Cerebral and lower limb near-infrared spectroscopy in adults on extracorporeal membrane oxygenation.

    Science.gov (United States)

    Wong, Joshua K; Smith, Thomas N; Pitcher, Harrison T; Hirose, Hitoshi; Cavarocchi, Nicholas C

    2012-08-01

    Percutaneous femoral venoarterial (VA) or jugular venovenous (VV) extracorporeal membrane oxygenation (ECMO) can result in delivery of hypoxic blood to the brain, coronaries, and upper extremities. Additionally, VA-ECMO by percutaneous femoral artery cannulation may compromise perfusion to the lower limbs. Use of near-infrared spectroscopy (NIRS) detects regional ischemia and warns of impending hypoxic damage. We report the first known series with standardized monitoring of this parameter in adults on ECMO. This is an institutional review board-approved single institution retrospective review of patients with NIRS monitoring on ECMO from July 2010 until June 2011. Patients were analyzed for drops in NIRS tracings below 40 or >25% from baseline. VA-ECMO and VV-ECMO were initiated by percutaneous cannulation of the femoral vessels and the internal jugular vein, respectively. Sensors were placed on the patients' foreheads and on the lower limbs. NIRS tracings were recorded, analyzed, and correlated with clinical events. Twenty patients were analyzed (median age: 47.5 years): 17 patients were placed on VA-ECMO, and three patients on VV-ECMO. The median duration on ECMO was 7 days (range 2-26). One hundred percent of patients had a significant drop in bilateral cerebral oximetry tracings resulting in hemodynamic interventions, which involved increasing pressure, oxygenation, and/or ECMO flow. In 16 patients (80%), these interventions corrected the underlying ischemia. Four patients (20%) required further diagnostic intervention for persistent decreased bilateral and/or unilateral cerebral oximetry tracings, and were found to have a cerebrovascular accident (CVA). Six (30%) patients had persistent unilateral lower limb oximetry events, which resolved upon placement or replacement of a distal perfusion cannula. No patient was found to have either lower limb ischemia or a CVA with normal NIRS tracings. Use of NIRS with ECMO is important in detecting ischemic cerebral and

  8. OXYGEN TRANSPORT CERAMIC MEMBRANES

    Energy Technology Data Exchange (ETDEWEB)

    Dr. Sukumar Bandopadhyay; Dr. Nagendra Nagabhushana

    2003-01-01

    In the present quarter, the possibility of using a more complex interfacial engineering approach to the development of reliable and stable oxygen transport perovskite ceramic membranes/metal seals is discussed. Experiments are presented and ceramic/metal interactions are characterized. Crack growth and fracture toughness of the membrane in the reducing conditions are also discussed. Future work regarding this approach is proposed are evaluated for strength and fracture in oxygen gradient conditions. Oxygen gradients are created in tubular membranes by insulating the inner surface from the reducing environment by platinum foils. Fracture in these test conditions is observed to have a gradient in trans and inter-granular fracture as opposed to pure trans-granular fracture observed in homogeneous conditions. Fracture gradients are reasoned to be due to oxygen gradient set up in the membrane, variation in stoichiometry across the thickness and due to varying decomposition of the parent perovskite. The studies are useful in predicting fracture criterion in actual reactor conditions and in understanding the initial evolution of fracture processes.

  9. Intensive Care Physiotherapy during Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome.

    Science.gov (United States)

    Munshi, Laveena; Kobayashi, Tadahiro; DeBacker, Julian; Doobay, Ravi; Telesnicki, Teagan; Lo, Vincent; Cote, Nathalie; Cypel, Marcelo; Keshavjee, Shaf; Ferguson, Niall D; Fan, Eddy

    2017-02-01

    There are limited data on physiotherapy during extracorporeal membrane oxygenation (ECMO) for acute respiratory distress syndrome (ARDS). We sought to characterize physiotherapy delivered to patients with ARDS supported with ECMO, as well as to evaluate the association of this therapeutic modality with mortality. We conducted a retrospective cohort study of all adult patients with ARDS supported with ECMO at our institution between 2010 and 2015. The highest level of daily activity while on ECMO was coded using the ICU Mobility Scale. Through multivariable logistic regression, we evaluated the association between intensive care unit (ICU) physiotherapy and ICU mortality. In an exploratory univariate analysis, we also evaluated factors associated with a higher intensity of ICU rehabilitation while on ECMO. Of 107 patients who underwent ECMO, 61 (57%) had ARDS requiring venovenous ECMO. The ICU physiotherapy team was consulted for 82% (n = 50) of patients. Thirty-nine percent (n = 18) of these patients achieved an activity level of 2 or higher (active exercises in bed), and 17% (n = 8) achieved an activity level 4 or higher (actively sitting over the side of the bed). In an exploratory analysis, consultation with the ICU physiotherapy team was associated with decreased ICU mortality (odds ratio, 0.19; 95% confidence interval, 0.04-0.98). In univariate analysis, severity-of-illness factors differentiated higher-intensity and lower-intensity physiotherapy. Physiotherapy during ECMO is feasible and safe when performed by an experienced team and executed in stages. Although our study suggests an association with improved ICU mortality, future research is needed to identify potential barriers, optimal timing, dosage, and safety profile.

  10. Continuous Renal Replacement Therapy and Extracorporeal Membrane Oxygenation in Cardias Surgery

    Directory of Open Access Journals (Sweden)

    S. V. Kolesnikov

    2014-01-01

    Full Text Available Objective: to analyze the combined use of extracorporeal membrane oxygenation (ECMO and continuous renal replacement therapy with switching into the ECMO circuit in cardiac surgical patients over 18 years of age and to reveal predictors of a fatal outcome in this combination of auxiliary organ support techniques. Materials and methods. The retrospective cohort study postoperatively used a combination of ECMO and continuous renal replacement therapy in 27 cardiac surgical patients aged over 18 years with severe cardiopulmonary insufficiency concurrent with acute kidney lesion. In all cases, the continuous renal replacement therapy circuit was switched into the line after an ECMO pump. The end points of the study were the duration of dialysis-dependent acute renal failure, the frequency of complications, and hospital mortality. Results. In all cases with a favorable outcome, the duration of continuous renal replacement therapy was 3 days longer than that of ECMO. There were no cases of recovery if the duration of continuous renal replacement therapy was shorter than that of ECMO and the duration of the latter was more than 10 days. The duration of sympathomimetic support (>3.5 days was shown to be an independent and significant predictor of death (AUC 0.99; CI 99.9%, 0.96—1.0 in the patients receiving continuous renal replacement therapy and ECMO. It was established that the number of inotrophic drugs (>2 and the highest lactate level (>1.99 mmol/l could be used to predict hospital mortality in patients with acute kidney injury and severe cardiopulmonary insufficiency (AUC 0.85 and 0.86; sensitivity/specificity 0.83/0.67 and 0.86/0.67, respectively.Conclusion. The concurrent use of ECMO and continuous renal replacement therapy in severe cardiac surgical patients with potentially reversible cardiopulmonary insufficiency and acute kidney injury is a sound and complementary combination of auxiliary organ support techniques.  

  11. Outcomes of the first 30 cases of an adult extracorporeal membrane oxygenation program: strategies to manage the "learning curve" and implications for intensive care unit risk adjustment models.

    Science.gov (United States)

    Mullany, Daniel V; Bull, Taressa N; Hunt, William; Shekar, Kiran; Thomson, Bruce; Fraser, John F; Ziegenfuss, Marc

    2012-06-01

    We established an adult extracorporeal membrane oxygenation (ECMO) service for cardiorespiratory support in April 2009. Complex therapies may show a learning curve and volume-outcome relationship. To describe our model of care, casemix and outcomes for the first 30 cases together with unique features of this service and potential strategies to manage the learning curve. Data were obtained from the intensive care unit database, medical record and minutes of multidisciplinary ECMO review meetings. The model of care was based heavily on that used at an experienced ECMO centre following Extracorporeal Life Support Organization guidelines. ECMO was established as an ICU-managed, multidisciplinary service with collaboration from other specialties using standardised policies and procedures, staff training and formal case review. A specific budget was allocated to training and education and a clinical perfusionist was present on site for the first 10 cases. Seventeen patients received venoarterial (VA) and 13 received venovenous (VV) ECMO. Median duration of ECMO was 7 days for VA and 15 days for VV ECMO. Median ICU stay was 22 days. Twenty patients were referred from 13 hospitals throughout Queensland. Hospital mortality was 47% for VA ECMO and 15% for VV ECMO. The unique features of this service are the use of a Levitronix CentriMag system as well as the Rotaflow system, and the use of extended daily haemodiafiltration using the Fresenius 4008s ARrT plus connected into the ECMO circuit. The clinical implications of conducting plasma exchange and sustained low-efficiency dialysis via direct ECMO circuit connection using the Fresenius ARrT machine, and using a second system for ECMO support, were notable challenges. Satisfactory outcomes were achieved using an ICU-based multidisciplinary approach with a broadly based education strategy with additional clinical perfusionist support to manage the learning curve.

  12. OXYGEN TRANSPORT CERAMIC MEMBRANES

    Energy Technology Data Exchange (ETDEWEB)

    Dr. Sukumar Bandopadhyay; Dr. Nagendra Nagabhushana

    2000-10-01

    This is the third quarterly report on oxygen Transport Ceramic Membranes. In the following, the report describes the progress made by our university partners in Tasks 1 through 6, experimental apparatus that was designed and built for various tasks of this project, thermodynamic calculations, where applicable and work planned for the future. (Task 1) Design, fabricate and evaluate ceramic to metal seals based on graded ceramic powder/metal braze joints. (Task 2) Evaluate the effect of defect configuration on ceramic membrane conductivity and long term chemical and structural stability. (Task 3) Determine materials mechanical properties under conditions of high temperatures and reactive atmospheres. (Task 4) Evaluate phase stability and thermal expansion of candidate perovskite membranes and develop techniques to support these materials on porous metal structures. (Task 5) Assess the microstructure of membrane materials to evaluate the effects of vacancy-impurity association, defect clusters, and vacancy-dopant association on the membrane performance and stability. (Task 6) Measure kinetics of oxygen uptake and transport in ceramic membrane materials under commercially relevant conditions using isotope labeling techniques.

  13. Extracorporeal membrane oxygenation in near-drowning patients with cardiac or pulmonary failure.

    Science.gov (United States)

    Kim, Kun Il; Lee, Won Yong; Kim, Hyoung Soo; Jeong, Jae Han; Ko, Ho Hyun

    2014-12-12

    The aim of this study was to determine the early outcomes of using extracorporeal membrane oxygenation (ECMO) in near-drowning patients with cardiac or pulmonary failure. This study was based on data from 9 patients including 2 children (mean age 33; 8 males, 1 female) who received ECMO after near-drowning between 2008 and 2013. Veno-arterial or veno-arteriovenous ECMO was used in 2 patients with sustained cardiac arrest and veno-venous ECMO was used in 7 patients with severe acute respiratory distress syndrome (ARDS). The means of the partial arterial oxygen pressure (PaO2), Murray score, sequential organ failure assessment (SOFA) score, and simplified acute physiology score II (SAPS-II) prior to ECMO were 59.7 ± 9.9 mmHg on 100% oxygen, 3.5 ± 0.6, 11.4 ± 1.9, and 73.0 ± 9.2, respectively. The PaO2 mean improved to 182 ± 152 mmHg within 2 h post-ECMO. The mean of SOFA score and SAPS-II decreased significantly to 8.6 ± 3.2 (p = 0.013) and 46.4 ± 5.1 (p = 0.008), respectively, at 24 h post-ECMO with mean flow rate of 3.9 ± 0.8 l/min. ECMO was weaned at a mean duration of 188 (range, 43-672) h in all patients. Seven patients were discharged home without neurological sequelae, while 2 patients who had hypoxic brain damage died after further referral. The overall survival with favourable neurological outcomes at 3 months was 77.8%. There were no complications related to ECMO. ECMO was safe and effective for patients with ongoing cardiac arrest or ARDS after a near-drowning incident and can be used as a resuscitative strategy in near-drowning patients with cardiac or pulmonary failure resistant to conventional ventilator therapy.

  14. Using ultrasonography to monitor liver blood flow for liver transplant from donors supported on extracorporeal membrane oxygenation.

    Science.gov (United States)

    Zhu, Xian-Sheng; Wang, Sha-Sha; Cheng, Qi; Ye, Chuang-Wen; Huo, Feng; Li, Peng

    2016-02-01

    Extracorporeal membrane oxygenation (ECMO) has been used to support brain-dead donors for liver procurement. This study investigated the potential role of ultrasonographic monitoring of hepatic perfusion as an aid to improve the viability of liver transplants obtained from brain-dead donors who are supported on ECMO. A total of 40 brain-dead patients maintained on ECMO served as the study population. Hepatic blood flow was monitored using ultrasonography, and perioperative optimal perfusion was maintained by calibrating ECMO. Liver function tests were performed to assess the viability of the graft. The hepatic arterial blood flow was well maintained with no significant changes observed before and after ECMO (206 ± 32 versus 241 ± 45 mL/minute; P = 0.06). Similarly, the portal venous blood flow was also maintained throughout (451 ± 65 versus 482 ± 77 mL/minute; P = 0.09). No significant change in levels of total bilirubin, alanine transaminase, and lactic acid were reported during ECMO (P = 0.17, P = 0.08, and P = 0.09, respectively). Before the liver is procured, ultrasonographic monitoring of hepatic blood flow could be a valuable aid to improve the viability of a liver transplant by allowing for real-time calibration of ECMO perfusion in brain-dead liver donors. In our study, ultrasonographic monitoring helped prevent warm ischemic injury to the liver graft by avoiding both overperfusion and underperfusion of the liver. © 2015 American Association for the Study of Liver Diseases.

  15. Extracorporeal membrane oxygenation in an HIV-positive man with severe acute respiratory distress syndrome secondary to pneumocystis and cytomegalovirus pneumonia.

    Science.gov (United States)

    Morley, Deirdre; Lynam, Almida; Carton, Edmund; Martin-Loeches, Ignacio; Sheehan, Gerard; Lynn, Niamh; O'Brien, Serena; Mulcahy, Fiona

    2018-02-01

    The management of critically ill human immunodeficiency virus (HIV)-positive patients is challenging; however, intensive care unit-related mortality has declined significantly in recent years. There are 10 case reports in the literature of extracorporeal membrane oxygenation (ECMO) use in HIV-positive patients, of whom seven survived to hospital discharge. We describe a 33-year-old Brazilian man who presented with Pneumocystis jirovecii pneumonia and severe hypoxic respiratory failure. He developed refractory acute respiratory distress syndrome (ARDS) and was commenced on veno-venous ECMO. He was successfully decannulated following 21 days of ECMO and survived to hospital discharge. Despite poor evidence surrounding the use of ECMO in immunocompromised patients, it is evident that ECMO could represent an important rescue therapy in HIV-positive patients with refractory ARDS.

  16. Usefulness of extracorporeal membrane oxygenation using double roller pumps in a low body weight newborn: A novel strategy for mechanical circulatory support in an infant

    Directory of Open Access Journals (Sweden)

    Keisuke Nakanishi

    2016-01-01

    Full Text Available Extracorporeal membrane oxygenation (ECMO with a centrifugal pump requires a certain flow rate; therefore, its application for low body weight infants is frequently accompanied by oxygenator membrane malfunction and/or inadequate perfusion. To prevent low-flow associated complications, we report a case in which a novel system of dual roller pumps was used. A baby girl with a body mass index 0.25 m 2 , who experienced difficulty weaning from cardiopulmonary bypass after a Norwood-like operation, required an ECMO. Concerns for the tube lifespan reduction due to roller pump friction led to the use of a double roller pump circulation. The termination of ECMO during tube exchange is not needed, because circulation is maintained by another roller pump. The novel strategy of ECMO with double roller pumps will allow low perfusion rate to provide adequate circulatory support for low body weight patients.

  17. Extracorporeal membrane oxygenation exposes infants to the plasticizer, di(2-ethylhexyl)phthalate.

    Science.gov (United States)

    Karle, V A; Short, B L; Martin, G R; Bulas, D I; Getson, P R; Luban, N L; O'Brien, A M; Rubin, R J

    1997-04-01

    To determine the exposure to, and evaluate the potential toxicity from, the plasticizer, di(2-ethylhexyl)phthalate (DEHP) during extracorporeal membrane oxygenation (ECMO) therapy. Protocol 1 consisted of a prospective comparison of three ECMO circuit designs in vitro. Protocol 2 consisted of a prospective, comparative clinical study evaluating DEHP plasma concentrations in ECMO vs. non-ECMO patients with respiratory failure. Neonatal intensive care unit at The Children's National Medical Center, Washington, DC. In protocol 2, 28 consecutive term infants were referred for ECMO therapy. Eighteen infants required ECMO; ten control patients received conventional ventilation and improved without ECMO. In protocol 1, three ECMO circuit designs were primed in vitro with normal saline, albumin, and human blood, which was maintained at 37 degrees C and recirculated at 400 mL/min for 48 hrs. Plasma samples were obtained at time 0, 1 hr, and every 6 hrs. In protocol 2, ventilatory and cardiovascular management of the patients in the study was conducted by the attending physician. Patients were placed on ECMO when they met the institutional criteria for ECMO therapy. Daily plasma concentrations for DEHP were collected until 3 days after decannulation from bypass in the ECMO group. Control patients were sampled daily until extubation. Evidence of cardiac, liver, or lung toxicity was evaluated by Chest Radiographic Scores, liver function studies, and echocardiograms obtained on day 1, day 3, and the day of decannulation in the ECMO group, or at the time of extubation in the control group. Sedation, blood product transfusions as indicated, antibiotics, and hyperalimentation were administered to all patients. All DEHP plasma concentrations were measured by gas chromatography. In protocol 1, three circuits were studied: circuit A (small surface area); circuit B (larger surface area); and circuit C (surface area of A but with heparin-bonded tubing in the circuit). DEHP leached from

  18. The simulation of an ex utero intrapartum procedure to extracorporeal membrane oxygenation.

    Science.gov (United States)

    Auguste, Tamika C; Boswick, J Aidan; Loyd, Mary K; Battista, Alexis

    2011-02-01

    We report a case of using simulation to aid in the performance of ex utero intrapartum treatment (EXIT) procedure to extracorporeal membrane oxygenation (ECMO). A primigravid with a fetus who was diagnosed with hypoplastic left heart syndrome was scheduled for an EXIT to ECMO procedure to be done by members of her obstetrical and neonatal teams. It would be the first time any of the members of the 2 teams would work together. Simulation was used to allow all involved parties to experience the procedure before the live operation. In addition, the simulation enabled the interdisciplinary teams to work with each other, identify possible complications, and further plan the coordination during the event. The EXIT to ECMO surgery was completed successfully. The use of low-fidelity, cost-effective simulation during a surgical rehearsal can give a surgical team critical advantage when performing a rare and/or complex procedure. Copyright © 2011 Elsevier Inc. All rights reserved.

  19. Chlorhexidine-related refractory anaphylactic shock: a case successfully resuscitated with extracorporeal membrane oxygenation.

    Science.gov (United States)

    Wang, Man-Ling; Chang, Ching-Tao; Huang, Hsing-Hao; Yeh, Yu-Chang; Lee, Tzong-Shiun; Hung, Kuan-Yu

    2016-11-01

    We report a patient with a life-threatening anaphylactic reaction to a chlorhexidine-coated central venous catheter, confirmed with a high serum level of chlorhexidine-specific IgE. To our knowledge, this is the first case successfully resuscitated using extracorporeal membrane oxygenation (ECMO). Great caution is required when using chlorhexidine and chlorhexidine-impregnated catheters, given that its widespread use has the potential to sensitize certain patients and may result in life-threatening anaphylaxis on subsequent exposure. A case report of a single patient with life-threatening anaphylactic shock to chlorhexidine, who was successfully resuscitated using ECMO. We have designed a flowchart for the diagnosis and management of severe anaphylaxis. This case report highlights the potential for chlorhexidine to be a source for the development of refractory anaphylactic shock. We suggest that ECMO may save the lives of patients with severe bronchospasm and refractory anaphylactic shock secondary to chlorhexidine. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. Refractory Septic Shock Treated with Nephrectomy under the Support of Extracorporeal Membrane Oxygenation

    Directory of Open Access Journals (Sweden)

    Young Kun Lee

    2015-08-01

    Full Text Available Conventional medical therapies have not been very successful in treating adults with refractory septic shock. The effects of direct hemoperfusion using polymyxin B and veno-arterial extracorporeal membrane oxygenation (ECMO for refractory septic shock remain uncertain. A 66-year-old man was admitted to the emergency department and suffered from sepsis-induced hemodynamic collapse. For hemodynamic improvement, we performed direct hemoperfusion using polymyxin B. Computed tomography scan of this patient revealed emphysematous pyelonephritis (EPN, for which he underwent emergent nephrectomy with veno-arterial ECMO support. To the best of our knowledge, this is the first report of successful treatment of EPN with refractory septic shock using polymyxin B hemoperfusion and nephrectomy under the support of ECMO.

  1. Ethical Considerations for Care of the Child Undergoing Extracorporeal Membrane Oxygenation.

    Science.gov (United States)

    Carter, Martha A

    2017-02-01

    Extracorporeal membrane oxygenation (ECMO) is a complex, highly technical surgical procedure that can offer hope for children born with congenital heart defects. The procedure may only briefly prolong a life, has limited potential for decreasing mortality, and may lead to serious complications, however. Perioperative nurses play an important role in caring for the child who requires ECMO. They are involved in assessing the child, implementing the plan of care, and facilitating communication between the child's family members and the health care team. Thus, perioperative nurses have a responsibility to consider the broad range of ethical issues associated with the procedure. By examining the ethical concepts of beneficence, nonmaleficence, autonomy, justice, and moral distress, the perioperative nurse can better understand the dilemmas that can affect the care and outcome of the critically ill child who requires ECMO. Copyright © 2017 AORN, Inc. Published by Elsevier Inc. All rights reserved.

  2. Runtime and aPTT predict venous thrombosis and thromboembolism in patients on extracorporeal membrane oxygenation: a retrospective analysis.

    Science.gov (United States)

    Trudzinski, Franziska C; Minko, Peter; Rapp, Daniel; Fähndrich, Sebastian; Haake, Hendrik; Haab, Myriam; Bohle, Rainer M; Flaig, Monika; Kaestner, Franziska; Bals, Robert; Wilkens, Heinrike; Muellenbach, Ralf M; Link, Andreas; Groesdonk, Heinrich V; Lensch, Christian; Langer, Frank; Lepper, Philipp M

    2016-12-01

    Even though bleeding and thromboembolic events are major complications of extracorporeal membrane oxygenation (ECMO), data on the incidence of venous thrombosis (VT) and thromboembolism (VTE) under ECMO are scarce. This study analyzes the incidence and predictors of VTE in patients treated with ECMO due to respiratory failure. Retrospective analysis of patients treated on ECMO in our center from 04/2010 to 11/2015. Patients with thromboembolic events prior to admission were excluded. Diagnosis was made by imaging in survivors and postmortem examination in deceased patients. Out of 102 screened cases, 42 survivors and 21 autopsy cases [mean age 46.0 ± 14.4 years; 37 (58.7 %) males] fulfilling the above-mentioned criteria were included. Thirty-four patients (54.0 %) underwent ECMO therapy due to ARDS, and 29 patients (46.0 %) with chronic organ failure were bridged to lung transplantation. Despite systemic anticoagulation at a mean PTT of 50.6 ± 12.8 s, [VT/VTE 47.0 ± 12.3 s and no VT/VTE 53.63 ± 12.51 s (p = 0.037)], VT and/or VTE was observed in 29 cases (46.1 %). The rate of V. cava thrombosis was 15/29 (51.7 %). Diagnosis of pulmonary embolism prevailed in deceased patients [5/21 (23.8 %) vs. 2/42 (4.8 %) (p = 0.036)]. In a multivariable analysis, only aPTT and time on ECMO predicted VT/VTE. There was no difference in the incidence of clinically diagnosed VT in ECMO survivors and autopsy findings. Venous thrombosis and thromboembolism following ECMO therapy are frequent. Quality of anticoagulation and ECMO runtime predicted thromboembolic events.

  3. Oxygen Transport Membranes

    Energy Technology Data Exchange (ETDEWEB)

    S. Bandopadhyay

    2008-08-30

    The focus of this research was to develop new membrane materials by synthesizing different compounds and determining their defect structures, crystallographic structures and electrical properties. In addition to measuring electrical conductivity, oxygen vacancy concentration was also evaluated using thermogravimetry, Neutron diffraction and Moessbauer Spectroscopy. The reducing conditions (CO{sub 2}/CO/H{sub 2} gas mixtures with steam) as encountered in a reactor environment can be expected to have significant influence on the mechanical properties of the oxides membranes. Various La based materials with and without Ti were selected as candidate membrane materials for OTM. The maximum electrical conductivity of LSF in air as a function of temperature was achieved at < 600 C and depends on the concentration of Sr (acceptor dopant). Oxygen occupancy in LSF was estimated using Neutron diffractometry and Moessbauer Spectroscopy by measuring magnetic moment changes depending on the Fe{sup 3+} and Fe{sup 4+} ratio. After extensive studies of candidate materials, lanthanum ferrites (LSF and LSFT) were selected as the favored materials for the oxygen transport membrane (OTM). LSF is a very good material for an OTM because of its high electronic and oxygen ionic conductivity if long term stability and mechanical strength are improved. LSFT not only exhibits p-type behavior in the high oxygen activity regime, but also has n-type conduction in reducing atmospheres. Higher concentrations of oxygen vacancies in the low oxygen activity regime may improve the performance of LSFT as an OTM. The hole concentration is related to the difference in the acceptor and donor concentration by the relation p = [Sr'{sub La}]-[Ti{sm_bullet}{sub Fe}]. The chemical formulation predicts that the hole concentration is, p = 0.8-0.45 or 0.35. Experimental measurements indicated that p is about {approx} 0.35. The activation energy of conduction is 0.2 eV which implies that LSCF conducts via the

  4. Effect of Anemia on Prognosis in Patients on Extracorporeal Membrane Oxygenation.

    Science.gov (United States)

    Jenq, Chang-Chyi; Tsai, Feng-Chun; Tsai, Tsung-Yu; Hsieh, Sue-Yun; Lai, Yi-Wen; Tian, Ya-Chung; Chang, Ming-Yang; Lin, Chan-Yu; Fang, Ji-Tseng; Yang, Chih-Wei; Chen, Yung-Chang

    2018-03-30

    Anemia is a component of the pathological triangle in cardiorenal anemia syndrome and is a risk factor for mortality in acute respiratory distress syndrome. This study assessed the predictive value of anemia for outcomes in critically ill patients receiving extracorporeal membrane oxygenation (ECMO) support. This retrospective study analyzed patients who received ECMO support at the cardiovascular surgery intensive care unit in the study institute between July 2003 and March 2012. Patient data, such as demographic information, etiologies of ECMO implementation, clinical parameters, and in-hospital and 6-month mortality rates, were statistically analyzed. The overall in-hospital mortality rate among the enrolled 295 patients was 55.6%. Multivariate logistical regression analysis indicated that age, albumin levels, sequential organ failure assessment (SOFA) score, and hemoglobin (Hb) level on ECMO day 1 exhibited independent prognostic significance for predicting in-hospital mortality rate. The SOFA score exhibited the highest areas under the receiver operating characteristic curve value (0.812 ± 0.025). The Hb level on ECMO day 1 exhibited satisfactory calibration and discriminatory power. The cumulative 6-month survival rates differed significantly between patients with Hb levels less than and more than 8.85 g/dL (30.6 vs. 54.0%, respectively, P < 0.001). This study indicated that old age, low albumin levels, low Hb levels, and higher SOFA scores on ECMO day 1 increased the risk of mortality. The Hb level is a readily measurable parameter and with good predictive power for critical patients on ECMO. © 2018 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

  5. Outcomes of neonates undergoing extracorporeal membrane oxygenation support using centrifugal versus roller blood pumps.

    Science.gov (United States)

    Barrett, Cindy S; Jaggers, James J; Cook, E Francis; Graham, Dionne A; Rajagopal, Satish K; Almond, Christopher S; Seeger, John D; Rycus, Peter T; Thiagarajan, Ravi R

    2012-11-01

    Advances in centrifugal blood pump technology have led to increased use of centrifugal pumps in extracorporeal membrane oxygenation (ECMO) circuits. Their efficacy and safety in critically ill neonates remains unknown. Blood cell trauma leading to hemolysis may result in end-organ injury in critically ill neonates receiving centrifugal pump ECMO. We hypothesized that neonates undergoing ECMO support using centrifugal pumps were at increased odds of hemolysis and subsequent end-organ injury. Children 30 days of age or younger who received support with venoarterial ECMO and were reported to the Extracorporeal Life Support Registry during 2007 to 2009 underwent propensity score matching (Greedy matching 1:1) using pre-ECMO support characteristics. A total of 1,592 neonates receiving ECMO (centrifugal pump = 163 and roller pump = 1,492) were identified. Significant differences in demographic, presupport, and cannulation variables were present before matching. One hundred seventy-six neonates who were supported using either centrifugal (n = 88) or roller pumps (n = 88) were matched using propensity scoring. No significant differences in demographic, presupport, or cannulation variables were present after matching. Neonates undergoing support using centrifugal pumps had increased odds of hemolysis (odds ratio [OR], 7.7 [2.8-21.2]), hyperbilirubinemia (OR, 20.8 [2.7-160.4]), hypertension (OR, 3.2 [1.3-8.0]), and acute renal failure (OR, 2.4 [1.1-5.6]). Survival to discharge was not different between pump types. Use of ECMO using centrifugal pumps is associated with increased odds of hemolysis that likely contributes to other end-organ injury. Research into the optimal use of centrifugal pumps and strategies to prevent support-related complications need to be investigated. Copyright © 2012 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  6. H1N1 Influenza Patient Saved by Extracorporeal Membrane Oxygenation: First Report from Iran

    Directory of Open Access Journals (Sweden)

    Alireza Jahangirifard

    2016-11-01

    Full Text Available Respiratory failure is a serious complication of H1N1 influenza that, if not properly managed, can cause death. When mechanical ventilation is not effective, the only way to save the patient’s life is extracorporeal membrane oxygenation (ECMO. A prolonged type of cardiopulmonary bypass, ECMO is a high-cost management modality compared to other conventional types and its maintenance requires skilled personnel. Such staff usually comprises the members of open-heart surgical teams.  Herein, we describe a patient with H1N1 influenza and severe respiratory failure not improved by mechanical ventilation who was admitted to Masih Daneshvari Medical Center in March 2015. She was placed on ECMO, from which she was successfully weaned 9 days later. The patient was discharged from the hospital after 52 days. Follow-up till 11 months after discharge revealed completely active life with no problem. There should be a close collaboration among infectious disease specialists, cardiac anesthetists, cardiac surgeons, and intensivists for the correct timing of ECMO placement, subsequent weaning, and care of the patient. This team work was the key to our success story. This is the first patient to survive H1N1 with the use of ECMO in Iran. 

  7. Roller and Centrifugal Pumps: A Retrospective Comparison of Bleeding Complications in Extracorporeal Membrane Oxygenation.

    Science.gov (United States)

    Halaweish, Ihab; Cole, Adam; Cooley, Elaine; Lynch, William R; Haft, Jonathan W

    2015-01-01

    Centrifugal pumps are increasingly used for extracorporeal membrane oxygenation (ECMO) rather than roller pumps. However, shear forces induced by these types of continuousflow pumps are associated with acquired von Willebrand factor deficiency and bleeding complications. This study was undertaken to compare adverse bleeding complications with the use of centrifugal and roller pumps in patients on prolonged ECMO support. The records of all adult ECMO patients from June 2002 to 2013 were retrospectively reviewed using the University of Michigan Health System database and the Extracorporeal Life Support Organization registry, focusing on patients supported for at least 5 days. Ninety-five ECMO patients met criteria for inclusion (48 roller vs. 47 centrifugal pump). Indications included pulmonary (79%), cardiac (15%), and extracorporeal cardiopulmonary resuscitation (6%), without significant difference between the two groups. Despite lower heparin anticoagulation (10.9 vs. 13.7 IU/kg/hr) with centrifugal pumps, there was a higher incidence of nonsurgical bleeding (gastrointestinal, pulmonary, and neurological) in centrifugal pump patients (26.1 vs. 9.0 events/1,000 patient-days, p = 0.024). In conclusion, in our historical comparison, despite reduced anticoagulation, ECMO support using centrifugal pumps was associated with a higher incidence of nonsurgical bleeding. The mechanisms behind this are multifactorial and require further investigation.

  8. Extracorporeal membrane oxygenation saved a mother and her son from fulminant peripartum cardiomyopathy.

    Science.gov (United States)

    Park, Sang Hyun; Chin, Jung Yeon; Choi, Min Suk; Choi, Jin Ho; Choi, Yu Jeong; Jung, Kyung Tae

    2014-07-01

    A 34-year-old full-term pregnant woman presented with abruptly aggravating dyspnea. A chest X-ray showed pulmonary edema, and an echocardiogram revealed a left ventricular ejection fraction of 39%. Despite conventional medical treatment for acute heart failure and mechanical ventilation, hypoxia and metabolic acidosis were aggravated, and the fetal heart rate decreased to 90 b.p.m., suggestive of fetal distress. We decided to initiate extracorporeal membrane oxygenation (ECMO) and perform a cesarean section. The infant was successfully delivered without hypoxic brain damage. The patient was weaned from ECMO 6 days after delivery and was extubated 1 day after discontinuation of ECMO. Left ventricular systolic function had completely recovered at this time. This is the first report of a patient with peripartum cardiomyopathy who had a successful delivery with the support of ECMO, demonstrating that ECMO can serve as a rescue therapy, not only treating peripartum cardiomyopathy but also permitting a safe delivery. © 2014 The Authors. Journal of Obstetrics and Gynaecology Research © 2014 Japan Society of Obstetrics and Gynecology.

  9. Extracorporeal Membrane Oxygenation Cannula Malposition in the Azygos Vein in a Neonate with Right-Sided Congenital Diaphragmatic Hernia

    Directory of Open Access Journals (Sweden)

    Seung Jun Choi

    2016-05-01

    Full Text Available Malposition of the extracorporeal membrane oxygenation (ECMO venous cannula in the azygos vein is not frequently reported. We hereby present such a case, which occurred in a neonate with right-sided congenital diaphragmatic hernia. Despite ECMO application, neither adequate flow nor sufficient oxygenation was achieved. On the cross-table lateral chest radiograph, the cannula tip was identified posterior to the heart silhouette, which implied malposition of the cannula in the azygos vein. After repositioning the cannula, the target flow and oxygenation were successfully achieved. When sufficient venous flow is not achieved, as in our case, clinicians should be alerted so they can identify the cannula tip location on lateral chest radiograph and confirm whether malposition in the azygos vein is the cause of the ineffective ECMO.

  10. Oxygen Transport Ceramic Membranes

    Energy Technology Data Exchange (ETDEWEB)

    S. Bandopadhyay; T. Nithyanantham

    2006-12-31

    Ti doping on La{sub 1-x}Sr{sub x}FeO{sub 3-{delta}} (LSF) tends to increase the oxygen equilibration kinetics of LSF in lower oxygen activity environment because of the high valence state of Ti. However, the addition of Ti decreases the total conductivity because the acceptor ([Sr{prime}{sub La}]) is compensated by the donor ([Ti{sub Fe}{sup {sm_bullet}}]) which decreases the carrier concentration. The properties of La{sub 0.2}Sr{sub 0.8}Fe{sub 1-x}Ti{sub x}O{sub 3-{delta}} (LSFT, x = 0.45) have been experimentally and theoretically investigated to elucidate (1) the dependence of oxygen occupancy and electrochemical properties on temperature and oxygen activity by thermogravimetric analysis (TGA) and (2) the electrical conductivity and carrier concentration by Seebeck coefficient and electrical measurements. In the present study, dual phase (La{sub 0.2}Sr{sub 0.8}Fe{sub 0.6}Ti{sub 0.4}O{sub 3-{delta}}/Ce{sub 0.9}Gd{sub 0.1}O{sub 2-{delta}}) membranes have been evaluated for structural properties such as hardness, fracture toughness and flexural strength. The effect of high temperature and slightly reducing atmosphere on the structural properties of the membranes was studied. The flexural strength of the membrane decreases upon exposure to slightly reducing conditions at 1000 C. The as-received and post-fractured membranes were characterized using XRD, SEM and TG-DTA to understand the fracture mechanisms. Changes in structural properties of the composite were sought to be correlated with the physiochemical features of the two-phases. We have reviewed the electrical conductivity data and stoichiometry data for La{sub 0.2}Sr{sub 0.8}Cr{sub 0.2}Fe{sub 0.8}O{sub 3-{delta}} some of which was reported previously. Electrical conductivity data for La{sub 0.2}Sr{sub 0.8}Cr{sub 0.2}Fe{sub 0.8}O{sub 3-{delta}} (LSCrF) were obtained in the temperature range, 752 {approx} 1055 C and in the pO{sub 2} range, 10{sup -18} {approx} 0.5 atm. The slope of the plot of log {sigma} vs

  11. An exploratory study with an adaptive continuous intravenous furosemide regimen in neonates treated with extracorporeal membrane oxygenation

    NARCIS (Netherlands)

    M.M.J. van der Vorst (Maria); J. den Hartigh (Jan); E.D. Wildschut (Enno); D. Tibboel (Dick); J. Burggraaf (Jacobus)

    2007-01-01

    textabstractIntroduction: The objective of the present study was to explore a continuous intravenous furosemide regimen that adapts to urine output in neonates treated with extracorporeal membrane oxygenation (ECMO). Methods: Seven neonates admitted to a paediatric surgical intensive care unit for

  12. Physiotherapy for Patients on Awake Extracorporeal Membrane Oxygenation: A Systematic Review.

    Science.gov (United States)

    Polastri, Massimiliano; Loforte, Antonino; Dell'Amore, Andrea; Nava, Stefano

    2016-12-01

    Extracorporeal membrane oxygenation (ECMO) is used as temporary life support in subjects with potentially reversible respiratory/cardiac failure. The principal purpose of this review was to assess the characteristics and potential advantages of physiotherapeutic interventions in subjects on awake ECMO support. Seven databases were interrogated: we searched titles, abstracts and keywords using the Medical Subject Headings terms 'extracorporeal membrane oxygenation' and 'rehabilitation' linked with the Boolean operator 'AND'. In total, 216 citations were retrieved. Nine citations satisfied our inclusion criteria and were subjected to full-text analysis. The numbers of patients enrolled in the included studies (most of which were case series) were low (n = 52). We found no prospective studies or randomized controlled trials. Overall, subjects on awake ECMO usually received a combination of passive and active physiotherapy, and most achieved an acceptable degree of autonomy after treatment. Emerging research in the field affords preliminary evidence supporting the safety of early mobilization and ambulation in patients on awake veno-venous ECMO support. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

  13. Benefit of extracorporeal membrane oxygenation in major burns after stun grenade explosion: Experience from a single military medical center.

    Science.gov (United States)

    Hsu, Po-Shun; Tsai, Yi-Ting; Lin, Chih-Yuan; Chen, Shyi-Gen; Dai, Niann-Tzyy; Chen, Cheng-Jung; Chen, Jia-Lin; Tsai, Chien-Sung

    2017-05-01

    Explosion injury is very common on the battlefield and is associated with major burn and inhalation injuries and subsequent high mortality and morbidity rates. Here we report six victims who suffered from explosion injuries caused by stun grenade; all were treated with extracorporeal membrane oxygenation (ECMO) as salvage therapy. This study was aimed to evaluate the indications and efficacy of ECMO in acute and critically ill major burn patients. This was a retrospective analysis of six patients from Tri-Service General Hospital, National Defense Medical Center in Taiwan. All suffered from major burns with 89.0±19.1% average of total body surface area over second degree (TBSA; range, 50-99%). ECMO was used due to inhalation injury in five patients and cardiogenic shock in one patient. The average interval to start ECMO was 26.5±19.0h (range, 14-63h). Venoarterial ECMO was used on in four patients due to unstable hemodynamic status, whereas venovenous ECMO was used in two patients for sustained hypoxemia. All patients had rhabdomyolysis with acute renal failure. The average duration of ECMO was 169.6±180.9h (range, 27-401h). All patients developed coagulopathy and needed debridement surgery during ECMO support, and five underwent torso escharotomy due to inspiratory compromise. Only one patient whose second and third degree burns covered 50% TBSA was successfully weaned from ECMO and survived; he was discharged after 221 hospital days. All patients who died had second and third degree burns covering over 90% of their TBSA. Three patients died of multiple organ failure, one died of septic shock, and the other died of cardiogenic shock. Overall survival rate was 16.7%. In acute and critically ill major burn patients, ECMO could be considered as a salvage therapy, particularly in those with inhalation injury and burn-related acute respiratory distress syndrome. However, ECMO does not seem to provide benefits for circulatory support in those with hemodynamic

  14. Triiodothyronine activates lactate oxidation without impairing fatty acid oxidation and improves weaning from extracorporeal membrane oxygenation

    Energy Technology Data Exchange (ETDEWEB)

    Kajimoto, Masaki; Ledee, Dolena R.; Xu, Chun; Kajimoto, Hidemi; Isern, Nancy G.; Portman, Michael A.

    2014-01-01

    Background: Extracorporeal membrane oxygenation (ECMO) provides a rescue for children with severe cardiac failure. We previously showed that triiodothyronine (T3) improves cardiac function by modulating pyruvate oxidation during weaning. This study was focused on fatty acid (FA) metabolism modulated by T3 for weaning from ECMO after cardiac injury. Methods: Nineteen immature piglets (9.1-15.3 kg) were separated into 3 groups with ECMO (6.5 hours) and wean: normal circulation (Group-C);transient coronary occlusion (10 minutes) followed by ECMO (Group-IR); and IR with T3 supplementation (Group-IR-T3). 13-Carbon labeled lactate, medium-chain and long-chain FAs were infused as oxidative substrates. Substrate fractional contribution to the citric acid cycle (FC) was analyzed by 13-Carbon nuclear magnetic resonance. Results: ECMO depressed circulating T3 levels to 40% baseline at 4 hours and were restored in Group-IR-T3. Group-IR decreased cardiac power, which was not fully restorable and 2 pigs were lost because of weaning failure. Group-IR also depressed FC-lactate, while the excellent contractile function and energy efficiency in Group-IR-T3 occurred along with a marked FC-lactate increase and [ATP]/[ADP] without either decreasing FC-FAs or elevating myocardial oxygen consumption over Group-C or -IR. Conclusions: T3 releases inhibition of lactate oxidation following ischemia-reperfusion injury without impairing FA oxidation. These findings indicate that T3 depression during ECMO is maladaptive, and that restoring levels improves metabolic flux and enhances contractile function during weaning.

  15. Chest computed tomography in children undergoing extra-corporeal membrane oxygenation: a 9-year single-centre experience

    Energy Technology Data Exchange (ETDEWEB)

    Goodwin, Susie J.; Calder, Alistair D. [Great Ormond Street Hospital for Children NHS Foundation Trust, Radiology Department, London (United Kingdom); Randle, Elise; Iguchi, Akane; Brown, Katherine; Hoskote, Aparna [Great Ormond Street Hospital for Children NHS Foundation Trust, Cardiac Intensive Care and ECMO, London (United Kingdom)

    2014-06-15

    We retrospectively reviewed the imaging findings, indications, technique and clinical impact in children who had undergone chest CT while undergoing extra-corporeal membrane oxygenation (ECMO). Radiology and ECMO databases were searched to identify all 19 children who had undergone chest CT (20 scans in total) while on ECMO at our institution between May 2003 and May 2012. We reviewed all CT scans for imaging findings. Chest CT is performed in a minority of children on ECMO (4.5% in our series). Timing of chest CT following commencement of ECMO varied among patient groups but generally it was performed earlier in the neonatal group. Clinically significant imaging findings were found in the majority of chest CT scans. Many scans contained several findings, with most cases demonstrating parenchymal or pleural abnormalities. Case examples illustrate the spectrum of imaging findings, including underlying pathology such as necrotising pneumonia and severe barotrauma, and ECMO-related complications such as tension haemothoraces and cannula migration. The results of chest CT led to a change in patient management in 16 of 19 children (84%). There were no adverse events related to patient transfer. An understanding of scan technique and awareness of potential findings is important for the radiologist to provide prompt and optimal image acquisition and interpretation in appropriate patients. (orig.)

  16. Tracheal injury during extraction of an esophageal foreign body: Repair utilizing venovenous ECMO

    Directory of Open Access Journals (Sweden)

    Shunpei Okochi, MD

    2017-05-01

    Full Text Available Extracorporeal membrane oxygenation (ECMO is a form of life support with an ever-expanding range of indications. Veno-venous (VV ECMO is often utilized to support children with respiratory compromise, and has been employed successfully in the acute setting of traumatic tracheobronchial injury as well as during elective tracheal surgery. We present a successful case of VV ECMO used in the perioperative management of a tracheal repair for a traumatic laceration caused by attempts to retrieve an esophageal foreign body. While this mechanism of injury appears to be rare, we believe that VV-ECMO allowed for the optimal management of this child and should be considered for other extensive tracheal injuries in children.

  17. Capgras syndrome: a clinical manifestation of watershed cerebral infarct complicating the use of extracorporeal membrane oxygenation.

    Science.gov (United States)

    Dejode, J M; Antonini, F; Lagier, P; Martin, C

    2001-08-01

    Ischaemic cerebral accidents are frequent following extracorporeal membrane oxygenation (ECMO), especially after fixing the reinjection cannula in the right primitive carotid artery, which leads to an interruption in downstream flow. We describe a rare and unusual symptom of cerebral ischaemic accident that is known as Capgras syndrome. This feature is interesting because it may be documented by computed tomography (CT) scan and particular electroencephalography signals. It appears that our observation represents the first documented case of Capgras syndrome complicating ECMO. This incident emphasizes the potential hazards associated with right common artery ligature for venoarterial extracorporeal membrane oxygenation (VAECMO). In addition, it shows that this psychiatric symptom (that has been interpreted psychodynamically for many years) can have an organic basis, which should be studied.

  18. Oxygen Transport Ceramic Membranes

    Energy Technology Data Exchange (ETDEWEB)

    S. Bandopadhyay; N. Nagabhushana; Thomas W. Eagar; Harold R. Larson; Raymundo Arroyave; X.-D Zhou; Y.-W. Shin; H.U. Anderson; Nigel Browning; Alan Jacobson; C.A. Mims

    2003-11-01

    The present quarterly report describes some of the initial studies on newer compositions and also includes newer approaches to address various materials issues such as in metal-ceramic sealing. The current quarter's research has also focused on developing a comprehensive reliability model for predicting the structural behavior of the membranes in realistic conditions. In parallel to industry provided compositions, models membranes have been evaluated in varying environment. Of importance is the behavior of flaws and generation of new flaws aiding in fracture. Fracture mechanics parameters such as crack tip stresses are generated to characterize the influence of environment. Room temperature slow crack growth studies have also been initiated in industry provided compositions. The electrical conductivity and defect chemistry of an A site deficient compound (La{sub 0.55}Sr{sub 0.35}FeO{sub 3}) was studied. A higher conductivity was observed for La{sub 0.55}Sr{sub 0.35}FeO{sub 3} than that of La{sub 0.60}Sr{sub 0.40}FeO{sub 3} and La{sub 0.80}Sr{sub 0.20}FeO{sub 3}. Defect chemistry analysis showed that it was primarily contributed by a higher carrier concentration in La{sub 0.55}Sr{sub 0.35}FeO{sub 3}. Moreover, the ability for oxygen vacancy generation is much higher in La{sub 0.55}Sr{sub 0.35}FeO{sub 3} as well, which indicates a lower bonding strength between Fe-O and a possible higher catalytic activity for La{sub 0.55}Sr{sub 0.35}FeO{sub 3}. The program continued to investigate the thermodynamic properties (stability and phase separation behavior) and total conductivity of prototype membrane materials. The data are needed together with the kinetic information to develop a complete model for the membrane transport. Previous report listed initial measurements on a sample of La{sub 0.2}Sr{sub 0.8}Fe{sub 0.55}Ti{sub 0.45}O{sub 3-x} prepared in-house by Praxair. Subsequently, a second sample of powder from a larger batch of sample were characterized and compared

  19. Extracorporeal Membrane Oxygenation in Diffuse Alveolar Hemorrhage Secondary to Systemic Lupus Erythematosus

    OpenAIRE

    Claudio, Christine Pacheco; Charbonney, Emmanuel; Durand, Madeleine; Kolan, Christophe; Laskine, Mikhael

    2014-01-01

    Diffuse alveolar hemorrhage (DAH) is a rare and potentially deadly complication of systemic lupus erythematosus (SLE). We report two adult cases where extracorporeal membrane oxygenation (ECMO) was used as rescue therapy for severe respiratory failure in this setting. We discuss the risk related to coagulation disturbance and the need for the circuit anticoagulation in this particular setting. We also briefly discuss the clinical problem of lack of knowledge on the bioavailability of the immu...

  20. Oxygen Transport Ceramic Membranes

    Energy Technology Data Exchange (ETDEWEB)

    S. Bandopadhyay; N. Nagabhushana

    2003-08-07

    In the present quarter, experiments are presented on ceramic/metal interactions of Zirconia/ Ni-B-Si system and with a thin Ti coating deposited on zirconia surface. Existing facilities were modified for evaluation of environmental assisted slow crack growth and creep in flexural mode. Processing of perovskites of LSC, LSF and LSCF composition were continued for evaluation of mechanical properties as a function of environment. These studies in parallel to those on the LSFCO composition is expect to yield important information on questions such as the role of cation segregation and the stability of the perovskite structure on crack initiation vs. crack growth. Studies have been continued on the La{sub 1-x}Sr{sub x}FeO{sub 3-d} composition using neutron diffraction and TGA studies. A transition from p-type to n-type of conductor was observed at relative low pO{sub 2}, at which the majority carriers changed from the holes to electrons because of the valence state decreases in Fe due to the further loss of oxygen. Investigation on the thermodynamic properties of the membrane materials are continued to develop a complete model for the membrane transport. Data obtained at 850 C show that the stoichiometry in La{sub 0.2}Sr{sub 0.8}Fe{sub 0.8}Cr{sub 0.2}O{sub 3-x} vary from {approx}2.85 to 2.6 over the pressure range studied. From the stoichiometry a lower limit of 2.6 corresponding to the reduction of all Fe{sup 4+} to Fe{sup 3+} and no reduction of Cr{sup 3+} is expected.

  1. Oxygen Transport Ceramic Membranes

    Energy Technology Data Exchange (ETDEWEB)

    S. Bandopadhyay; N. Nagabhushana; X.-D Zhou; Q. Cai; J. Yang; W.B. Yelon; W.J. James; H.U. Anderson; Alan Jacobson; C.A. Mims

    2004-10-01

    The present quarterly report describes some of the investigations on the structural properties of dense OTM bars provided by Praxair and studies on newer composition of Ti doped LSF. In this report, Moessbauer spectroscopy was used to study the local environmentals of LSFT with various level of oxygen deficiency. Ionic valence state, magnetic interaction and influence of Ti on superexchange are discussed Stable crack growth studies on Dense OTM bars provided by Praxair were done at elevated temperature, pressure and elevated conditions. Post-fracture X-ray data of the OTM fractured at 1000 C in environment were refined by FullProf code and results indicate a distortion of the parent cubic perovskite to orthorhombic structure with reduced symmetry. TGA-DTA studies on the post-fracture samples also indicated residual effect arising from the thermal and stress history of the samples. An electrochemical cell has been designed and built for measurements of the Seebeck coefficient as a function of temperature and pressure. The initial measurements on La{sub 0.2}Sr{sub 0.8}Fe{sub 0.55}Ti{sub 0.45}O{sub 3-{delta}} are reported. Neutron diffraction measurements of the same composition are in agreement with both the stoichiometry and the kinetic behavior observed in coulometric titration measurements. A series of isotope transients under air separation mode (small gradient) were completed on the membrane of LSCrF-2828 at 900 C. Low pO{sub 2} atmospheres based on with CO-CO{sub 2} mixtures have also been admitted to the delivery side of the LSCrF-2828 membrane to produce the gradients which exist under syngas generation conditions. The COCO{sub 2} mixtures have normal isotopic {sup 18}O abundances. The evolution of {sup 18}O on the delivery side in these experiments after an {sup 18}O pulse on the air side reveals a wealth of information about the oxygen transport processes.

  2. Fatal air embolism as complication of percutaneous dilatational tracheostomy on venovenous extracorporeal membrane oxygenation, two case reports.

    Science.gov (United States)

    Lother, Achim; Wengenmayer, Tobias; Benk, Christoph; Bode, Christoph; Staudacher, Dawid L

    2016-07-11

    Tracheostomy is recommended in case of prolonged mechanical ventilation. Therefore, most patients with an indication for venovenous extracorporeal membrane oxygenation (ECMO) will also have an indication for tracheostomy. We report 2 cases of fatal air embolism into the ECMO system as complication of percutaneous dilatational tracheostomy. Both patients had an AVALON ELITE® bi-caval cannula implanted draining blood from the vena cava superior and inferior. Since there is limited safety data on this specific group of patients, a routine early dilatational tracheostomy might be associated with a significant risk.

  3. Right ventricular rupture and tamponade caused by malposition of the Avalon cannula for venovenous extracorporeal membrane oxygenation

    Directory of Open Access Journals (Sweden)

    Hirose Hitoshi

    2012-04-01

    Full Text Available Abstract Placement of the Avalon Elite bicaval dual lumen cannula for venovenous extracorporeal membrane oxygenation (VV-ECMO via the internal jugular vein requires precise positioning of the cannula tip in the inferior vena cava with echocardiography or fluoroscopy guidance. Correct guidewire placement is clearly the key first step in assuring proper advancement of the cannula. We report a case of unexpected wire migration into the right ventricle at the time of final cannula advancement, resulting in right ventricular rupture and tamponade. Transesophageal echocardiography is an important monitoring modality for appropriate placement of the VV-ECMO guidewire and Avalon cannula, and in particular, for early identification of potential complications.

  4. Vancomycin Dosing in Pediatric Extracorporeal Membrane Oxygenation: Potential Impacts of New Technologies.

    Science.gov (United States)

    Lonabaugh, Kevin P; Lunsford, Kelly J; Fang, Gary Y; Kaufman, David A; Addison, Samuel D; Buck, Marcia L

    2017-01-01

    The objective of the current study was to evaluate the doses of vancomycin used to obtain therapeutic drug concentrations in pediatric patients on extracorporeal membrane oxygenation (ECMO), using new ECMO technologies. This was a single-center, retrospective study of patients treated with vancomycin while receiving ECMO using low-volume circuit technology. A total of 28 patients were included in the analysis of the primary endpoint. Patients had a median age of 6 weeks (0-11 years) and a median weight of 3.45 kg (2.44-37.2 kg). Ultrafiltration was used in 89.3% of patients at initiation of ECMO regardless of baseline renal function, resulting in a median urine output of 2 mL/kg/hr at the time of the final vancomycin dose. Most patients started vancomycin at the same time as ECMO. The median total daily dose was 30 mg/kg/day. The median total daily dose in a subset of patients less than one year of age was 20 mg/kg/day. Nearly all patients had at least 1 therapeutic trough serum vancomycin concentration. A total of 16 patients completed their vancomycin course using an interval of every 12 hours or shorter. Half-life was calculated in a subset of 11 patients and the mean was found to be 12.3 ± 2.8 hours. An initial dosing interval of every 12 hours to provide a total daily dose of 30 mg/kg/day is a possible option in pediatric patients on ECMO provided that renal function is normal at baseline. Monitoring of serum vancomycin concentrations for adjustment of dosing is required throughout therapy and is still warranted.

  5. Pyruvate modifies metabolic flux and nutrient sensing during extracorporeal membrane oxygenation in an immature swine model

    Energy Technology Data Exchange (ETDEWEB)

    Ledee, Dolena R.; Kajimoto, Masaki; O' Kelly-Priddy, Colleen M.; Olson, Aaron; Isern, Nancy G.; Robillard Frayne, Isabelle; Des Rosiers, Christine; Portman, Michael A.

    2015-07-01

    Extracorporeal membrane oxygenation (ECMO) provides mechanical circulatory support for infants and children with postoperative cardiopulmonary failure. Nutritional support is mandatory during ECMO, although specific actions for substrates on the heart have not been delineated. Prior work shows that enhancing pyruvate oxidation promotes successful weaning from ECMO. Accordingly, we closely examined the role of prolonged systemic pyruvate supplementation in modifying metabolic parameters during the unique conditions of ventricular unloading provided by ECMO. Twelve male mixed breed Yorkshire piglets (age 30-49 days) received systemic infusion of either normal saline (Group C) or pyruvate (Group P) during ECMO for 8 hours. Over the final hour piglets received [2-13C] pyruvate, and [13C6]-L-leucine, as an indicator for oxidation and protein synthesis. A significant increase in lactate and pyruvate concentrations occurred, along with an increase in the absolute concentration of all measured CAC intermediates. Group P showed greater anaplerotic flux through pyruvate carboxylation although pyruvate oxidation relative to citrate synthase flux was similar to Group C. The groups demonstrated similar leucine fractional contributions to acetyl-CoA and fractional protein synthesis rates. Pyruvate also promoted an increase in the phosphorylation state of several nutrient sensitive enzymes, such as AMPK and ACC, and promoted O-GlcNAcylation through the hexosamine biosynthetic pathway (HBP). In conclusion, prolonged pyruvate supplementation during ECMO modified anaplerotic pyruvate flux and elicited changes in important nutrient and energy sensitive pathways, while preserving protein synthesis. Therefore, the observed results support the further study of nutritional supplementation and its downstream effects on cardiac adaptation during ventricular unloading.

  6. Left Ventricular Mechanical Support with the Impella during Extracorporeal Membrane Oxygenation

    Directory of Open Access Journals (Sweden)

    Kasra Moazzami

    2017-03-01

    Full Text Available Background: Venoarterial extracorporeal membrane oxygenation (ECMO provides systemic arterial support without directly unloading the left heart, which causes an elevated left ventricular (LV pressure. The aim of the present study was to investigate the adjunctive application of the Impella device for LV unloading in patients during ECMO.Methods: This retrospective cohort study included patients who received Impella support in addition to venoarterial ECMO between April 2012 and December 2015. ECMO cannulation was performed peripherally or centrally, while the Impella device was surgically inserted into the femoral artery or the right axillary artery. Results: Among 62 patients, 10 (16.1% received an Impella device during ECMO support. Following Impella support, right atrial pressure improved from a median of 18 (IQR, 14–24 mmHg to 13 (IQR, 10–15 mmHg and pulmonary wedge pressure improved from 30 (IQR, 26–35 mmHg to 16 (IQR, 12–19 mmHg in all the patients (p value < 0.001. Follow-up transthoracic echocardiograms (n = 6 showed a median decrease of 0.8 cm in LV end-diastolic volume (p value = 0.021. There were 5 (50% in-hospital deaths due to sustained brain injury (n = 3 and refractory cardiogenic shock (n = 2. The remaining 5 patients were discharged and successfully bridged to more permanent LV assist device (n = 2 or heart transplantation (n = 3.Conclusion: The findings of the present study indicate that the application of the Impella device during ECMO support is effective in LV unloading and confers optimal hemodynamic support.

  7. Beneficial Effect of Extracorporeal Membrane Oxygenation on Organ Perfusion During Management of the Unstable Brain-dead Donor: A Case Series.

    Science.gov (United States)

    Kang, J H; Choi, B H; Moon, K M; Park, Y M; Yang, K H; Ryu, J H; Chu, C W

    2016-09-01

    It is well known that the quality of organs retrieved from brain-dead donors (DBDs) is better than those retrieved from circulatory death donors. However, in situations of organ retrieval from marginal DBDs, who are unstable despite intensive care, transplantation outcomes are not good. Organ ischemia is the most important determining factor in decreased organ quality in circulatory death donors and in some DBDs. Extracorporeal membrane oxygenation (ECMO) for management of DBDs can be an emergency countermeasure. The purpose of this report is to relay our experience with four cases of ECMO for DBD management. In all four cases, the donors were unstable and showed clear signs of ischemia despite intensive care, including ventilator use and administration of inotropic agents. Two donors had acute respiratory distress syndrome, and two exhibited dysfunctional oxygen delivery. ECMO was used to improve organ perfusion. ECMO resulted in an increased partial pressure of arterial oxygen increased and decreased lactic acid levels. Vital signs were stabilized, especially in the donors who were bleeding. The organ was successfully retrieved from each donor. Two livers (one of them was split), eight kidneys, and one pancreas were retrieved from four DBDs. All other organs were transplanted successfully, and there were no cases of primary nonfunction or delayed graft function. The ECMO machine is the most powerful supportive device for management of unstable DBDs. The use of ECMO in unstable DBDs can be beneficial in expanding the donor pool as well as improving the quality of retrieved organs. Copyright © 2016. Published by Elsevier Inc.

  8. Adult venovenous extracorporeal membrane oxygenation for severe respiratory failure: Current status and future perspectives

    Directory of Open Access Journals (Sweden)

    Ayan Sen

    2016-01-01

    Full Text Available Extracorporeal membrane oxygenation (ECMO for severe acute respiratory failure was proposed more than 40 years ago. Despite the publication of the ARDSNet study and adoption of lung protective ventilation, the mortality for acute respiratory failure due to acute respiratory distress syndrome has continued to remain high. This technology has evolved over the past couple of decades and has been noted to be safe and successful, especially during the worldwide H1N1 influenza pandemic with good survival rates. The primary indications for ECMO in acute respiratory failure include severe refractory hypoxemic and hypercarbic respiratory failure in spite of maximum lung protective ventilatory support. Various triage criteria have been described and published. Contraindications exist when application of ECMO may be futile or technically impossible. Knowledge and appreciation of the circuit, cannulae, and the physiology of gas exchange with ECMO are necessary to ensure lung rest, efficiency of oxygenation, and ventilation as well as troubleshooting problems. Anticoagulation is a major concern with ECMO, and the evidence is evolving with respect to diagnostic testing and use of anticoagulants. Clinical management of the patient includes comprehensive critical care addressing sedation and neurologic issues, ensuring lung recruitment, diuresis, early enteral nutrition, treatment and surveillance of infections, and multisystem organ support. Newer technology that delinks oxygenation and ventilation by extracorporeal carbon dioxide removal may lead to ultra-lung protective ventilation, avoidance of endotracheal intubation in some situations, and ambulatory therapies as a bridge to lung transplantation. Risks, complications, and long-term outcomes and resources need to be considered and weighed in before widespread application. Ethical challenges are a reality and a multidisciplinary approach that should be adopted for every case in consideration.

  9. Ventilatory and ECMO treatment of H1N1-induced severe respiratory failure: results of an Italian referral ECMO center

    Directory of Open Access Journals (Sweden)

    Giovannini Valtere

    2011-01-01

    Full Text Available Abstract Background Since the first outbreak of a respiratory illness caused by H1N1 virus in Mexico, several reports have described the need of intensive care or extracorporeal membrane oxygenation (ECMO assistance in young and often healthy patients. Here we describe our experience in H1N1-induced ARDS using both ventilation strategy and ECMO assistance. Methods Following Italian Ministry of Health instructions, an Emergency Service was established at the Careggi Teaching Hospital (Florence, Italy for the novel pandemic influenza. From Sept 09 to Jan 10, all patients admitted to our Intensive Care Unit (ICU of the Emergency Department with ARDS due to H1N1 infection were studied. All ECMO treatments were veno-venous. H1N1 infection was confirmed by PCR assayed on pharyngeal swab, subglottic aspiration and bronchoalveolar lavage. Lung pathology was evaluated daily by lung ultrasound (LUS examination. Results A total of 12 patients were studied: 7 underwent ECMO treatment, and 5 responded to protective mechanical ventilation. Two patients had co-infection by Legionella Pneumophila. One woman was pregnant. In our series, PCR from bronchoalveolar lavage had a 100% sensitivity compared to 75% from pharyngeal swab samples. The routine use of LUS limited the number of chest X-ray examinations and decreased transportation to radiology for CT-scan, increasing patient safety and avoiding the transitory disconnection from ventilator. No major complications occurred during ECMO treatments. In three cases, bleeding from vascular access sites due to heparin infusion required blood transfusions. Overall mortality rate was 8.3%. Conclusions In our experience, early ECMO assistance resulted safe and feasible, considering the life threatening condition, in H1N1-induced ARDS. Lung ultrasound is an effective mean for daily assessment of ARDS patients.

  10. Oxygen Transport Ceramic Membranes

    Energy Technology Data Exchange (ETDEWEB)

    S. Bandopadhyay; N. Nagabhushana; X.-D Zhou; Q. Cai; J. Yang; W.B. Yelon; W.J. James; H.U. Anderson; Alan Jacobson; C.A. Mims

    2004-05-01

    the LSCrF-2828 membrane to produce the gradients which exist under syngas generation conditions. The CO-CO{sub 2} mixtures have normal isotopic {sup 18}O abundances. The evolution of {sup 18}O on the delivery side in these experiments after an {sup 18}O pulse on the air side reveals a wealth of information about the oxygen transport processes.

  11. Extra-corporeal membrane oxygenation in the management of 2009 influenza A (H1N1) refractory respiratory failure.

    LENUS (Irish Health Repository)

    Das, J P

    2011-03-01

    Rapidly progressive acute respiratory failure attributed to 2009 H1N1 influenza A infection has been reported worldwide-3. Refractory hypoxaemia despite conventional mechanical ventilation and lung protective strategies has resulted in the use a combination of rescue therapies, such as conservative fluid management, prone positioning, inhaled nitric oxide, high frequency oscillatory ventilation and extracorporeal membrane oxygenation (ECMO)4. ECMO allows for pulmonary or cardiopulmonary support as an adjunct to respiratory and cardiac failure, minimising ventilator-associated lung injury (VALI). This permits treatment of the underlying disease process, while concurrently allowing for recovery of the acute lung injury. This case documents a previously healthy twenty-two year old Asian male patient with confirmed pandemic (H 1N1) 2009 influenza A who was successfully managed with ECMO in the setting of severe refractory hypoxaemia and progressive hypercapnia.

  12. Extra-corporeal membrane oxygenation in the management of 2009 influenza A (H1N1) refractory respiratory failure.

    LENUS (Irish Health Repository)

    Das, J P

    2012-02-01

    Rapidly progressive acute respiratory failure attributed to 2009 H1N1 influenza A infection has been reported worldwide-3. Refractory hypoxaemia despite conventional mechanical ventilation and lung protective strategies has resulted in the use a combination of rescue therapies, such as conservative fluid management, prone positioning, inhaled nitric oxide, high frequency oscillatory ventilation and extracorporeal membrane oxygenation (ECMO)4. ECMO allows for pulmonary or cardiopulmonary support as an adjunct to respiratory and cardiac failure, minimising ventilator-associated lung injury (VALI). This permits treatment of the underlying disease process, while concurrently allowing for recovery of the acute lung injury. This case documents a previously healthy twenty-two year old Asian male patient with confirmed pandemic (H 1N1) 2009 influenza A who was successfully managed with ECMO in the setting of severe refractory hypoxaemia and progressive hypercapnia.

  13. Emerging indications for extracorporeal membrane oxygenation in adults with respiratory failure.

    Science.gov (United States)

    Abrams, Darryl; Brodie, Daniel

    2013-08-01

    Recent advances in technology have spurred the increasing use of extracorporeal membrane oxygenation (ECMO) in patients with severe hypoxemic respiratory failure. However, this accounts for only a small percentage of patients with respiratory failure. We envision the application of ECMO in many other forms of respiratory failure in the coming years. Patients with less severe forms of acute respiratory distress syndrome, for instance, may benefit from enhanced lung-protective ventilation with the very low tidal volumes made possible by direct carbon dioxide removal from the blood. For those in whom hypercapnia predominates, extracorporeal support will allow for the elimination of invasive mechanical ventilation in some cases. The potential benefits of ECMO may be further enhanced by improved techniques, which facilitate active mobilization. Although ECMO for these and other expanded applications is under active investigation, it has yet to be proven beneficial in these settings in rigorous controlled trials. Ultimately, with upcoming and future technological advances, there is the promise of true destination therapy, which could lead to a major paradigm shift in the management of respiratory failure.

  14. New generation extracorporeal membrane oxygenation with MedTech Mag-Lev, a single-use, magnetically levitated, centrifugal blood pump: preclinical evaluation in calves.

    Science.gov (United States)

    Fujiwara, Tatsuki; Nagaoka, Eiki; Watanabe, Taiju; Miyagi, Naoto; Kitao, Takashi; Sakota, Daisuke; Mamiya, Taichi; Shinshi, Tadahiko; Arai, Hirokuni; Takatani, Setsuo

    2013-05-01

    We have evaluated the feasibility of a newly developed single-use, magnetically levitated centrifugal blood pump, MedTech Mag-Lev, in a 3-week extracorporeal membrane oxygenation (ECMO) study in calves against a Medtronic Bio-Pump BPX-80. A heparin- and silicone-coated polypropylene membrane oxygenator MERA NHP Excelung NSH-R was employed as an oxygenator. Six healthy male Holstein calves with body weights of about 100 kg were divided into two groups, four in the MedTech group and two in the Bio-Pump group. Under general anesthesia, the blood pump and oxygenator were inserted extracorporeally between the main pulmonary artery and the descending aorta via a fifth left thoracotomy. Postoperatively, both the pump and oxygen flow rates were controlled at 3 L/min. Heparin was continuously infused to maintain the activated clotting time at 200-240 s. All the MedTech ECMO calves completed the study duration. However, the Bio-Pump ECMO calves were terminated on postoperative days 7 and 10 because of severe hemolysis and thrombus formation. At the start of the MedTech ECMO, the pressure drop across the oxygenator was about 25 mm Hg with the pump operated at 2800 rpm and delivering 3 L/min flow. The PO2 of the oxygenator outlet was higher than 400 mm Hg with the PCO2 below 45 mm Hg. Hemolysis and thrombus were not seen in the MedTech ECMO circuits (plasma-free hemoglobin [PFH] 20 mg/dL) and large thrombus were observed in the Bio-Pump ECMO circuits. Plasma leakage from the oxygenator did not occur in any ECMO circuits. Three-week cardiopulmonary support was performed successfully with the MedTech ECMO without circuit exchanges. The MedTech Mag-Lev could help extend the durability of ECMO circuits by the improved biocompatible performances. © 2013, Copyright the Authors. Artificial Organs © 2013, International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

  15. OXYGEN TRANSPORT CERAMIC MEMBRANES

    Energy Technology Data Exchange (ETDEWEB)

    Dr. Sukumar Bandopadhyay; Dr. Nagendra Nagabhushana

    2001-02-01

    This is the fifth quarterly report on a new study to develop a ceramic membrane/metal joint. Results of wetting experiments on commercially available Nickel based brazing alloys on perovskite surfaces are described. Additionally, experimental and numerical investigations on the strength of concentric ceramic/metal joints are presented.

  16. Correlation of brain tissue oxygen tension with cerebral near-infrared spectroscopy and mixed venous oxygen saturation during extracorporeal membrane oxygenation.

    Science.gov (United States)

    Tyree, Kreangkai; Tyree, Melissa; DiGeronimo, Robert

    2009-09-01

    The aim of this prospective, animal study was to compare brain tissue oxygen tension (PbtO(2)) with cerebral near infrared spectroscopy (NIRS) and mixed venous oxygen saturation (SVO(2)) during venoarterial extracorporeal membrane oxygenation (VA ECMO) in a porcine model. This was accomplished using twelve immature piglets with surgically implanted catheters placed in the superficial cerebral cortex to measure brain PbtO(2) and microdialysis metabolites. The NIRS sensor was placed overlying the forehead to measure cerebral regional saturation index (rSO(2)i) while SVO(2) was measured directly from the ECMO circuit. Animals were placed on VA ECMO followed by an initial period of stabilization, after which they were subjected to graded hypoxia and recovery. Our results revealed that rSO(2)i and SVO(2) correlated only marginally with PbtO(2) (R(2)=0.32 and R(2)=0.26, respectively) while the correlation between rSO(2)i and SVO( 2) was significantly stronger (R(2)=0.59). Cerebral metabolites and rSO(2)i were significantly altered during attenuation of PbtO( 2), p<0.05). A subset of animals, following exposure to hypoxia, experienced markedly delayed recovery of both rSO(2)i and PbtO( 2) despite rapid normalization of SVO(2). Upon further analysis, these animals had significantly lower blood pressure (p=0.001), lower serum pH (p=0.01), and higher serum lactate (p=0.02). Additionally, in this subgroup, rSO(2)i correlated better with PbtO(2) (R(2)=0.76). These findings suggest that, in our ECMO model, rSO(2)i and SVO( 2) correlate reasonably well with each other, but not necessarily with brain PbtO(2) and that NIRS-derived rSO(2)i may more accurately reflect cerebral tissue hypoxia in sicker animals.

  17. OXYGEN TRANSPORT CERAMIC MEMBRANES

    Energy Technology Data Exchange (ETDEWEB)

    Dr. Sukumar Bandopadhyay; Dr. Nagendra Nagabhushana

    2003-01-01

    In the present quarter, experiments are presented on ceramic/metal interactions of Zirconia/Ni-B-Si system and with a thin Ti coating deposited on zirconia surface. Processing of perovskites of LSC, LSF and LSCF composition for evaluation of mechanical properties as a function of environment are begun. The studies are to be in parallel with LSFCO composition to characterize the segregation of cations and slow crack growth in environmental conditions. La{sub 1-x}Sr{sub x}FeO{sub 3-d} has also been characterized for paramagnetic ordering at room temperature and the evolution of magnetic moments as a function of temperature are investigated. Investigation on the thermodynamic properties of the membrane materials are continued to develop a complete model for the membrane transport.

  18. OXYGEN TRANSPORT CERAMIC MEMBRANES

    Energy Technology Data Exchange (ETDEWEB)

    Dr. Sukumar Bandopadhyay; Dr. Nagendra Nagabhushana

    2000-07-01

    This is the fourth quarterly report on a new study to develop a ceramic membrane/metal joint. The first experiments using the La-Sr-Fe-O ceramic are reported. Some of the analysis performed on the samples obtained are commented upon. A set of experiments to characterize the mechanical strength and thermal fatigue properties of the joints has been designed and begun. Finite element models of joints used to model residual stresses are described.

  19. Factors Associated with Bleeding and Thrombosis in Children Receiving Extracorporeal Membrane Oxygenation.

    Science.gov (United States)

    Dalton, Heidi J; Reeder, Ron; Garcia-Filion, Pamela; Holubkov, Richard; Berg, Robert A; Zuppa, Athena; Moler, Frank W; Shanley, Thomas; Pollack, Murray M; Newth, Christopher; Berger, John; Wessel, David; Carcillo, Joseph; Bell, Michael; Heidemann, Sabrina; Meert, Kathleen L; Harrison, Richard; Doctor, Allan; Tamburro, Robert F; Dean, J Michael; Jenkins, Tammara; Nicholson, Carol

    2017-09-15

    Extracorporeal membrane oxygenation (ECMO) is used for respiratory and cardiac failure in children but is complicated by bleeding and thrombosis. (1) To measure the incidence of bleeding (blood loss requiring transfusion or intracranial hemorrhage) and thrombosis during ECMO support; (2) to identify factors associated with these complications; and (3) to determine the impact of these complications on patient outcome. This was a prospective, observational cohort study in pediatric, cardiac, and neonatal intensive care units in eight hospitals, carried out from December 2012 to September 2014. ECMO was used on 514 consecutive patients under age 19 years. Demographics, anticoagulation practices, severity of illness, circuitry components, bleeding, thrombotic events, and outcome were recorded. Survival was 54.9%. Bleeding occurred in 70.2%, including intracranial hemorrhage in 16%, and was independently associated with higher daily risk of mortality. Circuit component changes were required in 31.1%, and patient-related clots occurred in 12.8%. Laboratory sampling contributed to transfusion requirement in 56.6%, and was the sole reason for at least one transfusion in 42.2% of patients. Pump type was not associated with bleeding, thrombosis, hemolysis, or mortality. Hemolysis was predictive of subsequent thrombotic events. Neither hemolysis nor thrombotic events increased the risk of mortality. The incidences of bleeding and thrombosis are high during ECMO support. Laboratory sampling is a major contributor to transfusion during ECMO. Strategies to reduce the daily risk of bleeding and thrombosis, and different thresholds for transfusion, may be appropriate subjects of future trials to improve outcomes of children requiring this supportive therapy.

  20. [Follow-up of survived children supported by extracorporeal membrane oxygenation].

    Science.gov (United States)

    Cheng, Y; Lu, Z J; Yan, X G; He, J; Yan, G F; Cai, X D; Shen, W J; Jin, A L; Lu, G P

    2016-11-02

    Objective: To summarize the follow-up of children treated with venoarterial extracorporeal membrane oxygenation (ECMO) by incision of internal carotid artery-vein. Method: This was a retrospective study, 10 children in whom the conventional therapy failed, but survived after treatment with ECMO technique through right internal jugular artery-venous incision and ligation after ECMO in pediatric intensive care unit (PICU) of Fudan University were followed up from December 2011 to December 2015. Primary disease situation, neurological development, growth and development, quality of life and personality development were included. All children were followed up once every six months after discharge, and once a year after 2 years. The longest follow-up period was 2 years. Result: Of the 10 children 6 were boys and 4 girls, and ranged in age of onset from 1 day to 12 years . Five children had neurological problems, including abnormal brain CT ( n =3), abnormal electroence phalogram (EEG) ( n =3), and mental retardation ( n =2). Three of those children had a history of hypoxia, 2 of whom accepted cardiopulmonary resuscitation. Eight children had normal brainstem evoked potential (BEAP) examinations. Primary diseases were all well controlled except for 6 children who had different degrees of sequelae, including mild arrhythmia ( n =1), heart structure abnormality ( n =2) and abnormal pulmonary function ( n =3). The sequelae caused by the primary diseases were just embodied in examination. Their head circumference measurement and physical examination showed no obvious abnormalities, and blood biochemical tests, hemoglobin and blood gas analysis were also normal. One child's height was less than P 3 . The one who accepted cardiopulmonary resuscitation (CPR) at early stage of primary disease had trouble in daily life, presenting uncoordinated and unstable walking. One child was slightly bad tempered and asocial, and the rest were normal. Conclusion: The rest could take care of

  1. Predictors of intracranial hemorrhage in adult patients on extracorporeal membrane oxygenation

    DEFF Research Database (Denmark)

    Fletcher Sandersjöö, Alexander; Bartek, Jiri; Thelin, Eric Peter

    2017-01-01

    BACKGROUND: Intracranial hemorrhage (ICH) is a recognized complication of adults treated with extracorporeal membrane oxygenation (ECMO) and is associated with increased morbidity and mortality. However, the predictors of ICH in this patient category are poorly understood. The purpose of this study...... were treated with ECMO for less than 12 h. In a comparative analysis, the primary end-points were the difference in baseline characteristics and predictors of hemorrhage occurrence (ICH vs. non-ICH cohorts). The secondary end-point was difference in mortality between groups. Paired testing and uni...... ICH. When comparing ICH vs. non-ICH cohorts, pre-admission antithrombotic therapy (p = 0.018), high pre-cannulation Sepsis-related Organ Failure Assessment (SOFA) coagulation score (p = 0.015), low platelet count (p hemorrhage (p = 0.045) were predictors of ICH...

  2. H3N2 Virus as Causative Agent of ARDS Requiring Extracorporeal Membrane Oxygenation Support

    Directory of Open Access Journals (Sweden)

    Adriano Peris

    2014-01-01

    Full Text Available Pandemic influenza virus A(H1N1 2009 was associated with a higher risk of viral pneumonia in comparison with seasonal influenza viruses. The influenza season 2011-2012 was characterized by the prevalent circulation of influenza A(H3N2 viruses. Whereas most H3N2 patients experienced mild, self-limited influenza-like illness, some patients were at increased risk for influenza complications because of age or underlying medical conditions. Cases presented were patients admitted to the Intensive Care Unit (ICU of ECMO referral center (Careggi Teaching Hospital, Florence, Italy. Despite extracorporeal membrane oxygenation treatment (ECMO, one patient with H3N2-induced ARDS did not survive. Our experience suggests that viral aetiology is becoming more important and hospitals should be able to perform a fast differential diagnosis between bacterial and viral aetiology.

  3. The peak of blood lactate during the first 24h predicts mortality in acute coronary syndrome patients under extracorporeal membrane oxygenation.

    Science.gov (United States)

    Rigamonti, Fabio; Montecucco, Fabrizio; Boroli, Filippo; Rey, Florian; Gencer, Baris; Cikirikcioglu, Mustafa; Reverdin, Stéphane; Carbone, Federico; Noble, Stephane; Roffi, Marco; Banfi, Carlo; Giraud, Raphael

    2016-10-15

    Parameters allowing for outcome discrimination of extracorporeal membrane oxygenation (ECMO) therapy in acute coronary syndromes (ACS) complicated by refractory cardiogenic shock (CS) and/or cardio-respiratory arrest (CA) remain elusive. We aimed at evaluating the potential prognostic roles of blood and procedural parameters associated with 30-day mortality following ECMO. A group of 29 patients with ACS complicated by CS and/or CA, who underwent ECMO at a single center, was retrospectively analyzed. Eighteen patients (62%) died at 30-day follow up. "Survivors" and "non-survivors" had similar demographics, clinical and biochemical characteristics at admission, except for blood lactate peak in the first 24h that was increased in non-survivors. Procedural characteristics of percutaneous coronary intervention (PCI) and ECMO were comparable in either group. The peak of blood lactate concentration predicted 30-day mortality independently of age, sex and ECMO duration. The cutoff value, determined by receiver operating characteristic (ROC) curve analysis, was found at 11mmol/l. The peak of serum lactate under ECMO in the first 24h predicted 30-day mortality in patients with ACS complicated with CS and CA. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  4. Oxygen Transport Ceramic Membranes

    Energy Technology Data Exchange (ETDEWEB)

    S. Bandopadhyay; T. Nithyanantham

    2006-06-30

    A non-agglomerated and nanocrystalline-sized powder was successfully produced using ethylene glycol nitrate methods. The LSFT powder prepared using this method exhibits well dispersed and nano-sized particles about 100-200 nm. The density of LSFT sintered at 1300 C was about 90% of the theoretical density at which is 100 C less than that of the previous LSFT which was sintered at 1400 C. The sample sintered at 1400 C exhibited the evidence of a liquid phase at the grain boundaries and 2nd phase formation which probably caused low mechanical stability. The electrical conductivity and Seebeck coefficient were measured as a function of temperature. The LSFT-CGO specimens were cut from the as sintered bars and used for the evaluation of Mechanical Properties after polishing. The effect of strain rate on the flexural strength of the LSFT-CGO test specimens was studied. Three strain rates 6, 60 and 600 {micro}m/ min were chosen for this study. It is observed from the results that with increasing cross head speed the membrane takes higher loads to fail. A reduction in the strength of the membrane was observed at 1000 C in N{sub 2}. Two different routes were investigated to synthesis GDC using either formate or carbonate precursors. The precursor and CGO particle morphologies were examined by scanning electron microscopy. The thermal decomposition behaviors of Ce(Gd)(HCOO){sub 3} and Ce(Gd)(CO{sub 3})(OH) were determined by thermogravimetric analysis (TGA) at a rate of 3 C/min in air. The X-ray powder diffraction patterns of the precursor and CGO were collected and nitrogen adsorption isotherms were measured. Conductivity measurements were made by AC impedance spectroscopy on sintered disks in air using platinum electrodes.

  5. Ventilator-associated pneumonia in patients assisted by veno-arterial extracorporeal membrane oxygenation support: Epidemiology and risk factors of treatment failure.

    Science.gov (United States)

    Bouglé, Adrien; Bombled, Camille; Margetis, Dimitri; Lebreton, Guillaume; Vidal, Charles; Coroir, Marine; Hajage, David; Amour, Julien

    2018-01-01

    Ventilator-associated pneumonia (VAP) is frequent in Intensive Care Unit (ICU) patients. In the specific case of patients treated with Veno-Arterial Extracorporeal Membrane Oxygenation Support (VA-ECMO), VAP treatment failures (VAP-TF) have been incompletely investigated. To investigate the risk factors of treatment failure (VAP-TF) in a large cohort of ICU patients treated with VA-ECMO, we conducted a retrospective study in a Surgical ICU about patients assisted with VA-ECMO between January 1, 2013, and December 31, 2014. Diagnosis of VAP was confirmed by a positive quantitative culture of a respiratory sample. VAP-TF was defined as composite of death attributable to pneumonia and relapse within 28 days of the first episode. In total, 152 patients underwent ECMO support for > 48h. During the VA-ECMO support, 85 (55.9%) patients developed a VAP, for a rate of 60.6 per 1000 ECMO days. The main pathogens identified were Pseudomonas aeruginosa and Enterobacteriaceae. VAP-TF occurred in 37.2% of patients and was associated with an increased 28-day mortality (Hazard Ratio 3.05 [1.66; 5.63], P<0.001), and VA-ECMO assistance duration (HR 1.47 [1.05-2.05], P = 0.025). Risk factors for VAP-TF were renal replacement therapy (HR 13.05 [1.73; 98.56], P = 0.013) and documentation of Pseudomonas aeruginosa (HR 2.36 [1.04; 5.35], P = 0.04). VAP in patients treated with VA-ECMO is associated with an increased morbidity and mortality. RRT and infection by Pseudomonas aeruginosa appear as strong risks factors of treatment failure. Further studies seem necessary to precise the best antibiotic management in these patients.

  6. THE SUCCESSFUL TREATMENT OF A PERIPHERAL VENO-VENOUS EXTRACORPOREAL MEMBRANE OXYGENATION FOR SEVERE ACUTE RESPIRATORY FAILURE IN THE EARLY PERIOD AFTER ADULT LIVER TRANSPLANTATION

    Directory of Open Access Journals (Sweden)

    V. N. Poptsov

    2014-01-01

    Full Text Available Aim: of our clinical study was to present own experience of veno-venous extracorporeal membrane oxygenation (VV ECMO for the treatment of an adult patient (female, 28 yrs, 150 cm, 35 kg with acute respiratory distress syndrome (ARDS in the early period after liver transplantation against satisfactory liver graft function. Materials and methods. Double-lumen cannula 22 F was placed percutaneously in the right internal jugular vein. The ext- racorporeal contour reduced in length and the polymethylpeptene oxygenator (priming volume 175 ml were also. Results. In 1 hour after the beginning of VV ECMO, we registered the noted improvement of arterial blood gas and acid-base balance (regress of respiratory acidosis, improvement of arterial oxygenation which allowed us to use the «protective» mode of mechanical ventilation. Improvement of gas exchange and regress of clinical and radiological manifestations of ARDS allowed for VV ECMO weaning and decannulation on day 7. The patient was discharged from ICU and then from our Centre to a homestay respectively on the 9th and 16th day after VV ECMO weaning with the satisfactory liver graft and lungs function. Conclusion. VV ECMO can be successfully applied to correct the life-threatening acute respiratory failure in the early period after liver transplantation. 

  7. When CRRT on ECMO Is Not Enough for Potassium Clearance: A Case Report

    Directory of Open Access Journals (Sweden)

    Janice A. Tijssen

    2017-08-01

    Full Text Available Background: Continuous renal replacement therapy (CRRT is an excellent method used to remove fluid and solutes. It may also reduce the systemic inflammatory response for patients on extracorporeal membrane oxygenation (ECMO support. The objective of this report is to describe a case where CRRT in combination with ECMO was insufficient to control hyperkalemia. Methods: We report the case of an adolescent patient with refractory symptomatic hyperkalemia due to substantial rhabdomyolysis in which CRRT insufficiently cleared the patient’s excess potassium. Results: Intermittent hemodialysis (IHD was added and proved successful. The patient was weaned off ECMO, CRRT, and IHD, and his cardiac and renal function eventually normalized. Conclusions: Two important lessons can be learned from this case report: (1 If CRRT is insufficient in achieving a desirable potassium balance, additional IHD should be considered and (2 separate IHD access should be considered to improve efficacy.

  8. ECMO as an effective rescue therapeutic for fulminant myocarditis complicated with refractory cardiac arrest.

    Science.gov (United States)

    Li, Ya-Ting; Yang, Li-Fen; Chen, Zhuang-Gui; Pan, Li; Duan, Meng-Qi; Hu, Yan; Zhou, Cheng-Bin; Guo, Yu-Xiong

    2017-01-01

    Fulminant myocarditis (FM) is a life-threatening disease in children. With a rapid, progressive course of deterioration, it causes refractory cardiorespiratory failure even with optimal clinical intervention. We present the case of a 9-year-old girl with FM complicated by cardiogenic shock, malignant arrhythmia, and refractory cardiac arrest. She received effective cardiopulmonary resuscitation, therapeutic hypothermia, and other supportive treatments. However, the patient rapidly worsened into pulseless ventricular tachycardia and refractory cardiac arrest. Therefore, we performed extracorporeal membrane oxygenation (ECMO) to establish spontaneous circulation after the failure of standard resuscitation measures. The girl recovered with intact cardiac and neurocognitive functions after continued ECMO treatment for 221 hours. Therefore, ECMO is an effective rescue therapeutics for FM, especially when complicated with refractory cardiac arrest.

  9. Ethical dilemma: offering short-term extracorporeal membrane oxygenation support for terminally ill children who are not candidates for long-term mechanical circulatory support or heart transplantation.

    Science.gov (United States)

    Shankar, Venkat; Costello, John P; Peer, Syed M; Klugman, Darren; Nath, Dilip S

    2014-04-01

    The use of extracorporeal membrane oxygenation (ECMO) in terminally ill pediatric patients who are not candidates for long-term mechanical circulatory support or heart transplantation requires careful deliberation. We present the case of a 16-year-old female with a relapse of acute lymphoid leukemia and acute-on-chronic cardiomyopathy who received short-term ECMO therapy. In addition, we highlight several ethical considerations that were crucial to this patient's family-centered care and demonstrate that this therapy can be accomplished in a manner that respects patient autonomy and family wishes.

  10. Use of veno-arterial extracorporeal membrane oxygenation in a case of tracheal injury repair in a patient with severe relapsing polychondritis.

    Science.gov (United States)

    Laliberte, Anne-Sophie; McDonald, Christine; Waddell, Tom; Yasufuku, Kazuhiro

    2017-11-01

    Tracheobronchial malacia occurs in 50% of patients with relapsing polychondritis (RP), and is often managed with stent insertion. While severe complications have been described after silicone tracheal stent insertion, there are few reports describing tracheal injury in patients with RP. We present a case of tracheal perforation secondary to Dumon ® stent manipulation in a patient with RP. The tracheal injury was successfully repaired with a silicone Y-stent inserted via right thoracotomy using veno-arterial extracorporeal membrane oxygenation (VA-ECMO) for ventilatory support. It is safe and feasible to introduce a silicone Y-stent through a thoracotomy for a tracheal trauma in combination with VA-ECMO support.

  11. [Predictive values of different critical scoring systems for mortality in patients with severe acute respiratory failure supported by extracorporeal membrane oxygenation].

    Science.gov (United States)

    Wang, R; Sun, B; Li, X Y; He, H Y; Tang, X; Zhan, Q Y; Tong, Z H

    2016-09-01

    To investigate the predictive values of different critical scoring systems for mortality in patients with severe acute respiratory failure (ARF) supported by venovenous extracorporeal membrane oxygenation (VV-ECMO). Forty-two patients with severe ARF supported by VV-ECMO were enrolled from November 2009 to July 2015.There were 25 males and 17 females. The mean age was (44±18) years (rang 18-69 years). Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ, Ⅲ, Ⅳ, Simplified Acute Physiology Score Ⅱ (SAPS) Ⅱ, Sequential Organ Failure Assessment (SOFA), ECMO net, PRedicting dEath for SEvere ARDS on VVECMO (PRESERVE), and Respiratory ECMO Survival Prediction (RESP) scores were collected within 6 hours before VV-ECMO support. The patients were divided into the survivors group (n=17) and the nonsurvivors group (n=25) by survival at 180 d after receiving VV-ECMO. The patient clinical characteristics and aforementioned scoring systems were compared between groups. Scoring systems for predicting prognosis were assessed using the area under the receiver-operating characteristic (ROC) curve. The Kaplan-Meier method was used to draw the surviving curve, and the survival of the patients was analyzed by the Log-rank test. The risk factors were assessed for prognosis by multiple logistic regression analysis. (1) Positive end expiratory pressure (PEEP) 6 hours prior to VV-ECMO support in the survivors group [(9.7±5.0)cmH2O, (1 cmH2O=0.098 kPa)] was lower than that in the nonsurvivors group [(13.2±5.4)cmH2O, t=-2.134, P=0.039]. VV-ECMO combination with continuous renal replacement therapy(CRRT) in the nonsurvivors group (32%) was used more than in the survivors group (6%, χ(2)=4.100, P=0.043). Duration of VV-ECMO support in the nonsurvivors group [(15±13) d] was longer than that in the survivors group [(12±11)d, t=-2.123, P=0.041]. APACHE Ⅱ, APACHE Ⅲ, APACHE Ⅳ, ECMO net, PRESERVE, and RESP scores in the survivors group were superior to the nonsurvivors

  12. Risk Factors for Acute Kidney Injury and In-Hospital Mortality in Patients Receiving Extracorporeal Membrane Oxygenation.

    Directory of Open Access Journals (Sweden)

    Sung Woo Lee

    Full Text Available Although acute kidney injury (AKI is the most frequent complication in patients receiving extracorporeal membrane oxygenation (ECMO, few studies have been conducted on the risk factors of AKI. We performed this study to identify the risk factors of AKI associated with in-hospital mortality.Data from 322 adult patients receiving ECMO were analyzed. AKI and its stages were defined according to Kidney Disease Improving Global Outcomes (KDIGO classifications. Variables within 24 h before ECMO insertion were collected and analyzed for the associations with AKI and in-hospital mortality.Stage 3 AKI was associated with in-hospital mortality, with a hazard ratio (HR (95% CI of 2.690 (1.472-4.915 compared to non-AKI (p = 0.001. The simplified acute physiology score 2 (SAPS2 and serum sodium level were also associated with in-hospital mortality, with HRs of 1.02 (1.004-1.035 per 1 score increase (p = 0.01 and 1.042 (1.014-1.070 per 1 mmol/L increase (p = 0.003. The initial pump speed of ECMO was significantly related to in-hospital mortality with a HR of 1.333 (1.020-1.742 per 1,000 rpm increase (p = 0.04. The pump speed was also associated with AKI (p = 0.02 and stage 3 AKI (p = 0.03 with ORs (95% CI of 2.018 (1.129-3.609 and 1.576 (1.058-2.348, respectively. We also found that the red cell distribution width (RDW above 14.1% was significantly related to stage 3 AKI.The initial pump speed of ECMO was a significant risk factor of in-hospital mortality and AKI in patients receiving ECMO. The RDW was a risk factor of stage 3 AKI.

  13. Low flow veno-venous ECMO: an experimental study.

    Science.gov (United States)

    Calderón, M; Verdín, R; Galván, J; Gonzalez, M; Cárdenas, H; Campos, R; Vidrio, H; Amezcua, J

    1994-01-01

    Clinical use of extracorporeal membrane oxygenation (ECMO) and carbon dioxide removal (ECCO 2R) have become well established techniques for the treatment of severe respiratory failure; however they require full cardiopulmonary bypass, representing major procedures with high morbidity. We theorized the possibility of an efficient low flow veno-venous extracorporeal membrane gas exchange method. Four mongrel 12 kg dogs were submitted to veno-venous extracorporeal membrane gas exchange via a jugular dialysis catheter using a low flow (10 ml/min) roller pump and a membrane oxygenator for a period of four hours. Respiratory rate was set at 4 breaths/min with a FiO 2 of 21% and ventilatory dead space was increased. Adequate gas exchange was obtained (pO 2139, pCO 224, Sat 99.4%), without major hemodynamic changes or hematuria. Our results demonstrate the feasibility of a low flow, less aggressive system. Further research should be considered.

  14. Perspective of clinical application of pumpless extracorporeal lung assist (ECMO in newborn

    Directory of Open Access Journals (Sweden)

    Gandolfi José Francisco

    2003-01-01

    Full Text Available Extracorporeal lung assist (ECLA has been proposed as an invasive alternative to conventional treatment when oxygenation is not possible by rigorous mechanical ventilation alone. Usually, ECLA is carried out by establishing a venovenous or venoarterial shunt consisting of a roller or centrifugal pump, a membrane oxygenator, and a heat exchanger. However, the extracorporeal membrane oxygenation (ECMO with circulatory support lead hemolysis, coagulation disorders, inflammatory response, and specific technical complications inherent to a procedure of high risk and cost. To reduce the drawbacks of mechanical blood trauma during prolonged ECLA, the patient´s arteriovenous pressure gradient as the driving force for the blood flow through for the extracorporeal circuit can be used. In this article are analysed the main contributions of pumpless ECMO, used experimentally and in children and adults with respiratory failure, with perspective of clinical application in newborn.

  15. Angioinvasive Aspergillus-associated Stroke in an Immunocompetent Host Following Cardiac Surgery and ECMO.

    Science.gov (United States)

    Kavi, Tapan; Madan, Nikhil; Majic, Tamara; Rosengart, Axel; Maya, Marcel; Bannykh, Serguei; Lahiri, Shouri

    2017-05-01

    Invasive cerebral aspergillosis is an uncommon cause of stroke among immunocompetent patients and has not been reported in association with cardiac surgery or extracorporeal membrane oxygenation (ECMO). We report the case of an immunocompetent host who developed aspergillus-associated stroke following coronary artery bypass graft (CABG) and ECMO. A 59-year-old woman developed cardiogenic shock after 3-vessel-CABG requiring intra-aortic balloon pump placement and subsequent veno-arterial ECMO. Noncontrast computed tomography of the brain was suggestive of multiple bihemispheric ischemic infarcts. Postmortem pathologic analysis revealed aspergillus-associated inflammation of blood vessels and ischemic and petechial hemorrhagic strokes in the affected territories. Ischemic infarcts in the setting of CABG or ECMO are often presumed to be thromboembolic from the heart or device, related to underlying hemodynamic instability, or due to a clinically apparent systemic infection such as endocarditis. This report suggests that invasive cerebral aspergillosis should be considered in seemingly immunocompetent patients following CABG or ECMO. The mechanism is unclear, but may be related to systemic inflammatory dysregulation resulting in increased susceptibility to uncommon pathogens.

  16. [Influenza A H1N1v treated with extra-corporal membrane oxygenation.

    DEFF Research Database (Denmark)

    Jensen, Reinhold; Severinsen, Inge Krogh; Terp, Kim

    2010-01-01

    A 37-year-old woman with body mass index > 30 was admitted to hospital with severe pneumonia due to H1N1v. Thoracic X-ray showed bilateral, diffuse infiltrates. There was no sign of complicating bacterial infection and all microbiological tests of tracheal secretion, blood and urine were negative....... Polymerase chain reaction test for H1N1v was positive until day ten. No mutations were found in the virus. The patient was given oseltamivir tablets and inhalable zanamivir as well as antibiotics. The patient was treated with extra-corporal membrane oxygenation (EcmO) for 12 days followed by ventilator...

  17. Extracorporeal membrane oxygenation cannulation trends for pediatric respiratory failure and central nervous system injury.

    Science.gov (United States)

    Rollins, Michael D; Hubbard, Ania; Zabrocki, Luke; Barnhart, Douglas C; Bratton, Susan L

    2012-01-01

    Guidelines regarding arterial cannula site and cannula site-specific risks of central nervous system (CNS) injury for pediatric patients requiring extracorporeal membrane oxygenation (ECMO) support are lacking. We reviewed cannulation trends for pediatric respiratory failure and evaluated CNS complication rates by cannulation site and mode of support. The Extracorporeal Life Support Organization (ELSO) registry was queried for all pediatric respiratory failure patients 5 years of age and >20 kg. Venovenous (VV) ECMO was used in >50% of children >10 years. No significant difference was identified in CNS injury between carotid and femoral cannulation in any age group but the femoral group was small (4.4%). VA support was independently associated with increased odds of CNS injury compared to VV cannulation (OR, 1.6). VA ECMO is the most common mode of support in pediatric respiratory failure patients. Although no significant difference in CNS injury was noted between carotid and femoral artery cannulation, the odds of injury were significantly higher than VV support. Copyright © 2012 Elsevier Inc. All rights reserved.

  18. Outcome of patients supported by extracorporeal membrane oxygenation for aluminum phosphide poisoning: An observational study.

    Science.gov (United States)

    Mohan, Bishav; Singh, Bhupinder; Gupta, Vivek; Ralhan, Sarju; Gupta, Dinesh; Puri, Sandeep; Goyal, Abhishek; Aslam, Naved; Tandon, Rohit; Wander, Gurpreet Singh

    2016-01-01

    Aluminum phosphide (AlP) poisoning has a high mortality rate despite intensive care management, primarily because it causes severe myocardial depression and severe acute respiratory distress syndrome. The purpose of this study was to evaluate the impact of the novel use of extracorporeal membrane oxygenation (ECMO), a modified "heart-lung" machine, in a specific subset of AlP poisoning patients who had profound myocardial dysfunction along with either severe metabolic acidosis and/or refractory cardiogenic shock. Between January 2011 and September 2014, 83 patients with AlP poisoning were enrolled in this study; 45 patients were classified as high risk. The outcome of the patients who received ECMO (n=15) was compared with that of patients who received conventional treatment (n=30). In the high-risk group (n=45), the mortality rate was significantly (ppoisoning having severe LV myocardial dysfunction. A low baseline LVEF and longer delay in hospital presentation were found to be predictors of mortality even after ECMO usage. Large, adequately controlled and standardized trials with long-term follow-up must be performed to confirm these findings. Copyright © 2016 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.

  19. Management of Cyanide Intoxication with Extracorporeal Membrane Oxygenation and Continuous Renal Replacement Therapy

    Directory of Open Access Journals (Sweden)

    Jin Park

    2015-08-01

    Full Text Available Cyanide intoxication results in severe metabolic acidosis and catastrophic prognosis with conventional treatment. Indications of extracorporeal membrane oxygenation (ECMO and continuous renal replacement therapy (CRRT are expanding to poisoning cases. A 50-year-old male patient arrived in the emergency room due to mental change after ingestion of cyanide as a suicide attempt 30 minutes prior. He was comatose, and brain stem reflexes were absent. Initial laboratory analysis demonstrated severe metabolic acidosis with increased lactic acid of 25 mM/L. Shock and acidosis were not corrected despite a large amount of fluid resuscitation with high-dose norepinephrine and continuous renal replacement therapy. We decided to apply ECMO and CRRT to allow time for stabilization of hemodynamic status. After administration of antidote infusion, although the patient had the potential to progress to brain death status, vital signs were improved with correction of acidosis. We considered the evaluation for organ donation. We report a male patient who showed typical cyanide intoxication as lethal metabolic acidosis and cardiac impairment, and the patient recovered after antidote administration during vital organ support through ECMO and CRRT.

  20. Safety and efficacy of distal perfusion catheterization to prevent limb ischemia after common femoral artery cannulation for extracorporeal membrane oxygenation

    International Nuclear Information System (INIS)

    Jeon, Chang Ho; Seong, Nak Jong; Yoon, Chang Jin

    2016-01-01

    The extracorporeal membrane oxygenation (ECMO) cannula has the potential for obstructing flow to the lower limb, thus causing severe ischemia and possible limb loss. We evaluated the safety and clinical efficacy of percutaneous distal perfusion catheterization in preventing limb ischemia. Between March 2013 and February 2015, 28 patients with distal perfusion catheterization after ECMO were included in this retrospective study. The technical success was evaluated by Doppler ultrasound at the popliteal level after saline injection via distal perfusion catheter. Clinical success was assessed when at least one of the following conditions was met: restoration of continuous peripheral limb oximetry value or presence of distal arterial pulse on Doppler ultrasound evaluation or resolution of early ischemic sign after connecting the catheter with ECMO. Twenty-six patients with early ischemia were successfully cannulated with a distal perfusion catheter (92.8%). Clinical success was achieved in 12/28 (42.8%) patients; 8/10 (80.0%) patients with survival duration exceeding 7 days and 4/18 (22.2%) patients with survival duration less than 7 days, respectively. A percutaneous distal perfusion catheter placement was a feasible tool with safety and efficacy in preventing lower limb ischemia for patients with prolonged common femoral arterial cannulation for ECMO

  1. Role of Extracorporeal Membrane Oxygenation in Aluminum Phosphide Poisoning-Induced Reversible Myocardial Dysfunction: A Novel Therapeutic Modality.

    Science.gov (United States)

    Mohan, Bishav; Gupta, Vivek; Ralhan, Sarju; Gupta, Dinesh; Puri, Sandeep; Wander, Gurpreet Singh; Singh, Bhupinder

    2015-11-01

    Aluminum phosphide (AlP) poisoning carries a high rate of mortality despite intensive care management, primarily because of refractory myocardial depression, resistant hypotension, and severe metabolic acidosis as well as acute respiratory distress syndrome. Extracorporeal membrane oxygenation (ECMO) is a modified "heart-lung" machine to provide temporary cardiorespiratory support. We studied the novel use of ECMO in the management of a subset of patients with AlP poisoning. In this case series, seven patients with AlP poisoning suffering from severe metabolic acidosis and refractory cardiogenic shock with a reduced left ventricular ejection fraction (poisoning-induced severe metabolic acidosis and refractory cardiogenic shock may lead to a significant improvement in overall survival. Therefore, ECMO might be considered as a bridge therapy for patients with intractable cardiorespiratory failure caused by AlP poisoning who are not responding to conventional treatment. ECMO, however, also is associated with significant complication rates, which must be incorporated into the risk-benefit analysis while considering treatment options. Copyright © 2015 Elsevier Inc. All rights reserved.

  2. Safety and efficacy of distal perfusion catheterization to prevent limb ischemia after common femoral artery cannulation for extracorporeal membrane oxygenation

    Energy Technology Data Exchange (ETDEWEB)

    Jeon, Chang Ho; Seong, Nak Jong; Yoon, Chang Jin [Dept. of Radiology, Seoul National University Bundang Hospital, Seongnam (Korea, Republic of)

    2016-06-15

    The extracorporeal membrane oxygenation (ECMO) cannula has the potential for obstructing flow to the lower limb, thus causing severe ischemia and possible limb loss. We evaluated the safety and clinical efficacy of percutaneous distal perfusion catheterization in preventing limb ischemia. Between March 2013 and February 2015, 28 patients with distal perfusion catheterization after ECMO were included in this retrospective study. The technical success was evaluated by Doppler ultrasound at the popliteal level after saline injection via distal perfusion catheter. Clinical success was assessed when at least one of the following conditions was met: restoration of continuous peripheral limb oximetry value or presence of distal arterial pulse on Doppler ultrasound evaluation or resolution of early ischemic sign after connecting the catheter with ECMO. Twenty-six patients with early ischemia were successfully cannulated with a distal perfusion catheter (92.8%). Clinical success was achieved in 12/28 (42.8%) patients; 8/10 (80.0%) patients with survival duration exceeding 7 days and 4/18 (22.2%) patients with survival duration less than 7 days, respectively. A percutaneous distal perfusion catheter placement was a feasible tool with safety and efficacy in preventing lower limb ischemia for patients with prolonged common femoral arterial cannulation for ECMO.

  3. ECMO: Improving our Results by Chasing the Rabbits

    Directory of Open Access Journals (Sweden)

    Luiz Fernando Canêo

    2015-12-01

    Full Text Available ABSTRACT As Marcelo Giugale published in the Financial Times, Latin America, on the whole, has not excelled at innovation - doing the same things in a new and better way or at doing new things. It has been slow to acquire, adopt and adapt technologies by this time available in other places[1]. Although extracorporeal membrane oxygenation (ECMO is not a new technology, its use in Latin America is not widespread as needed. Furthermore, we still have a number centers doing ECMO, not reporting their cases, lacking a structured training program and not registered with the extracorporeal life support organization (ELSO. With this scenario, and accepting that ECMO is the first step in any circulatory support program, it is difficult to anticipate the incorporation of new and more complex devices as the technologically advanced world is currently doing. However, the good news is that with the support of experts from USA, Europe and Canada the results in Latin America ELSO'S centers are improving by following its guidelines for training, and using a standard educational process. There is no doubt that we can learn a great deal from the high velocity organizations - the rabbits - whom everyone chases but never catches, that manage to stay ahead because of their endurance, responsiveness, and their velocity in self-correction[2].

  4. Differential Effects Of Octanoate And Heptanoate On Myocardial Metabolism During Extracorporeal Membrane Oxygenation In An Infant Swine Model

    Energy Technology Data Exchange (ETDEWEB)

    Kajimoto, Masaki; Ledee, Dolena R.; Isern, Nancy G.; Olson, Aaron; Des Rosiers, Christine; Portman, Michael A.

    2015-10-01

    Background: Nutritional energy support during extracorporeal membrane oxygenation (ECMO) should promote successful myocardial adaptation and eventual weaning from the ECMO circuit. Fatty acids (FAs) are a major myocardial energy source, and medium-chain FAs (MCFAs) are easily taken up by cell and mitochondria without membrane transporters. Oddnumbered MCFAs supply carbons to the citric acid cycle (CAC) via anaplerotic propionyl-CoA as well as acetyl-CoA, the predominant betaoxidation product for even-numbered MCFA. Theoretically, this anaplerotic pathway enhances carbon entry into the CAC, and provides superior energy state and preservation of protein synthesis. We tested this hypothesis in an immature swine model undergoing ECMO. Methods: Fifteen male Yorkshire pigs (26-45 days old) with 8-hour ECMO were received either normal saline, heptanoate (odd-numbered MCFA) or octanoate (even-numbered MCFA) at 2.3 μmol/kg body wt/min as MCFAs systemically during ECMO (n = 5 per group). The 13-Carbon (13C)-labeled substrates ([2-13C]lactate, [5,6,7-13C3]heptanoate and [U-13C6]leucine) were systemically infused as metabolic markers for the final 60 minutes before left ventricular tissue extraction. Extracted tissues were analyzed for the 13C-labeled and absolute concentrations of metabolites by nuclear magnetic resonance and gas chromatography-mass spectrometry. Results: Octanoate produced markedly higher myocardial citrate concentration, and led to a higher [ATP]/[ADP] ratio compared with other http://mc.manuscriptcentral.com/jpen Journal of Parenteral and Enteral Nutrition For Peer Review groups. Unexpectedly, octanoate increased the flux of propionyl-CoA relative to acetyl-CoA into the CAC as well as heptanoate. MCFAs promoted increases in leucine oxidation, but were not associated with a difference in fractional protein synthesis rate. Conclusion: Octanoate provides energetic advantages to the heart over heptanoate, while preserving protein synthesis.

  5. Differential effects of octanoate and heptanoate on myocardial metabolism during extracorporeal membrane oxygenation in an infant swine model.

    Science.gov (United States)

    Kajimoto, Masaki; Ledee, Dolena R; Olson, Aaron K; Isern, Nancy G; Des Rosiers, Christine; Portman, Michael A

    2015-10-01

    Nutritional energy support during extracorporeal membrane oxygenation (ECMO) should promote successful myocardial adaptation and eventual weaning from the ECMO circuit. Fatty acids (FAs) are a major myocardial energy source, and medium-chain FAs (MCFAs) are easily taken up by cell and mitochondria without membrane transporters. Odd-numbered MCFAs supply carbons to the citric acid cycle (CAC) via anaplerotic propionyl-CoA as well as acetyl-CoA, the predominant β-oxidation product for even-numbered MCFA. Theoretically, this anaplerotic pathway enhances carbon entry into the CAC, and provides superior energy state and preservation of protein synthesis. We tested this hypothesis in an immature swine model undergoing ECMO. Fifteen male Yorkshire pigs (26-45 days old) with 8-h ECMO received either normal saline, heptanoate (odd-numbered MCFA), or octanoate (even-numbered MCFA) at 2.3 μmol·kg body wt(-1)·min(-1) as MCFAs systemically during ECMO (n = 5/group). The 13-carbon ((13)C)-labeled substrates ([2-(13)C]lactate, [5,6,7-(13)C3]heptanoate, and [U-(13)C6]leucine) were systemically infused as metabolic markers for the final 60 min before left ventricular tissue extraction. Extracted tissues were analyzed for the (13)C-labeled and absolute concentrations of metabolites by nuclear magnetic resonance and gas chromatography-mass spectrometry. Octanoate produced markedly higher myocardial citrate concentration, and led to a higher [ATP]-to-[ADP] ratio compared with other groups. Unexpectedly, octanoate and heptanoate increased the flux of propionyl-CoA relative to acetyl-CoA into the CAC compared with control. MCFAs promoted increases in leucine oxidation, but were not associated with a difference in protein synthesis rate. In conclusion, octanoate provides energetic advantages to the heart over heptanoate. Copyright © 2015 the American Physiological Society.

  6. Effects of Continuous Triiodothyronine Infusion on Citric Acid Cycle in the Normal Immature Swine Heart under Extracorporeal Membrane Oxygenation in vivo

    Energy Technology Data Exchange (ETDEWEB)

    Kajimoto, Masaki [Seattle Children' s Research Inst., Seattle, WA (United States); O' Kelly-Priddy, Colleen M. [Seattle Children' s Research Inst., Seattle, WA (United States); Univ. of Washington, Seattle, WA (United States); Ledee, Dolena R. [Seattle Children' s Research Inst., Seattle, WA (United States); Xu, Chun [Seattle Children' s Research Inst., Seattle, WA (United States); Isern, Nancy G. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Olson, Aaron [Seattle Children' s Research Inst., Seattle, WA (United States); Univ. of Washington, Seattle, WA (United States); Portman, Michael A. [Seattle Children' s Research Inst., Seattle, WA (United States); Univ. of Washington, Seattle, WA (United States)

    2014-02-13

    Extracorporeal membrane oxygenation (ECMO) is frequently used in infants with postoperative cardiopulmonary failure. ECMO also suppresses circulating triiodothyronine (T3) levels and modifies myocardial metabolism. We assessed the hypothesis that T3 supplementation reverses ECMO induced metabolic abnormalities in the immature heart. Twenty-two male Yorkshire pigs (age 25-38 days) with ECMO were received [2-13C]lactate, [2,4,6,8-13C]octanoate (medium chain fatty acid) and [U-13C]long-chain fatty acids as metabolic tracers either systemically (totally physiological intracoronary concentration) or directly into the coronary artery (high substrate concentration) for the last 60 minutes of each protocol. Nuclear magnetic resonance (NMR) analysis of left ventricular tissue determined the fractional contribution (Fc) of these substrates to the citric acid cycle (CAC). Fifty percent of the pigs in each group received intravenous T3 supplement (bolus at 0.6 μg/kg and then continuous infusion at 0.2 μg/kg/hour) during ECMO. Under both substrate loading conditions T3 significantly increased lactate-Fc with a marginal increase in octanoate-Fc. Both T3 and high substrate provision increased myocardial energy status indexed by [Phosphocreatine]/[ATP]. In conclusion, T3 supplementation promoted lactate metabolism to the CAC during ECMO suggesting that T3 releases inhibition of pyruvate dehydrogenase. Manipulation of substrate utilization by T3 may be used therapeutically during ECMO to improve resting energy state and facilitate weaning.

  7. Catalyst containing oxygen transport membrane

    Science.gov (United States)

    Christie, Gervase Maxwell; Wilson, Jamie Robyn; van Hassel, Bart Antonie

    2012-12-04

    A composite oxygen transport membrane having a dense layer, a porous support layer and an intermediate porous layer located between the dense layer and the porous support layer. Both the dense layer and the intermediate porous layer are formed from an ionic conductive material to conduct oxygen ions and an electrically conductive material to conduct electrons. The porous support layer has a high permeability, high porosity, and a high average pore diameter and the intermediate porous layer has a lower permeability and lower pore diameter than the porous support layer. Catalyst particles selected to promote oxidation of a combustible substance are located in the intermediate porous layer and in the porous support adjacent to the intermediate porous layer. The catalyst particles can be formed by wicking a solution of catalyst precursors through the porous support toward the intermediate porous layer.

  8. A single center's conversion from roller pump to centrifugal pump technology in extracorporeal membrane oxygenation.

    Science.gov (United States)

    Shade, Brandon C; Schiavo, Kellie; Rosenthal, Tami; Connelly, James T; Melchior, Richard W

    2016-06-05

    Recent advances in blood pump technology have led to an increased use of centrifugal pumps for prolonged extracorporeal membrane oxygenation (ECMO). Data from the Extracorporeal Life Support Organization confirms that many institutions have converted to centrifugal pumps after prior experience with roller pump technology. Centrifugal pump technology is more compact and may generate less heat and hemolysis than a conventional roller pump. Based on the potential advantages of centrifugal pumps, a decision was made institution-wide to convert to centrifugal pump technology in pediatric implementation of ECMO. Based on limited prior experience with centrifugal pumps, a multidisciplinary approach was used to implement this new technology. The new centrifugal pump (Sorin Revolution, Arvada, CO) was intended for ECMO support in the cardiac intensive care unit (CICU), the pediatric intensive care unit (PICU) and the neonatal intensive care unit (NICU). The perfusion team used their knowledge and expertise with centrifugal pumps to create the necessary teaching tools and interactive training sessions for the technical specialists who consisted primarily of registered nurses and respiratory therapists. The first phase consisted of educating all personnel involved in the care of the ECMO patient, followed by patient implementation in the CICU, followed by the PICU and NICU. The institution-wide conversion took several months to complete and was well received among all disciplines in the CICU and PICU. The NICU personnel did use the centrifugal pump circuit, but decided to revert back to using the roller pump technology. A systematic transition from roller pump to centrifugal pump technology with a multidisciplinary team can ensure a safe and successful implementation. © The Author(s) 2016.

  9. Hemodynamic and respiratory support using venoarterial extracorporeal membrane oxygenation (ECMO) in a polytrauma patient

    OpenAIRE

    BASSI, Estevão; AZEVEDO, Luciano César Pontes; COSTA, Eduardo Leite Vieira; MACIEL, Alexandre Toledo; VASCONCELOS, Edzangela; FERREIRA, César Biselli; MALBOUISSON, Luiz Marcelo Sá; PARK, Marcelo

    2011-01-01

    Existem poucos relatos na literatura sobre o uso de oxigenação extracorpórea por membrana venoarterial por dupla disfunção decorrente de contusão cardíaca e pulmonar no paciente politraumatizado. Relatamos o caso de um paciente de 48 anos, vítima de acidente de motocicleta e automóvel, que evoluiu rapidamente com choque refratário com baixo débito cardíaco por contusão miocárdica e hipoxemia refratária decorrente de contusão pulmonar, tórax instável e pneumotórax bilateral. O suporte extracor...

  10. Extracorporeal Membrane Oxygenation for the Support of a Potential Organ Donor with a Fatal Brain Injury before Brain Death Determination

    Directory of Open Access Journals (Sweden)

    Sung Wook Chang

    2016-05-01

    Full Text Available The shortage of available organ donors is a significant problem and various efforts have been made to avoid the loss of organ donors. Among these, extracorporeal membrane oxygenation (ECMO has been introduced to help support and manage potential donors. Many traumatic brain injury patients have healthy organs that might be eligible for donation for transplantation. However, the condition of a donor with a fatal brain injury may rapidly deteriorate prior to brain death determination; this frequently results in the loss of eligible donors. Here, we report the use of venoarterial ECMO to support a potential donor with a fatal brain injury before brain death determination, and thereby preserve donor organs. The patient successfully donated his liver and kidneys after brain death determination.

  11. Venovenous Extracorporeal Membrane Oxygenation in an Adult Patient With Prader-Willi Syndrome: A Nutrition Case Report.

    Science.gov (United States)

    Pelekhaty, Stacy; Menaker, Jay

    2018-03-12

    Prader-Willi Syndrome (PWS) is a genetic condition that results in a constellation of symptoms and typically results in hyperphagia and obesity in adulthood. Critically ill adults with PWS present a unique challenge to the nutrition professional, particularly when they require support modalities such as extracorporeal membrane oxygenation (ECMO). The purpose of this case study is to review the nutrition care of a critically ill adult patient with PWS who required venovenous ECMO. The patient was successfully managed with a hypocaloric, high-protein approach, which did not result in the diagnosis of malnutrition during his hospitalization. The patient was ultimately transitioned off extracorporeal life support and discharged to a rehabilitation facility. © 2018 American Society for Parenteral and Enteral Nutrition.

  12. Improved Outcome of Cardiac Extracorporeal Membrane Oxygenation in Infants and Children Using Magnetic Levitation Centrifugal Pumps.

    Science.gov (United States)

    Luciani, Giovanni Battista; Hoxha, Stiljan; Torre, Salvatore; Rungatscher, Alessio; Menon, Tiziano; Barozzi, Luca; Faggian, Giuseppe

    2016-01-01

    Extracorporeal membrane oxygenation (ECMO) has traditionally been and, for the most part, still is being performed using roller pumps. Use of first-generation centrifugal pumps has yielded controversial outcomes, perhaps due to mechanical properties of the same and the ensuing risk of hemolysis and renal morbidity. Latest-generation centrifugal pumps, using magnetic levitation (ML), exhibit mechanical properties which may have overcome limitations of first-generation devices. This retrospective study aimed to assess the safety and efficacy of veno-arterial (V-A) ECMO for cardiac indications in neonates, infants, and children, using standard (SP) and latest-generation ML centrifugal pumps. Between 2002 and 2014, 33 consecutive neonates, infants, and young children were supported using V-A ECMO for cardiac indications. There were 21 males and 12 females, with median age of 29 days (4 days-5 years) and a median body weight of 3.2 kg (1.9-18 kg). Indication for V-A ECMO were acute circulatory collapse in ICU or ward after cardiac repair in 16 (49%) patients, failure to wean after repair of complex congenital heart disease in 9 (27%), fulminant myocarditis in 4 (12%), preoperative sepsis in 2 (6%), and refractory tachy-arrhythmias in 2 (6%). Central cannulation was used in 27 (81%) patients and peripheral in 6. Seven (21%) patients were supported with SP and 26 (79%) with ML centrifugal pumps. Median duration of support was 82 h (range 24-672 h), with 26 (79%) patients weaned from support. Three patients required a second ECMO run but died on support. Seventeen (51%) patients required peritoneal dialysis for acute renal failure. Overall survival to discharge was 39% (13/33 patients). All patients with fulminant myocarditis and with refractory arrhythmias were weaned, and five (83%) survived, whereas no patient supported for sepsis survived. Risk factors for hospital mortality included lower (pumps in infants and children yields outcomes absolutely comparable to

  13. Ceria Based Composite Membranes for Oxygen Separation

    DEFF Research Database (Denmark)

    Gurauskis, Jonas; Ovtar, Simona; Kaiser, Andreas

    2014-01-01

    Mixed ionic-electronic conducting membranes for oxygen gas separation are attracting a lot of interest due to their promising potential for the pure oxygen and the syngas production. Apart from the need for a sufficiently high oxygen permeation fluxes, the prolonged stability of these membranes...... under the large oxygen potential gradients at elevated temperatures is decisive for the future applications. The gadolinium doped cerium oxide (CGO) based composite membranes are considered as promising candidates due to inherent stability of CGO phase. The CGO matrix is a main oxygen ion transporter......; meanwhile the primary role of a secondary phase in this membrane is to compensate the low electronic conductivity of matrix at intended functioning conditions. In this work thin film (15-20 μm) composite membranes based on CGO matrix and LSF electronic conducting phase were fabricated and evaluated...

  14. Ventilação de alta freqüência em crianças e adolescentes com síndrome do desconforto respiratório agudo (impacto sobre o uso de ecmo High-frequency ventilation in children and adolescents with acute respiratory distress syndrome (impact on the use of ecmo

    Directory of Open Access Journals (Sweden)

    Lucília Santana Faria

    2007-06-01

    Full Text Available OBJETIVO: Avaliar o efeito da ventilação de alta freqüência (VAF em crianças e adolescentes com síndrome do desconforto respiratório (SDRA por meio de estimativas de sobrevida e tempo de ventilação. Verificar se a VAF reduziu a indicação de oxigenação de membrana extracorpórea (ECMO em crianças e adolescentes com SDRA. MÉTODOS: A técnica empregada foi uma revisão sistemática da literatura médica sobre o uso de VAF e ECMO em crianças e adolescentes com SDRA. O levantamento bibliográfico utilizou os bancos de dados Medline, Lilacs e Embase. Os termos utilizados para pesquisa foram: adult respiratory distress syndrome, ARDS, acute respiratory distress syndrome, respiratory distress syndrome, extracorporeal membrane oxygenation, ECMO, high-frequency ventilation, high-frequency jet ventilation e high-frequency oscillatory ventilation. Foram procurados ensaios clínicos controlados e randomizados, estudos de coorte e série de casos que comparavam VAF com ventilação mecânica convencional (VMC, ECMO com VMC ou VAF precedendo o uso de ECMO. RESULTADOS: Foram identificadas 289 publicações relacionadas a VAF, SDRA e ECMO. Destas, apenas nove atendiam aos critérios de seleção pré-estabelecidos referindo-se a utilização de VAF e/ou ECMO em crianças e adolescentes com SDRA. CONCLUSÃO: Não foi possível confirmar se o uso de VAF melhora a sobrevida de crianças e adolescentes com SDRA. Quanto ao tempo de ventilação, não houve estudo que comprovasse, com significância estatística, a sua redução ou aumento. Não foi possível verificar se VAF diminui ou não a indicação de ECMO em crianças e adolescentes com SDRA.OBJECTIVE: To assess the effect of high-frequency ventilation (HFV in children and adolescents with acute respiratory distress syndrome (ARDS through estimates of survival rate and time of ventilation. To verify whether HFV can reduce the indication for extracorporeal membrane oxygenation (ECMO in children

  15. Neurodevelopmental, educational and behavioral outcome at 8 years after neonatal ECMO: a nationwide multicenter study.

    Science.gov (United States)

    Madderom, Marlous J; Reuser, Jolanda J C M; Utens, Elisabeth M W J; van Rosmalen, Joost; Raets, Marlou; Govaert, Paul; Steiner, Katerina; Gischler, Saskia J; Tibboel, Dick; van Heijst, Arno F J; Ijsselstijn, Hanneke

    2013-09-01

    Reporting neurodevelopmental outcome of 8-year-old children treated with neonatal extracorporeal membrane oxygenation (ECMO). In a follow-up study in 135 8-year-old children who received neonatal ECMO between 1996 and 2001 we assessed intelligence (Revised Amsterdam Intelligence Test), concentration (Bourdon-Vos test), eye-hand coordination (Developmental Test of Visual-Motor Integration) and behavior (Child Behavior Checklist and Teacher Report Form). Intelligence fell within normal range (mean IQ 99.9, SD 17.7, n = 125) with 91 % of the children following regular education. Significantly more children attended special education (9 %) or received extra support in regular education (39 %) compared with normative data. Slower working speed (χ(2) = 132.36, p children with congenital diaphragmatic hernia scored lowest but still normally (mean 91.0, SD 16.4, n = 28). Mothers (n = 117) indicated more somatic and attention behavior problems; teachers (n = 115) indicated more somatic, social, thought, aggression and total problems compared with normative data. Mothers indicated more somatic problems than teachers (p = 0.003); teachers reported more attention problems than mothers (p = 0.036; n = 111). Eight-year-old children treated with neonatal ECMO fall in the normal range of intelligence with problems with concentration and behavior. Long-term follow-up for children treated with neonatal ECMO should focus on early detection of (subtle) learning deficits.

  16. Initial Egyptian ECMO experience

    Directory of Open Access Journals (Sweden)

    Akram Abdelbary

    2016-04-01

    Results: A total of twelve patients received ECMO between January 2014 and June 2015. The mean age was 35.9 years. (range 13–65 years, 8 males, with VV ECMO in 10 patients, and VA ECMO in 2 patients. Out of ten patients of VV ECMO, one had H1N1 pneumonia, one had advanced vasculitic lung, four had bacterial pneumonia, two traumatic lung contusions and one with organophosphorus poisoning, and one undiagnosed etiology leading to severe ARDS. Lung injury score range was 3–3.8, PaO2/FiO2 (20–76 mechanical ventilation duration before ECMO 1–14 days, Femoro-jugular cannulation in 7 patients and femoro-femoral in 2 patients and femoro-subclavian in 1 patient; all patients were initially sedated and paralyzed for (2–4 days and ventilated on pressure controlled ventilation with Pmax of 25 cm H2O and PEEP of 10 cm H2O. In VA ECMO patients were cannulated percutaneously using femoro-femoral approach. One patient showed no neurologic recovery and died after 24 h, the other had CABG on ECMO however the heart didn’t recover and died after 9 days. Heparin intravenous infusion was used initially in all patients and changed to Bivalirudin in 2 patients due to possible HIT. Pump flow ranged from 2.6 to 6.5 L/min. Average support time was 12 days (range 2–24 days. Seven patients (63.3% were successfully separated from ECMO and survived to hospital discharge. Hospital length of stay ranged from 3 to 42 days, tracheostomy was done percutaneously in 5 patients and surgically in 3. Gastrointestinal bleeding occurred in 6 patients, VAP in 7 patients, neurologic complications in 1 patient with complete recovery, cardiac arrhythmias in 3 patients, pneumothorax in 9 patients, and deep venous thrombosis in 2 patients.

  17. Coagulation Parameter Thresholds Associated with Non-Bleeding in the Eighth Hour of Adult Cardiac Surgical Post-Cardiotomy Extracorporeal Membrane Oxygenation.

    Science.gov (United States)

    Riley, Jeffrey B; Schears, Gregory J; Nuttall, Gregory A; Oliver, William C; Ereth, Mark H; Dearani, Joseph A

    2016-06-01

    Excessive bleeding and allogeneic transfusion during adult post-cardiotomy venoarterial extracorporeal membrane oxygenation (ECMO) are potentially harmful and expensive. Balancing the inhibition of clotting and distinguishing surgical from non-surgical bleeding in post-operative period is difficult. The sensitivity of coagulation tests including Thromboelastography(®) (TEG) to predict chest tube drainage in the early hours of ECMO was examined with the use of receiver-operating characteristics (ROC). The results are useful to incorporate in clinical evidence-based algorithms to guide management decisions. In the eighth hour of ECMO, 26 of the 53 adult patients (49%) studied were identified as non-bleeders (less than 2.0 mL/kg/h). All had experienced various types of cardiac surgical procedures. Fifty-two percent were female and the group was 54 ± 19 (mean ± 1 SD) years old. The coagulation parameter threshold with the maximum sensitivity and specificity to predict non-bleeding at 8 hours on ECMO was the kaolin plus heparinase TEG maximum amplitude (KH-TEG MA) at a significant ROC threshold (t) > 50 mm. The activated partial thromboplastin time (aPTT) t 51°, and the kaolin activated clotting time (ACT) t < 148 seconds were sensitive predictors of non-bleeders. The whole-blood KH-TEG MA was superior to the plasma-based aPTT or International Normalization Ratio (INR) to predict bleeding in the eighth hour of ECMO. Using coagulation laboratory thresholds that predict non-bleeding can begin a process of identifying patients earlier that are likely to bleed. Awareness of these parameter thresholds may improve care through patient protection from unnecessary transfusion and prolonging the life of the ECMO circuit. An algorithm incorporating the ROC thresholds was created to help recognize surgical bleeding to minimize unnecessary transfusions.

  18. Cheap Thin Film Oxygen Membranes

    DEFF Research Database (Denmark)

    2009-01-01

    The present invention provides a membrane, comprising a porous support layer a gas tight electronically and ionically conducting membrane layer and a catalyst layer, characterized in that the electronically and ionically conducting membrane layer is formed from a material having a crystallite...

  19. Technical-Induced Hemolysis in Patients with Respiratory Failure Supported with Veno-Venous ECMO - Prevalence and Risk Factors.

    Directory of Open Access Journals (Sweden)

    Karla Lehle

    Full Text Available The aim of the study was to explore the prevalence and risk factors for technical-induced hemolysis in adults supported with veno-venous extracorporeal membrane oxygenation (vvECMO and to analyze the effect of hemolytic episodes on outcome. This was a retrospective, single-center study that included 318 adult patients (Regensburg ECMO Registry, 2009-2014 with acute respiratory failure treated with different modern miniaturized ECMO systems. Free plasma hemoglobin (fHb was used as indicator for hemolysis. Throughout a cumulative support duration of 4,142 days on ECMO only 1.7% of the fHb levels were above a critical value of 500 mg/l. A grave rise in fHb indicated pumphead thrombosis (n = 8, while acute oxygenator thrombosis (n = 15 did not affect fHb. Replacement of the pumphead normalized fHb within two days. Neither pump or cannula type nor duration on the first system was associated with hemolysis. Multiple trauma, need for kidney replacement therapy, increased daily red blood cell transfusion requirements, and high blood flow (3.0-4.5 L/min through small-sized cannulas significantly resulted in augmented blood cell trauma. Survivors were characterized by lower peak levels of fHb [90 (60, 142 mg/l] in comparison to non-survivors [148 (91, 256 mg/l, p≤0.001]. In conclusion, marked hemolysis is not common in vvECMO with modern devices. Clinically obvious hemolysis often is caused by pumphead thrombosis. High flow velocity through small cannulas may also cause technical-induced hemolysis. In patients who developed lung failure due to trauma, fHb was elevated independantly of ECMO. In our cohort, the occurance of hemolysis was associated with increased mortality.

  20. ECMO as an effective rescue therapeutic for fulminant myocarditis complicated with refractory cardiac arrest

    Directory of Open Access Journals (Sweden)

    Li YT

    2017-11-01

    Full Text Available Ya-Ting Li,1,* Li-Fen Yang,1,* Zhuang-Gui Chen,1,* Li Pan,1 Meng-Qi Duan,1 Yan Hu,2 Cheng-bin Zhou,3 Yu-Xiong Guo2 1Pediatric Intensive Care Unit, Department of Pediatrics, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 2Pediatric Intensive Care Unit, Department of Pediatrics, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 3Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People’s Republic of China *These authors contributed equally to this work Abstract: Fulminant myocarditis (FM is a life-threatening disease in children. With a rapid, progressive course of deterioration, it causes refractory cardiorespiratory failure even with optimal clinical intervention. We present the case of a 9-year-old girl with FM complicated by cardiogenic shock, malignant arrhythmia, and refractory cardiac arrest. She received effective cardiopulmonary resuscitation, therapeutic hypothermia, and other supportive treatments. However, the patient rapidly worsened into pulseless ventricular tachycardia and refractory cardiac arrest. Therefore, we performed extracorporeal membrane oxygenation (ECMO to establish spontaneous circulation after the failure of standard resuscitation measures. The girl recovered with intact cardiac and neurocognitive functions after continued ECMO treatment for 221 hours. Therefore, ECMO is an effective rescue therapeutics for FM, especially when complicated with refractory cardiac arrest. Keywords: cardiac arrest, children, extracorporeal membrane oxygenation, fulminant myocarditis

  1. Ceramic oxygen transport membrane array reactor and reforming method

    Energy Technology Data Exchange (ETDEWEB)

    Kelly, Sean M.; Christie, Gervase Maxwell; Robinson, Charles; Wilson, Jamie R.; Gonzalez, Javier E.; Doraswami, Uttam R.

    2016-11-08

    The invention relates to a commercially viable modular ceramic oxygen transport membrane reforming reactor configured using repeating assemblies of oxygen transport membrane tubes and catalytic reforming reactors.

  2. Extracorporeal membrane oxygenation in the management of post-pneumonectomy air leak and adult respiratory distress syndrome of the non-operated lung.

    Science.gov (United States)

    Marek, Szkorupa; Martin, Simek; Ondrej, Zuscich; Josef, Chudacek; Cestmir, Neoral; Vladimir, Lonsky

    2017-07-01

    Post-pneumonectomy air leak and severe respiratory failure of the non-operated lung is considered to be a life-threatening complication of lung surgery. We present the case report of a 68-year-old man who underwent a right pneumonectomy for spinocellular carcinoma. Refractory respiratory failure occurred following bronchial stump air leakage and adult respiratory distress syndrome (ARDS) of the non-operated lung. Established veno-venous extracorporeal membrane oxygenation (VV ECMO) was utilized to maintain tissue oxygenation while re-do surgery was performed. The leaking bronchial stump was closed with an azygos vein patch and, subsequently, weaning off ECMO was accomplished 7 days later. The patient fully recovered and he is limited only by mild exertional dyspnea at 24 months follow-up after the initial surgery.

  3. Respiratory support with venovenous extracorporeal membrane oxygenation during stent placement for the palliation of critical airway obstruction: case series analysis.

    Science.gov (United States)

    Park, Jung-Hoon; Shin, Ji Hoon; Kim, Kun Yung; Lim, Ju Yong; Kim, Pyeong Hwa; Tsauo, Jiaywei; Kim, Min Tae; Song, Ho-Young

    2017-08-01

    Venovenous extracorporeal membrane oxygenation (VV ECMO) is used to support gas transfer of patients suffering from respiratory failure during various procedures. The purpose of this study was to evaluate the technical feasibility and safety of fluoroscopic stent placement under respiratory support with VV ECMO in patients with critical airway obstructions. We reviewed the records of 17 patients (14 male and 3 female; mean age: 63 years; range, 30-82 years) who underwent self-expandable metallic stent (SEMS) placement under VV ECMO respiratory support for critical airway obstruction caused by malignant (n=16) or benign (n=1) etiology. Fluoroscopic placement of SEMS was successful in all patients (100%) with no procedure-related complications. During a mean follow-up of 83 days (range, 10-367 days), 15 (88.2%) of 17 patients showed improvement of Hugh-Jones grades (from 4.7±0.4 to 3.1±0.9, Pcritical airway obstruction, especially in cases of respiratory distress despite ventilation support and an inability to lie in a supine position. However, further studies will be needed to validate the standardized methods and specific indications.

  4. Improvement in long-term ECMO by detailed monitoring of anticoagulation: a case report.

    Science.gov (United States)

    Sievert, Alicia; Uber, Walter; Laws, Stacey; Cochran, Joel

    2011-01-01

    The use of unfractionated heparin (UFH) as an anticoagulant during long-term extracorporeal support presents a unique challenge for the clinician in balancing the amount of anticoagulant to maintain adequate anticoagulation without causing excessive bleeding. Activated clotting times (ACT) and activated partial thromboplastin times (aPTT) are the most common modality to monitor UFH on extracorporeal membrane oxygenation (ECMO). Limitations to these tests include consumptive coagulopathies, clotting factor deficiencies, platelet dysfunction, and fibrinolysis. The following case report describes the use of alternative monitoring strategies to assess more accurately anticoagulation during ECMO. A 20-month-old female presented to the emergency department with a 5-6 day history of cough, fever, tachypnea, and respiratory distress. She was diagnosed with influenza A and B with pneumonia. The patient was placed on veno-venous ECMO (V-V ECMO) after mechanical ventilation failed. On ECMO day eight, the patient developed a thrombus in her inferior vena cava and pleural effusions, obstructing cannula flow. Laboratory tests revealed the ACT was within range, yet the aPTT was dropping, despite increased heparin. Heparin levels were low and antithrombin-III (AT) concentrations were 40%. Recombinant AT was given and subsequent aPTTs were within the therapeutic range. Later, the aPTT decreased to 475 mg/ dL, and Factor VIII >150 IU/dL, suggesting an acute phase reaction or ongoing systemic inflammation, increasing the risk for thrombosis. We maintained heparin assays between 0.5-0.7 IU/mL and AT >60% to assure heparin's effect. The patient showed no signs of excess bleeding, blood product administration, or clots in the circuit, suggesting proper anticoagulation. The patient was successfully weaned on day 33 and is currently alive and at home. Monitoring of anti-Xa UFH and AT proved effective for measuring anticoagulation and detecting inconsistencies in other anticoagulation

  5. Direct thrombolysis of multiple thrombi in both right and left heart atrium in a patient on extracorporeal membrane oxygenation support following urgent double-lung transplantation: a case report

    Directory of Open Access Journals (Sweden)

    Pollert L

    2016-06-01

    Full Text Available Lukas Pollert,1 Zuzana Prikrylova,1 Jan Berousek,1 Frantisek Mosna,1 Robert Lischke2 1Department of Anaesthesiology and Intensive Care, 2nd Faculty of Medicine, 23rd Surgical Department, 1st Faculty of Medicine, Charles University in Prague and Motol University Hospital, Praha, Czech Republic Background: Lung transplantation is considered an established treatment for patients with end-stage chronic respiratory failure. Patients with acute respiratory failure requiring respiratory support with invasive mechanical ventilation while awaiting lung transplantation are at high risk of death. Extracorporeal membrane oxygenation (ECMO has been proposed as an alternative bridging strategy to mechanical ventilation. The shear stress created by the mechanical pumps causes changes in the hematological system in almost all patients treated with ECMO. An antithrombotic strategy to mitigate ECMO bleeding and thrombotic complications is necessary. The use of thrombolytic therapy is recommended for patients with acute symptomatic embolism with associated hypotension or shock. In this setting, the hemodynamic benefits of thrombolytic treatment far outweigh its bleeding risk.Case presentation: This case report describes a 32-year-old woman suffering from lymphangioleiomyomatosis, who underwent urgent double-lung transplantation. This patient was maintained on ECMO preoperatively, perioperatively, and postoperatively due to life-threatening hypoxemia caused by the progression of her pulmonary tissue damage. Multiple thrombi developed in the early postoperative period, in both right and left heart atria. Direct thrombolysis was successfully performed on the first postoperative day.Conclusion: According to the current published literature, direct thrombolysis of thrombi in both right and left atria in a patient supported on ECMO following urgent double-lung transplantation is an extremely rare treatment method. Even when taking into account all of the risks

  6. Fentanyl uptake by the scimed membrane oxygenator.

    Science.gov (United States)

    Rosen, D; Rosen, K; Davidson, B; Broadman, L

    1988-10-01

    With the initiation of cardiopulmonary bypass (CPB), using a membrane oxygenator, the drop in circulating fentanyl concentration is greater than can be attributed to dilution alone. This study examined the Scimed brand (2A-800) membrane oxygenator as a site of fentanyl binding. Initial experiments used an assembled CPB circuit. Subsequent dissection and analysis of the oxygenator revealed that the silicone-based membrane sheets were the primary site of fentanyl binding. The silicone-containing waterproof wrapper was also responsible for 1% to 2% of fentanyl binding. Binding of fentanyl to the Scimed membrane oxygenator occurs at a rapid rate and continues until the membrane has taken up 130 ng/cm2 of membrane surface area. The interaction is complete by 15 to 30 minutes if suprasaturated concentrations are used. Samples of membrane material with a surface area of 1 cm2 were also studied. Isolated membrane squares in a nonmoving prime solution required two hours for saturation at the same fentanyl concentrations as the intact membrane with circulating prime. Introduction of motion to the priming solution accelerated the rate of fentanyl binding by the isolated membrane squares to a rate similar to the intact membrane. Motion also provided results similar to those previously reported using different analysis techniques. Therefore, this method of studying fentanyl-membrane interactions using samples of membrane and tritiated fentanyl is a valid model for the intact membrane oxygenator in the assembled bypass circuit. In addition to solution movement, fentanyl concentration of the priming solution was also found to affect the rate of fentanyl uptake. When fentanyl concentrations were used which were insufficient to achieve saturation of the membrane (10 ng/mL and 20 ng/mL), the rate of uptake was slowed. Binding of all available fentanyl under these conditions occurred within three hours. There is potential modification of this interaction by several clinically

  7. Incidence of platelet dysfunction by thromboelastography-platelet mapping in children supported with ECMO: A Pilot Retrospective Study.

    Directory of Open Access Journals (Sweden)

    Arun eSaini

    2016-01-01

    Full Text Available Background: Bleeding complications are common and decrease the odds of survival in children supported with extracorporeal membrane oxygenation (ECMO. The role of platelet dysfunction on ECMO-induced coagulopathy and resultant bleeding complications is not well understood. The primary objective of this pilot study was to determine the incidence and magnitude of platelet dysfunction according to thromboelastography (TEG®-platelet mapping (PM testing. Methods: Retrospective chart review of children <18 years old who required ECMO at a tertiary level hospital. We collected TEG®-PM and conventional coagulation tests data. We also collected demographic, medications, blood products administered, and clinical outcome data. We defined severe platelet dysfunction as less than 50 % aggregation in response to an agonist. Results: We identified 24 out of 46 children on ECMO, who had TEG®-PM performed during the study period. We found the incidence of severe bleeding was 42%, and mortality was 54% in our study cohort. In all samples measured, severe qualitative platelet dysfunction was more common for adenosine diphosphate (ADP-mediated aggregation (92% compared to arachidonic acid (AA-mediated aggregation (75%, (p=0.001. Also, ADP-mediated percent of platelet aggregation was significant lower than AA-mediated platelet aggregation (15% [IQR 2.8-48] vs 49% [IQR 22-82.5], p<0.001. There was no difference in kaolin-activated heparinase TEG® parameters between the bleeding group and the non-bleeding group. Only absolute platelet count and TEG®-PM had increased predictive value on receiver operating characteristics analyses for severe bleeding and mortality compared to ACT. Conclusions: We found frequent and severe qualitative platelet dysfunction on TEG®-PM testing in children on ECMO. Larger studies are needed to determine if the assessment of qualitative platelet function by TEG®-PM can improve prediction of bleeding complications for children on ECMO.

  8. A Case of MDMA-Associated Cerebral and Pulmonary Edema Requiring ECMO

    Directory of Open Access Journals (Sweden)

    A. Thakkar

    2017-01-01

    Full Text Available A 20-year-old female presented with confusion, generalized tonic-clonic seizures, and severe hyponatremia after ingesting 3,4-methylenedioxymethamphetamine (MDMA. Brain computed tomography (CT demonstrated cerebral edema. Her hospital course was rapidly complicated by respiratory failure and shock requiring intubation and vasopressors. Refractory acute respiratory distress syndrome (ARDS was diagnosed which was unresponsive to conventional and salvage therapies, requiring initiation of extracorporeal membrane oxygenation (ECMO, leading to normalization of oxygenation parameters. Hyponatremia was corrected and the encephalopathy resolved. The patient was decannulated and extubated after three days. MDMA-induced hyponatremia is hypothesized to result from enhanced serotonergic activity and arginine vasopressin (AVP release in the brain leading to hyperthermia-induced polydipsia and syndrome of inappropriate antidiuretic hormone (SIADH secretion. A common but often unrecognized complication of severe hyponatremia is the Ayus-Arieff syndrome where cerebral edema causes neurogenic pulmonary edema via centrally mediated increases in catecholamine release and capillary injury. For our patient, ECMO was required for three days while the hyponatremia was corrected which led to rapid clearing of the cerebral edema and neurogenic pulmonary edema. This case illustrates that, in selecting patients with refractory ARDS from MDMA-associated cerebral and pulmonary edema, ECMO may be a temporizing and life-saving modality of treatment.

  9. Integration of oxygen membranes for oxygen production in cement plants

    DEFF Research Database (Denmark)

    Puig Arnavat, Maria; Søgaard, Martin; Hjuler, Klaus

    2015-01-01

    The present paper describes the integration of oxygen membranes in cement plants both from an energy, exergy and economic point of view. Different configurations for oxygen enrichment of the tertiary air for combustion in the pre-calciner and full oxy-fuel combustion in both pre-calciner and kiln...... a concentrated CO2 source that can be used for enhanced oil recovery, in combination with biomass gasification and electrolysis for synthesis gas production, or possibly sequestered. The cases with oxygen enriched air provide very promising economic figures of merit with discounted payback periods slightly...

  10. High Serum Bilirubin Levels, NT-pro-BNP, and Lactate Predict Mortality in Long-Term, Severely Ill Respiratory ECMO Patients.

    Science.gov (United States)

    Kaestner, Franziska; Rapp, Daniel; Trudzinski, Franziska C; Olewczynska, Nicole; Wagenpfeil, Stefan; Langer, Frank; Flaig, Monika; Wilkens, Heinrike; Bals, Robert; Klingele, Matthias; Lensch, Christian; Fähndrich, Sebastian; Lepper, Philipp M

    Mortality in patients treated with extracorporeal membrane oxygenation (ECMO) is high. Therefore, it is crucial to better understand conditions that are associated with mortality in ECMO patients. In this retrospective analysis, we observed 51 patients treated with high-flow ECMO in 2013 and 2014 at our center. We recorded laboratory values and intensive care procedures. The hypothesis of bilirubin being a predictor of mortality during ECMO treatment was initially addressed. Therefore, laboratory values were obtained before initiation and at the time of highest bilirubin throughout the procedure. Receiver operating characteristic (ROC) curves and survival analysis were conducted. Our cohort consisted of patients with advanced age (median: 55 years; range: 22-76) and high mortality (26/51; 51%). Lactate, bilirubin, and NT-pro-BNP were significantly (p < 0.05) associated with mortality in univariable analyses. The cut-off values with highest Youden's index were bilirubin ≥10 mg/dl, lactate ≥2.25 mmol/L, and NT-pro-BNP ≥11,500 pg/ml. A multivariable analysis, revealed an area under the curve (AUC) of 0.85 (95% confidence interval [CI]: 0.74-0.97), sensitivity of 0.79, and specificity of 0.91. Bilirubin, lactate, and NT-pro-BNP were associated with mortality during ECMO treatment. However, laboratory values were only evaluated at the time of peak bilirubin.

  11. Technical complications during veno-venous extracorporeal membrane oxygenation and their relevance predicting a system-exchange--retrospective analysis of 265 cases.

    Directory of Open Access Journals (Sweden)

    Matthias Lubnow

    Full Text Available OBJECTIVES: Technical complications are a known hazard in veno-venous extracorporeal membrane oxygenation (vvECMO. Identifying these complications and predictive factors indicating a developing system-exchange was the goal of the study. METHODS: Retrospective study on prospectively collected data of technical complications including 265 adult patients (Regensburg ECMO Registry, 2009-2013 with acute respiratory failure treated with vvECMO. Alterations in blood flow resistance, gas transfer capability, hemolysis, coagulation and hemostasis parameters were evaluated in conjunction with a system-exchange in all patients with at least one exchange (n = 83. RESULTS: Values presented as median (interquartile range. Patient age was 50(36-60 years, the SOFA score 11(8-14.3 and the Murray lung injury Score 3.33(3.3-3.7. Cumulative ECMO support time 3411 days, 9(6-15 days per patient. Mechanical failure of the blood pump (n = 5, MO (n = 2 or cannula (n = 1 accounted for 10% of the exchanges. Acute clot formation within the pump head (visible clots, increase in plasma free hemoglobin (frHb, serum lactate dehydrogenase (LDH, n = 13 and MO (increase in pressure drop across the MO, n = 16 required an urgent system-exchange, of which nearly 50% could be foreseen by measuring the parameters mentioned below. Reasons for an elective system-exchange were worsening of gas transfer capability (n = 10 and device-related coagulation disorders (n = 32, either local fibrinolysis in the MO due to clot formation (increased D-dimers [DD], decreased platelet count; n = 24, or device-induced hyperfibrinolysis (increased DD, decreased fibrinogen [FG], decreased platelet count, diffuse bleeding tendency; n = 8, which could be reversed after system-exchange. Four MOs were exchanged due to suspicion of infection. CONCLUSIONS: The majority of ECMO system-exchanges could be predicted by regular inspection of the complete ECMO circuit, evaluation of gas exchange, pressure drop

  12. Novel Membranes and Processes for Oxygen Enrichment

    Energy Technology Data Exchange (ETDEWEB)

    Lin, Haiqing

    2011-11-15

    The overall goal of this project is to develop a membrane process that produces air containing 25-35% oxygen, at a cost of $25-40/ton of equivalent pure oxygen (EPO2). Oxygen-enriched air at such a low cost will allow existing air-fueled furnaces to be converted economically to oxygen-enriched furnaces, which in turn will improve the economic and energy efficiency of combustion processes significantly, and reduce the cost of CO{sub 2} capture and sequestration from flue gases throughout the U.S. manufacturing industries. During the 12-month Concept Definition project: We identified a series of perfluoropolymers (PFPs) with promising oxygen/nitrogen separation properties, which were successfully made into thin film composite membranes. The membranes showed oxygen permeance as high as 1,200 gpu and oxygen/nitrogen selectivity of 3.0, and the permeance and selectivity were stable over the time period tested (60 days). We successfully scaled up the production of high-flux PFP-based membranes, using MTR's commercial coaters. Two bench-scale spiral-wound modules with countercurrent designs were made and parametric tests were performed to understand the effect of feed flow rate and pressure, permeate pressure and sweep flow rate on the membrane module separation properties. At various operating conditions that modeled potential industrial operating conditions, the module separation properties were similar to the pure-gas separation properties in the membrane stamps. We also identified and synthesized new polymers [including polymers of intrinsic microporosity (PIMs) and polyimides] with higher oxygen/nitrogen selectivity (3.5-5.0) than the PFPs, and made these polymers into thin film composite membranes. However, these membranes were susceptible to severe aging; pure-gas permeance decreased nearly six-fold within two weeks, making them impractical for industrial applications of oxygen enrichment. We tested the effect of oxygen-enriched air on NO{sub x} emissions

  13. Direct thrombolysis of multiple thrombi in both right and left heart atrium in a patient on extracorporeal membrane oxygenation support following urgent double-lung transplantation: a case report.

    Science.gov (United States)

    Pollert, Lukas; Prikrylova, Zuzana; Berousek, Jan; Mosna, Frantisek; Lischke, Robert

    2016-01-01

    Lung transplantation is considered an established treatment for patients with end-stage chronic respiratory failure. Patients with acute respiratory failure requiring respiratory support with invasive mechanical ventilation while awaiting lung transplantation are at high risk of death. Extracorporeal membrane oxygenation (ECMO) has been proposed as an alternative bridging strategy to mechanical ventilation. The shear stress created by the mechanical pumps causes changes in the hematological system in almost all patients treated with ECMO. An antithrombotic strategy to mitigate ECMO bleeding and thrombotic complications is necessary. The use of thrombolytic therapy is recommended for patients with acute symptomatic embolism with associated hypotension or shock. In this setting, the hemodynamic benefits of thrombolytic treatment far outweigh its bleeding risk. This case report describes a 32-year-old woman suffering from lymphangioleiomyomatosis, who underwent urgent double-lung transplantation. This patient was maintained on ECMO preoperatively, perioperatively, and postoperatively due to life-threatening hypoxemia caused by the progression of her pulmonary tissue damage. Multiple thrombi developed in the early postoperative period, in both right and left heart atria. Direct thrombolysis was successfully performed on the first postoperative day. According to the current published literature, direct thrombolysis of thrombi in both right and left atria in a patient supported on ECMO following urgent double-lung transplantation is an extremely rare treatment method. Even when taking into account all of the risks associated with thrombolysis and arteriovenous ECMO support, we found that this technique is very effective and, without a doubt, it saved the life of our patient.

  14. Experimental study on ceramic membrane technology for onboard oxygen generation

    Directory of Open Access Journals (Sweden)

    Jiang Dongsheng

    2016-08-01

    Full Text Available The ceramic membrane oxygen generation technology has advantages of high concentration of produced oxygen and potential nuclear and biochemical protection capability. The present paper studies the ceramic membrane technology for onboard oxygen generation. Comparisons are made to have knowledge of the effects of two kinds of ceramic membrane separation technologies on oxygen generation, namely electricity driven ceramic membrane separation oxygen generation technology (EDCMSOGT and pressure driven ceramic membrane separation oxygen generation technology (PDCMSOGT. Experiments were conducted under different temperatures, pressures of feed air and produced oxygen flow rates. On the basis of these experiments, the flow rate of feed air, electric power provided, oxygen recovery rate and concentration of produced oxygen are compared under each working condition. It is concluded that the EDCMSOGT is the oxygen generation means more suitable for onboard conditions.

  15. Neonatal extracorporeal membrane oxygenation: Initial experience of Hospital de São João

    Directory of Open Access Journals (Sweden)

    G. Rocha

    2014-11-01

    Full Text Available The purpose of this series is to report the initial ECMO experience of the Neonatal Intensive Care Unit of Hospital de São João. The first three clinical cases are reported. Case report 1: a 39 weeks gestational age girl with severe lung hypoplasia secondary to a bilateral congenital diaphragmatic hernia. Case report 2: a 39 weeks gestational age girl with a right congenital diaphragmatic hernia and a tracheal stenosis. Case report 3: a 34 weeks gestational age boy, with 61 days of life, with a Bordetella pertussis pneumonia, severe pulmonary hypertension, shock, hyperleukocytosis and seizures. Resumo: O objetivo desta série é apresentar a experiência inicial da Unidade de Cuidados Intensivos Neonatais do Hospital de São João com ECMO no recém-nascido. São apresentados os 3 primeiros casos. Caso 1: recém-nascido de 39 semanas de idade gestacional, com hipoplasia pulmonar severa secundária a hérnia diafragmática congénita bilateral. Caso 2: recém-nascido de 39 semanas de idade gestacional, com hérnia diafragmática congénita direita e estenose traqueal. Caso 3: pré-termo de 34 semanas de idade gestacional, sexo masculino, com 61 dias de vida, com pneumonia por Bordetella pertussis, hipertensão pulmonar severa, choque, hiperleucocitose e convulsões. Keywords: Extracorporeal membrane oxygenation, Newborn, Congenital diaphragmatic hernia, Tracheal stenosis, Bordetella pertussis infection, Palavras-chave: Oxigenação por membrana extracorporal, Recém-nascido, Hérnia diafragmática congénita, Estenose traqueal, Infeção por Bordetella pertussis

  16. Extracorporeal membrane oxygenation system as a bridge to reparative surgery in ventricular septal defect complicating acute inferoposterior myocardial infarction.

    Science.gov (United States)

    Rozado, Jose; Pascual, Isaac; Avanzas, Pablo; Hernandez-Vaquero, Daniel; Alvarez, Ruben; Díaz, Rocio; Díaz, Beatriz; Martín, María; Carro, Amelia; Muñiz, Guillermo; Silva, Jacobo; Moris, Cesar

    2017-09-01

    Post-infarction ventricular septal defect (VSD) is a rare but potentially lethal complication of acute myocardial infarction. Medical management is usually futile, so definitive surgery remains the treatment of choice but the risk surgery is very high and the optimal timing for surgery is still under debate. A 55-year-old man with no previous medical history attended the emergency-room for 12 h evolution of oppressive chest pain and strong anginal pain 7 days ago. On physical examination, blood pressure was 96/70 mmHg, pansystolic murmur over left sternal border without pulmonary crackles. An electrocardiogram revealed sinus rhythm 110 bpm, elevation ST and Q in inferior-posterior leads. Transthoracic echocardiogram showed inferoposterior akinesia, posterior-basal septal rupture (2 cm × 2 cm) with left-right shunt. Suspecting VSD in inferior-posterior acute myocardial infarction evolved, we performed emergency coronarography with 3-vessels disease and complete subacute occlusion of the mid segment of the right coronary artery. Left ventriculography demonstrated shunting of contrast from the left ventricule to the right ventricule. He was rejected for heart transplantation because of his age. Considering the high surgical risk to early surgery and his hemodynamic and clinical stability, delayed surgical treatment is decided, and 4 days after admission the patient suffered hemodynamic instability so venoarterial extracorporeal membrane oxygenation system (ECMO) is implanted as a bridge to reparative surgery. The 9th day after admission double bypass, interventricular defect repair with pericardial two-patch exclusion technique, and ECMO decannulation were performed. The patient's postoperative course was free of complications and was discharged 10 days post VSD repair surgery. Follow-up 3-month later revealed the patient to be in good functional status and good image outcome with intact interventricular septal patch without shunt. ECMO as a bridge to reparative

  17. Performance of Multiple Risk Assessment Tools to Predict Mortality for Adult Respiratory Distress Syndrome with Extracorporeal Membrane Oxygenation Therapy: An External Validation Study Based on Chinese Single-center Data.

    Science.gov (United States)

    Huang, Lei; Li, Tong; Xu, Lei; Hu, Xiao-Min; Duan, Da-Wei; Li, Zhi-Bo; Gao, Xin-Jing; Li, Jun; Wu, Peng; Liu, Ying-Wu; Wang, Song; Lang, Yu-Heng

    2016-07-20

    There has been no external validation of survival prediction models for severe adult respiratory distress syndrome (ARDS) with extracorporeal membrane oxygenation (ECMO) therapy in China. The aim of study was to compare the performance of multiple models recently developed for patients with ARDS undergoing ECMO based on Chinese single-center data. A retrospective case study was performed, including twenty-three severe ARDS patients who received ECMO from January 2009 to July 2015. The PRESERVE (Predicting death for severe ARDS on VV-ECMO), ECMOnet, Respiratory Extracorporeal Membrane Oxygenation Survival Prediction (RESP) score, a center-specific model developed for inter-hospital transfers receiving ECMO, and the classical risk-prediction scores of Acute Physiology and Chronic Health Evaluation (APACHE) II and Sequential Organ Failure Assessment (SOFA) were calculated. In-hospital and six-month mortality were regarded as the endpoints and model performance was evaluated by comparing the area under the receiver operating characteristic curve (AUC). The RESP and APACHE II scores showed excellent discriminate performance in predicting survival with AUC of 0.835 (95% confidence interval [CI], 0.659-1.010, P = 0.007) and 0.762 (95% CI, 0.558-0.965, P = 0.035), respectively. The optimal cutoff values were risk class 3.5 for RESP and 35.5 for APACHE II score, and both showed 70.0% sensitivity and 84.6% specificity. The excellent performance of these models was also evident for the pneumonia etiological subgroup, for which the SOFA score was also shown to be predictive, with an AUC of 0.790 (95% CI, 0.571-1.009, P = 0.038). However, the ECMOnet and the score developed for externally retrieved ECMO patients failed to demonstrate significant discriminate power for the overall cohort. The PRESERVE model was unable to be evaluated fully since only one patient died six months postdischarge. The RESP, APCHAE II, and SOFA scorings systems show good predictive value for intra

  18. Extracorporeal membrane oxygenation and toilet bronchoscopy as a bridge to pneumonectomy in severe community-acquired methicillin-resistant Staphylococcus aureus pneumonia

    Science.gov (United States)

    Panchabhai, Tanmay S.; Khabbaza, Joseph E.; Raja, Siva; Mehta, Atul C.; Hatipoğlu, Umur

    2015-01-01

    Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) pneumonia is associated with very high mortality. Though surgical evacuation of necrotic tissue is desirable in patients unresponsive to antimicrobial therapy, most patients are acutely ill precluding surgical intervention. We utilized a combination of extracorporeal membrane oxygenation (ECMO) with frequent toilet bronchoscopies to salvage an unaffected right lung from spillage of necrotic pus from left lung cavitary CA-MRSA pneumonia in a 22-year-old patient. Our patient while on ECMO and after decannulation was positioned with the right lung up at all times with 1-2 toilet bronchoscopies every day for almost 30 days. This time was utilized for ventilator weaning and optimizing the nutritional status prior to extrapleural left pneumonectomy. Prevention of soilage of the unaffected right lung and mitigating volutrauma with ECMO support combined with the subsequent surgical evacuation of necrotic left lung tissue led to a favorable outcome in this case. This strategy could be of value in similar presentations of unilateral suppurative pneumonia, where the progressive disease occurs despite optimal medical therapy. PMID:26664570

  19. Brain-Dead Donors on Extracorporeal Membrane Oxygenation.

    Science.gov (United States)

    Bronchard, Régis; Durand, Louise; Legeai, Camille; Cohen, Johana; Guerrini, Patrice; Bastien, Olivier

    2017-10-01

    To describe donors after brain death with ongoing extracorporeal membrane oxygenation and to analyze the outcome of organs transplanted from these donors. Retrospective analysis of the national information system run by the French Biomedicine Agency (CRISTAL database). National registry data of all donors after brain death in France and their organ recipients between 2007 and 2013. Donors after brain death and their organ recipients. None. During the study period, there were 22,270 brain-dead patients diagnosed in France, of whom 161 with extracorporeal membrane oxygenation. Among these patients, 64 donors on extracorporeal membrane oxygenation and 10,805 donors without extracorporeal membrane oxygenation had at least one organ retrieved. Donors on extracorporeal membrane oxygenation were significantly younger and had more severe intensive care medical conditions (hemodynamic, biological, renal, and liver insults) than donors without extracorporeal membrane oxygenation. One hundred nine kidneys, 37 livers, seven hearts, and one lung were successfully transplanted from donors on extracorporeal membrane oxygenation. We found no significant difference in 1-year kidney graft survival (p = 0.24) and function between recipients from donors on extracorporeal membrane oxygenation (92.7% [85.9-96.3%]) and matching recipients from donors without extracorporeal membrane oxygenation (95.4% [93.0-97.0%]). We also found no significant difference in 1-year liver recipient survival (p = 0.91): 86.5% (70.5-94.1) from donors on extracorporeal membrane oxygenation versus 80.7% (79.8-81.6) from donors without extracorporeal membrane oxygenation. Brain-dead patients with ongoing extracorporeal membrane oxygenation have more severe medical conditions than those without extracorporeal membrane oxygenation. However, kidney graft survival and function were no different than usual. Brain-dead patients with ongoing extracorporeal membrane oxygenation are suitable for organ procurement.

  20. Prone Position Ventilation Used during a Transfer as a Bridge to Ecmo Therapy in Hantavirus-Induced Severe Cardiopulmonary Syndrome

    Directory of Open Access Journals (Sweden)

    R. Cornejo

    2013-01-01

    Full Text Available Background. Transport of critically ill patients is a complex issue. We present a case using prone positioning as a bridge to extracorporeal membrane oxygenation (ECMO, performed by a critical retrieval team from a university hospital. Case Report. A 28-year-old male developed fever, progressive respiratory failure, and shock. He was admitted to ICU from a public hospital, and mechanical ventilation was begun, but clinical response was not adequate. ECMO was deemed necessary due to severe respiratory failure and severe shock. A critical retrieval team of our center was assembled to attempt transfer. Prone positioning was employed to stabilize and transfer the patient, after risk-benefit assessment. Once in our hospital, ECMO was useful to resolve shock and pulmonary edema secondary to Hantavirus cardiopulmonary syndrome. Finally, he was discharged with normal functioning. Conclusion. This case exemplifies the relevance of a retrieval team and bridge therapy. Prone positioning improves oxygenation and is safe to perform as transport if performed by a trained team as in this case. Preparation and organization is necessary to improve outcomes, using teams and organized networks. Catastrophic respiratory failure and shock should not be contraindications to transferring patients, but it must be done with an experienced team.

  1. Rare cause of respiratory failure in a young woman: isolated diffuse alveolar haemorrhage requiring extracorporeal membrane oxygenation.

    Science.gov (United States)

    Kelly, David; Makkuni, Damodar; Ail, Dhiraj

    2017-08-03

    A previously healthy 21-year-old young woman presented with worsening dyspnoea and haemoptysis. Imaging was suggestive of widespread pulmonary haemorrhage. There was no other organ system involvement in particular no evidence of renal involvement. Raised antimyeloperoxidase titres allowed diagnosis of isolated diffuse alveolar haemorrhage (DAH) secondary to microscopic polyangiitis (MPA). The patient rapidly deteriorated with worsening respiratory failure despite invasive mechanical ventilation and required extracorporeal membrane oxygenation (ECMO). This maintained the patient long enough to allow aggressive therapy in the form of immunosuppression and plasma exchange. She made a remarkable recovery and is asymptomatic 2 years on. Isolated DAH in the absence of renal disease is an atypical presentation of MPA and can lead to diagnostic uncertainty. A literature review reveals increasing reports of successful use of ECMO in severe DAH due to pulmonary vasculitis. Despite this, the need for systemic anticoagulation in the presence of pre-existing haemorrhage remains a challenging dilemma. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  2. FIVE-YEAR EXPERIENCE IN PERIPHERAL VENOARTERIAL EXTRACORPOREAL MEMBRANE OXYGENATION AS A METHOD OF MECHANICAL CIRCULATORY SUPPORT IN POTENTIAL HEART TRANSPLANT RECIPIENTS

    Directory of Open Access Journals (Sweden)

    S. V. Gautier

    2016-01-01

    Full Text Available Introduction. Venoarterial extracorporeal membrane oxygenation (VA ECMO is one of the most widely used methods of temporary mechanical circulatory support (MCS during the preparation and performance of heart transplant surgery (HT [Barth E. et al., 2012; Kittleson M.M. et al., 2011].Aim of this study was to assess the effectiveness of using peripheral VA ECMO as a method of mechanical circulatory support in potential heart transplant recipients that urgently required transplantation.Materials and methods. The study included 125 potential heart transplant recipients (107 (86% men and 18 (14% women aged from 12 to 72 (43 ± 1.2 years with a peripheral VA ECMO system installed within the period from April 01, 2011 till August 12, 2016. The indication for the start of its use was rapidly progressing congestive heart failure (CHF of level 1 or 2 by the INTERMACS scale. Femoral blood vessel cannulation was performed using both open (surgical and closed (puncture methods. 23 and 25 F venous cannulae were utilized for femoral vein cannulation, and 15 and 17 F arterial cannulae were utilized for femoral artery cannulation. In all cases superfi cial femoral artery catheterization (14 F single-lumen catheter or cannulation (8 or 10 F arterial cannula was performed in the descending (anterograde direction for the prevention of lower limb ischemia on the side of the femoral artery cannulation.Results. The peripheral cannulation method was used to perform VA ECMO in 100% (n = 125 observations. In 69 (55.2% patients the severity of progressive CHF corresponded to INTERMACS level 1; in 51 (40.8% cases it corresponded to INTERMACS level 2. During VA ECMO the average volumetric extracorporeal circulation fl ow rate ranged from 2.2 to 4.5 (3.2 ± 0.4 l/min or 1.6 ± 0.2 l/min/m2 with the average rotation speed of the centrifugal pump of 3.216 ± 105 rpm. 113 (90.4% of 125 potential recipients underwent HT. The duration of VA ECMO prior to HT (n

  3. Ceramic oxygen transport membrane array reactor and reforming method

    Science.gov (United States)

    Kelly, Sean M.; Christie, Gervase Maxwell; Robinson, Charles; Wilson, Jamie R; Gonzalez, Javier E.; Doraswami, Uttam R.

    2017-10-03

    The invention relates to a commercially viable modular ceramic oxygen transport membrane system for utilizing heat generated in reactively-driven oxygen transport membrane tubes to generate steam, heat process fluid and/or provide energy to carry out endothermic chemical reactions. The system provides for improved thermal coupling of oxygen transport membrane tubes to steam generation tubes or process heater tubes or reactor tubes for efficient and effective radiant heat transfer.

  4. Oxygenated shunting from right to left: a feasibility study of minimized atrio-atrial extracorporeal membrane oxygenation for mid-term lung assistance in an acute ovine model.

    Science.gov (United States)

    Haushofer, Marcus; Abusabha, Yousef; Amerini, Andrea L A; Spillner, Jan; Nix, Christoph; Autschbach, Rüdiger; Goetzenich, Andreas; Hatam, Nima

    2013-07-01

    Right ventricular failure is often the final phase in acute and chronic respiratory failure. We combined right ventricular unloading with extracorporeal oxygenation in a new atrio-atrial extracorporeal membrane oxygenation (ECMO). Eleven sheep (65 kg) were cannulated by a 28-Fr inflow cannula to the right atrium and a 25-Fr outflow cannula through the lateral left atrial wall. Both were connected by a serial combination of a microaxial pump (Impella Elect(®), Abiomed Europe, Aachen, Germany) and a membrane oxygenator (Novalung(®)-iLA membrane oxygenator; Novalung GmbH, Hechingen, Germany). In four animals, three subsequent states were evaluated: normal circulation, apneic hypoxia and increased right atrial after load by pulmonary banding. We focused on haemodynamic stability and gas exchange. All animals reached the end of the study protocol. In the apnoea phase, the decrease in PaO2 (21.4 ± 3.6 mmHg) immediately recovered (179.1 ± 134.8 mmHg) on-device in continuous apnoea. Right heart failure by excessive after load decreased mean arterial pressure (59 ± 29 mmHg) and increased central venous pressure and systolic right ventricular pressure; PaO2 and SvO2 decreased significantly. On assist, mean arterial pressure (103 ± 29 mmHg), central venous pressure and right ventricular pressure normalized. The SvO2 increased to 89 ± 3% and PaO2 stabilized (129 ± 21 mmHg). We demonstrated the efficacy of a miniaturized atrio-atrial ECMO. Right ventricular unloading was achieved, and gas exchange was well taken over by the Novalung. This allows an effective short- to mid-term treatment of cardiopulmonary failure, successfully combining right ventricular and respiratory bridging. The parallel bypass of the right ventricle and lung circulation permits full unloading of both systems as well as gradual weaning. Further pathologies (e.g. ischaemic right heart failure and acute lung injury) will have to be evaluated.

  5. Factors Determining the Oxygen Permeability of Biological Membranes: Oxygen Transport Across Eye Lens Fiber-Cell Plasma Membranes.

    Science.gov (United States)

    Subczynski, Witold Karol; Widomska, Justyna; Mainali, Laxman

    2017-01-01

    Electron paramagnetic resonance (EPR) spin-label oximetry allows the oxygen permeability coefficient to be evaluated across homogeneous lipid bilayer membranes and, in some cases, across coexisting membrane domains without their physical separation. The most pronounced effect on oxygen permeability is observed for cholesterol, which additionally induces the formation of membrane domains. In intact biological membranes, integral proteins induce the formation of boundary and trapped lipid domains with a low oxygen permeability. The effective oxygen permeability coefficient across the intact biological membrane is affected not only by the oxygen permeability coefficients evaluated for each lipid domain but also by the surface area occupied by these domains in the membrane. All these factors observed in fiber cell plasma membranes of clear human eye lenses are reviewed here.

  6. Percutaneous Mechanical Circulation Support Combined with Extracorporeal Membrane Oxygenation (oxyRVAD) in Secondary Right Heart Failure.

    Science.gov (United States)

    Lepper, Philipp M; Hörsch, Sabrina I; Seiler, Frederik; Kamp, Annegret; Becker, Sören L; Lensch, Christian; Conzelmann, Lars O; Haake, Hendrik; Muellenbach, Ralf M; Bals, Robert; Kredel, Markus; Langer, Frank; Wilkens, Heinrike; Trudzinski, Franziska C

    2018-02-06

    Right heart failure (RHF) because of pulmonary hypertension (PH) is a frequently encountered clinical problem with high mortality. The last resort, if pharmacological therapy fails, is mechanical circulatory support. There is a lack of percutaneous systems to support the right ventricle (RV). Venoarterial extracorporeal membrane oxygenation is widely used as a bailout in acute RHF in non-left ventricular assist device patients. Venoarterial extracorporeal membrane oxygenation does not unload the left ventricle and may cause failure of the left ventricle if used for a longer period of time. We report the long-term use of an ECMO-based percutaneous right ventricular assist system (oxyRVAD) capable to deliver up to 6 L/min of blood flow with a returning cannula placed in the main pulmonary artery used in RHF originating from PH with poor oxygenation. We present a series of four patients on oxyRVAD (mean treatment duration 15 ± 7.6 days). Patients benefited from the system clinically; however, two patients eventually died while on oxyRVAD. Nevertheless, we provide a proof-of-concept of this system in PH patients, which is feasible and might provide a useful "bridge-to-recovery" or "bridge-to-transplant" option in the management of patients with severe RHF because of PH.

  7. Feasibility of perflutren microsphere contrast transthoracic echocardiography in the visualization of ventricular endocardium during venovenous extracorporeal membrane oxygenation in a validated ovine model.

    Science.gov (United States)

    Platts, David G; Diab, Sara; Dunster, Kimble R; Shekar, Kiran; Burstow, Darryl J; Sim, Beatrice; Tunbridge, Matthew; McDonald, Charles; Chemonges, Saul; Chan, Jonathan; Fraser, John F

    2015-03-01

    Transthoracic echocardiography (TTE) during extra corporeal membrane oxygenation (ECMO) is important but can be technically challenging. Contrast-specific TTE can improve imaging in suboptimal studies. These contrast microspheres are hydrodynamically labile structures. This study assessed the feasibility of contrast echocardiography (CE) during venovenous (VV) ECMO in a validated ovine model. Twenty-four sheep were commenced on VV ECMO. Parasternal long-axis (Plax) and short-axis (Psax) views were obtained pre- and postcontrast while on VV ECMO. Endocardial definition scores (EDS) per segment were graded: 1 = good, 2 = suboptimal 3 = not seen. Endocardial border definition score index (EBDSI) was calculated for each view. Endocardial length (EL) in the Plax view for the left ventricle (LV) and right ventricle (RV) was measured. Summation EDS data for the LV and RV for unenhanced TTE (UE) versus CE TTE imaging: EDS 1 = 289 versus 346, EDS 2 = 38 versus 10, EDS 3 = 33 versus 4, respectively. Wilcoxon matched-pairs rank-sign tests showed a significant ranking difference (improvement) pre- and postcontrast for the LV (P < 0.0001), RV (P < 0.0001) and combined ventricular data (P < 0.0001). EBDSI for CE TTE was significantly lower than UE TTE for the LV (1.05 ± 0.17 vs. 1.22 ± 0.38, P = 0.0004) and RV (1.06 ± 0.22 vs. 1.42 ± 0.47, P = 0.0.0006) respectively. Visualized EL was significantly longer in CE versus UE for both the LV (58.6 ± 11.0 mm vs. 47.4 ± 11.7 mm, P < 0.0001) and the RV (52.3 ± 8.6 mm vs. 36.0 ± 13.1 mm, P < 0.0001), respectively. Despite exposure to destructive hydrodynamic forces, CE is a feasible technique in an ovine ECMO model. CE results in significantly improved EDS and increased EL. © 2014, Wiley Periodicals, Inc.

  8. Ultramicroelectrode studies of oxygen reduction in polyelectrolyte membranes

    Energy Technology Data Exchange (ETDEWEB)

    Holdcroft, S.; Abdou, M.S.; Beattie, P.; Basura, V. [Simon Fraser Univ., Burnaby, BC (Canada). Dept. of Chemistry

    1997-12-31

    A study on the oxygen reduction reaction in a solid state electrochemical cell was presented. The oxygen reduction reaction is a rate limiting reaction in the operation of solid polymer electrolyte fuel cells which use H{sub 2} and O{sub 2}. Interest in the oxygen reduction reaction of platinum electrodes in contact with Nafion electrolytes stems from its role in fuel cell technology. The kinetics of the oxygen reduction reaction in different polyelectrolyte membranes, such as Nafion and non-Nafion membranes, were compared. The electrode kinetics and mass transport parameters of the oxygen reduction reaction in polyelectrolyte membranes were measured by ultramicroelectrode techniques. The major difference found between these two classes of membrane was the percentage of water, which is suggestive of superior electrochemical mass transport properties of the non-Nafion membranes. 2 refs. 1 fig.

  9. Experience in the management of ECMO therapy as a mortality risk factor.

    Science.gov (United States)

    Guilló Moreno, V; Gutiérrez Martínez, A; Romero Berrocal, A; Sánchez Castilla, M; García-Fernández, J

    2018-02-01

    The extracorporeal oxygenation membrane (ECMO) is a system that provides circulatory and respiratory assistance to patients in cardiac or respiratory failure refractory to conventional treatment. It is a therapy with numerous associated complications and high mortality. Multidisciplinary management and experienced teams increase survival. Our purpose is to evaluate and analyse the effect of the learning curve on mortality. Retrospective and observational study of 31 patients, from January 2012 to December 2015. Patients were separated into 2periods. These periods were divided by the establishment of an ECMO protocol. We compared the quantitative variables by performing the Mann-Whitney U test. For the categorical qualitative variables we performed the chi-square test or Fisher exact statistic as appropriate. The survival curve was computed using the Kaplan-Meier method, and the analysis of statistical significance using the Log-rank test. Data analysis was performed with the STATA programme 14. Survival curves show the tendency to lower mortality in the subsequent period (P=0.0601). The overall mortality rate in the initial period was higher than in the subsequent period (P=0.042). In another analysis, we compared the characteristics of the 2groups and concluded that they were homogeneous. The degree of experience is an independent factor for mortality. The application of a care protocol is fundamental to facilitate the management of ECMO therapy. Copyright © 2017 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  10. Successful Use of Extracorporeal Membrane Oxygenation for Respiratory Failure Caused by Mediastinal Precursor T Lymphoblastic Lymphoma

    OpenAIRE

    Masafumi Oto; Kyoko Inadomi; Toshiyuki Chosa; Shima Uneda; Soichi Uekihara; Minoru Yoshida

    2014-01-01

    Precursor T lymphoblastic lymphoma (T-LBL) often manifests as a mediastinal mass sometimes compressing vital structures like vessels or large airways. This case was a 40-year-old male who developed T-LBL presenting as respiratory failure caused by mediastinal T-LBL. He presented with persistent life threatening hypoxia despite tracheal intubation. We successfully managed this respiratory failure using venovenous (VV) ECMO. Induction chemotherapy was started after stabilizing oxygenation and t...

  11. Solid state oxygen anion and electron mediating membrane and catalytic membrane reactors containing them

    Science.gov (United States)

    Schwartz, Michael; White, James H.; Sammels, Anthony F.

    2000-01-01

    This invention relates to gas-impermeable, solid state materials fabricated into membranes for use in catalytic membrane reactors. This invention particularly relates to solid state oxygen anion- and electron-mediating membranes for use in catalytic membrane reactors for promoting partial or full oxidation of different chemical species, for decomposition of oxygen-containing species, and for separation of oxygen from other gases. Solid state materials for use in the membranes of this invention include mixed metal oxide compounds having the brownmillerite crystal structure.

  12. Adaptive periodic paralysis allows weaning deep sedation overcoming the drowning syndrome in ECMO patients bridged for lung transplantation: A case series.

    Science.gov (United States)

    Timofte, Irina; Terrin, Michael; Barr, Erik; Kim, June; Rinaldi, Joseph; Ladikos, Nicholas; Menaker, Jay; Tabatabai, Ali; Kon, Zachary; Griffith, Bartley; Pierson, Richard; Pham, Si; Iacono, Aldo; Herr, Daniel

    2017-12-01

    Sedation in extracorporeal membrane oxygenation (ECMO) is challenging. Patients require deep sedation because of extremely high respiratory rates and increased work of breathing ("Drowning Syndrome") resulting in altered intra-thoracic pressure and reduced pump flow associated with hemodynamic compromise and decreased oxygenation. However, deep sedation impedes essential active rehabilitation with physical therapy. We reviewed data on 3 ECMO patients for whom we used a novel approach to replace continuous drips with periodic sedation/paralysis. Initially our patients were on high dose narcotics, propofol, and dexmedetomidine and unable to interact and breathe comfortably. IV narcotics were weaned over 24h and were replaced by methadone. Dexmedetomidine was continued in order to block hyperadrenergic events. Propofol was weaned at a prescribed rate. When patients demonstrated agitation, decreased pump flow and hemodynamic compromise, diazepam was given in combination with a paralytic. By replacing IV narcotic and propofol, with PRN diazepam and vecuronium, patients were off continuous drips in 1week and were able to actively participate in physical therapy. Allowing patients to wake up by rapid weaning of continuous narcotics and anesthetic agents using Dexmedetomidine and periodic paralysis to favorably alter hemodynamics is a successful method to wean deep sedation in ECMO. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. SUCCESSFUL APPLICATION OF PERIPHERAL VENO-ARTERIAL EXTRACORPOREAL MEMBRANE OXYGENATION FOR CARDIAC ALLOGRAFT ANTIBODY-MEDIATED REJECTION WITH SEVERE HEMODYNAMIC COMPROMISE

    Directory of Open Access Journals (Sweden)

    V. N. Poptsov

    2015-01-01

    Full Text Available Introduction. Acute antibody-mediated rejection (AMR is one of the severe complications of early and late period after heart transplantation (HT. Only few case reports and studies presented of mechanical circulatory support (MCS application for refractory acute rejection causing hemodynamic compromise. Aim. We report the case of a woman with cardiogenic shock caused by severe AMR that was successfully treatment by peripheral venoarterial extracorporeal membrane oxygenation (VA ECMO. Material and methods. In december 2014, a 60-year-old woman with dilated cardiomyopathy was operated for HT. The patient had a good initial cardiac allograft function and no and was discharged from ICU on the 4th day after HT. 1st endomyocardial biopsy (EMB (the 7th day after HT showed absence of acute cellular and antibody-mediated rejection. On the 11th day after HT patient aggravated and presented clinical signs of life-threatening acute cardiac allograft dysfunction: arterial blood pressure 78/49/38 mm Hg, HR 111 in min, CVP 20 mm Hg, PAP 47/34/25 mm Hg, PCWP 25 mm Hg, CI 1.5 l/min/m2, adrenalin 110 ng/kg/min, dopamine 15 mcg/kg/min. ECG showed impairment of systolic left (LVEF 25% and right (RVEF 15% ventricle function, left and right ventricle diffuse hypokinesis, thickness of IVS, LV and RV wall 1.7, 1.4 and 0.8 cm, tricuspid and mitral valve regurgitation 2–3 degrees. EMB presented AMR. In conscience peripheral VA ECMO was installed. We used peripheral transcutaneous cannulation technique via femoral vessels – arterial cannula 15 F, venous cannula – 23 F, vascular catheter 14 G for anterograde leg’s perfusion. ACT 130–150 sec. AMR therapy included: methylprednisolon pulse-therapy (10 mg/kg for 5 day, IgG, plasmapheresis (No 7, rituximab. Results. Under MCS by VA ECMO we noted quick improvement of hemodynamic, metabolic homeostasis and organ functions. On the 6th day of VA ECMO (blood flow 1.8 l/min: arterial blood pressure 133/81/54 mm Hg, CVP 5 mm

  14. Successful extracorporeal membrane oxygenation therapy as a bridge to sequential bilateral lung transplantation for a patient after severe paraquat poisoning.

    Science.gov (United States)

    Tang, Xiao; Sun, Bing; He, Hangyong; Li, Hui; Hu, Bin; Qiu, Zewu; Li, Jie; Zhang, Chunyan; Hou, Shengcai; Tong, Zhaohui; Dai, Huaping

    2015-11-01

    Paraquat is a widely used herbicide that can cause severe to fatal poisoning in humans. The irreversible and rapid progression of pulmonary fibrosis associated with respiratory failure is the main cause of death in the later stages of poisoning. There are infrequent reports of successful lung transplants for cases of severe paraquat poisoning. We expect that this successful case will provide a reference for other patients in similar circumstances. A 24-year-old female was sent to the hospital approximately 2 hours after ingesting 50 ml of paraquat. She experienced rapidly aggravated pulmonary fibrosis and severe respiratory failure. On the 34th day after ingestion, she underwent intubation and invasive mechanical ventilation. The patient was evaluated for lung transplantation, and veno-venous extracorporeal membrane oxygenation (ECMO) was established as a bridge to lung transplantation on the 44th day. On the 56th day, she successfully underwent a bilateral sequential lung transplantation. Through respiratory and physical rehabilitation and nutrition support, the patient was weaned from mechanical ventilation and extubated on the 66th day. On the 80th day, she was discharged. During the 1-year follow-up, the patient was found to be in good condition, and her pulmonary function improved gradually. We suggest that lung transplantation may be an effective treatment in the end stages of paraquat-induced pulmonary fibrosis and consequential respiratory failure. For patients experiencing a rapid progression to a critical condition in whom lung transplantation cannot be performed immediately (e.g., while awaiting a viable donor or toxicant clearance), ECMO should be a viable bridge to lung transplantation.

  15. Effects of Mini-Volume Priming During Cardiopulmonary Bypass on Clinical Outcomes in Low-Bodyweight Neonates: Less Transfusion and Postoperative Extracorporeal Membrane Oxygenation Support.

    Science.gov (United States)

    Kim, Sang Yoon; Cho, Sungkyu; Choi, Eunseok; Kim, Woong-Han

    2016-01-01

    Mixing of autologous blood with priming volume has relatively significant effects on blood composition, especially in low-bodyweight neonates. In an effort to reduce these effects, mini-volume priming (MP) has been applied in cardiopulmonary bypass (CPB). The present study was designed to examine the effect of MP on clinical outcomes of low-bodyweight neonates undergoing open heart surgery.We retrospectively reviewed medical records of low-bodyweight (2.5 kg or less) neonates who underwent open heart surgery in our center from January 2000 to December 2014. A total of 64 patients were included. MP was introduced in 2007, and became a routine protocol in 2009. Preoperative and intraoperative characteristics included age, bodyweight, RACHS-1, priming volume, CPB time, and aortic cross-clamp time, transfusion, and hematocrit during CPB. Clinical outcomes included 30-day mortality, postoperative extracorporeal membrane oxygenation (ECMO) support, open sternum status, prolonged mechanical ventilation care (>7 days), and acute renal failure. MP was utilized in 39 patients and conventional priming (CP) was used in 25 patients. The priming volume decreased to 126.0 mL in the MP group compared with 321.6 mL in the CP group. Transfusion volume during CPB was 87.3 mL in the MP group versus 226.8 mL in the CP group, and the difference was statistically significant (P priming volume and higher RACHS-1 were significant risk factors of postoperative ECMO support in univariate and multivariate analysis. The results of the present study suggest that MP may be beneficial in avoiding transfusion without having a significant effect on the hematocrit. Clinical outcomes did not differ between the two groups. However, larger priming volume was a significant risk factor for postoperative ECMO support with RACHS-1 category. Copyright © 2015 International Center for Artificial Organs and Transplantation and Wiley Periodicals Inc.

  16. Processing of membranes for oxygenation using the Bellhouse-effect

    Directory of Open Access Journals (Sweden)

    Neußer C.

    2015-09-01

    Full Text Available State-of-the-art lung support systems are limited to short time application because of a lack of long term hemocompatibility and protein absorption on the membrane surfaces. In a highly interdisciplinary project at RWTH Aachen University a biohybrid lung assist system with endothelialised gas exchange flat membranes is developed to improve long term compatibility of oxygenators. To increase the gas exchange performance of flat membranes hollows are imprinted in the membrane surfaces. This approach is based on the research of B. J. Bell-house et al. [1], who discovered this effect, now known as Bellhouse-effect, around 1960. In this paper a processes to manufacture membrane assemblies for oxygenation with imprinted hollows on the flat membrane surfaces is reviewed.

  17. ATIVIDADE DA LACTATO DESIDROGENASE (LDH SÉRICA EM CÃES SUBMETIDOS À OXIGENAÇÃO EXTRACORPÓREA POR MEMBRANA (ECMO POR UM PERÍODO DE TRÊS HORAS

    Directory of Open Access Journals (Sweden)

    FELIPP SILVEIRA FERREIRA

    2011-09-01

    Full Text Available The extracorporeal membrane oxygenation (ECMO is a prolonged cardiopulmonary support technique, which aims to help the lungs and the heart when they do not respond to conventional non-invasive treatments. This research was carried out to determine the behavior oflactate dehydrogenase (LDH of five mongrel dogs undergoing ECMO for three hours. Under controlled ventilation, positive end-expiratory pressure (PEEP at 10mmHg and FiO2 at 21%, the animals were submitted to femoral cannulation for ECMO (artery and vein, by the arterial-venous (AV deviation. The LDH was measured and evaluated every thirty minutes for an uninterrupted period of three hours. The results were tabulated and statistically analyzed with ANOVA and Tukey tests, with p<0.05. The results showed an increase of serum LDH,featuring a muscle injury during the procedure due to a physiological response, similar to that caused by a hypovolemic shock. We concluded that ECMO is a viable technique for prolonged ventilatory support, but it needs some adjustments for clinical use in dogs.

  18. The development of zirconia membrane oxygen separation technology

    International Nuclear Information System (INIS)

    Chiacchi, F.T.; Badwal, S.P.S.; Velizko, V.

    2000-01-01

    The oxygen separation technology based on ceramic membranes constructed from stabilised zirconia is currently under development for applications ranging from oxygen generation or air enrichment for medical use to control of oxygen concentration or oxygen removal from gas streams and enclosures for semiconductor, food packaging and process control instrumentation industries. The technology is based on a rugged tubular design with extensive thermal cycling capability. Several single and three tube devices have been operated for periods up to 5000h. An eight tube module, as a building block for larger scale oxygen production or removal devices, has been constructed and is being evaluated. In this paper, the construction of the device, oxygen generating capacity, life time tests and performance of the ceramic membrane device under development at CSIRO will be discussed. Copyright (2000) The Australian Ceramic Society

  19. Reducing hospital-acquired pressure ulcers using bundle methodology in pediatric and neonatal patients receiving extracorporeal membrane oxygenation therapy: An integrative review and call to action.

    Science.gov (United States)

    Courtwright, Suzanne E; Mastro, Kari A; Preuster, Christa; Dardashti, Navid; McGill, Sandra; Madelon, Myrlene; Johnson, Donna

    2017-10-01

    This review focuses on identifying (1) evidence of the effectiveness of care bundle methodology to reduce hospital-acquired pressure ulcers (HAPUs) in pediatric and neonatal patients receiving extracorporeal membrane oxygenation (ECMO) therapy and (2) barriers to implementing HAPU care bundles in this at-risk population. An integrative review was conducted and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A search of the scientific literature was performed. Studies included were published between January 2011 and February 2016. A total of seven articles met inclusion criteria. Data were extracted from each published article and analyzed to identify common themes, specifically bundle methodology and barriers to implementing HAPU bundles, in this population. There is limited research on effectiveness of care bundle methodology in reducing HAPUs in children, and no research specific to its effectiveness in pediatric or neonatal ECMO patients. No research was identified studying barriers to implementation of HAPU care bundles in this population. Nurses are well poised to test innovative strategies to prevent HAPUs. Nurses should consider implementing and testing bundle methodology to reduce HAPU in this at-risk population, and conduct research to identify any barriers to implementing this strategy. There is literature to support the use of nurses as unit-based skin care champions to facilitate teamwork and reliable use of the bundle, both critical components to the success of bundle methodology. © 2017 Wiley Periodicals, Inc.

  20. Extracorporeal membrane oxygenator as a bridge to successful surgical repair of bronchopleural fistula following bilateral sequential lung transplantation: a case report and review of literature

    Directory of Open Access Journals (Sweden)

    Machaal Ali

    2007-06-01

    Full Text Available Abstract Background Lung transplantation (LTx is widely accepted as a therapeutic option for end-stage respiratory failure in cystic fibrosis. However, airway complications remain a major cause of morbidity and mortality in these patients, serious airway complications like bronchopleural fistula (BPF are rare, and their management is very difficult. Case presentation A 47-year-old man with end-stage respiratory failure due to cystic fibrosis underwent bilateral sequential lung transplantation. Severe post-operative bleeding occurred due to dense intrapleural adhesions of the native lungs. He was re-explored and packed leading to satisfactory haemostasis. He developed a bronchopleural fistula on the 14th post-operative day. The fistula was successfully repaired using pericardial and intercostal vascular flaps with veno-venous extracorporeal membrane oxygenator (VV-ECMO support. Subsequently his recovery was uneventful. Conclusion The combination of pedicled intercostal and pericardial flaps provide adequate vascular tissue for sealing a large BPF following LTx. Veno-venous ECMO allows a feasible bridge to recovery.

  1. Mechanical reliability of geometrically imperfect tubular oxygen transport membranes

    DEFF Research Database (Denmark)

    Kwok, Kawai; Frandsen, Henrik Lund; Søgaard, Martin

    2014-01-01

    operation. This paper investigates numerically the failure risk of tubular oxygen transport membranes under industrial operating conditions using finite element modeling and Weibull strength analysis. The effects of component manufacturing defects on fracture probability are elucidated by explicit modeling...... of imperfections in the tubular membrane geometry. A supported membrane made of dense and porous Zr-doped-BSCF is studied as an illustrative example. It is shown that stresses induced by oxygen stoichiometry gradients relax over time due to creep and external pressure is the dominating source of stress in the long...... quality (in terms of specification of tolerable deviation from perfect tubular shape) that allows fail-safe operation are deduced....

  2. Corrosion studies of oxygen permeating membrane materials

    Energy Technology Data Exchange (ETDEWEB)

    Waindich, Arleta; Mueller, Michael [Forschungszentrum Juelich GmbH (DE). Inst. fuer Energieforschung (IEF)

    2010-07-01

    Different perovskite-type materials being considered as oxygen membrane material for the OXY-COAL-AC process were investigated in the present study regarding their chemical stability under OXYCOAL-AC process conditions, namely La{sub 1-x}Sr{sub x}CO{sub 0.8}Fe{sub 0.2}O{sub 3-{delta}} (0.3{<=} x {<=} 0.8, LSCF YX28), La{sub 0.3}Ba{sub 0.7}Co{sub 0.8}Fe{sub 0.2}O{sub 3-{delta}} (LBCF 3728), Ba{sub 0.3}Sr{sub 0.7}Co{sub 0.8}Fe{sub 02}O{sub 3-{delta}} (BSCF 3728), Ba{sub 0.5}Sr{sub 05}CO{sub 0.2}Fe{sub 0.8}O{sub 3-{delta}} (BSCF 5582) and La{sub 2}NiO{sub 4}. Powders of all materials were uniaxially pressed into pellets and annealed under simulated feed-side conditions (72% N{sub 2}, 19 % O{sub 2}, 9% CO{sub 2}, 200 hours) and under simulated flue-gas-side conditions (61% CO{sub 2}, 30 % H{sub 2}O, 9% O{sub 2} + Na{sub 2}CO{sub 3} deposit or 61% CO{sub 2}, 29.8% H{sub 2}O, 9% O{sub 2}, 0.2% SO{sub 2}, + Na{sub 2}SO{sub 4}-K{sub 2}SO{sub 4}-eutectic deposit, 96 hours) in a temperature range of 600-800 C. Sample characterization was performed using light microscopy (LM), Scanning Electron Microscopy (SEM) with Energy Dispersive X-Ray Spectroscopy (EDX) and X-Ray Powder Diffraction (XRD). Some of the calcined LSCF compositions included Fe-Co-O precipitations. Generally speaking, corrosion increased with rising temperature. Feed-side conditions only influenced BSCF 5582. Flue-gas-side conditions caused severe corrosion on all materials. Top faces under the deposit were always more affected than sample sides only exposed to gaseous medium. The stability of LSCF materials enhanced with rising lanthanum content, especially when Na{sub 2}CO{sub 3} deposit was used. SrCO{sub 3}, Fe{sub 3}O{sub 4} and Fe-Co-O were the detected phases. LBCF 3728 and the BSCF materials mainly degraded to BaCO{sub 3} and BaSO{sub 4} referring to the deposits Na{sub 2}CO{sub 3} and Na{sub 2}SO{sub 4}-K{sub 2}SO{sub 4}-eutectic. In the case of La{sub 2}NiO{sub 4}, La{sub 2}O{sub 2}CO{sub 3} or La

  3. Yttrium doped BSCF membranes for oxygen separation

    DEFF Research Database (Denmark)

    Haworth, P.; Smart, S.; Glasscock, Julie

    2011-01-01

    (x = 0.2) for iron resulted in a non-cubic crystal structure that did not exhibit oxygen permeation. The yttrium partial substitution in BSCFY discs (1.2 mm thick) delivered best results for x = 0.025, as oxygen fluxes reached 2.05 ml cm−2 min−1 at 900 °C, an increase of 160% as compared to a blank...

  4. HIGH PERFORMANCE CERIA BASED OXYGEN MEMBRANE

    DEFF Research Database (Denmark)

    2014-01-01

    The invention describes a new class of highly stable mixed conducting materials based on acceptor doped cerium oxide (CeO2-8 ) in which the limiting electronic conductivity is significantly enhanced by co-doping with a second element or co- dopant, such as Nb, W and Zn, so that cerium and the co-...... thin film membrane devices using these materials....

  5. Extracorporeal Membrane Oxygenation and Modern Detoxification Techniques in a Puerpera with Viral and Bacterial Pneumonia Caused by Flu A(H1N1 Virus

    Directory of Open Access Journals (Sweden)

    R. A. Kornelyuk

    2017-01-01

    Full Text Available Outbreaks of viral infections have become a global healthcare challenge over the last decade. The 2009—2010 flu A (H1N1 outbreak resulted in global pandemia, associated with high morbidity and mortality reaching 31%. Another flu A (H1N1 outbreak occurred in 2015—2016. There is a strong probability that it may be repeated in the future. This infection is associated with its high incidence among pregnant women. There are some published reports describing the efficacy and safety of veno%venous extracorporeal membrane oxygenation (ECMO in patients with severe acute respiratory distress syndrome that is refractory to standard therapeutic options. The article presents a clinical case of a successful use of extracorporeal membrane oxygenation and intermittent renal replacement therapy in a puerpera with acute respiratory distress syndrome caused by flu A (H1N1-related severe viral and bacterial pneumonia. The positive effects of the combination of veno%venous extracorporeal membrane oxygenation and modern detoxification techniques have been demonstrated. Revealed organizational problemswere related to selection criteria for prescription of extracorporeal gas exchange, as well as to carrying out the procedure in an institution in the deficiency of the experienced staff and corresponding equipment.

  6. Aortic regurgitation and extracorporeal membrane oxygenation: An undiscussed topic

    Directory of Open Access Journals (Sweden)

    Fabrizio Sansone

    2012-01-01

    Full Text Available The aim of this short discussion is to open the question of the AR in case of ECMO implantation. This is the case of a young male admitted to the hospital for acute cardiac failure in chronic dilated cardio-myopathy due to aortic regurgitation (AR: the patient had previously refused aortic valve replacement (AVR for the fear of postoperative outcome. Further studies are required to assess this topic and the perspectives to increase the use of the peripheral ECMO and the percutaneous ventricular venting through the interatrial septum may be of interest to improve the outcome of such ill patients.

  7. RECENT PROGRESS OF OXYGEN/NITROGEN SEPARATION USING MEMBRANE TECHNOLOGY

    Directory of Open Access Journals (Sweden)

    K. C. CHONG

    2016-07-01

    Full Text Available The oxygen-enriched air is highly demanded for various industrial applications such as medical, chemical and enhanced combustion processes. The conventional oxygen/nitrogen production is either cryogenic distillation or pressure swing adsorption (PSA. Both of these techniques possess the production capability of 20 to 300 tonnes of oxygen per day and oxygen purity of more than 95%. However, these techniques are energy intensive. Alternatively, membrane technology is an emerging technology in gas separation as it requires low energy consumption and relatively moderate production volume, if compared to the conventional gas production techniques. These advantages have spurred much interest from industries and academics to speed up the commercial viability of the O2/N2 separation via membrane technology. In this review, the conventional and membrane technologies in O2/N2 separation, as well as recent development of membrane fabrication techniques and materials are reviewed. The latest membrane performance in O2/N2 separation is also tabulated and discussed.

  8. Prospects and problems of dense oxygen permeable membranes

    DEFF Research Database (Denmark)

    Hendriksen, P.V.; Larsen, P.H.; Mogensen, Mogens Bjerg

    2000-01-01

    The prospects of using mixed ionic/electronic conducting ceramics for syngas production in a catalytic membrane reactor are analysed. Problems relating to limited thermodynamic stability and poor dimensional stability of candidate materials are addressed, The consequences for these problems......, of flux improving measures like minimization of membrane thickness and minimization of the losses due to oxygen exchange over the membrane surfaces, are discussed. The analysis is conducted on two candidate materials: La0.6Sr0.4Co0.2Fe0.8O3-delta and SrFeCo0.5Ox. Finally. experimental investigations...

  9. Development of thin film inorganic membranes for oxygen separation

    Energy Technology Data Exchange (ETDEWEB)

    Moon, Hyo Jeong

    2012-08-22

    Membrane-based gas separation systems are noteworthy among technological options for carbon capture and storage (CCS), which is an important strategy to reduce CO{sub 2} emitted from point sources, e.g. mainly fossil power plants. In Oxyfuel-Combustion and Pre-Combustion of CCS power plant concepts oxygen separation from air is required. To meet this requirement oxygen transport membranes (OTM) consisting of gastight mixed ionic electronic conductors (MIEC) are proposed, which are associated with significantly lower efficiency losses compared with conventional air separation technologies. For cost effective application a maximum oxygen flux has to be achieved to reduce the membrane area. This can be met by reduction of membrane thickness. Therefore, the reduction of the membrane thickness to the micrometer range or even below is aimed in the present thesis. Ce{sub 0.8}Gd{sub 0.2}O{sub 2-{delta}} (CGO) with fluorite crystal structure and La{sub 0.58}Sr{sub 0.4}Co{sub 0.2}Fe{sub 0.8}O{sub 3-{delta}} (LSCF) with perovskite crystal structure were developed as thin film membrane. CGO is expected to be more stable than other potential MIEC membranes in reducing atmospheres and to achieve sufficient oxygen permeation, e.g. in syngas production or petrol chemistry. LSCF is expected to be highly permeable with an acceptable chemical stability in Oxyfuel-combustion. Various porous ceramic substrates were prepared by vacuum-slip-casting and warm-pressing, and then characterized for porosity, gas-permeability and surface roughness. Subsequently, two approaches to fabrication of thin film membranes were investigated, which are wetchemical deposition (WCD) and physical vapor deposition (PVD). For WCD, nano-dispersions and colloidal sols were prepared for membrane top-layer and/or interlayer. When CGO nano-dispersion (NDCGO) was spin-coated as thin film membrane, the gastightness of sintered membranes was increased with decrease in spinning time and increase in concentration of

  10. Oxygen transport membranes for biomass gasification and cement industry

    DEFF Research Database (Denmark)

    Cheng, Shiyang

    Oxygen transport membranes (OTMs) are of particular interest for their potential applications in high purity oxygen separation, biomass gasification and carbon capture and storage in cement production. Gd0.1Ce0.9O1.95-δ (GCO) is one of the interesting materials of OTMs because of its high ionic...... be an interstitial defect in GCO. Also dual phase membranes were studied. A 1-mm thick dual phase composite oxygen membrane (50vol.% Al0.02Ga0.02Zn0.96O1.02-50 vol.% Gd0.1Ce0.9O1.95-δ) with catalyst on both sides was observed to sustain an oxygen flux of 0.3 Nml cm-2 min-1 under air/N2 at 900 °C. The material....... In this study various routes for enhancing the electronic conductivity were investigated; either via elemental substitution or via mixing doped-ceria with another material when forming the membrane layers. The increase of electronic conductivity by substitution co-doped Gd and Pr in ceria was investigated...

  11. Hydrogen production from methane using oxygen-permeable ceramic membranes

    Science.gov (United States)

    Faraji, Sedigheh

    Non-porous ceramic membranes with mixed ionic and electronic conductivity have received significant interest in membrane reactor systems for the conversion of methane and higher hydrocarbons to higher value products like hydrogen. However, hydrogen generation by this method has not yet been commercialized and suffers from low membrane stability, low membrane oxygen flux, high membrane fabrication costs, and high reaction temperature requirements. In this dissertation, hydrogen production from methane on two different types of ceramic membranes (dense SFC and BSCF) has been investigated. The focus of this research was on the effects of different parameters to improve hydrogen production in a membrane reactor. These parameters included operating temperature, type of catalyst, membrane material, membrane thickness, membrane preparation pH, and feed ratio. The role of the membrane in the conversion of methane and the interaction with a Pt/CeZrO2 catalyst has been studied. Pulse studies of reactants and products over physical mixtures of crushed membrane material and catalyst have clearly demonstrated that a synergy exists between the membrane and the catalyst under reaction conditions. The degree of catalyst/membrane interaction strongly impacts the conversion of methane and the catalyst performance. During thermogravimetric analysis, the onset temperature of oxygen release for BSCF was observed to be lower than that for SFC while the amount of oxygen release was significantly greater. Pulse injections of CO2 over crushed membranes at 800°C have shown more CO2 dissociation on the BSCF membrane than the SFC membrane, resulting in higher CO formation on the BSCF membrane. Similar to the CO2 pulses, when CO was injected on the samples at 800°C, CO2 production was higher on BSCF than SFC. It was found that hydrogen consumption on BSCF particles is 24 times higher than that on SFC particles. Furthermore, Raman spectroscopy and temperature programmed desorption studies of

  12. Oxygenated shunting from right to left: a feasibility study of minimized atrio-atrial extracorporeal membrane oxygenation for mid-term lung assistance in an acute ovine model†‡

    Science.gov (United States)

    Haushofer, Marcus; Abusabha, Yousef; Amerini, Andrea L.A.; Spillner, Jan; Nix, Christoph; Autschbach, Rüdiger; Goetzenich, Andreas; Hatam, Nima

    2013-01-01

    OBJECTIVES Right ventricular failure is often the final phase in acute and chronic respiratory failure. We combined right ventricular unloading with extracorporeal oxygenation in a new atrio-atrial extracorporeal membrane oxygenation (ECMO). METHODS Eleven sheep (65 kg) were cannulated by a 28-Fr inflow cannula to the right atrium and a 25-Fr outflow cannula through the lateral left atrial wall. Both were connected by a serial combination of a microaxial pump (Impella Elect®, Abiomed Europe, Aachen, Germany) and a membrane oxygenator (Novalung®—iLA membrane oxygenator; Novalung GmbH, Hechingen, Germany). In four animals, three subsequent states were evaluated: normal circulation, apneic hypoxia and increased right atrial after load by pulmonary banding. We focused on haemodynamic stability and gas exchange. RESULTS All animals reached the end of the study protocol. In the apnoea phase, the decrease in PaO2 (21.4 ± 3.6 mmHg) immediately recovered (179.1 ± 134.8 mmHg) on-device in continuous apnoea. Right heart failure by excessive after load decreased mean arterial pressure (59 ± 29 mmHg) and increased central venous pressure and systolic right ventricular pressure; PaO2 and SvO2 decreased significantly. On assist, mean arterial pressure (103 ± 29 mmHg), central venous pressure and right ventricular pressure normalized. The SvO2 increased to 89 ± 3% and PaO2 stabilized (129 ± 21 mmHg). CONCLUSIONS We demonstrated the efficacy of a miniaturized atrio-atrial ECMO. Right ventricular unloading was achieved, and gas exchange was well taken over by the Novalung. This allows an effective short- to mid-term treatment of cardiopulmonary failure, successfully combining right ventricular and respiratory bridging. The parallel bypass of the right ventricle and lung circulation permits full unloading of both systems as well as gradual weaning. Further pathologies (e.g. ischaemic right heart failure and acute lung injury) will have to be evaluated. PMID:23543405

  13. Development of thin film oxygen transport membranes on metallic supports

    Energy Technology Data Exchange (ETDEWEB)

    Xing, Ye

    2012-04-25

    Asymmetric membrane structure has an attractive potential in the application of O{sub 2}/N{sub 2} gas separation membrane for the future membrane-based fossil fuel power plant using oxyfuel technology, which will reduce the carbon dioxide emission. The aim of this study is the development of a metal supported multi-layer membrane structure with a thin film top membrane layer and porous ceramic interlayers. Four perovskite materials were studied as candidate membrane materials. Material properties of these perovskite materials were investigated and compared. La{sub 0.58}Sr{sub 0.4}Co{sub 0.2}Fe{sub 0.8}O{sub 3-{delta}} (LSCF58428) showed sufficient oxygen permeability, an acceptable thermal expansion coefficient and a moderate sintering temperature. Alternatively, Ba{sub 0.5}Sr{sub 0.5}Co{sub 0.8}Fe{sub 0.2}O{sub 3-{delta}} (BSCF5582) is considered obtaining very high oxygen permeability but a higher thermal expansion and a lower thermal stability than LSCF58428. Four different Ni-based alloys were studied as candidate substrate materials in the asymmetric membrane structure. The chromia-scale alloys (Hastelloy X, Inconel 600 and Haynes 214) caused Cr poisoning of the membrane layer material LSCF58428 during high-temperature co-firing in air. NiCoCrAlY with a high Al content (12.7 wt%) was found to be the most promising substrate material. It showed a good chemical compatibility with perovskite materials at high temperatures. In order to bridge the highly porous substrate and the thin top membrane layer interlayers were developed. Two interlayers were coated by screen printing on the porous NiCoCrAlY substrate which was sintered at 1225 C in flowing H{sub 2} atmosphere. Screen printing pastes were optimized by investigating various solvent and binder combinations and various ceramic powder contents. The first interlayer significantly improved the surface quality and the surface pore size has been reduced from 30-50{mu}m on the substrate to few {mu}m on the first

  14. Review of Membrane Oxygen Enrichment for Efficient Combustion

    Science.gov (United States)

    Ariono, Danu; Kusuma Wardani, Anita

    2017-07-01

    Oxygen enrichment from air is a simple way of increasing the efficiency of combustion process, as in oxy-combustion. Oxy-combustion has become one of the most attracting combustion technologies because of its potential to address both pollutant reduction and CO2 capture. In oxy-combustion, the fuel and recycled flue gas are combusted with oxygen enriched air (OEA). By using OEA, many benefits can be obtained, such as increasing available heat, improving ignition characteristics, flue gas reduction, increasing productivity, energy efficiency, turndown ratio, and flame stability. Membrane-based gas separation for OEA production becomes an attractive technology over the conventional technology due to the some advantages, including low capital cost, low energy consumption, compact size, and modularity. A single pass through membrane usually can enrich O2 concentration in the air up to 35% and a 50% concentration can be achieved with a double pass of membrane. The use of OEA in the combustion process eliminates the presence of nitrogen in the flue gas. Hence, the flue gas is mainly composed of CO2 and condensable water that can be easily separated. This paper gives an overview of oxy-combustion with membrane technology for oxygen enrichment process. Special attention is given to OEA production and the effect of OEA to the efficiency of combustion.

  15. Hybrid membrane--PSA system for separating oxygen from air

    Science.gov (United States)

    Staiger, Chad L [Albuquerque, NM; Vaughn, Mark R [Albuquerque, NM; Miller, A Keith [Albuquerque, NM; Cornelius, Christopher J [Blackburg, VA

    2011-01-25

    A portable, non-cryogenic, oxygen generation system capable of delivering oxygen gas at purities greater than 98% and flow rates of 15 L/min or more is described. The system consists of two major components. The first component is a high efficiency membrane capable of separating argon and a portion of the nitrogen content from air, yielding an oxygen-enriched permeate flow. This is then fed to the second component, a pressure swing adsorption (PSA) unit utilizing a commercially available, but specifically formulated zeolite compound to remove the remainder of the nitrogen from the flow. The system is a unique gas separation system that can operate at ambient temperatures, for producing high purity oxygen for various applications (medical, refining, chemical production, enhanced combustion, fuel cells, etc . . . ) and represents a significant advance compared to current technologies.

  16. Dual phase oxygen transport membrane for efficient oxyfuel combustion

    International Nuclear Information System (INIS)

    Ramasamy, Madhumidha

    2016-01-01

    Oxygen transport membranes (OTMs) are attracting great interest for the separation of oxygen from air in an energy efficient way. A variety of solid oxide ceramic materials that possess mixed ionic and electronic conductivity (MIEC) are being investigated for efficient oxygen separation (Betz '10, Skinner '03). Unfortunately these materials do not exhibit high degradation stability under harsh ambient conditions such as flue gas containing CO 2 , SO x , H 2 O and dust, pressure gradients and high temperatures that are typical in fossil fuel power plants. For this reason, dual phase composite membranes are developed to combine the best characteristics of different compounds to achieve high oxygen permeability and sufficient chemical and mechanical stability at elevated temperatures. In this thesis, the dual phase membrane Ce 0.8 Gd 0.2 O 2-δ - FeCo 2 O 4 (CGO-FCO) was developed after systematic investigation of various combinations of ionic and electronic conductors. The phase distribution of the composite was investigated in detail using electron microscopes and this analysis revealed the phase interaction leading to grain boundary rock salt phase and formation of perovskite secondary phase. A systematic study explored the onset of phase interactions to form perovskite phase and the role of this unintended phase as pure electronic conductor was identified. Additionally optimization of conventional sintering process to eliminate spinel phase decomposition into rock salt was identified. An elaborate study on the absolute minimum electronic conductor requirement for efficient percolation network was carried out and its influence on oxygen flux value was measured. Oxygen permeation measurements in the temperature range of 600 C - 1000 C under partial pressure gradient provided by air and argon as feed and sweep gases are used to identify limiting transport processes. The dual phase membranes are much more prone to surface exchange limitations because of the

  17. Assistência circulatória com oxigenação por membrana extracorpórea (ECMO no adulto: um conceito falido ou esquecido? Adult extracorporeal life support: a failed or forgotten concept?

    Directory of Open Access Journals (Sweden)

    Alexandre Siciliano Colafranceschi

    2008-07-01

    Full Text Available FUNDAMENTO: A oxigenação por membrana extracorpórea (ECMO em recém-nascidos e crianças tem resultados excelentes. A experiência em adultos é mais modesta e os resultados imediatos são inferiores. Entretanto, a sobrevida em cinco anos de pacientes que sobrevivem a esse método é bastante promissora. Não há relato na literatura brasileira de experiências com esse sistema nesse contexto. OBJETIVO: Relatar a experiência com o uso da oxigenação por membrana extracorpórea no adulto que se apresenta em choque cardiogênico agudo e refratário. MÉTODOS: Análise retrospectiva de prontuários médicos de pacientes submetidos a implante do sistema de oxigenação por membrana extracorpórea para a assistência circulatória no choque cardiogênico agudo e refratário. RESULTADOS: Onze pacientes (63,5 anos; 45,5% homens foram considerados para análise no período de 2005 a 2007. O tempo médio de suporte circulatório foi de 77 horas (10-240h e cinco pacientes estavam vivos em 30 dias (45,5%. Dois pacientes foram subseqüentemente submetidos a implante de assistência circulatória prolongada após um período de ressuscitação em ECMO, um dos quais foi submetido ao transplante cardíaco. As causas de morte durante a assistência com ECMO (seis pacientes incluíram falência multiorgânica (66,6% ou sangramento refratário (33,4%. CONCLUSÃO: O sistema ECMO é uma opção de assistência circulatória temporária para pacientes adultos com falência cardíaca aguda refratária, podendo ser utilizado como ponte para a recuperação ou com o intuito de selecionar candidatos à assistência circulatória prolongada (ponte para a ponte.BACKGROUND: The extracorporeal membrane oxygenation (ECMO has been used in the neonatal and childhood periods with excellent results. The adult experience has been modest with inferior immediate results. The intermediate survival, however, has been promising. We have been using the extracorporeal membrane

  18. Improving hemocompatibility of membranes for extracorporeal membrane oxygenators by grafting nonthrombogenic polymer brushes

    Czech Academy of Sciences Publication Activity Database

    Obstals, F.; Vorobii, M.; Riedel, Tomáš; de los Santos Pereira, Andres; Bruns, M.; Singh, S.; Rodriguez-Emmenegger, C.

    2018-01-01

    Roč. 18, č. 3 (2018), s. 1-11, č. článku 1700359. ISSN 1616-5187 R&D Projects: GA ČR(CZ) GBP205/12/G118 Institutional support: RVO:61389013 Keywords : ECMO * hemocompatibility * nonthrombogenic Subject RIV: BO - Biophysics OBOR OECD: Biophysics Impact factor: 3.238, year: 2016

  19. Oxygen transport by oxygen potential gradient in dense ceramic oxide membranes

    Energy Technology Data Exchange (ETDEWEB)

    Maiya, P.S.; Balachandran, U.; Dusek, J.T.; Mieville, R.L. [Argonne National Lab., IL (United States). Energy Technology Div.; Kleefisch, M.S.; Udovich, C.A. [Amoco Exploration/Production, Naperville, IL (United States)

    1996-05-01

    Numerous studies have been conducted in recent years on the partial oxidation of methane to synthesis gas (syngas: CO + H{sub 2}) with air as the oxidant. In partial oxidation, a mixed-oxide ceramic membrane selectively transports oxygen from the air; this transport is driven by the oxygen potential gradient. Of the several ceramic materials the authors have tested, a mixed oxide based on the Sr-Fe-Co-O system has been found to be very attractive. Extensive oxygen permeability data have been obtained for this material in methane conversion experiments carried out in a reactor. The data have been analyzed by a transport equation based on the phenomenological theory of diffusion under oxygen potential gradients. Thermodynamic calculations were used to estimate the driving force for the transport of oxygen ions. The results show that the transport equation deduced from the literature describes the permeability data reasonably well and can be used to determine the diffusion coefficients and the associated activation energy of oxygen ions in the ceramic membrane material.

  20. [Near-Drowning with Good Outcome after ECMO-Therapy and Therapeutic Hypothermia Despite 20 Minutes of Anoxia and 16 Hours of Hypoxia].

    Science.gov (United States)

    Stachon, Peter; Kalbhenn, Johannes; Walterspacher, Stephan; Bode, Christoph; Staudacher, Dawid

    2017-04-01

    Introduction  Drowning with submersion over 10 minutes is associated with a high mortality. Here, we present a case, in which a good neurological outcome was achieved after interdisciplinary, intensive care therapy despite submersion of 20 minutes followed by 16 hours of hypoxia. History  A 19 year old man drowned in fresh-water. After 20 minutes submersion he was localized and salvaged from 8 meters depth and primarily resuscitated successfully after 10 minutes. Within the next hour, there condition worsened by respiratory deterioration due to a massive capillary leak syndrome in addition to a disseminated intravascular coagulation. Treatment  This made implantation of a veno-venous ECMO (extracorporeal membrane oxygenation) therapy necessary. Despite intensive care medicine including extracorporeal therapy a sufficient oxygenation (arterial pO 2 > 60 mmHg) was reached only 16 hours after the drowning. Clinical Course  During this time the patient was treated with a mild therapeutic hypothermia for cerebral protection. Despite the prolonged hypoxia, ECMO could be removed five days after the drowning and the patient was extubated after another five days without significant neurological deficits. Conclusion  Despite submersion of 20 minutes followed by prolonged hypoxia, a good neurological outcome could be achieved in our patient. This case suggests, that tolerance of hypoxia is possibly underestimated after drowning. © Georg Thieme Verlag KG Stuttgart · New York.

  1. Development and Validation of a Score to Predict Mortality in Children Undergoing Extracorporeal Membrane Oxygenation for Respiratory Failure: Pediatric Pulmonary Rescue With Extracorporeal Membrane Oxygenation Prediction Score.

    Science.gov (United States)

    Bailly, David K; Reeder, Ron W; Zabrocki, Luke A; Hubbard, Anna M; Wilkes, Jacob; Bratton, Susan L; Thiagarajan, Ravi R

    2017-01-01

    Our objective was to develop and validate a prognostic score for predicting mortality at the time of extracorporeal membrane oxygenation initiation for children with respiratory failure. Preextracorporeal membrane oxygenation mortality prediction is important for determining center-specific risk-adjusted outcomes and counseling families. Multivariable logistic regression of a large international cohort of pediatric extracorporeal membrane oxygenation patients. Multi-institutional data. Prognostic score development: A total of 4,352 children more than 7 days to less than 18 years old, with an initial extracorporeal membrane oxygenation run for respiratory failure reported to the Extracorporeal Life Support Organization's data registry during 2001-2013 were used for derivation (70%) and validation (30%). Bidirectional stepwise logistic regression was used to identify factors associated with mortality. Retained variables were assigned a score based on the odds of mortality with higher scores indicating greater mortality. External validation was accomplished using 2,007 patients from the Pediatric Health Information System dataset. None. The Pediatric Pulmonary Rescue with Extracorporeal Membrane Oxygenation Prediction score included mode of extracorporeal membrane oxygenation; preextracorporeal membrane oxygenation mechanical ventilation more than 14 days; preextracorporeal membrane oxygenation severity of hypoxia; primary pulmonary diagnostic categories including, asthma, aspiration, respiratory syncytial virus, sepsis-induced respiratory failure, pertussis, and "other"; and preextracorporeal membrane oxygenation comorbid conditions of cardiac arrest, cancer, renal and liver dysfunction. The area under the receiver operating characteristic curve for internal and external validation datasets were 0.69 (95% CI, 0.67-0.71) and 0.66 (95% CI, 0.63-0.69). Pediatric Pulmonary Rescue with Extracorporeal Membrane Oxygenation Prediction is a validated tool for predicting in

  2. Extracorporeal Membrane Oxygenation for Adult Community-Acquired Pneumonia: Outcomes and Predictors of Mortality.

    Science.gov (United States)

    Ramanathan, Kollengode; Tan, Chuen Seng; Rycus, Peter; MacLaren, Graeme

    2017-05-01

    Extracorporeal membrane oxygenation is a rescue therapy used to support severe cardiorespiratory failure. Data on outcomes from severe community-acquired pneumonia in adults receiving rescue extracorporeal membrane oxygenation are mainly confined to single-center experiences or specific pathogens. We examined data from the Extracorporeal Life Support Organisation registry to identify risk factors for poor outcomes in adult patients with community-acquired pneumonia. Retrospective data analysis. Extracorporeal Life Support Organization Registry database. We collected deidentified data on adult patients (> 18 yr) receiving extracorporeal membrane oxygenation for community-acquired pneumonia between 2002 and 2012. Patients with incomplete data or brain death were excluded. The primary outcome measure was in-hospital mortality. Other measurements included demographic information, pre-extracorporeal membrane oxygenation mechanical ventilation and biochemical variables, inotrope requirements, extracorporeal membrane oxygenation mode, duration, and complications. Initial univariate analysis assessed potential associations between survival and various pre-extracorporeal membrane oxygenation and extracorporeal membrane oxygenation factors. Variables with p values of less than 0.1 were considered for logistic regression analysis to identify predictors of mortality. None. One thousand fifty-five patients, who satisfied inclusion criteria, were included in the final analysis. There was an increase in the number of patients cannulated per annum over the 10-year period studied. Univariate analysis identified pre-extracorporeal membrane oxygenation and extracorporeal membrane oxygenation variables associated with high mortality. Further multiple regression analysis identified certain pre-extracorporeal membrane oxygenation factors as predictors of mortality, including duration of mechanical ventilation prior to extracorporeal membrane oxygenation, lower arterial pressure, fungal

  3. Experimental extrusion of tubular multilayer materials for Oxygen Transport Membranes

    DEFF Research Database (Denmark)

    Kothanda Ramachandran, Dhavanesan

    membrane based on gadolinia doped ceria oxide, (Ce0.9Gd0.1O1.95−δ), (CGO) was developed on a tubular, porous support structure based on cost-efficient magnesium oxide (MgO). The porous support structure was prepared by thermoplastic extrusion using MgO powder, thermoplastic binders and graphite pore former....... The results revealed sufficiently high bending strength values of 60 MPa for the MgO support at an operation temperature of 850 °C, whereas the strength at room temperature was 77 MPa. The oxygen permeation flux on an asymmetric tubular CGO membrane, consisting of an MgO support (porous), catalytic layer...

  4. Elucidation of the Oxygen Surface Kinetics in a Coated Dual-Phase Membrane for Enhancing Oxygen Permeation Flux.

    Science.gov (United States)

    Na, Beom Tak; Park, Jeong Hwan; Park, Jong Hyuk; Yu, Ji Haeng; Joo, Jong Hoon

    2017-06-14

    The dual-phase membrane has received much attention as the solution to the instability of the oxygen permeation membrane. It has been reported that the oxygen flux of the dual-phase membrane is greatly enhanced by the active coating layer. However, there has been little discussion about the enhancement mechanism by surface coating in the dual-phase membrane. This study investigates the oxygen flux of the Ce 0.9 Gd 0.1 O 2-δ -La 0.7 Sr 0.3 MnO 3±δ (GDC 80 vol %/LSM 20 vol %) composite membrane depending on the oxygen partial pressure (P O 2 ) to elucidate the mechanism of enhanced oxygen flux by the surface modification in the fluorite-rich phase dual-phase membrane. The oxygen permeation resistances were obtained from the oxygen flux as a function of P O 2 using the oxygen permeation model. The surface exchange coefficient (k) and the bulk diffusion coefficient (D) were calculated from these resistances. According to the calculated k and D values, we concluded that the active coating layer (La 0.6 Sr 0.4 CoO 3-δ ) significantly increased the k value of the membrane. Furthermore, the surface exchange reaction on the permeate side was more sluggish than that at the feed side under operating conditions (feed: 0.21 atm/permeate side: 4.7 × 10 -4 atm). Therefore, the enhancement of the oxygen surface exchange kinetics at the permeate side is more important in improving the oxygen permeation flux of the thin film-based fluorite-rich dual-phase membrane. These results provide new insight about the function of the surface coating to enhance the oxygen permeation flux of the dual-phase membrane.

  5. Primary study of ethyl cellulose nanofiber for oxygen-enrichment membrane

    Directory of Open Access Journals (Sweden)

    Shen Jing

    2016-01-01

    Full Text Available Ethyl cellulose is widely used for oxygen-enrichment membrane, however, its nanofiber membrane was rarely developed though it behaves more excellent performance. This paper gives a preliminary study to produce oxygen-enrichment membrane by bubbfil spinning.

  6. Liberal Right Ventricular Assist Device Extracorporeal Membrane Oxygenation Support for Right Ventricular Failure after Implantable Left Ventricular Assist Device Placement.

    Science.gov (United States)

    Fischer, Quentin; Kirsch, Matthias

    2017-11-27

    Refractory right ventricular failure (RVF) after implantation of left ventricular assist device (LVAD) is a dramatic complication. The addition of right ventricular assist device (RVAD) may improve RV recovery and lead to improve outcomes. From February 2012 to September 2014, 44 patients received a HeartMate II. These patients were retrospectively compared in two groups according to early liberal implantation of an extracorporeal membrane oxygenation (ECMO) used as a RVAD established between a femoral vein and the pulmonary artery. Of the 44 patients, 22 required addition of a temporary RVAD (t-RVAD group). Patients are sicker in the t-RVAD group with significantly higher rate of preoperative extracorporeal life support (46% vs. 9%; p = 0.016) or any mechanical circulatory support (55% vs. 14%; p = 0.01), more preoperative hemofiltration (23% vs. 0%; p = 0.048), and more inotrope support by dobutamine (68.2% vs. 27.3%; p = .015). Likewise Michigan risk score was significantly higher in t-RVAD group (2.61 ± 2.2 vs. 1.0 ± 1.6 pts; p = 0.013) and INTERMACS clinical profile (2.1 ± 0.6 vs. 3.4 ± 1.3 pts; p = 0.0001). Despite severity of preimplant conditions in t-RVAD group, clinical outcomes did not differ in both groups with similar survival rate at 6 months (60.4 ± 12 vs. 71.4 ± 9.9 months; p = 0.585). Early and liberal use of temporary RVAD in patients with risk factors of RVF could improve the prognostic after LVAD implantation.

  7. Oxygen permeation and thermo-chemical stability of oxygen separation membrane materials for the oxyfuel process

    Energy Technology Data Exchange (ETDEWEB)

    Ellett, Anna Judith

    2009-07-01

    The reduction of CO{sub 2} emissions, generally held to be one of the most significant contributors to global warming, is a major technological issue. CO{sub 2} Capture and Storage (CCS) techniques applied to large stationary sources such as coal-fired power plants could efficiently contribute to the global carbon mitigation effort. The oxyfuel process, which consists in the burning of coal in an oxygen-rich atmosphere to produce a flue gas highly concentrated in CO{sub 2}, is a technology considered for zero CO{sub 2} emission coal-fired power plants. The production of this O{sub 2}-rich combustion gas from air can be carried out using high purity oxygen separation membranes. Some of the most promising materials for this application are mixed ionic-electronic conducting (MIEC) materials with perovskite and K{sub 2}NiF{sub 4} perovskite-related structures. The present work examines the selection of La{sub 0.58}Sr{sub 0.4}Co{sub 0.2}Fe{sub 0.8}O{sub 3-{delta}} (LSCF58), La{sub 2}NiO{sub 4+{delta}}, Pr{sub 0.58}Sr{sub 0.4}Co{sub 0.2}Fe{sub 0.8}O{sub 3-{delta}} (PSCF58) and Ba{sub 0.5}Sr{sub 0.5}Co{sub 0.8}Fe{sub 0.2}O{sub 3-{delta}} (BSCF50) as membrane materials for the separation of O{sub 2} and N{sub 2} in the framework of the oxyfuel process with flue gas recycling. Annealing experiments were carried out on pellets exposed to CO{sub 2}, water vapour, O{sub 2} and Cr{sub 2}O{sub 3} in order to determine the thermo-chemical resistance to the atmospheres and the high temperature conditions present during membrane operation in a coal-fired power plant. The degradation of their microstructure was investigated using Scanning Electron Microscopy (SEM) in combination with electron dispersive spectroscopy (EDS) as well as X-Ray Diffraction (XRD). Also, the oxygen permeation fluxes of selected membranes were investigated as a function of temperature. The membrane materials selected were characterised using thermo-analytical techniques such as precision thermogravimetric

  8. Oxygen transport membrane system and method for transferring heat to catalytic/process reactors

    Science.gov (United States)

    Kelly, Sean M; Kromer, Brian R; Litwin, Michael M; Rosen, Lee J; Christie, Gervase Maxwell; Wilson, Jamie R; Kosowski, Lawrence W; Robinson, Charles

    2014-01-07

    A method and apparatus for producing heat used in a synthesis gas production is provided. The disclosed method and apparatus include a plurality of tubular oxygen transport membrane elements adapted to separate oxygen from an oxygen containing stream contacting the retentate side of the membrane elements. The permeated oxygen is combusted with a hydrogen containing synthesis gas stream contacting the permeate side of the tubular oxygen transport membrane elements thereby generating a reaction product stream and radiant heat. The present method and apparatus also includes at least one catalytic reactor containing a catalyst to promote the stream reforming reaction wherein the catalytic reactor is surrounded by the plurality of tubular oxygen transport membrane elements. The view factor between the catalytic reactor and the plurality of tubular oxygen transport membrane elements radiating heat to the catalytic reactor is greater than or equal to 0.5.

  9. System and method for air temperature control in an oxygen transport membrane based reactor

    Science.gov (United States)

    Kelly, Sean M

    2016-09-27

    A system and method for air temperature control in an oxygen transport membrane based reactor is provided. The system and method involves introducing a specific quantity of cooling air or trim air in between stages in a multistage oxygen transport membrane based reactor or furnace to maintain generally consistent surface temperatures of the oxygen transport membrane elements and associated reactors. The associated reactors may include reforming reactors, boilers or process gas heaters.

  10. System and method for temperature control in an oxygen transport membrane based reactor

    Science.gov (United States)

    Kelly, Sean M.

    2017-02-21

    A system and method for temperature control in an oxygen transport membrane based reactor is provided. The system and method involves introducing a specific quantity of cooling air or trim air in between stages in a multistage oxygen transport membrane based reactor or furnace to maintain generally consistent surface temperatures of the oxygen transport membrane elements and associated reactors. The associated reactors may include reforming reactors, boilers or process gas heaters.

  11. Astrocytic mitochondrial membrane hyperpolarization following extended oxygen and glucose deprivation.

    Directory of Open Access Journals (Sweden)

    Andrej Korenić

    Full Text Available Astrocytes can tolerate longer periods of oxygen and glucose deprivation (OGD as compared to neurons. The reasons for this reduced vulnerability are not well understood. Particularly, changes in mitochondrial membrane potential (Δψ(m in astrocytes, an indicator of the cellular redox state, have not been investigated during reperfusion after extended OGD exposure. Here, we subjected primary mouse astrocytes to glucose deprivation (GD, OGD and combinations of both conditions varying in duration and sequence. Changes in Δψ(m, visualized by change in the fluorescence of JC-1, were investigated within one hour after reconstitution of oxygen and glucose supply, intended to model in vivo reperfusion. In all experiments, astrocytes showed resilience to extended periods of OGD, which had little effect on Δψ(m during reperfusion, whereas GD caused a robust Δψ(m negativation. In case no Δψ(m negativation was observed after OGD, subsequent chemical oxygen deprivation (OD induced by sodium azide caused depolarization, which, however, was significantly delayed as compared to normoxic group. When GD preceded OD for 12 h, Δψ(m hyperpolarization was induced by both GD and subsequent OD, but significant interaction between these conditions was not detected. However, when GD was extended to 48 h preceding OGD, hyperpolarization enhanced during reperfusion. This implicates synergistic effects of both conditions in that sequence. These findings provide novel information regarding the role of the two main substrates of electron transport chain (glucose and oxygen and their hyperpolarizing effect on Δψ(m during substrate deprivation, thus shedding new light on mechanisms of astrocyte resilience to prolonged ischemic injury.

  12. Oxygen activation at the plasma membrane: relation between superoxide and hydroxyl radical production by isolated membranes.

    Science.gov (United States)

    Heyno, Eiri; Mary, Véronique; Schopfer, Peter; Krieger-Liszkay, Anja

    2011-07-01

    Production of reactive oxygen species (hydroxyl radicals, superoxide radicals and hydrogen peroxide) was studied using EPR spin-trapping techniques and specific dyes in isolated plasma membranes from the growing and the non-growing zones of hypocotyls and roots of etiolated soybean seedlings as well as coleoptiles and roots of etiolated maize seedlings. NAD(P)H mediated the production of superoxide in all plasma membrane samples. Hydroxyl radicals were only produced by the membranes of the hypocotyl growing zone when a Fenton catalyst (FeEDTA) was present. By contrast, in membranes from other parts of the seedlings a low rate of spontaneous hydroxyl radical formation was observed due to the presence of small amounts of tightly bound peroxidase. It is concluded that apoplastic hydroxyl radical generation depends fully, or for the most part, on peroxidase localized in the cell wall. In soybean plasma membranes from the growing zone of the hypocotyl pharmacological tests showed that the superoxide production could potentially be attributed to the action of at least two enzymes, an NADPH oxidase and, in the presence of menadione, a quinone reductase.

  13. Oxygen-transfer performance of a newly designed, very low-volume membrane oxygenator.

    Science.gov (United States)

    Burn, Felice; Ciocan, Sorin; Carmona, Natalia Mendez; Berner, Marion; Sourdon, Joevin; Carrel, Thierry P; Tevaearai Stahel, Hendrik T; Longnus, Sarah L

    2015-09-01

    Oxygenation of blood and other physiological solutions are routinely required in fundamental research for both in vitro and in vivo experimentation. However, very few oxygenators with suitable priming volumes (parallel-oriented microporous polypropylene hollow fibres, placed inside a hollow shell with a lateral-luer outlet, and sealed at both extremities. With this design, perfusate is delivered via the core-tube to the centre of the mini-oxygenator, and exits via the luer port. A series of mini-oxygenators were constructed and tested in an in vitro perfusion circuit by monitoring oxygen transfer using modified Krebs-Henseleit buffer or whole porcine blood. Effects of perfusion pressure and temperature over flows of 5-60 ml × min(-1) were assessed. Twelve mini-oxygenators with a mean priming volume of 1.5 ± 0.3 ml were evaluated. With buffer, oxygen transfer reached a maximum of 14.8 ± 1.0 ml O2 × l(-1) (pO2: 450 ± 32 mmHg) at perfusate flow rates of 5 ml × min(-1) and decreased with an increase in perfusate flow to 7.8 ± 0.7 ml ml O2 × l(-1) (pO2: 219 ± 24 mmHg) at 60 ml × min(-1). Similarly, with blood perfusate, oxygen transfer also decreased as perfusate flow increased, ranging from 33 ± 5 ml O2 × l(-1) at 5 ml × min(-1) to 11 ± 2 ml O2 × l(-1) at 60 ml × min(-1). Furthermore, oxygen transfer capacity remained stable with blood perfusion over a period of at least 2 h. We have developed a new miniaturized membrane oxygenator with an ultra-low priming volume (circuits, such as small animal extracorporeal circulation and ex vivo organ perfusion. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  14. Extracorporeal membrane oxygenation rescue in adolescent with bronchiolitis obliterans-organizing pneumonia like Wegener's granulomatosis.

    Science.gov (United States)

    Falk, Lars; Broman, Lars Mikael

    2017-01-01

    We report a 17-year-old woman with bronchiolitis obliterans-organizing pneumonia (BOOP)-like granulomatosis with polyangiitis developing severe airway obliterations. Pending age, phase and grade of autoimmune treatment, and offering ECMO treatment may be crucial for survival but occasionally preface futility. ECMO-treated patient with BOOP-like GPA has never been described before.

  15. Extracorporeal Membrane Oxygenation Support in Neonates: A Single Medical Center Experience in Taiwan

    Directory of Open Access Journals (Sweden)

    Chi-Man Kuok

    2017-08-01

    Conclusion: This is the first report for ECMO in neonatal disease in Taiwan. We achieved an overall survival rate of 59.2% with good neurological outcomes in this 10-year experience. ECMO could be a useful transportation tool for critical neonates who have a poor response to ventilator support.

  16. BLOOD COMPATIBILITY OF 2 DIFFERENT TYPES OF MEMBRANE-OXYGENATOR DURING CARDIOPULMONARY BYPASS IN INFANTS

    NARCIS (Netherlands)

    GU, YJ; BOONSTRA, PW; AKKERMAN, C; MUNGROOP, H; TIGCHELAAR, [No Value; VANOEVEREN, W

    1994-01-01

    The contact of blood with the artificial extracorporeal circuit causes a systemic inflammatory response due to blood activation. In this study, we compared two different paediatric membrane oxygenators used for extracorporeal circulation: a hollow fibre membrane oxygenator (Dideco Masterflo D-701,

  17. Extracorporeal membrane oxygenation in a child with traumatic ventricular septal defect

    Directory of Open Access Journals (Sweden)

    Jennifer Y. Lam

    2018-01-01

    Full Text Available Traumatic ventricular septal defect is an uncommon event following blunt thoracic trauma. Within the pediatric trauma literature, extracorporeal membrane oxygenation is most commonly used for secondary acute respiratory distress syndrome. We present the first account of rescue extracorporeal membrane oxygenation to allow for safe transport and access to definitive operative repair in the setting of blunt cardiac injury.

  18. A comparison of gaseous emboli release in five membrane oxygenators.

    Science.gov (United States)

    Beckley, P D; Shinko, P D; Sites, J P

    1997-03-01

    The purpose of this study was to compare the air handling capability of five currently used membrane oxygenators: the Avecor Affinity, the Bentley SpiralGold, the Medtronic Maxima Plus, the Sarns Turbo and the Sorin Monolyth M. A circuit was constructed to include a hardshell venous reservoir and roller pump. Pressure monitoring sites and ultrasonic microbubble detection probes were located proximal and distal to the oxygenator. An air injection/infusion site was provided proximal to the roller pump inlet. Each circuit was primed with fresh anticoagulated bovine blood, adjusted to a haematocrit of 25% and maintained at 38 +/- 1 degree C. Three different bolus amounts of air (10, 20 and 40 cm3) were injected at three blood flow rates (3, 4.5 and 6 l/min). A 1-min infusion of air delivered at 1 ml/s was also administered at three blood flow rates (3, 4.5 and 6 l/min). The hardshell reservoir was also completely emptied at each flow rate to simulate a massive air infusion. At any given blood flow, outlet microbubble counts were usually higher with greater bolus amounts of air. When indexed to the inlet bubble counts, the following average percent microbubbles were released from the outlet: Turbo 25%, Affinity 7%, Monolyth 5%, Maxima 3% and SpiralGold 1%. With a constant air infusion of 1 ml/s, greater outlet microbubble counts were associated with higher blood flow rates. Again, when indexed to the inlet bubble counts, the following average percent microbubbles were released from the outlet: Turbo 44%, Affinity 25%, Maxima 19%, Monolyth 16% and SpiralGold 0%. All oxygenators deprimed when the hardshell reservoir was emptied and all shed microbubbles into the outlet blood except the SpiralGold. The results of this study indicate that air handling is not a simple function of blood flow pattern (i.e. top to bottom versus bottom to top), but also includes dynamics associated with oxygenator design, fibre arrangement and flow resistance.

  19. The effect of temperature and pressure on the oxygen reduction reactions in polyelectrolyte membranes

    Energy Technology Data Exchange (ETDEWEB)

    Holdcroft, S.; Abdou, M.S.; Beattie, P.; Basura, V. [Simon Fraser Univ., Burnaby, BC (Canada). Dept. of Chemistry

    1997-12-31

    The effect of temperature and pressure on the oxygen reduction reaction in polyelectrolyte membranes was described. Polyelectrolytes chosen for the experiment differed in composition, weight and flexibility of the polymer chains. The study was conducted in a solid state electrochemical cell at temperatures between 30 and 95 degrees C and in the pressure range of 1 to 5 atm. The solubility of oxygen in these membranes was found to follow Henry`s Law, while the diffusion coefficient decreased with pressure. The effect of temperature on the solubility of oxygen and the diffusion coefficient of oxygen in the membranes was similar to that observed in solution electrolytes. 2 refs., 3 figs.

  20. Mobile ECMO - A divine technology or bridge to nowhere?

    Science.gov (United States)

    Merkle, Julia; Djorjevic, Ilija; Sabashnikov, Anton; Kuhn, Elmar W; Deppe, Antje-Christin; Eghbalzadeh, Kaveh; Fattulayev, Javid; Hohmann, Christopher; Zeriouh, Mohamed; Kuhn-Régnier, Ferdinand; Choi, Yeong-Hoon; Mader, Navid; Wahlers, Thorsten

    2017-10-01

    Extracorporeal life support emerged as a salvage option in patients with therapy-refractory severe hemodynamic or respiratory failure. However, this promising therapy option has been limited by the use of experienced teams in highly specialized tertiary-care centers. Thus, in order to provide this standard of care in local hospitals and due to increasing evidence on improved outcomes using ECMO devices and setting for patients with heart and lung failure, an increasing number of experienced ECMO centers have launched mobile ECMO retrieval services in recent years. Areas covered: This review provides a summary on the current scientific status concerning use, indications and complications of mobile ECMO devices and services. A scientific literature research was conducted in MEDLINE, Embase, Cochrane and Web of Science databases using keywords denoted. Expert commentary: Mobile ECMO devices and setting offer severely ill patients refractory to maximal conventional treatment an option of hemodynamic and/or respiratory stabilization and subsequent transportation to specialized care centers for further treatment. Compared to in-hospital ECMO support, out-of-hospital mobile ECMO implantation, transport and retrieval of patients require additional organizational, logistical and clinical efforts. This review provides a summary on the current scientific status concerning use, indications and complications of mobile ECMO services.

  1. Influence of temperature on oxygen permeation through ion transport membrane to feed a biomass gasifier

    Science.gov (United States)

    Antonini, T.; Foscolo, P. U.; Gallucci, K.; Stendardo, S.

    2015-11-01

    Oxygen-permeable perovskite membranes with mixed ionic-electronic conducting properties can play an important role in the high temperature separation of oxygen from air. A detailed design of a membrane test module is presented, useful to test mechanical resistance and structural stability of Ba0.5Sr0.5Co0.8Fe0.2O3-δ (BSCF) capillary membrane in the reactor environment. Preliminary experimental results of membrane permeation tests highlight the positive effect of temperature on perovskite materials. This behaviour is also confirmed by a computational model of char combustion with oxygen permeated through the membrane module, when it is placed inside a gasifier reactor to provide the necessary input of heat to the gasification endothermic process. The results show that the temperature affects the oxygen permeation of the BSCF membrane remarkably.

  2. DESIGN AND CONSTRUCTION OF A MEMBRANE REACTOR SILVER FOR THE STUDY OF OXYGEN PERMEABILITY

    OpenAIRE

    Cjuno H., Jesús A.; Barba R., Alejandro; Arroyo C., Juan

    2014-01-01

    To study the permeability of oxygen through a membrane of silver (thickness 0.13 mm) and the definition of parameters, it has designed and constructed a reactor formed by a cone silver membrane inserted into a cylindrical glass tube borosilicate. This assembly is assembled within a cylindrical thermostated oven electronically. The membrane reactor was conentado to an oxygen tank, and two peristaltic pump mercury manometer, enabling control of inflow of methanol, the temperature and internal p...

  3. A Membrane De-Oxygenator for the Study of Anoxic Processes

    DEFF Research Database (Denmark)

    Arcangeli, Jean-Pierre; Arvin, Erik

    1995-01-01

    , so oxygen diffuses through the silicone membrane and is absorbed in the sulfite solution. The maximum oxygen removal rate was 1.1 g m−2 d−1 at 15°C. The advantage of this de-oxygenator is its low cost and the ease with which it can be handled. A calculation method is discussed in relation...

  4. MEMBRANE-OXYGENATOR PREVENTS LUNG REPERFUSION INJURY IN CANINE CARDIOPULMONARY BYPASS

    NARCIS (Netherlands)

    GU, YJ; WANG, YS; CHIANG, BY; GAO, XD; YE, CX; WILDEVUUR, CRH

    The effect of blood activation on lung reperfusion injury during cardiopulmonary bypass was investigated in 20 dogs with the use of a bubble oxygenator (n = 10) or a membrane oxygenator (n = 10). In the bubble oxygenator group, significant leukocyte and platelet right to left atrium gradients were

  5. Surface oxygen vacancy and oxygen permeation flux limits of perovskite ion transport membranes

    KAUST Repository

    Hunt, Anton

    2015-09-01

    © 2015 Elsevier B.V. The mechanisms and quantitative models for how oxygen is separated from air using ion transport membranes (ITMs) are not well understood, largely due to the experimental complexity for determining surface exchange reactions at extreme temperatures (>800°C). This is especially true when fuels are present at the permeate surface. For both inert and reactive (fuels) operations, solid-state oxygen surface vacancies (δ) are ultimately responsible for driving the oxygen flux, JO2. In the inert case, the value of δ at either surface is a function of the local PO2 and temperature, whilst the magnitude of δ dictates both the JO2 and the inherent stability of the material. In this study values of δ are presented based on experimental measurements under inert (CO2) sweep: using a permeation flux model and local PO2 measurements, collected by means of a local gas-sampling probe in our large-scale reactor, we can determine δ directly. The ITM assessed was La0.9Ca0.1FeO3-δ (LCF); the relative resistances to JO2 were quantified using the pre-defined permeation flux model and local PO2 values. Across a temperature range from 825°C to 1056°C, δ was found to vary from 0.007 to 0.029 (<1%), safely within material stability limits, whilst the permeate surface exchange resistance dominates. An inert JO2 limit was identified owing to a maximum sweep surface δ, δmaxinert. The physical presence of δmaxinert is attributed to a rate limiting step shift from desorption to associative electron transfer steps on the sweep surface as PO2 is reduced. Permeate surface exchange limitations under non-reactive conditions suggest that reactive (fuel) operation is necessary to accelerate surface chemistry for future work, to reduce flux resistance and push δpast δmaxinert in a stable manner.

  6. Oxygen Transport Membranes: A Material Science and Process Engineering Approach

    NARCIS (Netherlands)

    Chen, Wei

    2014-01-01

    This thesis describes several fundamental aspects on the membrane-integrated oxy-fuel combustion process and can be divided in two parts: 1) The development and characterization of membrane materials; 2) The design, simulation and evaluation of a coal-fired power plant, coupled with a membrane

  7. Oxygen permeation through perovskitic membranes: The influence of steam in the sweep on the permeation performance

    Directory of Open Access Journals (Sweden)

    Michael Müller

    2016-08-01

    Full Text Available Experimental approaches are employed for the understanding of oxygen permeation through membranes. For the experiments, different oxygen partial pressures are applied to both sides of a BSCF5582 membrane, using synthetic air as feed and vacuum or steam/argon as sweep gas. Beside the partial pressure gradient, the permeation rate depends on the temperature and the membrane thickness. Sufficient permeation rates can be achieved by sweeping the membrane with water vapor (steam instead of a noble gas, which is optimized by ascending water content in the sweep gas. The influence of the steam content on the permeation performance as well as microstructural changes are demonstrated.

  8. Congenital diaphragmatic hernia and complete tracheal rings: Repair on ECMO

    Directory of Open Access Journals (Sweden)

    Sasha J. Tharakan

    2015-12-01

    Full Text Available A term newborn female presented with prenatally diagnosed congenital diaphragmatic hernia and postnatally diagnosed complete tracheal rings and tracheal stenosis. Initially, the spells associated with tracheal stenosis were misdiagnosed as pulmonary hypertension. Bronchoscopy showed a critically narrowed airway, and veno-arterial ECMO stabilized the baby for further workup. The endotracheal tube was removed while on ECMO to avoid further injury to the airway. Staged CDH repair followed by slide tracheoplasty were performed on ECMO. The multidisciplinary approach included neonatology, general surgery, otolaryngology, cardiac surgery and anesthesiology.

  9. Automated Inhaled Nitric Oxide Alerts for Adult Extracorporeal Membrane Oxygenation Patient Identification

    Science.gov (United States)

    2014-09-01

    26 26 Alive 3 33 Female Cystic fibrosis ARDS 9 13 Alive/died* 4 33 Male Fall with polytrauma ARDS 112 180 Alive 5 35 Female Sepsis/MRSA bacteremia...were collected including age, sex, admitting diagnosis , pre-ECMO diagnosis , duration of ICU and hospital stay, and outcome. In addition, MV mode, PaO2...positive end-expiratory pressure [PEEP], 10Y20 cm TABLE 1. Patient Characteristics Patient Age Sex Admitting Diagnosis ECMO Indication ICU Days

  10. Successful Treatment of Refractory Hypoxemia Secondary to Disseminated Histoplasmosis Using Extracorporeal Membrane Oxygenation Support.

    Science.gov (United States)

    Wanta, Brendan T; Tyner, Harmony L; Bohman, John K; Baddour, Larry M

    2016-10-15

    Refractory hypoxemia secondary to acute respiratory distress syndrome (ARDS) is associated with high mortality. Extracorporeal membraneoxygenation (ECMO) is an accepted strategy for treating refractory hypoxemia in patients with ARDS but is relatively contraindicated in the setting of systemic infections. We present a case of successful ECMO use in a host with refractory hypoxemia secondary to disseminated histoplasmosis with fungemia and discuss our management approach to this difficult patient.

  11. Outcome of patients supported by extracorporeal membrane oxygenation for aluminum phosphide poisoning: An observational study

    Directory of Open Access Journals (Sweden)

    Bishav Mohan

    2016-05-01

    Conclusion: Veno-arterial ECMO has been shown to improve the short-term survival of patients with AlP poisoning having severe LV myocardial dysfunction. A low baseline LVEF and longer delay in hospital presentation were found to be predictors of mortality even after ECMO usage. Large, adequately controlled and standardized trials with long-term follow-up must be performed to confirm these findings.

  12. Oxygen transport membrane based advanced power cycle with low pressure synthesis gas slip stream

    Science.gov (United States)

    Kromer, Brian R.; Litwin, Michael M.; Kelly, Sean M.

    2016-09-27

    A method and system for generating electrical power in which a high pressure synthesis gas stream generated in a gasifier is partially oxidized in an oxygen transport membrane based reactor, expanded and thereafter, is combusted in an oxygen transport membrane based boiler. A low pressure synthesis gas slip stream is split off downstream of the expanders and used as the source of fuel in the oxygen transport membrane based partial oxidation reactors to allow the oxygen transport membrane to operate at low fuel pressures with high fuel utilization. The combustion within the boiler generates heat to raise steam to in turn generate electricity by a generator coupled to a steam turbine. The resultant flue gas can be purified to produce a carbon dioxide product.

  13. Active rehabilitation and physical therapy during extracorporeal membrane oxygenation while awaiting lung transplantation: a practical approach.

    Science.gov (United States)

    Turner, David A; Cheifetz, Ira M; Rehder, Kyle J; Williford, W Lee; Bonadonna, Desiree; Banuelos, Scott J; Peterson-Carmichael, Stacey; Lin, Shu S; Davis, R Duane; Zaas, David

    2011-12-01

    Extracorporeal membrane oxygenation as a bridge to lung transplantation has traditionally been associated with substantial morbidity and mortality. A major contributor to these complications may be weakness and overall deconditioning secondary to pretransplant critical illness and immobility. In an attempt to address this issue, we developed a collaborative program to allow for active rehabilitation and physical therapy for patients requiring life support with extracorporeal membrane oxygenation before lung transplantation. An interdisciplinary team responded to an acute need to develop a mechanism for active rehabilitation and physical therapy for patients awaiting lung transplantation while being managed with extracorporeal membrane oxygenation. We describe a series of three patients who benefited from this new approach. A quaternary care pediatric intensive care unit in a children's hospital set within an 800-bed university academic hospital with an active lung transplantation program for adolescent and adult patients. PATIENTS, INTERVENTIONS, AND MAIN RESULTS: Three patients (ages 16, 20, and 24 yrs) with end-stage respiratory failure were rehabilitated while on extracorporeal membrane oxygenation awaiting lung transplantation. These patients were involved in active rehabilitation and physical therapy and, ultimately, were ambulatory on extracorporeal membrane oxygenation before successful transplantation. Following lung transplantation, the patients were liberated from mechanical ventilation, weaned to room air, transitioned out of the intensive care unit, and ambulatory less than 1 wk posttransplant. A comprehensive, multidisciplinary system can be developed to safely allow for active rehabilitation, physical therapy, and ambulation of patients being managed with extracorporeal membrane oxygenation. Such programs may lead to a decreased threshold for the utilization of extracorporeal membrane oxygenation before transplant and have the potential to improve

  14. Neonatal and pediatric extracorporeal membrane oxygenation in developing Latin American countries

    OpenAIRE

    Kattan, Javier; González, Álvaro; Castillo, Andrés; Caneo, Luiz Fernando

    2017-01-01

    Objective: To review the principles of neonatal‐pediatric extracorporeal membrane oxygenation therapy, prognosis, and its establishment in limited resource‐limited countries in Latino America. Sources: The PubMed database was explored from 1985 up to the present, selecting from highly‐indexed and leading Latin American journals, and Extracorporeal Life Support Organization reports. Summary of the findings: Extracorporeal membrane oxygenation provides “time” for pulmonary and cardiac res...

  15. Neonatal and pediatric extracorporeal membrane oxygenation in developing Latin American countries

    Directory of Open Access Journals (Sweden)

    Javier Kattan

    2017-03-01

    Conclusions: The best results in short‐ and long‐term survival are in patients with isolated respiratory diseases. Today extracorporeal membrane oxygenation therapy is a standard therapy in some Latin American referral centers. It is hoped that these new extracorporeal membrane oxygenation centers will have a positive impact on the survival of newborns and children with respiratory or cardiac failure, and that they will be available for an increasing number of patients from this region in the near future.

  16. Prolonged extracorporeal membrane oxygenation-assisted support provides improved survival in hypothermic patients with cardiocirculatory arrest.

    Science.gov (United States)

    Ruttmann, Elfriede; Weissenbacher, Annemarie; Ulmer, Hanno; Müller, Ludwig; Höfer, Daniel; Kilo, Juliane; Rabl, Walter; Schwarz, Birgit; Laufer, Günther; Antretter, Herwig; Mair, Peter

    2007-09-01

    Extracorporeal circulation is considered the gold standard in the treatment of hypothermic cardiocirculatory arrest; however, few centers use extracorporeal membrane oxygenation instead of standard extracorporeal circulation for this indication. The aim of this study was to evaluate whether extracorporeal membrane oxygenation-assisted resuscitation improves survival in patients with hypothermic cardiac arrest. A consecutive series of 59 patients with accidental hypothermia in cardiocirculatory arrest between 1987 and 2006 were included. Thirty-four patients (57.6%) were resuscitated by standard extracorporeal circulation, and 25 patients (42.4%) were resuscitated by extracorporeal membrane oxygenation. Accidental hypothermia was caused by avalanche in 22 patients (37.3%), drowning in 22 patients (37.3%), exposure to cold in 8 patients (13.5%), and falling into a crevasse in 7 patients (11.9%). Multivariate logistic regression analysis was used to compare extracorporeal membrane oxygenation with extracorporeal circulation resuscitation, with adjustment for relevant parameters. Restoration of spontaneous circulation was achieved in 32 patients (54.2%). A total of 12 patients (20.3%) survived hypothermia. In the extracorporeal circulation group, 64% of the nonsurviving patients who underwent restoration of spontaneous circulation died of severe pulmonary edema, but none died in the extracorporeal membrane oxygenation group. In multivariate analysis, extracorporeal membrane oxygenation-assisted resuscitation showed a 6.6-fold higher chance for survival (relative risk: 6.6, 95% confidence interval: 1.2-49.3, P = .042). Asphyxia-related hypothermia (avalanche or drowning) was the most predictive adverse factor for survival (relative risk: 0.09, 95% confidence interval: 0.01-0.60, P = .013). Potassium and pH failed to show statistical significance in the multivariate analysis. Extracorporeal rewarming with an extracorporeal membrane oxygenation system allows prolonged

  17. A novel CO2- and SO2-tolerant dual phase composite membrane for oxygen separation

    DEFF Research Database (Denmark)

    Cheng, Shiyang; Søgaard, Martin; Han, Li

    2015-01-01

    A novel dual phase composite oxygen membrane (Al0.02Ga0.02Zn0.96O1.02 – Gd0.1Ce0.9O1.95-δ) was successfully prepared and tested. The membrane shows chemical stability against CO2 and SO2, and a stable oxygen permeation over 300 hours in CO2 was demonstrated. ZnO is cheap and non...

  18. Analysis of heterogeneous oxygen exchange and fuel oxidation on the catalytic surface of perovskite membranes

    KAUST Repository

    Hong, Jongsup

    2013-10-01

    The catalytic kinetics of oxygen surface exchange and fuel oxidation for a perovskite membrane is investigated in terms of the thermodynamic state in the immediate vicinity of or on the membrane surface. Perovskite membranes have been shown to exhibit both oxygen perm-selectivity and catalytic activity for hydrocarbon conversion. A fundamental description of their catalytic surface reactions is needed. In this study, we infer the kinetic parameters for heterogeneous oxygen surface exchange and catalytic fuel conversion reactions, based on permeation rate measurements and a spatially resolved physical model that incorporates detailed chemical kinetics and transport in the gas-phase. The conservation equations for surface and bulk species are coupled with those of the gas-phase species through the species production rates from surface reactions. It is shown that oxygen surface exchange is limited by dissociative/associative adsorption/desorption of oxygen molecules onto/from the membrane surface. On the sweep side, while the catalytic conversion of methane to methyl radical governs the overall surface reactions at high temperature, carbon monoxide oxidation on the membrane surface is dominant at low temperature. Given the sweep side conditions considered in ITM reactor experiments, gas-phase reactions also play an important role, indicating the significance of investigating both homogeneous and heterogeneous chemistry and their coupling when examining the results. We show that the local thermodynamic state at the membrane surface should be considered when constructing and examining models of oxygen permeation and heterogeneous chemistry. © 2013 Elsevier B.V.

  19. Experience and needs of family members of patients treated with extracorporeal membrane oxygenation.

    Science.gov (United States)

    Tramm, Ralph; Ilic, Dragan; Murphy, Kerry; Sheldrake, Jayne; Pellegrino, Vincent; Hodgson, Carol

    2017-06-01

    To explore the experiences of family members of patients treated with extracorporeal membrane oxygenation. Sudden onset of an unexpected and severe illness is associated with an increased stress experience of family members. Only one study to date has explored the experience of family members of patients who are at high risk of dying and treated with extracorporeal membrane oxygenation. A qualitative descriptive research design was used. A total of 10 family members of patients treated with extracorporeal membrane oxygenation were recruited through a convenient sampling approach. Data were collected using open-ended semi-structured interviews. A six-step process was applied to analyse the data thematically. Four criteria were employed to evaluate methodological rigour. Family members of extracorporeal membrane oxygenation patients experienced psychological distress and strain during and after admission. Five main themes (Going Downhill, Intensive Care Unit Stress and Stressors, Carousel of Roles, Today and Advice) were identified. These themes were explored from the four roles of the Carousel of Roles theme (decision-maker, carer, manager and recorder) that participants experienced. Nurses and other staff involved in the care of extracorporeal membrane oxygenation patients must pay attention to individual needs of the family and activate all available support systems to help them cope with stress and strain. An information and recommendation guide for families and staff caring for extracorporeal membrane oxygenation patients was developed and needs to be applied cautiously to the individual clinical setting. © 2016 John Wiley & Sons Ltd.

  20. Prospective longitudinal evaluation of lung function during the first year of life after extracorporeal membrane oxygenation

    NARCIS (Netherlands)

    Hofhuis, W.; Hanekamp, M.N.; Ijsselstijn, H.; Nieuwhof, E.M.; Hop, W.C.J.; Tibboel, D.; Jongste, J.C. de; Merkus, P.J.F.M.

    2011-01-01

    OBJECTIVE: To collect longitudinal data on lung function in the first year of life after extracorporeal membrane oxygenation and to evaluate relationships between lung function and perinatal factors. Longitudinal data on lung function in the first year of life after extracorporeal membrane

  1. Design and optimization of porous ceramic supports for asymmetric ceria-based oxygen transport membranes

    DEFF Research Database (Denmark)

    Kaiser, Andreas; Foghmoes, Søren Preben Vagn; Pećanac, G.

    2016-01-01

    =7). The achieved gas permeability of 2.25×10−15 m2 for a 0.4 mm thick support will not limit the gas transport for oxygen production but in partial oxidation of methane to syngas at higher oxygen fluxes. For integration of the CGO support layer into a flat, asymmetric CGO membrane, the sintering...

  2. Tailoring of porosity of yttria-stabilized zirconia tubes as supports for oxygen separation membranes

    DEFF Research Database (Denmark)

    Bjørnetun Haugen, Astri; Kothanda Ramachandran, Dhavanesan; Gurauskis, Jonas

    Pure oxygen gas supplied by ceramic oxygen transport membranes can facilitate reduced CO2 emissions through more efficient gasification processes and CO2 capture and storage. Tubular membranes have some advantages compared to planar membranes, such as better resistance to thermal gradients and more...... straightforward sealing. The active oxygen separation layer in the membrane should be as thin as possible and therefore supported on a highly porous tubular substrate. In this work tubular porous supports of yttria-stabilized zirconia have been manufactured using thermoplastic extrusion. Two types of poreformers...... exceeding 55 % and gas permeabilities close to 10-14 m2 could be produced, demonstrating that thermoplastic extrusion is suitable for fabrication of porous and permeable tubes....

  3. Microbial activity catalyzes oxygen transfer in membrane-aerated nitritating biofilm reactors

    DEFF Research Database (Denmark)

    Pellicer i Nàcher, Carles; Domingo Felez, Carlos; Lackner, Susanne

    2013-01-01

    The remarkable oxygen transfer efficiencies attainable in membrane-aerated biofilm reactors (MABRs) are expected to favor their prompt industrial implementation. However, tests in clean water, currently used for the estimation of their oxygen transfer potential, lead to wrong estimates once biofilm...... is present, significantly complicating reactor modelling and control. This study shows for the first time the factors affecting oxygen mass transfer across membranes during clean water tests and reactor operation via undisturbed microelectrode inspection and bulk measurements. The mass transfer resistance...... of the liquid boundary layer developed at the membrane-liquid interface during clean water tests accounted for two thirds of the total mass transfer resistance, suggesting a strong underestimation of the oxygen transfer rates when it is absent (e.g. after biofilm growth). Reactor operation to attain partial...

  4. Hyperoxia Is Associated With Poor Outcomes in Pediatric Cardiac Patients Supported on Venoarterial Extracorporeal Membrane Oxygenation.

    Science.gov (United States)

    Sznycer-Taub, Nathaniel R; Lowery, Ray; Yu, Sunkyung; Owens, Sonal T; Hirsch-Romano, Jennifer C; Owens, Gabe E

    2016-04-01

    Patients who require venoarterial extracorporeal membrane oxygenation because of cardiac failure frequently have supranormal blood oxygen tensions (hyperoxia). Recent studies have suggested worse outcomes in patients with hyperoxia after resuscitation from cardiac or respiratory arrests, presumably because of oxidative stress. There are limited data regarding the effect of hyperoxia on outcomes in pediatric patients on venoarterial extracorporeal membrane oxygenation. Retrospective chart review. Pediatric cardiothoracic ICU. Cardiac surgery patients less than 1 year old requiring venoarterial extracorporeal membrane oxygenation in the postoperative period from 2007 to 2013. In 93 infants (median time on extracorporeal membrane oxygenation, 5 d), mortality at 30 days post surgery (primary outcome) was 38%. Using a receiver operating characteristic curve, a mean PaO2 of 193 mm Hg in the first 48 hours of extracorporeal membrane oxygenation was determined to have good discriminatory ability with regard to 30-day mortality. Univariate analysis identified a mean PaO2 greater than 193 mm Hg (p = 0.001), longer cardiopulmonary bypass times (p = 0.09), longer duration of extracorporeal membrane oxygenation (p membrane oxygenation pump flows (p = 0.052) as possible risk factors for 30-day mortality. In multivariable analysis controlling for the variables listed above, a mean PaO2 greater than 193 mm Hg remained an independent risk factor for mortality (p = 0.03). In addition, a mean PaO2 greater than 193 mm Hg was associated with the need for renal dialysis (p = 0.02) but not with neurologic injury (p = 0.41) during the hospitalization. In infants with congenital heart disease who are placed on venoarterial extracorporeal membrane oxygenation postoperatively, hyperoxia (defined as a mean PaO2 > 193 mm Hg in the first 48 hr of extracorporeal membrane oxygenation) was an independent risk factor for 30-day mortality after surgery. Future studies are needed to delineate the

  5. Steel reinforced composite silicone membranes and its integration to microfluidic oxygenators for high performance gas exchange.

    Science.gov (United States)

    Matharoo, Harpreet; Dabaghi, Mohammadhossein; Rochow, Niels; Fusch, Gerhard; Saraei, Neda; Tauhiduzzaman, Mohammed; Veldhuis, Stephen; Brash, John; Fusch, Christoph; Selvaganapathy, P Ravi

    2018-01-01

    Respiratory distress syndrome (RDS) is one of the main causes of fatality in newborn infants, particularly in neonates with low birth-weight. Commercial extracorporeal oxygenators have been used for low-birth-weight neonates in neonatal intensive care units. However, these oxygenators require high blood volumes to prime. In the last decade, microfluidics oxygenators using enriched oxygen have been developed for this purpose. Some of these oxygenators use thin polydimethylsiloxane (PDMS) membranes to facilitate gas exchange between the blood flowing in the microchannels and the ambient air outside. However, PDMS is elastic and the thin membranes exhibit significant deformation and delamination under pressure which alters the architecture of the devices causing poor oxygenation or device failure. Therefore, an alternate membrane with high stability, low deformation under pressure, and high gas exchange was desired. In this paper, we present a novel composite membrane consisting of an ultra-thin stainless-steel mesh embedded in PDMS, designed specifically for a microfluidic single oxygenator unit (SOU). In comparison to homogeneous PDMS membranes, this composite membrane demonstrated high stability, low deformation under pressure, and high gas exchange. In addition, a new design for oxygenator with sloping profile and tapered inlet configuration has been introduced to achieve the same gas exchange at lower pressure drops. SOUs were tested by bovine blood to evaluate gas exchange properties. Among all tested SOUs, the flat design SOU with composite membrane has the highest oxygen exchange of 40.32 ml/min m 2 . The superior performance of the new device with composite membrane was demonstrated by constructing a lung assist device (LAD) with a low priming volume of 10 ml. The LAD was achieved by the oxygen uptake of 0.48-0.90 ml/min and the CO 2 release of 1.05-2.27 ml/min at blood flow rates ranging between 8 and 48 ml/min. This LAD was shown to increase the

  6. Enhancing oxygen transport through Mixed-Ionic-and-Electronic-Conducting ceramic membranes

    Science.gov (United States)

    Yu, Anthony S.

    Ceramic membranes based on Mixed-Ionic-and-Electronic-Conducting (MIEC) oxides are capable of separating oxygen from air in the presence of an oxygen partial-pressure gradient. These MIEC membranes show great promise for oxygen consuming industrial processes, such as the production of syngas from steam reforming of natural gas (SRM), as well as for electricity generation in Solid Oxide Fuel Cells (SOFC). For both applications, the overall performance is dictated by the rate of oxygen transport across the membrane. Oxygen transport across MIEC membranes is composed of a bulk oxygen-ion diffusion process and surface processes, such as surface reactions and adsorption/desorption of gaseous reactants/products. The main goal of this thesis was to determine which process is rate-limiting in order to significantly enhance the overall rate of oxygen transport in MIEC membrane systems. The rate-limiting step was determined by evaluating the total resistance to oxygen transfer, Rtot. Rtot is the sum of a bulk diffusion resistance in the membrane itself, Rb, and interfacial loss components, Rs. Rb is a function of the membrane's ionic conductivity and thickness, while Rs arises primarily from slow surface-exchange kinetics that cause the P(O2) at the surfaces of the membrane to differ from the P(O 2) in the adjacent gas phases. Rtot can be calculated from the Nernst potential across the membrane and the measured oxygen flux. The rate-limiting process can be determined by evaluating the relative contributions of the various losses, Rs and Rb, to Rtot. Using this method, this thesis demonstrates that for most membrane systems, Rs is the dominating factor. In the development of membrane systems with high oxygen transport rates, thin membranes with high ionic conductivities are required to achieve fast bulk oxygen-ion diffusion. However, as membrane thickness is decreased, surface reaction kinetics become more important in determining the overall transport rate. The two

  7. Nosocomial Infections During Extracorporeal Membrane Oxygenation: Incidence, Etiology, and Impact on Patients' Outcome.

    Science.gov (United States)

    Grasselli, Giacomo; Scaravilli, Vittorio; Di Bella, Stefano; Biffi, Stefano; Bombino, Michela; Patroniti, Nicolò; Bisi, Luca; Peri, Anna Maria; Pesenti, Antonio; Gori, Andrea; Alagna, Laura

    2017-10-01

    To study incidence, type, etiology, risk factors, and impact on outcome of nosocomial infections during extracorporeal membrane oxygenation. Retrospective analysis of prospectively collected data. Italian tertiary referral center medical-surgical ICU. One hundred five consecutive patients who were treated with extracorporeal membrane oxygenation from January 2010 to November 2015. None. Ninety-two patients were included in the analysis (48.5 [37-56] years old, simplified acute physiology score II 37 [32-47]) who underwent peripheral extracorporeal membrane oxygenation (87% veno-venous) for medical indications (78% acute respiratory distress syndrome). Fifty-two patients (55%) were infected (50.4 infections/1,000 person-days of extracorporeal membrane oxygenation). We identified 32 ventilator-associated pneumonia, eight urinary tract infections, five blood stream infections, three catheter-related blood stream infections, two colitis, one extracorporeal membrane oxygenation cannula infection, and one pulmonary-catheter infection. G+ infections (35%) occurred earlier compared with G- (48%) (4 [2-10] vs. 13 [7-23] days from extracorporeal membrane oxygenation initiation; p infections. Younger age (2-35 years old) was independently associated with higher risk for nosocomial infections. Twenty-nine patients (31.5%) died (13.0 deaths/1,000 person-days of extracorporeal membrane oxygenation). Infected patients had higher risk for death (18 vs. 8 deaths/1,000 person-days of extracorporeal membrane oxygenation; p = 0.037) and longer ICU stay (32.5 [19.5-78] vs. 19 [10.5-27.5] days; p = 0.003), mechanical ventilation (36.5 [20-80.5] vs. 16.5 [9-25.5] days; p 50 years old), reason for connection different from acute respiratory distress syndrome, higher simplified acute physiology score II, diagnosis of ventilator-associated pneumonia, and infection by multidrug-resistant bacteria were independently associated to increased death rate. Infections (especially ventilator

  8. The Successful Use of Extracorporeal Membrane Oxygenation in Systemic Lupus Erythematosus-Induced Diffuse Alveolar Haemorrhage

    Directory of Open Access Journals (Sweden)

    Faye Pais

    2017-01-01

    Full Text Available Diffuse alveolar haemorrhage (DAH is a catastrophic pulmonary complication of systemic lupus erythematosus. It can result in refractory hypoxaemia despite mechanical ventilation. Increasing lung compliance and worsening pulmonary hypertension can potentiate cardiogenic shock from acute right ventricular failure. In such patients with cardiopulmonary collapse, veno-arterial (V-A ECMO maybe a viable option that can provide the required haemodynamic support. However, the use of V-A ECMO in such patients is limited due to an associated increased risk of bleeding. Our case report describes the successful use of V-A ECMO without the use of systemic anticoagulation in a patient with DAH. Despite the absence of systemic anticoagulation, no thrombotic complications within the circuit were noted.

  9. kinetic decompositionof La0.3Sr0.7CoO3-d perovskite membranes during oxygen permeation

    NARCIS (Netherlands)

    van Doorn, R.H.E.; van Doorn, R.H.E.; Bouwmeester, Henricus J.M.; Burggraaf, Anthonie; Burggraaf, A.J.

    1998-01-01

    In this paper, a study is presented towards the stability of oxygen permeable membranes of perovskite La0.3Sr0.7CoO3−δ in an oxygen pressure gradient. It is shown that phase separation occurs at the oxygen-lean side of the membrane, at 900°C, when the membrane is exposed to streams of air and inert

  10. Significant social events and increasing use of life-sustaining treatment: trend analysis using extracorporeal membrane oxygenation as an example.

    Science.gov (United States)

    Chen, Yen-Yuan; Chen, Likwang; Huang, Tien-Shang; Ko, Wen-Je; Chu, Tzong-Shinn; Ni, Yen-Hsuan; Chang, Shan-Chwen

    2014-03-04

    Most studies have examined the outcomes of patients supported by extracorporeal membrane oxygenation as a life-sustaining treatment. It is unclear whether significant social events are associated with the use of life-sustaining treatment. This study aimed to compare the trend of extracorporeal membrane oxygenation use in Taiwan with that in the world, and to examine the influence of significant social events on the trend of extracorporeal membrane oxygenation use in Taiwan. Taiwan's extracorporeal membrane oxygenation uses from 2000 to 2009 were collected from National Health Insurance Research Dataset. The number of the worldwide extracorporeal membrane oxygenation cases was mainly estimated using Extracorporeal Life Support Registry Report International Summary July 2012. The trend of Taiwan's crude annual incidence rate of extracorporeal membrane oxygenation use was compared with that of the rest of the world. Each trend of extracorporeal membrane oxygenation use was examined using joinpoint regression. The measurement was the crude annual incidence rate of extracorporeal membrane oxygenation use. Each of the Taiwan's crude annual incidence rates was much higher than the worldwide one in the same year. Both the trends of Taiwan's and worldwide crude annual incidence rates have significantly increased since 2000. Joinpoint regression selected the model of the Taiwan's trend with one joinpoint in 2006 as the best-fitted model, implying that the significant social events in 2006 were significantly associated with the trend change of extracorporeal membrane oxygenation use following 2006. In addition, significantly social events highlighted by the media are more likely to be associated with the increase of extracorporeal membrane oxygenation use than being fully covered by National Health Insurance. Significant social events, such as a well-known person's successful extracorporeal membrane oxygenation use highlighted by the mass media, are associated with the use of

  11. Severe hypoxemia during veno-venous extracorporeal membrane oxygenation: exploring the limits of extracorporeal respiratory support

    Directory of Open Access Journals (Sweden)

    Liane Brescovici Nunes

    2014-03-01

    Full Text Available OBJECTIVE: Veno-venous extracorporeal oxygenation for respiratory support has emerged as a rescue alternative for patients with hypoxemia. However, in some patients with more severe lung injury, extracorporeal support fails to restore arterial oxygenation. Based on four clinical vignettes, the aims of this article were to describe the pathophysiology of this concerning problem and to discuss possibilities for hypoxemia resolution. METHODS: Considering the main reasons and rationale for hypoxemia during veno-venous extracorporeal membrane oxygenation, some possible bedside solutions must be considered: 1 optimization of extracorporeal membrane oxygenation blood flow; 2 identification of recirculation and cannula repositioning if necessary; 3 optimization of residual lung function and consideration of blood transfusion; 4 diagnosis of oxygenator dysfunction and consideration of its replacement; and finally 5 optimization of the ratio of extracorporeal membrane oxygenation blood flow to cardiac output, based on the reduction of cardiac output. CONCLUSION: Therefore, based on the pathophysiology of hypoxemia during veno-venous extracorporeal oxygenation support, we propose a stepwise approach to help guide specific interventions.

  12. Combined application of extracorporeal membrane oxygenation and an artificial pacemaker in fulminant myocarditis in a child.

    Science.gov (United States)

    Ye, Sheng; Zhu, Lvchan; Ning, Botao; Zhang, Chenmei

    2017-06-01

    Fulminant myocarditis is severe and aggressive, but it is self-limited and usually has a favorable prognosis if the patients can survive the acute phase. When drug treatment is not effective, extracorporeal membrane oxygenation technology should be applied to support cardiopulmonary function. Extracorporeal membrane oxygenation can simultaneously support function of the left ventricle, right ventricle, and lungs, and provide stable blood circulation for patients with heart and respiratory failure, which allows sufficient time for the cardiopulmonary system to recover. Fulminant myocarditis affects cardiac systolic function, as well as the function of autorhythmic cells and the conduction system. If severe bradycardia or atrioventricular block appears, a pacemaker needs to be installed. We report a child with fulminant myocarditis who was treated with extracorporeal membrane oxygenation combined with an artificial pacemaker.

  13. Development of Dual-Phase Oxygen Transport Membranes for Carbon Capture Processes

    DEFF Research Database (Denmark)

    Pirou, Stéven

    -fuel combustion power plants. For the case of direct integration considered here the permeate side of the OTMs will be swept with recirculated flue gas whereby a driving force for oxygen transport through the membrane, which is fed with air on the other side, is directly established. It further facilitates...... developed and characterized as thick (1 mm) self-standing membranes and thin (8 μm) supported membranes. The stability of these membranes in gas streams containing CO2, SO2 and H2O was found to be excellent. However, the high volatility of the Zn in the AZO phase under mildly reducing atmospheres makes...... in the combustion, which greatly facilitates the down-stream CO2 capture. The main energy penalty for the oxy-fuel process is related to the production of the oxygen, which today commonly is done in cryogenic air separation units (ASUs). An alternative approach, which requires significant less energy is the use...

  14. Neonatal and pediatric extracorporeal membrane oxygenation in developing Latin American countries

    Directory of Open Access Journals (Sweden)

    Javier Kattan

    Full Text Available Abstract Objective: To review the principles of neonatal-pediatric extracorporeal membrane oxygenation therapy, prognosis, and its establishment in limited resource-limited countries in Latino America. Sources: The PubMed database was explored from 1985 up to the present, selecting from highly-indexed and leading Latin American journals, and Extracorporeal Life Support Organization reports. Summary of the findings: Extracorporeal membrane oxygenation provides “time” for pulmonary and cardiac rest and for recovery. It is used in the neonatal-pediatric field as a rescue therapy for more than 1300 patients with respiratory failure and around 1000 patients with cardiac diseases per year. The best results in short- and long-term survival are among patients with isolated respiratory diseases, currently established as a standard therapy in referral centers for high-risk patients. The first neonatal/pediatric extracorporeal membrane oxygenation Program in Latin America was established in Chile in 2003, which was also the first program in Latin America to affiliate with the Extracorporeal Life Support Organization. New extracorporeal membrane oxygenation programs have been developed in recent years in referral centers in Argentina, Colombia, Brazil, Mexico, Perú, Costa Rica, and Chile, which are currently funding the Latin American Extracorporeal Life Support Organization chapter. Conclusions: The best results in short- and long-term survival are in patients with isolated respiratory diseases. Today extracorporeal membrane oxygenation therapy is a standard therapy in some Latin American referral centers. It is hoped that these new extracorporeal membrane oxygenation centers will have a positive impact on the survival of newborns and children with respiratory or cardiac failure, and that they will be available for an increasing number of patients from this region in the near future.

  15. Neonatal and pediatric extracorporeal membrane oxygenation in developing Latin American countries.

    Science.gov (United States)

    Kattan, Javier; González, Álvaro; Castillo, Andrés; Caneo, Luiz Fernando

    To review the principles of neonatal-pediatric extracorporeal membrane oxygenation therapy, prognosis, and its establishment in limited resource-limited countries in Latino America. The PubMed database was explored from 1985 up to the present, selecting from highly-indexed and leading Latin American journals, and Extracorporeal Life Support Organization reports. Extracorporeal membrane oxygenation provides "time" for pulmonary and cardiac rest and for recovery. It is used in the neonatal-pediatric field as a rescue therapy for more than 1300 patients with respiratory failure and around 1000 patients with cardiac diseases per year. The best results in short- and long-term survival are among patients with isolated respiratory diseases, currently established as a standard therapy in referral centers for high-risk patients. The first neonatal/pediatric extracorporeal membrane oxygenation Program in Latin America was established in Chile in 2003, which was also the first program in Latin America to affiliate with the Extracorporeal Life Support Organization. New extracorporeal membrane oxygenation programs have been developed in recent years in referral centers in Argentina, Colombia, Brazil, Mexico, Perú, Costa Rica, and Chile, which are currently funding the Latin American Extracorporeal Life Support Organization chapter. The best results in short- and long-term survival are in patients with isolated respiratory diseases. Today extracorporeal membrane oxygenation therapy is a standard therapy in some Latin American referral centers. It is hoped that these new extracorporeal membrane oxygenation centers will have a positive impact on the survival of newborns and children with respiratory or cardiac failure, and that they will be available for an increasing number of patients from this region in the near future. Copyright © 2016 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

  16. Tailoring the porosity and shrinkage of extruded MgO support tubes for oxygen separation membranes by thermoplastic feedstock development

    DEFF Research Database (Denmark)

    Kothanda Ramachandran, Dhavanesan; Kaiser, Andreas; Glasscock, Julie

    Supported thin film oxygen separation membranes are suitable for membrane reactors applications such as oxyfuel or syngas production. Porous supports provide mechanical stability to supported thin film oxygen transport membranes and to allow unrestricted gas access to membrane layer. The feedstocks...... for co-extrusion and co-sintering of a porous Magnesium oxide (MgO) support with a thin film of cerium gadolinium oxide (Ce0.9Gd0.1O1.95-δ, CGO) as active oxygen transport membrane layer has been developed using a thermoplastic ceramic system and graphite as pore former. The feedstocks have been...

  17. Design and optimization of porous ceramic supports for asymmetric ceria-based oxygen transport membranes

    DEFF Research Database (Denmark)

    Kaiser, Andreas; Foghmoes, Søren Preben Vagn; Pećanac, G.

    2016-01-01

    The microstructure, mechanical properties and gas permeability of porous supports of Ce0.9Gd0.1O1.95−δ (CGO) were investigated as a function of sintering temperature and volume fraction of pore former for use in planar asymmetric oxygen transport membranes (OTMs). With increasing the pore former ...... activity of the CGO membrane was reduced by Fe2O3 addition (replacing Co3O4 as sintering additive)....

  18. Acute Cor Pulmonale in Veno-Venous Extracorporeal Membrane Oxygenation: Three Case Reports.

    Science.gov (United States)

    Dong, Erik R; Ng, David G; Ramzy, Danny; Chung, Joshua S; Friedman, Oren; Combes, Alain; Arabia, Francisco A; Nurok, Michael

    2018-01-10

    A retrospective review of three patients with acute respiratory distress syndrome (ARDS) and normal baseline right ventricular function admitted to the Cardiac Surgery Intensive Care Unit whom developed acute cor pulmonale while on veno-venous extracorporeal membrane oxygenation. These patients were diagnosed with ARDS using Berlin Criteria definitions and cannulated with a dual lumen (Avalon) cannula. Despite variations in history, presentation, and course, findings of acute cor pulmonale were encountered 4 to 6 weeks after extracorporeal membrane oxygenation cannulation. The potential mechanisms include thromboembolic burden to the pulmonary vasculature, hypoxemia, acidosis, the pathologic progression of ARDS, and chronic nonphysiologic flow to the right heart.

  19. A theoretical model for evaluation of the design of a hollow-fiber membrane oxygenator.

    Science.gov (United States)

    Tabesh, Hadi; Amoabediny, Ghassem; Poorkhalil, Ali; Khachab, Ali; Kashefi, Ali; Mottaghy, Khosrow

    2012-12-01

    Geometric data are fundamental to the design of a contactor. The efficiency of a membrane contactor is mainly defined by its mass-transfer coefficient. However, design modifications also have significant effects on the performance of membrane contactors. In a hollow-fiber membrane oxygenator (HFMO), properties such as priming volume and effective membrane surface area (referred to as design specifications) can be determined. In this study, an extensive theoretical model for calculation of geometric data and configuration properties, and, consequently, optimization of the design of an HFMO, is presented. Calculations were performed for Oxyphan(®) hollow-fiber micro-porous membranes, which are frequently used in current HFMOs because of their high gas exchange performance. The results reveal how to regulate both the transverse and longitudinal pitches of fiber bundles to obtain a lower rand width and a greater number of windings. Such modifications assist optimization of module design and, consequently, substantially increase the efficiency of an HFMO. On the basis of these considerations, three values, called efficiency factors, are proposed for evaluation of the design specifications of an HFMO with regard with its performance characteristics (i.e. oxygen-transfer rate and blood pressure drop). Moreover, the performance characteristics of six different commercial HFMOs were measured experimentally, in vitro, under the same standard conditions. Comparison of calculated efficiency factors reveals Quadrox(®) is the oxygenator with the most efficient design with regard with its performance among the oxygenators tested.

  20. Nutrient utilization and oxygen production by Chlorella Vulgaris in a hybrid membrane bioreactor and algal membrane photobioreactor system

    KAUST Repository

    Najm, Yasmeen Hani Kamal

    2017-02-17

    This work studied oxygen production and nutrient utilization by Chlorella Vulgaris at different organic/inorganic carbon (OC/IC) and ammonium/nitrate (NH4+-N/NO3--N) ratios to design a hybrid aerobic membrane bioreactor (MBR) and membrane photobioreactor (MPBR) system. Specific oxygen production by C. vulgaris was enough to support the MBR if high growth is accomplished. Nearly 100% removal (or utilization) of PO43--P and IC was achieved under all conditions tested. Optimal growth was achieved at mixotrophic carbon conditions (0.353 d-1) and the highest NH4+-N concentration (0.357 d-1), with preferable NH4+-N utilization rather than NO3--N. The results indicate the potential of alternative process designs to treat domestic wastewater by coupling the hybrid MBR - MPBR systems.

  1. Numerical simulation of ion transport membrane reactors: Oxygen permeation and transport and fuel conversion

    KAUST Repository

    Hong, Jongsup

    2012-07-01

    Ion transport membrane (ITM) based reactors have been suggested as a novel technology for several applications including fuel reforming and oxy-fuel combustion, which integrates air separation and fuel conversion while reducing complexity and the associated energy penalty. To utilize this technology more effectively, it is necessary to develop a better understanding of the fundamental processes of oxygen transport and fuel conversion in the immediate vicinity of the membrane. In this paper, a numerical model that spatially resolves the gas flow, transport and reactions is presented. The model incorporates detailed gas phase chemistry and transport. The model is used to express the oxygen permeation flux in terms of the oxygen concentrations at the membrane surface given data on the bulk concentration, which is necessary for cases when mass transfer limitations on the permeate side are important and for reactive flow modeling. The simulation results show the dependence of oxygen transport and fuel conversion on the geometry and flow parameters including the membrane temperature, feed and sweep gas flow, oxygen concentration in the feed and fuel concentration in the sweep gas. © 2012 Elsevier B.V.

  2. CESAR: conventional ventilatory support vs extracorporeal membrane oxygenation for severe adult respiratory failure

    Directory of Open Access Journals (Sweden)

    Mugford Miranda

    2006-12-01

    Full Text Available Abstract Background An estimated 350 adults develop severe, but potentially reversible respiratory failure in the UK annually. Current management uses intermittent positive pressure ventilation, but barotrauma, volutrauma and oxygen toxicity can prevent lung recovery. An alternative treatment, extracorporeal membrane oxygenation, uses cardio-pulmonary bypass technology to temporarily provide gas exchange, allowing ventilator settings to be reduced. While extracorporeal membrane oxygenation is proven to result in improved outcome when compared to conventional ventilation in neonates with severe respiratory failure, there is currently no good evidence from randomised controlled trials to compare these managements for important clinical outcomes in adults, although evidence from case series is promising. Methods/Design The aim of the randomised controlled trial of Conventional ventilatory support vs extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR is to assess whether, for patients with severe, but potentially reversible, respiratory failure, extracorporeal membrane oxygenation will increase the rate of survival without severe disability ('confined to bed' and 'unable to wash or dress' by six months post-randomisation, and be cost effective from the viewpoints of the NHS and society, compared to conventional ventilatory support. Following assent from a relative, adults (18–65 years with severe, but potentially reversible, respiratory failure (Murray score ≥ 3.0 or hypercapnea with pH Discussion Analysis will be based on intention to treat. A concurrent economic evaluation will also be performed to compare the costs and outcomes of both treatments.

  3. Catalytic reforming of methane to syngas in an oxygen-permeative membrane reactor

    Science.gov (United States)

    Urano, Takeshi; Kubo, Keiko; Saito, Tomoyuki; Hitomi, Atsushi

    2011-05-01

    For fuel cell applications, partial oxidative reforming of methane to syngas, hydrogen and carbon monoxide, was performed via a dense oxygen-permeative ceramic membrane composed by both ionic and electronic conductive materials. The modification of Ni-based catalyst by noble metals was investigated to increase oxygen permeation flux and decrease carbon deposition during reforming reaction. The role of each component in catalyst was also discussed.

  4. Surface characterization of the chitosan membrane after oxygen plasma treatment and its aging effect

    International Nuclear Information System (INIS)

    Wang Yingjun; Yin Shiheng; Ren Li; Zhao Lianna

    2009-01-01

    Chitosan has received considerable attention for biomedical applications in recent years because of its biocompatibility and biodegradability. In this paper, angle-resolved x-ray photoelectron spectroscopy (ARXPS) was carried out to investigate the chemical groups' spatial orientation on the chitosan membrane surface. Oxygen plasma treatment was also employed to improve the surface hydrophilicity of the chitosan membrane. The results of ARXPS revealed the distribution of surface polar groups, such as-OH and O=CNH 2 toward the membrane bulk, which was the origin of the chitosan membrane surface hydrophobicity. The contact angle measurements and XPS results indicated that oxygen plasma treatment can markedly improve the surface hydrophilicity and surface energy of the chitosan membrane by incorporating oxygen-containing polar groups. With the existence of the aging process, the influence of plasma treatment was not permanent, it faded with storage time. The ARXPS result discovered that the reorientation of polar functional groups generated by plasma treatment toward the membrane bulk was primarily responsible for the aging effect.

  5. [Biocompatibility of poly-L-lactic acid/Bioglass-guided bone regeneration membranes processed with oxygen plasma].

    Science.gov (United States)

    Fang, Wei; Zeng, Shu-Guang; Gao, Wen-Feng

    2015-04-01

    To prepare and characterize a nano-scale fibrous hydrophilic poly-L-lactic acid/ Bioglass (PLLA/BG) composite membrane and evaluate its biocompatibility as a composite membrane for guiding bone regeneration (GBR). PLLA/BG-guided bone regeneration membrane was treated by oxygen plasma to improved its hydrophilicity. The growth of MG-63 osteoblasts on the membrane was observed using Hoechst fluorescence staining, and the biocompatibility of the membrane was evaluated by calculating the cells adhesion rate and proliferation rate. Osteogenesis of MG-63 cells was assessed by detecting alkaline phosphatase (ALP), and the formation of calcified nodules and cell morphology changes were observed using scanning electron microscope (SEM). The cell adhesion rates of PLLA/BG-guided bone regeneration membrane treated with oxygen plasma were (30.570±0.96)%, (47.27±0.78)%, and (66.78±0.69)% at 1, 3, and 6 h, respectively, significantly higher than those on PLLA membrane and untreated PLLA/BG membrane (Pmembranes increased with time, but highest on oxygen plasma-treated PLLA/BG membrane (Pplasma treatment of the PLLA/BG membrane promoted cell adhesion. The membranes with Bioglass promoted the matrix secretion of the osteoblasts. Under SEM, the formation of calcified nodules and spindle-shaped cell morphology were observed on oxygen plasma-treated PLLA/BG membrane. Oxygen plasma-treated PLLA/BG composite membrane has good biocompatibility and can promote adhesion, proliferation and osteogenesis of the osteoblasts.

  6. Interactions between oxygen permeation and homogeneous-phase fuel conversion on the sweep side of an ion transport membrane

    KAUST Repository

    Hong, Jongsup

    2013-02-01

    The interactions between oxygen permeation and homogeneous fuel oxidation reactions on the sweep side of an ion transport membrane (ITM) are examined using a comprehensive model, which couples the dependency of the oxygen permeation rate on the membrane surface conditions and detailed chemistry and transport in the vicinity of the membrane. We assume that the membrane surface is not catalytic to hydrocarbon or syngas oxidation. Results show that increasing the sweep gas inlet temperature and fuel concentration enhances oxygen permeation substantially. This is accomplished through promoting oxidation reactions (oxygen consumption) and the transport of the products and reaction heat towards the membrane, which lowers the oxygen concentration and increases the gas temperature near the membrane. Faster reactions at higher fuel concentration and higher inlet gas temperature support substantial fuel conversion and lead to a higher oxygen permeation flux without the contribution of surface catalytic activity. Beyond a certain maximum in the fuel concentration, extensive heat loss to the membrane (and feed side) reduces the oxidation kinetic rates and limits oxygen permeation as the reaction front reaches the membrane. The sweep gas flow rate and channel height have moderate impacts on oxygen permeation and fuel conversion due to the residence time requirements for the chemical reactions and the location of the reaction zone relative to the membrane surface. © 2012 Elsevier B.V.

  7. Oxygen Transfer Model for a Flow-Through Hollow-Fiber Membrane Biofilm Reactor

    DEFF Research Database (Denmark)

    Gilmore, K. R.; Little, J. C.; Smets, Barth F.

    2009-01-01

    A mechanistic oxygen transfer model was developed and applied to a flow-through hollow-fiber membrane-aerated biofilm reactor. Model results are compared to conventional clean water test results as well as performance data obtained when an actively nitrifying biofilm was present on the fibers......-liquid interface was the most accurate of the predictive models (overpredicted by a factor of 1.1) while a coefficient determined by measuring bulk liquid dissolved oxygen underpredicted the oxygen transfer by a factor of 3. The mechanistic model was found to be an adequate tool for design because it used....... With the biofilm present, oxygen transfer efficiencies between 30 and 55% were calculated from the measured data including the outlet gas oxygen concentration, ammonia consumption stoichiometry, and oxidized nitrogen production stoichiometry, all of which were in reasonable agreement. The mechanistic model...

  8. Voltage-sensitive styryl dyes as singlet oxygen targets on the surface of bilayer lipid membrane.

    Science.gov (United States)

    Sokolov, V S; Gavrilchik, A N; Kulagina, A O; Meshkov, I N; Pohl, P; Gorbunova, Yu G

    2016-08-01

    Photosensitizers are widely used as photodynamic therapeutic agents killing cancer cells by photooxidation of their components. Development of new effective photosensitive molecules requires profound knowledge of possible targets for reactive oxygen species, especially for its singlet form. Here we studied photooxidation of voltage-sensitive styryl dyes (di-4-ANEPPS, di-8-ANEPPS, RH-421 and RH-237) by singlet oxygen on the surface of bilayer lipid membranes commonly used as cell membrane models. Oxidation was induced by irradiation of a photosensitizer (aluminum phthalocyanine tetrasulfonate) and monitored by the change of dipole potential on the surface of the membrane. We studied the drop of the dipole potential both in the case when the dye molecules were adsorbed on the same side of the lipid bilayer as the photosensitizer (cis-configuration) and in the case when they were adsorbed on the opposite side (trans-configuration). Based on a simple model, we determined the rate of oxidation of the dyes from the kinetics of change of the potential during and after irradiation. This rate is proportional to steady-state concentration of singlet oxygen in the membrane under irradiation. Comparison of the oxidation rates of various dyes reveals that compounds of ANEPPS series are more sensitive to singlet oxygen than RH type dyes, indicating that naphthalene group is primarily responsible for their oxidation. Copyright © 2016 Elsevier B.V. All rights reserved.

  9. Hemolysis in pediatric patients receiving centrifugal-pump extracorporeal membrane oxygenation: prevalence, risk factors, and outcomes.

    Science.gov (United States)

    Lou, Song; MacLaren, Graeme; Best, Derek; Delzoppo, Carmel; Butt, Warwick

    2014-05-01

    To explore the prevalence and risk factors for hemolysis in children receiving extracorporeal membrane oxygenation and examine the relationship between hemolysis and adverse outcomes. Retrospective, single-center study. Tertiary PICU. Two hundred seven children receiving extracorporeal membrane oxygenation. None. Plasma-free hemoglobin was tested daily and hemolysis was diagnosed based on peak plasma-free hemoglobin as mild ( 1.0 g/L). Gender, age, weight, diagnosis, oxygenator type, cannulation site, mean venous inlet pressure, mean pump speed, mean flow, and visible clots in the extracorporeal membrane oxygenation circuit were entered into the ordered logistic regression model to identify risk factors of hemolysis. Complications and clinical outcomes were compared across four hemolysis groups. Of the 207 patients, 69 patients (33.3%; 95% CI, 27.0-40.2%) did not have hemolysis, 98 patients (47.3%; 95% CI, 40.4-54.4%) had mild hemolysis, 26 patients (12.5%; 95% CI, 8.4-17.9%) had moderate hemolysis, and 14 patients (6.8%; 95% CI, 3.7-11.1%) had severe hemolysis with a median peak plasma-free hemoglobin of 1.51 g/L (1.18-2.05 g/L). The independent risk factors for hemolysis during extracorporeal membrane oxygenation were use of Quadrox D (odds ratio, 7.25; 95% CI, 3.10-16.95; p pump speed (odds ratio, 2.89; 95% CI, 1.36-6.14; p = 0.006). Patients with hemolysis were more likely to experience a longer extracorporeal membrane oxygenation run and require more blood products. After controlling for age, weight, pediatric index of mortality 2, and diagnosis, patients with severe hemolysis were more likely to die in the ICU (odds ratio, 5.93; 95% CI, 1.64-21.43; p = 0.007) and in hospital (odds ratio, 6.34; 95% CI, 1.71-23.54; p = 0.006). Hemolysis during extracorporeal membrane oxygenation with centrifugal pumps was common and associated with a number of adverse outcomes. Risk factors for hemolysis included oxygenator types, mean venous inlet pressure, and mean pump speed

  10. ECMO como puente a decisión

    Directory of Open Access Journals (Sweden)

    Charles E. Juvin-Bouvier

    2017-09-01

    La ECMO es una herramienta fundamental en el manejo del shock cardiogénico refractario para ganar tiempo con vistas a decidir una actitud definitiva pero puede condicionar situaciones de peligro vital como la hemorragia secundaria a la anticoagulación que requiere el dispositivo.

  11. Carbon dioxide remediation via oxygen-enriched combustion using dense ceramic membranes

    Science.gov (United States)

    Balachandran, Uthamalingam; Bose, Arun C.; McIlvried, Howard G.

    2001-01-01

    A method of combusting pulverized coal by mixing the pulverized coal and an oxidant gas to provide a pulverized coal-oxidant gas mixture and contacting the pulverized coal-oxidant gas mixture with a flame sufficiently hot to combust the mixture. An oxygen-containing gas is passed in contact with a dense ceramic membrane of metal oxide material having electron conductivity and oxygen ion conductivity that is gas-impervious until the oxygen concentration on one side of the membrane is not less than about 30% by volume. An oxidant gas with an oxygen concentration of not less than about 30% by volume and a CO.sub.2 concentration of not less than about 30% by volume and pulverized coal is contacted with a flame sufficiently hot to combust the mixture to produce heat and a flue gas. One dense ceramic membrane disclosed is selected from the group consisting of materials having formulae SrCo.sub.0.8 Fe.sub.0.2 O.sub.x, SrCo.sub.0.5 FeO.sub.x and La.sub.0.2 Sr.sub.0.8 Co.sub.0.4 Fe.sub.0.6 O.sub.x.

  12. Oxygen distribution in packed bed membrane reactors for partial oxidation systems and the effect on the product selectivity

    NARCIS (Netherlands)

    Kurten, U.; van Sint Annaland, M.; Kuipers, J.A.M.

    2004-01-01

    Packed bed membrane reactors (PBMRs) are currently considered for the distributive addition of oxygen in partial oxidation systems. Among other advantages the decreased oxygen concentrations in the PBMR can result in improved product selectivities for reaction systems in which the oxygen dependency

  13. Plasma Biomarkers of Brain Injury as Diagnostic Tools and Outcome Predictors After Extracorporeal Membrane Oxygenation.

    Science.gov (United States)

    Bembea, Melania M; Rizkalla, Nicole; Freedy, James; Barasch, Noah; Vaidya, Dhananjay; Pronovost, Peter J; Everett, Allen D; Mueller, Gregory

    2015-10-01

    To determine if elevations in plasma brain injury biomarkers are associated with outcome at hospital discharge in children who require extracorporeal membrane oxygenation. Prospective observational study. Single tertiary-care academic center. Eighty children who underwent extracorporeal membrane oxygenation between June 2010 and December 2013. None. We measured six brain injury biomarkers (glial fibrillary acidic protein, monocyte chemoattractant protein 1/chemokine (C-C motif) ligand 2, neuron-specific enolase, S100b, intercellular adhesion molecule-5, and brain-derived neurotrophic factor) daily during extracorporeal membrane oxygenation, using an electrochemiluminescent multiplex assay. We recorded clinical, neuroimaging, and extracorporeal membrane oxygenation course data. We analyzed the association of biomarker concentrations with favorable versus unfavorable outcome at hospital discharge. Favorable outcome was defined as Pediatric Cerebral Performance Category 1, 2, or no change from baseline. Patients had a median age of 3 days (interquartile range, 1 d-10 mo), and 56% were male. Thirty-three of 80 (41%) had unfavorable outcome, and 22 of 70 (31%) had abnormal neuroimaging findings during or after extracorporeal membrane oxygenation. Peak concentrations were significantly higher in patients with unfavorable outcome than in those with favorable outcome for glial fibrillary acidic protein (p = 0.002), monocyte chemoattractant protein 1/chemokine (C-C motif) ligand 2 (p = 0.030), neuron-specific enolase (p = 0.006), and S100b (p = 0.015) and in patients with versus without abnormal neuroimaging findings for glial fibrillary acidic protein (p = 0.001) and intercellular adhesion molecule-5 (p = 0.001). The area under the receiver operator characteristic curve for unfavorable outcome was 0.73 for a noncollinear biomarker combination. After removing collinear biomarkers, the adjusted odds ratios for unfavorable outcome were 2.89 (95% CI, 1.09-7.73) for neuron

  14. Toward enhanced hydrogen generation from water using oxygen permeating LCF membranes

    KAUST Repository

    Wu, Xiao-Yu

    2015-01-01

    © the Owner Societies. Hydrogen production from water thermolysis can be enhanced by the use of perovskite-type mixed ionic and electronic conducting (MIEC) membranes, through which oxygen permeation is driven by a chemical potential gradient. In this work, water thermolysis experiments were performed using 0.9 mm thick La0.9Ca0.1FeO3-δ (LCF-91) perovskite membranes at 990 °C in a lab-scale button-cell reactor. We examined the effects of the operating conditions such as the gas species concentrations and flow rates on the feed and sweep sides on the water thermolysis rate and oxygen flux. A single step reaction mechanism is proposed for surface reactions, and three-resistance permeation models are derived. Results show that water thermolysis is facilitated by the LCF-91 membrane especially when a fuel is added to the sweep gas. Increasing the gas flow rate and water concentration on the feed side or the hydrogen concentration on the sweep side enhances the hydrogen production rate. In this work, hydrogen is used as the fuel by construction, so that a single-step surface reaction mechanism can be developed and water thermolysis rate parameters can be derived. Both surface reaction rate parameters for oxygen incorporation/dissociation and hydrogen-oxygen reactions are fitted at 990 °C. We compare the oxygen fluxes in water thermolysis and air separation experiments, and identify different limiting steps in the processes involving various oxygen sources and sweep gases for this 0.9 mm thick LCF-91 membrane. In the air feed-inert sweep case, the bulk diffusion and sweep side surface reaction are the two limiting steps. In the water feed-inert sweep case, surface reaction on the feed side dominates the oxygen permeation process. Yet in the water feed-fuel sweep case, surface reactions on both the feed and sweep sides are rate determining when hydrogen concentration in the sweep side is in the range of 1-5 vol%. Furthermore, long term studies show that the surface

  15. Simulating extracorporeal membrane oxygenation emergencies to improve human performance. Part II: assessment of technical and behavioral skills.

    Science.gov (United States)

    Anderson, JoDee M; Murphy, Allison A; Boyle, Kristine B; Yaeger, Kim A; Halamek, Louis P

    2006-01-01

    Healthcare professionals are expected to make rapid, correct decisions in critical situations despite what may be a lack of real practical experience in a particular crisis situation. Successful resolution of a medical crisis depends upon demonstration not only of appropriate technical skills but also of key behavioral skills (eg, leadership, communication, and teamwork). We have developed a hands-on, high fidelity, simulation-based training program (ECMO Sim) to provide healthcare professionals with the opportunity to learn and practice the technical and behavioral skills necessary to manage ECMO emergencies. Nine ECMO nurse specialists participated in two sequential randomly assigned simulated ECMO emergencies. The simulated emergencies were captured on videotape and reviewed with the subjects during facilitated debriefings that occurred immediately following each scenario. All videotapes were scored for key technical and behavioral skills by reviewers blinded to the sequence of the scenarios. The ratings of the subjects' technical and behavioral skills in each scenario were compared. Subjects performed key technical skills correctly more often in the second simulated ECMO emergency. In addition, their response times for three out of five specific technical tasks improved from the first to the second simulated emergency by an average of 27 seconds. Subjects' behavioral skills were rated more highly by masked reviewers in the second simulated ECMO emergency. The improvement in comprehensive behavioral scores from the first to the second scenario reached statistical significance in eight of nine subjects. After exposure to high-fidelity simulated ECMO emergencies, subjects demonstrated significant improvements in their technical and behavioral skills. ECMO Sim creates a learning environment that readily supports the acquisition of the technical and behavioral skills that are important in solving clinically significant, potentially life-threatening problems that can

  16. Population Pharmacokinetics of Meropenem in Plasma and Subcutis in Patients on Extracorporeal Membrane Oxygenation Treatment

    DEFF Research Database (Denmark)

    Hanberg, Pelle; Öbrink-Hansen, Kristina; Thorsted, Anders

    2018-01-01

    The objectives of this study were to describe meropenem pharmacokinetics (PK) in plasma and/or subcutaneous adipose tissue (SCT) in critically ill patients receiving ECMO treatment, and to develop a population PK model to simulate alternative dosing regimens and modes of administration. We...... conducted a prospective observational study. Ten patients on ECMO treatment received meropenem (1 or 2 g) intravenously over 5 min every 8 hours. Serial SCT concentrations were determined using microdialysis and compared with plasma concentrations. A population PK model of SCT and plasma data was developed...... infusion would be needed for 100%fT>MIC and 100%fT>4xMIC to be obtained. Meropenem plasma and SCT concentrations were associated with estimated creatinine-clearance (eCLCr). Simulations showed that in patients with increased eCLCr, dose increment or continuous infusion may be needed to obtain therapeutic...

  17. Successful Use of Extracorporeal Membrane Oxygenation for the Treatment of Cardiogenic Shock due to Scorpion Envenomation

    Directory of Open Access Journals (Sweden)

    Amine Tarmiz

    2017-01-01

    Full Text Available Introduction. The occurrence of a cardiogenic shock is a rare presentation after scorpion envenomation. The treatment includes classically the use of inotropes and specific vasodilators. Case Presentation. We report a case of an 11-year-old boy presenting with cardiogenic shock and pulmonary edema after a scorpion sting. Despite adequate management at the emergency department and intensive care unit, the patient’s hemodynamic status worsened rapidly, justifying his transfer to our department for ventricular mechanical assistance by venoarterial extracorporeal membrane oxygenation. The following outcomes were favorable and the boy was discharged home on day 29 without aftereffects. Conclusion. This is the first report of successful use of extracorporeal membrane oxygenation for the treatment of cardiogenic shock after scorpion envenomation.

  18. Laminar oxy-fuel diffusion flame supported by an oxygen-permeable-ion-transport membrane

    KAUST Repository

    Hong, Jongsup

    2013-03-01

    A numerical model with detailed gas-phase chemistry and transport was used to predict homogeneous fuel conversion processes and to capture the important features (e.g., the location, temperature, thickness and structure of a flame) of laminar oxy-fuel diffusion flames stabilized on the sweep side of an oxygen permeable ion transport membrane (ITM). We assume that the membrane surface is not catalytic to hydrocarbon or syngas oxidation. It has been demonstrated that an ITM can be used for hydrocarbon conversion with enhanced reaction selectivity such as oxy-fuel combustion for carbon capture technologies and syngas production. Within an ITM unit, the oxidizer flow rate, i.e., the oxygen permeation flux, is not a pre-determined quantity, since it depends on the oxygen partial pressures on the feed and sweep sides and the membrane temperature. Instead, it is influenced by the oxidation reactions that are also dependent on the oxygen permeation rate, the initial conditions of the sweep gas, i.e., the fuel concentration, flow rate and temperature, and the diluent. In oxy-fuel combustion applications, the sweep side is fuel-diluted with CO2, and the entire unit is preheated to achieve a high oxygen permeation flux. This study focuses on the flame structure under these conditions and specifically on the chemical effect of CO2 dilution. Results show that, when the fuel diluent is CO2, a diffusion flame with a lower temperature and a larger thickness is established in the vicinity of the membrane, in comparison with the case in which N2 is used as a diluent. Enhanced OH-driven reactions and suppressed H radical chemistry result in the formation of products with larger CO and H2O and smaller H2 concentrations. Moreover, radical concentrations are reduced due to the high CO2 fraction in the sweep gas. CO2 dilution reduces CH3 formation and slows down the formation of soot precursors, C2H2 and C2H4. The flame location impacts the species diffusion and heat transfer from the

  19. Targetting redox polymers as mediators for laccase oxygen reduction in a membrane-less biofuel cell

    Energy Technology Data Exchange (ETDEWEB)

    Barriere, Frederic [Universite de Rennes I, Institut de Chimie, UMR CNRS 6510, 35042 Rennes (France); Ferry, Yvonne; Leech, Donal [Department of Chemistry, National University of Ireland, Galway (Ireland); Rochefort, Dominic [Departement de Chimie, Universite de Montreal, C.P. 6128, Succursale Centre-ville, Montreal, Que. (Canada)

    2004-03-01

    Electrodes modified with co-immobilized redox enzymes and redox polymers can be used to form membrane-less biofuel cells. In this communication, we report on our initial studies of a membrane-less biofuel cell concept using an osmium-based redox polymer for laccase-mediated reduction of oxygen coupled to glucose oxidase-mediated oxidation of glucose. We then present a thermodynamic examination of mediators of laccase oxygen reduction, and stemming from this, target two redox polymers of potential use, an osmium-based redox polymer (E{sup 0'}+0.40 V vs. Ag/AgCl) and a ruthenium-based redox polymer (E{sup 0'}+0.63 V vs. Ag/AgCl). The former shows promise for use in membrane-less biofuel cell cathodes, whilst the latter's redox potential is too high to be an effective mediator of oxygen reduction by the Trametes versicolor laccase used in this study.

  20. Design of a mixed ionic/electronic conducting oxygen transport membrane pilot module

    Energy Technology Data Exchange (ETDEWEB)

    Pfaff, E.M.; Kaletsch, A.; Broeckmann, C. [RWTH Aachen University, IWM, Aachen (Germany)

    2012-03-15

    In the last years, a lot of ceramic materials were developed that, at higher temperatures, have a high electrical conductivity and a high conductivity of oxygen ions. Such mixed ionic/electronic conductors can be used to produce high-purity oxygen. This work focuses on the realization of a pilot membrane module, with BSCF (Ba{sub 0.5}Sr{sub 0.5}Co{sub 0.8}Fe{sub 0.2}O{sub 3-{delta}}) perovskite selected as the membrane material. An amount of 500 kg of powder was industrially fabricated, spray-granulized and pressed into tubes. The best operation conditions concerning energy consumption were calculated, and a module reactor was designed operating at 850 C, with an air pressure of 15-20 bar on the feed site and a low vacuum of about 0.8 bar on the permeate site. Special emphasis was placed on joining alternatives for ceramic tubes in metallic bottoms. A first laboratory module was tested with a membrane area of 1 m{sup 2} and then advanced to a pilot module with 570 tubes and a capability of more than 300 000 L of pure oxygen per day. (Copyright copyright 2012 WILEY-VCH Verlag GmbH and Co. KGaA, Weinheim)

  1. Predicting Survival in Patients Treated With Extracorporeal Membrane Oxygenation After Myocardial Infarction.

    Science.gov (United States)

    Pabst, Dirk; Foy, Andrew J; Peterson, Brandon; Soleimani, Behzad; Brehm, Christoph E

    2018-01-25

    Acute myocardial infarction is the most common cause of cardiogenic shock. Although the number of patients with acute myocardial infarction complicated by cardiogenic shock who were treated with venoarterial extracorporeal membrane oxygenation increased during the last decade, detailed data on survival are lacking. We sought to analyze covariates that were independently associated with survival in this patient population and to externally validate the newly developed prEdictioN of Cardiogenic shock OUtcome foR Acute myocardial infarction patients salvaGed by venoarterial Extracorporeal membrane oxygenation (ENCOURAGE) score. Retrospective clinical study. A single academic teaching hospital. Adult patients with acute myocardial infarction complicated by cardiogenic shock who were supported by venoarterial extracorporeal membrane oxygenation from June 2008 to September 2016. Fourteen individual variables were assessed for their association with the primary endpoint. These variables were prespecified by the study team as being the most likely to affect survival. A receiver operating characteristic analysis was also performed to test the ability of the ENCOURAGE score to predict survival in this patient cohort. The primary endpoint of the study was in-hospital survival. A total of 61 patients were included in the analysis. Thirty-seven (60.7%) could be weaned from venoarterial extracorporeal membrane oxygenation and 36 (59.0%) survived. Survival was significantly higher in patients less than 65 years old (odds ratio, 14.6 [CI, 2.5-84.0]; p = 0.003), whose body mass index was less than 32 kg/m (odds ratio, 5.5 [CI, 1.2-25.4]; p = 0.029) and international normalized ratio was less than 2 (odds ratio, 7.3 [CI, 1.3-40.1]; p = 0.022). In patients where the first lactate drawn was less than 3 mmol/L, the survival was not significantly higher (odds ratio, 4.4 [CI, 0.6-32.6]; p = 0.147). The C-statistic for predicting survival using a modified version of the ENCOURAGE score

  2. ESTUDO DO COMPORTAMENTO DA CREATINO QUINASE (CK E CREATINO QUINASE-MB (CK-MB SÉRICA DE CÃES SUBMETIDOS À OXIGENAÇÃO POR MEMBRANA EXTRACORPÓREA (ECMO DURANTE UM PERÍODO DE TRÊS HORAS

    Directory of Open Access Journals (Sweden)

    Felipp Silveira Ferreira

    2010-10-01

    Full Text Available The extracorporeal membrane oxygenation (ECMCMO is a technique of prolonged cardiopulmonary support, which aims to help the lungs or the heart when these organs present failure processes not responsive to conventional treatments. As it is not a physiological procedure, it represents a major challenge for medicine, which seeks to make it a safer procedure. Thus, this research was carried out to determine the course of the cardiac markers CK and CK-MB of five dogs submitted at ECMO for three hours. Mongrel dogs of various ages, weight and sex were used. Under anesthesic maintenance, the animals were subjected to femoral cannulation for ECMCMO, in an arterial-venous (AV deviation. Once the circuit was established, the variables were measured every thirty minutes for a period of three hours. The data were statistically analyzed with Anova, Tukey and Pearson Correlation, with α = 5%. The results showed an increase of serum CK and CK-MB, characterizing a muscular injury during the procedure. The results showed that ECMO induced a cardiac muscle injury by a physiological mechanism. It was concluded that ECMCMO is a viable technical support and do not induce myocardial injury in dogs during a period of three hours.

  3. Numerical analysis of the effects of a high gradient magnetic field on flowing erythrocytes in a membrane oxygenator

    International Nuclear Information System (INIS)

    Mitamura, Yoshinori; Okamoto, Eiji

    2015-01-01

    This study was carried out to clarify the effect of a high gradient magnetic field on pressure characteristics of blood in a hollow fiber membrane oxygenator in a solenoid coil by means of numerical analysis. Deoxygenated erythrocytes are paramagnetic, and oxygenated erythrocytes are diamagnetic. Blood changes its magnetic susceptibility depending on whether it is carrying oxygen or not. Motion of blood was analyzed by solving the continuous equation and the Navier–Stokes equation. It was confirmed that oxygenation of deoxygenated blood in the downstream side of the applied magnetic field was effective for pressure rise in a non-uniform magnetic field. The pressure rise was enhanced greatly by an increase in magnetic field intensity. The results suggest that a membrane oxygenator works as an actuator and there is a possibility of self-circulation of blood through an oxygenator in a non-uniform magnetic field. - Highlights: • Effects of a gradient magnetic field on erythrocytes in an oxygenator were analyzed. • Blood changes magnetic susceptibility depending on if it is carrying oxygen or not. • Oxygenation of deoxygenated blood is effective for pressure rise in a magnetic field. • A membrane oxygenator works as an actuator. • There is a possibility of self-circulation of blood through an oxygenator

  4. Extracorporeal membrane oxygenation in children with heart disease and del22q11 syndrome: a review of the Extracorporeal Life Support Organization Registry.

    Science.gov (United States)

    Prodhan, P; Gossett, J M; Rycus, P T; Gupta, P

    2015-11-01

    The study objective was to evaluate outcomes among children with del22q11 (DiGeorge) syndrome supported on ECMO for heart disease. The ELSO registry database was queried to include all children syndrome and with no del22q11 syndrome. Eighty-eight ECMO runs occurred in children with del22q11 syndrome while 2694 ECMO runs occurred in children without del22q11 syndrome. For patients with heart defects receiving ECMO, del22q11 syndrome did not confer a significant mortality risk or an increased risk of infectious complications before or while on ECMO support. Neither the duration of ECMO nor mechanical ventilation prior to ECMO deployment were prolonged in patients with del22q11 syndrome compared to the controls. © The Author(s) 2015.

  5. Membrane-bound globin X protects the cell from reactive oxygen species.

    Science.gov (United States)

    Koch, Jonas; Burmester, Thorsten

    2016-01-08

    Globin X (GbX) is a member of the globin family that emerged early in the evolution of Metazoa. In vertebrates, GbX is restricted to lampreys, fish, amphibians and some reptiles, and is expressed in neurons. Unlike any other metazoan globin, GbX is N-terminally acylated and anchored in the cell membrane via myristoyl and palmitoyl groups, suggesting a unique function. Here, we compared the capacity of GbX to protect a mouse neuronal cell line from hypoxia and reactive oxygen species (ROS) with that of myoglobin. To evaluate the contribution of membrane-binding, we generated a mutated version of GbX without acyl groups. All three globins enhanced cell viability under hypoxia, with myoglobin having the most pronounced effect. GbX but not myoglobin protected the cells from hydrogen peroxide (H2O2)-induced stress. Membrane-bound GbX was significantly more efficient than its mutated, soluble form. Furthermore, myoglobin and mutated GbX increased production of ROS upon H2O2-treatment, while membrane-bound GbX did not. The results indicate that myoglobin enhances O2 supply while GbX protects the cell membrane from ROS-stress. The ancient origin of GbX suggests that ROS-protection reflects the function of the early globins before they acquired a respiratory role. Copyright © 2015 Elsevier Inc. All rights reserved.

  6. Freestanding eggshell membrane-based electrodes for high-performance supercapacitors and oxygen evolution reaction.

    Science.gov (United States)

    Geng, Jing; Wu, Hao; Al-Enizi, Abdullah M; Elzatahry, Ahmed A; Zheng, Gengfeng

    2015-09-14

    A type of freestanding, light-weight eggshell membrane-based electrode is demonstrated for supercapacitors and for oxygen evolution reaction (OER) catalysis. As a widely available daily waste, eggshell membranes have unique porous three-dimensional grid-like fibrous structures with relatively high surface area and abundant macropores, allowing for effective conjugation of carbon nanotubes and growth of NiCo2O4 nanowire arrays, an effective supercapacitor material and OER catalyst. The three-dimensional fibrous eggshell membrane frameworks with carbon nanotubes offer efficient pathways for charge transport, and the macropores between adjacent fibers are fully accessible for electrolytes and bubble evolution. As a supercapacitor, the eggshell membrane/carbon nanotube/NiCo2O4 electrode shows high specific capacitances at current densities from 1 to 20 A g(-1), with excellent capacitance retention (>90%) at 10 A g(-1) for over 10,000 cycles. When employed as an OER catalyst, this eggshell membrane-based electrode exhibits an OER onset potential of 1.53 V vs. the reversible hydrogen electrode (RHE), and a stable catalytic current density of 20 mA cm(-2) at 1.65 V vs. the RHE.

  7. Substantial Oxygen Flux in Dual-Phase Membrane of Ceria and Pure Electronic Conductor by Tailoring the Surface.

    Science.gov (United States)

    Joo, Jong Hoon; Yun, Kyong Sik; Kim, Jung-Hwa; Lee, Younki; Yoo, Chung-Yul; Yu, Ji Haeng

    2015-07-15

    The oxygen permeation flux of dual-phase membranes, Ce0.9Gd0.1O2-δ-La0.7Sr0.3MnO3±δ (GDC/LSM), has been systematically studied as a function of their LSM content, thickness, and coating material. The electronic percolation threshold of this GDC/LSM membrane occurs at about 20 vol % LSM. The coated LSM20 (80 vol % GDC, 20 vol % LSM) dual-phase membrane exhibits a maximum oxygen flux of 2.2 mL·cm(-2)·min(-1) at 850 °C, indicating that to enhance the oxygen permeation flux, the LSM content should be adjusted to the minimum value at which electronic percolation is maintained. The oxygen ion conductivity of the dual-phase membrane is reliably calculated from oxygen flux data by considering the effects of surface oxygen exchange. Thermal cycling tests confirm the mechanical stability of the membrane. Furthermore, a dual-phase membrane prepared here with a cobalt-free coating remains chemically stable in a CO2 atmosphere at a lower temperature (800 °C) than has previously been achieved.

  8. Development of Nanofiller-Modulated Polymeric Oxygen Enrichment Membranes for Reduction of Nitrogen Oxides in Coal Combustion

    Energy Technology Data Exchange (ETDEWEB)

    Jianzhong Lou; Shamsuddin Ilias

    2010-12-31

    North Carolina A&T State University in Greensboro, North Carolina, has undertaken this project to develop the knowledge and the material to improve the oxygen-enrichment polymer membrane, in order to provide high-grade oxygen-enriched streams for coal combustion and gasification applications. Both experimental and theoretical approaches were used in this project. The membranes evaluated thus far include single-walled carbon nano-tube, nano-fumed silica polydimethylsiloxane (PDMS), and zeolite-modulated polyimide membranes. To document the nanofiller-modulated polymer, molecular dynamics simulations have been conducted to calculate the theoretical oxygen molecular diffusion coefficient and nitrogen molecular coefficient inside single-walled carbon nano-tube PDMS membranes, in order to predict the effect of the nano-tubes on the gas-separation permeability. The team has performed permeation and diffusion experiments using polymers with nano-silica particles, nano-tubes, and zeolites as fillers; studied the influence of nano-fillers on the self diffusion, free volume, glass transition, oxygen diffusion and solubility, and perm-selectivity of oxygen in polymer membranes; developed molecular models of single-walled carbon nano-tube and nano-fumed silica PDMS membranes, and zeolites-modulated polyimide membranes. This project partially supported three graduate students (two finished degrees and one transferred to other institution). This project has resulted in two journal publications and additional publications will be prepared in the near future.

  9. Role of Membrane Lipids in the Regulation of Erythrocytic Oxygen-Transport Function in Cardiovascular Diseases.

    Science.gov (United States)

    Revin, Victor V; Gromova, Natalia V; Revina, Elvira S; Martynova, Maria I; Seikina, Angelina I; Revina, Nadezhda V; Imarova, Oksana G; Solomadin, Ilia N; Tychkov, Alexander Yu; Zhelev, Nikolai

    2016-01-01

    The composition and condition of membrane lipids, the morphology of erythrocytes, and hemoglobin distribution were explored with the help of laser interference microscopy (LIM) and Raman spectroscopy. It is shown that patients with cardiovascular diseases (CVD) have significant changes in the composition of their phospholipids and the fatty acids of membrane lipids. Furthermore, the microviscosity of the membranes and morphology of the erythrocytes are altered causing disordered oxygen transport by hemoglobin. Basic therapy carried out with the use of antiaggregants, statins, antianginals, beta-blockers, and calcium antagonists does not help to recover the morphofunctional properties of erythrocytes. Based on the results the authors assume that, for the relief of the ischemic crisis and further therapeutic treatment, it is necessary to include, in addition to cardiovascular disease medicines, medication that increases the ability of erythrocytes' hemoglobin to transport oxygen to the tissues. We assume that the use of LIM and Raman spectroscopy is advisable for early diagnosis of changes in the structure and functional state of erythrocytes when cardiovascular diseases develop.

  10. Topology and immersion depth of an integral membrane protein by paramagnetic rates from dissolved oxygen

    International Nuclear Information System (INIS)

    Al-Abdul-Wahid, M. Sameer; Verardi, Raffaello; Veglia, Gianluigi; Prosser, R. Scott

    2011-01-01

    In studies of membrane proteins, knowledge of protein topology can provide useful insight into both structure and function. In this work, we present a solution NMR method for the measurement the tilt angle and average immersion depth of alpha helices in membrane proteins, from analysis of the paramagnetic relaxation rate enhancements arising from dissolved oxygen. No modification to the micelle or protein is necessary, and the topology of both transmembrane and amphipathic helices are readily determined. We apply this method to the measure the topology of a monomeric mutant of phospholamban (AFA-PLN), a 52-residue membrane protein containing both an amphipathic and a transmembrane alpha helix. In dodecylphosphocholine micelles, the amphipathic helix of AFA-PLN was found to have a tilt angle of 87° ± 1° and an average immersion depth of 13.2 Å. The transmembrane helix was found to have an average immersion depth of 5.4 Å, indicating residues 41 and 42 are closest to the micelle centre. The resolution of paramagnetic relaxation rate enhancements from dissolved oxygen compares favourably to those from Ni (II), a hydrophilic paramagnetic species.

  11. Topology and immersion depth of an integral membrane protein by paramagnetic rates from dissolved oxygen.

    Science.gov (United States)

    Al-Abdul-Wahid, M Sameer; Verardi, Raffaello; Veglia, Gianluigi; Prosser, R Scott

    2011-09-01

    In studies of membrane proteins, knowledge of protein topology can provide useful insight into both structure and function. In this work, we present a solution NMR method for the measurement the tilt angle and average immersion depth of alpha helices in membrane proteins, from analysis of the paramagnetic relaxation rate enhancements arising from dissolved oxygen. No modification to the micelle or protein is necessary, and the topology of both transmembrane and amphipathic helices are readily determined. We apply this method to the measure the topology of a monomeric mutant of phospholamban (AFA-PLN), a 52-residue membrane protein containing both an amphipathic and a transmembrane alpha helix. In dodecylphosphocholine micelles, the amphipathic helix of AFA-PLN was found to have a tilt angle of 87° ± 1° and an average immersion depth of 13.2 Å. The transmembrane helix was found to have an average immersion depth of 5.4 Å, indicating residues 41 and 42 are closest to the micelle centre. The resolution of paramagnetic relaxation rate enhancements from dissolved oxygen compares favourably to those from Ni (II), a hydrophilic paramagnetic species.

  12. Role of Membrane Lipids in the Regulation of Erythrocytic Oxygen-Transport Function in Cardiovascular Diseases

    Directory of Open Access Journals (Sweden)

    Victor V. Revin

    2016-01-01

    Full Text Available The composition and condition of membrane lipids, the morphology of erythrocytes, and hemoglobin distribution were explored with the help of laser interference microscopy (LIM and Raman spectroscopy. It is shown that patients with cardiovascular diseases (CVD have significant changes in the composition of their phospholipids and the fatty acids of membrane lipids. Furthermore, the microviscosity of the membranes and morphology of the erythrocytes are altered causing disordered oxygen transport by hemoglobin. Basic therapy carried out with the use of antiaggregants, statins, antianginals, beta-blockers, and calcium antagonists does not help to recover the morphofunctional properties of erythrocytes. Based on the results the authors assume that, for the relief of the ischemic crisis and further therapeutic treatment, it is necessary to include, in addition to cardiovascular disease medicines, medication that increases the ability of erythrocytes’ hemoglobin to transport oxygen to the tissues. We assume that the use of LIM and Raman spectroscopy is advisable for early diagnosis of changes in the structure and functional state of erythrocytes when cardiovascular diseases develop.

  13. Extracorporeal membrane oxygenation support for intractable primary arrhythmias and complete congenital heart block in newborns and infants: short-term and medium-term outcomes.

    Science.gov (United States)

    Dyamenahalli, Umesh; Tuzcu, Volkan; Fontenot, Eudice; Papagiannis, John; Jaquiss, R D B; Bhutta, Adnan; Morrow, William R; Erickson, Christopher C; Imamura, Michiaki; Prodhan, Parthak

    2012-01-01

    To describe the experience with extracorporeal membrane oxygenation support for intractable primary arrhythmias in newborns and infants. Retrospective study. A tertiary care pediatric hospital. Patients younger than 1 yr supported with extracorporeal membrane oxygenation for primary cardiac arrhythmias were identified from the institutional extracorporeal membrane oxygenation registry. Extracorporeal membrane oxygenation support. Clinical characteristics and outcomes were investigated for patients with primary cardiac arrhythmia supported with extracorporeal membrane oxygenation. Outcomes investigated were time from initiation of extracorporeal membrane oxygenation support to arrhythmia control, duration of extracorporeal membrane oxygenation support, and results of interventions performed while supported with extracorporeal membrane oxygenation. We summarized the independent categorical and continuous variables using frequencies, percentages, and medians and ranges, respectively. Extracorporeal membrane oxygenation support was used in nine patients for rescue therapy for primary tachyarrhythmia and bradycardia. The primary arrhythmias were: focal atrial tachycardia (n = 2); reentrant supraventricular tachycardia (n = 3); junctional ectopic tachycardia (n = 2); and congenital complete atrioventricular block (n = 2) patients. Seven patients presented with severe hemodynamic compromise, with six patients requiring extracorporeal cardiopulmonary resuscitation. All patients required extracorporeal membrane oxygenation within 24 hrs of initial presentation. Balloon atrial septostomy was performed in three patients and ablation was performed in two patients. Sinus rhythm was achieved in all reentrant supraventricular tachycardia and rate control was established in both patients with focal atrial tachycardia and in one patient with junctional ectopic tachycardia while using extracorporeal membrane oxygenation support. All patients survived to hospital discharge, and

  14. Evolution of membrane oxygenator technology for utilization during pediatric cardiopulmonary bypass

    Directory of Open Access Journals (Sweden)

    Melchior RW

    2016-06-01

    Full Text Available Richard W Melchior,1 Steven W Sutton,2 William Harris,3 Heidi J Dalton4,5 1Department of Perfusion Services, The Children's Hospital of Philadelphia, Philadelphia, PA, 2Cardiovascular Support Services, Inc., Dallas, TX, 3Department of Perfusion Services, Ochsner Clinic Foundation, New Orleans, LA, 4Alaskan Native Tribal Health Consortium, Anchorage, AK, 5Department of Child Health, University of Arizona-College of Medicine, Phoenix, AZ, USAAbstract: The development of the membrane oxygenator for pediatric cardiopulmonary bypass has been an incorporation of ideology and technological advancements with contributions by many investigators throughout the past two centuries. With the pursuit of this technological achievement, the ability to care for mankind in the areas of cardiac surgery has been made possible. Heart disease can affect anyone within the general population, but one such segment that it can affect from inception includes children. Currently, congenital heart defects are the most common birth defects nationally and worldwide. A large meta-analysis study from 1930 to 2010 was conducted in review of published medical literature totaling 114 papers with a study population of 24,091,867 live births, and divulged a staggering incidence of congenital heart disease involving 164,396 subjects with diverse cardiac illnesses. The prevalence of these diseases increased from 0.6 per 1,000 live births from 1930–1934 to 9.1 per 1,000 live births after 1995. These data reveal an emphasis on a growing public health issue regarding congenital heart disease. This discovery displays a need for heightened awareness in the scientific and medical industrial community to accelerate investigative research on emerging cardiovascular devices in an effort to confront congenital anomalies. One such device that has evolved over the past several decades is the pediatric membrane oxygenator. The pediatric membrane oxygenator, in conjunction with the heart lung

  15. Nanopore formation process in artificial cell membrane induced by plasma-generated reactive oxygen species.

    Science.gov (United States)

    Tero, Ryugo; Yamashita, Ryuma; Hashizume, Hiroshi; Suda, Yoshiyuki; Takikawa, Hirofumi; Hori, Masaru; Ito, Masafumi

    2016-09-01

    We investigated morphological change of an artificial lipid bilayer membrane induced by oxygen radicals which were generated by non-equilibrium atmospheric pressure plasma. Neutral oxygen species, O((3)Pj) and O2((1)Δg), were irradiated of a supported lipid bilayer existing under a buffer solution at various conditions of dose time and distances, at which the dose amounts of the oxygen species were calculated quantitatively. Observation using an atomic force microscope and a fluorescence microscope revealed that dose of the neutral oxygen species generated nanopores with the diameter of 10-50 nm in a phospholipid bilayer, and finally destructed the bilayer structure. We found that protrusions appeared on the lipid bilayer surface prior to the formation of nanopores, and we attributed the protrusions to the precursor of the nanopores. We propose a mechanism of the pore formation induced by lipid oxidation on the basis of previous experimental and theoretical studies. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. Membrane oxygenator heat exchanger failure detected by unique blood gas findings.

    Science.gov (United States)

    Hawkins, Justin L

    2014-03-01

    Failure of components integrated into the cardiopulmonary bypass circuit, although rare, can bring about catastrophic results. One of these components is the heat exchanger of the membrane oxygenator. In this compartment, unsterile water from the heater cooler device is separated from the sterile blood by stainless steel, aluminum, or by polyurethane. These areas are glued or welded to keep the two compartments separate, maintaining sterility of the blood. Although quality control testing is performed by the manufacturer at the factory level, transport presents the real possibility for damage. Because of this, each manufacturer has included in the instructions for use a testing procedure for testing the integrity of the heat exchanger component. Water is circulated through the heat exchanger before priming and a visible check is made of the oxygenator bundle to check for leaks. If none are apparent, then priming of the oxygenator is performed. In this particular case, this procedure was not useful in detecting communication between the water and blood chambers of the oxygenator.

  17. The effects of organic carbon, ammoniacal-nitrogen, and oxygen partial pressure on the stratification of membrane-aerated biofilms.

    Science.gov (United States)

    LaPara, Timothy M; Cole, Alina C; Shanahan, John W; Semmens, Michael J

    2006-04-01

    The purpose of this study was to examine the effects of different nutrient (carbon, nitrogen, oxygen) concentrations on the microbial activity and community structure in membrane-aerated biofilms (MABs). MABs were grown under well-defined conditions of fluid flow, substrate concentration, and membrane oxygen partial pressure. Biofilms were then removed and thin-sliced using a cryostat/microtome parallel to the membrane. Individual slices were analyzed for changes with depth in biomass density, respiratory activity, and the population densities of ammonia-oxidizing and denitrifying bacteria populations. Oxygen-sensing microelectrodes were used to determine the depth of oxygen penetration into each biofilm. Our results demonstrated that ammonia-oxidizing bacteria grow near the membrane, while denitrifying bacteria grow a substantial distance from the membrane. However, nitrifying and denitrifying bacteria did not grow simultaneously when organic concentrations became too high or ammonia concentrations became too low. In conclusion, membrane-aerated biofilms exhibit substantial stratification with respect to community structure and activity. A fundamental understanding of the factors that control this stratification will help optimize the performance of full-scale membrane-aerated biofilm reactors for wastewater treatment.

  18. ECMO for Cardiac Rescue after Accidental Intravenous Mepivacaine Application

    Directory of Open Access Journals (Sweden)

    Michael Froehle

    2012-01-01

    Full Text Available Mepivacaine is a potent local anaesthetic and used for infiltration and regional anaesthesia in adults and pediatric patients. Intoxications with mepivacaine affect mainly the CNS and the cardiovascular system. We present a case of accidental intravenous mepivacaine application and intoxication of an infant resulting in seizure, broad complex bradyarrhythmia, arterial hypotension and finally cardiac arrest. The patient could be rescued by prolonged resuscitations and a rapid initiation of ECMO and survived without neurological damage. The management strategies of this rare complication including promising other treatment options with lipid emulsions are discussed.

  19. Numerical simulation of kinetic demixing and decomposition in a LaCoO3-δ oxygen membrane under an oxygen potential gradient

    DEFF Research Database (Denmark)

    Ta, Na; Chen, Ming; Zhang, Lijun

    2018-01-01

    A composition- and temperature-dependent mobility database of all ionic species in the LaCoO3-δ phase was developed and combined with a La-Co-O thermodynamic database to simulate kinetic demixing and partial decomposition in LaCoO3-δ oxygen membranes operated under a 0.0001/0.21 bar oxygen partia...... by the mobility of oxygen ions, and the latter is determined by the higher mobility of Co ions as compared to the La ion in the ABO3-type perovskite. A drift motion of both oxide surfaces towards the high PO2 side occurs with the movement of cations....

  20. Oxygen transport membrane reactor based method and system for generating electric power

    Science.gov (United States)

    Kelly, Sean M.; Chakravarti, Shrikar; Li, Juan

    2017-02-07

    A carbon capture enabled system and method for generating electric power and/or fuel from methane containing sources using oxygen transport membranes by first converting the methane containing feed gas into a high pressure synthesis gas. Then, in one configuration the synthesis gas is combusted in oxy-combustion mode in oxygen transport membranes based boiler reactor operating at a pressure at least twice that of ambient pressure and the heat generated heats steam in thermally coupled steam generation tubes within the boiler reactor; the steam is expanded in steam turbine to generate power; and the carbon dioxide rich effluent leaving the boiler reactor is processed to isolate carbon. In another configuration the synthesis gas is further treated in a gas conditioning system configured for carbon capture in a pre-combustion mode using water gas shift reactors and acid gas removal units to produce hydrogen or hydrogen-rich fuel gas that fuels an integrated gas turbine and steam turbine system to generate power. The disclosed method and system can also be adapted to integrate with coal gasification systems to produce power from both coal and methane containing sources with greater than 90% carbon isolation.

  1. Impact of Right Ventricular Performance in Patients Undergoing Extracorporeal Membrane Oxygenation Following Cardiac Surgery.

    Science.gov (United States)

    Bartko, Philipp E; Wiedemann, Dominik; Schrutka, Lore; Binder, Christina; Santos-Gallego, Carlos G; Zuckermann, Andreas; Steinlechner, Barbara; Koinig, Herbert; Heinz, Gottfried; Niessner, Alexander; Zimpfer, Daniel; Laufer, Günther; Lang, Irene M; Distelmaier, Klaus; Goliasch, Georg

    2017-07-28

    Extracorporeal membrane oxygenation following cardiac surgery safeguards end-organ oxygenation but unfavorably alters cardiac hemodynamics. Along with the detrimental effects of cardiac surgery to the right heart, this might impact outcome, particularly in patients with preexisting right ventricular (RV) dysfunction. We sought to determine the prognostic impact of RV function and to improve established risk-prediction models in this vulnerable patient cohort. Of 240 patients undergoing extracorporeal membrane oxygenation support following cardiac surgery, 111 had echocardiographic examinations at our institution before implantation of extracorporeal membrane oxygenation and were thus included. Median age was 67 years (interquartile range 60-74), and 74 patients were male. During a median follow-up of 27 months (interquartile range 16-63), 75 patients died. Fifty-one patients died within 30 days, 75 during long-term follow-up (median follow-up 27 months, minimum 5 months, maximum 125 months). Metrics of RV function were the strongest predictors of outcome, even stronger than left ventricular function ( P <0.001 for receiver operating characteristics comparisons). Specifically, RV free-wall strain was a powerful predictor univariately and after adjustment for clinical variables, Simplified Acute Physiology Score-3, tricuspid regurgitation, surgery type and duration with adjusted hazard ratios of 0.41 (95%CI 0.24-0.68; P =0.001) for 30-day mortality and 0.48 (95%CI 0.33-0.71; P <0.001) for long-term mortality for a 1-SD (SD=-6%) change in RV free-wall strain. Combined assessment of the additive EuroSCORE and RV free-wall strain improved risk classification by a net reclassification improvement of 57% for 30-day mortality ( P =0.01) and 56% for long-term mortality ( P =0.02) compared with the additive EuroSCORE alone. RV function is strongly linked to mortality, even after adjustment for baseline variables and clinical risk scores. RV performance improves

  2. Right ventricular assist device with membrane oxygenator support for right ventricular failure following implantable left ventricular assist device placement.

    Science.gov (United States)

    Leidenfrost, Jeremy; Prasad, Sunil; Itoh, Akinobu; Lawrance, Christopher P; Bell, Jennifer M; Silvestry, Scott C

    2016-01-01

    Cardiogenic shock from refractory right ventricular (RV) failure during left ventricular assist device placement is associated with high morbidity and mortality. The addition of extracorporeal membrane oxygenation to RV mechanical assistance may help RV recovery and lead to improved outcomes. We retrospectively reviewed all implanted continuous-flow left ventricular assist devices from April 2009 to June 2013. RV mechanical support was utilized for RV failure defined as haemodynamic instability despite vasopressors, pulmonary vascular dilators and inotropic therapy. RV assist devices were utilized with and without in-line membrane oxygenation. During the study period, 267 continuous-flow left ventricular assist devices were implanted. RV mechanical support was utilized in 27 (10%) patients; 12 (46%) had the addition of in-line extracorporeal membrane oxygenation. The mean age of patients with a right ventricular assist device with membrane oxygenation was lower than that in patients with a right ventricular assist device alone (45.6 ± 15.9 vs 64.6 ± 6.5, P = 0.001). Support was weaned in 66% (10 of 15) of patients with right ventricular assist device (RVAD) alone vs 83% (10 of 12) of those with RVAD with membrane oxygenation (P = 0.42). The RVAD was removed after 10.4 ± 9.4 vs 5 ± 2.99 days for patients with a RVAD with membrane oxygenation (P = 0.1). Patients with RVAD with membrane oxygenation had a 30-day mortality rate of 8 vs 47% for those with RVAD alone (P = 0.04). The survival rate after discharge was 86, 63 and 54% at 3, 6 and 12 months for both groups combined. Patients with a RVAD with membrane oxygenation support for acute RV failure after continuous-flow left ventricular assist device implantation had a lower 30-day mortality than those with a RVAD alone. Patients who survive to discharge have a reasonable 1-year survival. Combining membrane oxygenation with RVAD support appears to offer a short-term survival benefit in patients with RV failure

  3. Capabilities of a mobile extracorporeal membrane oxygenation service for severe respiratory failure delivered by intensive care specialists.

    Science.gov (United States)

    Sherren, P B; Shepherd, S J; Glover, G W; Meadows, C I S; Langrish, C; Ioannou, N; Wyncoll, D; Daly, K; Gooby, N; Agnew, N; Barrett, N A

    2015-06-01

    We conducted a single-centre observational study of retrievals for severe respiratory failure over 12 months. Our intensivist-delivered retrieval service has mobile extracorporeal membrane oxygenation capabilities. Sixty patients were analysed: 34 (57%) were female and the mean (SD) age was 44.1 (13.6) years. The mean (SD) PaO2 /FI O2 ratio at referral was 10.2 (4.1) kPa and median (IQR [range]) Murray score was 3.25 (3.0-3.5 [1.5-4.0]). Forty-eight patients (80%) required veno-venous extracorporeal membrane oxygenation at the referring centre. There were no cannulation or extracorporeal membrane oxygenation-related complications. The median (IQR [range]) retrieval distance was 47.2 (14.9-77.0 [2.3-342.0]) miles. There were no major adverse events during retrieval. Thirty-seven patients (77%) who received extracorporeal membrane oxygenation survived to discharge from the intensive care unit and 36 patients (75%) were alive after six months. Senior intensivist-initiated and delivered mobile extracorporeal membrane oxygenation is safe and associated with a high incidence of survival. © 2015 The Association of Anaesthetists of Great Britain and Ireland.

  4. Silver nanowire catalysts on carbon nanotubes-incorporated bacterial cellulose membrane electrodes for oxygen reduction reaction.

    Science.gov (United States)

    Kim, Bona; Choi, Youngeun; Cho, Se Youn; Yun, Young Soo; Jin, Hyoung-Joon

    2013-11-01

    Silver nanowires have unique electrical, thermal and optical properties, which support their potential application in numerous fields including catalysis, electronics, optoelectronics, sensing, and surface-enhanced spectroscopy. Especially, their application such as catalysts for alkaline fuel cells (AFCs) have attracted much interest because of their superior electrical conductivity over that of any metal and their lower cost compared to Pt. In this study, multiwalled carbon nanotubes (MWCNTs)-incorporated bacterial cellulose (BC) membrane electrode with silver nanowire catalyst was prepared. First, acid-treated MWCNTs were incorporated into BC membranes and then freeze-dried after solvent exchange to tert-butanol in order to maintain the 3D-network macroporous structure. Second, silver nanowires synthesized by polyol process were introduced onto the surface of the MWCNTs-incorporated BC membrane through easy vacuum filtration. Finally, thermal treatment was carried out to confirm the effect of the PVP on the silver nanowire catalysts toward oxygen reduction reaction. The electrode with thermally treated silver nanowire had great electrocatalytic activity compared with non-treated one. These results suggest that the MWCNTs-incorporated BC electrode with silver nanowire catalysts after thermal treatment could be potentially used in cathodes of AFCs.

  5. Extracellular ultrathin fibers sensitive to intracellular reactive oxygen species: Formation of intercellular membrane bridges

    Energy Technology Data Exchange (ETDEWEB)

    Jung, Se-Hui; Park, Jin-Young; Joo, Jung-Hoon; Kim, Young-Myeong; Ha, Kwon-Soo, E-mail: ksha@kangwon.ac.kr

    2011-07-15

    Membrane bridges are key cellular structures involved in intercellular communication; however, dynamics for their formation are not well understood. We demonstrated the formation and regulation of novel extracellular ultrathin fibers in NIH3T3 cells using confocal and atomic force microscopy. At adjacent regions of neighboring cells, phorbol 12-myristate 13-acetate (PMA) and glucose oxidase induced ultrathin fiber formation, which was prevented by Trolox, a reactive oxygen species (ROS) scavenger. The height of ROS-sensitive ultrathin fibers ranged from 2 to 4 nm. PMA-induced formation of ultrathin fibers was inhibited by cytochalasin D, but not by Taxol or colchicine, indicating that ultrathin fibers mainly comprise microfilaments. PMA-induced ultrathin fibers underwent dynamic structural changes, resulting in formation of intercellular membrane bridges. Thus, these fibers are formed by a mechanism(s) involving ROS and involved in formation of intercellular membrane bridges. Furthermore, ultrastructural imaging of ultrathin fibers may contribute to understanding the diverse mechanisms of cell-to-cell communication and the intercellular transfer of biomolecules, including proteins and cell organelles.

  6. Lipid engineering reveals regulatory roles for membrane fluidity in yeast flocculation and oxygen-limited growth

    Energy Technology Data Exchange (ETDEWEB)

    Degreif, Daniel [Joint BioEnergy Inst. (JBEI), Emeryville, CA (United States); Technical Univ. of Darmstadt (Germany); de Rond, Tristan [Joint BioEnergy Inst. (JBEI), Emeryville, CA (United States); Univ. of California, Berkeley, CA (United States); Bertl, Adam [Technical Univ. of Darmstadt (Germany); Keasling, Jay D. [Joint BioEnergy Inst. (JBEI), Emeryville, CA (United States); Univ. of California, Berkeley, CA (United States); Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Technical Univ. of Denmark, Lyngby (Denmark); Budin, Itay [Joint BioEnergy Inst. (JBEI), Emeryville, CA (United States); Univ. of California, Berkeley, CA (United States)

    2017-03-18

    Cells modulate lipid metabolism in order to maintain membrane homeostasis. In this paper, we use a metabolic engineering approach to manipulate the stoichiometry of fatty acid unsaturation, a regulator of cell membrane fluidity, in Saccharomyces cerevisiae. Unexpectedly, reduced lipid unsaturation triggered cell-cell adhesion (flocculation), a phenomenon characteristic of industrial yeast but uncommon in laboratory strains. We find that ER lipid saturation sensors induce expression of FLO1 – encoding a cell wall polysaccharide binding protein – independently of its canonical regulator. In wild-type cells, Flo1p-dependent flocculation occurs under oxygen-limited growth, which reduces unsaturated lipid synthesis and thus serves as the environmental trigger for flocculation. Transcriptional analysis shows that FLO1 is one of the most highly induced genes in response to changes in lipid unsaturation, and that the set of membrane fluidity-sensitive genes is globally activated as part of the cell's long-term response to hypoxia during fermentation. Finally, our results show how the lipid homeostasis machinery of budding yeast is adapted to carry out a broad response to an environmental stimulus important in biotechnology.

  7. Impact of embedded endocannabinoids and their oxygenation by lipoxygenase on membrane properties.

    Science.gov (United States)

    Dainese, Enrico; Sabatucci, Annalaura; Angelucci, Clotilde B; Barsacchi, Daniela; Chiarini, Marco; Maccarrone, Mauro

    2012-05-16

    N-Arachidonoylethanolamine (anandamide) and 2-arachidonoylglycerol are the best characterized endocannabinoids. Their biological activity is subjected to metabolic control whereby a dynamic equilibrium among biosynthetic, catabolic, and oxidative pathways drives their intracellular concentrations. In particular, lipoxygenases can generate hydroperoxy derivatives of endocannabinoids, endowed with distinct activities within cells. The in vivo interaction between lipoxygenases and endocannabinoids is likely to occur within cell membranes; thus, we sought to ascertain whether a prototypical enzyme like soybean (Glycine max) 15-lipoxygenase-1 is able to oxygenate endocannabinoids embedded in synthetic vesicles and how these substances could affect the binding ability of the enzyme to different lipid bilayers. We show that (i) embedded endocannabinoids increase membrane fluidity; (ii) 15-lipoxygenase-1 preferentially binds to endocannabinoid-containing bilayers; and that (iii) 15-lipoxygenase-1 oxidizes embedded endocannabinoids and thus reduces fluidity and local hydration of membrane lipids. Together, the present findings reveal further complexity in the regulation of endocannabinoid signaling within the central nervous system, disclosing novel control by oxidative pathways.

  8. Characterization of hollow fibre membranes for oxygen permeation and partial oxidation reactions

    Energy Technology Data Exchange (ETDEWEB)

    Santos, L.C.L. [Universidade Federal da Bahia (DCTM/UFBA), Salvador, BA (Brazil). Escola Politecnica. Dept. de Ciencia e Tecnologia dos Materiais; University of Manchester, (United Kingdom). School of Chem. Eng. and Analytical Science], e-mail: lclsantos@ufba.br; Moraes, C. [Universidade Federal do Rio de Janeiro (UFRJ), RJ (Brazil). Dept. de Engenharia Quimica; Hughes, R. [University of Salford (United Kingdom). Dept. of Chemical Engineering

    2011-01-15

    Experimental results regarding characterization of BSCF 5582 and LSCF 6428 in the form of hollow fibres are presented in this work. These are membranes that can be potentially used in applications such as oxygen permeation and syngas production. In the case of LSCF 6428 hollow fibres, a surface modification was proposed giving two different morphology structures which were called as 'smooth' and 'rough' surface. Three main techniques were used to characterize these membranes: X-ray diffraction (XRD) analysis, energy dispersive X-ray emission analysis (EDAX) and scanning electron microscopy (SEM). A large distribution of cavities was observed on the surface of BSCF 5582, which might be a concern for obtaining a gas-tight membrane. In the case of LSCF 6428, both morphologies present a structure filled with elongated finger-like cavities close to both outer and inner surface, which can be explored in catalyst impregnation. In addition, the rough surface structure is fairly spongy which might be of interest for catalyst impregnation and surface kinetic studies. (author)

  9. Metallic substrate materials for thin film oxygen transport membranes for application in a fossil power plant

    Energy Technology Data Exchange (ETDEWEB)

    Xing, Y.; Baumann, S.; Sebold, D.; Meulenberg, W.A.; Stoever, D. [Forschungszentrum Juelich GmbH (DE). Inst. fuer Energieforschung (IEF) - IEF-1 Materials Synthesis and Processing

    2010-07-01

    La{sub 0.58}Sr{sub 0.4}CO{sub 0.2}Fe{sub 0.8}O{sub 3-{delta}} (LSCF58428) and Ba{sub 0.5}Sr{sub 0.5}CO{sub 0.8}Fe{sub 3-{delta}} (BSCF5582) exhibit high oxygen permeability due to their high ionic and electronic conductivity. For this reason they are under discussion for application in oxygen transport membranes (OTMs) in zero-emission power plants using oxyfuel technology. A thin film membrane which can increase the oxygen flux is beneficial and a structural substrate is required. Two types of Ni-base alloys were studied as substrate material candidates with a number of advantages, such as high strength, high temperature stability, easy joining and similar thermal expansion coefficient to the selected perovskite materials. Chemical compositions and thermal expansion coefficients of Ni-base alloys were measured in this study. LSCF58428 and BSCF5582 layers were screen printed on Ni-based alloys and co-fired at high temperature in air. The microstructure and element analysis of samples were characterized by scanning electron microscopy (SEM and EDX). A Ni-base alloy, MCrAlY, with a high Al content was the most suitable substrate material, and showed better chemical compatibility with perovskite materials at high temperature than Hastelloy X, which is a chromia-forming Ni-base alloy. A reaction occurred between Sr in the perovskite and the alumina surface layers on MCr-AlY. However, the reaction zone did not increase in thickness during medium-term annealing at 800 C in air. Hence, it is expected that this reaction will not prevent the application of MCr-AlY as a substrate material. (orig.)

  10. Investigation of Zr-doped BSCF perovskite membrane for oxygen separation in the intermediate temperature range

    Energy Technology Data Exchange (ETDEWEB)

    Ravkina, Olga, E-mail: olga.ravkina@pci.uni-hannover.de [Gottfried Wilhelm Leibniz Universität Hannover, Institute of Physical Chemistry and Electrochemistry, Callinstr. 3A, 30167 Hannover (Germany); Klande, Tobias; Feldhoff, Armin [Gottfried Wilhelm Leibniz Universität Hannover, Institute of Physical Chemistry and Electrochemistry, Callinstr. 3A, 30167 Hannover (Germany)

    2013-05-01

    The series of (Ba₀.₅Sr₀.₅)(Co₀.₈Fe₀.₂){sub 1–z}Zr{sub z}O{sub 3–δ} (z=0, 0.01, 0.03, 0.05, 0.07, and 0.09) was synthesized by a sol–gel method. The materials with a zirconium content up to 3 mol% were found to be single phase. Further increase results in formation of a mixed (Ba,Sr)ZrO₃ by-phase, which was found along the grain boundaries and in the grains. With increasing zirconium content the oxygen permeation flux decreases considerably. The effect of the zirconium substitution on the long-term phase stability was investigated by long-term oxygen permeation experiments and X-ray diffraction. A slight stabilization of the oxygen flux of (Ba₀.₅Sr{sub 0.5})(Co₀.₈Fe₀.₂)₀.₉₇Zr₀.₀₃O{sub 3–δ} was found after 180 h at 1023 K. However, all compositions show a decrease in permeation flux with time, but the pure BSCF membrane exhibited the strongest drop after 180 h of operation. The decomposition products of the cubic perovskite phase were found to be a hexagonal Ba{sub 0.5±x}Sr{sub 0.5±x}CoO₃ and a rhombohedral Ba{sub 1–x}Sr{sub x}Co{sub 2–y}Fe{sub y}O{sub 5–δ}. - Graphical abstract: Backscattered-electron channeling contrast image of BSCF membrane cross-section after long-term oxygen permeation at 1023 K showing different phases in different colors. Highlights: • Ba₀.₅Sr₀.₅Co₀.₈Fe₀.₂O{sub 3–δ} systematically doped with increasing amount of zirconium. • Cubic single-phase materials up to 3 wt% zirconium. • Mixed (Ba,Sr)ZrO₃ by-phase formed mainly in the grain boundaries. • Jänecke prism was proposed by XRD and EDXS data. • (Ba₀.₅Sr₀.₅)(Co₀.₈Fe₀.₂)₀.₉₇Zr₀.₀₃O{sub 3–δ} showed a slight stabilization of oxygen flux as compared to pure Ba₀.₅Sr₀.₅Co₀.₈Fe₀.₂O{sub 3–δ}.

  11. A conceptual design of catalytic gasification fuel cell hybrid power plant with oxygen transfer membrane

    Science.gov (United States)

    Shi, Wangying; Han, Minfang

    2017-09-01

    A hybrid power generation system integrating catalytic gasification, solid oxide fuel cell (SOFC), oxygen transfer membrane (OTM) and gas turbine (GT) is established and system energy analysis is performed. In this work, the catalytic gasifier uses steam, recycled anode off-gas and pure oxygen from OTM system to gasify coal, and heated by hot cathode off-gas at the same time. A zero-dimension SOFC model is applied and verified by fitting experimental data. Thermodynamic analysis is performed to investigate the integrated system performance, and system sensitivities on anode off-gas back flow ratio, SOFC fuel utilization, temperature and pressure are discussed. Main conclusions are as follows: (1) System overall electricity efficiency reaches 60.7%(HHV) while the gasifier operates at 700 °C and SOFC at 850 °C with system pressure at 3.04 bar; (2) oxygen enriched combustion simplify the carbon-dioxide capture process, which derives CO2 of 99.2% purity, but results in a penalty of 6.7% on system electricity efficiency; (3) with SOFC fuel utilization or temperature increasing, the power output of SOFC increases while GT power output decreases, and increasing system pressure can improve both the performance of SOFC and GT.

  12. Investigation of Zr-doped BSCF perovskite membrane for oxygen separation in the intermediate temperature range

    Science.gov (United States)

    Ravkina, Olga; Klande, Tobias; Feldhoff, Armin

    2013-05-01

    The series of (Ba0.5Sr0.5)(Co0.8Fe0.2)1-zZrzO3-δ (z=0, 0.01, 0.03, 0.05, 0.07, and 0.09) was synthesized by a sol-gel method. The materials with a zirconium content up to 3 mol% were found to be single phase. Further increase results in formation of a mixed (Ba,Sr)ZrO3 by-phase, which was found along the grain boundaries and in the grains. With increasing zirconium content the oxygen permeation flux decreases considerably. The effect of the zirconium substitution on the long-term phase stability was investigated by long-term oxygen permeation experiments and X-ray diffraction. A slight stabilization of the oxygen flux of (Ba0.5Sr0.5)(Co0.8Fe0.2)0.97Zr0.03O3-δ was found after 180 h at 1023 K. However, all compositions show a decrease in permeation flux with time, but the pure BSCF membrane exhibited the strongest drop after 180 h of operation. The decomposition products of the cubic perovskite phase were found to be a hexagonal Ba0.5±xSr0.5±xCoO3 and a rhombohedral Ba1-xSrxCo2-yFeyO5-δ.

  13. Pressure pyrolysed non-precious oxygen reduction catalysts for proton exchange membrane fuel cells

    Science.gov (United States)

    Nallathambi, Vijayadurga

    2011-12-01

    Worldwide energy demand has driven long-term efforts towards developing a clean, hydrogen-based energy economy. Polymer electrolyte membrane fuel cells (PEMFC) are low emissions and high efficiency devices that utilize the power of hydrogen and are a key enabling technology for the hydrogen economy. Carbon supported platinum-black is the state-of the art catalyst for oxygen reduction in a PEMFC because it can withstand the acidic environment. However, the high cost and low abundance of this precious metal has limited large-scale commercialization of PEMFCs. Current efforts focus on developing alternative inexpensive, non-noble metal-based catalysts for oxygen reduction with performance comparable to conventional platinum based electrocatalysts. In this work, inexpensive metal-nitrogen-carbon (MNC) catalysts have been synthesized by pyrolyzing transition metal and nitrogen precursors together with high surface area carbon materials in a closed, constant-volume quartz tube. High pressure generated due to nitrogen precursor evaporation lead to increased surface nitrogen content in the catalysts post-pyrolysis. Electrochemical oxygen reduction activity of MNC catalysts was analyzed using half-cell Rotating Ring Disc Electrode (RRDE) studies. The effect of nitrogen precursor morphology on the generation of active sites has been explored in detail. By increasing the Nitrogen/Carbon ratio of the nitrogen precursor, the accessible active site density increased by reducing carbon deposition in the pores of the carbon support during pyrolysis. The most active catalysts were obtained using melamine, having a N/C ratio of 2. Single PEMFC measurements employing MNC catalysts as cathodes indicated kinetic current density as high as 15 A cm-3 at 0.8 ViR-free and over 100 h of stable current at 0.5 V were observed. Effects of carbon free ammonia generating solid nitrogen precursors such as urea and ammonium carbamate were also studied. These precursors etched the carbon support

  14. Free-radicals and advanced chemistries involved in cell membrane organization influence oxygen diffusion and pathology treatment.

    Science.gov (United States)

    Petersen, Richard C

    2017-01-01

    A breakthrough has been discovered in pathology chemistry related to increasing molecular structure that can interfere with oxygen diffusion through cell membranes. Free radicals can crosslink unsaturated low-viscosity fatty acid oils by chain-growth polymerization into more viscous liquids and even solids. Free radicals are released by mitochondria in response to intermittent hypoxia that can increase membrane molecular organization to reduce fluidity and oxygen diffusion in a possible continuing vicious cycle toward pathological disease. Alternate computational chemistry demonstrates molecular bond dynamics in free energy for cell membrane physiologic movements. Paired electrons in oxygen and nitrogen atoms require that oxygen bonds rotate and nitrogen bonds invert to seek polar nano-environments and hide from nonpolar nano-environments thus creating fluctuating instability at a nonpolar membrane and polar biologic fluid interface. Subsequent mechanomolecular movements provide free energy to increase diffusion by membrane transport of molecules and oxygen into the cell, cell-membrane signaling/recognition/defense in addition to protein movements for enzyme mixing. In other chemistry calcium bonds to membrane phosphates primarily on the outer plasma cell membrane surface to influence the membrane firing threshold for excitability and better seal out water permeation. Because calcium is an excellent metal conductor and membrane phosphate headgroups form a semiconductor at the biologic fluid interface, excess electrons released by mitochondria may have more broad dissipation potential by safe conduction through calcium atomic-sized circuits on the outer membrane surface. Regarding medical conditions, free radicals are known to produce pathology especially in age-related disease in addition to aging. Because cancer cell membranes develop extreme polymorphism that has been extensively followed in research, accentuated easily-visualized free-radical models are

  15. Polymerization of Phenylacetylene-Based Monodendrons with Alkoxy Peripheral Groups and Oxygen/Nitrogen Permeation Behavior of Their Membranes

    Directory of Open Access Journals (Sweden)

    Takashi Kaneko

    2012-01-01

    Full Text Available Monodendron monomers with alkoxy peripheral groups were synthesized, and the focal point of monodendrons, terminal acetylene, was polymerized with rhodium catalyst to yield corresponding polydendrons with a high molecular weight. The polydendrons were soluble in common organic solvents and readily formed membranes. Oxygen permselectivity was improved in the polydendrons with a space-persistent dendritic crowd. It was found that the well-defined dendritic and rod-like structure of the polydendrons was useful for permselective membrane.

  16. [Establishment of a Neonatal ECMO Programme on the Basis of a Special Training Programme--A 6-year Analysis].

    Science.gov (United States)

    Förster, K M; Herber-Jonat, S; Huebener, C; Hasbargen, U; Schmitz, C; Schramm, R; Lehner, M; Stehr, M; Schulze, A; Flemmer, A W

    2015-12-01

    Internationally the need for neonatal ECMO is decreasing and the Extracorporeal Life Support Organization (ELSO) recommends that centres providing neonatal ECMO should treat at least 6 children per year. After a one-year training programme and preparation of the clinical application, neonatal ECMO was established and subsequently 41 infants [median age 1 day (1-172 days), median weight 3.25 kg (1.27-5.79 kg)] with severe respiratory failure have been treated within a 6-year period (fall 2008-fall 2014). For rescue therapy we provide inhaled nitric oxide, high-frequency oscillation and other differentiated ventilator strategies. Parallel to the clinical use of ECMO all employees have been trained in a special programme at 3-monthly intervals. By establishing an elaborate training programme and concentrating the treatment of critically ill newborns in one centre, the expertise of both running and preventing of neonatal ECMO due to pulmonary failure can be achieved. The diagnoses correlate to those of other centres which perform neonatal ECMO. 13 infants needed ECMO. The resulting overall survival rate was 11/12 (91.7%) infants treated with ECMO with a curative approach. All patients could be weaned from ECMO. In the context of a specialised university hospital with all treatment options for critically ill newborns and with the establishment of a specialised training programme, neonatal ECMO for pulmonary failure can achieve equally good results in comparison to those of national and international ECMO centres. © Georg Thieme Verlag KG Stuttgart · New York.

  17. Highly sensitive oxygen sensors based on Cu(I) complex-polystyrene composite nanofibrous membranes prepared by electrospinning.

    Science.gov (United States)

    Wang, Yinghui; Li, Bin; Liu, Yanhong; Zhang, Liming; Zuo, Qinghui; Shi, Linfang; Su, Zhongmin

    2009-10-21

    The first optical oxygen sensor based on Cu(I) complex-polystyrene composite nanofibrous membranes, showing high sensitivity (I(0)/I(100) = 15.56), good linear Stern-Volmer characteristics (R(2) = 0.9966) and short response/recovery time (t(decrease) (s) = 7 and t(increase) (s) = 14), has been prepared; these results represent the best values reported for oxygen sensors based on Cu(I) complexes.

  18. Nitrogen-Coordinated Single Cobalt Atom Catalysts for Oxygen Reduction in Proton Exchange Membrane Fuel Cells.

    Science.gov (United States)

    Wang, Xiao Xia; Cullen, David A; Pan, Yung-Tin; Hwang, Sooyeon; Wang, Maoyu; Feng, Zhenxing; Wang, Jingyun; Engelhard, Mark H; Zhang, Hanguang; He, Yanghua; Shao, Yuyan; Su, Dong; More, Karren L; Spendelow, Jacob S; Wu, Gang

    2018-03-01

    Due to the Fenton reaction, the presence of Fe and peroxide in electrodes generates free radicals causing serious degradation of the organic ionomer and the membrane. Pt-free and Fe-free cathode catalysts therefore are urgently needed for durable and inexpensive proton exchange membrane fuel cells (PEMFCs). Herein, a high-performance nitrogen-coordinated single Co atom catalyst is derived from Co-doped metal-organic frameworks (MOFs) through a one-step thermal activation. Aberration-corrected electron microscopy combined with X-ray absorption spectroscopy virtually verifies the CoN 4 coordination at an atomic level in the catalysts. Through investigating effects of Co doping contents and thermal activation temperature, an atomically Co site dispersed catalyst with optimal chemical and structural properties has achieved respectable activity and stability for the oxygen reduction reaction (ORR) in challenging acidic media (e.g., half-wave potential of 0.80 V vs reversible hydrogen electrode (RHE). The performance is comparable to Fe-based catalysts and 60 mV lower than Pt/C -60 μg Pt cm -2 ). Fuel cell tests confirm that catalyst activity and stability can translate to high-performance cathodes in PEMFCs. The remarkably enhanced ORR performance is attributed to the presence of well-dispersed CoN 4 active sites embedded in 3D porous MOF-derived carbon particles, omitting any inactive Co aggregates. © 2018 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  19. Effect of hydrophobic additive on oxygen transport in catalyst layer of proton exchange membrane fuel cells

    Science.gov (United States)

    Wang, Shunzhong; Li, Xiaohui; Wan, Zhaohui; Chen, Yanan; Tan, Jinting; Pan, Mu

    2018-03-01

    Oxygen transport resistance (OTR) is a critical factor influencing the performance of proton exchange membrane fuel cells (PEMFCs). In this paper, an effective method to reduce the OTR of catalyst layers (CLs) by introducing a hydrophobic additive into traditional CLs is proposed. A low-molecular-weight polytetrafluoroethylene (PTFE) is selected for its feasibility to prepare an emulsion, which is mixed with a traditional catalyst ink to successfully fabricate the CL with PTFE of 10 wt%. The PTFE film exists in the mesopores between the carbon particles. The limiting current of the hydrophobic CL was almost 4000 mA/cm2, which is 500 mA/cm2 higher than that of the traditional CL. PTFE reduces the OTR of the CL in the dry region by as much as 24 s/m compared to the traditional CL and expands the dry region from 2000 mA/cm2 in the traditional CL to 2500 mA/cm2. Furthermore, the CL with the hydrophobic agent can improve the oxygen transport in the wet region (>2000 mA/cm2) more effectively than that in the dry region. All these results indicate that the CL with the hydrophobic agent shows a superior performance in terms of optimizing water management and effectively reduces the OTR in PEMFCs.

  20. A novel ion transport membrane reactor for fundamental investigations of oxygen permeation and oxy-combustion under reactive flow conditions

    KAUST Repository

    Kirchen, Patrick

    2013-01-01

    Ion transport membrane (ITM) reactors present an attractive technology for combined air separation and fuel conversion in applications such as syngas production, oxidative coupling or oxy-combustion, with the promise of lower capital and operating costs, as well higher product selectivities than traditional technologies. The oxygen permeation rate through a given ITM is defined by the membrane temperature and oxygen chemical potential difference across it. Both of these parameters can be strongly influenced by thermochemical reactions occurring in the vicinity of the membrane, though in the literature they are often characterized in terms of the well mixed product stream at the reactor exit. This work presents the development of a novel ITM reactor for the fundamental investigation of the coupling between fuel conversion and oxygen permeation under well defined fluid dynamic and thermodynamic conditions, including provisions for spatially resolved, in-situ investigations. A planar, finite gap stagnation flow reactor with optical and probe access to the reaction zone is used to facilitate in-situ measurements and cross-validation with detailed numerical simulations. Using this novel reactor, baseline measurements are presented to elucidate the impact of the sweep gas fuel (CH4) fraction on the oxygen permeation and fuel conversion. In addition, the difference between well-mixed gas compositions measured at the reactor outlet and those measured in the vicinity of the membrane surface are discussed, demonstrating the unique utility of the reactor. © 2012 The Combustion Institute. Published by Elsevier Inc. All rights reserved.

  1. CKD and hypertension during long-term follow-up in children and adolescents previously treated with extracorporeal membrane oxygenation

    NARCIS (Netherlands)

    A.J.M. Zwiers (Alexandra); H. IJsselstijn (Hanneke); J.M. van Rosmalen (Joost); S.J. Gischler (Saskia); S.N. de Wildt (Saskia); D. Tibboel (Dick); K. Cransberg (Karlien)

    2014-01-01

    markdownabstract__Abstract__ Background and objectives Many children receiving extracorporeal membrane oxygenation develop AKI. If AKI leads to permanent nephron loss, it may increase the risk of developing CKD. The prevalence of CKD and hypertension and its predictive factors during long-term

  2. Using fluorescence-activated flow cytometry to determine reactive oxygen species formation and membrane lipid peroxidation in viable boar spermatozoa

    Science.gov (United States)

    Fluorescence-activated flow cytometry analyses were developed for determination of reactive oxygen species (ROS) formation and membrane lipid peroxidation in live spermatozoa loaded with, respectively, hydroethidine (HE) or the lipophilic probe 4,4-difluoro-5-(4-phenyl-1,3-butadienyl)-4-bora-3a,4a-d...

  3. Growing Up After Critical Illness: Verbal, Visual-Spatial, and Working Memory Problems in Neonatal Extracorporeal Membrane Oxygenation Survivors

    NARCIS (Netherlands)

    Madderom, M.J.; Schiller, R.M.; Gischler, S.J.; Heijst, A.F.J. van; Tibboel, D.; Aarsen, F.K.; Ijsselstijn, H.

    2016-01-01

    OBJECTIVES: To assess neuropsychologic outcome in 17- and 18-year-old neonatal extracorporeal membrane oxygenation survivors. DESIGN: A prospective longitudinal follow-up study. SETTING: Follow-up program at the Erasmus MC-Sophia Children's Hospital in Rotterdam, The Netherlands. PATIENTS: Thirty

  4. Tympanic membrane bleeding complications during hyperbaric oxygen treatment in patients with or without antiplatelet and anticoagulant drug treatment

    NARCIS (Netherlands)

    Fijen, Valerie A.; Westerweel, Peter E.; van Ooij, Pieter Jan A. M.; van Hulst, Rob A.

    2016-01-01

    Middle ear barotrauma (MEBt) is a frequently occurring complication of hyperbaric oxygen treatment (HBOT). High-grade MEBt may involve tympanic membrane (TM) haemorrhaging. Although many patients undergoing HBOT use antiplatelet or anticoagulant drugs, it is unknown whether these drugs increase the

  5. Structural and functional properties of SrTi1-xFexO3-δ (0 ≤ x ≤ 1) for the use as oxygen transport membrane

    NARCIS (Netherlands)

    Schulze-Küppers, F.; Ten Donkelaar, S. F.P.; Baumann, S.; Prigorodov, P.; Sohn, Y. J.; Bouwmeester, H. J.M.; Meulenberg, W. A.; Guillon, O.

    2015-01-01

    Perovskitic oxides are widely investigated as oxygen transport membrane materials for the efficient generation of pure oxygen or the use in membrane reactors. However, most of high performance perovskites suffer from low stability in operation conditions. Therefore, solid solutions of SrTi1-xFexO3-δ

  6. Education for ECMO providers: Using education science to bridge the gap between clinical and educational expertise.

    Science.gov (United States)

    Johnston, Lindsay; Williams, Susan B; Ades, Anne

    2018-03-01

    A well-organized educational curriculum for the training of both novice and experienced ECMO providers is critical for the continued function of an institutional ECMO program. ELSO provides guidance for the education for ECMO specialists, physicians and staff, which incorporates "traditional" instructor-centered educational methods, such as didactic lectures and technical skill training. Novel research suggests utilization of strategies that align with principles of adult learning to promote active learner involvement and reflection on how the material can be applied to understand existing and new constructs may be more effective. Some examples include the "flipped classroom," e-learning, simulation, and interprofessional education. These methodologies have been shown to improve active participation, which can be related to improvements in understanding and long-term retention. A novel framework for ECMO training is considered. Challenges in assessment and credentialing are also discussed. Copyright © 2018 Elsevier Inc. All rights reserved.

  7. Pheochromocytoma Crisis in the ICU: A French Multicenter Cohort Study With Emphasis on Rescue Extracorporeal Membrane Oxygenation.

    Science.gov (United States)

    Sauneuf, Bertrand; Chudeau, Nicolas; Champigneulle, Benoit; Bouffard, Claire; Antona, Marion; Pichon, Nicolas; Marrache, David; Sonneville, Romain; Marchalot, Antoine; Welsch, Camille; Kimmoun, Antoine; Bouchet, Bruno; Messai, Elmi; Ricome, Sylvie; Grimaldi, David; Chelly, Jonathan; Hanouz, Jean-Luc; Mercat, Alain; Terzi, Nicolas

    2017-07-01

    To describe the characteristics, management, and outcome of patients admitted to ICUs for pheochromocytoma crisis. A 16-year multicenter retrospective study. Fifteen university and nonuniversity ICUs in France. Patients admitted in ICU for pheochromocytoma crisis. None. We included 34 patients with a median age of 46 years (40-54 yr); 65% were males. At admission, the median Sequential Organ Failure Assessment score was 8 (4-12) and median Simplified Acute Physiology Score II 49.5 (27-70). The left ventricular ejection fraction was consistently decreased with a median value of 30% (15-40%). Mechanical ventilation was required in 23 patients, mainly because of congestive heart failure. Vasoactive drugs were used in 23 patients (68%) and renal replacement therapy in eight patients (24%). Extracorporeal membrane oxygenation was used as a rescue therapy in 14 patients (41%). Pheochromocytoma was diagnosed by CT in 33 of 34 patients. When assayed, urinary metanephrine and catecholamine levels were consistently elevated. Five patients underwent urgent surgery, including two during extracorporeal membrane oxygenation. Overall ICU mortality was 24% (8/34), and overall 90-day mortality was 27% (9/34). Crude 90-day mortality was not significantly different between patients managed with versus without extracorporeal membrane oxygenation (22% vs 30%) (p = 0.7) despite higher severity scores at admission in the extracorporeal membrane oxygenation group. Mortality is high in pheochromocytoma crisis. Routinely considering this diagnosis and performing abdominal CT in patients with unexplained cardiogenic shock may allow an earlier diagnosis. Extracorporeal membrane oxygenation and adrenalectomy should be considered as a therapeutic in most severe cases.

  8. Preparation and characterization of structures of oxygen-ion-conductive thin-film membranes; Herstellung und Charakterisierung von sauerstoffionenleitenden Duennschichtmembranstrukturen

    Energy Technology Data Exchange (ETDEWEB)

    Betz, Michael

    2010-07-01

    In power plants using Oxyfuel technology, fossil fuels are combusted with pure oxygen. This leads to carbon dioxide of high purity, which is necessary for its transport and storage. Oxygen separation by means of perovskitic membranes have great potential to decrease the efficiency losses caused by the allocation of the enormous amounts of oxygen. The aim of this work is the preparation and characterisation of thin film membranes on porous substrates and the analysis of their oxygen permeation properties. Therefore the material system A{sub 0,68}Sr{sub 0,3}Fe{sub 0,8}Co{sub 0,2}O{sub 3-{delta}} (A68SFC) was analysed, where the A-site was substituted with Lanthanides (La, Pr, Nd, Eu, Sm, Gd, Dy, Er) or alkaline earth metals (Ba, Ca). After an extensive characterisation, the selection was reduced to the substitutions with La, Pr and Nd. Other compounds could not meet the demands with regard to phase purity, chemical stability or extension behaviour. All analyses were conducted in comparison to Ba{sub 0,5}Sr{sub 0,5}Co{sub 0,8}Fe{sub 0,2}O{sub 3-{delta}} (BSCF) which is known to exhibit higher permeation rates, but is more sensitive to stability issues. The dependency of permeation rates on membrane thickness or oxygen partial pressures on both membrane surfaces is discussed by means of permeation measurements conducted on bulk BSCF membranes. These cannot be described completely by the Wagner equation. This is due to changes of the driving force originating from influences of the surface reaction kinetics and concentration polarisation on the membrane surface, which are not considered. Porous substrates for asymmetric membranes were manufactured by tape casting and warm pressing. The application of the functional layer was performed via screen printing. Permeation measurements show that the asymmetric structures exhibit higher permeation rates in comparison to bulk membranes with L=1 mm. The moderate increase can be attributed to the low gas permeability of the

  9. Enhanced response of microbial fuel cell using sulfonated poly ether ether ketone membrane as a biochemical oxygen demand sensor

    International Nuclear Information System (INIS)

    Ayyaru, Sivasankaran; Dharmalingam, Sangeetha

    2014-01-01

    Graphical abstract: - Highlights: • Sulfonated poly ether ether ketone (SPEEK) membrane in SCMFC used to determine the BOD. • The biosensor produces a good linear relationship with the BOD concentration up to 650 ppm. • This sensing range was 62.5% higher than that of Nafion ® . • SPEEK exhibited one order lesser oxygen permeability than Nafion ® . • Nafion ® shows high anodic internal resistance (67 Ω) than the SPEEK (39 Ω). - Abstract: The present study is focused on the development of single chamber microbial fuel cell (SCMFC) using sulfonated poly ether ether ketone (SPEEK) membrane to determine the biochemical oxygen demand (BOD) matter present in artificial wastewater (AW). The biosensor produces a good linear relationship with the BOD concentration up to 650 ppm when using artificial wastewater. This sensing range was 62.5% higher than that of Nafion ® . The most serious problem in using MFC as a BOD sensor is the oxygen diffusion into the anode compartment, which consumes electrons in the anode compartment, thereby reducing the coulomb yield and reducing the electrical signal from the MFC. SPEEK exhibited one order lesser oxygen permeability than Nafion ® , resulting in low internal resistance and substrate loss, thus improving the sensing range of BOD. The system was further improved by making a double membrane electrode assembly (MEA) with an increased electrode surface area which provide high surface area for electrically active bacteria

  10. Enhanced response of microbial fuel cell using sulfonated poly ether ether ketone membrane as a biochemical oxygen demand sensor

    Energy Technology Data Exchange (ETDEWEB)

    Ayyaru, Sivasankaran; Dharmalingam, Sangeetha, E-mail: sangeetha@annauniv.edu

    2014-03-01

    Graphical abstract: - Highlights: • Sulfonated poly ether ether ketone (SPEEK) membrane in SCMFC used to determine the BOD. • The biosensor produces a good linear relationship with the BOD concentration up to 650 ppm. • This sensing range was 62.5% higher than that of Nafion{sup ®}. • SPEEK exhibited one order lesser oxygen permeability than Nafion{sup ®}. • Nafion{sup ®} shows high anodic internal resistance (67 Ω) than the SPEEK (39 Ω). - Abstract: The present study is focused on the development of single chamber microbial fuel cell (SCMFC) using sulfonated poly ether ether ketone (SPEEK) membrane to determine the biochemical oxygen demand (BOD) matter present in artificial wastewater (AW). The biosensor produces a good linear relationship with the BOD concentration up to 650 ppm when using artificial wastewater. This sensing range was 62.5% higher than that of Nafion{sup ®}. The most serious problem in using MFC as a BOD sensor is the oxygen diffusion into the anode compartment, which consumes electrons in the anode compartment, thereby reducing the coulomb yield and reducing the electrical signal from the MFC. SPEEK exhibited one order lesser oxygen permeability than Nafion{sup ®}, resulting in low internal resistance and substrate loss, thus improving the sensing range of BOD. The system was further improved by making a double membrane electrode assembly (MEA) with an increased electrode surface area which provide high surface area for electrically active bacteria.

  11. Hemocompatibility and oxygenation performance of polysulfone membranes grafted with polyethylene glycol and heparin by plasma-induced surface modification.

    Science.gov (United States)

    Wang, Weiping; Zheng, Zhi; Huang, Xin; Fan, Wenling; Yu, Wenkui; Zhang, Zhibing; Li, Lei; Mao, Chun

    2017-10-01

    Polyethylene glycol (PEG) and heparin (Hep) were grafted onto polysulfone (PSF) membrane by plasma-induced surface modification to prepare PSF-PEG-Hep membranes used for artificial lung. The effects of plasma treatment parameters, including power, gas type, gas flow rate, and treatment time, were investigated, and different PEG chains were bonded covalently onto the surface in the postplasma grafting process. Membrane surfaces were characterized by water contact angle, PEG grafting degree, attenuated total reflectance-Fourier transform infrared spectroscopy, ultraviolet-visible spectrophotometry, X-ray photoelectron spectroscopy, critical water permeability pressure, and scanning electron microscopy. Protein adsorption, platelet adhesion, and coagulation tests showed significant improvement in the hemocompatibility of PSF-PEG-Hep membranes compared to pristine PSF membrane. Gas exchange tests through PSF-PEG6000-Hep membrane showed that when the flow rate of porcine blood reached 5.0 L/min, the permeation fluxes of O 2 and CO 2 reached 192.6 and 166.9 mL/min, respectively, which were close to the gas exchange capacity of a commercial membrane oxygenator. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 1737-1746, 2017. © 2016 Wiley Periodicals, Inc.

  12. Randomized Crossover Study of Training Benefits of High Fidelity ECMO Simulation versus Porcine Animal Model An Interim Report

    Science.gov (United States)

    2017-02-25

    High- Fidelity ECMO Simulation versus Porcine Animal Model - An Interim Report presented at/published to ECMO and the Advanced Therapies for...event. If the sponsor of a conference or meeting is a non-DoD commercial entity or an entity seeking to do business with the government, then your...approval.) Randomized Crossover Study of Training Benefits of High-Fidelity ECMO Simulation versus Porcine Animal Model 6. TITLE OF MATERIAL TO BE

  13. Extracorporeal Membrane Oxygenation in a Patient With Refractory Acute Respiratory Distress Syndrome Secondary to Toxic Epidermal Necrolysis.

    Science.gov (United States)

    2014-12-01

    treatment in adults with swine flu (H1N1)3 and publication of the CESAR (conventional ventilation or ECMO for severe adult respiratory failure) trial,4...ing lactate. Prone positioning was considered but not offered because of the low likelihood of success, given her underlying lung pathology...which consisted primarily of silver nitrate dress- ings that require fewer dressing changes than other therapies. Lung -protective ventilator

  14. Acute kidney injury and renal replacement therapy independently predict mortality in neonatal and pediatric noncardiac patients on extracorporeal membrane oxygenation.

    Science.gov (United States)

    Askenazi, David J; Ambalavanan, Namasivayam; Hamilton, Kiya; Cutter, Gary; Laney, Debbie; Kaslow, Richard; Georgeson, Keith; Barnhart, Douglas C; Dimmitt, Reed A

    2011-01-01

    To determine the independent impact of acute kidney injury (AKI) and renal replacement therapy (RRT) in infants and children who receive extracorporeal membrane oxygenation. Despite continued expertise/technological advancement, patients who receive extracorporeal membrane oxygenation have high mortality. AKI and RRT portend poor outcomes independent of comorbidities and illness severity in several critically ill populations. Retrospective cohort study. The primary variables explored are AKI (categorical complication code for serum creatinine > 1.5 mg/dL or International Statistical Classification of Diseases and Related Health Problems, Revision 9 for acute renal failure), and RRT (complication/Current Procedural Terminology code for dialysis or hemofiltration). Multiple variables previously associated with mortality in this population were controlled, using logistic stepwise regression. Decision tree modeling was performed to determine optimal variables and cut points to predict mortality. Critically ill neonates (0-30 days old) and children (> 30 days but optimizing the timing/delivery of RRT may positively impact survival.

  15. Chronic mould exposure as a risk factor for severe community acquired pneumonia in a patient requiring extra corporeal membrane oxygenation

    Directory of Open Access Journals (Sweden)

    Stephanie Thomas

    2015-01-01

    Full Text Available A previously fit and well man developed acute respiratory failure due to environmental mould exposure from living in damp rental accommodation. Despite aggressive intensive care management he rapidly deteriorated and required respiratory and cardiac Extracorporeal Membrane Oxygenation. We hypothesize that poor domiciliary conditions may make an underestimated contribution to community respiratory disease. These conditions may present as acute and severe illness with non-typical pathogens identified.

  16. Extracorporeal membrane oxygenation as a bridge to lung transplantation: A single-center experience in the present era.

    Science.gov (United States)

    Todd, Emily M; Biswas Roy, Sreeja; Hashimi, A Samad; Serrone, Rosemarie; Panchanathan, Roshan; Kang, Paul; Varsch, Katherine E; Steinbock, Barry E; Huang, Jasmine; Omar, Ashraf; Patel, Vipul; Walia, Rajat; Smith, Michael A; Bremner, Ross M

    2017-11-01

    Extracorporeal membrane oxygenation has been used as a bridge to lung transplantation in patients with rapid pulmonary function deterioration. The reported success of this modality and perioperative and functional outcomes are varied. We retrospectively reviewed all patients who underwent lung transplantation at our institution over 1 year (January 1, 2015, to December 31, 2015). Patients were divided into 2 groups depending on whether they required extracorporeal membrane oxygenation support as a bridge to transplant; preoperative characteristics, lung transplantation outcomes, and survival were compared between groups. Of the 93 patients, 12 (13%) received bridge to transplant, and 81 (87%) did not. Patients receiving bridge to transplant were younger, had higher lung allocation scores, had lower functional status, and were more often on mechanical ventilation at listing. Most patients who received bridge to transplant (n = 10, 83.3%) had pulmonary fibrosis. Mean pretransplant extracorporeal membrane oxygenation support was 103.6 hours in duration (range, 16-395 hours). All patients who received bridge to transplant were decannulated immediately after lung transplantation but were more likely to return to the operating room for secondary chest closure or rethoracotomy. Grade 3 primary graft dysfunction within 72 hours was similar between groups. Lung transplantation success and hospital discharge were 100% in the bridge to transplant group; however, these patients experienced longer hospital stays and higher rates of discharge to acute rehabilitation. The 1-year survival was 100% in the bridge to transplant group and 91% in the non-bridge to transplant group (log-rank, P = .24). The 1-year functional status was excellent in both groups. Extracorporeal membrane oxygenation can be used to safely bridge high-acuity patients with end-stage lung disease to lung transplantation with good 30-day, 90-day, and 1-year survival and excellent 1-year functional status

  17. Species specificity of resistance to oxygen diffusion in thin cuticular membranes from amphibious plants

    DEFF Research Database (Denmark)

    Frost-Christensen, Henning; Jørgensen, Lise Bolt; Floto, Franz

    2003-01-01

    oxygen, diffusion, cuticula, amphibious plants, Hygrophila, Berula, Lobelia, Mentha, Potamogeton, Veronica, aquatic plants, submerged plants......oxygen, diffusion, cuticula, amphibious plants, Hygrophila, Berula, Lobelia, Mentha, Potamogeton, Veronica, aquatic plants, submerged plants...

  18. Oxygen permeation in thin, dense Ce0.9Gd0.1O 1.95- membranes I. Model study

    DEFF Research Database (Denmark)

    Chatzichristodoulou, Christodoulos; Søgaard, Martin; Hendriksen, Peter Vang

    2011-01-01

    at the feed and permeate side of the membrane, related to the gaseous oxygen reduction and fuel oxidation, respectively, as well as the gas conversion and gas diffusion resistances in the porous support structure at the permeate side. The temperature and oxygen activity dependence of the oxide ionic...... was analyzed by a separation of the various losses. The chemical expansion of Ce 0.9Gd0.1O1.95-δ under operation was estimated from the calculated oxygen activity and nonstoichiometry profiles inside the membrane. © 2011 The Electrochemical Society.......A model of a supported planar Ce0.9Gd0.1O 1.95-δ oxygen membrane in a plug-flow setup was constructed and a sensitivity analysis of its performance under varying operating conditions and membrane parameters was performed. The model takes into account the driving force losses at the catalysts...

  19. Continuous Venovenous Hemodialysis Via Extracorporeal Membrane Oxygenation Pump for Treatment of Hyperammonemia Secondary to Propionic Acidemia in Monochorionic Diamniotic Twin Boys.

    Science.gov (United States)

    Wen, Joy X; Feldenberg, L Richard; Abraham, Elizabeth; Sadiq, Farouk; Christensen, Katherine M; Braddock, Stephen R

    2016-08-01

    Late-preterm twins with propionic acidemia developed severe hyperammonemic encephalopathy at 5 days of age. Continuous venovenous hemodialysis was performed successfully for both infants via extracorporeal membrane oxygenation pump, and both rapidly improved. They were taken off continuous venovenous hemodialysis and extracorporeal membrane oxygenation and discharged with dietary therapy. At 3 years of age, neurodevelopment showed globally delayed milestones. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. Enhanced response of microbial fuel cell using sulfonated poly ether ether ketone membrane as a biochemical oxygen demand sensor.

    Science.gov (United States)

    Ayyaru, Sivasankaran; Dharmalingam, Sangeetha

    2014-03-25

    The present study is focused on the development of single chamber microbial fuel cell (SCMFC) using sulfonated poly ether ether ketone (SPEEK) membrane to determine the biochemical oxygen demand (BOD) matter present in artificial wastewater (AW). The biosensor produces a good linear relationship with the BOD concentration up to 650 ppm when using artificial wastewater. This sensing range was 62.5% higher than that of Nafion(®). The most serious problem in using MFC as a BOD sensor is the oxygen diffusion into the anode compartment, which consumes electrons in the anode compartment, thereby reducing the coulomb yield and reducing the electrical signal from the MFC. SPEEK exhibited one order lesser oxygen permeability than Nafion(®), resulting in low internal resistance and substrate loss, thus improving the sensing range of BOD. The system was further improved by making a double membrane electrode assembly (MEA) with an increased electrode surface area which provide high surface area for electrically active bacteria. Copyright © 2014 Elsevier B.V. All rights reserved.

  1. Development of alternative oxygen production source using a zirconia solid electrolyte membrane. Final report

    Energy Technology Data Exchange (ETDEWEB)

    Suitor, J.W.; Clark, D.J.; Losey, R.W.

    1990-08-01

    The objective of this multiyear effort was the development, fabrication and testing of a zirconia oxygen production module capable of delivering approximately 100 liters/minute (LPM) of oxygen. The work discussed in this report consists of development and improvement of the zirconia cell along with manufacture of cell components, preliminary design of the final plant, additional economic analysis and industrial participation. (VC)

  2. Development of alternative oxygen production source using a zirconia solid electrolyte membrane

    Energy Technology Data Exchange (ETDEWEB)

    Suitor, J.W.; Clark, D.J.; Losey, R.W.

    1990-08-01

    The objective of this multiyear effort was the development, fabrication and testing of a zirconia oxygen production module capable of delivering approximately 100 liters/minute (LPM) of oxygen. The work discussed in this report consists of development and improvement of the zirconia cell along with manufacture of cell components, preliminary design of the final plant, additional economic analysis and industrial participation. (VC)

  3. Development of alternative oxygen production source using a zirconia solid electrolyte membrane

    Science.gov (United States)

    Suitor, J. W.; Clark, D. J.; Losey, R. W.

    1990-01-01

    The objective of this multiyear effort was the development, fabrication and testing of a zirconia oxygen production module capable of delivering approximately 100 liters/minute (LPM) of oxygen. The work discussed in this report consists of development and improvement of the zirconia cell along with manufacture of cell components, preliminary design of the final plant, additional economic analysis and industrial participation.

  4. Hybrid membrane using polyethersulfone-modification of multiwalled carbon nanotubes with silane agent to enhance high performance oxygen separation

    Directory of Open Access Journals (Sweden)

    Tutuk Djoko Kusworo

    2014-04-01

    Full Text Available Mixed matrix membrane comprising carbon nanotubes embedded in polymer matrix have become one of the emerging technologies. This study was investigated in order to study the effect of silane agent modification towards carbon nanotubes (CNT surface at different concentration on oxygen enrichment performances of asymmetric mixed matrix membrane. The modified carbon nanotubes were prepared by treating the carbon nanotubes with chemical modification using Dynasylan Ameo (DA silane agent to allow PES chains to be grafted on carbon nanotubes surface. The results from the FESEM, DSC and FTIR analysis confirmed that chemical modification on carbon nanotubes surface had taken place. Sieve-in-a-cage’ morphology observed shows the poor adhesion between polymer and unmodified CNT. The gas separation performance of the asymmetric flat sheet mixed matrix membranes with modified CNT were relatively higher compared to the unmodified CNT. Hence, coated hollow fiber mixed matrix membrane with chemical modification on CNT surface using (3-aminopropyl-triethoxy methyl silane agent can potentially enhance the gas separation performance of O2 and N2.

  5. Plasma Deposited Thin Iron Oxide Films as Electrocatalyst for Oxygen Reduction Reaction in Proton Exchange Membrane Fuel Cells

    Directory of Open Access Journals (Sweden)

    Lukasz JOZWIAK

    2017-02-01

    Full Text Available The possibility of using plasma deposited thin films of iron oxides as electrocatalyst for oxygen reduction reaction (ORR in proton exchange membrane fuel cells (PEMFC was examined. Results of energy-dispersive X-ray spectroscopy (EDX and X-ray photoelectron spectroscopy (XPS analysis indicated that the plasma deposit consisted mainly of FeOX structures with the X parameter close to 1.5. For as deposited material iron atoms are almost exclusively in the Fe3+ oxidation state without annealing in oxygen containing atmosphere. However, the annealing procedure can be used to remove the remains of carbon deposit from surface. The single cell test (SCT was performed to determine the suitability of the produced material for ORR. Preliminary results showed that power density of 0.23 mW/cm2 could be reached in the tested cell.DOI: http://dx.doi.org/10.5755/j01.ms.23.1.14406

  6. Catalytic hydrogen/oxygen reaction assisted the proton exchange membrane fuel cell (PEMFC) startup at subzero temperature

    Science.gov (United States)

    Sun, Shucheng; Yu, Hongmei; Hou, Junbo; Shao, Zhigang; Yi, Baolian; Ming, Pingwen; Hou, Zhongjun

    Fuel cells for automobile application need to operate in a wide temperature range including freezing temperature. However, the rapid startup of a proton exchange membrane fuel cell (PEMFC) at subfreezing temperature, e.g., -20 °C, is very difficult. A cold-start procedure was developed, which made hydrogen and oxygen react to heat the fuel cell considering that the FC flow channel was the characteristic of microchannel reactor. The effect of hydrogen and oxygen reaction on fuel cell performance at ambient temperature was also investigated. The electrochemical characterizations such as I- V plot and cyclic voltammetry (CV) were performed. The heat generated rate for either the single cell or the stack was calculated. The results showed that the heat generated rate was proportional to the gas flow rate when H 2 concentration and the active area were constant. The fuel cell temperature rose rapidly and steadily by controlling gas flow rate.

  7. Experience with Early Enteral Feeding in a Patient with Venoarterial Extracorporeal Membrane Oxygenation

    Directory of Open Access Journals (Sweden)

    V. V. Lomivorotov

    2010-01-01

    Full Text Available The study deals with the pathogenesis and early diagnosis of renal dysfunction in low and extremely low birth weight (ELBW premature neonates. Objective: to study the specific features of the mechanisms responsible for the development of acute renal failure (ARF in low and ELBW neonates and to use an analysis of oxygen status parameters as a method for early diagnosis of neonatal ARF. Subjects and methods. The study included 172 neonatal infants with a birth body weight of 800 to 1500 g. The values of blood gas composition and base-acid balance, and oxygen status were daily studied in all the children, by analyzing all the indices reflecting tissue hypoxia. Results. Analysis of oxygen status parameters in relation to a baby’s body weight revealed no considerable differences. The development of renal dysfunction and ARF in low and ELBW neonates was demonstrated to be most frequently caused by the progression of respiratory failure and tissue hypoxia, which suggests secondary renal lesion in the pattern of multiple organ dysfunction. It was ascertained that edema had a direct correlation with a physiological shunt fraction and oxygenation index and a moderate inverse correlation with blood oxygen tension and respiration index. In addition, an inverse correlation was found between the serum concentration of lactate and the daily volume of diuresis. The rate of hourly diuresis had a direct correlation with respiratory index and an inverse correlation with oxygenation index. Conclusion. Dysfunction of the kidneys and acute renal failure in neonatal infants in the pattern of multiple organ syndrome are secondary and closely related to the progres– sion of respiratory failure, as suggested by the oxygen status parameters that may be used for the prediction and early diagnosis or Key words: acute renal failure, renal dysfunction, neonaQtal infants, low and extremely low birth weight, hypoxia, oxygen status, multiple organ dysfunction. neonates. Key

  8. Cascades for natural water enrichment in deuterium and oxygen-18 using membrane permeation

    International Nuclear Information System (INIS)

    Chmielewski, A.G.; Matuszak, A.; Zakrzewska-Trznadel, G.; Van Hook, A.

    1991-01-01

    The enrichment of water in heavy isotopes by permeation through a hydrophobic membrane is described. Simple counter - current cascades are of no practical interest because of their high energy demand. A better solution is to employ a double counter - current cascade re-utilizing part of the heat of condensation. Currently employed methods of natural water enrichment in heavy isotopes are compared to the proposed membrane process. (author). 18 refs, 14 tabs, 21 figs

  9. Melatonin affects membrane integrity, intracellular reactive oxygen species, caspase3 activity and AKT phosphorylation in frozen thawed human sperm.

    Science.gov (United States)

    Najafi, Atefeh; Adutwum, Emmanuel; Yari, Abazar; Salehi, Ensieh; Mikaeili, Saideh; Dashtestani, Fariba; Abolhassani, Farid; Rashki, Leila; Shiasi, Setareh; Asadi, Ebrahim

    2018-04-01

    Cryopreservation is known to induce oxidative stress in spermatozoa. Although melatonin has powerful antioxidant properties, little is known about its effects on human sperm quality during cryopreservation. The present study was undertaken to investigate the effects of melatonin treatment on human sperm parameters essential for fertilization. We first evaluated the effects of various concentrations of melatonin (0-15 mM) on human sperm parameters such as motility, viability and levels of intracellular reactive oxygen species during cryopreservation in order to identify an optimal dose with the greatest effects for further studies. Liquefied semen samples were then divided into three aliquots: cryopreserved without melatonin (control), cryopreserved with 3 mM melatonin and fresh groups. After being thawed, samples were evaluated for motility, viability, membrane integrity, intracellular reactive oxygen species levels, caspase-3 activity and AKT phosphorylation. Treatment of spermatozoa with the various concentrations of melatonin significantly increased their motility and viability and decreased their intracellular reactive oxygen species levels compared with the control group. The optimal melatonin concentration (3 mM) significantly decreased the intracellular reactive oxygen species levels, caspase-3 activity and the percentage of both dead and apoptotic-like sperm cells and increased the vitality, progressive motility and total motility and AKT phosphorylation compared with the control group. Thus, melatonin exerts protective effects against cryodamage during human spermatozoa cryopreservation and may exert its effects via the PI3K/AKT signaling pathway.

  10. The influence of selected parameters on the efficiency and economic charactersistics of the oxy-type coal unit with a membrane-cryogenic oxygen separator

    Directory of Open Access Journals (Sweden)

    Kotowicz Janusz

    2016-03-01

    Full Text Available In this paper a 600 MW oxy-type coal unit with a pulverized bed boiler and a membrane-cryogenic oxygen separator and carbon capture installation was analyzed. A membrane-cryogenic oxygen separation installation consists of a membrane module and two cryogenic distillation columns. In this system oxygen is produced with the purity equal to 95%. Installation of carbon capture was based on the physical separation method and allows to reduce the CO2 emission by 90%. In this work the influence of the main parameter of the membrane process – the selectivity coefficient, on the efficiency of the coal unit was presented. The economic analysis with the use of the break-even point method was carried out. The economic calculations were realized in view of the break-even price of electricity depending on a coal unit availability.

  11. The influence of selected parameters on the efficiency and economic charactersistics of the oxy-type coal unit with a membrane-cryogenic oxygen separator

    Science.gov (United States)

    Kotowicz, Janusz; Berdowska, Sylwia

    2016-03-01

    In this paper a 600 MW oxy-type coal unit with a pulverized bed boiler and a membrane-cryogenic oxygen separator and carbon capture installation was analyzed. A membrane-cryogenic oxygen separation installation consists of a membrane module and two cryogenic distillation columns. In this system oxygen is produced with the purity equal to 95%. Installation of carbon capture was based on the physical separation method and allows to reduce the CO2 emission by 90%. In this work the influence of the main parameter of the membrane process - the selectivity coefficient, on the efficiency of the coal unit was presented. The economic analysis with the use of the break-even point method was carried out. The economic calculations were realized in view of the break-even price of electricity depending on a coal unit availability.

  12. A Membrane-Free Neutral pH Formate Fuel Cell Enabled by a Selective Nickel Sulfide Oxygen Reduction Catalyst.

    Science.gov (United States)

    Yan, Bing; Concannon, Nolan M; Milshtein, Jarrod D; Brushett, Fikile R; Surendranath, Yogesh

    2017-06-19

    Polymer electrolyte membranes employed in contemporary fuel cells severely limit device design and restrict catalyst choice, but are essential for preventing short-circuiting reactions at unselective anode and cathode catalysts. Herein, we report that nickel sulfide Ni 3 S 2 is a highly selective catalyst for the oxygen reduction reaction in the presence of 1.0 m formate. We combine this selective cathode with a carbon-supported palladium (Pd/C) anode to establish a membrane-free, room-temperature formate fuel cell that operates under benign neutral pH conditions. Proof-of-concept cells display open circuit voltages of approximately 0.7 V and peak power values greater than 1 mW cm -2 , significantly outperforming the identical device employing an unselective platinum (Pt) cathode. The work establishes the power of selective catalysis to enable versatile membrane-free fuel cells. © 2017 Wiley-VCH Verlag GmbH & Co. KGaA, Weinheim.

  13. A survey of membrane oxygenator heat-exchanger integrity testing at cardiac surgery centres in Great Britain and Ireland.

    Science.gov (United States)

    Carlton, Matthew; Campbell, John

    2013-11-01

    Membrane oxygenator heat exchanger (HE) device failure is reported to be very low for both short- and long-term extracorporeal devices. All oxygenator manufacturers provide instructions for leak testing of their HE devices prior to patient use. In addition to these recommendations, since 2006 at Nottingham University Hospitals (NUH) we have also additionally pressure tested HE devices prior to use. We conducted a national survey of cardiac centers in Great Britain and Ireland to determine the methods undertaken in individual centers for validation of the integrity of HE devices. Furthermore, we also collected information on the routine maintenance techniques utilized within these centers to inhibit microbial growth in the water used in the heater-cooler units (HCUs). In total, 34 responses were collected from the 57 centers performing cardiac surgery, producing a response rate of 60%. Of the responding centers, 71% are adhering to manufacturer's recommended guidelines of circulating the water through the device for 5 minutes. Of these centers, 17% reported detecting a leak between the HE and membrane compartment of the oxygenator. In responding centers, 29% reported using the pressure test technique. In the centers utilizing pressure testing, 60% reported detecting a leak. This survey reports an association of a greater HE leak detection rate using the pressure test technique compared to using water testing in isolation (p = 0.034). We believe the pressure testing method provides the perfusionist with confidence in the integrity of the HE for short- and long-term circulatory support devices prior to use in both elective and emergency situations.

  14. Oxygen separating membrane manufactured from Ba0.5Sr0.5Co0 ...

    Indian Academy of Sciences (India)

    membrane forming (extrusion, isostatic pressing) as well as the sintering conditions (rate of heating and cooling, sin- ... bined uniaxial and isostatic pressing. Then the green pellets were sintered in the electrical .... the grains border lines bulges are visible creating numerous rugosity. These quantitative observations are ...

  15. A model to predict the removal of oxygen from air using a zirconia solid electrolyte membrane

    Science.gov (United States)

    Marner, W. J.; Suitor, J. W.; Glazer, C. R.

    1988-01-01

    A finite difference mathematical model has been developed to predict the removal of oxygen from air using a zirconia separation cell. The model predicts the electrical and mass transfer processes in circular disk cells with either axial or radial current flow in the electrodes and in tubular cells with axial current flow in the electrodes. Representative results are presented and discussed.

  16. Designing CO2-resistant oxygen-selective mixed ionic-electronic conducting membranes: guidelines, recent advances, and forward directions.

    Science.gov (United States)

    Zhang, Chi; Sunarso, Jaka; Liu, Shaomin

    2017-05-22

    CO 2 resistance is an enabling property for the wide-scale implementation of oxygen-selective mixed ionic-electronic conducting (MIEC) membranes in clean energy technologies, i.e., oxyfuel combustion, clean coal energy delivery, and catalytic membrane reactors for greener chemical synthesis. The significant rise in the number of studies over the past decade and the major progress in CO 2 -resistant MIEC materials warrant systematic guidelines on this topic. To this end, this review features the pertaining aspects in addition to the recent status and advances of the two most promising membrane materials, perovskite and fluorite-based dual-phase materials. We explain how to quantify and design CO 2 resistant membranes using the Lewis acid-base reaction concept and thermodynamics perspective and highlight the relevant characterization techniques. For perovskite materials, a trade-off generally exists between CO 2 resistance and O 2 permeability. Fluorite materials, despite their inherent CO 2 resistance, typically have low O 2 permeability but this can be improved via different approaches including thin film technology and the recently developed minimum internal electronic short-circuit second phase and external electronic short-circuit decoration. We then elaborate the two main future directions that are centralized around the development of new oxide compositions capable of featuring simultaneously high CO 2 resistance and O 2 permeability and the exploitation of phase reactions to create a new conductive phase along the grain boundaries of dual-phase materials. The final part of the review discusses various complimentary characterization techniques and the relevant studies that can provide insights into the degradation mechanism of oxide-based materials upon exposure to CO 2 .

  17. Numerical simulation of physicochemical interactions between oxygen atom and phosphatidylcholine due to direct irradiation of atmospheric pressure nonequilibrium plasma to biological membrane with quantum mechanical molecular dynamics

    Science.gov (United States)

    Uchida, Satoshi; Yoshida, Taketo; Tochikubo, Fumiyoshi

    2017-10-01

    Plasma medicine is one of the most attractive applications using atmospheric pressure nonequilibrium plasma. With respect to direct contact of the discharge plasma with a biological membrane, reactive oxygen species play an important role in induction of medical effects. However, complicated interactions between the plasma radicals and membrane have not been understood well. In the present work, we simulated elemental processes at the first stage of physicochemical interactions between oxygen atom and phosphatidylcholine using the quantum mechanical molecular dynamics code in a general software AMBER. The change in the above processes was classified according to the incident energy of oxygen atom. At an energy of 1 eV, the abstraction of a hydrogen atom and recombination to phosphatidylcholine were simultaneously occurred in chemical attachment of incident oxygen atom. The exothermal energy of the reaction was about 80% of estimated one based on the bond energies of ethane. An oxygen atom over 10 eV separated phosphatidylcholine partially. The behaviour became increasingly similar to physical sputtering. The reaction probability of oxygen atom was remarkably high in comparison with that of hydrogen peroxide. These results suggest that we can uniformly estimate various physicochemical dynamics of reactive oxygen species against membrane lipids.

  18. Growing Up After Critical Illness: Verbal, Visual-Spatial, and Working Memory Problems in Neonatal Extracorporeal Membrane Oxygenation Survivors.

    Science.gov (United States)

    Madderom, Marlous J; Schiller, Raisa M; Gischler, Saskia J; van Heijst, Arno F J; Tibboel, Dick; Aarsen, Femke K; IJsselstijn, Hanneke

    2016-06-01

    To assess neuropsychologic outcome in 17- and 18-year-old neonatal extracorporeal membrane oxygenation survivors. A prospective longitudinal follow-up study. Follow-up program at the Erasmus MC-Sophia Children's Hospital in Rotterdam, The Netherlands. Thirty adolescents 17 or 18 years old, treated between 1991 and 1997, underwent neuropsychologic assessment. None. Attention, memory, executive functioning, visual-spatial functions, social-emotional functioning, and behavior were assessed with validated instruments, and data were compared with reference data. Included predictors for analysis of adverse outcome were diagnosis, age at start extracorporeal membrane oxygenation, convulsions, and use of antiepileptics. Adolescents' performance (expressed as mean [SD] z score) was significantly lower than the norm on short-term and long-term verbal memory (z score = -1.40 [1.58], p = 0.016; z score = -1.54 [1.67], p = 0.010, respectively), visual-spatial memory (z score = -1.65 [1.37], p = 0.008; z score = -1.70 [1.23], p = 0.008, respectively), and working memory (32% vs 9% in the norm population). Parents reported more problems for their children regarding organization of materials (z score = -0.60 [0.90]; p = 0.03) and behavior evaluation (z score = -0.53 [0.88]; p = 0.05) on a questionnaire. Patients reported more withdrawn/depressed behavior (z score = -0.47 [0.54]; p = 0.02), somatic complaints (z score = -0.43 [0.48]; p = 0.03), and social problems (z score = -0.41 [0.46]; p = 0.04). Patients reported more positive feelings of self-esteem and an average health status. Adolescents treated with neonatal extracorporeal membrane oxygenation are at risk of verbal, visual-spatial, and working memory problems. Future research should focus on 1) the longitudinal outcome of specific neuropsychologic skills in adolescence and adulthood; 2) identifying risk factors of neuropsychologic dysfunction; 3) evaluating to what extent "severity of illness" is responsible for acquired

  19. Characteristics and Outcome of Patients After Allogeneic Hematopoietic Stem Cell Transplantation Treated With Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome.

    Science.gov (United States)

    Wohlfarth, Philipp; Beutel, Gernot; Lebiedz, Pia; Stemmler, Hans-Joachim; Staudinger, Thomas; Schmidt, Matthieu; Kochanek, Matthias; Liebregts, Tobias; Taccone, Fabio Silvio; Azoulay, Elie; Demoule, Alexandre; Kluge, Stefan; Svalebjørg, Morten; Lueck, Catherina; Tischer, Johanna; Combes, Alain; Böll, Boris; Rabitsch, Werner; Schellongowski, Peter

    2017-05-01

    The acute respiratory distress syndrome is a frequent condition following allogeneic hematopoietic stem cell transplantation. Extracorporeal membrane oxygenation may serve as rescue therapy in refractory acute respiratory distress syndrome but has not been assessed in allogeneic hematopoietic stem cell transplantation recipients. Multicenter, retrospective, observational study. ICUs in 12 European tertiary care centers (Austria, Germany, France, and Belgium). All allogeneic hematopoietic stem cell transplantation recipients treated with venovenous extracorporeal membrane oxygenation for acute respiratory distress syndrome between 2010 and 2015. None. Thirty-seven patients, nine of whom underwent noninvasive ventilation at the time of extracorporeal membrane oxygenation initiation, were analyzed. ICU admission occurred at a median of 146 (interquartile range, 27-321) days after allogeneic hematopoietic stem cell transplantation. The main reason for acute respiratory distress syndrome was pneumonia in 81% of patients. All but one patient undergoing noninvasive ventilation at extracorporeal membrane oxygenation initiation had to be intubated thereafter. Overall, seven patients (19%) survived to hospital discharge and were alive and in remission of their hematologic disease after a follow-up of 18 (range, 5-30) months. Only one of 24 patients (4%) initiated on extracorporeal membrane oxygenation within 240 days after allogeneic hematopoietic stem cell transplantation survived compared to six of 13 (46%) of those treated thereafter (p syndrome in this group. On the contrary, long-term allogeneic hematopoietic stem cell transplantation recipients otherwise eligible for full-code ICU management may be potential candidates for extracorporeal membrane oxygenation therapy in case of severe acute respiratory distress syndrome failing conventional measures.

  20. Methodologies For Characterising Mixed Conducting Oxides For Oxygen Membrane And SOFC Cathode Application

    DEFF Research Database (Denmark)

    Hendriksen, Peter Vang; Søgaard, Martin; Plonczak, Pawel

    2012-01-01

    Two methods for detailed characterization of the process of oxygen exchange between the gas phase and a mixed conducting solid oxide are discussed. First, the use of solid electrolyte probes for measuring the change in oxygen activity over the surface of a mixed conductor is presented...... and advantages of the technique discussed. Secondly, the use of thin film model electrodes is treated. Studies of thin films applied by PLD on both sides of a YSZ single crystal are presented for three different film materials; La0.85Sr0.15MnO3, La0.6Sr0.4Fe0.8Co0.2O3 and La0.6Sr0.4CoO3. Variations in electrode...

  1. Effect of hypothermia and extracorporeal life support on drug disposition in neonates

    NARCIS (Netherlands)

    Wildschut, Enno D.; de Wildt, Saskia N.; Mâthot, Ron A. A.; Reiss, I. K. M.; Tibboel, Dick; van den Anker, John

    2013-01-01

    Extracorporeal membrane oxygenation (ECMO) is a valuable treatment modality in neonates with reversible cardiopulmonary failure in therapy-resistant pulmonary hypertension after perinatal asphyxia, septic shock or ECMO cardiopulmonary resuscitation. Neonates with severe perinatal asphyxia are

  2. Biomass characterization by dielectric monitoring of viability and oxygen uptake rate measurements in a novel membrane bioreactor.

    Science.gov (United States)

    Shariati, Farshid Pajoum; Heran, Marc; Sarrafzadeh, Mohammad Hossein; Mehrnia, Mohammad Reza; Sarzana, Gabriele; Ghommidh, Charles; Grasmick, Alain

    2013-07-01

    The application of permittivity and oxygen uptake rate (OUR) as biological process control parameters in a wastewater treatment system was evaluated. Experiments were carried out in a novel airlift oxidation ditch membrane bioreactor under different organic loading rates (OLR). Permittivity as representative of activated sludge viability was measured by a capacitive on-line sensor. OUR was also measured as a representative for respirometric activity. Results showed that the biomass concentration increases with OLR and all biomass related measurements and simulators such as MLSS, permittivity, OUR, ASM1 and ASM3 almost follow the same increasing trends. The viability of biomass decreased when the OLR was reduced from 5 to 4 kg COD m(-3)d(-1). During decreasing of OLR, biomass related parameters generally decreased but not in a similar manner. Also, protein concentration in the system during OLR decreasing changed inversely with the activated sludge viability. Copyright © 2013 Elsevier Ltd. All rights reserved.

  3. Tailoring the microstructure of porous MgO supports for asymmetric oxygen separation membranes: Optimization of thermoplastic feedstock systems

    DEFF Research Database (Denmark)

    Kothanda Ramachandran, Dhavanesan; Clemens, F.; Glasscock, Julie

    2014-01-01

    Porous magnesium oxide (MgO) structures were prepared by thermoplastic processing for use as supports in asymmetric thin film oxygen transport membranes (OTMs). The open porosity, pore size distribution, and resulting gas permeability of the MgO structures were measured for different feedstock...... compositions and sintering temperatures. For a composition with 19 vol.% graphite as a pore‐former, sintering temperatures of 1300 °C and 1400 °C, resulted in support porosities of 36% and 26%, respectively, and gas permeabilities of 1.4 × 10‐16 m2 and 3.1 × 10‐16 m2, respectively. Electron microscopy showed...... that the unexpected increase in gas permeability at temperatures above 1300 °C was a result of the growth of macro‐pores and the opening of bottle‐neck pores which resulted in improved pore connectivity. Mercury intrusion porosimetry experiments confirmed an increase in average pore size for samples sintered above...

  4. Graphite and PMMA as pore formers for thermoplastic extrusion of porous 3Y-TZP oxygen transport membrane supports

    DEFF Research Database (Denmark)

    Bjørnetun Haugen, Astri; Gurauskis, Jonas; Kaiser, Andreas

    2016-01-01

    A gas permeable porous support is a crucial part of an asymmetric oxygen transport membrane (OTM). Here, we develop feedstocks for thermoplastic extrusion of tubular, porous 3Y-TZP (partially stabilized zirconia polycrystals, (Y2O3)0.03(ZrO2)0.97)) ceramics, using graphite and/or polymethyl...... with gas permeability exceeding the target of 10−14m2 are obtained. In the temperature range 1250–1400°C the support gas permeability is insensitive to the sintering temperature, and the feedstocks shrink more than 15% during sintering, making them ideal for co-sintering with functional OTM layers....... This demonstrates the suitability of thermoplastic extrusion for fabrication of porous 3Y-TZP OTM supports, or for other technologies requiring porous ceramics....

  5. Ultrafiltration by a compacted clay membrane. I - Oxygen and hydrogen isotopic fractionation. II - Sodium ion exclusion at various ionic strengths.

    Science.gov (United States)

    Coplen, T. B.; Hanshaw, B. B.

    1973-01-01

    Laboratory experiments were carried out to determine the magnitude of the isotopic fractionation of distilled water and of 0.01N NaCl forced to flow at ambient temperature under a hydraulic pressure drop of 100 bars across a montmorillonite disk compacted to a porosity of 35% by a pressure of 330 bars. The ultrafiltrates in both experiments were depleted in D by 2.5% and in O-18 by 0.8% relative to the residual solution. No additional isotopic fractionation due to a salt-filtering mechanism was observed at NaCl concentrations up to 0.01N. Adsorption is most likely the principal mechanism which produces isotopic fractionation, but molecular diffusion may play a minor role. The results suggest that oxygen and hydrogen isotopic fractionation of ground water during passage through compacted clayey sediments should be a common occurrence, in accord with published interpretations of isotopic data from the Illinois and Alberta basins. It is shown how it is possible to proceed from the ion exchange capacity of clay minerals and, by means of the Donnan membrane equilibrium concept and the Teorell-Meyer-Siever theory, develop a theory to explain why and to what extent ultrafiltration occurs when solutions of known concentration are forced to flow through a clay membrane.

  6. Interfacial microstructure and shear strength of reactive air brazed oxygen transport membrane ceramic-metal alloy joints

    Science.gov (United States)

    FR, Wahid Muhamad; Yoon, Dang-Hyok; Raju, Kati; Kim, Seyoung; Song, Kwang-sup; Yu, Ji Haeng

    2018-01-01

    To fabricate a multi-layered structure for maximizing oxygen production, oxygen transport membrane (OTM) ceramics need to be joined or sealed hermetically metal supports for interfacing with the peripheral components of the system. Therefore, in this study, Ag-10 wt% CuO was evaluated as an effective filler material for the reactive air brazing of dense Ce0.9Gd0.1O2-δ-La0.7Sr0.3MnO3±δ (GDC-LSM) OTM ceramics. Thermal decomposition in air and wetting behavior of the braze filler was performed. Reactive air brazing was performed at 1050 °C for 30 min in air to join GDC-LSM with four different commercially available high temperature-resistant metal alloys, such as Crofer 22 APU, Inconel 600, Fecralloy, and AISI 310S. The microstructure and elemental distribution of the ceramic-ceramic and ceramic-metal interfaces were examined from polished cross-sections. The mechanical shear strength at room temperature for the as-brazed and isothermally aged (800 °C for 24 h) joints of all the samples was compared. The results showed that the strength of the ceramic-ceramic joints was decreased marginally by aging; however, in the case of metal-ceramic joints, different decreases in strengths were observed according to the metal alloy used, which was explained based on the formation of different oxide layers at the interfaces.

  7. Optimization of the Pd-Fe-Mo Catalysts for Oxygen Reduction Reaction in Proton-Exchange Membrane Fuel Cells

    International Nuclear Information System (INIS)

    Lee, Yeayeon; Jang, Jeongseok; Lee, Jin Goo; Jeon, Ok Sung; Kim, Hyeong Su; Hwang, Ho Jung; Shul, Yong Gun

    2016-01-01

    Highlights: • Pd-Mo-Fe catalysts show high catalytic activity and stability for oxygen-reduction reactions in acid media. • The optimum compositions were 7.5:1.5:1.0 for Pd-Fe-Mo, and the optimum temperatures were 500 °C. • The Pd-Fe-Mo catalysts were successfully applied to the PEMFC cathode, showing ∼500 mA cm −1 at 0.6 V. • The lattice constant was strongly related to the activity and stability of the catalysts for oxygen-reduction reactions. - Abstract: Highly active and durable non-platinum catalysts for oxygen-reduction reaction (ORR) have been developed for energy conversion devices such as proton-exchange membrane fuel cells (PEMFCs). In this study, Pd-Fe-Mo catalyst is reported as a non-platinum catalyst for ORR. The atomic ratio and annealing temperatures are controlled on the catalysts to understand interplay between their physical and chemical properties and electrochemical activities. The Pd-Fe-Mo catalyst optimized with 7.5:1.5:1.0 of the atomic ratio and 500 °C of the annealing temperature shows 32.18 mA mg −1 PGM (PGM: platinum group metal) of the kinetic current density at 0.9 V for ORR, which is comparable to that of commercial Pt/C catalyst. The current density is degraded to 6.20 mA mg −1 PGM after 3000 cycling of cyclic voltammetry, but it is greatly enhanced value compared to other non-platinum catalysts. In actual application to PEMFCs, the 20% Pd-Fe-Mo catalyst supported on carbons exhibits a high performance of 506 mA cm −2 at 0.6 V. The results suggest that the Pd-Fe-Mo catalyst can be a good candidate for non-platinum ORR catalysts.

  8. (Ce,Gd)O2−δ-based dual phase membranes for oxygen separation

    DEFF Research Database (Denmark)

    Samson, Alfred Junio; Søgaard, Martin; Hendriksen, Peter Vang

    2014-01-01

    Composite membranes based on selected combinations of the ionic conductor Ce0.9Gd0.1O1.95 (CGO) and electronic/mixed conductors (Ag–CuO, LaCoO3 (LC), La0.6Sr0.4CoO3−δ (LSC), La0.6Sr0.4FeO3−δ (LSF), (La0.6Sr0.4)0.99Co0.2Fe0.8O3−δ (LSCF), and La0.75Sr0.25Cr0.97V0.03O3−δ (LSCrV)) were prepared and c...

  9. Long-term operation of oxygen-limiting membrane bioreactor (MBR) for the development of simultaneous partial nitrification, anammox and denitrification (SNAD) process.

    Science.gov (United States)

    Zhao, Chuanqi; Wang, Gang; Xu, Xiaochen; Yang, Yuesuo; Yang, Fenglin

    2017-07-18

    In this study, an oxygen-limiting membrane bioreactor (MBR) with recirculation of biogas for relieving membrane fouling was successfully operated to realize the simultaneous partial nitrification, anammox and denitrification (SNAD) process. The MBR operation was considered effective in the long-term test with total nitrogen (TN) and chemical oxygen demand (COD) removal efficiencies of 94.86% and 98.91%, respectively. Membrane fouling was significantly alleviated due to the recirculation of biogas and the membrane had been cleaned four times with a normal filtration period of 52 days. The co-existence of ammonia-oxidizing bacteria (AOB), anammox and denitrifying bacteria in MBR was confirmed by scanning electron microscopy (SEM) and fluorescence in situ hybridizations (FISH) analysis. Furthermore, AOB were found close to the granule surface, while denitrifying bacteria and anammox were in the deeper layer of granules. Potential in excellent TN and COD removal, operational stability and sustainability, as well as in alleviating membrane fouling is expected by using this oxygen-limiting MBR.

  10. Green synthesized silver nanoparticles destroy multidrug resistant bacteria via reactive oxygen species mediated membrane damage

    Directory of Open Access Journals (Sweden)

    Balaram Das

    2017-09-01

    Full Text Available The growing need of antimicrobial agent for novel therapies against multi-drug resistant bacteria has drawn researchers to green nanotechnology. Especially, eco-friendly biosynthesis of silver nanoparticles (Ag NPs has shown its interesting impact against bacterial infection in laboratory research. In this study, a simple method was developed to form Ag NPs at room temperature, bio-reduction of silver ions from silver nitrate salt by leaf extract from Ocimum gratissimum. The Ag NPs appear to be capped with plant proteins, but are otherwise highly crystalline and pure. The Ag NPs have a zeta potential of −15 mV, a hydrodynamic diameter of 31 nm with polydispersity index of 0.65, and dry sizes of 18 ± 3 nm and 16 ± 2 nm, based on scanning and transmission electron microscopy respectively. The minimum inhibitory concentration (MIC of the Ag NPs against a multi-drug resistant Escherichia coli was 4 μg/mL and the minimum bactericidal concentration (MBC was 8 μg/mL, while the MIC and MBC against a resistant strain of Staphylococcus aureus were slightly higher at 8 μg/mL and 16 μg/mL respectively. Further, the Ag NPs inhibited biofilm formation by both Escherichia coli and S. aureus at concentrations similar to the MIC for each strain. Treatment of E. coli and S. aureus with Ag NPs resulted in damage to the surface of the cells and the production of reactive oxygen species. Both mechanisms likely contribute to bacterial cell death. In summary, this new method appears promising for green biosynthesis of pure Ag NPs with potent antimicrobial activity.

  11. Oxygen permeability of transition metal-containing La(Sr,PrGa(MgO3-δ ceramic membranes

    Directory of Open Access Journals (Sweden)

    Frade, J. R.

    2004-08-01

    Full Text Available Acceptor-type doping of perovskite-type La1-xSrxGa0.80-yMgyM0.20O3-δ (x = 0-0.20, y = 0.15-0.20, M = Fe, Co, Ni leads to significant enhancement of ionic conductivity and oxygen permeability due to increasing oxygen vacancy concentration. The increase in strontium and magnesium content is accompanied, however, with increasing role of surface exchange kinetics as permeation-limiting factor. At temperatures below 1223 K, the oxygen permeation fluxes through La(SrGa(Mg,MO3-δ membranes with thickness less than 1.5 mm are predominantly limited by the exchange rates at membrane surface. The oxygen transport in transition metal-containing La(SrGa(MgO3-δ ceramics increase in the sequence Co El dopado aceptor de cerámicas tipo perovskita La1-xSrxGa0.80-yMgyM0.20O3-δ (x = 0-0.20, y = 0.15-0.20, M = Fe, Co, Ni da lugar a una mejora significativa de la conductividad iónica y de la permeabilidad al oxígeno debido al aumento de la concentración de vacantes de oxígeno. Sin embargo, el aumento de la cantidad de estroncio y magnesio viene acompañado de un aumento de la participación de las cinéticas de intercambio superficial como factor limitante de la permeabilidad. A temperaturas por debajo de 1223 K la permeabilidad al flujo de oxígeno a través de las membranas de La(SrGa(Mg,MO3-δ con espesor menor de 1.5 mm está limitado principalmente por las velocidades de intercambio en la superficie de la membrana. El transporte de oxígeno en las cerámicas La(SrGa(MgO3-δ que contienen M aumenta en la secuencia Co < Fe < Ni. La conductividad iónica en estas fases es, sin embargo, menor que en la de los compuestos La1-xSrxGa1-yMgyO3-δ. El mayor nivel de permeabilidad de oxígeno, comparable a la de las fases basadas en La(SrFe(CoO3 y La2NiO4, se observa para las membranas de La0.90Sr0.10Ga0.65Mg0.15Ni0.20O3-δ. Los coeficientes de dilatación térmica medios de las cerámicas La(SrGa(Mg,MO3-δ en aire son del orden de (11.6–18.4 × 10-6 K-1 a 373

  12. Survival, quality of life and impact of right heart failure in patients with acute cardiogenic shock treated with ECMO.

    Science.gov (United States)

    Schoenrath, Felix; Hoch, Dennis; Maisano, Francesco; Starck, Christoph T; Seifert, Burkhardt; Wenger, Urs; Ruschitzka, Frank; Wilhelm, Markus J

    2016-01-01

    Mechanical circulatory support is increasingly used in acute cardiogenic shock. To assess treatment strategies for cardiogenic shock. Data of 57 patients in acute intrinsic cardiogenic shock treated with ECMO were analyzed. Different subsequent strategies (weaning, VAD, transplantation) were followed.​ Overall 1, 2, and 4-year survival was 36.8 ± 6.4%, 32.2 ± 6.4%, 29.8 ± 6.3%. Elevated lactate and hemorrhagic complications (all p in patients with right heart failure prior to ECMO implantation, BVAD therapy showed a trend (p=0.058) towards superior survival compared with LVAD therapy. Seven of the BVAD patients received successful transplantation, with a 1-year survival of 71%. Among survivors Short Form 36 reported significantly lower combined physical scores (p=0.004). Right heart assessment prior to ECMO implantation may be beneficial to provide tailored therapy if ECMO weaning fails. Survival after cardiogenic shock requiring ECMO seems to be associated with impaired long-term quality of life. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. Modeling the performance of hydrogen-oxygen unitized regenerative proton exchange membrane fuel cells for energy storage

    Science.gov (United States)

    Guarnieri, Massimo; Alotto, Piergiorgio; Moro, Federico

    2015-11-01

    Thanks to the independent sizing of power and energy, hydrogen-based energy storage is one of the very few technologies capable of providing long operational times in addition to the other advantages offered by electrochemical energy storage, for example scalability, site versatility, and mobile service. The typical design consists of an electrolyzer in charge mode and a separate fuel cell in discharge mode. Instead, a unitized regenerative fuel cell (URFC) is a single device performing both energy conversions, achieving a higher compactness and power-to-weight ratio. This paper presents a performance model of a URFC based on a proton exchange membrane (PEM) electrolyte and working on hydrogen and oxygen, which can provide high energy and power densities (>0.7 W cm-2). It provides voltage, power, and efficiency at varying load conditions as functions of the controlling physical quantities: temperature, pressure, concentration, and humidification. The model constitutes a tool for designing the interface and control sub-system as well as for exploring optimized cell/stack designs and operational conditions. To date, only a few of such analyses have been carried out and more research is needed in order to explore the true potential of URFCs.

  14. The role of sacrificial fugitives in thermoplastic extrusion feedstocks onproperties of MgO supports for oxygen transport membranes

    DEFF Research Database (Denmark)

    Kothanda Ramachandran, Dhavanesan; Kwok, Kawai; Søgaard, Martin

    2015-01-01

    of the pore former on microstructure, gas permeation and the mechanical properties for various sintering temperatures were investigated.The gas permeation behavior of the MgO supports was highly dependent on pore neck size and total open porosity. MgO substrate, with 20% spherical graphite as a pore former......, sintered at 1300◦C for 2 h, showed a total porosity of 42.5% and gas permeability of 4.7 × 10−16m2. Subsequently, the4-point bending strengths of this substrate, scaled to an effective volume of 10 mm3, were 77 and 60 MPa for room and operation temperature(850◦C). Both, permeation rate and mechanical......2014AbstractThree different compositions of MgO compounds were investigated for use in oxygen transport membranes. Porous MgO supports were extruded using different kind (size, morphology and chemistry) of pore formers: A flaky graphite, a spherical graphite and ideal spheres of PMMA. The influence...

  15. Microfibrillated cellulose sheets coating oxygen-permeable PDMS membranes induce rat hepatocytes 3D aggregation into stably-attached 3D hemispheroids.

    Science.gov (United States)

    Evenou, Fanny; Couderc, Sandrine; Kim, Beomjoon; Fujii, Teruo; Sakai, Yasuyuki

    2011-01-01

    Here we report the use of natural, chemically-unmodified, microfibrillated cellulose (MFC) as a matrix for hepatocyte culture. We developed an original cell-culture design composed of a thin 3D-microstructured fibrous substrate consisting of a MFC sheet coating a highly O(2)-permeable polydimethylsiloxane (PDMS) membrane. The MFC-coated PDMS membranes were obtained according to a simple process where cellulose fibres were deposited from an aqueous suspension on the PDMS surfaces and the films were dried under mild conditions. To enable oxygen diffusion through the membranes, they were assembled on bottomless frames ('O(2)+' condition). Rat hepatocytes primary-cultured on such MFC-PDMS membranes quickly organized themselves into large hemispherical 3D aggregates which were tightly anchored to the MFC sheets. In contrast, hepatocytes cultured on smooth PDMS membranes in the O(2)+ system (O(2)+, PDMS) organized into unstable 2D monolayers which easily detached from the surfaces. Hepatocyte 3D cultures obtained on MFC-PDMS membranes exhibited higher liver-specific functions over a 2-week culture period, as assessed by both the higher albumin secretion and urea synthesis rate. The MFC-PDMS membranes appear suitable for obtaining stably-attached and functional hepatocyte 3D cultures and appear interesting for drug/chemical screenings in a microplate format, but also for microfluidic applications.

  16. Investigation of Oxygen Reduction Activity of Catalysts Derived from Co and Co/Zn Methyl-Imidazolate Frameworks in Proton Exchange Membrane Fuel Cells

    Energy Technology Data Exchange (ETDEWEB)

    Chong, Lina [Chemical Sciences and Engineering Division, Argonne National Laboratory, Argonne IL 60439 USA; Engineering Research Center of Light Alloy Net Forming and State Key Laboratory of Metal Matrix Composites, Shanghai Jiao Tong University, Shanghai P.R. China; Goenaga, Gabriel A. [Chemical and Biomolecular Engineering Department, University of Tennessee, Knoxville, TN 37996 USA; Williams, Kia [University of South Florida, Tampa FL 33620 USA; Barkholtz, Heather M. [Chemical Sciences and Engineering Division, Argonne National Laboratory, Argonne IL 60439 USA; Grabstanowicz, Lauren R. [Alcoa Technical Center, New Kensington PA 15068 USA; Brooksbank, Jeremy A. [Chemical and Biomolecular Engineering Department, University of Tennessee, Knoxville, TN 37996 USA; Papandrew, Alex B. [Chemical and Biomolecular Engineering Department, University of Tennessee, Knoxville, TN 37996 USA; Elzein, Radwan [University of South Florida, Tampa FL 33620 USA; Schlaf, Rudiger [University of South Florida, Tampa FL 33620 USA; Zawodzinski, Thomas A. [Chemical and Biomolecular Engineering Department, University of Tennessee, Knoxville, TN 37996 USA; Zou, Jianxin [Engineering Research Center of Light Alloy Net Forming and State Key Laboratory of Metal Matrix Composites, Shanghai Jiao Tong University, Shanghai P.R. China; Ma, Shengqian [University of South Florida, Tampa FL 33620 USA; Liu, Di-Jia [Chemical Sciences and Engineering Division, Argonne National Laboratory, Argonne IL 60439 USA

    2016-05-31

    We demonstrated that the oxygen reduction reaction (ORR) activity over the catalysts derived from pyrolyzed cobalt zeolitic imidazolate frameworks depends strongly on the imidazole ligand structure and cobalt content. The activity and durability of these catalysts were tested in the proton exchange membrane fuel cell for the first time. The membrane electrode assembly containing a catalyst derived from Co/Zn bimetallic ZIF at cathode achieved an open circuit voltage of 0.93 V, a current density of 28 mA cm-2 at 0.8 ViR-free and a peak power density of 374 mW cm-2.

  17. Development of novel CO{sub 2}-stable oxygen permeable dual phase membranes for CO{sub 2} capture in an oxy-fuel process

    Energy Technology Data Exchange (ETDEWEB)

    Luo, Huixia

    2012-07-19

    The combustion of fossil fuels in power stations with pure oxygen following the oxy-fuel process allows the Sequestration of CO{sub 2}. The pure oxygen needed can be separated from air by oxygen transporting ceramics like single phase perovskites. However, most of the so far developed single phase perovskites have stability problems in a CO{sub 2} containing atmosphere. Dual phase membranes are micro-scale mixtures of an electron conducting phase and an oxygen ion conducting phase and their compositions can be tailored according to practical requirements, which are considered to be promising substitutes for the single phase perovskite materials. In my thesis the issues of phase stability for perovskite-type material with the common composition Ba{sub 0.5}Sr{sub 0.5}Co{sub 0.8}Fe{sub 3-{delta}} (BSCF) as weil as the development of a series of novel CO{sub 2}-stable dual phase membranes were studied. In Chapter 2, the phase stability and permeation behavior of a dead-end BSCF tube membrane in high-purity oxygen at temperatures below 750 C, were elucidated using powder X-ray diffraction (XRD), energy dispersive X-ray spectroscopy (EDXS), high-angle annular dark-field (HAADF) and scanning transmission electron microscopy (STEM). lt was found that parts of the cubic perovskite BSCF transformed into a hexagonal perovskite Ba{sub 0.5{+-}x}Sr{sub 0.5{+-}x}CoO{sub 3-{delta}} (x {approx} 0.1) and a trigonal mixed oxide Ba{sub 1-x}Sr{sub x}CO{sub 2-y}Fe{sub y}O{sub 5{+-}{delta}} (x {approx} 0.15, y {approx} 0.25) in high-purity oxygen at 750 C. On the other hand, it was found that the partial degradation of cubic BSCF perovskite at 750 C was more pronounced under the strongly oxidizing conditions on the oxygen supply (feed) side than on the oxygen release (permeate) side of the membrane. The structural instability of BSCF is attributed to an oxidation of cobalt from Co{sup 2+} to Co{sup 3+} and Co{sup 4+}, which exhibits an ionic radius that is too small to be tolerated by

  18. Lysosomal membrane permeabilization: Carbon nanohorn-induced reactive oxygen species generation and toxicity by this neglected mechanism

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Mei, E-mail: happy_deercn@163.com [Nanotube Research Center, National Institute of Advanced Industrial Science and Technology 5-2, 1-1-1 Higashi, Tsukuba 305-8565 (Japan); Zhang, Minfang; Tahara, Yoshio; Chechetka, Svetlana; Miyako, Eijiro [Nanotube Research Center, National Institute of Advanced Industrial Science and Technology 5-2, 1-1-1 Higashi, Tsukuba 305-8565 (Japan); Iijima, Sumio [Nanotube Research Center, National Institute of Advanced Industrial Science and Technology 5-2, 1-1-1 Higashi, Tsukuba 305-8565 (Japan); Faculty of Science and Technology, Meijo University, 1-501 Shiogamaguchi, Tenpaku, Nagoya 468-8502 (Japan); Yudasaka, Masako, E-mail: m-yudasaka@aist.go.jp [Nanotube Research Center, National Institute of Advanced Industrial Science and Technology 5-2, 1-1-1 Higashi, Tsukuba 305-8565 (Japan)

    2014-10-01

    Understanding the molecular mechanisms responsible for the cytotoxic effects of carbon nanomaterials is important for their future biomedical applications. Carbon nanotubular materials induce the generation of reactive oxygen species (ROS), which causes cell death; however, the exact details of this process are still unclear. Here, we identify a mechanism of ROS generation that is involved in the apoptosis of RAW264.7 macrophages caused by excess uptake of carbon nanohorns (CNHs), a typical type of carbon nanotubule. CNH accumulated in the lysosomes, where they induced lysosomal membrane permeabilization (LMP) and the subsequent release of lysosomal proteases, such as cathepsins, which in turn caused mitochondrial dysfunction and triggered the generation of ROS in the mitochondria. The nicotinamide adenine dinucleotide phosphate oxidase was not directly involved in CNH-related ROS production, and the ROS generation cannot be regulated by mitochondrial electron transport chain. ROS fed back to amplify the mitochondrial dysfunction, leading to the subsequent activation of caspases and cell apoptosis. Carbon nanotubules commonly accumulate in the lysosomes after internalization in cells; however, lysosomal dysfunction has not attracted much attention in toxicity studies of these materials. These results suggest that LMP, a neglected mechanism, may be the primary reason for carbon nanotubule toxicity. - Highlights: • We clarify an apoptotic mechanism of RAW264.7 cells caused by carbon nanohorns. • In the meantime, the mechanism of CNH-induced ROS generation is identified. • LMP is the initial factor of CNH-induced ROS generation and cell death. • Cathepsins work as mediators that connect LMP and mitochondrial dysfunction.

  19. Micro-Membrane Electrode Assembly Design to Precisely Measure the in Situ Activity of Oxygen Reduction Reaction Electrocatalysts for PEMFC.

    Science.gov (United States)

    Long, Zhi; Li, Yankai; Deng, Guangrong; Liu, Changpeng; Ge, Junjie; Ma, Shuhua; Xing, Wei

    2017-06-20

    An in situ micro-MEA technique, which could precisely measure the performance of ORR electrocatalyst using Nafion as electrolyte, was designed and compared with regular thin-film rotating-disk electrode (TFRDE) (0.1 M HClO 4 ) and normal in situ membrane electrode assembly (MEA) tests. Compared to the traditional TFRDE method, the micro-MEA technique makes the acquisition of catalysts' behavior at low potential values easily achieved without being limited by the solubility of O 2 in water. At the same time, it successfully mimics the structure of regular MEAs and obtains similar results to a regular MEA, thus providing a new technique to simply measure the electrode activity without being bothered by complicated fabrication of regular MEA. In order to further understand the importance of in situ measurement, Fe-N-C as a typical oxygen reduction reaction (ORR) free-Pt catalyst was evaluated by TFRDE and micro-MEA. The results show that the half wave potential of Fe-N-C only shifted negatively by -135 mV in comparison with state-of-the-art Pt/C catalysts from TFRDE tests. However, the active site density, mass transfer of O 2 , and the proton transfer conductivity are found to strongly influence the catalyst activity in the micro-MEA, thereby resulting in a much lower limiting current density than Pt/C (8.7 times lower). Hence, it is suggested that the micro-MEA is better in evaluating the in situ ORR performance, where the catalysts are characterized more thoroughly in terms of intrinsic activity, active site density, proton transfer, and mass transfer properties.

  20. Iridium-decorated palladium-platinum core-shell catalysts for oxygen reduction reaction in proton exchange membrane fuel cell.

    Science.gov (United States)

    Wang, Chen-Hao; Hsu, Hsin-Cheng; Wang, Kai-Ching

    2014-08-01

    Carbon-supported Pt, Pd, Pd-Pt core-shell (Pt(shell)-Pd(core)/C) and Ir-decorated Pd-Pt core-shell (Ir-decorated Pt(shell)-Pd(core)/C) catalysts were synthesized, and their physical properties, electrochemical behaviors, oxygen reduction reaction (ORR) characteristics and proton exchange membrane fuel cell (PEMFC) performances were investigated herein. From the XRD patterns and TEM images, Ir-decorated Pt(shell)-Pd(core)/C has been confirmed that Pt was deposited on the Pd nanoparticle which had the core-shell structure. Ir-decorated Pt(shell)-Pd(core)/C has more positive OH reduction peak than Pt/C, which is beneficial to weaken the binding energy of Pt-OH during the ORR. Thus, Ir-decorated Pt(shell)-Pd(core)/C has higher ORR activity than Pt/C. The maximum power density of H2-O2 PEMFC using Ir-decorated Pt(shell)-Pd(core)/C is 792.2 mW cm(-2) at 70°C, which is 24% higher than that using Pt/C. The single-cell accelerated degradation test of PEMFC using Ir-decorated Pt(shell)-Pd(core)/C shows good durability by the potential cycling of 40,000 cycles. This study concludes that Ir-decorated Pt(shell)-Pd(core)/C has the low Pt content, but it can facilitate the low-cost and high-efficient PEMFC. Copyright © 2013 Elsevier Inc. All rights reserved.

  1. High-performance Platinum-free oxygen reduction reaction and hydrogen oxidation reaction catalyst in polymer electrolyte membrane fuel cell.

    Science.gov (United States)

    Chandran, Priji; Ghosh, Arpita; Ramaprabhu, Sundara

    2018-02-26

    The integration of polymer electrolyte membrane fuel cell (PEMFC) stack into vehicles necessitates the replacement of high-priced platinum (Pt)-based electrocatalyst, which contributes to about 45% of the cost of the stack. The implementation of high-performance and durable Pt metal-free catalyst for both oxygen reduction reaction (ORR) and hydrogen oxidation reaction (HOR) could significantly enable large-scale commercialization of fuel cell-powered vehicles. Towards this goal, a simple, scalable, single-step synthesis method was adopted to develop palladium-cobalt alloy supported on nitrogen-doped reduced graphene oxide (Pd 3 Co/NG) nanocomposite. Rotating ring-disk electrode (RRDE) studies for the electrochemical activity towards ORR indicates that ORR proceeds via nearly four-electron mechanism. Besides, the mass activity of Pd 3 Co/NG shows an enhancement of 1.6 times compared to that of Pd/NG. The full fuel cell measurements were carried out using Pd 3 Co/NG at the anode, cathode in conjunction with Pt/C and simultaneously at both anode and cathode. A maximum power density of 68 mW/cm 2 is accomplished from the simultaneous use of Pd 3 Co/NG as both anode and cathode electrocatalyst with individual loading of 0.5 mg/cm 2 at 60 °C without any backpressure. To the best of our knowledge, the present study is the first of its kind of a fully non-Pt based PEM full cell.

  2. Intestinal Conditioning After Cardiac Arrest: The Use of Normothermic Extracorporeal Membrane Oxygenation in the Non-Heart-Beating Animal Model.

    Science.gov (United States)

    Guo, Mingxiao; Yao, Danhua; Li, Linlin; Lu, Chunlei; Li, Yousheng; Li, Jieshou

    2016-08-01

    The effect of normothermic extracorporeal membrane oxygenation (NECMO) on small bowel preservation in a clinically relevant large animal model of expected donation after cardiac death (eDCD) was evaluated. Thirty domestic crossbred donor pigs were divided into five groups. The first group served as the live donation (LD) group, the second group served as the donation after cardiac death (DCD) group, and the remaining were further assigned into three subgroups: E1 group (1 h NECMO support), E3 group (3 h NECMO support), and E5 group (5 h NECMO support). Pathology, electron microscopy, energy metabolism, cell apoptosis, and tight junction (TJ) protein expression level of intestinal mucosa and the level of plasma d-lactic acid were evaluated in normal, cardiac death and at the end of extracorporeal support, respectively. The mean arterial pressure and PaO2 were maintained over 60 and 267 mm Hg during NECMO support, respectively. One hour of extracorporeal support could improve the energy status in intestines of the DCD group. Although the histologic damage and apoptosis of the E1 group had no significant difference with those of the LD and DCD groups (P > 0.05), the levels of intestinal mucosa TJ protein decreased (P intestinal mucosa damage and intestinal permeability gradually increased, as well as the content of adenosine triphosphate in intestinal mucosa. The normothermic extracorporeal support for 1 h in DCD is beneficial for improving the energy status and viability of the bowel. However, the integrity of intestinal mucosa was destroyed gradually as extracorporeal support time went by. And the activation of intestinal epithelial apoptosis and hyperoxia might be the factors that lead to intestinal mucosa injury. © 2016 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

  3. The Role of Hypothermia Coordinator: A Case of Hypothermic Cardiac Arrest Treated with ECMO.

    Science.gov (United States)

    Darocha, Tomasz; Kosinski, Sylweriusz; Moskwa, Maciej; Jarosz, Anna; Sobczyk, Dorota; Galazkowski, Robert; Slowik, Marcin; Drwila, Rafal

    2015-12-01

    We present a description of emergency medical rescue procedures in a patient suffering from severe hypothermia who was found in the Babia Gora mountain range (Poland). After diagnosing the symptoms of II/III stage hypothermia according to the Swiss Staging System, the Mountain Rescue Service notified the coordinator from the Severe Accidental Hypothermia Center (CLHG) Coordinator in Krakow and then kept in constant touch with him. In accordance with the protocol for managing such situations, the coordinator started the procedure for patients in severe hypothermia with the option of extracorporeal warming and secured access to a device for continuous mechanical chest compression. After reaching the hospital, extracorporeal warming with ECMO support in the arteriovenuous configuration was started. The total duration of circulatory arrest was 150 minutes. The rescue procedures were supervised by the coordinator, who was on 24-hour duty and was reached by means of an alarm phone. The task of the coordinator is to consult the management of hypothermia cases, use his knowledge and experience to help in the diagnosis and treatment. and if the need arises refer the patient for ECMO at CLHG. Good coordination, planning, predicting possible problems, and acting in accordance with the agreed procedures in the scheme, make it possible to shorten the time of reaching the destination hospital and implement effective treatment.

  4. OXYGEN TRANSPORT CERAMIC MEMBRANES

    Energy Technology Data Exchange (ETDEWEB)

    Dr. Sukumar Bandopadhyay; Dr. Nagendfra Nagabhushana

    2001-07-01

    The mechanical properties of model systems were analyzed. A reasonably accurate finite element model was implemented and a rational metric to predict the strength of ceramic/metal concentrical joints was developed. The mode of failure of the ceramic/metal joints was determined and the importance of the mechanical properties of the braze material was assessed. Thermal cycling experiments were performed on the model systems and the results were discussed. Additionally, experiments using the concept of placing diffusion barriers on the ceramic surface to limit the extent of the reaction with the braze were performed. It was also observed that the nature and morphology of the reaction zone depends greatly on the nature of the perovskite structure being used. From the experiments, it is observed that the presence of Cr in the Fe-occupied sites decreases the tendency of Fe to segregate and to precipitate out of the lattice. In these new experiments, Ni was observed to play a major role in the decomposition of the ceramic substrate.

  5. OXYGEN TRANSPORT CERAMIC MEMBRANES

    Energy Technology Data Exchange (ETDEWEB)

    Dr. Sukumar Bandopadhyay; Dr. Nagendra Nagabhushana

    2001-05-01

    The mechanical properties of model systems were analyzed. A reasonably accurate finite element model was implemented and a rational metric to predict the strength of ceramic/metal concentrical joints was developed. The mode of failure of the ceramic/metal joints was determined and the importance of the mechanical properties of the braze material was assessed. Thermal cycling experiments were performed on the model systems and the results were discussed. Additionally, experiments using the concept of placing diffusion barriers on the ceramic surface to limit the extent of the reaction with the braze were performed. It was also observed that the nature and morphology of the reaction zone depends greatly on the nature of the perovskite structure being used. From the experiments, it is observed that the presence of Cr in the Fe-occupied sites decreases the tendency of Fe to segregate and to precipitate out of the lattice. In these new experiments, Ni was observed to play a major role in the decomposition of the ceramic substrate.

  6. Reliability of new poly (lactic-co-glycolic acid) membranes treated with oxygen plasma plus silicon dioxide layers for pre-prosthetic guided bone regeneration processes.

    Science.gov (United States)

    Castillo-Dalí, G; Castillo-Oyagüe, R; Batista-Cruzado, A; López-Santos, C; Rodríguez-González-Elipe, A; Saffar, J-L; Lynch, C-D; Gutiérrez-Pérez, J-L; Torres-Lagares, D

    2017-03-01

    The use of cold plasmas may improve the surface roughness of poly(lactic-co-glycolic) acid (PLGA) membranes, which may stimulate the adhesion of osteogenic mediators and cells, thus accelerating the biodegradation of the barriers. Moreover, the incorporation of metallic-oxide particles to the surface of these membranes may enhance their osteoinductive capacity. Therefore, the aim of this paper was to evaluate the reliability of a new PLGA membrane after being treated with oxygen plasma (PO2) plus silicon dioxide (SiO2) layers for guided bone regeneration (GBR) processes. Circumferential bone defects (diameter: 11 mm; depth: 3 mm) were created on the top of eight experimentation rabbits' skulls and were randomly covered with: (1) PLGA membranes (control), or (2) PLGA/PO2/SiO2 barriers. The animals were euthanized two months afterwards. A micromorphologic study was then performed using ROI (region of interest) colour analysis. Percentage of new bone formation, length of mineralised bone, concentration of osteoclasts, and intensity of ostheosynthetic activity were assessed and compared with those of the original bone tissue. The Kruskal-Wallis test was applied for between-group com Asignificance level of a=0.05 was considered. The PLGA/PO2/SiO2 membranes achieved the significantly highest new bone formation, length of mineralised bone, concentration of osteoclasts, and ostheosynthetic activity. The percentage of regenerated bone supplied by the new membranes was similar to that of the original bone tissue. Unlike what happened in the control group, PLGA/PO2/SiO2 membranes predominantly showed bone layers in advanced stages of formation. The addition of SiO2 layers to PLGA membranes pre-treated with PO2 improves their bone-regeneration potential. Although further research is necessary to corroborate these conclusions in humans, this could be a promising strategy to rebuild the bone architecture prior to rehabilitate edentulous areas.

  7. Constants of the Alper and Howard-Flanders oxygen equation for damage to bacterial membrane, deduced from observations on the radiation-induced penicillin-sensitive lesion.

    Science.gov (United States)

    Obioha, F I; Gillies, N E; Cullen, B M; Walker, H C; Alper, T

    1984-05-01

    Energy deposited in the bacterial envelope of E. coli B/r induces lesions which are lethally attacked by penicillin in concentration insufficient to affect unirradiated bacteria. The critical lesions are probably in the membrane moiety. Bacteria were irradiated in the presence of 100 per cent oxygen, oxygen-free nitrogen and mixtures of 1.01, 0.59, 0.3, 0.1 and 0.06 per cent oxygen in nitrogen. Changes in sensitivity with pO2 conformed with the Alper and Howard-Flanders equation, for bacteria treated after irradiation by penicillin as well as for the untreated ones. The values of m were respectively 4.8 and 3.3; the values of K were identical, within experimental error, i.e. 4.4 mmHg. Sensitivity to induction of the penicillin-sensitive lesion was calculated from the difference in the reciprocals of D0 values proper to untreated and treated bacteria, for every gas used. The value of m could not be directly calculated because the effect of penicillin on anoxically irradiated bacteria was not detectable. For that reason, a transformation of the oxygen equation was used which allowed estimates to be made of both m and K, provided the results conformed with the equation. Within experimental error they did so conform. The calculated values of m and K for induction of the penicillin-sensitive lesion were respectively 8 and 5.9 mmHg, but it is shown that the oxygen enhancement ratio was probably underestimated and the K value overestimated. On the assumptions that these values of m and K are specific for radiation damage to bacterial membrane, and that radiation-induced killing is attributable to lethal lesions in the membrane as well as the DNA, the results demonstrate that any interaction of oxygen with sites of energy deposition in the DNA must play a very much smaller role in radiosensitization than does interaction with sites of energy deposition in the membrane.

  8. Constants of the Alper and Howard-Flanders oxygen equation for damage to bacterial membrane, deduced from observations on the radiation-induced penicillin-sensitive lesion

    International Nuclear Information System (INIS)

    Obioha, F.I.; Gillies, N.E.; Cullen, B.M.; Walker, H.C.; Alper, T.

    1984-01-01

    E. coli were irradiated in the presence of 100% oxygen, oxygen-free nitrogen and mixtures of 1.01, 0.59, 0.3, 0.1 and 0.06% oxygen in nitrogen. Changes in sensitivity with pO 2 conformed with the Alper and Howard-Flanders equation for bacteria treated after irradiation by penicillin as well as for the untreated ones. Values of m were respectively 4.8 and 3.3; values of K were identical, within experimental error, (4.4 mmHg). Sensitivity to induction of the bacterial membrane penicillin-sensitive lesion was calculated from the difference in the reciprocals of D 0 values proper to untreated and treated bacteria, for every gas used. The value of m could not be directly calculated because the effect of penicillin on anoxically irradiated bacteria was not detectable. For that reason, a transformation of the oxygen equation was used, allowing estimates to be made of both m and K, provided the results conformed with the equation. Within experimental error they did. Calculated values of m and K for induction of the penicillin-sensitive lesion were respectively 8 and 5.9 mmHg, but it is shown that the oxygen enhancement ratio was probably underestimated and the value overestimated. (author)

  9. DEVELOPMENT OF REACTION-DRIVEN IONIC TRANSPORT MEMBRANES (ITMs) TECHNOLOGY: PHASE IV/BUDGET PERIOD 6 “Development of ITM Oxygen Technology for Integration in IGCC and Other Advanced Power Generation Systems”

    Energy Technology Data Exchange (ETDEWEB)

    David, Studer

    2012-03-01

    Air Products and Chemicals, along with development participants and in association with the U.S. Department of Energy, has made substantial progress in developing a novel air separation technology. Unlike conventional cryogenic processes, this method uses high-temperature ceramic membranes to produce high-purity oxygen. The membranes selectively transport oxygen ions with high flux and infinite theoretical selectivity. Reaction-driven ceramic membranes are fabricated from non-porous, multi-component metallic oxides, operate at temperatures typically over 700°C, and have exceptionally high oxygen flux and selectivity. Oxygen from low-pressure air permeates as oxygen ions through the ceramic membrane and is consumed through chemical reactions, thus creating a chemical driving force that pulls oxygen ions across the membrane at high rates. The oxygen reacts with a hydrocarbon fuel in a partial oxidation process to produce a hydrogen and carbon monoxide mixture – synthesis gas. This project expands the partial-oxidation scope of ITM technology beyond natural gas feed and investigates the potential for ITM reaction-driven technology to be used in conjunction with gasification and pyrolysis technologies to provide more economical routes for producing hydrogen and synthesis gas. This report presents an overview of the ITM reaction-driven development effort, including ceramic materials development, fabrication and testing of small-scale ceramic modules, ceramic modeling, and the investigation of gasifier integration schemes

  10. Synthesis of a Fluorine-Containing Cis-Cisoidal One-Handed Helical Polyphenylacetylene and Application of Highly Selective Photocyclic Aromatization Product on Oxygen Permselective Membrane.

    Science.gov (United States)

    Zang, Yu; Yin, Guanwu; Aoki, Toshiki; Teraguchi, Masahiro; Kaneko, Takashi; Ma, Liqun; Jia, Hongge

    2015-08-01

    A novel phenylacetylene monomer having a perfluorinated alkyl group (M-F) was synthesized and polymerized in a chiral catalytic system to yield a one-handed helical polymer. The ability and efficiency of the chiral induction of the fluorine-containing monomer in the helix-sense-selective polymerization (HSSP) was much higher than those of a monomer having the corresponding alkyl group (M-H) we reported before. The resulting polymer showed cis-cisoidal one-handed helical conformation, and was suitable for highly selective photocyclic aromatization (SCAT) to give a 2D surface modifier (). Oxygen permselectivity through a base polymer membrane was highly enhanced from 1.83 to 2.36 by adding a small amount (1-5 wt%) of the 2D surface modifier . The improvement was thought to be caused by improvement of solution selectivity on the membrane surface which the 2D surface modifier effectively covered. © 2015 Wiley Periodicals, Inc.

  11. Enhancing co-production of H2 and syngas via water splitting and POM on surface-modified oxygen permeable membranes

    KAUST Repository

    Wu, Xiao-Yu

    2016-09-26

    In this article, we report a detailed study on co-production of H2 and syngas on La0.9Ca0.1FeO3−δ (LCF-91) membranes via water splitting and partial oxidation of methane, respectively. A permeation model shows that the surface reaction on the sweep side is the rate limiting step for this process on a 0.9 mm-thick dense membrane at 990°C. Hence, sweep side surface modifications such as adding a porous layer and nickel catalysts were applied; the hydrogen production rate from water thermolysis is enhanced by two orders of magnitude to 0.37 μmol/cm2•s compared with the results on the unmodified membrane. At the sweep side exit, syngas (H2/CO = 2) is produced and negligible solid carbon is found. Yet near the membrane surface on the sweep side, methane can decompose into solid carbon and hydrogen at the surface, or it may be oxidized into CO and CO2, depending on the oxygen permeation flux.

  12. Porous Fe21Cr7Al1Mo0.5Y metal supports for oxygen transport membranes: Thermo-mechanical properties, sintering and corrosion behaviour

    DEFF Research Database (Denmark)

    Glasscock, Julie; Mikkelsen, Lars; Persson, Åsa Helen

    2013-01-01

    An Fe21Cr7Al1Mo0.5Y alumina-forming stainless steel is designed and evaluated as a material for porous supports for oxygen transport membranes. The thermal expansion coefficient, elastic modulus and creep rates of the alloy are presented. The microstructure, porosity and pre-oxidation conditions...... resistance compared with an FeCr steel of similar composition and porosity. Modelling of the alloy lifetime as a function of surface area and Al-content was performed, and lifetimes over 30 000 h are predicted for a metal support with 30% porosity operating at a temperature of 750 C, where the oxidation...

  13. Oxygen transport properties of tubular Ce0.9Gd0.1O1.95-La0.6Sr0.4FeO3−d composite asymmetric oxygen permeation membranes supported on magnesium oxide

    DEFF Research Database (Denmark)

    Ovtar, Simona; Gurauskis, Jonas; Bjørnetun Haugen, Astri

    2017-01-01

    The oxygen permeation through dense Ce0.9Gd0.1O1.95-La0.6Sr0.4FeO3−d  dual-phase composite asymmetric membranes supported on a porous MgO tube was studied. The membranes were prepared by thermoplastic extrusion, dip coating, co-sintering and infiltration of a catalyst. Oxygen permeation measureme...

  14. Electronic and ionic transport in Ce0.8PrxTb0.2-xO2-δ and evaluation of performance as oxygen permeation membranes

    DEFF Research Database (Denmark)

    Chatzichristodoulou, Christodoulos; Hendriksen, Peter Vang

    2012-01-01

    is significantly enhanced relative to that of a Ce0.9Gd0.1O1.95-δ membrane at high oxygen activities of the permeate gas (aO2 an > 10-15) due to the enhanced electronic conductivity of the Ce0.8PrxTb0.2-xO2-δ compounds. Interference between the ionic and electronic flows has a significant positive effect......The electronic conductivity of Ce0.8PrxTb0.2-xO2-δ (x = 0, 0.05, 0.10, 0.15, 0.20) was determined in the oxygen activity range aO2 ≈ 103 to aO2 ≈ 10-17 at 700- 900 °C by means of Hebb-Wagner polarisation. The electronic conductivity of all the Ce0.8PrxTb0.2-xO2-δ compositions was significantly...... enhanced as compared to that of Ce0.9Gd0.1O1.95-δ, and its value was found to increase with increasing Pr/Tb ratio. The ionic mobility of Ce0.8PrxTb0.2-xO2-δ is similar to that of Ce1- 2δGd2δO2-δ at the same oxygen vacancy concentration. The calculated oxygen flux of a Ce0.8PrxTb0.2-xO2-δ membrane...

  15. Oxygen transport and degradation properties of high-temperature membranes for CO{sub 2}-free power plants; Sauerstofftransport und Degradationsverhalten von Hochtemperaturmembranen fuer CO{sub 2}-freie Kraftwerke

    Energy Technology Data Exchange (ETDEWEB)

    Schlehuber, Dominic

    2010-07-01

    This thesis deals with membranes for oxygen separation from air for high temperature application in fossil power plants within the scope of the oxyfuel-process. Different perovskite membrane materials (ABO3-ae) were investigated concerning the oxygen transport and their chemical stability under operation condition. The association between oxygen transport properties and both the thermodynamic boundary conditions as well as the material properties (membrane thickness and surface properties) was studied. One possibility to achieve higher oxygen fluxes through the membrane is to reduce the thickness. In this case the influence of surface processes on the overall permeation becomes noteworthy. The effect of different membrane surface modifications on the permeation rate was investigated. For example it could be confirmed, that a porous layer on the membrane surface significantly increases the permeation flux due to the compensation of surface exchange limitations. Beyond that, degradation processes during the operation under power plant condition were investigated. Special attention was attached to the influence of degradation on the permeation flux during long term operation. Thereby kinetic demixing of the membrane material was observed. (orig.)

  16. Promising monolayer membranes for CO{sub 2}/N{sub 2}/CH{sub 4} separation: Graphdiynes modified respectively with hydrogen, fluorine, and oxygen atoms

    Energy Technology Data Exchange (ETDEWEB)

    Zhao, Lianming, E-mail: lmzhao@upc.edu.cn; Sang, Pengpeng; Guo, Sheng; Liu, Xiuping; Li, Jing; Zhu, Houyu; Guo, Wenyue, E-mail: wyguo@upc.edu.cn

    2017-05-31

    Graphical abstract: Graphdiyne monolayer membrane modified by fluorine or oxygen can effectively separate CO{sub 2}/N{sub 2}/CH{sub 4} mixtures. - Highlights: • Three graphdiyne-like membranes were designed and their stabilities were confirmed. • The DFT and MD results claimed a tunable gas separation property of the membranes. • Graphdiyne modified with F or O can effectively separate CO{sub 2}/N{sub 2}/CH{sub 4} mixtures. - Abstract: Three graphdiyne-like monolayers were designed by substituting one-third diacetylenic linkages with heteroatoms hydrogen, fluorine, and oxygen (GDY-X, X = H, F, and O), respectively. The CO{sub 2}/N{sub 2}/CH{sub 4} separation performance of the designed graphdiyne-like monolayers was investigated by using both first-principle density functional theory (DFT) and molecular dynamic (MD) simulations. The stabilities of GDY-X monolayers were confirmed by the calculated cohesive energies and phonon dispersion spectra. Both the DFT and MD calculations demonstrated that although the GDY-H membrane has poor selectivity for CO{sub 2}/N{sub 2}/CH{sub 4} gases, the GDY-F and GDY-O membranes can excellently separate CO{sub 2} and N{sub 2} from CH{sub 4} in a wide temperature range. Moreover, the CO{sub 2}/N{sub 2} mixture can be effectively separated by GDY-O at temperatures lower than 300 K. Based on the kinetic theory, extremely high permeances were found for CO{sub 2} and N{sub 2} passing through the GDY-X membranes (10{sup −4}–10{sup −2} mol/m{sup 2} s Pa at 298 K). In addition, the influence of relative concentration on selectivity was also investigated for gases in the binary mixtures. This work provides an effective way to modify graphdiyne for the separation of large molecular gases, which is quite crucial in the gas separation industry.

  17. Extracorporeal membrane oxygenation in acute respiratory distress syndrome due to influenza A (H1N1)pdm09 pneumonia. A single-center experience during the 2013-2014 season.

    Science.gov (United States)

    Menon, Nithya; Perez-Velez, Carlos M; Wheeler, Jennifer A; Morris, Michael F; Amabile, Orazio L; Tasset, Mark R; Raschke, Robert A

    2017-01-01

    This report aimed to describe the outcomes of the patients with severe H1N1 associated acute respiratory distress syndrome who were treated with extracorporeal membrane oxygenation therapy. This retrospective review analyzed a single-center cohort of adult patients with H1N1-related acute respiratory distress syndrome who were managed with veno-venous extracorporeal membrane oxygenation during the winter of 2013/2014. A total of 10 patients received veno-venous extracorporeal membrane oxygenation for H1N1 influenza between January 2013 and March 2014. Seven patients were transferred to our center for extracorporeal membrane oxygenation consideration (all within 72 hours of initiating mechanical ventilation). The median patient age was forty years, and 30% were female. The median arterial oxygen partial pressure to fraction of inspired oxygen ratio was 62.5, and the median RESP score was 6. Three patients received inhaled nitric oxide, and four patients were proned as rescue therapy before extracorporeal membrane oxygenation was initiated. The median duration of mechanical ventilation was twenty-two days (range, 14 - 32). The median length of stay in the intensive care unit was twenty-seven days (range, 14 - 39). The median hospital length of stay was 29.1 days (range, 16.0 - 46.9). Minor bleeding complications occurred in 6 of 10 patients. Eight of the ten patients survived to hospital discharge. The survivors were relatively young and discharged with good functional status (i.e., enhancing quality-adjusted life-years-saved). Our experience shows that even a relatively new extracorporeal membrane oxygenation program can play an important role in that capacity and provide excellent outcomes for the sickest patients.

  18. A proposed agglomerate model for oxygen reduction in the catalyst layer of proton exchange membrane fuel cells

    International Nuclear Information System (INIS)

    Zhang, Xiaoxian; Gao, Yuan; Ostadi, Hossein; Jiang, Kyle; Chen, Rui

    2014-01-01

    Highlights: • We developed a new agglomerate model to describe oxygen reduction reaction. • We showed how to calculate the model parameters from catalyst layer structure. • We verified the agglomerate model. - Abstract: Oxygen diffusion and reduction in the catalyst layer of PEM fuel cell is an important process in fuel cell modelling, but models able to link the reduction rate to catalyst-layer structure are lack; this paper makes such an effort. We first link the average reduction rate over the agglomerate within a catalyst layer to a probability that an oxygen molecule, which is initially on the agglomerate surface, will enter and remain in the agglomerate at any time in the absence of any electrochemical reaction. We then propose a method to directly calculate distribution function of this probability and apply it to two catalyst layers with contrasting structures. A formula is proposed to describe these calculated distribution functions, from which the agglomerate model is derived. The model has two parameters and both can be independently calculated from catalyst layer structures. We verify the model by first showing that it is an improvement and able to reproduce what the spherical model describes, and then testing it against the average oxygen reductions directly calculated from pore-scale simulations of oxygen diffusion and reaction in the two catalyst layers. The proposed model is simple, but significant as it links the average oxygen reduction to catalyst layer structures, and its two parameters can be directly calculated rather than by calibration

  19. ECMO respiratorio como opción terapéutica en falla respiratoria refractaria en la edad pediátrica

    Directory of Open Access Journals (Sweden)

    Otto M. González-Pardo

    2016-11-01

    La ECMO es una terapia que desde el año 1985 ha mostrado tener una sobrevida del 53% en este grupo, llegando a niveles del 63% en los últimos años, particularmente, si la etiología es el virus sincitial respiratorio. Se reportan dos casos de pacientes lactantes menores con falla respiratoria refractaria en quienes se decidió iniciar la ECMO logrando la sobrevida de ambos.

  20. 'Pre-prosthetic use of poly(lactic-co-glycolic acid) membranes treated with oxygen plasma and TiO2 nanocomposite particles for guided bone regeneration processes'.

    Science.gov (United States)

    Castillo-Dalí, Gabriel; Castillo-Oyagüe, Raquel; Terriza, Antonia; Saffar, Jean-Louis; Batista-Cruzado, Antonio; Lynch, Christopher D; Sloan, Alastair J; Gutiérrez-Pérez, José-Luis; Torres-Lagares, Daniel

    2016-04-01

    Guided bone regeneration (GBR) processes are frequently necessary to achieve appropriate substrates before the restoration of edentulous areas. This study aimed to evaluate the bone regeneration reliability of a new poly-lactic-co-glycolic acid (PLGA) membrane after treatment with oxygen plasma (PO2) and titanium dioxide (TiO2) composite nanoparticles. Circumferential bone defects (diameter: 10mm; depth: 3mm) were created on the parietal bones of eight experimentation rabbits and were randomly covered with control membranes (Group 1: PLGA) or experimental membranes (Group 2: PLGA/PO2/TiO2). The animals were euthanized two months afterwards, and a morphologic study was then performed under microscope using ROI (region of interest) colour analysis. Percentage of new bone formation, length of mineralised bone formed in the grown defects, concentration of osteoclasts, and intensity of osteosynthetic activity were assessed. Comparisons among the groups and with the original bone tissue were made using the Kruskal-Wallis test. The level of significance was set in advance at a=0.05. The experimental group recorded higher values for new bone formation, mineralised bone length, and osteoclast concentration; this group also registered the highest osteosynthetic activity. Bone layers in advanced formation stages and low proportions of immature tissue were observed in the study group. The functionalised membranes showed the best efficacy for bone regeneration. The addition of TiO2 nanoparticles onto PLGA/PO2 membranes for GBR processes may be a promising technique to restore bone dimensions and anatomic contours as a prerequisite to well-supported and natural-appearing prosthetic rehabilitations. Copyright © 2016 Elsevier Ltd. All rights reserved.

  1. The Experimental Measurement of Local and Bulk Oxygen Transport Resistances in the Catalyst Layer of Proton Exchange Membrane Fuel Cells.

    Science.gov (United States)

    Wang, Chao; Cheng, Xiaojing; Lu, Jiabin; Shen, Shuiyun; Yan, Xiaohui; Yin, Jiewei; Wei, Guanghua; Zhang, Junliang

    2017-12-07

    Remarkable progress has been made in reducing the cathodic Pt loading of PEMFCs; however, a huge performance loss appears at high current densities, indicating the existence of a large oxygen transport resistance associated with the ultralow Pt loading catalyst layer. To reduce the Pt loading without sacrificing cell performance, it is essential to illuminate the oxygen transport mechanism in the catalyst layer. Toward this goal, an experimental approach to measure the oxygen transport resistance in catalyst layers is proposed and realized for the first time in this study. The measuring approach involves a dual-layer catalyst layer design, which consists of a dummy catalyst layer and a practical catalyst layer, followed by changing the thickness of dummy layer to respectively quantify the local and bulk resistances via limiting current measurements combined with linear extrapolation. The experimental results clearly reveal that the local resistance dominates the total resistance in the catalyst layer.

  2. Fabrication and characterization of cubic Ba{sub 0.5}Sr{sub 0.5}Co{sub 0.8}Fe{sub 0.2}O{sub 3−δ} perovskite for a novel “star-shaped” oxygen membrane with a developed surface

    Energy Technology Data Exchange (ETDEWEB)

    Borhan, Adrian Iulian [Institute of Power Engineering, Ceramic Department CEREL, Research Institute, 1 Techniczna St., 36-040 Boguchwała (Poland); Gromada, Magdalena, E-mail: gromada@cerel.pl [Institute of Power Engineering, Ceramic Department CEREL, Research Institute, 1 Techniczna St., 36-040 Boguchwała (Poland); Samoila, Petrisor [Petru Poni Institute of Macromolecular Chemistry, 41A, Gr. Ghica Voda Alley, 700487 Iasi (Romania); Gherca, Daniel [Alexandru Ioan Cuza University of Iasi, Faculty of Chemistry, 11 Carol 1 Boulevard, R-700506 Iasi (Romania)

    2016-07-15

    Highlights: • Innovative fabrication technology was elaborated for BSCF membrane with developed surface. • The tool for membranes forming with developed surface was designed and executed. • As a result of forming process, membranes with “star shape” design were obtained. • Concentration of oxygen vacancies in BSCF increases considerably with temperature. • The small polaron hopping depends on the oxygen stoichiometry deviation. - Abstract: Ba{sub 0.5}Sr{sub 0.5}Co{sub 0.8}Fe{sub 0.2}O{sub 3−δ} (BSCF), a material which can be used for the fabrication of oxygen membranes with developed surfaces, was synthesized by a solid state method. The most important material properties which have influence on the oxygen membrane usability were investigated. An innovative fabrication technology was developed for the preparation of oxygen membranes with developed surfaces by using vacuum extrusion. The tool to form membranes on a vacuum worm press was designed and executed. These allowed the formation, for the first time, of a novel “star shaped” architecture for an oxygen membrane, enabling the use of a higher effective surface for oxygen production. Comprehensive studies on structural and microstructural properties, apparent density and porosity, water absorbability, oxygen stoichiometry, thermal expansion and electrical conductivity of the BSCF membrane were performed. The results obtained demonstrated the potential application of “star-shaped” oxygen membranes in oxy-fuel combustion technology.

  3. Characterisation of perovskite-type high-temperature membranes used for oxygen supply in fossil fuelled power plant processes; Charakterisierung perowskitischer Hochtemperaturmembranen zur Sauerstoffbereitstellung fuer fossil gefeuerte Kraftwerksprozesse

    Energy Technology Data Exchange (ETDEWEB)

    Moebius, Sigrid Annett

    2010-03-12

    In this thesis thermochemical properties of mixed conducting perovskite-type materials were investigated. Those materials are assumed to be applicable as gas separation membranes in the oxyfuel process. Here, the materials are aimed to produce the required oxygen for the combustion more energy-efficient than using cryogenic air separation. High-temperature materials which are applicable for this purpose must be gastight and should exhibit a high oxygen permeation rate and a preferably low thermal expansion coefficient. Moreover, the materials need to be long-term stable under power plant relevant conditions. The aim of this work is a better understanding of the material behaviour. Furthermore, on the basis of the results it should be possible to draw conclusions concerning the suitability of the material for application in oxyfuel power plant processes. Therefor, the influence of the chemical composition (doping elements and stoichiometry) of the perovskites, the temperature and the oxygen content in the ambient atmosphere on the thermochemical properties are studied systematically. In the framework of this thesis it could be stated that the thermochemical behaviour of prospective membrane materials strongly depends on the above mentioned parameters. In addition, the degradation behaviour (thermochemical stability) of the materials was investigated. The degradation behaviour influences the suitability of the material to be used in oxyfuel power plant processes. Here, the influence of the chemical composition of the perovskites, the temperature and the CO{sub 2}-concentration in dry and humid atmospheres was also studied. On the basis of the results it could be stated that the thermochemical stability strongly depends on the surrounding atmosphere and on the chemical composition of the perovskites. (orig.)

  4. Effects of surface modification with Co3O4 nanoparticles on the oxygen permeability of Ba0.5Sr0.5Co0.8Fe0.2O3-δ membranes

    Science.gov (United States)

    Wang, Yu; Cheng, Jigui; Huang, Min; Liu, Meng; Li, Mingming; Xu, Chenxi

    2017-09-01

    To promote the oxygen permeability of Ba0.5Sr0.5Co0.8Fe0.2O3-δ (BSCF) membranes, Co3O4 nanoparticle catalysts were loaded onto the surfaces of BSCF membranes by a dip-coating process. X-ray diffraction (XRD) results reveal that Co3O4 nanoparticles crystalize in spinel phase. Scanning electron microscope (SEM) observation indicates that the mean particle size of the Co3O4 nanoparticles is about 100 nm in diameter and 20 μm in thickness after annealing at 500 °C for 5 h. Energy dispersive spectrometer (EDS) results testify that the percentage of the elements in the modified layer are in accordance with the stoichiometric ratio of Co3O4. Oxygen permeation tests were made in a laboratory self-made device, and the results show that loading Co3O4 nanoparticle catalysts onto the surfaces of BSCF membranes can significantly increase the oxygen permeability of the BSCF membranes. The unmodified BSCF membranes have an oxygen permeation flux of 0.1080 ml cm-2 min-1 at 600 °C. This increases to 0.4302 ml cm-2 min-1, for the modified membranes, which is four times higher than that of the unmodified BSCF membranes. The oxygen permeation activation energy decreases from 91.42 to 50.71 kJ mol-1 at 600-800 °C by loading Co3O4 nanoparticle catalysts on the surface of BSCF membranes.

  5. Research and Development on Oxygen Transport Membranes at the Technical University of Denmark from Materials to Modules

    DEFF Research Database (Denmark)

    Kiebach, Wolff-Ragnar; Pirou, Stéven; Ovtar, Simona

    2016-01-01

    material should ideally have high ionic and electronic conductivity as well as good chemical stability under both oxidizing and reducing conditions. Strategies for increasing the performance by using composite dual phase membranes consisting of an ionic conductor and a electronic conductor...

  6. Wortmannin induces MCF-7 breast cancer cell death via the apoptotic pathway, involving chromatin condensation, generation of reactive oxygen species, and membrane blebbing

    Directory of Open Access Journals (Sweden)

    Akter R

    2012-07-01

    Full Text Available Rozina Akter,1 Md. Zakir Hossain,2 Maurice G Kleve,3 Michael A Gealt31Applied Biosciences Emphasis, Department of Applied Science, 2Graduate Institute of Technology, 3Department of Biology, College of Science and of Mathematics, University Arkansas at Little Rock, Little Rock, AR, USABackground: Apoptosis can be used as a reliable marker for evaluating potential chemotherapeutic agents. Because wortmannin is a microbial steroidal metabolite, it specifically inhibits the phosphatidyl inositol 3-kinase pathway, and could be used as a promising apoptosis-based therapeutic agent in the treatment of cancer. The objective of this study was to investigate the biomolecular mechanisms involved in wortmannin-induced cell death of breast cancer-derived MCF-7 cells.Methods and results: Our experimental results demonstrate that wortmannin has strong apoptotic effects through a combination of different actions, including reduction of cell viability in a dose-dependent manner, inhibition of proliferation, and enhanced generation of intracellular reactive oxygen species.Conclusion: Our findings suggest that wortmannin induces MCF-7 cell death via a programmed pathway showing chromatin condensation, nuclear fragmentation, reactive oxygen species, and membrane blebbing, which are characteristics typical of apoptosis.Keywords: wortmannin, human breast adenocarcinoma, apoptosis, reactive oxygen species, flow cytometry

  7. Development and characterization of a novel immobilized microbial membrane for rapid determination of biochemical oxygen demand load in industrial waste-waters.

    Science.gov (United States)

    Rastogi, Shikha; Kumar, Anil; Mehra, N K; Makhijani, S D; Manoharan, A; Gangal, V; Kumar, Rita

    2003-01-01

    The rapid determination of waste-water quality of waste-water treatment plants in terms of pollutional strengt