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Sample records for requiring extracorporeal membrane

  1. Extracorporeal membrane oxygenation circuitry.

    Science.gov (United States)

    Lequier, Laurance; Horton, Stephen B; McMullan, D Michael; Bartlett, Robert H

    2013-06-01

    The extracorporeal membrane oxygenation circuit is made of a number of components that have been customized to provide adequate tissue oxygen delivery in patients with severe cardiac and/or respiratory failure for a prolonged period of time (days to weeks). A standard extracorporeal membrane oxygenation circuit consists of a mechanical blood pump, gas-exchange device, and a heat exchanger all connected together with circuit tubing. Extracorporeal membrane oxygenation circuits can vary from simple to complex and may include a variety of blood flow and pressure monitors, continuous oxyhemoglobin saturation monitors, circuit access sites, and a bridge connecting the venous access and arterial infusion limbs of the circuit. Significant technical advancements have been made in the equipment available for short- and long-term extracorporeal membrane oxygenation applications. Contemporary extracorporeal membrane oxygenation circuits have greater biocompatibility and allow for more prolonged cardiopulmonary support time while minimizing the procedure-related complications of bleeding, thrombosis, and other physiologic derangements, which were so common with the early application of extracorporeal membrane oxygenation. Modern era extracorporeal membrane oxygenation circuitry and components are simpler, safer, more compact, and can be used across a wide variety of patient sizes from neonates to adults.

  2. Extra-corporeal membrane oxygenation

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/article/007234.htm Extracorporeal membrane oxygenation To use the sharing features on this page, please enable JavaScript. Extracorporeal membrane oxygenation (ECMO) is a treatment that uses a ...

  3. Severe Tumor Lysis Syndrome and Acute Pulmonary Edema Requiring Extracorporeal Membrane Oxygenation Following Initiation of Chemotherapy for Metastatic Alveolar Rhabdomyosarcoma.

    Science.gov (United States)

    Sanford, Ethan; Wolbrink, Traci; Mack, Jennifer; Rowe, R Grant

    2016-05-01

    We present an 8-year-old male with metastatic alveolar rhabdomyosarcoma (ARMS) who developed precipitous cardiopulmonary collapse with severe tumor lysis syndrome (TLS) 48 hr after initiation of chemotherapy. Despite no detectable pulmonary metastases, acute hypoxemic respiratory failure developed, requiring extracorporeal membrane oxygenation (ECMO). Although TLS has been reported in disseminated ARMS, this singular case of life-threatening respiratory deterioration developing after initiation of chemotherapy presented unique therapeutic dilemmas. We review the clinical aspects of this case, including possible mechanisms of respiratory failure, and discuss the role of ECMO utilization in pediatric oncology.

  4. 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.

  5. Respiratory Failure Secondary to Human Metapneumovirus Requiring Extracorporeal Membrane Oxygenation in a 32-Month-Old Child

    Directory of Open Access Journals (Sweden)

    Abha Gupta

    2012-01-01

    Full Text Available Human metapneumovirus (HMPV is a common virus that can cause respiratory problems ranging from mild upper respiratory tract disease to respiratory failure requiring mechanical support. Here, we report a case of a 32-month-old male with a previous history of asthma, who developed respiratory failure two weeks after onset of cough and rhinorrhea and required extracorporeal membrane oxygenation (ECMO for 9 days after failing high-frequency oscillatory ventilation (HFOV. To our knowledge, this is the oldest reported pediatric patient with respiratory failure secondary to human metapneumovirus that did not respond to mechanical ventilation. This case highlights three critical points: the potentially fatal causative role of HMPV in respiratory failure in an older pediatric age group of immunocompetent hosts, the importance of early recognition of impending respiratory failure, and the timely utilization of ECMO.

  6. Physical rehabilitation of patients in the intensive care unit requiring extracorporeal membrane oxygenation: a small case series.

    Science.gov (United States)

    Rahimi, Rod A; Skrzat, Julie; Reddy, Dereddi Raja S; Zanni, Jennifer M; Fan, Eddy; Stephens, R Scott; Needham, Dale M

    2013-02-01

    Neuromuscular weakness and impaired physical function are common and long-lasting complications experienced by intensive care unit (ICU) survivors. There is growing evidence that implementing rehabilitation therapy shortly after ICU admission improves physical function and reduces health care utilization. Recently, there is increasing interest and utilization of extracorporeal membrane oxygenation (ECMO) to support patients with severe respiratory failure. Patients receiving ECMO are at great risk for significant physical impairments and pose unique challenges for delivering rehabilitation therapy. Consequently, there is a need for innovative examples of safely and feasibly delivering active rehabilitation to these patients. This case report describes 3 patients with respiratory failure requiring ECMO who received physical rehabilitation to illustrate and discuss relevant feasibility and safety issues. In case 1, sedation and femoral cannulation limited rehabilitation therapy while on ECMO. In the 2 subsequent cases, minimizing sedation and utilizing a single bicaval dual lumen ECMO cannula placed in the internal jugular vein allowed patients to be alert and participate in active physical therapy while on ECMO, illustrating feasible rehabilitation techniques for these patients. Although greater experience is needed to more fully evaluate the safety of rehabilitation on ECMO, these initial cases are encouraging. We recommend systematically and prospectively tracking safety events and patient outcomes during rehabilitation on ECMO to provide greater evidence in this area.

  7. Extracorporeal membrane oxygenation-hemostatic complications.

    Science.gov (United States)

    Murphy, Deirdre A; Hockings, Lisen E; Andrews, Robert K; Aubron, Cecile; Gardiner, Elizabeth E; Pellegrino, Vincent A; Davis, Amanda K

    2015-04-01

    The use of extracorporeal membrane oxygenation (ECMO) support for cardiac and respiratory failure has increased in recent years. Improvements in ECMO oxygenator and pump technologies have aided this increase in utilization. Additionally, reports of successful outcomes in supporting patients with respiratory failure during the 2009 H1N1 pandemic and reports of ECMO during cardiopulmonary resuscitation have led to increased uptake of ECMO. Patients requiring ECMO are a heterogenous group of critically ill patients with cardiac and respiratory failure. Bleeding and thrombotic complications remain a leading cause of morbidity and mortality in patients on ECMO. In this review, we describe the mechanisms and management of hemostatic, thrombotic and hemolytic complications during ECMO support.

  8. Use of extracorporeal membrane oxygenation in adults.

    Science.gov (United States)

    Lafç, Gökhan; Budak, Ali Baran; Yener, Ali Ümit; Cicek, Omer Faruk

    2014-01-01

    Since the first successful application of the heart-lung machine in 1953 by John Gibbon [1], great efforts have been made to modify the bypass techniques and devices in order to allow prolonged extracorporeal circulation in the intensive care unit (ICU), commonly referred to as extracorporeal membrane oxygenation (ECMO). ECMO uses classic cardiopulmonary bypass technology to support circulation. It provides continuous, non-pulsatile cardiac output and extracorporeal oxygenation [2]. Veno-venous ECMO (VV ECMO) provides respiratory support, while veno-arterial ECMO (VA ECMO) provides cardio-respiratory support to patients with severe but potentially reversible cardiac or respiratory deterioration refractory to standard therapeutic modalities. ECMO is a temporary form of life support providing a prolonged biventricular circulatory and pulmonary support for patients experiencing both pulmonary and cardiac failure unresponsive to conventional therapy. Despite the advent of newer ventricular assist devices that are more suitable for long term support, ECMO is simple to establish, cost-effective to operate.

  9. Extracorporeal membrane oxygenation for adult respiratory failure.

    Science.gov (United States)

    Turner, David A; Cheifetz, Ira M

    2013-06-01

    Extracorporeal membrane oxygenation (ECMO) is a form of cardiopulmonary bypass that is a mainstay of therapy in neonatal and pediatric patients with life threatening respiratory and/or cardiac failure. Historically, the use of ECMO in adults has been limited, but recent reports and technological advances have increased utilization and interest in this technology in adult patients with severe respiratory failure. As ECMO is considered in this critically ill population, patient selection, indications, contraindications, comorbidities, and pre-ECMO support are all important considerations. Once the decision is made to cannulate a patient for ECMO, meticulous multi-organ-system management is required, with a priority being placed on lung rest and minimization of ventilator-induced lung injury. Close monitoring is also necessary for complications, some of which are related to ECMO and others secondary to the patient's underlying degree of illness. Despite the risks, reports demonstrate survival > 70% in some circumstances for patients requiring ECMO for refractory respiratory failure. As the utilization of ECMO in adult patients with respiratory failure continues to expand, ongoing discussion and investigation are needed to determine whether ECMO should remain a "rescue" therapy or if earlier ECMO may be beneficial as a lung-protective strategy.

  10. [Newborn life threatening respiratory failure treatment with extracorporeal membrane oxygenation].

    Science.gov (United States)

    Urbańska, Ewa; Grzybowski, Adam; Haponiuk, Ireneusz; Przybylski, Roman; Walas, Wojciech; Stempniewicz, Krzysztof; Szary, Tomasz; Włoczka, Grzegorz; Skalski, Janusz H; Zembala, Marian

    2006-01-01

    THE AIM of the study was to show first results of newborn life threatening respiratory failure treatment with extracorporeal membrane oxygenation (ECMO) in Poland. Nine newborns were treated with extracorporeal membrane oxygenation in Silesian Center for Heart Diseases. Newborns were born in 38 week of gestational age (36-41 weeks) with mean birth weight of 3490 g. Reasons for the referral were: meconium aspiration syndrome, infection, and pulmonary hypertension. Each newborn fulfilled an Extracorporeal Life Support Organization (ELSO) criteria for extracorporeal membrane oxygenation. seven out of nine of patients treated with extracorporeal membrane oxygenation survived. Full clinical stabilization was reached about 6th hour of treatment. Mean extracorporeal oxygenation time was 162 hours. For eight newborns veno-venous method was applied and for one newborn veno-arterial method. Roller pump was used in 7 cases and centrifugal pomp in one case. Five newborns had uneventful treatment. During extracorporeal membrane oxygenation therapy we have observed several complications: PDA, hemorrhagic complications, renal failure, arterial hypertension, septicemia, tubing rupture. extracorporeal oxygenation is an effective method of treatment for newborn life threatening respiratory failure. Obtained results do not differ much from Extracorporeal Life Support Organization register results. The most essential problem for extracorporeal membrane oxygenation therapy is correct qualification, early referral, safe transportation as well as the development of centers providing ECMO treatment.

  11. Extracorporeal membrane oxygenation after living-related liver transplant.

    Science.gov (United States)

    Gedik, Ender; Çelik, Muhammet Reha; Otan, Emrah; Dişli, Olcay Murat; Erdil, Nevzat; Bayındır, Yaşar; Kutlu, Ramazan; Yılmaz, Sezai

    2015-04-01

    Various types of extracorporeal membrane oxygenation methods have been used in liver transplant operations. The main indications are portopulmonary or hepatopulmonary syndromes and other cardiorespiratory failure syndromes that are refractory to conventional therapy. There is little literature available about extracorporeal membrane oxygenation, especially after liver transplant. We describe our experience with 2 patients who had living-related liver transplant. A 69-year-old woman had refractory aspergillosis pneumonia and underwent pumpless extracorporeal lung assist therapy 4 weeks after liver transplant. An 8-month-old boy with biliary atresia underwent urgent liver transplant; he received venoarterial extracorporeal membrane oxygenation therapy on postoperative day 1. Despite our unsuccessful experience with 2 patients, extracorporeal membrane oxygenation and pumpless extracorporeal lung assist therapy for liver transplant patients may improve prognosis in selected cases.

  12. Determinants of Pharmacokinetic Variability during Extracorporeal Membrane Oxygenation: A roadmap to rational pharmacotherapy in children

    NARCIS (Netherlands)

    M.J. Ahsman (Maurice)

    2010-01-01

    textabstractCritically-ill infants sometimes require extracorporeal membrane oxygenation (ECMO) to provide adequate oxygenation and perfusion. Pharmacokinetic data are often lacking for this particular population, which leads to dose regimens that are based on personal experience or extrapolation fr

  13. 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

  14. Simulation training for extracorporeal membrane oxygenation

    Directory of Open Access Journals (Sweden)

    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.

  15. A simplified formula using early blood gas analysis can predict survival outcomes and the requirements for extracorporeal membrane oxygenation in congenital diaphragmatic hernia.

    Science.gov (United States)

    Park, Hye Won; Lee, Byong Sop; Lim, Gina; Choi, Yong-Sung; Kim, Ellen Ai-Rhan; Kim, Ki-Soo

    2013-06-01

    The aims of this study were to investigate whether early arterial blood gas analysis (ABGA) could define the severity of disease in infants with congenital diaphragmatic hernia (CDH). We conducted a retrospective study over a 21-yr period of infants diagnosed with CDH. Outcomes were defined as death before discharge, and extracorporeal membrane oxygenation requirements (ECMO) or death. A total 114 infants were included in this study. We investigated whether simplified prediction formula [PO2-PCO2] values at 0, 4, 8, and 12 hr after birth were associated with mortality, and ECMO or death. The area under curve (AUC) of receiver operating characteristic curve was used to determine the optimum ABGA values for predicting outcomes. The value of [PO2-PCO2] at birth was the best predictor of mortality (AUC 0.803, P < 0.001) and at 4 hr after birth was the most reliable predictor of ECMO or death (AUC 0.777, P < 0.001). The value of [PO2-PCO2] from ABGA early period after birth can reliably predict outcomes in infants with CDH.

  16. Active rehabilitation in a pediatric extracorporeal membrane oxygenation patient.

    Science.gov (United States)

    Zebuhr, Carleen; Sinha, Amit; Skillman, Heather; Buckvold, Shannon

    2014-05-01

    Decreased intensive care unit (ICU) mortality has led to an increase in ICU morbidity. ICU-induced immobilization plays a major role in this morbidity. Recently, ICU mobility has been shown to be safe and effective in adolescent and adult patients. We report the successful rehabilitation of an 8-year-old boy with severe acute respiratory distress syndrome on extracorporeal membrane oxygenation. A child who is critically ill may safely perform active rehabilitation while on venovenous extracorporeal membrane oxygenation. The gains achieved through active rehabilitation and optimal nutrition can facilitate recovery from severe acute respiratory distress syndrome in select pediatric patients on extracorporeal membrane oxygenation.

  17. 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 hem

  18. 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.

    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 wer

  19. A 22-year experience in global transport extracorporeal membrane oxygenation.

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    Coppola, Christopher P; Tyree, Melissa; Larry, Karen; DiGeronimo, Robert

    2008-01-01

    Transport extracorporeal membrane oxygenation (ECMO) is currently available at 12 centers. We report a 22-year experience from the only facility providing global transport ECMO. Indications for transport ECMO include lack of ECMO services, inability to transport conventionally, inability to wean from cardiopulmonary bypass, extracorporeal cardiopulmonary resuscitation, and need to move a patient on ECMO for specialized services such as organ transplantation. Retrospective database review of children undergoing inhouse and transport ECMO from 1985 to 2007. Sixty-eight children underwent transport ECMO. Fifty-six were transported on ECMO into our facility. The remaining 12 were moved between 2 outside locations. Ground vehicles and fixed-wing aircraft were used. Distance transported was 8 to 7500 miles (13-12070 km), mean 1380 miles (2220 km). There were 116 inhouse ECMO runs. No child died during transport. Survival to discharge after transport ECMO was 65% (44/68) and, for inhouse ECMO, was 70% (81/116). Transport ECMO is feasible and effective, with survival rates comparable to inhouse ECMO. We have used transport ECMO to help children at non-ECMO centers with pulmonary failure who have not improved with inhaled nitric oxide and high-frequency ventilation. We have also transported a child after extracorporeal cardiopulmonary resuscitation, which may represent an emerging indication for transport ECMO. Transport ECMO often is the only option for children too unstable for conventional transport or those already on ECMO and requiring a specialized service at another facility, such as organ transplantation.

  20. 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.

  1. 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.

  2. Salvage Extracorporeal Membrane Oxygenation Prior to "Bridge" Transcatheter Aortic Valve Replacement.

    Science.gov (United States)

    Chiu, Peter; Fearon, William F; Raleigh, Lindsay A; Burdon, Grayson; Rao, Vidya; Boyd, Jack H; Yeung, Alan C; Miller, David Craig; Fischbein, Michael P

    2016-06-01

    We describe a patient who presented in profound cardiogenic shock due to bioprosthetic aortic valve stenosis requiring salvage Extracorporeal Membrane Oxygenation followed by a "bridge" valve-in-valve transcatheter aortic valve replacement. doi: 10.1111/jocs.12750 (J Card Surg 2016;31:403-405).

  3. Extracorporeal Membrane Oxygenation Applications in Cardiac Critical Care.

    Science.gov (United States)

    Raleigh, Lindsay; Ha, Rich; Hill, Charles

    2015-12-01

    The use of extracorporeal membrane oxygenation therapy (ECMO) in cardiac critical care has steadily increased over the past decade. Significant improvements in the technology associated with ECMO have propagated this recent resurgence and contributed to improved patient outcomes in the fields of cardiac and transplant (heart and lung) surgery. Specifically, ECMO is being increasingly utilized as a bridge to heart and lung transplantation, as well as to ventricular assist device placement. ECMO is also employed during the administration of cardiopulmonary resuscitation, known as extracorporeal life support. In this review, we examine the recent literature regarding the applications of ECMO and also describe emerging topics involving current ECMO management strategies.

  4. Remote cannulation and extracorporeal membrane oxygenation transport is safe in a newly established program

    Science.gov (United States)

    Grenda, David S.; Moll, Vanessa; Kalin, Craig M.

    2017-01-01

    Extracorporeal membrane oxygenation (ECMO) has become an increasingly utilized modality for the support of patients with severe cardiac or pulmonary dysfunction. Unfortunately, the costs and expertise required to maintain a formal ECMO program preclude the vast majority of hospitals from employing such technology routinely. These barriers to implementation of an effective ECMO program highlight the importance of the safe transport of patients in need of extracorporeal support. While many centers with extensive expertise in the management of patients on extracorporeal support have demonstrated their ability to transport those same patients, the ability of new ECMO programs to provide such transportation remains poorly studied. We established an ECMO program at our institution and immediately provided equipment and personnel to transport patients in need of or receiving extracorporeal support to our institution. Overall, we found that 13 out of 28 patients transported to our institution on ECMO or for consideration of ECMO support during the first 15 months of the program survived to hospital discharge. During that period, four incidents associated with patient transport occurred but none were related to ECMO support or adversely affected patient outcome. These observations demonstrate that new ECMO programs can safely and reliably transport patients on or in need of extracorporeal support. PMID:28275616

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

    Directory of Open Access Journals (Sweden)

    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.

  6. Dense pulmonary opacification in neonates treated with extracorporeal membrane oxygenation

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    Schlesinger, A.E.; Cornish, J.D.; Null, D.M.

    1986-09-01

    Chest radiographic findings in three neonates with respiratory failure secondary to meconium aspiration treated with extracorporeal membrane oxygenation (ECMO) are described. The degree of pulmonary opacification on the chest radiographs failed to correlate with the patients' clinical status as measured by the arterial oxygen levels but correlated well with the peak airway pressure (PAP) and continuous positive airway pressure (CPAP) settings on the mechanical ventilator. Because a variable portion of the arterial blood oxygenation is performed by the extracorporeal membrane oxygenator and unusually large fluctuations in airway pressure settings can occur in these patients while on ECMO, it is important to realize that the chest radiography may not be an accurate predictor of the patients' clinical status.

  7. Monitoring of the Adult Patient on Venoarterial Extracorporeal Membrane Oxygenation

    Directory of Open Access Journals (Sweden)

    Mabel Chung

    2014-01-01

    Full Text Available Venoarterial extracorporeal membrane oxygenation (VA ECMO provides mechanical support to the patient with cardiac or cardiopulmonary failure. This paper reviews the physiology of VA ECMO including the determinants of ECMO flow and gas exchange. The efficacy of this therapy may be determined by assessing patient hemodynamics and device flow, overall gas exchange support, markers of adequate oxygen delivery, and pulsatility of the arterial blood pressure waveform.

  8. Transportation of Critically Ill Patients on Extracorporeal Membrane Oxygenation

    OpenAIRE

    Broman, L. Mikael; Frenckner, Björn

    2016-01-01

    Extracorporeal membrane oxygenation (ECMO) may be a life-saving procedure for patients with severe reversible pulmonary or cardiac failure or for patients in need for a bridge to transplantation. ECMO is provided by specialized centers, but patients in need of ECMO are frequently taken care of at other centers. Conventional transports to an ECMO center can be hazardous and deaths have been described. For this reason, many ECMO centers have developed transport programs with mobile ECMO. After ...

  9. 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.

  10. Examining Noncardiac Surgical Procedures in Patients on Extracorporeal Membrane Oxygenation.

    Science.gov (United States)

    Taghavi, Sharven; Jayarajan, Senthil N; Mangi, Abeel A; Hollenbach, Kathryn; Dauer, Elizabeth; Sjoholm, Lars O; Pathak, Abhijit; Santora, Thomas A; Goldberg, Amy J; Rappold, Joseph F

    2015-01-01

    As extracorporeal membrane oxygenation (ECMO) is increasingly used for patients with cardiac and/or pulmonary failure, the need for noncardiac surgical procedures (NCSPs) in these patients will continue to increase. This study examined the NCSP required in patients supported with ECMO and determined which variables affect outcomes. The National Inpatient Sample Database was examined for patients supported with ECMO from 2007 to 2010. There were 563 patients requiring ECMO during the study period. Of these, 269 (47.8%) required 380 NCSPs. There were 149 (39.2%) general surgical procedures, with abdominal exploration/bowel resection (18.2%) being most common. Vascular (29.5%) and thoracic procedures (23.4%) were also common. Patients requiring NCSP had longer median length of stay (15.5 vs. 9.2 days, p = 0.001), more wound infections (7.4% vs. 3.7%, p = 0.02), and more bleeding complications (27.9% vs. 17.3%, p = 0.01). The incidences of other complications and inpatient mortality (54.3% vs. 58.2%, p = 0.54) were similar. On logistic regression, the requirement of NCSPs was not associated with mortality (odds ratio [OR]: 0.91, 95% confidence interval [CI]: 0.68-1.23, p = 0.17). However, requirement of blood transfusion was associated with mortality (OR: 1.70, 95% CI: 1.06-2.74, p = 0.03). Although NCSPs in patients supported with ECMO does not increase mortality, it results in increased morbidity and longer hospital stay.

  11. Venovenous Extracorporeal Membrane Oxygenation in Pediatric Respiratory Failure.

    Science.gov (United States)

    Ham, P Benson; Hwang, Brice; Wise, Linda J; Walters, K Christian; Pipkin, Walter L; Howell, Charles G; Bhatia, Jatinder; Hatley, Robyn

    2016-09-01

    Conventional treatment of respiratory failure involves positive pressure ventilation that can worsen lung damage. Extracorporeal membrane oxygenation (ECMO) is typically used when conventional therapy fails. In this study, we evaluated the use of venovenous (VV)-ECMO for the treatment of severe pediatric respiratory failure at our institution. A retrospective analysis of pediatric patients (age 1-18) placed on ECMO in the last 15 years (1999-2014) by the pediatric surgery team for respiratory failure was performed. Five pediatric patients underwent ECMO (mean age 10 years; range, 2-16). All underwent VV-ECMO. Diagnoses were status asthmaticus (2), acute respiratory distress syndrome due to septic shock (1), aspergillus pneumonia (1), and respiratory failure due to parainfluenza (1). Two patients had severe barotrauma prior to ECMO initiation. Average oxygenation index (OI) prior to cannulation was 74 (range 23-122). No patients required conversion to VA-ECMO. The average ECMO run time was 4.4 days (range 2-6). The average number of days on the ventilator was 15 (range 4-27). There were no major complications due to the procedure. Survival to discharge was 100%. Average follow up is 4.4 years (range 1-15). A short run of VV-ECMO can be lifesaving for pediatric patients in respiratory failure. Survival is excellent despite severely elevated oxygen indices. VV-ECMO may be well tolerated and can be considered for severe pediatric respiratory failure.

  12. 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.

  13. Extracorporeal membrane oxygenation as an alternative to ventilation.

    Science.gov (United States)

    Malagon, Ignacio; Greenhalgh, Donna

    2013-02-01

    Following the recent H1N1 epidemic, there has been renewed interest in using extracorporeal membrane oxygenation (ECMO) as a treatment for acute respiratory failure. Currently, following the advances in technology, ECMO is now recommended as a definitive treatment for acute respiratory failure. However, there have been limited randomized trials and cohort studies evaluating this therapy. Currently, results imply that ECMO is superior to conventional ventilation providing lung rest. There is expansion in the indications for ECMO including a bridge to lung transplantation, the use of ECMO in awake patients, liver transplantation, as well as in adult respiratory distress syndrome. This article looks at the current indications and uses. Further studies are warranted to define and validate the role of ECMO, including studying the pharmacodynamics and pharmacokinetics of patients receiving support. The use of sedatives and antibiotics may be required to be changed significantly. If the incidence of intracerebral haemorrhage can be decreased, then in the author's opinion it may become the first-line treatment for acute respiratory failure.

  14. 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

  15. 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 oxygenati

  16. Cardiopulmonary support and extracorporeal membrane oxygenation for cardiac assist.

    Science.gov (United States)

    von Segesser, L K

    1999-08-01

    Use of cardiopulmonary bypass for emergency resuscitation is not new. In fact, John Gibbon proposed this concept for the treatment of severe pulmonary embolism in 1937. Significant progress has been made since, and two main concepts for cardiac assist based on cardiopulmonary bypass have emerged: cardiopulmonary support (CPS) and extracorporeal membrane oxygenation (ECMO). The objective of this review is to summarize the state of the art in these two technologies. Configuration of CPS is now fairly standard. A mobile cart with relatively large wheels allowing for easy transportation carries a centrifugal pump, a back-up battery with a charger, an oxygen cylinder, and a small heating system. Percutaneous cannulation, pump-driven venous return, rapid availability, and transportability are the main characteristics of a CPS system. Cardiocirculatory arrest is a major predictor of mortality despite the use of CPS. In contrast, CPS appears to be a powerful tool for patients in cardiogenic shock before cardiocirculatory arrest, requiring some type of therapeutic procedures, especially repair of anatomically correctable problems or bridging to other mechanical circulatory support systems such as ventricular assist devices. CPS is in general not suitable for long-term applications because of the small-bore cannulas, resulting in significant pressure gradients and eventually hemolysis. In contrast, ECMO can be designed for longer-term circulatory support. This requires large-bore cannulas and specifically designed oxygenators. The latter are either plasma leakage resistent (true membranes) or relatively thrombo-resistant (heparin coated). Both technologies require oxygenator changeovers although the main reason for this is different (clotting for the former, plasma leakage for the latter). Likewise, the tubing within a roller pump has to be displaced and centrifugal pump heads have to be replaced over time. ECMO is certainly the first choice for a circulatory support system

  17. Technological advances in extracorporeal membrane oxygenation for respiratory failure.

    Science.gov (United States)

    Rehder, Kyle J; Turner, David A; Bonadonna, Desiree; Walczak, Richard J; Rudder, Robert J; Cheifetz, Ira M

    2012-08-01

    Extracorporeal membrane oxygenation (ECMO) for neonatal and pediatric cardiac and/or respiratory failure is well established, and its use for adult respiratory failure is rapidly increasing. Management strategies developed over the past 30 years coupled with significant recent technological advances have led to improved ECMO survival. These new technologies are expanding the potential applications for ECMO in exciting ways, including new patient populations and the ability to make ECMO mobile for both intra- and inter-hospital transport. In this article, we highlight some of the recent technological advances and their impact on the utilization of ECMO in increasingly diverse patient populations.

  18. 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...

  19. Diffuse coronary artery spasm treated by extracorporeal membrane oxygenation.

    Science.gov (United States)

    Smith, Chez; Akowuah, Enoch; Theodore, Sanjay; Brown, Robin

    2009-07-01

    Diffuse coronary vasospasm is an unpredictable and serious complication following coronary artery bypass surgery. The treatment of this emergency is dependent on patient suitability for angiography and direct injection of vasodilators into the affected vessels. In patients unable to proceed to angiography the diagnosis can only be suspected but treatment is nevertheless still towards reinstitution of coronary blood flow. We present one such case in which re-grafting and extracorporeal membranous oxygenation proved successful in restoring cardiac function in a patient with diffuse coronary artery spasm.

  20. Recovery from Acute Respiratory Distress Syndrome with Long-Run Extracorporeal Membrane Oxygenation

    Directory of Open Access Journals (Sweden)

    Jin Jeon

    2014-08-01

    Full Text Available Acute respiratory distress syndrome (ARDS is a severe lung disease associated with high mortality despite recent advances in management. Significant advances in extracorporeal membrane oxygenation (ECMO devices and management allow short-term support for patients with acute reversible respiratory failure and can serve as a bridge to transplantation in patients with irreversible respiratory failure. When ARDS does not respond to conventional treatment, ECMO and the interventional lung assist membrane (iLA are the most widely used complementary treatment options. Here, we report a clinical case of an adult patient who required prolonged duration venovenous (VV-ECMO for severe ARDS resulting in improvement while waiting for lung transplantation.

  1. Extracorporeal membrane oxygenation support in post-traumatic cardiopulmonary failure

    Science.gov (United States)

    Lin, Chun-Yu; Tsai, Feng-Chun; Lee, Hsiu-An; Tseng, Yuan-His

    2017-01-01

    Abstract Patients with multiple traumas associated with cardiopulmonary failure have a high mortality rate; however, such patients can be temporarily stabilized using extracorporeal membrane oxygenation (ECMO), providing a bridge to rescue therapy. Using a retrospective study design, we aimed to clarify the prognostic factors of post-traumatic ECMO support. From March 2006 to July 2016, 43 adult patients (mean age, 37.3 ± 15.2 years; 7 females [16.3%]) underwent ECMO because of post-traumatic cardiopulmonary failure. Pre-ECMO demographics, peri-ECMO events, and post-ECMO recoveries were compared between survivors and nonsurvivors. The most common traumatic insult was traffic collision (n = 30, 69.8%), and involved injury areas included the chest (n = 33, 76.7%), head (n = 14, 32.6%), abdomen (n = 21, 48.8%), and fractures (n = 21, 48.8%). Fifteen patients (34.9%) underwent cardiopulmonary resuscitation and 22 (51.2%) received rescue interventions before ECMO deployment. The mean time interval between trauma and ECMO was 90.6 ± 130.1 hours, and the mode of support was venovenous in 26 patients (60.5%). A total of 26 patients (60.5%) were weaned off of ECMO and 22 (51.6%) survived to discharge, with an overall mean support time of 162.9 ± 182.7 hours. A multivariate regression analysis identified 2 significant predictors for in-hospital mortality: an injury severity score (ISS) >30 (odds ratio [OR], 9.48; 95% confidence interval [CI], 1.04–18.47; P = 0.042), and the requirement of renal replacement therapy (RRT) during ECMO (OR, 8.64; 95% CI, 1.73–26.09; P = 0.020). These two factors were also significant for the 1-year survival (ISS >30: 12.5%; ISS ≤30, 48.1%, P = 0.001) (RRT required, 15.0%; RRT not required, 52.2%, P = 0.006). Using ECMO in selected traumatized patients with cardiopulmonary failure can be a salvage therapy. Prompt intervention before shock-impaired systemic organ perfusion and acute

  2. Two successful neonatal extracorporeal membrane oxygenation treatment for severe heart failure after cardiac surgery

    Institute of Scientific and Technical Information of China (English)

    TAN Lin-hua; DU Li-zhong; HE Xiao-jun; SUN Mei-yue; ZHANG Ze-wei; LIN Ru

    2009-01-01

    @@ Extracorporeal membrane oxygenation(ECMO)can play an important role by providing short-term circulatory support to enable myocardial recovery in patients with life-threatening heart failure.Currently,over 4000 children who received ECMO for cardiac support have been reported to the Extracorporeal Life Support Registry,with the majority of patients placed on ECMO following cardiac surgery.

  3. Mechanical ventilation in patients subjected to extracorporeal membrane oxygenation (ECMO).

    Science.gov (United States)

    Sánchez, M L

    2017-02-07

    Mechanical ventilation (MV) is a crucial element in the management of acute respiratory distress syndrome (ARDS), because there is high level evidence that a low tidal volume of 6ml/kg (protective ventilation) improves survival. In these patients with refractory respiratory insufficiency, venovenous extracorporeal membrane oxygenation (ECMO) can be used. This salvage technique improves oxygenation, promotes CO2 clearance, and facilitates protective and ultraprotective MV, potentially minimizing ventilation-induced lung injury. Although numerous trials have investigated different ventilation strategies in patients with ARDS, consensus is lacking on the optimal MV settings during venovenous ECMO. Although the concept of "lung rest" was introduced years ago, there are no evidence-based guidelines on its use in application to MV in patients supported by ECMO. How MV in ECMO patients can promote lung recovery and weaning from ventilation is not clear. The purpose of this review is to describe the ventilation strategies used during venovenous ECMO in clinical practice.

  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. Extracorporeal membrane oxygenation in adults for severe acute respiratory failure.

    Science.gov (United States)

    Rozé, H; Repusseau, B; Ouattara, A

    2014-01-01

    The purpose of this review is to examine the indications of extracorporeal membrane oxygenation (ECMO) for severe acute respiratory distress syndrome (ARDS). This technique of oxygenation has significantly increased worldwide with the H1N1 flu pandemic. The goal of ECMO is to maintain a safe level of oxygenation and controlled respiratory acidosis under protective ventilation. The enthusiasm for ECMO should not obscure the consideration for potential associated complications. Before widespread diffusion of ECMO, new trials should test the efficacy of early initiation or CO2 removal in addition to, or even as an alternative to mechanical ventilation for severe ARDS. Copyright © 2014 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier SAS. All rights reserved.

  6. Quantification of Postmembrane Gaseous Microembolization During Venoarterial Extracorporeal Membrane Oxygenation.

    Science.gov (United States)

    Jiao, York; Gipson, Keith E; Bonde, Pramod; Mangi, Abeel; Hagberg, Robert; Rosinski, David J; Gross, Jeffrey B; Schonberger, Robert B

    2017-05-23

    Prolonged use of venoarterial extracorporeal membrane oxygenation (VA ECMO) may be complicated by end-organ dysfunction. Although gaseous microemboli (GME) are thought to damage end organs during cardiopulmonary bypass, patient exposures to GME have not been well characterized during VA ECMO. We therefore performed an observational study of GME in adult VA ECMO patients, with correlation to clinical events during routine patient care. After institutional review board (IRB) approval, we used two Doppler probes to detect GME noninvasively in extracorporeal membrane oxygenation (ECMO) circuits on four patients for 15 hours total while also recording patient care events. We then conducted in vitro trials to compare Doppler signals with gold-standard measurements using an Emboli Detection and Classification (EDAC) quantifier (Terumo Cardiovascular, Ann Arbor, MI) during simulated clinical interventions. Correlations between Doppler and EDAC data were used to estimate GME counts and volumes represented by clinical Doppler data. A total of 503 groups of Doppler peaks representing GME showers were observed, including 194 statistically larger showers during patient care activities containing 92% of total Doppler peaks. Intravenous injections accounted for an estimated 68% of GME and 88% of GME volume, whereas care involving movement accounted for an estimated 6% of GME and 3% of volume. Overall estimated embolic rates of 24,000 GME totaling 4 μl/hr rivals reported GME rates during cardiopulmonary bypass. Numerous GME are present in the postmembrane circuit during VA ECMO, raising concern for effects on microcirculation and organ dysfunction. Strategies to detect and minimize GME may be warranted to limit embolic exposures experienced by VA ECMO patients.

  7. Extracorporeal membrane oxygenation - An anesthesiologist′s perspective - Part II: Clinical and technical consideration

    Directory of Open Access Journals (Sweden)

    Sandeep Chauhan

    2012-01-01

    Full Text Available Although the concept of extracorporeal membrane oxygenation (ECMO has remained unchanged, component technology has evolved considerably over the past three decades. Presently the clinical conditions requiring ECMO support have been updated with input from the outcome data of patient registries. Modern circuit configuration has become less cumbersome, safer, and more efficient. Technological advances now allow prolonged support with fewer complications compared to the past eras and facilitate transition to a single bedside caregiver model, similar to hemofiltration or ventricular-assist devices. The clinical considerations and indicators for placing the patient on ECMO, the various circuit configurations, clinical and technical issues, and management aspects are considered in this article.

  8. Prolonged venovenous extracorporeal membrane oxygenation without anticoagulation: a case of Goodpasture syndrome-related pulmonary haemorrhage.

    Science.gov (United States)

    Herbert, David G; Buscher, Hergen; Nair, Priya

    2014-03-01

    We present a 16-year-old male with severe acute respiratory and renal failure as a result of Goodpasture syndrome, requiring venovenous extracorporeal membrane oxygenation (VV-ECMO) for pulmonary haemorrhage. The patient received no systemic anticoagulation for 25 of 26 ECMO days (20 days consecutively) and suffered no coagulation-related adverse events. The patient had a subtherapeutic anticoagulation profile according to recommended ECMO guidelines during most of this time. The patient made a full recovery without respiratory compromise, ECMO circuit failure, thrombotic events or the need for ongoing haemodialysis.

  9. 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.

  10. Drug therapies in neonates and children during extracorporeal membrane oxygenation (ECMO) : Keep your eyes open

    NARCIS (Netherlands)

    E.D. Wildschut (Enno)

    2010-01-01

    markdownabstract__Abstract__ Extracorporeal life support (ECLS) or extra corporeal membrane oxygenation (ECMO) is a technique for providing life support in severe but potentially reversible cardiorespiratory failure in patients with an expected mortality greater than 80%. First pioneered in cardiop

  11. Intravascular volume administration: a contributing risk factor for intracranial hemorrhage during extracorporeal membrane oxygenation?

    NARCIS (Netherlands)

    Mol, A.C. de; Gerrits, L.C.; Heijst, A.F.J. van; Straatman, H.; Staak, F.H.J.M. van der; Liem, K.D.

    2008-01-01

    OBJECTIVE: The objective of this study was to determine the relationship between the frequency and total volume of intravascular volume administration and the development of intracranial hemorrhage during venoarterial extracorporeal membrane oxygenation. METHODS: In a retrospective, matched,

  12. 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.

  13. 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

  14. 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.

  15. A systematic Review on Pharmacokinetic Changes in Critically ill Patients Role of Extracorporeal, Membrane Oxygenation

    Directory of Open Access Journals (Sweden)

    M Mojtahedzadeh

    2011-12-01

    Full Text Available Objective: Several factors including disease condition and different procedures could alter pharmacokinetic profile of drugs in critically ill patients. For optimizing patients outcome, changing in dosing regimen is necessary. Extracorporeal Membrane Oxygenation (ECMO is one of the procedures which could change pharmacokinetic parameters.The aim of this review was to evaluate the effect of ECMO support on pharmacokinetic parameters and subsequently pharmacotherapy. Method: A systematic review was conducted by reviewing all papers found by searching following key words; extracorporeal membrane oxygenation, ECMO, pharmacokinetic and pharmacotherapy in bibliography database. Results: Different drug classes have been studied; mostly antibiotics. Almost all of the studies have been performed in neonates (as a case series. ECMO support is associated with altered pharmacokinetic parameters that may result in acute changes in plasma concentrations with potentially unpredictable pharmacological effect. Altreation in volume of distribution, protein binding, renal or hepatic clearance and sequestration of drugs by ECMO circuit may result in higher or lower doses requirement during ECMO. As yet, definite dosing guideline is not available. ECMO is extensively used recently for therapy and as a procedure affects pharmacokinetics profile along with other factors in critically ill patients. For optimizing the pharmacodynamic response and outcome of patients, drug regimen should be individualized through therapeutic drug monitoring whenever possible.

  16. [Individualised care plan during extracorporeal membrane oxygenation. A clinical case].

    Science.gov (United States)

    Call Mañosa, S; Pujol Garcia, A; Chacón Jordan, E; Martí Hereu, L; Pérez Tejero, G; Gómez Simón, V; Estruga Asbert, A; Gallardo Herrera, L; Vaquer Araujo, S; de Haro López, C

    2016-01-01

    An individualised care plan is described for a woman diagnosed with pneumonia, intubated, and on invasive mechanical ventilation, who was admitted to the Intensive Care Unit for extracorporeal membrane oxygenation (ECMO). A nursing care plan was designed based on Marjory Gordon functional patterns. The most important nursing diagnoses were prioritised, using a model of clinical reasoning model (Analysis of the current status) and NANDA taxonomy. A description is presented on, death anxiety, impaired gas exchange, decreased cardiac output, dysfunctional gastrointestinal motility, risk for disuse syndrome, infection risk, and bleeding risk. The principal objectives were: to reduce the fear of the family, achieve optimal respiratory and cardiovascular status, to maintain gastrointestinal function, to avoid immobility complications, and to reduce the risk of infection and bleeding. As regards activities performed: we gave family support; correct management of the mechanical ventilation airway, cardio-respiratory monitoring, skin and nutritional status; control of possible infections and bleeding (management of therapies, care of catheters…). A Likert's scale was used to evaluate the results, accomplishing all key performance indicators which were propose at the beginning. Individualised care plans with NNN taxonomy using the veno-venous ECMO have not been described. Other ECMO care plans have not used the same analysis model. This case can help nurses to take care of patients subjected to veno-venous ECMO treatment, although more cases are needed to standardise nursing care using NANDA taxonomy.

  17. Cannulation strategies for percutaneous extracorporeal membrane oxygenation in adults.

    Science.gov (United States)

    Napp, L Christian; Kühn, Christian; Hoeper, Marius M; Vogel-Claussen, Jens; Haverich, Axel; Schäfer, Andreas; Bauersachs, Johann

    2016-04-01

    Extracorporeal membrane oxygenation (ECMO) has revolutionized treatment of severe isolated or combined failure of lung and heart. Due to remarkable technical development the frequency of use is growing fast, with increasing adoption by interventional cardiologists independent of cardiac surgery. Nevertheless, ECMO support harbors substantial risk such as bleeding, thromboembolic events and infection. Percutaneous ECMO circuits usually comprise cannulation of two large vessels ('dual' cannulation), either veno-venous for respiratory and veno-arterial for circulatory support. Recently experienced centers apply more advanced strategies by cannulation of three large vessels ('triple' cannulation), resulting in veno-veno-arterial or veno-arterio-venous cannulation. While the former intends to improve drainage and unloading, the latter represents a very potent method to provide circulatory and respiratory support at the same time. As such triple cannulation expands the field of application at the expense of increased complexity of ECMO systems. Here, we review percutaneous dual and triple cannulation strategies for different clinical scenarios of the critically ill. As there is no unifying terminology to date, we propose a nomenclature which uses "A" and all following letters for supplying cannulas and all letters before "A" for draining cannulas. This general and unequivocal code covers both dual and triple ECMO cannulation strategies (VV, VA, VVA, VAV). Notwithstanding the technical evolution, current knowledge of ECMO support is mainly based on observational experience and mostly retrospective studies. Prospective controlled trials are urgently needed to generate evidence on safety and efficacy of ECMO support in different clinical settings.

  18. Hemolysis-Associated Nitric Oxide Dysregulation during Extracorporeal Membrane Oxygenation

    Science.gov (United States)

    Sulkowski, Jason P.; Cooper, Jennifer N.; Pearson, Erik G.; Connelly, James T.; Rintoul, Natalie; Kilbaugh, Todd J.; Deans, Katherine J.; Minneci, Peter C.

    2014-01-01

    Abstract: Acute intravascular hemolysis during extracorporeal membrane oxygenation (ECMO) leads to increased levels of cell-free hemoglobin (FHb). Our aim was to investigate whether FHb levels are associated with nitric oxide (NO) consumption and clinical outcomes. A prospective observational study was performed involving pediatric patients on ECMO. Blood samples were collected before, during, and after the ECMO run, and plasma was evaluated for FHb, oxyhemoglobin, and NO consumption. Clinical data were collected including baseline patient characteristics, indications for ECMO, circuit changes, and mortality. Correlations between laboratory measures and associations between laboratory measures and clinical observations were evaluated. Twenty-three patients (11 male, 17 neonates) were enrolled with a median weight of 3.1 kg (interquartile range, 2.8–14.0 kg) and median ECMO run of 12 days (interquartile range, 5–19 day). There was a significant increase in FHb over time on ECMO (p = .007), and significant correlations were present between NO consumption and both FHb (r = .41, p = .01) and oxyhemoglobin levels (r = .98, p hemolysis and type of ECMO (venovenous versus venoarterial) or mortality. For children on ECMO, we observed a strong correlation between increased levels of plasma FHb and elevations in oxyhemoglobin and NO consumption; however, these changes were not associated with increased mortality. Increased hemolysis before circuit changes may be both a marker and a contributor to circuit failure. PMID:26357787

  19. Risk factors for nosocomial infection during extracorporeal membrane oxygenation.

    Science.gov (United States)

    Hsu, M-S; Chiu, K-M; Huang, Y-T; Kao, K-L; Chu, S-H; Liao, C-H

    2009-11-01

    An increasing number of patients receive extracorporeal membrane oxygenation (ECMO) for life support. This study aimed to investigate the incidence and risk factors for nosocomial infection in adult patients receiving ECMO. We reviewed the medical records of adult patients who received ECMO support for more than 72h at Far Eastern Memorial Hospital from 2001 to 2007. ECMO-related nosocomial infections were defined as infections occurring from 24h after ECMO initiation until 48h after ECMO discontinuation. There were 12 episodes of nosocomial infection identified in 10 of the 114 (8.77%) patients on ECMO, including four cases of pneumonia, three cases of bacteraemia, three surgical site infections and two urinary tract infections. The incidence of ECMO-related nosocomial infection was 11.92 per 1000 ECMO-days. The length of ECMO use and intensive care unit (ICU) stay were significantly different between patients with, and without, nosocomial infection (Pnosocomial infection rate (P=0.003). Gram-negative bacilli were responsible for 78% of the nosocomial infections. In the univariate analysis, the duration of ICU stay and duration of ECMO use were associated with nosocomial infection. In the multivariate analysis, only the duration of ECMO was independently associated with nosocomial infection (P=0.007). Overall, the only independent risk factor for ECMO-related nosocomial infection identified in this study was prolonged ECMO use.

  20. Veno-venous extracorporeal membrane oxygenation: cannulation techniques

    Science.gov (United States)

    Banfi, Carlo; Pozzi, Matteo; Siegenthaler, Nils; Brunner, Marie-Eve; Tassaux, Didier; Obadia, Jean-Francois; Bendjelid, Karim

    2016-01-01

    The development of extracorporeal membrane oxygenation (ECMO) technology allows a new approach for the intensive care management of acute cardiac and/or respiratory failure in adult patients who are not responsive to conventional treatment. Current ECMO therapies provide a variety of options for the multidisciplinary teams who are involved in the management of these critically ill patients. In this regard, veno-venous ECMO (VV-ECMO) can provide quite complete respiratory support, even if this highly complex technique presents substantial risks, such as bleeding, thromboembolic events and infection. While VV-ECMO circuits usually include the cannulation of two vessels (double cannulation) in its classic configuration, the use of a single cannula is now possible for VV-ECMO support. Recently, experienced centers have employed more advanced approaches by cannulating three vessels (triple cannulation) which follows veno-arterio-venous (VAV) or veno-arterio-pulmonary-arterial cannulation (VAPa). However, ‘triple’ cannulation expands the field of application but increases the complexity of ECMO systems. In the present review, the authors focus on the indications for VV-ECMO, patient assessment prior to cannulation, the role of ultrasound-guided vessel puncture, double lumen single bicaval cannulations, and finally triple cannulation in VV-ECMO. PMID:28149575

  1. Regional thrombolysis with tenecteplase during extracorporeal membrane oxygenation: a new approach for left ventricular thrombosis.

    Science.gov (United States)

    Sangalli, Fabio; Greco, Gianluca; Galbiati, Lucia; Formica, Francesco; Calcinati, Serena; Avalli, Leonello

    2015-06-01

    We present the case of a woman assisted with veno-arterial extracorporeal membrane oxygenation (v-a ECMO) for postischemic cardiogenic shock, who developed left ventricular thrombosis despite systemic anticoagulation and left ventricular apical venting. We successfully achieved local thrombolysis with tenecteplase administered through the venting cannula to obtain local thrombolysis while reducing systemic effects to a minimum. The procedure was effective with mild systemic bleeding and the patient was successfully weaned off the extracorporeal support a few days thereafter.

  2. Severe Acute Respiratory Failure due to Inhalation of Baby Powder and Successfully Treated with Venous-Venous Extracorporeal Membrane Oxygenation.

    Science.gov (United States)

    Panarello, Giovanna; Occhipinti, Giovanna; Piazza, Marcello; Capitanio, Guido; Vitulo, Patrizio; Gridelli, Bruno; Pilato, Michele; Arcadipane, Antonio

    2015-12-15

    Accidental inhalation of powder is a potential problem for infants. The clinical effects of inhaling powder depend on the powder contents, degree of aspiration, and the child's underlying systemic response. We present a case of accidental inhalation of rice starch powder in a 17-month-old girl, which led to severe acute respiratory distress syndrome responsive to conventional treatment, ultimately requiring venous-venous extracorporeal membrane oxygenation.

  3. Primary cardiac lymphoma complicated by cardiogenic shock: successful treatment with chemotherapy delivered under extracorporeal membrane oxygenation support.

    Science.gov (United States)

    Allain, Géraldine; Hajj-Chahine, Jamil; Lacroix, Corentin; Jayle, Christophe

    2015-12-01

    Primary cardiac lymphomas (PCLs) are rare in immunocompetent patients. Their clinical presentation is highly variable and in case of cardiogenic shock, death is often inevitable with a diagnosis made post-mortem. We report the case of a 65-year old immunocompetent man with cardiogenic shock requiring emergent extracorporeal membrane oxygenation (ECMO). Soon after, a diagnosis of PCL was given and chemotherapy was delivered under ECMO support. The patient was progressively weaned from the mechanical support. Six months later, he had fully recovered.

  4. The Utility of High-Fidelity Simulation for Training Critical Care Fellows in the Management of Extracorporeal Membrane Oxygenation Emergencies: A Randomized Controlled Trial.

    Science.gov (United States)

    Zakhary, Bishoy M; Kam, Lily M; Kaufman, Brian S; Felner, Kevin J

    2017-08-01

    Although extracorporeal membrane oxygenation volume has increased, proficiency in the technology requires extensive training. We compared traditional water-drill-based extracorporeal membrane oxygenation training with simulation-based extracorporeal membrane oxygenation training with the hypothesis that simulation-based training is superior. Randomized controlled trial. Academic medical center. Pulmonary/critical care fellows. Participants had a preintervention simulated extracorporeal membrane oxygenation emergency (Sim1-recirculation) then randomized into simulation and traditional groups. Each group participated in three teaching scenarios, via high-fidelity simulation or via water-drills. After 6 weeks and after 1 year, participants returned for two simulated extracorporeal membrane oxygenation emergencies (Sim2-pump failure and Sim3-access insufficiency). Sim2 was a case encountered during teaching, whereas Sim3 was novel. A critical action, necessary for resolution of each scenario, was preidentified for timing. Primary outcome was time required to perform critical actions. Twenty-one fellows participated in the study (simulation, 10; traditional, 11). Groups had similar scenario scores (p = 0.4) and times to critical action (p = 0.8) on Sim1. At 6 weeks, both groups had similar scenario scores on Sim2 (p = 0.5), but the simulation group scored higher on Sim3 (p = 0.03). Times to critical actions were shorter in the simulation group during Sim2 (127 vs 174 s, p = 0.004) and Sim3 (159 vs 300 s; p = 0.04). These findings persisted at 1 year. In novice critical care fellows, simulation-based extracorporeal membrane oxygenation training is superior to traditional training. Benefits transfer to novel scenarios and are maintained over the long term. Further studies evaluating the utility of simulation in other learner groups and for maintenance of proficiency are required.

  5. Extracorporeal Membrane Oxygenation in a Patient With Refractory Acute Respiratory Distress Syndrome Secondary to Toxic Epidermal Necrolysis.

    Science.gov (United States)

    2014-12-01

    life support (ECLS) in adults with acute respiratory distress syndrome (ARDS) has increased markedly during the past few years after suc- cessful...Extracorporeal Membrane Oxygenation in a Patient With Refractory Acute Respiratory Distress Syndrome Secondary to Toxic Epidermal Necrolysis Christy...COVERED - 4. TITLE AND SUBTITLE Extracorporeal Membrane Oxygenation in a Patient With Refractory Acute Respiratory Distress Syndrome Secondary to

  6. 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.

  7. 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.

  8. Extracorporeal Membrane Oxygenation (ECMO) for Hypothermic Cardiac Deterioration: A Case Series.

    Science.gov (United States)

    Niehaus, Matthew T; Pechulis, Rita M; Wu, James K; Frei, Steven; Hong, John J; Sandhu, Rovinder S; Greenberg, Marna Rayl

    2016-10-01

    Accidental hypothermia can lead to untoward cardiac manifestations and arrest. This report presents a case series of severe accidental hypothermia with cardiac complications in three emergency patients who were treated with extracorporeal membrane oxygenation (ECMO) and survived after re-warming. The aim of this discussion was to encourage more clinicians to consider ECMO as a re-warming therapy for severe hypothermia with circulatory collapse and to prompt discussion about decreasing the barriers to its use. Niehaus MT , Pechulis RM , Wu JK , Frei S , Hong JJ , Sandhu RS , Greenberg MR . Extracorporeal membrane oxygenation (ECMO) for hypothermic cardiac deterioration: a case series. Prehosp Disaster Med. 2016;31(5):570-571.

  9. Coxa vara with proximal femoral growth arrest in patients who had neonatal extracorporeal membrane oxygenation.

    Science.gov (United States)

    DiFazio, Rachel L; Kocher, Minider S; Berven, Sigurd; Kasser, James

    2003-01-01

    This is a retrospective review of four patients in whom a pattern of coxa vara with proximal femoral growth arrest and metaphyseal irregularities developed. These patients were all treated with neonatal extracorporeal membrane oxygenation and presented with a progressive gait disturbance and pain, leg-length discrepancy, and limited abduction. Imaging revealed coxa vara with proximal femoral growth arrest. Two patients (three hips) underwent proximal femoral valgus osteotomy, one patient underwent fixation of a femoral neck fracture with subsequent greater trochanter transfer, and one patient is being observed. This case series suggests an association between neonatal extracorporeal membrane oxygenation and this unusual pattern of coxa vara with proximal femoral growth arrest.

  10. Neonatal Extracorporeal Membrane Oxygenation Devices, Techniques and Team Roles: 2011 Survey Results of the United States’ Extracorporeal Life Support Organization Centers

    OpenAIRE

    Lawson, Scott; Ellis, Cory; Butler, Katie; McRobb, Craig; Mejak, Brian

    2011-01-01

    In early 2011, surveys of active Extracorporeal Life Support Organization (ELSO) centers within the United States were conducted by electronic mail regarding neonatal Extracorporeal Membrane Oxygenation (ECMO) equipment and professional staff. Seventy-four of 111 (67%) U.S. centers listed in the ELSO directory as neonatal centers responded to the survey. Of the responding centers, 53% routinely used roller pumps for neonatal ECMO, 15% reported using centrifugal pumps and 32% reported using a ...

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

    Directory of Open Access Journals (Sweden)

    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.

  12. Extracorporeal membrane oxygenation for repair of tracheal injury during transhiatal esophagectomy

    Directory of Open Access Journals (Sweden)

    Lilibeth Fermin

    2017-01-01

    Full Text Available Extracorporeal Membrane Oxygenation (ECMO for repair of tracheal injury during transhiatal esophagectomy Tracheal injury is a rare but potentially fatal complication of esophagectomies requiring prompt recognition and treatment. We describe a case of tracheal injury recognized in the operative period of an open transhiatal esophagectomy for squamous cell carcinoma of the mid to distal esophagus. When injury was discovered, attempts to improve oxygenation and ventilation by conventional methods were unsuccessful. Therefore, peripheral ECMO was used to support oxygenation during the tracheal defect repair. The use of ECMO for the repair of a tracheal injury during esophagectomy is very uncommon but, in our case, provided adequate oxygenation and ventilation while the surgeon repaired the injury and the patient was able to be promptly weaned from ECMO support and extubated not long after.

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

    Directory of Open Access Journals (Sweden)

    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.

  14. Successful treatment of severe asthma-associated plastic bronchitis with extracorporeal membrane oxygenation.

    Science.gov (United States)

    Tonan, Momoka; Hashimoto, Soshi; Kimura, Akio; Matsuyama, Hiroki; Kinose, Hiromi; Sawada, Maiko; Shime, Nobuaki; Tokuhira, Natsuko; Kato, Yuko; Sasaki, Masayuki; Tsuchiya, Kunihiko; Higaki, Satoshi; Oomae, Tadaki; Hashimoto, Satoru

    2012-04-01

    We describe a case of near-fatal asthma requiring extracorporeal membrane oxygenation (ECMO). The patient presented with severe respiratory distress, which was not responsive to conventional pharmacological therapy. The patient also failed to respond to mechanical ventilation and thus was placed on venovenous ECMO for temporary pulmonary support. A fiberoptic bronchoscopy revealed that large amounts of thick bronchial secretions had occluded the main bronchus, which suggested plastic bronchitis secondary to asthma. Aggressive airway hygiene with frequent bronchoscopies and application of biphasic cuirass ventilation for facilitation of secretion clearance were performed to improve the patient's respiratory status. The patient achieved a full recovery and suffered no neurological sequelae. This case illustrates that aggressive pulmonary hygiene with ECMO is a useful therapy for patients with asthma-associated plastic bronchitis.

  15. Trough Concentrations of Vancomycin in Patients Undergoing Extracorporeal Membrane Oxygenation.

    Directory of Open Access Journals (Sweden)

    So Jin Park

    Full Text Available To investigate the appropriateness of the current vancomycin dosing strategy in adult patients with extracorporeal membrane oxygenation (ECMO, between March 2013 and November 2013, patients who were treated with vancomycin while on ECMO were enrolled. Control group consisted of 60 patients on vancomycin without ECMO, stayed in medical intensive care unit during the same study period and with the same exclusion criteria. Early trough levels were obtained within the fourth dosing, and maintenance levels were measured at steady state. A total of 20 patients were included in the analysis in ECMO group. Sixteen patients received an initial intravenous dose of 1.0 g vancomycin followed by 1.0 g every 12 hours. The non-steady state trough level of vancomycin after starting administration was subtherapeutic in 19 patients (95.00% in ECMO group as compared with 40 patients (66.67% in the control group (p = 0.013. Vancomycin clearance was 1.27±0.51 mL/min/kg, vancomycin clearance/creatinine clearance ratio was 0.90 ± 0.37, and elimination rate constant was 0.12 ± 0.04 h-1. Vancomycin dosingfrequency and total daily dose were significantly increased after clinical pharmacokinetic services of the pharmacist based on calculated pharmacokinetic parameters (from 2.10 ± 0.72 to 2.90 ± 0.97 times/day, p = 0.002 and from 32.54 ± 8.43 to 42.24 ± 14.62mg/kg, p = 0.014 in ECMO group in contrast with those (from 2.11 ± 0.69 to 2.37 ± 0.86 times/day, p = 0.071 and from 33.91 ± 11.85 to 31.61 ± 17.50 mg/kg, p = 0.350 in the control group.Although the elimination rate for vancomycin was similar with population parameter of non ECMO patients, the current dosing strategy of our institution for vancomycinin our ICU was not sufficient to achieve the target trough in the initial period in most patients receiving ECMO.

  16. Measurement of the ductal L-R shunt during extracorporeal membrane oxygenation in the lamb.

    NARCIS (Netherlands)

    Tanke, R.B.; Heijst, A.F.J. van; Klaessens, J.H.G.M.; Daniels, O.; Festen, C.

    2004-01-01

    OBJECTIVE: In neonates, initially a ductal shunt is often observed during veno-arterial extracorporeal membrane oxygenation (ECMO). Depending on the degree of pulmonary hypertension in these patients, the ductal shunt will be right to left (R-L), left to right (L-R), or bidirectional. A ductal L-R s

  17. 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 cardiovasc

  18. The influence of ductal left-to-right shunting during extracorporeal membrane oxygenation.

    NARCIS (Netherlands)

    Tanke, R.B.; Daniëls, O.; Heyst, A. van; Lier, H.J.J. van; Festen, C.

    2002-01-01

    BACKGROUND/PURPOSE: The aim of this study was to analyze whether a ductal left-to-right (L-R) shunt will prolong extracorporeal membrane oxygenation (ECMO) in neonates with severe pulmonary hypertension. This report discusses the onset and termination of a ductal L-R shunt and its potential influenc

  19. Long-term Follow-up of Children Treated with Neonatal Extracorporeal Membrane Oxygenation: neuropsychological outcome

    NARCIS (Netherlands)

    M.J. Madderom (Marlous)

    2013-01-01

    textabstractThis thesis aims to describe the long-term neuropsychological outcome of children and adolescents treated with neonatal extracorporeal membrane oxygenation (ECMO). ECMO is a pulmonary bypass technique providing temporary life support in potentially acute reversible (cardio)respiratory fa

  20. Extracorporeal Membrane Oxygenation (ECMO): A Treatment for Neonates in Respiratory Failure.

    Science.gov (United States)

    Morris, Donna S.; Gonzalez, Lori S.; Stewart, Sharon R.; Sampers, Jackie

    2000-01-01

    A brief history is provided of extracorporeal membrane oxygenation (ECMO), a treatment option for infants that provides prolonged circulation and reoxgenation of blood outside the body to temporarily support a failing heart or lungs. The University of Kentucky ECMO program is described, along with the positive outcomes of 19 infants. (Contains…

  1. Multislice CT scans in patients on extracorporeal membrane oxygenation: Emphasis on hemodynamic changes and imaging pitfalls

    Energy Technology Data Exchange (ETDEWEB)

    Liu, Kao Lang; Wang, Yu Feng; Chang, Yeun Chung; Huang, Shu Chien; Chen, Shyh Jye; Chang, Chin Chen [National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei (China); Tsang, Yuk Ming [Dept. of Medical Imaging, Far Eastern Memorial Hospital, New Taipei City (China)

    2014-06-15

    This pictorial review provides the principles of extracorporeal membrane oxygenation (ECMO) support and associated CT imaging features with emphasis on the hemodynamic changes and possible imaging pitfalls encountered. It is important that radiologists in ECMO centers apply well-designed imaging protocols and familiarize themselves with post-contrast CT imaging findings in patients on ECMO.

  2. Congenital diaphragmatic hernia: To repair on or off extracorporeal membrane oxygenation?

    NARCIS (Netherlands)

    R. Keijzer (Richard); D.E. Wilschut (Dorien); R.J.M. Houmes (Robert Jan); K. van de Ven (Kees); L. de Jongste-van den Hout (Lieke); I. Sluijter (Ilona); P. Rycus (Peter); N.M.A. Bax (Klaas); D. Tibboel (Dick)

    2012-01-01

    textabstractBackground: Congenital diaphragmatic hernia (CDH) can be repaired on or off extracorporeal membrane oxygenation (ECMO). In many centers, operating off ECMO is advocated to prevent bleeding complications. We aimed to compare surgery-related bleeding complications between repair on or off

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

    NARCIS (Netherlands)

    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 h

  4. Rescue a drowning patient by prolonged extracorporeal membrane oxygenation support for 117 days.

    Science.gov (United States)

    Wang, Chih-Hsien; Chou, Chun-Chih; Ko, Wen-Je; Lee, Yung-Chie

    2010-07-01

    Drowning is one of the most common causes of accidental events. Here we report a drowning patient who experienced acute respiratory distress syndrome after hospitalization. Although the compliance of lung was as poor less as 5 mL/cm H2O, this patient was eventually rescued and recovered by extraprolonged extracorporeal membrane oxygenation support for 117 days.

  5. Congenital diaphragmatic hernia: To repair on or off extracorporeal membrane oxygenation?

    NARCIS (Netherlands)

    R. Keijzer (Richard); D.E. Wilschut (Dorien); R.J.M. Houmes (Robert Jan); K. van de Ven (Kees); L. de Jongste-van den Hout (Lieke); I. Sluijter (Ilona); P. Rycus (Peter); N.M.A. Bax (Klaas); D. Tibboel (Dick)

    2012-01-01

    textabstractBackground: Congenital diaphragmatic hernia (CDH) can be repaired on or off extracorporeal membrane oxygenation (ECMO). In many centers, operating off ECMO is advocated to prevent bleeding complications. We aimed to compare surgery-related bleeding complications between repair on or off

  6. 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.

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

    NARCIS (Netherlands)

    Nijhuis-Van der Sanden, M.W.G.; Cammen-van Zijp, M.H. van der; Janssen, A.J.M.; Reuser, J.J.C.M.; Mazer, P.; Heyst, A.F.J. van; Gischler, S.J.; Tibboel, D.; Kollee, L.A.A.

    2009-01-01

    INTRODUCTION: 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 aspiration syndrom

  8. 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 aspira

  9. Sensorineural hearing loss and language development following neonatal extracorporeal membrane oxygenation

    NARCIS (Netherlands)

    D. van den Hondel (Desiree); M.J. Madderom (Marlous); A. Goedegebure (Andre); S.J. Gischler (Saskia); P. Mazer (Petra); D. Tibboel (Dick); H. IJsselstijn (Hanneke)

    2012-01-01

    textabstractOBJECTIVE: To determine the prevalence of hearing loss in school-age children who have undergone neonatal extracorporeal membrane oxygenation (ECMO) treatment and to identify any effects of hearing loss on speech- and language development. DESIGN: Prospective longitudinal follow-up stud

  10. SUCCESSFUL EXTRACORPOREAL MEMBRANE OXYGENATION SUPPORT IN A PATIENT WITH FULMINANT MYOCARDITIS

    Institute of Scientific and Technical Information of China (English)

    Yong Yuan; Jian-ting Dong; Xuan-sheng Huang; Li-ting Zhang; Bin-fei Li; Zhi-gang Zhang; Ying Han

    2006-01-01

    @@ FULMINANT myocarditis complicated with refractory cardiogenic shock carries a very high mortality(76%). Herein we report our experience in treating a 23-year-old Chinese woman with fulminant myocarditis complicated with cardiogenic shock, who was rescued by extracorporeal membrane oxygenation (ECMO).

  11. Pharmacokinetics of cefotaxime and desacetylcefotaxime in infants during extracorporeal membrane oxygenation

    NARCIS (Netherlands)

    M.J. Ahsman (Maurice); E.D. Wildschut (Enno); D. Tibboel (Dick); R.A. Mathot (Ron)

    2010-01-01

    textabstractExtracorporeal membrane oxygenation (ECMO) is used to temporarily sustain cardiac and respiratory function in critically ill infants but can cause pharmacokinetic changes necessitating dose modifications. Cefotaxime (CTX) is used to prevent and treat infections during ECMO, but the curre

  12. Extracorporeal Membrane Oxygenation Outcomes After the Comprehensive Stage II Procedure in Patients With Single Ventricles.

    Science.gov (United States)

    Gomez, Daniel; Duffy, Vicky; Hersey, Diane; Backes, Carl; Rycus, Peter; McConnell, Patrick; Voss, Jordan; Galantowicz, Mark; Cua, Clifford L

    2017-01-01

    Outcomes for extracorporeal membrane oxygenation (ECMO) have been described for patients with single ventricle physiology (SVP) undergoing cavopulmonary connection (Glenn procedure). An alternative surgical pathway for patients with SVP consists of an initial hybrid procedure followed by a comprehensive Stage II procedure. No data exist describing the outcomes of patients requiring ECMO after the comprehensive Stage II procedure. The goal of this study is to describe the outcomes for patients who required ECMO after the comprehensive Stage II procedure. Data from the Extracorporeal Life Support Organization (ELSO) registry from 2001 to 2015 for children undergoing the comprehensive Stage II procedure older than 3 months of age were retrospectively analyzed. Demographics and ECMO characteristics were recorded. A total of six children required ECMO support after the comprehensive Stage II procedure (2 males, 4 females). Four patients had the diagnosis of hypoplastic left heart syndrome and two patients had the diagnosis of an unbalanced atrioventricular septal defect. Bypass time was 242.8 ± 110.9 min and cross-clamp time was 91.2 ± 46.2 min for the surgical procedure. Weight was 5.8 ± 1.3 kg and age was 150.2 + 37.9 days at time of ECMO. ECMO duration was 276.0 ± 218.1 h. Complications during the ECMO run included hemorrhage in four patients (67%), renal dysfunction in two patients (33%), and neurologic injury in two patients (33%). Four patients (67%) were discharged alive after ECMO decannulation. Despite being a much more extensive surgical procedure, the morbidity and mortality after ECMO in patients undergoing the comprehensive Stage II procedure are similar to those in patients undergoing the Glenn procedure. If needed, ECMO support is reasonable for patients after the comprehensive Stage II procedure.

  13. First steps in membrane oxygenation and prolonged extracorporeal perfusion in Duesseldorf using the Bramson membrane lung.

    Science.gov (United States)

    Schulte, Hagen D

    2003-05-01

    After a shortened history of conventional closed and open heart surgery, including hypothermia by surface cooling and extracorporeal circulation, the first application of a new membrane oxygenator developed by ML Bramson with an integrated temperature exchange system and a heart-lung machine (HLM) was reported in 1972. The aim was to have an efficient oxygenating and gas exchange artificial lung that allowed prolonged perfusions in patients with cardiogenic shock or acute respiratory insufficiency. After in vitro closed recirculation studies comparing different bubble, vertical screen, and the new membrane oxygenators, the Bramson HLM was used in dog experiments before starting clinical cardiac surgery with routine interventions (closure of an atrial septal defect). The first clinically prolonged support for more than three hours after a double valve replacement in a NYHA class IV patient failed. A partial venoarterial prolonged perfusion for 42 hours and 43 minutes in a 10-year-old girl after surgical correction of a partial av canal defect and postoperative development of consistent lung edema caused by myocardial failure after an ischemic time of 43 minutes was the first successful long-term perfusion case in Europe. These first experiences with the Bramson membrane lung formed the basis, in our group, for further investigations of different perfusion routes and cannulations in animal experiments. Also, scanning electron microscopy studies could be performed with experimentally and clinically used membranes. The development of disposable membrane lung devices, for instance, Lande-Edwards, Kolobow Scimed, and General Electric Peirce membrane lungs, ameliorated and improved the use of these devices considerably. Also, BRAMSON had developed a disposable membrane lung device that had proved to be very effective in animal experiments by 1972, but, unfortunately, this device did not become commercially available.

  14. Cerebral microemboli detected by transcranial doppler in patients treated with extracorporeal membrane oxygenation.

    Science.gov (United States)

    Marinoni, M; Migliaccio, M L; Trapani, S; Bonizzoli, M; Gucci, L; Cianchi, G; Gallerini, A; Tadini Buoninsegni, L; Cramaro, A; Valente, S; Chiostri, M; Peris, A

    2016-08-01

    Cerebrovascular complications rate in patients treated with extracorporeal membrane oxygenation (ECMO) is about 7%. Ischemic stroke may be caused by solid or gaseous microemboli due to thrombosis within the circuit or cannula. Transcranial Doppler (TCD) is the only method able to detect microembolic signals (MES) in real time. The objective of this study was to detect possible MES by TCD in patients treated with veno-venous (VV) and veno-arterial (VA) ECMO and to test for a relation between the number of MES and the 6-month clinical outcome of these patients. This is a monocentric observational prospective study in patients consecutively admitted and treated with ECMO at our regional ECMO referral center in 18 months. TCD detection of MES was performed in patients upon initiation of treatment and then repeated during treatment. Two hundred and forty-eight TCD monitoring were performed in 42 VV and 11 VA ECMO patients. MES were detected in 26.2% of VV ECMO patients and in 81.8% of VA ECMO patients (P < 0.001). In both subgroups of patients, no correlation was found between MES detection and extracorporeal flow velocities or aPTT values. In VA ECMO patients, an inverse correlation between left ventricular ejection fraction and MES grading was found (P = 0.037). In both groups, no clinical neurological impairments correlated to MES detection were found at 6 months follow-up. MES were found in both ECMO configurations; independently from their pathophysiology, MES do not seem to influence clinical outcome. Multicenter studies are still required with more extensive cases to confirm these results. © 2016 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

  15. 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.

  16. Femoral shaft fracture osteosynthesis in a critically ill patient under Extracorporeal Membrane Oxygenation (ECMO

    Directory of Open Access Journals (Sweden)

    Calvo Cristobal

    2016-01-01

    Full Text Available Introduction: Extracorporeal Membrane Oxygenation (ECMO is an invasive procedure used in critically ill patients with catastrophic pulmonary failure or cardiogenic shock in which conventional management has failed. These patients are managed with permanent anticoagulation, with increased bleeding risk. Hemorrhage is the main reported complication. Case: A 25-year-old polytraumatized woman, both lower limbs amputated and a left femoral shaft fracture with catastrophic pulmonary failure (Murray score 4 that required intensive management care with ECMO. During her evolution definitive femoral shaft osteosynthesis with a nail as required and the medical team decided to operate on the patient under ECMO. She recovered with fluctuations in her hematocrit, but was hemodynamically stable. The patient recovered satisfactorily, was weaned from ECMO and commenced her rehabilitation program. At 16 months, she was almost autovalent, and full consolidation was achieved, with no complication of the implants. Discussion: ECMO is a life-saving support, but requires permanent anticoagulation, which implies a high risk of hemorrhages, specially for surgical treatment. This patient underwent an osteosynthesis surgery satisfactorily. Hematoma was the only complication of her intramedullary femoral nail, without compromising hemodynamics. This case shows that patients on ECMO can undergo a major orthopedic surgery in selected cases.

  17. 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.

  18. Factors associated with outcomes of patients on extracorporeal membrane oxygenation support: a 5-year cohort study

    OpenAIRE

    Aubron, Cecile; Cheng, Allen C.; Pilcher, David; Leong, Tim; Magrin, Geoff; Cooper, D Jamie; Scheinkestel, Carlos; Pellegrino, Vince

    2013-01-01

    Introduction Mortality of patients on extracorporeal membrane oxygenation (ECMO) remains high. The objectives of this study were to assess the factors associated with outcome of patients undergoing ECMO in a large ECMO referral centre and to compare veno-arterial ECMO (VA ECMO) with veno-venous ECMO (VV ECMO). Methods We reviewed a prospectively obtained ECMO database and patients' medical records between January 2005 and June 2011. Demographic characteristics, illness severity at admission, ...

  19. 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.

  20. 2009 H1N1 influenza virus infection and necrotizing pneumonia treated with extracorporeal membrane oxygenation

    Directory of Open Access Journals (Sweden)

    Suntae Ji

    2011-08-01

    Full Text Available A 3-year-old girl with acute respiratory distress syndrome due to a H1N1 2009 influenza virus infection was complicated by necrotizing pneumonia was successfully treated with extracorporeal membrane oxygenation (ECMO. This is the first reported case in which a pediatric patient was rescued with ECMO during the H1N1 influenza epidemic in Korea in 2009.

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

    OpenAIRE

    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 aspiration syndrome (MAS), congenital diaphragmatic hernia (CDH), sepsis or persistent pulmonary hypertension (PPH). In five-year-old children who underwent VA-ECMO therapy as neonates, we assessed motor...

  2. A systematic review on pharmacokinetic changes in critically ill patients: role of extracorporeal membrane oxygenation

    OpenAIRE

    Mousavi, S.; Levcovich, B; M Mojtahedzadeh

    2011-01-01

    Objective Several factors including disease condition and different procedures could alter pharmacokinetic profile of drugs in critically ill patients. For optimizing patient's outcome, changing in dosing regimen is necessary. Extracorporeal Membrane Oxygenation (ECMO) is one of the procedures which could change pharmacokinetic parameters.The aim of this review was to evaluate the effect of ECMO support on pharmacokinetic parameters and subsequently pharmacotherapy. Method A systematic review...

  3. Extracorporeal Membrane Oxygenation as a Bridge to Chemotherapy in an Orthodox Jewish Patient

    OpenAIRE

    Meltzer, Ellen C.; Ivascu, Natalia S.; Acres, Cathleen A.; Stark, Meredith; Furman, Richard R.; Fins, Joseph J.

    2014-01-01

    Venoarterial extracorporeal membrane oxygenation (VA-ECMO) for cardiopulmonary support offers survival possibilities to patients who otherwise would succumb to cardiac failure. The authors present a novel case of VA-ECMO use in an Orthodox Jewish woman with potentially curable lymphoma encasing her heart to demonstrate the value of anticipating and preemptively resolving foreseeable religious or cultural objections to the terminal discontinuation of life-sustaining therapy.

  4. Myocardial Reloading after Extracorporeal Membrane Oxygenation Alters Substrate Metabolism While Promoting Protein Synthesis

    Energy Technology Data Exchange (ETDEWEB)

    Kajimoto, Masaki; Priddy, Colleen M.; Ledee, Dolena; Xu, Chun; Isern, Nancy G.; Olson, Aaron; Des Rosiers, Christine; Portman, Michael A.

    2013-08-19

    Extracorporeal membrane oxygenation (ECMO) unloads the heart providing a bridge to recovery in children after myocardial stunning. Mortality after ECMO remains high.Cardiac substrate and amino acid requirements upon weaning are unknown and may impact recovery. We assessed the hypothesis that ventricular reloading modulates both substrate entry into the citric acid cycle (CAC) and myocardial protein synthesis. Fourteen immature piglets (7.8-15.6 kg) were separated into 2 groups based on ventricular loading status: 8 hour-ECMO (UNLOAD) and post-wean from ECMO (RELOAD). We infused [2-13C]-pyruvate as an oxidative substrate and [13C6]-L-leucine, as a tracer of amino acid oxidation and protein synthesis into the coronary artery. RELOAD showed marked elevations in myocardial oxygen consumption above baseline and UNLOAD. Pyruvate uptake was markedly increased though RELOAD decreased pyruvate contribution to oxidative CAC metabolism.RELOAD also increased absolute concentrations of all CAC intermediates, while maintaining or increasing 13C-molar percent enrichment. RELOAD also significantly increased cardiac fractional protein synthesis rates by >70% over UNLOAD. Conclusions: RELOAD produced high energy metabolic requirement and rebound protein synthesis. Relative pyruvate decarboxylation decreased with RELOAD while promoting anaplerotic pyruvate carboxylation and amino acid incorporation into protein rather than to the CAC for oxidation. These perturbations may serve as therapeutic targets to improve contractile function after ECMO.

  5. Pheochromocytoma crisis with severe cyclic blood pressure fluctuations in a cardiac pheochromocytoma patient successfully resuscitated by extracorporeal membrane oxygenation: a case report

    National Research Council Canada - National Science Library

    Zhou, Xiang; Liu, Dawei; Su, Longxiang; Long, Yun; Du, Wei; Miao, Qi; Li, Fang; Jin, Zhengyu; Zeng, Zhengpei; Luo, Ailun; Huang, Yuguang

    2015-01-01

    Cardiac pheochromocytoma is relatively rare. Few reports describe the intraoperative and postoperative progression of patients experiencing a life-threatening pheochromocytoma crisis treated with extracorporeal membrane oxygenation (ECMO...

  6. The Impact of Renal Failure and Renal Replacement Therapy on Outcome During Extracorporeal Membrane Oxygenation Therapy.

    Science.gov (United States)

    Antonucci, Elio; Lamanna, Irene; Fagnoul, David; Vincent, Jean-Louis; De Backer, Daniel; Silvio Taccone, Fabio

    2016-08-01

    Acute kidney injury (AKI) is common in patients treated with veno-arterial (VA-) or veno-venous (VV-) extracorporeal membrane oxygenation (ECMO). In this setting, the use of continuous renal replacement therapy (CRRT) can help to optimize fluid status but may also negatively impact on patients' outcome. In contrast, the relationship between AKI, CRRT, and survival in critically ill adult patients receiving ECMO is not well defined. The institutional ECMO database (n = 162) from November 2008 to December 2013, excluding patients with ICU survival ECMO and 56 with VV-ECMO). Of these, 95 developed AKI, 63 (47%) of whom required CRRT; thus three groups of patients were identified: (a) no AKI; (b) AKI without CRRT (AKINOCRRT ); and (c) CRRT with AKI (AKICRRT ). AKINOCCRT patients were more likely to have preexisting heart disease, to be more severely ill, and to be treated with VA-ECMO than those without AKI. AKICRRT patients were also more likely to be treated with VA-ECMO, had more organ dysfunction at the time of ECMO insertion, and needed more transfusions and inotropic agents than patients without AKI. ICU mortality was 53% (72/135) and was similar in the three groups, even when different AKI stages or VA/VV-ECMO were analyzed separately. In this study, the use of CRRT was not associated with an increased mortality in an adult population of patients treated with ECMO, even after adjustment for confounders.

  7. Apnea test in the determination of brain death in patients treated with extracorporeal membrane oxygenation (ECMO).

    Science.gov (United States)

    Saucha, Wojciech; Sołek-Pastuszka, Joanna; Bohatyrewicz, Romuald; Knapik, Piotr

    2015-01-01

    Extracorporeal Membrane Oxygenation (ECMO) is a well-established method of support in patients with severe respiratory and/or circulatory failure. Unfortunately, this invasive method of treatment is associated with a high risk of neurological complications including brain death. Proper diagnosis of brain death is crucial for the termination of futile medical care. Currently, the legal system in Poland does not provide an accepted protocol for apnea tests for patients on ECMO support. Veno-arterial ECMO is particularly problematic in this regard because it provides both gas exchange and circulatory support. CO₂ elimination by ECMO prevents hypercapnia, which is required to perform an apnea test. Several authors have described a safe apnea test procedure in patients on ECMO. Maximal reduction of the sweep gas flow to the oxygenator should maintain an acceptable haemoglobin oxygenation level and reduce elimination of carbon dioxide. Hypercapnia achieved via this method should allow an apnea test to be conducted in the typical manner. In the case of profound desaturation and an inadequate increase in the arterial CO₂ concentration, the sweep gas flow rate may be increased to obtain the desired oxygenation level, and exogenous carbon dioxide may be added to achieve a target carbon dioxide level. Incorporation of an apnea test for ECMO patients is planned in the next edition of the Polish guidelines on the determination of brain death.

  8. 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.

  9. Plasma concentrations of oseltamivir and oseltamivir carboxylate in critically ill children on extracorporeal membrane oxygenation support.

    Directory of Open Access Journals (Sweden)

    Enno D Wildschut

    Full Text Available INTRODUCTION: To evaluate the effect of extracorporeal membrane oxygenation (ECMO support on pharmacokinetics of oseltamivir and oseltamivir carboxylate (OC in children. METHODOLOGY: Steady state 0-12 hour pharmacokinetic sampling was performed in new influenza A (H1N1 infected children treated with oseltamivir while on ECMO support. Cmax, Cmin and AUC(0-12 h were calculated. The age-specific oseltamivir dosage was doubled to counter expected decreased plasma drug concentrations due to increased volume of distribution on ECMO support. PRINCIPAL FINDINGS: Three patients were enrolled aged 15, 6 and 14 years in this pharmacokinetic case series. For two children the OC plasma concentrations were higher than those found in children and adults not on ECMO. These increased plasma concentrations related to the increased oseltamivir dosage and decreased kidney function. In one patient suboptimal plasma concentrations coincided with a decreased gastric motility. CONCLUSION: Oseltamivir pharmacokinetics do not appear to be significantly influenced by ECMO support. Caution is required in case of nasogastric administration and decreased gastric motility. Due to the limited number of (paediatric patients available further multicenter studies are warranted.

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

    Science.gov (United States)

    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. PMID:28127231

  11. Identifying Prognostic Criteria for Survival after Resuscitation Assisted by Extracorporeal Membrane Oxygenation

    Directory of Open Access Journals (Sweden)

    Alexandrine Brunner

    2016-01-01

    Full Text Available To improve survival rates during CPR, some patients are put on extracorporeal membrane oxygenation (ECMO. Among children who have undergone ECMO cardiopulmonary resuscitation (ECPR, the overall rate of survival to discharge is close to 40%. However, despite its wide acceptance and use, the appropriate indications and organizational requirements for ECPR have yet to be defined. Our objective was to assess the clinical outcomes of children after ECPR and to determine pre-ECPR prognostic factors for survival to guide its indication. Among the 19 patients who underwent ECPR between 2008 and 2014 in our center, 16 patients (84%, 95% confidence interval: 62–95% died during their hospital stay, including nine (47% who were on ECMO and seven (37% after successful weaning from ECMO. All three survivors had normal cognitive status, but one child suffered from spastic quadriplegia. Survivors tended to have lower lactate, higher bicarbonate, and higher pH levels before ECMO initiation, as well as shorter length of resuscitation. In conclusion, in our center, ECPR has a poorer outcome than expected. Therefore, it might be important to identify, a priori, patients who might benefit from this treatment.

  12. Daily nursing care on patients undergoing venous-venous extracorporeal membrane oxygenation: a challenging procedure!

    Science.gov (United States)

    Redaelli, Sara; Zanella, Alberto; Milan, Manuela; Isgrò, Stefano; Lucchini, Alberto; Pesenti, Antonio; Patroniti, Nicolò

    2016-12-01

    Daily nursing in critical care patients may alter vital parameters, especially in the most critically ill patients. The aim of our study was to evaluate feasibility and safety of daily nursing on patients undergoing venous-venous extracorporeal membrane oxygenation (vv-ECMO) for severe respiratory failure. Daily nursing was performed following defined phases (sponge bath, elevation with scooping stretcher, change position of endotracheal tube, dressing replacement). We recorded physiological and ECMO parameters before and during daily nursing in 5 patients for several days (total: 25 daily nursing) and adverse events: desaturation, hypertension, reduction of mixed venous oxygen saturation, arterial oxygen saturation or ECMO blood flow and elevation in minute ventilation. Sedative drug dosage and additional bolus were recorded. Daily nursing was performed in 92 % of cases (23/25), with a minimum of two adverse events per daily nursing. Hypertension and tachycardia were mostly recorded at the beginning, while desaturation, reduction in mixed venous oxygen saturation and blood flow were recorded during elevation with scooping stretcher. Increase in minute ventilation was frequent in spontaneous breathing patients. Additional bolus of sedation was required before and/or during nursing. Daily nursing significantly alters physiologic parameters; thus, it should be performed only when physicians are readily available to treat adverse events.

  13. Extracorporeal membrane oxygenation in the neonate with congenital renal disease and pulmonary hypoplasia.

    Science.gov (United States)

    Caesar, R E; Packer, M G; Kaplan, G W; Dudell, G G; Guerrant, A L; Griswold, W R; Lemire, J M; Mendoza, S A; Reznik, V M

    1995-11-01

    Extracorporeal membrane oxygenation (ECMO) is an effective treatment modality for the newborn with refractory hypoxemia. Oligohydramnios can be associated with congenital renal disease (CRD) and can result in respiratory insufficiency from pulmonary hypoplasia, delayed lung maturation, and persistent pulmonary hypertension of the newborn. In this retrospective study, the authors reviewed the outcome of four children with CRD who required ECMO in the neonatal period. Between October 1987 and December 1995, ECMO was used in four newborns with CRD and pulmonary hypoplasia unresponsive to maximal medical management. The causes of CRD were urinary obstruction (2), renal dysplasia (1), and vesicoureteral reflux (1). Neonatal survivors of ECMO with CRD had regular follow-up with a nephrologist, urologist, and pediatrician. Developmental history, assessment of renal function, and a nutritional evaluation were recorded on each visit. The follow-up period ranged from 6 months to 5 years. All patients with CRD were successfully weaned from ECMO. One child died, at 1 month of age, because of renal failure. The estimated glomerular filtration rates in the three survivors were 20, 24, and 60 mL/min/1.73 m2. Growth and development have been delayed in two patients. Based on the author's experience, ECMO may improve the survival of neonates with pulmonary hypoplasia and CRD. Factors associated with successful long-term outcome include (1) renal disease amenable to surgical correction, (2) aggressive nutritional support, and (3) a reliable social support system.

  14. 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. 

  15. Validity of Outcome Prediction Scoring Systems in Korean Patients with Severe Adult Respiratory Distress Syndrome Receiving Extracorporeal Membrane Oxygenation Therapy.

    Science.gov (United States)

    Lee, Seunghyun; Yeo, Hye Ju; Yoon, Seong Hoon; Lee, Seung Eun; Cho, Woo Hyun; Jeon, Doo Soo; Kim, Yun Seong; Son, Bong Soo; Kim, Do Hyung

    2016-06-01

    Recently, several prognostic scoring systems for patients with severe acute respiratory distress syndrome (ARDS) requiring extracorporeal membrane oxygenation (ECMO) have been published. The aim of this study was to validate the established scoring systems for outcome prediction in Korean patients. We retrospectively reviewed the data of 50 patients on ECMO therapy in our center from 2012 to 2014. A calculation of outcome prediction scoring tools was performed and the comparison across various models was conducted. In our study, the overall hospital survival was 46% and successful weaning rate was 58%. The Predicting Death for Severe ARDS on V-V ECMO (PRESERVE) score showed good discrimination of mortality prediction for patients on ECMO with AUC of 0.80 (95% CI 0.66-0.90). The respiratory extracorporeal membrane oxygenation survival prediction (RESP) score and simplified acute physiology score (SAPS) II score also showed fair prediction ability with AUC of 0.79 (95% CI 0.65-0.89) and AUC of 0.78 (95% CI 0.64-0.88), respectively. However, the ECMOnet score failed to predict mortality with AUC of 0.51 (95% CI 0.37-0.66). When evaluating the predictive accuracy according to optimal cut-off point of each scoring system, RESP score had a best specificity of 91.3% and 66.7% of sensitivity, respectively. This study supports the clinical usefulness of the prognostic scoring tools for severe ARDS with ECMO therapy when applying to the Korean patients receiving ECMO.

  16. Functional Status and Quality of Life in Survivors of Extracorporeal Membrane Oxygenation After the Norwood Operation.

    Science.gov (United States)

    Friedland-Little, Joshua M; Uzark, Karen; Yu, Sunkyung; Lowery, Ray; Aiyagari, Ranjit; Hirsch-Romano, Jennifer C

    2017-06-01

    Infants who require extracorporeal membrane oxygenation (ECMO) support after a Norwood operation are at increased risk for early and late death compared with patients who do not require ECMO post-Norwood. Little is known about the effect that ECMO post-Norwood has on functional status and quality of life among long-term survivors. We prospectively evaluated functional status and health-related quality of life in 12 surviving patients (cases) and 19 corresponding patients (controls) from a previous retrospective case-control assessment of long-term survival in patients requiring ECMO post-Norwood. Functional status was assessed with the Vineland Adaptive Behavior Scale-II, and health-related quality of life was assessed with the Pediatric Quality of Life Inventory (PedsQL) core and cardiac modules. There were no differences in demographics, extracardiac or genetic anomalies, or age at follow-up assessment between ECMO cases and non-ECMO controls. The Vineland Adaptive Behavior Scale-II scores were comparable between groups, with both groups demonstrating function in the normal range in all four domains tested. The only difference in PedsQL scores between cases and controls was perceived physical appearance, which was lower among ECMO survivors by both patient and proxy report. PedsQL scores of both groups were comparable to published scores for patients with single-ventricle congenital heart disease but generally lower than scores for the healthy population. The requirement for ECMO support after a Norwood operation does not appear to significantly affect functional status or quality of life among the subset of patients who achieve long-term survival. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  17. The inflammatory response to extracorporeal membrane oxygenation (ECMO): a review of the pathophysiology.

    Science.gov (United States)

    Millar, Jonathan E; Fanning, Jonathon P; McDonald, Charles I; McAuley, Daniel F; Fraser, John F

    2016-11-28

    Extracorporeal membrane oxygenation (ECMO) is a technology capable of providing short-term mechanical support to the heart, lungs or both. Over the last decade, the number of centres offering ECMO has grown rapidly. At the same time, the indications for its use have also been broadened. In part, this trend has been supported by advances in circuit design and in cannulation techniques. Despite the widespread adoption of extracorporeal life support techniques, the use of ECMO remains associated with significant morbidity and mortality. A complication witnessed during ECMO is the inflammatory response to extracorporeal circulation. This reaction shares similarities with the systemic inflammatory response syndrome (SIRS) and has been well-documented in relation to cardiopulmonary bypass. The exposure of a patient's blood to the non-endothelialised surface of the ECMO circuit results in the widespread activation of the innate immune system; if unchecked this may result in inflammation and organ injury. Here, we review the pathophysiology of the inflammatory response to ECMO, highlighting the complex interactions between arms of the innate immune response, the endothelium and coagulation. An understanding of the processes involved may guide the design of therapies and strategies aimed at ameliorating inflammation during ECMO. Likewise, an appreciation of the potentially deleterious inflammatory effects of ECMO may assist those weighing the risks and benefits of therapy.

  18. Veno-venous extracorporeal membrane oxygenation in a patient with severe acute respiratory failure – case report

    Science.gov (United States)

    Dec, Paweł Łukasz; Lesińska, Anna Justyna; Bocheńska, Anna; Wasilewski, Piotr; Feldyk, Grzegorz; Kubisa, Anna; Pieróg, Jarosław; Bielewicz, Michał; Grodzki, Tomasz

    2015-01-01

    Acute respiratory failure resistant to conventional pulmonary therapy often requires intensive medical care. In rare cases, ventilator therapy proves insufficient, and only the option of employing veno-venous extracorporeal membrane oxygenation (ECMO V-V) remains. The present article describes the case of a 23-year-old patient who experienced severe acute respiratory distress syndrome with associated multiple organ failure. The patient was admitted to the pulmonary ward of the Alfred Sokołowski Regional Pulmonary Hospital in Szczecin-Zdunowo with suspected pneumonia of unknown etiology. After the initial 5 days of diagnostics at the pulmonary ward, the patient required a further 97 days of hospital treatment and spent 63 days at the Intensive Care Unit. There, he underwent ECMO V-V therapy lasting 22 days, which resulted in the improvement of his arterial blood gas parameters and clinical condition. PMID:26336483

  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.

  20. A meta-analysis of complications and mortality of extracorporeal membrane oxygenation.

    Science.gov (United States)

    Zangrillo, Alberto; Landoni, Giovanni; Biondi-Zoccai, Giuseppe; Greco, Massimiliano; Greco, Teresa; Frati, Giacomo; Patroniti, Nicolò; Antonelli, Massimo; Pesenti, Antonio; Pappalardo, Federico

    2013-09-01

    To comprehensively assess published peer-reviewed studies related to extracorporeal membrane oxygenation (ECMO), focusing on outcomes and complications of ECMO in adult patients. Systematic review and meta-analysis. MEDLINE/PubMed was searched for articles on complications and mortality occurring during or after ECMO. Included studies had more than 100 patients receiving ECMO and reported in detail fatal or nonfatal complications occurring during or after ECMO. Primary outcome was mortality at the longest follow-up available; secondary outcomes were fatal and non-fatal complications. Twelve studies were included (1763 patients), mostly reporting on venoarterial ECMO. Criteria for applying ECMO were variable, but usually comprised acute respiratory failure, cardiogenic shock or both. After a median follow-up of 30 days (1st-3rd quartile, 30-68 days), overall mortality was 54% (95% CI, 47%-61%), with 45% (95% CI, 42%-48%) of fatal events occurring during ECMO and 13% (95% CI, 11%-15%) after it. The most common complications associated with ECMO were: renal failure requiring continuous venovenous haemofiltration (occurring in 52%), bacterial pneumonia (33%), any bleeding (33%), oxygenator dysfunction requiring replacement (29%), sepsis (26%), haemolysis (18%), liver dysfunction (16%), leg ischaemia (10%), venous thrombosis (10%), central nervous system complications (8%), gastrointestinal bleeding (7%), aspiration pneumonia (5%), and disseminated intravascular coagulation (5%). Even with conditions usually associated with a high chance of death, almost 50% of patients receiving ECMO survive up to discharge. Complications are frequent and most often comprise renal failure, pneumonia or sepsis, and bleeding.

  1. Peripheral Veno-Arterial Extracorporeal Membrane Oxygenation as a Bridge to Decision for Pediatric Fulminant Myocarditis.

    Science.gov (United States)

    Okada, Noritaka; Murayama, Hiroomi; Hasegawa, Hiroki; Kawai, Satoru; Mori, Hiromitsu; Yasuda, Kazushi

    2016-08-01

    It is essential to establish an appropriate initial treatment strategy for pediatric fulminant myocarditis. We reviewed eight cases of pediatric fulminant myocarditis that required extracorporeal membrane oxygenation (ECMO) from 2012 to 2015. The median age was 8 years (range 3 months-13 years), and the median body surface area was 0.89 m(2) (range 0.35-1.34 m(2) ). Peripheral veno-arterial ECMO was initially applied, and we evaluated whether heart decompression was sufficient. If the pump flow was insufficient, central cannulation was performed via median sternotomy (central ECMO). The need for subsequent ventricular assist device (VAD) support was determined 72 h after ECMO initiation. Six patients were bridged to recovery using peripheral ECMO support only (for 3-11 days), whereas two required VAD support. One patient was switched to central ECMO before VAD implantation. Three patients died of multiorgan failure, even though cardiac function recovered in two of those patients. The duration from hospital arrival to ECMO initiation was shorter in the survival (3.3 ± 1.3 h; range 1.6-4.7 h) than in the nonsurvival group (32 ± 28 h; range 0.7-55 h). Peripheral ECMO can be useful as a bridge to decision for pediatric fulminant myocarditis, which is frequently followed by a successful bridge to recovery. It is important to determine whether ECMO support should be initiated before organ dysfunction advances to preserve organ function, which provides a better bridge to subsequent VAD therapy and heart transplant or recovery.

  2. Predictors of Acute Renal Failure During Extracorporeal Membrane Oxygenation in Pediatric Patients After Cardiac Surgery.

    Science.gov (United States)

    Lv, Lin; Long, Cun; Liu, Jinping; Hei, Feilong; Ji, Bingyang; Yu, Kun; Hu, Qiang; Hu, Jinxiao; Yuan, Yuan; Gao, Guodong

    2016-05-01

    Acute renal failure (ARF) is associated with increased mortality in pediatric extracorporeal membrane oxygenation (ECMO). The aim of this study was to identify predictors of ARF during ECMO in pediatric patients after cardiac surgery. A retrospective study analyzed 42 children (≤15 years) after cardiac surgery requiring venous-arterial ECMO between December 2008 and December 2014 at Fuwai Hospital. ARF was defined as ≥300% rise in serum creatinine (SCr) concentration from baseline or application of dialysis. Multivariate logistic regression was performed to identify the predictors of ARF during ECMO. A total of 42 children (age, interquartile range [IQR], 13.0 [7.2-29.8] months; weight, IQR, 8.5 [6.7-11.0] kg) after cardiac surgery requiring ECMO were included in this study. The total survival rate was 52.4%, and the incidence of ARF was 40.5%. As the result of univariate analysis, ECMO duration, cardiopulmonary resuscitation, maximum free hemoglobin (FHB) during ECMO, lactate level, and mean blood pressure before initiation of ECMO were entered in multiple logistic regression analysis. In multiple logistic regression analysis, FHB during ECMO (OR 1.136, 95% CI 1.023-1.261) and lactate level before initiation of ECMO (OR 1.602, 95% CI 1.025-2.502) were risk factors for ARF during ECMO after pediatric cardiac surgery. There was a linear correlation between maximum SCr and maximum FHB (Pearson's r = 0.535, P = 0.001). Maximum SCr during ECMO has also a linear correlation with lactate level before initiation of ECMO (Pearson's r = 0.342, P = 0.044). Increased FHB during ECMO and high lactate level before initiation of ECMO were risk factors for ARF during ECMO in pediatric patients after cardiac surgery.

  3. Extracorporeal membrane oxygenation in adults: a brief review and ethical considerations for nonspecialist health providers and hospitalists.

    Science.gov (United States)

    Meltzer, Ellen C; Ivascu, Natalia S; Acres, Cathleen A; Stark, Meredith; Kirkpatrick, James N; Paul, Subroto; Sedrakyan, Art; Fins, Joseph J

    2014-12-01

    Given the pace, distribution, and uptake of technological innovation, patients experiencing respiratory failure, heart failure, or cardiac arrest are, with greater frequency, being treated with extracorporeal membrane oxygenation (ECMO). Although most hospitalists will not be responsible for ordering or managing ECMO, in-hospital healthcare providers continue to be a vital source of patient referral and, accordingly, need to understand the rudiments of these technologies so as to co-manage patients, counsel families, and help ensure that the provision of ECMO is consistent with patient preferences and appropriate goals of care. In an effort to prepare hospitalists for these clinical responsibilities, we review the history and technology behind modern-day ECMO, including venoarterial extracorporeal membrane oxygenation (VA-ECMO) and venovenous extracorporeal membrane oxygenation. Building upon that foundation, we further highlight special ethical considerations that may arise in VA-ECMO, and present an ethically grounded approach to the initiation, continuation, and discontinuation of treatment.

  4. Venovenous Extracorporeal Membrane Oxygenation With Prophylactic Subcutaneous Anticoagulation Only: An Observational Study in More Than 60 Patients.

    Science.gov (United States)

    Krueger, Kirsten; Schmutz, Axel; Zieger, Barbara; Kalbhenn, Johannes

    2017-02-01

    Extracorporeal lung support and therapeutic anticoagulation are dogmatically linked for most clinicians in fear of clotting of the extracorporeal circuit. In the last decade, however, we have learned that bleeding complications in the course of extracorporeal membrane oxygenation (ECMO) therapy are common and not occasionally limiting or fatal. Even though international guidelines lowered the PTT-target values, ECMO therapy without anticoagulation has only been reported sporadically in case reports heretofore. This monocentric, observational study was designed to evaluate a protocol for venovenous ECMO therapy without additional anticoagulation. Patients without former thrombotic events solely received thrombosis prophylaxis with 40 mg subcutaneous enoxaparin per day like every critical care patient. After approval by the local ethics committee (Albert-Ludwigs-University Freiburg ethics committee, EK 513/14) all consecutive patients treated with venovenous ECMO therapy since introduction of the protocol have been identified. Digital charts of the patients have been evaluated with special regard to bleeding and thrombotic or embolic events or breakdown of the extracorporeal circuit. Sixty-one patients received venovenous ECMO therapy with prophylactic subcutaneous enoxaparin only. Median duration of ECMO therapy was 7 days (2-32). Overall 560 ECMO days have been observed. No system exchange because of thrombotic occlusion was necessary within the permitted 5 days run time of the centrifugal pump. Overall we identified thrombotic complications in four patients. In three of them centrifugal pump after a runtime of more than 5 days unexpectedly stopped completely because of thrombotic occlusion. In all cases pump exchange was performed promptly and patients did not incur hypoxic deficit. One other patient received substitution of blood products and coagulation factor concentrates because of severe bleeding and sustained myocardial infarction the day after. Only 18% of

  5. Extracorporeal membrane oxygenation 2016: an update [version 1; referees: 3 approved

    Directory of Open Access Journals (Sweden)

    Warwick Butt

    2016-04-01

    Full Text Available The use of extracorporeal membrane oxygenation (ECMO is an important issue for intensivists, critical care nurses, surgeons, cardiologists, and many others. There has been a continued increase in the number of centres performing ECMO. This review examines novel applications and recent trends in the use of ECMO over the last 2 years. These include ECMO to facilitate the safe use of other treatments, changing the timing of initiation, newer equipment and better biocompatibility, and the ability of ECMO programs to essentially choose which cluster of potential complications they are prepared to accept. ECMO continues to evolve, diversify in its applications, and improve in safety.

  6. Extracorporeal membrane oxygenation in the pre and post lung transplant period

    Science.gov (United States)

    Hartwig, Mathew G.; Hayes, Don

    2017-01-01

    Evolution in technology has resulted in rapid increase in utilization of extracorporeal membrane oxygenation (ECMO) as a bridge to recovery and/or transplantation. Although there is limited evidence for the use of ECMO, recent improvements in ECMO technology, personnel training, ambulatory practices on ECMO and lung protective strategies have resulted in improved outcomes in patients bridged to lung transplantation. This review provides an insight into the current outcomes and best practices for utilization of ECMO in the pre- and post-lung transplantation period. PMID:28275619

  7. [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...

  8. [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...

  9. Extracorporeal Membrane Oxygenation Therapy for Aspiration Pneumonia in a Patient following Left Pneumonectomy for Lung Cancer

    Directory of Open Access Journals (Sweden)

    Jangwhan Jo

    2016-05-01

    Full Text Available A patient had undergone left pneumonectomy for lung cancer and had an increased risk of fatal complications such as pneumonia, including acute respiratory distress syndrome (ARDS. The treatment effects of veno-venous extracorporeal membrane oxygenation (VV-ECMO for ARDS of postpneumonectomy patient are uncertain. A 74-year-old man with one lung experienced aspiration pneumonia while swallowing pills after the operation, and his condition progressed to ARDS within a day. He was successfully treated with VV-ECMO support and intensive care unit care.

  10. Prognostic value of cerebral tissue oxygen saturation during neonatal extracorporeal membrane oxygenation

    Science.gov (United States)

    Clair, Marie-Philippine; Rambaud, Jérôme; Flahault, Adrien; Guedj, Romain; Guilbert, Julia; Guellec, Isabelle; Durandy, Amélie; Demoulin, Maryne; Jean, Sandrine; Mitanchez, Delphine; Chalard, François; Sileo, Chiara; Carbajal, Ricardo; Renolleau, Sylvain

    2017-01-01

    Objectives Extracorporeal membrane oxygenation support is indicated in severe and refractory respiratory or circulatory failures. Neurological complications are typically represented by acute ischemic or hemorrhagic lesions, which induce higher morbidity and mortality. The primary goal of this study was to assess the prognostic value of cerebral tissue oxygen saturation (StcO2) on mortality in neonates and young infants treated with ECMO. A secondary objective was to evaluate the association between StcO2 and the occurrence of cerebral lesions. Study design This was a prospective study in infants < 3 months of age admitted to a pediatric intensive care unit and requiring ECMO support. Measurements The assessment of cerebral perfusion was made by continuous StcO2 monitoring using near-infrared spectroscopy (NIRS) sensors placed on the two temporo-parietal regions. Neurological lesions were identified by MRI or transfontanellar echography. Results Thirty-four infants <3 months of age were included in the study over a period of 18 months. The ECMO duration was 10±7 days. The survival rate was 50% (17/34 patients), and the proportion of brain injuries was 20% (7/34 patients). The mean StcO2 during ECMO in the non-survivors was reduced in both hemispheres (p = 0.0008 right, p = 0.03 left) compared to the survivors. StcO2 was also reduced in deceased or brain-injured patients compared to the survivors without brain injury (p = 0.002). Conclusion StcO2 appears to be a strong prognostic factor of survival and of the presence of cerebral lesions in young infants during ECMO. PMID:28278259

  11. Extracorporeal membrane oxygenation for pulmonary hemorrhage in microscopic polyangiitis

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    @@ Microscopic polyangiitis (MPA) is characterized by an inflammatory process of the vessel walls and is classified according to the smallest vessels involved. Diagnosis is based on clinical manifestations, anti-neutrophil cytoplasmic autoantibody (ANCA) testing, and histology. In this disease, pulmonary hemorrhage is seen in 30% of patients and is associated with an eight-fold increase in mortality. Classically, MPA involves the kidneys and upper and lower respiratory tracts. Due to the perceived risk of increased bleeding secondary to the use of systemic anticoagulation, extra corporeal membrane oxygenation (ECMO) is often not used to treat patients with hemorrhage suffered from MPA. Here we report a case of a 50-year-old woman with MPA that was successfully supported with ECMO.

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

    Directory of Open Access Journals (Sweden)

    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.

  13. Intra-abdominal hypertension complicating pancreatitis-induced acute respiratory distress syndrome in three patients on extracorporeal membrane oxygenation.

    Science.gov (United States)

    Feddy, Lee; Barker, Julian; Fawcett, Pete; Malagon, Ignacio

    2016-01-01

    Severe acute pancreatitis is associated with sever multiorgan failure from 15 to 50%, depending on the series. In some of these patients, conventional methods of ventilation and respiratory support will fail, demanding the use of extracorporeal membrane oxygenation (ECMO). Abdominal compartment syndrome is potentially harmful in this cohort of patients. We describe the successful treatment of three patients with severe acute pancreatitis who underwent respiratory ECMO and where intra abdominal pressure was monitored regularly. Retrospective review of case notes. Three patients with severe acute pancreatitis requiring ECMO suffered from increased intra abdominal pressure during their ICU stay. No surgical interventions were taken to relieve abdominal compartment syndrome. Survival to hospital discharge was 100%. Monitoring intraabdominal pressure is a valuable adjunct to decision making while caring for these high-risk critically ill patients.

  14. 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.

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

    Institute of Scientific and Technical Information of China (English)

    Fabrizio Sansone

    2012-01-01

    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.

  16. The effect of inhaled nitric oxide on the course of extracorporeal membrane oxygenation and the occurrence of hemorrhagic complications.

    NARCIS (Netherlands)

    Mol, A.C. de; Heyst, A.F.J. van; Haan, T.F. de; Staak, F.H.J.M. van der; Liem, K.D.

    2009-01-01

    This study evaluated the relation between prior inhaled nitric oxide (iNO) and the time to initiation and duration of treatment with veno-arterial extracorporeal membrane oxygenation (ECMO) and the occurrence of hemorrhagic complications. A retrospective study was conducted in 59 human newborns trea

  17. Prognostic significance of early lactate clearance rate for severe acute respiratory failure patients on extracorporeal membrane oxygenation

    Institute of Scientific and Technical Information of China (English)

    臧芝栋

    2014-01-01

    Objective To investigate the prognostic significanceof early lactate clearance rate for severe acute respiratory failure patients on extracorporeal membrane oxygenation(ECMO).Methods Forty-three patients with severe acute respiratory failure supported by venous-venous(v-v)ECMO were enrolled from January 2007 to January 2013.Arterial blood lactate at pre-ECMO support(0 h)and at

  18. 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 foll

  19. 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 ad

  20. Oxygenation and hemodynamics in left and right cerebral hemispheres during induction of veno-arterial extracorporeal membrane oxygenation.

    NARCIS (Netherlands)

    Heijst, A.F.J. van; Liem, D.; Hopman, J.C.W.; Staak, F.H.J.M. van der; Sengers, R.C.A.

    2004-01-01

    OBJECTIVE: Oxygenation and hemodynamics in the left and right cerebral hemispheres were measured during induction of veno-arterial extracorporeal membrane oxygenation (VA-ECMO). STUDY DESIGN: Using near infrared spectrophotometry, effects of right common carotid artery (RCCA) and right internal

  1. Ductus arteriosus with left-to-right shunt during venoarterial extracorporeal membrane oxygenation: effects on cerebral oxygenation and hemodynamics.

    NARCIS (Netherlands)

    Heyst, A.F.J. van; Staak, F.H.J.M. van der; Hopman, J.C.W.; Tanke, R.B.; Sengers, R.C.A.; Liem, K.D.

    2003-01-01

    OBJECTIVE: To investigate the effect on cerebral oxygenation and hemodynamics of a patent ductus arteriosus with left-to-right shunt during venoarterial extracorporeal membrane oxygenation in a lamb model. DESIGN: Prospective intervention study in animals. SETTING: Animal research laboratory of a

  2. [The use of extracorporeal membrane oxygenation (ECMO) in the treatment of acute respiratory distress syndrome due to pandemic influenza].

    Science.gov (United States)

    Knapik, Piotr; Przybylski, Roman; Nadziakiewicz, Paweł; Koba, Rafał; Maciejewski, Tomasz; Borowicz, Marcin; Włoczka, Grzegorz; Pawlak, Szymon; Zembala, Marian

    2011-01-01

    Pandemic influenza particularly often is associated with symptoms of acute respiratory failure, and in case of refractory hypoxemia patients may have indications for the extracorporeal membrane oxygenation (ECMO). The paper presents a case of a pandemic influenza virus infection, where classical indications for veno-venous ECMO occured. Practical aspects of this kind of treatment in the intensive care unit are discussed.

  3. Distal limb perfusion: Achilles' heel in peripheral venoarterial extracorporeal membrane oxygenation.

    Science.gov (United States)

    Mohite, Prashant N; Fatullayev, Javid; Maunz, Olaf; Kaul, Sundip; Sabashnikov, Anton; Weymann, Alexander; Saez, Diana G; Patil, Nikhil P; Zych, Bartlomiej; Popov, Aron F; DeRobertis, Fabio; Bahrami, Toufan; Amrani, Mohamed; Simon, Andre R

    2014-11-01

    Extracorporeal membrane oxygenation (ECMO) is a temporary mechanical circulatory assist method that offers circulatory as well as respiratory support efficiently via peripheral access; however, it is liable to complications. Limb ischemia is one of the notorious complications of ECMO but can be avoided utilizing a proper distal limb perfusion method. A retrospective study of patients undergoing peripheral venoarterial (VA) ECMO for various reasons between June 2010 and December 2012 was performed. All patients were evaluated by our multidisciplinary team for suitability as candidates for ECMO. A peripheral VA-ECMO circuit was implanted via groin: inflow cannula in the femoral vein, an outflow cannula and distal-perfusion cannula, or an introducer sheath in the femoral artery. During the study period, 83 patients underwent various types of ECMO; 45 received peripheral VA-ECMO. Distal limb perfusion was achieved with an introducer sheath (6-8 Fr) in 13 cases and with a distal-perfusion cannula (10-12 Fr) in 32 cases. Nine (20%) patients developed signs of ischemia; five (11.2%) were treated conservatively, while four (8.8%) required surgical intervention. One patient required a below-knee amputation. The incidences of limb ischemia and limb ischemia requiring surgical intervention were significantly higher for the introducer sheath compared with the cannula (30.6 vs. 15.6% and 15.4 vs. 6.25%, respectively). Moreover, the patients supported on ECMO with a distal-perfusion cannula spent a significantly longer time on ECMO compared with the ones in whom an introducer sheath was used (11.9 ± 9.1 vs. 7.7 ± 4.3 days). The mean cannula size was significantly greater than the mean introducer sheath size (11.1 ± 1.3 vs. 7.0 ± 1.1 Fr). Use of a distal-perfusion cannula is a most reliable method of limb perfusion in peripheral VA-ECMO. The cannula can ensure adequate and smooth perfusion of the limb owing to its large caliber, its less turbulent flow, the ability it

  4. Extracorporeal membrane oxygenation during double-lung transplantation: single center experience

    Institute of Scientific and Technical Information of China (English)

    XU Ling-feng; LI Xin; GUO Zhen; XU Mei-yin; GAO Cheng-xin; ZHU Jin-hong; JI Bing-yang

    2010-01-01

    Background For patients with end-stage lung diseases, lung transplantation is the final therapeutic option. Sequential double-lung transplantation is recognized as an established procedure to avoid cardiopulmonary bypass (CPB). But some of the sequential double-lung transplantations require CPB support during the surgical procedure for various reasons. However, conventional CPB may increase the risk of bleeding and early allograft dysfunction. Extracorporeal membrane oxygenation (ECMO) is more advantageous than conventional CPB during the perioperative period of transplantation. Replacing traditional CPB with ECMO is promising for those patients needing cardiopulmonary support during a sequential double-lung transplantation procedure. This study aimed to summarize the preliminary experience of ECMO practice in lung transplantation.Methods Between November 2002 and October 2008, twelve patients with end-stage lung diseases undergoing sequential double-lung transplantation were subjected to ECMO during the surgical procedure. Eleven patients were prepared were prepared for the procedure via transverse thoracostomy (clamshell) and cannulated through the ascending aorta and right atrium for ECMO. The first patient who underwent bilateral thoracotomy for bilateral sequential lung transplantation required emergency ECMO via the femoral artery and vein during the second lung implantation. The Medtronic centrifugal pump and ECMO package (CB1V97R1, Medtronic, Inc., USA) were used for all of the patients.Results During ECMO,the blood flow rate was set between 1.88-2.0 L·m~(-2)·min~(-1) to keep hemodynamic and oxyhgen saturation stable; colloid oncotic pressure was maintained at more than 18 mmHg with albumin and hematocrit (HCT) kept at 28% or more. Two patients died early in this series and the other 10 patients were weaned from ECMO successfully. The duration of ECMO was 1.38-67.00 hours, and postoperative intubation was 10.5-67.0 hours.Conclusions As an established

  5. Neonatal extracorporeal membrane oxygenation devices, techniques and team roles: 2011 survey results of the United States' Extracorporeal Life Support Organization centers.

    Science.gov (United States)

    Lawson, Scott; Ellis, Cory; Butler, Katie; McRobb, Craig; Mejak, Brian

    2011-12-01

    In early 2011, surveys of active Extracorporeal Life Support Organization (ELSO) centers within the United States were conducted by electronic mail regarding neonatal Extracorporeal Membrane Oxygenation (ECMO) equipment and professional staff. Seventy-four of 111 (67%) U.S. centers listed in the ELSO directory as neonatal centers responded to the survey. Of the responding centers, 53% routinely used roller pumps for neonatal ECMO, 15% reported using centrifugal pumps and 32% reported using a combination of both. Of the centers using centrifugal pumps, 51% reported that they do not use a compliance bladder in the circuit. The majority (95%) of roller pump users reported using a compliance bladder and 97% reported using Tygon" S-97-E tubing in the raceway of their ECMO circuits. Silicone membrane oxygenators were reportedly used by 25% of the respondents, 5% reported using micro-porous hollow fiber oxygenators (MPHF), 70% reported using polymethylpentene (PMP) hollow fiber oxygenators and 5% reported using a combination of the different types. Some form of in-line blood monitoring was used by 88% of the responding centers and 63% of responding centers reported using a circuit surface coating. Anticoagulation monitoring via the activated clotting time (ACT) was reported by 100% of the reporting centers. The use of extracorporeal cardiopulmonary resuscitation (ECPR) was reported by 53% of the responding centers with 82% of those centers using a crystalloid primed circuit to initiate ECPR. A cooling protocol was used by 77% of the centers which have an ECPR program. When these data are compared with surveys from 2002 and 2008 it shows that the use of silicone membrane oxygenators continues to decline, the use of centrifugal pumps continues to increase and ECMO personnel continues to be comprised of multidisciplinary groups of dedicated allied health care professionals.

  6. Extracorporeal membrane oxygenation (ECMO) for critically ill adults in the emergency department: history, current applications, and future directions.

    Science.gov (United States)

    Mosier, Jarrod M; Kelsey, Melissa; Raz, Yuval; Gunnerson, Kyle J; Meyer, Robyn; Hypes, Cameron D; Malo, Josh; Whitmore, Sage P; Spaite, Daniel W

    2015-12-17

    Extracorporeal membrane oxygenation (ECMO) is a mode of extracorporeal life support that augments oxygenation, ventilation and/or cardiac output via cannulae connected to a circuit that pumps blood through an oxygenator and back into the patient. ECMO has been used for decades to support cardiopulmonary disease refractory to conventional therapy. While not robust, there are promising data for the use of ECMO in acute hypoxemic respiratory failure, cardiac arrest, and cardiogenic shock and the potential indications for ECMO continue to increase. This review discusses the existing literature on the potential use of ECMO in critically ill patients within the emergency department.

  7. A pilot investigation of mild hypothermia in neonates receiving extracorporeal membrane oxygenation (ECMO).

    Science.gov (United States)

    Horan, Marie; Ichiba, Shingo; Firmin, Richard K; Killer, Hilliary M; Edwards, David; Azzopardi, Denis; Hodge, Rachel; Kotecha, Sailesh; Field, David

    2004-03-01

    To investigate the safety and feasibility of using mild hypothermia in neonates receiving extracorporeal membrane oxygenation (ECMO). Study design A prospective, nonrandomized pilot study of 25 neonates referred for ECMO. Whole body cooling was achieved by adjustment of the temperature of the extracorporeal circuit water bath. Five groups (N=5 per group) were each studied for the first 5 days of ECMO. The first group was maintained at 37 degrees C throughout the study period. Subsequent groups were cooled to 36 degrees C, to 35 degrees C, and, finally, to 34 degrees C, respectively, for 24 hours and the final group to 34 degrees C for 48 hours before being rewarmed to 37 degrees C. Patients were carefully assessed clinically and biologically. In addition to routine laboratory tests, cytokines (IL-6 and IL-8), complement (C3a), and molecular markers of coagulation (thrombin/antithrombin III [TAT], antithrombin III, and plasmin-alpha2plasminogen) were measured. No major clinical or circuit problems were noted during cooling or rewarming. In particular, there were no problems of bleeding or cardiac arrhythmia. No significant difference was found between groups in terms of molecular markers of coagulation, complement, cytokines, and platelet transfusions. Applying mild hypothermia (34 degrees C) for 24 or 48 hours to neonates receiving ECMO is both feasible and safe.

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

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    Nijhuis-van der Sanden, Maria WG; van der Cammen-van Zijp, Monique HM; Janssen, Anjo JWM; Reuser, Jolanda JCM; Mazer, Petra; van Heijst, Arno FJ; Gischler, Saskia J; Tibboel, Dick; Kollée, Louis AA

    2009-01-01

    Introduction 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 aspiration syndrome (MAS), congenital diaphragmatic hernia (CDH), sepsis or persistent pulmonary hypertension (PPH). In five-year-old children who underwent VA-ECMO therapy as neonates, we assessed motor performance related to growth, intelligence and behaviour, and the association with the primary diagnosis. Methods In a prospective population-based study (n = 224) 174 five-year-old survivors born between 1993 and 2000 and treated in the two designated ECMO centres in the Netherlands (Radboud University Medical Centre Nijmegen and Sophia Children's Hospital, Erasmus MC – University Medical Center Rotterdam) were invited to undergo follow-up assessment including a paediatric assessment, the movement assessment battery for children (MABC), the revised Amsterdam intelligence test (RAKIT) and the child behaviour checklist (CBCL). Results Twenty-two percent of the children died before the age of five, 86% (n = 149) of the survivors were assessed. Normal development in all domains was found in 49% of children. Severe disabilities were present in 13%, and another 9% had impaired motor development combined with cognitive and/or behavioural problems. Chi-squared tests showed adverse outcome in MABC scores (P < 0.001) compared with the reference population in children with CDH, sepsis and PPH, but not in children with MAS. Compared with the Dutch population height, body mass index (BMI) and weight for height were lower in the CDH group (P < 0.001). RAKIT and CBCL scores did not differ from the reference population. Total MABC scores, socio-economic status, growth and CBCL scores were not related to each other, but negative motor outcome was related to lower intelligence quotient (IQ) scores (r

  9. Nationwide Evaluation of Congenital Hypothyroidism Screening during Neonatal Extracorporeal Membrane Oxygenation

    Science.gov (United States)

    Leeuwen, Lisette; van Heijst, Arno F.J.; Vijfhuize, Sanne; Beurskens, Leonardus W.J.E.; Weijman, Gert; Tibboel, Dick; van den Akker, Erica L.T.; IJsselstijn, Hanneke

    2016-01-01

    Background Thyroid hormone concentrations may deviate from normal values during critical illness. This condition is known as nonthyroidal illness syndrome (NTIS), and it can influence the results of screening for congenital hypothyroidism (CH) during neonatal extracorporeal membrane oxygenation (ECMO). Objectives To determine the incidence of aberrant CH screening results in ECMO-treated neonates, to identify possible determinants, and to follow up patients with abnormal thyroid hormone concentrations. Methods In this retrospective cohort study, we included 168 ECMO-treated neonates admitted from 2004 to 2014 and screened by protocol and divided them into the following 3 groups: group 1 (screened during ECMO, n = 107), group 2 (screened shortly before ECMO, n = 26), and group 3 (screened shortly after ECMO, n = 35). Results CH screening results were aberrant in 67.3% (72/107) of the neonates screened during ECMO, in 73.1% (19/26) of the neonates screened before ECMO, and in 31.4% (11/35) of the neonates screened after ECMO (p < 0.001). Of the neonates with an aberrant screening result, all but 2 (i.e. 98%) had a low thyroxine concentration with a normal thyrotropin concentration at screening, as is seen in NTIS. None was diagnosed with CH. Mortality did not significantly differ between neonates with an aberrant screening result (32.4%) and neonates with a normal screening result (22.7%; p = 0.18). Screening before ECMO (OR 5.92; 95% CI 1.93-18.20), screening during ECMO (OR 4.49; 95% CI 1.98-10.19), and a higher Pediatric Logistic Organ Dysfunction-2 score (OR 1.31; 95% CI 1.04-1.66) were associated with an aberrant screening result. Conclusions Aberrant CH screening results were found in most ECMO-treated neonates screened before or during ECMO, which is likely due to NTIS. Follow-up of thyroid hormone concentrations is best started after recovery from critical illness. Our results suggest that thyroxine therapy is not required during ECMO. PMID:27639769

  10. State of the art: strategies for extracorporeal membrane oxygenation in respiratory failure.

    Science.gov (United States)

    Rehder, Kyle J; Turner, David A; Bonadonna, Desiree; Walczak, Richard J; Cheifetz, Ira M

    2012-11-01

    Extracorporeal membrane oxygenation (ECMO) is an important rescue therapy for patients with cardiac and/or respiratory failure, with a growing body of literature supporting its use. Despite widespread use of ECMO, there remains a paucity of data on optimal management strategies for ECMO patients. Management of ECMO patients involves an understanding of the complex interaction between this technology and the critically ill patients being supported. ECMO providers typically rely on a combination of consensus guidelines and institutional experience to make management decisions. Substantial controversy continues to exist regarding many elements of ECMO management, including seemingly straightforward decisions such as the initial implementation of this technology. In addition, there are multiple providers involved in the management of ECMO patients who must be co-ordinated for this supportive therapy to be most effective. This manuscript provides an overview of current techniques for treating respiratory ECMO patients.

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

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    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.

  12. Contemporary extracorporeal membrane oxygenation therapy in adults: Fundamental principles and systematic review of the evidence.

    Science.gov (United States)

    Squiers, John J; Lima, Brian; DiMaio, J Michael

    2016-07-01

    Extracorporeal membrane oxygenation (ECMO) provides days to weeks of support for patients with respiratory, cardiac, or combined cardiopulmonary failure. Since ECMO was first reported in 1974, nearly 70,000 runs of ECMO have been implemented, and the use of ECMO in adults increased by more than 400% from 2006 to 2011 in the United States. A variety of factors, including the 2009 influenza A epidemic, results from recent clinical trials, and improvements in ECMO technology, have motivated this increased use in adults. Because ECMO is increasingly becoming available to a diverse population of critically ill patients, we provide an overview of its fundamental principles and a systematic review of the evidence basis of this treatment modality for a variety of indications in adults.

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

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    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.

  14. 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.

  15. Neonatal extracorporeal membrane oxygenation: A case report and current state in Mainland China

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    Jianguo Zhou

    2016-01-01

    Full Text Available We report the first successful treatment of extracorporeal membrane oxygenation (ECMO in a neonate with Group B streptococcus (GBS sepsis and cardiorespiratory failure, and further conduct a literature review in the experience of neonatal ECMO utility in Mainland China. A term neonate with cardiorespiratory failure secondary to GBS sepsis was put on venous-arterial ECMO at 23 h of age. After 273 h of ECMO running, the patient was saved and without major complications. The comprehensive literature review demonstrated that there were 22 neonates received ECMO previously in Mainland China, 14 of 22 of the patients are cases with congenital heart defects. The overall survival rate was 41% (9/22. Neonatal ECMO was underdeveloped in Mainland, China. Moreover, it does provide a chance of survival for neonates who have a grave prognosis by conventional treatment.

  16. Extracorporeal Membrane Oxygenation as a Bridge for Heart Failure and Cardiogenic Shock.

    Science.gov (United States)

    Zhong, Zhao-Peng; Wang, Hong; Hou, Xiao-Tong

    2016-01-01

    Heart failure (HF) can be defined as cardiac structural or functional abnormality leading to a series of symptoms due to deficiency of oxygen delivery. In the clinical practice, acute heart failure (AHF) is usually performed as cardiogenic shock (CS), pulmonary edema, and single or double ventricle congestive heart failure. CS refers to depressed or insufficient cardiac output (CO) attributable to myocardial infarction, fulminant myocarditis, acute circulatory failure attributable to intractable arrhythmias or the exacerbation of chronic heart failure, postcardiotomy low CO syndrome, and so forth. Epidemiological studies have shown that CS has higher in-hospital mortality in patients with AHF. Besides, we call the induced, sustained circulatory failure even after administration of high doses of inotropes and vasopressors refractory cardiogenic shock. In handling these cases, mechanical circulatory support devices are usually needed. In this review, we discuss the current application status and clinical points in utilizing extracorporeal membrane oxygenation (ECMO).

  17. Extracorporeal Membrane Oxygenation as a Bridge for Heart Failure and Cardiogenic Shock

    Directory of Open Access Journals (Sweden)

    Zhao-peng Zhong

    2016-01-01

    Full Text Available Heart failure (HF can be defined as cardiac structural or functional abnormality leading to a series of symptoms due to deficiency of oxygen delivery. In the clinical practice, acute heart failure (AHF is usually performed as cardiogenic shock (CS, pulmonary edema, and single or double ventricle congestive heart failure. CS refers to depressed or insufficient cardiac output (CO attributable to myocardial infarction, fulminant myocarditis, acute circulatory failure attributable to intractable arrhythmias or the exacerbation of chronic heart failure, postcardiotomy low CO syndrome, and so forth. Epidemiological studies have shown that CS has higher in-hospital mortality in patients with AHF. Besides, we call the induced, sustained circulatory failure even after administration of high doses of inotropes and vasopressors refractory cardiogenic shock. In handling these cases, mechanical circulatory support devices are usually needed. In this review, we discuss the current application status and clinical points in utilizing extracorporeal membrane oxygenation (ECMO.

  18. 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.

  19. 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.

  20. Treatment of Adenoviral Acute Respiratory Distress Syndrome Using Cidofovir With Extracorporeal Membrane Oxygenation.

    Science.gov (United States)

    Lee, Minhyeok; Kim, Seulgi; Kwon, Oh Jung; Kim, Ji Hye; Jeong, Inbeom; Son, Ji Woong; Na, Moon Jun; Yoon, Yoo Sang; Park, Hyun Woong; Kwon, Sun Jung

    2017-03-01

    Adenovirus infections are associated with respiratory (especially upper respiratory) infection and gastrointestinal disease and occur primarily in infants and children. Although rare in adults, severe lower respiratory adenovirus infections including pneumonia are reported in specific populations, such as military recruits and immunocompromised patients. Antiviral treatment is challenging due to limited clinical experience and lack of well-controlled randomized trials. Several previously reported cases of adenoviral pneumonia showed promising efficacy of cidofovir. However, few reports discussed the efficacy of cidofovir in acute respiratory distress syndrome (ARDS). We experienced 3 cases of adenoviral pneumonia associated with ARDS and treated with cidofovir and respiratory support, including extracorporeal membrane oxygenation (ECMO). All 3 patients showed a positive clinical response to cidofovir and survival at 28 days. Cidofovir with early ECMO therapy may be a therapeutic option in adenoviral ARDS. A literature review identified 15 cases of adenovirus pneumonia associated with ARDS.

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

    Science.gov (United States)

    Northey, Luke Cameron; Shiraev, Timothy; Omari, Abdullah

    2015-01-01

    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.

  2. Extracorporeal Membrane Oxygenation Support in Adult Patients with Hematologic Malignancies and Severe Acute Respiratory Failure

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    Tai Sun Park

    2016-08-01

    Full Text Available Background: Administering extracorporeal membrane oxygenation (ECMO to critically ill patients with acute respiratory distress syndrome has substantially increased over the last decade, however administering ECMO to patients with hematologic malignancies may carry a particularly high risk. Here, we report the clinical outcomes of patients with hematologic malignancies and severe acute respiratory failure who were treated with ECMO. Methods: We performed a retrospective review of the medical records of patients with hematologic malignancies and severe acute respiratory failure who were treated with ECMO at the medical intensive care unit of a tertiary referral hospital between March 2010 and April 2015. Results: A total of 15 patients (9 men; median age 45 years with hematologic malignancies and severe acute respiratory failure received ECMO therapy during the study period. The median values of the Acute Physiology and Chronic Health Evaluation II score, Murray Lung Injury Score, and Respiratory Extracorporeal Membrane Oxygenation Survival Prediction Score were 29, 3.3, and -2, respectively. Seven patients received venovenous ECMO, whereas 8 patients received venoarterial ECMO. The median ECMO duration was 2 days. Successful weaning of ECMO was achieved in 3 patients. Hemorrhage complications developed in 4 patients (1 pulmonary hemorrhage, 1 intracranial hemorrhage, and 2 cases of gastrointestinal bleeding. The longest period of patient survival was 59 days after ECMO initiation. No significant differences in survival were noted between venovenous and venoarterial ECMO groups (10.0 vs. 10.5 days; p = 0.56. Conclusions: Patients with hematologic malignancies and severe acute respiratory failure demonstrate poor outcomes after ECMO treatment. Careful and appropriate selection of candidates for ECMO in these patients is necessary.

  3. The "basic" approach: a single-centre experience with a cost-reducing model for paediatric cardiac extracorporeal membrane oxygenation.

    Science.gov (United States)

    Padalino, Massimo A; Tessari, Chiara; Guariento, Alvise; Frigo, Anna C; Vida, Vladimiro L; Marcolongo, Andrea; Zanella, Fabio; Harvey, Michael J; Thiagarajan, Ravi R; Stellin, Giovanni

    2017-04-01

    Extracorporeal membrane oxygenation (ECMO) is a lifesaving but expensive therapy in terms of financial, technical and human resources. We report our experience with a 'basic' ECMO support model, consisting of ECMO initiated and managed without the constant presence of a bedside specialist, to assess safety, clinical outcomes and financial impact on our health system. We did a retrospective single-centre study of paediatric cardiac ECMO between January 2001 and March 2014. Outcomes included postimplant complications and survival at weaning and at discharge. We used activity based costing to compare the costs of current basic ECMO with those of a 'full optional' dedicated ECMO team (hypothesis 1); ECMO with a bedside nurse and perfusionist (hypothesis 2), and ECMO with a bedside perfusionist (hypothesis 3). Basic cardiac ECMO was required for 121 patients (median age 75 days, median weight 4.4 kg). A total of 107 patients (88%) had congenital heart disease; 37 had univentricular physiology. The median duration of ECMO was 7 days (interquartile range [IQR], 4-15 days). Overall survival at weaning and at 30 days in the neonatal and paediatric age groups was 58.6% and 30.6%, respectively; these results were not significantly different from Extracorporeal Life Support Organization data. Cost analysis revealed a saving of €30 366, €22 144 and €13 837 for each patient on basic ECMO for hypotheses 1, 2 and 3, respectively. Despite reduced human, technical and economical resources, a basic ECMO model without a bedside specialist was associated with satisfactory survival and lower costs.

  4. 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.

  5. An experimental study on pumpless extracorporeal membrane oxygenation (ECMO support in a canine model.

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    Tamesue,Kiyokazu

    2006-06-01

    Full Text Available

    This study was carried out to determine whether an extracorporeal membrane oxygenation (ECMO support could be sufficiently conducted by the right ventricle alone from the viewpoint of the hemodynamics and blood gas state. Six infant dogs underwent a bypass between the left pulmonary artery and left atrium with an in-line oxygenator after a left pneumonectomy. Partial ECMO support was conducted simply by opening the circuit, and total ECMO support was conducted by ligating the right pulmonary artery. After the establishment of partial ECMO, approximately one-third of the right ventricular output was passively shunted through the bypass circuit, and the cardiac index and central venous pressure did not change. The mean pulmonary arterial pressures increased significantly. After a complete ligation of the right pulmonary artery, all 6 dogs survived for 12 h, but the cardiac output and blood pressure decreased significantly. The blood gas state was sufficiently maintained throughout the experiment. The results suggest the possibility of using the pumpless ECMO support. However, the flow resistance of the membrane oxygenator proved to still be too high for use in a total pumpless ECMO. Further studies on long-term ECMO and the development of a membrane oxygenator with a considerably low flow-resistance are needed.

  6. Factors associated with blood oxygen partial pressure and carbon dioxide partial pressure regulation during respiratory extracorporeal membrane oxygenation support: data from a swine model

    OpenAIRE

    Park, Marcelo; Mendes, Pedro Vitale; Costa, Eduardo Leite Vieira; Barbosa, Edzangela Vasconcelos Santos; Hirota,Adriana Sayuri; Azevedo, Luciano Cesar Pontes

    2016-01-01

    Objective The aim of this study was to explore the factors associated with blood oxygen partial pressure and carbon dioxide partial pressure. Methods The factors associated with oxygen - and carbon dioxide regulation were investigated in an apneic pig model under veno-venous extracorporeal membrane oxygenation support. A predefined sequence of blood and sweep flows was tested. Results Oxygenation was mainly associated with extracorporeal membrane oxygenation blood flow (beta coefficient = 0.0...

  7. North American neonatal extracorporeal membrane oxygenation (ECMO) devices and team roles: 2008 survey results of Extracorporeal Life Support Organization (ELSO) centers.

    Science.gov (United States)

    Lawson, D Scott; Lawson, Andrea F; Walczak, Rich; McRobb, Craig; McDermott, Patty; Shearer, Ian R; Lodge, Andrew; Jaggers, James

    2008-09-01

    In early 2008, surveys of active extracorporeal membrane oxygenation (ECMO) centers in North America were conducted by electronic mail regarding neonatal ECMO equipment and professional staff. Eighty of 103 (78%) North American ECMO centers listed in the Extracorporeal Life Support Organization directory as neonatal centers responded to the survey. Of the responding centers, 82.5% routinely used roller pumps for neonatal ECMO, and the remaining 17.5% used centrifugal pumps. Silicone membrane oxygenators were used by 67% of the respondents, whereas 19% used micro-porous hollow fiber oxygenators, and 14% used polymethylpentene hollow fiber oxygenators. Of the silicone membrane oxygenator users, 86% used the Medtronic Ecmotherm heat exchanger, 10% used the Gish HE-4 heat exchanger, and 4% used the Terumo Conducer device. Sixty-four percent of the responding centers used some form of in-line blood gas monitoring. Six percent of the centers used a bubble trap in the arterial line, and 5% used an arterial line filter. A bladder was used by 85% of the centers, and 4% of these used a mechanical bladder box for servo regulation; the remaining 96% used pressure servo regulation. An air bubble detector was used by 88% of the responding centers. A surface coating was used by 44% of the centers on all their neonatal ECMO patients. Thirty-one percent of the centers use an activated clotting time of 180-220 seconds. At 54% of the responding centers, perfusionists were involved with the ECMO program, registered nurses were involved at 70% of the centers, and respiratory therapists were involved at 46% of the centers. Compared with a 2002 survey, silicone membrane use is declining, and the use of centrifugal blood pumps and coated ECMO circuits is becoming more apparent. ECMO teams are still multidisciplinary, made up of combinations of registered nurses, respiratory therapists, and perfusionists.

  8. Extracorporeal membrane oxygenation in children with heart disease and down syndrome: a multicenter analysis.

    Science.gov (United States)

    Gupta, Punkaj; Gossett, Jeffrey M; Rycus, Peter T; Prodhan, Parthak

    2014-12-01

    The data on the outcomes of children with heart disease and Down syndrome receiving extracorporeal membrane oxygenation (ECMO) for cardiac or respiratory failure are limited. This study aimed to evaluate morbidity and mortality associated with ECMO in children with Down syndrome and heart disease. Children younger than 18 years undergoing heart surgery and ECMO reported in the Extracorporeal Life Support Organization (ELSO) registry (1998-2011) were included in the study. The registry was queried for the following five heart defects: common atrioventricular (AV) canal, tetralogy of Fallot, truncus arteriosus, transposition of great vessels, and interrupted aortic arch. Data collection included patient characteristics, ECMO characteristics, and outcomes. The outcomes evaluated included mortality, ECMO duration, and length of hospital stay for patients with Down syndrome and those with no Down syndrome. The study enrolled 2,815 patients qualified for inclusion. Of these patients, 121 had Down syndrome, whereas 2,694 had no genetic syndrome and were included in the control group. The median age of the patients was 45 days (interquartile range [IQR] 9-192 days), and the median weight was 3.8 kg (IQR 3.0-6.1 kg). The most common cardiac defects in Down syndrome group were common AV canal (63 %) and tetralogy of Fallot (40 %). The Down syndrome group included older patients with greater body weight than the control group. The mortality rate was lower in the Down syndrome group than in the control group (44 vs. 56 %; p = 0.01). The duration of ECMO and length of hospital stay were similar in the two groups. The findings showed that ECMO can be used for children with heart disease and Down syndrome with good results. The outcomes were comparable between the children with Down syndrome and the children without Down syndrome.

  9. 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.

  10. Experience with renal failure during extracorporeal membrane oxygenation: treatment with continuous hemofiltration.

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    Sell, L L; Cullen, M L; Whittlesey, G C; Lerner, G R; Klein, M D

    1987-07-01

    We use extracorporeal membrane oxygenation (ECMO) to treat respiratory and cardiac failure in children who are unresponsive to standard ventilator and pharmacologic management. All patients have cardiac and abdominal ultrasonography prior to ECMO to identify major structural anomalies and anatomically normal kidneys. Despite this, oliguric renal failure is seen in a number of patients. Acute renal failure (ARF) developed in two of the first 20 patients we placed on ECMO and both of these patients died. Six of the last 27 patients (22%) also developed ARF and were treated with continuous hemofiltration (CH) placed in-line with the extracorporeal circuit. The technique of CH removes plasma water and dissolved solutes while retaining proteins and cellular components of the intravascular space. The duration of CH ranged from 9 to 112 hours (mean 57.5 hours). Indications for CH were hypervolemia, hyperkalemia, and azotemia. The mean serum potassium prior to CH was 5.6 (range 4.3 to 7.0) compared with 4.5 after filtration. We filtered 5 to 10 mL/kg/h and replaced it with crystalloid chosen on the basis of serum and filtrate electrolytes. These six patients had a 33% mean weight gain prior to CH. We were able to remove as much as 2,200 g in the most edematous patient with significant improvement in cardiopulmonary status. Four of the patients on CH died of their primary pulmonary or cardiac disease without specific problems related to ARF. The other two patients were successfully weaned from ECMO, extubated, and have not needed further therapy for renal failure. We conclude that CH is useful in managing the complications of oliguric renal failure during ECMO.

  11. Intestinal epithelial apoptosis initiates gut mucosal injury during extracorporeal membrane oxygenation in the newborn piglet.

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    MohanKumar, Krishnan; Killingsworth, Cheryl R; McIlwain, R Britt; Timpa, Joseph G; Jagadeeswaran, Ramasamy; Namachivayam, Kopperuncholan; Kurundkar, Ashish R; Kelly, David R; Garzon, Steven A; Maheshwari, Akhil

    2014-02-01

    Neonates and young infants exposed to extracorporeal circulation during extracorporeal membrane oxygenation (ECMO) and cardiopulmonary bypass are at risk of developing a systemic inflammatory response syndrome with multi-organ dysfunction. We used a piglet model of ECMO to investigate the hypothesis that epithelial apoptosis is an early event that precedes villous damage during ECMO-related bowel injury. Healthy 3-week-old piglets were subjected to ECMO for up to 8 h. Epithelial apoptosis was measured in histopathological analysis, nuclear imaging, and terminal deoxynucleotidyl transferase dUTP nick end labeling. Plasma intestinal fatty acid-binding protein (I-FABP) levels were measured by enzyme immunoassay. Intestinal mast cells were isolated by fluorescence-assisted cell sorting. Cleaved caspase-8, caspase-9, phospho-p38 MAPK, and fas ligand expression were investigated by immunohistochemistry, western blots, and reverse transcriptase-quantitative PCR. Piglet ECMO was associated with increased gut epithelial apoptosis. Extensive apoptotic changes were noted on villus tips and in scattered crypt cells after 2 h of ECMO. After 8 h, the villi were denuded and apoptotic changes were evident in a majority of crypt cells. Increased circulating I-FABP levels, a marker of gut epithelial injury, showed that epithelial injury occurred during ECMO. We detected increased cleaved caspase-8, but not cleaved caspase-9, in epithelial cells indicating that the extrinsic apoptotic pathway was active. ECMO was associated with increased fas ligand expression in intestinal mast cells, which was induced through activation of the p38 mitogen-activated protein kinase. We conclude that epithelial apoptosis is an early event that initiates gut mucosal injury in a piglet model of ECMO.

  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 (<2.5 kg) body weight (P = 0.02) and rescue ECMO after cardiac

  13. Interdisciplinary Peripartum Management of Acute Respiratory Distress Syndrome with Extracorporeal Membrane Oxygenation – a Case Report and Literature Review

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    Weyrich, J.; Bogdanski, R.; Ortiz, J. U.; Kuschel, B.; Schneider, K. T. M.; Lobmaier, S. M.

    2016-01-01

    Extracorporeal membrane oxygenation (ECMO) is increasingly used for the management of acute severe cardiac and respiratory failure. One of the indications is acute respiratory distress syndrome (ARDS) for which, in some severe cases, ECMO represents the only possibility to save lives. We report on the successful long-term use of ECMO in a postpartum patient with recurrent pulmonary decompensation after peripartum uterine rupture with extensive blood loss. PMID:27065489

  14. Interdisciplinary Peripartum Management of Acute Respiratory Distress Syndrome with Extracorporeal Membrane Oxygenation - a Case Report and Literature Review.

    Science.gov (United States)

    Weyrich, J; Bogdanski, R; Ortiz, J U; Kuschel, B; Schneider, K T M; Lobmaier, S M

    2016-03-01

    Extracorporeal membrane oxygenation (ECMO) is increasingly used for the management of acute severe cardiac and respiratory failure. One of the indications is acute respiratory distress syndrome (ARDS) for which, in some severe cases, ECMO represents the only possibility to save lives. We report on the successful long-term use of ECMO in a postpartum patient with recurrent pulmonary decompensation after peripartum uterine rupture with extensive blood loss.

  15. Improving antibiotic dosing in special situations in the ICU: burns, renal replacement therapy and extracorporeal membrane oxygenation.

    Science.gov (United States)

    Jamal, Janattul-Ain; Economou, Caleb J P; Lipman, Jeffrey; Roberts, Jason A

    2012-10-01

    Antibiotic dosing for critically ill patients that is derived from other patient groups is likely to be suboptimal because of significant antibiotic pharmacokinetic changes, particularly in terms of drug volume of distribution and clearance. Organ support techniques including renal replacement therapy (RRT) and extracorporeal membrane oxygenation (ECMO) increase the pharmacokinetic variability. This article reviews the recently published antibiotic pharmacokinetic data associated with burns patients, those receiving continuous RRT (CRRT), sustained low-efficiency dialysis (SLED) and ECMO. These groups develop increases in volume of distribution that necessitate the use of higher initial doses to rapidly achieve therapeutic antibiotic concentrations. Burns patients have supranormal drug clearances requiring more frequent administration of antibiotics. Patients receiving CRRT or SLED have variable drug clearances related to different equipment and RRT settings at different institutions. ECMO presents a different challenge because there is such a dearth of data with higher than standard doses potentially required, even in the presence of end-organ failure. In the context of such variable pharmacokinetics, a guideline approach to dosing remains elusive because of insufficient available data and, therefore, use of therapeutic drug monitoring should be considered advantageous where possible.

  16. Veno-venous extracorporeal membrane oxygenation using an innovative dual-lumen cannula following implantation of a total artificial heart.

    Science.gov (United States)

    Youdle, Jemma; Penn, Sarah; Maunz, Olaf; Simon, Andre

    2017-01-01

    We report our first clinical use of the new Protek Duo(TM) cannula for peripheral veno-venous extra-corporeal life support (ECLS). A 53-year-old male patient underwent implantation of a total artificial heart (TAH) for biventricular failure. However, due to the development of post-operative respiratory dysfunction, the patient required ECLS for six days.

  17. Successful treatment of Chlamydophila pneumoniae acute respiratory distress syndrome with extracorporeal membrane oxygenator: a case report and diagnostic review

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    De Bels David

    2012-01-01

    Full Text Available Abstract Introduction Chlamydophila pneumoniae is a respiratory pathogen known to infect the upper and lower respiratory tracts. Infection severity can range from sub-clinical pulmonary infection to acute respiratory distress syndrome. Case presentation A previously healthy 62-year-old Caucasian man was admitted to our hospital for acute respiratory failure. Serum samples obtained every week starting from the day of admission showed clear-cut seroconversion for C. pneumoniae antibodies. All other cultures obtained during the first days of hospitalization were negative. Despite maximal ventilatory support (high positive end expiratory pressure, fraction of inspired oxygen of 1.0, nitric oxide inhalation, neuromuscular blocking agents and prone positioning, our patient remained severely hypoxemic, which led us to initiate an extracorporeal membrane oxygenation treatment. Extracorporeal membrane oxygenation and hemodiafiltration were withdrawn on day 12. Our patient was extubated on day 18 and discharged from our Intensive Care Unit on day 20. He went home a month later. Conclusion We describe the first published case of acute respiratory distress syndrome due to C. pneumoniae infection successfully treated by extracorporeal membrane oxygenation, a very useful tool in this syndrome. A quick and specific method for the definite diagnosis of Chlamydophila infection should be developed.

  18. 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

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    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.

  19. Extracorporeal membrane oxygenation support in refractory cardiogenic shock: treatment strategies and analysis of risk factors.

    Science.gov (United States)

    Loforte, Antonio; Marinelli, Giuseppe; Musumeci, Francesco; Folesani, Gianluca; Pilato, Emanuele; Martin Suarez, Sofia; Montalto, Andrea; Lilla Della Monica, Paola; Grigioni, Francesco; Frascaroli, Guido; Menichetti, Antonio; Di Bartolomeo, Roberto; Arpesella, Giorgio

    2014-07-01

    Two centrifugal pumps, the RotaFlow (Maquet, Jostra Medizintechnik AG, Hirrlingen, Germany) and Levitronix CentriMag (Levitronix LCC, Waltham, MA, USA), used in central or peripheral veno-arterial extracorporeal membrane oxygenation (ECMO) support systems have been investigated, in terms of double-center experience, as treatment for patients with refractory cardiogenic shock (CS). Between January 2006 and December 2012, 228 consecutive adult patients were supported on RotaFlow (n=213) or CentriMag (n=15) ECMO, at our institutions (155 men; age 58.3±10.5 years, range: 19-84 years). Indications for support were: failure to wean from cardiopulmonary bypass in the setting of postcardiotomy (n=118) and primary donor graft failure (n=37); postacute myocardial infarction CS (n=27); acute myocarditis (n=6); and CS on chronic heart failure (n=40). A peripheral ECMO setting was established in 126 (55.2%) patients while it was established centrally in 102 (44.7%). Overall mean support time was 10.9±9.7 days (range: 1-43 days). Eighty-four (36.8%) patients died on ECMO. Overall success rate, in terms of survival on ECMO (n=144), weaning from mechanical support (n=107; 46.9%), bridge to mid-long-term ventricular assist device (n=6; 2.6%), and bridge to heart transplantation (n=31; 13.5%), was 63.1%. One hundred twenty-two (53.5%) patients were successfully discharged. Stepwise logistic regression identified blood lactate level and MB isoenzyme of creatine kinase (CK-MB) relative index at 72 h after ECMO initiation, and number of packed red blood cells (PRBCs) transfused on ECMO as significant predictors of mortality on ECMO (P=0.010, odds ratio [OR]=2.94; 95% confidence interval [CI]=1.10-3.14; P=0.010, OR=2.82, 95% CI=1.014-3.721; and P=0.011, OR=2.69; 95% CI=1.06-4.16, respectively). Central ECMO population had significantly higher rate of continuous veno-venous hemofiltration need and bleeding requiring surgery events compared with the peripheral ECMO setting population

  20. Extracorporeal Membrane Oxygenation Outcomes in Acute Respiratory Distress Treatment: Case Study in a Chinese Referral Center

    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

    2017-01-01

    Background No definitive conclusions have been drawn from the available data about the utilization of extracorporeal membrane oxygenation (ECMO) to treat severe acute respiratory distress syndrome (ARDS). The aim of this study was to review our center’s experience with ECMO and determine predictors of outcome from our Chinese center. Material/Methods We retrospectively analyzed a total of 23 consecutive candidates who fulfilled the study entry criteria between January 2009 and December 2015. Detailed clinical data, ECMO flow, and respiratory parameters before and after the introduction of ECMO were compared among in-hospital survivors and nonsurvivors; factors associated with mortality were investigated. Results Hemodynamics and oxygenation parameters were significantly improved after ECMO initiation. Thirteen patients survived to hospital discharge. Univariate correlation analysis demonstrated that APACHE II score (r=−0.463, p=0.03), acute kidney injury (r=−0.574, p=0.005), membrane oxygenator replacement (r=−0.516, p=0.014) and total length of hospital stay (r=0.526, p=0.012) were significantly correlated with survival to hospital discharge, and that the evolution of the levels of urea nitrogen, platelet, and fibrinogen may help to determine patient prognosis. Sixteen patients referred for ECMO from an outside hospital were successfully transported to our institution by ambulance, including seven transported under ECMO support. The survival rate of the ECMO-transport group was comparable to the conventional transport or the non-transport group (both p=1.000). Conclusions ECMO is an effective alternative option for severe ARDS. APACHE II score on admission, onset of acute kidney injury, and membrane oxygenator replacement, and the evolution of levels of urea nitrogen, platelet, and fibrinogen during hospitalization may help to determine the in-hospital patient prognosis. By establishing a well-trained mobile ECMO team, a long-distance, inter

  1. Fluconazole population pharmacokinetics and dosing for prevention and treatment of invasive Candidiasis in children supported with extracorporeal membrane oxygenation.

    Science.gov (United States)

    Watt, Kevin M; Gonzalez, Daniel; Benjamin, Daniel K; Brouwer, Kim L R; Wade, Kelly C; Capparelli, Edmund; Barrett, Jeffrey; Cohen-Wolkowiez, Michael

    2015-07-01

    Candida infections are a leading cause of infectious disease-related death in children supported by extracorporeal membrane oxygenation (ECMO). The ECMO circuit can alter drug pharmacokinetics (PK); thus, standard fluconazole dosing may result in suboptimal drug exposures. The objective of our study was to determine the PK of fluconazole in children on ECMO. Forty children with 367 PK samples were included in the analysis. The PK data were analyzed using nonlinear mixed-effect modeling (NONMEM). A one-compartment model best described the data. Weight was included in the base model for clearance (CL) and volume of distribution (V). The final model included the effect of serum creatinine (SCR) level on CL and the effect of ECMO on V as follows: CL (in liters per hour) = 0.019 × weight × (SCR/0.4)(-0.29) × exp(ηCL) and V (in liters) = 0.93 × weight × 1.4(ECMO) × exp(ηV). The fluconazole V was increased in children supported by ECMO. Consequently, children on ECMO require a higher fluconazole loading dose for prophylaxis (12 mg/kg of body weight) and treatment (35 mg/kg) paired with standard maintenance doses to achieve exposures similar to those of children not on ECMO.

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

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    Jepson, S.L., E-mail: steven.jepson@uhl-tr.nhs.u [Department of Radiology, University Hospitals of Leicester (United Kingdom); Harvey, C. [Heart Link ECMO Centre, Glenfield Hospital, Leicester (United Kingdom); Entwisle, J.J. [Department of Radiology, University Hospitals of Leicester (United Kingdom); Peek, G.J. [Heart Link ECMO Centre, Glenfield Hospital, Leicester (United Kingdom)

    2010-11-15

    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.

  3. [Evaluation of non-invasive hemoglobin measurements using the Masimo Rainbow Radical-7® device in a patient with extracorporeal membrane oxygenation].

    Science.gov (United States)

    Moreno, I; Artieda, O; Vicente, R; Zarragoikoetxea, I; Vicente, J L; Barberá, M

    2014-01-01

    Circulatory assist devices such as extracorporeal membrane oxygenation are indicated in cases of cardiogenic shock refractory to optimal conventional treatment. Bleeding is a serious complication of such systems, mainly due to coagulation disorders caused by continuous administration of heparin, as well as platelet dysfunction. Serial coagulation and hemoglobin (Hb) measurements are essential. Hb measurements can be performed through repeated arterial blood gasometry, and more recently with a new spectrophotometric sensor, Masimo Rainbow Radical-7® device, which gives Hb values continuously and non-invasively. We report a case of a patient undergoing cardiac surgery who required extracorporeal membrane oxygenation for severe cardiogenic shock immediately after surgery. We compare the correlation and the level of agreement with Hb levels measured by 2 existing systems in clinical practice. Our results indicate that the Masimo® spectrophotometric monitor showed statistically comparable Hb values, in the correlation (r=.85; PMasimo® device as a valid alternative for the continuous follow-up of the Hb and control of bleeding in these patients.

  4. Impact of bloodstream infections on catheter colonization during extracorporeal membrane oxygenation.

    Science.gov (United States)

    Kim, Dong Wan; Yeo, Hye Ju; Yoon, Seong Hoon; Lee, Seung Eun; Lee, Su Jin; Cho, Woo Hyun; Jeon, Doo Soo; Kim, Yun Seong; Son, Bong Soo; Kim, Do Hyung

    2016-06-01

    There are concerns about secondary extracorporeal membrane oxygenation (ECMO) catheter infections in bacteremic patients. We investigated the association between blood stream infection (BSI) and ECMO catheter colonization. From January 2012 to August 2014, 47 adults who received ECMO support were enrolled. The ECMO catheter tip was cultured at the end of the ECMO procedure. The enrolled patients were classified into two groups according to the presence of BSI during ECMO support and analyzed with respect to ECMO catheter colonization. Of 47 cases, BSI during ECMO was identified in 13 patients (27.7 %). ECMO catheter colonization was identified in 6 (46.2 %) patients in the BSI group and 3 (8.8 %) in the non-BSI group. BSI during ECMO support was independently associated with ECMO catheter colonization [odds ratio (OR) 5.55; 95 % confidence interval (CI) 1.00-30.73; p = 0.049]. The organisms colonizing ECMO catheters in the setting of primary BSI were predominantly Gram-positive cocci and Candida species. Acinetobacter baumannii was the most common colonizing pathogen in the setting of secondary BSI. All the organisms colonizing ECMO catheters were multi-drug resistant organisms, including methicillin-resistant S. aureus, Candida glabrata, and carbapenem-resistant A. baumannii. ECMO catheters may become contaminated with multi-drug resistant pathogens in the presence of BSI. Therefore, ECMO should be applied cautiously in septic patients with bacteremia caused by multi-drug resistant pathogens.

  5. Neurological injuries and extracorporeal membrane oxygenation: the challenge of the new ECMO era.

    Science.gov (United States)

    Martucci, Gennaro; Lo Re, Vincenzina; Arcadipane, Antonio

    2016-07-01

    Extracorporeal membrane oxygenation (ECMO) is a life-saving mechanical respiratory and/or circulatory support for potentially reversible severe heart or respiratory injury untreatable with conventional therapies. Thanks to the technical and management improvements the use of ECMO has increased dramatically in the last few years. Data in the literature show a progressive increase in the overall outcome. Considering the improving survival rate of patients on ECMO, and the catastrophic effect of neurological injuries in such patients, the topic of neurological damage during the ICU stay in ECMO is gaining importance. We present a case series of six neurological injuries that occurred in 1 year during the ECMO run or after the ECMO weaning. In each case the neurological complication had a dramatic effect: ranging from brain death to prolonged ICU stay and long term disability. This case series has an informative impact for the multidisciplinary teams treating ECMO patients because of its heterogeneity in pathogenesis and clinical manifestation: cerebral hemorrhage, ischemic stroke due to cerebral fat embolism, acute disseminated encephalomyelitis due to H1N1 Influenza. In our ECMO hub we started strict neurological monitoring involving intensivists, a neurologist and our radiology service, but neurological complications are still an insidious diagnosis and treatment. Considering several possible neurological injuries may help reduce delay in diagnosis and speed rehabilitation.

  6. Development of a new interfacility extracorporeal membrane oxygenation transport program for pediatric lung transplantation evaluation

    Science.gov (United States)

    Shepherd, Edward G.; Gee, Samantha W.

    2017-01-01

    Pediatric lung transplantation is a life-saving intervention for children with irreversible end-stage lung disease. Access to transplant can be limited by geographic isolation from a center or the presence of comorbidities affecting transplant eligibility. Extracorporeal membrane oxygenation (ECMO)-supported patients are an uncommon but historically high-risk cohort of patients considered for lung transplant. We report the development of a service at our center to provide transport services to our hospital for patients unable to wean from ECMO support at their local institution for the purpose of evaluation for lung transplantation by our program. We developed a process for pre-transport consultation by the lung transplant physician team, standardized hand-off tools and equipment lists, and procedures for transitioning patients to transport ECMO machinery. Four patients have been transported to date including fixed wing (FW) and helicopter transports. All patients were successfully transported with either none or minor complications. Transport of ECMO-supported patients is a feasible method to increase access of patients with irreversible lung injured patients to evaluation for lung transplant. PMID:28275613

  7. Role of extracorporeal membrane oxygenation in adult respiratory failure: an overview.

    Science.gov (United States)

    Anand, Suneesh; Jayakumar, Divya; Aronow, Wilbert S; Chandy, Dipak

    2016-01-01

    Extracorporeal membrane oxygenation (ECMO) provides complete or partial support of the heart and lungs. Ever since its inception in the 1960s, it has been used across all age groups in the management of refractory respiratory failure and cardiogenic shock. While it has gained widespread acceptance in the neonatal and pediatric physician community, ECMO remains a controversial therapy for Acute Respiratory Distress Syndrome (ARDS) in adults. Its popularity was revived during the swine flu (H1N1) pandemic and advancements in technology have contributed to its increasing usage. ARDS continues to be a potentially devastating condition with significant mortality rates. Despite gaining more insights into this entity over the years, mechanical ventilation remains the only life-saving, yet potentially harmful intervention available for ARDS. ECMO shows promise in this regard by offering less dependence on mechanical ventilation, thereby potentially reducing ventilator-induced injury. However, the lack of rigorous clinical data has prevented ECMO from becoming the standard of care in the management of ARDS. Therefore, the results of two large ongoing randomized trials, which will hopefully throw more light on the role of ECMO in the management of this disease entity, are keenly awaited. In this article we will provide a basic overview of the development of ECMO, the types of ECMO, the pathogenesis of ARDS, different ventilation strategies for ARDS, the role of ECMO in ARDS and the role of ECMO as a bridge to lung transplantation.

  8. Interhospital Transport System for Critically Ill Patients: Mobile Extracorporeal Membrane Oxygenation without a Ventilator

    Science.gov (United States)

    Yeo, Hye Ju; Cho, Woo Hyun; Park, Jong Myung; Kim, Dohyung

    2017-01-01

    Background Extracorporeal membrane oxygenation (ECMO) has been successfully used as a method for the interhospital transportation of critically ill patients. In South Korea, a well-established ECMO interhospital transport system is lacking due to limited resources. We developed a simplified ECMO transport system without mechanical ventilation for use by public emergency medical services. Methods Eighteen patients utilized our ECMO transport system from December 2011 to September 2015. We retrospectively analyzed the indications for ECMO, the patient status during transport, and the patient outcomes. Results All transport was conducted on the ground by ambulance. The distances covered ranged from 26 to 408 km (mean, 65.9±88.1 km) and the average transport time was 56.1±57.3 minutes (range, 30 to 280 minutes). All patients were transported without adverse events. After transport, 4 patients (22.2%) underwent lung transplantation because of interstitial lung disease. Eight patients who had severe acute respiratory distress syndrome showed recovery of heart and lung function after ECMO therapy. A total of 13 patients (70.6%) were successfully taken off ECMO, and 11 patients (61.1%) survived. Conclusion Our ECMO transport system without mechanical ventilation can be considered a safe and useful method for interhospital transport and could be a good alternative option for ECMO transport in Korean hospitals with limited resources. PMID:28180097

  9. Complement activation by in vivo neonatal and in vitro extracorporeal membrane oxygenation.

    Science.gov (United States)

    Graulich, Johannes; Sonntag, Joseph; Marcinkowski, Monika; Bauer, Karl; Kössel, Hans; Bührer, Christoph; Obladen, Michael; Versmold, Hans T

    2002-01-01

    Complment activation during extracorporeal membrane oxygenation (ECMO) in newborns can be caused by both the underlying disease processes and by blood contact with the ECMO circuit. We investigated the relative importance of these mechanisms by measuring C3a, C5a and sC5b-9 before, during and after neonatal ECMO in six consecutive newborn patients using enzyme-linked immunoassay. In addition complement activation during in vitro ECMO with repeated flow of the same blood volume was measured using blood from healthy adult donors. C3a increased significantly in vivo after 1 h (from 1035+/-193 to 1865+/-419 microg/l) and in vitro ECMO (from 314+/-75 to 1962+/-1062 microg/l). C5a increased during ECMO without significant differences between in vivo and in vitro activation. In neonatal patients, sC5b-9 rose faster than in vitro, but the rapid increase was also significant for in vitro experiments (in vivo: from 328+/-63 to 1623+/-387 microg/l after 2 h; and in vitro: from 78+/-32 to 453+/-179 microg/l after 8 h). After this initial peak at 1-2 h, complement activation decreased gradually until 2-3 days after the initiation of ECMO. We conclude that in newborns the rapid activation of the complement system after the start of ECMO is predominantly caused by contact with artificial surfaces rather than the patient's underlying disease. PMID:12061426

  10. Extracorporeal membrane oxygenation support in potential organ donors for brain death determination.

    Science.gov (United States)

    Hsieh, C-E; Lin, H-C; Tsui, Y-C; Lin, P-Y; Lin, K-H; Chang, Y-Y; Chen, Y-L

    2011-09-01

    Extracorporeal membrane oxygenation (ECMO) must be applied in early stages to perfuse organs before donation in order to expand the donor pool. The aim of this study was to examine the benefits of ECMO for potential organ donors with multiple complications. This retrospective review describes patients with ECMO support who were on the verge of brain death and therefore potential subjects for organ donation. Six organ donors with severe neurological damage under ECMO support completed the procedures, namely, two women and four men of ages 19 to 58 years (mean, 32 years). Three donors completed the brain-death determination procedure, one failed the procedure, and two experienced cardiac asystole prior to the procedure and were unable to be declared dead even after resuscitation. Nine kidneys and three livers were successfully retrieved from 5/6 donors, leading to 11 successful transplantations: eight kidneys, two livers, and one simultaneous kidney-liver transplantations. The organs functioned well and the recipients made full recoveries. ECMO allows for the maintenance of abdominal organ tissue perfusion without warm ischemia before organ procurement, providing sufficient time for safe organ donation procedures and reducing the risk of unpredictable cardiac arrest that could result in the donor death and graft loss. Copyright © 2011 Elsevier Inc. All rights reserved.

  11. Early Extracorporeal Membrane Oxygenation Support for 5-Fluorouracil-induced Acute Heart Failure with Cardiogenic Shock.

    Science.gov (United States)

    Höllriegel, Robert; Fischer, Julia; Schuler, Gerhard

    2014-01-01

    A 50-year-old man with no previous history of cardiovascular disease or risk factors was admitted for syncope and orthopnea. Importantly, he underwent recent chemotherapy with 5-fluorouracil (5-FU) until 1 day before his acute presentation. In the emergency room, patient developed asystole and was successfully resuscitated for 2 min. At coronary angiography, no signs of coronary artery disease were detectable, but transthoracic echocardiography showed a severely decreased left-ventricular systolic function. Due to the progressive cardiogenic shock, an extracorporeal membrane oxygenation (ECMO) support was used as bridge-to-recovery and to avoid the use of sympathomimetics with their known disadvantages. On ECMO support, hemodynamic stabilization was evident and medical heart failure treatment was commenced. Left-ventricular function recovered to normal values within a short period of time. Cardiac complications after chemotherapy with 5-FU are not rare and should be taken into consideration even in acute heart failure with cardiogenic shock. ECMO as the most potent form of acute cardiorespiratory support enables complete relief of cardiac workload and therefore recovery of cardiac function.

  12. 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

    2017-06-22

    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.

  13. Delayed onset of acute limb compartment syndrome with neuropathy after venoarterial extracorporeal membrane oxygenation therapy.

    Science.gov (United States)

    Go, Jin Young; Min, Yu-Sun; Jung, Tae-Du

    2014-08-01

    Acute limb compartment syndrome (ALCS) is defined as compound symptoms resulting from poor oxygenation and decreased nutrition supply to muscles and nerves in a tightly confined compartment. The most common cause of ALCS is tibia fracture, followed by blunt trauma to soft tissue. However, non-traumatic causes are rare. We report an iatrogenic, non-traumatic ALCS case after venoarterial extracorporeal membrane oxygen (VA-ECMO) therapy. A 14-year-old male received VA-ECMO therapy due to cardiorespiratory failure after drowning. Although he had no symptoms during therapy, leg swelling appeared 10 hours after ECMO treatment. Two days after the leg swelling, the patient underwent a fasciotomy. Unfortunately, nerve conduction studies and electromyography showed multiple neuropathies in the lower leg. Despite 2 weeks of rehabilitation with electrical stimulation, an exercise program, and physical therapy, there was no definite change in muscle strength. To our knowledge, this is the first reported case of non-traumatic ALCS after VA-ECMO therapy in Korea.

  14. Awake extracorporeal membrane oxygenation in patients with severe postoperative acute respiratory distress syndrome.

    Science.gov (United States)

    Yeo, Hye Ju; Cho, Woo Hyun; Kim, Dohyung

    2016-01-01

    A clinical trial of extracorporeal membrane oxygenation (ECMO) as an alternative ventilator tool is being performed as a new indication for ECMO. The purpose of this study was to evaluate the feasibility of awake ECMO to increase the success rate of weaning patients from ECMO and ventilator care during treatment of postoperative severe acute respiratory distress syndrome (ARDS). We retrospectively analyzed the clinical reports of 10 patients who underwent awake ECMO due to postoperative ARDS between August 2012 and May 2015. We analyzed patient history, the partial arterial pressure of oxygen (PaO2)/fraction of inspired oxygen (FiO2) ratio, and patient outcome. Seven patients (70%) were weaned from ECMO without difficulty; one patient failed to maintain awake ECMO, was re-intubated after 2 days of awake ECMO, and was re-tried on awake ECMO after 4 days of ventilator care. We weaned that patient from ECMO 2 days later. We weaned a total of eight patients (80%) from awake ECMO. The ECMO duration of surviving patients was 9.13±2.2 days (range, 6-12 days), and mean ventilator use duration was 6.8±4.7 days (range, 2-16 days). Two cases failed awake ECMO and died due to disease aggravation. Awake ECMO was a useful weaning strategy after severe postoperative ARDS, as it avoids long-duration use of mechanical ventilation. Additionally, it is possible for patients to breathe spontaneously, which might prevents respiratory muscle dystrophy.

  15. Veno-arterial extracorporeal membrane oxygenation for Streptococcus pyogenes toxic shock syndrome in pregnancy.

    Science.gov (United States)

    Imaeda, Taro; Nakada, Taka-Aki; Abe, Ryuzo; Tateishi, Yoshihisa; Oda, Shigeto

    2016-06-01

    Streptococcal toxic shock syndrome (STSS), an invasive Streptococcus pyogenes (Group A streptococcus) infection with hypotension and multiple organ failure, is quite rare in pregnancy but is characterized by rapid disease progression and high fatality rates. We present a case of STSS with infection-induced cardiac dysfunction in a pregnant woman who was treated with veno-arterial extracorporeal membrane oxygenation (VA-ECMO). A 24-year-old multiparous woman in the third trimester had early symptoms of high fever and diarrhea 1 day prior to admission to the hospital emergency department. On admission, she had multiple organ failure including circulatory failure. Due to fetal distress, emergency Cesarean section was carried out and transferred to intensive care units. She had refractory circulatory failure with depressed myocardial contractility with progressive multiple organ failure, despite receiving significant hemodynamic supports including high-dose catecholamine. Thus, VA-ECMO was initiated 18 h after intensive care unit admission. Consequently, ECMO provided extra time to recover from infection and myocardial depression. She was successfully weaned from VA-ECMO on day 7 and was discharged home on day 53. VA-ECMO can be a therapeutic option for refractory circulatory failure with significant myocardial depression in STSS.

  16. Extracorporeal Membrane Oxygenation Can Save Lives in Children With Heart or Lung Failure After Liver Transplantation.

    Science.gov (United States)

    Jean, Sandrine; Chardot, Christophe; Oualha, Mehdi; Capito, Carmen; Bustarret, Olivier; Pouard, Philippe; Renolleau, Sylvain; Lacaille, Florence; Dupic, Laurent

    2017-09-01

    The risk of cardiac or lung failure after liver transplantation (LT) is significant. In rare cases, the usual intensive care techniques fail to maintain organ oxygenation with a risk of multiorgan dysfunction. Although extracorporeal membrane oxygenation (ECMO) is a difficult and risky procedure, it can be proposed as life-saving. Four children with either acute pulmonary (three) or cardiac (one) failure after LT, and the criteria that decided the use of ECMO (level of ventilation and results, dosage of inotropic drugs, cardiac ultrasound, blood lactate) were retrospectively reported. These patients, 1-11 years old, were treated with either veno-arterial (three) or veno-venous (one) ECMO. Two experienced a full recovery, with 3 and 6 years of follow-up. Two died of systemic inflammatory response syndrome (SIRS) due to ECMO, and relapse of heart failure due to the underlying disease. Although our patients' survival was only 50%, we showed that ECMO can be useful in children after LT. It should be considered before the development of irreversible multiorgan failure. © 2017 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

  17. Development of the orpheus perfusion simulator for use in high-fidelity extracorporeal membrane oxygenation simulation.

    Science.gov (United States)

    Lansdowne, William; Machin, David; Grant, David J

    2012-12-01

    Despite its life-sustaining potential, extracorporeal membrane oxygenation (ECMO) remains a complex treatment modality for which close teamwork is imperative with a high risk of adverse events leading to significant morbidity and mortality. The provision of adequate training and continuing education is key in mitigating these risks. Traditional training for ECMO has relied predominantly on didactic education and hands-on water drills. These methods may overemphasize cognitive skills while underemphasizing technical skills and completely ignoring team and human factor skills. These water drills are often static, lacking the time pressure, typical alarms, and a sense of urgency inherent to actual critical ECMO scenarios. Simulation-based training provides an opportunity for staff to develop and maintain technical proficiency in high-risk, infrequent events without fear of harming patients. In addition, it provides opportunities for interdisciplinary training and improved communication and teamwork among team members (1). Although simulation has become widely accepted for training of practitioners from many disciplines, there are currently, to our knowledge, no commercially available dedicated high-fidelity ECMO simulators. Our article describes the modification of the Orpheus Perfusion Simulator and its incorporation into a fully immersive, high-fidelity, point-of-care ECMO simulation model.

  18. Long-term neurodevelopmental outcomes of congenital diaphragmatic hernia survivors not treated with extracorporeal membrane oxygenation.

    Science.gov (United States)

    Frisk, Virginia; Jakobson, Lorna S; Unger, Sharon; Trachsel, Daniel; O'Brien, Karel

    2011-07-01

    Although there has been a marked improvement in the survival of children with congenital diaphragmatic hernia (CDH) in the past 2 decades, there are few reports of long-term neurodevelopmental outcome in this population. The present study examined neurodevelopmental outcomes in 10- to 16-year-old CDH survivors not treated with extracorporeal membrane oxygenation (ECMO). Parents of 27 CDH survivors completed questionnaires assessing medical problems, daily living skills, educational outcomes, behavioral problems, and executive functioning. Fifteen CDH survivors and matched full-term controls completed standardized intelligence, academic achievement, phonological processing, and working memory tests. Non-ECMO-treated CDH survivors demonstrated high rates of clinically significant difficulties on standardized academic achievement measures, and 14 of the 27 survivors had a formal diagnosis of specific learning disability, attention deficit hyperactivity disorder, or developmental disability. Specific problems with executive function, cognitive and attentional weaknesses, and social difficulties were more common in CDH patients than controls. Perioperative hypocapnia was linked to executive dysfunction, behavioral problems, lowered intelligence, and poor achievement in mathematics. Non-ECMO-treated CDH survivors are at substantial risk for neurodevelopmental problems in late childhood and adolescence. Copyright © 2011 Elsevier Inc. All rights reserved.

  19. Extracorporeal membrane oxygenation promotes long chain fatty acid oxidation in the immature swine heart in vivo

    Energy Technology Data Exchange (ETDEWEB)

    Kajimoto, Masaki; O' Kelly-Priddy, Colleen M.; Ledee, Dolena R.; Xu, Chun; Isern, Nancy G.; Olson, Aaron; Portman, Michael A.

    2013-09-01

    Extracorporeal membrane oxygenation (ECMO) supports infants and children with severe cardiopulmonary compromise. Nutritional support for these children includes provision of medium- and long-chain fatty acids (FAs). However, ECMO induces a stress response, which could limit the capacity for FA oxidation. Metabolic impairment could induce new or exacerbate existing myocardial dysfunction. Using a clinically relevant piglet model, we tested the hypothesis that ECMO maintains the myocardial capacity for FA oxidation and preserves myocardial energy state. Provision of 13-Carbon labeled medium-chain FA (octanoate), longchain free FAs (LCFAs), and lactate into systemic circulation showed that ECMO promoted relative increases in myocardial LCFA oxidation while inhibiting lactate oxidation. Loading of these labeled substrates at high dose into the left coronary artery demonstrated metabolic flexibility as the heart preferentially oxidized octanoate. ECMO preserved this octanoate metabolic response, but also promoted LCFA oxidation and inhibited lactate utilization. Rapid upregulation of pyruvate dehydrogenase kinase-4 (PDK4) protein appeared to participate in this metabolic shift during ECMO. ECMO also increased relative flux from lactate to alanine further supporting the role for pyruvate dehydrogenase inhibition by PDK4. High dose substrate loading during ECMO also elevated the myocardial energy state indexed by phosphocreatine to ATP ratio. ECMO promotes LCFA oxidation in immature hearts, while maintaining myocardial energy state. These data support the appropriateness of FA provision during ECMO support for the immature heart.

  20. 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.

  1. Interhospital transfer of seriously sick ARDS patients using veno-venous Extracorporeal Membrane Oxygenation (ECMO): Concept of an ECMO transport team

    OpenAIRE

    Starck, C T; Hasenclever, P; Falk, V; Wilhelm, M.J.

    2013-01-01

    Background: Extracorporeal membrane oxygenation (ECMO) therapy constitutes the last option for patients with acute respiratory distress syndrome (ARDS) refractory to conservative treatment. Since primary care centers are unable to provide this therapy, such patients need a transfer to a tertiary care center, which may be life-threatening without extracorporeal support. Methods: An ECMO transport team implanted an ECMO at the site of the primary care center with subsequent transport of the pat...

  2. [Venoarterial extracorporeal membrane oxygenation in an awake patient : Use of the mobile ECMO team for fulminant pulmonary embolism].

    Science.gov (United States)

    Keller, D; Lotz, C; Kippnich, M; Adami, P; Kranke, P; Roewer, N; Kredel, M; Schimmer, C; Leyh, R; Muellenbach, R M

    2015-05-01

    The current report highlights the use of venoarterial extracorporeal membrane oxygenation (va-ECMO) in a case of pulmonary embolism complicated by right ventricular failure. A 38-year-old woman was admitted to a secondary care hospital with dyspnea and systemic hypotension. Diagnostic testing revealed a massive pulmonary embolism. Thrombolytic therapy was unsuccessful necessitating thromboendarterectomy in the presence of cardiogenic shock. To allow the necessary transport of the highly unstable patient to a tertiary care center a mobile ECMO team was called in. The team immediately initiated awake va-ECMO as a bridge to therapy. Extracorporeal support subsequently allowed a safe transportation and successful completion of the surgical procedure with complete recovery.

  3. Cost-effective usage of membrane oxygenators in extracorporeal membrane oxygenation in infants.

    Science.gov (United States)

    Özyüksel, A; Ersoy, C; Akçevin, A; Türkoğlu, H; Çiçek, A E; Kahraman, A; Kayhan, B; Cantürk, E

    2015-04-01

    Although the poly-methylpentene (PMP) oxygenators have significant advantages in ECMO implementation, their usage may be limited in some situations, which may be related to economic constraints. In this report, we aimed to emphasize our cost-effective usage of a membrane oxygenator at the ECMO setup. We implemented ECMO with eight Capiox® FX05 or Baby RX05 hollow-fiber membrane oxygenators in five neonatal patients. The average ECMO duration was 121 hours (ranging from 41 to 272 hours). Following the termination of the ECMO, the system was broken down into its components for macroscopic analysis. Neither gross blood clots nor plasma leakage were observed in any of the components. The integration of a centrifugal pump and a separate hollow-fiber oxygenator may provide a cost-effective ECMO implementation setup with no adverse effects which may be an encouraging alternative for the low cost usage of ECMO in neonates.

  4. Hemodynamic changes in patients with extracorporeal membrane oxygenation (ECMO) demonstrated by contrast-enhanced CT examinations - implications for image acquisition technique.

    Science.gov (United States)

    Lambert, Lukas; Grus, Tomas; Balik, Martin; Fichtl, Jaromir; Kavan, Jan; Belohlavek, Jan

    2016-10-30

    Extracorporeal membrane oxygenation (ECMO) is an established tool for respiratory and circulatory support. In computed tomography, altered hemodynamics in ECMO patients requires special considerations and handling in contrast injection and its timing. In this article, we demonstrate changes in hemodynamics in ECMO patients captured on contrast-enhanced CT examinations and pitfalls in strategies for contrast injection in relation to the ECMO flow, cardiac function and the placement of ECMO cannulas. Contrast-enhanced CT of patients with ECMO requires prior knowledge of the ECMO cannulas, central venous lines, changes of hemodynamics induced by low cardiac output and the influence of adjustment of ECMO on blood flow in order to optimize injection of the contrast material and timing of the scan. Special considerations include temporary reduction of the ECMO flow, selection of the injection site and increasing volume or flow rate of the contrast material.

  5. Managing the extracorporeal membrane oxygenation (ECMO) circuit integrity and safety utilizing the perfusionist as the "ECMO Specialist".

    Science.gov (United States)

    Mongero, L B; Beck, J R; Charette, K A

    2013-11-01

    Extracorporeal membrane oxygenation (ECMO) is an extracorporeal technique of providing both cardiac and respiratory support to patients whose heart and lungs are so severely diseased or damaged that they can no longer serve their function. Neonatal and pediatric ECMO was accepted as practice in the early 1990s and according to the Extracorporeal Life Support Organization, ELSO; of the >50,000 patients registered, 73% have survived extracorporeal life support (ECLS). It is not uncommon to find initial cannulation of a patient receiving ECMO performed by a surgeon and then the maintenance of the patient being left in the hands of various others deemed as the "ECMO Specialists". The specialist has a broad base of professionals, including: nurses, respiratory therapists, perfusionists and physicians. Each institution, having its own unique training for these individuals, has provided a milieu for education, but does not share an established standard of care. From 2009, after the surge of the H1N1 epidemic, adult ECMO has been increasing; n=53 in 2010 to n=110 in 2012 at our institution. The perfusionist has been the "specialist" for ECMO at our institution since the early 1990s and remained at bedside during ECMO. We have now developed a safe circuit and fiscally responsible staffing model that utilizes a perfusionist and a telemetry-based electronic record keeper, permitting the perfusionist to leave the bedside and interact with the circuit when necessary. This has permitted an expansive growth of ECMO in our intensive care units at our facility incorporating a multidisciplinary collaboration system wide.

  6. "Awake Veno-arterial Extracorporeal Membrane Oxygenation" in Pediatric Cardiogenic Shock: A Single-Center Experience.

    Science.gov (United States)

    Schmidt, F; Jack, T; Sasse, M; Kaussen, T; Bertram, H; Horke, A; Seidemann, K; Beerbaum, P; Koeditz, H

    2015-12-01

    In pediatric patients with acute refractory cardiogenic shock (CS), extracorporeal membrane oxygenation (ECMO) remains an established procedure to maintain adequate organ perfusion. In this context, ECMO can be used as a bridging procedure to recovery, VAD or transplantation. While being supported by ECMO, most centers tend to keep their patients well sedated and supported by invasive ventilation. This may be associated with an increased risk of therapy-related morbidity and mortality. In order to optimize clinical management in pediatric patients with ECMO therapy, we report our strategy of veno-arterial ECMO (VA-ECMO) in extubated awake and conscious patients. We therefore present data of six of our patients with CS, who were treated by ECMO being awake without continuous analgosedation and invasive ventilation. Of these six patients, four were 14 years of age. Median time on ECMO was 17.4 days (range 6.9-94.2 days). Median time extubated, while receiving ECMO support was 9.5 days. Mean time extubated was 78 % of the total time on ECMO. Three patients reached full recovery of cardiac function on "Awake-VA-ECMO," whereas the other three were successfully bridged to destination therapy (VAD, heart transplantation, withdrawal). Four out of our six patients are still alive. Complications related to ECMO therapy (i.e., severe bleeding, site infection or dislocation of cannulas) were not observed. We conclude that "Awake-VA-ECMO" in extubated, spontaneously breathing conscious pediatric patients is feasible and safe for the treatment of acute CS and can be used as a "bridging therapy" to recovery, VAD implantation or transplantation.

  7. Relationship between renal function and extracorporeal membrane oxygenation use: a single-center experience.

    Science.gov (United States)

    Gupta, Punkaj; Carlson, Jacob; Wells, Dennis; Selakovich, Patrick; Robertson, Michael J; Gossett, Jeffrey M; Fontenot, Eudice E; Steiner, Matthew B

    2015-04-01

    The effects of extracorporeal membrane oxygenation (ECMO) support on renal function in children with critical illness are unknown. The objective of this study was to investigate the impact of ECMO on renal function among children in different age groups. We performed a single-center retrospective observational study in critically ill children ≤ 18 years supported on ECMO for refractory cardiac or pulmonary failure (2006-2012). The patient population was divided into four age groups for the purpose of comparisons. The Acute Kidney Injury Network's (AKIN's) validated, three-tiered staging system for acute kidney injury was used to categorize the degree of worsening renal function. Data on patient demographics, baseline characteristics, renal function parameters, dialysis, ultrafiltration, duration of mechanical cardiac support, and mortality were collected. Comparisons of baseline characteristics, duration of mechanical cardiac support, and renal function were made between the four age groups. During the study period, 311 patients qualified for inclusion, of whom 289 patients (94%) received venoarterial (VA) ECMO, 12 (4%) received venovenous (VV) ECMO, and 8 (3%) received both VV and VA ECMO. A total of 109 patients (36%) received ultrafiltration on ECMO, 58 (19%) received hemodialysis, and 51 (16%) received peritoneal dialysis. There was a steady and sustained improvement in renal function in all age groups during the ECMO run, with the maximum and longest-sustained improvement occurring in the oldest age group. Proportions of patients in different AKIN stages remained similar in the first 7 days after ECMO initiation. We demonstrate that renal dysfunction improves early after ECMO support. Irrespective of the underlying disease process or patient age, renal function improves in children with pulmonary or cardiac failure who are placed on ECMO.

  8. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  10. Myocardial Oxidative Metabolism and Protein Synthesis during Mechanical Circulatory Support by Extracorporeal Membrane Oxygenation

    Energy Technology Data Exchange (ETDEWEB)

    Priddy, MD, Colleen M.; Kajimoto, Masaki; Ledee, Dolena; Bouchard, Bertrand; Isern, Nancy G.; Olson, Aaron; Des Rosiers, Christine; Portman, Michael A.

    2013-02-01

    Extracorporeal membrane oxygenation (ECMO) provides mechanical circulatory support essential for survival in infants and children with acute cardiac decompensation. However, ECMO also causes metabolic disturbances, which contribute to total body wasting and protein loss. Cardiac stunning can also occur which prevents ECMO weaning, and contributes to high mortality. The heart may specifically undergo metabolic impairments, which influence functional recovery. We tested the hypothesis that ECMO alters oxidative. We focused on the amino acid leucine, and integration with myocardial protein synthesis. We used a translational immature swine model in which we assessed in heart (i) the fractional contribution of leucine (FcLeucine) and pyruvate (FCpyruvate) to mitochondrial acetyl-CoA formation by nuclear magnetic resonance and (ii) global protein fractional synthesis (FSR) by gas chromatography-mass spectrometry. Immature mixed breed Yorkshire male piglets (n = 22) were divided into four groups based on loading status (8 hours of normal circulation or ECMO) and intracoronary infusion [13C6,15N]-L-leucine (3.7 mM) alone or with [2-13C]-pyruvate (7.4 mM). ECMO decreased pulse pressure and correspondingly lowered myocardial oxygen consumption (~ 40%, n = 5), indicating decreased overall mitochondrial oxidative metabolism. However, FcLeucine was maintained and myocardial protein FSR was marginally increased. Pyruvate addition decreased tissue leucine enrichment, FcLeucine, and Fc for endogenous substrates as well as protein FSR. Conclusion: The heart under ECMO shows reduced oxidative metabolism of substrates, including amino acids, while maintaining (i) metabolic flexibility indicated by ability to respond to pyruvate, and (ii) a normal or increased capacity for global protein synthesis, suggesting an improved protein balance.

  11. Complement activation by in vivo neonatal and in vitro extracorporeal membrane oxygenation

    Directory of Open Access Journals (Sweden)

    Johannes Graulich

    2002-01-01

    Full Text Available Complement activation during extracorporeal membrane oxygenation (ECMO in newborns can be caused by both the underlying disease processes and by blood contact with the ECMO circuit. We investigated the relative importance of these mechanisms by measuring C3a, C5a and sC5b-9 before, during and after neonatal ECMO in six consecutive newborn patients using enzyme-linked immunoassay. In addition complement activation during in vitro ECMO with repeated flow of the same blood volume was measured using blood from healthy adult donors. C3a increased significantly in vivo after 1 h (from 1035 ± 193 to 1865 ± 419 μg/l and in vitro ECMO (from 314 ± 75 to 1962 ± 1062 μg/l. C5a increased during ECMO without significant differences between in vivo and in vitro activation. In neonatal patients, sC5b-9 rose faster than in vitro, but the rapid increase was also significant for in vitro experiments (in vivo: from 328 ± 63 to 1623 ± 387 μg/l after 2 h; and in vitro: from 78 ± 32 to 453 ± 179 μg/l after 8 h. After this initial peak at 1-2 h, complement activation decreased gradually until 2-3 days after the initiation of ECMO. We conclude that in newborns the rapid activation of the complement system after the start of ECMO is predominantly caused by contact with artificial surfaces rather than the patient's underlying disease.

  12. Combination of positioning therapy and venovenous extracorporeal membrane oxygenation in ARDS patients.

    Science.gov (United States)

    Kredel, M; Bischof, L; Wurmb, T E; Roewer, N; Muellenbach, R M

    2014-03-01

    Positioning therapy may improve lung recruitment and oxygenation and is part of the standard care in severe acute respiratory distress syndrome (ARDS). Venovenous extracorporeal membrane oxygenation (vvECMO) is a rescue strategy that may ensure sufficient gas exchange in ARDS patients failing conventional therapy. The aim of this case series was to describe the feasibility and pitfalls of combining positioning therapy and vvECMO in patients with severe ARDS. A retrospective cohort of nine patients is described. The patients received 20 (15-86) hours (median, 25(th) and 75(th) percentile) of positioning therapy while being treated with vvECMO. The initial PaO2/FiO2 index was 64 (51-67) mmHg and the arterial carbon dioxide tension was 60 (50-71) mmHg. Positioning therapy included 135 degrees prone, prone positioning and continuous lateral rotational therapy. During the first three days, the oxygenation index improved from 47 (41-47) to 12 (11-14) cmH2O/mmHg. The lung compliance improved from 20 (17-28) to 42 (27-43) ml/cmH2O. Complications related to positioning therapy were facial oedema (n=9); complications related to vvECMO were entrance of air (n=1) and pump failure (n=1). However, investigation of root causes revealed no association with the positioning therapy and had no documented effect on the outcome. The reported cases suggest that positioning therapy can be performed safely in ARDS patients treated with vvECMO, providing appropriate precautions are in place and a very experienced team is present.

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

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    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.

  14. 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

  15. Clinical Features and outcomes in adults with cardiogenic shock supported by extracorporeal membrane oxygenation.

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    Carroll, Brett J; Shah, Ravi V; Murthy, Venkatesh; McCullough, Stephen A; Reza, Nosheen; Thomas, Sunu S; Song, Tae H; Newton-Cheh, Christopher H; Camuso, Janice M; MacGillivray, Thomas; Sundt, Thoralf M; Semigran, Marc J; Lewis, Gregory D; Baker, Joshua N; Garcia, José P

    2015-11-15

    Extracorporeal membrane oxygenation (ECMO) is an increasingly used supportive measure for patients with refractory cardiogenic shock (CS). Despite its increasing use, there remain minimal data regarding which patients with refractory CS are most likely to benefit from ECMO. We retrospectively studied all patients (n = 123) who underwent initiation of ECMO for CS from February 2009 to September 2014 at a single center. Baseline patient characteristics, including demographics, co-morbid illness, cause of CS, available laboratory values, and patient outcomes were analyzed. Overall, 69 patients (56%) were weaned from ECMO, with 48 patients (39%) surviving to discharge. Survivors were younger (50 vs 60 years; p ≤0.0001), had a lower rate of previous smoking (27 vs 56%; p = 0.01) and chronic kidney disease (2% vs 13%; p = 0.03), and had lower lactate measured soon after ECMO initiation (3.1 vs 10.2 mmol/l; p = 0.01). Patients with pulmonary embolism (odds ratio 8.0, 95% confidence interval 2.00 to 31.99; p = 0.01) and acute cardiomyopathy (odds ratio 7.5, 95% confidence interval 1.69 to 33.27; p = 0.01) had a higher rate of survival than acute myocardial infarction, chronic cardiomyopathy, and miscellaneous etiologies compared to postcardiotomy CS as a referent. In conclusion, survival after ECMO initiation differs based on underlying cause of CS. Survival may be lower in older patients and those with early evidence of persistent hypoperfusion after initiation of ECMO for CS.

  16. Restrictive transfusion practice during extracorporeal membrane oxygenation therapy for severe acute respiratory distress syndrome.

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    Voelker, Maria T; Busch, Thilo; Bercker, Sven; Fichtner, Falk; Kaisers, Udo X; Laudi, Sven

    2015-04-01

    Recommendations concerning the management of hemoglobin levels and hematocrit in patients on extracorporeal membrane oxygenation (ECMO) still advise maintenance of a normal hematocrit. In contrast, current transfusion guidelines for critically ill patients support restrictive transfusion practice. We report on a series of patients receiving venovenous ECMO (vvECMO) for acute respiratory distress syndrome (ARDS) treated according to the restrictive transfusion regimen recommended for critically ill patients. We retrospectively analyzed 18 patients receiving vvECMO due to severe ARDS. Hemoglobin concentrations were kept between 7 and 9 g/dL with a transfusion trigger at 7 g/dL or when physiological transfusion triggers were apparent. We assessed baseline data, hospital mortality, time on ECMO, hemoglobin levels, hematocrit, quantities of packed red blood cells received, and lactate concentrations and compared survivors and nonsurvivors. The overall mortality of all patients on vvECMO was 38.9%. Mean hemoglobin concentration over all patients and ECMO days was 8.30 ± 0.51 g/dL, and hematocrit was 0.25 ± 0.01, with no difference between survivors and nonsurvivors. Mean numbers of given PRBCs showed a trend towards higher quantities in the group of nonsurvivors, but the difference was not significant (1.97 ± 1.47 vs. 0.96 ± 0.76 units; P = 0.07). Mean lactate clearance from the first to the third day was 45.4 ± 28.3%, with no significant difference between survivors and nonsurvivors (P = 0.19). In our cohort of patients treated with ECMO due to severe ARDS, the application of a restrictive transfusion protocol did not result in an increased mortality. Safety and feasibility of the application of a restrictive transfusion protocol in patients on ECMO must further be evaluated in randomized controlled trials.

  17. The endocrinological responses of veno-venous extracorporeal membrane oxygenation on hypoxic fetal lambs.

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    Nomura, Yasuhisa; Kato, Katsuhiko; Fujimori, Keiya; Shiroto, Tomohiro; Ishida, Tomohiko; Sato, Akira

    2012-01-01

    The purpose of this study was to observe endocrinological responses of veno-arterial and veno-venous extracorporeal membrane oxygenation (V-A and V-V ECMO) to support fetal oxygenation in utero. An ECMO system with a centrifugal pump was applied to six chronically instrumented fetal lambs, at 126-134 days of gestation. Blood was obtained through a double-lumen catheter inserted into the right atrium. After oxygenation, the blood was returned through a single-lumen catheter into either the carotid artery (veno-arterial; V-A ECMO) or the right atrium (V-V ECMO). After fetal hypoxia had been experimentally produced, V-A ECMO or V-V ECMO was instituted to maintain fetal oxygenation. We compared fetal blood gases and concentrations of atrial natriuretic peptide (ANP), epinephrine and norepinephrine with both routes of ECMO. Fetal carotid artery pH did not change during hypoxemia, but decreased after instituting V-A ECMO and V-V ECMO. After instituting V-A ECMO or V-V ECMO for 30 min, oxygen partial pressure (pO2) in the fetal cranial carotid artery recovered from the hypoxic level. The ANP concentration in V-V ECMO was significantly lower than that in V-A ECMO. Fetal serum epinephrine and norepinephrine concentrations significantly increased in association with hypoxic stimulation. There was a further increase in fetal serum epinephrine concentration after instituting V-A ECMO. No significant difference in concentration was found after instituting V-V ECMO from that of after the institution of V-A ECMO. This study suggested that V-V ECMO may possibly be less invasive than V-A ECMO for fetal heart, because ANP, a cardiac distress index, was lower in V-V ECMO than in V-A ECMO.

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

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    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.  

  19. 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.

  20. Post-traumatic ventricular septal defect: a rare indication for extracorporeal membrane oxygenation as a bridge to transplant

    Science.gov (United States)

    Hernández-Pérez, Francisco José; Gómez-Bueno, Manuel Francisco; Escudier-Villa, Juan Manuel; Castedo, Evaristo; Segovia, Javier; Alonso-Pulpón, Luis Antonio

    2017-01-01

    A ventricular septal defect (VSD) is a rare complication of blunt chest trauma. This report presents the case of a 44-year-old man who developed a VSD as a result of high-energy closed chest trauma. We describe the initial surgical and medical management of the cardiac rupture. After failed repair surgery, extracorporeal membrane oxygenation (ECMO) was used as a bridge to heart transplantation. We discuss the successful use of ECMO to improve the prognosis results in this rare and complex entity. PMID:28164015

  1. Extracorporeal membrane oxygenation as a rescue therapy for acute respiratory failure during chemotherapy in a patient with acute myeloid leukemia

    Science.gov (United States)

    Lee, Sang Won; Kim, Youn Seup

    2017-01-01

    Acute respiratory distress syndrome (ARDS) caused by pneumonia in patients with hematologic malignancies can be life-threatening. Extracorporeal membrane oxygenation (ECMO) is the only temporary treatment for patients with ARDS who are refractory to conventional treatment. However, the immunosuppression and coagulopathies in hematological malignancies such as lymphoma and acute leukemia are relative contraindications for ECMO, due to high risks of infection and bleeding. Here, we report a 22-year-old man with acute myeloid leukemia (AML) who developed pneumonia and ARDS during induction chemotherapy; he was treated with ECMO. PMID:28275497

  2. Successful 2,000-Kilometer International Transfer of an Infant Receiving Extracorporeal Membrane Oxygenation for Severe Respiratory Failure.

    Science.gov (United States)

    Brown, Kilian; Dunne, Ben; Festa, Marino; La Hei, Erik; Karpelowsky, Jonathan; Dando, Hayden; Orr, Yishay

    2016-08-01

    There is minimal reported experience with long-range retrieval of pediatric patients receiving extracorporeal membrane oxygenation (ECMO) support. We report the case of a 10-month old boy with necrotizing staphylococcal pneumonia complicated by a bronchopleural fistula, who was successfully retrieved and transported while receiving ECMO to our unit in Sydney, Australia, from a referring hospital 2,000 kilometers away in the Pacific Islands. He was successfully weaned from ECMO to receive single-lung ventilation after 13 days, and he underwent surgical repair of his bronchopleural fistula through a thoracotomy 3 days after decannulation. He has made a full recovery.

  3. Stent Placement in a Neonate with Sano Modification of the Norwood using Semi-Elective Extracorporeal Membrane Oxygenation

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    Mustafa Gulgun

    Full Text Available Abstract Extracorporeal membrane oxygenation (ECMO is a well-established tool of cardiopulmonary circulatory support for cardiopulmonary failure in children and adults. It has been used as a supportive strategy during interventional procedures in neonates with congenital heart disease. Herein, we describe a neonate with hypoplastic left heart syndrome who underwent stenting of the Sano shunt and left pulmonary artery after Norwood Sano operation using intra-procedural ECMO support. The use of ECMO as a bridge to recovery might be a feasible and reasonably safe adjunctive approach in the treatment of complications in selective case of neonates having undergone the Norwood Sano procedure.

  4. Stent Placement in a Neonate with Sano Modification of the Norwood using Semi-Elective Extracorporeal Membrane Oxygenation

    Science.gov (United States)

    Gulgun, Mustafa; Slack, Michael

    2016-01-01

    Extracorporeal membrane oxygenation (ECMO) is a well-established tool of cardiopulmonary circulatory support for cardiopulmonary failure in children and adults. It has been used as a supportive strategy during interventional procedures in neonates with congenital heart disease. Herein, we describe a neonate with hypoplastic left heart syndrome who underwent stenting of the Sano shunt and left pulmonary artery after Norwood Sano operation using intra-procedural ECMO support. The use of ECMO as a bridge to recovery might be a feasible and reasonably safe adjunctive approach in the treatment of complications in selective case of neonates having undergone the Norwood Sano procedure.

  5. 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.

  6. Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome following HAART Initiation in an HIV-infected Patient Being Treated for Severe Pneumonia: Case Report and Literature Review

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    Dong Won Park

    2016-05-01

    Full Text Available Pnuemocystis jirovecii pneumonia (PJP is one of leading causes of acute respiratory failure in patients infected with human immunodeficiency virus (HIV, and the mortality rate remains high in mechanically ventilated HIV patients with PJP. There are several reported cases who received extracorporeal membrane oxygenation (ECMO treatment for respiratory failure associated with severe PJP in HIV-infected patients. We report a patient who was newly diagnosed with HIV and PJP whose condition worsened after highly active antiretroviral therapy (HAART initiation and progressed to acute respiratory distress syndrome requiring veno-venous ECMO. The patient recovered from PJP and is undergoing treatment with HAART. ECMO support can be an effective life-saving salvage therapy for acute respiratory failure refractory to mechanical ventilation following HAART in HIV-infected patients with severe PJP.

  7. Contemporary Outcomes of Venoarterial Extracorporeal Membrane Oxygenation for Refractory Cardiogenic Shock at a Large Tertiary Care Center.

    Science.gov (United States)

    Truby, Lauren; Mundy, Lily; Kalesan, Bindu; Kirtane, Ajay; Colombo, Paolo C; Takeda, Koji; Fukuhara, Shinichi; Naka, Yoshifumi; Takayama, Hiroo

    2015-01-01

    Refractory cardiogenic shock (RCS) is associated with significant morbidity and mortality, and current mainstays of medical therapy appear inadequate. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) represents an increasingly accepted therapy for RCS. Demographics, past medical history, preoperative characteristics, outcomes, and adverse events were collected for consecutive patients who received VA-ECMO support for RCS at our institution from March 2007 to December 2013. One hundred and seventy-nine patients with a mean age of 56.9 ± 16.1 years were included. Etiologies of RCS included postcardiotomy shock in 70 patients (39%), acute myocardial infarction in 46 patients (26%), primary graft failure in 17 patients (10%), and acute decompensated heart failure in 24 patients (13%). Mean arterial pressure before VA-ECMO support was 59.4 ± 22.8 mm Hg and 30.7% (n = 55) were undergoing active cardiopulmonary resuscitation at the time of cannulation. Overall, 38.6% of patients (n = 69) survived to discharge and 44.7% of patients (n = 80) survived to 30 days. Myocardial recovery was achieved in 79.7% of survivors (n = 55) and 39.1% were transitioned to a more durable device. Univariate analysis identified age (p = 0.002) and etiology of RCS (p = 0.041) as the most significant predictors of in-hospital mortality. Venoarterial extracorporeal membrane oxygenation for RCS appears successful as salvage therapy. Age and etiology should be considered when evaluating patients for VA-ECMO.

  8. Pharmacokinetics of cefotaxime and desacetylcefotaxime in infants during extracorporeal membrane oxygenation.

    Science.gov (United States)

    Ahsman, Maurice J; Wildschut, Enno D; Tibboel, Dick; Mathot, Ron A

    2010-05-01

    Extracorporeal membrane oxygenation (ECMO) is used to temporarily sustain cardiac and respiratory function in critically ill infants but can cause pharmacokinetic changes necessitating dose modifications. Cefotaxime (CTX) is used to prevent and treat infections during ECMO, but the current dose regimen is based on pharmacokinetic data obtained for non-ECMO patients. The objective of this study was to validate the standard dose regimen of 50 mg/kg of body weight twice a day (postnatal age [PNA], 4 weeks). We included 37 neonates on ECMO, with a median (range) PNA of 3.3 (0.67 to 199) days and a median (range) body weight of 3.5 (2.0 to 6.2) kg at the onset of ECMO. Median (range) ECMO duration was 108 (16 to 374) h. Plasma samples were taken during routine care, and pharmacokinetic analysis of CTX and its active metabolite, desacetylcefotaxime (DACT), was done using nonlinear mixed-effects modeling (NONMEM). A one-compartment pharmacokinetic model for CTX and DACT adequately described the data. During ECMO, CTX clearance (CL(CTX)) was 0.36 liter/h (range, 0.19 to 0.75 liter/h), the volume of distribution of CTX (V(CTX)) was 1.82 liters (0.73 to 3.02 liters), CL(DACT) was 1.46 liters/h (0.48 to 5.93 liters/h), and V(DACT) was 11.0 liters (2.32 to 28.0 liters). Elimination half-lives for CTX and DACT were 3.5 h (1.6 to 6.8 h) and 5.4 h (0.8 to 14 h). Peak CTX concentration was 98.0 mg/liter (33.2 to 286 mg/liter). DACT concentration varied between 0 and 38.2 mg/liter, with a median of 10 mg/liter in the first 12 h postdose. Overall, CTX concentrations were above the MIC of 8 mg/liter over the entire dose interval. Only 1 of the 37 patients had a sub-MIC concentration for over 50% of the dose interval. In conclusion, the standard cefotaxime dose regimen provides sufficiently long periods of supra-MIC concentrations to provide adequate treatment of infants on ECMO.

  9. Extracorporeal Membrane Oxygenation (ECMO) for Lung Injury in Severe Acute Respiratory Distress Syndrome (ARDS): Review of the Literature.

    Science.gov (United States)

    Paolone, Summer

    2016-11-10

    Despite advances in mechanical ventilation, severe acute respiratory distress syndrome (ARDS) is associated with high morbidity and mortality rates ranging from 26% to 58%. Extracorporeal membrane oxygenation (ECMO) is a modified cardiopulmonary bypass circuit that serves as an artificial membrane lung and blood pump to provide gas exchange and systemic perfusion for patients when their own heart and lungs are unable to function adequately. ECMO is a complex network that provides oxygenation and ventilation and allows the lungs to rest and recover from respiratory failure while minimizing iatrogenic ventilator-induced lung injury. In critical care settings, ECMO is proven to improve survival rates and outcomes in patients with severe ARDS. This review defines severe ARDS; describes the ECMO circuit; and discusses recent research, optimal use of the ECMO circuit, limitations of therapy including potential complications, economic impact, and logistical factors; and discusses future research considerations.

  10. Combined venoarterial extracorporeal membrane oxygenation and transcatheter aortic valve implantation for the treatment of acute aortic prosthesis dysfunction in a high-risk patient.

    Science.gov (United States)

    Pergolini, Amedeo; Zampi, Giordano; Tinti, Maria Denitza; Polizzi, Vincenzo; Pino, Paolo Giuseppe; Pontillo, Daniele; Musumeci, Francesco; Luzi, Giampaolo

    2016-01-01

    We describe the case of a patient with acute bioprosthesis dysfunction in cardiogenic shock, in whom hemodynamic support was provided by venoarterial extracorporeal membrane oxygenation, and successfully treated by transcatheter aortic valve implantation. Copyright © 2016 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

  11. Role of Intra-Aortic Balloon Pump and Extracorporeal Membrane Oxygenation in Early Graft Failure After Cardiac Transplantation.

    Science.gov (United States)

    Loforte, Antonio; Murana, Giacomo; Cefarelli, Mariano; Jafrancesco, Giuliano; Sabatino, Mario; Martin Suarez, Sofia; Pilato, Emanuele; Pacini, Davide; Grigioni, Francesco; Bartolomeo, Roberto Di; Marinelli, Giuseppe

    2016-08-01

    Early graft failure (EGF) is a major risk factor for death after heart transplantation (Htx). We investigated the predictive risk factors for moderate-to-severe EGF requiring an intra-aortic balloon pump (IABP) or extracorporeal membrane oxygenation (ECMO) circulatory support as treatment after Htx. Between January 2000 and December 2014, 412 consecutive adult patients underwent isolated Htx at our institution. Moderate and severe EGF were defined as the need for IABP and ECMO support, respectively, within 24 h after Htx. All available recipient and donor variables were analyzed to assess the risk of EGF occurrence. Overall, moderate-to-severe EGF occurred in 46 (11.1%) patients. Twenty-nine (63.04%) patients required peripheral or central ECMO support in the treatment of severe EGF and 17 (36.9%) patients required IABP support for the treatment of moderate EGF. The predictive risk factors for moderate-to-severe EGF in recipients, as assessed by logistic regression analysis, were a preoperative transpulmonary gradient > 12 mm Hg (odds ratio [OR] 5.2; P = 0.023), a preoperative inotropic score > 10 (OR 8.5; P = 0.0001), and preoperative ECMO support (OR 4.2; P = 0.012). For donors, the predictive risk factor was a donor score ≥ 17 (OR 8.3; P = 0.006). The absence of EGF was correlated with improved long-term survival: 94% at 1 year and 81% at 5 years without EGF versus 76% and 36% at 1 year (P ECMO support, respectively. In-hospital weaned and survived patients after IABP or ECMO treatment for moderate-to-severe EGF had a similar 5-year conditional survival rate as transplant patients who had not suffered EGF: 88% without EGF versus 84% with EGF treated with mechanical circulatory support devices (P = 0.08). The occurrence of EGF is a multifactorial deleterious event that depends on donor and recipient profiles. IABP and ECMO support are reliable treatment strategies, depending on the grade of EGF. Furthermore, surviving patients

  12. Arterial protocol including prophylactic distal perfusion catheter decreases limb ischemia complications in patients undergoing extracorporeal membrane oxygenation.

    Science.gov (United States)

    Lamb, Kathleen M; DiMuzio, Paul J; Johnson, Adam; Batista, Philip; Moudgill, Neil; McCullough, Megan; Eisenberg, Joshua A; Hirose, Hitoshi; Cavarocchi, Nicholas C

    2017-04-01

    Venoarterial extracorporeal membrane oxygenation (ECMO) is a salvage therapy in patients with severe cardiopulmonary failure. Owing to the large size of the cannulas inserted via the femoral vessels (≤24-F) required for adequate oxygenation, this procedure could result in significant limb ischemic complications (10%-70%). This study evaluates the results of a distal limb perfusion arterial protocol designed to reduce associated complications. We conducted a retrospective institutional review board-approved review of consecutive patients requiring ECMO via femoral cannulation (July 2010-January 2015). To prevent arterial ischemia, a distal perfusion catheter (DPC) was placed antegrade into the superficial femoral artery and connected to the ECMO circuit. Limb perfusion was monitored via near-infrared spectroscopy (NIRS) placed on both calves. Decannulation involved open repair, patch angioplasty, and femoral thrombectomy as needed. A total of 91 patients were placed on ECMO via femoral arterial cannula (16-F to 24-F) for a mean duration of 9 days (range, 1-40 days). A percutaneous DPC was inserted prophylactically at the time of cannulation in 55 of 91 patients, without subsequent ischemia. Of the remaining 36 patients without initial DPC placement, 12 (33% without DPC) developed ipsilateral limb ischemia related to arterial insufficiency, as detected by NIRS and clinical findings. In these patients, the placement of a DPC (n = 7) with or without a fasciotomy, or with a fasciotomy alone (n = 4), resulted in limb salvage; only one patient required subsequent amputation. After decannulation (n = 7), no patients had further evidence of limb ischemia. Risk factors for the development of limb ischemia identified by categorical analysis included lack of DPC at time of cannulation and ECMO cannula size of less than 20-Fr. There was a trend toward younger patient age. Overall ECMO survival rate was 42%, whereas survival in patients with limb ischemia was only 25

  13. Determinants of oxygen and carbon dioxide transfer during extracorporeal membrane oxygenation in an experimental model of multiple organ dysfunction syndrome.

    Science.gov (United States)

    Park, Marcelo; Costa, Eduardo Leite Vieira; Maciel, Alexandre Toledo; Silva, Débora Prudêncio E; Friedrich, Natalia; Barbosa, Edzangela Vasconcelos Santos; Hirota, Adriana Sayuri; Schettino, Guilherme; Azevedo, Luciano Cesar Pontes

    2013-01-01

    Extracorporeal membrane oxygenation (ECMO) has gained renewed interest in the treatment of respiratory failure since the advent of the modern polymethylpentene membranes. Limited information exists, however, on the performance of these membranes in terms of gas transfers during multiple organ failure (MOF). We investigated determinants of oxygen and carbon dioxide transfer as well as biochemical alterations after the circulation of blood through the circuit in a pig model under ECMO support before and after induction of MOF. A predefined sequence of blood and sweep flows was tested before and after the induction of MOF with fecal peritonitis and saline lavage lung injury. In the multivariate analysis, oxygen transfer had a positive association with blood flow (slope = 66, PMOF from 7.19[6.92,7.32] to 7.41[7.13,7.5] (PMOF from 59 [47,91] to 34 [28,45] mmHg (P<0.001). In conclusion, both oxygen and carbon dioxide transfers were significantly determined by blood flow. Oxygen transfer was modulated by the pre-membrane SatO(2) and CO(2), while carbon dioxide transfer was affected by the gas flow, pre-membrane CO(2) and hemoglobin.

  14. 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.

  15. Pathological Substratum for a Case of Fulminant Myocarditis Treated with Extracorporeal Membrane Oxygenation and Subsequent Heart Transplantation.

    Science.gov (United States)

    Kim, In Ae; Yang, Hyun Suk; Kim, Wan Seop; Chee, Hyun Keun

    2015-09-01

    Fulminant myocarditis has been defined as the clinical manifestation of cardiac inflammation with rapid-onset heart failure and cardiogenic shock. We report on the case of a 23-yr-old woman with pathology-proven fulminant lymphocytic myocarditis presenting shock with elevated cardiac troponin I and ST segments in V1-2, following sustained ventricular tachycardia and a complete atrioventricular block. About 55 min of intensive cardio-pulmonary resuscitation, with extracorporeal membrane oxygenation support, bridged the patient to orthotopic heart transplantation. The explanted heart revealed diffuse lymphocytic infiltration and myocyte necrosis in all four cardiac chamber walls. Aggressive mechanical circulatory support may be an essential bridge for recovery or even transplantation in patients with fulminant myocarditis with shock.

  16. 体外膜肺氧合疗法研究进展%RESEARCH PROGRESS OF EXTRACORPOREAL MEMBRANE OXYGENATION

    Institute of Scientific and Technical Information of China (English)

    梁军; 庞晓军; 杜正隆

    2011-01-01

    通过对国内外相关文献进行归纳、综合、分析,简单介绍体外膜肺氧合疗法(EMCO)成功案例、ECMO的原理和简要操作、ECMO治疗的适应症及禁忌症及ECMO的临床应用和主要并发症的处理.认为ECMO联合血液透析应用可提高呼吸衰竭合并循环衰竭的危重病患者的抢救率.%Through summing up, integrating, analyzing the domestic and foreign correlated literatures, to introduce the successful cases, principle, operation, indications, contraindications, clinical application and complications of extracorporeal membrane oxygenation. The application of ECMO combined with the hemodialysis can enhance rescue rate of severe respiratory failure and circulatory collapse patients.

  17. Novel use of the AngioVac® system to remove thrombus during simultaneous extracorporeal membrane oxygenation life support.

    Science.gov (United States)

    Griffith, Kevin E; Jenkins, Eric; Copenhaver, William; Williams, David M

    2016-03-01

    Extracorporeal membrane oxygenation (ECMO) was introduced to clinical medicine over 40 years ago. While initially used as a treatment for acute respiratory failure in infants, the use of ECMO has grown to include respiratory and circulatory failure in both children and adults, cardiogenic shock, pulmonary embolism, sepsis, trauma, malignancy, pulmonary hemorrhage and as a treatment for hypothermic drowning.(1) Recent technological improvements in ECMO circuitry make it possible to minimize anticoagulation of the ECMO patient, decreasing the incidence of bleeding. Thrombus deposition within the ECMO circuit can be a life-threating complication. ECMO circuit thrombus can be contained in the circuit, adherent to cannula and deposited within the patient. The ability to remove thrombus while the patient remains on ECMO support could be a life-saving measure for some patients. The present case report outlines use of the AngioVac(®) thrombus removal system in concert with ECMO to remove a large thrombus adherent to an ECMO cannula.

  18. 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.

  19. Acute respiratory distress syndrome (ARDS) treated successfully by veno-venous extracorporeal membrane oxygenation (ECMO) in a nearly drowned patient.

    Science.gov (United States)

    Sonoo, Tomohiro; Ohshima, Kazuma; Kobayashi, Hiroaki; Asada, Toshifumi; Hiruma, Takahiro; Doi, Kento; Gunshin, Masataka; Murakawa, Tomohiro; Anraku, Masaki; Nakajima, Susumu; Nakajima, Jun; Yahagi, Naoki

    2014-09-01

    This report highlights about one acute respiratory distress syndrome (ARDS) case after near-drowning resuscitated using extracorporeal membrane oxygenation (ECMO). Few cases have been reported about ECMO use for near-drowning and in most of these cases, ECMO was initiated within the first week. However, in our report, we would like to emphasize that seemingly irreversible secondary worsening of ARDS after nearly drowned patient was successfully treated by ECMO use more than 1 week after near-drowning followed by discharge without home oxygen therapy, social support, or any complication. This is probably due to sufficient lung rest for ventilator-associated lung injury during ECMO use. Based on our case's clinical course, intensive care unit physicians must consider ECMO even in the late phase of worsened ARDS after near-drowning.

  20. Successful use of extracorporeal membrane oxygenation in an adult patient with toxic shock-induced heart failure.

    Science.gov (United States)

    Gabel, Eilon; Gudzenko, Vadim; Cruz, Daniel; Ardehali, Abbas; Fink, Mitchell P

    2015-02-01

    Cardiomyopathy secondary to toxic shock syndrome (TSS) is an uncommon but potentially life-threatening problem. We report the case of a 51-year-old male who presented with profound cardiogenic shock and multiorgan failure that could not be managed by conventional therapy with intravenous fluids, vasopressors and inotropes. Venoarterial extracorporeal membrane oxygenation (VA ECMO) was instituted as a bridge to recovery. After administration of antibiotics and intravenous immunoglobulin, the patient's condition improved and he was successfully weaned off ECMO after 6 days. The patient recovered from multiorgan failure, and left ventricular ejection fraction improved from <10% pre-ECMO to 65% 8 months after discharge. This case supports the view that VA ECMO can be used successfully to support vital organ perfusion in patients with profound but reversible cardiomyopathy attributed to TSS.

  1. 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.

  2. 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.

  3. 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.

  4. Extracorporeal Membrane Oxygenation in Sepsis%ECMO在脓毒症中应用的研究进展

    Institute of Scientific and Technical Information of China (English)

    左姝; 于凯江; 王洪亮; 郜杨; 刘海涛; 郭春文

    2013-01-01

    Extracorporeal membrane oxygenation (ECMO) is a modified form of cardiopulmonary bypass that allows short-term support for potentially reversible severe acute respiratory and/or cardiac failure in critically ill patients.In recent years,it was reported that more and more neonatal,pediatric and adult patients with sepsis were treated with ECMO successfully,which set off a craze of the application of ECMO in patients with sepsis.However,the clinical application of ECMO in patients with sepsis remains controversial.A large number of retrospective studies have shown that the success rate of application in neonatal and pediatric patients with sepsis is relatively higher.The number of adult patients with sepsis treated by ECMO is small,but ECMO should be tried in these patients who had failed in other treatments as soon as possible.%体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)是一种心肺支持技术,临床上能够为严重、可逆性的心肺衰竭患者提供循环、呼吸支持.近年来,新生儿、儿童和成人脓毒症患者应用ECMO治疗的成功报道日渐增多,掀起了脓毒症患者应用ECMO治疗的热潮.然而,ECMO在脓毒症患者中的临床应用却一直存在争议.大量回顾性研究表明新生儿及儿童脓毒症患者中应用的成功率相对较高,成人脓毒症患者应用ECMO治疗例数较少,但仍可在其他治疗无效的前提下尽早尝试ECMO治疗.

  5. Successful management of severe unilateral re-expansion pulmonary edema after mitral valve repair with mini-thoracotomy using extracorporeal membrane oxygenation.

    Science.gov (United States)

    Kitahara, Hiroto; Okamoto, Kazuma; Kudo, Mikihiko; Yoshitake, Akihiro; Hayashi, Kanako; Inaba, Yu; Ai, Kimiaki; Suzuki, Takeshi; Morisaki, Hiroshi; Shimizu, Hideyuki

    2017-03-01

    A 60-year-old man received mitral valve repair via right mini-thoracotomy, which was followed by unilateral re-expansion pulmonary edema on the right side and severe hemoptysis just after the surgery. Despite differential lung ventilation with unilateral high positive end expiratory pressure was initiated for the affected right lung, respiratory function did not improved and hemodynamics was collapsed in the next day. Veno-venous extracorporeal membrane oxygenation was initiated by cannulation of the right jugular and the left femoral vein. After pulmonary function recovered gradually, veno-venous extracorporeal membrane oxygenation was terminated on the fifth postoperative day. He was discharged in ambulatory condition on postoperative day 52.

  6. The ECMO PK Project: an incremental research approach to advance understanding of the pharmacokinetic alterations and improve patient outcomes during extracorporeal membrane oxygenation

    OpenAIRE

    Shekar, Kiran; Roberts, Jason A; Smith, Maree T.; Fung, Yoke L.; Fraser, John F.

    2013-01-01

    Background Extracorporeal membrane oxygenation (ECMO) is a supportive therapy and its success depends on optimal drug therapy along with other supportive care. Emerging evidence suggests significant interactions between the drug and the device resulting in altered pharmacokinetics (PK) of vital drugs which may be further complicated by the PK changes that occur in the context of critical illness. Such PK alterations are complex and challenging to investigate in critically ill patients on ECMO...

  7. Choosing the appropriate configuration and cannulation strategies for extracorporeal membrane oxygenation: the potential dynamic process of organ support and importance of hybrid modes.

    Science.gov (United States)

    Sorokin, Vitaly; MacLaren, Graeme; Vidanapathirana, Puwalani C; Delnoij, Thijs; Lorusso, Roberto

    2017-05-01

    Extracorporeal membrane oxygenation (ECMO) is becoming a common procedure to support patients with severe cardio-circulatory or respiratory failure as well as in case of combined compromise of the two systems. Deciding which ECMO configuration and proceeding with an uneventful implantation, however, may present minor or major shortcomings. Cannulation techniques should be tailored to specific patient conditions to provide sufficient regional and systemic perfusion, both of which must be comprehensively monitored. Changes in the patient's status or suboptimal ECMO-related support, however, may occur and should trigger re-appraisal of the cannulation strategy and circuit configuration. This dynamic management, based around the adequacy of end organ perfusion and patient requirements, may dictate ECMO configuration and cannulation changes. In these circumstances, adjunct of a cannula in the venous or arterial vasculature may represent a mandatory procedure to solve unfavorable hemodynamic status or enhance ECMO efficiency. These type of ECMO configurations, different from basic one, and called hybrid configurations, may represent, therefore, a critical aspect of optimal ECMO management towards optimized and successful temporary support. The aim of this review is to critically appraise and summarize the existing literature on adult ECMO configuration including cannulation strategies and circuit arrangement, and highlighting more complex pattern required in some specific clinical settings. © 2017 The Authors. European Journal of Heart Failure © 2017 European Society of Cardiology.

  8. Visual and fine-motor outcomes in adolescent survivors of high-risk congenital diaphragmatic hernia who did not receive extracorporeal membrane oxygenation.

    Science.gov (United States)

    Jakobson, L S; Frisk, V; Trachsel, D; O'Brien, K

    2009-09-01

    Although survivors of congenital diaphragmatic hernia (CDH) are at high risk for brain injury, little is known about their neurodevelopment. Studies exploring short-term outcomes in children who received extracorporeal membrane oxygenation (ECMO) therapy suggest an increased risk for abnormalities in tone and/or motor development. This study provides the first detailed examination of visual and fine-motor outcomes in adolescent survivors of high-risk CDH (manifesting within the first 24 h) who did not receive ECMO. A total of 13 CDH survivors (mean age 12.9 years) and 11 typically developing controls, matched to the CDH sample in terms of age at test, intelligence quotient and socioeconomic status (SES), completed a battery of visual and motor tests. CDH survivors performed normally on motor-free tests of visual-perceptual function and on tests requiring visual discrimination and scanning, but were impaired on tests requiring visual-motor integration and oral-motor programming. Survivors of high-risk CDH who did not receive ECMO treatment are at risk for long-term problems with oral motor and visuomotor control.

  9. Chronic mould exposure as a risk factor for severe community acquired pneumonia in a patient requiring extra corporeal membrane oxygenation

    Science.gov (United States)

    Thomas, Stephanie; Hassan, Ibrahim; Barker, Julian; Ashworth, Alan; Barnes, Anita; Fedor, Igor; Feddy, Lee; Hayes, Tim; Malagon, Ignacio; Stirling, Sarah; Szentgyorgyi, Lajos; Mutton, Ken; Richardson, Malcolm

    2015-01-01

    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. PMID:26236598

  10. 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.

  11. A Case Report of Churg-Strauss Syndrome Presenting With Cardiogenic Shock Treated With Extracorporeal Membrane Oxygenation.

    Science.gov (United States)

    Cui, Na; Su, Longxiang; Wang, Hao; Long, Yun; Pang, Cheng; Yang, Fei; Liu, Dawei

    2015-10-01

    Churg-Strauss Syndrome (CSS) complicated with cardiogenic shock is rare. Few case reports have described successful treatment of this rare disease. However, no one has reported on the application of mechanical life support with extracorporeal membrane oxygenation (ECMO) to treat this life-threatening disease.A 36-year-old female with limb numbness for >10 days, chest tightness for 2 days, and worsening dyspnea for 5 h presented in the emergency room. Vital signs showed a low blood pressure (104/60 mm Hg), increased heart rate (158 bpm), and respiration rate (28 bpm). Laboratory tests revealed that eosinophil was significantly increased (WBC: 34.46 × 10/L, neutrophil: 7.56 × 10/L[21.9%], eosinophil: 23.84 × 10/L[69.2%]), and serum myocardial enzymes was abnormal (CK 1049U/L, CKMB-mass 145.1 μg/L, cTnI 16.24 μg/L). Myocardial injury (tachycardia with ST elevation) and poor heart function (LVEF 31%) were found by electrocardiogram and transthoracic echocardiography. On the next day, cardiogenic shock had been developed as demonstrated by deteriorating the perfusion index.Churg-Strauss Syndrome with cardiogenic shock.A series of conservative therapy with drugs such as corticosteroids, anticoagulant, antiplatelet, nitrates, calcium antagonists, inotrope, and vasopressors were initiated on the day of admission. The treatment was ineffective and a cardiogenic shock developed on the next day. Thus, ECMO was initiated immediately to stabilize circulation and perfusion. At the same time, high-dose corticosteroids combined with immunosuppressive therapy were continuously used.Symptoms of cardiogenic shock were gradually improved after ECMO treatment. Elevated values of cardiac enzymes were decreased and the dose of vasoactive drugs was reduced. Extracorporeal membrane oxygenation was discontinued after 8 days, and the patient was eventually weaned off the ventilator. The patient was discharged after 40 days treatment.Once a CSS develops into a

  12. Veno-venous extracorporeal membrane oxygenation using a double-lumen bi-caval cannula for severe respiratory failure post total artificial heart implantation.

    Science.gov (United States)

    Miessau, J; Yang, Q; Unai, S; Entwistle, J W C; Cavarocchi, N C; Hirose, H

    2015-07-01

    We report a unique utilization of a double-lumen, bi-caval Avalon cannula for veno-venous (VV) extracorporeal membrane oxygenation (ECMO) during placement of a total artificial heart (TAH, SynCardia, Tucson, AZ). A 22-year-old female with post-partum cardiomyopathy was rescued on veno-arterial (VA) ECMO because of cardiogenic shock. The inability to wean ECMO necessitated implantation of the TAH as a bridge to transplant. In addition, the patient continued to have respiratory failure and concomitant VV ECMO was planned with the implant. During TAH implantation, the Avalon cannula was placed percutaneously from the right internal jugular vein into the inferior vena cava (IVC) under direct vision while the right atrium was open. During VV ECMO support, adequate flows on both ECMO and TAH were maintained without adverse events. VV ECMO was discontinued, without reopening the chest, once the patient's respiratory failure improved. However, the patient subsequently developed a profound respiratory acidosis and required VV ECMO for CO2 removal. The Avalon cannula was placed in the femoral vein to avoid accessing the internal jugular vein and risking damage to the TAH. The patient's oxygenation eventually improved and the cannula was removed at the bedside. The patient was supported for 22 days on VV ECMO and successfully weaned from the ventilator prior to her orthotropic heart transplantation.

  13. A pilot study: a combined therapy using polymyxin-B hemoperfusion and extracorporeal membrane oxygenation for acute exacerbation of interstitial pneumonia.

    Science.gov (United States)

    Itai, Junji; Ohshimo, Shinichiro; Kida, Yoshiko; Ota, Kohei; Iwasaki, Yasumasa; Hirohashi, Nobuyuki; Bonella, Francesco; Guzman, Josune; Costabel, Ulrich; Kohno, Nobuoki; Tanigawa, Koichi

    2015-01-05

    Direct hemoperfusion with polymyxin B-immobilized fiber (PMX-DHP) might be beneficial for treating acute exacerbation (AE) of interstitial pneumonia (IP). Venovenous extracorporeal membranous oxygenation (VV-ECMO) is an emerging tool to avoid ventilator-induced lung injury. This is a report presenting the first three patients with AE of IP treated with a combined therapy of PMX-DHP and VV-ECMO. Patient 1 was a 68-year-old male with acute interstitial pneumonia, patient 2 a 67-year-old male with AE of idiopathic pulmonary fibrosis, and patient 3 a 61-year-old female with AE of collagen vascular disease-associated interstitial pneumonia. All patients were severely hypoxemic and required mechanical ventilation. A combined therapy using PMX-DHP and VV-ECMO was initiated with support of intravenous corticosteroids and antibiotics. Radiological findings, oxygenation and laboratory findings markedly improved and all patients survived without severe complications. A combined therapy of PMX-DHP and VV-ECMO might be a therapeutic option for AE of IP.

  14. EXPERIENCE WITH APPLICATION OF EXTRACORPOREAL MEMBRANE OXYGENATION IN DOUBLE LUNG TRANSPLANTATION

    Directory of Open Access Journals (Sweden)

    O.A. Kurilova

    2014-01-01

    Full Text Available The most reliable intraoperative mechanical extracorporeal support is conventional сardiopulmonary bypass (CPB. However, CPB increases a risk of intraoperative bleeding and primary graft dysfunction. ECMO is more benefi cial method of intraoperative cardiopulmonary support than CPB in LTx.Aim. 10 LTx were retrospectively analyzed in the period from 01.2012 till 01.2014.Methods. Indications for ECMO were acute grafts edema after reperfusion (n = 4, group I. In group II (n = 6 indications for ECMO were severe hypoxia (РаО2 and FiO2 ratio < 1,0 and/or acidosis (pH < 7,2 during one lung ventilation. We used central type of veno-arterial ECMO: right atrium to ascending aorta.Results. Intraoperative ECMO lasted 4,1 ± 1,0 hours in group I and 8,5 ± 0,7 hours in group II. ECMO was prolonged into postoperative period in all patients from group I due to primary graft dysfunction. Application of ECMO in group II enabled to stabilize gas exchange and circulation as well as to decrease pulmonary arterial pressure in the time of reperfusion. ECMO was fi nished just after transplantation in group II. The 1-year survival in group I and II was 75,0 and 83,3%, respectively.Conclusion. Central veno-arterial ECMO is an adequate method of intraoperative cardiopulmonary support in LTx. It prevents postreperfusion edema of the lung grafts.

  15. Clinical implications of Mycobacterium chimaera detection in thermoregulatory devices used for extracorporeal membrane oxygenation (ECMO), Germany, 2015 to 2016.

    Science.gov (United States)

    Trudzinski, Franziska C; Schlotthauer, Uwe; Kamp, Annegret; Hennemann, Kai; Muellenbach, Ralf M; Reischl, Udo; Gärtner, Barbara; Wilkens, Heinrike; Bals, Robert; Herrmann, Mathias; Lepper, Philipp M; Becker, Sören L

    2016-11-17

    Mycobacterium chimaera, a non-tuberculous mycobacterium, was recently identified as causative agent of deep-seated infections in patients who had previously undergone open-chest cardiac surgery. Outbreak investigations suggested an aerosol-borne pathogen transmission originating from water contained in heater-cooler units (HCUs) used during cardiac surgery. Similar thermoregulatory devices are used for extracorporeal membrane oxygenation (ECMO) and M. chimaera might also be detectable in ECMO treatment settings. We performed a prospective microbiological study investigating the occurrence of M. chimaera in water from ECMO systems and in environmental samples, and a retrospective clinical review of possible ECMO-related mycobacterial infections among patients in a pneumological intensive care unit. We detected M. chimaera in 9 of 18 water samples from 10 different thermoregulatory ECMO devices; no mycobacteria were found in the nine room air samples and other environmental samples. Among 118 ECMO patients, 76 had bronchial specimens analysed for mycobacteria and M. chimaera was found in three individuals without signs of mycobacterial infection at the time of sampling. We conclude that M. chimaera can be detected in water samples from ECMO-associated thermoregulatory devices and might potentially pose patients at risk of infection. Further research is warranted to elucidate the clinical significance of M. chimaera in ECMO treatment settings.

  16. 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.

  17. 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.

  18. Retrospective Analysis of Transcranial Doppler Patterns in Veno-Arterial Extracorporeal Membrane Oxygenation Patients: Feasibility of Cerebral Circulatory Arrest Diagnosis.

    Science.gov (United States)

    Marinoni, Marinella; Cianchi, Giovanni; Trapani, Sara; Migliaccio, Maria L; Bonizzoli, Manuela; Gucci, Letizia; Cramaro, Antonella; Gallerini, Andrea; Picciafuochi, Fabio; Valente, Serafina; Peris, Adriano

    2017-08-01

    Transcranial Doppler (TCD) is able to detect cerebral hemodynamic changes in real-time. Impairment of cerebral blood flow during veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) treatment is referred to in the literature. Several cerebrovascular complications can affect VA ECMO patients, eventually leading to brain death (BD). Transcranial Doppler is a worldwide accepted technique for cerebral circulatory arrest (CCA) diagnosis for BD confirmation, and in Italy, it is mandatory in certain clinical conditions. Nowadays, no data have been published on the use of TCD as a confirmation test in VA ECMO patients evolved to BD. The aim of our study was to investigate the feasibility of TCD in CCA diagnosis during VA ECMO treatment. Thirty-two TCD examinations, performed in 25 patients on VA ECMO, were retrospectively analyzed, and factors that could be responsible for TCD waveforms abnormalities were reviewed. Differences in TCD patterns were detected depending on values of left ventricular ejection fraction and the absence or presence of intraaortic balloon pump (IABP). Four categories of different TCD patterns were then identified. In five BD patients, diagnostic CCA patterns in all cerebral arteries were identified by TCD. Our data suggest that cerebral hemodynamic changes due to both residual cardiac function and the effects of IABP can be detected by transcranial Doppler (TCD) in VA ECMO patients. In the case of BD, TCD seems to be a reliable instrumental test for CCA diagnosis in patients on VA ECMO when a pulsatile flow is maintained (native or IABP support).

  19. [Extracorporeal membrane oxygenation in primary graft dysfunction in a paediatric double lung transplant: presentation of a case].

    Science.gov (United States)

    López-Cantero, M; Grisolía, A L; Vicente, R; Moreno, I; Ramos, F; Porta, J; Torregrosa, S

    2014-04-01

    Primary graft dysfunction is a leading cause of morbimortality in the immediate postoperative period of patients undergoing lung transplantation. Among the treatment options are: lung protective ventilatory strategies, nitric oxide, lung surfactant therapy, and supportive treatment with extracorporeal membrane oxygenation (ECMO) as a bridge to recovery of lung function or re-transplant. We report the case of a 9-year-old girl affected by cystic fibrosis who underwent double-lung transplantation complicated with a severe primary graft dysfunction in the immediate postoperative period and refractory to standard therapies. Due to development of multiple organ failure, it was decided to insert arteriovenous ECMO catheters (pulmonary artery-right atrium). The postoperative course was satisfactory, allowing withdrawal of ECMO on the 5th post-surgical day. Currently the patient survives free of rejection and with an excellent quality of life after 600 days of follow up. Copyright © 2012 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Published by Elsevier España. All rights reserved.

  20. Dual Antiplatelet Therapy (DAPT) versus No Antiplatelet Therapy and Incidence of Major Bleeding in Patients on Venoarterial Extracorporeal Membrane Oxygenation.

    Science.gov (United States)

    Staudacher, Dawid L; Biever, Paul M; Benk, Christoph; Ahrens, Ingo; Bode, Christoph; Wengenmayer, Tobias

    2016-01-01

    Bleeding is a frequent complication in patients on venoarterial extracorporeal membrane oxygenation (VA-ECMO). An indication for dual antiplatelet therapy due to coronary stent implantation is present in a considerable number of these patients. The objective of this retrospective study was to evaluate if dual antiplatelet therapy (DAPT) significantly increases the high intrinsic bleeding risk in patients on VA-ECMO. A total of 93 patients were treated with VA-ECMO between October 2010 and October 2013. Average time on VA-ECMO was 58.9 ± 1.7 hours. Dual antiplatelet therapy was given to 51.6% of all patients. Any bleeding was recorded in 60.2% of all patients. There was no difference in bleeding incidence in patients on DAPT when compared to those without any antiplatelet therapy including any bleeding (66.7% vs. 57.1%, p = 0.35), BARC3 bleeding (43.8% vs. 33.3%, p = 0.31) or pulmonary bleeding (16.7% vs. 19.0%, p = 0.77). This holds true after adjustment for confounders. Rate of transfusion of red blood cells were similar in patients with or without DAPT (35.4% vs. 28.6%, p = 0.488). Bleeding on VA-ECMO is frequent. This registry recorded no statistical difference in bleeding in patients on dual antiplatelet therapy when compared to no antiplatelet therapy. When indicated, DAPT should not be withheld from VA ECMO patients.

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

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    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.)

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

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    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. Pheochromocytoma-Induced Inverted Takotsubo-Like Cardiomyopathy Leading to Cardiogenic Shock Successfully Treated With Extracorporeal Membrane Oxygenation.

    Science.gov (United States)

    Flam, Benjamin; Broomé, Michael; Frenckner, Björn; Bränström, Robert; Bell, Max

    2015-09-01

    Pheochromocytoma classically displays a variety of rather benign symptoms, such as headache, palpitations, and sweating, although severe cardiac manifestations have been described. We report a case of pheochromocytoma-induced inverted takotsubo-like cardiomyopathy leading to shock and cardiac arrest successfully treated with extracorporeal membrane oxygenation (ECMO) as a bridge to pharmacological therapy and curative adrenalectomy. A previously healthy 46-year-old woman presented to the emergency department with abdominal pain, dyspnea, nausea, and vomiting. Clinical evaluation revealed cardiorespiratory failure with hypoxia and severe metabolic acidosis. Computed tomography (CT) scan showed pulmonary edema and a left adrenal mass. Transthoracic echocardiography (TTE) displayed severe left ventricular dysfunction with inverted takotsubo contractile pattern. Despite mechanical ventilation and inotropic and vasopressor support, asystolic cardiac arrest ensued. The patient was resuscitated using manual chest compressions followed by venoarterial ECMO. Repeated TTEs demonstrated resolution of the cardiomyopathy within a few days. Laboratory results indicated transient renal and hepatic dysfunction, and CT scan of the brain displayed occipital infarctions. Biochemical testing and radionuclide scintigraphy confirmed a pheochromocytoma. Pharmacological adrenergic blockade was instituted prior to delayed adrenalectomy after which the diagnosis was histopathologically verified. The patient recovered after rehabilitation. We conclude that pheochromocytoma should be considered in patients presenting with unexplained cardiovascular compromise, especially if they display (inverted) takotsubo contractile pattern. Timely, adequate management might involve ECMO as a bridge to pharmacological therapy and curative surgery.

  4. 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.

  5. 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.

  6. Extracorporeal Membrane Oxygenation (ECMO) for Severe Toxicological Exposures: Review of the Toxicology Investigators Consortium (ToxIC).

    Science.gov (United States)

    Wang, G S; Levitan, R; Wiegand, T J; Lowry, J; Schult, R F; Yin, S

    2016-03-01

    Although there have been many developments related to specific strategies for treating patients after poisoning exposures, the mainstay of therapy remains symptomatic and supportive care. One of the most aggressive supportive modalities is extracorporeal membrane oxygenation (ECMO). Our goal was to describe the use of ECMO for toxicological exposures reported to the American College of Medical Toxicology (ACMT) Toxicology Investigators Consortium (ToxIC). We performed a retrospective review of the ACMT ToxIC Registry from January 1, 2010 to December 31, 2013. Inclusion criteria included patients aged 0 to 89 years, evaluated between January 2010 through December 2013, and received ECMO for toxicological exposure. There were 26,271 exposures (60 % female) reported to the ToxIC Registry, 10 (0.0004 %) received ECMO: 4 pediatric (18 years). Time of initiation of ECMO ranged from 4 h to 4 days, with duration from 15 h to 12 days. Exposures included carbon monoxide/smoke inhalation (2), bitter almonds, methanol, and several medications including antihistamines (2), antipsychotic/antidepressant (2), cardiovascular drugs (2), analgesics (2), sedative/hypnotics (2), and antidiabetics (2). Four ECMO patients received cardiopulmonary resuscitation (CPR) during their hospital course, and the overall survival rate was 80 %. ECMO was rarely used for poisoning exposures in the ACMT ToxIC Registry. ECMO was utilized for a variety of ages and for pharmaceutical and non-pharmaceutical exposures. In most cases, ECMO was administered prior to cardiovascular failure, and survival rate was high. If available, ECMO may be a valid treatment modality.

  7. 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.

  8. Impact of bypass flow rate and catheter position in veno-venous extracorporeal membrane oxygenation on gas exchange in vivo.

    Science.gov (United States)

    Togo, Konomi; Takewa, Yoshiaki; Katagiri, Nobumasa; Fujii, Yutaka; Kishimoto, Satoru; Date, Kazuma; Miyamoto, Yuji; Tatsumi, Eisuke

    2015-06-01

    The clinical use of veno-venous extracorporeal membrane oxygenation (VVECMO) in adult patients with respiratory failure is rapidly increasing. However, recirculation of blood oxygenated by ECMO back into the circuit may occur in VVECMO, resulting in insufficient oxygenation. The cannula position and bypass flow rate are two major factors influencing recirculation, but the relationship and ideal configuration of these factors are not fully understood. In the present study, we attempted to clarify these parameters for effective gas exchange. VVECMO was performed in eight adult goats under general anesthesia. The position of the drainage cannula was fixed in the inferior vena cava (IVC), but the return cannula position was varied between the IVC, right atrium (RA), and superior vena cava (SVC). At each position, the recirculation rates calculated, and the adequacy of oxygen delivery by ECMO in supplying systemic oxygen demand was assessed by measuring the arterial oxygen saturation (SaO2) and pressure (PaO2). Although the recirculation rates increased as the bypass flow rates increased, SaO2 and PaO2 also increased in any position of return cannula. The recirculation rates and PaO2 were 27 ± 2% and 162 ± 16 mmHg, 36 ± 6% and 139 ± 11 mmHg, and 63 ± 6% and 77 ± 9 mmHg in the SVC, RA and IVC position at 4 L/min respectively. In conclusion, the best return cannula position was the SVC, and a high bypass flow rate was advantageous for effective oxygenation. Both the bypass flow rates and cannula position must be considered to achieve effective oxygenation.

  9. Pheochromocytoma Crisis With Severe Cyclic Blood Pressure Fluctuations in a Cardiac Pheochromocytoma Patient Successfully Resuscitated by Extracorporeal Membrane Oxygenation

    Science.gov (United States)

    Zhou, Xiang; Liu, Dawei; Su, Longxiang; Long, Yun; Du, Wei; Miao, Qi; Li, Fang; Jin, Zhengyu; Zeng, Zhengpei; Luo, Ailun; Huang, Yuguang

    2015-01-01

    Abstract Cardiac pheochromocytoma is relatively rare. Few reports describe the intraoperative and postoperative progression of patients experiencing a life-threatening pheochromocytoma crisis treated with extracorporeal membrane oxygenation (ECMO). A 35-year-old man was referred to our facility for paroxysmal hypertension with a 10-year history of sweating, headaches, cardiac palpitations, and postexercise dyspnea. The patient initially underwent urine catecholamine measurement and an isotope scan, somatostatin receptor scintigraphy, and 18F-fluorodeoxyglucose positron emission tomography/computer tomography (CT), which indicated a multiple, cardiac pheochromocytoma. Echocardiography, cardiac magnetic resonance imaging (MRI), CT reconstruction, and a coronary CT angiography revealed several lesions at the aortic root and along the cardiac vasculature. Multifocal cardiac pheochromocytoma was diagnosed and pheochromocytoma crisis with severe cyclic blood pressure fluctuation occurred during surgery. Surgical resection of multiple pheochromocytomas in the right medial carotid sheath, mediastinum between the main and pulmonary arteries, and between the abdominal aorta and inferior vena artery was performed. To ensure cardiac perfusion and avoid severe circulatory fluctuation, the cardiac paraganglioma resection was prioritized. After resecting the cardiac pheochromocytoma, a severe pheochromocytoma crisis with rapid cyclic blood pressure fluctuation developed. ECMO and intraaortic balloon pump (IABP) were initiated to stabilize circulation and perfusion. Phenoxybenzamine, norepinephrine, epinephrine, and fluid resuscitation were administered to support cardiovascular function. The magnitude of blood pressure fluctuation steadily decreased with treatment. IABP was discontinued after 3 days, and ECMO was discontinued after 16 days. The patient was discharged 3 months postoperatively. This case indicates that mechanical life support with ECMO is a valuable option for

  10. Factors associated with blood oxygen partial pressure and carbon dioxide partial pressure regulation during respiratory extracorporeal membrane oxygenation support: data from a swine model.

    Science.gov (United States)

    Park, Marcelo; Mendes, Pedro Vitale; Costa, Eduardo Leite Vieira; Barbosa, Edzangela Vasconcelos Santos; Hirota, Adriana Sayuri; Azevedo, Luciano Cesar Pontes

    2016-01-01

    The aim of this study was to explore the factors associated with blood oxygen partial pressure and carbon dioxide partial pressure. The factors associated with oxygen - and carbon dioxide regulation were investigated in an apneic pig model under veno-venous extracorporeal membrane oxygenation support. A predefined sequence of blood and sweep flows was tested. Oxygenation was mainly associated with extracorporeal membrane oxygenation blood flow (beta coefficient = 0.036mmHg/mL/min), cardiac output (beta coefficient = -11.970mmHg/L/min) and pulmonary shunting (beta coefficient = -0.232mmHg/%). Furthermore, the initial oxygen partial pressure and carbon dioxide partial pressure measurements were also associated with oxygenation, with beta coefficients of 0.160 and 0.442mmHg/mmHg, respectively. Carbon dioxide partial pressure was associated with cardiac output (beta coefficient = 3.578mmHg/L/min), sweep gas flow (beta coefficient = -2.635mmHg/L/min), temperature (beta coefficient = 4.514mmHg/ºC), initial pH (beta coefficient = -66.065mmHg/0.01 unit) and hemoglobin (beta coefficient = 6.635mmHg/g/dL). In conclusion, elevations in blood and sweep gas flows in an apneic veno-venous extracorporeal membrane oxygenation model resulted in an increase in oxygen partial pressure and a reduction in carbon dioxide partial pressure 2, respectively. Furthermore, without the possibility of causal inference, oxygen partial pressure was negatively associated with pulmonary shunting and cardiac output, and carbon dioxide partial pressure was positively associated with cardiac output, core temperature and initial hemoglobin.

  11. [Complex control of the source of infection in sepsis : Extracorporeal membrane oxygenation (ECMO) as a bridging concept for tracheal fistula repair in sepsis-associated ARDS].

    Science.gov (United States)

    Weiterer, S; Schmidt, K; Deininger, M; Ulrich, A; Tochtermann, U; Eberhardt, R; Hofer, S; Weigand, M A; Brenner, T

    2016-09-01

    Here, we present a case of a tracheal fistula due to an anastomotic insufficiency following abdominothoracic esophageal resection. Despite immediate discontinuity resection, the tracheal fistula could not be surgically closed, resulting in incomplete control of the source of infection and an alternative treatment concept in the form of interventional fistula closure using a Y-tracheal stent. However, owing to existing severe acute respiratory distress syndrome (ARDS), which is associated with a considerable risk of peri-interventional hypoxia, a temporary bridging concept using venovenous extracorporeal membrane oxygenation (ECMO) was implemented successfully.

  12. Awake extracorporeal membrane oxygenation (ECMO) as bridge to recovery after left main coronary artery occlusion: a promising concept of haemodynamic support in cardiogenic shock.

    Science.gov (United States)

    Alozie, Anthony; Kische, Stephan; Birken, Thomas; Kaminski, Alexander; Westphal, Bernd; Nöldge-Schomburg, Gabriele; Ince, Hüseyin; Steinhoff, Gustav

    2014-10-01

    Cardiogenic shock following acute myocardial infarction is associated with high mortality rate. Different management concepts including fluid management, inotropic support, intra aortic balloon counterpulsation (IABP) and extracorporeal membrane oxygenation (ECMO) mainly in mechanically ventilated patients have been used as cornerstones of management. However, success rates have been disappointing. Few reports suggested that ECMO when performed under circumvention of mechanical ventilation, may offer some survival benefits. We herein present our experience with the use of veno-arterial ECMO as bridge to recovery in an awake and spontaneously breathing patient after left main coronary artery occlusion complicated by cardiogenic shock.

  13. Medication-induced Takotsubo Cardiomyopathy presenting with cardiogenic shock-utility of extracorporeal membrane oxygenation (ECMO): case report and review of the literature.

    Science.gov (United States)

    Rojas-Marte, Geurys; John, Jinu; Sadiq, Adnan; Moskovits, Norbert; Saunders, Paul; Shani, Jacob

    2015-01-01

    Takotsubo cardiomyopathy (TTC) is a transient condition that affects the myocardium and is seen mostly in post-menopausal women secondary to an emotional or physical stressor; however, certain drugs have been described as cause of this syndrome. We report the case of a young female with medication--induced TTC, who presented with cardiogenic shock as initial manifestation, treated successfully with extracorporeal membrane oxygenation (ECMO). To our knowledge, this is the first case in the literature describing the use of ECMO in cardiogenic shock due to medication-induced TTC.

  14. Impact of Extracorporeal Membrane Oxygenation Support on Clinical Outcome of Pediatric Patients with Acute Cardiopulmonary Failure: A Single-Center Experience

    Directory of Open Access Journals (Sweden)

    Ying-Jui Lin

    2013-02-01

    Full Text Available Background: Conventional therapy against acute pediatric cardiopulmonary failure (APCPF caused by a variety of disease entities remains unsatisfactory with extremely high morbidity and mortality. For refractory APCPF, extracorporeal membrane oxygenation (ECMO is one of the last resorts. Methods: In this study, the in-hospital outcomes of pediatric patients with refractory APCPF receiving ECMO support were reviewed. Results: Between August 2006 and May 2011, a single-center cohort study was performed in pediatric patients who required ECMO support due to cardiogenic shock or severe hypoxemia. A total of 22 patients with mean age of 7.0 ± 6.3 years received ECMO (male = 11; female = 11. The indications included acute fulminant myocarditis (AFM (n = 6, congenital diaphragmatic hernia (CDH (n = 3, acute respiratory distress syndrome (ARDS (n = 6, enterovirus 71 (n = 3, viral sepsis (n = 2, refractory ventricular fibrillation due to long QT syndrome (n = 1, and pulmonary edema with brain herniation (n = 1. Eighteen patients received veno-arterial (VA mode ECMO, while another four patients undertook the veno-venous (VV mode. The duration of ECMO use and hospitalization were 6.1 ± 3.1 and 24.4 ± 19.4 days, respectively. The survival rate in patients with AFM was 100% (n = 6. Successful ECMO weaning with uneventful discharge from hospital was noted in 14 (63.6% patients, whereas in-hospital mortality despite successful ECMO weaning occurred in 5 patients (22.7%. Failure in ECMO weaning and in-hospital death was noted in 3 patients (13.6%. Conclusions: ECMO resuscitation is an effective strategy in the clinical setting of APCPF.

  15. Extracorporeal Membrane Oxygenation for End-Stage Interstitial Lung Disease With Secondary Pulmonary Hypertension at Rest and Exercise: Insights From Simulation Modeling.

    Science.gov (United States)

    Chicotka, Scott; Burkhoff, Daniel; Dickstein, Marc L; Bacchetta, Matthew

    2017-08-31

    Interstitial lung disease (ILD) represents a collection of lung disorders with a lethal trajectory with few therapeutic options with the exception of lung transplantation. Various extracorporeal membrane oxygenation (ECMO) configurations have been used for bridge to transplant (BTT), yet no optimal configuration has been clearly demonstrated. Using a cardiopulmonary simulation, we assessed different ECMO configurations for patients with end-stage ILD to assess the physiologic deficits and help guide the development of new long-term pulmonary support devices. A cardiopulmonary ECMO simulation was created, and changes in hemodynamics and blood gases were compared for different inflow and outflow anatomic locations and for different sweep gas and blood pump flow rates. The system simulated the physiologic response of patients with severe ILD at rest and during exercise with central ECMO, peripheral ECMO, and with no ECMO. The output parameters were total cardiac output (CO), mixed venous oxygen (O2) saturation, arterial pH, and O2 delivery (DO2)/O2 utilization (VO2) at different levels of exercise. The model described the physiologic state of progressive ILD and showed the relative effects of using various ECMO configurations to support them. It elucidated the optimal device configurations and required physiologic pump performance and provided insight into the physiologic demands of exercise in ILD patients. The simulation program was able to model the pathophysiologic state of progressive ILD with PH and demonstrate how mechanical support devices can be implemented to improve cardiopulmonary function at rest and during exercise. The information generated from simulation can be used to optimize ECMO configuration selection for BTT patients and provide design guidance for new devices to better meet the physiologic demands of exercise associated with normal activities of daily living.

  16. Pulmonary alveolar proteinosis requiring "hybrid" extracorporeal life support, and complicated by acute necrotizing pneumonia.

    Science.gov (United States)

    Moisan, M; Lafargue, M; Calderon, J; Oses, P; Ouattara, A

    2013-04-01

    Pulmonary alveolar proteinosis (PAP), which was first described by Rosen in 1958, is a rare disease characterized by impaired surfactant metabolism that provokes the accumulation of proteinaceous material in the alveoli. PAP is usually an auto-immune disease though, less commonly, may be congenital or secondary to another underlying disorder, such as infection, an immunodeficiency or a haematological disease. A positive diagnosis can be made with the appearance of "crazy-paving" on a computed tomography scan, with a milky fluid bronchial aspiration. A cytological examination will also show eosinophilic material and pink stained periodic acid-Schiff-positive material. A whole lung lavage is the most widely accepted therapy for hypoxemic PAP. Herein, we report the case of a 27-year-old woman admitted into our intensive care unit for hypoxemic PAP that was complicated by a pulmonary embolism. Because the patient presented with refractory hypoxemia associated with a brief cardiac arrest, femoral veno-arterial extracorporeal life support (ECLS) was rapidly inserted. Under ECLS, the patient subsequently developed "Harlequin syndrome", which was managed using an original and minimally invasive method. A whole lung lavage as well as prone positioning was effectively performed under ECLS, and resulted in substantial improvement in oxygenation. The patient could be discharged from the hospital 40 days later.

  17. Changes in health-related quality of life across three post-heart transplantation stages: preoperative extracorporeal membrane versus non-extracorporeal membrane group/clinical trial plan group versus non-clinical trial plan group in Taiwan.

    Science.gov (United States)

    Tseng, P-H; Wang, S-S; Shih, F-J

    2012-05-01

    The aims of this research were to compare changes in overall health-related quality of life (HRQoL), working competence (WC), physical functions (PF), and quality of sleep across 3 crucial post-heart transplantation (HT) stages (1 month, 6 months, and 1 year post-HT) between the following: (1) preoperative extracorporeal membrane (preop-ECMO) versus non-ECMO group and (2) postoperative Clinical Trial Plan (CTP) group versus non-CTP group in Taiwan. A between-method triangulation design was used. Subjects who had undergone HT in the last 1-4 years were recruited from a leading medical center in Taipei. Quantitative data were collected using Visual Analog scale (VAS) and Taiwan's version of the World Health Organization Quality of Life (WHOQOL) questionnaire. Semistructured qualitative questions were added to explore the factors influencing the changes in social domains of HRQoL. A total of 62 heart transplant recipients (HTRs) participated in this study. Their ages ranged from 20 to 70 (mean, 47.16 ± 12.09) years; 80.6% were male. Compared with the subjects with preop-ECMO, HRQoL, WC, and PF of the subjects without preop-ECMO were less at 1 month post-HT; the difference reached statistical significance for HRQoL and PF for 1 month post-HT, but they recovered at the 6 months post-HT stage. HTRs who had participated in the CTP had higher HRQoL and perceived WC in the period of 1 month post-HT, 6 months post-HT, and 1 year post-HT as compared with the group not in CTP; meanwhile, the difference was statistically significant for HRQoL at 1 month post-HT and 6 months post-HT and for PF at 1 month post-HT. The efficacy of postop-CTP including HRQoL, WC, and PF was promising across the 3 post-HT stages. Postop-CTP was suggested both clinically and was shown to be statistically significant to HTR's recovery of their health status. Copyright © 2012 Elsevier Inc. All rights reserved.

  18. Extracorporeal membrane oxygenation as a platform for recovery: a case report of a child with pulmonary hemorrhage, refractory hypoxemic respiratory failure, and new onset goodpasture syndrome.

    Science.gov (United States)

    Dalabih, Abdallah; Pietsch, John; Jabs, Kathy; Hardison, Daphne; Bridges, Brian C

    2012-06-01

    We report a case of a 9-year-old female with acute pulmonary hemorrhage and refractory hypoxemic respiratory failure secondary to Goodpasture syndrome (GS). After failing treatment with high frequency oscillatory ventilation and inhaled nitric oxide, she was successfully managed with venovenous extracorporeal membrane oxygenation (VV ECMO). The patient's weight at the time of cannulation was 31 kg. A 19 French 18 cm (arterial) Biomedicus cannula was inserted in the right internal jugular vein and used as the drain. A 17 French 50 cm (venous) Biomedicus cannula was inserted in the right femoral vein and used as the return. Then the patient was anticoagulated with 100 units/kg of intravenous heparin and the circuit was primed with one unit of packed red blood cells. VV ECMO was performed with an SIII Sorin roller head pump with integrated servo regulator and a Quadrox D Bioline coated oxygenator. Despite systemic anticoagulation with heparin, the patient's pulmonary hemorrhage resolved. Extracorporeal membrane oxygenation served as a platform through which we were able to provide renal replacement therapy and plasmapheresis. The patient was successfully discharged home with normal pulmonary function.

  19. The history of extracorporeal oxygenators.

    Science.gov (United States)

    Lim, M W

    2006-10-01

    Extracorporeal oxygenators are artificial devices that substitute for anatomical lungs by delivering oxygen to, and extracting carbon dioxide from, blood. They were first conceptualised by the English scientist Robert Hooke (1635-1703) and developed into practical extracorporeal oxygenators by French and German experimental physiologists in the 19th century. Indeed, most of the extracorporeal oxygenators used until the late 1970s were derived from von Schroder's 1882 bubble oxygenator and Frey and Gruber's 1885 film oxygenator. As there is no intervening barrier between blood and oxygen, these are called 'direct contact' oxygenators; they contributed significantly to the development and practice of cardiac surgery till the 1980s. Membrane extracorporeal oxygenators introduce a gas-permeable interface between blood and oxygen. This greatly decreased the blood trauma of direct-contact extracorporeal oxygenators, and enabled extracorporeal oxygenators to be used in longer-term applications such as the intensive therapy of respiratory distress syndrome; this was demonstrably beneficial for neonates but less so for older patients. Much work since the 1960s focused on overcoming the gas exchange handicap of the membrane barrier, leading to the development of high-performance microporous hollow-fibre oxygenators that eventually replaced direct-contact oxygenators in cardiac theatres.

  20. Extracorporeal Membrane Oxygenation in Severe Influenza Infection with Respiratory Failure: A Systematic Review and Meta-analysis

    Science.gov (United States)

    Sukhal, Shashvat; Sethi, Jaskaran; Ganesh, Malini; Villablanca, Pedro A; Malhotra, Anita K; Ramakrishna, Harish

    2017-01-01

    Introduction: Extracorporeal membrane oxygenation (ECMO) has been extensively used for potentially reversible acute respiratory failure associated with severe influenza A (H1N1) pneumonia; however, it remains an expensive, resource-intensive therapy, with a high associated mortality. This systematic review and meta-analysis aims to summarize and pool outcomes data available in the published literature to guide clinical decision-making and further research. Methods: We conducted a systematic search of MEDLINE (1966 to April 15, 2015), EMBASE (1980 to April 15, 2015), CENTRAL, and Google Scholar for patients with severe H1N1 pneumonia and respiratory failure who received ECMO. The study validity was appraised by Newcastle–Ottawa Scale. The primary outcome was all-cause mortality. The secondary outcomes were duration of ECMO therapy, mechanical ventilation, and Intensive Care Unit (ICU) length of stay. Results: Of 698 abstracts screened and 142 full-text articles reviewed, we included 13 studies with a total of 494 patients receiving ECMO in our final review and meta-analysis. The study validity was satisfactory. The overall mortality was 37.1% (95% confidence interval: 30–45%) limited by underlying heterogeneity (I2 = 65%, P value of Q statistic = 0.006). The median duration for ECMO was 10 days, mechanical ventilation was 19 days, and ICU length of stay was 33 days. Exploratory meta-regression did not identify any statistically significant moderator of mortality (P < 0.05), except for the duration of pre-ECMO mechanical ventilation in days (coefficient 0.19, standard error: 0.09, Z = 2.01, P < 0.04, R2 = 0.16). The visual inspection of funnel plots did not suggest the presence of publication bias. Conclusions: ECMO therapy may be used as an adjunct or salvage therapy for severe H1N1 pneumonia with respiratory failure. It is associated with a prolonged duration of ventilator support, ICU length of stay, and high mortality. Initiating ECMO early once the patient

  1. Elective decompression of the left ventricle in pediatric patients may reduce the duration of venoarterial extracorporeal membrane oxygenation.

    Science.gov (United States)

    Hacking, Douglas F; Best, Derek; d'Udekem, Yves; Brizard, Christian P; Konstantinov, Igor E; Millar, Johnny; Butt, Warwick

    2015-04-01

    We aimed to determine the effect of elective left heart decompression at the time of initiation of central venoarterial extracorporeal membrane oxygenation (VA ECMO) on VA ECMO duration and clinical outcomes in children in a single tertiary ECMO referral center with a large pediatric population from a national referral center for pediatric cardiac surgery. We studied 51 episodes of VA ECMO in a historical cohort of 49 pediatric patients treated between the years 1990 and 2013 in the Paediatric Intensive Care Unit (PICU) of the Royal Children's Hospital, Melbourne. The cases had a variety of diagnoses including congenital cardiac abnormalities, sepsis, myocarditis, and cardiomyopathy. Left heart decompression as an elective treatment or an emergency intervention for left heart distension was effectively achieved by a number of methods, including left atrial venting, blade atrial septostomy, and left ventricular cannulation. Elective left heart decompression was associated with a reduction in time on ECMO (128 h) when compared with emergency decompression (236 h) (P = 0.013). Subgroup analysis showed that ECMO duration was greatest in noncardiac patients (elective 138 h, emergency 295 h; P = 0.02) and in patients who died despite both emergency decompression and ECMO (elective 133 h, emergency 354 h; P = 0.002). As the emergency cases had a lower pH, a higher PaCO2 , and a lower oxygenation index and were treated with a higher mean airway pressure, positive end-expiratory pressure, and respiratory rate prior to receiving VA ECMO, we undertook multivariate linear regression modeling to show that only PaCO2 and the timing of left heart decompression were associated with ECMO duration. However, elective left heart decompression was not associated with a reduction in length of PICU stay, duration of mechanical ventilation, or duration of oxygen therapy. Elective left heart decompression was not associated with improved ECMO survival or survival to PICU discharge

  2. Blastocystis hominis infection in a post-cardiotomy patient on extracorporeal membrane oxygenation support: A case report and literature review

    Directory of Open Access Journals (Sweden)

    Chih-Hsuan Chen

    2014-01-01

    CONCLUSION: This is the first published article showing that the opportunistic pathogen, B. hominis, can cause severe infection in patients on ECMO support, a result that should be kept in mind when patients come from a place with a high prevalence of B. hominis. The prophylactic medication should be administered routinely when patients live in the region and extracorporeal life-support is used.

  3. Clinical Use of Extracorporeal Membrane Oxygenation(ECMO)%ECMO临床应用分析

    Institute of Scientific and Technical Information of China (English)

    马媛

    2009-01-01

    目的 总结ECMO在临床使用中的经验.方法 ECMO辅助患者多例.术后严密监测,积极治疗.结果 出现出血、血栓、感染等并发症.结论 ECMO的选择以及并发症的处理是决定使用ECMO能否成功的关键.%Objective To review the experience of usng ECMO in clinical cases.Methods Patients required ECMO were kept under watch and the syndromes were actively treated after the operation.Results The patients suffered from thrombosis,hemolysis and infection.Conclusion The selection of ECMO type and complication treatment are critical in determining whether the ECMO can be used successfully.

  4. 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

  5. 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

  6. Hemolysis during cardiac extracorporeal membrane oxygenation: a case-control comparison of roller pumps and centrifugal pumps in a pediatric population.

    Science.gov (United States)

    Byrnes, Jonathan; McKamie, Wes; Swearingen, Christopher; Prodhan, Parthak; Bhutta, Adnan; Jaquiss, Robert; Imamura, Michiaki; Fiser, Richard

    2011-01-01

    Extracorporeal membrane oxygenation (ECMO) is a lifesaving therapy, which has been used for the support of children with a broad range of diseases. Two pumps of differing mechanisms have been used to generate the extracorporeal flow: roller-head pumps and centrifugal pumps. Seven patients supported during ECMO with Levitronix Centrimag (Centrimag group [CG]) were matched to 14 patients supported with Stockert-Shiley SIII (Stockert-Shiley group [SSG]) at a single institution from July 2007 to July 2009. We hypothesized that hemolysis as measured by plasma-free hemoglobin (PFH) is elevated in the SSG versus the CG during cardiac ECMO. Categorical data were analyzed using Fisher's exact test. Plasma-free hemoglobin differences between groups were analyzed using both Wilcoxon rank sum and beta regression. Overall, SSG patients had two times the odds of having a higher PFH than CG patients adjusting for repeated measures (odds ratio [OR] = 1.96, 95% confidence interval [CI]: [1.15-3.34], p pump supported group, when compared with the CG, a centrifugal pump supported group. Differences in circuit life did not reach statistical significance. This pilot study contrasts with past studies, which have demonstrated more hemolysis occurring with centrifugal pumps when compared with roller-head pumps.

  7. Prolonged extracorporeal membrane oxygenation therapy for severe acute respiratory distress syndrome in a child affected by rituximab-resistant autoimmune hemolytic anemia: a case report

    Directory of Open Access Journals (Sweden)

    Beretta Chiara

    2009-04-01

    Full Text Available Abstract Introduction Autoimmune hemolytic anemia in children younger than 2 years of age is usually characterized by a severe course, with a mortality rate of approximately 10%. The prolonged immunosuppression following specific treatment may be associated with a high risk of developing severe infections. Recently, the use of monoclonal antibodies (rituximab has allowed sustained remissions to be obtained in the majority of pediatric patients with refractory autoimmune hemolytic anemia. Case presentation We describe the case of an 8-month-old Caucasian girl affected by a severe form of autoimmune hemolytic anemia, which required continuous steroid treatment for 16 months. Thereafter, she received 4 weekly doses of rituximab (375 mg/m2/dose associated with steroid therapy, which was then tapered over the subsequent 2 weeks. One month after the last dose of rrituximab, she presented with recurrence of severe hemolysis and received two more doses of rrituximab. The patient remained in clinical remission for 7 months, before presenting with a further relapse. An alternative heavy immunosuppressive therapy was administered combining cyclophosphamide 10 mg/kg/day for 10 days with methylprednisolone 40 mg/kg/day for 5 days, which was then tapered down over 3 weeks. While still on steroid therapy, the patient developed an interstitial pneumonia with Acute Respiratory Distress Syndrome, which required immediate admission to the intensive care unit where extracorporeal membrane oxygenation therapy was administered continuously for 37 days. At 16-month follow-up, the patient is alive and in good clinical condition, with no organ dysfunction, free from any immunosuppressive treatment and with a normal Hb level. Conclusions This case shows that aggressive combined immunosuppressive therapy may lead to a sustained complete remission in children with refractory autoimmune hemolytic anemia. However, the severe life-threatening complication presented by our

  8. Extracorporeal membrane oxygenation (ECMO)

    African Journals Online (AJOL)

    and described a 24-year-old who had sustained blunt thoracic trauma that was successfully treated using ECMO.[1] Thereafter, the first randomised, prospective study of ECMO in severe acute respiratory ... received conventional mechanical ventilation (CMV) or CMV plus ... artery, brain oxygenation cannot be guaranteed.

  9. 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

  10. Successful administration of venovenous extracorporeal membrane oxygenation through the modified Blalock–Taussig operation in an infant with graft dysfunction after the Norwood procedure

    Directory of Open Access Journals (Sweden)

    Kanao-Kanda M

    2015-10-01

    Full Text Available Megumi Kanao-Kanda, Takayuki Kunisawa, Kunihiko Yamamoto, Hirotsugu Kanda, Hiroshi Iwasaki Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Asahikawa, Hokkaido, JapanInsufficient pulmonary blood flow through a right ventricle-to-pulmonary artery conduit following the Norwood procedure is remediable by adding a modified Blalock–Taussig shunt (MBTS.1 First, however, perioperative hypoxemia must be managed. Venovenous extracorporeal membrane oxygenation (VV-ECMO is likely to be a useful method for respiratory support in such cases.2,3 We present the case of a 2-month-old patient with graft dysfunction after the Norwood procedure who underwent MBTS with VV-ECMO support. 

  11. The progress in clinical applications of Extracorporeal Membrane Oxygenation%体外膜肺氧合在成人中的应用进展

    Institute of Scientific and Technical Information of China (English)

    孙培培; 童朝晖

    2010-01-01

    @@ 体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)是指一种将部分静脉血从体内引流到体外,再经膜肺氧合后由驱动泵将动脉血液泵入体内的心肺辅助技术.根据膜肺氧合血回输的途径不同,ECMO可以分为静脉-静脉ECMO(V-V ECMO)与静脉-动脉ECMO(V-A ECMO),V-V ECMO主要用于呼吸支持,V-A ECMO既可用于呼吸支持也可用于心脏支持.

  12. Case study of a high-risk neonate failing to thrive post-extracorporeal membrane oxygenation and post-necrotizing enterocolitis.

    Science.gov (United States)

    Bishop, G C; Lobo, M L

    1994-06-01

    Infants discharged from neonatal intensive care units (NICUs) often face a long journey of chronic illness, family stresses, and financial burdens. Health care professionals involved in acute care need to be aware of the far-reaching repercussions of neonatal illness. This report presents a case study of a low-income, single mother from a rural community and her son, a neonatal intensive care unit (NICU) graduate post-extracorporeal membrane oxygenation (ECMO) and post-necrotizing enterocolitis (NEC) discharged with a gastronomy tube (g-tube) and failure to thrive (FTT), from his birth to 10 months of age. Family-focused interventions aimed at improving growth and developmental delays and providing family support will be discussed.

  13. 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.

  14. 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. 

  15. Nursing of patients received' lung transplantation under the support of extracorporeal membrane oxygenator%体外膜肺支持下肺移植的护理

    Institute of Scientific and Technical Information of China (English)

    王雯; 王永功; 张建余; 徐继伟

    2010-01-01

    Objective To explore the nursing solutions of of patients received lung transplantation under the support of extracorporeal membrane oxygenator ( ECMO) and improve the success rate of lung transplantation. Methods The nusing experience were summarized for patients received lung transplantation under the support of (ECMO). Results After 2h removing the ECMO, the oxygen among all patients was good. There were no sever complications related to ECMO. 15 patients were removed the ECMO support immediately after the operation. Conclusions The targeted care solutions are helpful to find problem of ECMO supportie treatment of lung transplantation and satisfy the care needs of lung transplantation under ECMO support.%目的 探讨应用体外膜肺氧合(ECMO)支持下肺移植的护理方案,提高肺移植的成功率.方法 总结29 例在ECOM支持下进行肺移植患者护理经验.结果 所有患者ECMO撤除2 h后,供氧良好,没有发生与ECMO有关的严重并发症;15例术后即刻撤除ECMO支持.结论 针对性护理方案能及时发现并处理ECMO支持下肺移植术后出现的问题,可以满足ECMO支持下肺移植术的护理需要.

  16. 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

    2017-09-08

    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.

  17. Short-term mechanical circulatory support by veno-arterial extracorporeal membrane oxygenation in the management of cardiogenic shock and end-stage heart failure.

    Science.gov (United States)

    Brugts, Jasper J; Caliskan, Kadir

    2014-02-01

    Despite modern treatment modalities, cardiogenic shock is associated with a very high risk of mortality and morbidity. The short- and long-term survival in patients with cardiogenic shock or end-stage heart failure has improved considerably by recent technological advances in short and long-term mechanical circulatory support devices. For short-term mechanical support, veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has been increasingly used as bridge-to-decision and bridge-to-recovery in cardiogenic shock patients. Long-term mechanical circulatory support devices such as left ventricular assist devices (LVADs) are widely available and play a central role in bridge-to-transplantation in those eligible for heart transplantation (HTX) and as destination therapy (DT) in those not eligible for heart transplantation. Nevertheless, patients with critical cardiogenic shock show a deleterious outcome after LVAD-implantation or HTX with higher mortality, more complications and higher burden on financial resources. These considerations underscore the importance of optimal timing and appropriate patient selection for eventual LVAD therapy. The current report will focus on the immediate management of patients with cardiogenic shock with inotropes, discuss the use of IABP and focus mainly on pivotal choices to be made in the period spanned by short term mechanical circulatory support in patients with refractory cardiogenic shock.

  18. Continuous renal replacement therapy (CRRT) attenuates myocardial inflammation and mitochondrial injury induced by venovenous extracorporeal membrane oxygenation (VV ECMO) in a healthy piglet model.

    Science.gov (United States)

    Shen, Juanhong; Yu, Wenkui; Chen, Qiyi; Shi, Jialiang; Hu, Yimin; Zhang, Juanjuan; Gao, Tao; Xi, Fengchan; He, Changsheng; Gong, Jianfeng; Li, Ning; Li, Jieshou

    2013-10-01

    In this study, we investigated the myocardial inflammation and mitochondrial function during venovenous extracorporeal membrane oxygenation (VV ECMO) and further evaluated the effects of continuous renal replacement therapy (CRRT) on them. Eighteen piglets were assigned to the control group, ECMO group, and ECMO+CRRT group. Myocardial inflammation was assessed by the activity of myeloperoxidase (MPO), myocardial concentrations, and mRNA expression of TNF-α, IL-1β, and IL-6; mitochondrial function was assessed by activities of mitochondrial complexes I-V. VV ECMO elicited a general activation of serum and myocardial inflammation and significantly decreased the activities of mitochondrial complexes I and IV. After being combined with CRRT, serum and myocardial concentrations of IL-1β and IL-6, myocardial mRNA expression of IL-6, and the activity of MPO were decreased significantly; the activities of mitochondrial complexes were increased. We conclude that myocardial inflammation was activated during ECMO therapy, inducing mitochondrial injury; moreover, CRRT reduced myocardial inflammation and partially ameliorated mitochondrial function.

  19. 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.

  20. 48例小儿心脏术后体外膜肺氧合临床结果分析%Clinical outcomes with extracorporeal membrane oxygenation support in 48 pediatric patients after cardiac surgery

    Institute of Scientific and Technical Information of China (English)

    王旭; 李守军; 刘晋萍; 晏馥霞

    2012-01-01

    Objective:The puipose of our research was to study the clinical outcomes of children with congenital heart disease (CHD) requiring extracorporeal membrane oxygenation (ECMO) support after cardiac surgery at Fu Wai hospital. Methods: We retrospectively reviewed the medical record of 48 children requiring ECMO support from Dec. 2004 to now. Results; Patients age ranged from 5 day to 6 years and body weight ranged from 3 to 17kg. 30 children (62. 5% ) were successfully weaned and 24(50% ) survived to discharge. Inability to separate from ECMO support and the development of acute renal failure may have an increased risk of death. Conclusion: The overall treatment outcomes depends on the selection of indication and the complications during ECMO.%目的:对阜外医院小儿心脏手术后,不同适应症下实施体外膜肺氧合(ECMO)治疗的效果及并发症情况进行分析,为更好的把握ECMO的临床适应症提出依据.方法:回顾性分析2004年12月至今48例小儿心脏术后ECMO的临床资料.结果:患儿年龄5d~6岁;体质量3~17 kg.48例中脱离ECMO 30例(62.5%),最终治愈出院24例(50%).心、肺功能持续不恢复及后期继发的急性肾衰竭是导致死亡的主要原因.结论:适应症的选择及治疗期间的并发症决定了ECMO总体的治疗效果.

  1. 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.

  2. Mechanical support with venoarterial extracorporeal membrane oxygenation (ECMO-VA): Short-term and long-term prognosis after a successful weaning.

    Science.gov (United States)

    García-Gigorro, R; Renes-Carreño, E; Pérez-Vela, J L; Marín-Mateos, H; Gutiérrez, J; Corrés-Peiretti, M A; Delgado, J F; Pérez-de la Sota, E; Cortina-Romero, J M; Montejo-González, J C

    2017-03-02

    Extracorporeal membrane oxygenation (ECMO) affords mechanical circulatory assistance associated to high mortality. However, weaning from such mechanical support may not imply improved short- or long-term survival. This study describes the characteristics and evolution of patients with refractory cardiogenic shock (RCS) subjected to venoarterial ECMO (VA-ECMO) in a hospital with a heart transplant program. A single-center, retrospective cohort study was carried out. The cardiovascular ICU of a tertiary hospital. Forty-six patients consecutively subjected to VA-ECMO over 6 years. Hospital mortality after weaning from ECMO and overall survival (OS) were analyzed. Fifteen patients (33%) died with VA-ECMO and 31 (67%) were weaned after 8 days of support (IQR: 5-15). Fourteen patients under went transplantation. Hospital mortality in these patients was 32% (10/31), and was associated to age (P=.001), SAPS II score (P=.009), cannulation bleeding (P=.01) and post-acute myocardial infarction RCS (P=.001). After a median follow-up of 27 months (IQR: 11-49), 91% of the patients discharged from hospital were still alive. Overall survival after weaning from assistance was associated to the type of cardiac disease (P=.002). Patients with RCS after acute myocardial infarction had a poorer prognosis. In our experience, VA-ECMO can be used as mechanical assistance in the management of RCS. The technique is associated to high early mortality, though the long-term survival rate after hospital discharge is good. Copyright © 2017 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

  3. 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.

  4. Left anterior descending coronary artery blood flow and left ventricular unloading during extracorporeal membrane oxygenation support in a swine model of acute cardiogenic shock.

    Science.gov (United States)

    Brehm, Christoph; Schubert, Sarah; Carney, Elizabeth; Ghodsizad, Ali; Koerner, Michael; McCoach, Robert; El-Banayosy, Aly

    2015-02-01

    The impact of extracorporeal membrane oxygenation (ECMO) support on coronary blood flow and left ventricular unloading is still debated. This study aimed to further characterize the influence of ECMO on coronary artery blood flow and its ability to unload the left ventricle in a short-term model of acute cardiogenic shock. Seven anesthetized pigs were intubated and then underwent median sternotomy and cannulation for venoarterial (VA) ECMO. Flow in the left anterior descending (LAD) artery, left atrial pressure (LAP), left ventricular end-diastolic pressure (LVEDP), and mean arterial pressure (MAP) were measured before and after esmolol-induced cardiac dysfunction and after initiating VA-ECMO support. Induction of acute cardiogenic shock was associated with short-term increases in LAP from 8 ± 4 mm Hg to 18 ± 14 mm Hg (P = 0.9) and LVEDP from 5 ± 2 mm Hg to 13 ± 17 mm Hg (P = 0.9), and a decrease in MAP from 63 ± 16 mm Hg to 50 ± 24 mm Hg (P = 0.3). With VA-ECMO support, blood flow in the LAD increased from 28 ± 25 mL/min during acute unsupported cardiogenic shock to 67 ± 50 mL/min (P = 0.003), and LAP and LVEDP decreased to 8 + 5 mm Hg (P = 0.7) and 5 ± 3 mm Hg (P = 0.5), respectively. In this swine model of acute cardiogenic shock, VA-ECMO improved coronary blood flow and provided some degree of left ventricular unloading for the short duration of the study.

  5. Effects of continuous triiodothyronine infusion on the tricarboxylic acid cycle in the normal immature swine heart under extracorporeal membrane oxygenation in vivo.

    Science.gov (United States)

    Kajimoto, Masaki; Priddy, Colleen M O'Kelly; Ledee, Dolena R; Xu, Chun; Isern, Nancy; Olson, Aaron K; Portman, Michael A

    2014-04-15

    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 received [2-(13)C]lactate, [2,4,6,8-(13)C4]octanoate (medium-chain fatty acid), and [U-(13)C]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 min of each protocol. NMR analysis of left ventricular tissue determined the fractional contribution of these substrates to the tricarboxylic acid cycle. 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(-1)·h(-1)) during ECMO. Under both substrate loading conditions, T3 significantly increased the fractional contribution of lactate with a marginal increase in the fractional contribution of octanoate. Both T3 and high substrate provision increased the myocardial energy status, as indexed by phosphocreatine concentration/ATP concentration. In conclusion, T3 supplementation promoted lactate metabolism to the tricarboxylic acid cycle during ECMO, suggesting that T3 releases the inhibition of pyruvate dehydrogenase. Manipulation of substrate utilization by T3 may be used therapeutically during ECMO to improve the resting energy state and facilitate weaning.

  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. Bioengineering of Improved Biomaterials Coatings for Extracorporeal Circulation Requires Extended Observation of Blood-Biomaterial Interaction under Flow

    Directory of Open Access Journals (Sweden)

    Kris N. J. Stevens

    2007-01-01

    Full Text Available Extended use of cardiopulmonary bypass (CPB systems is often hampered by thrombus formation and infection. Part of these problems relates to imperfect hemocompatibility of the CPB circuitry. The engineering of biomaterial surfaces with genuine long-term hemocompatibility is essentially virgin territory in biomaterials science. For example, most experiments with the well-known Chandler loop model, for evaluation of blood-biomaterial interactions under flow, have been described for a maximum duration of 2 hours only. This study reports a systematic evaluation of two commercial CPB tubings, each with a hemocompatible coating, and one uncoated control. The experiments comprised (i testing over 5 hours under flow, with human whole blood from 4 different donors; (ii measurement of essential blood parameters of hemocompatibility; (iii analysis of the luminal surfaces by scanning electron microscopy and thrombin generation time measurements. The dataset indicated differences in hemocompatibility of the tubings. Furthermore, it appeared that discrimination between biomaterial coatings can be made only after several hours of blood-biomaterial contact. Platelet counting, myeloperoxidase quantification, and scanning electron microscopy proved to be the most useful methods. These findings are believed to be relevant with respect to the bioengineering of extracorporeal devices that should function in contact with blood for extended time.

  8. Detection of seizures with amplitude-integrated electroencephalography in a neonate treated with extracorporeal membrane ox%应用振幅整合脑电图监测体外膜肺治疗过程中的新生儿癫癎1例

    Institute of Scientific and Technical Information of China (English)

    李萌; 杨于嘉

    2008-01-01

    Infants with severe cardiorespiratory failure treated with extracorporeal membrane oxygenation are at risk of hypoxic-ischemic injury and infarction of the brain,intracranial hemorrhage,and seizures.Consequently,this can lead to adverse neumdevelopmental outcome. We present a neonate treated with veno-arterial extracorporeal membrane oxygenation due to diaphragmatic hernia.The infant'S brain function was continuously monitored with amplitude-integrated electroencephalography.The child experienced clinical seizures and subclinical seizure discharges,detected by amplitudeintegrated electroencephalography,permitting the opportunity to treat them and adjust the anticonvulsive treatment accordingly.

  9. Structural Requirements for Membrane Assembly of Proteins Spanning the Membrane Several Times

    OpenAIRE

    Lipp, Joachim; Flint, Nicholas; Haeuptle, Marie-Theres; Dobberstein, Bernhard

    1989-01-01

    We have investigated the structural requirements for the biogenesis of proteins spanning the membrane several times. Proteins containing various combinations of topological signals (signal anchor and stop transfer sequences) were synthesized in a cell-free translation system and their membrane topology was determined. Proteins spanning the membrane twice were obtained when a signal anchor sequence was followed by either a stop transfer sequence or a second signal anchor sequence. Thus, a sig...

  10. Proteomics in extracorporeal blood purification and peritoneal dialysis.

    Science.gov (United States)

    Thongboonkerd, Visith

    2010-01-03

    Extracorporeal blood purification and peritoneal dialysis are widely used in renal replacement therapy for patients with end-stage renal disease (ESRD) and acute kidney injury (AKI). Additionally, extracorporeal blood purification can be used also for treatment of non-renal disorders to remove endogenous or exogenous toxins from the blood circulation. Efforts have been made to characterize these toxins removed by diffusion (dialysis), convection (ultrafiltration), and/or adsorption (toxins are adsorbed onto the dialysis membrane and are thus removed) using different types of dialysis membrane. This review summarizes important findings obtained from recent proteomic studies applied to extracorporeal blood purification and peritoneal dialysis in settings of ESRD, AKI and hepatic failure.

  11. Emprego do suporte cardiopulmonar com bomba centrífuga e oxigenador de membrana em cirurgia cardiovascular pediátrica Use of centrifugal pump and extracorporeal membrane oxygenation as cardiopulmonary support in pediatric cardiovascular surgery

    Directory of Open Access Journals (Sweden)

    Fernando A. Atik

    2008-04-01

    Full Text Available FUNDAMENTO: O suporte cardiopulmonar com oxigenador de membrana é um método de ressuscitação de distúrbios hemodinâmicos, pulmonares ou ambos, consagrado em centros internacionais. OBJETIVOS: Descrever diversos aspectos relacionados ao suporte cardiopulmonar com oxigenador de membrana em um serviço de cirurgia cardiovascular nacional e determinar seus resultados imediatos e tardios. MÉTODOS: Entre outubro de 2005 e janeiro de 2007, 10 pacientes foram submetidos a suporte circulatório e/ou respiratório em candidatos ou submetidos a cirurgia cardiovascular pediátrica, com idade mediana de 58,5 dias (40% de neonatos e peso mediano de 3,9 kg. O suporte foi mantido com a intenção de recuperação e desmame, de acordo com critérios clínicos e ecocardiográficos diários. O suporte foi descontinuado nos pacientes sem indicação de transplante, com incapacidade de recuperação e com sobrevida limitada, de acordo com julgamento multidisciplinar. RESULTADOS: O suporte circulatório foi utilizado no pós-operatório de operações corretivas ou paliativas em 80% e no pré-operatório no restante. Instabilidade hemodinâmica grave irresponsiva (40%, falência miocárdica na saída de circulação extracorpórea (20% e parada cardíaca no pós-operatório (20% foram as indicações mais freqüentes. O tempo médio de permanência em suporte circulatório foi de 58 ± 37 horas. O suporte foi retirado com sucesso em 50% e 30% obtiveram alta hospitalar. A sobrevida atuarial foi de 40%, 30% e 20% aos 30 dias, 3 meses e 24 meses, respectivamente. CONCLUSÃO: O suporte cardiopulmonar com oxigenador de membrana foi um método eficaz e útil na ressuscitação de distúrbios cardiovasculares e pulmonares graves no perioperatório de cirurgia cardiovascular pediátrica.BACKGROUND: Extracorporeal membrane oxygenation is a well-documented resuscitation method in patients with severe hemodynamic and/or respiratory impairment. OBJECTIVE: To describe

  12. 乌司他丁在体外膜肺氧合中的肝保护作用%Effect of ulinastatin for hepatoprotection following extracorporeal membrane oxygenation

    Institute of Scientific and Technical Information of China (English)

    李斌飞; 廖小卒; 程周; 张志刚

    2012-01-01

    Objective To explore the effect of ulinastatin in hepatoprotection following extracorporeal membrane oxygenation (ECMO). Methods Forty patients with ECMO were randomized into two groups to receive ulinastatin treatment or not. Venous blood samples were collected to test ALT and AST levels following ECMO treatment for 12, 24 and 48 h. Results The two groups showed no significant difference in liver function indices before ECMO treatment. In both groups, the liver function worsened significantly after a 12-h ECMO treatment, but improved gradually after 24 h. The liver function damages were obviously lessened in ulinastatin group compared to those in patients without ulinastatin treatment (P<0.05). ECMO treatment significantly improved the liver function of the patients. Conclusion ECMO can significantly improve the liver function. The liver function damage reaches the peak level after a 12-h ECMO treatment, and ulinastatin can protect the liver function in patients undergoing ECMO.%目的 探讨乌司他丁在体外膜肺氧合(ECMO)中对肝脏的保护作用.方法 40例行ECMO治疗的患者按入院号随机分为A,B两组,其中A组为乌司他丁组,B组为对照组.采集患者ECMO治疗后12、24、48 h的静脉血对肝功能指标ALT,AST进行检测.结果 A,B两组患者行ECMO前的肝功能差异没有统计学意义,A,B患者在ECMO治疗后的12h后的肝功能最差,24 h后逐渐改善,但乌司他丁组的肝功能受损明显程度明显小于对照组(P<0.05),ECMO能显著改善肝功能.结论 ECMO能显著改善肝功能,体外膜肺氧合中患者的肝功能在第12小时受损到达高峰.乌司他丁对体外膜肺氧合中的肝具有保护作用.

  13. Membrane requirements for high-flux and convective therapies.

    Science.gov (United States)

    Bowry, Sudhir Kumar

    2011-01-01

    Worldwide, high-flux dialysis (HF-HD) has now surpassed low-flux dialysis (LF-HD) as the predominant treatment modality, recognition that removal of larger uremic retention solutes is desirable for the treatment of patients with end-stage chronic kidney disease (CKD). An even more advanced form of HF-HD in terms of removal of a broad spectrum of uremic toxins is on-line hemodiafiltration (HDF), involving convective transport mechanisms for solute removal. With the modality reaching considerable technical maturity over the last two decades, on-line HDF is now recognized for its clinical efficiency and effectiveness, versatility and safety. Such has been the success of on-line HDF that, in Europe, more patients are treated with on-line HDF than even peritoneal dialysis. Fabrication of high-flux membranes for convective therapies is more than a matter of simply making the membrane 'more open' or of increasing the membrane pore size which is not the only determinant for achieving higher convection. While convective transport of larger uremic retention solutes primarily demands membranes with high hydraulic permeability and sieving capabilities, the making of a modern dialysis membrane involves several other considerations that culminate in the delivery of an effective and safe therapy. In this communication I outline the essential membrane requirements and principles for solute removal by convection, as well of meeting additional features related to the therapy. The basic principles of the membrane manufacturing processes by which desired membrane morphology is derived for the separation phenomena involved in dialysis are further described. An awareness of this enables one to appreciate that, depending on the individual constituents and variations of the manufacturing processes, fabrication of all high-flux membranes entails achieving a balance between the ideal or desired criteria for blood purification. Dialysis membranes for convective therapies, even from the same

  14. Surgical myocardial revascularization without extracorporeal circulation

    Directory of Open Access Journals (Sweden)

    Salomón Soriano Ordinola Rojas

    2003-05-01

    Full Text Available OBJECTIVE: To assess the immediate postoperative period of patients undergoing myocardial revascularization without extracorporeal circulation with different types of grafts. METHODS: One hundred and twelve patients, 89 (79.5% of whom were males, were revascularized without extracorporeal circulation. Their ages ranged from 39 to 85 years. The criteria for indicating myocardial revascularization without extracorporeal circulation were as follows: revascularized coronary artery caliber > 1.5 mm, lack of intramyocardial trajectory on coronary angiography, noncalcified coronary arteries, and tolerance of the heart to the different rotation maneuvers. RESULTS: Myocardial revascularization without extracorporeal circulation was performed in 112 patients. Three were converted to extracorporeal circulation, which required a longer hospital stay but did not impact mortality. During the procedure, the following events were observed: atrial fibrillation in 10 patients, ventricular fibrillation in 4, total transient atrioventricular block in 2, ventricular extrasystoles in 58, use of a device to retrieve red blood cells in 53, blood transfusion in 8, and arterial hypotension in 89 patients. Coronary angiography was performed in 20 patients on the seventh postoperative day when the grafts were patent. CONCLUSION: Myocardial revascularization without extracorporeal circulation is a reproducible technique that is an alternative for treating ischemic heart disease.

  15. Extracorporeal treatment for carbamazepine poisoning

    DEFF Research Database (Denmark)

    Ghannoum, Marc; Yates, Christopher; Galvao, Tais F

    2014-01-01

    CONTEXT: The Extracorporeal Treatments in Poisoning (EXTRIP) workgroup was created to provide evidence and consensus-based recommendations on the use of extracorporeal treatments (ECTRs) in poisoning. OBJECTIVES: To perform a systematic review and provide clinical recommendations for ECTR...... in carbamazepine poisoning. METHODS: After a systematic literature search, the subgroup extracted the data and summarized the findings following a pre-determined format. The entire workgroup voted via a two-round modified Delphi method to reach a consensus on voting statements, using a RAND/UCLA Appropriateness...... is suggested in severe carbamazepine poisoning (2D). ECTR is recommended if multiple seizures occur and are refractory to treatment (1D), or if life-threatening dysrhythmias occur (1D). ECTR is suggested if prolonged coma or respiratory depression requiring mechanical ventilation are present (2D...

  16. Extracorporeal cardiopulmonary resuscitation

    Directory of Open Access Journals (Sweden)

    Steven A. Conrad

    2016-04-01

    Full Text Available ECPR is defined as the rapidly-deployed application of venoarterial extracorporeal membrane oxygenation, in patients with cardiac arrest, during cardiopulmonary resuscitation before the return of ROSC. ECPR is one of the most rapidly growing segments of ECLS, and is becoming more widespread. Consideration for institution of ECPR is given to patients with witnessed arrest, good quality CPR instituted within 5 min of arrest, in whom ROSC does not occur within 15 min, and who can complete cannulation within 30–60 min. Patients from both inpatient and out-of-hospital settings are candidates if they meet these criteria. Deep hypothermic cardiac arrest, such as cold-water drowning, should receive consideration for ECPR even after considerable duration of arrest. Available outcome data are based on retrospective observation studies, some with propensity matching, and suggests a higher chance for survival with ECPR. Published outcomes from ECPR, however, are difficult to interpret, since many centers classify their use of ECLS after ROSC, in addition to ECLS before ROSC, as ECPR. Both children and adults are candidates for ECPR, but the experience in children is weighted heavily toward those with a diagnosis of cardiac disease and arrest occurring within closely monitored units.

  17. Application of extracorporeal membrane oxygenation to cardiopulmonary cerebral resuscitation%体外膜肺氧合在心肺脑复苏中的应用

    Institute of Scientific and Technical Information of China (English)

    蒋崇慧; 黄子通; 谢钢; 李斌飞; 宁晔; 吴美英; 郑伟华; 尹刚; 赵双彪

    2008-01-01

    Objective To investigate the effects and values of extracorporeal membrane oxygenation (EC-MO) used in patients after cardiac arrest. Method During five years period from June 2002 to June 2007,fifteen cases taken for cardiopulmonary resuscitation were treated by using ECMO in the emergency department and ICU. All the measures for disgnosis and treatment were observed to the guidelines for cardiopulmonary resuscitation and emergency cardiovasculat care set by the American Heart Association in 2005, and ECMO was applied in addition. The study was a self-comparison trial. The biomarkers including heart rate (HR), mean arterial pressure (MAP), central venous pressure( CVP) , arterial partial oxygen pressure (PaO2), arterial partial pressure of carbon dioxide ( PCQ2), oxygen saturation (SaO2), hydrogen power (PH), and concentration of lactic acid were taken and assayed before and 10 min, 1 h,6 h, 12 h, and 24 h after treatment. Differences between the results of measurements were analysed by t -test for matched pairs using SPSS version 10.0 software package. Neurological sequelae was also observed and described. Results Ten minutes after ECMO treatment, MAP rose dramatically (P 的标准诊治方案进行救治,同时行体外膜肺氧合(ECMO)治疗.采用治疗前后自身对照的方法,监测ECMO治疗前、ECMO治疗后10 min、1 h、6 h、12 h、24 h,患者的心率、平均动脉压、中心静脉压(eve);并抽取桡动脉血检测动脉血氧分压、二氧化碳分压、血氧饱和度、酸碱度、动脉血乳酸含量等指标;统计数据以((x)±s)表示,采用SPSS 10.0统计软件包进行t检验,以P<0.05为差异具有统计学意义;同时就患者的神经性后遗症进行了观察和描述.结果 平均动脉压在ECMO治疗后10min比ECMO治疗前明显升高(P<0.01),ECMO治疗后1 h比ECMO治疗后10 min有所升高(P<0.05);CVP在ECMO治疗后10 min比ECMO治疗前,ECMO治疗后1 h比ECMO治疗后10 min有所降低(P<0.05);经ECMO治疗后10

  18. Establishment of rat model of extracorporeal membrane oxygenation%大鼠体外膜肺氧合模型的建立

    Institute of Scientific and Technical Information of China (English)

    秦科; 张素斌; 孙煦勇; 梁东科; 赖彦华; 董建辉

    2011-01-01

    目的 建立大鼠体外膜肺氧合(ECMO)模型.方法 选用成年健康雄性SPF级SD大鼠,利用特制微型动物膜式氧合器,经右颈静脉插管引流,尾动脉插管灌注建立小预充量的ECMO,转流时间120 min,股动脉插管监测血流动力学指标及血气、电解质的变化.结果 90%大鼠顺利建立ECMO模型,与ECMO前比较,平均动脉压(MAP)、红细胞压积(Hct)在ECMO 30 min、ECMO 60 min、ECMO120 min下降(P<0.05或P<0.01),动脉血气及电解质指标差异无统计学意义(P>0.05),基本达到理想的ECMO标准.停机后呼吸和心血管循环功能顺利恢复,获得了24h的较长时间生存.结论 本方法建立的大鼠ECMO模型切实可行,简单实用、重复性好.%Objective To establish a clinically relevant rat extracorporeal membrane oxygenation ( ECMO ) model that would be a valuable tool for investigating pathophysiological and therapeutic strategies on bypass.Methods 20 male SD aged rats were anesthetized and intubated.The right external jugular vein,femoral artery and tail artery were cannulated.The blood was drained from the right atrium via the right jugular vein and further transferred by a small roller pump to a miniaturized hollow fiber oxygenator and return to the systemic circulation through the tail artery.ECMO were performed for 120 min at a flow rate of 80 to 120 ml/( kg · min).During the whole process,the hemodynamics,electrocardiograph ( ECG ) and blood-gas analysis were observed.Results 18 of the 20 animals were performed successfully.Compared with before ECMO,MAP and Hct were decreased after ECMO( P <0.05 or P <0.01 ).The blood-gas analysis at different time points were within a normal range.After ECMO weaning,cardiovascular and respiratory functions recovered gradually.Conclusion We have successfully established a miniature circuit consisting of prime for a rat ECMO model that maintains clinically acceptable results regarding hemodynamic parameters,blood gases

  19. Comparison of a New Miniaturized Extracorporeal Membrane Oxygenation System With Integrated Rotary Blood Pump to a Standard System in a Porcine Model of Acute Lung Injury.

    Science.gov (United States)

    Pilarczyk, Kevin; Heckmann, Jens; Lyskawa, Kathrin; Strauß, Andreas; Haake, Nils; Wiese, Ingo; Jakob, Heinz; Kamler, Markus; Pizanis, Nikolaus

    2016-07-01

    Extracorporeal membrane oxygenation (ECMO) is used for severe acute respiratory distress syndrome. However, available ECMO systems are large and not well designed for fast delivery, emergency implantation, and interhospital transfer. Therefore, a new miniaturized oxygenator with integrated rotary blood pump (ILIAS) was developed and compared with a standard ECMO system in a large animal model. Acute lung injury was induced with repeated pulmonary saline lavage in 14 pigs until PaO2 /FiO2 -ratio was ECMO; group 3 (n = 5): vv-ILIAS. Gas exchange, hemodynamics, hemolysis, and coagulation activation were examined over a period of 8 h. No device failed during the observation period. PaCO2 decreased from 59.40 ± 4.14 mm Hg to 48.62 ± 4.50 mm Hg after 1 h in the ILIAS group compared with an improvement of PaCO2 from 48.86 ± 7.45 to 40.10 ± 6.02 in the conventional ECMO group (P = not significant [n.s.]). ARDS-induced respiratory acidosis was controlled promptly with a pH of 7.2 ± 0.1 at baseline increasing to 7.4 ± 0.1 in both study groups after 60 min of ECMO support. Mean carbon dioxide transfer was comparable between the conventional ECMO and ILIAS (211.36 ± 78.39 mL/min vs. 219.99 ± 76.72 mL/min, P = n.s.). PaO2 /FiO2 increased from 118.4 ± 15.5 mm Hg to 179.1 ± 72.4 mm Hg in the ILIAS group compared with an improvement of oxygenation from 107.1 ± 24.9 mm Hg to 179.0 ± 45.7 mm Hg in the standard ECMO group (P = n.s.). Mean oxygen transfer was calculated with 136.09 ± 30.25 mL/min for the ILIAS and 129.05 ± 36.28 mL/min for the standard ECMO. Hemodynamic instability or significant activation of the plasmatic coagulation was not observed. However, hemolysis was significantly higher in the ILIAS group compared with the conventional ECMO. As the ILIAS prototype provided excellent gas exchange with hemodynamic stability comparable with a standard ECMO

  20. 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

  1. Successful Management of a Patient with Refractory Ventricular Fibrillation (VF) due to Acute Myocardial Infarction (AMI) and Lung Injury by Transition from Percutaneous Cardiopulmonary Support (PCPS) to Veno-Venous Extracorporeal Membrane Oxygenation (ECMO).

    Science.gov (United States)

    Sato, Atsushi; Isoda, Kikuo; Gatate, Yodo; Akita, Koji; Daida, Hiroyuki

    2016-01-01

    A 69-year-old man was admitted to our hospital with cardiopulmonary arrest. Percutaneous cardio-pulmonary support (PCPS) using the right femoral artery and vein was initiated, because ventricular fibrillation continued. Although we succeeded in defibrillation after percutaneous coronary intervention (PCI), a chest radiograph indicated a pneumothorax in the right lung and a pulmonic contusion in the left lung caused by cardiopulmonary resuscitation. Two days after PCI, partial pressure of arterial oxygen (PaO2) from the right radial artery suddenly decreased, and his cardiac function showed improvement on an echocardiogram. To avoid additional brain damage, we converted the treatment to veno-venous extracorporeal membrane oxygenation by changing the blood returning site of PCPS from the right femoral artery to the right jugular vein. Thereafter, the patient's PaO2 level gradually improved.

  2. 体外膜氧合用于心脏死亡后捐献供肝的初步经验%Extracorporeal Membrane Oxygenation for the Initial Experience of Donor Donated after Cardiac Death

    Institute of Scientific and Technical Information of China (English)

    李志强; 许传屾; 王淑贤; 董霏霏; 郭源; 范宁; 王建红; 吴晓东; 臧运金

    2016-01-01

    Objective Discussion extracorporeal membrane oxygenation initial experience after cardiac death donation donor used.Methods Convenient select the December 2014 to December 2015 in our hospital cardiac death donor liver tissue of 30 patients were discussed, according to the different organs of protection will be divided into study group (20 cases) and control group (10 cases), thermal control group after ischemia 30 min to be in situ cold perfusion, UV was stored liver, the study group were treated with extracorporeal membrane oxygenation techniques to hold the organ until the acquisition, and compared the two groups of liver histopathology and liver function. Results Study patients warm ischemia 30 min after his liver congestion becomes black after extracorporeal membrane oxygenation secondary recycling, slowly returned to normal liver tissue full red state, the control group of patients seen after 4h store hepatocyte edema, sinusoidal expansion. ALT and AST levels in patients with the study group were (51.5 ± 12.4) U / L and (46.0 ± 23.3) U / L, the control group of patients, respectively (76.1 ± 33.4) U / L and (150.0 ± 29.3) U / L, The difference was statistically significant (P<0.05).Conclusion Extracorporeal membrane oxygenation for liver donation after cardiac death has a protective effect, which should be widely applied.%目的:探讨体外膜氧合用于心脏死亡后捐献供肝的初步经验。方法方便选取2014年12月一2015年12月在该院心脏死亡后捐献肝脏组织的30例患者进行探讨,根据器官保护方式的不同将其分为研究组(20例)和对照组(10例),对照组热缺血30 min后予以原位冷灌注,UV液保存肝脏,研究组患者采用体外膜氧合技术保持器官直至获取,并比较两组肝脏组织病理改变以及肝功能水平。结果研究组患者热缺血30 min后其肝脏组织变为乌黑淤血,体外膜氧合辅助再循环后,肝脏组织缓慢恢复至正常饱满鲜

  3. Use of extracorporeal life support for emergency coronary artery bypass grafting.

    Science.gov (United States)

    Panda, Biswa Ranjan; Prabhu, Anil; Provenzano, Sylvio; Karl, Tom

    2013-06-01

    A 14-year old boy was admitted with an anomalous origin of the right coronary artery (RCA) from the left sinus of Valsalva, with an interarterial course of the narrow proximal segment. He underwent coronary ostial augmentation and main pulmonary artery translocation to the left pulmonary artery. In the post-cardiopulmonary bypass (CPB) period, he developed thrombotic occlusion of the RCA resulting in arrhythmia and ventricular dysfunction, requiring extracorporeal life support (ECLS) in the form of extracorporeal membrane oxygenation rather than CPB. After confirming this complication by cardiac catheterization, the right coronary artery territory was revascularized with a pedicled right internal thoracic artery graft. The entire procedure was performed on a beating heart using a stabilizer during ECLS. This strategy may be useful in situations with unstable haemodynamics and a low risk of blood loss.

  4. 小儿体外膜肺氧合支持治疗8例%A case series of 8 children supported with extracorporeal membrane oxygenation

    Institute of Scientific and Technical Information of China (English)

    傅惟定; 张蔚; 王伟; 姜磊; 沈佳; 唐嘉忠; 朱德明

    2011-01-01

    目的 总结小儿先天性心脏病术后严重心力衰竭和暴发型心肌炎应用体外膜肺氧合(ECMO)支持治疗的经验.方法 8例中术后不能脱离CPB 7例、暴发型心肌炎1例.均使用离心泵,全部静脉-动脉模式;采用中心插管、右房-升主动脉7例,周围大血管插管、股静脉-股动脉模式1例.辅助65~498 h,辅助流量80~120ml·min-1·kg-1.结果 死亡5例;出院3例,生存率38%.并发症包括出血5例、血栓形成2例、溶血1例、DIC 1例、肝衰竭1例、营养不良2例、机械故障2例.结论 先心病术后无残余解削畸形,而出现严重心衰病例,往往因合并左、右心室并伴肺功能不全,宜及时施行ECMO支持治疗,而取代肺脏气体交换功能,减少呼吸器使用中的高浓度氧气和气道压的肺损伤,降低总体病死率;注意及时补充新鲜血小板、血浆等血制品;合理应用血管活性药物和肝素,根椐出血部位及量采用针对性措施,维持内环境稳定;加用超滤,减少机体特别是出血的并发症.应选用长期使用的肝素涂层膜肺,监测膜前后压力,注意血浆渗漏,减少机械并发症.%Objective The use of extracorporeal membrane oxygenation (ECMO) as a treatment for the failure of cardiopulmonary function after cardiac surgery is increasing and has been reported to be 3% to 5% in the cases with congenital heart disease. We reviewed our experience with ECMO in children who received heart surgery for congenital heart disease and complicated with severe heart failure postoperatively. Methods Eight patients received ECMO, seven was due to the failure to wean from bypass and one had fulminant myocarditis. Import membrane oxygenator,veno-arterial mode ECMO and right atriumascending aortic cannulation were used in 7 cases and peripheral cannulation via femoral veno-artery route was used in 1 case.Supportive intervention persisted from 65 to 498 hours, with flow rate maintained at 80 to 120 ml per minute per

  5. Extracorporeal treatment for thallium poisoning

    DEFF Research Database (Denmark)

    Ghannoum, Marc; Nolin, Thomas D; Goldfarb, David S

    2012-01-01

    The EXtracorporeal TReatments In Poisoning (EXTRIP) workgroup was formed to provide recommendations on the use of extracorporeal treatment (ECTR) in poisoning. To test and validate its methods, the workgroup reviewed data for thallium (Tl).......The EXtracorporeal TReatments In Poisoning (EXTRIP) workgroup was formed to provide recommendations on the use of extracorporeal treatment (ECTR) in poisoning. To test and validate its methods, the workgroup reviewed data for thallium (Tl)....

  6. Is Extracorporeal CO2 Removal Really "Safe" and "Less" Invasive? Observation of Blood Injury and Coagulation Impairment during ECCO2R.

    Science.gov (United States)

    Kalbhenn, Johannes; Neuffer, Nadine; Zieger, Barbara; Schmutz, Axel

    Extracorporeal CO2 removal (ECCO2R) is promoted with attributes like "safe" and "less invasive" compared with (high-flow) venovenous extracorporeal membrane oxygenation (ECMO) systems. With our experience in coagulation disorders during ECMO therapy with this observational study, we for the first time prospectively evaluate hemolysis and coagulation disorders during ECCO2R. Eight consecutive patients with predominant hypercapnic respiratory failure were treated with the Hemolung respiratory assist system (Alung-Technologies, Pittsburg, PA). Bleeding as well as changes of coagulation parameters was prospectively assessed. Overall therapy was observed in seven patients with 52 treatment days. In four of seven patients (57%), relevant clinical bleeding symptoms occurred. Thrombocytopenia, hemolysis, factor XIII deficiency and acquired von Willebrand syndrome (loss of high-molecular-weight von Willebrand factor multimers) were typical findings, and the patients spontaneously recovered after discontinuation of the extracorporeal system. In one patient, extracorporeal system stopped because of thrombotic occlusion. Six of seven patients required transfusion of red blood cells. Our observation shows that even low-flow extracorporeal lung support is associated with relevant clinical bleeding symptoms, blood cell injury, development of acquired von Willebrand syndrome and need for transfusion. In our opinion, it therefore is too early to quote ECCO2R "safe" and "less invasive."

  7. Follow-up of survived children supported by extracorporeal membrane oxygenation%儿童体外膜肺氧合术后随访分析

    Institute of Scientific and Technical Information of China (English)

    程晔; 陆铸今; 闫宪刚; 贺骏; 闫钢风; 蔡小狄; 沈伟杰; 金爱丽; 陆国平

    2016-01-01

    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 P3.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 themselves.The ECMO sequelae of those

  8. Application of ultrafiltration during extracorporeal membrane oxygenation%体外膜肺氧合期间超滤技术的应用

    Institute of Scientific and Technical Information of China (English)

    赵成秀; 李彤; 段大为; 胡晓旻; 张强; 吴鹏; 稂与恒; 侯跃龙

    2011-01-01

    OBJECTIVE To introduce the connection and effect of extracorporeal memhrane oxygenation ( ECMO ) combination with ultrafiltration in extracorporeal circulation. METHODS 3 severe heart disease patients with anuria and tissue oedema,whose age ranged from 57 years to 78 years ( average 69 years ) and body weight ranged from 63 kg to 89 kg ( average 73. 6 kg ) were treated with Medtronic ECMO circuit to assist cardiac function. The ultrafiltration devise with idio - designed methods was connected at the three - way joint of ECMO circuit and negative pressure site of centrifugal pump. RESULTS The ultrafiltration volume during ECMO assisting ranged from 5 750 ml to 14 850 ml of the three patients. After ECMO assisting combination with ultrafiltration for 36 hours and 42 hours. urinary production of two patients were recovery, who weaned off ECMO after cardiac function recovery and discharged. Another patient gave up treatment after ECMO assisting for 48 hours and left hospital. CONCLUSION For ECMO combination with ultrafiltration in extracorporeal circulation, the conjunction was simple , deflation was thorough and convenient, the effect of filtration was well and safe. Ultrafiltration was fitted for ECMO assist homeochronously.%目的 总结体外膜肺氧合(ECMO)中结合超滤一体化连接方法及应用效果.方法 3例重症心脏病患者,年龄57~78(69)岁,体重63~89(73.6)kg.采用Medtronic ECMO管路行ECMO心功能支持,ECMO前及ECMO期间无尿、组织脏器水肿,在ECMO管路三通板处与离心泵接负压处连接超滤.结果 3例患者在ECMO过程中滤水5 750~14 850 ml,2例患者经过ECMO辅助联合超滤治疗后36 h、42 h尿量逐渐恢复,心功能恢复后撤除ECMO,后康复出院,另1例患者ECMO辅助48 h,家属放弃治疗自动出院.结论 ECMO中结合超滤连接方法简便,排气方便彻底,滤水效果良好、安全,适合ECMO过程中同期使用.

  9. 体外膜肺氧合在失血性心脏骤停中的应用%Application of extracorporeal membrane oxygenation in patients with hemorrhagic cardiac arrest

    Institute of Scientific and Technical Information of China (English)

    廖小卒; 李斌飞; 张志刚; 程周; 夏晓文; 周引凤

    2011-01-01

    目的 探讨体外膜肺氧合(ECMO)在失血性心脏骤停中应用的价值.方法 回顾性分析我院20例因失血性休克致心脏骤停行ECMO治疗的患者.监测ECMO治疗前、ECMO治疗后10 min,原发病解决后ECMO治疗1h、6h、12h、24 h的心率、平均动脉压、中心静脉压(CVP);并抽取桡动脉血检测动脉血氧分压、动脉血乳酸含量.并且统计辅助时间.结果 平均动脉压在ECMO治疗后10 min比ECMO治疗前明显升高(P<0.05),原发病解决后ECMO治疗1h比ECMO治疗后10min有明显升高(P<0.05);CVP在ECMO治疗后10min比ECMO治疗前显著降低(P<0.05),ECMO治疗后1h比ECMO治疗后10 min显著升高(P<0.05);经ECMO治疗后10min动脉血氧分压较ECMO治疗前明显上升(P<0.05),动脉血乳酸含量明显降低(P<0.05),平均辅助时间(23.5±7.1)h.结论 失血性心脏骤停行ECMO治疗的辅助时间短,心功能恢复快,成功率高,ECMO在失血性心脏骤停中应用是可行的.%Objective To investigate the value of the application of extracorporeal membrane oxygenation in patients with hemorrhagic cardiac arrest Methods 20 cases with hcmorrhagic shock cardiac arrest patients who has been treated with ECMO were nalyzed retrospectively. The heart rate, mean arterial pressure, and central venous pressure (CVP) were monitored at various time points.The point of before ECMO treatment, the ECMO treatment after 10 min , ECMO treatment after solving original disease for 1 h, 6 h, 12 h, 24 h . Detect the arterial partial pressure of oxygen and blood lactic acid content Results The MAP of the point of the ECMO treatment afterlO min was increased more significantly than that of before ECMO treatment (P<0.05), the MAP of the point of the ECMO treatment after solving original disease for 1 h increased more significantly than that of the ECMO treatment after 10 min (P<0.05); the CVP of the point of the ECMO treatment afterlO min was reduced more than before ECMO treatment, and ECMO

  10. Isolation of mitochondria with cubic membrane morphology reveals specific ionic requirements for the preservation of membrane structure.

    Science.gov (United States)

    Chong, Ketpin; Tan, Olivia Li Ling; Almsherqi, Zakaria A; Lin, Qingsong; Kohlwein, Sepp D; Deng, Yuru

    2015-03-01

    Biological membranes with cubic symmetry are a hallmark of virus-infected or diseased cells. The mechanisms of formation and specific cellular functions of cubic membranes, however, are unclear. The best-documented cubic membrane formation occurs in the free-living giant amoeba Chaos carolinense. In that system, mitochondrial inner membranes undergo a reversible structural change from tubular to cubic membrane organization upon starvation of the organism. As a prerequisite to further analyze the structural and functional features of cubic membranes, we adapted protocols for the isolation of mitochondria from starved amoeba and have identified buffer conditions that preserve cubic membrane morphology in vitro. The requirement for high concentration of ion-chelating agents in the isolation media supports the importance of a balanced ion milieu in establishing and maintaining cubic membranes in vivo.

  11. 体外膜肺氧合在儿科心肺功能衰竭救治中的临床应用%Application of extracorporeal membrane oxygenation in pediatric cardiopulmonary failure

    Institute of Scientific and Technical Information of China (English)

    洪小杨; 周更须; 刘宇航; 刘颖悦; 王辉; 高海涛; 封志纯

    2015-01-01

    Objective To introduce the application of extracorporeal membrane oxygenation (ECMO) in treatment of pediatric cardiopulmonary failure. Methods The clinical data of pediatric patients with cardiopulmonary failure who received ECMO support from June 2012 to October 2014 were retrospectively analyzed. Results A total of 24 children with cardiopul-monary failure received ECMO support including 18 male and 6 female aged from 1 day to 7 years old with weight between 3-20 kg. There were 15 cases who successfully weaned from ECMO (62.5%) and 10 cases survived and discharged (42.7%). 14 patients died. Among them, 9 patients died of unsuccessful weaning from ECMO, 3 patients died of complications and 2 patients died of giving up treatment after weaning from ECMO. Complications were found in 11 cases (45.8%) during ECMO support. Conclusions ECMO can provide effective support for pediatric patients with refractory cardiopulmonary failure.%目的:探讨体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)技术在儿科心肺功能衰竭救治中的应用。方法回顾性分析2012年6月至2014年10月接受ECMO支持的心肺功能衰竭重症患儿的临床资料。结果共24例心肺功能衰竭患儿接受ECMO支持,男18例,女6例;年龄1 d~7岁;体质量3~20 kg;共有15例成功脱离ECMO,总撤概率62.5%;存活10例(42.7%),死亡14例,其中9例因无法撤离ECMO死亡,3例撤离ECMO后死于并发症,2例撤离ECMO家属放弃治疗死亡;11例(45.8%)患儿在ECMO支持期间出现并发症。结论对于难治性呼吸循环衰竭重症患儿ECMO技术可以提供有效的心肺支持。

  12. 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

    Institute of Scientific and Technical Information of China (English)

    Lei Huang; Tong Li; Lei Xu; Xiao-Min Hu; Da-Wei Duan; Zhi-Bo Li; Xin-Jing Gao

    2016-01-01

    Background: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.Methods: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).Results: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.Conclusions:The RESP,APCHAE Ⅱ,and SOFA scorings systems show good

  13. 体外膜肺氧合治疗心脏手术后急性心功能衰竭的疗效%Clinical application of extracorporeal membrane oxygenation support for acute heart failure after heart surgery

    Institute of Scientific and Technical Information of China (English)

    吴颖猛; 叶红雨; 李斌飞; 黄伟钊; 姜海明

    2013-01-01

    Objectives To evaluate the results and to summarize the experience of temporary extracorporeal membrane oxygenation (ECMO) support for patients with acute heart failure undergoing heart surgery.Methods A retrospective study was performed on 22 consecutive patients with acute heart failure who received ECMO support after heart surgery in Zhongshan Hospital of Sun Yat-sen University from October 2009 to February 2013.The clinical data of the patients,duration of ECMO support,complications,turnovers and so on were recorded.Results Duration of ECMO support was (100.0 ± 89.2) h.Four patients died of heart failure before ECMO withdrew; 18 patients were successfully withdrew from ECMO,of which 4 patients died after withdrew from ECMO support.The most common complications were bleeding and infection.Conclusions ECMO is an effective supportive therapy for patients with acute heart failure after heart surgery.%目的 总结体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)治疗心脏外科术后出现严重心功能衰竭的应用经验.方法 选择自2009年10月至2013年2月在中山市人民医院进行心脏外科手术,且术后出现急性心功能衰竭而应用ECMO治疗的22例患者为研究对象,总结其应用ECMO治疗的临床情况.结果 上机维持时间为(100.0±89.2)h.因心脏功能无法恢复,无法撤机并死亡4例;成功撤机18例,其中4例顺利撤机,但仍最终死亡;顺利恢复并出院14例.辅助过程中主要并发症为出血和感染.结论 ECMO的应用有利于辅助心肺功能和防治并发症,对于心脏术后心功能衰竭的治疗疗效肯定.

  14. 体外膜肺氧合对心脏手术后心源性休克的辅助效果%Extracorporeal membrane oxygenation for postcardiotomy cardiogenic shock

    Institute of Scientific and Technical Information of China (English)

    侯晓彤; 孟旭; 龚庆成; 尤斌; 张健群; 程沛; 王盛宇; 曹向戎; 毛斌

    2008-01-01

    Objective To report the experience on extracorporeal membrane oxygenation (ECMO) for cardiogenic shock after cardiac surgery. Methods From June 2004 to October 2005, 26 patients with cardiogenic shock after cardiac surgery were placed on venoarterial ECMO using a heparin-bonded circuit. Surgical procedures included 10 coronary bypass, 5 valve replacement, 5 congenital heart disease repair, 4 heart transplantation and 1 aortic procedure. Average of patient age was (44.6±19.7) years (range, 7 months to 76 years). Average body weight was (64.1 ± 18.6) kg (range, 6.5 to 90.0 kg). Results Average time on ECMO was ( 72.6 ± 74.9 ) hours (range, 8 to 336 hours). Sixteen patients ( 61.5 % ) were weaned from ECMO. Twelve patients (45.2 % ) were suceessfully discharged. Conclusion Extracorporeal membrane oxygenation can provide cardiac support in patients in cardiogenic shock after cardiac surgery. The hospital survival is rather good compared with relative reports.%目的 报道体外膜肺氧合器(ECMO)对心脏术后心源性休克进行辅助的初步结果并总结经验.方法 2004年6月至2006年10月,临床应用肝素涂层ECMO对心脏术后心源性休克进行辅助26例,其中冠心病10例,瓣膜病6例,心脏移植4例,先心病5例,大血管病变1例.年龄7个月~76岁,平均(44.6±19.7)岁;体重6.5~90.0 kg,平均(64.1±18.6)kg.结果 辅助8~336 h.16例脱机,脱机率为61.5%.4例脱机后死亡,12例生存出院(46.2%).结论 ECMO可以有效地进行心脏术后心源性休克的辅助,辅助效果较好.

  15. LEFT VENTRICLE UNLOADING BY PERCUTANEOUS TRANSFEMORAL TRANSSEPTAL CANNULATION OF LEFT ATRIUM IN PATIENTS BRIDGED TO HEART TRANSPLANTATION WITH PERIPHERAL VENO-ARTERIAL EXTRACORPOREAL MEMBRANE OXYGENATION

    Directory of Open Access Journals (Sweden)

    V. N. Poptsov

    2013-01-01

    Full Text Available Aim. Peripheral VA ECMO is effective method of circulatory support in heart transplant candidates with life th- reatening CHF. However this type of extracorporeal life support may be complicated by pulmonary congestion (“white lung” as a result of left ventricle (LV dilatation and volume overload. Difference approach proposed for LV unloading following VA ECMO circulatory support. We report our experience of LV unloading by percutaneous introduced of supplement drainage cannula in the left atrium (LA through the femoral vena and interatrial septum. Material and methods. In this study was included 33 heart transplant candidates (6/27 F/M, age 46.2 ± 3.7 yrs on peripheral VA ECMO support. For LV unloading we used supplement standard venous ECMO-cannula (15–19 F percutaneous introduced in LA through the femoral vena of conterlateral leg and connected to the venous line of ECMO circuit. Results. To 20 (60.6% from 33 patients needed of early (n = 10 or delayed (n = 10 LA drainage. After beginning of LV drainage we noted of significant (p < 0.05 decreasing of PAWP from 31 ± 3 to 14 ± 3 mm Hg and resolution of pulmonary edema. Mean blood flow on LA cannula was 1.5 ± 0.2 l/min. To 18 (90% from 20 patients was successfully bridged to heart transplantation. Duration VA ECMO before OHT was 8.6 ± 1.7 days. 16 (88.9% recipients were discharged from hospital. Conclusion. Active LA drainage is as effective tool of LV un- loading and protection of pulmonary congestion and edema in patients bridged to heart transplantation by peripheral VA ECMO. 

  16. Extracorporeal Treatment for Lithium Poisoning

    DEFF Research Database (Denmark)

    Decker, Brian S; Goldfarb, David S; Dargan, Paul I

    2015-01-01

    The Extracorporeal Treatments in Poisoning Workgroup was created to provide evidence-based recommendations on the use of extracorporeal treatments in poisoning. Here, the EXTRIP workgroup presents its recommendations for lithium poisoning. After a systematic literature search, clinical and toxico......The Extracorporeal Treatments in Poisoning Workgroup was created to provide evidence-based recommendations on the use of extracorporeal treatments in poisoning. Here, the EXTRIP workgroup presents its recommendations for lithium poisoning. After a systematic literature search, clinical...... extraction of patient-level data. The workgroup concluded that lithium is dialyzable (Level of evidence=A) and made the following recommendations: Extracorporeal treatment is recommended in severe lithium poisoning (1D). Extracorporeal treatment is recommended if kidney function is impaired and the [Li...... treatment (1D), but continuous RRT is an acceptable alternative (1D). The workgroup supported the use of extracorporeal treatment in severe lithium poisoning. Clinical decisions on when to use extracorporeal treatment should take into account the [Li(+)], kidney function, pattern of lithium toxicity...

  17. Extracorporeal Treatment for Metformin Poisoning

    DEFF Research Database (Denmark)

    Calello, Diane P; Liu, Kathleen D; Wiegand, Timothy J

    2015-01-01

    BACKGROUND: Metformin toxicity, a challenging clinical entity, is associated with a mortality of 30%. The role of extracorporeal treatments such as hemodialysis is poorly defined at present. Here, the Extracorporeal Treatments In Poisoning workgroup, comprising international experts representing...... diverse professions, presents its systematic review and clinical recommendations for extracorporeal treatment in metformin poisoning. METHODS: A systematic literature search was performed, data extracted, findings summarized, and structured voting statements developed. A two-round modified Delphi method......) and made the following recommendations: extracorporeal treatment is recommended in severe metformin poisoning (1D). Indications for extracorporeal treatment include lactate concentration greater than 20 mmol/L (1D), pH less than or equal to 7.0 (1D), shock (1D), failure of standard supportive measures (1D...

  18. Significant reduction in blood loss in patients undergoing minimal extracorporeal circulation

    NARCIS (Netherlands)

    Gerritsen, W. B.; van Boven, W. J.; Smelt, M.; Morshuis, W. J.; van Dongen, H. P.; Haas, F. J.; Aarts, L. P.

    2006-01-01

    Several recent studies have shown differences in blood loss and allogeneic transfusion requirements between on-pump and off-pump coronary artery bypass grafting (CABG). Recently a new concept, the mini-extracorporeal circulation, was introduced to minimize the side effects of extracorporeal circulat

  19. Clinical study of extracorporeal membrane oxygenation for cardiac arrest%急诊体外膜肺氧合在心脏骤停中的应用研究

    Institute of Scientific and Technical Information of China (English)

    蒋崇慧; 谢钢; 李斌飞; 宁晔; 吴美英; 郑伟华; 尹刚; 赵双彪; 黄子通

    2008-01-01

    Objective To investigate the effects and values of extracorporeal membrane oxygenation (ECMO)in treating patients of cardiac arrest.Methods Between June 2002 and July 2007,16 cases of cardiopulmonary resuscitation were treated by ECMO in our hospital,including male 10 cases,female 6 caseB.Interior iuguhr and femoral intubation were applied to these patients as well as centrifugal pumps and heparin-besmeared conduit.The support time of ECMO was 8 to 73 hours with an average of 19.We closely observed blood pressure and blood oxygen during the whole treatment.Results After ECMO treatment,mean arterial pressure rose 10 min and one hour later,it even got higher(P<0.05).On the other hand,CVP dropped at once and lower one hour Later(P<0.05).Besides,hypoxemia improved in a shot time,while arterial partial pressure of oxygen(Pao2).Oxygen saturation of blood increased clearly(P<0.05),lactive acid of arterial blood decreased significantly(P<0.05).Conclusion ECMO provides hearts with effective blood circulation,improves hypoxemia and oxygen metabohzation gready.Moreover,it provides brain with stable oxygen-mixed blood thus was good for cardiopulmonary resuscitation.%目的 探讨急诊体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)在心搏骤停患者中的治疗作用及应用价值.方法 2002年6月至2007年7月,应用急诊体外膜肺氧合(ECMO)治疗心搏骤停患者16例,患者男10例,女6例,均采用股动、静脉插管技术,应用离心泵和肝素涂敷管道.ECMO辅助8~73 h,平均19 h.监测治疗前后动脉血压及血气分析等指标.结果 平均动脉压在EcMO后10 min比ECMO前明显升高(P<0.01),ECMO后1h比ECMO后10 min有所升高(P<0.05),CVP在ECMO后10 min比ECMO前有所降低,ECMO后1 h比ECMO后10 min又有所降低(P<0.05).经ECMO辅助治疗后低氧血症均迅速改善,动脉血氧分压、血氧饱和度较转流前明显上升(P<0.05),动脉血乳酸含量明显降低(P<0.05).结论 ECMO治疗可辅

  20. 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.

  1. Analysis on Risk Factors of Limb Ischemia Injury after Extracorporeal Membrane Oxygenation%体外膜肺氧合致下肢缺血损伤的危险因素分析

    Institute of Scientific and Technical Information of China (English)

    陈妙莲; 李建伟; 徐雪影; 李云; 李斌飞; 叶红雨; 侯六生; 杨婷

    2016-01-01

    目的:总结体外膜肺氧合(ECMO)在成人心源性休克(CS)中的临床救治经验,探讨 ECMO 的临床应用价值及导致下肢缺血损伤的可能危险因素。方法:回顾性分析中山大学附属中山医院2009年7月至2014年7月因传统药物和(或)主动脉内球囊反搏(IABP)无效而行 ECMO 救治的成人 CS 患者的临床资料,将辅助前合并颅脑损伤及多器官功能衰竭的病例排除在外,根据患者是否合并下肢缺血将其分为缺血损伤组(n=9)与无缺血损伤组(n=49),通过组间单因素比较筛选出影响脱机的可能危险因素。结果:本研究入选的58例 ECMO 患者中,建立循环时间15-25 min,辅助时间132.5±89.2h,成功脱机35例(60.4%),康复出院26例(44.8%)。与无下肢缺血损伤组比较,患者平均年龄、糖尿病比例、心跳骤停比例、血乳酸水平以及 ECMO 辅助时间显著高于血运正常组(P<0.05),但心脏左室射血分数显著低于血运正常组(P<0.05)。组件插管口径、插管深度无统计学差异(P>0.05)。结论:ECMO 是救治成人心源性休克的较有效手段,肢体远端缺血损伤可直接影响疗效,尽早识别发生并发症的高危因素,并采取有效措施积极防治,是降低肢体远端缺血发生率,提高 ECMO 辅助成功的关键。%Objective:To summarize the clinical experience of treatment for adult cardiogenic shock (CS) with extracorporeal membrane oxygenation (ECMO) and analyze on risk factors of limb ischemia injury after ECMO. Methods:Patients with cardiogenic shock required veno-arterial ECMO after failure of conventional therapy and intra-aortic balloon pump counterpulsation therapy from July 2009 to July 2014 were retrospectively studied. Patients with traumatic brain injury and multiple organ failure were excluded. All patients were divided into limb ischemia injury group(n=9) and not

  2. Low thrombogenicity of polyethylene glycol-grafted cellulose membranes does not influence heparin requirements in hemodialysis.

    Science.gov (United States)

    Wright, M J; Woodrow, G; Umpleby, S; Hull, S; Brownjohn, A M; Turney, J H

    1999-07-01

    Heparin is the most commonly used anticoagulant for hemodialysis despite potentially serious side effects. Polyethylene glycol-grafted cellulose (PGC) membranes produce less activation of the coagulation cascade than cuprophane membranes. Anecdotally, we found some patients required a surprisingly low level of anticoagulation using these membranes. We compared the anticoagulant requirement of the PGC membrane with that of the cuprophane membrane in this randomized, prospective, crossover study. Sixty-three patients were randomized to treatment using either membrane, and heparin administration was progressively reduced to the lowest dose that prevented visible clotting in excess of that normally encountered. Patients underwent dialysis at this dose for 1 month, after which the heparin requirement and Kt/Vurea (1.162 x ln [urea pre/urea post]) were assessed. This process was then repeated for each patient using the other membrane, and the results were compared. Heparin administration during dialysis was reduced from a mean loading dose of 29.0 +/- 9.4 to 1.5 +/- 3.2 IU/kg for both membranes and a mean maintenance infusion of 14.0 +/- 6.7 to 0.77 +/- 1.6 IU/kg/h for both membranes (both P < 0.0001 v full anticoagulation; no difference between membranes). The Kt/Vurea was not significantly altered. Forty-six patients with PGC and 45 patients with cuprophane membranes underwent dialysis successfully without heparin during dialysis, and the other patients were using considerably reduced doses. Aspirin and warfarin had no effect on the heparin requirement. These results do not support the theory that PGC membranes have a lower anticoagulant requirement than cuprophane membranes; however, they suggest that dialysis can be performed successfully with much smaller anticoagulant doses than are currently in common use.

  3. Application of right jugular vessels to build extracorporeal membrane oxygenation for treating the critically ill children%右侧颈部置管建立体外膜肺氧合治疗危重症患儿

    Institute of Scientific and Technical Information of China (English)

    闫宪刚; 陆铸今; 郑继翠; 张文波; 陆国平; 贾兵

    2016-01-01

    Objective To summarize the experience in applying a technique of inserting a cannula through right internal jugular vein and common carotid artery to build extracorporeal membrane oxygenation (ECMO) for critically ill children.Method The data of critically ill patients received ECMO support through right internal jugular vein and common carotid artery between December 2011 and December 2015 from Children's Hospital of Fudan University were analyzed retrospectively.The data included diagnosis,age,body weight,time of cannula and ECMO running,complication and prognosis.Result In total 28 patients received ECMO support,3 patients of post-cardiac surgery with transthoracic cannula were excluded.Twenty-five patients inserted cannula through neck vessels were enrolled,15 boys and 10 girls,the median age was 1.8 years (range,1 d-13 years),the median weight was 12.0 (2.8-50.0) kg.All the cannula sites were right internal jugular vein and right common carotid artery,before cannula use 5 patients had been inserted central vein tube and 3 patients with blood filter tube in right internal jugular vein,in one case cannula was applied during cardiopulmonary resuscitation.V-A ECMO had been built for all the cases successfully,the median operation time was (45 ± 26) min.The pump flow was 80-150 ml/(kg · min),the median duration of ECMO support was 153 (14-567) h.Sixteen (64%) patients weaned off ECMO successfully,15 (60%) survived to hospital discharge.About the complication of cannula,six patients developed cannula site bleeding,and two patients required re-fixation of cannula,one patient's external jugular vein had been hurt and sutured for bleeding.Conclusion Application of right jugular vessels to build ECMO is easy and safe for treating the sick children.The skill should be proficient to assure ECMO run and reduce the complications.%目的 总结经右侧颈部血管切开置管建立体外膜肺氧合(ECMO)的技术体会.方法 回顾性分析2011年12月至2015年12

  4. Clinical application of extracorporeal membrane oxygenation for treatment of adult refractory cardiogenic shock%体外膜肺氧合在成人心原性休克救治中的临床应用

    Institute of Scientific and Technical Information of China (English)

    侯六生; 谢钢; 李建伟; 蒋崇慧; 袁勇; 李斌飞; 姜海明; 宁晔; 吴桂深

    2013-01-01

    Objective To summarize the clinical experience of extracorporeal membrane oxygenation (ECMO) treatment for adult refractory cardiogenic shock.Methods From January 2003 to January 2011,patients with refractory cardiogenic shock required veno-arterial ECMO by failure of conventional therapy and intra-aortic balloon pump counterpulsation therapy were retrospectively studied.Patients with severe traumatic brain injury,advanced malignancies and multiple organ failure were excluded.Patients were divided into weaned group(n =31) and not weaned group(n =23) according to the ECMO weaning.Results The duration of ECMO was 24.16(14.12,56.75) hours.Twenty-two out of 31 patients in the weaned group survived and were discharged,9 patients died after successfully weaned from ECMO (5 due to multisystem organ failure,2 due to reoccurred cardiogenic shock,1 due to infectious shock and 1 due to disseminated or diffuse intravascular coagulation).Pre-ECMO mean arterial pressure,ejection fraction,the duration of ECMO were significantly higher while pre-ECMO blood lactate [(8.64 ± 3.17) vs.(14.44 ± 2.52),P <0.01],the duration of ROSC [(16.70 ± 5.29) vs.(35.64 ± 5.89),P <0.01] and multisystem organ failure [0 vs.17.4% (4/23),P <0.05] were lower in weaned group than in not wean group.Conclusions ECMO is an effective mechanical assistant therapy strategy for adult refractory cardiogenic shock patients.Timely applying this strategy on suitable patients is crucial for the success of ECMO.Cardiac function and reversibility of heart failure are key factors determine the fate of weaned or not weaned ECMO in adult refractory cardiogenic shock patients.%目的 总结体外膜肺氧合(ECMO)在成人心原性休克(CS)中的临床救治经验,探讨ECMO的临床应用价值及影响脱机的可能危险因素.方法 回顾性分析中山大学附属中山医院2003年1月至2011年1月因药物和(或)主动脉内球囊反搏(IABP)无效而行ECMO救治的成人CS患者的临床资料,

  5. Vaccinia virus virion membrane biogenesis protein A11 associates with viral membranes in a manner that requires the expression of another membrane biogenesis protein, A6.

    Science.gov (United States)

    Wu, Xiang; Meng, Xiangzhi; Yan, Bo; Rose, Lloyd; Deng, Junpeng; Xiang, Yan

    2012-10-01

    A group of vaccinia virus (VACV) proteins, including A11, L2, and A6, are required for biogenesis of the primary envelope of VACV, specifically, for the acquisition of viral membrane precursors. However, the interconnection among these proteins is unknown and, with the exception of L2, the connection of these proteins with membranes is also unknown. In this study, prompted by the findings that A6 coprecipitated A11 and that the cellular distribution of A11 was dramatically altered by repression of A6 expression, we studied the localization of A11 in cells by using immunofluorescence and cell fractionation analysis. A11 was found to associate with membranes and colocalize with virion membrane proteins in viral replication factories during normal VACV replication. A11 partitioned almost equally between the detergent and aqueous phases upon Triton X-114 phase separation, demonstrating an intrinsic affinity with lipids. However, in the absence of infection or VACV late protein synthesis, A11 did not associate with cellular membranes. Furthermore, when A6 expression was repressed, A11 did not colocalize with any viral membrane proteins or associate with membranes. In contrast, when virion envelope formation was blocked at a later step by repression of A14 expression or by rifampin treatment, A11 colocalized with virion membrane proteins in the factories. Altogether, our data showed that A11 associates with viral membranes during VACV replication, and this association requires A6 expression. This study provides a physical connection between A11 and viral membranes and suggests that A6 regulates A11 membrane association.

  6. 中国儿童重症监护病房体外膜肺氧合技术应用现状调查%Surveying the status of extracorporeal membrane oxygenation application in Chinese pediatric intensive ;care unit

    Institute of Scientific and Technical Information of China (English)

    闫钢风; 陆国平; 张晨美; 洪小杨; 许煊; 钱素云; 王莹; 刘春峰

    2016-01-01

    Objective To investigate the application of extracorporeal membrane oxygenation ( ECMO) in pediatric intensive care unit( PICU) in China. Methods Data were collected by questionnaire in PICU of tertiary hospitals,which included children′s hospitals and the pediatric sections of general hospitals from 26 provinces/municipalities/autonomous regions in China from March to August 2015. Results Total 38 hospitals were enrolled, including 28 children hospitals and 10 general hospitals. Six PICU carried out ECMO technology. Fourteen PICU prepared to perform this technology. Nine had ECMO team, and 8 had received ECMO training. Ten PICU had a total of 12 ECMO machines. Sixty-three patients were supported with non-open chest ECMO, 49 ( 77. 8%) of which were decannulated from ECMO successfully, and 36 (57. 1%) survived. Twelve neonates were enrolled,including 10 patients with respiratory failure and 2 with cardiac failure,5 of them survived to discharge. Of 51 pediatric patients received ECMO,28 were supported for cardiac failure,21 for respiratory failure,and 2 for extracorporeal cardiopulmonary resuscitation,31 cases (60. 8%) survived to discharge. Conclusion ECMO technology is still at the initial stage. More efforts are needed to improve the relative equipment,ECMO team and ECMO training in China.%目的:了解中国PICU体外膜肺氧合( ECMO)技术开展及ECMO疗效情况。方法采用问卷调查方式,2015年3月至2015年8月对全国三级甲等医院PICU进行调查。结果共调查了38家儿童医院或综合医院的PICU,其中儿童医院28家,综合医院10家。10家医院的PICU拥有12台ECMO设备;能开展ECMO技术的单位6家,准备开展ECMO技术的单位14家;接受过ECMO培训的医院8家。共有63例患儿在 PICU 内接受非开胸 ECMO 治疗,成功撤离 ECMO 者49例,有效率77.8%;36例存活,存活率57.1%。儿童患者(大于28 d)51例,其中呼吸系统疾病21例,心脏疾病28例,心肺衰竭2例;存活出院31

  7. The Impact of Extracorporeal Life Support and Hypothermia on Drug Disposition in Critically Ill Infants and Children

    NARCIS (Netherlands)

    E.D. Wildschut (Enno); A. van Saet (Annewil); P. Pokorna (Pavla); M.J. Ahsman (Maurice); J.N. van den Anker (John); D. Tibboel (Dick)

    2012-01-01

    textabstractExtracorporeal membrane oxygenation (ECMO) support is an established lifesaving therapy for potentially reversible respiratory or cardiac failure. In 10% of all pediatric patients receiving ECMO, ECMO therapy is initiated during or after cardiopulmonary resuscitation. Therapeutic

  8. Extracorporeal Treatment for Salicylate Poisoning

    DEFF Research Database (Denmark)

    Juurlink, David N; Gosselin, Sophie; Kielstein, Jan T

    2015-01-01

    STUDY OBJECTIVE: Salicylate poisoning is a challenging clinical entity associated with substantial morbidity and mortality. The indications for extracorporeal treatments such as hemodialysis are poorly defined. We present a systematic review of the literature along with evidence- and consensus......-based recommendations on the use of extracorporeal treatment in salicylate poisoning. METHODS: The Extracorporeal Treatments in Poisoning (EXTRIP) Workgroup is a multidisciplinary group with international representation whose aim is to provide evidence-based recommendations on the use of extracorporeal treatments...... in poisoning. We conducted a systematic literature review followed by data extraction and summarized findings, following a predetermined format. The entire work group voted by a 2-round modified Delphi method to reach consensus on voting statements, using a RAND/UCLA Appropriateness Method to quantify...

  9. Extra-corporeal membrane oxygenation during the beating heart coronary artery bypass grafting for ;high risk patients-a single center experience%体外膜肺氧合在高危重症冠心病患者心脏不停跳冠状动脉旁路移植术中的应用

    Institute of Scientific and Technical Information of China (English)

    段大为; 刘迎午; 胡晓旻; 刘博江; 吴鹏; 张强; 李彤

    2016-01-01

    目的:总结体外膜肺氧合( extra-corporeal membrane oxygenation,ECMO)在高危重症冠心病患者心脏不停跳冠状动脉旁路移植术( coronary artery bypass grafting,CABG)中的应用方法和效果。方法选取2007年11月至2014年6月天津市第三中心医院心脏外科的高危重症冠心病行CABG术患者21例,年龄70~83(75.7±3.6)岁,在ECMO辅助下实施择期心脏不停跳CABG术。结果21例患者中,8例术后即刻顺利脱离ECMO辅助;8例桥血管吻合后ECMO不能立即撤离,继续辅助2.0~4.5 h 后撤离;5例在手术室时 ECMO 不能撤离,关胸后返回冠心病重症监护病房( CCU),考虑ECMO辅助时间较长,为克服ECMO非搏动性灌注,联合主动脉内球囊反搏( intra-aortic balloon pump,IABP)支持,IABP辅助时间76~147(115.2±25.9)h。5例CCU内ECMO辅助患者中:股动静脉插管部位渗血1例,经止血及加压包扎后好转;下肢缺血1例,安装旁路循环后缺血改善;均顺利脱机。21例患者均康复出院,住院时间11~28(17.4±2.8) d。结论 ECMO用于心脏不停跳CABG术可为高危重症冠心病患者提供手术治疗的支持和保护。%Objective To summarize clinical application, method and result of extra-corporeal membrane oxygenation ( ECMO) used during beating heart coronary artery bypass grafting ( CABG) in high risk patients. Methods Twenty one patients [ mean age ( 75. 7 ± 3. 6 ) years old ] who received beating-heart CABG surgery assisted with ECMO were included in the study. We observed the condition when ECMO weaned off, the duration on mechanical rentilato time of ICU stay and the occurance of related complications. Results Among the 21 patients, ECMO was weaned off uneventfully after surgery in 8 patients. Immediate weaning was failed in another 8 patients and required gradual weaning in 2. 0-4. 5 hrs. Five patients could not wean off the ECMO in operation room needing continuous ECMO support in CCU. ECMO was weaned off in CCU gradually with

  10. Progress on application of extracorporeal membrane oxygenation technology in nursing care of severe respiratory failure patients%体外膜肺氧合技术在重症呼吸衰竭病人护理中的应用进展

    Institute of Scientific and Technical Information of China (English)

    孙晓红; 朱振男

    2012-01-01

    It reviewed the applied progress of extracorporeal membrane ox-ygenation in nursing care of severe respiratory failure patients from the aspects of basic principle and development of the extracorporeal membrane oxygenation(ECMO) treatment, adaptation levy of ECMO technology applied in severe respiratory failure patients,nursing care of ECMO technology applied in severe respiratory failure patients including circular and vital sign monitoring, airway and ventilator management, prevention of infection, and oxygenator care.%从体外膜肺氧合(ECMO)治疗的基本原理及其发展、ECMO技术应用于重症呼吸衰竭的适应证、ECMO技术应用于重症呼吸衰竭病人的护理(包括循环和生命体征的监测、气道及呼吸机管理、预防感染、氧合器护理等)方面综述了体外膜肺氧合技术在重症呼吸衰竭病人护理中的应用进展.

  11. Application of extracorporeal membrane oxygenation as a bridge to lung transplantation%体外膜肺氧合在肺移植前支持过渡中的应用

    Institute of Scientific and Technical Information of China (English)

    毛文君; 陈静瑜

    2011-01-01

    目的 探讨体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)在肺移植前支持过渡中应用的可行性和疗效.方法 终末期肺病患者5例,原发病为特发性肺间质纤维化3例,结核性毁损肺1例,淹溺致吸入性肺炎合并急性呼吸窘迫综合征(ARDS)1例.药物治疗和呼吸机无法纠正呼吸衰竭,紧急行ECMO,等待肺移植.5例患者均经股动脉-股静脉插管,根据体重、血流动力学情况及血气分析结果,调整ECMO流量.过渡期间能获得供体者行肺移植.结果 经ECMO支持后,5例患者肺动脉压明显下降,氧合功能改善,其中例1、例2、例3成功过渡到肺移植,手术方式分别为双肺移植、右肺移植、右肺移植.例1、例2术后分别转流552 h和240 h,最终因严重并发症死亡;例3术后脱离ECMO,恢复良好,康复出院,现已存活1年半.例4于ECMO转流205 h后脱离ECMO,脱离7 d后死于脑部侵袭性真菌感染伴颅内出血;例5于ECMO转流160 h,死于多器官功能衰竭.结论 在等待肺移植过程中,采用ECMO作为支持过渡措施是可行的,具有一定的临床应用价值.

  12. Emergency use of extracorporeal membrane oxygenation in pediatric critically ill patients%体外膜肺氧合在儿科危重病急救中的应用

    Institute of Scientific and Technical Information of China (English)

    林茹; 张晨美; 谈林华; 施丽萍; 熊启星; 张泽伟; 舒强; 杜立中

    2012-01-01

    目的 总结体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)在儿科危重病急救中应用的管理经验.方法 回顾性分析2007年7月至2011年5月,浙江大学医学院附属儿童医院应用ECMO抢救12例多种原因所致严重心肺功能衰竭患儿的临床情况.结果 12例,男7例,女5例;年龄6d~11岁;体重2.8~35(17.21 ±11.64)kg,其中4例小于60 d.肺部感染并发急性呼吸窘迫(Acute Respiratory Distress Syndrome,ARDS)致呼吸衰竭2例,心脏术后低心排不能脱离体外循环直接转ECM0 4例,暴发性心肌炎3例,右心室心肌病反复心跳骤停4次1例,完全性大动脉转位术前严重低氧血症1例,过敏性休克并发大量肺出血,严重低氧血症1例.12例中有3例为心肺复苏胸外按压(cardiopulmonary resuscitation,CPR)同时建立ECMO (E-CPR).平均ECMO支持时间为151.75(15 ~572)h,12例中7例脱离ECMO,脱机率58.33%,存活出院6例,存活率50.00%,死亡6例.机械并发症:膜肺渗漏更换有2例,溶血更换系统3例,膜肺氧合不佳更换2例,膜肺血栓形成1例;机体并发症:伤口出血6例、二次开胸止血2例、急性肾衰2例、感染3例,高胆红素血症2例、下肢缺血1例、高血糖3例、弥漫性血管内凝血 1例.随访半年至4年半,1例因下肢缺血运动障碍,出院后1年行肢体矫形术,功能得到基本恢复;其余5例生活质量、社会功能良好,无任何智力、神经系统障碍.结论 ECMO可以有效地为可逆性严重心肺衰竭患儿提供呼吸循环支持治疗.%Objective The history of clinical application of extracorporeal membrane oxygenation (ECMO) has been more than 30 years. But in China,there were only a few ECMO centers with limited successful cases reported by the end of twentieth century. The high morbidities and mortalities in current pediatric ECMO practice are noted in China. Therefore,it is necessary to review the experience on rescue use of ECMO in critically ill pediatric

  13. Extracorporeal shock-wave lithotripsy of gallstones. Results and perspectives

    Energy Technology Data Exchange (ETDEWEB)

    Staritz, M.; Rambow, A.; Meyer zum Bueschenfelde, K.H.; Floth, A.; Hohenfellner, R.; Mildenberger, P.; Thelen, M.; Goebel, M.

    1987-12-01

    Recently extracorporeal shock-wave lithotripsy became a noteworthy alternative in the treatment of choledocolithiasis and cholecystolithiasis, in particular since the introduction of the second-generation shock-wave technique which allows to dispense with the positioning of the patient in the water bath required sofar and to place the patient on an examination table in freely movable way so as to position the gall stone to be disintegrated in the focus of the shock waves. Despite the beneficial treatment results, extracorporeal shock-wave lithotripsy still needs further improvement as a method especially in terms of the option of 'pulverizing' the stones. (orig./TRV)

  14. Cellular Membrane Composition Requirement by Antimicrobial and Anticancer Peptide GA-K4.

    Science.gov (United States)

    Mishig-Ochir, Tsogbadrakh; Gombosuren, Davaadulam; Jigjid, Altanchimeg; Tuguldur, Badamkhatan; Chuluunbaatar, Galbadrakh; Urnukhsaikhan, Enerelt; Pathak, Chinar; Lee, Bong-Jin

    2017-01-01

    Naturally occurring antimicrobial peptides important for innate immunity are widely studied for their antimicrobial and anticancer activity. The primary target of these AMPs is believed to be the bacterial cytoplasmic membrane. However, the interaction between cytoplasmic membrane and the antimicrobial peptides remains poorly understood. Therefore to focus on the target membrane composition that is required by AMPs to interact with membranes, we have examined the interaction of the antimicrobial and anticancer active 11-residue GA-K4 (FLKWLFKWAKK) peptide with model and intact cell membranes. Effect on the structural conformational properties of GA-K4 peptide was investigated by means of far-UV CD and fluorescence spectroscopic methods. The different conformation of GA-K4 peptide in large unilamellar vesicles (LUV) bilayer and micelle environment suggest that the curvature has an influence on the secondary structure acquired by the peptide. Furthermore, the leakage experiment result confirmed that GA-K4 induced the leakage of cytoplasmic membrane in Staphylococcus аureus bacterial cells. Fluorescence data revealed the interfacial location of GA-K4 peptide in the model membranes. The blue-shift in emission wavelength by tryptophan residues in fluorescence data indicated the penetration of GA-K4 peptide in micelles and phospholipid bilayers. These results showed that the GA-K4 peptide is a membrane-active peptide and its activity depends on membrane curvature and lipid composition. Although further studies are required to confirm the mechanism of action, the data suggest mechanism of toroidal pore formation for the interaction of GA-K4 peptide with membranes. Our studies will be helpful in better understanding of the membrane requirment of peptides to express their therapeutic effects. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  15. Tyrosine motifs are required for prestin basolateral membrane targeting

    Directory of Open Access Journals (Sweden)

    Yifan Zhang

    2015-01-01

    Full Text Available Prestin is targeted to the lateral wall of outer hair cells (OHCs where its electromotility is critical for cochlear amplification. Using MDCK cells as a model system for polarized epithelial sorting, we demonstrate that prestin uses tyrosine residues, in a YXXΦ motif, to target the basolateral surface. Both Y520 and Y667 are important for basolateral targeting of prestin. Mutation of these residues to glutamine or alanine resulted in retention within the Golgi and delayed egress from the Golgi in Y667Q. Basolateral targeting is restored upon mutation to phenylalanine suggesting the importance of a phenol ring in the tyrosine side chain. We also demonstrate that prestin targeting to the basolateral surface is dependent on AP1B (μ1B, and that prestin uses transferrin containing early endosomes in its passage from the Golgi to the basolateral plasma membrane. The presence of AP1B (μ1B in OHCs, and parallels between prestin targeting to the basolateral surface of OHCs and polarized epithelial cells suggest that outer hair cells resemble polarized epithelia rather than neurons in this important phenotypic measure.

  16. 体外膜肺氧合在心脏移植术后移植物衰竭支持治疗中的应用%Extracorporeal membrane oxygenation for primary graft failure after heart transplantation

    Institute of Scientific and Technical Information of China (English)

    黑飞龙; 段欣; 高国栋; 于坤; 李景文; 龙村

    2013-01-01

    目的:总结心脏移植术后早期移植物衰竭体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)支持治疗的临床经验.方法:自2008年1月至2011年12月,阜外医院共进行心脏移植181例,其中16例患者在心脏移植术后使用ECMO进行循环支持治疗.记录ECMO运行期间相关参数、机械辅助时间、并发症等指标.观察ECMO建立时、辅助24h和撤机时患者血浆乳酸值,ECMO辅助前和ECMO辅助24h多巴胺及肾上腺素的用量.结果:16例心脏移植围手术期接受ECMO支持治疗的患者中脱机14例(87.5%),存活出院13例(81.3%).其中2例因心脏功能无改善不能脱机放弃治疗,1例脱机后发生慢性排斥反应,出现多器官功能衰竭(MOF)死亡.所有患者均采用动脉—静脉(A-V)ECMO辅助方式,患者ECMO前、ECMO运行24h和停止ECMO时血浆乳酸值分别为:(8.36±3.41)、(2.42±1.53)、(2.25±2.17) mmol/L.运行24h及停止ECMO时,血浆乳酸值较安装前明显下降(P<0.05).ECMO前和运行24h多巴胺用量分别为:(7.38±3.42)和(5.29±1.93) μg·min-1 ·kg-1,两者之间比较,差异无统计学意义(P>0.05).ECMO前和运行24h肾上腺素用量分别为:(0.17±0.11)和(0.02±0.03) μg·min-1·kg-1,运行24h较ECMO前肾上腺素用量明显减小(P<0.05).结论:ECMO是一种有效的循环呼吸衰竭辅助支持疗法,能明显降低终末期心脏病患者心脏移植术后早期病死率.%Objective;To analyze our results with extracorporeal membrane oxygenation(ECMO) support for primary graft failure in heart transplant recipients. Methods: 181 heart transplantation cases, between January 2008 and December 2011, were retrospectively studied in Fuwai Hospital. Sixteen cases of them had received ECMO treatment after the transplantation. Data of the relevant parameters during ECMO, mechanism assistant duration and complications of the patients were collected. The level of lactic acid (LA) at the onset and 24 h of ECMO were measured. The

  17. Extracorporeal treatment for acetaminophen poisoning

    DEFF Research Database (Denmark)

    Gosselin, S; Juurlink, D N; Kielstein, J T

    2014-01-01

    BACKGROUND: The Extracorporeal Treatments in Poisoning (EXTRIP) workgroup was created to provide evidence-based recommendations on the use of extracorporeal treatments (ECTR) in poisoning and the results are presented here for acetaminophen (APAP). METHODS: After a systematic review...... cases of APAP poisoning. However, given that APAP is dialyzable, the workgroup agreed that ECTR is suggested in patients with excessively large overdoses who display features of mitochondrial dysfunction. This is reflected by early development of altered mental status and severe metabolic acidosis prior...... and an APAP concentration over 900 mg/L (5960 mmol/L) if NAC is administered (1D). Intermittent hemodialysis (HD) is the preferred ECTR modality in APAP poisoning (1D). CONCLUSION: APAP is amenable to extracorporeal removal. Due to the efficacy of NAC, ECTR is reserved for rare situations when the efficacy...

  18. Low-Flow Extracorporeal Carbon Dioxide Removal Using the Hemolung Respiratory Dialysis System(®) to Facilitate Lung-Protective Mechanical Ventilation in Acute Respiratory Distress Syndrome.

    Science.gov (United States)

    Akkanti, Bindu; Rajagopal, Keshava; Patel, Kirti P; Aravind, Sangeeta; Nunez-Centanu, Emmanuel; Hussain, Rahat; Shabari, Farshad Raissi; Hofstetter, Wayne L; Vaporciyan, Ara A; Banjac, Igor S; Kar, Biswajit; Gregoric, Igor D; Loyalka, Pranav

    2017-06-01

    Extracorporeal carbon dioxide removal (ECCO2R) permits reductions in alveolar ventilation requirements that the lungs would otherwise have to provide. This concept was applied to a case of hypercapnia refractory to high-level invasive mechanical ventilator support. We present a case of an 18-year-old man who developed post-pneumonectomy acute respiratory distress syndrome (ARDS) after resection of a mediastinal germ cell tumor involving the left lung hilum. Hypercapnia and hypoxemia persisted despite ventilator support even at traumatic levels. ECCO2R using a miniaturized system was instituted and provided effective carbon dioxide elimination. This facilitated establishment of lung-protective ventilator settings and lung function recovery. Extracorporeal lung support increasingly is being applied to treat ARDS. However, conventional extracorporeal membrane oxygenation (ECMO) generally involves using large cannulae capable of carrying high flow rates. A subset of patients with ARDS has mixed hypercapnia and hypoxemia despite high-level ventilator support. In the absence of profound hypoxemia, ECCO2R may be used to reduce ventilator support requirements to lung-protective levels, while avoiding risks associated with conventional ECMO.

  19. The strategy of extracorporeal membrane oxygenation support in the peri-operative period of heart transplantation%体外膜肺氧合在心脏移植围术期的支持策略

    Institute of Scientific and Technical Information of China (English)

    李平; 董念国; 赵阳; 高思海

    2014-01-01

    目的:回顾性分析总结体外膜肺氧合( ECMO)在心脏移植围术期的支持策略。方法自2008年9月至2014年7月武汉协和医院共行150例原位心脏移植术,其中1例为心肝联合移植。在围术期因严重心肺衰竭使用ECMO辅助11例,其中1例患者在等待供心期间急性左心衰行ECMO过渡后行心脏移植,4例边缘供心移植术中低心排中转ECMO辅助,5例心脏移植术后右心衰行ECMO辅助,1例移植术后左心衰行ECMO辅助。 ECMO辅助主要采用静脉-动脉( VA)模式,温度维持在36~37℃,流量维持在2.5~3.5 L/min,全血激活凝固时间维持在160~180 s,转流过程中血流动力学和呼吸参数平稳。结果11例心脏移植围术期ECMO辅助后8例脱机,脱机率72.7%。 ECMO辅助时间15~1532 h ,平均315 h。 ECMO期间患者血流动力学明显改善,正性肌力药物用量减少。 ECMO 期间1例出现插管远端肢体缺血,经远端血管插管供血后缓解。此外,出血2例,溶血1例,肾功能衰竭2例,经积极对应治疗后6例ECMO辅助患者痊愈出院。结论 ECMO能对心脏移植围术期的心肺功能衰竭提供强有效的支持治疗,并且提高“边缘供心”的使用成功率,扩大了供心来源。%[ Abstract]:Objective To summarize and analyze the clinical effect and experience of extracorporeal membrane oxygenation ( ECMO) support in the peri-operative period of heart transplant patients in Wuhan Union Hospital. Methods From September 2008 to May 2014, 150 orthotopic heart transplantations were performed in Wuhan Union Hospital, including one case with simultaneous heart-liver transplantation. Eleven patients with severe ventricular failure in the peri-operative period of heart transplant received EC⁃MO support. One patient received ECMO support because of acute left heart failure during waiting for donor heart;four patients of mar⁃ginal donor heart transplantation

  20. Extracorporeal treatment for digoxin poisoning

    DEFF Research Database (Denmark)

    Mowry, James B; Burdmann, Emmanuel A; Anseeuw, Kurt

    2016-01-01

    BACKGROUND: The Extracorporeal Treatments in Poisoning (EXTRIP) workgroup was formed to provide recommendations on the use of extracorporeal treatments (ECTR) in poisoning. Here, we present our results for digoxin. METHODS: After a systematic literature search, clinical and toxicokinetic data were...... recommended against the use of ECTR in cases of severe digoxin poisoning when Fab was available (1D) and also suggested against the use of ECTR when Fab was unavailable (2D). CONCLUSION: ECTR, in any form, is not indicated for either suspected or proven digoxin toxicity, regardless of the clinical context...

  1. 体外膜肺氧合在肺移植围手术期的应用30例%Perioperative application of extracorporeal membrane oxygenation (ECMO) in lung transplantation

    Institute of Scientific and Technical Information of China (English)

    郑明峰; 陈静瑜; 朱幸沨; 何毅军; 张稷; 叶书高; 刘峰; 陈若; 卫栋

    2011-01-01

    Objective To explore the perioperative application of extracorporeal membrane oxygenation (ECMO) in lung transplantation. Methods Thirty patients with primary and end-stage pulmonary disease accompanied by pulmonary hypertension were subjected to operation under the accessory of ECMO. Eighteen patients received single-lung transplantation and 12 patients bilateral sequential lung transplantation without sternal division in our hospital from November 2005 to July 2009. In 2 patients ECMO was given before operation and maintained for 19 days and 6 days respectively. In the remaining patients, ECMO pipeline was placed after anesthesia. After lung trarnsplantation,ECMO was removed after the recipients' oxygen saturation and hemodynamics were stable. Results In all recipients lung transplantation was successfully done. ECOM was removed in 27recipients after operation, and the rest 3 recipients were supported by ECMO after operation: the ECMO was removed at 36th h and 7th day after lung transplantation in two patients respectively,and another one was supported by ECMO for 5 days after operation and suffered acute kidney failure, and died of multiple organ failure 2 weeks post-transplantation. Two recipients were infected in thigh arteriovenous cut and one suffered femoral artery thrombosis, but all of them got better and discharged from hospital after treatment. Conclusion ECMO can be used for lung transplantation on patients with primary and secondary pulmonary hypertension. The complications may be associated with patients'serious condition and unstable hemodynamics. Early detection and active and effective treatment can improve patient's prognosis.%目的 总结体外膜肺氧合(ECMO)在肺移植围手术期应用的经验.方法 30例原发性终末期肺病伴继发性肺动脉高压的患者在肺移植术中应用了ECMO,其中单肺移植18例,不横断胸骨序贯式双肺移植12例.在术前使用ECMO维持者2例,分别维持19 d和6 d;其他患者在麻醉

  2. Evaluation of extracorporeal membrane oxygenation application in marginal heart transplantation%体外膜肺氧合在边缘供心移植中的临床应用研究

    Institute of Scientific and Technical Information of China (English)

    孟旭; GURBANOV Emin; 崔永强; 韩杰; 曾文; 贾一新

    2010-01-01

    目的 探讨体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)用于长时间冷缺血(long cold ischemic time,LCIT)供心心脏移植术的临床疗效.方法 2005年2月至2009年4月,11例患者[ECMO环路(intraoperative ECMO,i-ECMO)组]接受LCIT 超过7 h的供心移植,手术采用i-ECMO 进行心肺分流术,术毕直接转为ECMO辅助.同期有11例患者[心肺分流术(standard cardiopulmonary bypass,s-CPB)组,s-CPB组]行冷缺血少于7 h的心脏移植手术,术中常规s-CPB,术后接受了ECMO辅助.比较两组的ECMO的总体撤机率、ICU停留时间、浓缩红细胞输注量、左心室射血分数(LVEF)、住院费用、围手术期生存率、术后1年生存率,并了解ECMO相关并发症.结果 i-ECMO组和s-CPB组供心缺血时间分别为422~485(平均448) min、110~400(平均218)min,两组间比较差异有统计学意义(P0.05).i-ECMO组的ICU停留时间、浓缩红细胞输注量以及住院花费均显著低于对s-CPB组(均为P0.05).ECMO相关并发症及处理:5例患者(23%)因低心排量而应用了主动脉内球囊反搏(IABP),其中3例为成功撤离ECMO的病人,2例为未能撤离ECMO者;6例(27%)患者由于肾功能不全接受了持续肾替代治疗(CRRT),其中2例为成功撤离ECMO,4例为未能撤离ECMO者.结论 用边缘供心进行心脏移植术时,术中利用i-ECMO、术毕转为ECMO辅助可以为LCIT的供心提供早期、持续和有效的循环支持,从而在相当程度上改善此类边缘供心的移植成功率.同时,该研究方法 还具有ICU停留时间短,浓缩红细胞输注量低和显著节省费用的优点.

  3. Ethical Significance of Extracorporeal Circulation Membrane Oxygenation Application in Donation Organ Transplantation%体外膜肺氧合应用在捐献器官移植中的伦理学意义

    Institute of Scientific and Technical Information of China (English)

    蓝倩; 李壮江; 孙煦勇; 秦科; 董建辉; 周洁惠; 胡国庆

    2015-01-01

    目的:探讨体外膜肺氧合( ECMO)在捐献供体器官移植中应用的伦理学意义。方法分析ECMO在13例公民脑死亡后捐献供体器官保护的各项指标数据,核算因ECMO造成的医疗成本升高情况并深入受者家属进行沟通访谈。结果13例脑死亡( DBD )供者行ECMO转流期间,血流动力学逐步稳定,血管活性药物应用明显减少,甚至停用,受损的器官功能明显恢复,共产出经病理活检证实可用于移植的器官38个,其中肾脏26个、肝脏12个。38例受者肾移植手术均顺利完成。医疗费用总体上升5.3%。供者家属和受者及其家属均能接受ECMO的介入。结论 ECMO的应用能有效保护器官,提高器官利用率。相关技术标准的提高,法律、法规的完善及医护人员伦理道德的提高将会推动ECMO在器官移植应用中的发展。%Objective:To investigate the ethical significance of the extracorporeal circulation membrane oxy-genation ( ECMO) in the donation organ transplantation .Methods: Analyzing the data of ECMO protected to the organ in 13 donors after brain death , Accounting the rising costs which caused by ECMO and make the interview to the patients and family members .Results:In the period of ECMO flow , the hemodynamic of the DBD donors be-come stable gradually , the medications reduced significantly or stop , the function of organs was restored .There were 38 organs can be used for the transplantation which were proven by the pathological biopsy .Twenty six kid-neys were transplanted to 26 recipients and liver transplantation was performed in 12 recipients.All transplantations were successfully completed .Medical cost of this patients increase 5.3%, all of the family members and patients can accept the intervention of ECMO .Conclusion:ECMO is an effective method to protect and improve the utili-zation rate of the organ .the improvement of the related technical standards , legal, laws and

  4. Methane to syngas conversion. Part I. Equilibrium conditions and stability requirements of membrane materials

    Science.gov (United States)

    Frade, J. R.; Kharton, V. V.; Yaremchenko, A.; Naumovich, E.

    Thermodynamic data have been used to predict the dependence of methane conversion on temperature and oxygen partial pressure in mixed conducting membrane reactors, and the corresponding fractions of water vapor, H 2, CO and CO 2. The relations between methane conversion, gas composition and oxygen partial pressure were also used to formulate the oxygen balance in mixed conducting membrane reactors, with tubular reactor and continuous stirred tank reactor (CSTR) configurations. A single dimensionless parameter accounts for the combined effects of geometric parameters of the membrane reactor, the permeability of the membrane material, and flow rate at the entry of the reactor. Selected examples were calculated to illustrate the effects of steam to methane and inert to methane ratios in the gas entering the reactor. The values of oxygen partial pressure required to attain the highest yield of CO and H 2 were also used to estimate the stability requirements to be met by mixed conducting membrane materials. Suitable membrane designs might be needed to bridge the difference between the conditions inside the reactors and the stability limits of known mixed conductors.

  5. Extracorporeal Gas Exchange and Spontaneous Breathing for the Treatment of Acute Respiratory Distress Syndrome: An Alternative to Mechanical Ventilation?

    Science.gov (United States)

    2014-03-01

    and the artificial lung (extracorporeal gas exchange) in this setting. Design: Laboratory investigation. Setting: Animal ICU of a governmental...Finally, in this sce- nario, a somewhat new player, namely spontaneous breathing, would enter in the arena of the ICUs . This study sheds light on some... rehabilitation during extracorporeal membrane oxygenation as a bridge to lung transplan- tation. Respir Care 2013; 58:1291–1298 12. Turner DA, Cheifetz IM

  6. Compact intra- and extracorporeal oxygenator developments.

    Science.gov (United States)

    Cattaneo, Giorgio; Strauss, Andreas; Reul, Helmut

    2004-07-01

    For patients with acute lung failure, mechanical ventilation entails the risk of lung tissue damage due to high oxygen pressure and concentration. Membrane oxygenation for one to two weeks can rest the lungs due to decreased ventilation parameters, representing a potential bridge to recovery, but implies the substantial risks of blood damage, plasma leakage and infection, which often have fatal results for patients. At the Helmholtz Institute in Aachen, two types of membrane oxygenators, which aim to overcome previous limits, are under development. Both present compact designs, reduced surface and priming volumes and easier handling. HEXMO is a miniaturized extracorporeal membrane oxygenator. The integration of a small rotary blood pump into the centre of the oxygenator reduces the amount of tubing and connectors in the system. Blood is convectively warmed by the pump motor housing, thus, the use of a heat-exchanger can be avoided. This compact design reduces surface and priming volume and allows better handling, especially in critical situations. A second development is the intravascular oxygenator HIMOX, which is inserted directly into the vena cava. Priming volume and blood contact surface are reduced, as well as infection risk and control needs for the patient. A new cross-flow fibre configuration is used for improving gas transfer within the limited space inside the vena cava. A microaxial blood pump is integrated into the device for compensating the pressure drop across the fibres and allowing venous return and physiological pressure in the organs proximal to the oxygenator.

  7. 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.

  8. Automatic Control of Veno-Venous Extracorporeal Lung Assist.

    Science.gov (United States)

    Kopp, Ruedger; Bensberg, Ralf; Stollenwerk, Andre; Arens, Jutta; Grottke, Oliver; Walter, Marian; Rossaint, Rolf

    2016-10-01

    Veno-venous extracorporeal lung assist (ECLA) can provide sufficient gas exchange even in most severe cases of acute respiratory distress syndrome. Commercially available systems are manually controlled, although an automatically controlled ECLA could allow individualized and continuous adaption to clinical requirements. Therefore, we developed a demonstrator with an integrated control algorithm to keep continuously measured peripheral oxygen saturation and partial pressure of carbon dioxide constant by automatically adjusting extracorporeal blood and gas flow. The "SmartECLA" system was tested in six animal experiments with increasing pulmonary hypoventilation and hypoxic inspiratory gas mixture to simulate progressive acute respiratory failure. During a cumulative evaluation time of 32 h for all experiments, automatic ECLA control resulted in a peripheral oxygen saturation ≥90% for 98% of the time with the lowest value of 82% for 15 s. Partial pressure of venous carbon dioxide was between 40 and 49 mm Hg for 97% of the time with no value 49 mm Hg. With decreasing inspiratory oxygen concentration, extracorporeal oxygen uptake increased from 68 ± 25 to 154 ± 34 mL/min (P automatic control of the extracorporeal circuit. Proof of concept could be demonstrated for this novel automatically controlled veno-venous ECLA circuit. Copyright © 2015 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

  9. Music does not reduce alfentanil requirement during patient-controlled analgesia (PCA) use in extracorporeal shock wave lithotripsy for renal stones.

    Science.gov (United States)

    Cepeda, M S; Diaz, J E; Hernandez, V; Daza, E; Carr, D B

    1998-12-01

    To evaluate the impact of music on opioid requirements and pain levels during renal lithotripsy using alfentanil patient-controlled analgesia (PCA), we conducted a prospective, blinded, randomized controlled trial. Patients undergoing lithotripsy were instructed in PCA use and asked to rate their anxiety and select their preferred type of music. They were then premedicated with morphine and ketorolac and randomly allocated into two groups. Group 1 (n = 97) had music started 10 min before the procedure and maintained until 10 min after its conclusion. Group 2 (n = 96) had music begun at the conclusion of lithotripsy and continued for 10 min. Pain intensity, alfentanil requirement, side effects, quality of analgesia, patient satisfaction, and acceptance of the technique were evaluated. Demographics, alfentanil requirement, pain levels, side effects, quality of analgesia, and patient satisfaction were similar in both groups. The addition of music did not provide any benefit. This result raises the possibility that some nonpharmacologic therapies have minimal impact in settings where the painful stimulus is moderate to severe and adequate pharmacotherapy is available.

  10. Extracorporeal life support for refractory ventricular tachycardia

    Science.gov (United States)

    Joseph, Nicholas; Hofmann, James P.; Saranteas, Theodosios; Papadimos, Thomas J.

    2017-01-01

    Extracorporeal life support (ECLS) is a very effective bridging therapy in patients with refractory ventricular tachycardia (VT) associated with cardiogenic shock. A moribund patient in extremis, is not amenable to optimization by standard ACC/AHA guidelines. New approaches and novel salvage techniques are necessary to improve outcomes in patients with refractory clinical settings such as malignant ventricular arrhythmias, cardiac arrest, cardiogenic shock and/or pulmonary failure until further management options are explored. Data base searches were done using key words such as ECLS, VT, cardiac arrest, VT ablation, venoarterial extra-corporeal membrane oxygenation (VA-ECMO). The use of ECLS has been described in a few case reports to facilitate VT ablation for incessant VT refractory to medical therapy. For patients with, out-of- hospital ventricular fibrillation (VF) and VT, Minnesota Resuscitation Consortium has implemented emergent advanced perfusion and reperfusion strategy, followed by coronary angiography and primary coronary intervention to improve outcome. The major indications for ECLS are cardiogenic shock related to acute myocardial infarction, myocarditis, post embolic acute cor pulmonale, drug intoxication and post cardiac arrest syndrome with the threat of multi-organ failure. ECLS permits the use of negative inotropic antiarrhythmic drug therapy, facilitates the weaning of catecholamine administration, thereby ending the vicious cycle of catecholamine driven electric storm. ECLS provides hemodynamic support during ablation procedure, while mapping and induction of VT is undertaken. ECLS provides early access to cardiac catheterization laboratory in patients with cardiac arrest due to shockable rhythm. The current evidence from literature, supports the use of ECLS to ensure adequate vital organ perfusion in patients with refractory VT. ECLS is a safe, feasible and effective therapeutic option when conventional therapies are insufficient to support

  11. The p21 ras C-terminus is required for transformation and membrane association

    DEFF Research Database (Denmark)

    Willumsen, B M; Christensen, A; Hubbert, N L;

    1984-01-01

    , undergoes posttranslational modification and the mature protein subsequently becomes associated with the inner surface of the plasma membrane and binds lipid tightly. The p21 proteins have the capacity to bind guanine nucleotides non-covalently in vitro. To assess the biological relevance...... of these biochemical features of the protein, we have now studied a series of deletion mutants located at or near the C-terminus of the viral p21 protein. Our tissue culture studies indicate that amino acids located at or near the C-terminus are required for cellular transformation, membrane association and lipid...

  12. Pressure-Guided Positioning of Bicaval Dual-Lumen Catheters for Venovenous Extracorporeal Gas Exchange

    Science.gov (United States)

    2013-01-01

    Peterson-Carmichael S, Lin SS, Davis D, Zaas D (2011) Active rehabilitation and physical therapy during extracorporeal membrane oxygenation while...Defreyne L, Benoit DD, Decruyenaere J (2011) Epidemiology of contrast-associated acute kidney injury in ICU patients: a retrospective cohort analysis

  13. Extracorporeal treatment for theophylline poisoning

    DEFF Research Database (Denmark)

    Ghannoum, Marc; Wiegand, Timothy J; Liu, Kathleen D

    2015-01-01

    BACKGROUND: The Extracorporeal Treatments in Poisoning workgroup was created to provide evidence-based recommendations on the use of extracorporeal treatments (ECTRs) in poisoning. Here, the workgroup presents its systematic review and recommendations for theophylline. METHODS: After a systematic...... theophylline poisoning (1C). Specific recommendations for ECTR include a theophylline concentration [theophylline] > 100 mg/L (555 μmol/L) in acute exposure (1C), the presence of seizures (1D), life-threatening dysrhythmias (1D) or shock (1D), a rising [theophylline] despite optimal therapy (1D), and clinical...... deterioration despite optimal care (1D). In chronic poisoning, ECTR is suggested if [theophylline] > 60 mg/L (333 μmol/L) (2D) or if the [theophylline] > 50 mg/L (278 μmol/L) and the patient is either less than 6 months of age or older than 60 years of age (2D). ECTR is also suggested if gastrointestinal...

  14. Extracorporeal treatment for barbiturate poisoning

    DEFF Research Database (Denmark)

    Mactier, Robert; Laliberté, Martin; Mardini, Joelle

    2014-01-01

    The EXTRIP (Extracorporeal Treatments in Poisoning) Workgroup conducted a systematic review of barbiturate poisoning using a standardized evidence-based process to provide recommendations on the use of extracorporeal treatment (ECTR) in patients with barbiturate poisoning. The authors reviewed all......-acting barbiturates are dialyzable and short-acting barbiturates are moderately dialyzable. Four key recommendations were made. (1) The use of ECTR should be restricted to cases of severe long-acting barbiturate poisoning. (2) The indications for ECTR in this setting are the presence of prolonged coma, respiratory...... treatment should be continued during ECTR. (4) Cessation of ECTR is indicated when clinical improvement is apparent. This report provides detailed descriptions of the rationale for all recommendations. In summary, patients with long-acting barbiturate poisoning should be treated with ECTR provided at least...

  15. Extracorporeal Treatment in Phenytoin Poisoning

    DEFF Research Database (Denmark)

    Anseeuw, Kurt; Mowry, James B; Burdmann, Emmanuel A

    2016-01-01

    The Extracorporeal Treatments in Poisoning (EXTRIP) Workgroup conducted a systematic literature review using a standardized process to develop evidence-based recommendations on the use of extracorporeal treatment (ECTR) in patients with phenytoin poisoning. The authors reviewed all articles......) despite its high protein binding and made the following recommendations. ECTR would be reasonable in select cases of severe phenytoin poisoning (neutral recommendation, 3D). ECTR is suggested if prolonged coma is present or expected (graded 2D) and it would be reasonable if prolonged incapacitating ataxia...... is present or expected (graded 3D). If ECTR is used, it should be discontinued when clinical improvement is apparent (graded 1D). The preferred ECTR modality in phenytoin poisoning is intermittent hemodialysis (graded 1D), but hemoperfusion is an acceptable alternative if hemodialysis is not available...

  16. Glycosaminoglycans are required for translocation of amphipathic cell-penetrating peptides across membranes.

    Science.gov (United States)

    Pae, Janely; Liivamägi, Laura; Lubenets, Dmitri; Arukuusk, Piret; Langel, Ülo; Pooga, Margus

    2016-08-01

    Cell-penetrating peptides (CPPs) are considered as one of the most promising tools to mediate the cellular delivery of various biologically active compounds that are otherwise cell impermeable. CPPs can internalize into cells via two different pathways - endocytosis and direct translocation across the plasma membrane. In both cases, the initial step of internalization requires interactions between CPPs and different plasma membrane components. Despite the extensive research, it is not yet fully understood, which of these cell surface molecules mediate the direct translocation of CPPs across the plasma- and endosomal membrane. In the present study we used giant plasma membrane vesicles (GPMVs) as a model membrane system to elucidate the specific molecular mechanisms behind the internalization and the role of cell surface glycosaminoglycans (GAGs) in the translocation of four well-known CPPs, classified as cationic (nona-arginine, Tat peptide) and amphipathic (transportan and TP10). We demonstrate here that GAGs facilitate the translocation of amphipathic CPPs, but not the internalization of cationic CPPs; and that the uptake is not mediated by a specific GAG class, but rather the overall amount of these polysaccharides is crucial for the internalization of amphipathic peptides.

  17. Triggered Ca2+ influx is required for extended synaptotagmin 1-induced ER-plasma membrane tethering.

    Science.gov (United States)

    Idevall-Hagren, Olof; Lü, Alice; Xie, Beichen; De Camilli, Pietro

    2015-09-01

    The extended synaptotagmins (E-Syts) are ER proteins that act as Ca(2+)-regulated tethers between the ER and the plasma membrane (PM) and have a putative role in lipid transport between the two membranes. Ca(2+) regulation of their tethering function, as well as the interplay of their different domains in such function, remains poorly understood. By exposing semi-intact cells to buffers of variable Ca(2+) concentrations, we found that binding of E-Syt1 to the PI(4,5)P2-rich PM critically requires its C2C and C2E domains and that the EC50 of such binding is in the low micromolar Ca(2+) range. Accordingly, E-Syt1 accumulation at ER-PM contact sites occurred only upon experimental manipulations known to achieve these levels of Ca(2+) via its influx from the extracellular medium, such as store-operated Ca(2+) entry in fibroblasts and membrane depolarization in β-cells. We also show that in spite of their very different physiological functions, membrane tethering by E-Syt1 (ER to PM) and by synaptotagmin (secretory vesicles to PM) undergo a similar regulation by plasma membrane lipids and cytosolic Ca(2+).

  18. 影响体外膜肺治疗重症急性呼吸窘迫综合征预后的因素分析%The factors affecting the outcome of severe acute respiratory distress syndrome patients treated with extracorporeal membrane oxygenation

    Institute of Scientific and Technical Information of China (English)

    朱建军; 刘励军; Philippe Sauder

    2013-01-01

    Objective To find out the factors affecting the outcome of severe acute respiratory distress syndrome (ARDS) patients treated with extracorporeal membrane oxygenation (ECMO).Methods From November 2008 to September 2010,patients with severe acute respiratory distress syndrome (ARDS) required extracorporeal membrane oxygenation (ECMO) after failure of conventional therapy were retrospectively studied.Patients treated by veno-arterial ECMO,treated by mechanical ventilation for more than l0 days were excluded.All patients were divided into survival group and non-survival group,according to the 28 day survival situation after ECMO treatment.We compared the clinical data of the two groups when transferred to Intensive Care Unit (ICU),before and after ECMO treatment.We used Independent-samples t test and Chi-square tests to find out the factors affecting the results of ECMO treatment in the patients with severe ARDS.Results A total of twenty-five patients were enrolled in the study,of whom 15 patients survived,10 patients died.The results showed that the average age of the survival group is lower than that of non-survival group (49.8 ± 10.5) vs.(59.9 ± 11.5),P =0.044,and the proportion of patients with severe ARDS caused by Influenza A (H1 N1) in the survival group was higher than that of the non-survival group (x2 =4.453,P =0.048).In addition,the duration of mechanical ventilation before ECMO treatment in the survival group was shorter than that in the non-survival group (57.8 ± 8.7) hours vs.(68.3 ±13.7) hours,P =0.013.Conclusions The age,pre-ECMO ventilation duration and the cause of ARDS are the important factors influencing the efficacy of ECMO treatment in the patients with severe ARDS.%目的 分析接受体外膜肺(ECMO)治疗重症急性呼吸窘迫综合征(ARDS)患者的临床特征,探讨影响ECMO治疗重症ARDS预后的因素.方法 回顾性分析法国斯特拉斯堡医学院附属新民众医院2008年11月至2010年9月因常规治疗无效而

  19. 边缘性供心移植术中采用体外膜肺氧合技术四例%Perioperative extracorporeal membrane oxygenation technique for the marginal donor heart transplantation: a report of 4 cases

    Institute of Scientific and Technical Information of China (English)

    张海波; 孟旭; 韩杰; 曾文; 孙凌波; 许春雷; 贾一新

    2008-01-01

    Objective To investigate the clinical results of the perioperative extracorporeal membrane oxygenation(ECMO)technique instead of conservative CPB used in the heart transplantation operation with long ischemic time donor hearts.Methods In 2006 the ECMO technique instead of conservative CPB was tried in the heart transplantation in 4 cases of long ischemic time donor hearts with ischemic time arranging from 4.8 to 8.0 h.During the operation the pump blood flow rate was controlled at 4.5-5.0 L/min. The conservative ECMO canula connection was retained after the assisted blood flow was reduced to one half after the operation.Then the patients returned back to ICU with the ECMO assistance and the ECMO was removed in the following suitable time.Results Totally 4 cases of heart transplantation were performed with the ECMO techniques instead of the CPB.All the hearts rebeated automatically after the successful operation.The mean cross clamp time was(90±3)min with on pump(136±14)min.The femoral artery blood flow rate during the ECMO machines were removed the next day.All the recipients recovered without right ventricular failure or obvious tricuspid regurgitation which were commonly seen after heart transplantation Postoperative bleeding occurred in 2 cases and lymphoid leakage and leg nerve overreact phenomenon in 1 case respectively.All the 4 cases discharged with NYHA Ⅰ/Ⅱcardiac function without tricuspid regurgitation.The mean left ventricle end-diastolic dimension was 37-43 mm and the left ventricle ejection fraction arranged from 56% to 64 %.Conclusion Replacing the routine CPB with ECMO techniques in the heart transplantation could effectively protect the donor hearts even with long cold ischemic time and improve the cardiac function recovery.%目的 研究体外膜肺氧合(ECMO)技术用于边缘性供心移植的临床效果.方法 4例患者心脏移植时采用ECMO技术,其供心的冷缺血时间长达4.8~8.0 h.术中采用ECMO技术代替

  20. Application of extracorporeal membrane oxygenation techniques in heart transplantation operations%体外膜肺氧合技术在心脏移植不同时期的应用

    Institute of Scientific and Technical Information of China (English)

    张海波; 孟旭; 韩杰; 贾一新; 李岩; 曾文

    2011-01-01

    目的 探讨体外膜肺氧合技术(ECMO)在心脏移植术前辅助、术中替代体外循环及术后辅助治疗的临床应用效果.方法 对心脏移植术前过渡、术中代替常规体外循环以及术后心功能衰竭辅助治疗中使用ECMO技术患者的临床资料进行回顾分析.结果 3例等待心脏移植的患者术前应用ECMO 5~8 d,其中2例患者在等待供心的过程中发生多器官功能衰竭而死亡;1例患者成功接受心脏移植,术后顺利撤除了ECMO.12例在心脏移植术中应用了ECMO代替常规体外循环技术,均顺利完成手术,术后持续应用ECMO辅助的时间平均为(38±14)h,1例患者因发生多器官功能衰竭死亡,其余11例患者均痊愈,顺利出院,无患者发生右心功能衰竭和三尖瓣返流等心脏移植术后常见的并发症.心脏移植术后由于严重右心功能衰竭接受ECMO辅助治疗的患者有10例,起始时间为返回监护室后2 h至2 d,持续时间为43~176 h,其中7例患者痊愈,顺利出院,1例因发生严重感染而死亡,2例因发生多器官功能衰竭而死亡.以上死亡患者的死亡原因均与ECMO的出血或血栓形成等并发症无关.结论 尽早应用ECMO可以使等待心脏移植的心功能衰竭患者有效地过渡到心脏移植;术中应用ECMO替代常规体外循环技术可以更好地保护供心,有利于缺血时间较长供心的功能恢复,提高心脏移植手术成功率;术后患者出现右心功能衰竭时,应用ECMO有良好的辅助治疗效果.%Objective To investigate the clinical results of extracorporeal membrane oxygenation (ECMO) technique during the peri-operative heart transplantation. Methods The clinical data of heart transplantations supported by the ECMO were retrospectively analyzed, including during the bridge to transplant, working as routine bypass in the operation room, and supporting the heart failure after surgery. Results Three 3 cases were supported with ECMO to extend the

  1. Extracorporeal membrane oxygenation for acute respiratory distress syndrome:a study of 11 cases%体外膜氧合治疗急性呼吸窘迫综合征11例临床观察

    Institute of Scientific and Technical Information of China (English)

    严洁; 周敏; 朱艳红; 许红阳; 杨挺; 陈静瑜

    2012-01-01

    Objective To evaluate the value of extracorporeal membrane oxygenation (ECMO) for adult patients with severe acute respiratory distress syndrome (ARDS).Methods Twenty-five adult patients with severe ARDS admitted to Intensive Care Unit of Wuxi People' s Hospital from January 2008 to June 2011 were retrospectively studied.All the cases met the ECMO criteria.Patients were divided into ECMO group and non-ECMO group according to whether they were treated with ECMO or not.ECMO group was further divided into ECMO survivor group and ECMO non-survivor group according to the situation on the 30th day after ECMO treatment.Clinical features and prognosis were compared between groups.The statistics software of SPSS 13.0 was used for data analysis.Results Of the 25 patients,11 were treated with ECMO.There were 7 males and 4 females,aged from 21 to 61 years,with a mean age of (42 ± 12) years.Mean time of mechanical ventilation before ECMO therapy was (12 ± 8) h,with PaO2/FiO2 of (52 ± 19)mm Hg (1 mm Hg =0.133 kPa) and PaCO2 (84 ± 11) mm Hg.Six patients treated with ECMO survived.The survival rate between the ECMO group and non-ECMO group was not significantly different (54.5%,35.7%,x2=2.232,P >0.05).Duration of ECMO therapy was (10.4 ± 3.4) d in survivors and (6.2 ± 2.4) d in non-survivors.Early improvement of PaO2 to FiO2 ratio and decrease of PaCO2 were seen in both ECMO survivor group and non-survivor group (t =2.568-22.490,all P < 0.05).In survivor group,sermn lactate levels and norepinephrin doses decreased significantly (t =4.679-23.397,all P < 0.05),while the serum lactate levels and norepinephrin doses increased in non-survivor group(t =4.325-29.729,all P < 0.05).Conclusions Available data and our experience suggest that ECMO may be an effective salvage treatment for severe ARDS and should be used as early as possible for ARDS patients responding poorly to conventional mechanical ventilation support.%目的 评价体外膜氧合(ECMO)治

  2. Membraner

    DEFF Research Database (Denmark)

    Bach, Finn

    2009-01-01

    Notatet giver en kort introduktion til den statiske virkemåde af membraner og membrankonstruktioner......Notatet giver en kort introduktion til den statiske virkemåde af membraner og membrankonstruktioner...

  3. [Treatment of acute renal failure--concepts and controversies. 2. Extracorporeal renal replacement and peritoneal dialysis].

    Science.gov (United States)

    Gabriel, A; Müller, E; Tarnow, J

    2001-04-01

    Therapy of prolonged acute renal failure regularly requires a renal replacement therapy. This can be achieved by different extracorporal renal replacement therapies (ERRT) or by peritoneal dialysis. ERRT are classified according to the physical principle underlying toxin elimination as hemodialysis (diffusion) and hemofiltration (convection). Another classification refers to intermittent or continuous application modes. Biocompatibility of membranes is judged according to their activation of the complement system. Prospective randomized studies did not consolidate the assumptions about the benefit of particular modalities proposed on theoretical foundations. Mortality, duration and complication rates of acute renal failure are not significantly decreased by use of biocompatible membranes. Continuous modalities are not generally preferable but optimize treatment in hemodynamically unstable patients, in whom they endorse fluid balancing and maintenance of sufficient arterial blood pressure. The use of demanding hemofiltration techniques for cytokine removal should be limited to clinical studies. The effects of ERRT-"intensity" and the best timing for initiation of ERRT have not been evaluated sufficiently. The choice of the ERRT modality is subject to clinical judgement (criterion: hemodynamic situation), practical aspects (criteria: availability of equipment and handling experience), and costs. Prior to their general use new and expensive technical modalities and membrane types should be thoroughly evaluated in studies with regard to outcome-related aspects such as patient survival and preservation of renal function.

  4. Cardiac failure in very long chain acyl-CoA dehydrogenase deficiency requiring extracorporeal membrane oxygenation (ECMO treatment: A case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Sharon Katz

    2017-03-01

    As data regarding the use of ECMO in FAO defects in general, and VLCAD in particular, are scarce, we review the literature and discuss insights from in vitro models and several successful reported cases.

  5. Hospital Costs Of Extracorporeal Life Support Therapy

    NARCIS (Netherlands)

    Oude Lansink-Hartgring, Annemieke; van den Hengel, Berber; van der Bij, Wim; Erasmus, Michiel E.; Mariani, Massimo A.; Rienstra, Michiel; Cernak, Vladimir; Vermeulen, Karin M.; van den Bergh, Walter M.

    2016-01-01

    Objectives: To conduct an exploration of the hospital costs of extracorporeal life support therapy. Extracorporeal life support seems an efficient therapy for acute, potentially reversible cardiac or respiratory failure, when conventional therapy has been inadequate, or as bridge to transplant, but

  6. Tuning of Hemes b Equilibrium Redox Potential Is Not Required for Cross-Membrane Electron Transfer.

    Science.gov (United States)

    Pintscher, Sebastian; Kuleta, Patryk; Cieluch, Ewelina; Borek, Arkadiusz; Sarewicz, Marcin; Osyczka, Artur

    2016-03-25

    In biological energy conversion, cross-membrane electron transfer often involves an assembly of two hemesb The hemes display a large difference in redox midpoint potentials (ΔEm_b), which in several proteins is assumed to facilitate cross-membrane electron transfer and overcome a barrier of membrane potential. Here we challenge this assumption reporting on hemebligand mutants of cytochromebc1in which, for the first time in transmembrane cytochrome, one natural histidine has been replaced by lysine without loss of the native low spin type of heme iron. With these mutants we show that ΔEm_b can be markedly increased, and the redox potential of one of the hemes can stay above the level of quinone pool, or ΔEm_b can be markedly decreased to the point that two hemes are almost isopotential, yet the enzyme retains catalytically competent electron transfer between quinone binding sites and remains functionalin vivo This reveals that cytochromebc1can accommodate large changes in ΔEm_b without hampering catalysis, as long as these changes do not impose overly endergonic steps on downhill electron transfer from substrate to product. We propose that hemesbin this cytochrome and in other membranous cytochromesbact as electronic connectors for the catalytic sites with no fine tuning in ΔEm_b required for efficient cross-membrane electron transfer. We link this concept with a natural flexibility in occurrence of several thermodynamic configurations of the direction of electron flow and the direction of the gradient of potential in relation to the vector of the electric membrane potential. © 2016 by The American Society for Biochemistry and Molecular Biology, Inc.

  7. Conditions and procedures for in-hospital extracorporeal life support (ECLS) in cardiopulmonary resuscitation (CPR) of adult patients.

    Science.gov (United States)

    Swol, Justyna; Belohlávek, Jan; Haft, Jonathan W; Ichiba, Shingo; Lorusso, Roberto; Peek, Giles J

    2016-04-01

    The use of extracorporeal life support (ECLS) in cardiopulmonary resuscitation (CPR; ECPR) has been repeatedly published as non-randomized studies, mainly case series and case reports. The aim of this article is to support physicians, perfusionists, nurses and extracorporeal membrane oxygenation (ECMO) specialists who regularly perform ECPR or are willing to start an ECPR program by establishing standards for safe and efficient ECPR procedures. This article represents the experience and recommendations of physicians who provide ECPR routinely. Based on its survival and outcome rates, ECPR can be considered when determining the optimal treatment of patients who require CPR. The successful performance of ECLS cannulation during CPR is a life-saving measure and has been associated with improved outcome (including neurological outcome) after CPR. We summarize the general structure of an ECLS team and describe the cannulation procedure and the approaches for post-resuscitation care. The differences in hospital organizations and their regulations may result in variations of this model. © The Author(s) 2015.

  8. Identification of regions required for apical membrane localization of human multidrug resistance protein 2.

    Science.gov (United States)

    Bandler, Paul E; Westlake, Christopher J; Grant, Caroline E; Cole, Susan P C; Deeley, Roger G

    2008-07-01

    Multidrug resistance proteins MRP1 and MRP2 transport a wide range of endo- and xenobiotics. However, with the exception of certain parts of the brain, MRP1 traffics to basolateral membranes of polarized cells, whereas MRP2 is apical in location and thus it is particularly important for systemic elimination of such compounds. Different regions of MRP1 and MRP2 seem to target them to their respective membrane locations. In addition to two "core" membrane spanning domains (MSDs) characteristic of ATP-binding cassette transporters, MRP1 and MRP2 have a third NH2-terminal MSD (MSD0), which is not required for basolateral targeting of MRP1, or for transport of at least some substrates. Here, we demonstrate that all elements necessary for apical targeting of MRP2 reside in MSD0 and the adjacent cytoplasmic loop (CL) 3. Furthermore, we show that this region of MRP2 can target the core of MRP1 to an exclusively apical location. Within MRP2 CL3, we identified a lysine-rich element that is essential for apical targeting. When introduced into MRP1, this element alone is sufficient to result in partial apical localization. However, exclusive targeting to the apical membrane seems to require the integrity of the entire region encompassing MSD0 and CL3 of MRP2. Because CL3 of MRP1 is critical for binding, transport, or both of several compounds, we also examined the function of hybrids containing all, or portions of MRP2 MSD0 and CL3. Our results indicate that CL3 is important for interaction with both the glutathione and glucuronide conjugates tested, but that different regions may be involved.

  9. 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, n

  10. Clinical experience with adults receiving extracorporeal membrane oxygenation for cardiogeulc shock and quality of life in survivals%体外膜肺氧合治疗成人心脏术后心源性休克的临床经验及生命质量分析

    Institute of Scientific and Technical Information of China (English)

    王坚刚; 孟旭; 韩杰; 贾一新; 曾文; 许春雷; 张海波; 高峰; 侯晓彤

    2010-01-01

    Objective To review the experience with extracorporeal membrane oxygenation (ECMO) in adult postcardiotomy cadiogenic shock and evaluate quality of life (QOL) in survivals.Methods During 4 years 62 of 12,644 patients (0.49%) undergoing cardiac surgery (valve procedures,n=39; coronary artery bypass grafting, n=13; coronary artery bypass grafting plus valve procedures, n=4;heart transplantation, n=4, and total aortic arch replacement, n=2) required temporary postoperative ECMO support. At follow-up (mean 2.3±1.5 years, 100% complete), 32 were still alive and answered the Short-Form 36 Health Survey QOL questionnaire. Results Mean duration of ECMO support was 61±37 hors. Forty patients (64.5%) were successfully weaned from ECMO. Thirty-four patients (54.8%) were discharged from hospital after 44.3±17.6 days. The in-hospital mortality was 45.2%. The main cause of death was multiple organ failure. The postoperative peak lactate levels ≥ 12 mmol/L before ECMO initiation was a risk factor of in-hospital death. Mean QOL scores between the ECMO survivors and other patients after cardiac surgery without ECMO support showed no significant difference , except that the vitality and mental health were significant lower in the ECMO survivors (P<0.05). Both the ECMO survivors and the patients without ECMO support have significant lower QOL scores (except the vitality and mental health) relative to their respective Chinese population norms (P<0.05). Conclusion ECMO offers sufficient cardiopulmonary support in adults.Early indication, reduced complication could improve results with increasing experience. However, ECMO survivors had lower physical and mental health that need to be recovered.%目的 总结成人心脏术后心源性休克患者应用体外膜肺氧合(ECMO)治疗的临床经(ECMO)治疗的临床经验,对生存者进行生命质量分析.方法 2004年1月至2008年5月北京安贞医院心脏外科62例心用ECMO支持.其中男32例、女30例,年龄16~73(51

  11. Cross-linking of anaplasma marginale outer membrane proteins enhances immunogenicity, but is not required for protection from challenge

    Science.gov (United States)

    Bacterial outer membrane proteins are the primary targets of a protective immune response. The specific characteristics of outer membrane-based immunogens, in terms of antigen content and context that are required for protective immunity remain unknown for a wide variety of bacterial pathogens. Usin...

  12. A non-permselective membrane reactor for chemical processes normally requiring strict stoichiometric feed rates of reactants

    NARCIS (Netherlands)

    Sloot, H.J.; Versteeg, G.F.; Swaaij, W.P.M. van

    1990-01-01

    A novel type of membrane reactor with separated feeding of the reactants is presented for chemical processes normally requiring strict stoichiometric feed rates of premixed reactants. The reactants are fed in the reactor to the different sides of a porous membrane which is impregnated with a catalys

  13. A non-permselective membrane reactor for chemical processes normally requiring strict stoichiometric feed rates of reactants

    NARCIS (Netherlands)

    Sloot, H.J.; Versteeg, G.F.; Swaaij, W.P.M. van

    1990-01-01

    A novel type of membrane reactor with separated feeding of the reactants is presented for chemical processes normally requiring strict stoichiometric feed rates of premixed reactants. The reactants are fed in the reactor to the different sides of a porous membrane which is impregnated with a

  14. The experience of extracorporeal membrane oxygenation for severe acute respiratory failure in adults%体外膜氧合治疗重症急性呼吸衰竭的临床疗效分析

    Institute of Scientific and Technical Information of China (English)

    孙兵; 王春婷; 吴珺; 李绪言; 贺航咏; 张春艳; 童朝晖; 詹庆元; 王辰

    2012-01-01

    Objective To summarize the experience of extracorporeal membrane oxygenation (ECMO) for patients with severe acute respiratory failure in adults and to investigate the factors associated with death.Methods The clinical data of patients with severe acute respiratory failure supported with ECMO in respiratory intensive care unit of Beijing Chaoyang Hospital from November 2009 to December 2011 were prospectively collected and analyzed.The data included general condition before EMCO,blood gas analysis,hemodynamics,ventilator settings of mechanical ventilation and complications during ECMO.The primary outcome was death or severe disability within 3 months.Statistical software of SPSS (version 16.0)was used for data analysis.Results Twenty-five patients with severe respiratory failure received ECMO treatment,of which 16 patients were analyzed.The mean age was (45 ± 14) years old (range,22-64 years old).Thirteen patients were male.Before ECMO,all of the patients were treated with invasive positive pressure ventilation for (72 ± 64) hours.Eight patients had been treated with noninvasive ventilation for a median of 55 (10-114) hours.Patients had severe respiratory failure despite advanced mechanical ventilator support.The mean PaO2/fraction of inspired oxygenation (FiO2) ratio was (54 ± 18) mm Hg (1 mm Hg =0.133 kPa),positive end-expiratory pressure (PEEP) was (11 ± 6) cm H2O(1 cm H2O =0.098 kPa),Murray lung injury score was 3.6 ±0.5,serum lactate was (2.5 ±2.0) mmoL/L,serum white blood cell count was (16 ± 6) × 109/L,and APACHE Ⅱ score was 17 ± 8.All of the patients were treated with venous-venous ECMO (VV-ECMO).The change of mechanical ventilation settings were (pre-ECMO vs 2 hours post-ECMO):FiO2 1.0 vs 0.55 ± 0.21,PEEP (11 ± 6) vs (9 ± 6) cm H2O,VT (6.8 ± 2.2) vs (4.4 ±2.0) ml/kg PBW,peak airway pressure (27 ±8) vs (24 ±7) cm H2O,respiratory rate (37 ± 10)vs (23 ± 10) breaths/min.Arterial blood gas,including pH,PaO2 and PaCO2 were significantly

  15. FadD is required for utilization of endogenous fatty acids released from membrane lipids.

    Science.gov (United States)

    Pech-Canul, Ángel; Nogales, Joaquina; Miranda-Molina, Alfonso; Álvarez, Laura; Geiger, Otto; Soto, María José; López-Lara, Isabel M

    2011-11-01

    FadD is an acyl coenzyme A (CoA) synthetase responsible for the activation of exogenous long-chain fatty acids (LCFA) into acyl-CoAs. Mutation of fadD in the symbiotic nitrogen-fixing bacterium Sinorhizobium meliloti promotes swarming motility and leads to defects in nodulation of alfalfa plants. In this study, we found that S. meliloti fadD mutants accumulated a mixture of free fatty acids during the stationary phase of growth. The composition of the free fatty acid pool and the results obtained after specific labeling of esterified fatty acids with a Δ5-desaturase (Δ5-Des) were in agreement with membrane phospholipids being the origin of the released fatty acids. Escherichia coli fadD mutants also accumulated free fatty acids released from membrane lipids in the stationary phase. This phenomenon did not occur in a mutant of E. coli with a deficient FadL fatty acid transporter, suggesting that the accumulation of fatty acids in fadD mutants occurs inside the cell. Our results indicate that, besides the activation of exogenous LCFA, in bacteria FadD plays a major role in the activation of endogenous fatty acids released from membrane lipids. Furthermore, expression analysis performed with S. meliloti revealed that a functional FadD is required for the upregulation of genes involved in fatty acid degradation and suggested that in the wild-type strain, the fatty acids released from membrane lipids are degraded by β-oxidation in the stationary phase of growth.

  16. Components of SurA required for outer membrane biogenesis in uropathogenic Escherichia coli.

    Directory of Open Access Journals (Sweden)

    Kristin M Watts

    Full Text Available BACKGROUND: SurA is a periplasmic peptidyl-prolyl isomerase (PPIase and chaperone of Escherichia coli and other Gram-negative bacteria. In contrast to other PPIases, SurA appears to have a distinct role in chaperoning newly synthesized porins destined for insertion into the outer membrane. Previous studies have indicated that the chaperone activity of SurA rests in its "core module" (the N- plus C-terminal domains, based on in vivo envelope phenotypes and in vitro binding and protection of non-native substrates. METHODOLOGY/PRINCIPAL FINDINGS: In this study, we determined the components of SurA required for chaperone activity using in vivo phenotypes relevant to disease causation by uropathogenic E. coli (UPEC, namely membrane resistance to permeation by antimicrobials and maturation of the type 1 pilus usher FimD. FimD is a SurA-dependent, integral outer membrane protein through which heteropolymeric type 1 pili, which confer bladder epithelial binding and invasion capacity upon uropathogenic E. coli, are assembled and extruded. Consistent with prior results, the in vivo chaperone activity of SurA in UPEC rested primarily in the core module. However, the PPIase domains I and II were not expendable for wild-type resistance to novobiocin in broth culture. Steady-state levels of FimD were substantially restored in the UPEC surA mutant complemented with the SurA N- plus C-terminal domains. The addition of PPIase domain I augmented FimD maturation into the outer membrane, consistent with a model in which domain I enhances stability of and/or substrate binding by the core module. CONCLUSIONS/SIGNIFICANCE: Our results confirm the core module of E. coli SurA as a potential target for novel anti-infective development.

  17. Patient and personnel exposure during extracorporeal lithotripsy

    Energy Technology Data Exchange (ETDEWEB)

    Glaze, S.; LeBlanc, A.D.; Bushong, S.C.; Griffith, D.P.

    1987-12-01

    Extracorporeal shock wave lithotripsy (ESWL) has provided a nonsurgical approach to treatment of renal stones. The Dornier lithotripter uses dual image intensified x-ray systems to center the stone before treatment. Three imaging modes are offered: a fluoroscopic mode and two video spot filming modes. The average entrance exposure to the stone side of the typical patient at our facility is 2.6 X 10(-3) C kg-1 (10 R) (range: 0.5-7.7 X 10(-3) C kg-1 (2-30 R)) which is comparable and often much less than that reported for percutaneous lithotripsy. Recommendations are made for minimizing patient exposure. Scattered radiation levels in the lithotripter room are presented. We have determined that Pb protective apparel is not required during this procedure provided x-ray operation is temporarily halted should personnel be required to lean directly over the tub to attend to the patient. If the walls of the ESWL room are greater than 1.83 m (6 feet) from the tub, shielding in addition to conventional construction is not required.

  18. Patient and personnel exposure during extracorporeal lithotripsy.

    Science.gov (United States)

    Glaze, S; LeBlanc, A D; Bushong, S C; Griffith, D P

    1987-12-01

    Extracorporeal shock wave lithotripsy (ESWL) has provided a nonsurgical approach to treatment of renal stones. The Dornier lithotripter uses dual image intensified x-ray systems to center the stone before treatment. Three imaging modes are offered: a fluoroscopic mode and two video spot filming modes. The average entrance exposure to the stone side of the typical patient at our facility is 2.6 X 10(-3) C kg-1 (10 R) [range: 0.5-7.7 X 10(-3) C kg-1 (2-30 R)] which is comparable and often much less than that reported for percutaneous lithotripsy. Recommendations are made for minimizing patient exposure. Scattered radiation levels in the lithotripter room are presented. We have determined that Pb protective apparel is not required during this procedure provided x-ray operation is temporarily halted should personnel be required to lean directly over the tub to attend to the patient. If the walls of the ESWL room are greater than 1.83 m (6 feet) from the tub, shielding in addition to conventional construction is not required.

  19. Requirements for the formation of membrane pores by the reovirus myristoylated micro1N peptide.

    Science.gov (United States)

    Zhang, Lan; Agosto, Melina A; Ivanovic, Tijana; King, David S; Nibert, Max L; Harrison, Stephen C

    2009-07-01

    The outer capsid of the nonenveloped mammalian reovirus contains 200 trimers of the micro1 protein, each complexed with three copies of the protector protein sigma3. Conformational changes in micro1 following the proteolytic removal of sigma3 lead to release of the myristoylated N-terminal cleavage fragment micro1N and ultimately to membrane penetration. The micro1N fragment forms pores in red blood cell (RBC) membranes. In this report, we describe the interaction of recombinant micro1 trimers and synthetic micro1N peptides with both RBCs and liposomes. The micro1 trimer mediates hemolysis and liposome disruption under conditions that promote the micro1 conformational change, and mutations that inhibit micro1 conformational change in the context of intact virus particles also prevent liposome disruption by particle-free micro1 trimer. Autolytic cleavage to form micro1N is required for hemolysis but not for liposome disruption. Pretreatment of RBCs with proteases rescues hemolysis activity, suggesting that micro1N cleavage is not required when steric barriers are removed. Synthetic myristoylated micro1N peptide forms size-selective pores in liposomes, as measured by fluorescence dequenching of labeled dextrans of different sizes. Addition of a C-terminal solubility tag to the peptide does not affect activity, but sequence substitution V13N or L36D reduces liposome disruption. These substitutions are in regions of alternating hydrophobic residues. Their locations, the presence of an N-terminal myristoyl group, and the full activity of a C-terminally extended peptide, along with circular dichroism data that indicate prevalence of beta-strand secondary structure, suggest a model in which micro1N beta-hairpins assemble in the membrane to form a beta-barrel pore.

  20. Vascular access for extracorporeal renal replacement therapy in veterinary patients.

    Science.gov (United States)

    Chalhoub, Serge; Langston, Cathy E; Poeppel, Karen

    2011-01-01

    Vascular access is the first and most basic requirement for successful extracorporeal renal replacement therapy (ERRT). Dual-lumen catheters are the most commonly used method of vascular access for ERRT in veterinary patients. An adequately functioning dialysis catheter allows for smooth and efficient patient management, whereas a poorly functioning catheter frustrates the technician, doctor, and patient. These catheters are fairly quick to place but require meticulous care for optimal function. The most common complications are thrombosis and infection. Monitoring catheter performance should be a routine part of dialysis patient care.

  1. Extracorporeal shock wave lithotripsy in childhood

    Energy Technology Data Exchange (ETDEWEB)

    Kroovand, R.L.; Harrison, L.H.; McCullough, D.L.

    1987-10-01

    Extracorporeal shock wave lithotripsy is the treatment of choice for the majority of upper urinary calculi in adults. Technical limitations, including patient size and concerns over post-treatment stone fragment passage, have made the application of extracorporeal shock wave lithotripsy in children less clearly defined. We report the successful application of the Dornier lithotriptor in the management of 18 children (22 kidneys) with upper urinary calculi.

  2. Integrating complex functions: coordination of nuclear pore complex assembly and membrane expansion of the nuclear envelope requires a family of integral membrane proteins.

    Science.gov (United States)

    Schneiter, Roger; Cole, Charles N

    2010-01-01

    The nuclear envelope harbors numerous large proteinaceous channels, the nuclear pore complexes (NPCs), through which macromolecular exchange between the cytosol and the nucleoplasm occurs. This double-membrane nuclear envelope is continuous with the endoplasmic reticulum and thus functionally connected to such diverse processes as vesicular transport, protein maturation and lipid synthesis. Recent results obtained from studies in Saccharomyces cerevisiae indicate that assembly of the nuclear pore complex is functionally dependent upon maintenance of lipid homeostasis of the ER membrane. Previous work from one of our laboratories has revealed that an integral membrane protein Apq12 is important for the assembly of functional nuclear pores. Cells lacking APQ12 are viable but cannot grow at low temperatures, have aberrant NPCs and a defect in mRNA export. Remarkably, these defects in NPC assembly can be overcome by supplementing cells with a membrane fluidizing agent, benzyl alcohol, suggesting that Apq12 impacts the flexibility of the nuclear membrane, possibly by adjusting its lipid composition when cells are shifted to a reduced temperature. Our new study now expands these findings and reveals that an essential membrane protein, Brr6, shares at least partially overlapping functions with Apq12 and is also required for assembly of functional NPCs. A third nuclear envelope membrane protein, Brl1, is related to Brr6, and is also required for NPC assembly. Because maintenance of membrane homeostasis is essential for cellular survival, the fact that these three proteins are conserved in fungi that undergo closed mitoses, but are not found in metazoans or plants, may indicate that their functions are performed by proteins unrelated at the primary sequence level to Brr6, Brl1 and Apq12 in cells that disassemble their nuclear envelopes during mitosis.

  3. Factors that influence the membrane area of a multistage microfiltration process required to produce a micellar casein concentrate.

    Science.gov (United States)

    Hurt, Emily E; Barbano, David M

    2015-04-01

    The objective of the work reported in this paper was to develop a theoretical model to determine the effect of type of microfiltration (MF)-process feed, number of stages, and flux on the minimization of the MF membrane area required to produce a 95% serum protein-reduced micellar casein concentrate. The MF feed, number of stages, and flux were all factors that had an effect on the MF membrane area and should be taken into consideration when designing a MF system to produce a 95% serum protein-reduced micellar casein concentrate. Feeding the MF process with a diluted ultrafiltration retentate (DUR) diluted to the protein concentration of skim milk, as opposed to skim milk, reduced the required membrane area by 36% for a 5-stage process. When DUR was the MF feed, feed protein concentration, which depended on the number of MF stages, was optimized. The DUR protein concentration that minimized the required MF membrane area was 2.47, 3.85, 4.77, and 5.41% for a 2-, 3-, 4-, or 5-stage MF process, respectively. For a 5-stage process, increasing the protein concentration of the feed from 3.2 to 5.4% decreased the required MF membrane area by 10%. It was also found that as the number of stages increased from 2 to 5, the required MF membrane area decreased by 39%, when the MF feed was DUR at the optimal feed protein concentration. Finally, increasing the flux from 50 to 60 kg/m(2) per hour decreased the required MF membrane area by 17% when the MF feed was DUR at the optimal MF feed protein concentration. Overall, using DUR as a feed for MF could reduce the amount of MF membrane area required to make a 95% serum protein-reduced micellar casein concentrate.

  4. Inflammatory response and extracorporeal circulation.

    Science.gov (United States)

    Kraft, Florian; Schmidt, Christoph; Van Aken, Hugo; Zarbock, Alexander

    2015-06-01

    Patients undergoing cardiac surgery with extracorporeal circulation (EC) frequently develop a systemic inflammatory response syndrome. Surgical trauma, ischaemia-reperfusion injury, endotoxaemia and blood contact to nonendothelial circuit compounds promote the activation of coagulation pathways, complement factors and a cellular immune response. This review discusses the multiple pathways leading to endothelial cell activation, neutrophil recruitment and production of reactive oxygen species and nitric oxide. All these factors may induce cellular damage and subsequent organ injury. Multiple organ dysfunction after cardiac surgery with EC is associated with an increased morbidity and mortality. In addition to the pathogenesis of organ dysfunction after EC, this review deals with different therapeutic interventions aiming to alleviate the inflammatory response and consequently multiple organ dysfunction after cardiac surgery.

  5. [The combination of extracorporeal lithotripsy and percutaneous nephrostomy in the treatment of obstructive ureteral urate calculi].

    Science.gov (United States)

    Del Boca, C; Ferrari, C; Dotti, E; Corsi, G; Guardamagna, A; Giuberti, A C; Colloi, D

    1994-04-01

    The authors report their experience with combined percutaneous nephrostomy and extracorporeal shock-wave lithotripsy to treat obstructive uratic ureteral stones. The role of nephrostomy is stressed as a diagnosis and treatment method before, during and after lithotripsy. Thus, the method proved especially useful to drain obstructed kidneys and restore peristalsis, to evacuate septic urine, to facilitate the elimination of lithiasic fragments, to perform anterograde pyelography before, during and after lithotripsy and finally to allow pharmacological litholysis. Fourteen patients were successfully treated with combined extracorporeal lithotripsy and percutaneous nephrostomy and the results compared with those obtained with other techniques--e.g., ureteroscopy, whose value appears lower because the method requires general anesthesia and is more traumatic to the ureter. The authors conclude that combined extracorporeal lithotripsy and percutaneous nephrostomy make the best technique to treat obstructive uric acid stones thanks to their positive results, low invasiveness and to patients compliance.

  6. Early postpartum mitral valve thrombosis requiring extra corporeal membrane oxygenation before successful valve replacement.

    Science.gov (United States)

    Halldorsdottir, H; Nordström, J; Brattström, O; Sennström, M M; Sartipy, U; Mattsson, E

    2016-05-01

    Pregnancy is associated with an increased risk of thrombosis in women with mechanical prosthetic heart valves. We present the case of a 29-year-old woman who developed early postpartum mitral valve thrombus after an elective cesarean delivery. The patient had a mechanical mitral valve and was treated with warfarin in the second trimester, which was replaced with high-dose dalteparin during late pregnancy. Elective cesarean delivery was performed under general anesthesia at 37weeks of gestation. The patient was admitted to the intensive care unit for postoperative care and within 30min she developed dyspnea and hypoxia requiring mechanical ventilation. She deteriorated rapidly and developed pulmonary edema, worsening hypoxia and severe acidosis. Urgent extra corporeal membrane oxygenation was initiated. Transesophageal echocardiography revealed a mitral valve thrombus. The patient underwent a successful mitral valve replacement after three days on extra corporeal membrane oxygenation. This case highlights the importance of multidisciplinary care and frequent monitoring of anticoagulation during care of pregnant women with prosthetic heart valves.

  7. State of the art extracorporeal shock wave lithotripsy

    Energy Technology Data Exchange (ETDEWEB)

    Kandel, L.B. (State Univ. of New York at Stony Brook, Stony Brook, NY (US)); Harrison, L.H.; McCullough, D.L. (Wake Forest Univ. Medical Center, Winston-Salem, NC (US))

    1987-01-01

    This book contains 16 chapters. Some of the topics that are covered are: Extracorporeal Shock Wave Lithotripsy Development; Laser-Generated Extracorporeal Shock Wave Lithotripter; Radiation Exposure during ESWL; Caliceal Calculi; and Pediatric ESWL.

  8. Low-Intensity Extracorporeal Shock Wave as a Novel Treatment for Erectile Dysfunction.

    Science.gov (United States)

    Pan, Michael M; Raees, Ayman; Kovac, Jason R

    2016-03-01

    The paradigm of erectile dysfunction (ED) treatment was fundamentally altered following the introduction of oral phosphodiesterase type 5 inhibitors. Unfortunately, a significant number of men exhibit a suboptimal response and require additional management strategies. One of the novel, minimally invasive strategies being developed is low-intensity extracorporeal shock wave therapy. Used in the hope of delaying placement of an inflatable penile prosthesis, the final phase of ED treatment, low-intensity extracorporeal shock wave therapy is a unique application of an established technology that may hopefully one day expand the medical options for patients with ED. This commentary will highlight the physiology underlying this technique and summarize the most recent studies.

  9. Cysteine residues of SNAP-25 are required for SNARE disassembly and exocytosis, but not for membrane targeting.

    Science.gov (United States)

    Washbourne, P; Cansino, V; Mathews, J R; Graham, M; Burgoyne, R D; Wilson, M C

    2001-08-01

    The release of neurotransmitter at a synapse occurs via the regulated fusion of synaptic vesicles with the plasma membrane. The fusion of the two lipid bilayers is mediated by a protein complex that includes the plasma membrane target soluble N-ethylmaleimide-sensitive fusion protein (NSF) attachment protein (SNAP) receptors (t-SNAREs), syntaxin 1A and synaptosome-associated protein of 25 kDa (SNAP-25), and the vesicle SNARE (v-SNARE), vesicle-associated membrane protein (VAMP). Whereas syntaxin 1A and VAMP are tethered to the membrane by a C-terminal transmembrane domain, SNAP-25 has been suggested to be anchored to the membrane via four palmitoylated cysteine residues. We demonstrate that the cysteine residues of SNAP-25 are not required for membrane localization when syntaxin 1A is present. Analysis of the 7 S and 20 S complexes formed by mutants that lack cysteine residues demonstrates that the cysteines are required for efficient SNARE complex dissociation. Furthermore, these mutants are unable to support exocytosis, as demonstrated by a PC12 cell secretion assay. We hypothesize that syntaxin 1A serves to direct newly synthesized SNAP-25 through the Golgi transport pathway to the axons and synapses, and that palmitoylation of cysteine residues is not required for targeting, but to optimize interactions required for SNARE complex dissociation.

  10. Outer membrane lipoprotein VacJ is required for the membrane integrity, serum resistance and biofilm formation of Actinobacillus pleuropneumoniae.

    Science.gov (United States)

    Xie, Fang; Li, Gang; Zhang, Wanjiang; Zhang, Yanhe; Zhou, Long; Liu, Shuanghong; Liu, Siguo; Wang, Chunlai

    2016-02-01

    The outer membrane proteins of Actinobacillus pleuropneumoniae are mediators of infection, acting as targets for the host's defense system. The outer membrane lipoprotein VacJ is involved in serum resistance and intercellular spreading in several pathogenic bacteria. To investigate the role of VacJ in the pathogenicity of Actinobacillus pleuropneumoniae, the vacJ gene-deletion mutant MD12 ΔvacJ was constructed. The increased susceptibility to KCl, SDS plus EDTA, and several antibiotics in the MD12ΔvacJ mutant suggested that the stability of the outer membrane was impaired as a result of the mutation in the vacJ gene. The increased NPN fluorescence and significant cellular morphological variation in the MD12ΔvacJ mutant further demonstrated the crucial role of the VacJ lipoprotein in maintaining the outer membrane integrity of A. pleuropneumoniae. In addition, the MD12ΔvacJ mutant exhibited decreased survival from the serum and complement killing compared to the wild-type strain. Interestingly, the MD12ΔvacJ mutant showed reduced biofilm formation compared to the wild-type strain. To our knowledge, this is the first description of the VacJ lipoprotein contributing to bacterial biofilm formation. The data presented in this study illustrate the important role of the VacJ lipoprotein in the maintenance of cellular integrity, serum resistance, and biofilm formation in A. pleuropneumoniae. Copyright © 2015 Elsevier B.V. All rights reserved.

  11. Ankyrin and band 3 differentially affect expression of membrane glycoproteins but are not required for erythroblast enucleation.

    Science.gov (United States)

    Ji, Peng; Lodish, Harvey F

    2012-01-27

    During late stages of mammalian erythropoiesis the nucleus undergoes chromatin condensation, migration to the plasma membrane, and extrusion from the cytoplasm surrounded by a segment of plasma membrane. Since nuclear condensation occurs in all vertebrates, mammalian erythroid membrane and cytoskeleton proteins were implicated as playing important roles in mediating the movement and extrusion of the nucleus. Here we use erythroid ankyrin deficient and band 3 knockout mouse models to show that band 3, but not ankyrin, plays an important role in regulating the level of erythroid cell membrane proteins, as evidenced by decreased cell surface expression of glycophorin A in band 3 knockout mice. However, neither band 3 nor ankyrin are required for enucleation. These results demonstrate that mammalian erythroblast enucleation does not depend on the membrane integrity generated by the ankyrin-band 3 complex.

  12. Ankyrin and band 3 differentially affect expression of membrane glycoproteins but are not required for erythroblast enucleation

    Energy Technology Data Exchange (ETDEWEB)

    Ji, Peng, E-mail: peng-ji@fsm.northwestern.edu [Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611 (United States); Whitehead Institute for Biomedical Research, Cambridge, MA 02142 (United States); Lodish, Harvey F. [Whitehead Institute for Biomedical Research, Cambridge, MA 02142 (United States); Department of Biology, Massachusetts Institute of Technology, Cambridge, MA 02139 (United States)

    2012-01-27

    Highlights: Black-Right-Pointing-Pointer Ankyrin and band 3 are not required for erythroblasts enucleation. Black-Right-Pointing-Pointer Loss of ankyrin does not affect erythroid membrane glycoprotein expression. Black-Right-Pointing-Pointer Loss of band 3 influences erythroid membrane glycoprotein expression. -- Abstract: During late stages of mammalian erythropoiesis the nucleus undergoes chromatin condensation, migration to the plasma membrane, and extrusion from the cytoplasm surrounded by a segment of plasma membrane. Since nuclear condensation occurs in all vertebrates, mammalian erythroid membrane and cytoskeleton proteins were implicated as playing important roles in mediating the movement and extrusion of the nucleus. Here we use erythroid ankyrin deficient and band 3 knockout mouse models to show that band 3, but not ankyrin, plays an important role in regulating the level of erythroid cell membrane proteins, as evidenced by decreased cell surface expression of glycophorin A in band 3 knockout mice. However, neither band 3 nor ankyrin are required for enucleation. These results demonstrate that mammalian erythroblast enucleation does not depend on the membrane integrity generated by the ankyrin-band 3 complex.

  13. Phagocytosis of IgG‐Coated Polystyrene Beads by Macrophages Induces and Requires High Membrane Order

    National Research Council Canada - National Science Library

    Magenau, Astrid; Benzing, Carola; Proschogo, Nicholas; Don, Anthony S; Hejazi, Leila; Karunakaran, Denuja; Jessup, Wendy; Gaus, Katharina

    2011-01-01

    ...)‐coated polystyrene particles. We found that the plasma membrane undergoes rapid actin‐independent condensation to form highly ordered phagosomal membranes, the biophysical hallmark of lipid rafts...

  14. Arabidopsis CHL27, located in both envelope and thylakoid membranes, is required for the synthesis of protochlorophyllide.

    Science.gov (United States)

    Tottey, Stephen; Block, Maryse A; Allen, Michael; Westergren, Tomas; Albrieux, Catherine; Scheller, Henrik V; Merchant, Sabeeha; Jensen, Poul Erik

    2003-12-23

    CHL27, the Arabidopsis homologue to Chlamydomonas Crd1, a plastid-localized putative diiron protein, is required for the synthesis of protochlorophyllide and therefore is a candidate subunit of the aerobic cyclase in chlorophyll biosynthesis. delta-Aminolevulinic acid-fed antisense Arabidopsis plants with reduced amounts of Crd1/CHL27 accumulate Mg-protoporphyrin IX monomethyl ester, the substrate of the cyclase reaction. Mutant plants have chlorotic leaves with reduced abundance of all chlorophyll proteins. Fractionation of Arabidopsis chloroplast membranes shows that Crd1/CHL27 is equally distributed on a membrane-weight basis in the thylakoid and inner-envelope membranes.

  15. 体外膜肺技术在9例危重症患儿中的应用%Applications of extracorporeal membrane oxygenation in 9 critically ill children

    Institute of Scientific and Technical Information of China (English)

    程晔; 孙波; 陆铸今; 贾兵; 刘江滨; 陆国平; 蔡小狄; 贺骏; 钟慧; 胡静; 张玉侠

    2012-01-01

    目的 探讨心肺功能衰竭患儿体外膜肺(ECMO)支持治疗的临床经验.方法 回顾性分析2008年12月至2012年5月收住复旦大学附属儿科医院重症监护病房及心脏监护病房的9例危重症患儿接受ECMO治疗的情况及转归.结果 9例患儿均采用颈内动、静脉置管,V-A ECMO模式,体外肝素抗凝,活化凝血时间(ACT)维持在180~220 s;体外辅助血流量为50~100 mL·kg-1·min-1.治疗期间进行心肺功能、血液指标和影像学等监测.9例患儿ECMO使用时间为5~280 h,中位数112 h.经治疗后8例病情好转,撤离ECMO治疗,其中7例痊愈出院,1例撤离ECMO治疗后3 d自动出院.1例因室间隔缺损修补术后合并严重脓毒症、脓毒症休克和心肺功能衰竭,ECMO治疗1周,撤机后死亡.发生各类并发症共14例次,其中机械系统并发症6例次,包括氧合器漏液3例次,管路血栓2例次,水箱加温器故障1例次;机体并发症7例次,其中6例发生贫血,1例右上肢功能障碍;意外事件1例,患儿在ECMO运行过程中因右腋下动脉置管意外滑脱而形成血肿.未发生颅内并发症、出血和感染等.结论 ECMO能有效对危重症患儿行心肺功能支持,使用安全.建立一支专业的技术团队能促进ECMO的更好开展.%Objective To retrospectively analyze the clinical application of extracorporeal membrance oxygenation( ECMO ) support in 9 critically ill children who suffered from cardiac and/or pulmonary failure with no response to advanced treatment except ECMO or could not wean from cardiopulmonary bypass following cardiac surgery. Methods All 9 cases were collected from December 2008 to May 2012 in Childrens Hospital of Fudan University, and all received ECMO treatment. Four cases were from PICU and 5 were from CCU. Clinical data including age, sex, body weight, disease, clinical information before and after the treatment of ECMO and prognosis were reviewed. V-A ECMO was applied to all 9 cases after vessels

  16. Hyperbilirubinemia after extracorporeal circulation surgery: A recent and prospective study

    Institute of Scientific and Technical Information of China (English)

    Yong An; Ying-Bin Xiao; Qian-Jin Zhong

    2006-01-01

    AIM: To clarify the incidence and nature of postoperative hyperbilirubinemia in patients after modern extracorporeal circulation, to analyze possible perioperative risk factors, and to elucidate the clinical significance of postoperative hyperbilirubinemia associated morality and morbidity.METHODS: Between March 2005 and May 2006, three hundred and eighty six consecutive patients undergoing extracorporeal circulation surgery due to a variety of cardiac lesions were investigated prospectively. The incidence of postoperative hyperbilirubinemia was defined as a serum total bilirubin concentration of more than 51 μmol/L. Several perioperative parameters were compared by logistic regression between hyperbilirubinemia and non-hyperbilirubinemia patients to determine possible risk factors contributing to postoperative hyperbilirubinemia and mortality.RESULTS: Overall incidence of postoperative hyperbilirubinemia was 25.3% (98/386). In patients with postoperative hyperbilirubinemia, 56.2%reached peak total bilirubin concentration on the first postoperative day, 33.5% on the second day, and 10.3%on the seventh day. Eighty percent of the increase of total bilirubin resulted from an increase of both conjugated and unconjugated bilirubin. Development of postoperative hyperbilirubinemia was associated with a higher mortality (P < 0.01), longer duration of mechanical ventilation (P < 0.05) and longer ICU stay time (P < 0.05). Preoperative total bilirubin concentration, preoperative right atrium pressure,numbers of valves replaced and of blood transfusion requirement were identified as important predictors for postoperative hyperbilirubinemia.CONCLUSION: Early postoperative hyperbilirubinemia after modern extracorporeal circulation is mainly caused by an increase in both conjugated and unconjugated bilirubin, and is associated with a high mortality.Important contributing factors are the preoperative total bilirubin concentration, preoperative severity of right atrial

  17. [Treatment of hydroxychloroquine poisoning with extracorporeal circulation].

    Science.gov (United States)

    Mongenot, F; Gonthier, Y Tessier; Derderian, F; Durand, M; Blin, D

    2007-02-01

    We report a case of massive overdose of hydroxychloroquine treated with circulatory assistance by peripheral extracorporeal circulation (ECC). We expose the case of a 39-year-old woman who ingested 12 g of hydroxychloroquine with bromazepam, paroxetine, and zolpidem, in a suicide attempt. Patient has developed central nervous system depression, hemodynamic failure, life-threatening ventricular arrhythmias, and serious hypokalemia. Initially the patient has received conventional treatment with gastric lavage and activated charcoal for gastrointestinal decontamination, blood volume expansion and vasopressive drugs, intubation and mechanical ventilation, high dose of diazepam, and potassium replacement. A ventricular fibrillation was treated with external cardiac massage. In spite of this treatment, cardiogenic shock was uncontrolled, and imposed circulatory assistance. After extracorporeal circulation, we observed a spectacular improvement of hemodynamic parameters and electrocardiographic normalization at day one. Extracorporeal circulation could be used as a rescue treatment of cardiotrope and hydroxychloroquine overdoses.

  18. Progress in the application of extracorporeal membrane oxygenation for preserving organs from donation ;after circulatory death%心死亡捐献供体器官保护中体外膜肺氧合技术的应用研究进展

    Institute of Scientific and Technical Information of China (English)

    王志为; 杨志豪

    2013-01-01

    本文综述体外膜肺氧合(ECMO)在心死亡器官捐献(DCD)中的应用,讨论了“不触碰”时间、ECMO置管及开启时机、ECMO灌注温度、肝素化时机、ECMO支持过程中的炎症反应等相关问题。心死亡器官捐献器官获取过程中,ECMO 在改善 DCD 器官的可用性方面取得了非常好的效果。ECMO 的使用可以使器官热缺血时间明显减少,减少热缺血对器官的损伤。但在伦理、法律、ECMO 管理技术等方面还存在诸多的争议。%The application of the extracorporeal membrane oxygenation (ECMO) in the donation after circulatory death (DCD) is reviewed in this article. Correlative issues are also discussed including“no-touch time”, timing of inserting the cannulae and initiating ECMO, different temperatures of perfusion , “timing of heparin”, and inflammatory response during ECMO support. During the process of organ procurement, the ECMO can improve the availability of organs retrieved from the DCD. ECMO can decrease the warm ischemic time (WIT) and injuries induced from it. However, some ongoing controversies still exist, such as the ethical and legal issues, as well as the management technique of the ECMO.

  19. Uso de suporte hemodinâmico e respiratório por meio de oxigenação extracorpórea por membrana (ECMO venoarterial em um paciente politraumatizado Hemodynamic and respiratory support using venoarterial extracorporeal membrane oxygenation (ECMO in a polytrauma patient

    Directory of Open Access Journals (Sweden)

    Estevão Bassi

    2011-09-01

    Full Text Available 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 extracorpóreo foi uma medida efetiva de resgate para esse caso dramático, e o seu uso pôde ser interrompido com sucesso no 4º dia após o trauma. O paciente evoluiu com extenso infarto cerebral, morrendo no 7º dia de internaçãoThere are few reports in the literature regarding the use of venoarterial extracorporeal membrane oxygenation (ECMO for double-dysfunction from both heart and lung contusions in polytrauma patients. This article reports a 48-year-old patient admitted after a traffic accident. He rapidly progressed to shock with low cardiac output due to myocardial contusion and refractory hypoxemia due to pulmonary contusion, an unstable chest wall and bilateral pneumothorax. ECMO was an effective rescue procedure in this dramatic situation and was successfully discontinued on the fourth day after the trauma. The patient also developed an extensive brain infarction and eventually died on the seventh day after admission

  20. RNA Replication and Membrane Modification Require the Same Functions of Alphavirus Nonstructural Proteins.

    Science.gov (United States)

    Kallio, Katri; Hellström, Kirsi; Jokitalo, Eija; Ahola, Tero

    2015-11-18

    The alphaviruses induce membrane invaginations known as spherules as their RNA replication sites. Here, we show that inactivation of any function (polymerase, helicase, protease, or membrane association) essential for RNA synthesis also prevents the generation of spherule structures in a Semliki Forest virus trans-replication system. Mutants capable of negative-strand synthesis, including those defective in RNA capping, gave rise to spherules. Recruitment of RNA to membranes in the absence of spherule formation was not detected.

  1. Maximum yields of microsomal-type membranes from small amounts of plant material without requiring ultracentrifugation.

    Science.gov (United States)

    Abas, Lindy; Luschnig, Christian

    2010-06-15

    Isolation of a microsomal membrane fraction is a common procedure in studies involving membrane proteins. By conventional definition, microsomal membranes are collected by centrifugation of a postmitochondrial fraction at 100,000g in an ultracentrifuge, a method originally developed for large amounts of mammalian tissue. We present a method for isolating microsomal-type membranes from small amounts of Arabidopsis thaliana plant material that does not rely on ultracentrifugation but instead uses the lower relative centrifugal force (21,000g) of a microcentrifuge. We show that the 21,000g pellet is equivalent to that obtained at 100,000g and that it contains all of the membrane fractions expected in a conventional microsomal fraction. Our method incorporates specific manipulation of sample density throughout the procedure, with minimal preclearance, minimal volumes of extraction buffer, and minimal sedimentation pathlength. These features allow maximal membrane yields, enabling membrane isolation from limited amounts of material. We further demonstrate that conventional ultracentrifuge-based protocols give submaximal yields due to losses during early stages of the procedure; that is, extensive amounts of microsomal-type membranes can sediment prematurely during the typical preclearance steps. Our protocol avoids such losses, thereby ensuring maximal yield and a representative total membrane fraction. The principles of our method can be adapted for nonplant material.

  2. Acid phosphatase 2 (ACP2) is required for membrane fusion during influenza virus entry

    Science.gov (United States)

    Lee, Jihye; Kim, Jinhee; Son, Kidong; d’Alexandry d’Orengiani, Anne-Laure Pham Humg; Min, Ji-Young

    2017-01-01

    Influenza viruses exploit host factors to successfully replicate in infected cells. Using small interfering RNA (siRNA) technology, we identified six human genes required for influenza A virus (IAV) replication. Here we focused on the role of acid phosphatase 2 (ACP2), as its knockdown showed the greatest inhibition of IAV replication. In IAV-infected cells, depletion of ACP2 resulted in a significant reduction in the expression of viral proteins and mRNA, and led to the attenuation of virus multi-cycle growth. ACP2 knockdown also decreased replication of seasonal influenza A and B viruses and avian IAVs of the H7 subtype. Interestingly, ACP2 depletion had no effect on the replication of Ebola or hepatitis C virus. Because ACP2 is known to be a lysosomal acid phosphatase, we assessed the role of ACP2 in influenza virus entry. While neither binding of the viral particle to the cell surface nor endosomal acidification was affected in ACP2-depleted cells, fusion of the endosomal and viral membranes was impaired. As a result, downstream steps in viral entry were blocked, including nucleocapsid uncoating and nuclear import of viral ribonucleoproteins. Our results established ACP2 as a necessary host factor for regulating the fusion step of influenza virus entry. PMID:28272419

  3. 体外膜肺氧合辅助公民逝世后器官捐献供者的维护与器官获取%Extracorporeal membrane oxygenation in donor preservation and organ procurement of donation after citizens' death

    Institute of Scientific and Technical Information of China (English)

    范晓礼; 王彦峰; 胡龙; 陈治泉; 杜冰; 叶啟发

    2014-01-01

    Objective To study the effect of extracorporeal membrane oxygenation (ECMO) in donor preservation and organ procurement of donation after citizens' death.Method From 2013 to 2014,according to the ECMO indications,we used ECMO to provide circulation and breathing support for circulatory or respiratory function failure donation after brain death (DBD) donor and uncontrolled donation after cardiac death(DCD) donors.Through percutaneous liver puncture and living tissue rapid frozen section,the liver steatosis and fibrosis degree was determined.ECMO indications,ECMO related parameters and the result of blood gas analysis were recorded.alanine aminotransferase(ALT),aspartate aminotransferase(AST) and creatinine(Cr) before and after ECMO intervention were detected to evaluate liver and kidney function and damage.Whether the liver and kidney reached the requirements of the organ transplantation was assessed.Result The ECMO was used in 6 donors.Five cases of DBD were assisted through V-A ECMO because of circulatory or respiratory function failure.In one case of uncontrolled DCD recirculation was established through the thoracic aorta-blocked V-A ECMO.Four livers and 8 kidneys,from 4 donors,were retrieved and transplanted.Two donors' organs were discarded for damage beyond the standard.Conclusion For DBD donor with circulatory or respiratory function failure and uncontrolled DCD donors,the use of ECMO to assist circulatory and respiratory function or establish DCD recirculation can avoid liver and kidney injuries from vascular active drugs and DCD warm ischemia injury,thus,reduce the organ discarding rate of donation after citizens' death.%目的 探讨体外膜肺氧合(ECMO)技术在公民逝世后器官捐献中对供者的维护及在器官获取中的作用.方法 2013-2014年,对循环或呼吸功能衰竭的脑死亡器官捐献(DBD)供者(5例)及不可控性心脏死亡器官捐献(DCD)供者(1例)进行研究,根据ECMO介入指征,使用ECMO对供者进行循环

  4. Plasma membrane localization is required for RasA-mediated polarized morphogenesis and virulence of Aspergillus fumigatus.

    Science.gov (United States)

    Fortwendel, Jarrod R; Juvvadi, Praveen R; Rogg, Luise E; Asfaw, Yohannes G; Burns, Kimberlie A; Randell, Scott H; Steinbach, William J

    2012-08-01

    Ras is a highly conserved GTPase protein that is essential for proper polarized morphogenesis of filamentous fungi. Localization of Ras proteins to the plasma membrane and endomembranes through posttranslational addition of farnesyl and palmitoyl residues is an important mechanism through which cells provide specificity to Ras signal output. Although the Aspergillus fumigatus RasA protein is known to be a major regulator of growth and development, the membrane distribution of RasA during polarized morphogenesis and the role of properly localized Ras signaling in virulence of a pathogenic mold remain unknown. Here we demonstrate that Aspergillus fumigatus RasA localizes primarily to the plasma membrane of actively growing hyphae. We show that treatment with the palmitoylation inhibitor 2-bromopalmitate disrupts normal RasA plasma membrane association and decreases hyphal growth. Targeted mutations of the highly conserved RasA palmitoylation motif also mislocalized RasA from the plasma membrane and led to severe hyphal abnormalities, cell wall structural changes, and reduced virulence in murine invasive aspergillosis. Finally, we provide evidence that proper RasA localization is independent of the Ras palmitoyltransferase homolog, encoded by erfB, but requires the palmitoyltransferase complex subunit, encoded by erfD. Our results demonstrate that plasma membrane-associated RasA is critical for polarized morphogenesis, cell wall stability, and virulence in A. fumigatus.

  5. Heat shock protein 27 is required for sex steroid receptor trafficking to and functioning at the plasma membrane.

    Science.gov (United States)

    Razandi, Mahnaz; Pedram, Ali; Levin, Ellis R

    2010-07-01

    Classical sex steroid receptors (SRs) localize at the plasma membranes (PMs) of cells, initiating signal transduction through kinase cascades that contribute to steroid hormone action. Palmitoylation of the SRs is required for membrane localization and function, but the proteins that facilitate this modification and subsequent receptor trafficking are unknown. Initially using a proteomic approach, we identified that heat shock protein 27 (Hsp27) binds to a motif in estrogen receptor alpha (ERalpha) and promotes palmitoylation of the SR. Hsp27-induced acylation occurred on the ERalpha monomer and augmented caveolin-1 interactions with ERalpha, resulting in membrane localization, kinase activation, and DNA synthesis in breast cancer cells. Oligomerization of Hsp27 was required, and similar results were found for the trafficking of endogenous progesterone and androgen receptors to the PMs of breast and prostate cancer cells, respectively. Small interfering RNA (siRNA) knockdown of Hsp27 prevented sex SR trafficking to and signaling from the membrane. These results identify a conserved and novel function for Hsp27 with potential as a target for interrupting signaling from membrane sex SRs to tumor biology in hormone-responsive cancers.

  6. Clinical application of argatroban as an alternative anticoagulant for extracorporeal circulation.

    Science.gov (United States)

    Kawada, T; Kitagawa, H; Hoson, M; Okada, Y; Shiomura, J

    2000-04-01

    The authors attempted experimental and clinical use of argatroban as an alternative anticoagulant in left heart bypass with the centrifugal pump, percutaneous cardiopulmonary support (PCPS), and extracorporeal membrane oxygenation (ECMO) to determine if it has complementary effects in preventing thrombus formation without aggravating bleeding tendency. Its reversible binding to thrombin and its short half-life contributed to reduce the risk of excessive blood loss without clot formation within the extracorporeal circulation circuit during thoracic aortic surgery using left heart bypass. PCPS and ECMO were safely performed at doses ranging from 0.5 to 10 micrograms/kg/min to maintain activated clotting time at approximately 200 seconds. Although experimental studies showed argatroban to be advantageous in preserving platelet and fibrinogen, further clinical investigations are necessary.

  7. Extracorporeal total artificial heart as bailout surgery.

    Science.gov (United States)

    Perrodin, Stéphanie F; Muller, Olivier; Gronchi, Fabrizio; Liaudet, Lucas; Hullin, Roger; Kirsch, Matthias

    2017-03-01

    We report the use of a total extracorporeal heart for uncontrolled bleeding following a proximal left anterior descending artery perforation, using two centrifugal ventricular assist devices after heart explantation. The literature describing similar techniques and patient outcomes for this "bailout" technique are reviewed.

  8. Extracorporeal shockwave therapy in musculoskeletal disorders

    OpenAIRE

    Wang Ching-Jen

    2012-01-01

    Abstract The sources of shockwave generation include electrohydraulic, electromagnetic and piezoelectric principles. Electrohydraulic shockwaves are high-energy acoustic waves generated under water explosion with high voltage electrode. Shockwave in urology (lithotripsy) is primarily used to disintegrate urolithiasis, whereas shockwave in orthopedics (orthotripsy) is not used to disintegrate tissues, rather to induce tissue repair and regeneration. The application of extracorporeal shockwave ...

  9. Guidelines on the use of extracorporeal photopheresis

    DEFF Research Database (Denmark)

    Knobler, R; Berlin, G; Calzavara-Pinton, P;

    2014-01-01

    BACKGROUND: After the first investigational study on the use of extracorporeal photopheresis for the treatment of cutaneous T-cell lymphoma was published in 1983 with its subsequent recognition by the FDA for its refractory forms, the technology has shown significant promise in the treatment...

  10. Endocytic sorting and recycling require membrane phosphatidylserine asymmetry maintained by TAT-1/CHAT-1.

    Science.gov (United States)

    Chen, Baohui; Jiang, Yue; Zeng, Sheng; Yan, Jiacong; Li, Xin; Zhang, Yan; Zou, Wei; Wang, Xiaochen

    2010-12-09

    Endocytic sorting is achieved through the formation of morphologically and functionally distinct sub-domains within early endosomes. Cargoes destined for recycling are sorted to and transported through newly-formed tubular membranes, but the processes that regulate membrane tubulation are poorly understood. Here, we identified a novel Caenorhabditis elegans Cdc50 family protein, CHAT-1, which acts as the chaperone of the TAT-1 P4-ATPase to regulate membrane phosphatidylserine (PS) asymmetry and endocytic transport. In chat-1 and tat-1 mutants, the endocytic sorting process is disrupted, leading to defects in both cargo recycling and degradation. TAT-1 and CHAT-1 colocalize to the tubular domain of the early endosome, the tubular endocytic recycling compartment (ERC), and the recycling endosome where PS is enriched on the cytosolic surface. Loss of tat-1 and chat-1 function disrupts membrane PS asymmetry and abrogates the tubular membrane structure. Our data suggest that CHAT-1 and TAT-1 maintain membrane phosphatidylserine asymmetry, thus promoting membrane tubulation and regulating endocytic sorting and recycling.

  11. Required water quality for the use of high-performance membranes.

    Science.gov (United States)

    Aoike, Ikuo

    2011-01-01

    The clinical benefits of high-performance membrane (HPM) dialyzers have often been reported since the advent of the synthetic polyacrylonitrile dialysis membrane. HPMs, which have high water permeability, eliminate a wide spectrum of uremic toxins, and offer excellent biocompatibility, are now essential for hemodialysis, hemofiltration, and hemodiafiltration. For HPMs whose mean pore size is enlarged to secure better dialysis membrane performance, however, the dialyzing fluid must be highly purified to prevent contamination. Blood purification therapies using highly purified dialyzing fluid and HPM are expected to improve the prognosis of future patients undergoing dialysis. Copyright © 2011 S. Karger AG, Basel.

  12. Reduction of low potential electron acceptors requires the CbcL inner membrane cytochrome of Geobacter sulfurreducens.

    Science.gov (United States)

    Zacharoff, Lori; Chan, Chi Ho; Bond, Daniel R

    2016-02-01

    The respiration of metals by the bacterium Geobacter sulfurreducens requires electrons generated by metabolism to pass from the interior of the cell to electron acceptors beyond the cell membranes. The G. sulfurreducens inner membrane multiheme c-type cytochrome ImcH is required for respiration to extracellular electron acceptors with redox potentials greater than -0.1 V vs. SHE, but ImcH is not essential for electron transfer to lower potential acceptors. In contrast, deletion of cbcL, encoding an inner membrane protein consisting of b-type and multiheme c-type cytochrome domains, severely affected reduction of low potential electron acceptors such as Fe(III)-oxides and electrodes poised at -0.1 V vs. SHE. Catalytic cyclic voltammetry of a ΔcbcL strain growing on poised electrodes revealed a 50 mV positive shift in driving force required for electron transfer out of the cell. In non-catalytic conditions, low-potential peaks present in wild type biofilms were absent in ∆cbcL mutants. Expression of cbcL in trans increased growth at low redox potential and restored features to cyclic voltammetry. This evidence supports a model where CbcL is a component of a second electron transfer pathway out of the G. sulfurreducens inner membrane that dominates when redox potential is at or below -0.1 V vs. SHE.

  13. Enhanced Membrane Fusion in Sterol-enriched Vacuoles Bypasses the Vrp1p RequirementD⃞

    OpenAIRE

    Tedrick, Kelly; Trischuk, Tim; Lehner, Richard; Eitzen, Gary

    2004-01-01

    Organization of lipids into membrane microdomains is a vital mechanism of protein processing. Here we show that overexpression of ERG6, a gene involved in ergosterol synthesis, elevates sterol levels 1.5-fold on the vacuole membrane and enhances their homotypic fusion. The mechanism of sterol-enhanced fusion is not via more efficient sorting, but instead promotes increased kinetics of fusion subreactions. We initially isolated ERG6 as a suppressor of a vrp1Δ growth defect selective for vacuol...

  14. Enhanced Membrane Fusion in Sterol-enriched Vacuoles Bypasses the Vrp1p RequirementD⃞

    OpenAIRE

    Tedrick, Kelly; Trischuk, Tim; Lehner, Richard; Eitzen, Gary

    2004-01-01

    Organization of lipids into membrane microdomains is a vital mechanism of protein processing. Here we show that overexpression of ERG6, a gene involved in ergosterol synthesis, elevates sterol levels 1.5-fold on the vacuole membrane and enhances their homotypic fusion. The mechanism of sterol-enhanced fusion is not via more efficient sorting, but instead promotes increased kinetics of fusion subreactions. We initially isolated ERG6 as a suppressor of a vrp1Δ growth defect selective for vacuol...

  15. Pharmacokinetics of continuous-infusion meropenem in a pediatric patient receiving extracorporeal life support.

    Science.gov (United States)

    Cies, Jeffrey J; Moore, Wayne S; Dickerman, Mindy J; Small, Christine; Carella, Dominick; Chopra, Arun; Parker, Jason

    2014-10-01

    Meropenem, a broad-spectrum carbapenem, is commonly used for empirical and definitive therapy in the pediatric intensive care unit (ICU). Pharmacokinetic data to guide dosing in children, however, are limited to healthy volunteers or patients who are not in the ICU. Adult data demonstrate that pharmacokinetic parameters such as the volume of distribution and clearance can be significantly altered in individuals receiving extracorporeal membrane oxygenation (ECMO). Alterations in the volume of distribution and clearance of antimicrobials in patients with sepsis and septic shock have also been documented, and these patients have demonstrated lower than expected antimicrobial serum concentrations based on standard dosing regimens. Therefore, an understanding of the pharmacokinetic changes in critically ill children receiving ECMO is crucial to determining the most appropriate dose and dosing interval selection for any antimicrobial therapy. In this case report, we describe the pharmacokinetics of a continuous infusion of meropenem in a pediatric cardiac ICU patient who was receiving concurrent extracorporeal life support. The patient was an 8-month-old male infant who underwent a Glenn procedure and pulmonary artery reconstruction. Postoperatively, he required ECMO with a total run of 21 days. On day 11 of ECMO, a bronchoalveolar lavage was performed, and blood cultures from days 11 and 12 of ECMO grew Pseudomonas aeruginosa, with a meropenem minimum inhibitory concentration (MIC) of 0.5 μg/ml. On ECMO day 13, meropenem was initiated with a loading dose of 40 mg/kg and infused over 30 minutes, followed by a continuous infusion of 200 mg/kg/day. A meropenem serum concentration measured 8 hours after the start of the infusion was 46 μg/ml. Repeat levels were measured on days 3 and 9 of meropenem therapy and were 39 and 42 μg/ml, respectively. Repeat blood and respiratory cultures remained negative. This meropenem regimen (40-mg/kg bolus followed by a

  16. Intraflagellar transport is required for the vectorial movement of TRPV channels in the ciliary membrane.

    Science.gov (United States)

    Qin, Hongmin; Burnette, Dylan T; Bae, Young-Kyung; Forscher, Paul; Barr, Maureen M; Rosenbaum, Joel L

    2005-09-20

    The membranes of all eukaryotic motile (9 + 2) and immotile primary (9 + 0) cilia harbor channels and receptors involved in sensory transduction (reviewed by). These membrane proteins are transported from the cytoplasm onto the ciliary membrane by vesicles targeted for exocytosis at a point adjacent to the ciliary basal body. Here, we use time-lapse fluorescence microscopy to demonstrate that select GFP-tagged sensory receptors undergo rapid vectorial transport along the entire length of the cilia of Caenorhabditis elegans sensory neurons. Transient receptor potential vanilloid (TRPV) channels OSM-9 and OCR-2 move in ciliary membranes at rates comparable to the intraflagellar transport (IFT) machinery located between the membrane and the underlying axonemal microtubules. OSM-9 motility is disrupted in certain IFT mutant backgrounds. Surprisingly, motility of transient receptor potential polycystin (TRPP) channel PKD-2 (polycystic kidney disease-2), a mechano-receptor, was not detected. Our study demonstrates that IFT, previously shown to be necessary for transport of axonemal components, is also involved in the motility of TRPV membrane protein movement along cilia of C. elegans sensory cells.

  17. Dissecting the membrane cholesterol requirement for mycobacterial entry into host cells.

    Science.gov (United States)

    Viswanathan, Gopinath; Jafurulla, Md; Kumar, G Aditya; Raghunand, Tirumalai R; Chattopadhyay, Amitabha

    2015-07-01

    Mycobacteria are intracellular pathogens that can invade and survive within host macrophages, and are a major cause of mortality and morbidity worldwide. The molecular mechanism involved in the internalization of mycobacteria is poorly understood. In this work, we have explored the role of host membrane cholesterol in the entry of the avirulent surrogate mycobacterial strain Mycobacterium smegmatis into THP-1 macrophages. Our results show that depletion of host membrane cholesterol using methyl-β-cyclodextrin results in a significant reduction in the entry of M. smegmatis into host cells. More importantly, we show that the inhibition in the ability of M. smegmatis to enter host macrophages could be reversed upon replenishment of membrane cholesterol. To the best of our knowledge, these results constitute the first report showing that membrane cholesterol replenishment can reverse the inhibition in the entry of mycobacteria into host cells. In addition, we demonstrate that cholesterol complexation using amphotericin B (without physical depletion) is sufficient to inhibit mycobacterial entry. Importantly, we observed a significant reduction in mycobacterial entry upon enrichment of host membrane cholesterol. Taken together, our results demonstrate, for the first time, that an optimum host plasma membrane cholesterol is necessary for the entry of mycobacteria. These results assume relevance in the context of developing novel therapeutic strategies targeting cholesterol-mediated mycobacterial host cell entry.

  18. Hemodynamic support during vein-vein or vein-artery extracorporeal membrane oxygenation weaning%撤离静脉-静脉体外膜肺氧合和静脉-动脉体外膜肺氧合的血流动力学支持策略

    Institute of Scientific and Technical Information of China (English)

    周飞虎; 胡婕; 薛超

    2016-01-01

    体外膜肺氧合(extra corporeal membrane oxygenation, ECMO)已广泛应用于成年人、儿童、新生儿难治性心力衰竭、呼吸衰竭及心肺复苏,最常见的模式是静脉-静脉体外膜肺氧合(vein vein extra corporeal membrane oxygenation,VV-ECMO)和静脉-动脉体外膜肺氧合(vein artery extra corporeal membrane oxygenation,VA-ECMO),作为短期器官功能支持的手段,一般在数小时至一周内需要撤离。在ECMO,特别是VA-ECMO撤机时患者血流动力学会发生巨大变化,可能出现全身血管舒张、左心功能不全、左心室流出道梗阻及右心功能不全。ECMO撤离过程需要严密的血流动力学监测和反复心脏超声(经胸或经食管)的检查,药物(如左西孟旦等)和其他器官支持技术(主动脉球囊反搏和持续肾脏替代治疗)可能改善撤机时的血流动力学,但仍需进一步前瞻性临床研究评估上述措施的有效性。%Extracorporeal membrane oxygenation (ECMO) is broadly used to provide respiratory and cardiac support in patients with refractory respiratory or cardiac failure and during cardiopulmonary resuscitation in neonates, children and adults. The most common used modes include venous-venous ECMO (VV-ECMO) and venous-arterial ECMO (VA-ECMO). The utility of ECMO is usually limited to a short period of time but can sometimes be extended up to a week. During the weaning process of ECMO, especially under the VA-ECMO mode, the hemodynamics may become unstable due to a variety of factors such as systemic vasodilation, left ventricular (LV) dysfunction, LV outflow obstruction and right ventricular (RV) failure. Frequent and reliable assessments of hemodynamics as well as repeated performances of either transthoracic echocardiogram (TTE) or transesophageal echocardiogram (TEE) should be performed during the weaning of ECMO. Pharmacological support such as Levosimendan and other therapeutic tools including intra

  19. Cholesterol and F-actin are required for clustering of recycling synaptic vesicle proteins in the presynaptic plasma membrane.

    Science.gov (United States)

    Dason, Jeffrey S; Smith, Alex J; Marin, Leo; Charlton, Milton P

    2014-02-15

    Synaptic vesicles (SVs) and their proteins must be recycled for sustained synaptic transmission. We tested the hypothesis that SV cholesterol is required for proper sorting of SV proteins during recycling in live presynaptic terminals. We used the reversible block of endocytosis in the Drosophila temperature-sensitive dynamin mutant shibire-ts1 to trap exocytosed SV proteins, and then examined the effect of experimental treatments on the distribution of these proteins within the presynaptic plasma membrane by confocal microscopy. SV proteins synaptotagmin, vglut and csp were clustered following SV trapping in control experiments but dispersed in samples treated with the cholesterol chelator methyl-β-cyclodextrin to extract SV cholesterol. There was accumulation of phosphatidylinositol (4,5)-bisphosphate (PIP2) in presynaptic terminals following SV trapping and this was reduced following SV cholesterol extraction. Reduced PIP2 accumulation was associated with disrupted accumulation of actin in presynaptic terminals. Similar to vesicular cholesterol extraction, disruption of actin by latrunculin A after SV proteins had been trapped on the plasma membrane resulted in the dispersal of SV proteins and prevented recovery of synaptic transmission due to impaired endocytosis following relief of the endocytic block. Our results demonstrate that vesicular cholesterol is required for aggregation of exocytosed SV proteins in the presynaptic plasma membrane and are consistent with a mechanism involving regulation of PIP2 accumulation and local actin polymerization by cholesterol. Thus, alteration of membrane or SV lipids may affect the ability of synapses to undergo sustained synaptic transmission by compromising the recycling of SV proteins.

  20. Mitochondrial outer membrane proteome of Trypanosoma brucei reveals novel factors required to maintain mitochondrial morphology.

    Science.gov (United States)

    Niemann, Moritz; Wiese, Sebastian; Mani, Jan; Chanfon, Astrid; Jackson, Christopher; Meisinger, Chris; Warscheid, Bettina; Schneider, André

    2013-02-01

    Trypanosoma brucei is a unicellular parasite that causes devastating diseases in humans and animals. It diverged from most other eukaryotes very early in evolution and, as a consequence, has an unusual mitochondrial biology. Moreover, mitochondrial functions and morphology are highly regulated throughout the life cycle of the parasite. The outer mitochondrial membrane defines the boundary of the organelle. Its properties are therefore key for understanding how the cytosol and mitochondria communicate and how the organelle is integrated into the metabolism of the whole cell. We have purified the mitochondrial outer membrane of T. brucei and characterized its proteome using label-free quantitative mass spectrometry for protein abundance profiling in combination with statistical analysis. Our results show that the trypanosomal outer membrane proteome consists of 82 proteins, two-thirds of which have never been associated with mitochondria before. 40 proteins share homology with proteins of known functions. The function of 42 proteins, 33 of which are specific to trypanosomatids, remains unknown. 11 proteins are essential for the disease-causing bloodstream form of T. brucei and therefore may be exploited as novel drug targets. A comparison with the outer membrane proteome of yeast defines a set of 17 common proteins that are likely present in the mitochondrial outer membrane of all eukaryotes. Known factors involved in the regulation of mitochondrial morphology are virtually absent in T. brucei. Interestingly, RNAi-mediated ablation of three outer membrane proteins of unknown function resulted in a collapse of the network-like mitochondrion of procyclic cells and for the first time identified factors that control mitochondrial shape in T. brucei.

  1. Requirements for the Formation of Membrane Pores by the Reovirus Myristoylated μ1N Peptide▿

    OpenAIRE

    Zhang, Lan; Agosto, Melina A.; Ivanovic, Tijana; King, David S.; Nibert, Max L.; Harrison, Stephen C.

    2009-01-01

    The outer capsid of the nonenveloped mammalian reovirus contains 200 trimers of the μ1 protein, each complexed with three copies of the protector protein σ3. Conformational changes in μ1 following the proteolytic removal of σ3 lead to release of the myristoylated N-terminal cleavage fragment μ1N and ultimately to membrane penetration. The μ1N fragment forms pores in red blood cell (RBC) membranes. In this report, we describe the interaction of recombinant μ1 trimers and synthetic μ1N peptides...

  2. Neurotensin receptor-1 inducible palmitoylation is required for efficient receptor-mediated mitogenic-signaling within structured membrane microdomains

    OpenAIRE

    2011-01-01

    Neurotensin receptor-1 (NTSR-1) is a G-protein coupled receptor (GPCR) that has been recently identified as a mediator of cancer progression. NTSR-1 and its endogenous ligand, neurotensin (NTS), are co-expressed in several breast cancer cell lines and breast cancer tumor samples. Based on our previously published study demonstrating that intact structured membrane microdomains (SMDs) are required for NTSR-1 mitogenic signaling, we hypothesized that regulated receptor palmitoylation is respons...

  3. Cdc42 expression in keratinocytes is required for the maintenance of the basement membrane in skin

    DEFF Research Database (Denmark)

    Wu, Xunwei; Quondamatteo, Fabio; Brakebusch, Cord

    2006-01-01

    , structure and number of hemidesomosomes were not significantly changed in the Cdc42 mutant skin compared with the control mice and no blister formation was observed in mutant skin. These data indicate that Cdc42 in keratinocytes is important for maintenance of the basement membrane of skin....

  4. A transmembrane ubiquitin ligase required to sort membrane proteins into multivesicular bodies

    NARCIS (Netherlands)

    Reggiori, Fulvio; Pelham, Hugh R B; Reggiori, Fulvio

    2002-01-01

    Membrane proteins with transmembrane domains (TMDs) that contain polar residues exposed to the lipid bilayer are selectively sorted into multivesicular bodies (MVBs) and delivered to the yeast vacuole. Sorting of some, although not all, proteins into these structures is mediated by ubiquitination. W

  5. A transmembrane ubiquitin ligase required to sort membrane proteins into multivesicular bodies

    NARCIS (Netherlands)

    Reggiori, Fulvio; Pelham, Hugh R B; Reggiori, Fulvio

    2002-01-01

    Membrane proteins with transmembrane domains (TMDs) that contain polar residues exposed to the lipid bilayer are selectively sorted into multivesicular bodies (MVBs) and delivered to the yeast vacuole. Sorting of some, although not all, proteins into these structures is mediated by ubiquitination. W

  6. Extracorporeal life support in pediatric cardiac patients

    Directory of Open Access Journals (Sweden)

    Matteo Di NARDO

    2016-10-01

    Full Text Available Extracorporeal Life Support (ECLS is a valuable tool in the management of neonates and older children with severe cardiac or respiratory failure. In this review, we focus on ECLS when used for neonatal and pediatric cardiac disease. Strict selection of patients and timely deployment are necessary to optimize outcomes. Although every attempt should be made to deploy ECLS urgently rather than emergently, extracorporeal cardiopulmonary resuscitation (ECPR is being increasingly used and reasonable survival rates have been achieved after initiation of ECLS during active compressions of the chest following in-hospital cardiac arrest. Contraindications to ECLS are falling over time, although lethal chromosomal abnormalities, severe irreversible brain injury, and extremely low gestational age and weight (<32 weeks gestation or <1.5 kg remain firm contraindications.

  7. Extracorporeal treatment for tricyclic antidepressant poisoning

    DEFF Research Database (Denmark)

    Yates, Christopher; Galvao, Tais; Sowinski, Kevin M

    2014-01-01

    The Extracorporeal Treatments In Poisoning (EXTRIP) workgroup was formed to provide recommendations on the use of extracorporeal treatments (ECTR) in poisoning. Here, the workgroup presents its results for tricyclic antidepressants (TCAs). After an extensive literature search, using a predefined...... methodology, the subgroup responsible for this poison reviewed the articles, extracted the data, summarized findings, and proposed structured voting statements following a predetermined format. A two-round modified Delphi method was chosen to reach a consensus on voting statements and RAND...... yielding a very low quality of evidence for all recommendations. Data on 108 patients, including 12 fatalities, were abstracted. The workgroup concluded that TCAs are not dialyzable and made the following recommendation: ECTR is not recommended in severe TCA poisoning (1D). The workgroup considers...

  8. Extracorporeal treatment for valproic acid poisoning

    DEFF Research Database (Denmark)

    Ghannoum, Marc; Laliberté, Martin; Nolin, Thomas D

    2015-01-01

    BACKGROUND: The EXtracorporeal TReatments In Poisoning (EXTRIP) workgroup presents its systematic review and clinical recommendations on the use of extracorporeal treatment (ECTR) in valproic acid (VPA) poisoning. METHODS: The lead authors reviewed all of the articles from a systematic literature....... The workgroup concluded that VPA is moderately dialyzable (level of evidence = B) and made the following recommendations: ECTR is recommended in severe VPA poisoning (1D); recommendations for ECTR include a VPA concentration > 1300 mg/L (9000 μmol/L)(1D), the presence of cerebral edema (1D) or shock (1D...... 50 and 100 mg/L (350-700 μmol/L)(2D). Intermittent hemodialysis is the preferred ECTR in VPA poisoning (1D). If hemodialysis is not available, then intermittent hemoperfusion (1D) or continuous renal replacement therapy (2D) is an acceptable alternative. CONCLUSIONS: VPA is moderately dialyzable...

  9. Early Extracorporeal Detoxification after Cardiosurgical Interventions

    Directory of Open Access Journals (Sweden)

    G. P. Plotnikov

    2009-01-01

    Full Text Available Objective: to substantiate a need for early use of extracorporeal homeostatic correction techniques during cardiosurgical intensive care. Subjects and methods: A non-randomized study was conducted in 63 cardiosurgical patients with postoperatively evolving multiple organ dysfunction. The clinical efficiency and economic expediency of the early initiation of homeostatic correction were estimated by continuous low-flow venovenous hemofiltration on a Prisma apparatus. Results. The study has demonstrated the advantages of early (within the 36-hour postoperative period initiation of a procedure by the time of organ dysfunction recovery, the length of stay on a resuscitation bed, and pharmacoeconomic indices. Conclusion. The early (at the stage of dysfunction, until hemostasis becomes stable and in the absence of drainage volume losses initiation of hemofiltration in the development of multiple organ dysfunction after surgical interventions has been clinically and economically warranted. Key words: extracorporeal homeostatic correction, multiple organ dysfunction, cardiac surgery.

  10. 体外膜氧合成功救治新生儿心脏术后严重低心排综合征一例%Extracorporeal membrane oxygenation treatment of a neonate with severe low cardiac output syndrome following open heart surgery

    Institute of Scientific and Technical Information of China (English)

    林茹; 谈林华; 张泽伟; 孙眉月; 杜立中

    2008-01-01

    目的 总结ECMO救治新生儿心脏术后严重低心排的成功经验.方法 2007年7月18日我们对一例患先天性大动脉转位(TGA)合并房间隔缺损(ASD)、动脉导管未闭(PDA)2.8 kg出生6 d的新生儿,进行了大动脉调转术(arteries switch)、ASD修补、PDA结扎术,畸形矫正后出现严重低心排综合征,低血压[<39/30 mm Hg(1 mm Hg=0.133 kPa)]、高乳酸血症(Lac 8.8 mmol/L)、高左房压(LAP>20 mm Hg)、血性痰、少尿[<1 ml/(kg·h)],由于转流时间较长(263 min)且难以脱离体外循环,常规治疗无效后接V-A ECMO进行心肺辅助.结果 经87h ECMO辅助后,左心功能明显恢复,患儿顺利脱离ECMO,ECMO第1天LVEF 20%,第2天34%,第3天43%;ECMO第1天CKMB 41 μ/L,第2天恢复正常.脱离ECMO后,在较高浓度血管活性药支持下[肾上腺素0.2 μg/(kg·min),多巴胺/多巴酚丁胺8 μg/(kg·min),米力农0.56 μg/(kg·min)],循环基本稳定.ECMO撤离后第4天,关闭胸部切口.ECMO撤离后第22天,撤离呼吸机,术后30 d撤离血管活性药.术后58 d康复出院.出院时心肺、肝肾功能正常,神志清醒,四肢肌张力和运动正常.整个病程中多次头颅超声检查均未发现脑出血、梗死等病灶.ECMO并发症:(1)肺出血;(2)伤口出血和心包填塞;(3)溶血;(4)高胆红素血症.结论 ECMO对抢救新生儿心脏术后严重心功能不全有良好的疗效.%Objective To summarize the experience of extracorporeal membrane oxygenation (ECMO)to rescue a neonate with severe low cardiac output syndrome following open heart surgery.Methods The patient was a male,2 d,2.8 kg,G3P2 full-term neonate with gestational age 40 weeks,born by Cesarean-section with Apgar score of 10 at 1 min.He was admitted due to severe dyspnea with oxygen desaturation and heart murmur on the second day after birth.Physical examination showed clear consciousness,cyanosis,dyspnea,RR 70 bpm and a grade Ⅱ/6 heart murmur.Bp was 56/45 mm Hg (1 mm Hg=0.133 kPa)and SpO2 around 65

  11. [Ureterorenoscopy combined with extracorporeal shockwave lithotripsy].

    Science.gov (United States)

    González Cabrera, L A; Oro Ortiz, J

    1989-01-01

    In May 1986, extracorporeal shock wave lithotripsy and endourologic procedures became available in the treatment of lithiasis at the "Hermanos Ameijeiras" Hospital. The present study describes our experience and the results achieved during a 12-month period using endourologic procedures. During this period 65 URS procedures were performed to treat post-ESWL ureteral obstruction, and 22 to push the stone up to the kidney for subsequent ESWL treatment.

  12. Extracorporeal gas exchange with the DeltaStream rotary blood pump in experimental lung injury.

    Science.gov (United States)

    Dembinski, Rolf; Kopp, Rüdger; Henzler, Dietrich; Hochhausen, Nadine; Oslender, Nicole; Max, Martin; Rossaint, Rolf; Kuhlen, Ralf

    2003-06-01

    In most severe cases of the acute respiratory distress syndrome, veno-venous extracorporeal membrane oxygenation (ECMO) can be used to facilitate gas exchange. However, the clinical use is limited due to the size and the concomitant risk of severe adverse events of conventionally-used centrifugal blood pumps with high extracorporeal blood volumes. The DeltaStream blood pump is a small-sized rotary blood pump that may reduce extracorporeal blood volume, foreign surfaces, contact activation of the coagulation system, and blood trauma. The aim of the present study was to test the safety and efficacy of the DeltaStream pump for ECMO in animals with normal lung function and experimental acute lung injury (ALI). Therefore, veno-venous ECMO was performed for 6 hours in mechanically ventilated pigs with normal lung function (n=6) and with ALI induced by repeated lung lavage (n=6) with a blood flow of 30% of the cardiac output. Gas flow with a FiO2 of 1.0 was set to equal blood flow. With a mean activated clotting time of 121 +/- 22 s, no circulatory impairment or thrombus formation was revealed during ECMO. Furthermore, free plasma Hb did not increase. In controls, hemodynamics and gas exchange remained unchanged. In animals with ALI, hemodynamics remained stable and gas transfer across the extracorporeal oxygenators was optimal, but only in 2 animals was a marked increase in PaO2 observed. CO2 removal was efficacious in all animals. We concluded that the DeltaStream blood pump may be used for veno-venous ECMO without major blood damage or hemodynamic impairment.

  13. [Veno-venous extracorporeal oxygenation and veno-arterial extracorporeal oxygenation. Questions, answers].

    Science.gov (United States)

    Isetta, C; Lebreton, G; Janot, N; Prommenschenkel, M; Rilos, Z; Roques, F; Longrois, D

    2014-04-01

    A round table, organized by the French Society of Perfusion (Sofraperf) at the French national congress on extracorporeal circulations (Perfusion 2013), was attended by perfusionists, anaesthesiologists, intensivists and surgeons around the theme of respiratory veno-venous support and veno-arterial circulatory support with extracorporeal oxygenation in intensive care units. The debate was conducted in a participatory manner by bi-directional questions-answers session between moderators and assistance. The authors report management of this type of therapy that is not perfectly homogeneous, supported on literature data. Cannulae, cannulation, circuit, oxygenator, anticoagulation, control, surveillance, weaning are subject to paragraphs with defined entry whose contents are mutually enriching.

  14. Therapy strategy of extracorporeal membrane oxygenation (ECMO) combine with intra aortic balloon pump (IABP), continuous renal replacement therapy (CRRT) and respiratory machine in serious condition cardiac surgery cases%危重症心脏外科患者的ECMO辅助技术与IABP、CRRT、呼吸机的相互配合治疗策略

    Institute of Scientific and Technical Information of China (English)

    张海波; 孟旭; 韩杰; 李岩; 贾一新; 许春雷; 曾文; 王坚刚; 艾米儿

    2014-01-01

    Objective To investigate clinic results of the extracorporeal membrane oxygenation (ECMO) technique combine with Intro aortic balloon pump (IABP),Continuous renal replacement therapy (CRRT),respiratory machine therapy in the serious condition cardiac surgery cases.Methods From 2004 to 2009 all data of the cases received the ECMO therapy were analyzed retrospectively.Results Totally 180 cases were treated with extracorporeal membrane oxygenation (ECMO) technique in this period of time with weaning rate of 68.9% and survival rate of 72.8%.Besides of the of replacing rountine CPB 69 cases,49 cases died in the 111 cases of routine used ECMO cases (survival rate 55.9%).There were 40 cases treated with ECMO combined with IABP in which 23 cases died (survival rate 42.5%).After the first use of IABP 28 cases were treated with ECMO because of hemodynamic instability and 9 died (survival rate 54%).After the first use of ECMO because of severe valve disease or hemodynamic instability after heart transplantation,or emergency cardiopulmonary resuscitation and the IABP was admitted in 12 cases for the small pulse pressure,decreased left ventricular contraction (10 died,survival rate 36.1%).48 cases were treated with ECMO combined with CRRT (total survival rate 40%).In these cases 6 cases were treated with CRRT first and 4 cases died (survival rate 33.3%).And 42 cases received the ECMO first and 25 cases died (survival rate 47.9%).In the total series 19 cases were treated with ECMO combined with IABP,CRRT,respiratory machine and 12 cases died (survival rate 36.1%).Conclusion ECMO is an effective technique for the heart failure after cardiac surgery,the earlier use may bring earlier recovery of the heart function.Combine administration of ECMO,CRRT,IABP and respiratory machine may be adopted for the multiple organs failure cases with attention of the coordinate and weaning orders among the machines.%目的 探讨危重症心脏外科术后患者联合体外膜

  15. 体外膜肺氧合联合持续肾脏替代治疗对健康小猪细胞因子表达的影响及意义%Effects of extracorporeal membrane oxygenation combined with continuous renal replacement treatment on cytokines in piglets

    Institute of Scientific and Technical Information of China (English)

    何长生; 虞文魁; 石佳靓; 陈启仪; 沈娟红; 胡益民; 殷红珍; 李宁; 黎介寿

    2013-01-01

    Objective Extracorporeal membrane oxygenation ( ECMO ) can reduce mortality in critically-ill patients, but almost all patients treated by ECMO develop a systemic inflammatory response syndrome ( SIRS ) characterized by a " cytokine storm" , leukocyte activation, and multisystem organ dysfunction. We investigated the effects of ECMO and its combination with continuous renal replacement treatment ( CRRT ) on the plasma concentrations of inflammatory cytokines in piglets. Methods We randomly divided 24 piglets into four groups of equal number: control, sham, ECMO, and ECMO + CRRT. We collected blood samples from the piglets 1 h before and 2,6, 12 and 24 h after treatment, and determined the plasma levels of TNF-ct, IL-1β, IL-6, IL-8 and IL-10 by ELISA. Results There were no significant differences in the plasma levels of the cytokines before treatment, nor in the control and sham groups after it. The levels of TNF-ct, IL-1β, IL-6 and IL-8 were increased after ECMO and ECMO + CRRT, more significantly after ECMO than after ECMO + CRRT ( P <0.05 ). However, the IL-10 concentration of the ECMO group first went up and then down, to the similar level of the control and sham groups at 24 h, and it rose, too, in the ECMO + CRRT group and maintained at a higher level though decreased a little at 12h, with statistically significant differences from the control group ( P < 0. 05 ) as well as from the ECMO group at 12 and 24 h ( P < 0.05 ). Conclusion ECMO can increase the release of proinflammation cytokines and attenuate anti-inflammatory cytokine, while its combination with CRRT can keep a balance between proinflammatory and anti-inflammatory cytokines in the body, and ameliorate ECMO related SIRS.%目的 体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)治疗的患者均会发生不同程度的全身炎症反应,而持续肾脏替代治疗(continuous renal replacement treatment,CRRT)可以清除各种炎性递质,文中通过观察ECMO联合CRRT对健康小猪

  16. Extracorporeal piezoelectric lithotripsy for retained bile duct stones.

    Science.gov (United States)

    Weber, J; Adamek, H E; Riemann, J F

    1992-05-01

    Extracorporeal piezoelectric shock wave lithotripsy (EPL) was performed in 35 patients with endoscopically non-extractable stones. With this lithotripter, stones are visualized by ultrasound and shock waves are produced by a piezoelectric acoustic generator. The stones could be localized in 32 out of 35 patients. Fragmentation was achieved in 91.4% and complete stone removal in 77.1%. These results show that piezoelectric lithotripsy is also a useful method for the treatment of complicated bile duct stones, as already demonstrated for the electrohydraulically and electromagnetically generated shock waves systems. The piezoelectric system is especially useful in elderly and frail patients because no general anesthesia is needed and only 14% of cases require analgesia or sedation.

  17. A plant plasma membrane Ca2+ pump is required for normal pollen tube growth and fertilization

    DEFF Research Database (Denmark)

    Schiøtt, Morten; Romanowsky, Shawn M; Bækgaard, Lone

    2004-01-01

    Ca(2+) signals are thought to play important roles in plant growth and development, including key aspects of pollen tube growth and fertilization. The dynamics of a Ca(2+) signal are largely controlled by influx (through channels) and efflux (through pumps and antiporters). The Arabidopsis genome...... and a high frequency of aborted fertilization, resulting in a >80% reduction in seed set. These findings identify a plasma membrane Ca(2+) transporter as a key regulator of pollen development and fertilization in flowering plants....

  18. Evaluation of membrane bioreactor process capabilities to meet stringent effluent nutrient discharge requirements.

    Science.gov (United States)

    Fleischer, Edwin J; Broderick, Thomas A; Daigger, Glen T; Fonseca, Anabela D; Holbrook, R David; Murthy, Sudhir N

    2005-01-01

    A six-stage membrane bioreactor (MBR) pilot plant was operated to determine and demonstrate the capability of this process to produce a low-nutrient effluent, consistent with the nutrient reduction goals for the Chesapeake Bay. Biological nitrogen removal was accomplished using a multistage configuration with an initial anoxic zone (using the carbon in the influent wastewater), an aerobic zone (where nitrification occurred), a downstream anoxic zone (where methanol was added as a carbon source), and the aerated submerged membrane zone. The capability to reliably reduce effluent total nitrogen to less than 3 mg/L as nitrogen (N) was demonstrated. A combination of biological (using an initial anaerobic zone) and chemical (using alum) phosphorus removal was used to achieve effluent total phosphate concentrations reliably less than 0.1 mg/L as phosphorus (P) and as low as 0.03 mg/L as P. Alum addition also appeared to enhance the filtration characteristics of the MBR sludge and to reduce membrane fouling. Aeration of the submerged membranes results in thickened sludge with a high dissolved oxygen concentration (approaching saturation), which can be recycled to the main aeration zone rather than to an anoxic or anaerobic zone to optimize biological nutrient removal. Biological nutrient removal was characterized using the International Water Association Activated Sludge Model No. 2d. The stoichiometry of chemical phosphorus removal was also consistent with conventional theory and experience. The characteristics of the solids produced in the MBR were compared with those of a parallel full-scale conventional biological nitrogen removal process and were generally found to be similar. These results provide valuable insight to the design and operating characteristics of MBRs intended to produce effluents with very low nutrient concentrations.

  19. [A compact whole-body hyperthermia system utilizing extracorporeal circulation for anticancer treatment].

    Science.gov (United States)

    Agishi, T; Okumura, T; Saikusa, H; Seino, I; Masuda, T; Hattori, H

    1983-05-01

    A compact whole-body hyperthermia system utilizing extracorporeal circulation for anticancer treatment has been devised and its clinical applicability is discussed. Our system has the following advantages; 1. Our small heat-exchanger made of polyvinyl-chloride hollow fibers exhibited sufficient heat-exchanging capability. 2. Our system is so compact as not to require priming with blood components. 3. Temporary blood access, created by direct puncture of the femoral vessels, eliminates vascular surgery and cardiac overload to the patients.

  20. Requirements on paramagnetic relaxation enhancement data for membrane protein structure determination by NMR.

    Science.gov (United States)

    Gottstein, Daniel; Reckel, Sina; Dötsch, Volker; Güntert, Peter

    2012-06-06

    Nuclear magnetic resonance (NMR) structure calculations of the α-helical integral membrane proteins DsbB, GlpG, and halorhodopsin show that distance restraints from paramagnetic relaxation enhancement (PRE) can provide sufficient structural information to determine their structure with an accuracy of about 1.5 Å in the absence of other long-range conformational restraints. Our systematic study with simulated NMR data shows that about one spin label per transmembrane helix is necessary for obtaining enough PRE distance restraints to exclude wrong topologies, such as pseudo mirror images, if only limited other NMR restraints are available. Consequently, an experimentally realistic amount of PRE data enables α-helical membrane protein structure determinations that would not be feasible with the very limited amount of conventional NOESY data normally available for these systems. These findings are in line with our recent first de novo NMR structure determination of a heptahelical integral membrane protein, proteorhodopsin, that relied extensively on PRE data.

  1. N-terminal palmitoylation is required for Toxoplasma gondii HSP20 inner membrane complex localization.

    Science.gov (United States)

    De Napoli, M G; de Miguel, N; Lebrun, M; Moreno, S N J; Angel, S O; Corvi, M M

    2013-06-01

    Toxoplasma gondii is an obligate intracellular parasite and the causative agent of toxoplasmosis. Protein palmitoylation is known to play roles in signal transduction and in enhancing the hydrophobicity of proteins thus contributing to their membrane association. Global inhibition of protein palmitoylation has been shown to affect T. gondii physiology and invasion of the host cell. However, the proteins affected by this modification have been understudied. This paper shows that the small heat shock protein 20 from T. gondii (TgHSP20) is synthesized as a mature protein in the cytosol and is palmitoylated in three cysteine residues. However, its localization at the inner membrane complex (IMC) is dependent only on N-terminal palmitoylation. Absence or incomplete N-terminal palmitoylation causes TgHSP20 to partially accumulate in a membranous structure. Interestingly, TgHSP20 palmitoylation is not responsible for its interaction with the daughter cells IMCs. Together, our data describe the importance of palmitoylation in protein targeting to the IMC in T. gondii.

  2. Golgi membrane fission requires the CtBP1-S/BARS-induced activation of lysophosphatidic acid acyltransferase δ.

    Science.gov (United States)

    Pagliuso, Alessandro; Valente, Carmen; Giordano, Lucia Laura; Filograna, Angela; Li, Guiling; Circolo, Diego; Turacchio, Gabriele; Marzullo, Vincenzo Manuel; Mandrich, Luigi; Zhukovsky, Mikhail A; Formiggini, Fabio; Polishchuk, Roman S; Corda, Daniela; Luini, Alberto

    2016-07-12

    Membrane fission is an essential cellular process by which continuous membranes split into separate parts. We have previously identified CtBP1-S/BARS (BARS) as a key component of a protein complex that is required for fission of several endomembranes, including basolateral post-Golgi transport carriers. Assembly of this complex occurs at the Golgi apparatus, where BARS binds to the phosphoinositide kinase PI4KIIIβ through a 14-3-3γ dimer, as well as to ARF and the PKD and PAK kinases. We now report that, when incorporated into this complex, BARS binds to and activates a trans-Golgi lysophosphatidic acid (LPA) acyltransferase type δ (LPAATδ) that converts LPA into phosphatidic acid (PA); and that this reaction is essential for fission of the carriers. LPA and PA have unique biophysical properties, and their interconversion might facilitate the fission process either directly or indirectly (via recruitment of proteins that bind to PA, including BARS itself).

  3. Can low-intensity extracorporeal shockwave therapy improve erectile dysfunction?

    DEFF Research Database (Denmark)

    Olsen, Anne B; Persiani, Marie; Boie, Sidsel

    2015-01-01

    OBJECTIVE: The aim of this study was to investigate whether low-intensity extracorporeal shockwave therapy (LI-ESWT) can be used as a treatment for men with erectile dysfunction of organic origin. MATERIALS AND METHODS: This prospective, randomized, blinded, placebo-controlled study included 112 ...... are needed. KEYWORDS: Erectile dysfunction; extracorporeal shockwave; penis...

  4. Unfocused Extracorporeal Shock Waves Induce Anabolic Effects in Rat Bone

    NARCIS (Netherlands)

    O.P. van der Jagt (Olav); T.M. Piscaer (Tom); W. Schaden (Wolfgang); J. Li; N. Kops (Nicole); H. Jahr (Holger); J.C. van der Linden (Jacqueline); J.H. Waarsing (Jan); J.A.N. Verhaar (Jan); M. de Jong (Marion); H.H. Weinans (Harrie)

    2011-01-01

    textabstractAbstract. BACKGROUND: Extracorporeal shock waves are known to stimulate the differentiation of mesenchymal stem cells toward osteoprogenitors and induce the expression of osteogenic-related growth hormones. The aim of this study was to investigate if and how extracorporeal shock waves af

  5. Unfocused Extracorporeal Shock Waves Induce Anabolic Effects in Rat Bone

    NARCIS (Netherlands)

    O.P. van der Jagt (Olav); T.M. Piscaer (Tom); W. Schaden (Wolfgang); J. Li; N. Kops (Nicole); H. Jahr (Holger); J.C. van der Linden (Jacqueline); J.H. Waarsing (Jan); J.A.N. Verhaar (Jan); M. de Jong (Marion); H.H. Weinans (Harrie)

    2011-01-01

    textabstractAbstract. BACKGROUND: Extracorporeal shock waves are known to stimulate the differentiation of mesenchymal stem cells toward osteoprogenitors and induce the expression of osteogenic-related growth hormones. The aim of this study was to investigate if and how extracorporeal shock waves

  6. Extracorporeal shock wave lithotripsy of biliary and pancreatic stones

    NARCIS (Netherlands)

    R. den Toom (Rene)

    1993-01-01

    textabstractThe aim of the study was to answer the following questions: Is extracorporeal shock wave lithotripsy for gallbladder stones a safe and effective therapy? (Chapter 2) Is simultaneous treatment with extracorporeal shock wave lithotripsy and the solvent methyl te.rt-butyl ether feasible, sa

  7. [Extracorporeal detoxication in the treatment of peritonitis complicated with multiple organ insufficiency].

    Science.gov (United States)

    Lobakov, A I; Vatazin, A V; Fomin, A M; Andrianova, E Iu; Abakumova, L Ia

    1994-07-01

    The article deals with experience in the use of filtration and combined methods of extracorporeal detoxification in 201 patients with peritonitis in the phase of polyorganic insufficiency. The methods were developed in the department of abdominal surgery of the Moscow Regional Scientific Research Clinical Institute. The authors show the indications for and the advantages, the mechanisms of the effect, and the results of bifiltration cascade exchange plasmapheresis, improved hemofiltration method, and selective detoxification of portal blood, and the combination of these methods with continuous membrane blood oxygenation. The mortality reduced from 46.6% in the control group to 26.5% in the main group.

  8. Sialic acid is required for neuronal inhibition by soluble MAG but not for membrane bound MAG

    Directory of Open Access Journals (Sweden)

    Najat eAl-Bashir

    2016-04-01

    Full Text Available Myelin-Associated Glycoprotein (MAG, a major inhibitor of axonal growth, is a member of the immunoglobulin (Ig super-family. Importantly, MAG (also known as Siglec-4 is a member of the Siglec family of proteins (sialic acid-binding, immunoglobulin-like lectins, MAG binds to complex gangliosides, specifically GD1a and/or GT1b. Therefore, it has been proposed as neuronal receptors for MAG inhibitory effect of axonal growth. Previously, we showed that MAG binds sialic acid through domain 1 at Arg118 and is able to inhibit axonal growth through domain 5.We developed a neurite outgrowth assay (NOG, in which both wild type MAG and mutated MAG (MAG Arg118 are expressed on cells. In addition we also developed a soluble form NOG in which we utilized soluble MAG-Fc and mutated MAG (Arg118-Fc. Only MAG-Fc is able to inhibit neurite outgrowth, but not mutated MAG (Arg118-Fc that has been mutated at its sialic acid binding site. However, both forms of membrane bound MAG- and MAG (Arg118- expressing cells still inhibit neurite outgrowth. Here, we review various results from different groups regarding MAG’s inhibition of axonal growth. Also, we propose a model in which the sialic acid binding is not necessary for the inhibition induced by the membrane form of MAG, but it is necessary for the soluble form of MAG. This finding highlights the importance of understanding the different mechanisms by which MAG inhibits neurite outgrowth in both the soluble fragmented form and the membrane-bound form in myelin debris following CNS damage

  9. Carrier subunit of plasma membrane transporter is required for oxidative folding of its helper subunit.

    Science.gov (United States)

    Rius, Mònica; Chillarón, Josep

    2012-05-25

    We study the amino acid transport system b(0,+) as a model for folding, assembly, and early traffic of membrane protein complexes. System b(0,+) is made of two disulfide-linked membrane subunits: the carrier, b(0,+) amino acid transporter (b(0,+)AT), a polytopic protein, and the helper, related to b(0,+) amino acid transporter (rBAT), a type II glycoprotein. rBAT ectodomain mutants display folding/trafficking defects that lead to type I cystinuria. Here we show that, in the presence of b(0,+)AT, three disulfides were formed in the rBAT ectodomain. Disulfides Cys-242-Cys-273 and Cys-571-Cys-666 were essential for biogenesis. Cys-673-Cys-685 was dispensable, but the single mutants C673S, and C685S showed compromised stability and trafficking. Cys-242-Cys-273 likely was the first disulfide to form, and unpaired Cys-242 or Cys-273 disrupted oxidative folding. Strikingly, unassembled rBAT was found as an ensemble of different redox species, mainly monomeric. The ensemble did not change upon inhibition of rBAT degradation. Overall, these results indicated a b(0,+)AT-dependent oxidative folding of the rBAT ectodomain, with the initial and probably cotranslational formation of Cys-242-Cys-273, followed by the oxidation of Cys-571-Cys-666 and Cys-673-Cys-685, that was completed posttranslationally.

  10. Carrier Subunit of Plasma Membrane Transporter Is Required for Oxidative Folding of Its Helper Subunit*

    Science.gov (United States)

    Rius, Mònica; Chillarón, Josep

    2012-01-01

    We study the amino acid transport system b0,+ as a model for folding, assembly, and early traffic of membrane protein complexes. System b0,+ is made of two disulfide-linked membrane subunits: the carrier, b0,+ amino acid transporter (b0,+AT), a polytopic protein, and the helper, related to b0,+ amino acid transporter (rBAT), a type II glycoprotein. rBAT ectodomain mutants display folding/trafficking defects that lead to type I cystinuria. Here we show that, in the presence of b0,+AT, three disulfides were formed in the rBAT ectodomain. Disulfides Cys-242-Cys-273 and Cys-571-Cys-666 were essential for biogenesis. Cys-673-Cys-685 was dispensable, but the single mutants C673S, and C685S showed compromised stability and trafficking. Cys-242-Cys-273 likely was the first disulfide to form, and unpaired Cys-242 or Cys-273 disrupted oxidative folding. Strikingly, unassembled rBAT was found as an ensemble of different redox species, mainly monomeric. The ensemble did not change upon inhibition of rBAT degradation. Overall, these results indicated a b0,+AT-dependent oxidative folding of the rBAT ectodomain, with the initial and probably cotranslational formation of Cys-242-Cys-273, followed by the oxidation of Cys-571-Cys-666 and Cys-673-Cys-685, that was completed posttranslationally. PMID:22493502

  11. Venovenous extracorporeal membrane oxygenation in patients with atrial septal defects.

    Science.gov (United States)

    Julliard, W; Niles, S D; Maloney, J D

    2015-07-01

    Two patients presented in profound respiratory distress unresponsive to maximal support and were placed on venovenous ECMO. Subsequently, both were found to have a patent foramen ovale and high pulmonary artery pressures, resulting in a right to left shunt. Both patients had a better than expected response to ECMO, likely related to their shunts allowing oxygenated blood to bypass the high pulmonary artery pressures and go directly to the left heart. Both patients were successfully weaned from ECMO and discharged to home in good condition. © The Author(s) 2014.

  12. Morphine pharmacokinetics during venoarterial extracorporeal membrane oxygenation in neonates

    NARCIS (Netherlands)

    Peters, JWB; Anderson, BJ; Simons, SHP; Uges, DRA; Tibboel, D

    2005-01-01

    Objective: To study morphine pharmacokinetics in neonates undergoing venoarterial ECMO and to quantify differences between these neonates and neonates subjected to noncardiac major surgery. Design and Settings: Observational study in a level III referral center. Patients and methods: Pharmacokinetic

  13. Factors influencing the outcome of paediatric cardiac surgical patients during extracorporeal circulatory support

    Directory of Open Access Journals (Sweden)

    Peek Giles J

    2007-01-01

    Full Text Available Abstract Background Veno-arterial extracorporeal membrane oxygenation (ECMO is a common modality of circulatory assist device used in children. We assessed the outcome of children who had ECMO following repair of congenital cardiac defects (CCD and identified the risk factors associated with hospital mortality. Methods From April 1990 to December 2003, 53 patients required ECMO following surgical correction of CCD. Retrospectively collected data was analyzed with univariate and multivariate logistic regression analysis. Results Median age and weight of the patients were 150 days and 5.4 kgs respectively. The indications for ECMO were low cardiac output in 16, failure to wean cardiopulmonary bypass in 13, cardiac arrest in 10 and cardio-respiratory failure in 14 patients. The mean duration of ECMO was 143 hours. Weaning off from ECMO was successful in 66% and of these 83% were survival to hospital-discharge. 37.7% of patients were alive for the mean follow-up period of 75 months. On univariate analysis, arrhythmias, ECMO duration >168 hours, bleeding complications, renal replacement therapy on ECMO, arrhythmias and cardiac arrest after ECMO were associated with hospital mortality. On multivariate analysis, abnormal neurology, bleeding complications and arrhythmias after ECMO were associated with hospital mortality. Extra and intra-thoracic cannulations were used in 79% and 21% of patients respectively and extra-thoracic cannulation had significantly less bleeding complications (p = 0.031. Conclusion ECMO provides an effective circulatory support following surgical repair of CCD in children. Extra-thoracic cannulation is associated with less bleeding complications. Abnormal neurology, bleeding complications on ECMO and arrhythmias after ECMO are poor prognostic indicators for hospital survival.

  14. Preauricular transmasseteric anteroparotid approach for extracorporeal fixation of mandibular condyle fractures

    Directory of Open Access Journals (Sweden)

    Rajasekhar Gali

    2016-01-01

    Full Text Available Introduction: Free grafting or extracorporeal fixation of traumatically displaced mandibular condyles is sometimes required in patients with severe anteromedial displacement of condylar head. Majority of the published studies report the use of a submandibular, retromandibular or preauricular incisions for the access which have demerits of limited visibility, access and potential to cause damage to facial nerve and other parotid gland related complications. Purpose: This retrospective clinical case record study was done to evaluate the preauricular transmasseteric anteroparotid (P-TMAP approach for open reduction and extracorporeal fixation of displaced and dislocated high condylar fractures of the mandible. Patients and Methods: This retrospective study involved search of clinical case records of seven patients with displaced and dislocated high condylar fractures treated by open reduction and extracorporeal fixation over a 3-year period. The parameters assessed were as follows: a the ease of access for retrieval, reimplantation and fixation of the proximal segment; b the postoperative approach related complications; c the adequacy of anatomical reduction and stability of fixation; d the occlusal changes; and the e TMJ function and radiological changes. Results: Accessibility and visibility were good. Accurate anatomical reduction and fixation were achieved in all the patients. The recorded complications were minimal and transient. Facial nerve (buccal branch palsy was noted in one patient with spontaneous resolution within 3 months. No cases of sialocele or Frey's syndrome were seen. Conclusion: The P-TMAP approach provides good access for open reduction and extracorporeal fixation of severely displaced condylar fractures. It facilitates retrieval, transplantation, repositioning, fixing the condyle and also reduces the chances of requirement of a vertical ramus osteotomy. It gives straight-line access to condylar head and ramus thereby

  15. FadD Is Required for Utilization of Endogenous Fatty Acids Released from Membrane Lipids ▿ †

    Science.gov (United States)

    Pech-Canul, Ángel; Nogales, Joaquina; Miranda-Molina, Alfonso; Álvarez, Laura; Geiger, Otto; Soto, María José; López-Lara, Isabel M.

    2011-01-01

    FadD is an acyl coenzyme A (CoA) synthetase responsible for the activation of exogenous long-chain fatty acids (LCFA) into acyl-CoAs. Mutation of fadD in the symbiotic nitrogen-fixing bacterium Sinorhizobium meliloti promotes swarming motility and leads to defects in nodulation of alfalfa plants. In this study, we found that S. meliloti fadD mutants accumulated a mixture of free fatty acids during the stationary phase of growth. The composition of the free fatty acid pool and the results obtained after specific labeling of esterified fatty acids with a Δ5-desaturase (Δ5-Des) were in agreement with membrane phospholipids being the origin of the released fatty acids. Escherichia coli fadD mutants also accumulated free fatty acids released from membrane lipids in the stationary phase. This phenomenon did not occur in a mutant of E. coli with a deficient FadL fatty acid transporter, suggesting that the accumulation of fatty acids in fadD mutants occurs inside the cell. Our results indicate that, besides the activation of exogenous LCFA, in bacteria FadD plays a major role in the activation of endogenous fatty acids released from membrane lipids. Furthermore, expression analysis performed with S. meliloti revealed that a functional FadD is required for the upregulation of genes involved in fatty acid degradation and suggested that in the wild-type strain, the fatty acids released from membrane lipids are degraded by β-oxidation in the stationary phase of growth. PMID:21926226

  16. Translocation of the papillomavirus L2/vDNA complex across the limiting membrane requires the onset of mitosis.

    Science.gov (United States)

    Calton, Christine M; Bronnimann, Matthew P; Manson, Ariana R; Li, Shuaizhi; Chapman, Janice A; Suarez-Berumen, Marcela; Williamson, Tatum R; Molugu, Sudheer K; Bernal, Ricardo A; Campos, Samuel K

    2017-05-01

    The human papillomavirus type 16 (HPV16) L2 protein acts as a chaperone to ensure that the viral genome (vDNA) traffics from endosomes to the trans-Golgi network (TGN) and eventually the nucleus, where HPV replication occurs. En route to the nucleus, the L2/vDNA complex must translocate across limiting intracellular membranes. The details of this critical process remain poorly characterized. We have developed a system based on subcellular compartmentalization of the enzyme BirA and its cognate substrate to detect membrane translocation of L2-BirA from incoming virions. We find that L2 translocation requires transport to the TGN and is strictly dependent on entry into mitosis, coinciding with mitotic entry in synchronized cells. Cell cycle arrest causes retention of L2/vDNA at the TGN; only release and progression past G2/M enables translocation across the limiting membrane and subsequent infection. Microscopy of EdU-labeled vDNA reveals a rapid and dramatic shift in vDNA localization during early mitosis. At late G2/early prophase vDNA egresses from the TGN to a pericentriolar location, accumulating there through prometaphase where it begins to associate with condensed chromosomes. By metaphase and throughout anaphase the vDNA is seen bound to the mitotic chromosomes, ensuring distribution into both daughter nuclei. Mutations in a newly defined chromatin binding region of L2 potently blocked translocation, suggesting that translocation is dependent on chromatin binding during prometaphase. This represents the first time a virus has been shown to functionally couple the penetration of limiting membranes to cellular mitosis, explaining in part the tropism of HPV for mitotic basal keratinocytes.

  17. 超声在脑-心双死亡器官捐献供肝体外膜肺氧合模式中的应用价值研究%Application of ultrasound in extracorporeal membrane oxygenation for the liver donation after brain-cardiac death

    Institute of Scientific and Technical Information of China (English)

    朱贤胜; 程琦; 王莎莎; 叶创文; 庞树旺

    2016-01-01

    Objective To evaluate the application value of ultrasound in extracorporeal membrane oxygenation (ECMO)for protecting the liver donation after brain-cardiac death (DBCD).Methods Forty patients with brain death or irreversible brain injury,admitted to Guangzhou General Hospital of Guangzhou Military Command from April 2006 to November 201 4,were eligible for liver donation.The hepatic artery blood flow (QHA),portal vein blood flow (QPV)and ECMO-induced ECMO flow of hepatic artery (VE)of the donor liver were monitored by ultrasound before,5 min after the initiation of ECMO and immediately after ECMO.The changes of total bilirubin (TB),alanine transaminase (ALT)and lactic acid were observed at corresponding time points.Hepatic recovery was subsequently evaluated within 3 months after liver transplantation.Results The mean time of ECMO was (1 .0 ±0.2)h.There was no significant difference in QHA and QPV before and after ECMO (both in P >0.05).And there was no significant difference in liver function parameters before and after ECMO (all in P >0.05).At different time points within postoperative 3 months,the results of ultrasound evaluation and liver function test revealed that the transplant liver function was well recovered in 40 recipients.Conclusions Through monitoring QHA by ultrasound,the best ECMO flow should be chosen,which protects DBCD liver and averts perfusion injury and hypoperfusion.%目的:评价超声在体外膜肺氧合(ECMO)保护脑-心双死亡器官捐献(DBCD)供肝中的应用价值。方法选取2006年4月至2014年11月广州军区广州总医院收治的符合供肝要求的40例脑死亡或不可逆脑损伤患者作为研究对象。分别在 ECMO 运转前、运转后5 min、停转即刻,记录超声监测的供肝肝动脉流量(QHA)、门静脉流量(QPV)及 ECMO 导致的肝动脉 ECMO 流量(VE)。在相应时刻监测供体血液总胆红素(TB)、丙氨酸转氨酶(ALT)、乳酸的变化

  18. 体外膜肺氧合对成人急性呼吸窘迫综合征患者预后影响的Meta分析和系统评价%Use of extracorporeal membrane oxygenation on adults with adult acute respiratory distress syndrome: a meta-analysis and systematic review

    Institute of Scientific and Technical Information of China (English)

    刘松桥; 金辉; 黄英姿; 郭凤梅; 刘玲; 杨丛山; 杨毅; 邱海波

    2011-01-01

    目的 探讨体外膜肺氧合(ECMO)对急性呼吸窘迫综合征(ARDS)患者预后的影响.方法 计算机检索和手工检索收集1966-2010年ECMO治疗成人ARDS的英文和中文临床研究,按纳入与排除标准选择文献,提取资料,采用RevMan 5.0软件对数据进行Meta分析,对ECMO临床研究进行系统评价.结果 共纳入3篇随机对照研究,随机效应模型显示ECMO不降低成人重症ARDS患者病死率[RR=0.95(95%CI:0.76-1.18),P=0.64],但按发表时间的累积Meta分析显示ECMO呈现保护性效应;与以往临床研究相比,最近一项观察性临床研究显示ECMO明显降低甲型H1N1流感导致的重症ARDS患者病死率.结论 现有研究尚不能证实ECMO能改善成人ARDS患者预后,但对于病因可逆的重症ARDS患者早期应用ECMO可取得较好临床效益.%Objective To investigate the effects of extracorporeal membrane oxygenation (ECMO) on survival of adult from acute respiratory distress syndrome (ARDS). Method We searched Pubmed, Embase, Cochrane Library, Web of Science databases to find relevant literatues on ECMO in treatment of ARDS, which are reported from January 1966 to June 2010. Meta analyses was performed. Results Three papers about randomized controlled trial (RCT) of evaluating ECMO in patients with severe ARDS were enrolled for analyses. Meta-analysis of the three randomized controlled trials revealed ECMO did not decrease the mortality of ARDS patients. However, the cumulative meta-analysis of randomized trials showed ECMO had a protective effect on patients with ARDS. The most recent observational studies suggested that ECMO significantly decreased the mortality of ARDS caused by H1 N1 viral pneumonia. Conclusions There is no evidence to prove the benefit of ECMO in patients with ARDS. However, ECMO should be considered to use in early stage of ARDS as a last rescue resort for potentially reversible severe acute respiratory failure. Further investigation of large sample of high

  19. The effects of extracorporeal membrane oxygenation on gas exchanges of acute lung injury induced by endotoxin%体外膜肺氧合对内毒素诱导大鼠急性肺损伤后肺气体交换的影响

    Institute of Scientific and Technical Information of China (English)

    陈永梅; 龚兴瑞

    2011-01-01

    目的:观察体外膜肺氧合(ECMO)对内毒素诱导大鼠急性肺损伤(ALI)后肺气体交换的影响.方法:选择健康成年SD大鼠40只,随机分为对照组、模型组(LPS组)、体外膜肺氧合组(ECMO组).LPS组和ECMO组在麻醉后给予脂多糖(LPS)0.5mg/kg静脉注射;ECMO组在LPS注射1h后开始转流体外循环,转流时间为2h,对照组注射生理盐水.观察时间点为:T0:LPS注射前;T1:LPS注射后1h;T2:LPS注射后2h;T3:LPS注射后3h;T4:LPS注射后5h.分别在5个时间点观察3组大鼠的血压、心率、呼吸频率、动脉血氧分压(PO2)、动脉血CO2分压(PCO2),5h后处死大鼠测量肺组织湿(干)重量比值.结果:T2、T3、T4时刻对照组、ECMO组与模型组相比血压、心率较稳定,PO2较高,PCO2较低(P<0.05);大鼠处死后,对照组、ECMO组术后肺组织湿(干)比值较小(P<0.05).结论:内毒素导致急性肺损伤时,通过ECMO治疗可减轻肺水肿和呼吸窘迫症状,改善机体缺氧和CO2蓄积.%Objective:To observe the effects of extracorporeal membrane oxygenation ( ECMO) on gas exchange of acute lung injury(ALI) induced by endotoxin. Methods: 40 healthy SD rats were randomly divided into three groups: control group, model group(LPS) and ECMO group. Both model group and ECMO group were received Lipopolysaccharide 0. 5mg/kg intravenous injection after anesthesia induction for setting up acute lung injury models while the control group received saline. The observation time were To: beforeLipopolysaccharide injection; Tl: 1 hour after Lipopolysaccharide injection} T2:2 hours after Lipopolysaccharide injection; T3: 3 hours after Lipopolysaccharide injection; T4:5 hours after Lipopolysaccharide injection. The observation included blood pressure, respiratory rate, PO2, PCO2;The ratio of dry/wet of lung tissue was calculated when the rats were killed at T4. Results;the control group and ECMO group caused minor change of blood pressure, heart rate, respiratory rate, PO2 and

  20. 体外膜肺氧合治疗急性呼吸窘迫综合征的临床疗效观察%Clinical observation of therapeutic effect of extracorporeal membrane oxygenation in patients with acute respiratory distress syndrome

    Institute of Scientific and Technical Information of China (English)

    王传海; 童朝晖; 詹庆元; 孙兵; 权京玉; 李承红

    2012-01-01

    Objective To investigate the therapeutic effects and safety of extracorporeal membrane oxygenation (ECMO) in patients with acute respiratory distress syndrome (ARDS).Methods ECMO were initiated in 6 patients with ARDS, not responding to conventional mechanical ventilation. Oxygenation status, positive end-expiratory pressure (PEEP) level,and fraction of inspired oxygen (FiO2) were compared before and after treatment with ECMO,while the adverse effects of ECMO were recorded.Results In 6 cases,pulse blood oxygen saturation (SpO2) was elevated (0.45-0.92 up to 0.94-1.00),PEEP level (cm H2O,1 cm H2O=0.098 kPa) and FiO2 were lowered (PEEP:10.0-22.0 down to4.0-15.0; FiO2:1.00 down to 0.30-0.60) after treatment with ECMO.Of 6 cases,2 patients with severe influenza A/H1N1 pneumonia finally died of shock; 1 patient with severe influenza A/H1N1 pneumonia and 1 patient with Klebsiella pneumoniae pneumonia were withdrawn from ECMO treatment because of deterioration of the disease.One patient suffering from Cytomegalovirus pneumonia and another with Acinetobacter baumanii pneumonia were successfully discharged from hospital with recovery.The main complications were bleeding and hemolysis.Conclusions ECMO could improve gas exchange,oxygenation and partially replace pulmonary function.Patients with ARDS should be treated with ECMO early if artificial ventilation treatment was unresponsive.%目的 探讨体外膜肺氧合(ECMO)治疗急性呼吸窘迫综合征(ARDS)患者的临床疗效和安全性.方法 6例ARDS患者在机械通气治疗无明显效果后,予以ECMO辅助治疗.比较ECMO治疗前后氧合、呼气末正压(PEEP)水平和吸入氧浓度(FiO2)的变化,观察ECMO的不良反应.结果 应用ECMO辅助治疗后,6例患者脉搏血氧饱和度(SpO2)升高(从0.45 ~ 0.92升至0.94~ 1.00),PEEP(cm H2O,1 cm H2O =0.098 kPa)和FiO2降低(PEEP从10.0~22.0降至4.0~15.0;FiO2从1.00降至0.30~0.60).2例危重症甲型H1N1流感肺炎患者死于休克,1

  1. 体外膜肺氧合对成人急性呼吸窘迫综合征患者预后影响的荟萃分析%Use of extracorporeal membrane oxygenation in adults with acute respiratory distress syndrome: a Metaanalysis

    Institute of Scientific and Technical Information of China (English)

    蔡施霞; 刘松桥; 邱晓华; 黄英姿; 杨毅; 邱海波

    2012-01-01

    Objective To evaluate the effects of extracorporeal membrane oxygenation (ECMO) on mortality in adult patients with acute respiratory distress syndrome (ARDS).Methods Literature concerning randomized controlled trials (RCTs),case-control studies and prospective cohort studies from January 1966 to July 2011 on ECMO for the treatment of ARDS patients was retrieved by electronic and manual search.Meta-analysis of the use of ECMO in the treatment of ARDS patients was conducted using the methods recommended by the Cochrane Collaboration's software RevMan 5.0.Results Three papers reporting RCTs and 6 papers concerning observational cohort studies of using ECMO in patients with severe ARDS were enrolled for analysis.Meta-analysis of the 3 RCTs (310 patients,159of them treated with ECMO) revealed ECMO did not decrease the mortality of ARDS patients [ odds ratio (OR)=0.75,95% confidence interval (95% CI) 0.45-1.24,P=0.27 ].Meta-analysis of the all 9 studies (1058 patients,386 of them treated with ECMO ) revealed ECMO increased the mortality of ARDS patients (OR=1.58,95%CI 0.94-2.67,P=0.08).Conclusion There is no evidence to prove that ECMO is beneficial in adult patients with ARDS,therefore further investigation with a large sample of high quality RCT is warranted.%目的 评估体外膜肺氧合(ECMO)对成人急性呼吸窘迫综合征(ARDS)患者预后的影响.方法 计算机检索和手工检索收集1966年1月至2011年7月ECMO治疗成人ARDS的英文和中文临床研究文献,按纳入与排除标准选择文献,提取资料,采用RevMan 5.0软件对数据进行荟萃分析(Meta分析).结果 共纳入9篇文献,其中3篇为随机对照临床试验(RCT)研究,6篇为观察性研究.3篇RCT研究共入选310例患者,ECMO治疗组159例,对照组151例;Meta分析显示:与传统机械通气治疗相比,ECMO治疗不能降低成人重症ARDS患者病死率[优势比(OR)=0.75,95%可信区间(95%CI) 0.45~1.24,P=0.27].9篇文献共入选1058

  2. Electrostatically induced recruitment of membrane peptides into clusters requires ligand binding at both interfaces.

    Directory of Open Access Journals (Sweden)

    Yuri N Antonenko

    Full Text Available Protein recruitment to specific membrane locations may be governed or facilitated by electrostatic attraction, which originates from a multivalent ligand. Here we explored the energetics of a model system in which this simple electrostatic recruitment mechanism failed. That is, basic poly-L-lysine binding to one leaflet of a planar lipid bilayer did not recruit the triply-charged peptide (O-Pyromellitylgramicidin. Clustering was only observed in cases where PLL was bound to both channel ends. Clustering was indicated (i by the decreased diffusional PLL mobility D(PLL and (ii by an increased lifetime τ(PLL of the clustered channels. In contrast, if PLL was bound to only one leaflet, neither D(PLL nor τ(P changed. Simple calculations suggest that electrostatic repulsion of the unbound ends prevented neighboring OPg dimers from approaching each other. We believe that a similar mechanism may also operate in cell signaling and that it may e.g. contribute to the controversial results obtained for the ligand driven dimerization of G protein-coupled receptors.

  3. The integral membrane protein SEN1 is required for symbiotic nitrogen fixation in Lotus japonicus nodules.

    Science.gov (United States)

    Hakoyama, Tsuneo; Niimi, Kaori; Yamamoto, Takeshi; Isobe, Sawa; Sato, Shusei; Nakamura, Yasukazu; Tabata, Satoshi; Kumagai, Hirotaka; Umehara, Yosuke; Brossuleit, Katja; Petersen, Thomas R; Sandal, Niels; Stougaard, Jens; Udvardi, Michael K; Tamaoki, Masanori; Kawaguchi, Masayoshi; Kouchi, Hiroshi; Suganuma, Norio

    2012-01-01

    Legume plants establish a symbiotic association with bacteria called rhizobia, resulting in the formation of nitrogen-fixing root nodules. A Lotus japonicus symbiotic mutant, sen1, forms nodules that are infected by rhizobia but that do not fix nitrogen. Here, we report molecular identification of the causal gene, SEN1, by map-based cloning. The SEN1 gene encodes an integral membrane protein homologous to Glycine max nodulin-21, and also to CCC1, a vacuolar iron/manganese transporter of Saccharomyces cerevisiae, and VIT1, a vacuolar iron transporter of Arabidopsis thaliana. Expression of the SEN1 gene was detected exclusively in nodule-infected cells and increased during nodule development. Nif gene expression as well as the presence of nitrogenase proteins was detected in rhizobia from sen1 nodules, although the levels of expression were low compared with those from wild-type nodules. Microscopic observations revealed that symbiosome and/or bacteroid differentiation are impaired in the sen1 nodules even at a very early stage of nodule development. Phylogenetic analysis indicated that SEN1 belongs to a protein clade specific to legumes. These results indicate that SEN1 is essential for nitrogen fixation activity and symbiosome/bacteroid differentiation in legume nodules.

  4. First level prevention instead of third level intervention-review of research to improve biocompatibility and performance of capillary membrane apheresis in critically ill patients.

    Science.gov (United States)

    Russ, Martin; Bedarf, Janis R; Grosch-Ott, Sascha; Haltern, Claudia; Rossaint, Rolf; Unger, Juliane K

    2013-06-01

    In intensive care medicine, convection-based apheresis is of growing interest. Applying extracorporeal systems in the critically ill patient can cause severe complications like nosocomial infections and bleeding, which can be worsened or even initialized by the anticoagulation protocol used. Furthermore, the filter modules (hemo- and plasmafilters) often tend to a fast blockage. A decrease in sieving performance due to membrane fouling may be tolerable for some time, but the complete blockage of high percentages of hollow fibers, which is named "clotting," often requires the immediate exchange of the filter. Extracorporeal detoxification and high clearance renal replacement regimes both require high blood flow and filtration rates. As a consequence, filter clotting and anticoagulation-associated bleeding are the most sensitive aspects in these applications. We were interested in the paradox phenomenon of the parallel occurrence of intra vitam bleeding and filter clotting in critically ill patients. Through stepwise investigations based on in vitro and animal experiments, we identified a stasis of blood flow followed by blood cell sedimentation and aggregation ("clogging") as the main factor of hollow fiber blockage in hemo- and plasma filters. As a result, various aspects which increase the risk of stasis inside the hollow fibers were investigated, for example, patient's hemorheology, configuration of an extracorporeal treatment system including interaction of catheter features with the filtration procedure, and basic therapeutic approaches such as colloidal volume substitutes and tolerated acidosis. Finally, an etiological triad for the blockage of hollow fibers due to filter clogging and consecutive filter failure was formed.

  5. Extracorporeal shock wave therapy (ESWT) for wound healing: technology, mechanisms, and clinical efficacy.

    Science.gov (United States)

    Mittermayr, Rainer; Antonic, Vlado; Hartinger, Joachim; Kaufmann, Hanna; Redl, Heinz; Téot, Luc; Stojadinovic, Alexander; Schaden, Wolfgang

    2012-01-01

    For almost 30 years, extracorporeal shock wave therapy has been clinically implemented as an effective treatment to disintegrate urinary stones. This technology has also emerged as an effective noninvasive treatment modality for several orthopedic and traumatic indications including problematic soft tissue wounds. Delayed/nonhealing or chronic wounds constitute a burden for each patient affected, significantly impairing quality of life. Intensive wound care is required, and this places an enormous burden on society in terms of lost productivity and healthcare costs. Therefore, cost-effective, noninvasive, and efficacious treatments are imperative to achieve both (accelerated and complete) healing of problematic wounds and reduce treatment-related costs. Several experimental and clinical studies show efficacy for extracorporeal shock wave therapy as means to accelerate tissue repair and regeneration in various wounds. However, the biomolecular mechanism by which this treatment modality exerts its therapeutic effects remains unclear. Potential mechanisms, which are discussed herein, include initial neovascularization with ensuing durable and functional angiogenesis. Furthermore, recruitment of mesenchymal stem cells, stimulated cell proliferation and differentiation, and anti-inflammatory and antimicrobial effects as well as suppression of nociception are considered important facets of the biological responses to therapeutic shock waves. This review aims to provide an overview of shock wave therapy, its history and development as well as its current place in clinical practice. Recent research advances are discussed emphasizing the role of extracorporeal shock wave therapy in soft tissue wound healing.

  6. Hydroxyethyl starch solution for extracorporeal tissue perfusion.

    Science.gov (United States)

    Taeger, Christian D; Friedrich, Oliver; Drechsler, Caroline; Weigand, Annika; Hobe, Frieder; Geppert, Carol I; Münch, Frank; Birkholz, Torsten; Buchholz, Rainer; Horch, Raymund E; Präbst, Konstantin

    2016-11-04

    In the field of free flap transfer in reconstructive surgery, the trans- or replanted tissue always undergoes cell damage during ischemia to a more or less strong extent. In previous studies we already showed that conserving muscle transplants by means of extracorporeal perfusion over a period of 6 hours by using a crystalloid solution for perfusion. However, we observed significant edema formation. In this study we aimed at reducing the edema formation by using an iso-oncotic colloid as perfusion solution. This way we wanted to evaluate a possible new application of hydroxyl-ethyl starch in an extracorporeal setup to exploit potential benefits of the colloid.Examined parameters include the muscles' functionality with external field stimulation, histological examination and edema formation. Perfused muscles showed a statistically significant higher ability to exert force compared to nonperfused ones. These findings can be confirmed using Annexin V as marker for cell damage, as perfusion of muscle tissue limits damage significantly compared to nonperfused tissue. Substituting the electrolyte perfusion solution with a colloidal one shows the tendency to reduce the edema formation however without statistical significance.

  7. Klebsiella pneumoniae outer membrane protein A is required to prevent the activation of airway epithelial cells.

    Science.gov (United States)

    March, Catalina; Moranta, David; Regueiro, Verónica; Llobet, Enrique; Tomás, Anna; Garmendia, Junkal; Bengoechea, José A

    2011-03-25

    Outer membrane protein A (OmpA) is a class of proteins highly conserved among the Enterobacteriaceae family and throughout evolution. Klebsiella pneumoniae is a capsulated gram-negative pathogen. It is an important cause of community-acquired and nosocomial pneumonia. Evidence indicates that K. pneumoniae infections are characterized by a lack of an early inflammatory response. Data from our laboratory indicate that K. pneumoniae CPS helps to suppress the host inflammatory response. However, it is unknown whether K. pneumoniae employs additional factors to modulate host inflammatory responses. Here, we report that K. pneumoniae OmpA is important for immune evasion in vitro and in vivo. Infection of A549 and normal human bronchial cells with 52OmpA2, an ompA mutant, increased the levels of IL-8. 52145-Δwca(K2)ompA, which does not express CPS and ompA, induced the highest levels of IL-8. Both mutants could be complemented. In vivo, 52OmpA2 induced higher levels of tnfα, kc, and il6 than the wild type. ompA mutants activated NF-κB, and the phosphorylation of p38, p44/42, and JNK MAPKs and IL-8 induction was via NF-κB-dependent and p38- and p44/42-dependent pathways. 52OmpA2 engaged TLR2 and -4 to activate NF-κB, whereas 52145-Δwca(K2)ompA activated not only TLR2 and TLR4 but also NOD1. Finally, we demonstrate that the ompA mutant is attenuated in the pneumonia mouse model. The results of this study indicate that K. pneumoniae OmpA contributes to attenuate airway cell responses. This may facilitate pathogen survival in the hostile environment of the lung.

  8. 阜外医院10年间成人体外膜肺氧合支持治疗回顾:治疗策略及影响因素分析%Outcome of extracorporeal membrane oxygenation support for adult patients in Fuwai Hospital during the last 10 years: treatment strategy and risk factors

    Institute of Scientific and Technical Information of China (English)

    高国栋; 吕琳; 胡强; 胡金晓; 黑飞龙; 吉冰洋; 刘晋萍; 于坤; 龙村

    2015-01-01

    Objective To retrospectively review the clinical data of patients receiving extracorporeal membrane oxygenation (ECMO) during the last 10 years in Fuwai Hospital in order to assess the factors associated with the outcome of patients who had undergone ECMO,as well as to summarize the clinical experience,and to adopt a treatment strategy for future clinical decision.Methods The clinical data of adult patients undergoing ECMO admitted to Fuwai Hospital from December 2004 to December 2014 were retrospectively analyzed.Demographic characteristics,diagnosis,ECMO related data,including ECMO indication,operation,underg