Journal of Extra-Corporeal Technology最新文献

{"title":"A Systematic Review with Meta-Analysis Investigating the Impact of Targeted Perfusion Parameters during Extracorporeal Cardiopulmonary Resuscitation in Out-of-Hospital and Inhospital Cardiac Arrest.","authors":"Lars Saemann,&nbsp;Sven Maier,&nbsp;Lisa Rösner,&nbsp;Matthias Kohl,&nbsp;Christine Schmucker,&nbsp;Christian Scherer,&nbsp;Georg Trummer,&nbsp;Friedhelm Beyersdorf,&nbsp;Christoph Benk","doi":"10.1182/ject-191-202","DOIUrl":"https://doi.org/10.1182/ject-191-202","url":null,"abstract":"<p><p>Evidence regarding perfusion conditions during extracorporeal cardiopulmonary resuscitation (ECPR) is rare. Therefore, we investigated the impact of perfusion parameters on neurologic outcome and survival in patients with in- or out-of-hospital cardiac arrest (IHCA; OHCA) treated with ECPR. We performed a systematic review with meta-analysis. The focus was set on perfusion parameters and their impact on survival and a goal neurological outcome using the cerebral performance category score of 1-2. We conducted random- and mixed-effects meta-analyses and computed pooled estimates and 95% confidence intervals (CI). We included a total of <i>n</i> = 1,282 ECPR (100%) patients from 20 ECPR studies. The target values of flow and mean arterial pressure (MAP) were frequently available. We transferred flow and MAP target values to high, medium, and low categories. The meta-analysis could not demonstrate a single effect of flow or MAP on outcome variables. In a second mixed-effects model, the combined occurrence of targeted flow and MAP as medium and high showed a significant effect on survival (OHCA: 52%, 95% CI: 29%, 74%; IHCA: 60%, 95% CI: 35%, 85%) and on neurological outcomes (OHCA: 53%, 95% CI: 27%, 78%; IHCA: 62%, 95% CI: 38%, 86%). Random-effects analysis showed also that IHCA led to a significant 11% (<i>p</i> = 0.006; 95% CI: 3%, 18%) improvement in survival and 12% (<i>p</i> = .005; 95% CI: 4%, 21%) improvement in neurological outcomes compared to OHCA. A combination of medium flow and high MAP showed advantages in survival and for neurological outcomes. We also identified improved outcomes for IHCA.</p>","PeriodicalId":39644,"journal":{"name":"Journal of Extra-Corporeal Technology","volume":"54 3","pages":"191-202"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9891490/pdf/ject-191-202.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10802979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mitochondrial ATP Synthase Tetramer Disassembly following Blood-Based or del Nido Cardioplegia during Neonatal Cardiac Surgery.","authors":"Bartholomew V Simon,&nbsp;Gisela Beutner,&nbsp;Michael F Swartz,&nbsp;Ron Angona,&nbsp;Karen Smith,&nbsp;George A Porter,&nbsp;George M Alfieris","doi":"10.1182/ject-203-211","DOIUrl":"https://doi.org/10.1182/ject-203-211","url":null,"abstract":"<p><p>Conservation of mitochondrial adenosine triphosphate (ATP) synthase proteins during ischemia is critical to preserve ATP supply and ventricular function. Following myocardial ischemia in adults, higher order ATP synthase tetramer proteins disassemble into simpler monomer units, reducing the efficiency of ATP production. However, it is unknown if myocardial ischemia following the use of cardioplegia results in tetramer disassembly in neonates, and whether it can be mitigated by cardioplegia if it does occur. We investigated myocardial ATP synthase tetramer disassembly in both a neonatal lamb cardiac surgery model and in neonatal children requiring cardiac surgery for the repair of congenital heart disease. Neonatal lambs (<i>Ovis aries</i>) were placed on cardiopulmonary bypass (CPB) and underwent cardioplegic arrest using a single dose of 30 mL/kg antegrade blood-based potassium cardioplegia (<i>n</i> = 4) or a single dose of 30 mL/kg antegrade del Nido cardioplegia (<i>n</i> = 6). Right ventricular biopsies were taken at baseline on CPB (<i>n</i> = 10) and after approximately 60 minutes of cardioplegic arrest before the cross clamp was released (<i>n</i> = 10). Human right ventricular biopsies (<i>n</i> = 3) were taken following 40.0 ± 23.1 minutes of ischemia after a single dose of antegrade blood-based cardioplegia. Protein complexes were separated on clear native gels and the tetramer to monomer ratio quantified. From the neonatal lamb model regardless of the cardioplegia strategy, the tetramer:monomer ratio decreased significantly during ischemia from baseline measurements (.6 ± .2 vs. .5 ± .1; <i>p</i> = .03). The del Nido solution better preserved the tetramer:monomer ratio when compared to the blood-based cardioplegia (Blood .4 ± .1 vs. del Nido .5 ± .1; <i>p</i> = .05). The tetramer:monomer ratio following the use of blood-based cardioplegia in humans aligned with the lamb data (tetramer:monomer .5 ± .2). These initial results suggest that despite cardioprotection, ischemia during neonatal cardiac surgery results in tetramer disassembly which may be limited when using the del Nido solution.</p>","PeriodicalId":39644,"journal":{"name":"Journal of Extra-Corporeal Technology","volume":"54 3","pages":"203-211"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9891487/pdf/ject-203-211.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10802981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Alterations in Pre/Post Oxygenator Flows Due to Fibrin Deposition in the CardioHelp System-A Case Report.","authors":"Tyler Wahl,&nbsp;Angela Stokes,&nbsp;Caleb Varner,&nbsp;Burak Zeybek,&nbsp;Amit Bardia","doi":"10.1182/ject-239-241","DOIUrl":"https://doi.org/10.1182/ject-239-241","url":null,"abstract":"<p><p>We present a 62-year-old patient with COVID-19 pneumonia on Veno-venous (VV) Extracorporeal Membrane Oxygenation (ECMO) with unique perturbations to pre and post oxygenator pressures due to fibrin deposition in despite being on a Heparin/Bivalirudin infusion and activated Partial Thromboplastin Time (aPTT) within therapeutic range of 60-80 seconds. On Day 8 of ECMO support, it was noticed that flows steadily decreased despite unchanged RPMs. Unlike typical blood flow to circuit pressure relationships, the circuit pressures did not correlate with the observed decreased flow. The Delta Pressure (Δ<i>P</i>) was not elevated. The patient's vitals were stable. On inspection post change-out, clots were noted in the oxygenator outlets. Oxygenator clots are usually associated with increased Δ<i>P</i>. In this scenario, clots in the oxygenator blocked 1 of the 4 outlets in the oxygenator causing the flow, pressures, and Δ<i>P</i> to drop consecutively. Due to reduced flow, the Δ<i>P</i> was not elevated despite extensive clots. The fibrin clot location in the CardioHelp ECMO circuit may lead to unexpected pressure and flow alterations. Sole reliance on Δ<i>P</i> as a marker for oxygenator clots may be misleading. Careful monitoring and timely diagnosis of coagulation status may lead to changes in anticoagulation goals and meaningfully impact patient outcomes.</p>","PeriodicalId":39644,"journal":{"name":"Journal of Extra-Corporeal Technology","volume":"54 3","pages":"239-241"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9891478/pdf/ject-239-241.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9532571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interprofessional Simulation in Cardiothoracic Surgery Improves Team Confidence.","authors":"HelenMari Merritt-Genore,&nbsp;Austin Adams,&nbsp;Ryan Zavala,&nbsp;Tara Brakke","doi":"10.1182/ject-250-254","DOIUrl":"https://doi.org/10.1182/ject-250-254","url":null,"abstract":"<p><p>Interest in simulation has grown substantially, as has enthusiasm for team-based approaches to surgical training. In cardiothoracic surgery, the dynamic ability of the entire team is critical to emergent events. We developed innovative, interprofessional simulation events to improve team confidence. Two separate simulations event replicating critical steps and potential crises of cardiopulmonary bypass (CPB) were attended by members of the multidisciplinary cardiothoracic team. Standard CPB equipment, echocardiography, an app to control vital signs, and typical operating room tools for cannulation were all used. Participant started at their typical roles, then rotated into unfamiliar roles for subsequent simulations. Survey and Likert scale self-assessment tools were used to determine outcomes. Statistical analysis compared results. Two separate events were attended by a total of 37 team members (17 facilitators and 20 participants). Participants rotated roles through 12 routine and high-risk scenarios for instituting and separating from CPB. Participant evaluation results were highly favorable, with requests for further similar events. Objectively, the mean score for self-assessment rose significantly comparing the pre- and post-simulation assessments. Despite a small sample size, these differences did reach statistical significance in two categories: iatrogenic dissection (<i>p</i> 0.008), and emergent return to CPB (<i>p</i> 0.016). In our experience, high-fidelity interprofessional simulation promoted team communication and confidence for key scenarios related to institution of and separation from CPB.</p>","PeriodicalId":39644,"journal":{"name":"Journal of Extra-Corporeal Technology","volume":"54 3","pages":"250-254"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9891484/pdf/ject-250-254.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10802982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Quick and Reliable Mental Formula to Calculate the BSA of a Patient.","authors":"Keith J Pelletier","doi":"10.1182/ject-255-256","DOIUrl":"https://doi.org/10.1182/ject-255-256","url":null,"abstract":"A patient’s body surface area (BSA) is used throughout healthcare settings, but it usually requires a calculator due to involvement of the calculations (1). The BSA is used for an array of purposes such as determining metabolic demand, medication dosages, sizes of mechanical replacement devices (e.g., cardiac valves), and blood perfusion flows for adequate blood flow during cardiac surgery (1). Much of the purposes for BSA are for quick medical treatments. For example, when a patient suffers cardiac arrest and needs emergent cardiopulmonary bypass (CPB) support to address the underlying causes of the cardiac arrest, the perfusionist must know the patient’s BSA so they can provide enough blood flow, delivering adequate oxygen supply to the patient. Much critical time before initiating CPB is used getting the heart–lung machine ready to initiate CPB. The perfusionist also needs to make sure they are ready with proper medications and disposable devices for CPB. Because of these requirements, the perfusionist does not usually have much downtime to take out a calculator to determine the BSA and find out what an adequate blood flow is required during CPB. After calculating BSA, the perfusionist can use a cardiac index (C.I.) between 1.8 and 2.4 L/min/m to multiply by the BSA to determine the required blood flow during CPB (2). Since this situation refers to emergent cardiac surgery, the perfusionist can simply use a C.I. of 2 L/min/m multiplied by the BSA to quickly reference what the average required CPB blood flow should be. Because this calculation is required, having quick access to an accurate BSA is a useful information when valuable time is not devoted to computing the BSA on a calculator.","PeriodicalId":39644,"journal":{"name":"Journal of Extra-Corporeal Technology","volume":"54 3","pages":"255-256"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9891482/pdf/ject-255-256.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9142672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Remowell II and Cytokine Adsorber; a Synergistic Strategy During Cardiopulmonary Bypass.","authors":"Ignazio Condello","doi":"10.1182/ject-257-257","DOIUrl":"https://doi.org/10.1182/ject-257-257","url":null,"abstract":"Cardiopulmonary bypass (CPB) is often associated with degrees of complex inflammatory response mediated by various cytokines. This response can, in severe cases, lead to systemic hypotension and organ dysfunction. Cytokine removal might therefore improve outcomes of patients undergoing cardiac surgery (1). A cytokine adsorber (HA380, Jafron) is expected to reduce the level of cytokines during CPB, which may decrease both intraoperative and postoperative inflammation. For adults Remowell II (Eurosets SPA, Medolla, Italy) device is the only oxygenator-integrated reservoir which combines two strategies: fat emboli and leukocytes removal; by filtration and supernatant elimination. We share our perfusion strategy to contain inflammatory response syndrome and the products of hemolysis in high risk fragile patients. This is achieved through the use of a dedicated device, the cytokine adsorber (HA380), in series with the new generation of venous reservoir (Remowell II, Eurosets SPA) (Figure 1). We hypothesize that the synergistic use of these two devices will show improvements in cytokine levels (IL-2, IL-6, TNF-a, IFN gamma) and secondary parameters (Fibrinogen, Albumin, Platelets, Hemoglobin, Hematocrit, White Blood Cells, Neutrophils, Lymphocytes, Monocytes, Eosinophils, Basophils) measured at anesthesia induction, end of CPB; as well as improvements in primary outcomes: hemodynamics with or without vasoconstrictors use, the mechanical ventilation time and length of stay in intensive care unit. For this reason, we are carrying out a controlled randomized prospective study: “Jafron Haemoadsorption During Cardiopulmonary Bypass (JAFRONCPB),” to evaluate the use of this approach and their impact on inflammation and patient outcome (2). We hope to share and publish the full data in a study as soon as possible.","PeriodicalId":39644,"journal":{"name":"Journal of Extra-Corporeal Technology","volume":"54 3","pages":"257"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9891483/pdf/ject-257-257.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9142675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"COVID-19 and Blood Clots: A Report of Massive Pulmonary Embolism in COVID-19 Patient Supported on Veno-Venous ECMO and the Utility of Thrombolysis.","authors":"Bindu Akkanti,&nbsp;Joseph Zwischenberger,&nbsp;Mark T Warner,&nbsp;Kha Dinh,&nbsp;Rahat Hussain,&nbsp;Farah Kazzaz,&nbsp;Pascal Kingah,&nbsp;Lisa M Janowiak,&nbsp;Biswajit Kar,&nbsp;Igor D Gregoric","doi":"10.1182/ject-235-238","DOIUrl":"https://doi.org/10.1182/ject-235-238","url":null,"abstract":"<p><p>COVID-19 morbidity and mortality are not equivalent to other etiologies of acute respiratory distress syndrome (ARDS) as fulminant activation of coagulation can occur, thereby resulting in widespread microvascular thrombosis and consumption of coagulation factors. A 53-year-old female presented to an emergency center on two occasions with progressive gastrointestinal and respiratory symptoms. She was diagnosed with COVID-19 pneumonia and admitted to a satellite intensive care unit with hypoxemic respiratory failure. She was intubated and mechanically ventilated, but her ARDS progressed over the next 48 hours. The patient was emergently cannulated for veno-venous extracorporeal membrane oxygenation (V-V ECMO) and transferred to our hospital. She was in profound shock requiring multiple vasopressors for hemodynamic support with worsening clinical status on arrival. On bedside echocardiography, she was found to have a massive pulmonary embolism with clot-in-transit visualized in the right atrium and right ventricular outflow tract. After a multidisciplinary discussion, systemic thrombolytic therapy was administered. The patient's hemodynamics improved and vasopressors were discontinued. This case illustrates the utility of bedside echocardiography in shock determination, the need for continued vigilance in the systematic evaluation of unstable patients in the intensive care unit, and the use of systemic thrombolytics during V-V ECMO in a novel disease process with evolving understanding.</p>","PeriodicalId":39644,"journal":{"name":"Journal of Extra-Corporeal Technology","volume":"54 3","pages":"235-238"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9891489/pdf/ject-235-238.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10802980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Overt Disseminated Intravascular Coagulation with Severe Hypofibrinogenemia During Veno-Venous Extracorporeal Membrane Oxygenation.","authors":"Stephen Yang,&nbsp;Brittney Williams,&nbsp;David Kaczorowski,&nbsp;Michael Mazzeffi","doi":"10.1182/ject-148-152","DOIUrl":"https://doi.org/10.1182/ject-148-152","url":null,"abstract":"<p><p>Disseminated intravascular coagulation (DIC) is a life-threatening hematologic derangement characterized by dysregulated thrombin generation and excessive fibrinolysis. However, DIC is poorly characterized in the extracorporeal membrane oxygenation (ECMO) population, and the underlying mechanisms are not well understood. Several mechanisms contribute to DIC in ECMO, including consumption of coagulation factors, acquired von Willebrand's syndrome leading to thrombocytopenia, and hyperfibrinolysis. There are few case reports of DIC in adult ECMO patients. Most are in the context of venoarterial ECMO, which is typically used in the setting of cardiogenic shock and cardiac arrest. These disease states themselves are known to be associated with DIC, liver failure, impaired anticoagulant mechanisms, and increased fibrinolysis. We present an unusual case of a 74-year-old man who developed overt DIC during veno-venous (VV) ECMO. DIC resulted in clinical bleeding and severe hypofibrinogenemia requiring massive cryoprecipitate transfusion of 87 pooled units. When the patient was decannulated from ECMO, his platelet count and fibrinogen concentration improved within 24 hours, suggesting that ECMO was a proximate cause of his DIC.</p>","PeriodicalId":39644,"journal":{"name":"Journal of Extra-Corporeal Technology","volume":"54 2","pages":"148-152"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9302396/pdf/ject-148-152.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9630641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of the Cardioplegia Interval on Myocardial Protection Using the Modified St. Thomas Solution in Minimally Invasive Mitral Valve Surgery: A Double-Center Study.","authors":"Kohei Nagashima,&nbsp;Takafumi Inoue,&nbsp;Hiroshi Nakanaga,&nbsp;Shigefumi Matsuyama,&nbsp;Eiichi Geshi,&nbsp;Minoru Tabata","doi":"10.1182/ject-135-141","DOIUrl":"https://doi.org/10.1182/ject-135-141","url":null,"abstract":"<p><p>It has been reported that a single-dose cardioplegia interval is useful, but the safe interval doses are not clear. We aimed to investigate the impact of the cardioplegia interval on myocardial protection using the modified St. Thomas solution. We included consecutive isolated minimally invasive mitral valvuloplasty procedures (<i>n</i> = 229) performed at a hospital and medical center from January 2014 to December 2020. We compared postoperative peak creatine kinase MB and creatine kinase levels and other indicators between the short (Group S, <i>n</i> = 135; maximum myocardial protection interval <60 minutes) and long (Group L, <i>n</i> = 94; maximum myocardial protection interval ≥60 minutes) interval groups. Propensity score matching was used to adjust for confounders between the two groups. After propensity score matching, Groups S and L contained 47 patients each. Groups S and L did not differ significantly in peak creatine kinase MB (45.8 ± 26.3 IU/L and 41.5 ± 27.9 IU/L, respectively; <i>p</i> = .441) and creatine kinase levels (1,133 ± 567 IU/L and 1,100 ± 916 IU/L, respectively; <i>p</i> = .837) after admission to the intensive care unit on the day of surgery based on propensity score matching. In multivariate analysis, a cardioplegia dosing interval ≥60 minutes was not significantly associated with the maximum creatine kinase MB level after admission to the intensive care unit on the day of surgery (<i>p</i> = .354; 95% confidence interval: -1.67 to 4.65). Using the antegrade modified St. Thomas solution, the long interval dose method is useful and safe in minimally invasive mitral valvuloplasty.</p>","PeriodicalId":39644,"journal":{"name":"Journal of Extra-Corporeal Technology","volume":" ","pages":"135-141"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9302395/pdf/ject-135-141.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40585051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nitric Oxide on Extracorporeal Life Support-Circuit Modifications for a Safe Therapy.","authors":"Carlisle O'Meara,&nbsp;Joseph Timpa,&nbsp;Giles Peek,&nbsp;Melissa Sindelar,&nbsp;Jenny Ross,&nbsp;Justin Raper,&nbsp;Jonathan W Byrnes","doi":"10.1182/ject-142-147","DOIUrl":"https://doi.org/10.1182/ject-142-147","url":null,"abstract":"<p><p>Nitric oxide (NO) incorporation into the sweep gas of the extracorporeal life support (ECLS) circuit has been proposed as a strategy to ameliorate the insults caused by the systemic inflammatory response. This technical study describes circuit modifications allowing nitric oxide to be incorporated into the circuit and describing and validating the oxygenator sweep flow rates necessary to achieve consistent safe delivery of the therapy. For patients requiring sweep rates less than 2 L/min, a simplified setup, incorporating a pressure relief valve/low flow meter in the gas delivery line, was placed in line between the blender/NO injector module and the NO sampling port/oxygenator. This setup allows titration of sweep to low flows without the need to blend in CO₂ while maintaining the manufacturer recommendation of a minimum 2 L/min of sweep gas to safely deliver NO without nitric dioxide (NO₂) buildup. This setup was tested three times at three different FiO₂ rates and eleven different desired low sweep flows to test for reproducibility and safety to build an easy-to-follow chart for making gas flow changes. For patients requiring oxygenator sweep rates greater than 2 L/min, the pressure relief valve/low flow meter apparatus is not needed. Maintaining consistent sweep rate and nitric oxide delivery is required in order to utilize this therapy in ECLS. We demonstrated gas delivery across all flow rates. There were no issues delivering 20 parts per million of NO and negligible NO₂ detection. The results from testing this setup were used to provide the specialist a chart at which to set the low flow meter to produce the desired flow rate at which the patient needs. This has been used clinically on 15 ECLS patients with success.</p>","PeriodicalId":39644,"journal":{"name":"Journal of Extra-Corporeal Technology","volume":" ","pages":"142-147"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9302404/pdf/ject-142-147.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40585056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}