Perfusion
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Delays in initiating extracorporeal membrane oxygenation (ECMO) in the critically ill pediatric patient may lead to adverse outcomes. Maintaining a primed ECMO circuit can considerably reduce the initiation time. The predominant concerns precluding this practice are a decrease in oxygenator efficiency due to the saturation of microporous hollow fibers and compromised sterility when the oxygenator has been primed for 30 days. ⋯ After 6 hours of use, the average transfer values all decreased to 111.4+/-2.1 (@ 55% SvO2, p <0.05 versus control), 104.0+/-5.6 (@ 65% SvO2, p <0.05 versus control) and 88.4+/-3.2 (@ 75% SvO2, p <0.05 versus control). In conclusion, there was a decrease in the average oxygen transfer values for the test group after 6 hours versus the control. The modest loss of oxygen transfer ability observed can be considered acceptable due to the amount of surface area of the Minimax Plus oxygenator when used on a neonate, making it feasible to adopt the practice of prepriming the Minimax oxygenator for neonatal ECMO.
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Due to the short supply of donor organs available, many patients decompensate or die while waiting for transplantation. Options for mechanical support for infants and pediatrics with congenital heart disease are limited because of the patient's size and device availability. Extracorporeal membrane oxygenation (ECMO) is the most common means of cardiac and respiratory support for these patients. ⋯ Converting the ECMO circuit to an open cardiopulmonary bypass system in the OR minimizes the patient's exposure to new circuitry, decreases further donor exposures and provides continuous support for patients in cardiac and/or respiratory failure. In addition, the ability to use modified ultrafiltration post-bypass aids in reducing extracellular fluid, increasing the hematocrit and improving hemodynamic stability following an extended duration of ECMO and bypass support. The integrity of the ECMO circuit is maintained and can be converted back to ECMO for support postoperatively if needed.
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Comparative Study Clinical Trial
Comparison of hollow-fiber membrane oxygenators in terms of pressure drop of the membranes during normothermic and hypothermic cardiopulmonary bypass in neonates.
The objective of this study was to investigate the effects of two hollow-fiber membrane oxygenators, the Capiox SX10 and the Lilliput 901, on pressure drop of the membranes during normothermic and hypothermic cardiopulmonary bypass (CPB) in neonates. ⋯ These results suggest that the Capiox SX10 hollow-fiber membrane oxygenator produced significantly lower membrane pressure drops and pre- and post-oxygenator ECC during normothermic and hypothermic CPB. Thus, blood trauma with the Capiox during extracorporeal circulation may be significantly lower compared to the Lilliput. Further studies, including the level of complements, platelets, neutrophils and cytokines, with these oxygenators are warranted.
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Comparative Study
Performance of polymethyl pentene oxygenators for neonatal extracorporeal membrane oxygenation: a comparison with silicone membrane oxygenators.
To review the performance of polymethyl pentene versus silicone oxygenators in terms of efficiency in priming and oxygenation, oxygenator resistance, requirements for coagulation proteins and consumption of blood products, for neonatal extracorporeal membrane oxygenation (ECMO) patients. ⋯ Small PMP oxygenators (Medos Hilite 800 LT) provide adequate gas exchange and offer technical advantages in terms of more efficient priming, reduced haemodynamic resistance and better control and preservation of coagulation proteins than silicone oxygenators.
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To report a single case of oxygenator failure caused by clot embolism originating from the bladder; and to discuss some preventative options. ⋯ There is a need for improvement in the design of small oxygenators and ECMO circuits. Adjustment of the coagulation parameters and lowering the tolerance towards clots in the circuit by electively changing them may reduce the incidence of sudden unexpected oxygenator failure. However, using a slightly larger Medos oxygenator may gain valuable time needed to arrange an oxygenator/circuit change.