ASAIO journal : a peer-reviewed journal of the American Society for Artificial Internal Organs
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The authors evaluated the efficacy of treatment by extracorporeal perfusion on experimental canine septic shock. Canine septic shock was produced by intravenous infusion of Escherichia coli endotoxin and treated by three techniques: no treatment (Sham), hemoperfusion over Polymyxin B immobilized fiber (PMX), and plasma perfusion over anion exchange resin (Resin). The 24 hr survival rates of the Sham, PMX, and Resin groups were 0%, 80%, and 40%, respectively. ⋯ In addition, blood endotoxin levels in the PMX group were significantly lower, resulting in a significant suppression of TNF release. In the Resin group, some parameters were significantly better than those of the Sham group, but the efficacy of this treatment was less than that of the PMX treatment. Hemoperfusion over Polymyxin B immobilized fibers can detoxify circulatory endotoxin, resulting in improvement of systemic and organic disorders caused by sepsis.
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Patients with aortic arch aneurysms underwent surgery using a selective cerebral perfusion (SCP) method. For this purpose, a protocol for SCP was established on the basis of an animal experimental study. Our SCP procedure is performed at a perfusion rate of 6 ml/kg/min with the patient under deep hypothermia at 20 degrees C. ⋯ There was no definite production of lactate in the brain. Cerebral disorders considered to have been caused by SCP occurred in only two cases. It appears that cerebral metabolism can be maintained safely, and that our SCP method is useful during surgery for aortic arch aneurysms.
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The effects of intraaortic balloon pumping (IABP) on portal venous flow were assessed using color Doppler echography. A total of 23 heart failure patients treated with IABP were assessed. Balloon inflation was timed to occur with every other cardiac contraction. ⋯ The velocities measured with IABP ON were larger than or equal to those with IABP OFF in all cases, however, except one. Thus, Vmax (22 +/- 8 cm/sec) and Vmean (17 +/- 6 cm/sec) with IABP ON were significantly larger (p 0.01) than those with IABP OFF (20 +/- 7 cm/sec and 16 +/- 6 cm/sec, respectively). The flow pattern of the portal vein was characteristically pulsatile either with IABP ON or OFF in most cases.
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Extracorporeal membrane oxygenation (ECMO) can provide univentricular or biventricular cardiac, as well as respiratory, support; it has extended the application of ECMO to infants and children who develop refractory cardiogenic shock before or after repair of congenital heart defects. The Pediatric Cardiac ECMO Registry, recently established by the Extracorporeal Life Support Organization, reports an overall survival rate of 47%. ⋯ Hemorrhage remains the most common complication of ECMO. The future of ECMO for cardiac support depends on development of methods to prevent cardiac failure, improved ECMO techniques, and increased pediatric cardiac transplantation.
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The implantable pump field is now more than 20 years old. The original goal of developing a totally artificial beta-cell remains unrealized, but programmable insulin pumps that contain all of the elements of the artificial beta-cell except the glucose sensor are involved in clinical trials in the United States and are commercially available in Europe. ⋯ Only a few of the potential applications of implantable pumps have been developed to the stage of commercial availability. This is, in part, because drug companies have traditionally developed parenteral drug applications only as a last resort and, in part, because of the complexity of the regulatory process for implantable pumps, often requiring review by both the drug and device branches of the Food and Drug Administration.