ASAIO journal : a peer-reviewed journal of the American Society for Artificial Internal Organs
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Advances in medical science and, in particular, minimally invasive surgical and diagnostic procedures have stimulated the development of new and improved medical devices. This has been made possible because of developments in engineering and material sciences. The design of devices for reusability is particularly important in an effort to provide cost effective healthcare. ⋯ The user needs to balance cost versus convenience and reprocessing requirements for reusables. Current trends are to reuse more devices, including many of which were meant to be disposable. Cost effective designs can best be achieved when the user and manufacturer work together on the design.(ABSTRACT TRUNCATED AT 250 WORDS)
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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.