Cardiopulmonary Support System Research Articles

Pushing the Survival Bar Higher: Two Decades of Innovation in Lung Transplantation.

Survival after lung transplantation has significantly improved during the last two decades. The refinement of the already existing extracorporeal life support (ECLS) systems, such as extracorporeal membrane oxygenation (ECMO), and the introduction of new techniques for donor lung optimization, such as ex vivo lung perfusion (EVLP), have allowed the extension of transplant indication to patients with end-stage lung failure after acute respiratory distress syndrome (ARDS) and the expansion of the donor organ pool, due to the better evaluation and optimization of extended-criteria donor (ECD) lungs and of donors after circulatory death (DCD). The close monitoring of anti-HLA donor-specific antibodies (DSAs) has allowed the early recognition of pulmonary antibody-mediated rejection (AMR), which requires a completely different treatment and has a worse prognosis than acute cellular rejection (ACR). As such, the standardization of patient selection and post-transplant management has significantly contributed to this positive trend, especially at high-volume centers. This review focuses on lung transplantation after ARDS, on the role of EVLP in lung donor expansion, on ECMO as a principal cardiopulmonary support system in lung transplantation, and on the diagnosis and therapy of pulmonary AMR.

Significance of a Simulation for the Relocation of an Intensive Care Unit.

There have been few reports concerning simulation drills for the relocation of severely ill or injured patients treated in intensive care units (ICUs). We herein report our experience of one such simulation drill. It is a Narrative method. A simulation drill was performed on a weekday 2 weeks prior to the actual relocation. We selected 3 mock patients. The first one was a severely ill and unstable patient, the second had severe stroke, and the third had severe trauma. After the simulation, the average transportation time was 15minutes. The simulation revealed that mock patients with a percutaneous cardiopulmonary support system and intra-aortic balloon pumping in a standard ICU bed could not be accommodated in the elevator. Furthermore, working the elevator controls resulted in wasted time while transferring the patients. As a result, the number of people, who controlled the elevator, was therefore increased during the actual relocation. During the actual relocation, all patients were transported safely and more quickly than predicted based on the results of the simulation drill. Most physicians and paramedical staff have little experience with relocating ICUs, so a simulation drill was necessary to ensure the safe and prompt transport of patients.

Novel hybrid total artificial heart with integrated oxygenator.

There continues to be an unmet therapeutic need for an alternative treatment strategy for respiratory distress and lung disease. We are developing a portable cardiopulmonary support system that integrates an implantable oxygenator with a hybrid, dual-support, continuous-flow total artificial heart (TAH). The TAH has a centrifugal flow pump that is rotating about an axial flow pump. By attaching the hollow fiber bundle of the oxygenator to the base of the TAH, we establish a new cardiopulmonary support technology that permits a patient to be ambulatory during usage. In this study, we investigated the design and improvement of the blood flow pathway from the inflow-to-outflow of four oxygenators using a mathematical model and computational fluid dynamics (CFD). Pressure loss and gas transport through diffusion were examined to assess oxygenator design. The oxygenator designs led to a resistance-driven pressure loss range of less than 35 mmHg for flow rates of 1-7 L/min. All of the designs met requirements. The configuration having an outside-to-inside blood flow direction was found to have higher oxygen transport. Based on this advantageous flow direction, two designs (Model 1 and 3) were then integrated with the axial-flow impeller of the TAH for simulation. Flow rates of 1-7 L/min and speeds of 10,000-16,000 RPM were analyzed. Blood damage studies were performed, and Model 1 demonstrated the lowest potential for hemolysis. Future work will focus on developing and testing a physical prototype for integration into the new cardiopulmonary assist system.

Extracorporeal membrane oxygenation and paracorporeal lung assist devices as a bridge to pediatric lung transplantation.

"Bridging" is a term used to describe the implementation of various treatment modalities to improve waitlist survival while a patient awaits lung transplantation. ECMO and PLAD are technologies used to bridge patients to lung transplantation. ECMO and PLAD are cardiopulmonary support systems that help move blood forward while using an artificial membrane to remove CO2 from and add O2 to the blood. Recent studies showed that these technologies are increasingly effective in bridging patients to lung transplantation, especially with optimizing patient selection, implementing physical rehabilitation and ambulation goals, standardization of management decisions, and increasing staff experience, among other considerations. We review these technologies, their roles as bridges to pediatric lung transplantation, as well as indications, contraindications, complications, and mortality rates. Finally, we discuss the existing knowledge gaps and areas for future research to improve patient outcomes and understanding of lung assist devices.

A Post Market Surveillance Study of the Hemovent Extracorporeal Cardiopulmonary Support System of Cardiac and Respiratory Support: The MOBYBOX Trial

A Post Market Surveillance Study of the Hemovent Extracorporeal Cardiopulmonary Support System of Cardiac and Respiratory Support: The MOBYBOX Trial

489. Risk Factors for Mortality in Patients with Elizabethkingia and Clinical Impact of Antimicrobial Susceptibility Patterns

Background Elizabethkingia spp. is a non-fermenting, non-motile, oxidase-positive gram-negative aerobic bacilli that is ubiquitous in the environment, found in freshwater, saltwater and soil. Nowadays, they are emerging as nosocomial pathogens. In this study, we analyzed Elizabethkingia spp infected cases clinically and microbiologically.MethodsThis study was performed to evaluate the risk factors for mortality and to study the impact of microbiologic response on clinical outcomes in patient with Elizabethkingia spp Data on 210 patient of Elizabethkingia pneumonia and bacteremia that have occurred between November 1, 2005, and May 31, 2016, in a teaching hospital (2000 beds) in Seoul, Korea, were analyzed. Furthermore, antimicrobial susceptibility testing of Elizabethkingia from sputum and blood cultures was performed by E test for rifampin, moxifloxacin and vancomycin.ResultsAmong 210 patients, there were 157(74.8%) survivor and 53(25.2%) non-survivor. Among these patients, 129 patients (61.4%) were male and the median age was 66.5 years. There were no significant differences in the Charlson comorbidity index between survivor and non-survivor groups (P = 0.413). In the multivariate logistic regression, microbiologic failure (odds ratio [OR], 7.862; 95% confidence interval [CI], 3.448–17.931; pElizabethkingia infection (OR, 1.032; 95% CI, 1.013–1.051; P = 0.001), previous use of immunosuppressants (OR, 3.309; 95% CI, 1.334–8.210; P = 0.010), and Percutaneous cardiopulmonary support system use at the time of Elizabethkingia infection (OR, 7.439; 95% CI,1.180–46.900; P = 0.033) were significantly associated with 28day mortality. Patients with moxifloxacin-resistant and vancomycin-resistant showed higher mortality rate but no statistically significant difference.ConclusionThe early identification of these clinical factors in patients with Elizabethkingia infection is important to improve prognosisDisclosures All authors: No reported disclosures.

A Development of Agility Mode in Cardiopulmonary Resuscitation Learning Support System Visualized by Augmented Reality

A Development of Agility Mode in Cardiopulmonary Resuscitation Learning Support System Visualized by Augmented Reality

The role of cardiopulmonary support system for transcatheter valve therapy

The role of cardiopulmonary support system for transcatheter valve therapy

Extubation in patients undergoing extracorporeal life support.

Extracorporeal life support (ECLS) is a cardiopulmonary support system used for the treatment of severe cardiac and/or respiratory failure. Mortality is high partly because of the severity of the condition that requires support. The use of ECLS is generally associated with heavy sedation. The aim of this study was to demonstrate the feasibility of stopping sedation, allowing extubation of patients supported by ECLS. 196 patients supported by ECLS for a period of 4 years were included. Sedation was stopped as soon as possible to allow extubation. The 44 extubated patients were compared with non-extubated patients. Finally, 24% of patients were not extubated without a determined cause and were compared with extubated patients. The extubated patients had a lower incidence of ventilator-associated pneumonia. In a multivariate analysis, the independent risk factors for death were the duration of ECLS, age and lack of extubation. Stopping sedation and extubation are feasible in selected patients under ECLS. This strategy could be a survival factor.

PCPS (経皮的心肺補助装置)により安全にステント留置できた症例

PCPS (経皮的心肺補助装置)により安全にステント留置できた症例

A case of fulminant myocarditis treated with very long-term support by cardiopulmonary support system

Fulminant myocarditis (FM) sometimes causes severe left ventricular dysfunction and lethal arrhythmias leading to cardiogenic shock and critical conditions. Thus, mechanical circulation support with intra-aortic balloon pumping and/or a cardiopulmonary support system (CPS) is sometimes needed to save lives. The special recommended therapies for FM for that classified as class I (evidence level C) in the guidelines of the Japanese Circulation Society are intra-aortic balloon pumping, CPS, percutaneous cardiac pacing, and a left ventricular assist device (LVAD), and they are well established in evidence-based medicine. We experienced a case of FM that we were able to save by long-term stable CPS support. Because, unfortunately, the LVAD was not commercially available in Japan at that time, intensive treatments including CPS were continued in our hospital. Finally, a good course of the illness was achieved without any adverse complications. Thus, these intensive treatments in the present case may be one of the optional effective strategies for FM, especially in hospitals and/or countries where the LVAD is not (commercially) available, and when an LVAD may not be suitable because of complications associated with infectious disease.<Learning objective: Intensive treatment including cardiopulmonary support system as in this case may be one of the optional effective strategies for fulminant myocarditis, especially in hospitals and/or countries where left ventricular assist devices (LVAD) are not (commercially) available, and when an LVAD may not be suitable because of complications associated with infectious disease.>

Improvement of Two-Stage Centrifugal Blood Pump for Cardiopulmonary Support System and Evaluation of Anti-Hemolysis Performance

Abstract In cardiopulmonary support systems with a membrane oxygenation such as a percutaneous cardiopulmonary support (PCPS) or an extracorporeal membrane oxygenation (ECMO), blood pumps need to generate the pressure rise of approximately 200mmHg or higher, due to the high hydraulic resistances of the membrane oxygenation and of the cannula tubing. In order to realize the blood pump with higher pressure rise, higher anti-hemolysis and thrombosis performances, the development of novel centrifugal blood pump composed of two-stage has been conducted by the authors. In the present paper, effective attempts to decrease the wall shear stress and to suppress the stagnation are introduced for the prevention of hemolysis and thrombosis in blood pumps. The hemolysis test was also carried out and it was clarified that the decrease of wall shear stress is effective as a guideline of design of blood pumps for improving the anti-hemolysis performance. Keywords: Centrifugal Pump, Artificial Heart, Blood, Hemolysis, Thrombosis

A patient with catastrophic shock by grown left arterial myxoma which prolapses into left ventricle across the mitral valve was successfully survivor by application of percutaneus cardiopulmonary support system

A patient with catastrophic shock by grown left arterial myxoma which prolapses into left ventricle across the mitral valve was successfully survivor by application of percutaneus cardiopulmonary support system

Study on the Development of Two-Stage Centrifugal Blood Pump for Cardiopulmonary Support System

【In the cardiopulmonary support system with an ECMO (extracorporeal membrane oxygenation), a higher pump head is demanded for a blood pump. In order to realize a blood pump with higher pump head, higher anti-hemolysis and thrombosis performances, a study on the development of unprecedented multistage blood pump was conducted. In consideration of the application of the blood pump for pediatric patients, a miniature two-stage centrifugal blood pump with the impeller's diameter of 40mm was designed and the performance was examined in experiments and computations. Some useful knowledge for a design of the blood pump with higher anti-hemolysis and thrombosis performances was obtained.】

経皮的心肺補助法(PCPS)合併症を含めた，全身管理に苦慮した劇症型心筋炎の1例

経皮的心肺補助法(PCPS)合併症を含めた，全身管理に苦慮した劇症型心筋炎の1例

Application of percutaneous cardiopulmonary support system in critically ill patients

To summarize the experiences of percutaneous cardiopulmonary support system (PCPS) for critically ill patients and examine the risk factors associated with prognosis. The clinical data of 22 patients with acute severe cardiorespiratory failure on PCPS at intensive care unit of Zhejiang Provincial People's Hospital from September 2006 to February 2013 were retrospectively collected and analyzed. According to the prognosis, they were divided into the survival and mortality groups. And their risk factors of prognosis were analyzed. The PCPS support time was 2-334 (75 ± 10) hours, 14 cases (63.6%) were successfully weaned and 12 cases (54.6%) discharged. The inter-group differences of blood lactic acid level before PCPS, heart ejection fraction, sequential organ failure assessment (SOFA) score and number of multiple organ failure (> 3) were statistically significant (P < 0.05). PCPS is an effective approach for severe acute patients with cardiopulmonary failure. And blood lactic acid level before PCPS, heart ejection fraction, SOFA score and number of multiple organ failure (>3) may be the risk factors related with prognosis.

Brachial Plexus Injury Associated With Extracorporeal Membrane Oxygenation

Extracorporeal membrane oxygenation (ECMO) is a cardiopulmonary support system. We present 2 patients of ECMO-related brachial plexus injury. Patients were selected from a registry of 154 patients treated with ECMO from January 2002 to September 2011. Five patients had unilateral arm weakness after the initiation of ECMO therapy. There was no neurological examination or electrophysiological testing data available for 3 patients. Diagnosis of brachial plexus injury was confirmed in 2 patients, one based on neurological examination and one based on electrophysiological testing. Axillary artery cannulation resulting in hematoma formation was identified as a probable risk factor for brachial plexus injury in our 2 patients.

臨床 急性心筋梗塞における大動脈内バルンパンピング(IABP)無効の心原性ショックの病態とこれに対する経皮的心肺補助法(PCPS)の有用性ならびに問題点

臨床 急性心筋梗塞における大動脈内バルンパンピング(IABP)無効の心原性ショックの病態とこれに対する経皮的心肺補助法(PCPS)の有用性ならびに問題点

The challenges in the management of right ventricular infarction

In recent years, right ventricular (RV) infarction seems to be underdiagnosed in most cases of acute myocardial ischaemia despite its frequent association with inferior-wall and, occasionally, anterior-wall myocardial infarction (MI). However, its initial management is drastically different from that of left ventricular MI, and studies have indicated that RV infarction remains associated with significant morbidity and mortality, even in the mechanical reperfusion era. The pathophysiology of RV infarction involves the interaction between the right and left ventricle (LV), and the mechanism has been clarified with the advent of diagnostic non-invasive modalities, such as echocardiography and cardiac magnetic resonance. In recent years, considerable progress has been made in the treatment of RV infarction; early revascularization remains the cornerstone of the management, and fluid resuscitation, with appropriate target selection, is necessary to maintain appropriate preload. Early recognition in intensive care with clear understanding of the pathophysiology is essential to improve its prognosis. In terms of management, the support strategy for RV dysfunction is different from that for LV dysfunction since the former may often be temporary. Along with early reperfusion, maintenance of an adequate heart rate and atrioventricular synchrony are essential to sustain a sufficient cardiac output in patients with RV infarction. In refractory cases, more intensive mechanical support is required, and new therapeutic options, such as Tandem-Heart or percutaneous cardiopulmonary support systems, are being developed.

Prompt institution of percutaneous cardiopulmonary support managed perioperative refractory vascular spasm after isolated coronary artery bypass grafting surgery

A 51-year-old Japanese male underwent on-pump coronary artery bypass grafting surgery. After weaning from cardiopulmonary bypass (348min), sudden bradycardia and hypotension occurred, followed by ventricular fibrillation. Although defibrillation and infusion of catecholamine restored sinus rhythm, transesophageal echocardiography demonstrated severely reduced contraction of both ventricles, and perioperative vascular spasm was suspected. As vascular spasm was refractory to medications, percutaneous cardiopulmonary support (PCPS) system was quickly instituted under cardiac massage. Coronary angiography revealed vascular spasm of not only the native coronary arteries but also the implanted left internal thoracic artery. After 3days of full hemodynamic assist, PCPS was withdrawn with no obvious abnormalities in regional wall motion by transesophageal echocardiography. The patient was extubated on postoperative day 6 with no impaired brain function. In this case, the immediate diagnosis of refractory vascular spasm by transesophageal echocardiography and full cardiocirculatory assistance by PCPS helped to save the life of the patient.