Extracorporeal Circulation Technology Research Articles

Comparative effects of off-pump and multiple cardiopulmonary bypass strategies in coronary artery bypass grafting surgery: protocol for a systematic review and network meta-analysis

IntroductionMultiple revascularisation strategies with or without cardiac arrest have been developed to minimise the negative effects of cardiopulmonary bypass interventions during coronary artery bypass grafting (CABG) surgery. Several observational and...

Lung transplantation following donation after circulatory death

• Lung transplantation, a potentially life-saving therapy, remains significantly limited due to donor organ availability. • Donation after Circulatory Death (DCD) is a promising clinical endeavor that may increase the donor pool for viable organs with successful post-transplant outcomes. • The clinical setting and circumstances surrounding DCD are important in successful recovery. • Controlled DCD lung transplantation has success rates similar to lung transplantation following Donation after Brain Death (DBD). • The evolving application of extracorporeal circulation technology, both the ex vivo lung perfusion (EVLP) modality as well as the more recent thoracoabdominal normothermic regional perfusion (TA-NRP), could have a leading role in the optimization of DCD transplants soon.

The impact of circulation in a heart-lung machine on function and survival characteristics of red blood cells.

Extracorporeal circulation is accompanied by changes in red blood cell morphology and structural integrity that affect cell function and survival, and thereby may contribute to the various side effects of heart–lung machine‐assisted surgery. Our main objectives were to determine the effect of circulation of red blood cells in a stand‐alone extracorporeal circuit on several parameters that are known to be affected by, as well as contribute to red blood cell aging. As a source of RBCs, we employed blood bank storage units of different ages. In order to assess the relevance of our in vitro observations for the characterization of extracorporal circulation technology, we compared these changes in those of patients undergoing extracorporeal circulation‐assisted cardiac surgery. Our results show that circulation in a heart–lung machine is accompanied by changes in red blood cell volume, an increase in osmotic fragility, changes in deformability and aggregation behavior, and alterations in the exposure of phosphatidylserine and in microvesicle generation. RBCs from 1‐week‐old concentrates showed the highest similarities with the in vivo situation. These changes in key characteristics of the red blood cell aging process likely increase the susceptibility of red blood cells to the various mechanical, osmotic, and immunological stress conditions encountered during and after surgery in the patient’s circulation, and thereby contribute to the side effects of surgery. Thus, aging‐related parameters in red blood cell structure and function provide a foundation for the validation and improvement of extracorporeal circulation technology.

Pathophysiology and Complications during Extracorporeal Circulation.

Extracorporeal circulation, unlike pulsatile flow based on the beating heart, is the non-pulsatile flow through a blood pump, and the systemic circulation falls into non-physiological conditions. The living body shows various reactions to extracorporeal circulation. The pathophysiology of extracorporeal circulation includes changes in hemodynamics, coagulation, fibrinolysis, acid-base equilibrium, electrolytes, incretion, metabolism, and immune system. With advances in extracorporeal circulation technology, operability has been dramatically improved and safety has rapidly advanced as well. However, there are specific complications with extracorporeal circulation. We need to have a good knowledge of the pathophysiology and complications during extracorporeal circulation, as well as each component of the extracorporeal circulation system.

Из истории экспериментальной и клинической биомедицины: У. Гарвей, С. С. Брюхоненко, В. П. Демихов, К. Барнард

<p class="Default">Статья представляет собой философско-методологический анализ революционных этапов развития биомедицины XVII–XX вв. Показан приоритет отечественной науки в создании технологии искусственного кровообращения и трансплантации органов.</p>

Extending normothermic regional perfusion to the thorax in donors after circulatory death.

Despite a significant increase in the utilization of donors after circulatory death (DCD), the number of organs recovered and their function are largely inferior to those from donors after brain death. This review summarizes recent advances in in-situ normothermic regional perfusion of DCD organs prior to procurement. The combination of warm and cold ischemia in DCD donation are detrimental to organ function. As a consequence, the acceptance criteria are far more restrictive and many organs are discarded.The application of extracorporeal circulation technology to DCD organ retrieval in the form of abdominal normothermic regional perfusion (NRP) made a significant impact on organ procurement. DCD heart transplantation has been made possible by technological developments of ex-situ preservation. Extending NRP to include cardio-thoracic organs is a recent development enabling conversion from a DCD to a donor after brain death-type procurement.NRP offers the opportunity for a dynamic assessment of function and may lead to expansion of acceptance criteria as well as allowing for early interventions to modulate organ function. Thoraco-abdominal NRP may become the new gold standard for DCD organ retrieval. Further research and education are required to streamline logistics, define organ function markers and increase acceptance and utilization.

Use of minimal invasive extracorporeal circulation in cardiac surgery: principles, definitions and potential benefits. A position paper from the Minimal invasive Extra-Corporeal Technologies international Society (MiECTiS).

Minimal invasive extracorporeal circulation (MiECC) systems have initiated important efforts within science and technology to further improve the biocompatibility of cardiopulmonary bypass components to minimize the adverse effects and improve end-organ protection. The Minimal invasive Extra-Corporeal Technologies international Society was founded to create an international forum for the exchange of ideas on clinical application and research of minimal invasive extracorporeal circulation technology. The present work is a consensus document developed to standardize the terminology and the definition of minimal invasive extracorporeal circulation technology as well as to provide recommendations for the clinical practice. The goal of this manuscript is to promote the use of MiECC systems into clinical practice as a multidisciplinary strategy involving cardiac surgeons, anaesthesiologists and perfusionists.

Minimal invasive Extra-Corporeal Circulation (MiECC): a revolutionary evolution in perfusion.

Since the beginning of extracorporeal circulation (ECC) in cardiac surgery, a multitude of changes and improvements were aimed to reduce the adverse systemic effects caused by the artificial surfaces of the perfusion circuit. The clinical picture is similar to a systemic inflammatory response syndrome [1]. The magnitude of the inflammatory response adversely influences clinical outcomes [2]. Hence, the overall morbidity associated with cardiac surgery is substantial [3]. The off-pump coronary artery bypass (OPCAB) technique was introduced as a strategy to decrease the side effects of cardiopulmonary bypass (CPB). But the real advantages of OPCAB have been questioned in recent years [4]. In the early 2000s, a simplified perfusion system comprising all technological advancements was designed [5]. The modifications of the new system were much more revolutionary than the individual improvements to the existing conventional CPB circuits. The idea was to create a system including all established benefits in one CPB set-up. The Minimal Extra-Corporeal Circulation (MiECC) technology was born. Since then, MiECC systems have been developed to increase the technical ease of on-pump surgery while tempering its disadvantages. For many years, cardiac surgeons, anaesthesiologists and perfusionists considered MiECC systems as a miniaturization or simplification of traditional CPB only. MiECC significantly attenuated morbidity attributed to conventional ECC, as for beatingheart procedures, while permitting optimal technical surgical conditions [6]. ‘The authors believe that MiECC technology represents more than a miniaturization process: it is a major step forward and a totally new philosophy to be integrated in contemporary cardiac surgery’. The idea of MiECC systems has initiated new efforts to improve the biocompatibility of CPB systems and minimize their side effects, offering finally better postoperative end-organ function. Characteristics of MiECC include the following: (1) a blood pump with optimal biocompatibility, low thrombogenicity, minimal haemolysis and activation of leucocytes as well as proinflammtory mediators; (2) a minimal tubing length to reduce the priming volume required and thus minimize haemodilution, decreasing the need for foreign blood transfusions; (3) coated surfaces to reduce protein adsorption and platelet activation; (4) separation of shed blood and exclusion of activated blood components via cell salvage; (5) closed system to avoid blood–air contact; (6) temperature management depending on the need and magnitude of surgery should be possible; (7) use of modern concepts of myocardial protection, like blood cardioplegia, must be easy to integrate; (8) safe de-airing must be possible following open heart procedures; (9) finally, it should help modern concepts of fast-track anaesthesia [7, 8]. These characteristics will help to make MiECC an element of a minimal invasive procedure rather than simply a miniaturized CPB system. Numerous randomized clinical studies have proved that MiECC exerts significant beneficial effects on postoperative morbidity, by reducing haemodilution, mediastinal bleeding, need for blood transfusion and inflammatory response. Clinical benefits are: improved end-organ (myocardial, renal and cerebral) protection and reduction of the length of intensive care unit stay [5–8]. Moreover, it is associated with a significant survival benefit in coronary procedures compared with conventional ECC as shown in a recent meta-analysis. This analysis reported randomized trials including 24 studies with a total of 2770 patients [9] and provided a Scientific Class I, Level of evidence A for implementation of MiECC, at least for coronary revascularization. Despite these clear clinical advantages, penetration of the MiECC technology into clinical practice remains significantly low. Thus, the authors took the initiative to organize the ‘1st International Symposium on Minimal invasive Extracorporeal Circulation Technologies (1st MiECT)’ in Thessaloniki, Greece during June 13–14 to create a dedicated international forum to stimulate the exchange of ideas in clinical application and research in the field of Minimal invasive Extracorporeal Circulation Technology without geographical bias (www.miect.org). More than 400 participants from all continents registered. Beside scientific sessions, wet-labs with two simulators for ‘hands-on training’ allowed participants to practice on all commercially available MiECC systems. Twenty abstracts were selected for publication and are part of this Interactive Cardiovascular and Thoracic Surgery issue. During the congress, the ‘Minimal invasive Feedback from the 1st International Symposium on Minimal invasive Extracorporeal Circulation Technologies, Thessaloniki, Greece, 13–14 June 2014.

Development of Clinical Engineering in Japan

The qualification of CE, incorporating both engineering and medicine, was first established in 1987. The CE is a health care professional who ensures the safety and effectiveness of medical equipment. A basic duties guideline for CEs was devised in 2010. The main duties of the CE are classified as respiratory therapy, cardiopulmonary bypass , dialysis units, intensive care units, cardiac catheterization, hyperbaric oxygen therapy, pacemakers and medical equipment management. To enhance the ability of CEs to engage in more extensive duties and develop specialties, there is a certification system in each field. The CE plays a role that is socially important by ensuring the safety of medical equipment and its effective maintenance. Purpose of establishment of CE Recent progress with medical equipment has extended the range of medical care, and specialists who can operate and maintain many complex pieces of equipment are required. The qualification of CE, incorporating both engineering and medicine, was first established in 1987, and CEs began to work in Japan from 1988. The CE is a health care professional who ensures the safety and effectiveness of medical equipment. Current state of CE education A CE must graduate from a CE training school (university, junior college, or technical school) and pass a national examination. The training schools devised guidelines for the national examination to maintain a certain standard of CE education. The examination covers questions from the fields of medicine, engineering, and medical technology. The number of questions is 180 (90 in the morning and 90 in the afternoon) and the examination is carried out over 2 sessions of 2.5 hours each. There are some universities setting up graduate schools for CE education, and there are some CEs who already have a master’s degree or a doctorate in the field of BME. Present status of CEs As of 2012, there are approximately 12,000 CEs in Japan. A basic duties guideline for CEs was devised in 2010[1]. The main duties of the CE are classified as respiratory therapy, maintenance of cardiopulmonary bypass units, dialysis equipment, and surgical equipment, intensive care Koichi Umimoto Department of Biomedical Engineering Osaka Electro-Communication University, Osaka, Japan (Tel: 072-876-5376, Fax: 072-876-5281 e-mail: umimoto@isc.osakac.ac.jp). units, cardiac catheterization, hyperbaric oxygen therapy, other treatment (defibrillators, pacemakers, and implantable cardioverter defibrillators) and medical equipment management. A team of CEs are involved in dialysis. The duties of CEs in the dialysis unit are preparation of the dialysis sets, blood access, operation of the equipment and monitoring patient during treatment, and maintenance of the dialysis equipment. Certification for CEs in each field To enhance the ability of CEs to engage in more extensive duties and develop specialties, as well as provide better health care services, there is a certification system in each field. This involves certification by the Japanese CE Society and the Associated Societies. Regarding certification by the Japanese CE Society, there is a CE certification system for specialization in blood purification, a pacemaker-related CE specialty, and a respiratory treatment specialty. Regarding certification by the Associated Societies, there are qualifications in dialysis technology, extracorporeal circulation technology, respiratory therapy, clinical medical engineering equipment technologist, hyperbaric oxygen therapy, and apheresis treatment. Future prospects Since the CE was born in 1988, 24 years have passed. The CE plays a role that is socially important by ensuring the safety of medical equipment and its effective maintenance. In addition to technology, we must develop managerial skills for medical equipment like CEs in the USA. Therefore it is important to establish an advanced CE education system in Japan like that of the American College of Clinical Engineering[2].

Cardiac Calendar—2011 to 2012

Cardiac Calendar—2011 to 2012

Virtual Patient Simulator for the Perfusion Resource Management Drill

Perfusionists require a detailed understanding of a patient’s physiological status while comprehending the mechanics and engineering of the cardiopulmonary bypass system, so it is beneficial for them to obtain relevant practical skills using extra-corporeal circulation technology and educational physiological simulators. We designed a perfusion simulator system (ECCSIM: Extracorporeal Circulation SIMulator system) based on a hybrid of a simple hydraulic mock circulation loop linked to a computer simulation model. Patient physiological conditions (height, weight, and cardiac indices) were determined by a parameter estimation procedure and used to accurately reproduce hemodynamic conditions. Extracorporeal circulation trainees in pre-clinical education were able to maintain venous oxygen saturation levels above 50%, except during cardiac standstill and a brief resumption of pulsation. Infant amplitudes of reservoir volume oscillation and flow rate were greatly increased compared with adult cardiovascular parameters, this enabled the instructor to control the difficulty level of the operation using different hemodynamic variations. High-fidelity simula tor systems with controllable difficulty levels and high physiological reproducibility are useful in constructing a perfusion resource management environment that enable basic training and periodic crisis management drills to be performed.

Cardiac Calendar—2009 to 2011

Cardiac Calendar—2009 to 2011

Cardiac Calendar—2009 to 2010

Twenty-Ninth Annual San Diego Cardiothoracic Surgery Symposium. San Diego, CA. February 12-15, 2009. Contact: CREF 2009, 475 West Stetson, Suite T, Hemet, CA 92543, www.amainc.com. IARS Eighty-Third Clinical and Scientific Congress. San Diego, CA. March 13-17, 2009. Contact: IARS, 2 Summit Park Drive, Suite 140, Cleveland, OH 44131, e-mail: [email protected] . Fourteenth Annual Update on Cardiopulmonary Bypass. Whistler, British Columbia, Canada. March 15-19, 2009. Contact: SCA, PO Box 11086, 2209 Dickens Road, Richmond, VA 23230-1086, www.scahq.org. Twenty-Ninth International Symposium on Intensive Care and Emergency Medicine. Brussels, Belgium. March 24-27, 2009. Contact: Erasmus University Hospital, Route de Lennik 808, B-1070 Brussels, Belgium, e-mail: [email protected] . Fifty-Sixth Annual Meeting Association of University Anesthesiologists. Galveston, TX. April 3-5, 2009. Contact: AUA, 520 N Northwest Highway, Park Ridge, IL 60068, e-mail: [email protected] . Thirty-First Annual Meeting and Workshop, Society of Cardiovascular Anesthesiologists. San Antonio, TX. April 18-22, 2009. Contact: SCA, PO Box 11086, 2209 Dickens Road, Richmond, VA 23230-1086, www.scahq.org. Sixth Vienna Interdisciplinary Symposium on Aortic Repair. Vienna, Austria. April 22-24, 2009. Contact: E&E PCO, Nobilegasse 23-25, 1150 Wien, Austria, e-mail: [email protected] . Annual Scientific Meeting The American Geriatric Society. Washington, DC. April 29-May 3, 2009. Contact: AGS, 350 5th Ave, Suite 801, New York, NY 10118. Eighty-Ninth Annual Meeting American Association for Thoracic Surgery. Boston, MA. May 9-13, 2009. Contact: www.aats.org. Twenty-Third Annual Meeting of the European Association of Cardiothoracic Anesthesiologists. Athens, Greece. May 27-30, 2009. Contact: Dr Lila Papadimitriou, Henry Dunant General Hospital, Mesogiou Ave 107, 11526 Athens, Greece, e-mail: [email protected] . Euroanesthesia 2009. Milan, Italy. June 6-9, 2009. Contact: ESA Office, 24 Rue des Comediens, B-100 Brussels, Belgium, [email protected]. Perioperative Care for the Geriatric Patient. Prague, Czech Republic. June 14-16, 2009. Contact: GUARANT International, Opletalova 22, 11000 Prague 1, Czech Republic, www.geriatric09.cz. Thirteenth European Congress on Extracorporeal Circulation Technology. Aarhus, Denmark. June 17-20, 2009. Contact: Konprex Komfagniet Nordhavnsgadel, Aarhus, Denmark, e-mail: [email protected] . “Bail Outs” Aortic Challenges. When Surgeons and Interventional Radiologists Depend on Each Other. Graz, Austria. September 10-11, 2009. Contact: Congress Secretariat, Univ. Klinik Chirurgie, Auenbruggerplatz 29, A-8036 Graz, Austria, e-mail: [email protected] . Fourteenth Annual Meeting of Japanese Society of Cardiovascular Anesthesiologists and Eighth Meeting of the Asian Society of Cardiothoracic Anesthesia. Tokyo, Japan. September 10-12, 2009. Contact: Minoru Nomura, MD, Dept of Women's Medical University, 8-1 Kawada-Cho, Shinjuku-ku, Tokyo 162, 86666, Japan, e-mail: [email protected] . American Society of Anesthesiologists Annual Meeting. New Orleans, LA. October 17-21, 2009. Contact: ASA, 520 N Northwest Highway, Park Ridge, IL 60068, ASAhq.org . Sixty-Third Postgraduate Assembly in Anesthesiology, New York State Society of Anesthesiology. New York, NY. December 11-15, 2009. Contact: NYSSA, 85 Fifth Ave, New York, NY 10003, www.nyssa-pga.org. Twenty-Eighth Annual Symposium: Clinical Update in Anesthesiology, Surgery and Perioperative Medicine. Hotel Atlantis, Paradise Island, Bahamas. January 17-23, 2010. Contact: H. Phillips, Mount Sinai Medical Center, 1 Gustave L. Levy Place, Box 1010, New York, NY 10029-6574. Thirtieth International Symposium on Intensive Care and Emergency Medicine. Brussels, Belgium. March 23-26, 2010. Contact: Erasmus University Hospital, Route de Lennik 808, B-1070 Brussels, Belgium, e-mail: [email protected] . IARS Eighty-Fourth Clinical and Scientific Congress. Honolulu, HI. March 26-30, 2010. Contact: IARS, 2 Summit Park Drive, Suite 140, Cleveland, OH 44131, e-mail: [email protected] . The Journal of Cardiothoracic and Vascular Anesthesia welcomes announcements of interest to physicians, researchers, and others concerned with cardiothoracic and vascular anesthesiology, medicine, pharmacology, and related areas. All copies are reviewed and edited for style, clarity, and length. Complete information must be received at least 4 months before the date of publication and should be addressed to George Silvay, MD, PhD, Editor, Department of Anesthesiology, Mount Sinai Medical Center, 1 Gustave L Levy Place, Box 1010, New York, NY 10029-6574.

Eighth European Congress on Extracorporeal Circulation Technology

Eighth European Congress on Extracorporeal Circulation Technology

Recycling of Renewable Resources in Extra corporeal Circulation Technology

This project evaluated the cost effectiveness and feasibility for recycling of renewable resources and disposing of non-recyclable materials generated in the perfusion department of an open heart surgery program. Forty-one adult and pediatric open heart cases were randomly assigned to participate as the control or the recycling group. The control group had no separation of materials. In the recycling group, packaging materials such as glass bottles, corrugated cardboard, and plastics were recycled, providing there was no contamination with blood or body fluids. Non-infectious waste was also separated from infectious waste. The recycled bags, the non-infectious waste bags, and the infectious waste bags were weighed to the nearest one-half pound. The type, weight, and number of bags were recorded. The results from the two groups were analyzed using a one sided Student's t-test. A p value < 0.05 was considered significant. The results indicated that recycling and proper separating of waste significantly decreased the amount of waste discarded as "contaminated". Because contaminated or infectious waste costs $5.60 per red bag and non-infectious waste costs $0.02 per pound, decreasing both forms of waste is economically attractive to hospitals. The perfusionist can decrease the amount of waste products generated in the operating room that must be either incinerated or disposed of in landfill. Recycling and proper separation of waste significantly decreased the expenditure for waste disposal, and decreased the impact of perfusion services on our environment.

Supported Angioplasty: A New Contribution for Extra-Corporeal Circulation Technology

To date there have been no fewer than seven palliative treatments for atherosclerotic coronary artery disease. The expanding role of interventional cardiology in the treatment of patients with severe coronary artery disease will result in a mandatory and significant allocation of perfusion services dedicated to the catheterization laboratory. Historical, and now more recent data, indicate that femoro-femoral bypass can be utilized as a resuscitative tool and as an adjunct to interventional cardiology techniques. The role of the perfusion team in the catheterization lab will evolve and expand along with the growing application of interventional cardiology techniques.