Life Support Devices Research Articles

Acute Kidney Injury in ARDS: Insights into Physiology and Pathology

Abstract: Acute kidney injury is a common problem in the critically ill patient. It is often part of the multi system organ failure syndrome where other organs such as the lungs are involved. In the critically ill patient, primary pathology in one organ can affect other organs, and systemic illness can affect both at the same time. In this review article, we closely examine the definition and stages of dysfunction in lungs and kidneys and the relationship between the physiology and pathology of these two organs as they interact and affect each other in the critically ill patient. We also seek to understand the effects common intensive care units interventions have on both those organs, with a special emphasis on external life support devices such as mechanical ventilation, dialysis and extracorporeal membranous oxygenation.

Family Members' Feedback on the "Quality of Death" of Adult Patients Who Died in Intensive Care Units and the Factors Affecting the Death Quality: A Systematic Review and Meta-Analysis.

Intensive care units (ICUs) are designed for critically ill patients who often experience high mortality rates owing to the severity of their conditions. Although the primary goal is patient recovery, it is crucial to understand the quality of death in the ICU setting. Nevertheless, there is a notable lack of systematic reviews on measured death quality and its associated factors. This study aims to conduct a quantitative synthesis of evidence regarding the quality of death in the ICU and offers a comprehensive overview of the factors influencing this quality, including its relationship with the post-intensive care syndrome-family (PICS-F). A thorough search without any language restrictions across MEDLINE, CINAHL, PsycINFO, and Igaku Chuo Zasshi databases identified relevant studies published until September 2023. We aggregated the results regarding the quality of death care for patients who died in the ICU across each measurement tool and calculated the point estimates and 95% confidence intervals.The quantitative synthesis encompassed 19 studies, wherein the Quality of Dying and Death-single item (QODD-1) was reported in 13 instances (Point estimate: 7.0, 95% CI: 6.93-7.06). Patient demographic data, including age and gender, as well as the presence or absence of invasive procedures, such as life support devices and cardiopulmonary resuscitation, along with the management of pain and physical symptoms, were found to be associated with a high quality of death. Only one study reported an association between quality of death and PICS-F scores; however, no significant association was identified. The QODD-1 scale emerged as a frequently referenced and valuable metric for evaluating the quality of death in the ICU, and factors associated with the quality of ICU death were identified. However, research gaps persist, particularly regarding the variations in the quality of ICU deaths based on cultural backgrounds and healthcare systems. This review contributes to a better understanding of the quality of death in the ICU and emphasises the need for comprehensive research in this critical healthcare domain.

Radio Frequency Identification Gate System to Identify Misused Personal Dosimeters.

The use of two personal dosimeters, one worn over and one worn under a protective apron, provides the best estimate of effective dose. However, inappropriate positioning of dosimeters is a common occurrence, resulting in abnormally high or low radiation exposure records. Although such incorrect positioning can be identified by radiation exposure records, doing so is time-consuming and labor-intensive for administrators. Therefore, a system that can identify incorrect locations of dosimeters without burdening administrators must be developed. In this study, we developed a radio frequency identification (RFID) gate system that can differentiate between two RFID-tagged dosimeters placed over and under a metal apron and identify misused dosimeters. To simulate the position of the RFID-tagged dosimeters, we designed four dosimeter-wearing classes, including "proper use" and three types of "misuse" (i.e., "reversed," "both under," and "both over"). When the system predicts "misuse" based on the tag reading, the worker is alerted with lights and alarms. The system performance was evaluated using a confusion matrix, with an overall accuracy of 97.75%, demonstrating high classification performance. The safety of the system against life support devices was also investigated, demonstrating that they were not affected by the electric field at 0.3m or more from the antenna of the system under any transmit powers tested. This RFID gate system is highly capable of identifying incorrectly positioned dosimeters, enabling real-time monitoring of dosimeters to manage their positioning.

Multidetector Computed Tomographic Evaluation of Hydrocephalus

Introduction: Hydrocephalus is characterized by imbalance of cerebrospinal fluid formation and absorption. It is manifested as a dilatation of the ventricular system. Computed tomography (CT) is useful in determining the ventricular size and shape as well as the amount of the cerebral cortex present in the evaluation of suspected hydrocephalus. Aim and Objectives: Detection of hydrocephalus and determining the cause of hydrocephalus. Differentiating communicating from noncommunicating (obstructive) hydrocephalus. to assess the severity of the hydrocephalus and seek for any consequences. Materials and Methods: This prospective study included 50 patients referred to the Acharya Vinoba Bhave Rural Hospital, Sawangi (Meghe), Wardha, for 1 year. Patients clinically diagnosed with hydrocephalus were included in the study. Multidetector CT (MDCT) imaging was performed on Siemens 16 Slice MDCT machine. Multiplanar reformation and three-dimensional reconstruction were done wherever necessary. Results: 20% were diagnosed to have meningitis, 10% had Intraparenchymal haemorrhage and Intraventricular extension, 12% had aqueduct stenosis, and 12% had communicating hydrocephalus. In the study, 40% of them had communicating-type hydrocephalus or extraventricular obstructive hydrocephalus and 60% had obstructive hydrocephalus. On the CT scan, it was observed that at the lateral ventricle, dilatation was observed in four regions. Frontal horn dilatation (98%), body dilatation (98%), and 100% dilatation were seen at the temporal horn and occipital horn. Among 100 patients, 14% had cortical thinning and thus were classified as severe hydrocephalus with a poor prognosis, and 20% had periventricular edema. Conclusion: CT is the best means of obtaining images as it is easily available, fast, reliable, and compatible with standard life support devices.

Evolution of Clinical Phenotypes of COVID-19 Patients During Intensive Care Treatment: An Unsupervised Machine Learning Analysis.

Identification of clinical phenotypes in critically ill COVID-19 patients could improve understanding of the disease heterogeneity and enable prognostic and predictive enrichment. However, previous attempts did not take into account temporal dynamics with high granularity. By including the dimension of time, we aim to gain further insights into the heterogeneity of COVID-19. We used granular data from 3202 adult COVID patients in the Dutch Data Warehouse that were admitted to one of 25 Dutch ICUs between February 2020 and March 2021. Parameters including demographics, clinical observations, medications, laboratory values, vital signs, and data from life support devices were selected. Twenty-one datasets were created that each covered 24 h of ICU data for each day of ICU treatment. Clinical phenotypes in each dataset were identified by performing cluster analyses. Both evolution of the clinical phenotypes over time and patient allocation to these clusters over time were tracked. The final patient cohort consisted of 2438 COVID-19 patients with a ICU mortality outcome. Forty-one parameters were chosen for cluster analysis. On admission, both a mild and a severe clinical phenotype were found. After day 4, the severe phenotype split into an intermediate and a severe phenotype for 11 consecutive days. Heterogeneity between phenotypes appears to be driven by inflammation and dead space ventilation. During the 21-day period, only 8.2% and 4.6% of patients in the initial mild and severe clusters remained assigned to the same phenotype respectively. The clinical phenotype half-life was between 5 and 6 days for the mild and severe phenotypes, and about 3 days for the medium severe phenotype. Patients typically do not remain in the same cluster throughout intensive care treatment. This may have important implications for prognostic or predictive enrichment. Prominent dissimilarities between clinical phenotypes are predominantly driven by inflammation and dead space ventilation.

Systolic Heart Failure and Optimization of Medical Therapy: A Quality Improvement Study

Introduction: Congestive heart failure (CHF) accounts for significant medical costs and patient mortality. There are ways to mitigate these parameters by providing patient and provider education, optimizing medications, and applying life-saving devices with a referral for a left ventricular assist device (LVAD) when appropriate. We retrospectively observed the charts of 40 patients at our Dayton Veterans Affairs Medical Center (VAMC) for areas of improvement. Methods: Charts were manually reviewed over 2019 for ejection fraction (EF) at the time of diagnosis and ischemic cardiomyopathy (ICM) vs. nonischemic cardiomyopathy (NICM) etiology of heart failure. Information on the titration of beta-blockers (BB), angiotensin-converting enzyme inhibitors (ACE-I), angiotensin receptor blockers (ARBs), and advanced heart failure medications was collected. Readmission rates and heart failure follow-up appointment rates were gathered, and further details were investigated regarding the application of a life vest and automatic implantable cardioverter-defibrillator (AICD) when clinically appropriate. Results: Median EF for patients was 34%, consistent with systolic heart failure. 65% of patients had ICM. For medications, BB was maximally titrated for 85% of patients within a wide data range. ACE-I/ARBs titration was appropriate in 75% of patients. An average of 4.7 dose adjustments for BB and 3.6 dose adjustments for ACE-I/ARBs occurred. Advanced CHF medications were rarely prescribed. Exacerbation rates were 60%, from 1–5 readmissions and an average of 1.07 readmissions. 98% of patients received CHF-specific follow-up after each CHF admission. 60% were eligible for advanced life support devices, 25% were offered life vests, and 62% were offered AICD. No patient was referred to a tertiary center for LVAD. Conclusion: We should work towards 100% medication titration to improve outcomes, especially BB which is known to have morbidity value. We can continue to reduce heart failure readmission rates by providing patient and provider education and continuing to do well at heart failure follow-up appointments. Life vest and AICD should be offered more consistently, and tertiary referral to receive LVAD should remain offered per standard of care.

Cefepime Extraction by Extracorporeal Life Support Circuits

Extracorporeal life support (ECLS) devices are lifesaving for critically ill patients with multi-organ dysfunction. Despite this, patients supported with ECLS are at high risk for ECLS-related complications, including nosocomial infections, and mortality rates are high in this patient population. The high mortality rates are suspected to be, in part, a result of significantly altered drug disposition by the ECLS circuit, resulting in suboptimal antimicrobial dosing. Cefepime is commonly used in critically ill patients with serious infections. Cefepime dosing is not routinely guided by therapeutic drug monitoring and treatment success is dependent upon the percentage of time of the dosing interval that the drug concentration remains above the minimum inhibitory concentration of the organism. Thisex vivostudy measured the extraction of cefepime by continuous renal replacement therapy (CRRT) and extracorporeal membrane oxygenation (ECMO) circuits. Cefepime was studied in four closed-loop CRRT circuit configurations and a single closed-loop ECMO circuit configuration. Circuits were primed with a physiologic human blood–plasma mixture and the drug was dosed to achieve therapeutic concentrations. Serial blood samples were collected over time and concentrations were quantified using validated assays. Inex vivoCRRT experiments, cefepime was rapidly cleared by dialysis, hemofiltration, and hemodiafiltration, with greater than 96% cefepime eliminated from the circuit by 2 hours. In the ECMO circuits, the mean recovery of cefepime was similar in both circuit and standard control. Mean (standard deviation) recovery of cefepime in the ECMO circuits (n = 6) was 39.2% (8.0) at 24 hours. Mean recovery in the standard control (n = 3) at 24 hours was 52.2% (1.5). Cefepime is rapidly cleared by dialysis, hemofiltration, and hemodiafiltration in the CRRT circuit but minimally adsorbed by either the CRRT or ECMO circuits. Dosing adjustments are needed for patients supported with CRRT.

Cefepime Extraction by Extracorporeal Life Support Circuits.

Extracorporeal life support (ECLS) devices are lifesaving for critically ill patients with multi-organ dysfunction. Despite this, patients supported with ECLS are at high risk for ECLS-related complications, including nosocomial infections, and mortality rates are high in this patient population. The high mortality rates are suspected to be, in part, a result of significantly altered drug disposition by the ECLS circuit, resulting in suboptimal antimicrobial dosing. Cefepime is commonly used in critically ill patients with serious infections. Cefepime dosing is not routinely guided by therapeutic drug monitoring and treatment success is dependent upon the percentage of time of the dosing interval that the drug concentration remains above the minimum inhibitory concentration of the organism. This ex vivo study measured the extraction of cefepime by continuous renal replacement therapy (CRRT) and extracorporeal membrane oxygenation (ECMO) circuits. Cefepime was studied in four closed-loop CRRT circuit configurations and a single closed-loop ECMO circuit configuration. Circuits were primed with a physiologic human blood-plasma mixture and the drug was dosed to achieve therapeutic concentrations. Serial blood samples were collected over time and concentrations were quantified using validated assays. In ex vivo CRRT experiments, cefepime was rapidly cleared by dialysis, hemofiltration, and hemodiafiltration, with greater than 96% cefepime eliminated from the circuit by 2 hours. In the ECMO circuits, the mean recovery of cefepime was similar in both circuit and standard control. Mean (standard deviation) recovery of cefepime in the ECMO circuits (n = 6) was 39.2% (8.0) at 24 hours. Mean recovery in the standard control (n = 3) at 24 hours was 52.2% (1.5). Cefepime is rapidly cleared by dialysis, hemofiltration, and hemodiafiltration in the CRRT circuit but minimally adsorbed by either the CRRT or ECMO circuits. Dosing adjustments are needed for patients supported with CRRT.

The perceptions on good death of the older adults in the semi-urban community: A qualitative study

ObjectiveThis study aimed to explore the perceptions of good death of the older adults living in Bang Nang Li Sub-District, Amphawa District, Samut Songkhram Province, Thailand. MethodThe data of the study was collected using in-depth interviews between October 2019 to January 2020. The data collected a total of 14 older adults who had firsthand experience in caring for terminally ill patients were recruited for the study. Content analysis was employed to analyze qualitative data. ResultsThe results of this study revealed the perceptions of good death which were categorized into three main themes and eight sub-themes, including 1) death without suffering (not suffering from life support devices, dying with care); 2) natural death (death with the end of life expectancy, death with illness or ailments); and 3) death without the worries (preparation for death, spiritual and belief practice toward preparation for death, family and property management before death, death among family members and at their familiar place). ConclusionThe findings of this research provided the insight to clarify the understanding of the perceptions on a good death of older adults. The findings can be used to support the practice and management of nursing education and health care providers who have to be involved in palliative care for terminally ill older adults.

Are High-Altitude Residents More Susceptible to Covid-19 in India? Findings and Potential Implications for Research and Policy

In this paper, we study the incidence of COVID-19 and the associated fatality with altitude using high frequency, district level data from India. To understand the implications of the nationwide lockdown after the outbreak, we use data for about four months- two from the lockdown period starting from March 25 till May 31, 2020 and about two months after unlocking was initiated (June 1-July 26, 2020). The multivariate regression result indicates slower growth in average rate of infection during the lockdown period in hilly regions, the gains of which attenuated after the unlocking was initiated. Despite these early gains, the rate of fatalities is significantly higher during the lockdown period in comparison to the plains. The findings remain robust to multiple alternative specifications and methods including one that accounts for confounding possibilities via unobservable and provides consistent estimates of bias adjusted treatment effects. The evidence supports the need for provisioning of public health services and infrastructure upgradation, especially maintenance of adequate stock of life support devices, in high altitude regions. It also underscores the necessity for strengthening and revising the existing Hill Areas Development Programme and integrating important aspects of public health as part of this policy.

Perceptions of their knowledge, practices and competence in sports injury prevention recognition and management by physical education teachers in Yogyakarta, Indonesia

During a Physical Education (PE) class, students may encounter risks of injury. PE teachers, therefore, should possess competent knowledge and skill levels in sports injury prevention as well as good self-awareness of their abilities to manage any injury. This study aimed to evaluate the perceived knowledge, practices, and competence in the area of sports injury prevention, recognition, and management of PE teachers in Yogyakarta Special Province. The associations between PE teachers’ sociodemographic characteristics and their self-perceptions were also investigated. Subjects were Senior High School PE teachers who were willing to complete the questionnaire developed by the research team. 191 PE teachers voluntarily participated in the study. The results showed the lowest scores were found for: 1) the teachers’ practice in recording students’ medical history and assessing injury risk when starting a new academic year; 2) the teachers’ practice in evaluating the condition of first aid kits and Basic Life Support (BLS) devices; and 3) the teachers’ perceived competence in splinting. Only greater knowledge of the PRICE principle was associated with the teachers’ level of education and training experience and splinting competence with years of teaching. BLS training experience had the stronger association with perceptions of knowledge and skills in the recognition and treating of injuries.

Predictors for extubation failure in COVID-19 patients using a machine learning approach

IntroductionDetermining the optimal timing for extubation can be challenging in the intensive care. In this study, we aim to identify predictors for extubation failure in critically ill patients with COVID-19.MethodsWe used highly granular data from 3464 adult critically ill COVID patients in the multicenter Dutch Data Warehouse, including demographics, clinical observations, medications, fluid balance, laboratory values, vital signs, and data from life support devices. All intubated patients with at least one extubation attempt were eligible for analysis. Transferred patients, patients admitted for less than 24 h, and patients still admitted at the time of data extraction were excluded. Potential predictors were selected by a team of intensive care physicians. The primary and secondary outcomes were extubation without reintubation or death within the next 7 days and within 48 h, respectively. We trained and validated multiple machine learning algorithms using fivefold nested cross-validation. Predictor importance was estimated using Shapley additive explanations, while cutoff values for the relative probability of failed extubation were estimated through partial dependence plots.ResultsA total of 883 patients were included in the model derivation. The reintubation rate was 13.4% within 48 h and 18.9% at day 7, with a mortality rate of 0.6% and 1.0% respectively. The grandient-boost model performed best (area under the curve of 0.70) and was used to calculate predictor importance. Ventilatory characteristics and settings were the most important predictors. More specifically, a controlled mode duration longer than 4 days, a last fraction of inspired oxygen higher than 35%, a mean tidal volume per kg ideal body weight above 8 ml/kg in the day before extubation, and a shorter duration in assisted mode (< 2 days) compared to their median values. Additionally, a higher C-reactive protein and leukocyte count, a lower thrombocyte count, a lower Glasgow coma scale and a lower body mass index compared to their medians were associated with extubation failure.ConclusionThe most important predictors for extubation failure in critically ill COVID-19 patients include ventilatory settings, inflammatory parameters, neurological status, and body mass index. These predictors should therefore be routinely captured in electronic health records.

New Trends, Advantages and Disadvantages in Anticoagulation and Coating Methods Used in Extracorporeal Life Support Devices.

The use of extracorporeal life support (ECLS) devices has significantly increased in the last decades. Despite medical and technological advancements, a main challenge in the ECLS field remains the complex interaction between the human body, blood, and artificial materials. Indeed, blood exposure to artificial surfaces generates an unbalanced activation of the coagulation cascade, leading to hemorrhagic and thrombotic events. Over time, several anticoagulation and coatings methods have been introduced to address this problem. This narrative review summarizes trends, advantages, and disadvantages of anticoagulation and coating methods used in the ECLS field. Evidence was collected through a PubMed search and reference scanning. A group of experts was convened to openly discuss the retrieved references. Clinical practice in ECLS is still based on the large use of unfractionated heparin and, as an alternative in case of contraindications, nafamostat mesilate, bivalirudin, and argatroban. Other anticoagulation methods are under investigation, but none is about to enter the clinical routine. From an engineering point of view, material modifications have focused on commercially available biomimetic and biopassive surfaces and on the development of endothelialized surfaces. Biocompatible and bio-hybrid materials not requiring combined systemic anticoagulation should be the future goal, but intense efforts are still required to fulfill this purpose.

Scoring System to Evaluate the Performance of ICU Ventilators in the Pandemic of COVID-19: A Lung Model Study.

Ventilators in the intensive care units (ICU) are life-support devices that help physicians to gain additional time to cure the patients. The aim of the study was to establish a scoring system to evaluate the ventilator performance in the context of COVID-19. The scoring system was established by weighting the ventilator performance on five different aspects: the stability of pressurization, response to leaks alteration, performance of reaction, volume delivery, and accuracy in oxygen delivery. The weighting factors were determined with analytic hierarchy process (AHP). Survey was sent out to 66 clinical and mechanical experts. The scoring system was built based on 54 valid replies. A total of 12 commercially available ICU ventilators providing non-invasive ventilation were evaluated using the novel scoring system. A total of eight ICU ventilators with non-invasive ventilation mode and four dedicated non-invasive ventilators were tested according to the scoring system. Four COVID-19 phenotypes were simulated using the ASL5000 lung simulator, namely (1) increased airway resistance (IR) (10 cm H2O/L/s), (2) low compliance (LC) (compliance of 20 ml/cmH2O), (3) low compliance plus increased respiratory effort (LCIE) (respiratory rate of 40 and inspiratory effort of 10 cmH2O), (4) high compliance (HC) (compliance of 50 ml/cmH2O). All of the ventilators were set to three combinations of pressure support and positive end-expiratory pressure levels. The data were collected at baseline and at three customized leak levels. Significant inaccuracies and variations in performance between different non-invasive ventilators were observed, especially in the aspect of leaks alteration, oxygen and volume delivery. Some ventilators have stable performance in different simulated phenotypes whereas the others have over 10% scoring differences. It is feasible to use the proposed scoring system to evaluate the ventilator performance. In the COVID-19 pandemic, clinicians should be aware of possible strengths and weaknesses of ventilators.

Toward an artificial endothelium: Development of blood-compatible surfaces for extracorporeal life support.

A new generation of extracorporeal artificial organ support technologies, collectively known as extracorporeal life support (ECLS) devices, is being developed for diverse applications to include acute support for trauma-induced organ failure, transitional support for bridge to organ transplant, and terminal support for chronic diseases. Across applications, one significant complication limits the use of these life-saving devices: thrombosis, bleeding, and inflammation caused by foreign surface-induced blood interactions. To address this challenge, transdisciplinary scientists and clinicians look to the vascular endothelium as inspiration for development of new biocompatible materials for ECLS. Here, we describe clinically approved and new investigational biomaterial solutions for thrombosis, such as immobilized heparin, nitric oxide-functionalized polymers, "slippery" nonadhesive coatings, and surface endothelialization. We describe how hemocompatible materials could abrogate the use of anticoagulant drugs during ECLS and by doing so radically change treatments in critical care. Additionally, we examine several special considerations for the design of biomaterials for ECLS, including: (1) preserving function of the artificial organ, (2) longevity of use, and (3) multifaceted approaches for the diversity of device functions and applications.

Inverted takotsubo syndrome complicated with cardiogenic shock requiring veno-arterial extracorporeal membrane oxygenation in a patient with bilateral pheochromocytoma: a case report.

BackgroundTakotsubo syndrome (TS) is characterized by a transient left ventricular (LV) dysfunction and rarely presents with cardiogenic shock (CS). Inverted TS (ITS) is a rare entity associated with the presence of a pheochromocytoma.Case summaryWe present a case of a young woman was admitted to the emergency department due to intense headache, chest discomfort, palpitations, and breathlessness. An ITS secondary to a pheochromocytoma crisis presenting with CS was diagnosed. The patient was managed with veno-arterial extracorporeal membrane oxygenation, until recovery of LV function. On the 35th day of hospitalization, open bilateral adrenalectomy was performed.DiscussionTakotsubo syndrome patients presenting with CS are challenging and clinicians should be aware of underlying causes. Specific triggers such as pheochromocytoma should systematically be considered particularly if ITS was presented. Extracorporeal life support devices could provide temporary mechanical circulatory support in patients with TS on refractory CS and help to manage complex cases with TS due to pheochromocytoma.

CardiWall: A Trusted Firewall for the Detection of Malicious Clinical Programming of Cardiac Implantable Electronic Devices

Today, cardiac implantable electronic devices (CIEDs), such as pacemakers and implantable cardioverter defibrillators (ICDs), play an increasingly important role in healthcare ecosystems as patient life support devices. Physicians control, program and configure CIEDs on a regular basis using a dedicated programmer device. The programmer device is open to external connections (e.g., USB, Bluetooth, etc.), and thus it is exposed to a variety of cyber-attacks by which an attacker can manipulate the programmer device’s operations and consequently harm the patient. In this paper, we present CardiWall, a novel detection and prevention system designed to protect ICDs from cyber-attacks aimed at the programmer device. Our system has six different layers of protection, leveraging medical experts’ knowledge, statistical methods, and machine learning algorithms. We evaluated the CardiWall system extensively in two comprehensive experiments. For the evaluation, we gathered data for a period of four years and used 775 benign clinical commands that are related to hundreds of different patients (obtained from different programmer devices located at Barzilai University Medical center) and 28 malicious clinical commands (created by two cardiology experts from different hospitals). The evaluation results show that only two out of the six layers proposed in CardiWall system provided a high detection capability associated with high rates of true positive, and low rates of false positive. With the configuration that provided the best harmonic mean of sensitivity and specificity ( HMSS ), CardiWall achieved a high true positive rate ( TPR ) of 91.4% and a very low false positive rate ( FPR ) of 1%, with an AUC o f 94.7%.

Study on the formulation of maintenance and inspection guidelines for life support devices

Study on the formulation of maintenance and inspection guidelines for life support devices

First Russian experience of liver and kidneys transplantation obtained from the donor with out-of-hospital irreversible cardiac arrest

Organs’ shortage remains the main limiting problem for accessibility of organ transplantation. There is the growing interest among transplant society for use organs obtained from «uncontrolled» donors after cardiac death (uDCDs), or, asystolic donors. But the warm ischemic time is critical factor for wide accepting of practice of transplantation such kind of organs. The article presents the first case of successful clinical organ transplants from the donor with out-of-hospital irreversible cardiac arrest obtained with help of life support devices.

Pressure and flow properties of cannulae for extracorporeal membrane oxygenation II: drainage (venous) cannulae.

The use of extracorporeal life support devices such as extracorporeal membrane oxygenation in adults requires cannulation of the patient's vessels with comparatively large diameter cannulae to allow circulation of large volumes of blood (>5 L/min). The cannula diameter and length are the major determinants for extracorporeal membrane oxygenation flow. Manufacturing companies present pressure-flow charts for the cannulae; however, these tests are performed with water. Aims of this study were 1. to investigate the specified pressure-flow charts obtained when using human blood as the circulating medium and 2. to support extracorporeal membrane oxygenation providers with pressure-flow data for correct choice of the cannula to reach an optimal flow with optimal hydrodynamic performance. Eighteen extracorporeal membrane oxygenation drainage cannulae, donated by the manufacturers (n = 6), were studied in a centrifugal pump driven mock loop. Pressure-flow properties and cannula features were described. The results showed that when blood with a hematocrit of 27% was used, the drainage pressure was consistently higher for a given flow (range 10%-350%) than when water was used (data from each respective manufacturer's product information). It is concluded that the information provided by manufacturers in line with regulatory guidelines does not correspond to clinical performance and therefore may not provide the best guidance for clinicians.