scholarly journals Postcardiotomy Extracorporeal Membrane Oxygenation in Neonates

2021 ◽  
Vol 69 (S 03) ◽  
pp. e41-e47
Author(s):  
Xindi Yu ◽  
Yinyu Yang ◽  
Wei Zhang ◽  
Zheng Guo ◽  
Jia Shen ◽  
...  
Keyword(s):  
Heart Failure ◽  
Extracorporeal Membrane Oxygenation ◽  
Heart Surgery ◽  
Discharge Rate ◽  
Univariate Analysis ◽  
Open Heart Surgery ◽  
Bleeding Event ◽  
Circulatory Support ◽  
Membrane Oxygenation ◽  
Cardiopulmonary Failure

Abstract Background Extracorporeal membrane oxygenation (ECMO) provides circulatory support in children with congenital heart disease, particularly in the setting of cardiopulmonary failure and inability to wean from cardiopulmonary bypass. This study summarized the clinical application of ECMO in the treatment of heart failure after cardiac surgery in neonates. Materials and Methods Clinical data of 23 neonates who received ECMO support in our center from January 2017 to June 2019 were retrospectively analyzed. Results Twenty-three neonates, aged from 0 to 25 days and weight between 2,300 and 4,500 g, with heart failure postcardiotomy were supported with ECMO. The successful weaning rate was 78.26% and discharge rate was 52.17%. Bleeding and residual malformation were the most common complications. The univariate analysis showed that nonsurvivors were related to the factors such as higher lactate value of ECMO 12 and 24 hours (p = 0.008 and 0.001, respectively), longer time to lactate normalization (p = 0.001), lactate > 10 mmol/L before ECMO (p = 0.01), lower weight (p = 0.01), longer ECMO duration (p = 0.005), lower platelet count (p = 0.001), more surgical site bleeding (p = 0.001), and surgical residual malformation (p = 0.04). Further logistic regression analysis revealed that higher lactate value of ECMO 24 hours (p = 0.003), longer ECMO duration (p = 0.015), and surgical site bleeding (p = 0.025) were independent risk factors. Conclusion ECMO was an effective technology to support the neonates with cardiopulmonary failure after open heart surgery. Control the lactate acidosis and surgical site bleeding event may be helpful for patients' recovery.

The Development of Extracorporeal Membrane Oxygenation

2018 ◽  
Vol 84 (4) ◽  
pp. 587-592 ◽  
Author(s):  
Don K. Nakayama
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Heart Surgery ◽  
Life Support ◽  
Open Heart Surgery ◽  
Newborn Infants ◽  
Open Heart ◽  
Older Children ◽  
Membrane Oxygenation ◽  
Ann Arbor ◽  
History Of

Evolving from the development of heart-lung machines for open-heart surgery, extracorporeal membrane oxygenation has reemerged as a rescue modality for patients with acute respiratory failure that cannot be supported by conventional modes of ventilation. The history of extracorporeal membrane oxygenation begins with the discovery of heparin, fundamental to the success of extracorporeal circulation and membrane lungs. Engineers and scientists created suitable artificial membranes that allowed gas exchange while keeping gas and blood phases separate. Special pumps circulated blood through the devices and into patients without damage to delicate red cells and denaturing plasma. Initial attempts in adults ended in failure, but Robert Bartlett, first at Loma Linda, CA, then at Ann Arbor, MI, succeeded in applying the technology in newborn infants with persistent pulmonary hypertension. Preserved in the critical care of infants, the technology in time could be reapplied in the life support of older children and adults.

Proposed Entry Criteria for Postoperative Cardiac Extracorporeal Membrane Oxygenation After Pediatric Open Heart Surgery

1999 ◽  
Vol 23 (11) ◽  
pp. 1010-1014 ◽  
Author(s):  
Gerhard Trittenwein ◽  
Heike Pansi ◽  
Bernadette Graf ◽  
Johann Golej ◽  
Gudrun Burda ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Open Heart ◽  
Membrane Oxygenation

scholarly journals Myocardial perfusion and cardiac dimensions during extracorporeal membrane oxygenation–supported circulation in a porcine model of critical post-cardiotomy failure

Perfusion ◽  
2020 ◽  
Vol 35 (8) ◽  
pp. 763-771
Author(s):  
Atle Solholm ◽  
Pirjo-Riitta Salminen ◽  
Lodve Stangeland ◽  
Christian Arvei Moen ◽  
Arve Mongstad ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiopulmonary Bypass ◽  
Myocardial Perfusion ◽  
Extracorporeal Membrane Oxygenation ◽  
Left Ventricular ◽  
Circulatory Support ◽  
Myocardial Tissue ◽  
Membrane Oxygenation ◽  
Venoarterial Extracorporeal Membrane Oxygenation ◽  
Tissue Oedema

Introduction: Venoarterial extracorporeal membrane oxygenation is widely used as mechanical circulatory support for severe heart failure. A major concern with this treatment modality is left ventricular distension due to inability to overcome the afterload created by the extracorporeal membrane oxygenation circuit. The present porcine study evaluates coronary circulation, myocardial perfusion and ventricular distension during venoarterial extracorporeal membrane oxygenation. Methods: Ten anesthetized open-chest pigs were cannulated and put on cardiopulmonary bypass. Heart failure was achieved by 90 minutes of aortic cross-clamping with insufficient cardioplegic protection. After declamping, the animals were supported by venoarterial extracorporeal membrane oxygenation for 3 hours. Continuous haemodynamic measurements were performed at baseline, during cardiopulmonary bypass/aortic cross-clamping and during venoarterial extracorporeal membrane oxygenation. Fluorescent microsphere injections at baseline and after 1, 2 and 3 hours on venoarterial extracorporeal membrane oxygenation evaluated myocardial perfusion. Left ventricular function and distension were assessed by epicardial echocardiography. Results: The myocardial injury caused by 90 minutes of ischaemia resulted in a poorly contracting myocardium, necessitating venoarterial extracorporeal membrane oxygenation in all animals. The circulatory support maintained the mean arterial blood pressure within a satisfactory range. A hyperaemic left anterior descending coronary artery flow while on extracorporeal membrane oxygenation was observed compared to baseline. Myocardial tissue perfusion measured by microspheres was low, especially in the subendocardium. Echocardiography revealed myocardial tissue oedema, a virtually empty left ventricle, and a left ventricular output that remained negligible throughout the extracorporeal membrane oxygenation run. Conclusion: Coronary artery blood flow is maintained during venoarterial extracorporeal membrane oxygenation after cardiopulmonary bypass and cardioplegic arrest despite severely affected performance of the left ventricle. Myocardial perfusion decreases, however, presumably due to rapid development of myocardial tissue oedema.

scholarly journals Extracorporeal Membrane Oxygenation as a Bridge for Heart Failure and Cardiogenic Shock

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Zhao-peng Zhong ◽  
Hong Wang ◽  
Xiao-tong Hou
Keyword(s):  
Heart Failure ◽  
Extracorporeal Membrane Oxygenation ◽  
Cardiogenic Shock ◽  
Epidemiological Studies ◽  
Circulatory Failure ◽  
Fulminant Myocarditis ◽  
Circulatory Support ◽  
Functional Abnormality ◽  
Current Application ◽  
Membrane Oxygenation

Heart failure (HF) can be defined as cardiac structural or functional abnormality leading to a series of symptoms due to deficiency of oxygen delivery. In the clinical practice, acute heart failure (AHF) is usually performed as cardiogenic shock (CS), pulmonary edema, and single or double ventricle congestive heart failure. CS refers to depressed or insufficient cardiac output (CO) attributable to myocardial infarction, fulminant myocarditis, acute circulatory failure attributable to intractable arrhythmias or the exacerbation of chronic heart failure, postcardiotomy low CO syndrome, and so forth. Epidemiological studies have shown that CS has higher in-hospital mortality in patients with AHF. Besides, we call the induced, sustained circulatory failure even after administration of high doses of inotropes and vasopressors refractory cardiogenic shock. In handling these cases, mechanical circulatory support devices are usually needed. In this review, we discuss the current application status and clinical points in utilizing extracorporeal membrane oxygenation (ECMO).

scholarly journals Development of a Pulsatile Flow-Generating Circulatory Assist Device (K-Beat) for Use with Veno-Arterial Extracorporeal Membrane Oxygenation in a Pig Model Study

Biology ◽  
2020 ◽  
Vol 9 (6) ◽  
pp. 121
Author(s):  
Yutaka Fujii ◽  
Nobuo Akamatsu ◽  
Yasunori Yamasaki ◽  
Kota Miki ◽  
Masayuki Banno ◽  
...  
Keyword(s):  
Heart Failure ◽  
Extracorporeal Membrane Oxygenation ◽  
Pulsatile Flow ◽  
Circulatory Support ◽  
Large Animal ◽  
Assist Device ◽  
Membrane Oxygenation ◽  
First Choice ◽  
Circulatory Flow ◽  
Diastolic Augmentation

Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) preserves the life of heart failure patients by providing an adequate oxygen supply and blood flow to vital organs. For patients with severe cardiogenic shock secondary to acute myocardial infarction or acute myocarditis, V-A ECMO is commonly used as the first choice among cardiac circulatory support devices. While V-A ECMO generates circulatory flow using a centrifugal pump, the provision of pulsatile flow is difficult. We previously reported our development of a new circulatory flow assist device (K-beat) for cardiac management with pulsatile flow. To obtain more efficient pulsatile assist flow (diastolic augmentation), an electrocardiogram (ECG)-analyzing device that can detect R waves and T waves increases the assist flow selectively in the diastole phase by controlling (opening and closing) the magnetic valve of the tamper. Here, we describe the first use of the K-beat on a large animal in combination with a clinical device. In addition, the diastolic augmentation effect of the K-beat as a circulatory flow assist device was examined in a pig V-A ECMO model. The K-beat was stopped every 60 min for a period of a few minutes, and blood pressure waveforms in the pulsatile and non-pulsatile phases were checked. This experiment showed that stable V-A ECMO could be achieved and that hemodynamics were managed in all animals. The pulsatile flow was provided in synchrony with the ECG in all cases. A diastolic augmentation waveform of femoral arterial pressure was confirmed in the pulsatile phase. K-beat could be useful in patients with severe heart failure.

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