A comparison of radiographic signs of pulmonary inflammation during ECMO between silicon and poly-methyl pentene oxygenators

Perfusion â—½  
2007 â—½  
Vol 22 (1) â—½  
pp. 15-21 â—½  
Author(s):  
Espeed Khoshbin â—½  
Anthony EW Dux â—½  
Hilliary Killer â—½  
Andrzej W Sosnowski â—½  
Richard K Firmin â—½  
...  
Keyword(s):  
Inflammatory Response â—½  
Quantitative Methods â—½  
Inflammatory Process â—½  
Life Support â—½  
Extracorporeal Life Support â—½  
Pulmonary Inflammation â—½  
Delayed Response â—½  
Heparin Coating â—½  
Percentage Survival â—½  
Inflammatory Changes

Introduction: The inflammatory response caused by extracorporeal membrane oxygenation (ECMO) is clearly visible within the first 24 h of cannulation. The inflammatory process affects all areas of the lung, even areas previously spared by the primary disease. Objective: To compare the change in the radiographic signs of inflammatory response to ECMO between poly-methyl pentene and silicon oxygenators. Study design: Retrospective review of neonates and adults pre- and post-replacement of silicon oxygenators with poly-methyl pentene devices. Data were collected from Extracorporeal Life Support Organisation (ELSO) registry forms and patient records. Results were analysed by quantitative and semi-quantitative methods. Results: There was a significant reduction in the radiographic signs of inflammatory response to ECMO, and a reduction in the time taken to revert to pre-ECMO state in the neonatal poly-methyl pentene group compared to silicon. However, there was no significant reduction in the duration of ECMO runs and the percentage survival between these groups in the neonates. In adults, there was no difference in severity of radiographic signs between groups. However, the inflammatory changes were relatively delayed in the adult poly-methyl pentene group. Conclusion: Poly-methyl pentene (Medos) oxygenators have reduced the host's response phenomenon `white out' in neonates, and caused a delayed response in adults. This is most likely a consequence of smaller blood contact surface area combined with the effect of heparin coating of the oxygenator membrane. However, recovery was not a function of the type of gas exchange device used. Perfusion (2007) 22, 15-21.

Laboratory Evaluation of Hemolysis and Systemic Inflammatory Response in Neonatal Nonpulsatile and Pulsatile Extracorporeal Life Support Systems

Artificial Organs â—½  
10.1111/aor.12466 â—½  
2015 â—½  
Vol 39 (9) â—½  
pp. 774-781 â—½  
Author(s):  
Shigang Wang â—½  
Conrad Krawiec â—½  
Sunil Patel â—½  
Allen R. Kunselman â—½  
Jianxun Song â—½  
...  
Keyword(s):  
Inflammatory Response â—½  
Life Support â—½  
Support Systems â—½  
Extracorporeal Life Support â—½  
Systemic Inflammatory Response â—½  
Laboratory Evaluation â—½  
Life Support Systems

Hemoadsorption treatment with CytoSorb® in patients with extracorporeal life support therapy: A case series

2019 â—½  
Vol 43 (6) â—½  
pp. 422-429
Author(s):  
Karl Träger â—½  
Christian Skrabal â—½  
Guenther Fischer â—½  
Janpeter Schroeder â—½  
Larissa Marenski â—½  
...  
Keyword(s):  
Inflammatory Response â—½  
Interleukin 6 â—½  
Life Support â—½  
Extracorporeal Life Support â—½  
Therapeutic Option â—½  
Case Series â—½  
Organ Support â—½  
Retrospective Case â—½  
Cytokine Levels â—½  
Pre Treatment

Introduction: Extracorporeal life support is an increasingly used technique for respiratory and cardiocirculatory support. Besides primary organ dysfunction, an excessive systemic hyperinflammatory response can be the underlying cause for acute organ failure necessitating extracorporeal life support therapy, or it may be associated with the extracorporeal life support itself. Controlling this overwhelming inflammatory response using CytoSorb® hemoadsorption has been shown to be associated with improved hemodynamics and restored metabolic balance resulting in preserved organ functions. Methods: In this retrospective case series, we describe 23 patients undergoing extracorporeal life support therapy and CytoSorb hemoadsorption. Cytokine levels were monitored, hemodynamic and metabolic variables were recorded, and outcome measures such as duration of organ support, intensive care unit mortality, and hospital mortality were noted. Results: CytoSorb treatment was associated with a trend toward a reduction in plasma cytokine levels (first treatment median interleukin-6 pre 595 vs post 350 pg/mL (n.s.); second treatment median interleukin-6 317 vs 108 pg/mL, p < 0.05), a reduced vasoplegic response resulting in a reduction in vasopressor requirements (first treatment median norepinephrine pre 0.15 vs post 0.02 µg/kg/min (n.s.); second treatment median norepinephrine 0.1 vs 0.02 µg/kg/min, p < 0.05) as well as rebalancing of deranged metabolic parameters (first treatment median lactate pre-treatment 6 vs post-treatment median lactate 2 mmol/L, p < 0.05). The hemoperfusion treatment was well tolerated and safe, without the occurrence of any CytoSorb device-related adverse events. Conclusion: Hemoadsorption may offer a potentially promising therapeutic option for critically ill patients undergoing extracorporeal life support therapy, with cytokine reduction and a consecutively mitigated inflammatory response, decreased vasoplegia, and improved organ function as seen in our patients.

Hemoadsorption in cardiac shock with bi ventricular failure and giant-cell myocarditis: A case report

2018 â—½  
Vol 41 (8) â—½  
pp. 474-479 â—½  
Author(s):  
Günes Dogan â—½  
Jasmin Hanke â—½  
Jakob Puntigam â—½  
Axel Haverich â—½  
Jan D Schmitto
Keyword(s):  
Inflammatory Response â—½  
Giant Cell â—½  
Life Support â—½  
Extracorporeal Life Support â—½  
Therapeutic Option â—½  
Combined Treatment â—½  
Right Heart Failure â—½  
Left Ventricular â—½  
Circulatory Support â—½  
Giant Cell Myocarditis

Purpose: Giant-cell myocarditis represents a rare and often fatal autoimmune disorder. Despite extracorporeal life support being a valid treatment option, alternatives to control the underlying inflammatory response remain sparse. A new hemoadsorption device (CytoSorb) has recently been introduced to treat patients with an excessive inflammatory response. Methods: A 57-year-old patient developed fulminant right heart failure, respiratory insufficiency, hemodynamic instability, and oliguric–anuric renal failure. An extracorporeal life support together with an Impella was implanted for circulatory support. Due to non-pulsatility, acontractility of the left ventricle and a heavily reduced right ventricular function, a left ventricular assist device implantation and change from extracorporeal life support to veno-pulmonary arterial extracorporeal membrane oxygenation was performed. Since adequate hemodynamic stabilization could not be achieved and due to increasing inflammatory mediators and bilirubin levels, the decision was made to additionally integrate a CytoSorb hemoadsorber into the system. Results: The combined treatment resulted in a clear and steady improvement in hemodynamics and the inflammatory condition with marked reductions in all measured parameters throughout the treatment period. Metabolic acidosis resolved and liver function improved. Conclusion: Extracorporeal life support therapy represents a bridging approach to heart transplantation or to cardiac recovery and can be complemented by CytoSorb as an independent therapeutic option. The patient described herein with giant-cell myocarditis and fulminant cardiac failure who received substantial extracorporeal support in combination with CytoSorb hemoadsorption therapy benefited in terms of an improvement of organ function and his inflammatory situation.

Longevity and precision of online blood gas monitoring in patients with ECMO or extracorporeal life support (ECLS) -8 years of experience

2011 â—½  
Vol 59 (S 01) â—½  
Author(s):  
M Kaluza â—½  
D Bösemann â—½  
B Runge â—½  
G Färber â—½  
T Doenst
Keyword(s):  
Life Support â—½  
Extracorporeal Life Support â—½  
Years Of Experience â—½  
Blood Gas â—½  
Gas Monitoring â—½  
Blood Gas Monitoring

Central extracorporeal life support with integrated left ventricular vent in children with low cardiac output: Pathophysiologic considerations

2013 â—½  
Vol 61 (S 01) â—½  
Author(s):  
S Sandrio â—½  
W Springer â—½  
M Karck â—½  
M Gorenflo â—½  
T Loukanov
Keyword(s):  
Cardiac Output â—½  
Life Support â—½  
Extracorporeal Life Support â—½  
Left Ventricular â—½  
Low Cardiac Output

Evaluation of Left Ventricular Unloading by Peripherial Extracorporeal Life Support (ECLS) in a Pig Model of Acute Myocardial Infarction

2015 â—½  
Vol 63 (S 01) â—½  
Author(s):  
S. Guethoff â—½  
C. Hagl â—½  
N. Khaladj â—½  
F. Born â—½  
A. Howe â—½  
...  
Keyword(s):  
Myocardial Infarction â—½  
Acute Myocardial Infarction â—½  
Life Support â—½  
Extracorporeal Life Support â—½  
Left Ventricular â—½  
Pig Model

Clinical Outcomes of Venoarterial Extracorporeal Life Support in 462 Patients: Single-Center Experience

2020 â—½  
Author(s):  
K. Zhigalov â—½  
A. Alofesh â—½  
J. Easo â—½  
H. Eichstaedt â—½  
J. Ennker â—½  
...  
Keyword(s):  
Clinical Outcomes â—½  
Life Support â—½  
Extracorporeal Life Support â—½  
Single Center â—½  
Single Center Experience

Role of extracorporeal life support in thoracic surgery

2020 â—½  
Vol 99 (10) â—½  
Keyword(s):  
Thoracic Surgery â—½  
Extracorporeal Circulation â—½  
Life Support â—½  
Close Contact â—½  
Extracorporeal Life Support â—½  
Tumour Resection â—½  
R0 Resection â—½  
Malignant Tumours â—½  
En Bloc â—½  
Frequent Use

Besides the conventional extracorporeal circulation, commonly used in cardiac surgery, the methods of extracorporeal life support (ECLS) have been applied ever more frequently in thoracic surgery in recent years. The most commonly used modalities of such supports include extracorporeal membrane oxygenation (ECMO) and the Novalung interventional lung assist device (iLA). Successful application of ECLS has led to its more frequent use in general thoracic surgery, especially as a tool to treat hypercapnia and to ensure oxygenation and haemodynamic support. However, these methods are essential in lung transplant programmes; without their help, in most cases, it would not be possible to perform the transplantatioz or prevent the severe complications associated with critical primary graft dysfunction. Additionally, the extracorporeal circulation also facilitates the performing of specific surgical procedures that would not be feasible under standard conditions or would be associated with an inadequate risk. The application of extracorporeal life supports can fundamentally increase the level of resection when treating advanced intrathoracic malignancies that are in close contact with the heart and large vessels or even directly extend into them. Without the possibility of resecting such structures en bloc, together with the tumour, and, thus, achieving an R0 resection, these malignant tumours are often directly contraindicated for surgery or are operated non-radically, i.e. unsuccessfully. Complete tumour resection is the most important prognostic factor in the surgery.

Diagnosis of coronary affection in patients with AADA and treatment of postcardiotomy myocardial failure using extracorporeal life support (ECLS)

2014 â—½  
Vol 17 (5) â—½  
pp. 253 â—½  
Author(s):  
Sabina P W Guenther â—½  
Sven Peterss â—½  
Angela Reichelt â—½  
Frank Born â—½  
Matthias Fischer â—½  
...  
Keyword(s):  
Heart Failure â—½  
Coronary Artery â—½  
Life Support â—½  
Extracorporeal Life Support â—½  
Artery Bypass â—½  
Preoperative Evaluation â—½  
Left Heart Failure â—½  
Myocardial Failure â—½  
Coronary Abnormalities â—½  
Ventricular Support

<p><b>Background:</b> Myocardial ischemia due to concomitant coronary artery disease (CAD) or coronary dissection in patients with acute aortic dissection type Stanford A (AADA) is associated with myocardial failure and poor outcomes. Preoperative coronary angiography in this group of patients is still debated. The use of CT scan to diagnose coronary affection along with the establishment of high-pitched dual-spiral CT protocols are essential for improving outcomes.</p><p><b>Methods:</b> We retrospectively analyzed six AADA patients with heart failure who were treated using extracorporeal life support (ECLS). Options for diagnosing coronary affection and different therapeutic strategies for postcardiotomy cardiogenic shock in this patient cohort are discussed.</p><p><b>Results:</b> Retrospective review of CT images showed coronary abnormalities in 83% (n = 5). Four patients (67%) underwent unplanned coronary artery bypass grafting (CABG). ECLS was instituted in 67% (n = 4) due to left heart failure and in 33% (n = 2) due to right heart failure. Thirty day mortality was 67% (n = 4). The two patients that received ECLS for right ventricular support survived and both had undergone CABG.</p><p><b>Conclusion:</b> Besides preoperative evaluation of the extent of the dissection, focus on coronary affection in CT-scans helps to triage the operative procedure. Hybrid operating rooms allow for immediate interventional and/or surgical treatment and enable for immediate control of revascularization results. The use of ECLS over other types of ventricular support systems may allow for myocardial recovery in selected cases.</p>

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