Reserve-driven flow control for extracorporeal life support: proof of principle

Perfusion ◽  
2010 ◽  
Vol 25 (1) ◽  
pp. 25-29 ◽  
Author(s):  
AP Simons ◽  
KD Reesink ◽  
MD Lancé ◽  
T. van der Nagel ◽  
FH van der Veen ◽  
...  
Keyword(s):  
Control Strategy ◽  
Control Algorithm ◽  
Continuous Monitoring ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Servo Control ◽  
Low Flow ◽  
Circulatory Support ◽  
Control Schemes ◽  
Proof Of Principle

Extracorporeal life support systems lack volume-buffering capacity. Therefore, any decrease in venous intravascular volume available for drainage may result in acutely reduced support flow. We recently developed a method to quantify drainable volume and now conceived a reserve-driven pump control strategy, which is different from existing pressure or flow servo control schemes. Here, we give an outline of the algorithm and present animal experimental data showing proof of principle. With an acute reduction in circulatory volume (10-15%), pump flow immediately dropped from 4.1 to 1.9 l/min. Our pump control algorithm was able to restore bypass flow to 3.2 l/min (about 80% of the original level) and, thereby, reduced the duration of the low-flow condition. This demonstrates that a reserve-driven pump control strategy, based on the continuous monitoring of drainable volume, may maintain extracorporeal circulatory support flow, despite serious changes in filling conditions.

scholarly journals Organization and Application of ECLS Therapy—A Nationwide Survey in German Cardiosurgical Departments

2018 ◽  
Vol 67 (03) ◽  
pp. 164-169
Author(s):  
Alexander Assmann ◽  
Udo Boeken ◽  
Stefan Klotz ◽  
Wolfgang Harringer ◽  
Andreas Beckmann
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Extracorporeal Circulation ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Nationwide Survey ◽  
Left Ventricular ◽  
Local Application ◽  
Circulatory Support ◽  
Anticoagulation Management ◽  
The Status

Background In context of the multidisciplinary German scientific guideline “Use of extracorporeal circulation (extracorporeal life support [ECLS]/extracorporeal membrane oxygenation) for cardiac and circulatory failure,” a nationwide survey should depict the status of organization and application of ECLS therapy in Germany. Methods Between June and October 2017, a standardized questionnaire consisting of 30 items related to ECLS therapy was sent to all German cardiosurgical departments, and all returned results were analyzed and evaluated. Results The return rate amounted to 92.9% (78 out of 84 departments). In the participating departments, ECLS therapy is subject to different responsibilities, and exhibits divergent processes and various ways for specialization of the involved personnel. This also concerns local application standards, such as cannulation strategies, anticoagulation management, left ventricular unloading, antiwatershed treatment, and weaning from circulatory support. Conclusion This nationwide survey underlines the necessity of a multidisciplinary guideline concerning ECLS therapy.

Abstract 19091: Prognosis of Patients With Out-of-hospital Refractory Cardiac Arrest Referred for Extracorporeal Life Support: An Observational Study

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Cecile Ursat ◽  
Marie-Ange Tilliette ◽  
Charles Groizard ◽  
Margot Cassuto ◽  
Anna Ozguler ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Spontaneous Circulation ◽  
Flow Time ◽  
Low Flow ◽  
Time Interval ◽  
Specific Situation ◽  
Time Intervals ◽  
Paris Area

Introduction: In case of no return of spontaneous circulation (ROSC) after conventional cardio-pulmonary resuscitation (CPR), out-of-hospital cardiac arrest (OHCA) patients could be referred for extracorporeal life support (ECLS). Guidelines have been published concerning this specific situation (1). The aim of our study was to describe the prognosis of OHCA patients and verify if referral to ECLS was compliant with these recommendations mainly studying time intervals (no-flow < 5 min, low-flow < 100 min). Methods: A prospective survey on OHCA referred to ECLS was implemented from 03/01/12 until 06/11/15 in an Emergency Medical Service (EMS) located in Paris area (France). This survey included 43 patients referred to hospital for ECLS. Variables were given as means and percentages. Results: Patients referred to ECLS were more often men (77%), with a mean age of 51 years old. Most of 43 OHCA occurred at home (51%), although 26% occurred on public area and 16% at workplace. In 40% of cases, CPR was performed by a witness and in 33% by a health professional. A first Basic Life Support ambulance arrived on scene within 7 min 50 sec, whereas EMS ambulance arrived on scene within 18 min 27 sec after OHCA. At EMS arrival on scene, patients were on asystole (44%), ventricular fibrillation (37%), and on spontaneous circulation (12%). The no-flow time interval was 4 min 10 sec on average (6 patients had a no-flow over 5 min) with 43% of patients with no no-flow. Low-flow time-interval was 44 min. External electric shock was delivered before EMS arrival on 21% of cases, and EMS itself delivered a shock in 40% of cases. Epinephrine was used for all patients, 10.35 mg on average. No patient survived OHCA after referral to ECLS. Discussion: Although this is a small series of 43 patients, no OHCA patient referred to ECLS survived. These results are mainly due to a non-shockable initial condition or too long no-flow time intervals. In order to improve the outcome and bring benefit to the proper expected patients through a cost-effective pathway, we released a reminder of the right recommendations in our EMS. (1) Riou B., Adnet F., Baud F et al. A. Recommandation sur les indications de l’assistance circulatoire dans le traitement des arrêts cardiaques réfractaires. Ann Fr Anesth Réanim 2009 ; 28 : 182-6.

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

2020 ◽  
Vol 4 (2) ◽  
pp. 1-5
Author(s):  
Bebiana Manuela Monteiro Faria ◽  
João Português ◽  
Roberto Roncon-Albuquerque Jr ◽  
Rodrigo Pimentel
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Cardiogenic Shock ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Left Ventricular ◽  
Circulatory Support ◽  
Lv Function ◽  
Takotsubo Syndrome ◽  
Membrane Oxygenation ◽  
Lv Dysfunction

Abstract Background Takotsubo 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 summary We 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. Discussion Takotsubo 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.

scholarly journals German Heart Surgery Report 2019: The Annual Updated Registry of the German Society for Thoracic and Cardiovascular Surgery

2020 ◽  
Vol 68 (04) ◽  
pp. 263-276 ◽  
Author(s):  
Andreas Beckmann ◽  
Renate Meyer ◽  
Jana Lewandowski ◽  
Andreas Markewitz ◽  
Jan Gummert
Keyword(s):  
Heart Surgery ◽  
Life Support ◽  
Cardiovascular Surgery ◽  
Isolated Heart ◽  
Extracorporeal Life Support ◽  
Artery Bypass ◽  
German Society ◽  
Patient Treatment ◽  
Circulatory Support ◽  
Isolated Lung

AbstractBased on a longtime voluntary registry, founded by the German Society for Thoracic and Cardiovascular Surgery (GSTCVS) in 1980, well-defined data of all cardiac, thoracic, and vascular surgery procedures performed in 78 German heart surgery departments during the year 2019 are analyzed. For this period, a total of 175,705 procedures were submitted to the registry, 100,446 summarized as heart surgery procedures in a classical sense. The unadjusted in-hospital survival rate for the 34,224 isolated coronary artery bypass grafting procedures (relationship on-/off-pump 3.8:1) was 97.3%. For the 36,650 isolated heart valve procedures (16,625 transcatheter interventions included), it was 96.4%. Concerning short- and long-term circulatory support, a total of 2,716 extracorporeal life support/extracorporeal membrane oxygenation implantations, resp. 953 assist device implantations (L-/ R-/ BVAD, TAH) were registered. In 2019, the number of isolated heart transplantations increased to 333, a rise of 6.7% compared to the previous year. The isolated lung transplantations amounted to 311, a decrease of 8.5%. This annually updated registry of the GSTCVS represents voluntary public reporting by accumulating actual information for nearly all heart surgical procedures in Germany, constitutes advancements in heart medicine, and represents a basis for quality management for all participating institutions. In addition, the registry demonstrates that the provision of cardiac surgery in Germany is up to date, appropriate, and nationwide patient treatment is guaranteed all the time.

scholarly journals Trans-Aortic or Pulmonary Artery-Based Drainage for Left Ventricular Unloading and Veno-Arterial Extracorporeal Life Support Management in a Porcine Cardiogenic Shock Model.

2020 ◽  
Author(s):  
Paolo Meani ◽  
Mikulas Mlcek ◽  
Mariusz Kowalewski ◽  
Giuseppe Maria Raffa ◽  
Federica Jiritano ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Cardiogenic Shock ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Blood Stasis ◽  
Left Ventricular ◽  
Circulatory Support ◽  
Stroke Work ◽  
Organ Perfusion ◽  
Suction Device

Abstract Background The use of peripheral veno-arterial extracorporeal life support (V-A ECLS) as a mechanical circulatory support in cardiogenic shock has increased dramatically over the last years. However, increased afterload may jeopardize left ventricle (LV) recovery and cause blood stasis and pulmonary edema. Therefore, several LV unloading techniques have been developed and used with limited understanding of the actual difference among them. The aim of the present study was to compare a trans-aortic suction device (Impella) and pulmonary artery (PA) drainage, for LV unloading and V-A ECLS management as well as efficacy in a porcine cardiogenic shock (CS) model Methods A dedicated CS model compared included twelve female swine (21± 1,8-weeks old and weighing 54,3 ± 4,6 kg) supported with V-A ECLS and randomized to Impella or PA-related LV drainage. LV unloading and end-organ perfusion were evaluated through the pulmonary artery catheter and the LV pressure/volume analysis. All the variables were collected at baseline, profound CS, V-A ECLS support with maximum flow and when Impella or PA cannula run on top. Results CS was successfully induced in all twelve animals. Impella resulted in a marked drop of LVEDV compared to a slight decrease in the PA cannula group, resulting in an overall stroke work (SW) and Pressure-Volume Area (PVA) reductions with both techniques. However, SW reduction was significant in the Impella CP group (VA ECMO 3998.82027.6 mmHg x mL vs VAECMO + Impella 1796.9±1033.9 mmHg x ml, p value 0,016), leading to a more consistent PVA reduction (Impella reduction 34,7% vs PA cannula reduction 9,7%) In terms of end organ perfusion, central and mixed O 2 saturation improved with V-A ECLS, and subsequently, remaining unchanged with either Impella or PA cannula as unloading strategy Conclusions Trans-aortic suction and PA drainage provided effective LV unloading during V-A ECLS while maintaining adequate end-organ perfusion. Trans-aortic suction device provides a greater LV unloading effect and reduces more effectively the total LV stroke work.

Standardized Weaning from Temporary Extracorporeal Life Support in Cardiovascular Patients

2019 ◽  
Vol 68 (05) ◽  
pp. 425-432
Author(s):  
Marie Thomas ◽  
Maximilian Kreibich ◽  
Friedhelm Beyersdorf ◽  
Christoph Benk ◽  
Sven Maier ◽  
...  
Keyword(s):  
Life Support ◽  
Extracorporeal Life Support ◽  
Survival Rates ◽  
Specific Treatment ◽  
Patient Characteristics ◽  
Circulatory Support ◽  
Cardiovascular Patients ◽  
Successful Weaning ◽  
Individual Decisions ◽  
Group B

Objectives Separation from extracorporeal life support (ECLS) is often based on individual decisions rather than evaluated standard operating procedures (SOPs). Therefore, we strived to evaluate a SOP, summarizing specific treatment paths for this group of patients. Methods A total of 107 cardiovascular patients were supported with ECLS within a 4-year period. Fifty-three patients were treated before the SOP was introduced (group A) and 54 patients were treated afterward (group B). Patient characteristics and outcomes were analyzed and compared between the two time periods regarding baseline characteristics, compliance with SOP criteria, and the end points successful weaning and 30-day survival. Results Successful weaning rose significantly from 56.6 to 74.1% (p = 0.045) and 30-day survival rate increased from 34.0 to 50.0% (p = 0.069) after implementation of the SOP. Successful weaning was significantly associated with daily echocardiography (p = 0.012) and circulatory support with dobutamine (p = 0.026). The investigated other criteria used in the weaning process did not show a significant correlation with better outcome. Conclusion The SOP for ECLS weaning showed higher weaning rates compared with a weaning based on individual decisions. Although only parts of the SOP were associated with higher weaning and survival rates, the SOP was experienced as a useful guideline for standardized ECLS management.

Device Specific Aortic Outflow Cannula Jets Studied Using 2D PIV and High-Performance 3D CFD Simulation

2012 ◽  
Author(s):  
Prahlad G. Menon ◽  
Nikola Teslovich ◽  
Chia-Yuan Chen ◽  
Fotis Sotiropoulos ◽  
Akif Undar ◽  
...  
Keyword(s):  
Blood Flow ◽  
High Performance ◽  
Life Support ◽  
Cfd Simulation ◽  
Extracorporeal Life Support ◽  
Circulatory Support ◽  
Jet Flows ◽  
Mechanical Complication ◽  
Developmental Defects ◽  
Inner Diameter

In the US, approximately 1 in 100 children are born with a clinically significant congenital heart defect (CHD). The palliative repair of these defects requires complex biventricular and univentricular surgical operations in newborns often smaller than 2 kg. However, recovery after neonatal intervention remains suboptimal 1. A major component of these surgeries is the cardiopulmonary by-pass (CPB) procedure which if prolonged can potentially lead to neurological complications and developmental defects in a young patient. During CPB, tiny aortic cannulae (2–3 mm inner diameter), with micro-scale blood-wetting features transport relatively large blood volumes (0.3 to 1.0 L/min) resulting in high blood flow velocities. Our recent 3D computational fluid dynamics (CFD) simulations of jet flows in device specific cannulae 2 have indicated that the turbulent jet wake at high physiological neonatal extracorporeal life support (ECLS) circuit blood flow rates can potentially have damaging hemolytic effects, when evaluated in a cuboidal flow domain, as well as in in-silico aortic insertion configurations. Such severe flow conditions can result in platelet activation, vascular injuries and blood damage. Despite these risks, cannulation methods have received little attention compared to the effort expended to assure the safety and efficacy of the mechanical circulatory support blood pumps. Qui et al 3 report that cannula problems are the second most frequently reported mechanical complication in ECLS therapy for respiratory cases and the third most frequent complication in cardiac cases. The purpose of this study is to quantitatively evaluate the jet wake region of two popular 8FR pediatric cannulae, DLP Medtronic 77008 and RMI FEM II – 008 – AT (inner diameter ∼1850 microns), using stereo particle image velocimetry (PIV) to validate numerically computed flow fields.

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