Cost-effective usage of membrane oxygenators in extracorporeal membrane oxygenation in infants

Perfusion ◽  
2014 ◽  
Vol 30 (3) ◽  
pp. 239-242 ◽  
Author(s):  
A Özyüksel ◽  
C Ersoy ◽  
A Akçevin ◽  
H Türkoğlu ◽  
AE Çiçek ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Cost Effective ◽  
Membrane Oxygenation ◽  
Membrane Oxygenators

In vitro clearance of dexmedetomidine in extracorporeal membrane oxygenation

Perfusion ◽  
2012 ◽  
Vol 28 (1) ◽  
pp. 40-46 ◽  
Author(s):  
D Wagner ◽  
D Pasko ◽  
K Phillips ◽  
J Waldvogel ◽  
G Annich
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Membrane Oxygenator ◽  
Ecmo Circuit ◽  
Membrane Oxygenation ◽  
Concentration Changes ◽  
Membrane Oxygenators ◽  
Serial Samples ◽  
Ecmo Therapy ◽  
Time Point

Dexmedetomidine (DMET) is a useful agent for sedation, both alone and in combination with other agents, in critically ill patients, including those on extracorporeal membrane oxygenation (ECMO) therapy. The drug is a clonidine-like derivative with an 8-fold greater specificity for the alpha 2-receptor while maintaining respiratory and cardiovascular stability. An in vitro ECMO circuit was used to study the effects of both “new” and “old” membrane oxygenators on the clearance of dexmedetomidine over the course of 24 hours. Once primed, the circuit was dosed with 840 μg of dexmedetomidine for a final concentration of 0.9 μg/ml. Serial samples, both pre- and post-oxygenator, were taken at 5, 60, 360, and 1440 minutes. Concentrations of the drug were expressed as a percentage of the original concentration remaining at each time point, both for new and old circuits. The new circuits were run at a standard flow for 24 hours, after which time the circuit was considered old and re-dosed with dexmedetomidine and the trial repeated. Results show that dexmedetomidine losses occur early in the circuits and then continue to decline. Initial losses in the first hour were 11+-65% and 59-73% pre- and post-oxygenator in the new circuit and 36-50% and 42-72% in the old circuit. The clearance of the drug through the membrane oxygenator exhibits no statistical difference between pre and post or new and old circuits. Dexmedetomidine can be expected to exhibit concentration changes during ECMO therapy. This effect appears to be more related to adsorption to the polyvinyl chloride (PVC) tubing rather than the membrane oxygenator. Dosage adjustments during dexmedetomidine administration during ECMO therapy may be warranted in order to maintain adequate serum concentrations and, hence, the desired degree of sedation.*(Lack of equilibrium)

D-dimers Are a Predictor of Clot Volume Inside Membrane Oxygenators During Extracorporeal Membrane Oxygenation

2015 ◽  
Vol 39 (9) ◽  
pp. 782-787 ◽  
Author(s):  
Christian Dornia ◽  
Alois Philipp ◽  
Stefan Bauer ◽  
Christian Stroszczynski ◽  
Andreas G. Schreyer ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Membrane Oxygenation ◽  
Membrane Oxygenators

scholarly journals Extracorporeal membrane oxygenation and V/Q ratios: an ex vivo analysis of CO2 clearance within the Maquet Quadrox-iD oxygenator

Perfusion ◽  
2020 ◽  
Vol 35 (1_suppl) ◽  
pp. 29-33 ◽  
Author(s):  
Bishoy Zakhary ◽  
Jayne Sheldrake ◽  
Vincent Pellegrino
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Dead Space ◽  
Gas Flow ◽  
Ex Vivo ◽  
Respiratory Acidosis ◽  
Gas Flows ◽  
Membrane Oxygenation ◽  
In Series ◽  
Membrane Oxygenators ◽  
Different Levels

While hypercapnia is typically well treated with modern membrane oxygenators, there are cases where respiratory acidosis persists despite maximal extracorporeal membrane oxygenation support. To better understand the physiology of gas exchange within the membrane oxygenator, CO2 clearance within an adult Maquet Quadrox-iD oxygenator was evaluated at varying blood CO2 tensions and V/Q ratios in an ex vivo extracorporeal membrane oxygenation circuit. A closed blood-primed circuit incorporating two Maquet Quadrox-iD oxygenators in series was attached to a Maquet PLS Rotaflow pump. A varying blend of CO2 and air was connected to the first oxygenator to provide different levels of pre-oxygenator blood CO2 levels (PvCO2) to the second oxygenator. Varying sweep gas flows of 100% O2 were connected to the second oxygenator to provide different V/Q ratios. Exhaust CO2 was directly measured, and then VCO2 and oxygenator dead space fraction (VD/VT) were calculated. VCO2 increased with increasing gas flow rates with plateauing at V/Q ratios greater than 4.0. Exhaust CO2 increased with PvCO2 in a linear fashion with the slope of the line decreasing at high V/Q ratios. Oxygenator dead space fraction varied with V/Q ratio—at lower ratios, dead space fraction was 0.3-0.4 and rose to 0.8-0.9 at ratios greater than 4.0. Within the Maquet Quadrox-iD oxygenator, CO2 clearance is limited at high V/Q ratios and correlated with elevated oxygenator dead space fraction. These findings have important implications for patients requiring high levels of extracorporeal membrane oxygenation support.

Performance of polymethyl pentene oxygenators for neonatal extracorporeal membrane oxygenation: a comparison with silicone membrane oxygenators

Perfusion ◽  
2005 ◽  
Vol 20 (3) ◽  
pp. 129-134 ◽  
Author(s):  
Espeed Khoshbin ◽  
Claire Westrope ◽  
Suneel Pooboni ◽  
David Machin ◽  
Hilliary Killer ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Silicone Membrane ◽  
Membrane Oxygenation ◽  
Membrane Oxygenators

scholarly journals The Efficiency and Safety of Bivalirudin versus Heparin in The Anticoagulation Therapy in Extracorporeal Membrane Oxygenation: A Meta-Analysis

2021 ◽  
Author(s):  
Min Ma ◽  
Shichu Liang ◽  
Jingbo Zhu ◽  
Yong He
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Major Bleeding ◽  
Meta Analysis ◽  
Anticoagulation Therapy ◽  
Cost Effective ◽  
Cochrane Library ◽  
Thrombin Inhibitor ◽  
Membrane Oxygenation ◽  
Meta Analyses ◽  
The Cochrane Library

Abstract Background: Bivalirudin is a direct thrombin inhibitor (DTI), which can be the alternative of unfractionated heparin (UFH). The efficiency and safety of bivalirudin versus UFH in the anticoagulation therapy in Extracorporeal membrane oxygenation(ECMO) remains unclear. The purpose of the meta-analysis is to evaluate the efficiency and safety of bivalirudin versus UFH in the anticoagulation therapy in ECMO.Methods: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were followed. A systematic literature search for original studies was performed in PubMed, EMBASE and The Cochrane Library to identify all relevant studies published prior to January 13,2021. Studies were reviewed according to eligibility and exclusion criteria. The meta-analysis was used to estimate the efficiency and safety of bivalirudin versus UFH in the anticoagulation therapy in extracorporeal membrane oxygenation. Results: 6 retrospective studies with 254 patients were eventually included for the quantitative analysis. The results showed that the incidence of major bleeding(I2=66%, P=0.16, OR=0.43, 95%CI:0.13-1.40), thrombosis(I2=0%, P=0.09<0.1, OR=0.56, 95%CI:0.29-1.09) and 30-day mortality(I2=0%, P=0.50, OR=0.90, 95%CI:0.42-1.53) was not statistically significant between the bivalirudin group and the UFH group.Conclusions:This study suggests that bivalirudin and UFH are associated with similar rates of major bleeding, thrombosis and 30-day mortality in adult and pediatric ECMO support, which is safe, practicable, dependable, and cost-effective in comparison with UFH. Bivalirudin is non-inferior to UFH in the anticoagulation therapy in ECMO.

scholarly journals A skills acquisition study on ECMOjo: a screen-based simulator for extracorporeal membrane oxygenation

Perfusion ◽  
2019 ◽  
Vol 35 (2) ◽  
pp. 110-116 ◽  
Author(s):  
Abdullah Alsalemi ◽  
Len Tanaka ◽  
Mark Ogino ◽  
Mohammed Al Disi ◽  
Yahya Alhomsi ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Cognitive Skills ◽  
Cost Effective ◽  
Skills Acquisition ◽  
Behavioral Skills ◽  
Didactic Teaching ◽  
Membrane Oxygenation ◽  
Effective Manner ◽  
Simulation Based ◽  
Educational Efficacy

Background: Extracorporeal membrane oxygenation relies heavily on didactic teaching, emphasizing on essential cognitive skills, but overlooking core behavioral skills such as leadership and communication. Therefore, simulation-based training has been adopted to instill clinical knowledge through immersive experiences. Despite simulation-based training’s effectiveness, training opportunities are lessened due to high costs. This is where screen-based simulators come into the scene as affordable and realistic alternatives. Aim: This article evaluates the educational efficacy of ECMOjo, an open-source screen-based extracorporeal membrane oxygenation simulator that aims to replace extracorporeal membrane oxygenation didactic instruction in an interactive and cost-effective manner. Method: A prospective cohort skills acquisition study was carried out. A total of 44 participants were pre-assessed, divided into two groups, where the first group received traditional didactic teaching, and the second used ECMOjo. Participants were then evaluated through a wet lab assessment and two questionnaires. Results: The obtained results indicate that the two assessed groups show no statistically significant differences in knowledge and efficacy. Hence, ECMOjo is considered an alternative to didactic teaching as per the learning outcomes. Conclusion: The present findings show no significant dissimilarities between ECMOjo and didactic classroom-based teaching. Both methods are very comparable in terms of the learner’s reported self-efficacy and complementary to mannequin-based simulations.

scholarly journals Cost-Effective Extracorporeal Membrane Oxygenation Simulation

2018 ◽  
Vol 02 (01) ◽  
pp. 005-009 ◽  
Author(s):  
Guillaume Alinier
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Best Practice ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Low Cost ◽  
Cost Effective ◽  
Emergency Situations ◽  
Membrane Oxygenation ◽  
Ensure Patient Safety ◽  
Simulation Based

AbstractThis invited review article was presented orally on the occasion of the South West Asian Chapter conference of the Extracorporeal Life Support Organization (ELSO) held in New Delhi, India in January 2018. It has an educational focus on the topic of extracorporeal membrane oxygenation (ECMO), which is increasingly being used as a lifesaving bridge therapy. A case is being made regarding the adage “practice makes perfect” to be considered in the context of simulation-based education to ensure patient safety. Technology-enhanced simulation-based deliberate practice should be used more commonly to support clinicians in the development of all their professional skills. This is an ethical imperative that may be addressed using low-cost simulation modalities that are sometimes proven to be as effective as more expensive approaches. Educators can now design their programs according to published best practice standards for the benefit of their learners, and ultimately the patients they care for. Simulation-based education clearly has a place and important role to play in preparing ECMO teams dealing with routine procedures as well as emergency situations. Several solution and approaches are being presented alongside innovative work currently being done in collaboration between a regional ELSO center of excellence and an academic institution. This innovative simulator is composed of several modules serving different functions required for the simulation of ECMO emergencies at a much lower cost than using the real machine and its various expensive disposable components.

scholarly journals A Modular Approach for a Patient Unit for Extracorporeal Membrane Oxygenation Simulator

Membranes ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. 424
Author(s):  
Yahya Alhomsi ◽  
Abdullah Alsalemi ◽  
Mohammad Noorizadeh ◽  
Faycal Bensaali ◽  
Nader Meskin ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Real Life ◽  
Cost Effective ◽  
Training Process ◽  
New Approach ◽  
Membrane Oxygenation ◽  
Audio Cues ◽  
Effective Manner ◽  
Simulation Based ◽  
Emergency Scenarios

Despite many advancements in extracorporeal membrane oxygenation (ECMO), the procedure is still correlated with a high risk of patient complications. Simulation-based training provides the opportunity for ECMO staff to practice on real-life scenarios without exposing ECMO patients to medical errors while practicing. At Hamad Medical Corporation (HMC) in Qatar, there is a critical need of expert ECMO staff. Thus, a modular ECMO simulator is being developed to enhance the training process in a cost-effective manner. This ECMO simulator gives the instructor the ability to control the simulation modules and run common simulation scenarios through a tablet application. The core modules of the simulation system are placed in the patient unit. The unit is designed modularly such that more modules can be added throughout the simulation sessions to increase the realism of the simulation sessions. The new approach is to enclose the patient unit in a trolley, which is custom-designed and made to include all the components in a modular fashion. Each module is enclosed in a separate box and then mounted to the main blood simulation loop box using screws, quick connect/disconnect liquid fittings, and electrical plugs. This method allows fast upgrade and maintenance for each module separately as well as upgrading modules easily without modifying the trolley’s design. The prototype patient unit has been developed for portability, maintenance, and extensibility. After implementation and testing, the prototype has proven to successfully simulate the main visual and audio cues of the real emergency scenarios, while keeping costs to a minimum.

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