scholarly journals Newly Developed Pediatric Membrane Oxygenator that Suppresses Excessive Pressure Drop in Cardiopulmonary Bypass and Extracorporeal Membrane Oxygenation (ECMO)

Membranes ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. 362
Author(s):  
Makoto Fukuda ◽  
Asako Tokumine ◽  
Kyohei Noda ◽  
Kiyotaka Sakai
Keyword(s):  
Blood Flow ◽  
Pressure Drop ◽  
Extracorporeal Membrane Oxygenation ◽  
High Performance ◽  
Flow Channel ◽  
Gas Transfer ◽  
Membrane Oxygenator ◽  
Excessive Pressure ◽  
Transfer Rates ◽  
Membrane Oxygenation

This article developes a pediatric membrane oxygenator that is compact, high performance, and highly safe. This novel experimental approach, which imaging the inside of a membrane oxygenator during fluid perfusion using high-power X-ray CT, identifies air and blood retention in the local part of a membrane oxygenator. The cause of excessive pressure drop in a membrane oxygenator, which has been the most serious dysfunction in cardiovascular surgery and extracorporeal membrane oxygenation (ECMO), is the local retention of blood and air inside the oxygenator. Our designed blood flow channel for a membrane oxygenator has a circular channel and minimizes the boundary between laminated parts. The pressure drop in the blood flow channel is reduced, and the maximum gas transfer rates are increased by using this pediatric membrane oxygenator, as compared with the conventional oxygenator. Furthermore, it would be possible to reduce the incidents, which have occurred clinically, due to excessive pressure drop in the blood flow channel of the membrane oxygenator. The membrane oxygenator is said to be the “last stronghold” for patients with COVID-19 receiving ECMO treatment. Accordingly, the specification of our prototype is promising for low weight and pediatric patients.

Physiological closed-loop control of mechanical ventilation and extracorporeal membrane oxygenation

2017 ◽  
Vol 62 (2) ◽  
Author(s):  
Christian Brendle ◽  
Thorsten Mülders ◽  
Jan Kühn ◽  
Thorsten Janisch ◽  
Rüdger Kopp ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Extracorporeal Membrane Oxygenation ◽  
Controller Synthesis ◽  
Gas Transfer ◽  
Therapeutic Approaches ◽  
Loop Control ◽  
Transfer Rates ◽  
Lung Protection ◽  
Membrane Oxygenation ◽  
Loop Control System

AbstractA new concept is presented for cooperative automation of mechanical ventilation and extracorporeal membrane oxygenation (ECMO) therapy for treatment of acute respiratory distress syndrome (ARDS). While mechanical ventilation is continuously optimized to promote lung protection, extracorporeal gas transfer rates are simultaneously adjusted to control oxygen supply and carbon dioxide removal using a robust patient-in-the-loop control system. In addition, the cooperative therapy management uses higher-level algorithms to adjust both therapeutic approaches. The controller synthesis is derived based on the introduced objectives, the experimental setup and the uncertain models. Finally, the autonomous ARDS therapy system capabilities are demonstrated and discussed based on

The physiology of extracorporeal membrane oxygenation: The Fick principle

Perfusion ◽  
2021 ◽  
pp. 026765912110559
Author(s):  
Hoong Lim
Keyword(s):  
Blood Flow ◽  
Extracorporeal Membrane Oxygenation ◽  
Arterial Oxygen Saturation ◽  
Arterial Oxygen ◽  
Fick Principle ◽  
Membrane Oxygenation ◽  
Lung Failure ◽  
Va Ecmo ◽  
The Relationship ◽  
Vv Ecmo

Extracorporeal membrane oxygenation (ECMO) can be delivered in veno-arterial (VA) and veno-venous (VV) configurations based on the cannulation strategy. VA and VV ECMO are delivered primarily for haemodynamic and respiratory support in patients with severe heart and lung failure, respectively. The Fick principle describes the relationship between blood flow and oxygen consumption – key parameters in the physiological management of extracorporeal support. This review will discuss the application of the Fick principle in: (i) recirculation in VV ECMO; (ii) the quantification of oxygen delivery (DO2) in VV ECMO and (iii) the quantification of transpulmonary blood flow and systemic arterial oxygen saturation in VA ECMO.

scholarly journals Regional blood flow distribution during extracorporeal membrane oxygenation in rabbits

1989 ◽  
Vol 98 (6) ◽  
pp. 1138-1143 ◽  
Author(s):  
Todd T. Nowlen ◽  
Steven O. Salley ◽  
Grant C. Whittlesey ◽  
Sourav K. Kundu ◽  
Nancy A. Maniaci ◽  
...  
Keyword(s):  
Blood Flow ◽  
Extracorporeal Membrane Oxygenation ◽  
Regional Blood Flow ◽  
Flow Distribution ◽  
Blood Flow Distribution ◽  
Membrane Oxygenation

Comparison of estimation of cardiac output using an uncalibrated pulse contour method and echocardiography during veno-venous extracorporeal membrane oxygenation

Perfusion ◽  
2019 ◽  
Vol 35 (5) ◽  
pp. 397-401
Author(s):  
Ottavia Bond ◽  
Selene Pozzebon ◽  
Federico Franchi ◽  
Federica Zama Cavicchi ◽  
Jacques Creteur ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cardiac Output ◽  
Extracorporeal Membrane Oxygenation ◽  
Linear Regression Analysis ◽  
Pulse Contour ◽  
Contour Method ◽  
Cardiac Output Monitoring ◽  
Membrane Oxygenation ◽  
Output Monitoring ◽  
Pulse Contour Method

Introduction: During veno-venous extracorporeal membrane oxygenation, cardiac output monitoring is essential to assess tissue oxygen delivery. Adequate arterial oxygenation depends on the ratio between the extracorporeal pump blood flow and the cardiac output. The aim of this study was to compare estimates of cardiac output and blood flow/cardiac output ratios made using an uncalibrated pulse contour method with those made using echocardiography in patients treated with veno-venous extracorporeal membrane oxygenation. Methods: Cardiac output was estimated simultaneously using a pulse contour method (MostCareUp; Vygon, Encouen, France) and echocardiography in 17 hemodynamically stable patients treated with veno-venous extracorporeal membrane oxygenation. Comparisons were made using Bland–Altman and linear regression analysis. Results: There were significant correlations between cardiac output estimated using pulse contour method and echocardiography and between blood flow/cardiac output estimated using pulse contour method and blood flow/cardiac output estimated using echocardiography (r = 0.84, p < 0.001 and r = 0.87, p < 0.001, respectively). Bland–Altman analysis showed a good agreement (bias −0.20 ± 0.50 L/min) and a low percentage of error (25%) for the cardiac output values estimated by the two methods. The bias between the blood flow/cardiac output ratios obtained with the two methods was 5.19% ± 12.3% (percentage of error = 28.1%). Conclusions: The pulse contour method is a valuable alternative to echocardiography for the assessment of cardiac output and the blood flow/cardiac output ratio in patients treated with veno-venous extracorporeal membrane oxygenation.

Creating a Controlled Arterio-Venous Shunt by Reversing the Extracorporeal Membrane Oxygenation Blood Flow

2017 ◽  
Vol 18 (10) ◽  
pp. 973-976 ◽  
Author(s):  
Christian Adrian Mattke ◽  
Emma Haisz ◽  
Nischal Pandya ◽  
Anthony Black ◽  
Prem Venugopal
Keyword(s):  
Blood Flow ◽  
Extracorporeal Membrane Oxygenation ◽  
Membrane Oxygenation ◽  
Venous Shunt

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)

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