Setting up a Rescue Extracorporeal Life Support Program
This article outlines how we established our unique Rescue ECLS Cannulation program. We outline the planning, development, and implementation of the program and describe the unique aspects contributing to successful implementation including longitudinal training, staged program evolution, and a bundled approach to care. We also describe the patients who we have cannulated since its inception. Rescue ECLS Cannulation Programs provide access to consistent, high-quality, and lifesaving care to critically ill patients at sites without the resources to support a full ECLS program. (Source: ASAIO Journal)
Source: ASAIO Journal - October 1, 2022 Category: Medical Devices Tags: How to do it Article Source Type: research

Multilayer Scaling of a Biomimetic Microfluidic Oxygenator
Extracorporeal membrane oxygenation (ECMO) has been advancing rapidly due to a combination of rising rates of acute and chronic lung diseases as well as significant improvements in the safety and efficacy of this therapeutic modality. However, the complexity of the ECMO blood circuit, and challenges with regard to clotting and bleeding, remain as barriers to further expansion of the technology. Recent advances in microfluidic fabrication techniques, devices, and systems present an opportunity to develop new solutions stemming from the ability to precisely maintain critical dimensions such as gas transfer membrane thickness...
Source: ASAIO Journal - October 1, 2022 Category: Medical Devices Tags: Pulmonary Source Type: research

Extracorporeal Life Support for Status Asthmaticus: Early Outcomes in Teens and Young Adults
Extracorporeal life support (ECLS) may be life saving for patients with status asthmaticus (SA), a difficult-to-treat, severe subset of asthma. Contemporary ECLS outcomes for SA in teens and young adults are not well described. The Extracorporeal Life Support Organization (ELSO) Registry was reviewed (2009–2019) for patients (15–35 years) with a primary diagnosis of SA. In-hospital mortality and complications were described. Multivariable logistic regression was used to identify independent risk factors for hospital mortality. Overall, 137 patients, (26 teens and 111 young adults; median age 25 years) were included. Ex...
Source: ASAIO Journal - October 1, 2022 Category: Medical Devices Tags: Pediatric Circulatory Support Source Type: research

Key Considerations in Establishing a Pediatric Rescue Extracorporeal Life Support Program: A Multi Methods Review
Extracorporeal life support (ECLS) is generally limited to centers with cardiac surgery. However, pediatric centers without cardiac surgery can still provide potentially lifesaving ECLS through a Rescue Program, allowing a local team to cannulate and stabilize patients before they are transported to a center with cardiac surgery support for ongoing care. This multimethod study provides an exploration of pediatric ECLS team insights regarding program implementation and offers recommendations for other centers wishing to develop a similar program. We performed surveys and semi-structured interviews to gather perspectives fro...
Source: ASAIO Journal - October 1, 2022 Category: Medical Devices Tags: Pediatric Circulatory Support Source Type: research

Association of Volume Status During Veno-Venous Extracorporeal Membrane Oxygenation with Outcome
Fluid overload in acute respiratory distress syndrome is associated with increased mortality. The purpose of this study was to investigate the association of cumulative fluid balance (CFB) during the first 7 days of veno-venous extracorporeal membrane oxygenation (VV ECMO) and mortality. Adult patients on VV ECMO for greater than 168 hours, between November 2015 and October 2019, were included. CFB during the first 7 ECMO days was compared between survivors and nonsurvivors, and survival was analyzed using Kaplan-Meier analysis and cox proportional hazards modeling. One hundred forty-six patients were included. Median age ...
Source: ASAIO Journal - October 1, 2022 Category: Medical Devices Tags: Clinical Critical Care Source Type: research

Prolonged (24-hour) Normothermic ex vivo Heart Perfusion Facilitated by Perfusate Hemofiltration
We present a model of NEVHP using continuous hemofiltration (HFn) with sustained myocardial viability up to 24 hours. Twenty hearts from 6–10 kg piglets were procured and maintained on our NEVHP circuit. HFn hearts (n = 10) underwent NEVHP with HFn, whereas controls (n = 10) used NEVHP alone. All HFn vs. four controls were viable at 24 h (p = 0.004). At end perfusion, HFn hearts had higher left ventricular systolic pressure (51.5 ± 6.8 mm Hg, 38.3 ± 5.2 mm Hg, p = 0.05), lower coronary resistance (0.83 ± 0.11 mm Hg/mL/min, 1.18 ± 0.21mmHg/mL/min, p (Source: ASAIO Journal)
Source: ASAIO Journal - October 1, 2022 Category: Medical Devices Tags: Clinical Cardiovascular Source Type: research

High-Versatility Left Ventricle Pump and Aortic Mock Circulatory Loop Development for Patient-Specific Hemodynamic In Vitro Analysis
This study describes the design of a versatile setup composed by a custom pulsatile left ventricular pump system and a 3D-printed mock circulatory loop for the in vitro analysis of a patient-specific case of an aortic complex. The performances of the pump were validated first with a set of test flow profiles. It was demonstrated that the system was able to cover a wide range of aortic and mitral flows. Second, the pump system was inserted within the full mock circulatory loop. A patient-specific case was reproduced, both in terms of flow and pressure profiles. A successful validation of the flow and pressure waveforms was ...
Source: ASAIO Journal - October 1, 2022 Category: Medical Devices Tags: Biomedical Engineering Source Type: research

In silico Prediction of Thrombosis Risk in a Ventricular Assist Device Supported Right Heart: The Impact of Cannulation Site
This study aims to investigate the thrombosis risk of cannulation via the right atrium (RA) and right ventricle (RV) (diaphragmatic) under full RVAD support using computational fluid dynamics. A HeartWare HVAD inflow cannula was virtually implanted in either the RA or RV of a rigid-walled right heart geometry (including RA, RV, superior, and inferior vena cava) extracted from computed tomography data of a biventricular support patient. Transient simulations, validated with particle image velocimetry, were performed with constant inflow. Thrombosis risk was predicted by analyzing the time-averaged blood velocity, blood stag...
Source: ASAIO Journal - October 1, 2022 Category: Medical Devices Tags: Biomedical Engineering Source Type: research

In-vitro Assessments of Clot Elicitation by Thrombogenic Fibers vs. Embolization Coils
The objective of this study is to compare whole blood coagulation elicited by a textile stent-graft equipped with thrombogenic, patented “Kardiozis” fibers (PKF) to that elicited by embolization coils in an in vitro study. (Source: ASAIO Journal)
Source: ASAIO Journal - October 1, 2022 Category: Medical Devices Tags: Biomedical Engineering Source Type: research

Platelet Transfusion and In-Hospital Mortality in Veno-Arterial Extracorporeal Membrane Oxygenation Patients
Thrombocytopenia is common during extracorporeal membrane oxygenation (ECMO), and platelets are sometimes transfused to meet arbitrary goals. We performed a retrospective cohort study of veno-arterial (VA) ECMO patients from a single academic medical center and explored the relationship between platelet transfusion and in-hospital mortality using multivariable logistic regression. One hundred eighty-eight VA ECMO patients were included in the study. Ninety-one patients (48.4%) were transfused platelets during ECMO. Patients who received platelet transfusion had more coronary artery disease, lower platelet counts at cannula...
Source: ASAIO Journal - October 1, 2022 Category: Medical Devices Tags: Adult Circulatory Support Source Type: research

Utility of D-dimers in COVID-19 Patients Requiring Extracorporeal Membrane Oxygenation
A retrospective study was performed examining the trend of inflammatory markers, including D-dimers, in 29 COVID-19 patients requiring veno-venous (VV) extracorporeal membrane oxygenation (ECMO) support. We observed that COVID-19 patients with pre-cannulation D-dimer levels>3,000 ng/mL had a significantly shorter time from admission to cannulation (4.78 vs. 8.44 days, p = 0.049) compared to those with D-dimer 3,000 ng/mL had a trend of lower pH (7.24 vs. 7.33), higher pCO2 (61.33 vs. 50.69), and higher vasoactive inotropic score (7.23 vs. 3.97) at time of cannulation, however, these were not statistically significant. This...
Source: ASAIO Journal - October 1, 2022 Category: Medical Devices Tags: Management of COVID-19 Patients Source Type: research

Improving Extracorporeal Membrane Oxygenation Survival in COVID-19. Effect of a Bundle of Care
Veno-venous extracorporeal membrane oxygenation (ECMO) support surged during the COVID-19 pandemic. Our program changed the model of care pursuing to protect the multidisciplinary team from the risk of infection and to serve as many patients as possible. Patient–healthcare interactions were restricted, and the ECMO bed capacity was increased by reducing the ECMO specialist–patient ratio to 1:4 with non-ECMO trained nurses support. The outcomes worsened and we paused while we evaluated and modified our model of care. The ECMO bed capacity was reduced to allow a nurse ECMO–specialist nurse ratio 2:1 with an ECMO traine...
Source: ASAIO Journal - October 1, 2022 Category: Medical Devices Tags: Management of COVID-19 Patients Source Type: research

Engineering Solutions to Biologic Challenges Exemplified in Times of Crisis
No abstract available (Source: ASAIO Journal)
Source: ASAIO Journal - October 1, 2022 Category: Medical Devices Tags: Invited Commentary Source Type: research

Meet the Authors
No abstract available (Source: ASAIO Journal)
Source: ASAIO Journal - October 1, 2022 Category: Medical Devices Tags: Meet the Authors Source Type: research

FDA Emergency Use Authorization-Approved Novel Coronavirus Disease 2019, Pressure-Regulated, Mechanical Ventilator Splitter That Enables Differential Compliance Multiplexing
Infection with the novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), may cause viral pneumonia and acute respiratory distress syndrome (ARDS). Treatment of ARDS often requires mechanical ventilation and may take weeks for resolution. In areas with a large outbreaks, there may be shortages of ventilators available. While rudimentary methods for ventilator splitting have been described, given the range of independent ventilatory settings required for each patient, this solution is suboptimal. Here, we describe a device that can split a ventilator among up to four patients while allowing for ind...
Source: ASAIO Journal - October 1, 2022 Category: Medical Devices Tags: Management of COVID-19 Patients Source Type: research