A Review of Extracorporeal Blood Purification Techniques for the Treatment of Critically Ill Coronavirus Disease 2019 Patients
In late 2019, a novel betacoronavirus, later termed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was discovered in patients with an unknown respiratory illness in Wuhan, China. SARS-CoV-2 and the disease caused by the novel coronavirus, coronavirus disease 2019 (COVID-19), spread rapidly and resulted in the World Health Organization declaring a pandemic in March 2020. In a minority of patients infected with SARS-CoV-2, severe illness develops characterized by a dysregulated immune response, acute respiratory distress syndrome, and multisystem organ failure. Despite the development of antiviral and multiple...
Source: ASAIO Journal - October 1, 2022 Category: Medical Devices Tags: Review Source Type: research

Response to Muller et al. Regarding “Impact of COVID-19 on Patients Supported with a Left Ventricular Assist Device”
No abstract available (Source: ASAIO Journal)
Source: ASAIO Journal - September 1, 2022 Category: Medical Devices Tags: Letters to the Editor Source Type: research

Letter by Muller et al Regarding Article “Impact of COVID-19 on Patients Supported with a Left Ventricular Assist Device”
No abstract available (Source: ASAIO Journal)
Source: ASAIO Journal - September 1, 2022 Category: Medical Devices Tags: Letters to the Editor Source Type: research

Management of Heparin-Induced Thrombocytopenia Using Plasmapharesis in Patients Undergoing HeartMate 3 Left Ventricular Assist Device
We describe a case series of four patients who developed HIT in their hospital course before HeartMate 3 (HM3) left ventricular assist device implantation. Following a multidisciplinary approach, all patients did well intraoperatively with an approach of preoperative plasmapheresis, intraoperative unfractionated heparin (UFH), and postoperative conversion to bivalirudin with a bridge to warfarin. However, two patients had postoperative bleeding complications on bivalirudin. This case series details the therapeutic challenges encountered for HM3 implantation in patients with HIT and offers a therapeutic alternative to intra...
Source: ASAIO Journal - September 1, 2022 Category: Medical Devices Tags: Case Reports Source Type: research

Hemodynamic Effects of Left-Atrial Venous Arterial Extra-Corporeal Membrane Oxygenation (LAVA-ECMO)
We report a case of a 59-year-old male in post-myocardial infarction cardiogenic shock undergoing left atrial venous arterial extracorporeal membrane oxygenation (LAVA-ECMO) as a bridge to transplantation. The unique feature of this ECMO configuration is use of a single trans-septal cannula to provide biventricular unloading and use of a single arterial access. (Source: ASAIO Journal)
Source: ASAIO Journal - September 1, 2022 Category: Medical Devices Tags: Case Reports Source Type: research

The Effects of Pencil Beam Scanning Proton Beam Therapy on a HeartMate 3 Left Ventricular Assist Device: Implications for Patient Safety
No abstract available (Source: ASAIO Journal)
Source: ASAIO Journal - September 1, 2022 Category: Medical Devices Tags: Brief Communication Source Type: research

Development of a Novel Adapter to Enable Less-Invasive Left Ventricular Assist Device Implantation via the Left Ventricular Apex
The first prototype of an adapter to enable left ventricular assist device (LVAD) implantation solely via the left ventricular (LV) apex and without requiring cardiopulmonary bypass (CPB) was tested in healthy and acutely failing pig hearts. The adapter consists of a fixation, blood guiding, and connecting module fitting to a HeartMate 3 (HM3; Abbott, Chicago, IL) pump. Implantation was performed via a left thoracotomy in five pigs (96 ± 18 kg). Invasive blood pressure was measured before (CTRL), 30 minutes after HM3 initiation (HM3_CTRL), during acute heart failure (HF) induced by rapid pacing (CTRL_HF), and 5 minu...
Source: ASAIO Journal - September 1, 2022 Category: Medical Devices Tags: How to do it Article Source Type: research

Inulin Clearance During Ex vivo Normothermic Machine Perfusion as a Marker of Renal Function
This study describes the evaluation of inulin clearance as a potential marker for the ex vivo function of porcine kidneys during NMP. The function assessment was performed in both kidneys from slaughterhouse pigs (n = 20) and kidneys from pigs in a laboratory setting (n = 28). The kidneys were exposed to different warm ischemia times (WIT). After a period of static cold storage, the kidneys underwent a 4-hour NMP with autologous whole blood. Inulin clearance, hemodynamic parameters, and urine output were measured. Based on the inulin excretion behavior laboratory pig kidneys were assigned to three classes (functional, limi...
Source: ASAIO Journal - September 1, 2022 Category: Medical Devices Tags: Renal/Extracorporeal Blood Treatment Source Type: research

Remdesivir and GS-441524 Extraction by Ex Vivo Extracorporeal Life Support Circuits
Patients with severe, COVID-related multi-organ failure often require extracorporeal life support (ECLS) such as extracorporeal membrane oxygenation (ECMO) or continuous renal replacement therapy (CRRT). An ECLS can alter drug exposure via multiple mechanisms. Remdesivir (RDV) and its active metabolite GS-441524 are likely to interact with ECLS circuits, resulting in lower than expected exposures. We evaluated circuit-drug interactions in closed loop, ex vivo ECMO and CRRT circuits. We found that mean (standard deviation) recovery of RDV at 6 hours after dosing was low in both the ECMO (33.3% [2.0]) and CRRT (3.5% [0.4]) c...
Source: ASAIO Journal - September 1, 2022 Category: Medical Devices Tags: Renal/Extracorporeal Blood Treatment Source Type: research

Preclinical Evaluation of a New ECCO2R Setup
Low flow extracorporeal carbon dioxide removal (ECCO2R) is a promising approach to correct hypercapnic lung failure, facilitate lung protective ventilation in acute respiratory distress syndrome and to possibly prevent the application of invasive ventilation. However, the predominant availability of adult membrane lungs (MLs) at most intensive care units are burdens for low flow ECCO2R that intends to reduce cannula size and promote the mobility of the patients. Herein, in a mock setup, we combine the idea of a low flow ECCO2R and the use of adult MLs by installing a recirculation channel into the circuit and comparing the...
Source: ASAIO Journal - September 1, 2022 Category: Medical Devices Tags: Pulmonary Source Type: research

Utility of Routine Head Ultrasounds in Infants on Extracorporeal Life Support: When is it Safe to Stop Scanning?
Intracranial hemorrhage (ICH) can be a devastating complication of extracorporeal life support (ECLS); however, studies on the timing of ICH detection by head ultrasound (HUS) are from 2 decades ago, suggesting ICH is diagnosed by day 5 of ECLS. Given advancements in imaging and critical care, our aim was to evaluate if the timing of ICH diagnosis in infants on ECLS support has changed. Patients (Source: ASAIO Journal)
Source: ASAIO Journal - September 1, 2022 Category: Medical Devices Tags: Pediatric Circulatory Support Source Type: research

Trends in Body Mass Index and Association With Outcomes in Pediatric Patients on Continuous Flow Ventricular Assist Device Support
Data are limited regarding body mass index (BMI) in pediatric patients supported by ventricular assist devices (VAD) and associated clinical outcomes and complications. We performed a retrospective single-center cohort study including patients aged ≤21 years on durable continuous-flow VAD support for ≥30 days from 2009 to 2020. Patients were classified based on BMI percentile at implant using the US Centers for Disease Control and Prevention criteria: underweight ( (Source: ASAIO Journal)
Source: ASAIO Journal - September 1, 2022 Category: Medical Devices Tags: Pediatric Circulatory Support Source Type: research

Adverse Events Associated with Cardiac Catheterization in Children Supported with Ventricular Assist Devices
Children on ventricular assist device (VAD) support can present several unique challenges, including small patient size, univentricular or biventricular congenital heart disease (1V- or 2V-CHD) and need for biventricular VAD (BiVAD) support. While cardiac catheterization can provide valuable information, it is an invasive procedure with inherent risks. We sought to evaluate the safety of catheterization in pediatric patients on VAD support. We performed a retrospective review of patients on VAD support who underwent catheterization at Lucile Packard Children’s Hospital between January 1, 2014 and September 1, 2019. Using...
Source: ASAIO Journal - September 1, 2022 Category: Medical Devices Tags: Pediatric Circulatory Support Source Type: research

Pediatric Extracorporeal Life Support Transport in Western Canada: Experience over 14 years
This retrospective cohort study describes all children transported on extracorporeal life support (ECLS) by the Stollery Children’s Hospital Pediatric Transport team (SCH-PTT) between 2004 and 2018. We compared outcomes and complications between primary (SCH-PTT performed ECLS cannulation) vs. secondary (cannulation performed by referring facility) transports, as well as secondary transports from referring centers with and without an established ECLS cannulation program. SCH-PTT performed 68 ECLS transports during the study period. Median (IQR) transport distance was 298 (298–1,068) kilometers. Mean (SD) times from ref...
Source: ASAIO Journal - September 1, 2022 Category: Medical Devices Tags: Pediatric Circulatory Support Source Type: research

Predictors of Favorable Neurologic Outcomes in a Territory-First Extracorporeal Cardiopulmonary Resuscitation Program
Extracorporeal cardiopulmonary resuscitation (ECPR) is an advanced resuscitation method that has been associated with better outcomes after cardiac arrest compared with conventional cardiopulmonary resuscitation. This is a retrospective analysis of all patients who received ECPR for cardiac arrest in Hong Kong’s first ECPR program from 2012 to 2020. The primary outcome was favorable neurologic outcome at 3 months. A new risk prediction model was developed and its performance was compared with published risk scores. One-hundred two patients received ECPR and 19 (18.6%) patients survived with favorable neurologic outcome. ...
Source: ASAIO Journal - September 1, 2022 Category: Medical Devices Tags: Clinical Critical Care Source Type: research