Evolution of the Extracorporeal Life Support Circuitry

Palanzo, David A; Qiu, Feng; Baer, Larry D.; Clark, Joseph B.; Myers, John L.; Ündar, Akif

doi:10.1111/j.1525-1594.2010.01127.x

Cited by 84 publications

(82 citation statements)

References 11 publications

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“…In vitro simulated circuit studies that duplicate physiologic conditions as closely as possible using standardized adult ECMO circuits have the potential to provide insights into circuit drug interactions and help further refine ECMO circuitry. Extracorporeal membrane oxygenation is a technology in evolution [42], and further studies are required to quantify drug losses in miniaturized circuits that use polymethylpentene oxygenators, magnetically levitated centrifugal pumps, coated tubing, and cannulae.…”

Section: E11 Pharmacokinetic Changes In Patients Receiving Ecmomentioning

confidence: 99%

Pharmacokinetic changes in patients receiving extracorporeal membrane oxygenation

Shekar

Fraser

Smith

et al. 2012

Journal of Critical Care

287

315

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Section: E11 Pharmacokinetic Changes In Patients Receiving Ecmomentioning

confidence: 99%

Pharmacokinetic changes in patients receiving extracorporeal membrane oxygenation

Shekar

Fraser

Smith

et al. 2012

Journal of Critical Care

287

315

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“…It functions as an artificial lung removing carbon dioxide and oxygenating blood. Early oxygenators were made of silicon materials whereas in recent years, hallow fiber oxygenators are mostly utilized [10]. Compared to silicon oxygenators, hallow fiber oxygenators have a shorter prime time with lower prime volume that makes them superior.…”

Section: Ecmo Oxygenatormentioning

confidence: 99%

Anticoagulation during ECMO: The Past, Present and Future

Doymaz¹

2018

J Intensive Crit Care

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In recent years, many medical centres started to use extracorporeal membrane oxygenator (ECMO) support as the last treatment option for critically ill patients when the conventional therapy fails. There are significant improvements in ECMO management since the early days of its application. In this report, we aimed to review several aspects in this complex treatment modality. One of the main areas reviewed in this article will be the anticoagulation strategy used during ECMO support and the tests utilized for monitoring coagulation parameters. Additionally, technologies used in ECMO circuits and new advances in the field were reviewed.

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“…Recently, interest in ECMO has risen. Technology advancements have made ECMO safer (1). The CESAR trial showed that Acute Respiratory Distress Syndrome (ARDS) patients might have better outcomes if treated with ECMO rather than conventional strategies (2).…”

mentioning

confidence: 99%

Hemostatic changes during extracorporeal membrane oxygenation: a commentary

Patroniti¹,

Scaravilli²

2016

Ann. Transl. Med.

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Veno-venous extracorporeal membrane oxygenation (ECMO) is a technique utilized to support patients suffering from respiratory failure. Historically, ECMO has been used as a last resort life-saving procedure by a restricted group of highly specialized centers of care. Recently, interest in ECMO has risen. Technology advancements have made ECMO safer (1). The CESAR trial showed that Acute Respiratory Distress Syndrome (ARDS) patients might have better outcomes if treated with ECMO rather than conventional strategies (2). The H1N1 experience demonstrated the feasibility of implementation of ECMO even in centers with limited experience (3).Notwithstanding these progresses, use of ECMO is guided by center-specific experiences rather than by evidence-based guidelines. This is particularly true for coagulation management. Anticoagulation policies vary widely among centers (4) and each ECMO center has elaborated its anticoagulation protocol. Most of these local anticoagulation protocols are founded on the Extracorporeal Life Support Organization (ELSO) clinical indications (5), which are a guide to safe clinical practice, but not a consensus recommendation or an evidence-based blueprint.These difficulties stem from the lacking of knowledge of the biology of blood compatibility (6). Seminal works have shown activation of coagulation factors and complement factors, platelets consumption and impairment (7-10) leading to bleeding (11) and thromboembolic (12) complications following ECMO connection. Since then, not many studies have focused on coagulation during ECMO. Indeed, few properly performed studies evaluated the clinical impact of technological advances, such as of heparin-coated circuitry (13,14), centrifugal pumps (15) and polymethylpentane oxygenators (16). To the contrary, only recently the interest in studying the effects of veno-venous ECMO upon coagulation has re-grown (17) and provided interesting hints. In particular, Heilmann et al. (18) have shown that during ECMO extracorporeal blood undergoes high shear stress, leading to the uncoiling of von Willebrand factor (vWF). This in turns reduces the capabilities of vWF in binding collagen and platelets, resulting in a state of thrombosis, fibrinolysis and impaired platelet function that propagate from the extracorporeal circuit to the patient. Malfertheiner et al. (19) expanded our knowledge on coagulation during ECMO. The Authors randomized a cohort of 54 consecutive adult patients with acute respiratory failure to be treated with three different veno-venous ECMO circuits (i.e., CardioHelp, Maquet Cardiopulmonary, Rastatt, Germany; Dideco ECC.O5, Sorin Group, Mirandola, Italy; Hilite 7000 LT, Medos Medizintechnik, AG, Stolberg, Germany) and extensively assessed the effect of long-term extracorporeal support upon coagulation. Notably, all these systems have polymethylpentene hollow-fiber oxygenator and two (i.e., Maquet and Medos) are heparin-coated while the latter (i.e., Sorin) is phosphorylcholine-coated. Patients were managed by continuous infusion of unf...

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Evolution of the Extracorporeal Life Support Circuitry

Cited by 84 publications

References 11 publications

Pharmacokinetic changes in patients receiving extracorporeal membrane oxygenation

Pharmacokinetic changes in patients receiving extracorporeal membrane oxygenation

Anticoagulation during ECMO: The Past, Present and Future

Hemostatic changes during extracorporeal membrane oxygenation: a commentary

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