Feasibility of Perflutren Microsphere Contrast Transthoracic Echocardiography in the Visualization of Ventricular Endocardium during Venovenous Extracorporeal Membrane Oxygenation in a Validated Ovine Model

Platts, D.; Diab, Sara; Dunster, Kimble; Shekar, Kiran; Burstow, Darryl J.; Sim, Beatrice; Tunbridge, Matthew; McDonald, Charles; Chemonges, Saul; Chan, Jonathan

doi:10.1111/echo.12695

Cited by 12 publications

(10 citation statements)

References 38 publications

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“…Our results corroborate previously described quantification of microbubble destruction in an ECMO circuit, both in vitro and in an ovine model. 24,25 Unlike previous studies, we were able to document the rate of UCA destruction by the oxygenator alone using US to continuously measure bubble destruction in a closed in vitro circuit, eliminating the interference of additional support equipment, interactions within the patient or animal, general shear forces, and microbubble instability. We observed a relatively small absolute decrease of UCA intensity across the oxygenator over time, with further microbubble destruction likely attributable to the additional circuit equipment.…”

Section: Discussionmentioning

confidence: 99%

Contrast‐Enhanced Ultrasound in Extracorporeal Support: In Vitro Studies and Initial Experience and Safety Data in the Extreme Premature Fetal Lamb Maintained by the Extrauterine Environment for Neonatal Development

Didier

Sridharan

Lawrence

et al. 2018

J of Ultrasound Medicine

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Objectives To evaluate the effects of ultrasound contrast agent (UCA) administration on hemodynamic parameters and support equipment in in vitro and in vivo models of extracorporeal support. Methods In vitro, incrementally increasing bolus doses of a UCA were administered proximal to a membrane oxygenator, and ultrasound cine clips were obtained. The rates of microbubble destruction across the oxygenator and over time were calculated from time‐intensity‐curves. Measurements across the membrane oxygenator were recorded and compared by a repeated‐measures analysis of variance. In vivo, 7 premature fetal lambs were transferred from placental support to the extrauterine environment for neonatal development. Contrast agent boluses were administered for contrast‐enhanced ultrasound (CEUS) examinations. Hemodynamic parameters and serum laboratory values were evaluated before and after the examinations by paired t tests. For oxygenator staining, oxygenator membranes from the in vitro circuit, study animals (n = 4), and control animals (n = 4) were stained for the adherent UCA. Results In vitro, with all doses (0.1–4 mL), there was no difference in measured parameters across the oxygenator (P ≥ .09). Contrast agent destruction (3%–14%) across the oxygenator was observed at the first pass with a progressive decline in contrast intensity over time. In vivo, there was no difference in hemodynamic parameters or serum laboratory values (P ≥ .08) with any CEUS examination (n = 17). For oxygenator staining, all oxygenator membranes were negative for UCA with lipid staining. Conclusions The UCA had no detectable effect on the oxygenator or measured parameters in in vitro and in vivo studies, thus providing additional safety data to support the use of CEUS in the setting of extracorporeal support.

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Section: Discussionmentioning

confidence: 99%

Contrast‐Enhanced Ultrasound in Extracorporeal Support: In Vitro Studies and Initial Experience and Safety Data in the Extreme Premature Fetal Lamb Maintained by the Extrauterine Environment for Neonatal Development

Didier

Sridharan

Lawrence

et al. 2018

J of Ultrasound Medicine

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“…There is limited data on the safety and efficacy of contrast echocardiography in patients supported with mechanical cardiac support. It has been shown to be feasible in an ovine ECMO model [ 49 ] as well as limited description of its use in the clinical setting [ 50 – 53 ].…”

Section: Discussionmentioning

confidence: 99%

Contrast Microsphere Destruction by a Continuous Flow Ventricular Assist Device: An In Vitro Evaluation Using a Mock Circulation Loop

Platts

Bartnikowski

Gregory

et al. 2017

BioMed Research International

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Objectives Transthoracic echocardiography (TTE) is fundamental in managing patients supported with ventricular assist devices (VAD). However imaging can be difficult in these patients. Contrast improves image quality but they are hydrodynamically fragile agents. The aim was to assess contrast concentration following passage through a VAD utilising a mock circulation loop (MCL). Methods Heartware continuous flow (CF) VAD was incorporated into a MCL. Definity® contrast was infused into the MCL with imaging before and after CF-VAD. 5 mm2 regions of interest were used to obtain signal intensity (decibels), as a surrogate of contrast concentration. Results Four pump speeds revealed significant reduction in contrast signal intensity after CF-VAD compared to before CF-VAD (all p < 0.0001). Combined pre- and postpump data at all speeds showed a 22.2% absolute reduction in contrast signal intensity across the CF-VAD (14.8 ± 0.8 dB prepump versus 11.6 ± 1.4 dB postpump; p < 0.0001). Mean signal intensity reduction at each speed showed an inverse relationship between speed and relative reduction in signal intensity. Conclusion Contrast microsphere transit through a CF-VAD within a MCL resulted in significant reduction in signal intensity, consistent with destruction within the pump. This was evident at all CF-VAD pump speeds but relative signal drop was inversely proportional to pump speed.

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“…Along with laser Doppler flowmetry, it is an ideal imaging modality for studying the microcirculation of organ blood flow/velocity patterns [ 141 , 142 ]. Unlike other modalities CEU is safe, free of disruptive haemodynamic effects, and easy to utilise in patients on ECMO; however investigation into the destructive effects of the circuit interface on the concentration and utility of the contrast microspheres is warranted [ 143 – 145 ]. Due to logistical and incompatibility issues related to the ECMO circuit, recent advancements in other imaging modalities cannot be utilised to investigate EAKI.…”

Section: Methods For Investigating Ecmo-associated Kidney Injurymentioning

confidence: 99%

The Complex Relationship of Extracorporeal Membrane Oxygenation and Acute Kidney Injury: Causation or Association?

Kilburn

Shekar

Fraser

2016

BioMed Research International

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Extracorporeal membrane oxygenation (ECMO) is a modified cardiopulmonary bypass (CPB) circuit capable of providing prolonged cardiorespiratory support. Recent advancement in ECMO technology has resulted in increased utilisation and clinical application. It can be used as a bridge-to-recovery, bridge-to-bridge, bridge-to-transplant, or bridge-to-decision. ECMO can restitute physiology in critically ill patients, which may minimise the risk of progressive multiorgan dysfunction. Alternatively, iatrogenic complications of ECMO clearly contribute to worse outcomes. These factors affect the risk : benefit ratio of ECMO which ultimately influence commencement/timing of ECMO. The complex interplay of pre-ECMO, ECMO, and post-ECMO pathophysiological processes are responsible for the substantial increased incidence of ECMO-associated acute kidney injury (EAKI). The development of EAKI significantly contributes to morbidity and mortality; however, there is a lack of evidence defining a potential benefit or causative link between ECMO and AKI. This area warrants investigation as further research will delineate the mechanisms involved and subsequent strategies to minimise the risk of EAKI. This review summarizes the current literature of ECMO and AKI, considers the possible benefits and risks of ECMO on renal function, outlines the related pathophysiology, highlights relevant investigative tools, and ultimately suggests an approach for future research into this under investigated area of critical care.

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Feasibility of Perflutren Microsphere Contrast Transthoracic Echocardiography in the Visualization of Ventricular Endocardium during Venovenous Extracorporeal Membrane Oxygenation in a Validated Ovine Model

Abstract: Despite exposure to destructive hydrodynamic forces, CE is a feasible technique in an ovine ECMO model. CE results in significantly improved EDS and increased EL.

Cited by 12 publications

References 38 publications

Contrast‐Enhanced Ultrasound in Extracorporeal Support: In Vitro Studies and Initial Experience and Safety Data in the Extreme Premature Fetal Lamb Maintained by the Extrauterine Environment for Neonatal Development

Contrast‐Enhanced Ultrasound in Extracorporeal Support: In Vitro Studies and Initial Experience and Safety Data in the Extreme Premature Fetal Lamb Maintained by the Extrauterine Environment for Neonatal Development

Contrast Microsphere Destruction by a Continuous Flow Ventricular Assist Device: An In Vitro Evaluation Using a Mock Circulation Loop

The Complex Relationship of Extracorporeal Membrane Oxygenation and Acute Kidney Injury: Causation or Association?

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