In vitro effects of an extracorporeal membrane oxygenation circuit on the sequestration of ϵ-aminocaproic acid.

OBJECTIVE: To assess the in vitro effects of drug sequestration in extracorporeal membrane oxygenation (ECMO) on ϵ-aminocaproic acid (EACA) concentrations. METHODS AND DESIGN: This in vitro study will determine changes in EACA concentration over time in ECMO circuits. A pediatric dose of 2,500 mg was administered to whole expired blood in the simulated pediatric ECMO circuit. Blood samples were collected at 0, 30, 60, 360 and 1440-minute intervals after initial administration equilibration from three different sites of the circuit: pre-oxygenator (PRE), post-oxygenator (POST) and PVC tubing (PVC) to determine the predominant site of drug loss. The circuit was maintained for two consecutive days with a re-dose at 24 hours to establish a comparison between unsaturated (New) and saturated (Old) oxygenator membranes. Comparisons between sample sites, sample times and New versus Old membranes were statistically analyzed by a linear mixed-effects model with significance defined as a p-value <0.05. RESULTS: There were no significant differences in EACA concentration with respect to sample site, with PRE and POST samples demonstrating respective mean differences of 0.30 mg/ml and 0.34 mg/ml as compared to PVC, resulting in non-significant p-values of 0.373 [95% CI (-0.37, 0.98)] and 0.324 [95% CI (-0.34, 1.01)], respectively. The comparison of New vs. Old ECMO circuits resulted in non-significant changes from baseline, with a mean difference of 0.50 mg/ml, 95% CI (-0.65, 1.65), p=0.315. CONCLUSION: The findings of this study did not show any significant changes in drug concentration that can be attributed to sequestration within the ECMO circuit. Mean concentrations between ECMO circuit sample sites did not differ significantly. Comparison between New and Old circuits also did not differ significantly in the change from baseline concentration over time. Sequestration within ECMO circuits appears not to be a considerable factor for EACA administration.

Effects of engineered lignin-graft-PLGA and zein-based nanoparticles on soybean health.

The majority of published research on the effect of engineered nanoparticles on terrestrial plant species is focused on inorganic nanoparticles, with the effects of organic polymeric nanoparticles (NP) on plants remaining largely unexplored. It is critical to understand the impact of polymeric NPs on plants if these particles are to be used as agrochemical delivery systems. This study investigates the effect of biodegradable polymeric lignin-based nanoparticles (LNPs) and zein nanoparticles (ZNP) on soybean plant health. The LNPs (114 ± 3.4 nm, -53.8 ± 6.9 mV) were synthesized by emulsion evaporation from lignin-graft-poly(lactic-co-glycolic) acid, and ZNPs (142 ± 3.9 nm and + 64.5 ± 4.7 mV) were synthesized by nanoprecipitation. Soybeans were grown hydroponically and treated with 0.02, 0.2, and 2 mg/ml of LNPs or ZNPs at 28 days after germination. Plants were harvested after 1, 3, 7 and 14 days of particle exposure and analyzed for root and stem length, chlorophyll concentration, dry biomass of roots and stem, nutrient uptake and plant ROS. Root and stem length, chlorophyll and stem biomass did not differ significantly between treatments and controls for LNPs-treated plants at all concentrations, and at low doses of ZNPs. At 2 mg/ml ZNPs, the highest concentration tested, after 7 days of treatment chlorophyll levels and root biomass increased and stem length was reduced in comparison to the control. Nutrient uptake was largely unaffected at 0.02 and 0.2 mg/ml NPs. A concentration-dependent increase in the oxidative stresss was detected, especially in the ZNP treated plants. Overall, LNPs and ZNPs had a minimum impact on soybean health especially at low and medium doses. To our knowledge this is the first study to show the effect of zein and lignin based polymeric NPs designed for agrochemical delivery on soybean plant health.

Simulation training enables emergency medicine providers to rapidly and safely initiate extracorporeal cardiopulmonary resuscitation (ECPR) in a simulated cardiac arrest scenario.

BACKGROUND: Extracorporeal cardiopulmonaryresuscitation (ECPR) is emerging as a viable rescue strategy for refractory out-of-hospital cardiac arrest. In the U.S., limited training of emergency medicine providers is a barrier to widespread implementation. AIMS: Test the hypothesis that emergency medicine physicians and nurses can acquire and retain the skills to rapidly and safely initiate ECPR using high-fidelity simulation. STUDY DESIGN: Prospective interventional study. SETTING: U.S. tertiary academic medical center. SUBJECTS: Emergency medicine physicians and nurses with no prior ECPR/ECMO experience. METHODS: Teams of three physicians and three nurses underwent a two-day ECPR training course including didactics, hands-on training, and simulation. Teams were videotaped initiating ECPR in a high-fidelity simulation scenario before and after simulation training. The primary outcome was the proportion of simulations in which full ECPR support was achieved within 30 min of patient arrival. RESULTS: Five teams completed the entire study. Full ECPR support was achieved within 30 min of patient arrival in 11/15, 15/15, and 15/15 attempts at baseline (B), post-testing (PT) and 3-month post-testing (3-PT), respectively (p = 0.06). Intervals (mean ± sd) required to achieve full ECPR support at B, PT, and 3-PT were 25.8±5.3, 17.2±4.6, and 19.2±1.9 min respectively (p < 0.05 for B vs. PT and 3-PT). CONCLUSION: High fidelity simulation training is effective in preparing emergency medicine physicians and nurses to rapidly and safely initiate ECPR in a simulated cardiac arrest scenario, and should be considered when implementing an ED-based ECPR program.

Inferior vena cava filter placement before ECMO decannulation.

Venous thromboembolism (VTE), particularly thrombi in the inferior vena cava (IVC) and pulmonary embolism, can occur after successful extracorporeal membrane oxygenation (ECMO) and can be associated with adverse outcomes including death. VTE is related to the presence of a venous cannula and in some cases inadequate anticoagulation caused by clinical bleeding. We have developed a simple method for guidewire exchange of the femoral venous ECMO cannula to a working catheter for intravascular ultrasound (IVUS) IVC filter placement, and describe the specific methodology.