[Use of extracorporeal circulation (ECLS/ECMO) for cardiac and circulatory failure : Short version of the S3 guideline]. / Einsatz der extrakorporalen Zirkulation (ECLS/ECMO) bei Herz- und Kreislaufversagen : Kurzversion der AWMF-S3-Leitlinie.

In Germany, a remarkable increase regarding the usage of extracorporeal membrane oxygenation (ECMO) and extracorporeal life support (ECLS) systems has been observed in recent years with approximately 3000 ECLS/ECMO implantations annually since 2015. Despite the widespread use of ECLS/ECMO, evidence-based recommendations or guidelines are still lacking regarding indications, contraindications, limitations and management of ECMO/ECLS patients. Therefore in 2015, the German Society of Thoracic and Cardiovascular Surgery (GSTCVS) registered the multidisciplinary S3 guideline "Use of extracorporeal circulation (ECLS/ECMO) for cardiac and circulatory failure" to develop evidence-based recommendations for ECMO/ECLS systems according to the requirements of the Association of the Scientific Medical Societies in Germany (AWMF). Although the clinical application of ECMO/ECLS represents the main focus, the presented guideline also addresses structural and economic issues. Experts from 17 German, Austrian and Swiss scientific societies and a patients' organization, guided by the GSTCVS, completed the project in February 2021. In this report, we present a summary of the methodological concept and tables displaying the recommendations for each chapter of the guideline.

[Use of extracorporeal circulation (ECLS/ECMO) for cardiac and circulatory failure : Short version of the S3 guideline]. / Einsatz der extrakorporalen Zirkulation (ECLS/ECMO) bei Herz- und Kreislaufversagen : Kurzversion der AWMF-S3-Leitlinie.

In Germany, a remarkable increase regarding the usage of extracorporeal membrane oxygenation (ECMO) and extracorporeal life support (ECLS) systems has been observed in recent years with approximately 3000 ECLS/ECMO implantations annually since 2015. Despite the widespread use of ECLS/ECMO, evidence-based recommendations or guidelines are still lacking regarding indications, contraindications, limitations and management of ECMO/ECLS patients. Therefore in 2015, the German Society of Thoracic and Cardiovascular Surgery (GSTCVS) registered the multidisciplinary S3 guideline "Use of extracorporeal circulation (ECLS/ECMO) for cardiac and circulatory failure" to develop evidence-based recommendations for ECMO/ECLS systems according to the requirements of the Association of the Scientific Medical Societies in Germany (AWMF). Although the clinical application of ECMO/ECLS represents the main focus, the presented guideline also addresses structural and economic issues. Experts from 17 German, Austrian and Swiss scientific societies and a patients' organization, guided by the GSTCVS, completed the project in February 2021. In this report, we present a summary of the methodological concept and tables displaying the recommendations for each chapter of the guideline.

Physiological Acclimatization of the Liver to 180-Day Isolation and the Mars Solar Day.

Physiological changes in humans are evident under environmental conditions similar to those on a Mars mission involving both a space factor (long-term isolation) and a time factor (the Mars solar day). However, very few studies have investigated the response of the liver to those conditions. Serum protein levels, bilirubin levels, aminotransferase activities, blood alkaline phosphatase, gamma-glutamyltransferase, lipid levels, and serum cytokines interleukin-6 and interferon-γ levels were analyzed 30 days before the mock mission; on days 2, 30, 60, 75, 90, 105, 120, 150, and 175 of the mission; and 30 days after the mission, in four subjects in 4-person 180-day Controlled Ecological Life Support System Experiment. Serum protein levels (total protein and globulin) decreased and bilirubin increased under the isolation environment from day 2 and exhibited chronic acclimatization from days 30 to 175. Effects of the Mars solar day were evident on day 75. Blood lipid levels were somewhat affected. No obvious peak in any enzyme level was detected during the mission. The change tendency of these results indicated that future studies should explore whether protein parameters especially globulin could serve as indicators of immunological function exposure to the stress of a Mars mission.

Relationship between the Gut Microbiome and Energy/Nutrient Intake in a Confined Bioregenerative Life Support System.

Recent studies have suggested that the gut microbiome is modified in space analogs and that human health can be affected during actual spaceflight. However, the relationship between the gut microbiome and dietary intake in simulator subjects and astronauts remains unclear. Bioregenerative life support systems (BLSSs) are confined and self-sufficient ecosystems that enable exploration of this issue. Here, we correlate changes in gut microbes to the nutrient types present in controlled diets within subjects cohabitating in a BLSS. A metagenome-wide association study (MWAS) was performed on 55 shotgun-sequenced fecal samples longitudinally obtained from healthy Chinese subjects (n = 4 in total, n = 2 per sex) subjected to a 60-day BLSS stay and a specialized diet. Each food item was categorized based on nutrient type according to the Chinese Food Ingredients List (https://wenku.baidu.com/view/3f2b628488eb172ded630b1c59eef8c75fbf9514.html?from=search). The physical parameters of each subject fluctuated within normal medical ranges. Sex- and individual-specific differences and a trend of individual convergence of the gut microbiome in the BLSS were observed. Depletion of bacterial taxa such as Faecalibacterium prausnitzii, Bifidobacterium longum, and Escherichia coli and functional modules such as short-chain fatty acid (SCFA) production, as well as an increase in an unidentified Lachnospiraceae and glutamate/tryptophan synthesis, were observed in the BLSS. Correlation analysis showed that these compositional and functional changes were associated with energy/nutrient intake during the BLSS stay. Our findings suggest that the gut microbiota is a useful indicator for monitoring health and that individual nutritive diets should be considered according to sex and individual differences in simulations or in spaceflight.IMPORTANCE The gut microbiome shows individual specificity and is affected by sex, environment, and diet; gut microbiome imbalance is related to cancer, cardiovascular diseases, and autoimmune diseases. Astronauts are faced with a challenging environment and limited diet in outer space. Recent studies indicate that the gut microbiome is altered in space simulators and space, but what happens to intestinal microorganisms when astronauts cohabitate in a self-sufficient ecosystem in which they plant and cook food is unclear. Bioregenerative life support systems (BLSSs) are ideal devices to investigate the above issues because they are closed and self-sufficient. Four healthy Chinese subjects cohabitated in a confined BLSS for 60 days, during which their physical parameters and energy/nutrient intake were recorded. We performed a metagenome-wide association study (MWAS) on 55 shotgun-sequenced fecal samples longitudinally obtained from the subjects. Alterations occurred in the gut microbial composition and function, and their relationships with energy/nutrient intake were explored.

Trends in the Utilization of Life-Sustaining Procedures and Palliative Care Consultation Among Dying Patients With Advanced Chronic Pancreas Illnesses in US Hospitals: 2005 to 2014.

AIM: Pancreas cancer continues to carry a poor prognosis. Hospitalized patients with advanced chronic pancreatic illnesses increasingly receive palliative care due to its perceived clinical benefits. Meanwhile, a growing proportion of elderly patients are reportedly receiving life-sustaining procedures. Temporal trends in the utilization of life-sustaining procedures and palliative care consultation among dying patients with advanced chronic pancreatic illnesses in US hospitals were examined. METHODS AND MATERIALS: A serial, cross-sectional analysis was carried out using the National Inpatient Sample Database. Decedents 18 years and older with a principal diagnosis of pancreas cancer or other advanced chronic pancreatic illnesses from 2005 through 2014. The compound annual growth rates (CAGRs) and Cochrane-Armitage correction of χ2 statistic were used. The receipt of life-sustaining systemic procedures, intra-abdominal local procedures and surgeries, and palliative care consultation were examined. Multilevel multivariate logistic regressions were performed to examine the association of various procedures with the utilization of palliative care consultation. RESULTS: Among 77 394 183 hospitalizations, 29 515 patients were examined. The CAGRs of systemic procedures, intra-abdominal procedures, surgeries, and palliative care were -4.19% (P = .008), 2.17%, -1.40%, and 14.03% (P < .001), respectively. The receipt of systemic procedures (odds ratio [OR] = 2.40, 95% confidence interval [CI], 2.08-2.74), local intra-abdominal procedures (OR = 1.46, 95% CI, 1.27-1.70), and surgeries (OR = 2.51, 95% CI, 2.07-3.05) was associated with palliative care consultation (Ps < .001). CONCLUSIONS: Among adults with pancreatic cancer or other advanced chronic pancreatic illnesses in the US hospitals from 2005 to 2014, the utilization of life-sustaining systemic procedures decreased while the prevalence of palliative care consultation increased.

Suitability of Solanum lycopersicum L. 'Microtom' for growth in Bioregenerative Life Support Systems: exploring the effect of high-LET ionising radiation on photosynthesis, leaf structure and fruit traits.

The realisation of manned space exploration requires the development of Bioregenerative Life Support Systems (BLSS). In such self-sufficient closed habitats, higher plants have a fundamental role in air regeneration, water recovery, food production and waste recycling. In the space environment, ionising radiation represents one of the main constraints to plant growth. In this study, we explore whether low doses of heavy ions, namely Ca 25 Gy, delivered at the seed stage, may induce positive outcomes on growth and functional traits in plants of Solanum lycopersicum L. 'Microtom'. After irradiation of seed, plant growth was monitored during the whole plant life cycle, from germination to fruit ripening. Morphological parameters, photosynthetic efficiency, leaf anatomical functional traits and antioxidant production in leaves and fruits were analysed. Our data demonstrate that irradiation of seeds with 25 Gy Ca ions does not prevent achievement of the seed-to-seed cycle in 'Microtom', and induces a more compact plant size compared to the control. Plants germinated from irradiated seeds show better photochemical efficiency than controls, likely due to the higher amount of D1 protein and photosynthetic pigment content. Leaves of these plants also had smaller cells with a lower number of chloroplasts. The dose of 25 Gy Ca ions is also responsible for positive outcomes in fruits: although developing a lower number of berries, plants germinated from irradiated seeds produce larger berries, richer in carotenoids, ascorbic acid and anthocyanins than controls. These specific traits may be useful for 'Microtom' cultivation in BLSS in space, in so far as the crew members could benefit from fresh food richer in functional compounds that can be directly produced on board.

Estimating CO2 gas exchange in mixed age vegetable plant communities grown on soil-like substrates for life support systems.

If soil-like substrate (SLS) is to be used in human life support systems with a high degree of mass closure, the rate of its gas exchange as a compartment for mineralization of plant biomass should be understood. The purpose of this study was to compare variations in CO2 gas exchange of vegetable plant communities grown on the soil-like substrate using a number of plant age groups, which determined the so-called conveyor interval. Two experimental plant communities were grown as plant conveyors with different conveyor intervals. The first plant community consisted of conveyors with intervals of 7 days for carrot and beet and 14 days for chufa sedge. The conveyor intervals in the second plant community were 14 days for carrot and beet and 28 days for chufa sedge. This study showed that increasing the number of age groups in the conveyor and, thus, increasing the frequency of adding plant waste to the SLS, decreased the range of variations in CO2 concentration in the "plant-soil-like substrate" system. However, the resultant CO2 gas exchange was shifted towards CO2 release to the atmosphere of the plant community with short conveyor intervals. The duration of the conveyor interval did not significantly affect productivity and mineral composition of plants grown on the SLS.

Aromatic hydrocarbons in a controlled ecological life support system during a 4-person-180-day integrated experiment.

Indoor air quality is vital to the health and comfort of people who live inside a controlled ecological life support system (CELSS) built for long-term space explorations. Here we measured aromatic hydrocarbons to assess their sources and health risks during a 4-person-180-day integrated experiment inside a CELSS with four cabins for growing crops, vegetables and fruits and other two cabins for working, accommodations and resources management. During the experiment, the average concentrations of benzene, ethylbenzene, m,p-xylenes and o-xylene were found to decrease exponentially from 7.91±3.72, 37.2±35.2, 100.8±111.7 and 46.8±44.1µg/m3 to 0.39±0.34, 1.4±0.5, 2.8±0.7 and 2.1±0.9µg/m3, with half-lives of 25.3, 44.8, 44.7 and 69.3days, respectively. Toluene to benzene ratios indicated emission from construction materials or furniture to be a dominant source for toluene, and concentrations of toluene fluctuated during the experiment largely due to the changing sorption by growing plants. The cancer and no-cancer risks based on exposure pattern of the crews were insignificant in the end of the experiment. This study also suggested that using low-emitting materials/furniture, growing plants and purifying air actively would all help to lower hazardous air pollutants inside CELSS. Broadly, the results would benefit not only the development of safe and comfort life support systems for space exploration but also the understanding of interactions between human and the total environment in closed systems.

Initial Clinical Experiences With Novel Diagonal ECLS System in Pediatric Cardiac Patients.

Extracorporeal life support (ECLS) provides mechanical support following cardiac surgery when respiratory or cardiac failure occurs. The aim of this study was to analyze the safety and feasibility of the Medos Deltastream diagonal pump (DP3) ECLS system in pediatric cardiac patients. We described the technical considerations and risk factors related to the survival outcomes in 102 pediatric cardiac patients who received ECLS support between March 2011 and April 2016. We switched from the DP2 system, which was used for the initial 25 patients, to the DP3 system after November 2012. The DP3 was then used in a consecutive series of 77 patients (4.5% of all pediatric patients who underwent congenital heart surgery during the same time period). The patients' median age was 90 days (range: 2 days-12 years), while their median weight was 4 kg (range: 2.1-40 kg). Fifty four patients (70%) were weaned off ECLS, while 28 patients (36.3%) were successfully discharged from the hospital by means of the DP3 system. The median ECLS duration for survivors was 8.2 days (range: 4-14.5 days). The ECLS indications, durations, and initiation times had no statistical significance in terms of survival. Renal, hemorrhagic, and neurologic complications were all associated with decreased hospital discharge rates (P = 0.003, P = 0.045, and P < 0.001 respectively). Higher lactate levels (P = 0.009) and longer duration for normalization (P < 0.001) were both associated to failure to wean off ECLS support and, hence, to hospital deaths. The weaning rate was 36% prior to November 2012. It increased to 70.3% after that time (P = 0.009). The mechanical complication rate was 9% with the DP3 system and 32% with the DP2, which was statistically significant (P = 0.009). Additionally, the lactate levels were higher and decreased more slowly in the patients supported by the DP2. As a result of the shift to the DP3 system, a revised ECLS protocol, and increased ECLS experience, a significant improvement was observed in our clinical outcomes. The results of this study suggested that the combination of a DP3 pump and a Hilite oxygenator in pediatric ECLS circuits may improve durability and reduce circuit-induced complications.

Fragilidades na atenção ao potencial doador de órgãos: percepção de enfermeiros / Weaknesses in the care for potential organ donors: the perception of nurses / Deficiencias en la atención al potencial donante de órganos: la percepción de los enfermeros

Resumo Objetivou-se conhecer a percepção de enfermeiros sobre fragilidades na atenção ao potencial doador de órgãos. Trata-se de estudo exploratório-descritivo, com abordagem qualitativa, envolvendo oito enfermeiros de hospital de referência. Entrevista semiestruturada foi utilizada e os resultados foram analisados conforme a técnica de análise do discurso. Emergiram duas categorias: "percepção dos enfermeiros sobre o trabalho com potenciais doadores de órgãos" e "fragilidades na atenção aos potenciais doadores". Verificou-se atuação limitada no âmbito da organização de procura de órgãos. Entraves envolvem recursos humanos e financeiros, recusa familiar, elevado tempo de espera por exames e problemas estruturais. Assim, o trabalho nesta comissão está limitado a ações assistenciais, em detrimento das gerenciais. Os profissionais percebem fragilidades e temem interferência negativa. Há que se investir em estrutura e educação permanente para que isso se reflita em melhor atenção ao potencial doador e sua família.

Abstract This study aimed to get to know the perception of nurses about weaknesses in the care for potential organ donors. This is an exploratory-descriptive study with a qualitative approach, involving eight nurses from a reference hospital. It used semi-structured interviews and the results were analyzed according to discourse analysis. Two categories emerged: "perception of nurses on working with potential organ donors" and "weaknesses in the care for potential donors". There is a limited role of the organ procurement organization. The barriers involve human and financial resources, family refusal, long wait for test results and structural problems. The work of this committee is limited to health care activities, in detriment of management. The professionals perceive weaknesses and fear negative repercussions. One must invest in structure and continuing education for this to be reflected in better care to potential donors and their family.

Resumen Este estudio tuvo como objetivo conocer la percepción de los enfermeros sobre las deficiencias en la atención al potencial donante de órganos. Se trata de estudio exploratorio-descriptivo con enfoque cualitativo, con la participación de ocho enfermeros de un hospital de referencia. Se utilizaron entrevistas semiestructuradas y los resultados fueron analizados siguiendo la técnica de análisis del discurso. Emergieron dos categorías: "percepción de los enfermeros sobre el trabajo con potenciales donantes de órganos" y "deficiencias en la atención a los posibles donantes". Fue identificada actuación limitada en el ámbito de la organización de búsqueda de órganos. Los obstáculos están relacionados con los recursos humanos y financieros, la negativa de la familia, los prolongados tiempos de espera de resultados de exámenes y problemas estructurales. Por lo tanto, el trabajo de este grupo se limita a acciones asistenciales, en detrimento de las de gestión. Los profesionales perciben las deficiencias y temen una interferencia negativa. Es necesario invertir en la estructura y en la formación permanente para que esto se refleja en una mejor atención al donante potencial y a su familia.

Laboratory Evaluation of Hemolysis and Systemic Inflammatory Response in Neonatal Nonpulsatile and Pulsatile Extracorporeal Life Support Systems.

The objective of this study was to compare the systemic inflammatory response and hemolytic characteristics of a conventional roller pump (HL20-NP) and an alternative diagonal pump with nonpulsatile (DP3-NP) and pulsatile mode (DP3-P) in simulated neonatal extracorporeal life support (ECLS) systems. The experimental neonatal ECLS circuits consist of a conventional Jostra HL20 roller pump or an alternative Medos DP3 diagonal pump, and Medos Hilite 800 LT hollow-fiber oxygenator with diffusion membrane. Eighteen sterile circuits were primed with freshly donated whole blood and divided into three groups: conventional HL20 with nonpulsatile flow (HL20-NP), DP3 with nonpulsatile flow (DP3-NP), and DP3 with pulsatile flow (DP3-P). All trials were conducted for durations of 12 h at a flow rate of 500 mL/min at 36°C. Simultaneous blood flow and pressure waveforms were recorded. Blood samples were collected to measure plasma-free hemoglobin (PFH), human tumor necrosis factor-alpha, interleukin-6 (IL-6), and IL-8, in addition to the routine blood gas, lactate dehydrogenase, and lactic acid levels. HL20-NP group had the highest PFH levels (mean ± standard error of the mean) after a 12-h ECLS run, but the difference among groups did not reach statistical significance (HL20-NP group: 907.6 ± 253.1 mg/L, DP3-NP group: 343.7 ± 163.2 mg/L, and DP3-P group: 407.6 ± 156.6 mg/L, P = 0.06). Although there were similar trends but no statistical differences for the levels of proinflammatory cytokines among the three groups, the HL20-NP group had much greater levels than the other groups (P > 0.05). Pulsatile flow generated higher total hemodynamic energy and surplus hemodynamic energy levels at pre-oxygenator and pre-clamp sites (P < 0.01). Our study demonstrated that the alternative diagonal pump ECLS circuits appeared to have less systemic inflammatory response and hemolysis compared with the conventional roller pump ECLS circuit in simulated neonatal ECLS systems. Pulsatile flow delivered more hemodynamic energy to the pseudo-patient without increased odds of hemolysis compared with the conventional, nonpulsatile roller pump group.

Minimally invasive access for central extracorporeal life support: how we do it.

Central extracorporeal life support (ECLS) is an effective treatment method of cardiogenic shock patients with or without lung failure. However, complications like infection and bleeding are common. The classical implantation approach requires full sternotomy, mobilization of the heart, with the well-known risks of bleeding and mediastinal infections. We present our minimally invasive technique for central ECLS through a nonsternotomy incision. Minimized right-sided thoracotomy is performed. Flexible arterial and venous cannulas are tunneled toward the right thoracotomy incision through the eighth intercostal space. A sewing ring is secured to the right atrium and a tube graft is anastomosed to the ascending aorta. Following full-dose heparinization, the arterial cannula is inserted with the tip into the vascular graft of the ascending aorta and the venous cannula via the ring into the right atrium. After meticulous deairing, the central ECLS is set at full flow.

Rate and patterns of ICU admission among colorectal cancer patients: a single-center experience.

PURPOSE: The purposes of this study were to evaluate, in colorectal cancer patients, the cause of ICU admission and to find predictors of death during and after hospitalization. METHODS: This is a retrospective study including all patients with colorectal cancer admitted in the ICU of a cancer hospital from January 1st 2003 to December 31 2012. RESULTS: Among 3721 ICU admissions occurring during the study period, 119 (3.2 %) admissions dealt with colorectal cancer, of whom 89 were eligible and assessable. The main reasons for admission were of metabolic (24 %), hemodynamic (19 %), cardiovascular (18 %), gastrointestinal (16 %), respiratory (13 %), or neurologic (6 %) origin. These complications were due to cancer in 43 %, to the antineoplastic treatment in 25 %, or were unrelated to the cancer or its treatment in 33 %. A quarter of the patients died during hospitalization. Independent predictors of death were the Sequential Organ Failure Assessment (SOFA) score (with risk of dying increasing by 42 % per unit of SOFA score), fever (with risk of dying multiplied by three per °C), and high values of GOT (with risk of dying multiplied by 1 % per unit increase), while cancer control (i.e., stage progression or not), compliance to the initial cancer treatment plan, and LDH ≤ median levels had prognostic significance for further longer survival after hospital discharge. CONCLUSION: This is the first study looking at specific causes for unplanned ICU admission of patients with colorectal cancer. Hospital mortality was influenced by the characteristics of the complication that entailed the ICU admission while cancer characteristics retained their prognostic influence on survival after hospital discharge.

Impact of Pulsatile Flow Settings on Hemodynamic Energy Levels Using the Novel Diagonal Medos DP3 Pump in a Simulated Pediatric Extracorporeal Life Support System.

BACKGROUND: The objective of this study was to evaluate the pump performance of the novel diagonal Medos Deltastream DP3 diagonal pump (MEDOS Medizintechnik AG, , Stolberg, Germany) under nonpulsatile to pulsatile mode with varying differential speed values in a simulated pediatric extracorporeal life support system. METHODS: The experimental circuit consisted of a Medos Deltastream DP3 pump head and console, a Medos Hilite 2400 LT hollow fiber membrane oxygenator (MEDOS Medizintechnik AG), a 14F Medtronic DLP arterial cannula (Medtronic Inc, Minnesota), and a 20F Terumo TenderFlow Pediatric venous return cannula (Terumo Corporation, Michigan). Trials were conducted at flow rates ranging from 500 mL/min to 2,000 mL/min (500 mL/min increments) and pulsatile differential speed values ranging from 500 rpm to 2,500 rpm (500 rpm increments) using human blood (hematocrit 35%). The postcannula pressure was maintained constantly at 60 mm Hg. Real-time pressure and flow data were recorded using a custom-made data acquisition system and Labview software. RESULTS: Under all experimental conditions, pulsatile flow (P) generated significantly greater energy equivalent pressure (EEP), surplus hemodynamic energy (SHE), and total hemodynamic energy (THE) than those of nonpulsatile flow (NP). Under NP, SHE was zero. Higher differential speed values generated greater EEP, SHE, and THE values. There was little variation in the oxygenator pressure drop and the cannula pressure drop in P, compared to NP. CONCLUSIONS: The novel Medos Deltastream DP3 diagonal pump is able to generate physiological quality of P, without backflow. With increased differential rpm, the pump generated greater EEP, SHE, and THE. Physiological quality of pulsatility may be associated with better microcirculation because of greater EEP, SHE, and THE.

Extracorporeal life support after cardiac surgery in children: outcomes from a single institution.

Extracorporeal life support (ECLS) is used after congenital heart surgery for several indications, including failure to separate from cardiopulmonary bypass, postoperative low cardiac output syndrome, and extracorporeal cardiopulmonary resuscitation. Here, we assessed the outcomes of ECLS in children after cardiac surgery at our institution. Medical records of all children who required postoperative ECLS at our institution were reviewed. Between 2003 and 2011, 36 (1.4%) of 2541 pediatric cardiac surgical cases required postoperative ECLS. Median age of patients was 64 days (range: 0 days-4.1 years). ECLS was in the form of either extracorporeal membrane oxygenation (ECMO; n = 24) or ventricular assist system (VAS; n = 12). Mean duration of ECLS was 4.9 ± 4.2 days. Overall, 21 patients (58%) were weaned off ECLS, and 17 patients (47%) were successfully discharged from the hospital. Patients with biventricular heart (BVH) had higher survival-to-hospital discharge rates compared with those with univentricular heart (UVH) (P = 0.019). Regarding ECLS type, UVH patients who received VAS showed higher rates of device discontinuation than UVH patients who received ECMO (P = 0.012). However, rates of hospital discharge were not significantly different between UVH patients who received VAS or ECMO. Surgical interventions, such as banding of Blalock-Taussig shunt to reduce pulmonary blood flow or placing bidirectional cavopulmonary shunt to minimize ventricular volume overload, were effective for weaning off ECLS in patients with UVH. ECLS is beneficial to children with low cardiac output after cardiac surgery. Rates of survival-to-hospital discharge were higher in BVH patients than UVH patients. Additional interventions to reduce ventricular volume load may be effective for discontinuing ECLS in patients with UVH.

Anesthesia for tracheal reconstruction and transplantation.

PURPOSE OF REVIEW: Tracheobronchial lesions requiring significant resection of the airway have limited surgical options and present significant obstacles to the anesthesiologist and surgeon. This article will review recent advancements in anesthetic and surgical management. RECENT FINDINGS: Technological advances have introduced novel approaches to the patient with large airway lesions. The use of pump-driven and pumpless extracorporeal life support has rapidly expanded and allow for prolonged periods of apneic airway surgery. Tracheal transplantation has advanced from the cadaveric decellularized scaffolds initially used to true synthetic based structures with autologous stem cell derived epithelium. SUMMARY: Significant leaps in tissue engineered airway transplantation have created curative options for patients previously considered inoperable. These patients pose significant challenges to the anesthesiologist during the entire perioperative period. Close collaboration with surgeons and intensivists and the use of recently developed systems for extracorporeal life support are required.

Successful coronary artery bypass grafting with the aid of a portable minimized extracorporeal life support system.

Extracorporeal life support system has been successfully used in patients with cardiac failure after open heart surgery, as a bridge to transplantation, and in patients with prolonged cardiogenic shock or cardiopulmonary arrest. This report presents our early experience with the new system Cardiohelp in coronary artery bypass grafting (CABG). Between August 2010 and June 2011, 50 patients underwent CABG with the aid of Cardiohelp. This subgroup was matched for sex and logistic EuroSCORE with 100 patients, who underwent CABG using two different extracorporeal circulation systems, a minimized (MECC) (n = 50) and a conventional (CECC) (n = 50) during the same period. Because of less hemodilution, the intraoperative blood transfusion was significantly lower in the Cardiohelp group (36%) and MECC group (40%) compared with the CECC group (64%). Postoperative release of creatinine kinase and lactate was lower in the Cardiohelp and MECC groups (p < 0.001). Furthermore, these patients had shorter duration of ventilation and lengths of stay at the intensive care unit (p < 0.05). Device-related complications were not observed. A conversion to CECC was not necessary. In conclusion, the Cardiohelp is a safe alternative for CABG surgery. Valid technical innovations and limited number of side effects support its employment as a highly effective device for coronary surgery.

Successful extracorporeal life support for life-threatening hypercapnia with bronchiolitis obliterans after allogeneic hematopoietic stem cell transplantation.

Bronchiolitis obliterans (BO) is a disease with a poor prognosis, and a key factor that limits long-term survival after allogeneic hematopoietic stem cell transplantation (HSCT). We here report a case of a 31-year woman with acute lymphatic leukemia, which was treated by chemotherapy and HSCT, and consequently developed BO 2 years after HSCT. A non-tuberculous mycobacterial infection occurred and showed gradual exacerbation. She started taking anti-mycobacterial drugs, but lost appetite, felt tired and finally lost consciousness one month after beginning medication. Arterial blood gas revealed marked hypercapnia. Using extracorporeal life support (ECLS), the carbon dioxide concentration was reduced and her consciousness recovered. To our knowledge, this is the first case in which ECLS was successfully used for hypercapnia in a patient with BO.

Trends in biomedical engineering: focus on Patient Specific Modeling and Life Support Systems.

Over the last twenty years major advancements have taken place in the design of medical devices and personalized therapies. They have paralleled the impressive evolution of three-dimensional, non invasive, medical imaging techniques and have been continuously fuelled by increasing computing power and the emergence of novel and sophisticated software tools. This paper aims to showcase a number of major contributions to the advancements of modeling of surgical and interventional procedures and to the design of life support systems. The selected examples will span from pediatric cardiac surgery procedures to valve and ventricle repair techniques, from stent design and endovascular procedures to life support systems and innovative ventilation techniques.

Fulminant myocarditis managed with pulsatile extracorporeal life support; use of Twin Pulse Life support (T-PLS®).

Fulminant myocarditis frequently results in severe hemodynamic deterioration. High-dose vasopressors or sometimes mechanical circulatory support are required. We report on two cases of fulminant myocarditis successfully treated with pulsatile extracorporeal life support (T-PLS®, Twin Pulse Life support, New heart bio.BHK, Seoul, Korea). With T-PLS, we were able to provide mechanical support to patients until they recovered completely.