RESUMO
Since April 1973 we have treated nine patients with extracorporeal membrane oxygenation (ECMO), utilizing the spiral coil membrane lung. One patient is a long-term survivor. All patients except one showed substantial improvement in peripheral arterial oxygen tension. Four adults and two neonates were treated for critical hypoxia. Two patients were treated for cardiac failure but failed to show improved myocardial function. Complications involving perfusion circuitry, cannulation, chronic systemic heparinization, thrombocytopenia, and renal failure have been managed with minimal difficulty. However, irreversible pulmonary, neurologic, hepatic, or gastrointestinal damage due to hypoxia present before the institution of ECMO was associated with lethal complications. The ECMO has supplied adequate oxygenation to this group of nine critically hypoxic patients. Institution of ECMO at an earlier date in patients with critical hypoxia would provide a higher likelihood of survival.
Assuntos
Oxigenadores de Membrana , Injúria Renal Aguda/etiologia , Adolescente , Adulto , Transtornos da Coagulação Sanguínea/etiologia , Dióxido de Carbono/sangue , Pré-Escolar , Feminino , Veia Femoral , Hemorragia Gastrointestinal/etiologia , Insuficiência Cardíaca/terapia , Humanos , Hipóxia/terapia , Recém-Nascido , Veias Jugulares , Masculino , Pessoa de Meia-Idade , Oxigênio/sangue , Oxigenadores de Membrana/efeitos adversos , Oxigenadores de Membrana/instrumentação , Perfusão/métodos , Respiração com Pressão Positiva , Edema Pulmonar/terapia , Insuficiência Respiratória/terapia , Veia Cava Inferior , Veia Cava SuperiorRESUMO
The purpose of this study was to evaluate a compact, single-pump membrane oxygenator system designed for both short-term open-heart procedures and long-term extracorporeal support. Work was directed at developing a compatible, disposable venous reservoir, fabricating a compact mounting board, determining acceptable priming volumes, and establishing safe and effective modes of setup and operation. Ten adult baboons undergoing total cardiopulmonary autotransplantation as part of a separate study were operated on using a 1.5 m2 Kolobow spiral-coil membrane system. Blood gases, oxygen transfer, extracorporeal blood flows, priming volume, and setup times were determined. In addition, 3 infant and 6 adult human subjects undergoing cardiac operations in which spiral-coil membranes of various sizes were used were also similarly studied. The data and experience from these studies suggest that the spiral-coil membrane system utilized is safe and effective in procedures requiring short-term cardiopulmonary bypass.