Development of a collaborative program to provide extracorporeal membrane oxygenation for adults with refractory hypoxemia within the framework of a pandemic.

Objective: We report the process used to rapidly develop a collaborative adult respiratory extracorporeal membrane oxygenation program as a response to caring for young adult patients with refractory hypoxemia in the setting of the pH1N1 pandemic.

Design: Interdisciplinary response of a complex medical system to a public health crisis. PATIENTS, INTERVENTIONS, MEASUREMENTS, AND MAIN RESULTS: After the successful use of extracorporeal membrane oxygenation in young adults with pH1N1-induced acute respiratory distress syndrome refractory to conventional therapies, an adult venovenous extracorporeal membrane oxygenation program was implemented over an 8-wk period.

North American neonatal extracorporeal membrane oxygenation (ECMO) devices and team roles: 2008 survey results of Extracorporeal Life Support Organization (ELSO) centers.

In early 2008, surveys of active extracorporeal membrane oxygenation (ECMO) centers in North America were conducted by electronic mail regarding neonatal ECMO equipment and professional staff. Eighty of 103 (78%) North American ECMO centers listed in the Extracorporeal Life Support Organization directory as neonatal centers responded to the survey. Of the responding centers, 82.

Venous line filtration: a novel technique for cases involving inferior vena caval and right atrial tumor and associated thrombus: a two-case series.

Two patients are presented with right atrial tumors, who were considered to be at risk for tumor thrombus migration down the venous line into the cardiopulmonary bypass (CPB) circuit during surgical excision, which may lead to compromised or interrupted venous drainage. An arterial line filter was placed in the venous line to capture any material that might become dislodged and embolize into the circuit. Vacuum-assisted venous drainage, at approximately -50 mmHg, was used to overcome any resistance caused by the filter in the venous line.

An isolated limb infusion technique: a guide for the perfusionist.

Isolated limb perfusion with the administration of cytotoxic drugs has been successfully used to treat melanomas of the extremity since it was first introduced in 1958. The use of hyperthermia (40 degrees C) combined with chemotherapy agents, primarily melphalan, has resulted in greater cytotoxicity in laboratory studies, which led to the application of hyperthermia in clinical studies during the 1960s. The effectiveness of this regional technique and the absence of any good systemic therapy made hyperthermic-isolated limb perfusion (HILP) the main treatment for patients with regionally advanced melanoma.

Hemolytic characteristics of three commercially available centrifugal blood pumps.

Objective: As compared with traditional extracorporeal roller-occlusion blood pumps, nonocclusive centrifugal pumps offer the benefits of requiring a smaller circuit surface area and, thus, a smaller prime volume. However, centrifugal blood pumps have been reported to generate unacceptable levels of hemolysis. We hypothesize that the newer generation centrifugal pumps have an incidence of hemolysis similar to the traditional roller head pumps and, thus, could be used for extracorporeal membrane oxygenation circuits.

An ultrafiltration technique for directly reinfusing residual cardiopulmonary bypass blood.

Given the shortages of banked blood, the risks of transfusion reactions, disease transmissions, and transfusion errors, we perfusionists must find ways to avoid blood transfusions. At the end of any given bypass run, there is residual blood left in the bypass circuit, the perfusionist must get this blood back to the patient. Most commonly either a cell saver or a hemoconcentrator (HC) has been used, in some fashion, to reinfuse residual circuit blood.

A clinical comparison of two commercially available pediatric hemoconcentrators.

Hemoconcentration is a technique that involves selective removal of plasma water and some dissolved solutes by way of an ultrafiltration membrane. Hemoconcentrators (HC) are routinely used during pediatric cardiopulmonary bypass (CPB) to remove free plasma water and various inflammatory mediators. This paper examines two different commercial HCs, the Dideco DHF0.

North American neonatal extracorporeal membrane oxygenation (ECMO) devices: 2002 survey results.

In mid 2002, surveys of active extracorporeal membrane oxygenation (ECMO) centers in the United States and Canada were conducted via E-mail regarding neonatal equipment and personnel. Seventy-four out of 99 (75%) North American ECMO centers listed in the Extracorporeal Life Support Organization (ELSO) directory responded to the survey. Of the responding centers, 95% use roller pumps, and the remaining 5% use centrifugal pumps.