Context: Conventional MRI is incompatible with extracorporeal membrane oxygenation (ECMO) cannulas and pumps. Ultra-low-field portable MRI (ULF-pMRI) with 0.064 Tesla may provide a solution, but its safety and compatibility is unknown.
Hypothesis: ULF-pMRI does not cause significant displacement and heating of ECMO cannulas and does not affect ECMO pump function.
Methods And Models: ECMO cannulas in various sizes were tested ex vivo using phantom models to assess displacement force and heating according to the American Society for Testing and Materials criteria. ECMO pump function was assessed by pump flow and power consumption. In vivo studies involved five female domestic pigs (20-42 kg) undergoing different ECMO configurations (peripheral and central cannulation) and types of cannulas with an imaging protocol consisting of T2-weighted, T1-weighted, FLuid-Attenuated Inversion Recovery, and diffusion-weighted imaging sequences.
Results: Phantom models demonstrated that ECMO cannulas, both single lumen with various sizes (15-24-Fr) and double lumen cannula, had average displacement force less than gravitational force within 5 gauss safety line of ULF-pMRI and temperature changes less than 1°C over 15 minutes of scanning and ECMO pump maintained stable flow and power consumption immediately outside of the 5 gauss line. All pig models showed no visible motion due to displacement force or heating of the cannulas. ECMO flow and the animals' hemodynamic status maintained stability, with no changes greater than 10%, respectively.
Interpretation And Conclusions: ULF-pMRI is safe and feasible for use with standard ECMO configurations, supporting its clinical application as a neuroimaging modality in ECMO patients.
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http://dx.doi.org/10.1097/CCE.0000000000001169 | DOI Listing |
Perfusion
December 2024
Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA.
Introduction: No clear guidelines exist for unfractionated heparin (UFH) monitoring in adult patients on veno-arterial extracorporeal life support (VA-ECLS) for refractory cardiogenic shock. In this study, we sought to compare outcomes between anti-factor Xa (FXa) and activated partial thromboplastin time (aPTT) strategies for UFH monitoring during VA-ECLS.
Methods: This is a single-center, retrospective review of VA-ECLS patients who received UFH in the cardiothoracic intensive care unit between July 2019 and November 2023.
Arch Cardiovasc Dis
December 2024
Department of Cardiology, Bastia Hospital Centre, 20604 Bastia, France.
Background: Percutaneous extracorporeal membrane oxygenation (ECMO) has been developed thanks to the progress in the field of cannulation, but still justifies the presence of an on-site cardiac resuscitation department. Corsica is a French island without an on-site cardiac surgery department.
Aim: To evaluate the percutaneous ECMO programme in Corsica.
ASAIO J
December 2024
From the Cardio-Respiratory Engineering and Technology Laboratory, Mechanical and Aerospace Engineering, Monash University, Clayton, Victoria, Australia.
A critical factor in thrombus formation during venoarterial extracorporeal membrane oxygenation (VA ECMO) is prothrombotic flow dynamics generated by the drainage cannula's design. This study aimed to create and evaluate a novel drainage cannula design which optimized blood flow dynamics to reduce thrombus formation. Computational fluid dynamics (CFD) was used to iteratively vary drainage cannula design parameters such as inner wall shape and side hole shape.
View Article and Find Full Text PDFInt J Emerg Med
December 2024
Department of Critical Care Medicine, Zhongda Hospital, Southeast University, No.87, Dingjiaqiao, Gulou District, Nanjing, 210009, China.
Venoarterial extracorporeal membrane oxygenation (VA-ECMO) has been utilized to treat massive pulmonary embolism (PE) accompanied by cardiac arrest or refractory cardiogenic shock. Our team opted for a femoral-femoral approach for vascular cannulation, using drainage and return cannulas in the common femoral vein and artery, respectively. However, femoral venous cannulation can be limited or challenging due to the presence of thrombus in the inferior vena cava (IVC), making the insertion of the drainage cannula via the femoral vein difficult.
View Article and Find Full Text PDFKorean J Intern Med
December 2024
Division of Cardiology, Department of Internal Medicine, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong, Korea.
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