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Okahara S, Miyamoto S, Soh Z, Yoshino M, Takahashi H, Itoh H, Tsuji T. Correlation Analysis Between Echinocytosis Stages and Blood Viscosity During Oxygenator Perfusion: An In Vitro Study. ASAIO J 2024:00002480-990000000-00470. [PMID: 38635489 DOI: 10.1097/mat.0000000000002214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2024] Open
Abstract
The study aimed to investigate the effect of red blood cell (RBC) morphology on oxygenator perfusion, focusing on stages of echinocytosis and their correlation with blood viscosity. A test circuit with an oxygenator and human RBC mixtures was used to induce changes in RBC shape by increasing sodium salicylate concentrations (0, 10, 20, 30, 60, and 120 mmol/L), while hematocrit, blood temperature, and anticoagulation were maintained. Blood viscosity was measured using a continuous blood viscosity monitoring system based on pressure-flow characteristics. Under a scanning electron microscope, the percentages of discocytes, echinocytes I-III, spheroechinocytes, and spherocytes were determined from approximately 400 cells per RBC sample. Early echinocytes, mainly discocytes and echinocytes I and II in the range of 0-30 mmol/L were predominant, resulting in a gradual increase in blood viscosity from 1.78 ± 0.12 to 1.94 ± 0.12 mPa s. At 60 mmol/L spherocytes emerged, and at 120 mmol/L, spheroidal RBCs constituted 50% of the population, and blood viscosity sharply rose to 2.50 ± 0.15 mPa s, indicating a 40% overall increase. In conclusion, the presence of spherocytes significantly increases blood viscosity, which may affect oxygenator perfusion.
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Affiliation(s)
- Shigeyuki Okahara
- From the Graduate School of Health Sciences, Junshin Gakuen University, Fukuoka, Japan
| | - Satoshi Miyamoto
- Department of Clinical Engineering, Hiroshima University Hospital, Hiroshima, Japan
| | - Zu Soh
- Graduate School of Advanced Science and Engineering, Hiroshima University, Hiroshima, Japan
| | - Masaru Yoshino
- Department of Clinical Engineering, Hiroshima University Hospital, Hiroshima, Japan
| | - Hidenobu Takahashi
- Faculty of Health Sciences, Department of Medical Science and Technology, Hiroshima International University, Hiroshima, Japan
| | - Hideshi Itoh
- Department of Health and Medical Sciences, Nippon Bunri University, Ōita, Japan
| | - Toshio Tsuji
- Graduate School of Advanced Science and Engineering, Hiroshima University, Hiroshima, Japan
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Roberts TR, Persello A, Harea GT, Vedula EM, Isenberg BC, Zang Y, Santos J, Borenstein JT, Batchinsky AI. First 24 Hour-Long Intensive Care Unit Testing of a Clinical-Scale Microfluidic Oxygenator in Swine: A Safety and Feasibility Study. ASAIO J 2024:00002480-990000000-00382. [PMID: 38165978 DOI: 10.1097/mat.0000000000002127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2024] Open
Abstract
Microfluidic membrane oxygenators are designed to mimic branching vasculature of the native lung during extracorporeal lung support. To date, scaling of such devices to achieve clinically relevant blood flow and lung support has been a limitation. We evaluated a novel multilayer microfluidic blood oxygenator (BLOx) capable of supporting 750-800 ml/min blood flow versus a standard hollow fiber membrane oxygenator (HFMO) in vivo during veno-venous extracorporeal life support for 24 hours in anesthetized, mechanically ventilated uninjured swine (n = 3/group). The objective was to assess feasibility, safety, and biocompatibility. Circuits remained patent and operated with stable pressures throughout 24 hours. No group differences in vital signs or evidence of end-organ damage occurred. No change in plasma free hemoglobin and von Willebrand factor multimer size distribution were observed. Platelet count decreased in BLOx at 6 hours (37% dec, P = 0.03), but not in HFMO; however, thrombin generation potential was elevated in HFMO (596 ± 81 nM·min) versus BLOx (323 ± 39 nM·min) at 24 hours (P = 0.04). Other coagulation and inflammatory mediator results were unremarkable. BLOx required higher mechanical ventilator settings and showed lower gas transfer efficiency versus HFMO, but the stable device performance indicates that this technology is ready for further performance scaling and testing in lung injury models and during longer use conditions.
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Affiliation(s)
- Teryn R Roberts
- From the Autonomous Reanimation and Evacuation Research Program, The Geneva Foundation, San Antonio, Texas
| | - Antoine Persello
- From the Autonomous Reanimation and Evacuation Research Program, The Geneva Foundation, San Antonio, Texas
| | - George T Harea
- From the Autonomous Reanimation and Evacuation Research Program, The Geneva Foundation, San Antonio, Texas
| | - Else M Vedula
- Bioengineering Division, Draper, Cambridge, Massachusetts
| | | | - Yanyi Zang
- From the Autonomous Reanimation and Evacuation Research Program, The Geneva Foundation, San Antonio, Texas
| | - Jose Santos
- Bioengineering Division, Draper, Cambridge, Massachusetts
| | | | - Andriy I Batchinsky
- From the Autonomous Reanimation and Evacuation Research Program, The Geneva Foundation, San Antonio, Texas
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Mathieu L, Beurton A, Rougier N, Flambard M, Germain C, Pernot M, Ouattara A. Heparin consumption and inflammatory response according to the coating of cardiopulmonary bypass circuits in cardiac surgery: A retrospective analysis. Perfusion 2023:2676591231215282. [PMID: 37944166 DOI: 10.1177/02676591231215282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
INTRODUCTION There are several types of surface treatments (coatings) aimed at improving the biocompatibility of cardiopulmonary bypass (CPB) circuit. Some coatings appear to require higher doses of heparin to maintain anticoagulation goals, and some of them might induce postoperative coagulopathy. In this study, we compared the amount of heparin required, postoperative bleeding, and inflammatory response according to three types of coatings. METHOD We retrospectively included 300 consecutive adult patients who underwent cardiac surgery with CPB and received one of three coatings (Phisio®, Trillium®, and Xcoating™). Our primary objective was to compare, according to coating, the amount of heparin required to maintain an ACT > 400s during CPB. Our secondary objectives were to compare postoperative bleeding for 48 h and CRP rate. RESULTS Baseline characteristics were comparable between groups except for age and preoperative CRP. We did not find a significant difference between the 3 coatings regarding the amount of heparin reinjected. However, we found less postoperative bleeding with the Xcoating™ circuit compared to the Phisio® circuit (-149 mL [-289; -26.5]; p = 0.02) and a lower elevation of CRP with the Phisio® circuit (2.8 times higher than preoperative CRP) compared to Trillium® (4.9 times higher) and Xcoating™ (6.4 times higher); p < 10-3. CONCLUSION The choice of coating did not influence the amount of heparin required during CPB; however, the post-CPB inflammatory syndrome may be impacted by this choice.
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Affiliation(s)
- Laurent Mathieu
- Department of Cardiovascular Surgery, Haut-Lévêque Hospital, Surgical Centre, Bordeaux University Hospital, Pessac, France
| | - Antoine Beurton
- Department of Cardiovascular Anesthesia and Critical Care, Haut-Lévêque Hospital, Bordeaux University Hospital, Bordeaux, France
- Univ. Bordeaux, INSERM, Biologie des maladies cardiovasculaires, U1034, F-33600 Pessac, France
| | - Nicolas Rougier
- Department of Cardiovascular Surgery, Haut-Lévêque Hospital, Surgical Centre, Bordeaux University Hospital, Pessac, France
| | - Maude Flambard
- Department of Cardiovascular Surgery, Haut-Lévêque Hospital, Surgical Centre, Bordeaux University Hospital, Pessac, France
| | - Christine Germain
- Research and Innovation Unit in Healthcare and Humanities (URISH), Bordeaux-University Hospital, Bordeaux, France
| | - Mathieu Pernot
- Department of Cardiovascular Surgery, Haut-Lévêque Hospital, Surgical Centre, Bordeaux University Hospital, Pessac, France
| | - Alexandre Ouattara
- Department of Cardiovascular Anesthesia and Critical Care, Haut-Lévêque Hospital, Bordeaux University Hospital, Bordeaux, France
- Univ. Bordeaux, INSERM, Biologie des maladies cardiovasculaires, U1034, F-33600 Pessac, France
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Costantini S, Belliato M, Ferrari F, Gazzaniga G, Ravasi M, Manera M, De Piero ME, Curcelli A, Cardinale A, Lorusso R. A retrospective analysis of the hemolysis occurrence during extracorporeal membrane oxygenation in a single center. Perfusion 2023; 38:609-621. [PMID: 35225087 DOI: 10.1177/02676591211073768] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Extracorporeal membrane oxygenation (ECMO)-associated hemolysis still represents a serious complication. The present study aimed to investigate those predictive factors, such as flow rates, the use of anticoagulants, and circuit connected dialysis, that might play a pivotal role in hemolysis in adult patients. METHODS This is a retrospective single-center case series of 35 consecutive adult patients undergoing veno-venous ECMO support at our center between April 2014 and February 2020. Daily plasma-free hemoglobin (pfHb) and haptoglobin (Hpt) levels were chosen as hemolysis markers and they were analyzed along with patients' characteristics, daily laboratory findings, and corresponding ECMO system variables, as well as continuous renal replacement therapy (CRRT) when administered, looking for factors influencing their trends over time. RESULTS Among the many settings related to the ECMO support, the presence of CRRT connected to the ECMO circuit has been found associated with both higher daily pfHb levels and lower Hpt levels. After correction for potential confounders, hemolysis was ascribable to circuit-related variables, in particular the membrane oxygenation dead space was associated with an Hpt reduction (B = -215.307, p = 0.004). Moreover, a reduction of ECMO blood flow by 1 L/min has been associated with a daily Hpt consumption of 93.371 mg/dL (p = 0.001). CONCLUSIONS Technical-induced hemolysis during ECMO should be monitored not only when suspected but also during quotidian management and check-ups. While considering the clinical complexity of patients on ECMO support, clinicians should not only be aware of and anticipate possible circuitry malfunctions or inadequate flow settings, but they should also take into account the effects of an ECMO circuit-connected CRRT, as an equally important key factor triggering hemolysis.
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Affiliation(s)
- Silvia Costantini
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, 19001University of Pavia, Pavia, Italy
| | - Mirko Belliato
- UOC Anestesia e Rianimazione II Cardiopolmonare, 18631Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Cardio-Thoracic Surgery Department, Heart & Vascular Centre, 199236Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Fiorenza Ferrari
- UOC Anestesia e Rianimazione I, 18631Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Giulia Gazzaniga
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, 19001University of Pavia, Pavia, Italy
| | - Marta Ravasi
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, 19001University of Pavia, Pavia, Italy
| | - Miriam Manera
- UOC Anestesia e Rianimazione II Cardiopolmonare, 18631Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Antonio Curcelli
- Cardiac Anesthesia and Intensive Care ICLAS Rapallo, 18591GVM Care & Res, Rapallo, Italy
| | - Alessandra Cardinale
- Department of Statistical Sciences, 9311Sapienza University of Rome, Rome, Italy
| | - Roberto Lorusso
- Cardio-Thoracic Surgery Department, Heart & Vascular Centre, 199236Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands.,118066Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherland
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Limandal HK, Kayğın MA, Ergün S, Özkara T, Diler MS, Çüçen HI, Yıldız Z, Dağ Ö. Clinical evaluation of two adult oxygenator systems in terms of mortality and major adverse events. Perfusion 2023; 38:515-522. [PMID: 34939512 DOI: 10.1177/02676591211063830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The primary aim of this study was to examine the effects of two oxygenator systems on major adverse events and mortality. METHODS A total of 181 consecutive patients undergoing coronary artery bypass grafting in our clinic were retrospectively analyzed. The patients were divided into two groups according to the oxygenator used: Group M, in which a Medtronic Affinity (Medtronic Operational Headquarters, Minneapolis, MN, USA) oxygenator was used, and Group S, in which a Sorin Inspire (Sorin Group Italia, Mirandola, Italy) oxygenator was used. RESULTS Group S consisted of 89 patients, whereas Group M included 92 patients. No statistically significant differences were found between the two groups in terms of age (p = .112), weight (p = .465), body surface area (p = .956), or gender (p = .484). There was no statistically significant difference in hemorrhage on the first or second postoperative day (p = .318 and p = .455, respectively). No statistically significant differences were observed in terms of red blood cell (p = .468), fresh frozen plasma (p = .116), or platelet concentrate transfusion (p = .212). Infections, wound complications, and delayed sternal closure were significantly more common in Group M (p = .006, p = .023, and p = .019, respectively). Extracorporeal membrane oxygenators and intra-aortic balloon pumps were required significantly more frequently in Group S (p = .025 and p = .013, respectively). Major adverse events occurred in 16 (18%) patients in Group S and 14 (15.2%) patients in Group M (p = .382). Mortality was observed in six (6.7%) patients in Group S and three (3.3%) patients in Group M (p = .232). No statistically significant difference was found between the two groups in terms of length of hospital stay (p = .451). CONCLUSION The clinical outcomes of the two oxygenator systems, including mortality, major adverse events, hemorrhage, erythrocyte and platelet transfusions, and length of hospital stay, were similar.
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Affiliation(s)
- Hüsnü Kamil Limandal
- Department of Cardiovascular Surgery, Erzurum Regional Education and Research Hospital, Erzurum, Turkey
| | - Mehmet Ali Kayğın
- Department of Cardiovascular Surgery, Erzurum Regional Education and Research Hospital, Erzurum, Turkey
| | - Servet Ergün
- Department of Pediatric Cardiovacscular Surgery, Erzurum Regional Education and Research Hospital, Erzurum, Turkey
| | - Taha Özkara
- Department of Cardiovascular Surgery, Erzurum Regional Education and Research Hospital, Erzurum, Turkey
| | - Mevriye Serpil Diler
- Department of Cardiovascular Surgery, Erzurum Regional Education and Research Hospital, Erzurum, Turkey
| | - Hatice Işıl Çüçen
- Department of Cardiovascular Surgery, Erzurum Regional Education and Research Hospital, Erzurum, Turkey
| | - Ziya Yıldız
- Department of Cardiovascular Surgery, Erzurum Regional Education and Research Hospital, Erzurum, Turkey
| | - Özgür Dağ
- Department of Cardiovascular Surgery, Erzurum Regional Education and Research Hospital, Erzurum, Turkey
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Extended Cellular Deposits on Gas Exchange Capillaries are Not an Indicator of Clot Formation: Analysis of Different Membrane Oxygenators. ASAIO J 2023; 69:e134-e141. [PMID: 36780695 DOI: 10.1097/mat.0000000000001892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Abstract
Antithrombogenic coatings of artificial surfaces within extracorporeal membrane oxygenation (ECMO) circuits improved its bio- and hemocompatibility. However, there is still a risk of thrombus formation in particular within the membrane oxygenator (MO). Since inflammatory cells are essential components within clots, the aim was to identify the extent of cellular accumulations on gas exchange capillaries from different ECMO systems. Thirty-four MOs (PLS, n = 27, Getinge; Hilite 7000 LT, n = 7, Fresenius Medical Care, Germany) were collected from adult patients. The extent of cellular deposits on gas exchange capillaries was classified using nuclear 4',6-diamidino-2-phenylindole staining and fluorescence microscopy. All Hilite oxygenators exhibited small cellular deposits. In contrast, the cellular distribution was heterogeneous on capillaries from PLS oxygenators: small deposits (34%), clusters (44%) and membrane-spanning cell structures (pseudomembranes) (22%). Overall, the median fluorescence intensity was significantly higher in the PLS group. Nevertheless, within 3 days before MO removal, there was no alteration in critical parameters (d-dimer and fibrinogen levels, platelet counts, and pressure drop across the MO). In conclusion, despite the histological differences on the gas capillaries from different types of oxygenators, there was no further evidence of increased inflammation and coagulation parameters that indicate clot formation within oxygenators.
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Hesselmann F, Arnemann D, Bongartz P, Wessling M, Cornelissen C, Schmitz-Rode T, Steinseifer U, Jansen SV, Arens J. Three-dimensional membranes for artificial lungs: Comparison of flow-induced hemolysis. Artif Organs 2021; 46:412-426. [PMID: 34606117 DOI: 10.1111/aor.14081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 08/11/2021] [Accepted: 09/22/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Membranes based on triply periodic minimal surfaces (TPMS) have proven a superior gas transfer compared to the contemporary hollow fiber membrane (HFM) design in artificial lungs. The improved oxygen transfer is attributed to disrupting the laminar boundary layer adjacent to the membrane surface known as main limiting factor to mass transport. However, it requires experimental proof that this improvement is not at the expense of greater damage to the blood. Hence, the aim of this work is a valid statement regarding the structure-dependent hemolytic behavior of TPMS structures compared to the current HFM design. METHODS Hemolysis tests were performed on structure samples of three different kind of TPMS-based designs (Schwarz-P, Schwarz-D and Schoen's Gyroid) in direct comparison to a hollow fiber structure as reference. RESULTS The results of this study suggest that the difference in hemolysis between TPMS membranes compared to HFMs is small although slightly increased for the TPMS membranes. There is no significant difference between the TPMS structures and the hollow fiber design. Nevertheless, the ratio between the achieved additional oxygen transfer and the additional hemolysis favors the TPMS-based membrane shapes. CONCLUSION TPMS-shaped membranes offer a safe way to improve gas transfer in artificial lungs.
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Affiliation(s)
- Felix Hesselmann
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Helmholtz Institute, RWTH Aachen University, Aachen, Germany
| | - Daniel Arnemann
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Helmholtz Institute, RWTH Aachen University, Aachen, Germany
| | - Patrick Bongartz
- Chair of Chemical Process Engineering, RWTH Aachen University, Aachen, Germany
| | - Matthias Wessling
- Chair of Chemical Process Engineering, RWTH Aachen University, Aachen, Germany.,DWI-Leibniz Institute for Interactive Materials, RWTH Aachen University, Aachen, Germany
| | - Christian Cornelissen
- Department of Pneumology and Internal Intensive Care Medicine, Medical Clinic V, RWTH Aachen University Hospital, Aachen, Germany
| | - Thomas Schmitz-Rode
- Institute of Applied Medical Engineering, Helmholtz Institute, RWTH Aachen University, Aachen, Germany
| | - Ulrich Steinseifer
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Helmholtz Institute, RWTH Aachen University, Aachen, Germany
| | - Sebastian Victor Jansen
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Helmholtz Institute, RWTH Aachen University, Aachen, Germany
| | - Jutta Arens
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Helmholtz Institute, RWTH Aachen University, Aachen, Germany.,Chair of Engineering Organ Support Technologies, Department of Biomechanical Engineering, Faculty of Engineering, Technology University of Twente, Twente, The Netherlands
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Swol J, Shigemura N, Ichiba S, Steinseifer U, Anraku M, Lorusso R. Artificial lungs--Where are we going with the lung replacement therapy? Artif Organs 2020; 44:1135-1149. [PMID: 33098217 DOI: 10.1111/aor.13801] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 08/03/2020] [Accepted: 08/04/2020] [Indexed: 12/12/2022]
Abstract
Lung transplantation may be a final destination therapy in lung failure, but limited donor organ availability creates a need for alternative management, including artificial lung technology. This invited review discusses ongoing developments and future research pathways for respiratory assist devices and tissue engineering to treat advanced and refractory lung disease. An overview is also given on the aftermath of the coronavirus disease 2019 pandemic and lessons learned as the world comes out of this situation. The first order of business in the future of lung support is solving the problems with existing mechanical devices. Interestingly, challenges identified during the early days of development persist today. These challenges include device-related infection, bleeding, thrombosis, cost, and patient quality of life. The main approaches of the future directions are to repair, restore, replace, or regenerate the lungs. Engineering improvements to hollow fiber membrane gas exchangers are enabling longer term wearable systems and can be used to bridge lung failure patients to transplantation. Progress in the development of microchannel-based devices has provided the concept of biomimetic devices that may even enable intracorporeal implantation. Tissue engineering and cell-based technologies have provided the concept of bioartificial lungs with properties similar to the native organ. Recent progress in artificial lung technologies includes continued advances in both engineering and biology. The final goal is to achieve a truly implantable and durable artificial lung that is applicable to destination therapy.
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Affiliation(s)
- Justyna Swol
- Department of Respiratory Medicine, Allergology and Sleep Medicine, Intensive Care Medicine, Paracelsus Medical University Nuremberg, General Hospital Nuremberg, Nuremberg, Germany
| | - Norihisa Shigemura
- Division of Cardiovascular Surgery, Temple University Health System Inc., Philadelphia, PA, USA
| | - Shingo Ichiba
- Department of Surgical Intensive Care Medicine, Nippon Medical School Hospital, Bunkyo-ku, Japan
| | - Ulrich Steinseifer
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Aachen, Germany
| | - Masaki Anraku
- Department of Thoracic Surgery, The University of Tokyo Graduate School of Medicine Faculty of Medicine, Bunkyo-ku, Japan
| | - Roberto Lorusso
- Cardio-Thoracic Surgery Department - Heart & Vascular Centre, Maastricht University Medical Hospital, Maastricht, The Netherlands
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Eusébio TM, Martins AR, Pon G, Faria M, Morgado P, Pinto ML, Filipe EJM, de Pinho MN. Sorption/Diffusion Contributions to the Gas Permeation Properties of Bi-Soft Segment Polyurethane/Polycaprolactone Membranes for Membrane Blood Oxygenators. MEMBRANES 2020; 10:membranes10010008. [PMID: 31906453 PMCID: PMC7023210 DOI: 10.3390/membranes10010008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 12/18/2019] [Accepted: 12/20/2019] [Indexed: 06/10/2023]
Abstract
Due to their high hemocompatibility and gas permeation capacity, bi-soft segment polyurethane/polycaprolactone (PU/PCL) polymers are promising materials for use in membrane blood oxygenators. In this work, both nonporous symmetric and integral asymmetric PU/PCL membranes were synthesized, and the permeation properties of the atmospheric gases N2, O2, and CO2 through these membranes were experimentally determined using a new custom-built gas permeation apparatus. Permeate pressure vs. time curves were obtained at 37.0 °C and gas feed pressures up to 5 bar. Fluxes, permeances, and permeability coefficients were determined from the steady-state part of the curves, and the diffusion and sorption coefficients were estimated from the analysis of the transient state using the time-lag method. Independent measurements of the sorption coefficients of the three gases were performed, under equilibrium conditions, in order to validate the new setup and procedure. This work shows that the gas sorption in the PU/PCL polymers is the dominant factor for the permeation properties of the atmospheric gases in these membranes.
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Affiliation(s)
- Tiago M. Eusébio
- Department of Chemical Engineering, CeFEMA—Center of Physics and Engineering of Advanced Materials, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais, 1049-001 Lisbon, Portugal; (T.M.E.); (A.R.M.); (G.P.); (M.F.)
- Department of Chemical Engineering, CQE—Centro de Química Estrutural, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais, 1049-001 Lisbon, Portugal; (P.M.); (E.J.M.F.)
| | - Ana Rita Martins
- Department of Chemical Engineering, CeFEMA—Center of Physics and Engineering of Advanced Materials, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais, 1049-001 Lisbon, Portugal; (T.M.E.); (A.R.M.); (G.P.); (M.F.)
- Department of Chemical Engineering, CQE—Centro de Química Estrutural, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais, 1049-001 Lisbon, Portugal; (P.M.); (E.J.M.F.)
| | - Gabriela Pon
- Department of Chemical Engineering, CeFEMA—Center of Physics and Engineering of Advanced Materials, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais, 1049-001 Lisbon, Portugal; (T.M.E.); (A.R.M.); (G.P.); (M.F.)
- Department of Chemical Engineering, CQE—Centro de Química Estrutural, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais, 1049-001 Lisbon, Portugal; (P.M.); (E.J.M.F.)
| | - Mónica Faria
- Department of Chemical Engineering, CeFEMA—Center of Physics and Engineering of Advanced Materials, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais, 1049-001 Lisbon, Portugal; (T.M.E.); (A.R.M.); (G.P.); (M.F.)
| | - Pedro Morgado
- Department of Chemical Engineering, CQE—Centro de Química Estrutural, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais, 1049-001 Lisbon, Portugal; (P.M.); (E.J.M.F.)
| | - Moisés L. Pinto
- Departamento de Engenharia Química, CERENA, Instituto Superior Técnico, Universidade de Lisboa, 1049-001 Lisboa, Portugal;
| | - Eduardo J. M. Filipe
- Department of Chemical Engineering, CQE—Centro de Química Estrutural, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais, 1049-001 Lisbon, Portugal; (P.M.); (E.J.M.F.)
| | - Maria Norberta de Pinho
- Department of Chemical Engineering, CeFEMA—Center of Physics and Engineering of Advanced Materials, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais, 1049-001 Lisbon, Portugal; (T.M.E.); (A.R.M.); (G.P.); (M.F.)
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Life span of different extracorporeal membrane systems for severe respiratory failure in the clinical practice. PLoS One 2018; 13:e0198392. [PMID: 29856834 PMCID: PMC5983427 DOI: 10.1371/journal.pone.0198392] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 04/25/2018] [Indexed: 11/19/2022] Open
Abstract
Over the past decade, veno-venous extracorporeal membrane oxygenation (vvECMO) has been increasingly utilized in respiratory failure in patients. This study presents our institution´s experience focusing on the life span of ECMO systems reflecting the performance of a particular system. A retrospective review of our ECMO database identified 461 adult patients undergoing vvECMO (2010-2017). Patients that required more than one system and survived the first exchange >24 hours (n = 139) were included. Life span until the first exchange and exchange criteria were analyzed for all systems (PLS, Cardiohelp HLS-set, both Maquet Cardiopulmonary, Rastatt, Germany; Deltastream/Hilite7000LT, iLA-activve, Xenios/NovaLung, Heilbronn, Germany; ECC.O5, LivaNova, Mirandola, Italy). At our ECMO center, the frequency of a system exchange was 30%. The median (IQR) life span was 9 (6-12) days. There was no difference regarding the different systems (p = 0.145 and p = 0.108, respectively). However, the Deltastream systems were exchanged more frequently due to elective technical complications (e. g. worsened gas transfer, development of coagulation disorder, increased bleedings complications) compared to the other exchanged systems (p = 0.013). In summary, the used ECMO systems are safe and effective for acute respiratory failure. There is no evidence for the usage of a specific system. Only the increased predictability of an imminent exchange preferred the usage of a Deltastream system. However, the decision to use a particular system should not depend solely on the possible criteria for an exchange.
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Hendrix RHJ, Ganushchak YM, Weerwind PW. Contemporary Oxygenator Design: Shear Stress-Related Oxygen and Carbon Dioxide Transfer. Artif Organs 2018; 42:611-619. [DOI: 10.1111/aor.13084] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 09/28/2017] [Accepted: 10/23/2017] [Indexed: 12/26/2022]
Affiliation(s)
- Rik H. J. Hendrix
- Department of Extra-Corporeal Circulation; Maastricht University Medical Centre; Maastricht The Netherlands
| | - Yuri M. Ganushchak
- Department of Extra-Corporeal Circulation; Maastricht University Medical Centre; Maastricht The Netherlands
| | - Patrick W. Weerwind
- Department of Extra-Corporeal Circulation; Maastricht University Medical Centre; Maastricht The Netherlands
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12
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Schraven L, Kaesler A, Flege C, Kopp R, Schmitz-Rode T, Steinseifer U, Arens J. Effects of Pulsatile Blood Flow on Oxygenator Performance. Artif Organs 2018; 42:410-419. [DOI: 10.1111/aor.13088] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 11/01/2017] [Accepted: 11/02/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Lotte Schraven
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering; RWTH Aachen University; Aachen Germany
| | - Andreas Kaesler
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering; RWTH Aachen University; Aachen Germany
| | - Christian Flege
- Department of Intensive Care; University Hospital, RWTH Aachen University; Aachen Germany
| | - Rüdger Kopp
- Department of Intensive Care; University Hospital, RWTH Aachen University; Aachen Germany
| | - Thomas Schmitz-Rode
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering; RWTH Aachen University; Aachen Germany
| | - Ulrich Steinseifer
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering; RWTH Aachen University; Aachen Germany
| | - Jutta Arens
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering; RWTH Aachen University; Aachen Germany
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13
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Okahara S, Takahashi S, Sueda T, Tsuji T. Blood viscosity monitoring during cardiopulmonary bypass based on pressure-flow characteristics of a Newtonian fluid. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2016:2331-2334. [PMID: 28268793 DOI: 10.1109/embc.2016.7591197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We proposed a blood viscosity estimation method based on pressure-flow characteristics of oxygenators used during cardiopulmonary bypass (CPB) in a previous study that showed the estimated viscosity to correlate well with the measured viscosity. However, the determination of the parameters included in the method required the use of blood, thereby leading to high cost of calibration. Therefore, in this study we propose a new method to monitor blood viscosity, which approximates the pressure-flow characteristics of blood considered as a non-Newtonian fluid with characteristics of a Newtonian fluid by using the parameters derived from glycerin solution to enable ease of acquisition. Because parameters used in the estimation method are based on fluid types, bovine blood parameters were used to calculate estimated viscosity (ηe), and glycerin parameters were used to estimate deemed viscosity (ηdeem). Three samples of whole bovine blood with different hematocrit levels (21.8%, 31.0%, and 39.8%) were prepared and perfused into the oxygenator. As the temperature changed from 37 °C to 27 °C, the oxygenator mean inlet pressure and outlet pressure were recorded for flows of 2 L/min and 4 L/min, and the viscosity was estimated. The value of deemed viscosity calculated with the glycerin parameters was lower than estimated viscosity calculated with bovine blood parameters by 20-33% at 21.8% hematocrit, 12-27% at 31.0% hematocrit, and 10-15% at 39.8% hematocrit. Furthermore, deemed viscosity was lower than estimated viscosity by 10-30% at 2 L/min and 30-40% at 4 L/min. Nevertheless, estimated and deemed viscosities varied with a similar slope. Therefore, this shows that deemed viscosity achieved using glycerin parameters may be capable of successfully monitoring relative viscosity changes of blood in a perfusing oxygenator.
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14
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Okahara S, Soh Z, Miyamoto S, Takahashi H, Takahashi S, Sueda T, Tsuji T. Continuous Blood Viscosity Monitoring System for Cardiopulmonary Bypass Applications. IEEE Trans Biomed Eng 2016; 64:1503-1512. [PMID: 27662668 DOI: 10.1109/tbme.2016.2610968] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This paper proposes an algorithm that estimates blood viscosity during cardiopulmonary bypass (CPB) and validates its application in clinical cases. The proposed algorithm involves adjustable parameters based on the oxygenator and fluid types and estimates blood viscosity based on pressure-flow characteristics of the fluid perfusing through the oxygenator. This novel nonlinear model requires four parameters that were derived by in vitro experiments. The results estimated by the proposed method were then compared with a conventional linear model to demonstrate the former's optimal curve fitting. The viscosity (ηe) estimated using the proposed algorithm and the viscosity (η) measured using a viscometer were compared for 20 patients who underwent mildly hypothermic CPB. The developed system was applied to ten patients, and ηe was recorded for comparisons with hematocrit and blood temperature. The residual sum of squares between the two curve fittings confirmed the significant difference, with p < 0.001. ηe and η showed a very strong correlation with R2 = 0.9537 and p < 0.001. Regarding the mean coefficient of determination for all cases, the hematocrit and temperature showed weak correlations at 0.33 ± 0.14 and 0.22 ± 0.21, respectively. For CPB measurements of all cases, ηe was more than 98% distributed in the range from 1 to 3 mPa⋅s. This new system for estimating viscosity may be useful for detecting various viscosity-related effects that may occur during CPB.
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15
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Okahara S, Tsuji T, Takahashi S, Sueda T. A blood viscosity estimation method based on pressure-flow characteristics of an oxygenator during cardiopulmonary bypass and its clinical application. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2016; 2015:5525-8. [PMID: 26737543 DOI: 10.1109/embc.2015.7319643] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
In this paper, we developed a model that uses pressure-flow monitoring information in the oxygenator to estimate viscosity of human blood. The comparison between estimated viscosity (ηe) and measured viscosity (η) was assessed in 16 patients who underwent cardiac surgery using mild hypothermia cardiopulmonary bypass (CPB). After initiation of CPB, ηe was recorded at three periods: post-establishment of total CPB, post-aortic cross-clamp, and post-declamp. During the same period, blood samples were collected from the circuit and η was measured with a torsional oscillation viscometer. The ηe was plotted as a function of η and the systematic errors and compatibility between two methods were assessed using Bland-Altman analysis. The parameters ηe and η were very strongly correlated at all points (R(2)=0.9616, p<;0.001). The Bland-Altman analysis revealed a mean bias of -0.001 mPas, a standard deviation of 0.03 mPas, limits of agreement of -0.06 mPas to 0.06 mPas, and a percent error of 3.3%. There was no fixed bias or proportion bias for the viscosity. As this method estimates blood viscosity with good precision during CPB continuously, it may be helpful for clinical perfusion management.
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16
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Abstract
Advances in cardiopulmonary bypass equipment have played a critical role in improving outcomes for cardiac surgery patients. Recent advancements include reduced priming volumes, biocompatible coatings and gaseous microemboli handling, as well as the incorporation of an arterial filter into the oxygenator. The purpose of this study was to conduct a comprehensive clinical evaluation of adult oxygenators on the market. Oxygenators assessed included the Sorin Synthesis® (n = 30), the Sorin Inspire 6F® (n = 10) and Inspire 8F® (n = 30), the Terumo FX15® (n = 13) and FX25® (n = 30), the Maquet Quadrox-i® (n = 30) and the Medtronic Fusion® (n = 30). Parameters assessed included functional prime volumes, gas exchange, pressure gradients and the effects on patient hematology. The Synthesis had the largest functional prime volume (1426 ml), the FX15 the lowest (956 ml). The Inspire 6F, 8F and Fusion had the greatest O2 transfer. The Sorin oxygenators required the lowest sweep gas flows to obtain a PaCO2 of 40 mmHg. The Sorin oxygenators had the largest pressure gradients. While no differences were observed for hemoglobin and platelet levels post cross-clamp removal, the Sorin Synthesis and Inspire 8F had the largest increases in white blood cell (WBC) counts (122% and 141% of baseline, respectively) and neutrophils (162% and 185% of baseline, respectively). The data demonstrate that no single product is superior in all aspects. The choice of ideal oxygenator depends on the aspect(s) of oxygenator performance the perfusion team believes most clinically acceptable based on available data.
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17
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Ganushchak YM, Simons AP, Weerwind PW. The hidden limitations in "advertising" a novel synchronized cardiac assist device. Artif Organs 2015; 39:451-2. [PMID: 25953235 DOI: 10.1111/aor.12503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Yuri M Ganushchak
- Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Antoine P Simons
- Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, The Netherlands. .,Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands.
| | - Patrick W Weerwind
- Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
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