Статті в журналах: "Extracorporeal perfusion"

1

&NA;. "EXTRACORPOREAL PERFUSION." ASAIO Journal 42, no. 2 (April 1996): 58–65. http://dx.doi.org/10.1097/00002480-199642020-00012.

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2

Cypel, Marcelo, and Shaf Keshavjee. "Extracorporeal lung perfusion." Current Opinion in Organ Transplantation 16, no. 5 (October 2011): 469–75. http://dx.doi.org/10.1097/mot.0b013e32834ab15a.

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3

McChesney, LP, EA Fagan, DL Rowell, JV Del Rio, F. Fabrega, M. Mills, and JW Williams. "Extracorporeal liver perfusion." Lancet 353, no. 9147 (January 1999): 120–21. http://dx.doi.org/10.1016/s0140-6736(05)76157-2.

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4

Hessheimer, Amelia J., Constantino Fondevila, and Juan C. García-Valdecasas. "Extracorporeal machine liver perfusion." Current Opinion in Organ Transplantation 17, no. 2 (April 2012): 143–47. http://dx.doi.org/10.1097/mot.0b013e328351082a.

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5

&NA;. "EXTRACORPOREAL PERFUSION/ECMO/ECCO2R." ASAIO Journal 43, no. 2 (March 1997): 29–36. http://dx.doi.org/10.1097/00002480-199743020-00007.

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6

Cypel, Marcelo, and Shaf Keshavjee. "Extracorporeal lung perfusion (ex-vivo lung perfusion)." Current Opinion in Organ Transplantation 21, no. 3 (June 2016): 329–35. http://dx.doi.org/10.1097/mot.0000000000000320.

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7

Neuhaus, P., and G. Blumhardt. "Extracorporeal Liver Perfusion: Applications of an Improved Model for Experimental Studies of the Liver." International Journal of Artificial Organs 16, no. 10 (October 1993): 729–39. http://dx.doi.org/10.1177/039139889301601010.

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Long-term extracorporeal liver perfusion of up to 24 hours was achieved with an improved model of pig liver perfusion. Functional and structural integrity of the extracorporeal liver was maintained during the entire duration of extracorporeal perfusion. After 24 hours SGOT was 33.5 (± 6.5) U/L, bile production was 11.5 ml/h. Survival of hepatectomized pigs could be extended to 18.9 (± 3.8) hours with extracorporeal liver perfusion (p < 0.01). The improvement of liver perfusion in our particular model is primarily based on optimised perfusion of the low pressure system of the portal and hepatic vein by the application of sinusoidal pressure profiles. These pressure profiles imitate intra-abdominal conditions and achieve homogeneous perfusion of the low pressure system of the portal vein and complete drainage of hepatic venous blood.

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8

Borel Rinkes, Inne H. M., Mehmet Toner, Ronald G. Tompkins, and Martin L. Yarmush. "An Extracorporeal Microscopy Perfusion Chamber for On-Line Studies of Environmental Effects on Cultured Hepatocytes." Journal of Biomechanical Engineering 116, no. 2 (May 1, 1994): 135–39. http://dx.doi.org/10.1115/1.2895711.

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The development of bioartificial-hybrid organ support systems is hampered by the lack of knowledge on the effects of different (in vivo) environments on cells during extracorporeal perfusion. In the present study, a perfusion chamber was designed for continuous monitoring of cultured cells during perfusion with media, as well as during plasma perfusion in an extracorporeal circuit. Chamber characterization showed satisfactory thermal and perfusion profiles and no major pH fluctuations. Further testing was performed with hepatocytes that were cultured in between two collagen layers, a configuration which was previously shown to preserve hepatocyte morphology and function for over six weeks of culture. Perfusion of the hepatocytes with culture media did not adversely affect cell morphology and function, provided the perfusion time was ≤ 48 hours. Perfusion of the cultures during connection of the chamber to an extracorporeal circuit involving normal rats for six hours resulted in reversible cytoplasmic changes, unaltered cell shapes indices, and a 40 percent increase in albumin secretion rate during the first post-perfusion day, followed by a return to stable control levels. We expect that this chamber will be a valuable tool for on-line studies of cells under (extracorporeal) perfusion conditions and could be used for a large variety of studies on regeneration, reperfusion damage, and detoxification.

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Ozturk, Muhammed Besir, Tolga Aksan, Ismail Bulent Ozcelik, Cengiz Ertekin, Bahadir Akcakoyunlu, Sidika Seyma Ozkanli, and Mustafa Tezcan. "Extracorporeal Free Flap Perfusion Using Extracorporeal Membrane Oxygenation Device." Annals of Plastic Surgery 83, no. 6 (December 2019): 702–8. http://dx.doi.org/10.1097/sap.0000000000002014.

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10

Ohira, Suguru, Masashi Kawamura, Kristin Ahern, Nicholas Cavarocchi, and Hitoshi Hirose. "Aggressive placement of distal limb perfusion catheter in venoarterial extracorporeal membrane oxygenation." International Journal of Artificial Organs 43, no. 12 (April 20, 2020): 796–802. http://dx.doi.org/10.1177/0391398820917160.

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Objective: The aim of this study is to review the impacts of aggressive placement of a distal perfusion catheter on the outcomes in patients supported with venoarterial extracorporeal membrane oxygenation via femoral cannulation. Methods: Analysis was performed with 143 consecutive femoral venoarterial extracorporeal membrane oxygenation cannulation. Patients were divided into two groups: the early period (October 2010 to December 2012, N = 47) where placement of a distal perfusion catheter was attempted percutaneously but not surgically and the late period (January 2013 to November 2018, N = 96) in which placement of distal perfusion catheter was aggressively utilized both percutaneously and surgically. The modification of venoarterial extracorporeal membrane oxygenation cannulation protocol for the late period involved (1) an immediate insertion of a distal perfusion catheter regardless of the size of femoral arterial cannula, (2) an open insertion of a distal perfusion catheter if percutaneous approach failed, and (3) when venoarterial extracorporeal membrane oxygenation cannulation was completed at a non-extracorporeal membrane oxygenation cannulation center, it was encouraged that they attempt insertion of a distal perfusion catheter at the time of cannulation. Results: In the late period, a distal perfusion catheter was placed in 96% (92/96) which was significantly increased from 66% (31/47) in the early period. Of these 92 patients in late period, nine patients (9.8%) required open direct insertion of a distal perfusion catheter. The incidence of lower limb ischemia (early vs. late period 26% vs 12%, P = 0.031) was significantly decreased in the late period. Logistic regression analyses showed that distal perfusion catheter placement was the only factor for preventing lower limb ischemia. Conclusion: Aggressive insertion of a distal perfusion catheter even utilizing surgical cut-down technique was shown to decrease the incidence of distal limb complications.

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11

Ellam, Sten, Otto Pitkänen, Pasi Lahtinen, Tadeusz Musialowicz, Mikko Hippeläinen, Juha Hartikainen, and Jari Halonen. "Impact of minimal invasive extracorporeal circulation on the need of red blood cell transfusion." Perfusion 34, no. 7 (April 26, 2019): 605–12. http://dx.doi.org/10.1177/0267659119842811.

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Objective: Minimal invasive extracorporeal circulation may decrease the need of packed red blood cell transfusions and reduce hemodilution during cardiopulmonary bypass. However, more data are needed on the effects of minimal invasive extracorporeal circulation in more complex cardiac procedures. We compared minimal invasive extracorporeal circulation and conventional extracorporeal circulation methods of cardiopulmonary bypass. Methods: A total of 424 patients in the minimal invasive extracorporeal circulation group and 844 patients in the conventional extracorporeal circulation group undergoing coronary artery bypass grafting and more complex cardiac surgery were evaluated. Age, sex, type of surgery, and duration of perfusion were used as matching criteria. Hemoglobin <80 g/L was used as red blood cell transfusion trigger. The primary endpoint was the use of red blood cells during the day of operation and the five postoperative days. Secondary endpoints were hemodilution (hemoglobin drop after the onset of perfusion) and postoperative bleeding from the chest tubes during the first 12 hours after the operation. Results: Red blood cell transfusions were needed less often in the minimal invasive extracorporeal circulation group compared to the conventional extracorporeal circulation group (26.4% vs. 33.4%, p = 0.011, odds ratio 0.72, 95% confidence interval 0.55-0.93), especially in coronary artery bypass grafting subgroup (21.3% vs. 35.1%, p < 0.001, odds ratio 0.50, 95% confidence interval 0.35-0.73). Hemoglobin drop after onset of perfusion was also lower in the minimal invasive extracorporeal circulation group than in the conventional extracorporeal circulation group (24.2 ± 8.5% vs. 32.6 ± 12.6%, p < 0.001). Postoperative bleeding from the chest tube did not differ between the groups (p = 0.808). Conclusion: Minimal invasive extracorporeal circulation reduced the need of red blood cell transfusions and hemoglobin drop when compared to the conventional extracorporeal circulation group. This may have implications when choosing the perfusion method in cardiac surgery.

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12

Solholm, Atle, Pirjo-Riitta Salminen, Lodve Stangeland, Christian Arvei Moen, Arve Mongstad, Bård Svenheim, Rune Haaverstad, and Ketil Grong. "Myocardial perfusion and cardiac dimensions during extracorporeal membrane oxygenation–supported circulation in a porcine model of critical post-cardiotomy failure." Perfusion 35, no. 8 (March 4, 2020): 763–71. http://dx.doi.org/10.1177/0267659120907557.

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Introduction: Venoarterial extracorporeal membrane oxygenation is widely used as mechanical circulatory support for severe heart failure. A major concern with this treatment modality is left ventricular distension due to inability to overcome the afterload created by the extracorporeal membrane oxygenation circuit. The present porcine study evaluates coronary circulation, myocardial perfusion and ventricular distension during venoarterial extracorporeal membrane oxygenation. Methods: Ten anesthetized open-chest pigs were cannulated and put on cardiopulmonary bypass. Heart failure was achieved by 90 minutes of aortic cross-clamping with insufficient cardioplegic protection. After declamping, the animals were supported by venoarterial extracorporeal membrane oxygenation for 3 hours. Continuous haemodynamic measurements were performed at baseline, during cardiopulmonary bypass/aortic cross-clamping and during venoarterial extracorporeal membrane oxygenation. Fluorescent microsphere injections at baseline and after 1, 2 and 3 hours on venoarterial extracorporeal membrane oxygenation evaluated myocardial perfusion. Left ventricular function and distension were assessed by epicardial echocardiography. Results: The myocardial injury caused by 90 minutes of ischaemia resulted in a poorly contracting myocardium, necessitating venoarterial extracorporeal membrane oxygenation in all animals. The circulatory support maintained the mean arterial blood pressure within a satisfactory range. A hyperaemic left anterior descending coronary artery flow while on extracorporeal membrane oxygenation was observed compared to baseline. Myocardial tissue perfusion measured by microspheres was low, especially in the subendocardium. Echocardiography revealed myocardial tissue oedema, a virtually empty left ventricle, and a left ventricular output that remained negligible throughout the extracorporeal membrane oxygenation run. Conclusion: Coronary artery blood flow is maintained during venoarterial extracorporeal membrane oxygenation after cardiopulmonary bypass and cardioplegic arrest despite severely affected performance of the left ventricle. Myocardial perfusion decreases, however, presumably due to rapid development of myocardial tissue oedema.

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13

Kaufeld, Tim, Eric Beckmann, Fabio Ius, Nurbol Koigeldiev, Wiebke Sommer, Bakr Mashaqi, Felix N. Fleissner, et al. "Risk factors for critical limb ischemia in patients undergoing femoral cannulation for venoarterial extracorporeal membrane oxygenation: Is distal limb perfusion a mandatory approach?" Perfusion 34, no. 6 (February 8, 2019): 453–59. http://dx.doi.org/10.1177/0267659119827231.

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Background: Venoarterial extracorporeal membrane oxygenation support is a well-established tool in the care of severe refractory cardiac and respiratory failure. The application of this support may serve as a bridge to transplant, recovery or to implantation of a ventricular assist device. Venoarterial extracorporeal membrane oxygenation support can be administered through an open surgical access via the common femoral or axillary artery or a percutaneous approach using Seldinger technique. Both techniques may obstruct the blood flow to the lower limb and may cause a significant ischemia with possible limb loss. Malperfusion of the distal limb can be avoided using an ipsilateral distal limb perfusion, which may be established by adding a single-lumen catheter during venoarterial extracorporeal membrane oxygenation treatment to overcome the obstruction. The aim of this study is to distinguish the presence or absence of a distal limb perfusion regarding the incidence of distal limb ischemia. Furthermore, expected risk factors of open and percutaneous femoral venoarterial extracorporeal membrane oxygenation installation were evaluated for the development of distal limb ischemia. Methods: Between January 2012 and September 2015, 489 patients received venoarterial extracorporeal membrane oxygenation support at our institution. In total, 307 patients (204 male, 103 female) with femoral cannulation were included in the analysis. The cohort was distinguished by the presence (group A; n = 237) or absence (group B; n = 70) of a distal limb perfusion during peripheral venoarterial extracorporeal membrane oxygenation treatment. Furthermore, a risk factor analysis for the development of distal limb ischemia was performed. Results: The main indications for venoarterial extracorporeal membrane oxygenation therapy were a low cardiac output syndrome (LCOS) (53%) and failed weaning of extracorporeal circulation (23%). A total of 23 patients (7.49%) under venoarterial extracorporeal membrane oxygenation support developed severe distal limb malperfusion (3.38% in group A vs 21.42% in group B). Preemptive installation of distal limb perfusion extended the intervention-free intervals to 7.8 ± 19.3 days in group A and 6.3 ± 12.5 in group B. A missing distal limb perfusion (p = 0.001) was identified as a main risk factor for critical limb ischemia. Other comorbidities such as arterial occlusion disease (p = 0.738) were not statistically significantly associated. Surgical intervention due to vascular complications after extracorporeal membrane oxygenation explantation was needed in 14 cases (4.22% in group A and 5.71% in group B). Conclusion: We were able to identify the absence of distal limb perfusion as an independent risk factor for the development of critical distal limb ischemia during femoral venoarterial extracorporeal membrane oxygenation treatment. The application of a distal limb perfusion should be considered as a mandatory approach in the context of femoral venoarterial extracorporeal membrane oxygenation treatment regardless of the implantation technique.

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14

Carozza, Roberto, Diego Fazzi, Armando Pietrini, Mariano Cefarelli, Francesca Mazzocca, Walter Vessella, Paolo Berretta, et al. "Minimally invasive aortic valve replacement: extracorporeal circulation optimization and minimally invasive extracorporeal circulation system evolution." Perfusion 35, no. 8 (March 31, 2020): 865–69. http://dx.doi.org/10.1177/0267659120913385.

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Treatment of aortic valve disease has become less and less invasive during the last years, thanks to progress in anesthesiology, surgical techniques, and perfusion management. In fact, it has been demonstrated that shorter skin incision, combined with ultra-fast-track anesthesia and minimized extracorporeal circuit could improve clinical outcomes. Current evidence shows that minimally invasive extracorporeal circulation system is associated with reduced red blood cells’ transfusion rate, improved end-organ perfusion, decreased incidence of postoperative atrial fibrillation, air embolism leakage, and so less cerebral accidents with better neurological outcomes. Moreover, the use of a closed circuit seems to be more physiologic for the patients, reducing systemic inflammatory response due to less air–blood contact and the use of biocompatible surfaces. In the literature, the benefits of minimally invasive extracorporeal circulation are described mostly for coronary surgery but few data are nowadays available for minimally invasive extracorporeal circulation during aortic valve replacement. In this article, we describe our perfusion protocol in minimally invasive aortic valve replacement.

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15

Macdonald, Peter S., Hong C. Chew, Mark Connellan, and Kumud Dhital. "Extracorporeal heart perfusion before heart transplantation." Current Opinion in Organ Transplantation 21, no. 3 (June 2016): 336–42. http://dx.doi.org/10.1097/mot.0000000000000309.

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16

Kueckelhaus, Maximilian, Flemming Puscz, Alexander Dermietzel, Mehran Dadras, Sebastian Fischer, Nicco Krezdorn, Bohdan Pomahac, and Tobias Hirsch. "Extracorporeal Perfusion in Vascularized Composite Allotransplantation." Annals of Plastic Surgery 80, no. 6 (June 2018): 669–78. http://dx.doi.org/10.1097/sap.0000000000001477.

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17

Lane, R. J., M. N. Phillips, D. Mcmillan, M. Huckson, S. Liang, and G. Roger. "VS01ï¿½HYPERTENSIVE EXTRACORPOREAL LIMB PERFUSION - HELP." ANZ Journal of Surgery 79 (May 2009): A88. http://dx.doi.org/10.1111/j.1445-2197.2009.04935_1.x.

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18

Voitsekhovskaya, E. Kh, E. M. Esikova, B. L. Kiselev, A. N. Prokhorenko, and A. I. Khaitlin. "Perfusion equipment for extracorporeal blood clearance." Biomedical Engineering 24, no. 4 (July 1990): 142–44. http://dx.doi.org/10.1007/bf00560759.

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19

Bulletti, Carlo, Valerio Maria Jasonni, Stephan Lubicz, Carlo Flamigni, and Erlio Gurpide. "Extracorporeal perfusion of the human uterus." American Journal of Obstetrics and Gynecology 154, no. 3 (March 1986): 683–88. http://dx.doi.org/10.1016/0002-9378(86)90630-7.

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20

Dijkstra, Martijn L., Rodney J. Lane, and Walid Mohabbat. "PS104. Hypertensive Extracorporeal Limb Perfusion (HELP)." Journal of Vascular Surgery 55, no. 6 (June 2012): 53S—54S. http://dx.doi.org/10.1016/j.jvs.2012.03.146.

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21

MATSUDA, TSUKASA. "Clinical comparison of extracorporeal circulation.Pulsatile flow perfusion and steady flow perfusion." Japanese journal of extra-corporeal technology 18, no. 1 (1992): 37–39. http://dx.doi.org/10.7130/hokkaidoshakai.18.37.

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22

Taeger, Christian D., Oliver Friedrich, Caroline Drechsler, Annika Weigand, Frieder Hobe, Carol I. Geppert, Frank Münch, et al. "Hydroxyethyl starch solution for extracorporeal tissue perfusion." Clinical Hemorheology and Microcirculation 64, no. 1 (November 4, 2016): 91–103. http://dx.doi.org/10.3233/ch-162049.

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23

Lange, Stefan, and Holger Hydén. "Extracorporeal Perfusion Treatment with Immobilized L-Asparaginase." Scandinavian Journal of Haematology 18, no. 3 (April 24, 2009): 244–48. http://dx.doi.org/10.1111/j.1600-0609.1977.tb02336.x.

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24

Taeger, Christian D., Philipp Lamby, Jürgen Dolderer, Alois Philipp, Andreas Kehrer, Raymund E. Horch, Konstantin Präbst, and Lukas Prantl. "Extracorporeal Perfusion for Salvage of Major Amputates." Annals of Surgery 270, no. 1 (July 2019): e5-e6. http://dx.doi.org/10.1097/sla.0000000000003226.

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25

Bauernschmitt, R., E. Naujokat, H. Mehmanesh, S. Schulz, C. F. Vahl, S. Hagl, and R. Lange. "Mathematical modelling of extracorporeal circulation: simulation of different perfusion regimens." Perfusion 14, no. 5 (September 1999): 321–30. http://dx.doi.org/10.1177/026765919901400502.

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Computer- and sensor-aided control of the heart-lung machine is considered a major goal for perfusion sciences for the next few years. At present, control of perfusion is achieved by surgeons, anaesthesiologists and perfusionists making short-term decisions, which leads to variations of the perfusion regimens between different centres and even between different teams in the operating theatre. As the basis for an integrated control of extracorporeal circulation (ECC), we proposed a mathematical model for simulating haemodynamics during pulsatile perfusion. This model was then modified to allow it to simulate the effects of different perfusion regimens on arterial haemodynamics and whole body oxygen consumption. The model was constructed on a PC using MATLAB/SIMULINK. The human arterial tree was divided into a multibranch structure consisting of 128 segments characterized by their particular physical properties. Peripheral branches were terminated by a resistance term representing smaller vessels like arterioles and capillaries. Flow and pressure were expressed by the intensity of current and voltage in an electrotechnical analogon; inductivity, resistance and capacitance were implemented according to the physical properties of the arterial tree and the rheology of blood. The effects of different perfusion regimens (pulsatility, flow amount, acid-base regulation) were studied. After introducing an input signal to the model, flow and pressure waves established themselves throughout the simulated arterial tree. During the simulation experiments, marked differences among different perfusion regimens were displayed by the model. Variations in acid-base management mainly influenced the distribution of perfusion: during simulation of low-flow perfusion (1.2 l/min/m2), cerebral blood flow was 6.2 ml/s using an alpha-stat regimen, while it was increased to 9.4 ml/s during pH-stat, caused by an implementation of reduced cerebral resistance. Whole body oxygen consumption was predominantly regulated by the perfusion rate. While central venous oxygen saturation was calculated to be 84.7% during simulation of high-flow perfusion (2.4 l/min/m2), it dropped to 70% during simulation of low-flow perfusion regimens. The model proved to be useful for a realistic simulation of different perfusion regimens. Therefore it can be considered a continuing step for the derivation of a ‘state’ observer leading to the realization of an automatically controlled heart-lung machine.

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26

Edmunds, L. Henry. "Effects of cardiopulmonary bypass on the coagulation system." Cardiology in the Young 3, no. 3 (July 1993): 251–56. http://dx.doi.org/10.1017/s1047951100001645.

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Cardiopulmonary bypass makes a mess of homeostasis. Extracorporeal perfusion produces pulseless flow without physiologic controls, showers microemboli throughout the body, and brings blood diluted with additives to an enzymatic boil. Much of the morbidity associated with open heart surgery is due to contact of blood with the synthetic surfaces of the extracorporeal perfusion circuit. Bypass temporarily impairs function of every organ, alters concentrations of over 25 vasoactive substances within the plasma, and causes massive retention of fluid. In short, cardiopulmonary bypass makes patients sick.

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Shann, Kenneth G., Carmen R. Giacomuzzi, Lynn Harness, Gerard J. Myers, Theron A. Paugh, Nicholas Mellas, Robert C. Groom, et al. "Complications relating to perfusion and extracorporeal circulation associated with the treatment of patients with congenital cardiac disease: Consensus Definitions from the Multi-Societal Database Committee for Pediatric and Congenital Heart Disease." Cardiology in the Young 18, S2 (December 2008): 206–14. http://dx.doi.org/10.1017/s1047951108003065.

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AbstractThe International Consortium for Evidence-Based Perfusion (www.bestpracticeperfusion.org) is a collaborative partnership of societies of perfusionists, professional medical societies, and interested clinicians, whose aim is to promote the continuous improvement of the delivery of care and outcomes for patients undergoing extracorporeal circulation. Despite the many advances made throughout the history of cardiopulmonary bypass, significant variation in practice and potential for complication remains. To help address this issue, the International Consortium for Evidence-Based Perfusion has joined the Multi-Societal Database Committee for Pediatric and Congenital Heart Disease to develop a list of complications in congenital cardiac surgery related to extracorporeal circulation conducted via cardiopulmonary bypass, extracorporeal membrane oxygenation, or mechanical circulatory support devices, which include ventricular assist devices and intra-aortic balloon pumps. Understanding and defining the complications that may occur related to extracorporeal circulation in congenital patients is requisite for assessing and subsequently improving the care provided to the patients we serve. The aim of this manuscript is to identify and define the myriad of complications directly related to the extracorporeal circulation of congenital patients.

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Sharma, Gaurav, Suruchi Hasija, and Poonam Malhotra Kapoor. "Perfusion Strategies for Bivalirudin Anticoagulation: AIIMS Protocol." Journal of Cardiac Critical Care TSS 06, no. 01 (January 2022): 054–58. http://dx.doi.org/10.1055/s-0042-1750011.

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AbstractAnticoagulation strategies for cardiac surgery are witnessing a change with the identification of serious limitations of heparin, including development of resistance in 3 to 13% of patients undergoing cardiac surgery and heparin-induced thrombocytopenia/thrombosis syndrome in 1 to 5.5% of patients. Heparin alternatives have a potential role in these scenarios. Bivalirudin, a reversible direct thrombin inhibitor, has an onset time of 2 to 4 minutes and half-life of 25 minutes, is eliminated mainly by a proteolytic mechanism, does not require antithrombin III for effect, and is nonimmunogenic. The considerations for extracorporeal circulation are peculiar with its use, and this article outlines the aspects of initiating, maintaining, and terminating cardiopulmonary bypass and extracorporeal membrane oxygenation with bivalirudin as the anticoagulant.

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Boschetti, F., F. M. Montevecchi, and R. Fumero. "Virtual Extracorporeal Circulation Process." International Journal of Artificial Organs 20, no. 6 (June 1997): 341–51. http://dx.doi.org/10.1177/039139889702000608.

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Virtual instruments for an extracorporeal circulation (ECC) process were developed to simulate the reactions of a patient to different artificial perfusion conditions. The computer simulation of the patient takes into account the hydraulic, volume, thermal and biochemical phenomena and their interaction with the devices involved in ECC (cannulae dimensions, oxygenator and filter types, pulsatile or continuous pump and thermal exchangers). On the basis of the patient's initialisation data (height, weight, Ht) and perfusion variables (pump flow rate, water temperature, gas flow rate and composition) imposed by the operator, the virtual ECC monitors simulated arterial and venous pressure tracings in real time, along with arterial and venous flow rate tracings, urine production tracing and temperature levels. Oxyhemoglobin arterial and venous blood saturation together with other related variables (pO2, pCO2, pH, HCO3) are also monitored. A drug model which allows the simulation of the effect of vasodilator and diuretic drugs is also implemented. Alarms are provided in order to check which variables (pressure, saturation, pH, urine flow) are out of the expected ranges during the ECC simulation. Consequently the possibility of modifying the control parameters of the virtual devices of the ECC in run-time mode offers an interaction mode between the operator and the virtual environment.

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30

Taeger, Christian D., Oliver Friedrich, Raymund E. Horch, Caroline Distler, Annika Kengelbach-Weigand, Carina Wenzel, Lukas Prantl, and Konstantin Präbst. "Tissue Viability of Free Flaps after Extracorporeal Perfusion Using a Modified Hydroxyethyl Starch Solution." Journal of Clinical Medicine 9, no. 12 (December 3, 2020): 3929. http://dx.doi.org/10.3390/jcm9123929.

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Background: In free flap surgery, tissue is stored under hypothermic ischemia. Extracorporeal perfusion (EP) has the potential to extend storage time and the tissue’s perspective of survival. In the present study, the aim is to improve a recently established, simplified extracorporeal perfusion system. Methods: Porcine musculus rectus abdominis were stored under different conditions. One group was perfused continuously with a simplified one-way perfusion system for six hours, while the other received only a single flush but no further treatment. A modified hydroxyethyl starch solution was used as a perfusion and flushing solution. Vitality, functionality, and metabolic activity of both groups were analyzed. Results: Perfused muscles, in contrast to the ischemically stored ones, showed no loss of vitality and significantly less functionality loss, confirming the superiority of storage under continuous perfusion over ischemic storage. Furthermore, in comparison to a previous study, the results were improved even further by using a modified hydroxyethyl starch solution. Conclusion: The use of EP has major benefits compared to the clinical standard static storage at room temperature. Continuous perfusion not only maintains the oxygen and nutrient supply but also removes toxic metabolites formed due to inadequate storage conditions.

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31

Caruso, Maria Vittoria, Vera Gramigna, Attilio Renzulli, and Gionata Fragomeni. "A Computational Study of Perfusion During the ExtraCorporeal Membrane Oxygenation (ECMO)." International Journal of Privacy and Health Information Management 5, no. 1 (January 2017): 40–52. http://dx.doi.org/10.4018/ijphim.2017010103.

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The extracorporeal membrane oxygenation (ECMO) is a common procedure of extracorporeal circulation (ECC) used in case of cardiopulmonary diseases. The major clinical complications are related to hemodynamic changes and to the mechanical shear stress. The aim of this study is to evaluate the effects of the modality of perfusion during ECMO, comparing the hemodynamic behavior generated by constant flow (normal modality) with the one obtained by pulsed perfusion induced by the intra-aortic balloon pump (IABP). To carry out the study, the computational fluid dynamic (CFD) approach was chosen, realizing a multi-scale model. The numerical results have highlighted that the IABP-induced pulsed perfusion increases both flow and pressure in the supraaortic vessels, even if the balloon makes the wall shear stress (WSS) pattern and the hemolysis index worse.

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Maunz, O., J. Horisberger, and LK von Segesser. "Bridge to Life: The Lifebridge B2T® extracorporeal life support system in an in vitro trial." Perfusion 23, no. 5 (September 2008): 279–82. http://dx.doi.org/10.1177/0267659109104259.

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Extracorporeal life support systems (ECLS) have become common in cardiothoracic surgery, but are still “Terra Incognita” in other medical fields due to the fact that perfusion units are normally bound to cardiothoracic centres. The Lifebridge B2T® is an ECLS that is meant to be used as an easy and fast-track extracorporeal cardiac support to provide short-term perfusion for the transport of a patient to a specialized centre. With the Lifebridge B2T®, it is now possible to provide extracorporeal bypass for patients in hospitals without a perfusion unit. The Lifebridge B2T® was tested on three calves to analyze the handling, performance and security of this system. The Lifebridge B2T® safely can be used clinically and can provide full extracorporeal support for patients in cardiac or pulmonary failure. Flows up to 3.9 ± 0.2l/min were reached, with an inflow pressure of −103 ± 13mmHg, using a 21Fr. BioMedicus® (Medtronic, Minneapolis, MN, USA) venous cannula. The “Plug and Play” philosophy, with semi-automatic priming, integrated check-list, a long battery time of over two hours and instinctively designed user interface, makes this device very interesting for units with high-risk interventions, such as catheterisation labs. If a system is necessary in an emergency unit, the Lifebridge can provide a high security level, even in centres not acquainted with cardiopulmonary bypass.

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Santos, Juan Carlos, Jose Maria Jaime, and Jose Maria Gonzalez. "Goal Directed Perfusion: Bibliographical Review." Revista Española de Perfusión, no. 66 (June 2019): 5–11. http://dx.doi.org/10.36579/rep.2019.66.1.

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Objective: The aim of this study is to synthesize the existing evidence on Goal Directed Perfusion Methods: The search for the existing evidence was made in the MEDLINE databases, using the PubMed search engine. The initial search term was “goal directed perfusion.” In order to narrow the search, MeHS terms such as “cardiac surgery” and “cardiopulmonary bypass” were used together with the initial term and the Boolean operator AND. Results: At first, 238 references were obtained, combined whit “cardiac surgery” there were 49 references and finally whit “cardiopulmonary bypass” 21. We read 23 articles. Levels of oxygen delivery (DO2i) > 272 ml/min/m2, minimize hemodilution an maintain hematocrit values > 26% decrease acute kidney injury. A carbon dioxide production VCO2 i > of 60 ml/min/m2 and DO2i/VCO2i < 5 are predictors of hyperlactatemia. The mixed venous oxygen saturation (SvO2) and the oxygen extraction rate (ERO2) are better predictors of transfusion during extracorporeal circulation than hemoglobin value. The majority of the bibliography refers to adult surgery, but the application of GDP to the pediatric perfusion is beginning. Conclusion: The improvement of “optimal” perfusion, considered the gold standard, towards goal directed perfusion is already in use. Many hospitals are incorporating online monitoring of the new perfusion parameters in order to apply a specific perfusion to each patient as well as his metabolic needs during extracorporeal circulation.

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34

Govender, Krianthan, and Pedro Cabrales. "Extracorporeal circulation impairs microcirculation perfusion and organ function." Journal of Applied Physiology 132, no. 3 (March 1, 2022): 794–810. http://dx.doi.org/10.1152/japplphysiol.00726.2021.

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ECC reduces microvascular perfusion, with no full recovery 24 h after ECC. HSA performed better as compared with LR in terms of FCD and venule flow, as well as venule oxygen saturation. Increases in inflammatory and damage markers in key organs were observed within all organs analyzed.

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35

SATO, TAKAFUMI, JAMES P. ORLOWSKI, and MACIEJ ZBOROWSKI. "Experimental Study of Extracorporeal Perfusion for Septic Shock." ASAIO Journal 39, no. 3 (July 1993): M790—M793. http://dx.doi.org/10.1097/00002480-199307000-00131.

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36

Sato, Takafumi, James P. Orlowski, and Maciej Zborowski. "Experimental Study of Extracorporeal Perfusion for Septic Shock." ASAIO Journal 39, no. 3 (July 1993): M790—M793. http://dx.doi.org/10.1097/00002480-199339030-00124.

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37

Johnson, D., D. Thomson, T. Hurst, K. Prasad, T. Wilson, F. Murphy, A. Saxena, and I. Mayers. "Neutrophil-mediated acute lung injury after extracorporeal perfusion." Journal of Thoracic and Cardiovascular Surgery 107, no. 5 (May 1994): 1193–202. http://dx.doi.org/10.1016/s0022-5223(94)70037-0.

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38

Kato, Junji, Takahiko Seo, Hisami Ando, Hiroyuki Takagi, and Takahiro Ito. "Coronary arterial perfusion during venoarterial extracorporeal membrane oxygenation." Journal of Thoracic and Cardiovascular Surgery 111, no. 3 (March 1996): 630–36. http://dx.doi.org/10.1016/s0022-5223(96)70315-x.

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39

Khin, Nyan Y., Martijn L. Dijkstra, Matt Huckson, Mark Phillips, Darryl McMillan, Seiji Itoh, Greg Roger, and Rodney J. Lane. "Hypertensive extracorporeal limb perfusion for critical limb ischemia." Journal of Vascular Surgery 58, no. 5 (November 2013): 1244–53. http://dx.doi.org/10.1016/j.jvs.2013.05.004.

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40

Fichter, Andreas M., Lucas M. Ritschl, Andrea Rau, Claudia Schwarzer, Achim von Bomhard, Stefan Wagenpfeil, Klaus-Dietrich Wolff, and Thomas Mücke. "Free flap rescue using an extracorporeal perfusion device." Journal of Cranio-Maxillofacial Surgery 44, no. 12 (December 2016): 1889–95. http://dx.doi.org/10.1016/j.jcms.2016.09.010.

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41

Hysi, Ilir, Olivier Fabre, Carlos Renaut, and Laurent Guesnier. "Extracorporeal Membrane Oxygenation with Direct Axillary Artery Perfusion." Journal of Cardiac Surgery 29, no. 2 (October 17, 2013): 268–69. http://dx.doi.org/10.1111/jocs.12229.

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42

Butler, Andrew J., Michael A. Rees, Derek G. D. Wight, Neil D. Casey, Graeme Alexander, David J. G. White, and Peter J. Friend. "Successful extracorporeal porcine liver perfusion for 72 hr1." Transplantation 73, no. 8 (April 2002): 1212–18. http://dx.doi.org/10.1097/00007890-200204270-00005.

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43

Navia, José L., Fernando A. Atik, Erik A. Beyer, and Pablo Ruda Vega. "Extracorporeal Membrane Oxygenation With Right Axillary Artery Perfusion." Annals of Thoracic Surgery 79, no. 6 (June 2005): 2163–65. http://dx.doi.org/10.1016/j.athoracsur.2004.01.031.

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44

Mora, N., L. Kaptanoglu, Z. Zhang, Marek Niekrasz, S. Black, K. Ver Steeg, R. Wade, et al. "Single vs Dual Vessel Porcine Extracorporeal Liver Perfusion." Journal of Surgical Research 103, no. 2 (April 2002): 228–35. http://dx.doi.org/10.1006/jsre.2002.6366.

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45

Kasirajan, V., I. Simmons, J. King, M. D. Shumaker, A. DeAnda, and R. S. Higgins. "Technique to prevent limb ischemia during peripheral cannulation for extracorporeal membrane oxygenation." Perfusion 17, no. 6 (December 2002): 427–28. http://dx.doi.org/10.1191/0267659102pf614oa.

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46

Roselli, R. J., R. E. Parker, W. R. Riddle, and N. A. Pou. "Fluid balance in sheep lungs before and after extracorporeal perfusion." Journal of Applied Physiology 69, no. 4 (October 1, 1990): 1518–24. http://dx.doi.org/10.1152/jappl.1990.69.4.1518.

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Lung fluid balance was studied in sheep under the following conditions: 1) unanesthetized, standing in a metabolic cage; 2) anesthetized, in a supine position; 3) 1 h after extracorporeal perfusion; and 4) either 4-6 h after extracorporeal perfusion (i.e., control experiments) or 1.5 h after left atrial pressure was increased by 15 cmH2O. Lung lymph flow rate (QL), plasma and lymph concentrations for nine protein fractions, urea permeability-surface area product (PS), urea effective diffusivity (D1/2S), and extravascular lung water (VE) were measured under each condition. Bloodless wet and dry lung weights were measured at the end of each experiment. QL increased and lymph-to-plasma concentration ratio for total proteins (L/P) decreased after the sheep were anesthetized and placed in a supine position. This possibly resulted from an increase in microvascular pressure induced by anesthesia and/or reorientation of the lungs. PS, D1/2S, and VE decreased, indicating a decrease in perfused surface area associated with a decreased cardiac output or alteration in lung orientation. After 90 min of extracorporeal perfusion, no significant differences were found in QL, PS, and D1/2S compared with those measured during the anesthetized period. No changes in PS or D1/2S could be detected after an average of 4.2 h of extracorporeal perfusion. The average bloodless wet-to-dry lung weight ratio [(W-D)/D] was 3.77 +/- 0.12, well within the range for normal sheep lungs. An increase in venous pressure of 15 cmH2O produced a response similar to that observed in the unanesthetized sheep lung lymph preparation: QL increased, L/P decreased, PS and D1/2S did not increase, and VE and (W-D)/D increased slightly.(ABSTRACT TRUNCATED AT 250 WORDS)

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47

KAWAI, NORIYUKI. "Comparative examination of pulsatile flow perfusion and steady flow perfusion in extracorporeal circulation." Japanese journal of extra-corporeal technology 26, no. 1 (1999): 36–39. http://dx.doi.org/10.7130/hokkaidoshakai.26.36.

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48

Uribarri, Aitor, Loreto Bravo, Javier Jimenez-Candil, Javier Martin-Moreiras, Eduardo Villacorta, and Pedro L. Sanchez. "Percutaneous extracorporeal membrane oxygenation in electrical storm: five case reports addressing efficacy, transferring allowance or radiofrequency ablation support." European Heart Journal: Acute Cardiovascular Care 7, no. 5 (September 7, 2017): 484–89. http://dx.doi.org/10.1177/2048872617730036.

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Extracorporeal membrane oxygenation systems have undergone rapid technological improvements and are now feasible options for medium-term support of severe cardiac or pulmonary failure. We report five cases of electrical storm that was rescued by the insertion of peripheral veno-arterial extracorporeal membrane oxygenation systems. This device could help to restore systemic circulation as well as permitting organ perfusion in patients with cardiogenic shock in relation to electrical storm thus achieving greater electrical stability. Also, in some cases extracorporeal membrane oxygenation support could facilitate electrophysiology study.

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Assad, R. S., F. Y. Lee, K. Bergner, and F. L. Hanley. "Extracorporeal circulation in the isolated in situ lamb placenta: hemodynamic characteristics." Journal of Applied Physiology 72, no. 6 (June 1, 1992): 2176–80. http://dx.doi.org/10.1152/jappl.1992.72.6.2176.

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Decreased placental perfusion and respiratory gas exchange have been observed after experimental fetal cardiopulmonary bypass (CPB). To better characterize placental hemodynamics during CPB, seven isolated in situ lamb placentas were placed on a CPB circuit by use of umbilical arterial and venous cannulation. Measures were taken to simulate normal placental hemodynamics. Perfusion flow rates were varied from 15 to 300 ml.min-1.kg fetal wt-1 during normothermia and hypothermia. Placental vascular resistance (PVR) remained constant when perfusion pressure and flow were varied above 40 mmHg and 150 ml.min-1.kg-1, respectively. Below these values, PVR varied inversely. This increase in PVR was more marked when CPB was performed with hypothermia than with normothermia. The clinical implication is that decreased placental flow and pressure on CPB may lead to a vicious cycle, resulting in further impairment of placental perfusion and respiratory gas exchange. Hypothermia promotes this impairment.

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Kuttila, Kari, and Juha Niinikoski. "Peripheral tissue perfusion during coronary artery bypass grafting." Perfusion 4, no. 1 (January 1989): 25–31. http://dx.doi.org/10.1177/026765918900400104.

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Central haemodynamics, peripheral tissue perfusion and blood lactate concentration were studied in eight male patients undergoing coronary artery bypass grafting, being operated upon under moderate haemodilution and systemic hypothermia. Peripheral tissue perfusion was assessed by continuous recordings of subcutaneous tissue PO2 (PscO2), skin red cell flux (RCF) and transcutaneous PO2 (PtcO2) in the upper extremity. PtcO2 index (= PtcO2/arterial PO2) was determined and finger-tip temperature (Tft) serially measured. PaO2 and PtcO2 reached maximum values during the extracorporeal circulation (ECC) at the deepest hypothermia, whereas PscO2, PtcO2 index, RCF and Tft decreased markedly during ECC, rose during rewarming and fell again towards the end of surgery. Lactate accumulated in the blood especially after coming off bypass. These data suggest that the patients develop hypoperfusion and hypoxia of the peripheral tissues during extracorporeal circulation and again at the end of operation despite seemingly adequate central haemodynamics. This is possibly caused by the cooling and vasoconstriction of the peripheral vascular bed.

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