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... (n 10). From the 13 patients, 10 could be weaned from the system successfully. Derived from the above-mentioned experience with Life-Support- System, the transportable minimal extracorporeal circulation (TMECC) resulted after continuous refinement. The compact system consists of two mobile modules with a centrifugal pump and gas exchange (Fig. 3). The whole priming volume is 500 ml. The weight is 12 kilos. The pump console and monitoring is equally portable and connected with a 1.5 m long line. Weight of this console is 15 kilos. Via the femoral artery with a cannula of 15-17 Fr and the femoral vein with a cannula of 21-23 Fr, the patient is connected usually by the Seldinger ...
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Neonatal patients with congenital cardiac defects require proper diagnosis often by cardiac catheterization before surgical repair. In our institution, patients whose echocardiograms reveal surgically correctable lesions, but who are severely decompensated, have been placed on Extracorporeal Life Support (ECLS) prior to catheterization or surgery....
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The cardio pulmonary bypass (CPB) is used in heart surgery for circulatory and respiratory replacement. The effectiveness of this technique, as well circulatory as respiratory goes and will go to spread its use far beyond the strictly surgical field. The unexpected starts on CPB include not provided starts, anticipated stars, and renewed stars. The not provided starts concern going on CPB for a cardiac or respiratory failure, not reacting to the conventional techniques of cardiopulmonary resuscitation and rare cases of inability to access the airway in emergency. This could be an exceptional complement to external cardiac massage. The anticipated departures involve patients in the operating room for cardiac surgery for which the establishment of the CPB has to treat with emergency life threatening brutal cardiac failure on valvular or coronary artery disease. The renewed starts are being on CPB or after weaning of CPB. It is being CPB to change a failed oxygenator responsible for a tissue hypoxia or replace a piece of tube main circuit of the CPB. A new start on CPB after weaning is essentially for circulatory assistance made necessary by postcardiotomy heart failure, by side effects of protamine injection, excessive bleeding or intra cardiac thrombosis. The oxygenator replacement techniques in emergency are exposed. This techniques demand a well trained and mobile medical and para medical staff.
Hypothermia is used in various clinical settings to inhibit ischemia-related organ damage. However, prothrombotic effects have been described as potential side effects. This study aimed to elucidate the mechanism of hypothermia-induced platelet activation and subsequent prothrombotic events and to develop preventative pharmacological strategies applicable during clinically used hypothermia.
Platelet function was investigated ex vivo and in vivo at clinically used hypothermia (28°C/18°C). Hypothermic mice demonstrated increased expression of platelet activation marker P-selectin, platelet-leukocyte aggregate formation, and thrombocytopenia. Intravital microscopy of FeCl(3)-injured murine mesenteric arteries revealed increased platelet thrombus formation with hypothermia. Ex vivo flow chamber experiments indicated increased platelet-fibrinogen adhesion under hypothermia. We show that hypothermia results in reduced ADP hydrolysis via reduction of CD39 (E-NTPDase1) activity, resulting in increased levels of ADP and subsequent augmented primary and secondary platelet activation. In vivo administration of ADP receptor P(2)Y(12) antagonists and recombinant soluble CD39 prevented hypothermia-induced thrombus formation and thrombocytopenia, respectively.
The platelet agonist ADP plays a key role in hypothermia-induced platelet activation. Inhibition of receptor binding or hydrolysis of ADP has the potential to protect platelets against hypothermia-induced activation. Our findings provide a rational basis for further evaluation of novel antithrombotic strategies in clinically applied hypothermia.
