In order to evaluate causes and the effective treatment of postoperative bleeding after open heart surgery, we measured platelet count and plasma fibrinogen levels before, during a 30 and 60-minute, and after a 30, 60 and 90-minute extracorporeal circulation in 5 patients perfused by a bubble and membrane oxygenator, respectively. The results were as follows: 1) The platelet count was reduced significantly by 57.2+/-3.04% during a 30-minute extracorporeal circulation using the bubble oxygenator and by 43.8+/-0.84% using the membrane oxygenator, and these levels were maintained throughout the extracorporeal circulation. 2) The platelet count after a 90-minute extracorporeal circulation increased significantly compared with after a 30-minute extracorporeal circulation (p<0.05) and these effects were more prominent using the bubble oxygenator (p<0.025). 3) The plasma fibrinogen level was reduced by 28.6+/-7.50% during a 30-minute extracorporeal circulation using the bubble oxygenator and by 33.6+/-5.77% using the membrane oxygenator, and these levels were maintained throughout the extracorporeal circulation. 4) The plasma fibrinogen level after a 90-minute extracorporeal circulation increased significantly compared with after a 30-minute extracorporeal circulation (p<0.05).
Blood Platelets* ; Extracorporeal Circulation* ; Fibrinogen* ; Hemorrhage ; Humans ; Oxygen ; Oxygenators ; Oxygenators, Membrane ; Plasma* ; Platelet Count* ; Thoracic Surgery

BACKGROUND: Maintenance of adequate concentration of carbon dioxide during hypothermic cardiopulmonary bypass is important in order to improve tissue perfusion by maintaining vasodilatation. This study evaluated the usefulness of the analysis of gas sampled from the exhaust port of a membrane oxygenator in the estimation of carbon dioxide tension in arterial blood (PaCO2). METHODS: One hundred sixty four arterial blood gases were drawn from 45 adult and 30 pediatric cardiac surgical patients undergoing hypothermic cardiopulmonary bypass. Carbon dioxide tensions were measured in the membrane oxygenator exhaust gas (swept gas; PswCO2) using a capnography and in arterial blood using intermittent gas analysis. We compared the PswCO2 with temperature-uncorrected (alpha-stat) and -corrected (pH-stat) PaCO2 during cardiopulmoary bypass. RESULTS: The mean PaCO2 measured with alpha-stat and pH-stat, and PswCO2 obtained in adult patients during hypothermic cardiopulmonary bypass were 29.8 +/- 4.9, 19.5 +/- 4.1 and 22.3 +/- 4.2 mmHg, respectively. In pediatric patients, alpha-stat PaCO2, pH-stat PaCO2 and PswCO2 were 39.7 +/- 7.7, 24.7 +/- 6.2 and 20.3 +/- 6.0 mmHg, respectively. There was a significant positive correlation between PswCO2 and alpha-stat PaCO2 (adult patients: slope = 0.49, r = 0.64, P < 0.001; pediatric patients: slope = 0.53, r = 0.68, P < 0.001) and pH-stat PaCO2 (adult patients: slope = 0.85, r = 0.81, P < 0.001; pediatric patients: slope = 0.73, r = 0.73, P < 0.001). On comparison of subsequent measurements, 3.8% (adult patients) and 11.4% (pediatric patients) of changes in PaCO2 and PswCO2 were in opposite direction. CONCLUSIONS: Our results indicate that in adult and pediatric patients undergoing hypothermic cardiopulmonary bypass PswCO2 can be an indicator of changes in trend of PaCO2.
Adult ; Capnography ; Carbon Dioxide* ; Carbon* ; Cardiopulmonary Bypass* ; Gases ; Humans ; Oxygen* ; Oxygenators* ; Oxygenators, Membrane ; Perfusion ; Vasodilation

Extracorporeal membrane oxygenation (ECMO) is a salvage therapy for critically ill patients. Although ECMO is becoming more common, hemorrhagic and thromboembolic complications remain the major causes of death in patients undergoing ECMO treatments. These complications commence upon blood contact with artificial surfaces of the circuit, blood pump, and oxygenator system. Therefore, anticoagulation therapy is required in most cases to prevent these problems. Anticoagulation is more complicated in pediatric patients than in adults, and the foreign surface of ECMO only increases the complexity of systemic anticoagulation. In this review, we discuss the pathophysiology of coagulation, anticoagulants, and monitoring tools in pediatric patients receiving ECMO.
Adult ; Anticoagulants ; Cause of Death ; Critical Illness ; Extracorporeal Membrane Oxygenation ; Humans ; Membranes ; Oxygen ; Oxygenators ; Oxygenators, Membrane ; Pediatrics ; Salvage Therapy

The influence of isoflurane on systemic vascular resistances was studied during total cardiopulmonary bypass with membrane oxygenator, low rate of 2.4 L/min/m(2) and moderate hypothermia Data were obtained from 40 adult patients undergoing corrective surgery for congenital or aquired heart disease. The materials were randomly divided in two groups with 20 and 20 patients, respectively, Before cadiopulmonary bypass, the same anesthetic technique was applied to 2 groups. During cardiapuhnonary bypass, isoflurane was given into oxygenator at 0.5-1.5% concentration in group I. In group II, no isoflurane was given but 0.2 mg/kg midazolam was supplied into the oxygenator at the beginning of bypass. To both groups small amounts of fentanyl were given during bypass. There were no significant differences in mean cardiopulmonary bypass time and pump flow between the groups.In group I, systemic vascular resistance did not increase until 60 minutes, whereas in group II systemic vascular resistance increased significantly after 30 minutes and maximal increase was noticed at 60 minutes. Data for base excess demonstrated that significant fall after 40 minutes of perfusion in group II, but not changes in group I. It is concluded that isoflurane exerts a beneficial vasodilatory action during caardiopulmonary bypass and hypothermia. And the harzards of local reduction in organic blood flow are ehminated, because an adequate perfusion pressure and flow are maintained by the heart lung machine.
Adult ; Cardiopulmonary Bypass* ; Fentanyl ; Heart Diseases ; Heart-Lung Machine ; Humans ; Hypothermia ; Isoflurane* ; Midazolam ; Oxygen ; Oxygenators ; Oxygenators, Membrane ; Perfusion ; Vascular Resistance

A 3 month old female baby, who had been diagnosed with right atrial isomerism associated with total anomalous pulmonary venous return (TAPVR), a functional single ventricle and major aortopulmonary collateral arteries (MAPCA), underwent left MAPCA unifocalization and left Blalock-Taussig shunt (3.5 mm) at 3 months of age. The postoperative course was complicated by pulmonary venous congestion, and the drainage site of the TAPVR was found to be stenotic on echocardiography. We performed sutureless repair of the TAPVR along with unifocalization of the right MAPCA. She was put on an extracorporeal membrane oxygenator for 8 days after the 2nd operation, and she was able to come off the oxygenator with the placement of a central shunt (3 mm). She developed tracheal stenosis, which was presumably due to longstanding endotracheal intubation, and she then underwent tracheostomy. She was discharged to home on day 104 after the 1st operation, and she has been followed up for 2 months in a good clinical condition.
Arteries ; Drainage ; Echocardiography ; Extracorporeal Membrane Oxygenation ; Female ; Heterotaxy Syndrome* ; Humans ; Hyperemia ; Infant ; Intubation, Intratracheal ; Oxygen ; Oxygenators ; Oxygenators, Membrane ; Scimitar Syndrome ; Tracheal Stenosis ; Tracheostomy

The extracorporeal membrane oxygenation(ECMO) for acute respiratory distress, syndrome was started in Korea from 1990. Until now there were 4 clinical cases in Korea. Three cases were cardiac patients who received the open heart surgery and one was lung contusion patient by a automobile accident. Among them one case survived after 90 hours ECMO and became the first successful ECMO case in Korea and also the first in Asia except Japan. In this case we used new anticoagulant nafamostat mesilate in order to reduce the subcutaneous bleeding. All the oxygenators were membrane type. The last one was the heparin-bonded microporous membrane type which was made for the cardiopulmonary bypass of open heart surgery. The last case showed the possibility of the use of microporous membrane oxygenator for prolonged extracorporeal membrane oxygenation without administration of the anticoagulation. We believe that the ECMO will become popular as a prolonged life supporting method in near future in Korea.
Asia ; Automobiles ; Cardiopulmonary Bypass ; Contusions ; Extracorporeal Membrane Oxygenation* ; Heart* ; Hemorrhage ; Humans ; Japan ; Korea ; Lung* ; Membranes ; Mesylates ; Oxygen ; Oxygenators ; Oxygenators, Membrane ; Thoracic Surgery

We report on the application of a venovenous type extracorporeal membrane oxygenator (ECMO) in high-risk tracheal procedures in six cases consisting of five patients with tracheal stenosis. An ECMO should be helpful for preventing respiratory emergency during a tracheal procedure.
Emergencies ; Extracorporeal Circulation ; Extracorporeal Membrane Oxygenation ; Humans ; Membranes ; Oxygenators, Membrane ; Tracheal Stenosis

Bronchogenic carcinoma involving the carina has remained a challenging problem for thoracic surgeons. Carinal resection and reconstruction is limitedly indicated because this aggressive surgical approach has been reported to be associated with significant morbidity and mortality while long-term outcome has not been determined. Wesuccessfully performed carinal reconstruction and sleeve right upper lobectomy assisted with ECMO for a 60-year-old male with squamous cell carcinoma in the right upper lobe extending to the carina.
Carcinoma, Bronchogenic ; Carcinoma, Squamous Cell ; Extracorporeal Membrane Oxygenation ; Humans ; Lung ; Male ; Membranes ; Middle Aged ; Oxygenators, Membrane

The artificial lung is a technical device for providing life support; it will be put in use when the natural lungs are failing and are not able to maintain sufficient oxygenation of the body's organ systems. From the viewpoint of long-term development, the artificial lung should be permanently implanted in the body, so that it will substitute for the human pulmonary function partially or completely. In this paper, four artificial lung technologies were expounded with reference to the development and research process of artificial lung. They were extracorporeal membrane oxygenation, intravascular artificial lung, implantable artificial lung, and pumpless extracorporeal lung assist. In this paper were described the structure of the four kinds of artificial lung, the working principle, and their advantages, disadvantages and indications. The prospect of artificial lung was evaluated in the light of the data from the existing animal experiments and from the clinical experience of the centers.
Animals ; Artificial Organs ; trends ; Extracorporeal Membrane Oxygenation ; instrumentation ; trends ; Humans ; Lung ; Oxygenators, Membrane ; trends

Recently, the use of extracorporeal membrane oxygenation has evolved rapidly and there is potential for expanding its use. There are many complications associated with extracorporeal membrane oxygenation, but the fracture of a guidewire has been reported to be very rare during extracorporeal membrane oxygenation insertion. We describe our experience of successfully removing a fractured 0.038-inch guidewire using a catheter wedge with balloon inflation following a fracture that occurred during insertion of extracorporeal membrane oxygenation through the left femoral vein.
Catheters ; Device Removal ; Equipment Failure ; Extracorporeal Membrane Oxygenation ; Femoral Vein ; Inflation, Economic ; Membranes* ; Oxygenators, Membrane*