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Mechanical Effects of Cardiovascular Drugs and Devices
Published in Michel R. Labrosse, Cardiovascular Mechanics, 2018
The second category of short-term blood-contacting devices is external circuits through which blood is pumped and oxygenated. These include cardiopulmonary bypass (CPB), used during open heart surgery, and extracorporeal membrane oxygenation (ECMO), which provides longer-term support when evaluating treatment options for cardiopulmonary dysfunction. Cardiopulmonary bypass was developed in 1953 by Dr. John Gibbons at the Mayo Clinic to support the open-heart surgery needed for heart transplantation. In CPB, the patient’s heart is arrested and blood is diverted through an external circuit for gas exchange before being returned to the body. This provides a static bloodless field for the surgeon to repair the heart chamber or valves, replace valves or blood vessels, implant a left ventricular assist device (LVAD), remove clots from the pulmonary artery, and transplant a heart. The circuit is connected to the circulation under general anesthesia, with aortic cannulation for return of oxygenated blood and right atrial cannulation for gravity-assisted drainage of deoxygenated blood into the circuit. A perfusionist monitors and regulates blood flow and blood oxygenation to optimize tissue perfusion and protection. Most procedures strive to limit the time on CPB to 1 hour or less.
Research progress of portable extracorporeal membrane oxygenation
Published in Expert Review of Medical Devices, 2023
Yuansen Chen, Duo Li, Ziquan Liu, Yanqing Liu, Haojun Fan, Shike Hou
Extracorporeal membrane oxygenation (ECMO), as an effective extracorporeal life support technology, is mainly used in patients with acute cardiopulmonary failure. In recent years, with the rapid development of ECMO technology, its clinical indications have gradually increased, and it has been applied in the treatment of many critical diseases [1]. Its good therapeutic effects have been achieved in the rescue and treatment of patient with severe respiratory failure, cardiogenic shock, cardiac arrest, organ transplantation, poisoning and trauma [2–6]. As the novel coronavirus disease-19 (COVID-19) epidemic has rapidly spread around the world since 2019, ECMO has played an active role in the treatment of critically ill patients with COVID-19, which has been generally accepted and recognized by the public. According to the report of the extracorporeal life support organization (ELSO), in 2020, the number of ECMO transfers worldwide would reach more than 170,000 [7].
Overview of Impella and mechanical devices in cardiogenic shock
Published in Expert Review of Medical Devices, 2018
Hymie Habib Chera, Menachem Nagar, Nai-Lun Chang, Carlos Morales-Mangual, George Dous, Jonathan D. Marmur, Muhammad Ihsan, Paul Madaj, Yitzhak Rosen
Extracorporeal membrane oxygenation (ECMO) is a cardiopulmonary bypass enabling peripheral oxygenation, circulation, and ventilation in patients with long-standing cardiovascular diseases. ECMO uses an inflow cannula which receives deoxygenated blood pumped through an extracorporeal centrifugal pump placed in a membrane oxygenator for gas exchange and reversed via the outflow cannula into venovenous (VV) or venoarterial (VA) systems. VV ECMO uses an inflow cannula located in the femoral vein or internal jugular vein, and oxygenated blood is pumped back through the right atrium or internal jugular vein. VA ECMO, on the other hand, utilizes an inflow cannula in the same location; however, the outflow cannula is located in the aorta or femoral artery. Peripheral ECMO uses the femoral vein and artery and can be performed percutaneously at the bedside or via open surgical placement [4].
Patients’ exposure to PVC plasticizers from ECMO circuits
Published in Expert Review of Medical Devices, 2018
Charlotte Fernandez-Canal, Pierre-Gabriel Pinta, Teuta Eljezi, Virginie Larbre, Sophie Kauffmann, Lionel Camilleri, Bernard Cosserant, Lise Bernard, Bruno Pereira, Jean-Michel Constantin, Gael Grimandi, Valérie Sautou
Extracorporeal Membrane Oxygenation (ECMO) is an artificial and temporary support for the heart, the lungs, or both for patients suffering from cardiorespiratory failure when conventional treatments have failed. This artificial support may facilitate therapeutic intervention or act as a bridge to recovery or to long-term support devices or transplantation. The use of ECMO in Intensive Care Unit (ICU) is a recent phenomenon that has seen an increase since 2007 [1]. ECMO consists of collecting blood through a cannula connected to an extracorporeal circuit that includes an artificial membrane where gas and heat exchange occurs, before returning it to the patient.