In this article, summary data from the annual international Extracorporeal Life Support Organization (ELSO) Registry Reports through July 2012 are presented. Nearly 51,000 patients have received extracorporeal life support (ECLS). Of the... more
In this article, summary data from the annual international Extracorporeal Life Support Organization (ELSO) Registry Reports through July 2012 are presented. Nearly 51,000 patients have received extracorporeal life support (ECLS). Of the patients, 50% (>25,000) were neonatal respiratory failure, with a 75% overall survival to discharge or transfer. Congenital diaphragmatic hernia remains a major use of ECLS in this population with 51% survival. Extracorporeal life support use for pediatric respiratory failure has nearly doubled since 2000, with approximately 350 patients treated per year in the past 3 years examined (56% survival). Previously stable at about 100 cases a year for a decade, adult respiratory failure ECLS cases increased dramatically in 2009 with the H1N1 influenza pandemic and publication of the Conventional Ventilation or ECMO for Severe Adult Respiratory failure (CESAR) trial results and have remained at approximately 400 cases a year through 2011 (55% survival). Use of ECLS for cardiac support represents a large area of consistent growth. Approximately 13,000 patients have been treated with survival to discharge rates of 40%, 49%, and 39% for neonates, pediatric, and adults, respectively. ASAIO Journal 2013;59:202–210.
To explore the feasibility and operating limits of arteriovenous extracorporeal CO2 removal (AVCO2R) for support of acute respiratory failure, the authors developed a mathematical model to simulate (AVCO2R), evaluate the effects of... more
To explore the feasibility and operating limits of arteriovenous extracorporeal CO2 removal (AVCO2R) for support of acute respiratory failure, the authors developed a mathematical model to simulate (AVCO2R), evaluate the effects of several parameters used in its application, and predict the feasibility and necessary conditions for total CO2 removal. The mathematical model incorporated compartments representing blood, pulmonary alveoli, pulmonary capillaries, peripheral tissues and capillaries, and an extracorporeal gas exchange device. The model was validated against an animal model of extracorporeal CO2 removal. This model consisted of anesthetized and mechanically ventilated piglets. An extracorporeal CO2 removal device was placed by cannulation of a femoral artery and vein. Dynamic and steady state measurements of CO2 transfer were made and compared with simulations using the mathematical model. There was good agreement between experimental and simulated data, validating the mathematical model under a variety of conditions. The mathematical model was used to determine operating parameters for total CO2 removal. Relationships between extracorporeal blood flow, device diffusing capacity, and device gas sweep flow were established for CO2 removal at various levels of CO2 production. These simulations indicate that it is possible to achieve total CO2 removal using an extracorporeal shunt fraction of 10%-15% of cardiac output, a device diffusing capacity of 0.5 ml x min(-1) x torr(-1) (kg body weight)(-1), and a gas:blood flow of 5 or greater.
Congenital Diaphragmatic Hernia (CDH) is a rare birth defect in which the diaphragm fails to close during prenatal development, which causes the intestinal contents to herniate into the chest from the abdominal cavity causing lung... more
Congenital Diaphragmatic Hernia (CDH) is a rare birth defect in which the diaphragm fails to close during prenatal development, which causes the intestinal contents to herniate into the chest from the abdominal cavity causing lung hypoplasia and persistent pulmonary hypertension of the newborn (PPHN). Extracorporeal membrane oxygenation (ECMO) is a rescue therapy for infants having CDH on whom the conventional ventilation strategies fail. Our systematic review aimed to evaluate the outcomes of Extracorporeal Membrane Oxygenation (ECMO) use on infants with Congenital Diaphragmatic Hernia (CDH). We used PubMed, Embase, Web of Science and Google Scholars databases for our data collection, and articles from 2010-2021 were analyzed and included as part of this research. We included studies in the English language conducted on human infants. We excluded studies conducted before 2010, studies on animals, languages other than English, or studies conducted on the adult population from our research. We identified a total of 3650 studies from the databases. After removing duplicates, screening titles, applying inclusion-exclusion criteria, and assessing the papers' quality, we were left with nine articles. Six out of these nine articles were retrospective cohort studies, and three were literature reviews. We extracted data manually from these studies. ECMO's role in managing CDH in infants is controversial as some studies show improvements in infants' survival rate. In contrast, other studies mention that the risks involved in ECMO use outweigh the benefits, and we should only use it in those infants who are severely affected. Due to inadequate data, we require additional research to determine whether the use of ECMO is favorable or should it be discouraged.
