ABSTRACT
Official reports relate that, in the US, one patient/month dies as a result of the emergency oxygenator change-out procedure, and the permanent injury of some patients is the result of current oxygenator change-out procedures or oxygenator failures, both in extracorporeal circulation (ECC) and extracorporeal membrane oxygenation (ECMO). The aim of this article is to evaluate a new system and procedure, dedicated to oxygenator change-out, represented by two three-way stopcocks inserted in the ECC line in use. A dedicated back-up oxygenator and circuit can be easily primed and connected to the dedicated connector on the stopcocks, then blood flow is diverted to the new oxygenator without interruption of the ECC. Tests performed showed that oxygenator change-out can be completed by perfusionists in 62.13 +/- 11.12 sec. Results obtained show that the new system and procedure allows fast, safe and reproducible oxygenator change-out without interruption of the ECC.
Subject(s)
Extracorporeal Membrane Oxygenation/instrumentation , Anesthesiology , Blood Loss, Surgical/prevention & control , Equipment Design , Equipment Failure , Equipment Reuse , Extracorporeal Membrane Oxygenation/adverse effects , Humans , Intraoperative Complications/etiology , Intraoperative Complications/prevention & control , Maintenance/methods , Operating Room TechniciansABSTRACT
Umbilical cord blood (UCB) is a source of hematopoietic progenitor cells and is used as an alternative to the bone marrow or peripheral blood for treatment of several onco-hematological diseases. Because of the limited number of CD34+ hematopoietic stem cells present in UCB units and of the elevated costs of cryopreservation, it is of paramount importance to select the UCB units that are clinically useful before storage and optimize banking efficiency by designing reliable procedures to process and freeze the selected units. Among the different parameters characterizing UCB, nucleated cell (NC) and CD34+ cell content provides useful criteria to select UCB units since clinical data documented that the infused cell load (both NC and CD34+ cells) plays an important role in the successful outcome of transplants. By evaluating volume, CD34+ cell content, NC total amount, and NC density of 117 UCB units, we found a significant association between CD34+ cell content and NC density and total amount, indicating these parameters as useful to decide UCB clinical utility. Furthermore, we set up a fast procedure to process UCB units for storage. A system for NC separation and volume reduction of UCB samples in a dedicated, germ-free, closed circuit was developed, where plasma and red blood cells (RBC) depletion was obtained by sedimentation in the presence of a 3.5% Polygeline solution. By this separation system, both RBC depletion and high NC and CD34+ cell recoveries were achieved in 60 min, and the yield was comparable to the one obtained by other separation methods. Since Polygeline has been clinically used as a plasma expander and no toxic effects on patients were reported, the protocol can be applied in the large-scale banking of UCB.
