ABSTRACT
The need for a portable extracorporeal support system that can be rapidly initiated for various types of cardiopulmonary failure is well known. The authors report on a system consisting of 3/8 inch tubing, a Sci-Med membrane oxygenator, Omnitherm heat exchanger, Biomedicus or Sarns centrifugal pump, portable battery, and oxygen tanks. The system is mounted on a cart for easy mobility and can be primed in 5-10 min. USCI, DLP, or Axiom cannulas can be inserted femorally. Over 30 months, 29 patients, aged 19-78 years, underwent extracorporeal membrane oxygenation (ECMO) support for cardiac arrest during catheterization (10 patients), shock secondary to acute myocardial infarction (MI) (10 patients), elective percutaneous transluminal coronary angioplasty (PTCA) support (four patients), postcardiotomy failure (four patients), and exposure hypothermia (one patient). Adequate support was achieved in all but one patient. Device flows ranged from 0.2 to 6.0 l/min. There were six survivors (elective PTCA support, three patients; cardiac arrest during catheterization, three patients). Complications included bleeding (15 patients), deep venous thrombosis (three patients), and pump failure (one patient). A portable ECMO system has been developed that allows rapid institution of circulatory support.
Subject(s)
Angioplasty, Balloon, Coronary/instrumentation , Cardiac Catheterization/instrumentation , Emergencies , Extracorporeal Membrane Oxygenation/instrumentation , Heart Failure/therapy , Myocardial Infarction/therapy , Resuscitation/instrumentation , Shock, Cardiogenic/therapy , Equipment Design , Female , Heart Arrest/therapy , Heart-Assist Devices , Hemodynamics , Humans , Male , Middle Aged , Ventricular Fibrillation/therapyABSTRACT
A case is described in which hemagglutination occurred intraoperatively in cold blood flushed through the blood cardioplegia delivery system from a patient with unsuspected cold agglutinin disease. On initiating cardiopulmonary bypass and then selectively cooling the perfusate in the blood cardioplegia delivery system before inducing systemic cooling, it is possible to check for cold agglutination. Routine use of this technique may be worthwhile to detect cold agglutination in vitro before systemic cooling is begun in the rare patient with unsuspected cold agglutinins.
