Interhospital air transport of a blind patient on extracorporeal life support with consecutive and successful left ventricular assist device implantation.

The use of extracorporeal life support systems (ECLS) in patients with postcardiotomy low cardiac output syndrome (LCO) as a bridge to recovery and bridge to implantation of ventricular assist device (VAD) is common nowadays. A 59-year-old patient with acute myocardial infarction received a percutaneous transluminal angioplasty and stenting of the circumflex artery. During catheterization of the left coronary artery (LAD), the patient showed ventricular fibrillation and required defibrillation and cardiopulmonary resuscitation. After implantation of an intra-aortic balloon pump, the patient immediately was transmitted to the operating room. He received emergency coronary artery bypass grafting in a beating heart technique using pump-assisted minimal extracorporeal circulation circuit (MECC). Two bypass grafts were performed to the LAD and the right posterior descending artery. Despite initial successful weaning off cardiopulmonary bypass with high-dose inotropic support, the patient presented postcardiotomy LCO and an ECLS was implanted. The primary setup of the heparin-coated MECC system was modified and used postoperatively. As a result of the absence of an in-house VAD program, the patient was switched to a transportable ECLS the next day and was transferred by helicopter to the nearest VAD center where the patient received a successful insertion of a left VAD 3 days later.

In vitro comparison of the new in-line monitor BMU 40 versus a conventional laboratory analyzer.

Reliable information about different blood parameters is essential in maintaining hemodynamics, perfusion, and gas exchange during cardiopulmonary bypass (CPB). For this purpose, a precise and continuous monitoring is needed. The objective of this in vitro study was to compare a novel continuous in-line blood parameter monitoring system versus a reference laboratory analyzer. The study was conducted as an in vitro prospective experimental study during a CPB simulation. The reliability of BMU 40 was tested in monitoring the pO2, oxygen saturation (SO2), and hematocrit (Hct) under physiological and extreme conditions with regards to temperature, oxygenation, and blood concentration. Four different tests were performed and conducted with five sensors each. Correlation analyses and Bland-Altman analyses were performed. A total of 350 measurement points were compared. All monitored values of blood parameters correlated highly with laboratory values (all r values >.90). Test 1: Biases of pO2 (act) varied from -3.24 mmHg (+/- 6.86 mmHg) up to 6.0 mmHg (+/- 17.89 mmHg). The biases of pO2 (37 degrees C) ranged from -3.52 mmHg (+/- 6.01 mmHg) up to 68.8 mmHg (+/- 67.82 mmHg). Test 2: The biases standard deviations (SD) for Hct ranged from -0.35% (+/- .79%) up to 2.35% (+/- .91%). The biases (SD) for SO2 varied from -.45% (+/- .86%) up to .85% (+/- 1.01%). Test 3: The biases (SD) of Hct ranged from -1.00% (+/- 1.84%) up to -.67% (+/- 1.49%). Test 4: The biases (SD) for SO2 varied from -.36% (+/- 1.60%) up to .48% (+/- .90%).The BMU 40 is a reliable device in measuring the partial oxygen pressure (pO2), SO2, and Hct under normal physiological and extreme conditions with regards to temperature, oxygenation, and blood concentration in simulation of CPB. The algorithm to calculate pO2 (37 degrees C) under hypothermic conditions needs to be adjusted. (Before the official market launch a new software version of the BMU 40 has been developed. The algorithm to calculate pO2 (37 degrees C) under hypothermic conditions has been improved and the miscalculation eliminated.)

Clinical evaluation of the new BMU 40 in-line blood analysis monitor.

BACKGROUND: Accurate information about different blood parameters is essential in maintaining haemodynamics, perfusion and gas exchange during cardiopulmonary bypass (CPB). For this purpose, precise, accurate and continuous measurement and monitoring, preferably visually available, is needed.The objective of this clinical study was to compare the newly developed continuous in-line blood parameter monitoring system (CIBPMS) BMU 40 with a reference laboratory analyser with regards to the precision and accuracy of blood parameter measurement. METHODS: Thirty adult patients underwent elective cardiac surgery, CPB and mild hypothermia (32 degrees C). At five predetermined time points (S1 - S5) arterial and venous blood samples were analysed using the BMU 40 for five different parameters (PaO(2)(37 degrees C), PaO(2)(act), SvO(2), Hb(ven) and Hct(ven)) and these results were compared to the gold standard laboratory analyser, the ABL 700. RESULTS: A total of 150 paired blood samples were included to compare means, to analyse correlation, and to calculate measures of bias, precision, limits of agreement and 95% confidence intervals. Results revealed good agreement between the two devices for all parameters. Bias +/- precision of S2 - S5 PaO( 2)(37 degrees C) were: 2.17 +/- 9.61; PaO(2)(act) 2.58 +/- 9.54; SvO(2) -1.44 +/- 2.35; Hb(ven) 0.01 +/- 0.42; Hct(ven) 0.04 +/- 1.29. Statistically significant differences were detected for SvO(2) (p<0.00001) at S1. Correlations after this first time point (S1) improved following an in vivo calibration. CONCLUSION: The BMU 40 is a precise, accurate and reliable continuous in-line blood parameter measuring system that can easily be used within a standard CPB setup. However, present data suggest an in vivo calibration of the BMU 40 should be performed.