Extracorporeal membrane oxygenation (ECMO) as lung or heart assist.

Extracorporeal membrane oxygenation (ECMO) may serve as extracorporeal lung assist (ECLA) in patients with acute respiratory failure (ARF) or as extracorporeal heart assist (ECHA) in patients with low output syndrome (LOS) after open heart surgery. From 1988 to 1992 seven patients underwent ECMO in our hospital; four suffered from ARF and three from LOS. Various bypass techniques were employed. Two ARF patients, aged 58 and 18 years, had veno-venous bypass; in the latter, ECMO was reinstituted as a veno-arterial bypass one week after weaning. In a three-year-old boy, the ECMO outflow tubing was primarily connected to the pulmonary artery, and shortly afterwards relocated to the common carotid artery. In a 31-year-old man with ARF, and three LOS patients, a 56-year-old woman, and two men aged 68 and 70 years, ECMO was veno-arterial with direct access to the ascending aorta. A heparin-coated system was used, and all but one patient, who was treated with warfarin, received a daily low dose of heparin, which was withdrawn after from one to nine days. Six patients were weaned off ECMO after 4.5 to 21 days. Three ARF patients recovered completely; the child died. In one LOS patient, ECMO was withdrawn due to a poor general condition. Two others were weaned off ECMO and the intra-aortic balloon pump, and the inotropic support was significantly reduced, but both died of multiple system organ failure. Although no firm conclusions can be drawn from these few case reports, the heparin-coated system used as ECLA appears promising, whereas ECHA seems to imply a poor prognosis in patients who are not candidates for cardiac transplantation.

The effect of rate of cooling, time of day and light regime on the shivering response in rabbits.

In man hypothermia exists when core temperature (Tc) falls below 35 degrees C. The onset of hypothermia is often insidious in that it can occur without any particular symptoms of serious discomfort. There is evidence that this decrease in thermosensitivity is most likely to occur when the rate of body cooling is slow. In addition there is some evidence that the susceptibility to become hypothermic varies with the circadian rhythm of Tc, particularly in animals maintained under constant light conditions. A systematic investigation has been carried out to determine whether the thermoregulatory response to body core cooling is affected by the rate of change of body temperature, the time of day at which the cooling takes place and/or by the light regime under which the animals are maintained. The investigation was made in rabbits maintained either under a 12-h light/dark (LD) cycle or under conditions of continuous light (LL). Thermosensitivity (relationship between falling Tc and the induced increase in metabolic heat production) was determined at two different rates of body cooling (1 degrees C decrease in core temperature in either 30 or 160 min.) and at different times of the day. A chronically implanted intravascular heat exchanger was used to extract heat from the animals. The results indicate that neither the rate of body cooling nor the time of day at which the cooling took place had any clear effect on the shivering response. Likewise there was no clear difference in the shivering response of the animals maintained under (LD) conditions as compared to those maintained under (LL) conditions.