[Indications for and results of extracorporeal membrane oxygenation (author's transl)]. / Indikation und Ergebnisse der extrakorporalen Membranoxygenation.

Extracorporeal membrane oxygenation (ECMO) is a new and, in the hands of an experienced team, safe method for treating severe acute respiratory insufficiency. It protects the patient against the risk of hypoxia and respiratory acidosis and, provided there is a chance of survival, allows the repair of the damaged lung tissue. The chances of success depend on whether the lung damage is reversible since, so far as is known, ECMO has not, or only very rarely, any effect on the actual lesion. Reliable prognostic criteria are therefore needed in the choice of suitable cases. Persons with acute non-infectious lung disease who receive this treatment within a few hours or days after the onset of the disease have the best chances of survival.

Pulmonary and extrapulmonary support for patients with Pneumocystis carinii pneumonia.

Temporary extrapulmonary oxygenation may benefit selected patients with Pneumocystis carinii pneumonia who exhibit severe respiratory insufficiency. Four persons were considered candidates for extrapulmonary oxygenation with a membrane lung while under treatment for pneumocystis pneumonia. In one patient, attempts to institute membrane lung circulation were postponed until his condition was terminal. In another individual, membrane lung support was discontinued prematurely because of complications of anticoagulation. A third patient died of cardiac failure even though her oxygenation had improved during respiratory assistance. In the fourth, the membrane lung was used successfully to maintain the patient through therapy until lung recovery was adequate to resume vital function. The four cases presented are examples of the immunosuppression that creates susceptibility to pneumocystis pneumonia: In two patients, immunodeficiency was caused by lymphoma and combination chemotherapy for the underlying disease; in two others, immunosuppression was induced for the purposes of transplantation. Two patients underwent veno-venous perfusion for prepulmonary oxygenation, and one underwent venoarterial bypass with the membrane lung. Indications for, and techniques of, membrane lung bypass are reviewed. This method of extrapulmonary membrane lung support may save some patients with transient severe pulmonary insufficiency due to P, carinii pneumonia, and the membrane lung may be an adjunct to antimicrobial therapy.

[Temporary mechanical cardiocirculatory assistance in an adolescent suffering from subacute cardiac failure]. / Assistance mécanique cardio-circulatoire temporaire chez un adolescent atteint d'insuffisance cardiaque subaiguë

A case is reported of subacute carciac failure during the course of a non-obstructive cardiomypathy in an adolescent. When the exacerbation of cardiac failure, which was accompanied by severe arrhythmias, failed to respond to medical treatment, the combination of a veno-arterial bypass and membrane oxygenator with diastolic counter-pressure from an intra-aortic balloon was tried with success. A reasonable remission was obtained by this means, but the young patient died 8 months later from cardiac failure which proved resistant to treatment.

[Experimental and clinical use of the mini-size bubble-bag thermooxygenator by the Rygg-Kyvsgaard method]. / Experimenteller und klinischer Einsatz des Mini-size-bubble-bag-Thermooxygenators nach Rygg-Kyvsgaard

The authors report on experimental and clinical use of the Mini-size-bubble-bag-thermooxygenator according to Rygg-Kyvsgaard. The advantages and possible applications are demonstrated. The Mini-size-bubble-bag-thermooxygenator is recommended for routine cardiosurgery on infants. The authors point at possibilities to use it in systems of extracorporeal circulation beyond cardiac surgery.

Construction and evaluation of a simple membrane oxygenator for small organ perfusion.

A simple membrane oxygenator for isolated organ perfusion is described. The membrane employed consisted of an ordinary silicone rubber tubing, 2 mm internal diameter, 0.3 mm wall thickness, the length of the tubing varying according to the required gas transfer. When describing the capacity of the oxygenator, it was found that the maximum gas transfer rate per unit membrane surface was an inadequate measure, since this would vary with both flow rate through the oxygenator and the gas binding capacity of the perfusate. The following formula for the function describing the relation between maximally possible change in gas concentration in the perfusate (C), flow rate (F) and actual change in gas concentration in the perfusate (U) was proposed: U=C-e(-bF), b being a constant specific for the gas and the membrane. This formula was tested by a series of in vitro experiments and proved to give a valid description of the capacity of the oxygenator. It was also found that carbon dioxide was always more easily transferred than oxygen, so that oxygen transfer capcity was the limiting factor in the use of the oxygenator. To facilitate the construction of the right size membrane, a nomogram was constructed for oxygen transfer.