The veno-venoarterial (VVA) mode of extracorporeal membrane oxygenation (ECMO) is defined by having both venous and arterial reinfusion cannulas. It is purposed to improve upper body oxygenation as the venous reinfusion cannula is typically placed in the upper body. We performed a single-center retrospective review to better characterize the patients placed on this mode. Adults (n = 23) were 40.4 ± 14.7 years old and were supported with ECMO for a median of 141 (97, 253) hours, with VVA support 110 (63, 179) hours. Ten (43%) were initially cannulated VVA; reasons for conversion included cardiac failure (46%), North-South syndrome (38%), and worsening hypoxia (15%). Survival was 39% and neurological complications 13%. Pediatrics (n = 8) were 13.0 ± 2.4 years old and were supported with ECMO for a median of 258 (168, 419) hours, with VVA support 131 (98, 161) hours. One (12.5%) was initially cannulated VVA; reasons for conversion were North-South syndrome (42%), cardiac failure (29%), and worsening hypoxia (29%). Survival was 71% and neurological complications 29%. We concluded that there was neither survival advantage nor complication reduction with the VVA mode in this cohort; however, VVA does have value for unique clinical situations when conventional ECMO modes do not meet support needs.
A novel
electrochemically controlled release method for nitric
oxide (NO) (based on electrochemical reduction of nitrite ions) is
combined with an amperometric oxygen sensor within a dual lumen catheter
configuration for the continuous in vivo sensing
of the partial pressure of oxygen (PO2) in blood. The on-demand electrochemical NO generation/release method
is shown to be fully compatible with amperometric PO2 sensing. The performance of the sensors is evaluated
in rabbit veins and pig arteries for 7 and 21 h, respectively. Overall,
the NO releasing sensors measure both venous and arterial PO2 values more accurately with an average deviation
of −2 ± 11% and good correlation (R2 = 0.97) with in vitro blood measurements,
whereas the corresponding control sensors without NO release show
an average deviation of −31 ± 28% and poor correlation
(R2 = 0.43) at time points >4 h after
implantation in veins and >6 h in arteries. The NO releasing sensors
induce less thrombus formation on the catheter surface in both veins
and arteries (p < 0.05). This electrochemical
NO generation/release method could offer a new and attractive means
to improve the biocompatibility and performance of implantable chemical
sensors.
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