The use of the Deltastream DP3 seems to be safe and effective for MCS in children and may show a low degree of haemolysis. We observed no system-related complications and an overall good outcome in this demanding patient cohort.

In the setting of reduced cardiac output, as commonly observed in patients on LVAD therapy, a large anastomosis to the ascending aorta for the outflow cannula induces the least-adverse flow patterns in the aortic root. Our approach may aid in a better understanding of LVAD-induced flow-pattern changes. Optimization of the cannula position and anastomosis may help to prevent the progression of aortic valve-regurgitation and thrombus formation.

A long-term implantable photoplethysmographic sensor system is proposed. The system employs an elastic cuff which is directly wrapped around an arterial blood vessel. The optically transparent cuff is equipped with light emitting diodes and a photo transistor including the technology of pulse oximetry. The sensor will permit real-time, continuous monitoring of important vital parameters such as arterial blood oxygen saturation and pulse rate over a long-term period in vivo. We emphasize on the specific requirements for design and instrumentation of the implantable sensor and discuss first in vitro data acquired with that new photonics-based sensor.

No abstract

NSE correlates to laboratory parameters indicative of haemolysis in VAD and TAH patients. Our data suggest an influence of intravascular haemolysis on NSE. Therefore, the parameter should be used with caution when it is used to assess cerebral damage.

The results of this study provide insight into the mechanisms underlying possible thrombus formation inside a ventricular assist device and the effect of different system adjustments. The presented methods may permit the optimization of future ventricular assist device systems with respect to optimal flow conditions.

In the last few years, progress in engineering has helped to develop minimized systems for extracorporeal membrane oxygenation and circulatory support. However, despite progress in engineering, the use of these systems still requires a trained team with special skills to be a beneficial and safe tool in the care of critically ill patients. The described indications and proceedings are based on the daily experience of the Freiburg group using these systems both on site in our own hospital and for transport purposes from primary care hospitals into our center of maximum care. The aim of this review is to share our hands-on experience in urgent/emergent implantations and therefore contribute to the knowledge within the growing community of users in this specialized field of extracorporeal support.

Extracorporeal life support (ECLS) weaning is a complex interdisciplinary process with no clear guidelines. To assess ventricular and pulmonary function as well as hemodynamics including end-organ recovery during ECLS weaning, we developed a standardized weaning protocol. We reviewed our experience 2 years later to assess its feasibility and efficacy. In 2015 we established an inter-professional, standardized, stepwise protocol for weaning from ECLS. If the patient did not require further surgery, weaning was conducted bedside in the intensive care unit (ICU). Most of the weaning procedures are guided via echocardiography. Data acquisition began at baseline level, followed by four-step course (each step lasting 10 min), entailing flow-reduction and ending 30 min after decannulation. Moreover, data from the preprotocol era are presented. Between May 2015 and 2017, 26 consecutive patients (18 male), median age 177 days (2 days-20 years) required ECLS with median support of 4 (2-11) days. Excluding eight not weanable patients, 21 standardized weaning procedures were protocolled in the remaining 18 children. Our generally successful protocol-guided weaning rate (with at least 24-h survival) was 89%, with a discharge home rate of 58%. Practical application of the novel standard protocol seems to facilitate ECLS weaning and to improve its success rate. The protocol can be administered as part of standard bedside ICU assessment.