Efficacy and safety of ECG‐synchronized pulsatile extracorporeal membrane oxygenation in the clinical setting: The SynCor Trial

Voigt, Ingo; Spangenberg, Tobias; Ibrahim, Tareq; Bradaric, Christian; Viertel, Achim; Tallone, Ezequiel Marcelo; Skurk, Carsten; Abel, Peter; Graf, Joachim; Rinne, Torsten; Böhm, J.; Ghanem, Alexander; Liebetrau, Christoph

doi:10.1111/aor.14147

Cited by 8 publications

(7 citation statements)

References 38 publications

(80 reference statements)

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“…Since no thromboembolism was observed in the autopsy findings, we assumed that the thrombi formed in the oxygenator were not flushed out of the oxygenator by the pulsatile flow but were inhibited at the very early stage of the thrombus‐formation cascade. Various studies on pulsatile flow in ECMO and ventricular assist devices have been reported not only in basic research but also in clinical applications 31–33 . However, although improvement of gas exchange capacity of oxygenators with the pulsatile flow has been reported, 34–36 we could not find any reports on the inhibitory effect of pulsatile flow on thrombus formation.…”

Section: Discussionmentioning

confidence: 81%

“…Various studies on pulsatile flow in ECMO and ventricular assist devices have been reported not only in basic research but also in clinical applications. [31][32][33] However, although improvement of gas exchange capacity of oxygenators with the pulsatile flow has been reported, [34][35][36] we could not find any reports on the inhibitory effect of pulsatile flow on thrombus formation. On the other hand, it has been suggested that pulsatile flow may inhibit thrombus formation in the pump.…”

Section: Discussionmentioning

confidence: 86%

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Innovative experimental animal models for real‐time comparison of antithrombogenicity between two oxygenators using dual extracorporeal circulation circuits and indocyanine green fluorescence imaging

et al. 2022

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Background Antithrombogenicity of extracorporeal membrane oxygenation (ECMO) devices, particularly oxygenators, is a current problem, with numerous studies and developments underway. However, there has been limited progress in developing methods to accurately compare the antithrombogenicity of oxygenators. Animal experiments are commonly conducted to evaluate the antithrombogenicity of devices; however, it is challenging to maintain a steady experimental environment. We propose an innovative experimental animal model to evaluate different devices in a constant experimental environment in real‐time. Methods This model uses two venous–arterial ECMO circuits attached to one animal (one by jugular vein and carotid artery, one by femoral vein and artery) and real‐time assessment of thrombus formation in the oxygenator by indocyanine green (ICG) fluorescence imaging. Comparison studies were conducted using three pigs: one to compare different oxygenators (MERA vs. CAPIOX) (Case 1), and two to compare antithrombotic properties of the oxygenator (QUADROX) when used under different hydrodynamic conditions (continuous flow vs. pulsatile flow) (Cases 2 and 3). Results Thrombi, visualized using ICG imaging, appeared as black dots on a white background in each oxygenator. In Case 1, differences in the site of thrombus formation and rate of thrombus growth were observed in real‐time in two oxygenators. In Case 2 and 3, the thrombus region was smaller in pulsatile than in continuous conditions. Conclusions We devised an innovative experimental animal model for comparison of antithrombogenicity in ECMO circuits. This model enabled simultaneous evaluation of two different ECMO circuits under the same biological conditions and reduced the number of sacrificed experimental animals.

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Section: Discussionmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 86%

Innovative experimental animal models for real‐time comparison of antithrombogenicity between two oxygenators using dual extracorporeal circulation circuits and indocyanine green fluorescence imaging

et al. 2022

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“…The reported incidence of ALI under VA-ECMO varies from one study to another, ranging from 11% to 52%. A prospective trial found an incidence of critical limb ischemia of 38% in patients with refractory cardiogenic shock supported with VA-ECMO [ 19 ]. ALI can lead to further complications and negatively affect patients’ survival [ 3 ].…”

Section: Discussionmentioning

confidence: 99%

Preventing Acute Limb Ischemia during VA-ECMO—In Silico Analysis of Physical Parameters Associated with Lower Limb Perfusion

Brockaert,

Ferreira,

Laplante

et al. 2023

JCM

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Background: Peripheral femoro-femoral veno-arterial extracorporeal membrane oxygenation is increasingly used in refractory cardiogenic shock. However, the obstruction of the femoral artery by the return cannula could lead to acute limb ischemia, a frequently encountered situation that is inconstantly prevented by the adjunction of a distal perfusion cannula (DPC). The aim of this study was to investigate the influence of three physical parameters on the perfusion of the cannulated lower limb. Methods: Using patient-specific arterial models and computational fluid dynamic simulations, we studied four diameters of arterial cannula, three diameters of DPC, and two percentages of arterial section limitation. Results: We found that adequate perfusion of the cannulated limb was achieved in only two out of the twenty-one configurations tested, specifically, when the arterial cannula had a diameter of 17 Fr, was considered to limit the section of the artery by 90%, and was associated with an 8 Fr or a 10 Fr DPC. Multivariable analysis revealed that the perfusion of the cannulated lower limb was correlated with the diameter of the DPC, but also with the diameter of the arterial cannula and the percentage of arterial section limitation. Conclusions: In most of the cases simulated here, the current system combining unsized arterial cannula and non-specific DPC was not sufficient to provide adequate perfusion of the cannulated lower limb, urging the need for innovative strategies to efficiently prevent acute limb ischemia during peripheral femoro-femoral veno-arterial extracorporeal membrane oxygenation.

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“…However, further investigation is needed to determine optimal patient selection, flow rates, pulse pressures, cannula types, and the potential for hemolysis. [18][19][20]…”

Section: Left Ventricular Unloadingmentioning

confidence: 99%

Year in review: Highlights in ECLS Innovation and Technology, Anno 2022-2023

Vercaemst

2023

Perfusion

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Background In the field of extracorporeal life support (ECLS), the rapid influx of novel technologies and innovative techniques presents an ongoing challenge for professionals to stay informed about these advancements. To address this issue and ensure the ECLS community remains up-to-date, we have compiled a concise overview of recent technological innovations in ECLS. Purpose This overview focuses primarily on academically investigated and reported advancements in the ECLS domain. It underscores the importance of transparent communication regarding technological limitations in healthcare and advocates for collaboration between medical professionals and engineers to elevate patient care. Research Design This manuscript presents a compilation of recent technological advancements in ECLS, with an emphasis on innovations that have been academically explored and documented. The research approach involves gathering information from scholarly sources, reports, and studies to provide a comprehensive overview. Study Sample The study sample comprises a diverse range of recent technological innovations in the field of extracorporeal life support (ECLS). These innovations span various aspects of ECLS technology and have been investigated and reported on within the academic literature. Analysis Data collection involved systematically reviewing academic literature, reports, and studies related to recent technological advancements in ECLS. The collected information was then analyzed to identify common trends, notable developments, and the impact of these innovations on patient care. Results The compilation highlights several significant technological innovations within the ECLS domain. Notable advancements include the development of new dual lumen cannulae, innovative devices for left ventricular (LV) unloading, lightweight ECMO transport systems, streamlined driving consoles to facilitate patient mobility, intricate systems for extracorporeal cardiopulmonary resuscitation (ECPR), standardized driving consoles for networking, and non-invasive circuit pressure monitoring. Some of these innovations have obtained regulatory approvals for distribution in the United States and/or authorization for the European market. Conclusions The manuscript underscores the critical role of collaboration between clinicians, researchers, and industry in driving recent technological innovations within the ECLS field. It emphasizes the necessity of open communication about technological limitations and the potential for repurposing established technologies in novel ways. However, the resourcefulness of physicians in repurposing devices requires validation through comprehensive scientific and technical investigation. Thus, fostering broader collaboration among stakeholders is recommended to ensure the rigorous evaluation and validation of new applications for established ECLS devices.

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Efficacy and safety of ECG‐synchronized pulsatile extracorporeal membrane oxygenation in the clinical setting: The SynCor Trial

Cited by 8 publications

References 38 publications

Innovative experimental animal models for real‐time comparison of antithrombogenicity between two oxygenators using dual extracorporeal circulation circuits and indocyanine green fluorescence imaging

Innovative experimental animal models for real‐time comparison of antithrombogenicity between two oxygenators using dual extracorporeal circulation circuits and indocyanine green fluorescence imaging

Preventing Acute Limb Ischemia during VA-ECMO—In Silico Analysis of Physical Parameters Associated with Lower Limb Perfusion

Year in review: Highlights in ECLS Innovation and Technology, Anno 2022-2023

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