Open and closed chest extrathoracic cannulation for cardiopulmonary bypass and extracorporeal life support: methods, indications, and outcomes

Field, Mark; Al-Alao, Bassel; Mediratta, Neeraj; Sosnowski, Andrzej

doi:10.1136/pgmj.2005.037929

Cited by 26 publications

(21 citation statements)

References 49 publications

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“…[4][5][6] Cannula size and locations are listed in Table 2. [4][5][6] Cannula size and locations are listed in Table 2.…”

Section: Methodsmentioning

confidence: 99%

“…3,4 Reinfused oxygenated blood from the ECMO circuit flows retrograde through the abdominal aorta and creates a "mixing point" as it meets antegrade blood flow from the left ventricle (Figure 4). 3,4 Reinfused oxygenated blood from the ECMO circuit flows retrograde through the abdominal aorta and creates a "mixing point" as it meets antegrade blood flow from the left ventricle (Figure 4).…”

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confidence: 99%

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Hybrid Configurations via Percutaneous Access for Extracorporeal Membrane Oxygenation

Biscotti¹,

Lee

Basner

et al. 2014

ASAIO Journal

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Use of extracorporeal membrane oxygenation (ECMO) in adults has surged in recent years. Typical configurations are venovenous (VV), which provides respiratory support, or venoarterial (VA), which provides both respiratory and circulatory support. In patients supported with VV ECMO who develop hemodynamic compromise, an arterial limb can be added (venovenous-arterial ECMO) to provide additional circulatory support. For patients on VA ECMO who develop concomitant respiratory failure in the setting of some residual cardiac function, an oxygenated reinfusion limb can be added to the internal jugular vein (venoarterial-venous ECMO) to improve oxygen delivery to the cerebral and coronary circulation. Such hybrid configurations can provide differential support for various forms of cardiopulmonary failure. We describe 21 patients who ultimately received a hybrid configuration at our institution between 2012 and 2013. Eight patients (38.1%) died during ECMO support, four patients (19.0%) died after decannulation but before hospital discharge, and nine patients (42.9%) survived to hospital discharge. Our modest survival rate is likely related to the complexity and severity of illness of these patients, and this relative success suggests that hybrid configurations can be effective. It serves patients well to maintain a flexible and adaptable approach to ECMO configurations for their variable cardiopulmonary needs.

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“…[4][5][6] Cannula size and locations are listed in Table 2. [4][5][6] Cannula size and locations are listed in Table 2.…”

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

Hybrid Configurations via Percutaneous Access for Extracorporeal Membrane Oxygenation

Biscotti¹,

Lee

Basner

et al. 2014

ASAIO Journal

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“…This technique is now well implanted in some centers, and retrospective studies have been conducted to prove its efficiency and safety. 2,3 Different techniques have been invented to increase the blood flow, such as vacuum-assisted system, kinetic-assisted system with the use of a centrifugal pump, and, more recently, self-expanding basket 4 and self-expanding cannulas. 2 To provide a sufficient blood flow without reducing the operative field with two central cannulas, a peripheral cannulation is needed.…”

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confidence: 99%

“…A femoral venous cannulation is often used for this process. 3,4,6 The target blood flow can be difficult to reach with a percutaneous cannula, which can lead to a problem such as vessel chattering, as reported in Toomasian and McCarthy's 3 study. 5,6 However, the design of this cannula ( Fig.…”

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confidence: 99%

Performance Increase in Venous Drainage for Mini-Invasive Heart Surgery: Superiority of Self-Expanding Cannulas

Belkoniene

Abdel-Sayed

Favre

et al. 2014

Innovations�(Phila)

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Objective Originally, the Smartcanula principle (collapsed insertion and expansion in situ) was developed for venous drainage by gravity. However, in minimally invasive surgery, augmentation with either constrained force vortex pumps or vacuum is often used. The current study was set up to assess whether smaller diameters of self-expanding venous cannulas are sufficient in conjunction with venous drainage augmentation resulting in smaller access orifices. Methods To evaluate cannulas intended for cardiopulmonary bypass, an in vitro circuit was set up with silicone tubing between the test cannula encased in a lower reservoir, the centrifugal pump, and after an upper reservoir. Afterload was set arbitrarily at 60 mm Hg using a centrifugal pump. The pressure value was measured using Millar pressure transducers. Flow rate (Q) was measured using an ultrasonic flow meter calibrated with volume tank and timer. Revolutions per minute of the centrifugal pump were calibrated with a stroboscope. Data display and data recording were controlled using a Lab View application. Self-expanding (24F Smartcanula) and control (25F Biomedicus) cannulas were used. Results Sixty measurements were recorded. At pump speed of 1500, 1570, 2000, 2500, and 3000 rpm, the Q values were 3.6, 5.2, 6.6, 9.3, and 11.8 L/min for the 24F self-expanding cannula and 3, 4.3, 5.4, 7.5, and 9.3 L/min for the control cannula. The pressure values were 3.6, −5.4, −15.9, −45.3, and 80.6 mm Hg. Biomedicus 25F showed Q values from 16% to 19% less as compared with 24F Smartcanula. The pressure values were 6, 7, 4, 2, and 2 times more as compared with 24F Smartcanula. Conclusions Our experimental evaluation demonstrated the superior performance of the Smartcanula with its self-expanding design in comparison with the reference commercially available standard cannulas. The Smartcanula with its small diameter is particularly welcome for minimally invasive surgery.

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“…One should then assess the external surface of the heart and vessels. Evidence that the surgeon had used cardiopulmonary bypass to rest the heart during surgery includes suture material in the right atrium, typically in the right atrial appendage, and ascending aorta; unless, for technical reasons, such as a calcified aorta or aortic dissection [1], the pump run was established by placing catheters in a femoral artery and vein or other peripheral vessels. For drainage of venous blood to the pump, a double lumen catheter is commonly placed through an incision in the right atrial appendage.…”

Section: Look At the External Surface Of The Heart And Great Vesselsmentioning

confidence: 99%

The Cardiac Dissection

Houser

2009

The Operated Heart at Autopsy

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An approach is offered here to assist the pathologist with the actual dissection of the operated heart at autopsy. The challenge to the pathologist is to define any underlying cardiac pathology, recognize changes in morphology brought about by prior surgical intervention, and correlate the gross cardiac findings with the hemodynamic status of the deceased prior to death. Even without detailed clinical records, one can still perform the dissection in a consistent and careful manner that allows an accurate assessment of the heart regardless of postoperative adhesions and complex surgical reconstructions. Developing the plane of dissection between the heart and adherent parietal pericardium should be done with a scalpel, using a methodical technique. As one examines the external surface of the heart, one may observe clues that the surgeon had used cardiopulmonary bypass to rest the heart during surgery and that specific surgical procedures had been performed. By removal of the coronary arteries with any bypass grafts off the heart and subsequent careful examination of the chambers and great vessels of the heart, the pathologist can then begin to understand the "real story." Keywords Dissection · Pericardium · Heart surgery · Coronary arteries · Surgical footprints · Cardiopulmonary bypass · Sharp dissection In this chapter, an approach is offered to assist the pathologist with the actual dissection of the operated heart at autopsy. This dissection, depending on what operation was done and how long prior to autopsy the operation was performed, may range in complexity from a simple procedure to quite a daunting task. The challenge to the pathologist is to define any underlying cardiac pathology, recognize changes in morphology brought about by prior surgical intervention, and correlate the gross cardiac findings with the hemodynamic status of the deceased prior to death. In short, to what extent did failure of cardiac function contribute to the person's death, and how did the previous heart surgery affect the outcome of the case?Having a detailed knowledge of the deceased's past surgical history, as provided by operative notes, hospital discharge summaries, and available informed clinicians is an obvious advantage to the pathologist at autopsy. However, even without this 31 S.L. Houser, The Operated Heart at Autopsy,

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Open and closed chest extrathoracic cannulation for cardiopulmonary bypass and extracorporeal life support: methods, indications, and outcomes

Cited by 26 publications

References 49 publications

Hybrid Configurations via Percutaneous Access for Extracorporeal Membrane Oxygenation

Hybrid Configurations via Percutaneous Access for Extracorporeal Membrane Oxygenation

Performance Increase in Venous Drainage for Mini-Invasive Heart Surgery: Superiority of Self-Expanding Cannulas

The Cardiac Dissection

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