Showing papers by "Robert H. Bartlett published in 2000"
TL;DR: The University of Michigan experience with extracorporeal life support (ECLS) in 1000 consecutive patients between 1980 and 1998 is the largest series at one institution in the world and has shown that ECLS saves lives of patients with acute cardiac or pulmonary failure in a variety of clinical settings.
Abstract: The University of Michigan experience with extracorporeal life support
(ECLS) in 1000 consecutive patients between 1980 and 1998 is the largest series
at one institution in the world. Among this patient population, survival to
hospital discharge in moribund patients with respiratory failure was 88% in
586 neonates, 70% in 132 children, and 56% in 146 adults. Survival in moribund
patients with cardiac failure was 48% in 105 children and 33% in 31 adults.
This article describes the University of Michigan's overall ECLS patient experience,
the progression of ECLS from laboratory experiments to clinical application
at the bedside, the expansion of the technology to other centers, and current
ECLS technology and outcomes. Despite the challenges faced in clinical research
in this field, our experience and that of others has shown that ECLS saves
lives of patients with acute cardiac or pulmonary failure in a variety of
clinical settings.
340 citations
TL;DR: The incorporation of nitric oxide into the surface of extracorporeal circuits reduces platelet consumption and eliminates the need for systemic heparinization in a rabbit model of extacorporeal circulation.
Abstract: Objective: To determine whether the use of nitric oxide (NO)-releasing polymers coated onto the inner surface of extracorporeal circuits can reduce platelet consumption and activation in the absence of systemic heparinization using a rabbit model of veno-venous extracorporeal circulation. Design: Prospective, controlled trial Setting: Research laboratory at an academic medical institution. Subjects: New Zealand White Rabbits Interventions: Anesthetized, tracheotomized, and ventilated New Zealand White rabbits were injected with freshly prepared, 111 In(oxine) 3 labeled single donor platelets through the external jugular vein. After baseline measurements, these animals were placed on venovenous extracorporeal circulation through a 1-m control circuit or NO test circuit for 4 hrs at a blood flow rate of 109-118 mL/min via roller pump. Four groups were studied: systemically heparinized control circuits, systemically heparinized NO test circuits, nonheparinized control circuits, and nonheparinized NO test circuits. Platelet counts, fibrinogen levels, and plasma free indium levels were measured hourly. Circuits were rinsed and retained for gamma counting after the 4-hr run or when the circuit clotted. Four animals, one from each group, did not receive radiolabeled platelets so that the circuits could be preserved for scanning electron microscopic examination after the 4-hr study. Measurements and Main Results: Platelet consumption was significantly reduced in both the heparinized and nonheparinized NO test groups when compared with the controls (p <.0001 and p <.0004, respectively). Platelet adhesion to the extracorporeal circuits was significantly reduced in the nonheparinized test circuits when compared with the controls (p <.05). Scanning electron microscopic examination of the circuits revealed that in the absence of heparin and in the presence of a NO-releasing surface, platelets retained their spherical nonactivated shape. Conclusions: The incorporation of NO into the surface of extracorporeal circuits reduces platelet consumption and eliminates the need for systemic heparinization in a rabbit model of extracorporeal circulation.
152 citations
TL;DR: A single-center experience with pediatric extracorporeal life support (ECLS) is described and variables predictive of outcome in pediatric patients, both before the institution of ECLS and while on support are determined.
118 citations
TL;DR: Overall survival of pediatric patients with acute respiratory failure supported by VA or VV ECLS was comparable, and a randomized clinical trial may be useful in clarifying these observations.
Abstract: Objectives:To examine the Extracorporeal Life Support Organization (ELSO) registry database of infants and children with acute respiratory failure to compare outcome and complications of venovenous (VV) vs. venoarterial (VA) Extracorporeal Life Support (ECLS).Design:Retrospective cohort study.Settin
71 citations
TL;DR: In selected high-risk patients, LVAD survival after initial ECLS was not different from survival after LVAD support alone and an initial period of resuscitation with ECLs is an effective strategy to salvage patients with cardiac arrest or extreme hemodynamic instability and multiorgan injury.
51 citations
TL;DR: Extracorporeal life support (ECLS) is a safe and effective means to keep patients alive during severe respiratory failure that otherwise would be fatal as mentioned in this paper, which allows days of time for study and treatment of other conditions and other organ failure.
36 citations
TL;DR: This device demonstrates the feasibility of a pumpless pulmonary assist device relying on the right ventricle for perfusion, and five of 7 animals survived 24 hours with 75% to 100% of the cardiac output diverted through the device.
34 citations
TL;DR: Unlike ischemic or chemically induced models of liver failure, the dogs were hemodynamically and neurologically stable and can be used to test the safety and efficacy of liver-assist devices aimed at temporizing the detoxification functions of the failing liver.
21 citations
TL;DR: Percutaneous access may be used safely and effectively for venovenous ECLS in pediatric patients and there was no procedure-related mortality.
19 citations
TL;DR: Although significant progress has been made in the treatment of patients with acute lung failure in the critical care setting, the mortality rate from acute lung injury and ARDS is unacceptably high, given the numbers of patients treated for these syndromes each year.
TL;DR: The rate of PFHb generation scaled inversely with the Cavitation number at a constant flow rate, suggesting that the size of the attached cavity was the dominant hemolytic factor.
Abstract: The purpose of this study was to determine the hemolytic potentials of discrete bubble cavitation and attached cavitation. To generate controlled cavitation events, a venturigeometry hydrodynamic device, called a Cavitation Susceptibility Meter (CSM), was constructed. A comparison between the hemolytic potential of discrete bubble cavitation and attached cavitation was investigated with a single-pass flow apparatus and a recirculating flow apparatus, both utilizing the CSM. An analytical model, based on spherical bubble dynamics, was developed for predicting the hemolysis caused by discrete bubble cavitation. Experimentally, discrete bubble cavitation did not correlate with a measurable increase in plasma-free hemoglobin (PFHb), as predicted by the analytical model. However, attached cavitation did result in significant PFHb generation. The rate of PFHb generation scaled inversely with the Cavitation number at a constant flow rate, suggesting that the size of the attached cavity was the dominant hemolytic factor.