• Journal of Medicine and Life Science
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• v.15 no.2
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• pp.108-111
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• 2018

Extra-corporeal membrane oxygenation (ECMO) has the potential to rescue patients in cardiac arrest or respiratory failure. ECMO has two systems such as veno-arterial and veno-venous circulation. In cardiac arrest resulting from acute myocardial infarction, veno-arterial ECMO is mandatory for systemic circulation and oxygenation. A 75-year old female patient underwent primary coronary intervention for acute myocardial infarction. Despite successful revascularization, recurrent ventricular tachycardia and heart failure were progressing. We performed a veno-arterial ECMO through the femoral artery and vein, then the patient seemed to be stable clinically. However, laboratory studies, echocardiography, and vital signs indicated multi-organ failure and decreasing cardiac function. We found out an error that we performed veno-venous ECMO instead of veno-arterial ECMO. We added a femoral artery cannula and exchange the circuit system to veno-arterial ECMO. While the systemic circulation seemed to be recovered, the left ventricular function was decreased persistently. A hypovolemia resulting from pulmonary hemorrhage was occurred, which lead to ECMO failure. The patient died of cardiac arrest and multi-organ failure 23 hours after ECMO. Because the color of arterial and venous circuits represent the position and efficacy of ECMO, if unexpected or abnormal circuit colors are detected, prompt and aggressive evaluation for ECMO function is mandatory.

• Journal of computational fluids engineering
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• v.21 no.1
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• pp.103-109
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• 2016

With the rapid increase in the number of patients with cardiopulmonary diseases, more cardiopulmonary circulatory assist devices are also needed. These devices can be employed when heart and/or lung function poorly. Due to the critical role they take, these devices have to be designed optimally from both mechanical and biomechanical aspects. This paper presents the CFD results of a baseline model of a centrifugal blood pump for the ECMO condition. The details of flow characteristics of the baseline model together with the performance curves and the modified index of hemolysis(MIH) are investigated. Then, the geometry of baseline impeller and the volute are modified in order to improve the biomechanical performance and reduce the MIH value. The numerical simulations of two cases represent that when impeller radius and prime volume decrease the MIH value also decreases. In addition, the modified geometry shows more uniform pressure distribution inside the volute. The findings provide valuable information for further modification and improvement of centrifugal blood pumps from both mechanical and biomechanical aspects.

• Journal of Korean Critical Care Nursing
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• v.9 no.1
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• pp.66-76
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• 2016

Purpose: This study was conducted to examine the relationship between lateral position change and sternal complications after cardiac surgery through median sternotomy. Methods: This study was a retrospective descriptive case-control study, involving 241 patients who underwent cardiac surgery through median sternotomy. Data from October 2011 to September 2014 were collected. Results: Sternal complications (i.e. dehiscence, sternal instability, mediastinitis) developed in 33 patients (13.7%). Primary symptoms of complications were discharge and erythema, and the mean time difference from surgery to appearance of symptoms was 15 days (range, 1-138 days). The factors associated with sternal complications were cancer comorbidity (${\chi}^2=5.22$, p=.039), internal mammary artery procedure (${\chi}^2=4.16$, p=.041), and duration of extra-corporeal membrane oxygenation (p=.033). Position change was not related to incidence of sternal complications (${\chi}^2=0.14$, p=.704). Pressure ulcers appeared in 63 patients (26.1%). Mean time difference from surgery until occurrence of ulcers was 6.7 hours (range, 0-323.0 hours), but position change was started from 132.4 hours (range, 27.1-503.2 hours) after intensive care unit admission. Conclusions: These results provide baseline data to create a standard position change and activity protocol for patients after median sternotomy. Furthermore, the study could help clinical practitioners establish evidence-based nursing practices.

• The Korean Journal of Physiology and Pharmacology
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• v.19 no.3
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• pp.229-234
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• 2015

Nafamostat mesilate (NM) is a serine protease inhibitor with anticoagulant and anti-inflammatory effects. NM has been used in Asia for anticoagulation during extracorporeal circulation in patients undergoing continuous renal replacement therapy and extra corporeal membrane oxygenation. Oxidative stress is an independent risk factor for atherosclerotic vascular disease and is associated with vascular endothelial function. We investigated whether NM could inhibit endothelial dysfunction induced by tumor necrosis factor-${\alpha}$ (TNF-${\alpha}$ ). Human umbilical vein endothelial cells (HUVECs) were treated with TNF-${\alpha}$ for 24 h. The effects of NM on monocyte adhesion, vascular cell adhesion molecule-1 (VCAM-1) and intracellular adhesion molecule-1 (ICAM-1) protein expression, p38 mitogenactivated protein kinase (MAPK) activation, and intracellular superoxide production were then examined. NM ($0.01{\sim}100{\mu}g/mL$) did not affect HUVEC viability; however, it inhibited the increases in reactive oxygen species (ROS) production and p66shc expression elicited by TNF-${\alpha}$ (3 ng/mL), and it dose dependently prevented the TNF-${\alpha}$ -induced upregulation of endothelial VCAM-1 and ICAM-1. In addition, it mitigated TNF-${\alpha}$ -induced p38 MAPK phosphorylation and the adhesion of U937 monocytes. These data suggest that NM mitigates TNF-${\alpha}$ -induced monocyte adhesion and the expression of endothelial cell adhesion molecules, and that the anti-adhesive effect of NM is mediated through the inhibition of p66shc, ROS production, and p38 MAPK activation.

• Journal of Chest Surgery
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• v.42 no.4
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• pp.464-472
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• 2009

Background: We analyzed the clinical results and the factors for survival of patients who underwent extracorporeal life support system after adult cardiovascular surgery. Material and Method: We retrospectively reviewed the medical record of 44 patients (1.6% of the total adult cardiovascular surgical cases) who underwent the use of a ventricular assisted device or extracorporeal membrane oxygenation from January 2002 to August 2008. There were 32 (72.7%) males and their mean age was 61.7$\pm$14.9(range: 20$\sim$73) years old. The mean duration of extracorporeal life support system was 5.3$\pm$3.0 (range: 1$\sim$12) days. Result: Of these 44 patients, 24 (54.5%) patients were successfully weaned from the extracorporeal device. Eighteen (40.9%) survivors were able to be discharged from the hospital. Complications were noted in 38 patients (86.4%). An emergency operation, no usage of a concomitant intraaortic balloon pump and major complications during use of the extra corporeal life support system such as bleeding, flow instability and renal failure were identified as significant risk factors for poor survival on univariated analysis. Owing to educational support and a continuous renal replacement therapy system, the clinical outcomes of these patients have improved since 2006. On multivariated analysis, renal failure and bleeding during extracorporeal life support were significant risk factors for poor survival. Conclusion: Although using. extracorporeal life support systems after adult cardiovascular surgery revealed acceptable clinical results, determining the optimal treatment strategy and further well designed larger studies are needed to improve the survival rate of patients who undergo extracorporeal life support after adult cardiovascular surgery.