• Journal of Chest Surgery
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• v.38 no.10 s.255
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• pp.661-668
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• 2005

Background: We have hypothesized that, if a low resistant gravity-flow membrane oxygenator is used, then the twin blood sacs of TPLS can be located at downstream of the membrane oxyenator, which may double the pulse rate at a given pump rate and increase the pump output. The purpose of this study was to determine the optimal configuration for the ECLS circuits by using the concept of pulse energy and pump output. Material and Method: Animals were randomly assigned to 2 groups in a total cardiopulmonary bypass model. In the serial group, a conventional membrane oxygenator was located between the twin blood sacs. In the parallel group, the twin blood sacs were placed downstream of the gravity-flow membrane oxygenator. Energy equivalent pressure (EEP) and pump output were collected at pump-setting rates of 30, 40, and 50 BPM. Result: At the given pump-setting rate, the pulse rate was doubled in the parallel group. Percent changes of mean arterial pressure to EEP were $13.0\pm1.7,\; 12.0\pm1.9\;and\;7.6\pm0.9\%$ in the parallel group, and $22.5\pm2.4,\; 23.2\pm1.9,\;and\;21.8\pm1.4\%$ in the serial group at 30, 40, and 50 BPM of pump-setting rates. Pump output was higher in the parallel circuit at 40 and 50 BPM of pump-setting rates $(3.1\pm0.2,\;3.7\pm0.2L/min\;vs.\;2.2\pm0.1\;and\;2.5\pm0.1L/min,\;respectively,\;p=0.01)$. Conclusion: Either parallel or serial circuit configuration of the ECLS generates effective pulsatility. As for the pump out, the parallel circuit configuration provides higher flow than the serial circuit configuration.

• Journal of the Institute of Electronics Engineers of Korea SC
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• v.44 no.1
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• pp.94-99
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• 2007

Many cases of acute cardiac shock and cardiac arrest in emergency room and ICU have been increasing. In this case, ECMO with centrifugal pump has been used generally. However, due to the heavy weight and big size, the system is not adequate for emergency cases. And other defects of this system are that membrane oxygenator's pressure is high and blood are exposed to the air. There was some tries of ECMO using pulsatile pump, but it was found that the weak point of these system is high peak pressure and hemolysis. The mechanism of twin pulsatile pump is that Membrane oxygenator Outlet Pump(MOP) make negative pressure when Membrane oxygenator Inlet Pump(MIP) provides high positive pressure, and the negative pressure will decrease positive pressure of Membrane Oxygenator. Our group analyzed this advantage through In-Vitro and 12 Cases In-Vivo test.

• Journal of Chest Surgery
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• v.43 no.3
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• pp.312-315
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• 2010

Infection of both native and prosthetic vessels in the groin is a very serious disease because of recurrent arterial rupture and sepsis, which can cause death. The successful treatment of groin infection, including infection of the femoral artery, requires extensive excision of the infected tissues and restoration of the circulation where the infected area is isolated. Here we describe a case of obturator bypass in a patient with infected femoral artery rupture that occurred after extracorporeal membrane oxygenation for myocarditis and severe heart failure.

• Journal of Chest Surgery
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• v.37 no.3
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• pp.201-209
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• 2004

Extracorporeal life support (ECLS) system is a device for respiratory and/or heart failure treatment, and there have been many trials for development and clinical application in the world. Currently, a non-pulsatile blood pump is a standard for ECLS system. Although a pulsatile blood pump is advantageous in physiologic aspects, high pressure generated in the circuits and resultant blood cell trauma remain major concerns which make one reluctant to use a pulsatile blood pump in artificial lung circuits containing a membrane oxygenator. The study was designed to evaluate the hypothesis that placement of a pressure-relieving compliance chamber between a pulsatile pump and a membrane oxygenator might reduce the above mentioned side effects while providing physiologic pulsatile blood flow. The study was performed in a canine model of oleic acid induced acute lung injury (N=16). The animals were divided into three groups according to the type of pump used and the presence of the compliance chamber, In group 1, a non-pulsatile centrifugal pump was used as a control (n=6). In group 2 (n=4), a single-pulsatile pump was used. In group 3 (n=6), a single-pulsatile pump equipped with a compliance chamber was used. The experimental model was a partial bypass between the right atrium and the aorta at a pump flow of 1.8∼2 L/min for 2 hours. The observed parameters were focused on hemodynamic changes, intra-circuit pressure, laboratory studies for blood profile, and the effect on blood cell trauma. In hemodynamics, the pulsatile group II & III generated higher arterial pulse pressure (47$\pm$ 10 and 41 $\pm$ 9 mmHg) than the nonpulsatile group 1 (17 $\pm$ 7 mmHg, p<0.001). The intra-circuit pressure at membrane oxygenator were 222 $\pm$ 8 mmHg in group 1, 739 $\pm$ 35 mmHg in group 2, and 470 $\pm$ 17 mmHg in group 3 (p<0.001). At 2 hour bypass, arterial oxygen partial pressures were significantly higher in the pulsatile group 2 & 3 than in the non-pulsatile group 1 (77 $\pm$ 41 mmHg in group 1, 96 $\pm$ 48 mmHg in group 2, and 97 $\pm$ 25 mmHg in group 3: p<0.05). The levels of plasma free hemoglobin which was an indicator of blood cell trauma were lowest in group 1, highest in group 2, and significantly decreased in group 3 (55.7 $\pm$ 43.3, 162.8 $\pm$ 113.6, 82.5 $\pm$ 25.1 mg%, respectively; p<0.05). Other laboratory findings for blood profile were not different. The above results imply that the pulsatile blood pump is beneficial in oxygenation while deleterious in the aspects to high pressure generation in the circuits and blood cell trauma. However, when a pressure-relieving compliance chamber is applied between the pulsatile pump and a membrane oxygenator, it can significantly reduce the high circuit pressure and result in low blood cell trauma.

• 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.