Ecmo in change-from ultima ratio to first line therapy an interdisciplinary approach

BackgroundSince the first successful operation with left heart bypass performed by Dodrill in Michigan in 1952 (The Michigan Heart) and the first successful application of the heart lung machine in 1953 performed by Gibbon the extracorporeal circulation has become a conditio sine qua non in cardiac surgery. Through the last decades extracorporeal circulation has become an important therapeutic tool not only in cardiac surgery. It is used in several indications in neonatology, pediatrics, oncology, and vascular surgery. The most important indication next to cardiac surgery is the use as ECMO in intensive care medicine to treat patients with ARDS, cardiac failure, severe lung embolism and sepsis.MethodsBetween January 2005 and April 2012, 311 ECMO were implanted in our hospital. In 79 patients a venovenous System was implanted, in 230 patients we performed a venoarterial ECMO and in 2 patients we used a second venous approach as a venovenousarterial ECMO. Different Oxygenators (Quadrox®, ECCO®, Eurosets®and Medtronic®) and different Systems.(Levitronics®, Medtronic®, Lifebridge®, Medos®and Cardiohelp®) were used.ResultsThe average survival in Patients allover is 46%. The highest survival rate is shown in the department for cardiac surgery with 68%. The highest Mortality is shown in the department for internal medicine with 66%. Different Indications, Risk factors, time of Implantation and learning curve might be some reasons for this difference in outcome. It is also shown that we could decrease Mortality in Patients treated with an ECMO in cardiac surgery through the last 5 Years from almost 80% to 32 %.ConclusionECMO has become an important therapy part in the management of different medical emergencies such as ARDS, cardiogenic shock, severe lung embolism and sepsis. By increasing in hospital experience in hemodynamically and respiratory compromised patients we established an interdisciplinary ECMO program and decreased mortality in such emergencies. These new technologies are expanding the potential applications for ECMO in exciting ways, including new patient populations and the ability to make ECMO mobile for both intra-and inter-hospital transport. The team approach between Cardiac surgery, Anesthesia, Perfusion and internal medicine was not only a gain on security it is an option to develop ECMO further

Age-Dependent Protein Expression of Serine/Threonine Phosphatases and Their Inhibitors in the Human Cardiac Atrium

Heart failure and aging of the heart show many similarities regarding hemodynamic and biochemical parameters. There is evidence that heart failure in experimental animals and humans is accompanied and possibly exacerbated by increased activity of protein phosphatase (PP) 1 and/or 2A. Here, we wanted to study the age-dependent protein expression of major members of the protein phosphatase family in human hearts. Right atrial samples were obtained during bypass surgery. Patients (n=60) were suffering from chronic coronary artery disease (CCS 2-3; New York Heart Association (NYHA) stage 1–3). Age ranged from 48 to 84 years (median 69). All patients included in the study were given β-adrenoceptor blockers. Other medications included angiotensin-converting enzyme (ACE) or angiotensin-receptor-1 (AT1) inhibitors, statins, nitrates, and acetylsalicylic acid (ASS). 100 µg of right atrial homogenates was used for western blotting. Antibodies against catalytic subunits (and their major regulatory proteins) of all presently known cardiac serine/threonine phosphatases were used for antigen detection. In detail, we studied the expression of the catalytic subunit of PP1 (PP1c); I1PP1 and I2PP1, proteins that can inhibit the activity of PP1c; the catalytic subunit of PP2A (PP2Ac); regulatory A-subunit of PP2A (PP2AA); regulatory B56α-subunit of PP2A (PP2AB); I1PP2A and I2PP2A, inhibitory subunits of PP2A; catalytic and regulatory subunits of calcineurin: PP2BA and PP2BB; PP2C; PP5; and PP6. All data were obtained within the linear range of the assay. There was a significant decline in PP2Ac and I2PP2A expression in older patients, whereas all other parameters remained unchanged with age. It remains to be elucidated whether the decrease in the protein expression of I2PP2A might elevate cardiac PP2A activity in a detrimental way or is overcome by a reduced protein expression and thus a reduced activity of PP2Ac

Microarray-Based Gene Expression Profiling Suggests adaptation of Lung Epithelial Cells Subjected to Chronic Cyclic Strain

Background/Aims: Mechanical strain of the lung tissue is a physiological process that affects the behavior of lung cells. Since recent evidence also suggests alterations in the expression of certain genes as a consequence of mechanotransduction, our study aimed at the analysis of the gene expression profile in lung epithelial cells subjected to chronic cyclic strain. Methods: Various human lung epithelial cell lines (A549 as principal adherent cell line and four others) were subjected to cyclic strain (16 % surface distension, 12 min-1) in a Strain Cell Culture Device for 24 h. In comparison to static controls, expression analyses were performed by gene microarray and qPCR. Results: Microarray analysis revealed many differences in the gene expression but at moderate levels. Altogether 25 genes were moderately down-regulated (0.86-fold ± 0.06) and 26 genes were up-regulated (1.18-fold ± 0.10) in A549 and the others. Strain-regulated genes often code for transcription factors, such as E2F4 and SRF. qPCR analyses confirmed the up-regulation of both transcription factors and further genes, such as PLAU (urokinase-type plasminogen activator) and S100A4 (S100 protein A4). Moreover, we showed the down-regulations of AGR2 (anterior gradient 2) and LCN2 (lipocalin 2). Conclusions: We identified many genes of which the expression was moderately altered in lung epithelial cells subjected to chronic cyclic strain. Although many moderate changes in the gene expression profile might affect cellular behavior, it also suggests an effective adaptation of cells to mechanical forces in long-term conditions