In this study, Capiox Emergency Bypass System (Capiox EBS™; Terumo Inc., Tokyo, Japan) was used as the ECMO system. This system consisted of an extracorporeal life controller including a back-up battery and a disposable bypass circuit integrated with a heparin-coated membrane oxygenator and a centrifugal pump. The device was implanted onto the femoral artery and vein by percutaneous cannulation using the Seldinger technique. The tip of the arterial cannula was positioned in the common iliac artery and the tip of the venous cannula was placed at the junction of the right atrium and the superior vena cava. Anticoagulation was achieved by administering a bolus injection of unfractionated heparin and maintaining an activated clotting time between 180 and 220 seconds with a continuous intravenous infusion of unfractionated heparin. The initial flow rate of ECMO was 2.2 L/min/m2, which was subsequently regulated to maintain a mean arterial pressure of 65 mmHg. ECMO weaning was considered when the patient was hemodynamically stable and properly oxygenated and when ECMO flow rate was <1 L/min/m2 for 4 hours. Successful weaning was defined as removal of ECMO support without reinsertion or death within 24 hours.
Capiox ebs
Manufactured by Terumo
Sourced in Japan
The Capiox EBS is a laboratory equipment product manufactured by Terumo. It is designed to provide extracorporeal blood circulation support during medical procedures. The core function of the Capiox EBS is to facilitate the movement and oxygenation of blood outside the body.
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Lab products found in correlation
8 protocols using capiox ebs
1
Femoral Artery-Vein ECMO Implantation
2
ECMO Initiation and Maintenance Protocol
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The decision to implant ECMO was made by an experienced team, and the ECMO was placed by either cardiovascular surgeons or interventional cardiologists. The Capiox Emergency Bypass System (Capiox EBS™; Terumo, Inc., Tokyo, Japan) and Permanent Life Support (PLS) System (MAQUET, Rastatt, Germany) were used. Heparin was intravenously administered as a bolus of 5000 units, followed by continuous intravenous infusion to maintain an activated clotting time between 150 and 180 s. After initiation of ECMO, the pump blood flow rate was initially set above 2.2 L/min/body surface area (m2) and subsequently adjusted to maintain a mean arterial pressure above 65 mmHg. Blood pressure was continuously monitored through an arterial catheter, and arterial blood gas analysis was performed in the artery of the right arm to estimate cerebral oxygenation. Additional fluids, blood transfusion, and/or catecholamines (i.e., norepinephrine, epinephrine, or dobutamine) were supplied to maintain intravascular volume and/or to achieve a mean arterial pressure above 65 mmHg if necessary [8 (link)].
3
Extracorporeal Membrane Oxygenation for Refractory Cardiogenic Shock
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The indication for and characteristics of ECMO were decided by cardiovascular surgeons, cardiologists, and/or emergency department physicians when they encountered patients with refractory cardiogenic shock or patients under cardiopulmonary resuscitation. The catheter for ECMO was inserted percutaneously with the peripheral vascular approach by cardiovascular surgeons using the Seldinger technique. Cannulation was most commonly performed in the femoral vein and femoral artery. The size of the cannula ranged from 16 to 18 Fr for the femoral artery and from 20 to 22 Fr for the femoral vein. The Capiox Emergency Bypass System (Capiox EBS, Terumo Inc., Tokyo, Japan) and Permanent Life Support (Maquet, Rastatt, Germany) were used. Continuous unfractionated heparin was infused to maintain the activated partial thromboplastin time between 45 and 60 seconds, or activated clotting time between 140 and 180 seconds. We tried to maintain the mean arterial pressure between 65 and 80 mm Hg.
4
ECMO Initiation and Management Protocol
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Intensive care specialists, cardiologists, or cardiothoracic surgeons determined the need for ECMO initiation by evaluating the patient’s medical condition. The ECMO techniques used in our institution have been described in a previously published study7 (link). Cannulation was performed using the Seldinger technique, and the preferred cannulation sites were the femoral and internal jugular veins for VV ECMO and the femoral vein and artery for VA ECMO. If additional cardiogenic support was required for patients receiving VV ECMO, an additional arterial catheter was inserted and the mode was switched to VAV ECMO. For the analysis, the specific mode with the highest number of catheters inserted was determined for each ECMO mode. All patients who underwent ECMO cannulation were infused with heparin (2000 IU). The target activated coagulation time was 180–200 s. The Capiox EBS (Terumo Co., Ltd., Tokyo, Japan) or Bioline heparin-coated Quadrox PLS circuit system (Maquet Cardiopulmonary, Hirrlingen, Germany) was used in all patients. All ECMO patients requiring addition of continuous renal replacement therapy (CRRT) used separate circuits for each system.
5
ECPR for In-Hospital Cardiac Arrest
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A total of 82 patients underwent ECMO (CAPIOX EBS®; Terumo, Tokyo, Japan) at our institution between July 2011 and December 2015. Of these, 23 patients underwent ECPR for IHCA. Among these, we excluded 4 patients who received ECPR immediately after cardiac arrest, from an ECMO team that was already activated before the arrest occurred. We excluded another 3 patients who did not undergo subsequent therapeutic hypothermia. Finally, we identified 16 patients who met the enrollment criteria (Figure 1 ). The primary outcome of the study was in-hospital mortality, and the secondary outcome was 1-year survival.
This study was approved by our Ethics Committee/Institutional Review Board, which waived the requirement for informed patient consent because of the retrospective nature of the analysis.
This study was approved by our Ethics Committee/Institutional Review Board, which waived the requirement for informed patient consent because of the retrospective nature of the analysis.
6
ECMO System Percutaneous Femoral Cannulation
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The ECMO system consists of a centrifugal blood pump with a pump controller (Capiox SP®, Terumo Inc., Tokyo, Japan), a polymethylpentene (PMP) circuit (Capiox EBS® with X coating, Terumo Inc., Tokyo, Japan) with poly-(2-methoxyethyl acrylate) (PMEA) polymer-coated polyvinylchloride (PVC) tubing and an air-oxygen mixer (Secrist Ind., Anaheim, CA, USA). The centrifugal blood pump was set at an initial blow flow of 3.0–4.0 L/min. ECMO equipment was implanted using percutaneous femoral peripheral cannulation with a 17-Fr arterial cannula (BioMedicus Medtronic Inc., Minneapolis, MN, USA) and a 21-Fr venous cannula (BioMedicus multistage femoral venous cannula).
7
Extracorporeal Membrane Oxygenation Protocol
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We used Capiox EBS (Terumo, Tokyo, Japan) or PLS (MAQUET, Hirrlingen, Germany) equipment. One femoral vein and 1 femoral artery (VA ECMO) were percutaneously cannulated using the Seldinger technique under fluoroscopic guidance. 17- to 19-Fr (for artery) and 21-Fr (for vein) cannulas were placed (DLP and Bio-Medicus, Medtronic, Minneapolis, MN,; RMI, Edward's Life sciences LLC, Irine, CA). Circulation through ECMO system was established with venous blood drainage from the right atrium and arterial blood return to the femoral artery. During ECMO support, mean arterial pressure was maintained at > 60 mm Hg and the target activated partial thromboplastin time (aPTT) was 60 to 80 s; heparin or nafamostat mesilate (SK Chemicals Life Science Biz., Seoul, Korea; licensed by Torii Pharmaceutical, Tokyo, Japan) was used for anticoagulation. The target hematocrit and platelet counts were > 35% and > 50,000 to 80,000/mm3, respectively. Patients received antithrombin III when the initial antithrombin III level was < 70%, with a loading dose of 2,000 IU followed by a maintenance dose of 500 IU every 6 hours for 3 days. Continuous renal replacement therapy (CRRT) was commenced if a patient exhibited progressive oliguria (i.e., urine output < 0.5 cc/kg/h for > 6 hours).
8
Percutaneous Veno-Arterial ECMO Initiation
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VA-ECMO was administered in the ED in the ED-ECPR cohort, whereas a cardiovascular fluoroscopy room was used for the initiation of VA-ECMO in the ECPR-call group. The inflow and outflow cannulas were inserted into the femoral vessels by a cardiologist using the percutaneous Seldinger technique. An inflow cannula was inserted into the femoral artery and an outflow cannula was implanted into the femoral vein. The target perfusion volume was 60 mL/kg based on the approximate patient weight. For achieving a flow rate of 4 L/min, a 16.5 Fr cannula was selected for the inflow, paired with a 21 Fr cannula for the outflow; whereas for a flow rate of 3 L/min, a 15 Fr cannula was selected for the inflow along with a 19.5 Fr cannula for the outflow. Cannula size was determined according to the surgeon's instructions. The ECMO centrifugal pumps, circuits, and cannulation were of the same type (Capiox EBS; Terumo Corp., Tokyo, Japan).
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