Редактирование: Artificial organs (раздел)

=== Artificial heart + lungs ===
'''ECMO A/V'''<br/>
ECMO is like artificial heart + lungs.<br/>
"People can stay on ECMO anywhere from days to weeks"[https://my.clevelandclinic.org/health/treatments/21722-extracorporeal-membrane-oxygenation-ecmo] <br/>
[[Record of successful being on ECMO |Record of successful being on A/V ECMO]] seems like at least 37 days (or maybe 87 days).<br/>
How much survival depends on how long you have been on ECMO? What complications ECMO has that it's used for only weeks? <br/>
ECMO mortality is high (~34% for adults[https://pubmed.ncbi.nlm.nih.gov/12220309/]) but perhaps in part due to acute health problems preceding ECMO?<br/>
Anyway, ~63% of deaths on AV ECMO were due to multiorgan failure: https://pubmed.ncbi.nlm.nih.gov/23616484/, table 2.<br/>
Multiorgan failure happens largely due to sepsis or <br/>
A good video is...<br/>
Currently, "Most people with end-stage heart failure have a life expectancy of less than 1 year"[https://samaritannj.org/hospice-blog-and-events/hospice-palliative-care-blog/end-stage-heart-failure-what-to-expect/]<br/>
Median cost of ECMO in Norway in 2007 was ~$62k, median total hospital cost ~$191k, mean stay on ECMO was 9.5 days https://pubmed.ncbi.nlm.nih.gov/19699650/ <br/>

'''ECMO V/V'''<br/>
ECMO V/V is like artificial lungs<br/>
[[Record of successful being on ECMO |Record of successful being on V/V ECMO]] seems like about >300days or at least 107 days.<br/>

'''Generally about ECMO'''<br/>
"The incidence of acute kidney injury is 70-85% in ECMO patients. Therefore, renal replacement therapy is required in approximately 50% of these patients"<ref name="pubmed24928419">https://pubmed.ncbi.nlm.nih.gov/24928419/</ref>  However, that can be partly explained by the fact that patietns have factors for AKI even before ECMO: "Prior to the initiation of ECMO, the etiology of AKI in these patients is almost always because of multiple factors such as sepsis, low cardiac output syndrome, exposure to nephrotoxic agents"<ref name="pubmed24928419">https://pubmed.ncbi.nlm.nih.gov/24928419/</ref>.<br/>
ECMO introduces major haemodynamic changes and needs anticoagulation treatment (which might cause bleeding complications)<ref>https://pubmed.ncbi.nlm.nih.gov/32095838/</ref>. Would we need anticoagulation treatment in head transplantation to artificial body? Btw would it be simpler to have access to major brain arteries to somehow alleviate their probable atherosclerotic processes? (with stents/etc). <br/>

'''About artificial heart (w/o lungs).'''<br/>
Syncardia artificial heart is the only biventricular cardiac replacement approved by FDA[https://pubmed.ncbi.nlm.nih.gov/34181241/].

Syncardia artificial hearts were implanted in more than 2000 patients worldwide<ref name="syncardiafaq">https://syncardia.com/faqs/</ref> <br/>
(btw, "The TAH-t has been covered by Medicare since 2008"<ref name="syncardiafaq">https://syncardia.com/faqs/</ref>) <br/>

"After a TAH-t patient becomes clinically stable, they can be switched from the Companion 2 (C2) Hospital Driver to the Freedom Driver, a smaller, lighter pneumatic pump"<ref name="syncardia_freedom">https://syncardia.com/freedom-portable-driver-system/</ref> which weights just ~6.8kg. Though it was approved by FDA in 2014 (and in Canada in 2011), the current experience is just 240 patient-years<ref name="syncardia_freedom">https://syncardia.com/freedom-portable-driver-system/</ref> (as of jan2023).

However, the total number of surgeries with artificial heart implantation seems to decrease rapidly in recent years. <br/>
For example, this 2022y paper of Cedar Sinai Medical Center says: "The annual volume increased from 1 case in 2012 to 24 cases in 2014, and subsequently declined thereafter to 1 case in 2022" (p.2); "The utilization of TAH-t at our center has decreased dramatically. That decrease is in large part due to improvements in short-term MCS options such as ECMO and improved outcomes with left ventricular assist device therapy" (p.6).