Edward Darling
State University of New York Upstate Medical University
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Featured researches published by Edward Darling.
Perfusion | 2007
Joshua Walker; Johanna Primmer; Bruce Searles; Edward Darling
Introduction. Some degree of recirculation occurs during venovenous extracorporeal membrane oxygenation (VV ECMO) which, (1) reduces oxygen (O2) delivery, and (2) renders venous line oxygen saturation monitoring unreliable as an index of perfusion adequacy. Ultrasound dilution allows clinicians to rapidly monitor and quantify the percent of recirculation that is occurring during VV ECMO. The purpose of this paper is to test whether accurate patient mixed venous oxygen saturation (SVO2) can be calculated once recirculation is determined. It is hypothesized that it is possible to derive patient mixed venous saturations by integrating recirculation data with the ECMO circuit arterial and venous line oxygen saturation data. Methods. A test system containing sheep blood adjusted to three venous saturations (low-30%, med-60%, high-80%) was interfaced via a mixing chamber with a standard VV ECMO circuit. Recirculation, arterial line and venous line oxygen saturations were measured and entered into a derived equation to calculate the mixed venous saturation. The resulting value was compared to the actual mixed venous saturation. Results. Recirculation was held constant at 30.5 ± 2.0% for all tests. A linear regression comparison of “actual” versus “calculated” mixed venous saturations produced a correlation coefficient of R2 = 0.88. Direct comparison of actual versus calculated saturations for all three test groups respectively are as follows; Low: 31.8 ± 3.95% vs. 37.0 ± 6.7% (NS), Med: 61.7 ± 1.5% vs. 72.3 ± 1.8% (p < 0.05), High: 84.4 ± 0.9% vs. 91.2 ± 1.1% (p < 0.05). Discussion. There was a strong correlation between actual and calculated mixed venous saturations; however, significant differences between actual and calculated values where observed at the Med and High groups. While this data suggests that using quantified recirculation data to calculate SVO2 is promising, it appears that a straightforward derivative of the oxygen saturation-based equation may not be sufficient to produce clinically accurate calculations of actual mixed venous saturations. Perfusion (2007) 22, 239—244.
Critical Care Clinics | 2017
David Fitzgerald; Edward Darling; Monika F. Cardona
Although the reasons for the recent growth in adult extracorporeal membrane oxygenation (ECMO) are multifactorial, much of the success may be attributed to the development of well-trained staff and the technological innovations in equipment and monitoring devices used during extracorporeal support. In this article, the authors discuss general educational formats for the ECMO bedside provider, staffing support models, and devices designed to best meet the needs of the patient while simultaneously ensuring the proper delivery of ECMO-related care.
Perfusion | 2012
T Kelting; Bruce Searles; Edward Darling
The ideal location of air bubble detector (ABD) placement on the cardiopulmonary bypass (CPB) circuit is debatable. There is, however, very little data characterizing the prevalence of specific ABD placement preferences by perfusionists. Therefore, the purpose of this study was to survey the perfusion community to collect data describing the primary locations of air bubble detector placement on the CPB circuit. In June 2011, an 18-question on-line survey was conducted. Completed surveys were received from 627 participants. Of these, analysis of the responses from the 559 certified clinical perfusionists (CCP) was performed. The routine use of ABD during CPB was reported by 96.8% of CCPs. Of this group, specific placement of the bubble detector is as follows: distal to the venous reservoir outlet (35.6%), between the arterial pump and oxygenator (3.8%), between the oxygenator and arterial line filter (35.1%), distal to the arterial line filter (ALF) (23.6%), and other (1.8%). Those placing the ABD distal to the venous reservoir predominately argued that an emptied venous reservoir was the most likely place to introduce air into the circuit. Those who placed the ABD between the oxygenator and the arterial line filter commonly reasoned that this placement protects against air exiting the membrane. Those placing the ABD distal to the ALF (23.6%) cited that this location protects from all possible entry points of air. A recent false alarm event from an ABD during a case was reported by 36.1% of CCPs. This study demonstrates that the majority of CCPs use an ABD during the conduct of CPB. The placement of the ABD on the circuit, however, is highly variable across the perfusion community. A strong rationale for the various ABD placements suggests that the adoption of multiple ABD may offer the greatest comprehensive protection against air emboli.
Archive | 2008
Bruce Searles; Edward Darling
Ultrafiltration is the removal of plasma water and its soluble components across a microporous membrane. Various ultrafiltration techniques have been developed for use in cardiopulmonary bypass (CPB). These techniques can be categorized into two rationales: blood concentration and blood nitration. This chapter introduces the reader to the spectrum of ultrafiltration techniques that can be applied to CPB. Special emphasis is placed on the technical considerations for integrating these techniques into clinical practice and a literature review of the reported outcome measures for each technique.
The journal of extra-corporeal technology | 2004
Jeffrey B. Riley; Jon W. Austin; David W. Holt; Bruce Searles; Edward Darling
Perfusion | 2003
Richard M. Ginther; Roy Fillingham; Bruce Searles; Edward Darling
The journal of extra-corporeal technology | 2004
Karen Jones; Fadi Nasrallah; Edward Darling; Nicole Clay; Bruce Searles
Pediatric Cardiology | 2011
Edward Darling; Naveen Thuramalla; Bruce Searles
The journal of extra-corporeal technology | 2004
Ben Roeder; Susan Graham; Bruce Searles; Edward Darling
The journal of extra-corporeal technology | 2002
Edward Darling; Bruce Searles; Fadi Nasrallah; Michael Robins; Xiaomang You; Louis A. Gatto; Nicole Clay; Anthony Picone; Jay Steinberg; Gary F. Nieman