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Failure Mode Effects Analysis (FMEA) of Cryospray Ablation in the Airways of Swine
Author(s) -
Krimsky William,
Sarkar Saiyad,
McKenzie Karen,
Petras Robert,
Cartledge Jennifer,
Askew Timothy
Publication year - 2008
Publication title -
the faseb journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.709
H-Index - 277
eISSN - 1530-6860
pISSN - 0892-6638
DOI - 10.1096/fasebj.22.1_supplement.1220.1
Subject(s) - medicine , fluoroscopy , airway , pulmonary artery , catheter , cardiology , ventricle , heart failure , anesthesia , pulse oximetry , surgery
Background: Cryospray Ablation (CSA) evokes tissue necrosis, allowing the regeneration of healthy tissue. In order to determine feasibility and safety of CSA for human lung disease, we tested FMEA in swine. Methods: Three swine were tested to cardiopulmonary collapse defined as the absence of tissue perfusion and oxygenation. Physiologic measurements were continuously assessed, including pulmonary artery pressure, end tidal (EtCO2), pulse oximetry, EKG, BP, and fluoroscopy of the chest. The cryospray catheter was placed into the airway via the bronchoscope and a closed system was maintained. Cryospray was delivered into the airway until cardiopulmonary collapse (CPC). Results: The appearance of barotrauma on fluoroscopy defined as a visible pneumothorax did not result in substantive change of hemodynamic or gas exchange parameters. However, progressive increases in intrathoracic pressure from the continued delivery of the cryospray resulted in CPC secondary to right heart failure. The heralding event of collapse in all animals was the eventration of the right ventricle on fluoroscopy followed rapidly by the development of a non‐perfusing rhythm, the loss of a waveform on the pulmonary artery catheter (PAC), and the loss of EtCO2 and pulse oximetry data. Using pulmonary artery systolic pressure (PASP) as a surrogate for intrathoracic pressure, PAC data suggested it was necessary to raise PASP to greater than 70mmHG (baseline values ∼20mmHG) to achieve the above result. Cardiac function could be restored to normal upon the retardation of cryospray. There was no evidence of airway disruption. Conclusion: FMEA of the CSA system in the airway suggests the potential to safely use this modality for the treatment of human lung diseases.