scholarly journals Clinical agreement and interchangeability of TEG5000 and TEG6s during cardiac surgery

2020 ◽  
Vol 48 (1) ◽  
pp. 43-52
Author(s):  
Qi Wong ◽  
Kelly P Byrne ◽  
Scott C Robinson
Keyword(s):  
Cardiac Surgery ◽  
Reaction Time ◽  
Alpha Angle ◽  
Maximum Amplitude ◽  
Surgical Patients ◽  
Treatment Recommendation ◽  
New Device ◽  
Management Algorithm ◽  
Arterial Blood ◽  
Significant Difference

TEG6s® is a new device introduced by the Haemonetics Corporation and designed to provide the same information as TEG® 5000 (Haemonetics Corporation, Braintree, MA, USA) but with much greater ease of use. We tested whether using citrated TEG6s gave reaction time, maximum amplitude and percentage of clot that had lysed at 30 minutes values similar to a non-citrated TEG5000, to allow clinical interchangeability using our current thrombelastography management algorithm for cardiac surgery. We also examined the agreement between the alpha-angle and functional fibrinogen maximum amplitude in our cardiac surgical patients.  In total, 243 paired arterial blood samples in 99 patients were tested, using TEG5000 (non-citrated) and TEG6s (citrated) after induction of anaesthesia (prior to heparin administration), following protamine administration at the end of the cardiac bypass and whenever a TEG5000 was requested after this by the attending anaesthetist. Bland–Altman plots and Lin’s concordance coefficient were used to compare agreement whereas modified Bland–Altman plots and McNemar’s test were used to illustrate the differences in management recommendations between the two thrombelastography devices.  All 243 samples were compared for reaction time and alpha-angle; 239 samples were compared for maximum amplitude; 136 samples were compared for the percentage of clot that had lysed at 30 minutes; 16 samples were compared for functional fibrinogen maximum amplitude. Lin’s concordance coefficient for these parameters was: reaction time 0.63, alpha-angle 0.39, maximum amplitude 0.5, percentage of clot that had lysed at 30 minutes 0.09 and functional fibrinogen maximum amplitude 0.31. Differences between the two devices became more marked at more abnormal values. Significant differences in median values, suggesting a fixed bias, were found for maximum amplitude and functional fibrinogen maximum amplitude. Differences in treatment recommendation could only be calculated for reaction time and maximum amplitude. Maximum amplitude was found to have a significant difference in treatment recommendation between the two devices using our current thrombelastography management algorithm for cardiac surgery with TEG6s recommending treatment in 11.5% more patients than TEG5000.  Using the TEG6s with our current TEG5000–based thrombelastography management algorithm for cardiac surgery would result in a change in treatment recommendation in at least 10% of our cardiac surgical patients. Agreement between the two thrombelastography devices appears to decrease with increasing patient coagulopathy. New algorithms will need to be developed and tested to validate TEG6s for cardiac surgical patients in our institution.

The Effects of Aprotinin on Thromboelastography with Three Different Activators

2001 ◽  
Vol 95 (5) ◽  
pp. 1169-1174 ◽  
Author(s):  
Michael S. Avidan ◽  
Jorge Da Fonseca ◽  
Kiran Parmar ◽  
Emma Alcock ◽  
José Ponte ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Reaction Time ◽  
Tissue Factor ◽  
Alpha Angle ◽  
Maximum Amplitude ◽  
International Normalized Ratio ◽  
Clot Strength ◽  
Product Usage ◽  
Activated Clotting Time ◽  
Before And After

Background Thromboelastography is used for assessment of hemostasis. Adherence to thromboelastography-guided algorithms and aprotinin administration each decrease bleeding and blood product usage after cardiac surgery. Aprotinin, through inhibition of kallikrein, causes prolongation of the celite-activated clotting time and the activated partial thromboplastin ratio. The aim of this study was to assess the effects of aprotinin on the thromboelastography trace. Methods Three activators were used in the thromboelastography: celite (which is widely established), kaolin, and tissue factor. Assessment was performed on blood from volunteers and from patients before and after cardiac surgery. Results The tissue factor-activated thromboelastography trace was unaffected by the addition of aprotinin. When celite and kaolin were used as activators in the presence of aprotinin, the reaction time (time to clot formation) of the thromboelastography trace was prolonged (P < 0.0001) and the maximum amplitude (clot strength) was decreased (P < 0.05). With celite as an activator, the addition of aprotinin decreased (P < 0.05) the thromboelastography alpha angle (rate of clot extension). The reaction time of the celite-activated trace correlated with the activated partial thromboplastin ratio (P < 0.01). The reaction time of the tissue factor-activated trace correlated with the international normalized ratio (P < 0.01). Conclusion The thromboelastography trace is altered in the presence of aprotinin when celite and kaolin are used as activators but not when tissue factor is the activator.

scholarly journals Comparing citrated native, kaolin-activated, and tissue factor–activated samples and determining intraindividual variability for feline thromboelastography

2011 ◽  
Vol 23 (6) ◽  
pp. 1109-1113 ◽  
Author(s):  
Amrita Banerjee ◽  
Shauna L. Blois ◽  
R. Darren Wood
Keyword(s):  
Veterinary Medicine ◽  
Tissue Factor ◽  
Blood Test ◽  
Jugular Vein ◽  
Point Of Care ◽  
Alpha Angle ◽  
Maximum Amplitude ◽  
Intraindividual Variability ◽  
Significant Difference ◽  
Kappa Value

Thromboelastography (TEG) is a point-of-care whole blood test of hemostasis. While TEG is becoming more widely used in veterinary medicine, few studies describe the use of TEG in cats. The objectives of the current study were to: 1) document the range of TEG variables produced in healthy cats using 3 sample types (citrated native, kaolin-activated, and tissue factor–activated), and 2) determine if there was a significant difference between 2 separate samples obtained from individual healthy cats on the same day. Jugular venipuncture was performed in 20 cats, and citrated blood collected for TEG. TEG analysis was performed on citrated native, kaolin-activated, and tissue factor–activated blood for each sample. Two hours later, the procedure was repeated from the opposite jugular vein, yielding a total of 120 analyses. Reaction time ( R), alpha angle (α), kappa value (κ), and maximum amplitude (MA) were recorded from each tracing. No significant differences were found between TEG tracings from the first and second venipuncture samples. Significant differences were found between sample types for R, α, κ, and MA. Means for citrated native/kaolin-activated/tissue factor–activated methods were R = 4.1/3.7/0.6 min; κ = 2.5/1.8/2.2 min; α = 59.9/65.1/70.4 degrees; MA = 47.4/49.9/44.7 mm. A limitation of this study was the small number of cats used. Thromboelastography analysis may be a suitable method of evaluating hemostasis in cats.

Influence of needle gauge and venepuncture difficulty on thromboelastography in healthy cats

2018 ◽  
Vol 21 (8) ◽  
pp. 708-713 ◽  
Author(s):  
Duree Shin ◽  
Aryung Nam ◽  
Kun Ho Song ◽  
Kyoung Won Seo
Keyword(s):  
Jugular Vein ◽  
Alpha Angle ◽  
Maximum Amplitude ◽  
Clot Strength ◽  
Blood Samples ◽  
Study Results ◽  
Significant Difference ◽  
Whole Blood Samples ◽  
Difficulty Score ◽  
Clot Formation Time

Objectives The aim of this study was to evaluate the effect of two differently sized butterfly catheter needles and the effect of venepuncture difficulty on thromboelastography (TEG) results in healthy cats. Methods Twenty-four healthy cats were included. Blood samples were collected from the jugular vein by syringe aspiration via direct venepuncture with 21 G and 22 G butterfly needles. The venepuncture difficulty score was classified into four categories. The first 1.5 ml blood drawn from each subject was discarded before collecting a sample for TEG analysis. TEG analyses were performed on citrated whole blood samples from 17 clinically healthy cats, using assays with kaolin as activators. Among the TEG parameters, reaction time (R), clot formation time (κ), alpha angle (α), maximum amplitude (MA) and global clot strength (G) were recorded from each tracing. Results Seven cats were excluded from the study; results were obtained for the remaining 17 cats. There were no statistically significant differences between the use of two different needles for R ( P = 0.72), κ ( P = 0.74), α ( P = 0.99), MA ( P = 0.08) and G ( P = 0.09). Samples with difficulty scores ⩾1 were not significantly different from samples with difficulty scores of 0 for R ( P = 0.24), κ ( P = 0.65), α ( P = 0.65), MA ( P = 0.72) and G ( P = 0.77). Conclusions and relevance The results of TEG in clinically healthy cats do not differ significantly when using two different gauge needles. There was no significant difference in the TEG results according to venepuncture difficulty scoring.

scholarly journals Remifentanil Concentration during Target-controlled Infusion of Propofol

2002 ◽  
Vol 30 (5) ◽  
pp. 578-583 ◽  
Author(s):  
D. P. Crankshaw ◽  
C. Chan ◽  
K. Leslie ◽  
A. R. Bjorksten
Keyword(s):  
High Performance ◽  
Sequential Analysis ◽  
Surgical Patients ◽  
Target Concentration ◽  
Blood Concentrations ◽  
Remifentanil Infusion ◽  
Arterial Blood ◽  
Respiratory Parameters ◽  
Significant Difference ◽  
Written Informed Consent

After institutional approval and with written informed consent, eight surgical patients were infused intravenously with remifentanil at 250 ng.kg lean body mass (LBM) -1 .min -1 for 30 min. Cardiovascular and respiratory parameters were recorded and arterial blood samples were taken at regular intervals. In each patient, the same protocol was repeated 40 min later during propofol infused to a target concentration of 3.0 μg.ml -1. Blood concentrations of remifentanil and propofol were assayed using capillary gas chromatography and high performance liquid chromatography techniques respectively. The number of subjects enrolled was determined by testing the successive areas under the remifentanil time-concentration curve (AUC) for significant difference or non-difference using sequential analysis. The median measured propofol concentration was 3.5 (range: 2.6–4.5) μg.ml -1 which did not change significantly during the second remifentanil infusion. The median AUC during propofol infusion was greater than control in all subjects, although there was considerable variation of 94.4 (64.3–129.6) versus 64.6 (34.8–126.9) ng.ml -1 .min; P=0.008, n=8. After 30 min, there was no significant difference in remifentanil concentration during propofol infusion when compared with remifentanil alone of 4.6 (3.2–5.7) versus 3.8 (1.6–4.9) ng.ml -1; P=0.73, n=8. Co-administration of propofol and remifentanil may result in greater remifentanil concentrations than when remifentanil is infused alone.

Pentraxin 3 and other inflammatory biomarkers related to atrial fibrillation in cardiac surgery

Perfusion ◽  
2016 ◽  
Vol 32 (4) ◽  
pp. 269-278 ◽  
Author(s):  
Zdenka Holubcova ◽  
Pavel Kunes ◽  
Jiri Mandak ◽  
Dana Vlaskova ◽  
Martina Kolackova ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Serum Levels ◽  
Inflammatory Biomarkers ◽  
Surgical Patients ◽  
Significant Difference ◽  
History Of ◽  
Group A ◽  
Group B ◽  
New Onset

Objectives: The aim was to evaluate the association between perioperative inflammatory biomarkers and atrial fibrillation (AF) in cardiac surgical patients. Methods: Forty-two patients undergoing cardiac surgery were divided into three groups according to the occurrence of AF: Group A (n = 22) – patients with no AF, Group B (n = 11) – patients with new onset AF postoperatively and Group C (n = 9) – patients with preoperative history of atrial fibrillation. The serum levels of PTX3, CRP, TLR2, IL-8, IL-18, sFas, MMP-7 and MMP-8 were measured at the following time points: before surgery, immediately and 6 h after surgery and on the 1st, 3rd and 7th postoperative days (POD). Results: Serum levels of PTX3 showed a significant difference between Groups A and C on the 3rd POD (p<0.05) and on the 7th POD (p<0.0001). IL-8 levels were different between Groups A and C immediately after surgery (p<0.05), 6 hours after surgery (p<0.05) and on the 3rd POD (p<0.05). There was a difference between Groups B and C on the 1st POD in IL-8 levels (p<0.05). The sFas levels differed between Groups A and C on the 3rd POD (p<0.01) and the 7th POD (p<0.05). There was also a difference on the 7th POD (p<0.05) between the Groups B and C. No significant differences between the groups was seen for other biomarkers. Conclusion: This study demonstrates significantly different dynamics of PTX3, IL-8 and sFas levels after cardiac surgery in relation to AF.

Expression of CD200/CD200R regulatory molecules on granulocytes and monocytes is modulated by cardiac surgical operation

Perfusion ◽  
2010 ◽  
Vol 25 (6) ◽  
pp. 389-397 ◽  
Author(s):  
Jan Krejsek ◽  
Martina Kolackova ◽  
Jiri Mandak ◽  
Pavel Kunes ◽  
Karolina Jankovicova ◽  
...  
Keyword(s):  
Flow Cytometry ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Inflammatory Response ◽  
Early Postoperative Period ◽  
Regulatory Mechanisms ◽  
Surgical Patients ◽  
Surgical Operation ◽  
Significant Difference ◽  
Time Point

Aims: Cardiac surgical operation is inseparably linked to the induction of an inflammatory response. Both humoral and cellular regulatory mechanisms are operating to maintain body homeostasis. We followed the changes in the expression of CD200/CD200R regulatory molecules on monocytes and granulocyte of cardiac surgical patients operated on using either standard (OP) or modified “mini-invasive” cardiopulmonary bypass (MOP). Methods: Expression of CD200/CD200R regulatory molecules was determined by flow cytometry. Results: The expression of CD200R on granulocytes was increased after surgery in both groups of patients, but the increase was statistically significant only in OP patients (p<0.01). At this time point, there was a significant difference in CD200R expression on granulocytes when comparing OP to MOP patients, being higher in the former group (p<0.01). The expression of CD200R on monocytes was diminished after surgery and during an early postoperative period in both groups of patients. The expression of CD200 on monocytes was significantly diminished after surgery in both groups (p<0.01). Nonetheless, we observed an increase in CD200 expression in OP patients at the 3rd postoperative day. There was a statistically significantly increased CD200 expression on monocytes of OP patients (p<0.001) at the 3rd postoperative day when we compared OP and MOP groups. The expression of CD200 on granulocytes was significantly higher after surgery and at the 3rd postoperative day in OP when compared to MOP patients. Conclusions: CD200R expression on granulocytes was significantly increased, while CD200 and CD200R expression on monocytes was decreased after cardiac surgery.

scholarly journals Conservative versus conventional oxygen therapy for cardiac surgical patients: A before-and-after study

2019 ◽  
Vol 47 (2) ◽  
pp. 175-182 ◽  
Author(s):  
Glenn M Eastwood ◽  
Matthew J Chan ◽  
Leah Peck ◽  
Helen Young ◽  
Johan Mårtensson ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Oxygen Therapy ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Surgical Patients ◽  
Arterial Blood Gas ◽  
Conservative Group ◽  
Arterial Blood ◽  
Before And After ◽  
Therapy Target

Avoiding hypoxaemia is considered crucial in cardiac surgery patients admitted to the intensive care unit (ICU). However, avoiding hyperoxaemia may also be important. A conservative approach to oxygen therapy may reduce exposure to hyperoxaemia without increasing the risk of hypoxaemia. Using a before-and-after design, we evaluated the introduction of conservative oxygen therapy (target SpO2 88%–92% using the lowest FiO2) for cardiac surgical patients admitted to the ICU. We studied 9041 arterial blood gas (ABG) datasets: 4298 ABGs from 245 ‘conventional’ and 4743 ABGs from 298 ‘conservative’ oxygen therapy patients. During mechanical ventilation (MV) and while in the ICU, compared to the conventional group, conservative group patients had significantly lower FiO2 exposure and PaO2 values ( P < 0.001 for each). Accordingly, using the mean PaO2 during MV, more conservative group patients were classified as normoxaemic (226 versus 62 patients, P < 0.01), fewer as hyperoxaemic (66 versus 178 patients, P < 0.01) and no patient in either group as hypoxaemic or severely hypoxaemic. Moreover, more ABG samples were hyperoxaemic or severely hyperoxaemic during conventional treatment ( P < 0.001). Finally, there was no difference in ICU or hospital length of stay, ICU or hospital mortality or 30-day mortality between the groups. Our findings support the feasibility and physiological safety of conservative oxygen therapy in patients admitted to ICU after cardiac surgery.

scholarly journals Whole Blood Stored at 4°C for 7 Days Is Equivalent to Fresh Whole Blood for Resuscitation of Severe Polytrauma

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 1558-1558 ◽  
Author(s):  
Daniel N Darlington ◽  
Jacob Chen ◽  
Xiaowu Wu ◽  
Jeffery Keesee ◽  
Bin Liu ◽  
...  
Keyword(s):  
Platelet Aggregation ◽  
Arterial Pressure ◽  
Blood Volume ◽  
Whole Blood ◽  
Prehospital Care ◽  
Alpha Angle ◽  
Plasma Lactate ◽  
Arterial Blood ◽  
Significant Difference ◽  
The Right

Abstract Background: Currently, whole blood is rarely used in trauma resuscitation due, in part, to the widely held belief that refrigeration will reduce the hemostatic efficacy of stored platelets. Recently, however, Pidcoke et al. (Transfusion 2013, 53:137s) showed that hemostatic function of human whole blood was well preserved when stored at 4°C for up to 21 days. The hemostatic and resuscitative efficacy of cold-stored whole blood has not been tested in a coagulopathic animal polytrauma model. Hypothesis: We hypothesized that blood stored for 7 days at 4°C is equivalent to fresh whole blood with regard to hemostatic and coagulation function in resuscitation of severe trauma. Method: Sprague-Dawley rats (300-400g) were anesthetized with Isoflurane. Polytrauma was induced by damaging the small intestines, the left and medial liver lobes, the right leg skeletal muscle, and by fracturing the right femur. The rats were then bled to a mean arterial pressure of 40mmHg and held there until 40% of the blood volume was removed. Hemorrhage was usually completed between 30-60 min. Resuscitation was started at 1hr and included the following groups: Lactated Ringer’s (LR), fresh whole blood (FWB) or FWB stored at 4°C for 7 days (sFWB). The resuscitation volume was 20% of blood volume and represents the approximate volume used in prehospital care of trauma patients in both civilian and military settings. The experiment was terminated at 2hrs. Blood samples were taken before (time 0) and 2hrs after trauma (1hr after resuscitation) to assess hemostatic function. Prothombin time (PT), activated partial thromboplastin time (aPTT) and fibrinogen were measured on ST-4 (Stago). Platelet aggregation was measured with Multiplate (Diapharma) after stimulation with ADP, collagen or thrombin (PAR4) and expressed as area under the curve per 1000 platelets. Clotting function was assessed using ROTEM (Tem International). Results: Resuscitation with FWB and sFWB led to recovery of mean arterial blood pressure to levels similar to baseline (FWB 92±2.4 to 86±3, sFWB 93±3 to 91±4). Resuscitation with LR led to a significantly lower arterial pressure (96±3 to 61±3.8mmHg, p<0.05). Plasma lactate levels were significantly elevated in all groups. However, plasma lactate was lower after resuscitation with FWB and sFWB (0.52±0.06 to 1.22±0.08, and 0.5±0.05 to 1.28±0.12mM, respectively), as compared to LR (0.47±0.05 to 2.36±0.24mM). Several coagulation parameters changed significantly after resuscitation (PT, aPTT, fibrinogen, mean clotting firmness, clotting time and alpha angle). However, there was no difference in the change of any of these parameters between animals treated with FWB or sFWB. Because platelets make up most of the clot strength, we assessed the ability of agonists (ADP, thrombin agonist, collagen) to stimulate platelet aggregation. The degree of aggregation after resuscitation with all fluids was significantly decreased to stimulation with collagen (15 to 26%). However there was no significant difference in the aggregation changes between the FWB or sFWB groups. Resuscitation with any of the fluids had no effect on ADP or PAR4 stimulation of aggregation. Conclusion: These data strongly suggest that FWB and FWB stored for 7days at 4° are equivalent for treating severe polytrauma and hemorrhage when considering recovery of arterial pressure and plasma lactate, changes in clotting function and changes in platelet aggregation as endpoints necessary for recovery of the patient. This project was funded by the US Army Medical Research and Materiel Command. Disclosures No relevant conflicts of interest to declare.

Safety and Efficacy of Recombinant Factor VIIa (NovoSeven) Use during ECMO Support in Patients after Cardiac Surgery

2021 ◽  
Vol 5 (4) ◽  
Author(s):  
Natanov R ◽  
◽  
Madrahimov N ◽  
Fleissner F ◽  
Mogaldea A ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Recombinant Factor Viia ◽  
Factor Viia ◽  
Postoperative Bleeding ◽  
Ecmo Support ◽  
Surgical Patients ◽  
Safety And Efficacy ◽  
Rfviia Administration ◽  
Significant Difference ◽  
Ecmo Therapy

Background: Acute postoperative bleeding in cardiac surgical patients is a major cause of morbidity and mortality. Substitution of coagulatory factors may not always provide optimal hemostasis and off label, use of recombinant FVIIa has been proposed. When on ECMO, extra care must be taken during coagulatory substitution as clotting of the system may cause cardiovascular complications and possible ECMO failure, leading to death. In this paper, we examined the safety and efficacy of rFVIIa during ECMO support in postoperative cardio-surgical patients. Methods: We retrospectively examined all patients receiving rFVIIa postoperatively from December 2005 and January 2020. Clinical characteristics, demographics, bleeding, thrombotic complications, mortality, and rFVIIa administration were analyzed. Results: A total of 74 patients received rFVIIa postoperatively due to uncontrollable bleeding after cardiac surgery on our ICU. Of these patients, 23 patients were on ECMO treatment. Twelve patients received rFVIIa during, but not prior to the initiation of ECMO therapy. Six patients (50%) were male; mean age was 46 years (30-72 years). Eleven patients (91.7%) were on venoarterial ECMO, one patient was on central ECMO (8.3%). Dose of administered rFVIIa was corrected for body weight; mean dosage was 82μg/kg. We saw a significant reduction in need for red packed cells, fresh frozen plasma and thrombocyte transfusion after rFVIIa administration. There was no impact on the functionality of the ECMO system, especially regarding the oxygenator after rFVIIa administration. One patient suffered a stroke due thromboembolism (8.3%). One patient developed late thromboembolism in the leg (8.3%), and two cases of pulmonary embolism (16.7%) were recorded. Overall survival was 25% and there was no significant difference in survival between ECMO and non-ECMO patients. Weaning from ECMO could be achieved successfully in 41.7% of our patients. Conclusion: Recombinant Factor VIIa is an effective agent in reducing blood loss during ongoing ECMO therapy in patients with refractory bleeding. Although no direct relation between rFVIIa application and thromboembolic events could be established, its use should be done with the utmost care and in selected patients. However, rFVIIa therapy did not impact ECMO function in our cohort.

scholarly journals A New Medical Device to Provide Independent Ventilation to Two Subjects Using a Single Ventilator: Evaluation in Lung-Healthy Pigs

2020 ◽  
Vol 2020 ◽  
pp. 1-6 ◽  
Author(s):  
Ignacio Lugones ◽  
Roberto Orofino Giambastiani ◽  
Oscar Robledo ◽  
Martín Marcos ◽  
Javier Mouly ◽  
...  
Keyword(s):  
Medical Device ◽  
Developed Countries ◽  
Secondary Outcome ◽  
Positive End Expiratory Pressure ◽  
New Device ◽  
Arterial Blood ◽  
Number Of Patients ◽  
Significant Difference ◽  
End Tidal ◽  
End Tidal Co2

Background. The global crisis situation caused by SARS-CoV-2 has created an explosive demand for ventilators, which cannot be met even in developed countries. Designing a simple and inexpensive device with the ability to increase the number of patients that can be connected to existing ventilators would have a major impact on the number of lives that could be saved. We conducted a study to determine whether two pigs with significant differences in size and weight could be ventilated simultaneously using a single ventilator connected to a new medical device called DuplicARⓇ. Methods. Six pigs (median weight 12 kg, range 9–25 kg) were connected in pairs to a single ventilator using the new device for 6 hours. Both the ventilator and the device were manipulated throughout the experiment according to the needs of each animal. Tidal volume and positive end-expiratory pressure were individually controlled with the device. Primary and secondary outcome variables were defined to assess ventilation and hemodynamics in all animals throughout the experiment. Results. Median difference in weight between the animals of each pair was 67% (range: 11–108). All animals could be successfully oxygenated and ventilated for 6 hours through manipulation of the ventilator and the DuplicARⓇ device, despite significant discrepancies in body size and weight. Mean PaCO2 in arterial blood was 42.1 ± 4.4 mmHg, mean PaO2 was 162.8 ± 46.8 mmHg, and mean oxygen saturation was 98 ± 1.3%. End-tidal CO2 values showed no statistically significant difference among subjects of each pair. Mean difference in arterial PaCO2 measured at the same time in both animals of each pair was 4.8 ± 3 mmHg, reflecting the ability of the device to ventilate each animal according to its particular requirements. Independent management of PEEP was achieved by manipulation of the device controllers. Conclusion. It is possible to ventilate two lung-healthy animals with a single ventilator according to each one’s needs through manipulation of both the ventilator and the DuplicARⓇ device. This gives this device the potential to expand local ventilators surge capacity during disasters or pandemics until emergency supplies can be delivered from central stockpiles.

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