Journal of Extra-Corporeal Technology最新文献

{"title":"Evaluation of the appropriate cool-seal system settings in EVAHEART® blood pump shutdown-restart events","authors":"Yuma Tanaka, Yuki Nakamura, Y. Minematsu, Shigetaka Kusumoto, K. Yoshida, M. Takashina","doi":"10.7130/jject.49.361","DOIUrl":"https://doi.org/10.7130/jject.49.361","url":null,"abstract":"","PeriodicalId":39644,"journal":{"name":"Journal of Extra-Corporeal Technology","volume":"74 35","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72445195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative study of gas transfer between parallel and series connection of artificial lung in ECMO","authors":"Keiichi Tojo, Haruna Kinoshita, Akikazu Takeda, Hiroyuki Oshima, Misaki Gingawa, Kyoko Nakamura, Masami Fujii","doi":"10.7130/jject.49.1","DOIUrl":"https://doi.org/10.7130/jject.49.1","url":null,"abstract":"","PeriodicalId":39644,"journal":{"name":"Journal of Extra-Corporeal Technology","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87827559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk and Safety Perceptions Contribute to Transfusion Decisions in Coronary Artery Bypass Grafting.","authors":"Joshua L Bourque,&nbsp;Raymond J Strobel,&nbsp;Joyce Loh,&nbsp;Darin B Zahuranec,&nbsp;Gaetano Paone,&nbsp;Robert S Kramer,&nbsp;Alphonse Delucia,&nbsp;Warren D Behr,&nbsp;Min Zhang,&nbsp;Milo C Engoren,&nbsp;Richard L Prager,&nbsp;Xiaoting Wu,&nbsp;Donald S Likosky","doi":"10.1182/ject-2100026","DOIUrl":"https://doi.org/10.1182/ject-2100026","url":null,"abstract":"<p><p>Variability persists in intraoperative red blood cell (RBC) transfusion rates, despite evidence supporting associated adverse sequelae. We evaluated whether beliefs concerning transfusion risk and safety are independently associated with the inclination to transfuse. We surveyed intraoperative transfusion decision-makers from 33 cardiac surgery programs in Michigan. The primary outcome was a provider's reported inclination to transfuse (via a six-point Likert Scale) averaged across 10 clinical vignettes based on Class IIA or IIB blood management guideline recommendations. Survey questions assessed hematocrit threshold for transfusion (\"hematocrit trigger\"), demographic and practice characteristics, years and case-volume of practice, knowledge of transfusion guidelines, and provider attitude regarding perceived risk and safety of blood transfusions. Linear regression models were used to estimate the effect of these variables on transfusion inclination. Mixed effect models were used to quantify the variation attributed to provider specialties and hematocrit triggers. The mean inclination to transfuse was 3.2 (might NOT transfuse) on the survey Likert scale (SD: .86) across vignettes among 202/413 (48.9%) returned surveys. Hematocrit triggers ranged from 15% to 30% (average: 20.4%; SE: .18%). The inclination to transfuse in situations with weak-to-moderate evidence for supporting transfusion was associated with a provider's hematocrit trigger (<i>p</i> < .01) and specialty. Providers believing in the safety of transfusions were significantly more likely to transfuse. Provider specialty and belief in transfusion safety were significantly associated with a provider's hematocrit trigger and likelihood for transfusion. Our findings suggest that blood management interventions should target these previously unaccounted for blood transfusion determinants.</p>","PeriodicalId":39644,"journal":{"name":"Journal of Extra-Corporeal Technology","volume":"53 4","pages":"270-278"},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8717726/pdf/ject-53-270.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39668360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Central Partial Bypass Management Technique for Distal Arch Surgery.","authors":"Amanda Cornelius,&nbsp;Krithika Ramaprabhu,&nbsp;Elizabeth Stephens,&nbsp;Nishant Saran,&nbsp;Alberto Pochettino","doi":"10.1182/ject-2100025","DOIUrl":"https://doi.org/10.1182/ject-2100025","url":null,"abstract":"<p><p>Circulatory arrest and left heart bypass are the most common approaches to manage perfusion during distal arch surgery. We report a novel perfusion technique utilized in the treatment of aneurysmal Komerrell's diverticulum (KD) and aberrant subclavian artery (ASA) that allows for a reliable conduct of perfusion. From 2016 to 2020, 12 adult patients with aneurysmal KD and ASA underwent repair of distal arch through lateral thoracotomy ipsilateral to the arch side using central partial bypass. Once the patients were fully heparinized the lower thoracic aorta and the right atrium were cannulated. The cannulas were connected to the cardiopulmonary bypass (CPB) circuit with an oxygenator. Partial bypass was initiated. Ventilation via anesthesia was continued as the mode of gas exchange to the upper body while the CPB circuit provided gas exchange to the lower body. In all patients, CPB was initiated allowing the patient to maintain a mean arterial pressure >60 mmHg in the femoral artery and a mean arterial pressure (MAP) >80 mmHg in the radial artery to allow adequate native ejection into the proximal circulation. The venous line was partially occluded to control the radial pressure. The aorta was cross clamped proximal and distal to the KD to isolate the aorta to be replaced. KD was excised in all patients having performed contralateral subclavian to carotid transposition previously. Once the aorta was reconstructed, clamps were released and the patients were weaned off CPB. All were extubated on the same day and there was no early mortality.</p>","PeriodicalId":39644,"journal":{"name":"Journal of Extra-Corporeal Technology","volume":"53 4","pages":"306-308"},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8717718/pdf/ject-53-306.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39904380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Encouraging Quality Improvement through the Use of a National Perfusion Database.","authors":"Matthew S Mosca,&nbsp;Alfred H Stammers,&nbsp;Alex Reynolds,&nbsp;Candice Kalin,&nbsp;Matthew S Schuldes,&nbsp;Tammy Atwood,&nbsp;Brian McCann,&nbsp;Aaron Nichols,&nbsp;Jeffrey Chores,&nbsp;Don Nieter","doi":"10.1182/ject-2100050","DOIUrl":"https://doi.org/10.1182/ject-2100050","url":null,"abstract":"On a daily basis, perfusionists may informally discuss aspects of quality improvement (QI), but the formal practice of QI is more difficult to operationalize. Efforts and expectations for QI may be limited by experience and/or available tools. In addition, high-quality data and sound analytic assessment are needed for the development and integration of evidence-based clinical guidelines. Since 2010, there have been developments within the perfusion community directed at fostering QI including 1) the creation of a national perfusion database endorsed by the American Society of Extracorporeal Technology (AmSECT) called PERFusion Measures and Outcomes (PERForm), 2) the establishment of a partnership between participating PERForm institutions in Michigan and Anthem Blue Shield Blue Cross, and 3) the redeployment of the AmSECT Quality Committee (AQC). The Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative (MSTCVS-QC) created the PERForm Registry in 2010. PERForm is a multi-institutional cardiovascular perfusion database focusing on the practice and outcome of cardiopulmonary bypass (CPB). PERForm data is linked with existing adult cardiac surgical databases and is used to provide a comprehensive and informed view of cardiovascular operative practices and their relation to clinical outcomes. This linkage allows for the creation and dissemination of quarterly benchmarking reports to facilitate quality assurance and improvement. Benchmarking reports are generated from variables abstracted from The PERForm Registry data entry form (1). Variables from this form are displayed against de-identified participating centers such that each participant can compare against their peers. For example, the proportion of cases where pump suckers were terminated “prior to, or at initiation of, protamine delivery” is displayed on a bar graph with participating centers numbered on the x-axis. Only members of each center are aware of the number assigned to their institution. Data review sessions are also conducted quarterly to promote collaboration among cardiovascular surgeons, perfusionists, data managers, administrators, and other healthcare professionals. Any perfusionist who participates in PERForm is invited to attend these quarterly meetings. A memorandum of understanding exists between the PERForm Registry and AmSECT, which establishes the mutual endorsement between the two entities. PERForm, the officially endorsed cardiovascular perfusion registry of AmSECT, supports AmSECT activities (particularly those related to quality assurance/QI) and promotes the development of national QI initiatives. The PERForm registry and AmSECT work symbiotically to encourage participation in a national perfusion registry, to engage more of the community in AmSECT membership, and to promote QI initiatives. PERForm and The Society of Thoracic Surgeons (STS) data are combined to create a more comprehensive view of the pre-op, intra-op, and post-op period. The","PeriodicalId":39644,"journal":{"name":"Journal of Extra-Corporeal Technology","volume":"53 4","pages":"309-311"},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8717722/pdf/ject-53-309.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39904382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Leadership and Mentoring.","authors":"Raymond K Wong","doi":"10.1182/ject-53-237","DOIUrl":"10.1182/ject-53-237","url":null,"abstract":"","PeriodicalId":39644,"journal":{"name":"Journal of Extra-Corporeal Technology","volume":"53 4","pages":"237-238"},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8717723/pdf/ject-53-237.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39668355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In Defense of Science.","authors":"David Sidebotham","doi":"10.1182/ject-2100052","DOIUrl":"10.1182/ject-2100052","url":null,"abstract":"","PeriodicalId":39644,"journal":{"name":"Journal of Extra-Corporeal Technology","volume":"53 4","pages":"239-244"},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8717720/pdf/ject-53-239.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39668357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effectiveness of Three Different Curricular Models to Teach Fundamental ECMO Specialist Skills to Entry Level Perfusionists.","authors":"Jeffrey B Riley,&nbsp;Bruce E Searles,&nbsp;Edward M Darling,&nbsp;Dawn M Oles,&nbsp;Hani Aiash","doi":"10.1182/ject-2100008","DOIUrl":"https://doi.org/10.1182/ject-2100008","url":null,"abstract":"<p><p>The dramatic increase in the use of extracorporeal membrane oxygenation (ECMO) over the last decade with the concomitant need for ECMO competent perfusionists has raised questions of how well perfusion education programs are preparing entry-level perfusionists to participate in ECMO. While all perfusion schools teach ECMO principles, there is no standardized or systematic approach to the delivery of didactic knowledge and clinical skills in ECMO. Given this variability of ECMO education across and within perfusion schools, the CES-A exam may provide a metric for comparing curricular approaches. The purpose of this study is to examine three different curricular approaches to prepare new perfusion graduates to master the Adult ECMO Specialist Certification exam (CES-A). We examined three different curricular approaches to prepare new perfusion graduates to master the Adult ECMO Specialist Certification exam (CES-A). We hypothesized that there would be no difference in CES-A pass rate, exam score, Rasch measure, and item category scores between SUNY Cardiovascular Perfusion Program (CVP) graduates who completed SUNY's ECMO Capstone experience (Group III) and CVP graduates who did not select the ECMO Capstone experience (Group II). Further, we studied the performance of a third group of new graduates from an external program that does not offer formal ECMO courses or an ECMO Capstone experience (Group I). Every perfusion graduate in all groups passed the adult ECMO specialist exam. The graduates who as students completed an ECMO Capstone experience (Group III) scored higher on the exam and significantly higher on four exam categories: coagulation and hemostasis (<i>p</i> = .058), lab analysis point of care (<i>p</i> = .035), and monitor patient and circuit (<i>p</i> = .073), and the safety and failure modes (<i>p</i> = .017). Overall the median graduate Rasch measures ranked with Group III demonstrating the highest measure to Group I the lowest measures (not significant at <i>p</i> = .085). There is a positive educational effect due to CVP graduates completion of the ECMO Capstone experience compared to the program standard ECMO-related curricula in the two perfusion programs participating in this study. From this observation a structured ECMO simulation-based program appears to be equally effective as a traditional, typical lecture-only, clinical perfusion preceptorship, while demonstrating a more satisfactory experience with a higher reported case experience. In this study the standard perfusionist education curriculum prepared the new graduate to be successful on the CES-A exam. The three curricular approaches appear to prepare perfusionist graduates to be successful on the Adult ECMO Specialist exam.</p>","PeriodicalId":39644,"journal":{"name":"Journal of Extra-Corporeal Technology","volume":"53 4","pages":"245-250"},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8717719/pdf/ject-53-245.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39668356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"To RAP or Not to RAP: A Retrospective Comparison of the Effects of Retrograde Autologous Priming.","authors":"Emily Foreman,&nbsp;Morgan Eddy,&nbsp;Jenny Holdcombe,&nbsp;Phoebe Warren,&nbsp;Lisa Gebicke,&nbsp;Pamela Raney,&nbsp;Wilson Clements,&nbsp;James Zellner","doi":"10.1182/ject-2100031","DOIUrl":"10.1182/ject-2100031","url":null,"abstract":"<p><p>Retrograde autologous priming (RAP) is a process used to reduce hemodilution associated with the initiation of cardiopulmonary bypass (CPB). Previous studies have reported potential benefits to RAP; however, many of these studies do not evaluate the benefits of RAP with limited preoperative fluid administration combined with a condensed CPB circuit. We examined clinical metrics of patients who underwent RAP versus those who did not undergo RAP prior to the initiation of CPB. This was a retrospective data review of 1,303 patients who underwent CPB in the setting of open-heart surgery for a 2-year period. RAP was used on all patients between June 1, 2017 and June 30, 2018 (<i>n</i> = 519) and not used on patients between July 1, 2018 and June 30, 2019 (<i>n</i> = 784). Both groups were subjected to a low-prime CPB circuit volume of 800-900 mL. We compared the clinical metrics for packed red blood cell (PRBC) transfusion, oxygen delivery, postoperative acute kidney injury (AKI), Albumin utilization, ventilator time, Intensive Care Unit length of stay (ICU LOS), and 30-day mortality between the two groups. Our data analysis showed there were no statistically significantly differences between the two groups on the incidence of postoperative AKI, PRBC administration, ventilator time, ICU LOS or 30-day mortality. In the RAP group, there was a statistically significant lower oxygen delivery and a statistically significant increased volume of Albumin administered postoperatively, although those differences were so small, they were potentially not clinically significant. Our analysis revealed no significant benefit to performing RAP with limited preoperative fluid administration and minimized CPB circuit prime volume. We formalized a process that included limiting preoperative fluid administration and minimizing the CPB circuit volume so that we were not required to RAP and did not simultaneously sacrifice patient outcomes in other areas.</p>","PeriodicalId":39644,"journal":{"name":"Journal of Extra-Corporeal Technology","volume":"53 4","pages":"279-285"},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8717721/pdf/ject-53-279.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39668361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Alternative Input for Perfusion Management Devices: Voice Recognition for Data Input and the Effects on Charting and Perioperative Calculation Use.","authors":"Kara Lung,&nbsp;Brandi Brummer,&nbsp;Scott Sanderson,&nbsp;David W Holt","doi":"10.1182/ject-2100037","DOIUrl":"https://doi.org/10.1182/ject-2100037","url":null,"abstract":"<p><p>Technology in healthcare has become increasingly prevalent and user friendly. In the last decade, advances in hands-free methods of data input have become more viable in a variety of medical professions. The aim of this study was to assess the advantages or disadvantages of hands-free charting through a voice-to-text app designed for perfusionists. Twelve clinical perfusion students using two different simulated bypass cases were recorded and assessed for the number of events noticed and charted, as well as the speed at which they accomplished these steps. Paper charts were compared with a custom app with voice-to-text charting capability. Data was analyzed using linear mixed models to detect differences in length of time until a chartable event was noticed, and how long after noticing an event it took to record the event. Timeliness of recording an event was made by assessing log-transformed time data. There was significantly more information recorded when charting on paper, while charting with voice-to-text resulted in significantly faster mean time from noticing an event to the recording of it. There was no significant difference between how many events were noticed and recorded. When using paper charting, a higher percentage of events that were missed were drug administration events, while voice charting had a higher percentage of missed events that were associated with cardioplegia delivery or bypass timing. With a decreased time interval between noticing an event and charting the event, speech-to-text for perfusion could be of benefit in situations where many events occur at once, such as emergency situations or highly active portions of bypass such as initiation and termination. While efforts were made to make the app as intuitive as possible, there is room for improvement.</p>","PeriodicalId":39644,"journal":{"name":"Journal of Extra-Corporeal Technology","volume":"53 4","pages":"286-292"},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8717729/pdf/ject-53-286.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39668362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}