Journal of Extra-Corporeal Technology最新文献

{"title":"Meropenem Extraction by Ex Vivo Extracorporeal Life Support Circuits","authors":"Christopher Cole Honeycutt, C. Griffin McDaniel, Autumn McKnite, J. Porter Hunt, Aviva Whelan, Danielle J. Green, Kevin M. Watt","doi":"10.1051/ject/2023035","DOIUrl":"https://doi.org/10.1051/ject/2023035","url":null,"abstract":"Background Meropenem is a broad-spectrum carbapenem-type antibiotic commonly used to treat critically ill patients infected with extended-spectrum β-lactamases (ESBL)-producing Enterobacteriaceae. As many of these patients require extracorporeal membrane oxygenation (ECMO) and/or continuous renal replacement therapy (CRRT), it is important to understand how these extracorporeal life support circuits impact meropenem pharmacokinetics. Based on the physicochemical properties of meropenem, it is expected that ECMO circuits will minimally extract meropenem, while CRRT circuits will rapidly clear meropenem. The present study seeks to determine the extraction of meropenem from ex vivo ECMO and CRRT circuits and elucidate the contribution of different ECMO circuit components to extraction. Methods Standard doses of meropenem were administered to three different configurations (n=3 per configuration) of blood-primed ex vivo ECMO circuits and serial sampling was conducted over 24 hours. Similarly, standard doses of meropenem were administered to CRRT circuits (n=4) and serial sampling was conducted over 4 hours. Meropenem was administered to separate tubes primed with circuit blood to serve as controls to account for drug degradation. Meropenem concentrations were quantified, and percent recovery was calculated for each sample. Results Meropenem was cleared at a similar rate in ECMO circuits of different configurations (n=3) and controls (n=6), with mean (standard deviation) recovery at 24 hours of 15.6% (12.9) in Complete circuits, 37.9% (8.3) in Oxygenator circuits, 47.1% (8.2) in Pump circuits, and 20.6% (20.6) in controls. In CRRT circuits (n=4) meropenem was cleared rapidly compared with controls (n=6) with a mean recovery at 2 hours of 2.36% (1.44) in circuits and 93.0% (7.1) in controls. Conclusion Meropenem is rapidly cleared by hemodiafiltration during CRRT. There is minimal adsorption of meropenem to ECMO circuit components; however, meropenem undergoes significant degradation and/or plasma metabolism at physiological conditions. These ex vivo findings will advise pharmacists and physicians in appropriate dosing of meropenem.","PeriodicalId":39644,"journal":{"name":"Journal of Extra-Corporeal Technology","volume":"351 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135109780","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":"Protamine dose to neutralize heparin at the completion of cardiopulmonary bypass can be reduced significantly without affecting post-operative bleeding.","authors":"Min-Ho Lee,&nbsp;Matthew Beck,&nbsp;Kenneth Shann","doi":"10.1051/ject/2023026","DOIUrl":"https://doi.org/10.1051/ject/2023026","url":null,"abstract":"<p><strong>Background: </strong>Systemic anticoagulation with heparin during cardiopulmonary bypass (CPB) should be neutralized by protamine administration to restore normal hemostasis. Our previous study showed the protamine-to-heparin ratio (P-to-H) of 1:1 (1 mg protamine:100 IU circulating heparin; 1.0 Ratio) is likely an overestimation. Thus, we reduced the P-to-H in the HMS Plus Hemostasis Management System to 0.9:1 (0.9 Ratio) for 5 months and then to 0.8:1 (0.8 Ratio). We monitored post-operative (post-op) bleeding in the setting of reduced protamine dose (PD).</p><p><strong>Methods: </strong>We performed a retrospective study of 632 patients (209 for the 1.0 Ratio, 211 for 0.9 Ratio, 212 for 0.8 Ratio group) who underwent cardiac surgery to measure the reduction of PD and how it affects 24-hour (24 h) post-op chest tube output. We also analyzed the entire data set to explore whether further reduction of P-to-H is warranted.</p><p><strong>Results: </strong>While there was no difference in the indexed heparin dose among the three groups, we achieved a significant reduction in the indexed actual protamine dose (APDi) by 24% (0.9 Ratio) and 31% (0.8 Ratio) reductions compared to the 1.0 Ratio group. On average, APDi was 88 ± 22, 67 ± 18, and 61 ± 15 mg/m² in the 1.0, 0.9, and 0.8 Ratio groups, respectively. We found no significant difference in 24 h post-op bleeding among the three groups.</p><p><strong>Conclusion: </strong>1.0 Ratio at the completion of CPB is likely an excessive administration of protamine. With the stepwise reduction of PD, we observed no increase in post-op bleeding, which may indicate that no meaningful increase in heparin rebound occurred. In addition, further analysis of the entire data set demonstrates that a 0.75 Ratio is likely sufficient to neutralize the heparin completely.</p>","PeriodicalId":39644,"journal":{"name":"Journal of Extra-Corporeal Technology","volume":"55 3","pages":"105-111"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10487347/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10197507","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":"Veno-arterial extracorporeal membrane oxygenation for post-infarction ventricular septal defect in a low-volume center.","authors":"Miha Antonic,&nbsp;Anze Djordjevic,&nbsp;Tomaz Podlesnikar,&nbsp;Maja Pirnat,&nbsp;Boris Robic,&nbsp;Rene Petrovic,&nbsp;Igor D Gregoric","doi":"10.1051/ject/2023013","DOIUrl":"https://doi.org/10.1051/ject/2023013","url":null,"abstract":"<p><p>Managing patients with post-ischaemic ventricular septal defects (VSD) and postcardiotomy cardiogenic shock can be extremely challenging in a low-volume cardiac surgery unit. We present a case of a 68-year-old patient who received veno-arterial extracorporeal membrane oxygenation support due to cardiogenic shock after VSD repair. The patient was successfully weaned off support after 86 h. In the postoperative period, mediastinitis occurred, and negative pressure wound therapy was instituted.</p>","PeriodicalId":39644,"journal":{"name":"Journal of Extra-Corporeal Technology","volume":"55 3","pages":"144-146"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10487343/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10567576","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":"Oxygenator faliure - Are you prepared?","authors":"Tim Willcox","doi":"10.1051/ject/2023020","DOIUrl":"10.1051/ject/2023020","url":null,"abstract":"In the last six months, the frequency of Australia and New Zealand Perfusion Incident Reporting System (ANZCP PIRS) reports has been about one per fortnight which is representative of the rate of reports over the last 3 years. The mix of severity is 50:50 Good Catch Near-Miss and Good Catch No-Harm (reached the patient with no discernible harm occurring). While we continue to encourage voluntary reporting to PIRS of Good Catch near-miss and no-harm incidents, arguably changing the blame culture associated with unintended events to that of the benefits of sharing the lessons from the smart workarounds of reporting Good Catch incidents lies with perfusion leadership. How frequently do you hear the comment – “oh that happened to. . .me us them”. In the last six months somewhat interestingly there have been two reports of oxygenator change-out during CPB (one in process at the time of writing) as well as a decision not to change out but manage a leaking oxygenator. Oxygenator change-out is considered a rare event and many perfusionists will say they have never changed out an oxygenator in their career. A more interesting question would be how often was change-out considered but on a risk-benefit basis the decision was made to continue with the “faulty device”? There are a number of PIRS reports in the last 2 years where the oxygenator was changed-out either immediately prior to CPB or in one case where the patient was weaned from CPB prior to cross-clamping to enable changeout. An interrogation of the FDA Manufacturer and User Facility Device Experience (MAUDE) database (https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfmaude/ search.cfm) reveals multiple instances of oxygenator changeout in the last 12 months. Furthermore, there were many instances where change-out was considered but not done, sometimes with periods of marked hypoxaemia (“They continued to use the involved product and finished the case with it. However, they were unable to get the desired po2 while using it during the case”). So, what determines the threshold for changing out a “failing” oxygenator? Clearly, the elimination of causes apart from the device itself with a clear analysis pathway for the diagnosis of oxygenator failure is required to preclude unnecessary changeout. For instance, gas supply issues related to a misseated vaporiser have been commonly reported to PIRS. Alan Soo and colleagues, in their 2012 paper Successful Management of Membrane Oxygenator Failure during Cardiopulmonary Bypass -The Importance of Safety Algorithm and Simulation Drills [1] make the following comment in the discussion: “Groom et al. proposed replacement of the failed oxygenator by inserting a second oxygenator in parallel within the cardiopulmonary bypass circuit obviating the need to stop CPB (5). However, as we are not familiar with this technique, it was not used in this case. In our center, the perfusion staff perform simulation drills on a weekly basis for management of emergency situa","PeriodicalId":39644,"journal":{"name":"Journal of Extra-Corporeal Technology","volume":"55 3","pages":"153-154"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10487349/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10286152","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":"Role of generative artificial intelligence in publishing. What is acceptable, what is not.","authors":"Raymond Wong","doi":"10.1051/ject/2023033","DOIUrl":"https://doi.org/10.1051/ject/2023033","url":null,"abstract":"Without a doubt, Generative Artificial Intelligence (AI) is a hot topic in the media in recent times. This was spurred initially by the popular, widespread use of ChatGPT and other platforms to generate written material, imagery, and even audio/visual productions based on user-inputted prompts. Generative AI is defined by AI as: “a type of AI that uses machine learning algorithms to create new and original content like images, video, text, and audio” [1]. How do these technological advancements impact us in the scientific publishing world? Specifically, when is it appropriate and perhaps more importantly, when is it NOT appropriate to use such tools in producing published scientific articles? Strictly speaking, every time a word processor suggests a better way to phrase a sentence, basic AI is being applied in one’s writing. Taken to a much more sophisticated level, a writer can submit a roughly written draft to a generative AI platform using large language models (LLMs) and a more sophisticated written output could be produced and ultimately submitted. If a student in an English class, meant to teach students how to write well did submit such a piece for an assignment, this use of AI might constitute cheating. However, when authors use AIs to help polish their work for publication, this should be entirely appropriate since such an application enhances the work to help readers comprehend and appreciate such work better. Our journal has recently started providing our authors the option of using a “comprehensive writing and publication assistant” to improve their submissions. Submitting authors should see a link to the service we are partnering with the Paperpal Preflight Screening Tool. For a very reasonable fee, the tool offers translation, paraphrasing, consistency, and journal submission readiness checks on uploaded manuscript drafts. This service is particularly helpful for some international authors who may have a challenging time meeting our language requirement standards. In another scenario applicable to publishing, say a peer reviewer wishes to use AI to evaluate a submission. You might be asking: “wait, can AI do that?” Most certainly! Would that be acceptable though? There are indeed platforms out there that are trained on publicly available biomedical publications such that the AI is able to look up references to help a peer reviewer assess manuscripts. Maybe the peer reviewer just needs help getting started with the first draft of their review, or they may feel that the author’s language skills need a lot of help like in the earlier scenario. A major difference here, however, is that when a peer reviewer uploads a manuscript on one of these platforms, they would be breaching confidentiality which is not acceptable. The NIH does not allow AI to be used for the peer review of grant applications [2], and neither should such technology be used for publication peer reviews because the same breach of confidentiality occurs when an author’s ","PeriodicalId":39644,"journal":{"name":"Journal of Extra-Corporeal Technology","volume":"55 3","pages":"103-104"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10487329/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10286153","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":"Minimal invasive extracorporeal circulation an alternative to ECMO in ventricular tachycardia ablation.","authors":"Ignazio Condello","doi":"10.1051/ject/2023031","DOIUrl":"https://doi.org/10.1051/ject/2023031","url":null,"abstract":"<p><strong>Background: </strong>The advantages of mechanical assistance during ventricular tachycardia (VT) ablation have not been clinically demonstrated. We propose and discuss a technique, set up by us, that makes use of minimally invasive extra-corporeal circulation (MiECC) type III associated with a venous reservoir system, which allows complete cardiac flow support and blood oxygenation as well as hemodynamic stability during long-lasting procedures.</p><p><strong>Methods: </strong>We present a retrospective case series of ten patients with valvular heart disease and unresponsive Ventricular Tachycardia (VT) who underwent VT ablation with MiECC support. The mean age of the patients was 72 ± 8 years and the left ventricular ejection fraction was 36 ± 12%. All patients underwent a clinical evaluation to identify the cause of VT unresponsiveness (e.g., ischemic heart disease).</p><p><strong>Results: </strong>A total of 140 min, the following parameters were evaluated and recorded for 140 min. Central venous pressure (CVP) was used to evaluate excess volume. During the first 5 min, the mean was 15 mmHg, with a pump flow of 1.5 L/min and a mean systemic arterial pressure of 100 mmHg while setting up the circulation support. Following drainage in a volumetric bag of 1 L of blood, CVP was reduced to a value of 5 mmHg with a flow rate of 5 L/min and a mean systemic arterial pressure of 65 mmHg. In the case of small and low-weight patients our \"1 L protocol\" can be modified.</p><p><strong>Conclusions: </strong>In this preliminary retrospective case series, the MiECC type III system may represent the ideal support system during VT ablation, and further studies are needed to support this preliminary report.</p>","PeriodicalId":39644,"journal":{"name":"Journal of Extra-Corporeal Technology","volume":"55 3","pages":"138-143"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10487307/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10197506","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 need for a structured pathway to facilitate perfusionist mobility across borders.","authors":"Salman Pervaiz Butt","doi":"10.1051/ject/2023030","DOIUrl":"https://doi.org/10.1051/ject/2023030","url":null,"abstract":"This letter highlights the need for a structured pathway for Perfusionists to work across borders in order to address workforce shortages and provide comparable opportunities to other medical professions. Perfusionists play a critical role in cardiothoracic surgery but face significant barriers when seeking international employment. The limited pathways can be attributed to varying recognition, absence of an international certification framework, and countries prioritizing their own workforce planning. International collaboration is necessary to establish common standards and recognize perfusionist qualifications globally. The increasing presence of structured Perfusion education and training programs enables the establishment of a conversion pathway. Research, advocacy, bilateral agreements, and investment in training programs are recommended to address the shortage of perfusionists and enhance international mobility. A comprehensive framework with standardized curricula and guidelines would ensure consistency and quality, promoting collaboration and improving patient care. Purpose of this letter is to raise awareness and drive positive changes in international healthcare practices.","PeriodicalId":39644,"journal":{"name":"Journal of Extra-Corporeal Technology","volume":"55 3","pages":"155-156"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10487300/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10286149","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":"Neurogenic diabetes insipidus in a critical patient with COVID-19 pneumonia in treatment with extracorporeal membrane oxygenation: a case report.","authors":"Bruno Samaniego-Segovia,&nbsp;Lilia Rizo-Topete,&nbsp;Montserrat de la Garza-Gomez,&nbsp;Cesar Alejandro Rodriguez-Salinas,&nbsp;Salim Martínez-Cadena,&nbsp;Alicia López-Romo,&nbsp;Rene Gomez-Gutierrez,&nbsp;Uriel Chavarría-Martínez,&nbsp;Sergio Sánchez-Salazar","doi":"10.1051/ject/2023021","DOIUrl":"https://doi.org/10.1051/ject/2023021","url":null,"abstract":"<p><p>The following case report analyses a patient with extracorporeal membrane oxygenation (ECMO), who suffered from a severe Acute Respiratory Distress Syndrome (ARDS) due to COVID-19 pneumonia. ARDS is defined as a diffuse and inflammatory injury of the lungs; classifying this as severe when the ratio of arterial oxygen tension to a fraction of inspired oxygen (PaO₂/FiO₂) is equal to or lower than 100 mmHg. To decide if the patient was suitable for the use of ECMO therapy, the ELSO criteria were used; and in this case, the patient matched with the criteria of hypoxemic respiratory failure (with a PaO₂/FiO₂ < 80 mmHg) after optimal medical management, including, in the absence of contraindications, a trial of prone positioning. During hospitalization, the patient presented a Central Diabetes Insipidus (CDI), probably explained by the damage hypoxia generated on the central nervous system. There are few reports of this complication produced by COVID-19. The case is about a 39-year-old woman, who started with ECMO 6 days after the beginning of Invasive Mechanical Ventilation (IMV), because of a severe ARDS. On the fifth day of ECMO, the patient started with a polyuria of 7 L in 24 h. A series of paraclinical studies were made, but no evidence of central nervous system lesions was found. After treatment with desmopressin was initiated and the ARDS was solved, polyuria stopped; with this, CDI was diagnosed. There are many complications secondary to the evolution of COVID-19 infection, and some of them are not yet well explained.</p>","PeriodicalId":39644,"journal":{"name":"Journal of Extra-Corporeal Technology","volume":"55 3","pages":"134-137"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10487344/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10252955","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":"Anticoagulation strategies in COVID-19 infected patients receiving ECMO support.","authors":"Dayne Diaz,&nbsp;Jenny Martinez,&nbsp;Grant Bushman,&nbsp;William R Wolowich","doi":"10.1051/ject/2023027","DOIUrl":"https://doi.org/10.1051/ject/2023027","url":null,"abstract":"<p><strong>Background: </strong>Hospitalized COVID-19 patients with hypoxemic respiratory failure may deteriorate despite invasive mechanical ventilation and thus require extracorporeal membrane oxygenation (ECMO) support. Unfractionated heparin (UFH) is the antithrombotic of choice, however, bivalirudin may offer more predictable pharmacokinetics resulting in consistent anticoagulant effects with lower bleeding and thrombotic occurrences. The aim of this study was to evaluate efficacy and safety outcomes in patients undergoing venovenous (VV) ECMO receiving bivalirudin or UFH-based anticoagulation.</p><p><strong>Methods: </strong>This retrospective, single-center, observational cohort study included patients with confirmed COVID-19 infection requiring VV ECMO support receiving anticoagulation with UFH or bivalirudin. Primary endpoints were time to reach therapeutic aPTT, percent time spent in aPTT range, and the occurrence of thrombotic events over the entire course of ECMO support. Secondary endpoints included the incidence of major/minor bleeding, the ability to wean off ECMO support, in-hospital mortality, and length of stay.</p><p><strong>Results: </strong>Twenty-two patients were included in the study (n = 10 UFH, n = 12 bivalirudin). Time to therapeutic aPTT was achieved faster with UFH (10 h vs. 20 h). The percentage time spent within the goal aPTT range was similar between UFH and bivalirudin (50% vs. 52%). Thrombotic events were significantly higher in the UFH group (40% DVT, 40% PE, 80% oxygenator thrombus in ECMO machine, 10% ischemic stroke) versus bivalirudin (8% DVT, 17% PE, 33% oxygenator thrombus, no ischemic strokes) (CI 95%, p = 0.04). The overall bleeding incidence was higher in the UFH arm (90% vs. 75%). The mortality rate was 90% in the UFH group and 58% in the bivalirudin group. The length of stay was similar between the two study arms.</p><p><strong>Conclusion: </strong>In hospitalized patients with COVID-19-associated acute respiratory distress syndrome (ARDS) on VV ECMO support, the use of bivalirudin showed to be a viable anticoagulation alternative in terms of efficacy compared to UFH and resulted in a favorable safety profile with lower rates of bleeding and thrombotic events.</p>","PeriodicalId":39644,"journal":{"name":"Journal of Extra-Corporeal Technology","volume":"55 3","pages":"121-129"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10487306/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10567577","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":"Extracorporeal Membrane Oxygenation (ECMO) for suspected neonatal genetic diagnoses with cardiorespiratory failure.","authors":"Kelechi Ikeri,&nbsp;Vilmaris Quinones Cardona,&nbsp;Swosti Joshi,&nbsp;Ogechukwu Menkiti","doi":"10.1051/ject/2023016","DOIUrl":"https://doi.org/10.1051/ject/2023016","url":null,"abstract":"<p><p>Recent data describe an increasing use of extracorporeal membrane oxygenation (ECMO) in neonates with various clinical conditions besides primary respiratory or cardiac diagnoses. Infants with underlying genetic disorders characterized by cardiopulmonary failure pose unique management challenges. When pathognomonic dysmorphic features for common genetic diagnoses are not present, the prognosis is uncertain at best when determining ECMO candidacy. Lengthy turnaround times of genetic testing often delay definitive diagnosis during the ECMO course. Clinical management pathways to guide practice and evidence to support the use of ECMO in rare genetic conditions are lacking. The decision to initiate ECMO is daunting but may be of benefit if the subsequent genetic diagnosis is non-lethal. In lethal genetic cases warranting discontinuation of care, the time spent on ECMO may still be advantageous as a bridge to diagnosis while allowing for parental bonding with the terminally ill infant. Diagnostic confirmation may also facilitate the attainment of closure for these parents. Here, we report our experience providing ECMO to three neonates presenting with cardiorespiratory failure and later diagnosed with rare genetic syndromes. We share the challenges faced, lessons learned, and outcomes of these critically ill neonates.</p>","PeriodicalId":39644,"journal":{"name":"Journal of Extra-Corporeal Technology","volume":"55 3","pages":"147-152"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10487301/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10549094","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}