Journal of Extra-Corporeal Technology最新文献

{"title":"Use of hepatic support with MARS in a patient with SARS-CoV-2 Pneumonia, in treatment with ECMO and CRRT therapies: Case Report.","authors":"Irma Villarreal-Ondarza,&nbsp;Cesar Alejandro Rodríguez-Salinas,&nbsp;Rene Gómez-Gutierrez,&nbsp;Israel Guerrero-Izaguirre,&nbsp;Lilia María Rizo-Topete","doi":"10.1051/ject/2023025","DOIUrl":"https://doi.org/10.1051/ject/2023025","url":null,"abstract":"<p><p>Extracorporeal Membrane Oxygenation (ECMO) therapy had an important role in the treatment of severe COVID-19 pneumonia, where invasive mechanical ventilation was not enough to provide correct oxygenation to various organ systems. However, there are other extracorporeal technologies, such as the Molecular Absorbent Recirculation System (MARS) and Continuous Renal Replacement Therapy (CRRT), that provide temporal support for any critical patient. The following case describes a 60-year-old man with severe Acute Respiratory Distress Syndrome (ARDS), who needed ECMO therapy. During the critical days of hospitalization, CRRT was used, but a sudden hyperbilirubinemia ensued. Consequently, MARS therapy was initiated; followed by an improvement of bilirubin levels. Additional studies are needed to establish the possible benefits of the combination of MARS therapy and ECMO; however, we detected that concomitantly, there was a decrease in other laboratory parameters such as acute phase reactants. Even though, no change in clinical course was observed, as shown in some studies.</p>","PeriodicalId":39644,"journal":{"name":"Journal of Extra-Corporeal Technology","volume":"55 3","pages":"130-133"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10487337/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10567574","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":"Indexed oxygen delivery during pediatric cardiopulmonary bypass is a modifiable risk factor for postoperative acute kidney injury.","authors":"Molly Dreher,&nbsp;Jungwon Min,&nbsp;Constantine Mavroudis,&nbsp;Douglas Ryba,&nbsp;Svetlana Ostapenko,&nbsp;Richard Melchior,&nbsp;Tami Rosenthal,&nbsp;Muhammad Nuri,&nbsp;Joshua Blinder","doi":"10.1051/ject/2023029","DOIUrl":"https://doi.org/10.1051/ject/2023029","url":null,"abstract":"<p><strong>Background: </strong>Acute kidney injury after pediatric cardiac surgery is a common complication with few established modifiable risk factors. We sought to characterize whether indexed oxygen delivery during cardiopulmonary bypass was associated with postoperative acute kidney injury in a large pediatric cohort.</p><p><strong>Methods: </strong>This was a retrospective analysis of patients under 1 year old undergoing cardiac surgery with cardiopulmonary bypass between January 1, 2013, and January 1, 2020. Receiver operating characteristic curves across values ranging from 260 to 400 mL/min/m² were used to identify the indexed oxygen delivery most significantly associated with acute kidney injury risk.</p><p><strong>Results: </strong>We included 980 patients with acute kidney injury occurring in 212 (21.2%). After adjusting for covariates associated with acute kidney injury, an indexed oxygen delivery threshold of 340 mL/min/m² predicted acute kidney injury in STAT 4 and 5 neonates (area under the curve = 0.66, 95% CI = 0.60 - 0.72, sensitivity = 56.1%, specificity = 69.4%). An indexed oxygen delivery threshold of 400 mL/min/m² predicted acute kidney injury in STAT 1-3 infants (area under the curve = 0.65, 95% CI = 0.58 - 0.72, sensitivity = 52.6%, specificity = 74.6%).</p><p><strong>Conclusion: </strong>Indexed oxygen delivery during cardiopulmonary bypass is a modifiable variable independently associated with postoperative acute kidney injury in specific pediatric populations. Strategies aimed at maintaining oxygen delivery greater than 340 mL/min/m² in complex neonates and greater than 400 mL/min/m² in infants may reduce the occurrence of postoperative acute kidney injury in the pediatric population.</p>","PeriodicalId":39644,"journal":{"name":"Journal of Extra-Corporeal Technology","volume":"55 3","pages":"112-120"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10487348/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10567573","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":"Survival of 2nd trimester pregnant patient and di-di twin on COVID-19 ECMO.","authors":"Yookwi Lee,&nbsp;Kholoud Nassar,&nbsp;Atit Parikh","doi":"10.1051/ject/2023012","DOIUrl":"https://doi.org/10.1051/ject/2023012","url":null,"abstract":"<p><p>A 35-year-old unvaccinated woman, pregnant with twins at 22 weeks and 5 days of gestation presented with worsening hypoxia, due to COVID-19 pneumonia (PNA) with acute respiratory distress syndrome (ARDS). The patient was placed on V-V ECMO (veno-venous extracorporeal membrane oxygenation) and delivered twin babies by cesarean section (C-section) at 23 weeks and 5 days of gestation. The patient was successfully weaned off ECMO 42 days after initiation, and the twins were also extubated in NICU.</p>","PeriodicalId":39644,"journal":{"name":"Journal of Extra-Corporeal Technology","volume":"55 2","pages":"91-93"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10304913/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9727653","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":"Case Report: Congenital tuberculosis in a premature infant requiring extracorporeal membrane oxygenation.","authors":"Hugh K Quach,&nbsp;Briana L Scott,&nbsp;Denise A Lopez-Domowicz,&nbsp;Rachel M Gambino,&nbsp;Amy E Evans,&nbsp;Caroline P Ozment","doi":"10.1051/ject/2023007","DOIUrl":"https://doi.org/10.1051/ject/2023007","url":null,"abstract":"<p><p>Congenital tuberculosis is a rare infectious disease with less than 500 cases documented worldwide. Mortality is significant, ranging from 34 to 53%, and death without treatment is inevitable. Patients exhibit nonspecific symptoms such as fever, cough, respiratory distress, feeding intolerance, and irritability which can make appropriate diagnosis challenging in Peng et al. (2011) Pediatr Pulmonol 46(12), 1215-1224. Tuberculosis prevalence is particularly high in developing countries where access to resources can be limited in World Health Organization (2019) Global tuberculosis report 2019, Geneva. We present a 2.4-kg premature male infant with acute respiratory distress syndrome secondary to congenital tuberculosis caused by Mycobacterium bovis and tuberculosis-immune reconstitution inflammatory syndrome who was successfully supported with veno-arterial extracorporeal membrane oxygenation.</p>","PeriodicalId":39644,"journal":{"name":"Journal of Extra-Corporeal Technology","volume":"55 2","pages":"86-90"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10304822/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9782364","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":"A ROTEM-guided algorithm aimed to reduce blood product utilization during neonatal and infant cardiac surgery.","authors":"Aymen N Naguib,&nbsp;Sergio A Carrillo,&nbsp;Marco Corridore,&nbsp;Amee M Bigelow,&nbsp;Ashley Walczak,&nbsp;Nguyen K Tram,&nbsp;Diane Hersey,&nbsp;Mark Galantowicz,&nbsp;Joseph D Tobias","doi":"10.1051/ject/2023017","DOIUrl":"https://doi.org/10.1051/ject/2023017","url":null,"abstract":"<p><strong>Background: </strong>Neonates and infants undergoing cardiac surgery tend to receive high volumes of blood products. The use of rotational thromboelastometry (ROTEM^®) has been shown to reduce the administration of blood products in adults after cardiac surgery. We sought to develop a targeted administration of blood products based on ROTEM^® to reduce blood product utilization during and after neonatal and infant cardiac surgery.</p><p><strong>Methods: </strong>We conducted a retrospective review of data from a single center for neonates and infants undergoing congenital cardiac surgery using cardiopulmonary bypass (CPB) from September 2018-April 2019 (control group). Then, using a ROTEM^® algorithm, we collected data prospectively between April-November 2021 (ROTEM group). Data collected included age, weight, gender, procedure, STAT score, CPB time, aortic cross-clamp time, volume, and type of blood products administered in the operating room and cardiothoracic intensive care unit (CTICU). In addition, ROTEM^® data, coagulation profile in CTICU, chest tube output at 6 and 24 hours, use of factors concentrate, and thromboembolic complications were recorded.</p><p><strong>Results: </strong>The final cohort of patients included 28 patients in the control group and 40 patients in the ROTEM group. The cohort included neonates and infants undergoing the following procedures: arterial switch, aortic arch augmentation, Norwood procedure, and comprehensive stage II procedure. There were no differences in the demographics or procedure complexity between the two groups. Patients in the ROTEM^® group received fewer platelets (36 ± 12 vs. 49 ± 27 mL/kg, p 0.028) and cryoprecipitate (8 ± 3 vs. 15 ± 10 mL/kg, p 0.001) intraoperatively when compared to the control group.</p><p><strong>Conclusion: </strong>The utilization of ROTEM^® may have contributed to a significant reduction in some blood product administration during cardiac surgery for infants and neonates. ROTEM^® data may play a role in reducing blood product administration in neonatal and infant cardiac surgery.</p>","PeriodicalId":39644,"journal":{"name":"Journal of Extra-Corporeal Technology","volume":"55 2","pages":"60-69"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10304858/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9727649","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":"3D-Printed silicone anatomic patient simulator to enhance training on cardiopulmonary bypass.","authors":"Branden Tyler Messarra,&nbsp;Yaxin Wang,&nbsp;P Alex Smith,&nbsp;Preston Peak,&nbsp;Deborah L Adams,&nbsp;Terry N Crane","doi":"10.1051/ject/2023005","DOIUrl":"https://doi.org/10.1051/ject/2023005","url":null,"abstract":"<p><strong>Background: </strong>Simulator training is important for teaching perfusion students fundamental skills associated with CBP before they start working in the clinic. Currently available high-fidelity simulators lack anatomic features that would help students visually understand the connection between hemodynamic parameters and anatomic structure. Therefore, a 3D-printed silicone cardiovascular system was developed at our institution. This study aimed to determine whether using this anatomic perfusion simulator instead of a traditional \"bucket\" simulator would better improve perfusion students' understanding of cannulation sites, blood flow, and anatomy.</p><p><strong>Methods: </strong>Sixteen students were tested to establish their baseline knowledge. They were randomly divided into two groups to witness a simulated bypass pump run on one of two simulators - anatomic or bucket - then retested. To better analyze the data, we defined \"true learning\" as characterized by an incorrect answer on the pre-simulation assessment being corrected on the post-simulation assessment.</p><p><strong>Results: </strong>The group that witnessed the simulated pump run on the anatomic simulator showed a larger increase in mean test score, more instances of true learning, and a larger gain in the acuity confidence interval.</p><p><strong>Conclusions: </strong>Despite the small sample size, the results suggest that the anatomic simulator is a valuable instrument for teaching new perfusion students.</p>","PeriodicalId":39644,"journal":{"name":"Journal of Extra-Corporeal Technology","volume":"55 2","pages":"53-59"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10304827/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9730293","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 circulation in theory and practice.","authors":"Alfred H Stammers","doi":"10.1051/ject/2023011","DOIUrl":"https://doi.org/10.1051/ject/2023011","url":null,"abstract":"","PeriodicalId":39644,"journal":{"name":"Journal of Extra-Corporeal Technology","volume":"55 2","pages":"98-99"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10304755/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9730296","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 evolution of the Journal covers: 55 years of uninterrupted progress.","authors":"Alfred H Stammers","doi":"10.1051/ject/2023018","DOIUrl":"https://doi.org/10.1051/ject/2023018","url":null,"abstract":"In the spring of 1961 a small group of individuals from diverse backgrounds all had one thing in common: They were performing a new technology called extracorporeal circulation (ECC). Less than a decade earlier surgeons and researchers had shown that patients suffering from cardiac disease could be placed on a `heart-lung’ machine for a short period of time facilitating intracardiac access for surgical repair. The first formal meeting for individuals practicing and studying ECC, using either `heart-lung’ or dialysis machines, was held in 1962. In 1963 the American Society of Extracorporeal Circulation Technicians was formed serving as the first professional society devoted to ECC, and included both perfusionists (a new professional group) and dialysis technicians, who were often nurses. The first formal meeting of AmSECT was held in Chicago at the Sol Fox Lounge in December 14, 1963. In 1967 the Society was formally incorporated with a name change to the American Society of Extra-Corporeal Technology, maintaining the familiar acronym AmSECT. The following year, due to the undaunted efforts of perfusionists and surgeons, a new journal appeared devoted entirely to this emerging field, and was titled The Journal of Extra-Corporeal Technology, commonly referred to today as JECT. The goal was to publish the progress and growth of technological knowledge on ECC, and to share the research in a multidisciplinary manner. In the first issue of JECT Jim Wade, the president of AmSECT at the time, wrote in an editorial that the primary goal of both the Society and JECT would be the “communication and the professional exchange of information” by perfusionists, surgeons and administrators [1]. While individuals from numerous other professions have benefited from the 55-year history of the publication of JECT, the goals of the initial formation of the Journal remain similar. During those years there have been many changes to the Journal with perhaps the most obvious being the cover. This year the Journal will undergo its fifth major cover change so it may be fitting to review the history of the front page of this publication. The first editor-in-chief of JECT was Ed Berger a practicing perfusionist from the Charles T. Miller Hospital in St. Paul, Minnesota. Ed was truly a visionary who saw the importance of the scientific pursuit of quality evidence as paramount in supporting methodologies and practices that would improve the conduct of ECC, with the ultimate goal of improving patient care. In his first editorial he established the focus of the Journal as a collaborative effort and stated “by us banding together for the acquiring and sharing of information in order to develop a more perfect technology and more perfect technologists” [2]. Indeed, today, as in 1968, these words remain the driving force for all of us as we commit obligation to our patients.","PeriodicalId":39644,"journal":{"name":"Journal of Extra-Corporeal Technology","volume":"55 2","pages":"44-52"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10304979/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10112908","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":"ABO-incompatible orthotopic heart transplant: a case report★.","authors":"Ashlyn Strickland,&nbsp;Dafne Andrea Chianella,&nbsp;Minoo Kavarana,&nbsp;Andrew Savage","doi":"10.1051/ject/2023009","DOIUrl":"https://doi.org/10.1051/ject/2023009","url":null,"abstract":"<p><strong>Background: </strong>ABOi heart transplant has become routine for the majority of children <2 years old. An 8-month-old child with complex congenital heart disease presented to the Medical University of South Carolina Shawn Jenkins Children's Hospital in need of transplantation.</p><p><strong>Methods: </strong>This case report describes the use of ABOi transplantation and describes the details of the total exchange transfusion prior to cardiopulmonary bypass.</p><p><strong>Results: </strong>After a successful intraoperative total exchange transfusion following the ABOi protocol, the patient's isohemagglutinin titers were 1 VC on postoperative day (POD) 1, and isohemagglutinin titer was <1 VC on POD 14. The patient had no signs of rejection and continued to recover.</p><p><strong>Conclusions: </strong>Successful ABOi transplantation requires planning, an interdisciplinary approach, and clear closed-loop communication. Planning with the surgical and anesthesia teams is necessary for the hemodynamic stability of the patient during the total volume exchange as well as precautions put in place to ensure the blood products used in this procedure are correct. Planning with the lab and blood bank is also necessary to ensure they are prepared with enough blood products and can run isohemagglutinin titers.</p>","PeriodicalId":39644,"journal":{"name":"Journal of Extra-Corporeal Technology","volume":"55 2","pages":"94-97"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10304726/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9727651","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":"Turbulence in surgical suction heads as detected by MRI.","authors":"Gunnar Hanekop,&nbsp;Jost M Kollmeier,&nbsp;Jens Frahm,&nbsp;Ireneusz Iwanowski,&nbsp;Sepideh Khabbazzadeh,&nbsp;Ingo Kutschka,&nbsp;Theodor Tirilomis,&nbsp;Christian Ulrich,&nbsp;Martin G Friedrich","doi":"10.1051/ject/2023015","DOIUrl":"https://doi.org/10.1051/ject/2023015","url":null,"abstract":"<p><strong>Background: </strong>Blood loss is common during surgical procedures, especially in open cardiac surgery. Allogenic blood transfusion is associated with increased morbidity and mortality. Blood conservation programs in cardiac surgery recommend re-transfusion of shed blood directly or after processing, as this decreases transfusion rates of allogenic blood. But aspiration of blood from the wound area is often associated with increased hemolysis, due to flow induced forces, mainly through development of turbulence.</p><p><strong>Methods: </strong>We evaluated magnetic resonance imaging (MRI) as a qualitative tool for detection of turbulence. MRI is sensitive to flow; this study uses velocity-compensated T1-weighted 3D MRI for turbulence detection in four geometrically different cardiotomy suction heads under comparable flow conditions (0-1250 mL/min).</p><p><strong>Results: </strong>Our standard control suction head Model A showed pronounced signs of turbulence at all flow rates measured, while turbulence was only detectable in our modified Models 1-3 at higher flow rates (Models 1 and 3) or not at all (Model 2).</p><p><strong>Conclusions: </strong>The comparison of flow performance of surgical suction heads with different geometries via acceleration-sensitized 3D MRI revealed significant differences in turbulence development between our standard control Model A and the modified alternatives (Models 1-3). As flow conditions during measurement have been comparable, the specific geometry of the respective suction heads must have been the main factor responsible. The underlying mechanisms and causative factors can only be speculated about, but as other investigations have shown, hemolytic activity is positively associated with degree of turbulence. The turbulence data measured in this study correlate with data from other investigations about hemolysis induced by surgical suction heads. The experimental MRI technique used showed added value for further elucidating the underlying physical phenomena causing blood damage due to non-physiological flow.</p>","PeriodicalId":39644,"journal":{"name":"Journal of Extra-Corporeal Technology","volume":"55 2","pages":"70-81"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10304939/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9727652","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}