Journal of Extra-Corporeal Technology最新文献

{"title":"Contemporary management of intracardiac thrombi: a tale of two clots.","authors":"Ben Branigan,&nbsp;Sam Brown,&nbsp;Ryan Zavala,&nbsp;HelenMari Merritt","doi":"10.1051/ject/2023010","DOIUrl":"https://doi.org/10.1051/ject/2023010","url":null,"abstract":"<p><p>Intracardiac thrombi such as pulmonary emboli represent a high risk of mortality. In this case study, we review two cases of intracardiac thrombi occurring within 24 h of one another and managed differently by the same cardiothoracic surgical team, highlighting the importance of an individualized approach as well as an understanding of current guidelines and contemporary management techniques.</p>","PeriodicalId":39644,"journal":{"name":"Journal of Extra-Corporeal Technology","volume":"55 2","pages":"82-85"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10304866/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9727654","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":"Classic literature and textbooks in perfusion, how they continue to influence.","authors":"Joseph J Sistino","doi":"10.1051/ject/2023014","DOIUrl":"https://doi.org/10.1051/ject/2023014","url":null,"abstract":"When I was a student in 1974 there were two textbooks that had a major influence on my perfusion career. The first was HeartLung Bypass; Principles in Extracorporeal Circulation by Galletti and Brecher [1], and the other was Cardiac Surgery by John Norman [2]. At the time, both of these books were comprehensive reviews of the state-of-the-art of perfusion technology. In Cardiac Surgery by John Norman, there was a chapter on the role of the perfusionist and the importance of academic perfusion education by Vasko and Dearing [3]. Jim Dearing emphasized perfusion as an emerging profession, as he was involved in the relatively new Ohio State perfusion education program. My own interest in university-based perfusion education had its beginnings in this chapter, and later I advocated for graduate level perfusion education in an editorial in this journal [4]. Heart-Lung Bypass was a very comprehensive review of perfusion research in the 1950s and the early 1960s. One area of interest that was stimulated by reading this book was blood conservation. I had read about the demands for blood products as cardiac surgery expanded in the early 1970’s, but didn’t realize that all available blood products would be needed for cardiac surgery unless something was done to reduce blood usage. Before there was hemodilution and before there was, cell washing devices, there was a technique used called “paired perfusion”. This technique was discussed in Galetti’s book [5]. I had a hard time finding this publication when I was looking for references on blood conservation. I remember reading about double pump runs in Galetti’s book, and eventually found the reference. Since it was an old journal, I asked one of cardiac surgeons that I was working with if he had old Thoracic and Cardiovascular Surgery journals. I went to his office, and I found a bound copy of the journal from 1967. I was so excited, he gave me the bound copy, which I still have today. The article on “paired perfusion” outlined the technique using the same heart-lung machine for two patients in a row. When I taught perfusion research class, this was usually the first paper that we reviewed because I wanted students to appreciate the history of cardiopulmonary bypass and vast amount of perfusion literature that’s available not just online, but also in libraries. The research study was conducted at Boston Children’s Hospital. It was a very different time, when pediatric patients are averaged around 30 kg. The heart lung machine required 5 units of fresh heparinized blood to prime, and the disc oxygenators needed a whole day to be cleaned and sterilized between operations. This limited the amount of surgery that could be done. To reduce blood usage and allow more operations to be completed, the technique of using the same heart-lung-machine for two patients in a row was evaluated. I recently discovered that the lead author, a junior resident Robert Replogle, was responsible for cleaning the disc oxygenators. Of","PeriodicalId":39644,"journal":{"name":"Journal of Extra-Corporeal Technology","volume":"55 2","pages":"101-102"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10304725/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10137699","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":"Relative and absolute blood flow values during cardiopulmonary bypass.","authors":"Ignazio Condello","doi":"10.1051/ject/2023008","DOIUrl":"https://doi.org/10.1051/ject/2023008","url":null,"abstract":"Blood fl ow (BF) management during cardiopulmonary bypass (CPB) is crucial for preventing injury to vital organs. The quantitative aspects of BF have been associated with cardiac index and body surface area and they are managed according to metabolic parameters, such as the relationship between delivery and oxygen consumption in relation to temperature, and hemodynamic parameters, such as mean arterial pressure. The qualitative aspects of BF are managed via different types of pumps (roller or centrifugal) with either a pulsed or continuous fl ow. However, the quantity and quality of BF measured during CPB weaning remain relative and not absolute specifying parameters, especially during the establishment and weaning phases of CPB, owing to the use of vents in the aortic root that sequesters BF or replenish bleeding via aspiration, which constitutes a theft of systemic fl ow. In such circumstances, the reintegration of the value stolen by endo-cavitary aspiration or bleeding (considered as a dynamic shunt to the circulation) is advisable. Inthis context, we read with great interest the article titled “ Pulsatile versus nonpulsatile blood fl ow during cardiopulmonary bypass ” by Chaney. In this interesting review, the author highlights the importance and advantages of pulsatile fl ow compared with non-pulsatile fl ow. Multiple studies that have evaluated the ef fi cacy of pulsatile fl ow during CPB have reported controversial results [1]. The suggested","PeriodicalId":39644,"journal":{"name":"Journal of Extra-Corporeal Technology","volume":"55 2","pages":"100"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10304737/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9791425","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 brand-new era has begun for JECT.","authors":"Raymond K Wong","doi":"10.1051/ject/2023006","DOIUrl":"10.1051/ject/2023006","url":null,"abstract":"","PeriodicalId":39644,"journal":{"name":"Journal of Extra-Corporeal Technology","volume":"55 1","pages":"1-2"},"PeriodicalIF":0.0,"publicationDate":"2023-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10061937/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9844429","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":"Association of postoperative atrial fibrillation with higher dosing ratios of protamine-to-heparin.","authors":"Yasuharu Yamada,&nbsp;Junzo Iemura,&nbsp;Atushi Kambara,&nbsp;Noboru Tateishi,&nbsp;Yuji Kozaki,&nbsp;Masako Yamada,&nbsp;Junko Maruyama,&nbsp;Eiichi Azuma","doi":"10.1051/ject/2023003","DOIUrl":"https://doi.org/10.1051/ject/2023003","url":null,"abstract":"<p><p><i>Background</i>: Postoperative atrial fibrillation (POAF) is defined as new-onset AF in the immediate postoperative period. The relatively high incidence of POAF after cardiac surgery is well described, but pathophysiological mechanisms underlying the initiation, maintenance, and progression of POAF may be multifactorial and have not yet been comprehensively characterized. One of the mechanisms includes altered Ca²⁺ kinetics. Accumulating evidence has suggested that altered atrial cytosolic calcium handling contributes to the development of POAF, protamine reversibly modulates the calcium release channel/ryanodine receptor 2 (RyR2) and voltage-dependent cardiac RyR2. However, it is currently unknown whether such abnormalities contribute to the arrhythmogenic substrate predisposing patients to the development of POAF. <i>Methods</i>: We have retrospectively analyzed 147 patients who underwent cardiac surgery with cardiopulmonary bypass support. Of these, 40 patients were excluded from the analysis because of pre-existing AF. All patients received heparin followed by protamine at different dosing ratios of protamine-to-heparin, depending on the periods studied. <i>Results</i>: The dosing ratio of protamine-to-heparin = 1.0 was compared with higher dosing ratios of protamine-to-heparin >1.0 up to 1.7. POAF developed in 15 patients (15/107 = 14%), of these, 5 out of 57 patients (33.3%) in the dosing ratio of protamine-to-heparin = 1.0 and 10 out of 35 patients (66.7%) in the higher dosing ratios of protamine-to-heparin. Statistical significance was observed in patients with higher dosing ratios of protamine-to-heparin, compared with the dosing ratio of protamine-to-heparin = 1.0 (odds ratio = 3.890, 95% CI = 1.130-13.300, <i>p</i>-value = 0.031). When types of diseases were analyzed in terms of higher dosing ratios of protamine-to-heparin, only valvular disorders were significantly associated with POAF (<i>p</i> = 0.04). <i>Conclusions</i>: Protamine is clinically utilized to reverse heparin overdose and has been shown to display immunological and inflammatory alterations. However, its association with POAF has not been reported. Our results provide evidence that higher dosing ratios of protamine-to-heparin may increase the incidence of POAF.</p>","PeriodicalId":39644,"journal":{"name":"Journal of Extra-Corporeal Technology","volume":"55 1","pages":"23-29"},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10071503/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9326547","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":"Haematic antegrade repriming to enhance recovery after cardiac surgery from the perfusionist side.","authors":"Juan Blanco-Morillo,&nbsp;Diego Salmerón Martínez,&nbsp;Jose M Arribas-Leal,&nbsp;Piero Farina,&nbsp;Luc Puis,&nbsp;Angel J Sornichero-Caballero,&nbsp;Sergio J Cánovas-Lόpez","doi":"10.1051/ject/2023004","DOIUrl":"https://doi.org/10.1051/ject/2023004","url":null,"abstract":"<p><p><i>Background</i>: New era of cardiac surgery aims to provide an enhanced postoperative recovery through the implementation of every step of the process. Thus, perfusion strategy should adopt evidence-based measures to reduce the impact of cardiopulmonary bypass (CPB). Hematic Antegrade Repriming (HAR) provides a standardized procedure combining several measures to reduce haemodilutional priming to 300 mL. Once the safety of the procedure in terms of embolic release has been proven, the evaluation of its beneficial effects in terms of transfusion and ICU stay should be assessed to determine if could be considered for inclusion in Enhanced Recovery After Cardiac Surgery (ERACS) programs. <i>Methods</i>: Two retrospective and non-randomized cohorts of high-risk patients, with similar characteristics, were assessed with a propensity score matching model. The treatment group (HG) (<i>n</i> = 225) received the HAR. A historical cohort, exposed to conventional priming with 1350 mL of crystalloid confirmed the control group (CG) (<i>n</i> = 210). <i>Results</i>: Exposure to any transfusion was lower in treated (66.75% vs. 6.88%, <i>p</i> < 0.01). Prolonged mechanical ventilation (>10 h) (26.51% vs. 12.62%; <i>p</i> < 0.01) and extended ICU stay (>2 d) (47.47% vs. 31.19%; <i>p</i> < 0.01) were fewer for treated. HAR did not increase early morbidity and mortality. Related savings varied from 581 to 2741.94 $/patient, depending on if direct or global expenses were considered. <i>Discussion</i>: By reducing the gaseous and crystalloid emboli during CPB initiation, HAR seems to have a beneficial impact on recovery and reduces the overall transfusion until discharge, leading to significant cost savings per process. Due to the preliminary and retrospective nature of the research and its limitations, our findings should be validated by future prospective and randomized studies.</p>","PeriodicalId":39644,"journal":{"name":"Journal of Extra-Corporeal Technology","volume":"55 1","pages":"30-38"},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10062161/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9336679","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":"Adult Clinical Perfusion Practice Survey: 2020 results.","authors":"Breana Lohbusch,&nbsp;Kaylee Olson,&nbsp;Benjamin Magowan,&nbsp;Robert Cherichella,&nbsp;Jeremy Wolverton,&nbsp;Laura Dell'Aiera,&nbsp;Donald S Likosky,&nbsp;David Fitzgerald","doi":"10.1051/ject/2023002","DOIUrl":"https://doi.org/10.1051/ject/2023002","url":null,"abstract":"<p><p><i>Background</i>: Cardiovascular perfusion is a dynamic healthcare profession where new practices are frequently introduced. Despite the emergence of evidence-based clinical practice guidelines, little is known about their dissemination at the institutional level. Clinical practice surveys have been used to identify current trends in perfusion practice in the areas of equipment, techniques, and staffing. This survey aims to describe clinical perfusion practices across adult cardiac surgical programs located in a large, single, geographical region of the United States. <i>Methods</i>: Following Institutional Review Board (IRB) approval, an 81-question survey was distributed to 167 adult perfusion programs across the Zone IV region of the American Society of Extracorporeal Technology (AmSECT), a non-profit professional society representing the extracorporeal technology community. Surveys were distributed to chief perfusionists through the Research Electronic Data Capture (REDCap) web-based survey response system. <i>Results</i>: Responses were received from 58 of 167 centers across (34.7% response rate). Centrifugal pumps were used at 81% (<i>n</i> = 47) of centers and 96.6% (<i>n</i> = 56) use an open venous system or hard-shell venous reservoir. Del Nido was the most frequently used cardioplegia strategy with 62.1% (<i>n</i> = 36) of centers reporting its use. The use of electronic medical records was reported in 43% (<i>n</i> = 25) of centers, while 84.5% (<i>n</i> = 49) reported using Cardiopulmonary Bypass (CPB) protocols (>75% of all CPB activities). Extracorporeal Membrane Oxygenation (ECMO) support was reported in 93.1% (<i>n</i> = 54) of programs, with 59.2% of programs (<i>n</i> = 34) employing a perfusionist as ECMO Coordinator. The <i>n</i> + 1 staffing model was reported by 50% (<i>n</i> = 29), with 24% supporting the <i>n</i> + 1 staffing for after-hours and on-call procedures. <i>Conclusion</i>: Clinical practice surveys can be effective tools to inform clinicians about contemporary perfusion practice and identify deviations from professional standards and guidelines. Subsequent surveys may describe trends over time, assess standardization of practice, measure adherence to evidence-based guidelines, and foster improved patient care and outcomes.</p>","PeriodicalId":39644,"journal":{"name":"Journal of Extra-Corporeal Technology","volume":"55 1","pages":"3-22"},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10071505/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9326541","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":"Foundations of a life support equipment exchange platform.","authors":"Justin R Sleasman,&nbsp;Ula Hijawi,&nbsp;Abdullah Alsalemi,&nbsp;Mohamed Rabie,&nbsp;Mohammad Noorizadeh,&nbsp;Aidan Stead,&nbsp;Christopher Cooley,&nbsp;Conor Donnelly,&nbsp;Jonathan W Haft,&nbsp;Darryl Abrams,&nbsp;Christine Stead,&nbsp;Kathleen R Ryan,&nbsp;Peter Rycus,&nbsp;Alexander D Fox,&nbsp;Mark T Ogino,&nbsp;Peta M A Alexander","doi":"10.1051/ject/2023001","DOIUrl":"https://doi.org/10.1051/ject/2023001","url":null,"abstract":"<p><p><i>Background</i>: The Extracorporeal Life Support Organization Supplies Platform (https://Supplies.ELSO.org) was created out of Extracorporeal Membrane Oxygenation (ECMO) disposable product shortage prior to and during the Coronavirus Disease 2019 (COVID-19) pandemic. This novel Platform supports Centers in obtaining disposables from other Centers when alternative avenues are exhausted. <i>Methods</i>: Driven by the opportunity for increased patient care by using the product availability of the 962 ELSO centers worldwide was the motivation to form an efficient online supply sharing Platform. The pandemic created by COVID-19 became a catalyst to further recognize the magnitude of the supply disruption on a global scale, impacting allocations and guidelines for institutions, practice, and patient care. <i>Conclusions</i>: Records kept on the Platform website are helpful to the industry by providing insights into where difficulties exist in the supply chain for needed equipment. Yet, the common thread is awareness, of how critical situations can stretch resources and challenge our resolve for the best patient care. ELSO is proud to support member centers in these situations, by providing a means of attaining needed ECMO life support products to cover supply shortages.</p>","PeriodicalId":39644,"journal":{"name":"Journal of Extra-Corporeal Technology","volume":"55 1","pages":"39-43"},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10071502/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9326543","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":"Myocardial protective effect by preconditioning effect of inhalation anesthetic administration via artificial lung: 2nd report","authors":"K. Yamada, Takeshi Kamizono, Tatsuya Naito, Yuichi Sato, Yuta Kasai, H. Tsuneyoshi","doi":"10.7130/jject.50.123","DOIUrl":"https://doi.org/10.7130/jject.50.123","url":null,"abstract":"","PeriodicalId":39644,"journal":{"name":"Journal of Extra-Corporeal Technology","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85923199","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":"The effect of roller head pump on von Willebrand factor and platelet aggregation during simulated extracorporeal circulation","authors":"T. Furugaki","doi":"10.7130/jject.50.26","DOIUrl":"https://doi.org/10.7130/jject.50.26","url":null,"abstract":"","PeriodicalId":39644,"journal":{"name":"Journal of Extra-Corporeal Technology","volume":"32 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77636692","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}