Journal of Extra-Corporeal Technology最新文献

{"title":"Is a Health and Wellness Coach a Missing Link in Improving Outcomes for Patients on ECMO?","authors":"Jared Bienstock, Summer Pizzuti, Jodi-Ann Edwards","doi":"10.1182/ject-2200037","DOIUrl":"https://doi.org/10.1182/ject-2200037","url":null,"abstract":"","PeriodicalId":39644,"journal":{"name":"Journal of Extra-Corporeal Technology","volume":"54 4","pages":"343-344"},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9891472/pdf/ject-343-344.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9526831","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":"International Survey of Perfusion Practice for Pediatric and Congenital Heart Surgery: 2021 Results.","authors":"Ashley B Walczak,&nbsp;Jordan M Voss,&nbsp;Molly Dreher,&nbsp;Gregory S Matte,&nbsp;Rachel Fonseca,&nbsp;Rajeev Gupta,&nbsp;Tatiana Averina,&nbsp;Xin Li Xin,&nbsp;Robert Groom","doi":"10.1182/ject-2200012","DOIUrl":"https://doi.org/10.1182/ject-2200012","url":null,"abstract":"<p><p>The conduct of cardiopulmonary bypass in neonatal, infant, and pediatric patients continuously evolves as new devices and innovative techniques are introduced. Since 1989, periodic pediatric perfusion surveys have been conducted to ascertain practice patterns involving demographics, equipment, and perfusion techniques. The goal of this current project is to provide an updated perspective on international pediatric and congenital perfusion practice since the last survey conducted in 2016. In July 2021, a 100-question perfusion survey was distributed to 284 pediatric cardiac surgery centers using a secure web browser-based data application. Each center was given a unique survey hyperlink to ensure one response per institution and to monitor the response rate. Centers were given 1 month to complete the survey and electronic reminders were sent weekly to nonrespondents. After the survey was closed, information from completed surveys was exported to a software program for analysis. Responses were received from 153 of 284 pediatric centers for a response rate of 54%. Sixty respondents (39%) were from North American (NA) centers while 93 respondents (61%) were from non-North American (NNA) centers. The vast majority of centers use a roller head arterial pump (93%), hollow fiber oxygenators with open reservoirs (86%), and integrated arterial line filters (73%). The use of modified ultrafiltration was reported by 76% of centers. Ninety-two percent of centers reported the use of selective antegrade cerebral perfusion for aortic arch repairs. The N + 1 staffing model was most prevalent (52%), followed by two perfusionists per case (33%). Periodic surveys continue to be a useful modality in assessing regional variation in pediatric perfusion practice. This survey marked the first time the majority of responses came from non-North American institutions. Identifying these practice patterns may aid in the development of, and adherence to, regional standards and guidelines. This would foster the reduction of variation in practice and potentially improve patient safety.</p>","PeriodicalId":39644,"journal":{"name":"Journal of Extra-Corporeal Technology","volume":"54 4","pages":"291-317"},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9891471/pdf/ject-291-317.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9251563","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":"Reduced Intracranial Hemorrhage with Anticoagulation Guideline Implementation.","authors":"Vicky Duffy,&nbsp;Brian Schneider,&nbsp;Matt Deitemyer,&nbsp;Ashley Walczak,&nbsp;Janet M Simsic","doi":"10.1182/ject-2200011","DOIUrl":"https://doi.org/10.1182/ject-2200011","url":null,"abstract":"<p><p>Hemorrhagic and thrombotic complications, including intracranial hemorrhage, embolic stroke, surgical bleeding, and circuit thrombosis, are common during extracorporeal membrane oxygenation (ECMO), occurring in up to 50% of patients. These complications have a significant impact on morbidity and mortality. Our objective was to implement standardized ECMO anticoagulation guidelines for the pediatric cardiothoracic intensive care unit (CTICU) to reduce the incidence of intracranial hemorrhage while on ECMO. All CTICU patients who received ECMO from January 2016 to December 2020 were retrospectively reviewed. Standardized ECMO anticoagulation guidelines were implemented in the fourth quarter of 2017. Variables and clinical outcomes before and after guideline implementation were compared. From January 2016 to December 2017, there were 22 separate ECMO runs. Eight of 22 (36%) suffered intracranial hemorrhage while on ECMO. Seven of 8 (88%) were withdrawn from ECMO secondary to bleed and expired prior to hospital discharge. From January 2018 to December 2020, there were 22 separate ECMO runs in the CTICU. Three of 22 (14%) suffered intracranial hemorrhage while on ECMO. One of 3 (33%) expired prior to hospital discharge. Implementation of standardized ECMO anticoagulation guidelines in the CTICU was successful in improving clinical outcomes as evidenced by reduction in the incidence of intracranial hemorrhage in this high-risk patient population.</p>","PeriodicalId":39644,"journal":{"name":"Journal of Extra-Corporeal Technology","volume":"54 4","pages":"318-323"},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9891476/pdf/ject-318-323.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9251565","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":"New Era for JECT Announced.","authors":"Raymond K Wong,&nbsp;Tami Rosenthal","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":39644,"journal":{"name":"Journal of Extra-Corporeal Technology","volume":"54 4","pages":"265-266"},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9891474/pdf/ject-265-266.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9526830","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":"Anticoagulant Use During Extracorporeal Membrane Oxygenation Using Heparin and Direct Thrombin Inhibitors in COVID-19 and ARDS Patients.","authors":"Alfred H Stammers,&nbsp;Eric A Tesdahl,&nbsp;Shannon Barletti,&nbsp;Linda Mongero,&nbsp;Kirti Patel,&nbsp;Matthew Mosca,&nbsp;Anthony Sestokas,&nbsp;Michael S Firstenberg,&nbsp;Jeffrey P Jacobs","doi":"10.1182/ject-223-234","DOIUrl":"https://doi.org/10.1182/ject-223-234","url":null,"abstract":"<p><p>Coagulopathies develop in patients supported with the use of extracorporeal membrane oxygenation (ECMO) and can be hemorrhagic and/or thrombophilic in spite of the use of systemic anticoagulation. The purpose this study was to examine the use of heparin and direct thrombin inhibitors (DTI) in COVID-19 patients with acute respiratory distress syndrome (ARDS) on ECMO, with a subset analysis by disease state. Following IRB approval, 570 consecutive records were reviewed of adult patients on venovenous ECMO between May 2020 and December 2021. Patients were grouped by anticoagulant use: Heparin Only (n = 373), DTI Only (bivalirudin or argatroban, n = 90), or DTI after Heparin (n = 107). The effect of anticoagulant grouping was assessed using Bayesian mixed-effects logistic regression adjusting for age, body mass index (BMI), gender, days of mechanical ventilation prior to ECMO, indication for ECMO support, hepatic and renal failure, hours on ECMO, hours off anticoagulation, coagulation monitoring target, and hospital. The primary endpoint was circuit failure requiring change-out with secondary endpoints of organ failure and mortality. Regression-adjusted probability of circuit change-outs were as follows: DTI after Heparin patients-32.7%, 95% Credible Interval [16.1-51.9%]; DTI Only patients-23.3% [7.5-40.8%]; and Heparin Only patients-19.8% [8.1-31.3%]. The posterior probability of difference between groups was strongest for DTI after Heparin vs. Heparin Only (97.0%), moderate for DTI after Heparin vs. DTI Only (88.2%), and weak for DTI Only vs. Heparin only (66.6%). The occurrence of both hepatic and renal failure for DTI Only and DTI after Heparin patients was higher than that of Heparin Only patients. Unadjusted mortality was highest for DTI after Heparin (64.5%) followed by DTI Only (56.7%), and Heparin Only (50.1%, <i>p</i> = 0.027). DTI after Heparin was associated with an increased likelihood of circuit change-out. Unadjusted hepatic failure, renal failure, and mortality were more frequent among DTI patients than Heparin Only patients.</p>","PeriodicalId":39644,"journal":{"name":"Journal of Extra-Corporeal Technology","volume":"54 3","pages":"223-234"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9891485/pdf/ject-223-234.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10802977","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":"Open Access Publishing and New Perfusion Safety Initiative.","authors":"Raymond K Wong","doi":"10.1182/ject-173-174","DOIUrl":"10.1182/ject-173-174","url":null,"abstract":"","PeriodicalId":39644,"journal":{"name":"Journal of Extra-Corporeal Technology","volume":"54 3","pages":"173-174"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9891488/pdf/ject-173-174.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9142673","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":"Instructions for Authors.","authors":"","doi":"10.1182/ject-258-262","DOIUrl":"https://doi.org/10.1182/ject-258-262","url":null,"abstract":"","PeriodicalId":39644,"journal":{"name":"Journal of Extra-Corporeal Technology","volume":"54 3","pages":"258-262"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9891486/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10644528","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":"Developing a Prospective Incident-Reporting System for Clinical Perfusion Practice in the United States.","authors":"Michael Colligan, Theron Paugh, Sean Murtha","doi":"10.1182/ject-175-190","DOIUrl":"10.1182/ject-175-190","url":null,"abstract":"<p><p>For nearly 20 years, prominent perfusionists have called for a perfusion-centric prospective incident-reporting system to collect near-miss and patient harm incidents that occur during clinical practice in the United States. In this article, we describe the development of a widely available prospective incident-reporting system for use by perfusionists in the United States. The system was developed in three phases: literature review, system incorporation, and submission for listing as a Patient Safety Organization (PSO). It is anticipated that the knowledge gained from analysis of events contributed to this PSO-protected reporting system will lead to improvements in safety and quality of perfusion services, as well as expanding the understanding of best practices in training, equipment use, system design, and simulation scenarios.</p>","PeriodicalId":39644,"journal":{"name":"Journal of Extra-Corporeal Technology","volume":"54 3","pages":"175-190"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9891481/pdf/ject-175-190.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9142674","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 Design and Implementation of a Convertible Extracorporeal Circuit for Lung Transplantation.","authors":"Rachel Gambino,&nbsp;Desiree Bonadonna,&nbsp;William Dauch","doi":"10.1182/ject-242-249","DOIUrl":"https://doi.org/10.1182/ject-242-249","url":null,"abstract":"<p><p>Intraoperative management for patients during orthotopic lung transplantation may be performed without mechanical circulatory support, with veno-arterial extracorporeal membrane oxygenation (VA-ECMO), or cardiopulmonary bypass (CPB). For certain patients, an intraoperative conversion from VA-ECMO to CPB may be indicated. If a VA-ECMO patient requires CPB conversion, the previous model at our institution used two separate machines and was overall inefficient. The primary aim of this project was to develop a CPB pack modification to create a circuit that easily converts from VA-ECMO to CPB if indicated. The secondary aim was to create new supportive protocols and a comprehensive education and training curriculum for our large perfusion department to enhance patient safety. The new circuit was carefully designed and evaluated to minimize changes to the current CPB circuit while allowing for the safest configuration of VA-ECMO. A new protocol was designed with multi-disciplinary collaboration. A comprehensive education and training curriculum, as well as an objective competency assessment tool, were created. The circuit was subjectively evaluated by perfusionists and outscored our previous model in the areas of ease of setup, use, and CPB conversion. It received positive feedback from cardiothoracic surgeons and anesthesiologists as well. Lastly, it provided a financial benefit to our institution.</p>","PeriodicalId":39644,"journal":{"name":"Journal of Extra-Corporeal Technology","volume":"54 3","pages":"242-249"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9891480/pdf/ject-242-249.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10802978","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 Systematic Review with Meta-Analysis Investigating the Impact of Targeted Perfusion Parameters during Extracorporeal Cardiopulmonary Resuscitation in Out-of-Hospital and Inhospital Cardiac Arrest.","authors":"Lars Saemann,&nbsp;Sven Maier,&nbsp;Lisa Rösner,&nbsp;Matthias Kohl,&nbsp;Christine Schmucker,&nbsp;Christian Scherer,&nbsp;Georg Trummer,&nbsp;Friedhelm Beyersdorf,&nbsp;Christoph Benk","doi":"10.1182/ject-191-202","DOIUrl":"https://doi.org/10.1182/ject-191-202","url":null,"abstract":"<p><p>Evidence regarding perfusion conditions during extracorporeal cardiopulmonary resuscitation (ECPR) is rare. Therefore, we investigated the impact of perfusion parameters on neurologic outcome and survival in patients with in- or out-of-hospital cardiac arrest (IHCA; OHCA) treated with ECPR. We performed a systematic review with meta-analysis. The focus was set on perfusion parameters and their impact on survival and a goal neurological outcome using the cerebral performance category score of 1-2. We conducted random- and mixed-effects meta-analyses and computed pooled estimates and 95% confidence intervals (CI). We included a total of <i>n</i> = 1,282 ECPR (100%) patients from 20 ECPR studies. The target values of flow and mean arterial pressure (MAP) were frequently available. We transferred flow and MAP target values to high, medium, and low categories. The meta-analysis could not demonstrate a single effect of flow or MAP on outcome variables. In a second mixed-effects model, the combined occurrence of targeted flow and MAP as medium and high showed a significant effect on survival (OHCA: 52%, 95% CI: 29%, 74%; IHCA: 60%, 95% CI: 35%, 85%) and on neurological outcomes (OHCA: 53%, 95% CI: 27%, 78%; IHCA: 62%, 95% CI: 38%, 86%). Random-effects analysis showed also that IHCA led to a significant 11% (<i>p</i> = 0.006; 95% CI: 3%, 18%) improvement in survival and 12% (<i>p</i> = .005; 95% CI: 4%, 21%) improvement in neurological outcomes compared to OHCA. A combination of medium flow and high MAP showed advantages in survival and for neurological outcomes. We also identified improved outcomes for IHCA.</p>","PeriodicalId":39644,"journal":{"name":"Journal of Extra-Corporeal Technology","volume":"54 3","pages":"191-202"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9891490/pdf/ject-191-202.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10802979","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}