Perfusion-Uk最新文献

{"title":"Impact of high-fidelity simulation on the performance of oxygenator change-outs among perfusion students.","authors":"Julie Collins, Alexis Voitik, Alexander R Leonor, Luke T Juricek, Makenna Ellis, Ramandeep Kaur, Allison Weinberg","doi":"10.1177/02676591251331159","DOIUrl":"https://doi.org/10.1177/02676591251331159","url":null,"abstract":"<p><p>BackgroundSimulation is increasingly utilized in the clinical training of healthcare professionals. Many perfusion programs in the United States use simulation to teach students both technical skills and effective communication. However, there is a lack of clarity regarding the optimal timing for introducing simulation into the curriculum and how to assess students' competencies. This study aims to evaluate whether combining simulation with didactic education is more effective than didactic education alone for learning perfusion-specific tasks, such as oxygenator changeouts.MethodsThis was a pilot, randomized controlled study conducted during November 2020. Subjects who were in their first year and enrolled in a cardiovascular perfusion program at the university were included. Subjects were randomly assigned to receive didactic education alone (control) or didactic in combination with the simulation training (experimental). Both groups received the didactic portion of the oxygenator change out procedure and the experimental group received supplemental simulation training. The primary outcome was oxygenator change-out completion time (recorded in minutes and seconds) to identify and change-out an oxygenator in a cardiopulmonary bypass circuit. The secondary outcome was total communication score and subject's overall performance assessment using the scoring system referenced by Burkhart et al.ResultsThe experimental group (<i>n</i> = 8) performed the oxygenator change-out significantly faster (363.63 ± 87.1 seconds vs 558.11 ± 185.75 seconds, <i>p</i> = .016) as compared to the control group (<i>n</i> = 9). However, there was no significant difference between the control and experimental groups in overall communication skills (<i>p</i> = .152) or the scoring system (<i>p</i> = .053) used to score subjects technical skills.ConclusionThe study findings revealed that the group receiving both didactic instruction and simulation performed an oxygenator change-out significantly faster than the group that received only didactic instruction. These results suggest that incorporating simulation of emergency scenarios into perfusion training can enhance students' speed in performing complex tasks, better preparing them for real clinical situations.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"2676591251331159"},"PeriodicalIF":1.1,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143812821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Redefining ECMO cannulation: A case for TEE-guided VP ECMO and flotation catheter.","authors":"Daniel Manzur-Sandoval, Gian Manuel Jiménez-Rodríguez, Eduardo Bucio-Reta, Alejandro Sierra-González de Cossío, Jessy Steve Masso-Bueso, Gustavo Rojas-Velasco","doi":"10.1177/02676591251331017","DOIUrl":"https://doi.org/10.1177/02676591251331017","url":null,"abstract":"<p><p>Venopulmonary ECMO (VP ECMO) is an advanced support strategy for patients with severe respiratory failure and right ventricular (RV) dysfunction, providing pulmonary protection by oxygenating blood and unloading the RV. This case discusses a 57-year-old female with septic cardiomyopathy, refractory cardiogenic shock, and ARDS, who developed progressive respiratory deterioration despite conventional treatment. Due to patient instability, she was placed on VP ECMO (femoral venous drainage and pulmonary artery reinfusion), guided exclusively by transesophageal echocardiography (TEE). The use of TEE enabled successful pulmonary artery cannulation without the need for fluoroscopic guidance. Additionally, a flotation catheter was used to facilitate guidewire placement, improving procedural success in this emergent situation. After initiating ECMO, the patient showed significant clinical improvement, with resolution of RV dilation and paradoxical septal motion. This case underscores the feasibility and safety of TEE-guided VP ECMO, suggesting that the flotation catheter technique could be beneficial in critical situations, warranting further investigation to establish clinical guidelines.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"2676591251331017"},"PeriodicalIF":1.1,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143774625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of red blood cell transfusions and hemostatic transfusions and their relation to thromboses in pediatric patients receiving extracorporeal membrane oxygenation therapy.","authors":"Michael J Martinez, Tahmineh Romero, Myke D Federman","doi":"10.1177/02676591241260185","DOIUrl":"10.1177/02676591241260185","url":null,"abstract":"<p><p>ObjectiveTo evaluate the association of RBC transfusions with thrombosis in pediatric patients on extracorporeal membrane oxygenation (ECMO) and compare this with the transfusion of other blood products and their association with thrombosis.MethodsThis was a secondary analysis of the Bleeding and Thrombosis during ECMO (BATE) study, which was a multicenter prospective observational study involving patients less than 19 years of age treated with ECMO.Results514 patients were analyzed, of which 282 (55%) were neonates (≤31 days) and 302 (58.7%) were male. When analyzing the entire cohort independently of other blood products, each 10 mL/kg of packed red blood cells (PRBCs) was associated with a 1.0% increase in the average number of thromboses (1.010; 1.008,1.013; <i>p</i> < .001). In neonates, each 10 mL/kg of PRBC was associated with a 0.9% increase in the average number of thromboses (1.009; 1.003,1.013; <i>p</i> < .001). In pediatric patients, each 10 mL/kg of PRBC was associated with a 1.2% increase in the average number of thromboses (1.012; 1.008,1.012; <i>p</i> < .001). The percent increase in the average number of thromboses was similar between PRBCs, platelets, and FFP, but increased significantly with cryoprecipitate.ConclusionsRBC transfusions and hemostatic transfusions are likely associated with thromboses in pediatric patients on ECMO.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"750-756"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141293903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A hardshell reservoir technique for administering del Nido cardioplegia.","authors":"Giuseppe Comentale, Alessandra Notarnicola, Ilaria Ruffo, Paola Bianca Pisco, Anna Milione, Antonio Pacciolla, Anna Damiano, Concetta Calanni, Emanuele Pilato","doi":"10.1177/02676591241260859","DOIUrl":"10.1177/02676591241260859","url":null,"abstract":"<p><p>IntroductionThe use of del Nido cardioplegia has increased in the adult cardiac surgery population. Centers have adopted the formula with a variety of circuit systems. This report includes our set up for delivering 1:4 (blood: crystalloid) del Nido cardioplegia.Materials and MethodsA homemade circuit for cardioplegia administration was built with a pediatric reservoir, a roller pump, a coil cooler, a 3/16-inch circuit to administer and recycle cardioplegia, and two ¼-inch tubes to collect the patient's blood.TechniqueThe circuit allows the perfusionist to collect the blood directly from the cardiopulmonary bypass arterial limb of the circuit, to precisely mix it with the crystalloid component of the del Nido cardioplegia solution already in the reservoir, and to administer the final solution under strictly controlled parameters.SummaryWe present a circuit design that can accurately measure and administer del Nido cardioplegia through the use of a roller pump and a pediatric reservoir. It simplifies and enhances the accuracy and efficiency of cardioplegic administration in our practice.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"568-571"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141285109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of diabetes on short-term outcomes in patients undergoing coronary artery bypass grafting surgery in acute coronary syndrome.","authors":"Ihor Krasivskyi, Borko Ivanov, Zakaria Msallati, Clara Großmann, Stephen Gerfer, Mariya Mihaylova, Kaveh Eghbalzadeh, Christian Origel Romero, Ilija Djordjevic, Thorsten Wahlers, Farhad Bakhtiary, Anton Sabashnikov","doi":"10.1177/02676591241253461","DOIUrl":"10.1177/02676591241253461","url":null,"abstract":"<p><p>IntroductionDiabetes mellitus (DM) is associated with concomitant comorbidities, such as atherosclerosis and cardiovascular disease. Coronary artery bypass grafting (CABG) surgery is the optimal therapy in diabetic patients with triple vessel disease. DM is also known to be a relevant risk factor for higher morbidity and mortality in patients who underwent elective CABG procedures. Data regarding outcomes in diabetic patients in acute coronary syndrome (ACS) is heterogeneous. This study aimed to investigate the impact of DM on short-term outcomes in patients who underwent CABG surgery in ACS.MethodsA retrospective propensity score matched (PSM) analysis of 1370 patients who underwent bypass surgery for ACS between June 2011 and October 2019 was conducted. All patients were divided into two groups: non-diabetic group (<i>n</i> = 905) and diabetic group (<i>n</i> = 465). In-hospital mortality was the primary outcome. Secondary outcomes were perioperative myocardial infarction, new onset dialysis, reopening for bleeding and duration of intensive care unit (ICU) stay. A subgroup analysis of patients with insulin-dependent and non-insulin dependent DM was also performed.ResultsAfter performing PSM analysis, baseline characteristics and the preoperative risk profile were comparable between both groups. The proportion of patients who underwent total arterial revascularization (<i>p</i> = .048) with the use of both internal thoracic arteries (<i>p</i> < .001) was significantly higher in the non-diabetic group. The incidence of perioperative myocardial infarction (<i>p</i> = .048) and new onset dialysis (<i>p</i> = .008) was significantly higher in the diabetic group. In-hospital mortality was statistically (<i>p</i> = .907) comparable between the two groups.ConclusionDM was associated with a higher incidence of adverse outcomes, however with comparable in-hospital mortality in patients who underwent CABG procedure for ACS.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"640-646"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140891361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrigendum to \"Microplegia in paediatric hearts\".","authors":"","doi":"10.1177/02676591231223095","DOIUrl":"10.1177/02676591231223095","url":null,"abstract":"","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"798"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138886454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Flow capabilities of arterial and drainage cannulae during venoarterial extracorporeal membrane oxygenation: A simulation model.","authors":"Avishka Wickramarachchi, Aidan J C Burrell, Patrick R Joyce, Rinaldo Bellomo, Jaishankar Raman, Shaun D Gregory, Andrew F Stephens","doi":"10.1177/02676591241256502","DOIUrl":"10.1177/02676591241256502","url":null,"abstract":"<p><p>BackgroundLarge cannulae can increase cannula-related complications during venoarterial extracorporeal membrane oxygenation (VA ECMO). Conversely, the ability for small cannulae to provide adequate support is poorly understood. Therefore, we aimed to evaluate a range of cannula sizes and VA ECMO flow rates in a simulated patient under various disease states.MethodsArterial cannulae sizes between 13 and 21 Fr and drainage cannula sizes between 21 and 25 Fr were tested in a VA ECMO circuit connected to a mock circulation loop simulating a patient with severe left ventricular failure. Systemic and pulmonary hypertension, physiologically normal, and hypotension were simulated by varying systemic and pulmonary vascular resistances (SVR and PVR, respectively). All cannula combinations were evaluated against all combinations of SVR, PVR, and VA ECMO flow rates.ResultsA 15 Fr arterial cannula combined with a 21 Fr drainage cannula could provide >4 L/min of total flow and a mean arterial pressure of 81.1 mmHg. Changes in SVR produced marked changes to all measured parameters, while changes to PVR had minimal effect. Larger drainage cannulae only increased maximum circuit flow rates when combined with larger arterial cannulae.ConclusionSmaller cannulae and lower flow rates could sufficiently support the simulated patient under various disease states. We found arterial cannula size and SVR to be key factors in determining the flow-delivering capabilities for any given VA ECMO circuit. Overall, our results challenge the notion that larger cannulae and high flows must be used to achieve adequate ECMO support.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"668-677"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11951468/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141086563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Conventional versus minimally invasive extra-corporeal circulation in patients undergoing cardiac surgery: A randomized controlled trial (COMICS).","authors":"Gianni D Angelini, Barnaby C Reeves, Lucy A Culliford, Rachel Maishman, Chris A Rogers, Kyriakos Anastasiadis, Polychronis Antonitsis, Helena Argiriadou, Thierry Carrel, Dorothée Keller, Andreas Liebold, Fatma Ashkaniani, Aschraf El-Essawi, Ingo Breitenbach, Clinton Lloyd, Mark Bennett, Alex Cale, Serdar Gunaydin, Eren Gunertem, Farouk Oueida, Ibrahim M Yassin, Cyril Serrick, John M Murkin, Vivek Rao, Marco Moscarelli, Ignazzo Condello, Prakash Punjabi, Cha Rajakaruna, Apostolos Deliopoulos, Daniel Bone, William Lansdown, Narain Moorjani, Sarah Dennis","doi":"10.1177/02676591241258054","DOIUrl":"10.1177/02676591241258054","url":null,"abstract":"<p><p>IntroductionThe trial hypothesized that minimally invasive extra-corporeal circulation (MiECC) reduces the risk of serious adverse events (SAEs) after cardiac surgery operations requiring extra-corporeal circulation without circulatory arrest.MethodsThis is a multicentre, international randomized controlled trial across fourteen cardiac surgery centres including patients aged ≥18 and <85 years undergoing elective or urgent isolated coronary artery bypass grafting (CABG), isolated aortic valve replacement (AVR) surgery, or CABG + AVR surgery. Participants were randomized to MiECC or conventional extra-corporeal circulation (CECC), stratified by centre and operation. The primary outcome was a composite of 12 post-operative SAEs up to 30 days after surgery, the risk of which MiECC was hypothesized to reduce. Secondary outcomes comprised: other SAEs; all-cause mortality; transfusion of blood products; time to discharge from intensive care and hospital; health-related quality-of-life. Analyses were performed on a modified intention-to-treat basis.ResultsThe trial terminated early due to the COVID-19 pandemic; 1071 participants (896 isolated CABG, 97 isolated AVR, 69 CABG + AVR) with median age 66 years and median EuroSCORE II 1.24 were randomized (535 to MiECC, 536 to CECC). Twenty-six participants withdrew after randomization, 22 before and four after intervention. Fifty of 517 (9.7%) randomized to MiECC and 69/522 (13.2%) randomized to CECC group experienced the primary outcome (risk ratio = 0.732, 95% confidence interval (95% CI) = 0.556 to 0.962, <i>p</i> = 0.025). The risk of any SAE not contributing to the primary outcome was similarly reduced (risk ratio = 0.791, 95% CI 0.530 to 1.179, <i>p</i> = 0.250).ConclusionsMiECC reduces the relative risk of primary outcome events by about 25%. The risk of other SAEs was similarly reduced. Because the trial terminated early without achieving the target sample size, these potential benefits of MiECC are uncertain.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"730-741"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11951381/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141236195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes following additional drainage during veno-venous extracorporeal membrane oxygenation: A single-center retrospective study.","authors":"Sagar B Dave, Eric Leiendecker, Christina Creel-Bulos, Casey Frost Miller, David W Boorman, Jeffrey Javidfar, Tamer Attia, Mani Daneshmand, Craig S Jabaley, Mark Caridi-Schieble","doi":"10.1177/02676591241249609","DOIUrl":"10.1177/02676591241249609","url":null,"abstract":"<p><p>Refractory hypoxemia during veno-venous (V-V) extracorporeal membrane oxygenation (ECMO) may require an additional cannula (VV-V ECMO) to improve oxygenation. This intervention includes risk of recirculation and other various adverse events (AEs) such as injury to the lung, cannula malpositioning, bleeding, circuit or cannula thrombosis requiring intervention (i.e., clot), or cerebral injury. During the study period, 23 of 142 V-V ECMO patients were converted to VV-V utilizing two separate cannulas for bi-caval drainage with an additional upper extremity cannula placed for return. Of those, 21 had COVID-19. In the first 24 h after conversion, ECMO flow rates were higher (5.96 vs 5.24 L/min, <i>p</i> = .002) with no significant change in pump speed (3764 vs 3630 revolutions per minute [RPMs], <i>p</i> = .42). Arterial oxygenation (PaO₂) increased (87 vs 64 mmHg, <i>p</i> < .0001) with comparable pre-oxygenator venous saturation (61 vs 53.3, <i>p</i> = .12). By day 5, flows were similar to pre-conversion values at lower pump speed but with improved PaO₂. Unadjusted survival was similar in those converted to VV-V ECMO compared to V-V ECMO alone (70% [16/23] vs 66.4% [79/119], <i>p</i> = .77). In a mixed effect regression model, any incidence of AEs, demonstrated a negative impact on PaO₂ in the first 48 h but not at day 5. VV-V ECMO improved oxygenation with increasing flows without a significant difference in AEs or pump speed. AEs transiently impacted oxygenation. VV-V ECMO is effective and feasible strategy for refractory hypoxemia on VV-ECMO allowing for higher flow rate and unchanged pump speed.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"647-656"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140960558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of geography on the use of ultrafiltration during cardiac surgery with cardiopulmonary bypass.","authors":"Keith A Samolyk","doi":"10.1177/02676591241256523","DOIUrl":"10.1177/02676591241256523","url":null,"abstract":"","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"793-794"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141075344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}