Perfusion-Uk最新文献

{"title":"The emerging role of minimally invasive extracorporeal circulation in totally endoscopic and robotic-assisted cardiac surgery procedures.","authors":"Ignazio Condello, Andrea Amabile, Massimo Baudo, Gianluca Torregrossa, Tommaso Hinna Danesi","doi":"10.1177/02676591241281793","DOIUrl":"https://doi.org/10.1177/02676591241281793","url":null,"abstract":"<p><p><i>Background:</i> This review explores the potential benefits of combining totally endoscopic and robotic-assisted cardiac surgery with minimally invasive extracorporeal circulation (MiECC). Robotic techniques herald a new era of surgical precision, leveraging advanced instrumentation and enhanced visualization to navigate cardiac anatomy with unprecedented accuracy. <i>Purpose:</i> Concurrently, MiECC systems provide tailored physiological support during cardiopulmonary bypass, meticulously managing perfusion parameters to safeguard vital organs' function. <i>Results:</i> The convergence of these cutting-edge technologies marks a paradigmatic shift in cardiac surgical practice, with potential mitigation of invasiveness, attenuation of perioperative complications, and expedite postoperative recovery. <i>Conclusions:</i> This review also addresses prevailing challenges and limitations, including technological complexities and procedural intricacies, while elucidating the strategic imperatives for optimizing their collaborative utilization.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142156482","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":"Safety and feasibility of conversion from venoarterial to venovenous extracorporeal membrane oxygenation in pediatric patients: A case series.","authors":"Kathryn M Maselli, Nikhil R Shah, Keyonna Williams, Brianna Spencer, Samir K Gadepalli, Arul S Thirumoorthi","doi":"10.1177/02676591241282578","DOIUrl":"https://doi.org/10.1177/02676591241282578","url":null,"abstract":"<p><strong>Introduction: </strong>In children requiring venoarterial (VA) extracorporeal membrane oxygenation (ECMO) for long durations, conversion to venovenous (VV) support may be advantageous. The purpose of this study was to evaluate the feasibility and safety of conversion from VA to VV ECMO.</p><p><strong>Methods: </strong>This is a retrospective review of all children who underwent conversion from VA to VV ECMO at a single institution, from 2015 to 2022. Indications for and methods of conversion were examined as well as adverse events including re-operation, ischemic complications, renal failure, and mortality.</p><p><strong>Results: </strong>Of 422 pediatric patients on initial VA ECMO, 4 children (0.9%) underwent conversion from VA to VV support. The indications for cannulation were: respiratory failure due to COVID19, respiratory failure due to congenital diaphragmatic hernia, cardiac dysfunction following heart transplant, and sepsis with associated left ventricular dysfunction. The indications for conversion were bleeding from the arterial cannula and ongoing respiratory failure. The median time to conversion was 6.5 days (range 4-54 days) and the median length of ECMO run was 34.5 days. Three patients required renal replacement therapy with two progressing to long-term dialysis. There were no ischemic limb complications although one patient developed a femoral artery pseudoaneurysm that required re-operation. Three patients survived to discharge. One patient was unable to be decannulated after conversion and mechanical support was withdrawn.</p><p><strong>Conclusions: </strong>Conversion to VV ECMO from initial VA ECMO cannulation is feasible but a rare event. For patients with cardiac stability but continued need for respiratory support, conversion to VV ECMO can be considered.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142143457","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":"Successful management of pulmonary hemorrhage from lung carcinoid, in a patient on VenoArterial extracorporeal membrane oxygenation support.","authors":"Antigoni Koliopoulou, Michael Antonopoulos, Fotios Theodoropoulos, Michael Efremidis, Konstantinos Letsas, Aggeliki Gouziouta, Stamatis Adamopoulos, Themistocles Chamogeorgakis, Stavros Dimopoulos","doi":"10.1177/02676591241252723","DOIUrl":"https://doi.org/10.1177/02676591241252723","url":null,"abstract":"<p><strong>Introduction: </strong>A young man was referred to our Center for refractory cardiogenic shock, accompanied with uncontrolled atrial flutter of unknown duration. The patient was supported with VenoArterial Extracorporeal Membrane Oxygenation (VA ECMO) and Intra-Aortic Balloon Pump (IABP) as a bridge to decision.</p><p><strong>Case report: </strong>His course was complicated by pulmonary hemorrhage due to an unknown endobronchial mass. A low-grade typical carcinoid without metastases was revealed during work up. He was treated successfully with bronchoscopy-guided interventional therapies and cavo-tricuspid isthmus ablation. Mechanical support was successfully weaned off and 3 months after discharge, he was asymptomatic with no sign of residual tumor.</p><p><strong>Discussion: </strong>Endobronchial treatment is a parenchyma-preserving alternative to surgery, with a comparable recurrence rate, especially in patients with typical carcinoid.</p><p><strong>Conclusion: </strong>This is the first case report describing the successful management of pulmonary hemorrhage due to lung carcinoid, in a patient supported with VA ECMO for cardiogenic shock.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142143458","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":"Do not ask if ECMO, but when - More unanswered questions.","authors":"Justyna Swol","doi":"10.1177/02676591241282589","DOIUrl":"https://doi.org/10.1177/02676591241282589","url":null,"abstract":"","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142127164","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":"Extracorporeal membrane oxygenation support in adult patients: Comparing COVID-19- and non-COVID-19-associated respiratory failure.","authors":"Tak Kyu Oh, In-Ae Song","doi":"10.1177/02676591241281792","DOIUrl":"https://doi.org/10.1177/02676591241281792","url":null,"abstract":"<p><strong>Introduction: </strong>Extracorporeal membrane oxygenation (ECMO) is a vital intervention for acute respiratory distress syndrome (ARDS), yet its efficacy with coronavirus disease 2019 (COVID-19) remains unknown. This study compared the long-term mortality rates of patients receiving ECMO for COVID-19 with those experiencing other respiratory disease-associated ARDS.</p><p><strong>Methods: </strong>This retrospective cohort study included adults with ARDS receiving ECMO for respiratory disease (COVID-19 and non-COVID-19) based on information collected from the National Health Insurance Service of South Korea from February 1, 2020, to December 31, 2021. The primary outcome was all-cause mortality at 6 months and 1 year post-ECMO initiation.</p><p><strong>Results: </strong>Data from 3094 patients with COVID-19 (<i>N</i> = 1095) and non-COVID-19 respiratory disease-associated ARDS (<i>N</i> = 1999) who received ECMO support were analyzed. Despite a higher Charlson Comorbidity index in the non-COVID group, patients with COVID-19 had higher cumulative mortality rates at 6 months and 1 year post-ECMO initiation compared to those with non-COVID-19 respiratory diseases, after adjusting for confounders. Patients with COVID-19 also experienced longer intensive care unit stays, higher hospitalization costs, longer ECMO and mechanical ventilation durations, and lower intensity coverage.</p><p><strong>Conclusions: </strong>Patients with COVID-19 requiring ECMO showed higher mortality rates, possibly due to its distinct long-lasting and potentially fatal consequences compared to other respiratory illnesses.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142120982","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":"Successful management of intracranial hemorrhage with brain herniation in a postpartum patient on extracorporeal membranous oxygenation: A case report.","authors":"Jing Wang, Laith Altaweel, Mehul Desai, Heidi Dalton, Jessica Buchner, Lucy Q Zhang, Pouya Tahsili-Fahadan","doi":"10.1177/02676591241279745","DOIUrl":"https://doi.org/10.1177/02676591241279745","url":null,"abstract":"<p><p>Managing intracranial hemorrhage in patients supported by extracorporeal oxygenation (ECMO) presents significant clinical challenges. We report a case of a postpartum patient with severe acute respiratory distress syndrome (ARDS) necessitating venovenous ECMO support, complicated by multicompartmental intracranial hemorrhage resulting in brain herniation and necessitating emergent medical and surgical management of refractory intracranial hypertension. Care was guided by multimodal neuromonitoring, including intracranial pressure monitoring and electroencephalography. Despite these challenges, the patient achieved excellent neurological recovery. This case underscores the intricacies of managing neurological complications during ECMO and highlights the potential benefits of comprehensive neuromonitoring strategies.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142120983","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":"Pediatric COVID-19 extracorporeal membrane oxygenation transport during the pandemic.","authors":"Marco Daverio, Sylvia Belda Hofheinz, Vladimiro Vida, Fabio Scattolin, Eduardo López Fernández, Enrique García Torres, Imanol Tajuelo-Llopis, Jaume Izquierdo-Blasco, Antoni Pàmies-Catalán, Matteo Di Nardo, Maria Elena De Piero, Joan Balcells, Angela Amigoni","doi":"10.1177/02676591231176243","DOIUrl":"10.1177/02676591231176243","url":null,"abstract":"<p><strong>Introduction: </strong>ExtraCorporeal Membrane Oxygenation (ECMO) in pediatric patients with COVID-19 has a survival rate similar to adults. Occasionally, patients may need to be cannulated by an ECMO team in a referring hospital and transported to an ECMO center. The ECMO transport of a COVID-19 patient has additional risks than normal pediatric ECMO transport for the possible COVID-19 transmissibility to the ECMO team and the reduction of the ECMO team performance due to the need of wearing full personal protective equipment. Since pediatric data on ECMO transport of COVID-19 patients are lacking, we explored the outcomes of the pediatric COVID-19 ECMO transports collected in the EuroECMO COVID_Neo/Ped Survey.</p><p><strong>Methods: </strong>We reported five European consecutive ECMO transports of COVID-19 pediatric patients collected in the EuroECMO COVID_Neo/Ped Survey including 52 European neonatal and/or pediatric ECMO centers and endorsed by the EuroELSO from March 2020 till September 2021.</p><p><strong>Results: </strong>The ECMO transports were performed for two indications, pediatric ARDS and myocarditis associated to the multisystem inflammatory syndrome related to COVID-19. Cannulation strategies differed among patients according to the age of the patients, transport distance varied between 8 and 390 km with a total transport duration between 5 to 15 h. In all five cases, the ECMO transports were successfully performed without major adverse events. One patient reported a harlequin syndrome and another patient a cannula displacement both without major clinical consequences. Hospital survival was 60% with one patient reporting neurological sequelae. No ECMO team member developed COVID-19 symptoms after the transport.</p><p><strong>Conclusion: </strong>Five transports of pediatric patients with COVID-19 supported with ECMO were reported in the EuroECMO COVID_Neo/Ped Survey. All transports were performed by an experienced multidisciplinary ECMO team and were feasible and safe for both the patient and the ECMO team. Further experiences are needed to better characterize these transports and draw insightful conclusions.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10185475/pdf/10.1177_02676591231176243.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9474819","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":"A quality improvement initiative to increase adult ECMO decision-making abilities in a perfusion education program: The use of 3D ECMO simulation.","authors":"Angela McIntyre, Garrett Schroder, Adannaya Amadi, Michael Jimenez, John Marflak, Laura Dell'Aiera, David Fitzgerald","doi":"10.1177/02676591231177903","DOIUrl":"10.1177/02676591231177903","url":null,"abstract":"<p><strong>Introduction: </strong>Adult and pediatric ECMO procedures have been increasingly established as conventional life-saving modalities in critical care services across the world. Since 2017, a multidisciplinary team of program advisors for our perfusion education program have aimed to increase cardiovascular perfusion (CVP) student ECMO exposure and improve clinical decision-making. In this QI intervention, the use of 3D computer-based simulation was assessed in establishing a standardized process to improve the diagnosis and treatment of adult ECMO complications among first year CVP students.</p><p><strong>Methods: </strong>The Califia 3D Patient Simulator was incorporated into the curriculum for first year CVP students (<i>n</i> = 26) along with traditional lecture for the adult ECMO complication laboratory session. Pre-class knowledge assessments using de-identified polling software were compared to post-class assessments following the first assigned learning activity. Assessments from students that received simulation before lecture (SIM, <i>n</i> = 15) were compared to students receiving lecture before simulation (LEC, <i>n</i> = 11). User experience questionnaires (UEQ) consisting of 26 questions for six scales of simulation instruction were administered to measure the comprehensive impression of the student experience.</p><p><strong>Results: </strong>Overall median [IQR] pre- and -post knowledge assessment scores were 74% [11] and 84% [11], respectively (<i>p</i> = 0.01). There were no significant differences in pre-class assessment scores between the SIM and LEC groups (74.0% and 74.0%, respectively, <i>p</i> = 0.959). The LEC group achieved higher median post-assessment scores than the SIM group (84% vs 79%, <i>p</i> = 0.032). Among the 26 UEQ survey scales, 23 were positively evaluated (>0.8), and three were a neutral evaluation (-0.8 to 0.8). Cronbach Alpha-Coefficients of >0.78 were measured for attractiveness, perspicuity, efficacy, and stimulation. The coefficient for dependability was 0.37. 25 (96.2%) students indicated that 3D simulation was beneficial to improving ECMO clinical decision-making.</p><p><strong>Conclusions: </strong>In this QI intervention, the implementation of computer-based 3D simulation following lecture was perceived by learners to help improve the diagnosis and treatment of ECMO-related complications.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9523659","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":"Veno-arterial extracorporeal membrane oxygenation versus standard medical management for massive pulmonary embolism.","authors":"Catherine E Kelty, Wael Berjaoui, Nabin K Shrestha, Stephen Fitch, Stefan M Jovinge, Renzo Loyaga Rendon","doi":"10.1177/02676591231182247","DOIUrl":"10.1177/02676591231182247","url":null,"abstract":"<p><strong>Purpose: </strong>There is limited research on the use and outcomes of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) treatment for massive pulmonary embolism (PE). This study compared VA-ECMO treatment for massive PE versus patients treated medically.</p><p><strong>Materials and methods: </strong>Patients diagnosed with massive PE at one hospital system were reviewed. VA-ECMO and non-ECMO groups were compared by <i>t</i> test and Chi-square. Mortality risk factors were identified by logistic regression. Survival was assessed by Kaplan Meier and propensity matching of groups.</p><p><strong>Results: </strong>Ninety-two patients were included (22 VA-ECMO and 70 non-ECMO). Age (OR 1.08, 95% CI 1.03-1.13), arterial SBP (OR 0.97, 95% CI 0.94-0.99), albumin (OR 0.3, 95% CI 0.1-0.8), and phosphorus (OR 2.0, 95% CI 1.4-3.17) were independently associated with 30-day mortality. Alkaline phosphate (OR 1.03, 95% CI 1.01-1.05) and SOFA score (OR 1.3, 95% CI 1.06-1.51) were associated with 1-year mortality. Propensity matching showed no difference in 30-day (59% VA-ECMO versus 72% non-ECMO, <i>p</i> = 0.363) or 1-year survival (50% VA-ECMO versus 64% non-ECMO, <i>p</i> = 0.355).</p><p><strong>Conclusions: </strong>Patients treated with VA-ECMO for massive PE and medically treated patients have similar short- and long-term survival. Further research is needed to define clinical recommendations and benefits of intensive therapy such as VA-ECMO in this critically ill population.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9586703","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":"Del nido versus conventional blood cardioplegia in patients with obstructive hypertrophic cardiomyopathy.","authors":"Yingshan Huang, Shujie Yan, Yi Song, Xiaoqi Wang, Ke Yang, Ling Zhang, Wenting Gui, Jiao Wang, Yunling Yang, Yan Xie, Dongmei Wang, Xinyue Li","doi":"10.1177/02676591231163270","DOIUrl":"10.1177/02676591231163270","url":null,"abstract":"<p><strong>Background: </strong>Myocardial protection is essential in cardiac surgery with cardiopulmonary bypass The Del Nido cardioplegia which was initially used in pediatric cardiac surgery, has been increasingly used in adult cardiac surgery recently. However, no literature has reported the efficacy of DNC in hypertrophic obstructive cardiomyopathy.</p><p><strong>Methods: </strong>This retrospective study involved elective patients who underwent extended surgical myectomy with or without concomitant cardiac surgical procedures between September 2017 and June 2022. Patients were distributed into two groups, the DNC and the CBC group. The primary outcome was high-sensitivity cardiac troponin I (hs-TnI) and creatine kinase-MB (CK-MB) levels at the 0, 1, and 2 postoperative days. The secondary outcomes contained: intraoperative LVEF, return to spontaneous rhythm; postoperative myocardial infarction, worsening or deteriorating of EF, mechanical circulatory support; new-onset atrial fibrillation; mechanical ventilation duration; intensive care unit hours; in-hospital days.</p><p><strong>Results: </strong>Fifty-nine patients were included and divided into the CBC (<i>n</i> = 15) and the DNC group (<i>n</i> = 44). There was no statistical difference in patients' demographics and preoperative parameters between the two groups. No in-hospital mortality. The total cardioplegia volume [21.93(18.36,26.07) vs. 25.68(23.17,37.12), <i>p</i> = 0.012] and infusion times [1(1,1) vs. 2(2,3), <i>p</i> = 0.000] were less and the incidence of return to spontaneous rhythm after declamping was higher in the DNC group [97.7% vs. 73.3%, <i>p</i> = 0.013]. Postoperative hs-TnI and CK-MB levels were comparable between the two groups. A longer DNC infusion interval was associated with higher levels of CK-MB on postoperative day 1 and day 2 (<i>p</i> = 0.009 and <i>p</i> = 0.011, respectively).</p><p><strong>Conclusions: </strong>The use of DNC in extended surgical myectomy procedure was as safe and effective as CBC. However, DNC infusion interval over 60 minutes was associated with increased postoperative CK-MB levels.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9490976","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}