Perfusion-Uk最新文献

{"title":"Body mass index is not associated with time on veno-venous extracorporeal membrane oxygenation or in-hospital mortality.","authors":"Jordin S Roden-Foreman, Michael L Foreman, Kara Monday, Kaitlyn Lingle, Britton Blough, Mohamad M Safa, Gary Schwartz","doi":"10.1177/02676591231193269","DOIUrl":"10.1177/02676591231193269","url":null,"abstract":"<p><p>Morbid obesity, as characterized by BMI, is often utilized as an exclusion criterion for VV-ECMO because of presumed poor prognosis and technically complex cannulation. However, the \"obesity paradox\" suggests obesity may be protective during critical illness, and BMI does not capture variations in body type, adiposity, or fluid balance. This study examines relationships between BMI and patient outcomes. Adult VV-ECMO patients with BMI ≥ 35 kg/m² admitted January 2012 to June 2021 were identified from an institutional registry. BMI and outcomes were analyzed with Mann-Whitney U tests and Pearson correlations with Bayesian post-hoc analyses. 116 of 960 ECMO patients met inclusion criteria. Median (Q1, Q3) BMI was 42.3 (37.3, 50.8) and min, max of 35.0, 87.8 with 9.0 (5.0, 15.5) ECMO days. BMI was not significantly correlated with ECMO days (r = -0.102; <i>p</i> = .279). Bayesian analyses showed moderate evidence against BMI correlating with ECMO days. In-hospital mortality (27%) was significantly associated with ECMO days (<i>p</i> = .014) but not BMI (<i>p</i> = .485). In this cohort of high-BMI patients, BMI was not associated with survival or time on ECMO. BMI itself should not be used as an exclusion criterion for VV-ECMO.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"1356-1362"},"PeriodicalIF":1.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9883604","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":"The association between intraoperative cardiopulmonary bypass power and complications after cardiac surgery.","authors":"Victor Hui, Kwok M Ho, Rebecca Hahn, Brian Wright, Robert Larbalestier, Warren Pavey","doi":"10.1177/02676591231187958","DOIUrl":"10.1177/02676591231187958","url":null,"abstract":"<p><strong>Background: </strong>Low cardiac power (product of flow and pressure) has been shown to be associated with mortality in patients with cardiogenic shock after acute myocardial infarction, but has not been studied in cardiac surgical patients. This study's hypothesis was that cardiac power during cardiopulmonary bypass for cardiac surgery would have a greater association with adverse events than either flow or MAP (mean arterial pressure) alone.</p><p><strong>Methods: </strong>We undertook a retrospective observational study using patient data from February 2015 to March 2022 undergoing cardiac surgery at Fiona Stanley Hospital in Perth Australia. Excluded were patient age less than 18 years old, patients undergoing thoracic transplantation, ventricular assist devices, off pump cardiac surgery and aortic surgery. The primary outcome was a composite outcome of 30-days mortality, stroke or new-onset renal insufficiency.</p><p><strong>Results: </strong>Overall, 1984 cardiac surgeries were included in the analysis. Neither duration nor area below thresholds tested for power, MAP or flow was associated with the primary composite outcome. However, we found that an area below MAP thresholds 35-50 mmHg was associated with new renal insufficiency (adjusted odds ratio 1.17 [95% CI 1.02 to 1.35] for patients spending 10 min at 10 mmHg below 50 mmHg MAP compared to those who did not).</p><p><strong>Conclusions: </strong>This study suggests that MAP during cardiopulmonary bypass, but not power or flow, was an independent risk factor for adverse renal outcomes for cardiac surgical patients.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"1304-1313"},"PeriodicalIF":1.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10152880","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 aortic arch cannulation and perfusion of a heart donated after circulatory death: A case report.","authors":"Mats T Vervoorn, Paul van Kaam, Mostafa M Mokhles, Niels P van der Kaaij, Monica Gianoli","doi":"10.1177/02676591231200986","DOIUrl":"10.1177/02676591231200986","url":null,"abstract":"<p><strong>Introduction: </strong>We describe successful aortic arch cannulation and perfusion of a heart donated after circulatory death using the Transmedics Organ Care System™.</p><p><strong>Case report: </strong>A 47-year old man developed advanced heart failure symptoms after prior mustard operation for transposition of the great arteries. He matched a DCD-donor and required an elongated aorta for implantation due to his altered anatomy. The donor heart was retrieved and successfully perfused via aortic arch cannulation for 4.5 h with satisfactory perfusion parameters.</p><p><strong>Disussion: </strong>Although Transmedics advises against aortic arch cannulation due to concerns regarding malperfusion, satisfactory and safe perfusion can be achieved by careful positioning of the heart. Awareness and attention to the occurrence of malperfusion is mandatory, especially during transport, to achieve satisfactory outcome.</p><p><strong>Conclusion: </strong>Aortic arch cannulation is feasible without compromising quality of perfusion. This is relevant for patient that require an elongated aorta after surgically corrected congenital heart disease.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"1478-1480"},"PeriodicalIF":1.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11462774/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10515179","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":"Direct oral anticoagulants versus vitamin K antagonists: Which one is more effective in atrial fibrillation.","authors":"Alireza Khodadadiyan, Kimia Jazi, Hamed Bazrafshan Drissi, Helia Bazroodi, Mina Mashayekh, Erfan Sadeghi, Ghazal Gholamabbas, Mehdi Bazrafshan, Mahdi Rahmanian","doi":"10.1177/02676591231202383","DOIUrl":"10.1177/02676591231202383","url":null,"abstract":"<p><strong>Background: </strong>The optimal approach for anticoagulation in patients with bioprosthetic valves and atrial fibrillation (AF) remains a subject of debate. A meta-analysis using updated evidence to evaluate the efficacy and safety of direct oral anticoagulants (DOACs) compared to vitamin K antagonists (VKAs) in patients with AF and bioprosthetic valves to address this controversy.</p><p><strong>Methods: </strong>A comprehensive search was conducted in multiple databases, including PubMed, Scopus, Web of Science, ProQuest, and the Cochrane Central Register of Controlled Trials, up until March 2023. The search aimed to identify relevant randomized controlled trials (RCTs) that examined the efficacy and safety outcomes of both direct oral anticoagulants (DOACs) and vitamin K antagonists (VKAs) in patients with bioprosthetic valves and atrial fibrillation. The primary outcomes of interest were major bleeding and all-cause mortality.</p><p><strong>Results: </strong>Our study demonstrated that despite the difference was not significant, the hazard of all-cause mortality was 2.5% higher in the DOAC group (HR = 1.03, 95% CI = [0.88, 1.19], p-value = .75). Similarly, the hazard of stroke (HR = 1.03, 95% CI = [0.87, 1.32], p-value = .71) and major bleeding (HR = 1.11, 95% CI = [0.89, 1.38], p-value = .36) were found to be respectively 3.2 and 10.7% higher in the DOAC group, although the difference was not significant. However, the hazard of intracranial hemorrhage was found to be 28.8 lower in the DOAC treatment group (HR = 0.71, 95% CI = [0.39, 1.31], p-value = .27), which again was not statistically significant.</p><p><strong>Conclusions: </strong>Our meta-analysis demonstrates that in patients undergoing bioprosthetic valve surgery and presenting with AF afterward, DOAC and VKA are similar regarding life-threatening and all-cause mortality outcomes, including major bleeding, stroke, and intracranial hemorrhage.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"1286-1294"},"PeriodicalIF":1.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10211153","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 the effect of uric acid/albumin ratio on coronary colleteral circulation with other inflammation-based markers in stable coronary artery disease patients.","authors":"Kenan Toprak, Rüstem Yılmaz, Mustafa Kaplangoray, Tolga Memioğlu, Mehmet İnanır, Selahattin Akyol, Kaya Özen, Asuman Biçer, Recep Demirbağ","doi":"10.1177/02676591231202105","DOIUrl":"10.1177/02676591231202105","url":null,"abstract":"<p><strong>Background: </strong>The Uric acid/Albumin ratio (UAR) has recently been identified as a prominent marker in cardiovascular diseases. In this study, we aimed to reveal the effect of UAR on coronary collateral circulation (CCC) in patients with stable coronary artery disease (CAD) patients by comparing it with conventional inflammation-based markers.</p><p><strong>Methods: </strong>In this study, 415 consecutive patients who underwent coronary angiography for stable angina pectoris and were found to have chronic total occlusion in at least one coronary artery were retrospectively included. The study population was divided into two groups as good CCC (Rentrop 2-3) and poor CCC (Rentrop 0-1) according to the Rentrop classification, and the groups were compared in terms of UAR and other traditional inflammation-based markers.</p><p><strong>Results: </strong>In the poor CCC group, C-reactive protein/albumin ratio (CAR), monocyte/high-density lipoprotein cholesterol ratio (MHR), neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), systemic immune-inflammation index (SII) and UAR were found to be significantly high (<i>p</i> < .05, for all). UAR negatively correlated with rentrop classification (r = -0.383, <i>p</i> < .001). In multivariate regression analysis, MHR, NLR, SII and UAR were determined as independent predictors for poor CCC (<i>p</i> < .05, for all). The ability of UAR to predict poor CCC was superior to uric acid and albumin alone (<i>p</i> < .0001, for both). In addition, UAR was found to be superior to other inflammation-based markers in predicting poor CCC (<i>p</i> < .005, for all).</p><p><strong>Conclusion: </strong>UAR was identified as a strong and independent predictor of CCC. In this context, UAR may be a useful biomarker in the risk prediction of patients with stable CAD.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"1440-1452"},"PeriodicalIF":1.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10161285","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":"Accurate protamine:heparin matching (not just smaller protamine doses) decreases postoperative bleeding in cardiac surgery; results from a high-volume academic medical center.","authors":"Michael W Vespe, Marc E Stone, Hung-Mo Lin, Yuxia Ouyang","doi":"10.1177/02676591231190739","DOIUrl":"10.1177/02676591231190739","url":null,"abstract":"<p><strong>Background: </strong>A multidisciplinary Quality Assurance/Performance Improvement study to identify the incidence of \"heparin rebound\" in our adult cardiac surgical population instead detected a thromboelastometry pattern suggestive of initial protamine overdose in 34% despite Hepcon-guided anticoagulation management. Analysis of our practice led to an intervention that made an additional lower-range Hepcon cartridge available to the perfusionists.</p><p><strong>Methods: </strong>One year later, an IRB-approved retrospective study was conducted in >500 patients to analyze the effects of the intervention, specifically focusing on the impact of the initial protamine dose accuracy and 18-h mediastinal chest tube drainage (MCTd).</p><p><strong>Results: </strong>No differences were observed between group demographics, surgical procedures, duration of CPB or perioperative blood product transfusion. Both groups were managed using the same perfusion and anesthesia equipment, strategies, and protocols. The median initial protamine dose decreased by 19% (<i>p</i> < .001) in the intervention group (170 [IQR 140-220] mg; <i>n</i> = 295) versus the control group (210 [180-250] mg; <i>n</i> = 257). Mean 18-h MCTd decreased by 13% (<i>p</i> < .001) in the intervention group (405.15 ± 231.54 mL; <i>n</i> = 295) versus the control group (466.13 ± 286.73 mL; <i>n</i> = 257). Covariate-adjusted mixed effects model showed a significant reduction of MCTd in the intervention group, starting from hour 11 after surgery (group by time interaction <i>p</i> = .002).</p><p><strong>Conclusion: </strong>Though previous investigators have associated lower protamine doses with less MCTd, this study demonstrates that more accurately matching the initial protamine dose to the remaining circulating heparin concentration reduces postoperative bleeding.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"1335-1347"},"PeriodicalIF":1.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9925220","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":"Establishment of a national quality improvement process on oxygen delivery index during cardiopulmonary bypass.","authors":"Alfred H Stammers, Jeffrey B Chores, Eric A Tesdahl, Kirti P Patel, Jennifer Baeza, Matthew S Mosca, Michalis Varsamis, Craig M Petterson, Michael S Firstenberg, Jeffrey P Jacobs","doi":"10.1177/02676591231198366","DOIUrl":"10.1177/02676591231198366","url":null,"abstract":"<p><p>Targeted oxygen delivery during cardiopulmonary bypass (CPB) has received significant attention due to its influence on patient outcomes, especially in mitigating acute kidney injury. While it has gained popularity in select institutions, there remains a gap in establishing it globally across multiple centers. The purpose of this investigation was to describe the development of a quality improvement process of targeted oxygen delivery during CPB across hospitals throughout the United States. A systematic approach to utilize oxygen delivery index (DO₂i) as a key performance indicator within hospitals serviced by a national provider of perfusion services. The process included a review of the current literature on DO₂i, which yielded a target nadir value (272 mL/min/m²) and an area under the curve (DO₂i²⁷²AUC) cut off of 632. All data is displayed on a dashboard with results categorized across multiple levels from system-wide to individual clinician performance. From January 2020 through December 2022, DO₂i data from 91 hospitals and 11,165 coronary artery bypass graft procedures were collected. During this period the monthly proportion of DO₂i measurements above the target nadir DO₂i²⁷² ranged from 60.5% to 78.4% with a mean+/-SD of 70.8 +/- 4.2%. Binary logistic regression for the first 7 months following monthly DO₂i performance reporting has shown a statistically significant positive linear trend in the probability of achieving the target DO₂i²⁷² (<i>p</i> < .001), with a crude increase of approximately 7.8% for DO₂i²⁷²AUC, and a 73.8% success rate (<i>p</i> < .001). A survey was sent to all individuals measuring oxygen delivery during CPB to assess why a target DO₂i²⁷² could not be reached. The two most common responses were an 'inability to improve CPB flow rates' and 'restrictive allogeneic red blood cell transfusion policies'. This study demonstrates that targeting a minimum level of oxygen delivery can serve as a key performance indicator during CPB using a structured quality improvement process.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"1405-1414"},"PeriodicalIF":1.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10063025","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":"Methadone as an opioid and sedative weaning strategy in adults receiving extracorporeal membrane oxygenation.","authors":"Christopher Remmington, Victor Liew, Fraser Hanks, Luigi Camporota, Oliver Stubbs, Angelo Sousa, Nicholas A Barrett","doi":"10.1177/02676591231195303","DOIUrl":"10.1177/02676591231195303","url":null,"abstract":"","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"1481-1484"},"PeriodicalIF":1.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10396106","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":"Learning: A lifelong process of evolution.","authors":"Prakash P Punjabi","doi":"10.1177/02676591241280139","DOIUrl":"10.1177/02676591241280139","url":null,"abstract":"","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"1285"},"PeriodicalIF":1.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142134278","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":"Iron deposition in infants undergoing ECMO: A retrospective analysis of Postmortem tissue samples.","authors":"Zachary J Weber, Ashley E Sam, Jonathan M King, Cody L Henderson, Christian Davidson, Nicholas R Carr","doi":"10.1177/02676591241288780","DOIUrl":"https://doi.org/10.1177/02676591241288780","url":null,"abstract":"<p><strong>Background: </strong>Infants undergoing ECMO may have elevated serum ferritin and iron levels, raising concerns about iron overload. Recent studies question the utility of these markers for acute vs. chronic iron overload during ECMO. This study evaluates iron content and localization in autopsy tissues from deceased infants who received or were considered for ECMO.</p><p><strong>Methods: </strong>This retrospective single-center case-control study analyzed paraffin-embedded tissues from the basal ganglia, liver, spleen, pancreas, and kidney. Tissue sections were stained to quantify iron deposition and an independent pathologist reviewed samples for iron accumulation.</p><p><strong>Results: </strong>Eighteen deceased infants' tissues were analyzed: nine underwent ECMO, and nine were considered for it. Both groups showed multi-organ iron accumulation with no significant difference between ECMO and non-ECMO cohorts. Red blood cell transfusions were linked to increased iron content in adrenal (<i>p</i> = 0.004), hepatic (<i>p</i> = 0.042), and splenic (<i>p</i> = 0.013) tissues.</p><p><strong>Conclusions: </strong>ECMO exposure alone does not independently increase iron content in infants' organs. Multi-organ iron accumulation in both groups suggests iron deposition in critically ill pediatric patients irrespective of ECMO exposure. Further research is needed to understand the mechanisms and implications.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"2676591241288780"},"PeriodicalIF":1.1,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331076","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}