Perfusion-Uk最新文献_第2页

Cause-specific mortality during ECMO: A call for a standardized definition? 关于 ECMO 期间特定原因死亡率的信件：是否需要一个标准化的定义？

IF 1.1 4区医学

Perfusion-Uk Pub Date : 2025-04-01 Epub Date: 2024-05-05 DOI: 10.1177/02676591241249616

Mauro Panigada, Chiara Martinet, Paolo Properzi, Daniela Tubiolo, Alessio Caccioppola, Giacomo Grasselli

引用次数: 0

Novel weaning assessment for veno-arteriovenous to veno-venous extracorporeal membrane oxygenation using pump-controlled retrograde trial off. 利用泵控逆行试验断开静脉-动静脉到静脉-静脉体外膜肺氧合的新型断流评估。

IF 1.1 4区医学

Perfusion-Uk Pub Date : 2025-04-01 Epub Date: 2024-05-29 DOI: 10.1177/02676591241258689

Kazuki Matsumura, Keiki Shimizu, Yuichi Horikoshi, Jun Hamaguchi, Takeo Matsuyoshi, Junichi Sasaki

引用次数: 0

Antithrombin restriction in extracorporeal membrane oxygenation support (ARES): A multidisciplinary approach. 体外膜氧合支持（ARES）中的抗凝血酶限制：多学科方法。

IF 1.1 4区医学

Perfusion-Uk Pub Date : 2025-04-01 Epub Date: 2024-06-06 DOI: 10.1177/02676591241260179

Jade C Lam, Erwin H Lam, Sai Pidathala, Josna P Padiyar

{"title":"Antithrombin restriction in extracorporeal membrane oxygenation support (ARES): A multidisciplinary approach.","authors":"Jade C Lam, Erwin H Lam, Sai Pidathala, Josna P Padiyar","doi":"10.1177/02676591241260179","DOIUrl":"10.1177/02676591241260179","url":null,"abstract":"Background: Antithrombin (AT) replacement is occasionally utilized in the setting of extracorporeal membrane oxygenation (ECMO)-associated heparin resistance. Although past studies emphasized the high costs and limited clinical benefit of AT supplementation, guidance on strategies to prevent unnecessary use remain lacking.Methods: In this retrospective study, we evaluated the cost, efficacy, and safety outcomes three years pre- and post-implementation of an AT restriction protocol in adult ECMO patients. The primary endpoint was the cost spent on anticoagulation and AT normalized to ECMO duration. Secondary endpoints included thromboembolic and bleeding outcomes.Results: 175 patients were included for analysis (pre-restriction protocol n = 87; post-restriction protocol n = 88). Implementation of the restriction resulted in complete elimination of AT use and significantly reduced the primary cost endpoint from $1009.20 to $42.99 per ECMO day (p < .001). There was no significant change in occurrence of new Venous Thromboembolism (VTE) (p = .099). Those in the pre-implementation group had significantly higher rates of transfusions (p < .001) and ISTH major bleeding (p < .001). Outcomes remained significant after exclusion of patients with coronavirus infections.Conclusion: Results of this study exemplify how AT restriction can be successfully implemented to decrease anticoagulation-associated costs without jeopardizing the risk of bleeding and thrombosis in ECMO patients.","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"742-749"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141285110","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}

引用次数: 0

Dual oxygenator circuits in extracorporeal membrane oxygenator support. 体外膜氧合器支持中的双氧合器回路。

IF 1.1 4区医学

Perfusion-Uk Pub Date : 2025-04-01 Epub Date: 2024-05-29 DOI: 10.1177/02676591241258688

Kanhua Yin, Jaishankar Raman, Robert March, Erica Bak, Nikola Dobrilovic

引用次数: 0

Evaluation of an aPTT guided versus a multimodal heparin monitoring approach in patients on extra corporeal membrane oxygenation: A retrospective cohort study. 对使用体外膜肺氧合的患者进行 aPTT 引导与多模式肝素监测方法的评估：一项回顾性队列研究。

IF 1.1 4区医学

Perfusion-Uk Pub Date : 2025-04-01 Epub Date: 2024-05-13 DOI: 10.1177/02676591241253474

Diman Taha, Joppe G Drop, Enno D Wildschut, Matthijs De Hoog, C Heleen van Ommen, Dinis Dos Reis Miranda

{"title":"Evaluation of an aPTT guided versus a multimodal heparin monitoring approach in patients on extra corporeal membrane oxygenation: A retrospective cohort study.","authors":"Diman Taha, Joppe G Drop, Enno D Wildschut, Matthijs De Hoog, C Heleen van Ommen, Dinis Dos Reis Miranda","doi":"10.1177/02676591241253474","DOIUrl":"10.1177/02676591241253474","url":null,"abstract":"IntroductionBleeding and thrombotic complications are common in extracorporeal membrane oxygenation (ECMO) patients and are associated with increased mortality and morbidity. The optimal anticoagulation monitoring protocol in these patients is unknown. This study aims to compare the incidence of thrombotic and hemorrhagic complications before and after a protocol change. In addition, the association between hemostatic complications, coagulation tests and risk factors is evaluated.MethodsThis is a retrospective single center cohort study of adult ECMO patients. We collected demographics, ECMO parameters and coagulation test results. Outcomes of the aPTT guided and multimodal protocol, including aPTT, anti-Xa assay and rotational thromboelastometry were compared and the association between coagulation tests, risk factors and hemostatic complications was determined using a logistic regression analysis for repeated measurements.ResultsIn total, 250 patients were included, 138 in the aPTT protocol and 112 in the multimodal protocol. The incidence of thrombosis (aPTT: 14%; multimodal: 12%) and bleeding (aPTT: 36%; multimodal: 40%), did not significantly differ between protocols. In the aPTT guided protocol, the aPTT was associated with thrombosis (Odds Ratio [OR] 1.015; 95% confidence interval [CI] 1.004-1.027). In both protocols, surgical interventions were risk factors for bleeding and thrombotic complications (aPTT: OR 93.2, CI 39.9-217.6; multimodal OR 17.5, CI 6.5-46.9).DiscussionThe incidence of hemostatic complications was similar between both protocols and surgical interventions were a risk factor for hemostatic complications. Results from this study help to elucidate the role of coagulation tests and risk factors in predicting hemostatic complications in patients undergoing ECMO support.","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"557-567"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11951356/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140913168","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}

引用次数: 0

Developing a generalizable pediatric ECMO emergency checklist for clinical specialist: Progress and challenges. 为临床专家制定可通用的儿科 ECMO 紧急情况检查表：进展与挑战。

IF 1.1 4区医学

Perfusion-Uk Pub Date : 2025-04-01 Epub Date: 2024-05-29 DOI: 10.1177/02676591241258067

Jamie M Furlong-Dillard, Kamal Abulebda, Aaron W Calhoun

{"title":"Developing a generalizable pediatric ECMO emergency checklist for clinical specialist: Progress and challenges.","authors":"Jamie M Furlong-Dillard, Kamal Abulebda, Aaron W Calhoun","doi":"10.1177/02676591241258067","DOIUrl":"10.1177/02676591241258067","url":null,"abstract":"IntroductionExtracorporeal membrane oxygenation (ECMO) emergencies require skilled clinical specialist (CS) who manage ECMO circuits. While tools for assessing CS skills have been published, there is significant variation in protocols and circuit design. This study aims to further develop these checklists to produce a generalizable ECMO skill assessment with adequate validity evidence to support its use as a summative evaluation tool.MethodsAn initial survey determined variation in ECMO circuit components and configurations, and the original checklists and simulations were altered through a modified Delphi process. The finalized checklist and simulation were then assessed for validity and reliability. Three trained raters assessed ten simulations from five subjects at two different institutions using two circuit designs. Data analysis was conducted using a fully crossed subject x rater x circuit generalizability (G) and decision (D) study.ResultsThe G-study coefficient was 0 with 0% variance across subject and circuit. The greatest variance was among raters (28.7%). Significant variance was also associated with the subject and pump type relationship (27%).ConclusionDespite the rigorous process used to modify the assessment, generalizability was poor. Lack of familiarity with center-specific circuit design played a key role. Future endeavors in ECMO skill assessment should focus either on developing and validating site-specific tools or standardizing circuit designs.","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"693-700"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141162654","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}

引用次数: 0

Antithrombin during veno-venous extracorporeal membrane oxygenation with heparin anticoagulation: A single-center cohort study. 静脉-静脉体外膜氧合与肝素抗凝期间的抗凝血酶：单中心队列研究。

IF 1.1 4区医学

Perfusion-Uk Pub Date : 2025-04-01 Epub Date: 2024-06-04 DOI: 10.1177/02676591241258048

Bethany A Hileman, Gennaro Martucci, Nicolò Rizzitello, Giovanna Occhipinti, Matteo Rossetti, Fabio Tuzzolino, Roberto Lorusso, Mauro Panigada, Kenichi Tanaka, Antonio Arcadipane, Giovanna Panarello

{"title":"Antithrombin during veno-venous extracorporeal membrane oxygenation with heparin anticoagulation: A single-center cohort study.","authors":"Bethany A Hileman, Gennaro Martucci, Nicolò Rizzitello, Giovanna Occhipinti, Matteo Rossetti, Fabio Tuzzolino, Roberto Lorusso, Mauro Panigada, Kenichi Tanaka, Antonio Arcadipane, Giovanna Panarello","doi":"10.1177/02676591241258048","DOIUrl":"10.1177/02676591241258048","url":null,"abstract":"IntroductionAntithrombin (AT) is a natural anticoagulant essential to enhancing the unfractionated heparin (UFH) anticoagulant effect. Its supplementation in the management of UFH-based anticoagulation during veno-venous extracorporeal membrane oxygenation (VV ECMO) has a strong pathophysiological rationale.MethodsThis is a single-center, retrospective cohort study of adult VV ECMO patients with anticoagulation maintained by UFH targeting an activated partial thromboplastin time (aPTT) of 40-50 s and AT activity >80%. We compare anticoagulation management and survival outcomes between AT subpopulations, defined by a threshold AT activity ≥80%. Linear and logistic regression analyses were used to evaluate the variation in AT activity and its association with ICU survival.ResultsIn 244 patients enrolled from 2009 to 2022, anticoagulation was maintained by a median heparin dose of 11.4 IU/kg/h [IQR: 8.2-14.7] with a mean aPTT of 46.1 s (±7.3) and AT activity of 88.9% (±17.0). A lower mean aPTT, higher dose of UFH and shorter fraction of time without UFH were associated with higher AT activity (p < .01). Higher AT activity showed a consistent association with ICU survival (for 10% increase of AT, odds ratio for ICU mortality: 0.95; 95% CI 0.93-0.97; p value <.01).ConclusionsThere is a positive association between AT activity and UFH requirements but no significant difference in the rate of bleeding events. A higher mean AT during VV ECMO was associated with ICU survival. Future studies are needed to differentiate between exogenously supplemented versus endogenous AT effect.","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"720-729"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11951385/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141236220","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}

引用次数: 0

Hybrid extracorporeal cannulation for aortic root pseudoaneurysm re-operation: The role of a multidisciplinary team. 用于主动脉根部假性动脉瘤再手术的混合体外插管：多学科团队的作用。

IF 1.1 4区医学

Perfusion-Uk Pub Date : 2025-04-01 Epub Date: 2024-05-16 DOI: 10.1177/02676591241255649

Ilaria Franzese, Florida Gripshi, Marco Anzini, Enzo Mazzaro

引用次数: 0

The effect of excessive gas to blood ratios in an ECMO oxygenator. ECMO 氧合器中气体与血液比例过高的影响。

IF 1.1 4区医学

Perfusion-Uk Pub Date : 2025-04-01 Epub Date: 2024-05-23 DOI: 10.1177/02676591241256089

Michael Shaw, Nigel Cross, Rebecca Richardson, Richard Crook, Timothy Thirulchelvam, Richard W Issitt

{"title":"The effect of excessive gas to blood ratios in an ECMO oxygenator.","authors":"Michael Shaw, Nigel Cross, Rebecca Richardson, Richard Crook, Timothy Thirulchelvam, Richard W Issitt","doi":"10.1177/02676591241256089","DOIUrl":"10.1177/02676591241256089","url":null,"abstract":"IntroductionOxygenators for paediatric Extracorporeal Membrane Oxygenation (ECMO) are required to operate over a wide range of flow rates, in a patient group ranging from neonates through to fully grown adolescents. ECMO oxygenators typically have a manufacturer's stated maximum gas: blood flow rate (GBFR) ratio of 2:1, however, many patients require greater ratios than this for adequate CO2 removal. Mismatches in GBFR in theory could result in high gas phase pressures. These increased pressures in theory could cause the formation of gross gaseous microemboli (GME) placing the child at higher risk of neurological injury.MethodsWe evaluated 6 paediatric and 6 adult A.L.ONE™ ECMO oxygenators and assessed their gas phase pressures and GME release, in an ex vivo setting, in GBFR ratios up to greater than 2, across a range of gas flow (1L - 10 L/min) rates with a fraction of inspired oxygen (FiO2) content of 50% and 100%.ResultsThere were no increases above 10 mmHg observed in gas phase pressures in GBFR >= 2:1 in either adult or paediatric oxygenators. Laboratory examination of GME activity demonstrated a small increase in post-membrane GME release over the study period. GME release was unaffected by FiO2 setting or gas flow rate, with a maximum volume of < 6 µL in both paediatric and adult oxygenators.ConclusionsIn an ex vivo setting, increasing GBFR above 2:1 in a paediatric oxygenator, and to a GBFR of 2:1 in an adult oxygenator did not significantly increase gas phase pressures, and no oxygenator membrane rupture was observed. There were no associations between gas flow rates and GME production.","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"678-685"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141086765","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}

引用次数: 0

Brain injury plasma biomarkers in patients on veno-arterial extracorporeal membrane oxygenation: A pilot prospective observational study. 静脉-动脉体外膜氧合患者的脑损伤血浆生物标志物：一项试点前瞻性观察研究。

IF 1.1 4区医学

Perfusion-Uk Pub Date : 2025-04-01 Epub Date: 2024-05-17 DOI: 10.1177/02676591241256006

Syed Ameen Ahmad, Shrey Kapoor, Siam Muquit, Aaron Gusdon, Shivalika Khanduja, Wendy Ziai, Allen D Everett, Glenn Whitman, Sung-Min Cho, On Behalf Of Herald Investigators

{"title":"Brain injury plasma biomarkers in patients on veno-arterial extracorporeal membrane oxygenation: A pilot prospective observational study.","authors":"Syed Ameen Ahmad, Shrey Kapoor, Siam Muquit, Aaron Gusdon, Shivalika Khanduja, Wendy Ziai, Allen D Everett, Glenn Whitman, Sung-Min Cho, On Behalf Of Herald Investigators","doi":"10.1177/02676591241256006","DOIUrl":"10.1177/02676591241256006","url":null,"abstract":"IntroductionEarly diagnosis of acute brain injury (ABI) is critical for patients on veno-arterial extracorporeal membrane oxygenation (V-A ECMO) to guide anticoagulation strategy; however, neurological assessment in ECMO is often limited by patient sedation.MethodsIn this pilot study of adults from June 2018 to May 2019, plasma samples of glial fibrillary acidic protein (GFAP), neurofilament light chain (NFL), and tubulin associated unit (Tau) were collected daily after V-A ECMO cannulation and measured using a multiplex platform. Primary outcomes were occurrence of ABI, assessed clinically, and neurologic outcome, assessed by modified Rankin Scale (mRS).ResultsOf 20 consented patients (median age = 48.5°years; 55% female), 8 (40%) had ABI and 15 (75%) had unfavorable neurologic outcome at discharge. 10 (50%) patients were centrally cannulated. Median duration on ECMO was 4.5°days (IQR: 2.5-9.5). Peak GFAP, NFL, and Tau levels were higher in patients with ABI vs. without (AUC = 0.77; 0.85; 0.57, respectively) and in patients with unfavorable vs. favorable neurologic outcomes (AUC = 0.64; 0.59; 0.73, respectively). GFAP elevated first, NFL elevated to the highest degree, and Tau showed limited change regardless of ABI.ConclusionFurther studies are warranted to determine how plasma biomarkers may facilitate early detection of ABIs in V-A ECMO to assist timely clinical decision-making.","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"657-667"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11569265/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140960556","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}

引用次数: 0