Perfusion-Uk最新文献

{"title":"Factors associated with activated clotting time following heparin administration in pediatric cardiopulmonary bypass: A retrospective study.","authors":"Mizuho Hida, Koichi Kashiwa, Hideo Kurosawa, Mai Takahashi, Saori Fujiya, Kazuki Fujishiro, Junpei Shimoda, Hitoshi Kubo, Ryota Inokuchi, Kent Doi, Yasutaka Hirata","doi":"10.1177/02676591241311724","DOIUrl":"10.1177/02676591241311724","url":null,"abstract":"<p><p>IntroductionThe recently recommended activated clotting time (ACT) to be maintained at the initiation of and during cardiopulmonary bypass (CPB) is ≥480 s. However, the post-unfractionated heparin (UFH) administration ACT occasionally does not exceed 480 s. Therefore, in this study, we retrospectively evaluated the factors influencing post-heparin administration ACT before initiating CPB.MethodsIn this retrospective study, patients aged <7 years who had undergone open-heart surgery with CPB between August 2021 and June 2023 were investigated. Those who lacked preoperative data or received antithrombin or fresh frozen plasma preparations prior to undergoing CPB were excluded. Multiple regression analysis was performed using the initial ACT as the dependent variable and preoperative covariates as independent variables.ResultsThis retrospective study included 91 patients. The median age of the patients was 265 (interquartile range [IQR]: 127-750) days. The median initial ACT was 589 (IQR: 506-713) s. In 17 (19%) patients, the initial ACT was <480 s. Multiple regression analysis revealed a statistically significant association between the platelet count and initial ACT, with a regression coefficient of -5.26 (95% confidence interval [-8.56 to -1.95]) and standard regression coefficient of -0.39 (<i>p</i> = .002).ConclusionA high preoperative platelet count was associated with a reduced heparin response. Nevertheless, the platelet count cannot solely elucidate the heparin response, and further investigations are required to determine the predictive factors affecting this response.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"1607-1611"},"PeriodicalIF":1.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142933265","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":"Concordance and discordance of anticoagulation assays in children supported by ECMO: The truth is out there.","authors":"Carlos A Carmona, Jesse Bain, Oliver Karam","doi":"10.1177/02676591241309841","DOIUrl":"10.1177/02676591241309841","url":null,"abstract":"<p><p>IntroductionExtracorporeal membrane oxygenation (ECMO) provides critical support to patients in severe cardiac and respiratory failure, but it requires anticoagulation to prevent complications like bleeding and thrombosis. Heparin, the primary anticoagulant utilized, is monitored by activated partial thromboplastin time (aPTT) and anti-Factor Xa (AntiXa) levels. Discordance between the two assays complicates its titration and the impact on patient outcomes is not well-established. This study examines the prevalence of discordance, its impact on heparin dosing, and the association of bleeding, thrombosis, ICU-free days, and mortality in pediatric ECMO patients.MethodsThis secondary analysis of the Bleeding and Thrombosis on Extracorporeal Membrane Oxygenation study consisted of 511 patients under 19 years. Demographics, laboratory results, ECMO indications, daily heparin doses, and clinical outcomes were collected. Discordance was categorized as major or minor, and adjustments to heparin dosing were analyzed for appropriateness based on normal ranges of aPTT and AntiXa. Logistic regression models assessed the impact of heparin titration strategies on bleeding, clotting, ICU-free days, and mortality.ResultsMajor discordance occurred on 17.5% of days with high aPTT and low AntiXa being most common. Titrating heparin based on AntiXa in scenarios of discordance was associated with an 11% lower incidence of bleeding compared to aPTT (<i>p</i> = .02). Higher proportion of concordance was independently associated with increased bleeding and/or clotting, but not significantly affect ICU-free days or mortality.ConclusionDiscordance is common in pediatric ECMO patients. AntiXa-guided heparin titration, notably during discordant periods, is associated with fewer bleeding and clotting events. This emphasizes the need for improved anticoagulation protocols since discordance does not demonstrate worse ICU-free days or mortality.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"1592-1599"},"PeriodicalIF":1.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142886354","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":"Unfractionated heparin monitoring by anti-factor Xa versus activated partial thromboplastin time strategies during venoarterial extracorporeal life support.","authors":"Iris Feng, Tanner R Powley, Christine G Yang, Paul A Kurlansky, Lauren D Sutherland, Jonathan M Hastie, Yuji Kaku, Justin A Fried, Koji Takeda","doi":"10.1177/02676591241309500","DOIUrl":"10.1177/02676591241309500","url":null,"abstract":"<p><p>IntroductionNo clear guidelines exist for unfractionated heparin (UFH) monitoring in adult patients on veno-arterial extracorporeal life support (VA-ECLS) for refractory cardiogenic shock. In this study, we sought to compare outcomes between anti-factor Xa (FXa) and activated partial thromboplastin time (aPTT) strategies for UFH monitoring during VA-ECLS.MethodsThis is a single-center, retrospective review of VA-ECLS patients who received UFH in the cardiothoracic intensive care unit between July 2019 and November 2023. Standard protocol for UFH titration was aPTT goal of 45-60 sec (<i>n</i> = 52) before September 2021, then transitioned to FXa goal of 0.1-0.2 U/mL (<i>n</i> = 50) thereafter. Inverse probability of treatment weighting was used to balance baseline differences between cohorts.ResultsIn adjusted analyses, 89.3% of FXa patients and 76.0% of aPTT patients achieved goal range for their respective assay. Total UFH duration (4.0 vs 4.0 days, <i>p</i> = .239) and maximum weight-adjusted UFH dose (9.3 vs 9.4 U/hr/kg, <i>p</i> = .823) remained comparable between adjusted FXa and aPTT cohorts. Moreover, in-hospital mortality (50.3% vs 33.9%, <i>p</i> = .133), major bleeding events (20.6% vs 11.2%, <i>p</i> = .292), and thromboembolic events (30.1% vs 30.1%, <i>p</i> = .998) were not significantly different. Extracorporeal circuit thrombosis and cannula site bleeding were the most frequent events in both groups. Multivariate logistic regression found the FXa strategy was not a significant risk factor for the composite outcome of major bleeding or thromboembolism (OR [95% CI]: 1.539 [0.575, 4.116], <i>p</i> = .393).ConclusionsIn adult VA-ECLS patients at our institution, bleeding and thromboembolic complications occurred at a similar rate regardless of which UFH monitoring strategy was utilized. Further studies in larger and more institutionally diverse cohorts are warranted.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"1575-1584"},"PeriodicalIF":1.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142899607","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":"Mitigating the adverse haematological consequences of extracorporeal membrane oxygenation.","authors":"Graeme MacLaren","doi":"10.1177/02676591251382344","DOIUrl":"10.1177/02676591251382344","url":null,"abstract":"","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"1533-1534"},"PeriodicalIF":1.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145056225","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":"Considering veno-venous extracorporeal membrane oxygenation as a first-line strategy for rewarming in accidental hypothermia complicated by cardiac arrest - a case series.","authors":"H Shayan, D Gunning, M Mozel, K Valchanov","doi":"10.1177/02676591241313167","DOIUrl":"10.1177/02676591241313167","url":null,"abstract":"<p><p>Severe accidental hypothermia can lead to cardiac arrest. The most efficient method of resuscitating and warming is by ECMO (Extracorporeal Membrane Oxygenation). While the convention is to use VA ECMO (Veno Arterial ECMO), using VV ECMO (Veno Venous ECMO) in which the blood is returned directly into the right ventricle could be an alternative and lead to conversion to life sustaining cardiac rhythm. In this article we present our case series of ECMO for resuscitation of accidental hypothermia complicated by cardiac arrest. We used VV ECMO for 4 patients; in 3 of them ROSC (Return of Spontaneous Circulation) was successfully achieved. We also discuss the potential advantages of VV ECMO and VA ECMO in this setting and present our algorithm for management.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"1708-1713"},"PeriodicalIF":1.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014938","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 influence of cardiopulmonary bypass residual volume processing technique on blood management in cardiac surgical patients.","authors":"Jennifer Baeza, Alfred H Stammers, Scott R Beckman, Eric A Tesdahl, Jeffrey Chores, Kirti P Patel, Craig M Petterson, Ty Thompson, Alexander Baginski, Cozette Wilkins, Stephen Choi, Omar M Sharaf, Michael S Firstenberg, Jeffrey P Jacobs","doi":"10.1177/02676591251317678","DOIUrl":"10.1177/02676591251317678","url":null,"abstract":"<p><p><i>Background:</i> Post-cardiopulmonary bypass (CPB) blood processing is an important component of blood management during cardiac surgery. <i>Purpose:</i> The purpose of this study is to evaluate several methods of processing post-CPB residual blood.<i>Research Design:</i> Using a multi-institutional national database (SpecialtyCare Operative Procedural rEgistry [SCOPE]), 77,591 cardiac surgical operations performed in adults (>18 years) between January 2017 and September 2022 were reviewed.<i>Study Sample:</i> Blood processing methods included: Cell washing (CW, <i>n</i> = 63,592), Ultrafiltration (UF, <i>n</i> = 6286), Whole blood (WB, <i>n</i> = 3749), Hemobag (HB, <i>n</i> = 2480), and No processing (NO, <i>n</i> = 1484). The primary outcome was intraoperative post-CPB allogenic red blood cell (RBC) transfusion.<i>Data Analysis:</i> Group differences in RBC transfusion were assessed using a Bayesian mixed-effects logistic regression model controlling for multiple operative variables.<i>Results:</i> Across blood processing groups, patients had similar ages, body mass index and surgical procedures performed as well as preoperative hematocrit and nadir operative hematocrit. Median hematocrit change from last-in-operating room to first-in-ICU were highest in UF and HB groups (3.0 [IQR = 2.0-4.8] and 2.5 [IQR = 0.4-5.0]), respectively. The model-predicted probability of intraoperative post-CPB RBC transfusion was lowest in the HB group (0.79% [95% CrI = 0.37%-1.26%]), and highest in NO group (2.12% [95% CrI = 1.47%-2.82%]). Relative to CW, the odds of RBC transfusion for HB cases were reduced by half (OR = 0.5 [95% CrI = 0.28-0.89], statistical reliability = 99.1%), while odds for NO were 1.41 greater (OR = 1.41 [95% CrI = 1.03-1.93], statistical reliability = 98.2%).<i>Conclusions:</i> Post-CPB blood processing affects the likelihood for both receiving an intraoperative post-CPB RBC transfusion and for hematocrit change, with HB use resulting in the lowest predicted risk for transfusion, and NO the highest.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"1633-1641"},"PeriodicalIF":1.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069002","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":"Exploring the experiences of cardiovascular perfusionists during philanthropic cardiac surgery in low-income countries.","authors":"Bhumika Jakkaraddi, Lorena Araujo, Allison Weinberg, Ramandeep Kaur, Julie Collins","doi":"10.1177/02676591251317679","DOIUrl":"10.1177/02676591251317679","url":null,"abstract":"<p><p><i>Background</i>: Medical mission trips address the global burden of cardiac disease, particularly in Sub-Saharan Africa, where limited access to cardiac surgery exacerbates challenges faced by affected individuals. However, a lack of literature exists on the experiences of perfusionists involved in these missions, despite their crucial role in delivering cardiac surgery services. Therefore, the purpose of this descriptive study was to evaluate the experiences of cardiovascular perfusionists involved in philanthropic cardiac surgery in low-income countries.<i>Methods</i>: A descriptive survey research design was conducted among perfusionists who have participated in cardiac mission trips. The survey link was distributed in February 2024 via the Liv Perfusion LLC social media account. The survey included questions regarding years of experience, countries visited, adequacy of equipment and personnel, language and cultural barriers, and establishment of long-term care.<i>Results</i>: A total of 23 respondents completed the survey, 15 of which were included in the study. All of the survey takers were perfusionists with a mean clinical experience of 10.67 ± 7.96 years and 67% held a master's degree. All of the survey respondents were either very satisfied or satisfied with their cardiac mission trip experience. Despite high satisfaction, 60% reported language differences, and 40% reported cultural barriers and legal restrictions as significant challenges in their delivery of care. Additionally, 67% reported having adequate medical equipment and 80% reported having adequate personnel during the mission trip.<i>Conclusion</i>: In summary, cardiovascular perfusionists reported high satisfaction with philanthropic cardiac missions but faced challenges such as language barriers, and cultural and legal constraints. Addressing these issues could improve mission effectiveness and patient care in low-income countries.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"1642-1645"},"PeriodicalIF":1.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068996","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":"Reduction of the inflammatory response triggered by sanguineous priming of the cardiopulmonary bypass circuit.","authors":"Vitor Mendes, François Verdy, Amir-Reza Hosseinpour","doi":"10.1177/02676591251313974","DOIUrl":"10.1177/02676591251313974","url":null,"abstract":"","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"1717-1718"},"PeriodicalIF":1.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142957848","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":"Buttock ischemia in adults with femoral venoarterial-extracorporeal membranoxygenation - A single center experience.","authors":"Verena Scriba, Ralf Loeschhorn-Becker, Arash Motekallemi, Christopher Lotz, Philipp M Lepper, Iuliu E Torje, Maximilian Feth, Caroline B Rolfes, Ralf M Muellenbach, Jonas Ajouri","doi":"10.1177/02676591251321997","DOIUrl":"10.1177/02676591251321997","url":null,"abstract":"<p><p>IntroductionFemoral veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is used as an ultima ratio to maintain circulation in patients with refractory cardiorespiratory failure, but is also associated with vascular and ischemic complications. Buttock ischemia appears to be an underreported complication in these patients. <i>Methods:</i> In this retrospective single-center case series over a five-year period, all patients who received femoral VA-ECMO and survived for more than 24 hours were screened for buttock ischemia. Buttock ischemia was diagnosed using a two-step approach, which involved identifying characteristic skin lesions and CT scans suggesting hypoperfusion of the ipsilateral internal iliac artery.ResultsOver the five-year period, 264 patients were assessed for buttock ischemia, which occurred in seven patients, with an average annual incidence of 2.7%. Unilateral buttock ischemia was observed in six patients, while bilateral buttock ischemia was seen in one patient and led to multiple surgeries in three patients. The CT scans showed that, in all cases, the arterial ECMO cannula covered the origin of the internal iliac artery and revealed additional bilateral atherosclerotic lesions in the iliac arteries.ConclusionButtock ischemia is a rare and not fully understood complication of femoral VA-ECMO but may lead to clinically significant sequelae. Widespread knowledge and awareness are therefore important to recognize buttock ischemia, followed by individualized strategies for selecting and positioning the arterial cannula.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"1653-1662"},"PeriodicalIF":1.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143450729","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":"Percutaneous coronary saccular aneurysm exclusion.","authors":"Stephen Maharaj, Amanda-Marie Mc Carthy, Jose Martinez, Risshi Rampersad, Gianni Angelini","doi":"10.1177/02676591241308985","DOIUrl":"10.1177/02676591241308985","url":null,"abstract":"<p><p>Coronary artery aneurysms are a relatively uncommon finding during coronary angiography and can present certain challenges in terms of treatment options. This may be due to unclear underlying mechanisms and varying presentations, as well as a lack of large-scale outcome data. In this case report we present the successful use of percutaneous coronary intervention (PCI) in treating a 43-year-old male patient who presented with acute myocardial infarction and was discovered during angiography to have a saccular coronary aneurysm.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"1701-1703"},"PeriodicalIF":1.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142866101","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}