Perfusion-Uk最新文献

{"title":"Sanguineous cardiopulmonary bypass prime accelerates the inflammatory response during pediatric cardiac surgery.","authors":"Joel Bierer, Roger Stanzel, Mark Henderson, John Sapp, Pantelis Andreou, Jean S Marshall, David Horne","doi":"10.1177/02676591241291944","DOIUrl":"10.1177/02676591241291944","url":null,"abstract":"<p><p>BackgroundThe inflammatory response to cardiopulmonary bypass (CPB) in pediatric patients remains an unresolved challenge. Sanguineous CPB prime, composed of allogenic blood products, is one potentially important stimulus. This study aims to identify specific inflammatory mediators active in sanguineous CPB prime and their impact on the inflammatory response at CPB initiation.MethodsIn a post-hoc analysis of a prospective observational cohort study (NCT05154864), where pediatric patients undergoing cardiac surgery with CPB were enrolled after informed consent, patients were grouped by CPB prime type (<i>sanguineous</i> vs <i>crystalloid</i>). Arterial samples were collected post-sternotomy as a baseline and again at CPB initiation from all patients. In the <i>sanguineous</i> group, CPB prime samples were also collected after buffered ultrafiltration but before CPB initiation. <i>Luminex®</i> measured concentrations of 24 inflammatory mediators for comparison between groups. Statistical analyses were by Mann-Whitney test and Wilcoxon signed-rank test. Data are presented as median [IQR].ResultsForty consecutive pediatric patients participated. The <i>sanguineous</i> group (<i>n</i> = 26) was younger (4.0 [0.2 - 6.0] vs 48.5 [39.0 - 69.5] months; <i>p</i> = 2.6 × 10^-7) and smaller (4.9 [34 - 6.6] vs 17.2 [14.9 - 19.6] kg; <i>p</i> = 2.6 × 10^-7) than the <i>crystalloid</i> group (<i>n</i> = 14). Despite this, baseline concentrations of 20 complement and cytokine concentrations were comparable between groups (<i>p</i> > 0.05) while four showed differences between groups (<i>p</i> < 0.05). The sanguineous prime contained supraphysiologic concentrations of complement mediators: C2, C3, C3a, C3b, and C5a. Correspondingly, upon CPB initiation, patients receiving sanguineous prime exhibited a significantly larger burden of C2, C3, C3b, C5, and C5a (<i>p</i> < 0.001) relative to the crystalloid group. Cytokine and chemokine mediators were present at trace levels in the sanguineous prime.ConclusionsSanguineous prime contains activated complement that accelerates the inflammatory response at CPB initiation in neonates and infants. Immunomodulatory interventions targeting complement during CPB prime preparation could offer substantial benefits for these vulnerable patients.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"1678-1688"},"PeriodicalIF":1.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12450242/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142394729","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":"Level of sedation in patients with COVID-19 supported with ECMO: A comparative analysis of the critical care consortium international database.","authors":"Silver Heinsar, Ahmed Labib, Marcela Cespedes, Jordi Riera, Nicole White, Akram Zaaqoq, Jeffrey P Jacobs, Hergen Buscher, Peta M A Alexander, Anna Ciullo, Muhammad Aftab, Jacky Y Suen, Gianluigi Li Bassi, Roberto Lorusso, John F Fraser, Giles Peek","doi":"10.1177/02676591251324136","DOIUrl":"10.1177/02676591251324136","url":null,"abstract":"<p><p>BackgroundLiberation from sedation may be beneficial for patients with acute respiratory distress syndrome supported by veno-venous (VV) extracorporeal membrane oxygenation (ECMO). Currently, there is limited evidence to support this approach. Therefore, this study aimed to compare the 90-day patient mortality of different sedation strategies in COVID-19 patients supported with VV ECMO.MethodsRetrospective, observational sub-study of the COVID-19 Critical Care Consortium database including COVID-19 patients supported with VV ECMO. Two cohorts were compared: high sedation patients who received neuromuscular blocking agents (NMBAs) throughout ECMO and low sedation patients who did not receive NMBA consistently. Patients' level of sedation during ECMO was also considered. The primary outcome was 90-day in-hospital mortality and was assessed using cause-specific Cox proportional hazard models.Results224 low and 104 high sedation patients were included. Pre-ECMO respiratory condition prior was similar between groups, except for the ratio of partial pressure of oxygen to inspired fraction of oxygen, which was lower in the high sedation group at 93 [61-130] than the low sedation group at 106 [69-140]. No difference was observed in disease severity scores between cohorts. Low sedation patients had longer ECMO runs, more circuit changes, but lower infectious and hemorrhagic complications. Higher sedation was associated with a hazard ratio for death of 3.23 (95% CI 2.16-4.83) compared to low sedation.ConclusionsReduced sedation in COVID-19 ECMO patients is feasible and may be associated with improved survival and reduced complications compared to continuous paralysis, albeit with longer ECMO runs.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"1689-1700"},"PeriodicalIF":1.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143517127","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":"Thoracic endovascular aortic repair for retrograde type a intramural hematoma or aortic dissection with intimal disruption in the descending aorta: Systematic review and meta-analysis.","authors":"Noritsugu Naito, Hisato Takagi","doi":"10.1177/02676591251322963","DOIUrl":"10.1177/02676591251322963","url":null,"abstract":"<p><p>BackgroundWhile thoracic endovascular aortic repair (TEVAR) for type B aortic dissection is widely used, its use in cases of type A acute aortic syndrome remains limited. This meta-analysis was conducted to determine the outcomes of TEVAR for retrograde type A intramural hematoma (IMH) and aortic dissection with intimal disruption located in the descending aorta.MethodsSystematic searches were conducted up to April 2024. Pooled proportions of perioperative and late outcomes were computed. Additionally, standard mean differences (SMD) with 95% confidence intervals (CI) in aortic dimensions following TEVAR were calculated. Kaplan-Meier curves, derived from individual patient data extracted from the studies, were utilized to elucidate long-term all-cause mortality.ResultsA systematic review identified 13 non-randomized studies encompassing 288 patients. Pooled proportions revealed short-term mortality at 1%, with incidences of spinal cord injury, stroke, new intimal tear/dissection in the ascending aorta, aortic rupture, necessity for aortic re-intervention, and late mortality each recorded at 1%, 1%, 3%, 1%, 6%, and 7%, respectively. Substantial reductions in the diameters of the ascending aorta, descending aorta, IMH/false lumen of the ascending aorta, and IMH/false lumen of the descending aorta were observed post-TEVAR (SMD [95% CI] = 1.11 [0.82-1.39], 1.02 [0.58-1.47], 3.06 [2.39-3.74], and 2.77 [2.28-3.26], respectively). The anticipated 5-year survival rate stood at 91.1%.ConclusionThis meta-analysis suggests TEVAR may offer a viable and safe therapeutic option for retrograde type A acute aortic syndrome. Nevertheless, definitive conclusions are hindered by the scarcity of available data.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"1663-1677"},"PeriodicalIF":1.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469785","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":"VV-ECMO as a lifesaving measure for refractory bronchospasm in anaphylactic shock: A case report.","authors":"Juan P Garcia-Mendez, Troy G Seelhammer, Patrick M Wieruszewski, Erica D Wittwer, Juan G Ripoll","doi":"10.1177/02676591251385891","DOIUrl":"https://doi.org/10.1177/02676591251385891","url":null,"abstract":"<p><p>Refractory anaphylaxis is rare but carries high mortality, particularly when complicated by severe bronchospasm and respiratory failure. We present a 32-year-old individual with food-induced anaphylaxis and profound bronchospasm unresponsive to first- and second-line therapies, resulting in severe hypoxemic and hypercapnic respiratory failure despite mechanical ventilation. Peripheral venovenous extracorporeal membrane oxygenation (VV-ECMO) was emergently initiated, leading to rapid stabilization and full recovery. This case demonstrates the successful use of VV-ECMO as a life-saving bridge in anaphylaxis-induced respiratory failure. This is one of the few reported cases of successful use of VV-ECMO for refractory bronchospasm secondary to anaphylaxis.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"2676591251385891"},"PeriodicalIF":1.1,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193749","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":"Retraction: Limb ischemic preconditioning attenuates cerebral ischemic injury in rat model.","authors":"","doi":"10.1177/02676591251381205","DOIUrl":"https://doi.org/10.1177/02676591251381205","url":null,"abstract":"","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"2676591251381205"},"PeriodicalIF":1.1,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145114862","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":"Histidine-tryptophan-ketoglutarate (Custodiol® HTK) solution for renal protection during open thoracoabdominal aortic aneurysm repair: A two-stage perfusion technique.","authors":"Nicola Colangelo, Alessandro Aina, Francesco De Simone, Giulia Gallio, Jacopo D'Andria Ursoleo, Margherita Licheri, Gaia Barucco, Fabrizio Monaco","doi":"10.1177/02676591251374634","DOIUrl":"https://doi.org/10.1177/02676591251374634","url":null,"abstract":"<p><p>This study outlines a technique for selective kidney perfusion using histidine-tryptophan-ketoglutarate (Custodiol® HTK) solution during open thoracoabdominal aortic aneurysm repair to mitigate acute kidney injury resulting from renal ischemia. This proposed approach features a two-stage perfusion process - initial bolus followed by continuous perfusion - delivered via a simplified gravitational flow system. This low-pressure infusion system encompasses several theoretical key advantages, including reduced risk of renal edema and fluid overload, improved patient safety, and enhanced surgical outcomes. Furthermore, compared to traditional techniques (i.e., active infusion), it may prove effective in optimizing renal perfusion during complex open aortic surgeries. In this study, we present a step-by-step description of the two-stage technique for Custodiol® HTK administration.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"2676591251374634"},"PeriodicalIF":1.1,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145087906","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":"From pump technicians to academic perfusionists: The evolution of the perfusionist profession in Türkiye.","authors":"Reşat Dikme","doi":"10.1177/02676591251380664","DOIUrl":"https://doi.org/10.1177/02676591251380664","url":null,"abstract":"<p><p>The perfusionist profession is a vital healthcare field responsible for managing devices that temporarily maintain a patient's circulation and respiration outside the body. In Türkiye, the perfusionist profession has evolved significantly over the past decade-from a technician-based role known colloquially as \"pump operator\" and learned through a master-apprentice model-into a recognized and professional discipline.In recent years, the perfusionist profession has gained academic identity and now plays a critical role in extracorporeal circulation procedures. This article provides a detailed analysis of the historical development, educational and legal evolution, and the professionalization process of the perfusionist profession in Türkiye.Moreover, by highlighting the roles of organizations such as the European Board of Cardiovascular Perfusion (EBCP) and the American Board of Cardiovascular Perfusion (ABCP), the study offers a comparative evaluation of the structure, education, and standards in Türkiye with those in Europe and the United States of America (USA).Based on national regulations, international guidelines, and an extensive review of the literature, this study presents a descriptive analysis that aims to determine where the perfusionist profession in Türkiye stands in the context of global standards. The process, spanning from the 1960s to the present, reflects the transformation of the profession from a technical \"pump operator\" role into a well-established academic discipline.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"2676591251380664"},"PeriodicalIF":1.1,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145076460","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 in the immediate post-liver transplantation setting: A national inpatient sample analysis.","authors":"Spencer R Goble, Yasmin O Ali, Justin R Parekh, Thomas M Leventhal","doi":"10.1177/02676591251380660","DOIUrl":"https://doi.org/10.1177/02676591251380660","url":null,"abstract":"<p><p>IntroductionThere has been limited generalizable assessment of the utilization and outcomes of ECMO in the post-liver transplantation setting.MethodsThis is a retrospective study using the National Inpatient Sample to assess liver transplantation hospitalizations from 2016 to 2021. Patients who were treated with ECMO were compared to those not treated with ECMO. Furthermore, outcomes when ECMO was initiated on the same day of transplantation were compared to outcomes when ECMO was initiated later. In-hospital mortality, renal replacement therapy (RRT), tracheostomy, discharge to home, length of stay and cost were the assessed outcomes.Results45,420 patients were included, 665 (1.5%) of which were treated with ECMO. Mean age of the combined cohort was 55.1 years and 63.1% of patients were male. Mortality was increased in those treated with ECMO (24.1% vs 2.7%, aOR = 11.20, 95% CI: 6.33-19.79, <i>p</i> < .001), as were rates of RRT (31.6% vs 16.5%, <i>p</i> < .001) and tracheostomy (10.5% vs 3.1%, <i>p</i> < .001). Mortality was increased when ECMO was initiated at least one calendar day after transplantation compared to same day cannulation (53.6% vs 16.2%, aOR = 3.52, 95% CI: 1.06-11.68, <i>p</i> = .039).ConclusionsThree-quarters of patients who undergo ECMO after liver transplantation survive to discharge and outcomes appear better in those who are cannulated on the same day of transplantation compared to those cannulated at least 1 day after transplantation.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"2676591251380660"},"PeriodicalIF":1.1,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145070984","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":"Salvage extracorporeal membrane oxygenation in severe pulmonary haemorrhage: A single-center retrospective observational study.","authors":"Maximilian Leitner, Jeannine L Kühnle, Torben M Rixecker, Kai Borchardt, Egzona Sulollari, Robert Bals, Philipp M Lepper, Vitalie Mazuru","doi":"10.1177/02676591251376517","DOIUrl":"https://doi.org/10.1177/02676591251376517","url":null,"abstract":"<p><p>IntroductionExtracorporeal membrane oxygenation (ECMO) has emerged as a treatment option for respiratory failure. Evidence supports use of ECMO for severe ARDS. Diffuse alveolar haemorrhage (DAH) involves diffuse bleeding in the alveolar tissue, typically due to autoimmune or coagulatory disturbances. The accumulation of blood in the alveoli impairs gas exchange and creates a functional right-to-left shunt, leading to hypoxaemia. While ECMO is effective in managing severe ARDS, its role and outcomes in patients with severe DAH are not well documented.MethodsWe performed a retrospective analysis of all patients with diffuse alveolar haemorrhage receiving ECMO support at the Saarland University Medical center from 03/2012 to 02/2025.ResultsFrom an electronic database, 15 Patients with DAH receiving ECMO support were identified. Patients with critical hypoxia due to pulmonary haemorrhage were included. The median PaO2/FiO2 right before ECMO-canulation was 53 (41.43; 56.42). Flexible bronchoscopy identified diffuse bleeding as the main cause of respiratory insufficiency. All included patients (mean age 39.9 ± 19.4 years; nine male) received primary veno-venous (V-V) ECMO. The median duration of ECMO-therapy was 15 (9.31; 25.69) days. The mean blood flow was 3.89 L/min (±1.06) with a sweep gas flow of 3.34 L/min (±2.37 L/min) in the first five ECMO-days. Anticoagulation strategy was determined according to clinical presentation. In two patients, no anticoagulation was administered due to fulminant bleeding. The remaining patients received unfractionated heparin at an average dose of 7.43 IE/kg/h (±3.46 IE/kg/h). Median aPTT of the anticoagulated patients was 39.49 s (±11.76). ECMO was successfully removed following respiratory stabilization in 10 patients. Among the 15 patients in total, 5 (33.33%) died.ConclusionFor patients with critical, refractoy pulmonary bleeding, V-V ECMO is a bridge to recovery option.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"2676591251376517"},"PeriodicalIF":1.1,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145070952","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":"Delivery of oxygen during cardiopulmonary bypass and associated clinical outcomes among adult cardiac surgery patients: A systematic review.","authors":"Roger D Dias, Paulo Borges, Geoffrey Rance, Rithy Srey, Lauren R Kennedy Metz, Annette Martinez-Rioux, David Arney, Phani Paladugu, Ajami Gikandi, Christian Miccile, Ryan Harari, Kristina Iwai, Jennifer Fitzgerald, Paul O'Gara, Kenneth Shann, Matthew Gombolay, Marco A Zenati","doi":"10.1177/02676591251380659","DOIUrl":"https://doi.org/10.1177/02676591251380659","url":null,"abstract":"<p><p>PurposeOxygen delivery (DO₂) during cardiopulmonary bypass (CPB) is critical in preventing postoperative complications in adult cardiac surgery. This systematic review aimed to assess the relationship between intraoperative DO₂ during CPB, particularly within Goal-directed Perfusion (GDP) strategies, and associated clinical outcomes.MethodsA systematic search of MEDLINE, Embase, Web of Science, PsycINFO, CINAHL, PROSPERO, and Cochrane was conducted from database inception through December 2024, adhering to PRISMA 2020 guidelines. Studies reported intraoperative DO₂ measurements and their relationship with clinical outcomes among adults undergoing cardiac surgery with CPB. Data extraction and quality assessment were performed independently by two reviewers.ResultsThirty-nine studies (71,050 patients) were included, with acute kidney injury (AKI) being the most frequently studied outcome (84.6% of studies). A consistent association was found between lower intraoperative DO₂ and increased risk of AKI, intraoperative lactate elevations, and prolonged mechanical ventilation. Five randomized controlled trials (RCTs) demonstrated that maintaining DO₂ levels, indexed to body surface area (iDO₂), above a threshold of 270-300 mL/min/m² significantly reduced the risk of postoperative AKI. However, evidence linking DO₂ management directly to reductions in mortality or neurologic complications remains limited, as well as studies reporting compliance with GDP strategies.ConclusionMaintaining adequate iDO₂ during CPB significantly reduces postoperative complications, especially AKI. These findings underscore the clinical relevance of GDP strategies, highlighting the importance of individualized perfusion management to optimize outcomes. Further large-scale RCTs are needed to confirm these benefits, standardize specific iDO₂ threshold levels that are beneficial, and to explore strategies that impact mortality and neurologic outcomes, as well as investigate the role that temperature management plays in DO₂ threshold determination.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"2676591251380659"},"PeriodicalIF":1.1,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145056254","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}