Perfusion-Uk最新文献

{"title":"If you can't have fun doing what you are doing, you shouldn't be doing it.","authors":"John M Toomasian","doi":"10.1177/02676591251328614","DOIUrl":"10.1177/02676591251328614","url":null,"abstract":"","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"805-806"},"PeriodicalIF":1.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143659050","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":"Easy flow: An eclectic cardiopulmonary bypass simulation model.","authors":"Ishaq I Najmuddin, P Sainath, P R Srinidhi","doi":"10.1177/02676591241261017","DOIUrl":"10.1177/02676591241261017","url":null,"abstract":"<p><p>The aphorism \"Primum non nocere\" underscores the responsibility of healthcare professionals to prioritize patient safety. Perfusionists, experts in extracorporeal circulation, play a pivotal role in maintaining cardiac function during critical situations. However, the evolving landscape of medical technology has not been without challenges, particularly in ensuring equitable access to perfusion training. Easy Flow Cardiopulmonary Bypass Simulation Model stands out as a cost-effective alternative, utilizing routine CPB equipment found in operating theatres. The uniqueness lies in its incorporation of double reservoirs and two pumps, a novel approach not reported before in educational CPB simulation models. The benefits of this model extend beyond skill development to encompass team management, communication enhancement, and disaster management training. Multiple scenarios, from the initiation of CPB to addressing emergencies like massive air embolism, can be simulated. Although the model requires an instructor, this facilitates the integration of essential professional and communication skills into training. The adaptability of the Easy Flow model makes it a practical and sustainable solution. It provides hands-on experience for perfusion students, translating theoretical knowledge into practical competence. The model's simplicity, combined with its use of readily available materials, positions it to be an accessible tool for educational institutions and healthcare centers globally. In conclusion, the Easy Flow CPB Simulation Model not only fills a critical gap in perfusion education but also exemplifies how innovation can bridge disparities, ensuring that quality healthcare education is within reach for all. Its potential impact on global healthcare training is profound, promising a future where knowledge sharing leads to improved patient care.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"841-845"},"PeriodicalIF":1.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12014952/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141301971","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":"Science of left ventricular unloading.","authors":"Paolo Meani, Serena Todaro, Giacomo Veronese, Mariusz Kowalewski, Andrea Montisci, Ilaria Protti, Giuseppe Marchese, Christiaan Meuwese, Roberto Lorusso, Federico Pappalardo","doi":"10.1177/02676591241268389","DOIUrl":"10.1177/02676591241268389","url":null,"abstract":"<p><p>The concept of left ventricular unloading has its foundation in heart physiology. In fact, the left ventricular mechanics and energetics represent the cornerstone of this approach. The novel sophisticated therapies for acute heart failure, particularly mechanical circulatory supports, strongly impact on the mechanical functioning and energy consuption of the heart, ultimately affecting left ventricle loading. Notably, extracorporeal circulatory life support which is implemented for life-threatening conditions, may even overload the left heart, requiring additional unloading strategies. As a consequence, the understanding of ventricular overload, and the associated potential unloading strategies, founds its utility in several aspects of day-by-day clinical practice. Emerging clinical and pre-clinical research on left ventricular unloading and its benefits in heart failure and recovery has been conducted, providing meaningful insights for therapeutical interventions. Here, we review the current knowledge on left ventricular unloading, from physiology and molecular biology to its application in heart failure and recovery.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"818-831"},"PeriodicalIF":1.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12014955/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141762073","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 novel configuration for providing continuous renal replacement therapy via the ECMO circuit in VV ECMO without alarm adjustment.","authors":"Christopher Noel, Adam Green, Ioana Florea, Nitin Puri, Solomon Dawson, Meghan Gorski, Robert Rios, Michael Kouch","doi":"10.1177/02676591241263268","DOIUrl":"10.1177/02676591241263268","url":null,"abstract":"<p><p>BackgroundIt is common for patients on venovenous extracorporeal membrane oxygenation (VV ECMO) to require continuous renal replacement therapy (CRRT). This can be done using separate vascular access for the CRRT circuit, by placing the CRRT hemofilter within the ECMO circuit, or through a separate CRRT circuit connected to the ECMO circuit. When a CRRT circuit is connected to the ECMO circuit, the inflow and outflow CRRT limbs can both be placed pre-ECMO pump or the CRRT circuit can span the ECMO pump, with the CRRT inflow post-ECMO pump and the outflow pre-ECMO pump. Both configurations require the CRRT alarms to be inactivated due to high positive pressure experienced post-pump and low negative pressure pre-pump. We describe a novel technique that does not require separate venous access and still allows the CRRT alarms to be activated.TechniqueThe CRRT inflow line is connected to the post-oxygenator de-airing port. The CRRT outflow line is connected to the pre-pump side of the ECMO circuit. Pigtails allow for these connections and act as resistors negating the large range of pressures generated by the ECMO centrifugal pump.ResultsWe implemented this configuration in 11 patients with 100% success rate allowing for alarms to be maintained in all patients. The median number of interruptions per 100 CRRT days was 11.7. The median CRRT filter lifespan was 2.2 days, and the average blood flow was maintained at 311 mL/min.ConclusionsThis configuration allows for efficient use of CRRT in ECMO patients while maintaining the safety alarms on the CRRT machine.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"836-840"},"PeriodicalIF":1.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141428061","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":"In situ simulation in the intensive care unit: A phenomenological study of staff experiences.","authors":"Andres Ferre, Andres Giglio, Nicolette Van Sint Jan, Javiera Garcia, Martin Benites, Karen Vergara, María Galleguillos, Jorge Dreyse, Pablo Hasbun","doi":"10.1177/02676591241272058","DOIUrl":"10.1177/02676591241272058","url":null,"abstract":"<p><p>ObjectiveTo explore the experiences of clinical and non-clinical staff in an intensive care unit regarding the perceived benefits and drawbacks of using in situ simulation as a training tool.MethodsA descriptive phenomenological qualitative study was conducted among clinical and nonclinical ICU personnel. Simulations and interviews were conducted until data saturation was achieved. The interviews were recorded, transcribed verbatim for analysis, and interpreted using the Colaizzi method.ResultsTen participant interviews generated data saturation. ISS was found to be feasible and beneficial in the ICU, facilitating experiential and emotion-based learning in real-world environments. Eight result categories were identified: simulation benefits, simulation benefits in real conditions, scenario authenticity, interference with usual work, ISS sessions, high-fidelity generating affective bonding, ISS as knowledge reinforcement, and recommendations for improvement. The fundamental structure revealed that ISS is perceived as an authentic and emotionally impactful team simulation modality that promotes experiential learning, reflection, and care improvement opportunities within the complex sociotechnical system of the ICU.ConclusionsAll interviewees considered ISS to be a feasible simulation tool that should be implemented in the ICU to improve knowledge and skills, thereby enhancing teamwork.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"962-973"},"PeriodicalIF":1.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141898672","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":"Validation and optimization of a blood transfusion prediction model for low transfusion rate adult cardiac surgery.","authors":"Renard Haumann, Tomasz Plonek, Edward Niesten, Jolanda Maaskant, Jutta Arens, Job van der Palen, Frank Halfwerk","doi":"10.1177/02676591251334903","DOIUrl":"https://doi.org/10.1177/02676591251334903","url":null,"abstract":"<p><p>IntroductionBlood transfusion is associated with adverse events and should be prevented. Preoperative identification of patients at risk is necessary and makes subsequent preventive intervention possible. Many risk models have been developed of which the Transfusion Risk and Clinical Knowledge (TRACK) model includes criteria reflecting daily practice. The aim of this study is to validate and update the TRACK model in a low-transfusion-rate adult cardiac-surgery population.MethodsExternal validation of the TRACK model was performed using a database of 4072 adult patients receiving cardiac surgery between 2015 and 2022 (original TRACK model). Subsequently, the original TRACK model coefficients were updated by cross-validation (uTRACK model). Preoperative antiplatelet therapy was added as an extra variable to the updated TRACK model (uTRACK + APT model).ResultsIn our population, 26% of patients received red blood cell transfusions. The original TRACK model demonstrated good discrimination (AUC-ROC of 0.76; 95% CI 0.74 - 0.78) but inadequate calibration (<i>p</i> < .001). Updating TRACK coefficients resulted in improved discrimination (AUC-ROC of 0.78; 95% CI 0.75 - 0.81), calibration (<i>p</i> = .19), and reclassification (Categorical NRI: 0.21; 95% CI [0.17 - 0.24]; <i>p</i> < .001). Adding preoperative antiplatelet therapy did not significantly improve net reclassification improvement (Categorical NRI: 0.01; 95% CI -0.001 - 0.029; <i>p</i> = .40).ConclusionThe original TRACK model overestimates blood transfusion risk in a low-transfusion-rate population. Risk classification significantly improved by updating the original TRACK coefficients. Using the uTRACK model provides more accurate identification of patients at risk of receiving red blood cell transfusions in a low transfusion rate population.Trial RegistryClinicalTrials.gov (https://clinicaltrials.gov), registration number: <b>NCT05581238</b>.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"2676591251334903"},"PeriodicalIF":1.1,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144051688","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":"Outcomes of emergency medical service transport on venoarterial extracorporeal life support in cardiogenic shock.","authors":"Christine Yang, Iris Feng, Paul Kurlansky, Kathryn Fidlow, Dana A Mullin, Melana Yuzefpolskaya, Paolo C Colombo, Gabriel Sayer, Nir Uriel, Yuji Kaku, Justin Fried, Koji Takeda","doi":"10.1177/02676591251331952","DOIUrl":"https://doi.org/10.1177/02676591251331952","url":null,"abstract":"<p><p>IntroductionVeno-arterial extracorporeal life support (V-A ECLS) can be utilized to transport cardiogenic shock patients from a regional to a tertiary center. Mobile extracorporeal membrane oxygenation (ECMO) may be life-saving for critically ill patients to bridge to transplant or a higher level of care.MethodsThis study is a retrospective review of adult patients placed on V-A ECMO for cardiogenic shock between 2018 and 2022. Indications and outcomes were compared between patients who were cannulated at referring hospitals and transported via ambulance and those who were placed on VA-ECLS at our institution.Results547 patients with V-A ECMO placed due to cardiogenic shock were included. 94 patients were transported from referring hospitals, while 453 were placed on V-A ECMO at our institution. All were safely transported. In-hospital mortality was significantly higher in transport patients (49.1% vs 59.5%, <i>p</i> = .042). Transport patients had significantly higher rates of acute kidney injury requiring dialysis (27.8% vs 39.4%, <i>p</i>-value = .035) and cerebrovascular accident (6.2% vs 12.8%, <i>p</i>-value = .026). Kaplan-Meier curves showed 6-month survival was significantly lower in transport group (48.5% vs 37.3%, <i>p</i> = .021). Multivariate analysis demonstrated ECMO indication of AMI (OR 1.43, <i>p</i>-value = .037), ECPR (OR 2.45, <i>p</i>-value <.001), and history of COPD (OR 1.55, <i>p</i>-value = .014) were predictors of mortality within 12 months. Notably ECMO transport was not a significant risk factor.ConclusionsPatients transported on V-A ECMO had higher in-hospital mortality, as well as lower 1-year survival. Careful patient selection is required.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"2676591251331952"},"PeriodicalIF":1.1,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144024743","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":"Sex-related outcomes during short-term mechanical circulatory support: A systematic review and meta-analysis of propensity-score matched studies.","authors":"Laura Luiz, Douglas Mesadri Gewehr, Susimar Picado-Loaiza, Leonardo Ohashi, Nora Goebel, Bartosz Rylski, Rafael Ayala","doi":"10.1177/02676591251324643","DOIUrl":"https://doi.org/10.1177/02676591251324643","url":null,"abstract":"<p><p>BackgroundThe association between sex and cardiovascular risk and different responses to heart failure therapies is well established. However, sex related outcomes of different types of short-term mechanical circulatory support (MCS) therapy remains controversial.MethodsWe performed a systematic review and meta-analysis of studies comparing outcomes of MCS between sexes. We restricted inclusion to propensity score matched studies to minimize the risk of confounding. We pooled binary and continuous outcomes with odds ratio (OR) and mean differences (MD), respectively, under a random effects model.ResultsWe pooled 6 propensity score matched studies evaluating sex related outcomes during short-term MCS, with 18,720 patients, of whom 9442 (50.5%) were male and 9278 (49.5%) were female. Subgroup analysis showed higher 30-day mortality during ECMO (OR 1.11; 95% CI 1.01-1.22; <i>p</i> = .038; I² = 0%) in males, but lower 30-day mortality during Impella® therapy than females (OR 0.87; 95% CI 0.80-0.94; <i>p</i> = .001; I² = 0%). Males had a higher need of myocardial revascularization (OR 3.09; 95% CI 1.56-5.99; <i>p</i> = .001; I² = 0%), but a higher risk of acute kidney injury (OR 1.20; 95% CI 1.09-1.31; <i>p</i> < .001; I² = 18%).ConclusionIn-hospital and 30-day mortality were similar between females and males.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"2676591251324643"},"PeriodicalIF":1.1,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144043619","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":"Navigating coagulation: Key markers in the first 24 hours of pediatric ECMO.","authors":"Jan V Stevens, Katherine Regling, Elika Ridelman, Meera Chitlur, Michelle Veenstra, Christina Shanti","doi":"10.1177/02676591251335592","DOIUrl":"https://doi.org/10.1177/02676591251335592","url":null,"abstract":"<p><p>BackgroundAnticoagulation in pediatric extracorporeal membrane oxygenation (ECMO) presents unique challenges due to developmental hemostasis, coagulation factor production, and response to anticoagulants. This process requires close monitoring to prevent bleeding and thrombotic events. Limited data exist on how traditional coagulation tests correlate with these complications in this population in the first 24 h after ECMO cannulation.MethodsThis institutional review board-approved retrospective review was conducted on 126 children requiring ECMO between January 2017 and March 2022. Pre- and post-cannulation partial thromboplastin time (PTT), prothrombin time (PT), international normalized ratio (INR), hemoglobin, platelet count, and fibrinogen were collected. Also measured were initial activated clotting time (ACT), time to reach target ACT post-heparin bolus (≤250 s), initial unfractionated heparin (UFH) infusion rate, and post-cannulation antithrombin III activity (ATIII).ResultsCompared to those who did not experience complications, patients who experienced bleeds showed a longer time until target ACT was reached (<i>p</i> = 0.003), prolonged post-cannulation PT and INR (<i>p</i> = 0.002 for both), lower pre- and post-cannulation fibrinogen levels (<i>p</i> = 0.008 and <i>p</i> = <0.001, respectively), and lower post-cannulation platelet counts (<i>p</i> = 0.035). However, those who experienced thrombotic complications showed only higher pre-cannulation fibrinogen levels (<i>p</i> = 0.017).ConclusionsOur data shows that fibrinogen is an important parameter which defines the risk of early bleeding or thrombotic complications during the first 24 hours of ECMO cannulation. Attention to these baseline and immediate post-cannulation laboratory values may be important to determine initial bolus dosing and adjustment of anticoagulation in these patients. Continued multi-center collaboration to determine the utility of incorporation of other coagulation studies, like anti-factor Xa and viscoelastic assays, is needed.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"2676591251335592"},"PeriodicalIF":1.1,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144039603","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 impact of arterial cannulation strategy on carotid perfusion during cardiopulmonary bypass: A computational fluid dynamics analysis from the perspective of vascular anatomy.","authors":"Shengxun Lu, Yachuang Xing, Jie Liu, Jinghua Li, Shengkai Zhou, Guiqing Liu, Feng Wang, Junhui Luo","doi":"10.1177/02676591251334900","DOIUrl":"https://doi.org/10.1177/02676591251334900","url":null,"abstract":"<p><p><i>Introduction:</i> Cardiopulmonary bypass (CPB) is utilized during cardiovascular surgery to maintain organ oxygen supply and blood perfusion instead of cardiopulmonary function. Three primary methods of artery cannulation used for CPB include ascending aortic cannulation (AscAoC), right axillary artery cannulation (rAxAC), and femoral artery cannulation (FAC).<i>Methods:</i> In this study, computational fluid dynamics simulation technology was employed to analyze aorta and main branches of 62 patients undergoing CPB with different arterial cannulation schemes, observing carotid artery (CarA) perfusion and characteristics.<i>Conclusions:</i> Results indicate that the total perfusion of bilateral CarAs using the three cannulation methods was sufficient when there was no significant variation in arterial morphology. Without considering the peripheral resistance and the body's autoregulatory function, the right CarA was less perfused than the left CarA under AscAoC and rAxAC, leading to perfusion imbalance. Especially heteroplastic patients with rAxAC may be at risk of the right CarA hypoperfusion during CPB. FAC provides balanced and adequate perfusion of both hemispheres without stenosis or dissection of the aorta.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"2676591251334900"},"PeriodicalIF":1.1,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144043252","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}