Perfusion-Uk最新文献

{"title":"Blood conservation strategies in complex aortic surgery for a Jehovah's Witness: A case report.","authors":"Hannah Lewis, Joseph Devlin","doi":"10.1177/02676591251324644","DOIUrl":"https://doi.org/10.1177/02676591251324644","url":null,"abstract":"<p><p><i>Introduction</i>: Complex aortic surgery involving Jehovah's Witness patients presents a significant challenge due to their refusal of blood products.<i>Case report</i>: This case report details the management of a 50-year-old female Jehovah's Witness with anaemia and a low body surface area, undergoing an urgent ascending aorta and hemi-arch replacement for a type A dissection. A broad range of blood conservation strategies were utilised in order to preserve haematocrit and clotting factors.<i>Conclusions:</i> This report highlights the importance of careful planning, team collaboration, and the meticulous application of blood conservation techniques in achieving a favourable postoperative outcome.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"2676591251324644"},"PeriodicalIF":1.1,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143525080","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":"Quantitative methods to improve bivalirudin dosing in pediatric cardiac ICU patients.","authors":"Lindsey Brinkley, Zasha Vazquez-Colon, Aashay Patel, Matthew S Purlee, Terry Vasilopoulos, Mark S Bleiweis, Jeffrey P Jacobs, Giles J Peek, Helen Moore","doi":"10.1177/02676591251324648","DOIUrl":"https://doi.org/10.1177/02676591251324648","url":null,"abstract":"<p><strong>Background: </strong>A gap in knowledge exists related to optimal bivalirudin dosing in children. The purpose of our analysis is to use quantitative methods and baseline data to quickly predict the optimal therapeutic bivalirudin dose for children.</p><p><strong>Methods: </strong>We developed an internal database of pediatric patients on ECMO or VAD, including baseline patient information, bivalirudin doses, and partial thromboplastin time (PTT) measurements throughout the treatment period. We fit an analysis of covariance (ANCOVA) model to the baseline data to determine the best predictors of therapeutic bivalirudin dose. We used five-fold cross-validation to ensure the model was not overfitting to any specific data subset.</p><p><strong>Results: </strong>The most notable variables that were statistically significant (<i>p</i> < .05) were: the primary use of bivalirudin for heart failure prophylaxis, no complications before bivalirudin administration, other reasons for bivalirudin use, other race (including Asian, pacific islander, and native American), Hispanic or Latinx ethnicity, primary diagnosis of heart failure, and primary diagnosis of myocarditis. To compare our model-predicted dose and the actual starting dose administered to the patients, we looked at how far off each of those was from the therapeutic dose. The mean of absolute differences was 0.28 mg/kg/hr for the administered starting dose and 0.23 mg/kg/hr for the model-predicted dose; therefore, the model results in an improvement of 18% in the difference from the therapeutic dose.</p><p><strong>Conclusion: </strong>Our model provides an initial framework for determining a starting bivalirudin dose that takes into account patient demographic information and baseline admission data.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"2676591251324648"},"PeriodicalIF":1.1,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143525081","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":"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":"https://doi.org/10.1177/02676591251324136","url":null,"abstract":"<p><strong>Background: </strong>Liberation 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.</p><p><strong>Methods: </strong>Retrospective, 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.</p><p><strong>Results: </strong>224 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.</p><p><strong>Conclusions: </strong>Reduced 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":"2676591251324136"},"PeriodicalIF":1.1,"publicationDate":"2025-02-26","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":"ECMO for the pregnant and peripartum patient: A practical review of indications, unique management considerations, and an approach framework.","authors":"Carmen S Hrymak, Ahmed Labib, Bindu Akkanti, Marta V Antonini, Bradley Bruggeman, Matthew J Griffee, Silver Heinsar, Jeffrey P Jacobs, Michelle Larzelere, Emily Naoum, Erika O'Neil, Dikea Roussos-Ross, Akram M Zaaqoq, Giles J Peek, Rakesh C Arora","doi":"10.1177/02676591251321070","DOIUrl":"10.1177/02676591251321070","url":null,"abstract":"<p><p>The use of extracorporeal membrane oxygenation (ECMO) to support the pregnant patient and fetus requires a complex decision-making process. Peripartum ECMO requires coordinated and informed decision-making between an interdisciplinary team of experts, incorporating the unique considerations and, at times, competing physiologic priorities of the pregnant patient. It is often confounded by a scarcity of local relevant experience engendered by its rare occurrence. No event has made the need for an organized approach to the utilization of ECMO in pregnant patients more pressing than the COVID pandemic. The conditions affecting pregnant patients that warrant ECMO consideration are high stakes and, at times, ethically challenging, although outcomes are favourable compared to the general population. This review provides background information and context, followed by a practical approach to the care and specific medical management of patients who are facing life-threatening conditions warranting ECMO while pregnant.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"2676591251321070"},"PeriodicalIF":1.1,"publicationDate":"2025-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484562","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":"https://doi.org/10.1177/02676591251322963","url":null,"abstract":"<p><strong>Background: </strong>While 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.</p><p><strong>Methods: </strong>Systematic 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.</p><p><strong>Results: </strong>A 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%.</p><p><strong>Conclusion: </strong>This 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":"2676591251322963"},"PeriodicalIF":1.1,"publicationDate":"2025-02-20","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":"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":"https://doi.org/10.1177/02676591251321997","url":null,"abstract":"<p><strong>Introduction: </strong>Femoral 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.</p><p><strong>Results: </strong>Over 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.</p><p><strong>Conclusion: </strong>Buttock 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":"2676591251321997"},"PeriodicalIF":1.1,"publicationDate":"2025-02-19","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":"Evaluation of the impact of extracorporeal membrane oxygenation (ECMO) oxygenator shunt flow on neonatal hemolysis: An in vitro study.","authors":"Christopher Nemeh, Caleb Varner, Nicholas Schmoke, Elon Trager, Yeu Sanz Wu, Michael Brewer, Caitlin Cain-Trivette, Nikki Aw, Richard O Francis, Diana Vargas Chaves, Eva W Cheung, William Middlesworth","doi":"10.1177/02676591251322000","DOIUrl":"https://doi.org/10.1177/02676591251322000","url":null,"abstract":"<p><strong>Introduction: </strong>Extracorporeal membrane oxygenation (ECMO) is utilized in critically ill neonates with severe cardiopulmonary failure. Hemolysis is a potential complication and is associated with significantly increased morbidity and mortality. The etiology of hemolysis in neonates is multifactorial, including shear forces generated by the ECMO pump, higher flow resistance from smaller tubing and smaller cannulas, the oxygenator, and other patient factors. Centrifugal pumps and oxygenators commonly have shunts with partially occluding clamps to regulate blood flow. We hypothesized that these clamps are significant contributors to hemolysis.</p><p><strong>Method: </strong>An in vitro study was conducted with three identical ECMO circuits containing an integrated polymethylpentene (PMP) oxygenator and centrifugal pump (Cardiohelp HLS 5.0) and 1/4″ arteriovenous (AV) loop tubing. The circuits were primed with equal components, including expired ABO-compatible packed red blood cells (pRBCs), 25% albumin, 5% albumin, sodium bicarbonate, heparin, and calcium chloride. Circuit A had a completely occluded shunt. Circuit B had a partially occluded shunt, allowing 500 mL/min of shunt flow back to the oxygenator. Circuit C had a fully open shunt, generating 1000 mL/min of shunt flow back to the oxygenator. Plasma-free hemoglobin values were measured serially over 5 days.</p><p><strong>Results: </strong>Baseline plasma-free hemoglobin levels were equal in all three circuits. Circuit C had the greatest increase in plasma-free hemoglobin daily (26.3 mg/dL/day) compared to Circuit A and Circuit B, which were 14.1 mg/dL/day and 12.9 mg/dL/day, respectively.</p><p><strong>Conclusions: </strong>Our data suggests that partially occluding clamps are not a significant contributor to hemolysis; rather, increased flow through the oxygenator significantly increased the rate of hemolysis in neonatal ECMO circuits.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"2676591251322000"},"PeriodicalIF":1.1,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143442593","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":"https://doi.org/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":"2676591251317679"},"PeriodicalIF":1.1,"publicationDate":"2025-01-31","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":"Thanks to reviewers.","authors":"","doi":"10.1177/02676591251317146","DOIUrl":"https://doi.org/10.1177/02676591251317146","url":null,"abstract":"","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"2676591251317146"},"PeriodicalIF":1.1,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068999","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":"Trauma-related psychopathologies after extracorporeal membrane oxygenation support: A systematic review and meta-analysis.","authors":"Ashley Demory, Elizabeth Broden, Lucile Equey, Melissa C Funaro, Mona Sharifi, Ilan Harpaz-Rotem, Chani Traube, Oliver Karam","doi":"10.1177/02676591251317919","DOIUrl":"https://doi.org/10.1177/02676591251317919","url":null,"abstract":"<p><p>Extracorporeal Membrane Oxygenation (ECMO) use is associated with substantial psychiatric morbidity in patients and their families. This systematic review and meta-analysis quantifies the prevalence of post-traumatic stress disorder (PTSD), anxiety, and depression among ECMO survivors and their families. Included studies enrolled patients on ECMO or their families and reported at least one trauma-related psychopathology. Of 1767 screened studies, 55 were included (5146 participants): 50 in adult ECMO survivors, one in pediatric ECMO survivors, and four in families of ECMO patients (two adult, two pediatric.). The pooled prevalence of PTSD was 19% in adult ECMO survivors, 20% in pediatric ECMO survivors, 25% in families of adult ECMO patients, and 21% in families of pediatric ECMO patients. The pooled prevalence of anxiety was 30% in adult ECMO survivors, 8% in pediatric ECMO survivors, 67% in families of adult ECMO patients, and 46% in families of pediatric ECMO patients. The pooled prevalence of depression was 24% in adult ECMO survivors, 8% in pediatric ECMO survivors, 50% in families of adult ECMO patients, and 32% in families of pediatric ECMO patients. This meta-analysis demonstrates a high prevalence of trauma-related psychopathologies surrounding ECMO use, highlighting the need for interventions to improve post-ECMO outcomes.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"2676591251317919"},"PeriodicalIF":1.1,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069029","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}