Perfusion-Uk最新文献

{"title":"A hardshell reservoir technique for administering del Nido cardioplegia.","authors":"Giuseppe Comentale, Alessandra Notarnicola, Ilaria Ruffo, Paola Bianca Pisco, Anna Milione, Antonio Pacciolla, Anna Damiano, Concetta Calanni, Emanuele Pilato","doi":"10.1177/02676591241260859","DOIUrl":"10.1177/02676591241260859","url":null,"abstract":"<p><p>IntroductionThe use of del Nido cardioplegia has increased in the adult cardiac surgery population. Centers have adopted the formula with a variety of circuit systems. This report includes our set up for delivering 1:4 (blood: crystalloid) del Nido cardioplegia.Materials and MethodsA homemade circuit for cardioplegia administration was built with a pediatric reservoir, a roller pump, a coil cooler, a 3/16-inch circuit to administer and recycle cardioplegia, and two ¼-inch tubes to collect the patient's blood.TechniqueThe circuit allows the perfusionist to collect the blood directly from the cardiopulmonary bypass arterial limb of the circuit, to precisely mix it with the crystalloid component of the del Nido cardioplegia solution already in the reservoir, and to administer the final solution under strictly controlled parameters.SummaryWe present a circuit design that can accurately measure and administer del Nido cardioplegia through the use of a roller pump and a pediatric reservoir. It simplifies and enhances the accuracy and efficiency of cardioplegic administration in our practice.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"568-571"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141285109","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":"Infectious diseases and infection control prevention strategies in adult and pediatric population on ECMO.","authors":"Zasha Vazquez-Colon, Joseph E Marcus, Emily Levy, Aditya Shah, Graeme MacLaren, Giles Peek","doi":"10.1177/02676591241249612","DOIUrl":"10.1177/02676591241249612","url":null,"abstract":"<p><p>As survival after ECMO improves and use of ECMO support increases in both pediatric and adult population, there is a need to focus on both the morbidities and complications associated with ECMO and how to manage and prevent them. Infectious complications during ECMO often have a significant clinical impact, resulting in increased morbidity or mortality irrespective of the underlying etiology necessitating cardiorespiratory support. In this review article, we discuss the prevention, management, challenges, and differences of infectious complications in adult and pediatric patients receiving ECMO support.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"6S-14S"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141301972","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":"Corrigendum to \"Microplegia in paediatric hearts\".","authors":"","doi":"10.1177/02676591231223095","DOIUrl":"10.1177/02676591231223095","url":null,"abstract":"","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"798"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138886454","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 following additional drainage during veno-venous extracorporeal membrane oxygenation: A single-center retrospective study.","authors":"Sagar B Dave, Eric Leiendecker, Christina Creel-Bulos, Casey Frost Miller, David W Boorman, Jeffrey Javidfar, Tamer Attia, Mani Daneshmand, Craig S Jabaley, Mark Caridi-Schieble","doi":"10.1177/02676591241249609","DOIUrl":"10.1177/02676591241249609","url":null,"abstract":"<p><p>Refractory hypoxemia during veno-venous (V-V) extracorporeal membrane oxygenation (ECMO) may require an additional cannula (VV-V ECMO) to improve oxygenation. This intervention includes risk of recirculation and other various adverse events (AEs) such as injury to the lung, cannula malpositioning, bleeding, circuit or cannula thrombosis requiring intervention (i.e., clot), or cerebral injury. During the study period, 23 of 142 V-V ECMO patients were converted to VV-V utilizing two separate cannulas for bi-caval drainage with an additional upper extremity cannula placed for return. Of those, 21 had COVID-19. In the first 24 h after conversion, ECMO flow rates were higher (5.96 vs 5.24 L/min, <i>p</i> = .002) with no significant change in pump speed (3764 vs 3630 revolutions per minute [RPMs], <i>p</i> = .42). Arterial oxygenation (PaO₂) increased (87 vs 64 mmHg, <i>p</i> < .0001) with comparable pre-oxygenator venous saturation (61 vs 53.3, <i>p</i> = .12). By day 5, flows were similar to pre-conversion values at lower pump speed but with improved PaO₂. Unadjusted survival was similar in those converted to VV-V ECMO compared to V-V ECMO alone (70% [16/23] vs 66.4% [79/119], <i>p</i> = .77). In a mixed effect regression model, any incidence of AEs, demonstrated a negative impact on PaO₂ in the first 48 h but not at day 5. VV-V ECMO improved oxygenation with increasing flows without a significant difference in AEs or pump speed. AEs transiently impacted oxygenation. VV-V ECMO is effective and feasible strategy for refractory hypoxemia on VV-ECMO allowing for higher flow rate and unchanged pump speed.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"647-656"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140960558","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":"Can we reduce the risk of neurological injury in critically ill children on initiation of ECLS? A narrative review of potential modifiable factors.","authors":"N Joram, R R Thiagarajan, M Bembea, S M Cho, A M Guerguerian, R Lorusso, A Polito, L Raman, E Sanford, N Shah, A Zaaqoq, A Hoskote, M Di Nardo","doi":"10.1177/02676591251329555","DOIUrl":"https://doi.org/10.1177/02676591251329555","url":null,"abstract":"<p><p>Neurological morbidity and mortality remain high in children requiring extracorporeal membrane oxygenation (ECMO). Although the severity of illness at the time of ECMO initiation and the nature of the underlying disease are strongly linked to the development of acute brain injury, several important factors are associated with neurological complications during ECMO support. Many of these factors, particularly those encountered during the early phase of ECMO initiation (first 24 hours), may be modifiable and represent potential targets for interventional studies aiming for improvement of neurological outcomes in pediatric ECMO patients. In this review from the European Extracorporeal Life Support Organization (EuroELSO) Working Group on Neurologic Monitoring and Outcome, we aim to summarize current knowledge on modifiable factors associated with brain injury during ECMO and their potential impact on outcome.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":"40 1_suppl","pages":"29S-38S"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144038144","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":"Impact of diabetes on short-term outcomes in patients undergoing coronary artery bypass grafting surgery in acute coronary syndrome.","authors":"Ihor Krasivskyi, Borko Ivanov, Zakaria Msallati, Clara Großmann, Stephen Gerfer, Mariya Mihaylova, Kaveh Eghbalzadeh, Christian Origel Romero, Ilija Djordjevic, Thorsten Wahlers, Farhad Bakhtiary, Anton Sabashnikov","doi":"10.1177/02676591241253461","DOIUrl":"10.1177/02676591241253461","url":null,"abstract":"<p><p>IntroductionDiabetes mellitus (DM) is associated with concomitant comorbidities, such as atherosclerosis and cardiovascular disease. Coronary artery bypass grafting (CABG) surgery is the optimal therapy in diabetic patients with triple vessel disease. DM is also known to be a relevant risk factor for higher morbidity and mortality in patients who underwent elective CABG procedures. Data regarding outcomes in diabetic patients in acute coronary syndrome (ACS) is heterogeneous. This study aimed to investigate the impact of DM on short-term outcomes in patients who underwent CABG surgery in ACS.MethodsA retrospective propensity score matched (PSM) analysis of 1370 patients who underwent bypass surgery for ACS between June 2011 and October 2019 was conducted. All patients were divided into two groups: non-diabetic group (<i>n</i> = 905) and diabetic group (<i>n</i> = 465). In-hospital mortality was the primary outcome. Secondary outcomes were perioperative myocardial infarction, new onset dialysis, reopening for bleeding and duration of intensive care unit (ICU) stay. A subgroup analysis of patients with insulin-dependent and non-insulin dependent DM was also performed.ResultsAfter performing PSM analysis, baseline characteristics and the preoperative risk profile were comparable between both groups. The proportion of patients who underwent total arterial revascularization (<i>p</i> = .048) with the use of both internal thoracic arteries (<i>p</i> < .001) was significantly higher in the non-diabetic group. The incidence of perioperative myocardial infarction (<i>p</i> = .048) and new onset dialysis (<i>p</i> = .008) was significantly higher in the diabetic group. In-hospital mortality was statistically (<i>p</i> = .907) comparable between the two groups.ConclusionDM was associated with a higher incidence of adverse outcomes, however with comparable in-hospital mortality in patients who underwent CABG procedure for ACS.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"640-646"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140891361","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":"Red blood cell transfusion in veno-arterial extracorporeal membrane oxygenation - the disconnect between oxygen delivery and tissue oxygenation.","authors":"Sophie H Fincher, Warwick Butt","doi":"10.1177/02676591241239569","DOIUrl":"https://doi.org/10.1177/02676591241239569","url":null,"abstract":"<p><p>BackgroundRed cell transufion in veno-arterial membrane oxygenation (VA ECMO) has been widely debated.PurposeThis narrative review aims to examine the historical and current approaches of red cell transfusion in veno-arterial extracorporeal membrane oxygenation (VA ECMO) to enhance oxygen delivery. It will explore the potential benefits and pitfalls of red blood cell (RBC) transfusion in VA ECMO, including relationship between haemoglobin (Hb) concentration, tissue oxygenation and patient outcomes associated with transfusion. Following it will review the impact of cardiogenic shock on the microcirculation, performance of transfused RBC and effects of the ECMO circuit on RBC function. It will conclude with an introduction to potential mechanisms by which we might manipulate red cells to improve tissue oxygenation, without augmentation of Hb concentration.ConclusionFurther research is needed to provide insight into optimal RBC transfusion thresholds and strategies to augment red cell function to optimise tissue oxygenation in VA ECMO.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":"40 1_suppl","pages":"15S-28S"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144055809","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":"Flow capabilities of arterial and drainage cannulae during venoarterial extracorporeal membrane oxygenation: A simulation model.","authors":"Avishka Wickramarachchi, Aidan J C Burrell, Patrick R Joyce, Rinaldo Bellomo, Jaishankar Raman, Shaun D Gregory, Andrew F Stephens","doi":"10.1177/02676591241256502","DOIUrl":"10.1177/02676591241256502","url":null,"abstract":"<p><p>BackgroundLarge cannulae can increase cannula-related complications during venoarterial extracorporeal membrane oxygenation (VA ECMO). Conversely, the ability for small cannulae to provide adequate support is poorly understood. Therefore, we aimed to evaluate a range of cannula sizes and VA ECMO flow rates in a simulated patient under various disease states.MethodsArterial cannulae sizes between 13 and 21 Fr and drainage cannula sizes between 21 and 25 Fr were tested in a VA ECMO circuit connected to a mock circulation loop simulating a patient with severe left ventricular failure. Systemic and pulmonary hypertension, physiologically normal, and hypotension were simulated by varying systemic and pulmonary vascular resistances (SVR and PVR, respectively). All cannula combinations were evaluated against all combinations of SVR, PVR, and VA ECMO flow rates.ResultsA 15 Fr arterial cannula combined with a 21 Fr drainage cannula could provide >4 L/min of total flow and a mean arterial pressure of 81.1 mmHg. Changes in SVR produced marked changes to all measured parameters, while changes to PVR had minimal effect. Larger drainage cannulae only increased maximum circuit flow rates when combined with larger arterial cannulae.ConclusionSmaller cannulae and lower flow rates could sufficiently support the simulated patient under various disease states. We found arterial cannula size and SVR to be key factors in determining the flow-delivering capabilities for any given VA ECMO circuit. Overall, our results challenge the notion that larger cannulae and high flows must be used to achieve adequate ECMO support.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"668-677"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11951468/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141086563","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":"Conventional versus minimally invasive extra-corporeal circulation in patients undergoing cardiac surgery: A randomized controlled trial (COMICS).","authors":"Gianni D Angelini, Barnaby C Reeves, Lucy A Culliford, Rachel Maishman, Chris A Rogers, Kyriakos Anastasiadis, Polychronis Antonitsis, Helena Argiriadou, Thierry Carrel, Dorothée Keller, Andreas Liebold, Fatma Ashkaniani, Aschraf El-Essawi, Ingo Breitenbach, Clinton Lloyd, Mark Bennett, Alex Cale, Serdar Gunaydin, Eren Gunertem, Farouk Oueida, Ibrahim M Yassin, Cyril Serrick, John M Murkin, Vivek Rao, Marco Moscarelli, Ignazzo Condello, Prakash Punjabi, Cha Rajakaruna, Apostolos Deliopoulos, Daniel Bone, William Lansdown, Narain Moorjani, Sarah Dennis","doi":"10.1177/02676591241258054","DOIUrl":"10.1177/02676591241258054","url":null,"abstract":"<p><p>IntroductionThe trial hypothesized that minimally invasive extra-corporeal circulation (MiECC) reduces the risk of serious adverse events (SAEs) after cardiac surgery operations requiring extra-corporeal circulation without circulatory arrest.MethodsThis is a multicentre, international randomized controlled trial across fourteen cardiac surgery centres including patients aged ≥18 and <85 years undergoing elective or urgent isolated coronary artery bypass grafting (CABG), isolated aortic valve replacement (AVR) surgery, or CABG + AVR surgery. Participants were randomized to MiECC or conventional extra-corporeal circulation (CECC), stratified by centre and operation. The primary outcome was a composite of 12 post-operative SAEs up to 30 days after surgery, the risk of which MiECC was hypothesized to reduce. Secondary outcomes comprised: other SAEs; all-cause mortality; transfusion of blood products; time to discharge from intensive care and hospital; health-related quality-of-life. Analyses were performed on a modified intention-to-treat basis.ResultsThe trial terminated early due to the COVID-19 pandemic; 1071 participants (896 isolated CABG, 97 isolated AVR, 69 CABG + AVR) with median age 66 years and median EuroSCORE II 1.24 were randomized (535 to MiECC, 536 to CECC). Twenty-six participants withdrew after randomization, 22 before and four after intervention. Fifty of 517 (9.7%) randomized to MiECC and 69/522 (13.2%) randomized to CECC group experienced the primary outcome (risk ratio = 0.732, 95% confidence interval (95% CI) = 0.556 to 0.962, <i>p</i> = 0.025). The risk of any SAE not contributing to the primary outcome was similarly reduced (risk ratio = 0.791, 95% CI 0.530 to 1.179, <i>p</i> = 0.250).ConclusionsMiECC reduces the relative risk of primary outcome events by about 25%. The risk of other SAEs was similarly reduced. Because the trial terminated early without achieving the target sample size, these potential benefits of MiECC are uncertain.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"730-741"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11951381/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141236195","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":"Effect of geography on the use of ultrafiltration during cardiac surgery with cardiopulmonary bypass.","authors":"Keith A Samolyk","doi":"10.1177/02676591241256523","DOIUrl":"10.1177/02676591241256523","url":null,"abstract":"","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"793-794"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141075344","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}