Perfusion-Uk最新文献_第9页

Developing a generalizable pediatric ECMO emergency checklist for clinical specialist: Progress and challenges. 为临床专家制定可通用的儿科 ECMO 紧急情况检查表：进展与挑战。

IF 1.1 4区医学

Perfusion-Uk Pub Date : 2025-04-01 Epub Date: 2024-05-29 DOI: 10.1177/02676591241258067

Jamie M Furlong-Dillard, Kamal Abulebda, Aaron W Calhoun

{"title":"Developing a generalizable pediatric ECMO emergency checklist for clinical specialist: Progress and challenges.","authors":"Jamie M Furlong-Dillard, Kamal Abulebda, Aaron W Calhoun","doi":"10.1177/02676591241258067","DOIUrl":"10.1177/02676591241258067","url":null,"abstract":"IntroductionExtracorporeal membrane oxygenation (ECMO) emergencies require skilled clinical specialist (CS) who manage ECMO circuits. While tools for assessing CS skills have been published, there is significant variation in protocols and circuit design. This study aims to further develop these checklists to produce a generalizable ECMO skill assessment with adequate validity evidence to support its use as a summative evaluation tool.MethodsAn initial survey determined variation in ECMO circuit components and configurations, and the original checklists and simulations were altered through a modified Delphi process. The finalized checklist and simulation were then assessed for validity and reliability. Three trained raters assessed ten simulations from five subjects at two different institutions using two circuit designs. Data analysis was conducted using a fully crossed subject x rater x circuit generalizability (G) and decision (D) study.ResultsThe G-study coefficient was 0 with 0% variance across subject and circuit. The greatest variance was among raters (28.7%). Significant variance was also associated with the subject and pump type relationship (27%).ConclusionDespite the rigorous process used to modify the assessment, generalizability was poor. Lack of familiarity with center-specific circuit design played a key role. Future endeavors in ECMO skill assessment should focus either on developing and validating site-specific tools or standardizing circuit designs.","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"693-700"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141162654","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}

引用次数: 0

Evaluation of an aPTT guided versus a multimodal heparin monitoring approach in patients on extra corporeal membrane oxygenation: A retrospective cohort study. 对使用体外膜肺氧合的患者进行 aPTT 引导与多模式肝素监测方法的评估：一项回顾性队列研究。

IF 1.1 4区医学

Perfusion-Uk Pub Date : 2025-04-01 Epub Date: 2024-05-13 DOI: 10.1177/02676591241253474

Diman Taha, Joppe G Drop, Enno D Wildschut, Matthijs De Hoog, C Heleen van Ommen, Dinis Dos Reis Miranda

{"title":"Evaluation of an aPTT guided versus a multimodal heparin monitoring approach in patients on extra corporeal membrane oxygenation: A retrospective cohort study.","authors":"Diman Taha, Joppe G Drop, Enno D Wildschut, Matthijs De Hoog, C Heleen van Ommen, Dinis Dos Reis Miranda","doi":"10.1177/02676591241253474","DOIUrl":"10.1177/02676591241253474","url":null,"abstract":"IntroductionBleeding and thrombotic complications are common in extracorporeal membrane oxygenation (ECMO) patients and are associated with increased mortality and morbidity. The optimal anticoagulation monitoring protocol in these patients is unknown. This study aims to compare the incidence of thrombotic and hemorrhagic complications before and after a protocol change. In addition, the association between hemostatic complications, coagulation tests and risk factors is evaluated.MethodsThis is a retrospective single center cohort study of adult ECMO patients. We collected demographics, ECMO parameters and coagulation test results. Outcomes of the aPTT guided and multimodal protocol, including aPTT, anti-Xa assay and rotational thromboelastometry were compared and the association between coagulation tests, risk factors and hemostatic complications was determined using a logistic regression analysis for repeated measurements.ResultsIn total, 250 patients were included, 138 in the aPTT protocol and 112 in the multimodal protocol. The incidence of thrombosis (aPTT: 14%; multimodal: 12%) and bleeding (aPTT: 36%; multimodal: 40%), did not significantly differ between protocols. In the aPTT guided protocol, the aPTT was associated with thrombosis (Odds Ratio [OR] 1.015; 95% confidence interval [CI] 1.004-1.027). In both protocols, surgical interventions were risk factors for bleeding and thrombotic complications (aPTT: OR 93.2, CI 39.9-217.6; multimodal OR 17.5, CI 6.5-46.9).DiscussionThe incidence of hemostatic complications was similar between both protocols and surgical interventions were a risk factor for hemostatic complications. Results from this study help to elucidate the role of coagulation tests and risk factors in predicting hemostatic complications in patients undergoing ECMO support.","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"557-567"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11951356/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140913168","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}

引用次数: 0

Hybrid extracorporeal cannulation for aortic root pseudoaneurysm re-operation: The role of a multidisciplinary team. 用于主动脉根部假性动脉瘤再手术的混合体外插管：多学科团队的作用。

IF 1.1 4区医学

Perfusion-Uk Pub Date : 2025-04-01 Epub Date: 2024-05-16 DOI: 10.1177/02676591241255649

Ilaria Franzese, Florida Gripshi, Marco Anzini, Enzo Mazzaro

引用次数: 0

Brain injury plasma biomarkers in patients on veno-arterial extracorporeal membrane oxygenation: A pilot prospective observational study. 静脉-动脉体外膜氧合患者的脑损伤血浆生物标志物：一项试点前瞻性观察研究。

IF 1.1 4区医学

Perfusion-Uk Pub Date : 2025-04-01 Epub Date: 2024-05-17 DOI: 10.1177/02676591241256006

Syed Ameen Ahmad, Shrey Kapoor, Siam Muquit, Aaron Gusdon, Shivalika Khanduja, Wendy Ziai, Allen D Everett, Glenn Whitman, Sung-Min Cho, On Behalf Of Herald Investigators

{"title":"Brain injury plasma biomarkers in patients on veno-arterial extracorporeal membrane oxygenation: A pilot prospective observational study.","authors":"Syed Ameen Ahmad, Shrey Kapoor, Siam Muquit, Aaron Gusdon, Shivalika Khanduja, Wendy Ziai, Allen D Everett, Glenn Whitman, Sung-Min Cho, On Behalf Of Herald Investigators","doi":"10.1177/02676591241256006","DOIUrl":"10.1177/02676591241256006","url":null,"abstract":"IntroductionEarly diagnosis of acute brain injury (ABI) is critical for patients on veno-arterial extracorporeal membrane oxygenation (V-A ECMO) to guide anticoagulation strategy; however, neurological assessment in ECMO is often limited by patient sedation.MethodsIn this pilot study of adults from June 2018 to May 2019, plasma samples of glial fibrillary acidic protein (GFAP), neurofilament light chain (NFL), and tubulin associated unit (Tau) were collected daily after V-A ECMO cannulation and measured using a multiplex platform. Primary outcomes were occurrence of ABI, assessed clinically, and neurologic outcome, assessed by modified Rankin Scale (mRS).ResultsOf 20 consented patients (median age = 48.5°years; 55% female), 8 (40%) had ABI and 15 (75%) had unfavorable neurologic outcome at discharge. 10 (50%) patients were centrally cannulated. Median duration on ECMO was 4.5°days (IQR: 2.5-9.5). Peak GFAP, NFL, and Tau levels were higher in patients with ABI vs. without (AUC = 0.77; 0.85; 0.57, respectively) and in patients with unfavorable vs. favorable neurologic outcomes (AUC = 0.64; 0.59; 0.73, respectively). GFAP elevated first, NFL elevated to the highest degree, and Tau showed limited change regardless of ABI.ConclusionFurther studies are warranted to determine how plasma biomarkers may facilitate early detection of ABIs in V-A ECMO to assist timely clinical decision-making.","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"657-667"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11569265/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140960556","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}

引用次数: 0

Can a low prime volume arterial filter be used as an alternative for a venous bubble trap in minimal extracorporeal circulation? An in vitro investigation. 在最小体外循环中，低原液容量动脉过滤器能否替代静脉气泡捕捉器？一项体外研究。

IF 1.1 4区医学

Perfusion-Uk Pub Date : 2025-04-01 Epub Date: 2024-05-20 DOI: 10.1177/02676591241256532

Marco Stehouwer, Kristina Legg, Roel de Vroege

{"title":"Can a low prime volume arterial filter be used as an alternative for a venous bubble trap in minimal extracorporeal circulation? An in vitro investigation.","authors":"Marco Stehouwer, Kristina Legg, Roel de Vroege","doi":"10.1177/02676591241256532","DOIUrl":"10.1177/02676591241256532","url":null,"abstract":"BackgroundDuring cardiac surgery the use of a minimal extracorporeal circulation (MiECC) system may reduce the adverse effects for the patient. This is probably caused by reduced inflammation and hemodilution. For the use of a MiECC circuit, a venous bubble trap (VBT) is warranted for safety reasons. The aim of this study was to assess if an arterial filter with a small prime volume has the same (or better) air removal capacities as a VBT in a MiECC circuit and subsequentially may be used as an alternative.MethodsIn an in vitro study, air removal properties were compared between the arterial filter and three VBT's on the market, VBT160 (Getinge), VBT 8 (LivaNova and VARD (Medtronic). In a MiECC circuit, the filter devices were placed in a venous position and challenged with massive and micro air. Gaseous microemboli (GME) were measured with a bubble counter proximal and distal of the VBT device.ResultsMore than 99.9 % of the air was removed after a bolus air challenge by all VBT's. Both the VARD and the AF100 showed better GME removal properties (not significant for the AF100) compared to the other devices. All filters showed GME generation after a challenge with massive air. Compared to the other filters, only the VARD showed no passing of larger bubbles when a volume of 50 mL of air was present in the filter.ConclusionsThe AF100 seems to be a safe and low prime alternative for use in a MiECC system as a venous air trap. A word of caution, placement of the AF100 arterial filter in the venous line is off label use.","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"686-692"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141072093","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}

引用次数: 0

The effect of excessive gas to blood ratios in an ECMO oxygenator. ECMO 氧合器中气体与血液比例过高的影响。

IF 1.1 4区医学

Perfusion-Uk Pub Date : 2025-04-01 Epub Date: 2024-05-23 DOI: 10.1177/02676591241256089

Michael Shaw, Nigel Cross, Rebecca Richardson, Richard Crook, Timothy Thirulchelvam, Richard W Issitt

{"title":"The effect of excessive gas to blood ratios in an ECMO oxygenator.","authors":"Michael Shaw, Nigel Cross, Rebecca Richardson, Richard Crook, Timothy Thirulchelvam, Richard W Issitt","doi":"10.1177/02676591241256089","DOIUrl":"10.1177/02676591241256089","url":null,"abstract":"IntroductionOxygenators for paediatric Extracorporeal Membrane Oxygenation (ECMO) are required to operate over a wide range of flow rates, in a patient group ranging from neonates through to fully grown adolescents. ECMO oxygenators typically have a manufacturer's stated maximum gas: blood flow rate (GBFR) ratio of 2:1, however, many patients require greater ratios than this for adequate CO2 removal. Mismatches in GBFR in theory could result in high gas phase pressures. These increased pressures in theory could cause the formation of gross gaseous microemboli (GME) placing the child at higher risk of neurological injury.MethodsWe evaluated 6 paediatric and 6 adult A.L.ONE™ ECMO oxygenators and assessed their gas phase pressures and GME release, in an ex vivo setting, in GBFR ratios up to greater than 2, across a range of gas flow (1L - 10 L/min) rates with a fraction of inspired oxygen (FiO2) content of 50% and 100%.ResultsThere were no increases above 10 mmHg observed in gas phase pressures in GBFR >= 2:1 in either adult or paediatric oxygenators. Laboratory examination of GME activity demonstrated a small increase in post-membrane GME release over the study period. GME release was unaffected by FiO2 setting or gas flow rate, with a maximum volume of < 6 µL in both paediatric and adult oxygenators.ConclusionsIn an ex vivo setting, increasing GBFR above 2:1 in a paediatric oxygenator, and to a GBFR of 2:1 in an adult oxygenator did not significantly increase gas phase pressures, and no oxygenator membrane rupture was observed. There were no associations between gas flow rates and GME production.","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"678-685"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141086765","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}

引用次数: 0

Building on the past - A bridge to the future. 建立在过去的基础上-通往未来的桥梁。

IF 1.1 4区医学

Perfusion-Uk Pub Date : 2025-04-01 Epub Date: 2025-04-22 DOI: 10.1177/02676591251320847

Justyna Swol, Filip De Somer

{"title":"Building on the past - A bridge to the future.","authors":"Justyna Swol, Filip De Somer","doi":"10.1177/02676591251320847","DOIUrl":"https://doi.org/10.1177/02676591251320847","url":null,"abstract":"Extracorporeal Membrane Oxygenation (ECMO) has evolved significantly over the decades, from its early experimental stages to its current use as a standard of care in intensive care medicine. ECMO devices continue to evolve rapidly. \"Building on the past - a bridge to the future\" emphasises balance: moving forward with a vision for the future, while drawing strength and guidance from what has come before. Understanding the past in the development of the ECMO device components such as oxygenators and pumps will guide future innovations, as will the lessons learned from complications such as clotting or the advances in anticoagulation management. The future development will bring significant improvements in portability, safety, efficiency, and accessibility of ECMO. Advances in AI-driven monitoring and predictive models, biocompatible materials, and expanded clinical applications will make ECMO a more effective and widespread tool for managing critical heart and lung failure. These innovations are likely to make ECMO available earlier, in more settings, and safer for a wider range of patients, ensuring that it continues to save lives in an increasingly diverse range of medical situations.","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":"40 1_suppl","pages":"3S-5S"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143995475","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}

引用次数: 0

Extracorporeal life support after surgical repair for acute type a aortic dissection: A systematic review and meta-analysis. 急性主动脉夹层手术修复后的体外生命支持：系统回顾和荟萃分析。

IF 1.1 4区医学

Perfusion-Uk Pub Date : 2025-04-01 Epub Date: 2024-05-10 DOI: 10.1177/02676591241253464

Michel Pompeu Sá, Xander Jacquemyn, Nicholas Hess, James A Brown, Tulio Caldonazo, Hristo Kirov, Torsten Doenst, Derek Serna-Gallegos, David Kaczorowski, Ibrahim Sultan

{"title":"Extracorporeal life support after surgical repair for acute type a aortic dissection: A systematic review and meta-analysis.","authors":"Michel Pompeu Sá, Xander Jacquemyn, Nicholas Hess, James A Brown, Tulio Caldonazo, Hristo Kirov, Torsten Doenst, Derek Serna-Gallegos, David Kaczorowski, Ibrahim Sultan","doi":"10.1177/02676591241253464","DOIUrl":"10.1177/02676591241253464","url":null,"abstract":"BackgroundThe use of extracorporeal life support (ECLS) in patients after surgical repair for acute type A aortic dissection (ATAAD) has not been well documented.MethodsWe performed a systematic review and meta-analysis to assess the outcomes of ECLS after surgery for ATAAD with data published by October 2023 in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and the Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guidelines. The protocol was registered in PROSPERO (CRD42023479955).ResultsTwelve observational studies met our eligibility criteria, including 280 patients. Mean age was 55.0 years and women represented 25.3% of the overall population. Although the mean preoperative left ventricle ejection fraction was 59.8%, 60.8% of patients developed left ventricle failure and 34.0% developed biventricular failure. Coronary involvement and malperfusion were found in 37.1% and 25.6%, respectively. Concomitant coronary bypass surgery was performed in 38.5% of patients. Regarding ECLS, retrograde flow (femoral) was present in 39.9% and central cannulation was present in 35.4%. In-hospital mortality was 62.8% and pooled estimate of successful weaning was 50.8%. Neurological complications, bleeding and renal failure were found in 25.9%, 38.7%, and 65.5%, respectively.ConclusionECLS after surgical repair for ATAAD remains associated with high rates of in-hospital death and complications, but it still represents a chance of survival in critical situations. ECLS remains a salvage attempt and surgeons should not try to avoid ECLS at all costs after repairing an ATAAD case.","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"631-639"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140908733","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}

引用次数: 0

Haemodynamic monitoring in veno-venous ecmo. 静脉-静脉 ecmo 的血流动力学监测。

IF 1.1 4区医学

Perfusion-Uk Pub Date : 2025-04-01 Epub Date: 2024-05-29 DOI: 10.1177/02676591241258882

Francesco Alessandri, Giovanni Giordano

引用次数: 0

The dosage makes the poison - ECMO support considerations in poisoning. 剂量使中毒- ECMO支持中毒的考虑。

IF 1.1 4区医学

Perfusion-Uk Pub Date : 2025-04-01 Epub Date: 2025-04-22 DOI: 10.1177/02676591251329000

Stepan Maruniak, Daryna Tkachenko, Justyna Swol, Tim Sternberg, Julian Hoffmann

{"title":"The dosage makes the poison - ECMO support considerations in poisoning.","authors":"Stepan Maruniak, Daryna Tkachenko, Justyna Swol, Tim Sternberg, Julian Hoffmann","doi":"10.1177/02676591251329000","DOIUrl":"https://doi.org/10.1177/02676591251329000","url":null,"abstract":"Acute poisoning may lead to life-threatening conditions that require advanced life support, such as extracorporeal membrane oxygenation (ECMO). Data about the use of ECMO in intoxications and overdose are limited to case reports and case series. This review focuses on the classification of toxic agents, mechanisms of toxicity, treatment strategies, and predictors of mortality among ECMO-supported patients. Cardiogenic shock and arrhythmias can arise from cardiovascular toxins, including β-blockers, calcium channel blockers, and tricyclic antidepressants, while severe respiratory failure can result from respiratory toxins such as opioids and paraquat. ECMO is used as a bridge to recovery, transplantation, or adjunctive therapies, and the survival rates vary widely. Mortality predictors include severe acidosis (pH< 7.1) and the need for renal replacement therapy prior to ECMO. Despite its lifesaving potential, ECMO does not treat the underlying toxicity; it only stabilizes patients during the clearance of toxin or the administration of antidotes. Nevertheless, ECMO is a valuable but underutilized tool in managing severe poisoning that offers nonspecific organ support, particularly in refractory cardiogenic shock and respiratory failure, and it provides critical time for recovery. Future research should address data gaps, including underreporting of non-survivors, to better understand ECMO's role and outcomes in intoxication management.","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":"40 1_suppl","pages":"54S-61S"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143991930","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}

引用次数: 0