Perfusion-Uk最新文献

{"title":"Thoracoabdominal normothermic regional perfusion in donors with neurological determination of death extends organ donors pool.","authors":"S Chaikovska, B Todurov, G Kovtun, S Sudakevych, M Melnyk, I Kuzmych, J Swol, Ali S Merza, S Maruniak","doi":"10.1177/02676591251329895","DOIUrl":"https://doi.org/10.1177/02676591251329895","url":null,"abstract":"<p><p>BackgroundHeart transplantation team of the Heart Institute of the Ministry of Health of Ukraine performs thoracoabdominal normothermic regional perfusion (TA-NRP) procedure for organ preconditioning in marginal donors. Martial law in Ukraine worsens preexisting shortage of donor organs since February 2022. The use of TA-NRP has been shown to be effective in rescucitating organs in donors with circulatory determination of death (CDD), and we hypothesize that TA-NRP can be used to perform in situ organ perfusion in donors with neurological determination of death (NDD) as well, thereby improve organ quality.MethodsA single centre, retrospective analysis of outcomes after heart transplantation using organs from donors with NDD who underwent TA-NRP for preconditioning from 2022 to 2024 year at the Heart Institute Ministry of Health of Ukraine. The indications for TA-NRP were hemodynamic instability of donors with NDD, characterized by the need for norepinephrine >1.0 μg/kg/h to maintain mean blood pressure >50 mm Hg.ResultsTA-NRP for donor preconditioning was performed in 12 cases (11.3%) of 106 heart transplantations between 2019 and 2023. The average duration of TA-NRP was 124.5 ± 10.1 minutes. Prior to TA-NRP initiation, all donors exhibited metabolic acidosis, hyperkalemia, and hyperlactatemia. The implementation of TA-NRP normalized the acid-base balance, demonstrated by a significant increase in pH (<i>p</i> < .001), correction of base excess (BE) (<i>p</i> < .001), and an increase in bicarbonate levels (HCO3-) (<i>p</i> < .001). TA-NRP also significantly reduced baseline lactate levels from 10.4 ± 2.91 mmol/L to 1.57 ± 0.33 mmol/L (<i>p</i> < .001) and decreased potassium levels (<i>p</i> = .003). Additionally, it led to a significant reduction in donor heart rate (<i>p</i> = .001) and an increase in mean arterial pressure (<i>p</i> = .012), accompanied by a 6.6-fold reduction in donor norepinephrine requirements (<i>p</i> = .003).ConclusionThe use of TA-NRP in donors with NDD improved organ quality which resulted in 30 days survival rate of 83% and 1-year survival rate of 75% in organ recipients.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":"40 1_suppl","pages":"46S-53S"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144003459","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":"Sodium-glucose cotransporter-2 inhibitors in individuals with ischemia reperfusion injury: A systematic review.","authors":"Hossein Behzad, Hila Asham, Samineh Beheshtirouy, Sina Mashayekhi, Negin Jafari, Taher Entezari-Maleki","doi":"10.1177/02676591241257371","DOIUrl":"10.1177/02676591241257371","url":null,"abstract":"<p><p><i>Background:</i> The effects of sodium-glucose cotransporter-2 (SGLT-2) inhibitors on ischemia reperfusion injury (IRI) is a novel concept and only limited number of animals studies have yet been investigated. We aimed to perform a systematic review of literature to explore the clinical studies which investigated the effects of SGLT-2 inhibitors on myocardial IRI setting.<i>Methods:</i> We searched MEDLINE, Embase, and Cochrane Library from inception until December 7^th, 2023. ClinicalTrials.gov was also explored for ongoing studies. Two authors independently conducted the literature search, examined the studies, and evaluated the eligibility criteria. Any disagreements or uncertainties were resolved by the corresponding author. The search strategy followed the PICO process (Population, Intervention, Comparison, and Outcome) and Emtree was used to select relevant keywords.<i>Results:</i> Of 220 articles identified from the literature research, five articles were included in the study, of which three studies lately were retracted. The remaining studies included 1229 participants, with 209 receiving SGLT-2 inhibitors and 1090 not receiving them. All of the participants were diabetic patients admitted with acute myocardial infarction (AMI), undergoing percutaneous coronary intervention (PCI). The results demonstrated that the use of SGLT-2 inhibitors is associated with lower troponin levels, and higher rates of ST resolution. The results of the studies also showed smaller infarct sizes, lower inflammatory biomarkers and improved left ventricular function at discharge among SGLT-2 inhibitor users.<i>Conclusion:</i> In line with in vivo and ex vivo findings, the results of this systematic review supported benefits of SGLT-2 inhibitors in IRI through reducing infarct size and inflammatory biomarkers. However, further clinical trials are warranted to provide robust evidence.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"701-710"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141176783","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":"Cause-specific mortality during ECMO: A call for a standardized definition?","authors":"Mauro Panigada, Chiara Martinet, Paolo Properzi, Daniela Tubiolo, Alessio Caccioppola, Giacomo Grasselli","doi":"10.1177/02676591241249616","DOIUrl":"10.1177/02676591241249616","url":null,"abstract":"","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"787-788"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11951450/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140873900","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":"Dual oxygenator circuits in extracorporeal membrane oxygenator support.","authors":"Kanhua Yin, Jaishankar Raman, Robert March, Erica Bak, Nikola Dobrilovic","doi":"10.1177/02676591241258688","DOIUrl":"10.1177/02676591241258688","url":null,"abstract":"","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"789-790"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141162694","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":"Novel weaning assessment for veno-arteriovenous to veno-venous extracorporeal membrane oxygenation using pump-controlled retrograde trial off.","authors":"Kazuki Matsumura, Keiki Shimizu, Yuichi Horikoshi, Jun Hamaguchi, Takeo Matsuyoshi, Junichi Sasaki","doi":"10.1177/02676591241258689","DOIUrl":"10.1177/02676591241258689","url":null,"abstract":"<p><p>IntroductionPump-controlled retrograde trial off (PCRTO) is described as an effective weaning strategy for veno-arterial extracorporeal membrane oxygenation (ECMO) in the guidelines. Contrastingly, there is no established weaning strategy for veno-arteriovenous (V-AV) ECMO. We report a novel application of PCRTO in a patient undergoing V-AV ECMO.Case reportA 49-year-old man had pneumonia and a history of kidney transplantation. Two days after intubation, respiratory failure progressed and veno-venous (V-V) ECMO was introduced. On day 7 after ECMO, the configuration was changed to V-AV ECMO owing to septic cardiomyopathy due to suspected cholangitis. On day 15, with partial haemodynamic improvement and persistent respiratory failure, PCRTO was performed; the patient was safely returned to V-V ECMO.DiscussionIn patients undergoing V-AV ECMO, PCRTO could have the potential to accurately simulate decannulation of the arterial cannula.ConclusionThis novel weaning strategy could be considered in patients undergoing V-AV ECMO.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"782-786"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141162744","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":"Antithrombin restriction in extracorporeal membrane oxygenation support (ARES): A multidisciplinary approach.","authors":"Jade C Lam, Erwin H Lam, Sai Pidathala, Josna P Padiyar","doi":"10.1177/02676591241260179","DOIUrl":"10.1177/02676591241260179","url":null,"abstract":"<p><p><i>Background:</i> Antithrombin (AT) replacement is occasionally utilized in the setting of extracorporeal membrane oxygenation (ECMO)-associated heparin resistance. Although past studies emphasized the high costs and limited clinical benefit of AT supplementation,  guidance on strategies to prevent unnecessary use remain lacking.<i>Methods:</i> In this retrospective study, we evaluated the cost, efficacy, and safety outcomes three years pre- and post-implementation of an AT restriction protocol in adult ECMO patients. The primary endpoint was the cost spent on anticoagulation and AT normalized to ECMO duration. Secondary endpoints included thromboembolic and bleeding outcomes.<i>Results:</i> 175 patients were included for analysis (pre-restriction protocol n = 87; post-restriction protocol n = 88). Implementation of the restriction resulted in complete elimination of AT use and significantly reduced the primary cost endpoint from $1009.20 to $42.99 per ECMO day (<i>p</i> < .001). There was no significant change in occurrence of new Venous Thromboembolism (VTE) (<i>p</i> = .099). Those in the pre-implementation group had significantly higher rates of transfusions (<i>p</i> < .001) and ISTH major bleeding (<i>p</i> < .001). Outcomes remained significant after exclusion of patients with coronavirus infections.<i>Conclusion:</i> Results of this study exemplify how AT restriction can be successfully implemented to decrease anticoagulation-associated costs without jeopardizing the risk of bleeding and thrombosis in ECMO patients.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"742-749"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141285110","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":"Series of case report: Left - sided cannulation in paediatric patient on VV ECMO.","authors":"Stanislav Shkolnyi, Viktoriia Matviichuk, Yana Demchenko, Andrii Vysotskyi","doi":"10.1177/02676591251320840","DOIUrl":"https://doi.org/10.1177/02676591251320840","url":null,"abstract":"<p><p>IntroductionThis article presents our experience with an alternative cannulation strategy for VV ECMO, adding it to previously reported cases found on PubMed.Case reportWe report three cases: two patients aged 17 and one aged 3. Two required VV ECMO for pneumonia, and one for airway surgery. All patients had a two-site approach. In two cases, drainage was initiated from the left side of the neck at the onset of therapy, with return to the groin. One patient required a change in the drainage cannula from the right to the left side during treatment, while the return continued to the groin.DiscussionMany centres have reported positive outcomes with alternative sites for cannulation in adults, including the left side of the neck. Alternative sites for cannulation require proper visualization techniques for guidewire and cannula insertion due to possible complications. We share our positive experience with left-sided cannulation using transthoracic echocardiographic visualization and a supraclavicular approach in paediatric patients of various weights.ConclusionLeft-sided cannulation is a safe option in specific clinical cases. Further studies are needed to validate this approach, especially for paediatric patients.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":"40 1_suppl","pages":"62S-66S"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144038145","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":"Antithrombin during veno-venous extracorporeal membrane oxygenation with heparin anticoagulation: A single-center cohort study.","authors":"Bethany A Hileman, Gennaro Martucci, Nicolò Rizzitello, Giovanna Occhipinti, Matteo Rossetti, Fabio Tuzzolino, Roberto Lorusso, Mauro Panigada, Kenichi Tanaka, Antonio Arcadipane, Giovanna Panarello","doi":"10.1177/02676591241258048","DOIUrl":"10.1177/02676591241258048","url":null,"abstract":"<p><p>IntroductionAntithrombin (AT) is a natural anticoagulant essential to enhancing the unfractionated heparin (UFH) anticoagulant effect. Its supplementation in the management of UFH-based anticoagulation during veno-venous extracorporeal membrane oxygenation (VV ECMO) has a strong pathophysiological rationale.MethodsThis is a single-center, retrospective cohort study of adult VV ECMO patients with anticoagulation maintained by UFH targeting an activated partial thromboplastin time (aPTT) of 40-50 s and AT activity >80%. We compare anticoagulation management and survival outcomes between AT subpopulations, defined by a threshold AT activity ≥80%. Linear and logistic regression analyses were used to evaluate the variation in AT activity and its association with ICU survival.ResultsIn 244 patients enrolled from 2009 to 2022, anticoagulation was maintained by a median heparin dose of 11.4 IU/kg/h [IQR: 8.2-14.7] with a mean aPTT of 46.1 s (±7.3) and AT activity of 88.9% (±17.0). A lower mean aPTT, higher dose of UFH and shorter fraction of time without UFH were associated with higher AT activity (<i>p</i> < .01). Higher AT activity showed a consistent association with ICU survival (for 10% increase of AT, odds ratio for ICU mortality: 0.95; 95% CI 0.93-0.97; <i>p</i> value <.01).ConclusionsThere is a positive association between AT activity and UFH requirements but no significant difference in the rate of bleeding events. A higher mean AT during VV ECMO was associated with ICU survival. Future studies are needed to differentiate between exogenously supplemented versus endogenous AT effect.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"720-729"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11951385/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141236220","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":"Eleven years of extracorporeal membrane oxygenation support in adults in Ukrainian ECMO center - Retrospective study.","authors":"Stepan Maruniak, Oleh Loskutov, Serhii Sudakevych, Ihor Kuzmych, Justyna Swol, Borys Todurov","doi":"10.1177/02676591251329903","DOIUrl":"https://doi.org/10.1177/02676591251329903","url":null,"abstract":"<p><p><i>Introduction</i>Implementation of an ECMO program in a middle-income country is a challenge, due to high cost and the need for highly skilled staff required. This is a retrospective single center analysis of adult consecutive patients supported on ECMO in ECMO center of Heart Institute Ministry of Health of Ukraine.<i>Materials and methods</i>Primary outcomes are intensive care unit (ICU) and in-hospital survival. Collected data include age, gender, body mass index, ECMO modes, ECMO indications, location of ECMO cannulation, ECMO duration, use of renal replacement therapy (RRT) and intraaortical balloon pump (IABP), type of oxygenator; length of ICU and hospital stays.Results115 consecutive adult patients (80/70% male) were supported on ECMO between 2012 and 2023. 16 patients (14%) received veno-venous (V-V) support for respiratory failure and 99 (86%) veno-arterial (V-A) support. The median age of the patients was 59 (45; 65) years. The most frequent indication for V-V ECMO was pneumonia in 12 (87%). The indications for V-A cannulation were postcardiotomy ECMO in weaning failure from CPB in 54 (54%), cardiogenic shock in acute coronary syndrome in 19 (19%), and extracorporeal cardiopulmonary resuscitation (ECPR) in 19 (19%) of cases. ECMO was provided for primary graft dysfunction after heart transplantation (HTx) in 5 (5%) and as a bridge to HTx in 2 (2%) cases. ICU and in-hospital survival for V-V ECMO were 56% and 50%, for V-A ECMO, 46% and 44%, respectively. ECPR for in-hospital cardiac arrest survival rates were 37% and 32%.ConclusionOur limited resources ECMO center has comparable ECMO outcomes reported in the ELSO registry. Nevertheless, it is important to establish an \"ECMO rescue chain\" to improve organization of ECMO care in Ukraine.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":"40 1_suppl","pages":"39S-45S"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144028705","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":"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":"<p><p>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.</p>","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}