The Journal of ExtraCorporeal Technology最新文献

{"title":"Increased white blood cell count is associated with an increased demand for unfractionated heparin during veno-arterial extracorporeal oxygenation in lung transplantation","authors":"Koichi Kashiwa, Hideo Kurosawa, Kazuki Fujishiro, Hitoshi Kubo, Ryota Inokuchi, Masahiko Bougaki, Gaku Kawamura, Masaaki Sato, C. Konoeda, Jun Nakajima, Kent Doi","doi":"10.1051/ject/2024022","DOIUrl":"https://doi.org/10.1051/ject/2024022","url":null,"abstract":"This retrospective observational study aimed to examine whether clinical inflammatory parameters were associated with the requirement dosage of unfractionated heparin (UFH) to maintain the range of ACT in veno-arterial extracorporeal membrane oxygenation (V-A ECMO) during lung transplantation surgery. Among all patients who underwent lung transplantation using V-A ECMO from January 2021 to May 2022, 27 patients were included. These patients were divided into the two groups based on whether the infusion rate of UFH was increased from the initial infusion rate (7-8 units/kg/hr) (increased group, n = 10) or the infusion rate was maintained or decreased (non-increased group, n = 17). The infusion rate was adjusted with activated clotting time (ACT) target of 160 to 200 seconds. At 1-2 hours after starting ECMO, ACT was significantly lower (179.0 (166.5-188.5) versus 224.0 (193.0-242.0) sec, P=0.006) and white blood cell (WBC) counts were higher in the increased group (12.6±3.3 versus 9.5±4.0×103/μL, P=0.046). The UFH infusion rates were higher in the increased group during the surgery. The cutoff value of WBC count at 1-2 hours after starting ECMO for discriminating the need for increasing the UFH dosage was determined as 10.2 × 103/μL (sensitivity 90.0%, specificity 58.8%, area under the curve 0.712) and discrimination of this cut off value was confirmed as statistically significant (P=0.018). These data suggested that WBC count was associated with the requirement of increase in UFH infusion rate of V-A ECMO during lung transplantation surgery. Further evaluation is necessary to clarify the role of WBC count for determining the optimal UFH dosage.","PeriodicalId":506828,"journal":{"name":"The Journal of ExtraCorporeal Technology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141796400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiopulmonary Bypass in a Pediatric Patient with Factor XII Deficiency","authors":"Julie Fenske, Julie Tinius-Juliani, Cynthia Herrington","doi":"10.1051/ject/2024021","DOIUrl":"https://doi.org/10.1051/ject/2024021","url":null,"abstract":"Safe use of cardiopulmonary bypass (CPB) relies upon the ability to administer, monitor, and reverse anticoagulation. Although rare, the factor XII deficient patient creates a challenge for the perfusionist due to resultant complication in monitoring anticoagulation. There have been proposed strategies to aid in monitoring anticoagulation in the factor XII deficient patient, however documentation of successful monitoring during CPB is infrequent. With use of the Hemochron Signature Elite and ACT+ cartridges, CPB in a factor XII deficient 8-month-old was completed with predictable and reliable anticoagulation monitoring. This case report explores the current suggestions as to factor XII deficiency management with CPB.","PeriodicalId":506828,"journal":{"name":"The Journal of ExtraCorporeal Technology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141801927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A case of the effective inhalation of nitric oxide therapy for caused severe pulmonary hypertension with protamine neutralization of systemic heparinization during totally endoscopic minimally invasive cardiac surgery","authors":"Tomohisa Takeichi, Y. Morimoto, Akitoshi Yamada, Takanori Tanaka","doi":"10.1051/ject/2024018","DOIUrl":"https://doi.org/10.1051/ject/2024018","url":null,"abstract":"Severe pulmonary vasoconstriction induced by protamine is a rare complication. We report a case of a 77-year-old male patient who had a history of mitral valve plasty (MVP). He underwent redo MVP via right thoracotomy under the totally endoscopic procedure (MICS redo-MVP). Immediately after weaning cardiopulmonary bypass (CPB), protamine was administrated. 10 minutes later peak systolic pulmonary arterial pressure (sys PAP) rose to 62 mm Hg, and 30 minutes later to 80 mmHg. Due to the negative impact of protamine administration, nitric oxide inhalation (iNO) therapy was started with a concentration of 20 ppm. 10 minutes after iNO therapy started, sys PAP decreased to 63 mmHg. After entering the intensive care unit (ICU), sys PAP decreased to 35 mmHg. Here, we present an effective iNO therapy case for pulmonary hypertension due to protamine and the patient had a good postoperative recovery.This study was approved by the Institutional Review Board at Kitaharima medical center (IRB-0602) with the waiver of informed consent.","PeriodicalId":506828,"journal":{"name":"The Journal of ExtraCorporeal Technology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141799504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High Pressure Excursion in a Radial Design Oxygenator","authors":"Ashley Svec, Tyler Eadie, Brandon D'Aloiso, Peter Arlia","doi":"10.1051/ject/2024019","DOIUrl":"https://doi.org/10.1051/ject/2024019","url":null,"abstract":"Oxygenator high pressure excursion (HPE) is a phenomenon that can occur during cardiopulmonary bypass (CPB) in which the oxygenator inlet pressure increases rapidly, thereby limiting flow. Most perfusionists globally do not use inlet oxygenator pressure monitoring and therefore HPE is not often recognized. HPE may occur for various reasons, and it is not fully understood. Patient factors that put a patient at a higher risk of HPE are increased body surface area, blood type, and hematocrit count. Size, blood flow, and pressure drops of the oxygenator incorporated into the circuit can also increase the probability of an HPE occurring. This case study overviews our experience when dealing with an interesting case of HPE and the most up to date knowledge on appropriate steps to mitigate the effects on the patient.","PeriodicalId":506828,"journal":{"name":"The Journal of ExtraCorporeal Technology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141804688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes in patients who received ECMO and/or volatile anesthetics as rescue therapies for status asthmaticus","authors":"Kavipriya Komeswaran, Deanna Todd Tzanetos, Tiffany Wright, Jamie M. Furlong-Dillard","doi":"10.1051/ject/2024008","DOIUrl":"https://doi.org/10.1051/ject/2024008","url":null,"abstract":"Background:\u0000In the state of Kentucky many status asthmaticus (SA) patients require care in the Pediatric Intensive Care Unit (PICU) and a fraction of these patients may receive “rescue therapies” with inhaled volatile anesthetics (IVA) and/or Extracorporeal Membrane Oxygenation (ECMO). Our objective was to compare the clinical parameters of individual patients who received either or both therapies.\u0000 \u0000Methods:\u0000Children between 2-18 years of age admitted to our PICU from January 2014- July 2020 with SA were reviewed categorized as 1) patients who received IVA alone 2) patients who received IVA and then subsequently ECMO and 3) patients on ECMO alone.\u0000 \u0000Results:\u00001772 children with SA episodes were identified with a mortality of 13 patients.  7 children with SA were identified who received either IVA, ECMO or both. One patient received only IVA, 5 received both IVA and ECMO and one received only ECMO.  All received standard asthma therapies of steroids, albuterol, magnesium sulphate and aminophylline prior to escalation. Six out of seven refractory SA received IVA, and five (83%) of those were subsequently escalated to ECMO. pCO2 levels had no improvement after IVA administration but decreased by an average of 20 points after ECMO. Patients peak inspiratory pressures decreased within the 1 st 24 hours of ECMO cannulation from a mean of 30 to 18. There were no other complications related to ECMO placement.\u0000 \u0000Conclusion: While we cannot decisively draw any conclusions from our study due to small sample, it was noted that there was no clear advantage of using IVA prior to ECMO in our patients. Most patients who received IVA were escalated to ECMO indicating that early ECMO cannulation may be beneficial. Given the high cost and potential complications of both, there is a need for the development of well-defined guidelines for severe SA management in the PICU.","PeriodicalId":506828,"journal":{"name":"The Journal of ExtraCorporeal Technology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140702440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quantifying Potential Fluid Transfused through Pressure Monitoring and Circuit Flushes in Pediatric ECMO Patients","authors":"Steven Robertson, Katherine White","doi":"10.1051/ject/2024007","DOIUrl":"https://doi.org/10.1051/ject/2024007","url":null,"abstract":"Background: Pressure monitoring on pediatric ECMO circuits is used to aid in the evaluation of patient hemodynamics and circuit health. ELSO recommends monitoring pressures on the venous line, pre, and post oxygenator. In order to keep pressure ports patent, crystalloid can be used as a flush. The fluid transfused to the patient through these lines can be challenging to quantify accurately due to variance in clinician practice. Currently, there is no published data or practice suggestions on this topic. Methods: This study reports on experiments used to quantify passively and actively infused crystalloid using an Edwards TruWave transducer and pressurized IV bag. Frequent negative and positive pressures measured during neonatal ECMO runs were simulated in order to quantify infused volumes. Results: When the pressure transducer and associated tubing is kept patent by using a pressurized IV bag, per the instructions for use, the daily volume transfused was found to be close to a typical neonates total blood volume. Conclusions: An alternative method for pressure transducer line patency is discussed which includes the use of an automated syringe pump. This allows for more precise infusion volumes within a 24 hour period. Further study is recommended to develop and publish best practices.","PeriodicalId":506828,"journal":{"name":"The Journal of ExtraCorporeal Technology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140717587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perfusion Measures and Outcomes (PERForm) Registry: First Annual Report","authors":"David Fitzgerald, Xiaoting Wu, Timothy A Dickinson, Donald Nieter, Erin Harris, Shelby Curtis, Emily Mauntel, Amanda Crosby, Gaetano Paone, Joshua B Goldberg, Alphonse Delucia, Iii, Kaushik Mandal, Patricia F Theurer, Carol Ling, J. Chores, Donny Likosky","doi":"10.1051/ject/2024006","DOIUrl":"https://doi.org/10.1051/ject/2024006","url":null,"abstract":"Background: The Perfusion Measures and Outcomes (PERForm) registry was established in 2010 to advance cardiopulmonary bypass (CPB) practices and outcomes. The registry is maintained through the Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative and is the official registry of the American Society of Extracorporeal Technology. \u0000Methods: This first annual PERForm registry report summarizes patient characteristics as well as CPB-related practice patterns in adult (>18 years of age) patients between 2019 and 2022 from 42 participating hospitals. Data from PERForm are probabilistically matched to institutional surgical registry data. Trends in myocardial protection, glucose, anticoagulation, temperature, anemia (hematocrit), and fluid management are summarized.  Additionally, trends in equipment (hardware/disposables) utilization and employed patient safety practices are reported.  \u0000Results: A total of 40,777 adult patients undergoing CPB were matched to institutional surgical registry data from 42 centers.  Among these patients, 54.9% underwent a CABG procedure, 71.6% were male, and the median (IQR) age was 66.0 [58.0, 73.0] years.  Overall, 33.1% of the CPB procedures utilized a roller pump for the arterial pump device, and a perfusion checklist was employed 99.6% of the time.  The use of conventional ultrafiltration decreased over the study period (2019 vs 2022; 27.1% vs 24.9%) while the median (IQR) last hematocrit on CPB has remained stable [27.0 (24.0, 30.0) vs 27.0 (24.0, 30.0)]. Pump sucker termination before protamine administration increased over the study period: (54.8% vs 75.9%).\u0000Conclusion: Few robust clinical registries exist to collect data regarding the practice of CPB.  Although data submitted to the PERForm registry demonstrate overall compliance with published perfusion evidence-based guidelines, noted opportunities to advance patient safety and outcomes remain.","PeriodicalId":506828,"journal":{"name":"The Journal of ExtraCorporeal Technology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140210087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Designing an Experimental Method for Assessing Biocompatibility of Circuit Coatings Using Biomarkers for Platelet Activation During Cardiopulmonary Bypass","authors":"Meghal Sancheti, Mitchell Rentschler, Charlotte Bolch, Weidang Li, Katelyn Necco, Thomas Rath, Mitra Esfandiarei, Nathaniel Darban","doi":"10.1051/ject/2024003","DOIUrl":"https://doi.org/10.1051/ject/2024003","url":null,"abstract":"Background: Cardiopulmonary bypass is an essential component of cardiothoracic surgeries. However, significant complications such as systemic inflammatory response syndrome (SIRS) resulting from cardiopulmonary bypass (CPB) is a common occurrence due to contact between circulating blood and foreign surfaces that leads to platelet activation. It is suggested that different available CPB circuit coatings can potentially reduce platelet activation. However, there have been no published evidence-based reports confirming these claims. In addition, there is no well-established protocol for studying platelet activation biomarkers during CPB in vitro in a laboratory setting.  \u0000Methods: CPB was simulated in the laboratory using bovine blood in two different types of coated CPB circuits: Trillium® Biosurface by Medtronic, and XcoatingTM Surface by Terumo. Fresh bovine blood samples were collected and circulated through the CPB circuit following the standard protocol used in the operation rooms. Blood samples were then collected at 5, 30, and 55 minutes during the circulation. Blood plasmas were separated and subjected to enzyme-linked immunosorbent assay to measure most established platelet activation markers P-selectin, Platelet Factor 4 (PF4), Glycoprotein IIb/IIIa (GPIIb/IIIa), and β-thromboglobulin (β-TG) at different time points. \u0000Results: The biomarker values at 30 & 55 minutes were compared to the base values at 5 minutes for each type of CPB circuit. The results of the means from all measured biomarkers showed data measurements that indicated no significant variability within each coating. All collected data points fell within ± 2 SD of the means, which was considered as acceptable variations across technical replicates.  \u0000Conclusion: In this study, we were able to establish an in vitro protocol in the laboratory setting that is precise and reliable with minimum intra-variability. This established protocol will allow for future studies in which different coated CPB circuits can be compared for their effectiveness in blocking platelet activation during the CPB.","PeriodicalId":506828,"journal":{"name":"The Journal of ExtraCorporeal Technology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140443310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}