The journal of extra-corporeal technology最新文献

{"title":"Is hyperoxia during veno-arterial extracorporeal life support due to cardiopulmonary failure associated with mortality in pediatric patients?","authors":"Asaad G Beshish, Rebecca Shamah, Joshua Qian, Kasey Keane-Lerner, Paola Rodriguez Morales, Tawanda Zinyandu, Joel Davis, Joshua M Rosenblum, Heather K Viamonte","doi":"10.1051/ject/2025006","DOIUrl":"10.1051/ject/2025006","url":null,"abstract":"<p><strong>Background: </strong>Data is limited regarding the effects of supraphysiologic blood oxygen tension in patients requiring extracorporeal life support (ECLS). We sought to evaluate the association between hyperoxia and outcomes in pediatric patients requiring veno-arterial (VA) ECLS.</p><p><strong>Methods: </strong>Retrospective single-center study at an academic children's hospital that included all patients 0-18 years who required VA-ECLS between 01/2014 and 12/2019.</p><p><strong>Results: </strong>During the study period, 229 VA-ECLS runs occurred in 229 patients. The majority of patients were neonates (73.4%), with cardiac being the most common indication (48.9%). The median time from admission to cannulation was 78.5 h (IQR 14, 356) with a median ECLS duration of 111.5 h (IQR 65.5, 184.5). The overall mortality rate was 44.5%. Using a receiver operating curve, a mean PaO₂ of 233 mmHg in the first 48 h of ECLS was determined to have the optimal discriminatory ability for mortality (sensitivity 36% and specificity 76%). Of the VA-ECLS cohort, 68 (29.7%) had a mean PaO₂ > 233 mmHg (hyperoxia group). The hyperoxia group tended to be older (median age 4.6 vs 1.5 months, p = 0.019), had a primary cardiac indication for VA-ECLS (60% vs 44%, p = 0.0004), and had a higher mortality rate (54% vs 40%, p = 0.050). In the multivariable analysis, after adjusting for covariables, the data demonstrated increased odds of mortality (aOR 2.02, 95% CI [1.03, 3.97], p = 0.03). The odds of development of stage II or III acute kidney injury (AKI) (aOR 2.04, 95% CI [0.82, 5.50]), but that did not reach statistical significance (p = 0.120).</p><p><strong>Conclusion: </strong>There is evidence that hyperoxia during the first 48 h of VA-ECLS may be associated with mortality and development of acute kidney injury, although this did not reach statistical significance. Multicenter and prospective evaluation of this modifiable risk factor is imperative to improve the care of this high-risk cohort.</p>","PeriodicalId":519952,"journal":{"name":"The journal of extra-corporeal technology","volume":"57 3","pages":"129-136"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12435806/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Automated temperature management during cardiopulmonary bypass: a step toward safety and precision perfusion.","authors":"Youssef El Dsouki, Ignazio Condello","doi":"10.1051/ject/2025021","DOIUrl":"10.1051/ject/2025021","url":null,"abstract":"<p><p>Precise temperature management during cardiopulmonary bypass (CPB) is crucial for optimizing patient outcomes, and influencing metabolic rate, organ protection, and neurological integrity. Traditionally, temperature control during CPB has relied on manual adjustments by perfusionists, a practice fraught with potential for human error and variability in outcomes. Such variability can lead to severe complications, including cerebral hyperthermia and inflammatory responses, which significantly impact patient recovery and morbidity. This paper introduces a novel, fully automated temperature management system, which integrates with existing heater-cooler units (HCUs) and advanced perfusion systems to enhance precision and reliability. By utilizing real-time physiological monitoring and intelligent automation, the system dynamically adjusts temperature phases based on continuous patient feedback. Preliminary simulation data are presented to validate the system's feasibility and responsiveness. Ethical considerations regarding automated decision-making in surgery are also briefly discussed.</p>","PeriodicalId":519952,"journal":{"name":"The journal of extra-corporeal technology","volume":"57 3","pages":"137-146"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12435808/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using an intermittent flow (\"clamp and flash\") method to assess the readiness to wean from VA ECMO in adult and pediatric patients.","authors":"James R Neal, Pavel V Mishin, Caitlin L Blau, Devon O Aganga, Troy G Seelhammer","doi":"10.1051/ject/2025018","DOIUrl":"10.1051/ject/2025018","url":null,"abstract":"<p><strong>Background: </strong>The use of VA extracorporeal membrane oxygenation (ECMO) for cardiac recovery is widely adopted, with extensive publications on assessing readiness to wean from VA ECMO. Techniques to reduce ECMO support vary, including reducing flows to a low continuous cardiac index, adding bridges, temporary flow cessation, or decreasing ECMO RPMs.</p><p><strong>Method: </strong>We propose an alternative method involving repeated cycles of 3-4 min of ECMO flow cessation (\"clamp\") followed by a 30-second return (\"flash\") of flow. This method requires additional anticoagulation to achieve an elevated ACT, targeting 220 s for adults and 210 s for pediatrics with heparin drip and bolus, or 240 s for adults and 225 s for pediatrics with bivalirudin drip and heparin bolus. During the clamp period, flow is stopped in adult ECMO circuits with a single venous line clamp, while in pediatric circuits, flow continues via the manifold shunt but is stopped in the arterial and venous lines with a single venous line clamp. Flashing the circuit resumes patient flow for 30 s to circulate stagnant blood.</p><p><strong>Results: </strong>This method significantly reduces support during the trial, which lasts one hour for adults and up to two hours for pediatric patients. The heart is unsupported 85-90% of the time, with an 85% decrease in cardiac support compared to low-flow trials.</p><p><strong>Conclusion: </strong>Since 2011, our center has used this technique without thrombotic complications when the protocol is followed. Most patients removed from ECMO did not require reinstitution, with rare cases needing VV support or VA support due to sepsis onset.</p>","PeriodicalId":519952,"journal":{"name":"The journal of extra-corporeal technology","volume":"57 3","pages":"147-152"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12435822/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pulmonary thrombectomy and extracorporeal membrane oxygenation: a case study.","authors":"Mariah DeRenzo","doi":"10.1051/ject/2025024","DOIUrl":"10.1051/ject/2025024","url":null,"abstract":"<p><p>A 71-year-old male with a history of chronic thromboembolic pulmonary hypertension scheduled for an elective pulmonary thrombectomy was removed from the surgical list in 2019 for unknown reasons. Four years later, a different surgeon elected to perform the surgery with cardiopulmonary bypass support. Following surgery, the patient was placed on extracorporeal membrane oxygenation and ultimately died. This case report highlights the surgical and perfusion techniques, as well as the rare events that occurred during his care.</p>","PeriodicalId":519952,"journal":{"name":"The journal of extra-corporeal technology","volume":"57 3","pages":"171-173"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12435813/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Building better ECMO rooms: a roadmap to standardization and innovation.","authors":"Nada A Aljassim, Salman Abdulaziz, John F Fraser","doi":"10.1051/ject/2025032","DOIUrl":"10.1051/ject/2025032","url":null,"abstract":"","PeriodicalId":519952,"journal":{"name":"The journal of extra-corporeal technology","volume":"57 3","pages":"181-183"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12435817/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An effective case of pulsatile flow for cerebral malperfusion of stanford type A aortic dissection.","authors":"Tomohisa Takeichi, Yoshihisa Morimoto, Akitoshi Yamada, Takanori Tanaka, Kunihiro Fujiwara, Masanobu Sato, Ryo Toma, Kiyoto Mitsui, Takumi Sugita, Kunio Gan","doi":"10.1051/ject/2025011","DOIUrl":"10.1051/ject/2025011","url":null,"abstract":"<p><p>The surgical management of preoperative malperfusion poses considerable challenges, particularly in cases of acute type A aortic dissection (TAAD). Herein, we describe the case of a 78-year-old female patient presenting with TAAD complicated by malperfusion of the left lower extremity and an entry tear localized to the ascending aorta. During the initiation of cardiopulmonary bypass (CPB), a pronounced bilateral discrepancy in radial mean arterial blood pressure (mABP) was identified, alongside a significant reduction in cerebral tissue oxygenation index (TOI) and the oxyhemoglobin change rate (ΔHbO₂). To mitigate the malperfusion, pulsatile flow (PF) was utilized during CPB. This report elucidates the meticulous application of PF during CPB in the management of this complex malperfusion scenario, culminating in a favorable postoperative outcome.</p>","PeriodicalId":519952,"journal":{"name":"The journal of extra-corporeal technology","volume":"57 3","pages":"153-159"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12435821/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Peripheral veno-arterial extracorporeal membrane oxygenation as a bridge to surgery in type A aortic dissection: a review on strategic approach to managing malperfusion syndrome.","authors":"Ignazio Condello","doi":"10.1051/ject/2025015","DOIUrl":"10.1051/ject/2025015","url":null,"abstract":"<p><strong>Background: </strong>Acute Type A aortic dissection (ATAAD) is a critical cardiovascular emergency characterized by high mortality rates and complex management challenges. The presence of a tear in the ascending aorta often extends into the aortic arch and descending thoracic aorta, leading to malperfusion syndrome, a severe condition resulting from obstructed blood flow to vital organs. Despite the high risks associated with ATAAD, the use of Peripheral Veno-Arterial (VA), Extracorporeal Membrane Oxygenation (ECMO) remains controversial. This intervention aims to maintain systemic circulation and organ perfusion, potentially stabilizing patients prior to surgical repair.</p><p><strong>Materials and methods: </strong>A narrative review of the literature was conducted through a comprehensive search of PubMed and Embase databases, covering the period from January 2000 to March 2025. Keywords included \"ECMO\", \"Type A Aortic Dissection\", \"malperfusion\", and \"bridge to surgery\", among others. Although this is a narrative review, the methodology was guided by the PRISMA guidelines to ensure transparency and reproducibility in the selection and reporting of the included studies.</p><p><strong>Results: </strong>Ten relevant articles were identified, including observational studies, case series, and reviews. This narrative review presents the role of peripheral VA ECMO in managing ATAAD, focusing on the timing of ECMO initiation and its implications for patient outcomes. The approach emphasizes rapid deployment following confirmation that the iliac and femoral arteries are free from dissection involvement, ensuring safe cannulation and effective circulatory support. The discussion also explores ECMO's role as a bridge to surgery, detailing its impact on preventing malperfusion to critical organs such as the brain, kidneys, and splanchnic organs.</p><p><strong>Conclusion: </strong>While VA ECMO offers a potential lifeline for patients with severe ATAAD, its application must be carefully considered within an integrated treatment strategy. The ongoing debate and emerging research underscore the need for further studies to define clear guidelines and optimize ECMO's use in this high-risk patient population. The balance between preventing malperfusion and managing increased myocardial workload presents a complex clinical challenge, necessitating continued investigation and dialogue within the medical community.</p>","PeriodicalId":519952,"journal":{"name":"The journal of extra-corporeal technology","volume":"57 3","pages":"119-122"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12435823/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Investing in the future: addressing the rising cost of perfusion education in 2025.","authors":"Blaine Johnson","doi":"10.1051/ject/2025029","DOIUrl":"10.1051/ject/2025029","url":null,"abstract":"<p><p>The demand for allied healthcare professionals has surged, raising concerns about the rising costs of education. Tuition for post-baccalaureate and master's programs in perfusion technology ranges from $18,000 to $106,500 annually, often surpassing $100,000 in total expenses. This financial burden presents significant challenges for prospective students, restricting their entry into the field. High costs could lead to a reduction in the number of qualified perfusionists, negatively impacting patient care. To address these challenges, partnerships between academic institutions and healthcare organizations could facilitate the development of scholarships or sponsored work studies. Additionally, policymakers should advocate for increased funding and other initiatives to help alleviate the financial strain allied health professionals face. Creating innovative solutions to these financial challenges may lead to a more diverse group of professionals in the field, enriching perspectives and approaches to patient care. Investing in accessible education will strengthen the healthcare system, benefiting providers and patients.</p>","PeriodicalId":519952,"journal":{"name":"The journal of extra-corporeal technology","volume":"57 3","pages":"178-180"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12435809/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Finding \"Time\" for recertification.","authors":"Anthony G Shackelford","doi":"10.1051/ject/2025036","DOIUrl":"10.1051/ject/2025036","url":null,"abstract":"","PeriodicalId":519952,"journal":{"name":"The journal of extra-corporeal technology","volume":"57 3","pages":"117-118"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12435814/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acid-base status of the blood contained in the cardiotomy reservoir during deep hypothermic circulatory arrest at 18 °C.","authors":"Sylvain Diop, Marwan Nader, Elie Fadel, Maria Cristina Kassab, Hamdi Ghadbane, Iolanda Ion, Jacques Thes","doi":"10.1051/ject/2025014","DOIUrl":"10.1051/ject/2025014","url":null,"abstract":"<p><strong>Background: </strong>During deep hypothermic circulatory arrest (DHCA) for pulmonary artery endarterectomy (PAE), the blood volume stored in the cardiotomy reservoir circulates through the oxygenator via the arterial shunt line, where it remains oxygenated and decarboxylated. The aim of the study was to investigate the change in the acid-base balance of the blood contained in the cardiotomy reservoir during DHCA.</p><p><strong>Methods: </strong>A four-month retrospective analysis was conducted on patients undergoing PAE. The sweep gas inflow and the inspired fraction of O₂ were kept constant throughout the duration of DHCA. Arterial blood gases were sampled at the beginning and at the end of the DHCA and were analyzed according to the alpha-stat and pH-stat strategies.</p><p><strong>Results: </strong>Twenty-four patients were included with a mean age of 59.2 (±15.7) years. The mean duration of DHCA was 15.2 (±4.1) min and the mean sweep gas inflow was 1.4 (±0.8) L/min. Initial pH and PaCO₂ were 7.31 (±0.09) and 43.2 (±9.9) mmHg, respectively, and final pH and PaCO₂ were 7.51 (± 0.14), p < 0.001 and 23.4 (±11.9) mmHg, p < 0.001. There was a significant correlation between the sweep gas inflow and the post-DHCA pH (r = 0.797).</p><p><strong>Conclusion: </strong>The pH increases significantly during the DHCA according to the sweep gas inflow. Decreasing the sweep gas inflow between 0.5 and 1.0 L/min allows for limiting the pH variation during the DHCA period.</p>","PeriodicalId":519952,"journal":{"name":"The journal of extra-corporeal technology","volume":"57 3","pages":"123-128"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12435818/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}