The journal of extra-corporeal technology最新文献

{"title":"The American Society of ExtraCorporeal Technology Standards and Guidelines for Pediatric and Congenital Perfusion Practice: 2025 Update☆.","authors":"Molly Elisabeth Oldeen, Carrie Whittaker Striker, Ronald Angona, Dafne Andrea Chianella, Chelsea Capone, Ashley B Walczak, Thomas Klein","doi":"10.1051/ject/2026012","DOIUrl":"10.1051/ject/2026012","url":null,"abstract":"<p><strong>Background: </strong>In 2019, the American Society of ExtraCorporeal Technology (AmSECT) approved the inaugural Standards and Guidelines for Pediatric and Congenital Perfusion Practice. These standards and guidelines were created with the intent of periodic revision to ensure continued alignment with evolving best practices. In 2023, an AmSECT subcommittee initiated this review in consideration of current literature and contemporary clinical practices.</p><p><strong>Methods: </strong>The subcommittee, consisting of pediatric and congenital perfusionists, conducted a systematic literature review assessing each standard and guideline to determine if current evidence supports elevation of guidelines to standards, incorporation of new guidelines or standards, or whether existing standards and guidelines should remain unchanged. AmSECT's adult Standards and Guidelines for Perfusion Practice (2023) updates were also considered. Proposed revisions were reviewed by the 2024 AmSECT International conference attendees, AmSECT Pediatric and Congenital Perfusion Committee, AmSECT Fellows of Pediatric Perfusion (FPP), and the AmSECT International Consortium for Evidence-Based Perfusion (ICEBP).</p><p><strong>Results: </strong>Regarding pediatric and congenital specific changes, five guidelines were elevated to standards and three new guidelines and one standard were introduced. Additionally, five patient safety-related standards and one additional guideline were adopted from the Standards for Perfusion Practice (2023) document.</p><p><strong>Conclusion: </strong>Over the course of two years, consisting of an extensive literature review and feedback from multiple stakeholders, the 2025 update to the Standards and Guidelines for Pediatric and Congenital Perfusion Practice were approved by AmSECT leadership, ratified by an AmSECT membership vote, and subsequently endorsed by CHSS.</p>","PeriodicalId":519952,"journal":{"name":"The journal of extra-corporeal technology","volume":"58 3","pages":"211-216"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13577638/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148979185","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":"Cardioplegia strategies in ALCAPA surgery: A narrative review on practical comparison of techniques.","authors":"Youssef El Dsouki, Gopikrishnan Thalapathy, Ignazio Condello","doi":"10.1051/ject/2026013","DOIUrl":"10.1051/ject/2026013","url":null,"abstract":"<p><p>Anomalous left coronary artery from the pulmonary artery (ALCAPA) is a rare yet life-threatening congenital cardiac anomaly in which the left coronary artery originates from the pulmonary trunk, leading to severe myocardial ischemia, infarction, and progressive heart failure if untreated. Definitive management requires surgical reimplantation of the anomalous artery into the aorta, supported by meticulously tailored cardioplegia to protect the vulnerable pediatric myocardium, whose perfusion is further complicated by right-to-left coronary collaterals. This manuscript reports the findings of a targeted narrative review of operative videos, technical tutorials, and institutional protocols, synthesising practical knowledge on myocardial protection strategies for ALCAPA repair. Three techniques emerged as the most widely adopted and technically distinct: (1) simultaneous aortic and pulmonary-root administration of cold Custodiol^®, providing prolonged single-dose crystalloid protection; (2) antegrade cold-blood cardioplegia supplemented by direct left-coronary ostial perfusion after main pulmonary artery transection, allowing staged protection during extended cross-clamp times; and (3) a classical normothermic blood protocol with repeated root doses and routine half-dose ostial delivery, offering dynamic electrolyte control and familiarity to most congenital teams. For each strategy, we summarise precise indications, operative setup, perfusion pressures, dosing schedules, and practical tips for managing collateral-driven early electrical activity. By distilling evidence and expert practice into a concise technical comparison, this narrative review provides congenital cardiac surgeons with an up-to-date, step-by-step reference for safe, effective myocardial protection in ALCAPA repair.</p>","PeriodicalId":519952,"journal":{"name":"The journal of extra-corporeal technology","volume":"58 3","pages":"295-300"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13577639/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148979227","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":"SBUF-SMUF: On the path to the optimum hemofiltration technique in pediatric cardiopulmonary bypass: A randomized clinical trial.","authors":"Mehrtash Shadmehr, Babar Ali, Rosa Abdollahzadeh, Khalil Zarrabi, Hamid Gerami, Salman Parvaiz Butt","doi":"10.1051/ject/2026020","DOIUrl":"10.1051/ject/2026020","url":null,"abstract":"<p><strong>Background: </strong>Hemofiltration during pediatric cardiopulmonary bypass (CPB) is essential to mitigate hemodilution, inflammatory responses, and postoperative complications. Conventional ultrafiltration (CUF) is widely practiced, but novel methods such as subzero balanced ultrafiltration combined with simple modified ultrafiltration (SBUF-SMUF) may offer superior outcomes.</p><p><strong>Objective: </strong>To compare the clinical efficacy and safety of CUF versus SBUF-SMUF in pediatric patients undergoing open-heart surgery.</p><p><strong>Methods: </strong>In this prospective randomized, outcome-assessor-blinded clinical trial, 80 pediatric patients with congenital heart disease were allocated to either CUF (n = 40) or SBUF-SMUF (n = 40) during CPB. Baseline demographics, intraoperative characteristics, fluid balance, blood product utilization, and postoperative outcomes were assessed. Statistical analysis was conducted using independent t-tests, Chi-square tests, and Fisher's exact tests. Statistical significance was defined as a two-tailed p-Value of less than 0.05.</p><p><strong>Results: </strong>Demographic and preoperative variables were comparable between groups. Mean fluid balance was significantly positive in the CUF group (+192.1 ± 178.8 mL) but negative in the SBUF-SMUF group (-105.0 ± 78.9 mL, p < 0.001). The SBUF-SMUF group required significantly less intraoperative PRBC (141.7 ± 70.2 vs. 261.0 ± 68.8 mL, p < 0.001) and postoperative FFP transfusion (2% vs. 10%, p = 0.020). Post-bypass hematocrit levels were higher (31.2% vs. 27.3%, p = 0.001) and extubation occurred earlier in the SBUF-SMUF group (1.05 ± 1.03 vs. 2.27 ± 2.37 days, p = 0.006). No significant differences were observed in potassium levels or incidence of acute kidney injury.</p><p><strong>Conclusion: </strong>The SBUF-SMUF technique is safe, effective, and superior to CUF in optimizing fluid balance, reducing blood product utilization, and facilitating earlier extubation in pediatric cardiac surgery. No additional risk of oliguria or electrolyte imbalance was observed compared to CUF. Its simplicity and reproducibility support its consideration as a standard approach in pediatric CPB.</p>","PeriodicalId":519952,"journal":{"name":"The journal of extra-corporeal technology","volume":"58 3","pages":"228-236"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13577640/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148979187","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":"Integrating soft skills into perfusion education: a necessity for modern clinical practice.","authors":"Salman Pervaiz Butt, Salman Abdulaziz, Umer Darr, Gopal Bhatnagar","doi":"10.1051/ject/2025047","DOIUrl":"10.1051/ject/2025047","url":null,"abstract":"<p><p>Soft, non-technical competencies are important in perfusion practice but are often inconsistently taught. Key domains include communication, teamwork, leadership, adaptability, emotional intelligence, conflict management, professionalism, and cultural awareness. Suggested methods are interprofessional simulation, structured debriefing with feedback, short courses on communication and conflict resolution, mentored rotations with behavioral checklists, and recognition of progress through competency milestones and continuing professional development. Clear learning objectives and simple, validated assessments can help programs include these elements. Embedding soft-skill expectations in perfusion curricula, appraisal, and certification supports better coordination in the operating room, more consistent crisis management, and stronger collaboration across disciplines and with patients. A steady, stepwise adoption of these methods can improve consistency and patient safety across programs.</p>","PeriodicalId":519952,"journal":{"name":"The journal of extra-corporeal technology","volume":"58 3","pages":"318-319"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13577629/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148978654","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":"Expected drainage pressures on extracorporeal membrane oxygenation based on in-vitro modeling of pressure-flow variables.","authors":"Yeu Sanz Wu, Caitlin J Cain-Trivette, Samantha Lai, Caleb Varner, Kenmond Fung, Weijia Fan, Jimmy Duong, Bin Cheng, Nicholas Schmoke, Christopher Nemeh, William Middlesworth, Vincent Duron","doi":"10.1051/ject/2026008","DOIUrl":"10.1051/ject/2026008","url":null,"abstract":"<p><strong>Background: </strong>Pressure readings used in extracorporeal membrane oxygenation (ECMO) guide a variety of clinical interventions. However, several factors affect the accuracy of these measurements. We aimed to determine a model to mathematically predict expected pressure readings for different pediatric ECMO cannulae.</p><p><strong>Methods: </strong>We assembled an in-vitro circuit simulating those used clinically. Flow (mL/min) was adjusted, and the corresponding pressure drop (mm Hg) across the cannula was documented for various Medtronic Bio-medicus^® and Life Support^® cannulae. We utilized both water and blood product mixtures of differing hematocrit (Hct) levels - analogous to differing viscosities. Experimentally derived mathematical models were then applied to clinical data.</p><p><strong>Results: </strong>The relationship between flow and pressure drops across different cannulae and at different Hct levels was graphed and analyzed. At the same flow, larger cannula size corresponded to smaller drops in pressure, and increased viscosity corresponded to larger drops in pressure. Using regression models of the experimental data, we estimated five exponential equations that include Hct and flow to predict the expected pressure drop for different pediatric ECMO cannulae. There was high variability in data among patients, with significant differences between clinically observed and expected pressures.</p><p><strong>Conclusion: </strong>Our models derived from in-vitro experimentation are the first steps towards defining the pressure-flow relationship and validating drainage pressure as a surrogate measure of intravascular volume for critically ill patients on ECMO. Further studies are still needed to refine these models and validate their clinical applicability.</p>","PeriodicalId":519952,"journal":{"name":"The journal of extra-corporeal technology","volume":"58 3","pages":"246-254"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13577618/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148979316","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":"A predictive model for prudent albumin priming in cardiopulmonary bypass circuits.","authors":"Julie Fenske, Isabel Centner","doi":"10.1051/ject/2026016","DOIUrl":"10.1051/ject/2026016","url":null,"abstract":"<p><strong>Background: </strong>Dosing albumin to normalize colloid osmotic pressure is an underutilized strategy within the application of cardiopulmonary bypass. The negative sequelae of third-spacing and edema post-bypass are well known and documented within the literature, yet it is not common practice for perfusionists to calculate albumin dilution or tailor albumin administration to each individual patient.</p><p><strong>Methods: </strong>The author explored relevant literature to justify quantifying albumin dosing and concentration within the application of cardiopulmonary bypass. Sequelae following edema in the cardiac patient were also explored and presented, justifying the investigation of this topic. Formulas to quantify albumin dilution, resultant drop in colloid osmotic pressure, and suggested albumin dosing, were presented and unified into a model.</p><p><strong>Results: </strong>A spreadsheet-based model was developed to quantify albumin dilution that may be accessed or recreated by the reader for information purposes or for clinical use. This model enables the user to solely quantify their albumin dilution during bypass, or more proactively calculate albumin concentration and dosing in an attempt to mitigate large colloid osmotic pressure changes during bypass.</p><p><strong>Conclusions: </strong>Intentional albumin management can yield more physiologically normal albumin concentrations and colloid osmotic pressures undergoing cardiopulmonary bypass, reducing the sequelae previously described. The model presented enables informed albumin dosing by the perfusionist, and use of this model may be of especially great benefit to patients who are hypovolemic, underweight, or pediatric.</p>","PeriodicalId":519952,"journal":{"name":"The journal of extra-corporeal technology","volume":"58 3","pages":"223-227"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13577643/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148979238","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":"Geometry, shunt, and recirculation in hollow-fiber oxygenators.","authors":"Ignazio Condello, Youssef El Dsouki","doi":"10.1051/ject/2025066","DOIUrl":"10.1051/ject/2025066","url":null,"abstract":"","PeriodicalId":519952,"journal":{"name":"The journal of extra-corporeal technology","volume":"58 3","pages":"209-210"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13577631/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148978736","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":"Cannula tip separation and configuration as determinants of recirculation in venovenous ECMO.","authors":"Elliott T Worku, Michael G Pittard, Richard J Totaro","doi":"10.1051/ject/2026010","DOIUrl":"10.1051/ject/2026010","url":null,"abstract":"<p><strong>Background: </strong>Recirculation during venovenous extracorporeal membrane oxygenation (VV ECMO) is an important phenomenon that limits the efficiency of support. Femoro-jugular (FJ) cannulation may be associated with lower recirculation than femoro-femoral (FF) configurations. Local practice is to routinely overlap cannula in the FJ configuration; this approach remains poorly described, and its impact on recirculation is not understood.</p><p><strong>Methods: </strong>The saturation-based formula was used to assess recirculation fraction amongst 24 patients receiving VV ECMO between July 2018 and March 2025 in this single-centre retrospective study. All received VV ECMO via a multistage drainage cannula and a single-stage return. Factors considered relevant to recirculation were also collected at the time of a recirculation assessment, and cannula separation was obtained from chest X-ray imaging. Recirculation was compared between configurations, with further analysis where an overlap of cannula was present. Univariate and multivariate regression were performed to evaluate the influence on recirculation and clinical outcomes.</p><p><strong>Results: </strong>Demography was similar between configurations, with the majority of VV ECMO indications being ARDS secondary to bacterial pneumonia. Patients in whom recirculation was assessable were similar to those excluded. Recirculation was non significantly lower amongst patients with FJ cannulation and lacked a clear relationship to extracorporeal blood flow and drainage tip position. There were no significant differences in clinical outcomes between cannula configurations, numerically higher rates of tracheostomy and awake ECMO were observed for FJ cannulations. Older age and higher vasoactive burden were associated with length of stay and survival.</p><p><strong>Conclusion: </strong>There are a dearth of studies investigating recirculation in patients with deliberate overlap of femoral and jugular cannula, particularly in the context of large calibre multistage drainage devices. A prospective study is necessary to systematically evaluate the influence of this practice on VV ECMO efficiency, ideally using advanced recirculation measurements and contemporaneous cardiac output monitoring.</p>","PeriodicalId":519952,"journal":{"name":"The journal of extra-corporeal technology","volume":"58 3","pages":"255-266"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13577619/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148979258","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":"Corrigendum to: Investing in the future: addressing the rising cost of perfusion education in 2025.","authors":"Blaine Johnson","doi":"10.1051/ject/2026024","DOIUrl":"10.1051/ject/2026024","url":null,"abstract":"","PeriodicalId":519952,"journal":{"name":"The journal of extra-corporeal technology","volume":"58 3","pages":"320-321"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13577635/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148979229","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":"Impact of adenosine in controlled aortic root reperfusion on clinical outcomes among patients undergoing valvular heart surgery.","authors":"Farshad Jalili Shahandashti, Naser Kachoueian, Mostafa Fattahi, Davoud Samaie, Maryam Ghanbari Garekani, Atefeh Taherkhani, Seyedehmasoumeh Seyedebrahimi, Saied Heydari Nia, Farhad Gorjipour, Fazel Gorjipour","doi":"10.1051/ject/2026006","DOIUrl":"10.1051/ject/2026006","url":null,"abstract":"<p><strong>Background: </strong>Adenosine is a vital medication in cardiac surgery, particularly in valvular heart procedures. While its use has been linked to improved postoperative cardiac function in some studies, there remains significant uncertainty regarding the adenosine usage in aortic reperfusion phase. This lack of consensus poses challenges for surgeons, perfusionists, and anesthesiologists alike. This study aims to explore the impact of adenosine on clinical outcomes in patients undergoing valvular heart surgery.</p><p><strong>Method: </strong>This prospective randomized controlled trial was conducted over a three-month period. Sixty patients undergoing valvular heart surgery were enrolled using a continuous sampling method and randomly allocated into two equal groups of 30 patients each. The intervention group received adenosine-enriched aortic root reperfusion immediately prior to aortic declamping, while the control group underwent standard warm blood aortic root reperfusion. Both groups were matched for demographic and clinical characteristics to ensure comparability.</p><p><strong>Results: </strong>Results indicated no significant differences in mean cardiopulmonary bypass (CPB) time, aortic cross-clamping duration, or mechanical ventilation between the intervention and control groups. However, the intervention group that received adenosine had a higher rate of antiarrhythmic agent usage in the operating room (P < 0.05). Inotropic agent usage was similar in both groups during surgery and in the ICU. Additionally, laboratory parameters on the first day of ICU admission were comparable between groups.</p><p><strong>Conclusion: </strong>Results in the control group showed more favorable outcomes in terms of anti-arrhythmic drug usage, electroshock application, and arrhythmia prevalence. This study showed advantages for the standard warm blood aortic root reperfusion technique in managing post-operative cardiac rhythm disturbances, in comparison with the trial group.</p>","PeriodicalId":519952,"journal":{"name":"The journal of extra-corporeal technology","volume":"58 3","pages":"217-222"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13577647/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148978716","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}