The journal of extra-corporeal technology最新文献

{"title":"The potential benefits of monitoring oxygen delivery in relation to O₂ERi and VCO₂ during normothermic regional perfusion in DCD donors.","authors":"Ignazio Condello","doi":"10.1051/ject/2024028","DOIUrl":"10.1051/ject/2024028","url":null,"abstract":"","PeriodicalId":519952,"journal":{"name":"The journal of extra-corporeal technology","volume":"56 4","pages":"147-148"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11661785/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142869680","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 technique avoiding cardioplegia delivery complications: a case using systemic hyperkalemia cardiopulmonary bypass combined with circulatory arrest.","authors":"Tomohisa Takeichi, Yoshihisa Morimoto, Akitoshi Yamada, Takanori Tanaka","doi":"10.1051/ject/2024027","DOIUrl":"10.1051/ject/2024027","url":null,"abstract":"<p><p>We conducted a high-risk redo mitral valve replacement through a right mini-thoracotomy without rib spreading (redo-MICS MVR) under systemic hyperkalemia combined with circulatory arrest to circumvent complications associated with cardioplegia delivery. The patient, a 75-year-old man, had a predicted mortality rate of 20%. Initial antegrade cardioplegia successfully induced cardiac arrest, which was administered every 30 min. However, upon infusion of the second dose of cardioplegia, the aortic root pressure was approximately 20 mmHg. Despite multiple attempts to re-cross the clamp, the aortic root pressure did not improve. Consequently, retrograde cardioplegia was considered, but due to significant adhesion of the inferior vena cava, this approach was abandoned. Thus, the procedure was altered to utilize systemic hyperkalemia without aortic cross-clamping (ACC). Given the preoperative transesophageal echocardiography (TEE) diagnosis of mild aortic regurgitation, maintaining a clear surgical field was challenging, necessitating the combination of redo-MVR with circulatory arrest. This case exemplifies the successful management of cardioplegia delivery complications using systemic hyperkalemia and circulatory arrest, resulting in a favorable postoperative recovery for the patient.</p>","PeriodicalId":519952,"journal":{"name":"The journal of extra-corporeal technology","volume":"56 4","pages":"207-210"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11661784/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142869837","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":"Failure to oxygenate during cardiopulmonary bypass; treatment options and intervention algorithm.","authors":"Gregory S Matte, William L Regan, Sarah I Gadille, Kevin R Connor, Sharon L Boyle, Francis E Fynn-Thompson","doi":"10.1051/ject/2024026","DOIUrl":"10.1051/ject/2024026","url":null,"abstract":"<p><p>Membrane oxygenator failure remains a concern for perfusion teams. Successful outcomes for this low-frequency, high-risk intervention are predicated on having written institutional protocols for both the oxygenator change-out procedure as well as how often the procedure is practiced by staff perfusionists. A recent review of peer-reviewed journal articles, textbooks and online resources revealed a lack of a unified intervention algorithm for failure to oxygenate during cardiopulmonary bypass (CPB). While an oxygenator change-out procedure may still be considered the gold standard for a confirmed device failure, temporizing measures exist that, in select cases, can afford time to the clinical team and even obviate the need for an oxygenator change-out procedure. We now consider the venous piggyback technique sourcing blood from the venous limb of the circuit a first-line intervention to afford enhanced patient safety while the clinical team decides on required interventions when oxygenator failure presents during CPB.</p>","PeriodicalId":519952,"journal":{"name":"The journal of extra-corporeal technology","volume":"56 4","pages":"216-224"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11661781/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142869574","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":"Plasmapheresis for extracorporeal membrane oxygenation (ECMO)-induced hemolysis in infants.","authors":"Gail Budhu, Kaydeen Morris-Whyte, Alexandru R Constantinescu","doi":"10.1051/ject/2024032","DOIUrl":"10.1051/ject/2024032","url":null,"abstract":"<p><strong>Background: </strong>Intravascular hemolysis is a known complication of extracorporeal membrane oxygenation (ECMO). Characterized by elevated plasma-free hemoglobin (PFH), intravascular hemolysis is associated with cytotoxic effects leading to renal replacement therapy (RRT), longer ECMO runs, and mortality. Therapeutic plasma exchange (TPE) in tandem with ECMO was described as a therapy for various pathologic conditions, but there are no Extracorporeal Life Support Organization (ELSO) guidelines for the treatment of ECMO-induced hemolysis. We describe the use of TPE in the management of severe ECMO-induced hemolysis.</p><p><strong>Methods: </strong>Two-term neonates receiving veno-arterial (VA) ECMO developed severe PFH, with peak values over 500 mg/dL. TPE was performed in tandem with the ECMO circuit. Packed red cells were used to prime the TPE circuit, and citrate anticoagulation was added to establish the interface, which could not be achieved with existing heparin in the ECMO circuit. Therapy was completed with saline solution as a decoy for citrate, to avoid hypocalcemia and intracranial bleeding. Plasma volume was replaced by fresh frozen plasma (FFP).</p><p><strong>Results: </strong>In one patient PFH fell to 120 mg/dL, but rebounded to close to 500 mg/dL, only to stabilize between 210 and 300 mg/dL after the second TPE. He was liberated from ECMO, but could not survive a respiratory decompensation. The other patient's PFH improved to 360 mg/dL after one TPE and continued to decline to 120 mg/dL over the ensuing days. Despite that improvement, care was withdrawn.</p><p><strong>Conclusion: </strong>TPE is effective in decreasing the burden of PFH and is well tolerated in tandem with ECMO, and a database of infants with ECMO-induced hemolysis needs to be created to assess the current practice and establish clinical guidelines for its most appropriate therapy.</p>","PeriodicalId":519952,"journal":{"name":"The journal of extra-corporeal technology","volume":"56 4","pages":"211-215"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11661778/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142869630","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":"Determining the association of hyperoxia while on extracorporeal life support with mortality in neonates following Norwood operation.","authors":"Asaad G Beshish, Alaa Aljiffry, Yijin Xiang, Sean Evans, Amy Scheel, Ashley Harriott, Shayli Patel, Alan Amedi, Amanda Harding, Joel Davis, Subhadra Shashidharan, David M Kwiatkowski","doi":"10.1051/ject/2024020","DOIUrl":"10.1051/ject/2024020","url":null,"abstract":"<p><strong>Background: </strong>Patients requiring extracorporeal life support (ECLS) support post-Norwood operation constitute an extremely high-risk group.</p><p><strong>Materials and methods: </strong>We retrospectively aimed to evaluate the relationship of hyperoxia with mortality and other clinical outcomes in patients who required ECLS following Norwood operation between January/2010 and December/2020 in a large volume center.</p><p><strong>Results: </strong>During the study period 65 patients required ECLS post-Norwood. Using receiver operating characteristic (ROC) curve analysis, mean PaO₂ of 182 mmHg in the first 48-hour on ECLS was determined to have the optimal discriminatory ability for mortality (sensitivity 68%, specificity 70%). Of the 65 patients, 52% had PaO₂ > 182 mmHg and were designated as hyperoxia group. Patients in the hyperoxia-group had longer cardiopulmonary bypass time (187 vs. 165 min, p = 0.023), shorter duration from CICU arrival to ECLS-cannulation (13.28 vs. 132.58 h, p = 0.003), higher serum lactate within 2-hours from ECLS-canulation (14.55 vs. 5.80, p = 0.01), higher ECLS flows in the first 4-hours (152.68 vs. 124.14, p = 0.006), and higher mortality (77% vs. 39%, p = 0.005). In the unadjusted-analysis, using a derived cut-point, patients in the hyperoxia-group had 5.15 higher odds of mortality (p = 0.003). However, this association was insignificant when adjusting for confounding variables (p = 0.104). Using a functional status scale, new morbidity (38% vs. 21%), and unfavorable outcomes (13% vs. 5%) were higher in the hyperoxia group. Despite being higher in the hyperoxia group, this did not reach statistical significance.</p><p><strong>Conclusion: </strong>Neonates with hyperoxia (PaO₂ > 182 Torr) during the first 48-hour of ECLS post-Norwood operation had 5 times higher odds of mortality in the unadjusted analysis, however, this was insignificant when adjusting for confounding variables. Patients in the hyperoxia group had shorter duration from CICU arrival to ECLS-cannulation, higher serum lactate prior to ECLS-canulation, and higher ECLS flows in the first 4-hours, (p < 0.05). Multicenter 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":"56 4","pages":"174-184"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11661777/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142869838","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":"List of JECT reviewers 2024.","authors":"","doi":"10.1051/ject/2024035","DOIUrl":"https://doi.org/10.1051/ject/2024035","url":null,"abstract":"","PeriodicalId":519952,"journal":{"name":"The journal of extra-corporeal technology","volume":"56 4","pages":"145-146"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142869663","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":"Enhancing lung transplantation with ECMO: a comprehensive review of mechanisms, outcomes, and future considerations.","authors":"Salman Pervaiz Butt, Vivek Kakar, Salman Abdulaziz, Nabeel Razzaq, Yasir Saleem, Arun Kumar, Fazil Ashiq, Praveen Ghisulal, Aaron Thrush, Sadaf Malik, Mairead Griffin, Mahanoor Amir, Umar Khan, Ashal Salim, Zaid Zoumot, Izanee Mydin, Yazan Aljabery, Gopal Bhatnagar, Yusuf Bayrak, Andres Obeso, Usman Ahmed","doi":"10.1051/ject/2024023","DOIUrl":"10.1051/ject/2024023","url":null,"abstract":"<p><strong>Background: </strong>Lung transplantation (LTx) is a critical intervention for patients with end-stage lung disease. However, challenges such as donor organ scarcity and post-transplant complications significantly affect its success. Recent advancements in Extracorporeal Membrane Oxygenation (ECMO) have shown promise in improving the outcomes and expanding eligibility for LTx.</p><p><strong>Methods: </strong>A comprehensive literature review was conducted, focusing on studies that explore the use of ECMO in lung transplantation. A thorough search of relevant studies on ECMO and LTx was conducted using multiple scholarly databases and relevant keywords, resulting in 73 studies that met the inclusion criteria. Sources included peer-reviewed journals and clinical trial results, with emphasis on articles captured recent advancements in ECMO technology and techniques.</p><p><strong>Results: </strong>ECMO has been crucial in supporting patients before, during, and after LTx. It serves as a bridge to transplantation by maintaining pulmonary and circulatory stability in critically ill patients awaiting donor organs. ECMO also aids in the evaluation of marginal donor lungs and supports patients through acute post-transplant complications. Recent technological advancements have improved the safety and efficacy of ECMO, further solidifying its role in LTx.</p><p><strong>Conclusion: </strong>In conclusion, this review underscores ECMO's critical role in enhancing outcomes across all stages of lung transplantation. Its various configurations and strategies have shown promise in stabilizing critically ill patients and improving transplant success rates. Looking ahead, it's important to gather more information about the long-term outcomes and potential complications associated with ECMO use. More research and data collection will help us understand the benefits and risks better, leading to improved decision-making and patient care in this field.</p>","PeriodicalId":519952,"journal":{"name":"The journal of extra-corporeal technology","volume":"56 4","pages":"191-202"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11661783/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142869431","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":"Development of a professional advancement model for perfusionists.","authors":"Adam K Blakey","doi":"10.1051/ject/2024025","DOIUrl":"10.1051/ject/2024025","url":null,"abstract":"<p><strong>Background: </strong>Improvement in professional advancement opportunities may reduce turnover and improve retention for perfusionists. However, the current literature lacks examples of professional advancement models (PAMs) for perfusionists.</p><p><strong>Methods: </strong>This review looks at examples from other healthcare fields to provide the rationale and develop a framework for such a model.</p><p><strong>Results: </strong>The review results led to the development of a point-based PAM that included four levels: perfusionist I, II, III, and IV. Each level is associated with its own point requirement, experience level, and salary increase. Points can be acquired through four defined categories.</p><p><strong>Conclusion: </strong>Perfusion programs needing professional advancement can use these results as a foundation for implementing a PAM for perfusionists.</p>","PeriodicalId":519952,"journal":{"name":"The journal of extra-corporeal technology","volume":"56 4","pages":"185-190"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11661775/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142869839","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":"Interaction of milrinone with extracorporeal life support.","authors":"Aviva J Whelan, Sabiha Mim, J Porter Hunt, Autumn M McKnite, Danielle J Green, Carina E Imburgia, Jeremiah D Momper, Gideon Stitt, Kevin M Watt","doi":"10.1051/ject/2024014","DOIUrl":"10.1051/ject/2024014","url":null,"abstract":"<p><strong>Background: </strong>Milrinone is commonly prescribed to critically ill patients who need extracorporeal life support such as extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT). Currently, the effect of ECMO and CRRT on the disposition of milrinone is unknown.</p><p><strong>Methods: </strong>Ex vivo ECMO and CRRT circuits were primed with human blood and then dosed with milrinone to study drug extraction by the circuits. Milrinone percent recovery over time was calculated to determine circuit component interaction with milrinone.</p><p><strong>Results: </strong>Milrinone did not exhibit measurable interactions with the ECMO circuit, however, CRRT cleared 99% of milrinone from the experimental circuit within the first 2 hours.</p><p><strong>Conclusion: </strong>Milrinone dosing adjustments are likely required in patients who are supported with CRRT while dosing adjustments for ECMO based on these ex-vivo results are likely unnecessary. These results will help improve the safety and efficacy of milrinone in patients requiring ECMO and CRRT. Due to the limitations of ex-vivo experiments, future studies of milrinone exposure with ECLS should include patient circuit interactions as well as the physiology of critical illness.</p>","PeriodicalId":519952,"journal":{"name":"The journal of extra-corporeal technology","volume":"56 4","pages":"167-173"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11661780/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142869578","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":"Outcomes of Del Nido and hyperkalemic blood cardioplegia in adult cardiac surgery with prolonged aortic cross-clamp times★.","authors":"Malgorzata Szpytma, Damian Gimpel, Jordan Ross, Richard F Newland, Gareth Crouch, Gregory D Rice, Jayme S Bennetts, Robert A Baker","doi":"10.1051/ject/2024029","DOIUrl":"10.1051/ject/2024029","url":null,"abstract":"<p><strong>Background: </strong>The utility and uptake of Del Nido cardioplegia in adult cardiac surgery is rapidly increasing. Cases with prolonged aortic cross-clamp times necessitate multi-dosing however an understanding of safe ischaemic times and definitive guidelines in this domain are lacking. Therefore, this study aimed to assess the safety and efficacy of our DNC strategy by comparing post-operative troponin profiles and clinical outcomes between Del Nido and hyperkalaemic cardioplegia for cases with aortic cross-clamp times of greater than 90 min.</p><p><strong>Methods: </strong>A single-centre, retrospective cohort study at Flinders Medical Centre and Flinders Private Hospital of patients undergoing composite cardiac surgery with a cross-clamp time longer than 90 min. Data was prospectively collected from the Flinders Cardiac Surgery Registry from June 2014 to December 2022. A propensity-matched (1:1) analysis was performed comparing patients receiving Del Nido cardioplegia (n = 194) to those receiving hyperkalemic blood cardioplegia (n = 194). The primary outcome was the postoperative troponin release profile with clinical events reported as secondary outcomes.</p><p><strong>Results: </strong>There was no difference in the peak or median troponin at 6, 12 and 72 h nor the number of patients with positive troponin profiles postoperatively between cohorts. There was no difference in clinical outcomes between groups with aortic cross-clamp times of 90 min which remained true in sensitivity analysis extending out to 120 min. The Del Nido cohort received less cardioplegia volume (p < 0.001) and were more likely to return to spontaneous rhythm (p < 0.002).</p><p><strong>Conclusion: </strong>Del Nido cardioplegia for anticipated aortic cross-clamp times of greater than 90 min provided equivocal post-operative troponin profiles and clinical outcomes compared to multidose hyperkalemic blood cardioplegia.</p>","PeriodicalId":519952,"journal":{"name":"The journal of extra-corporeal technology","volume":"56 4","pages":"149-158"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11661786/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142869675","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}