The journal of extra-corporeal technology最新文献

{"title":"Perfusion practices and safety standards in Pakistan: Insights from a preliminary nationwide survey.","authors":"Salman Pervaiz Butt, Nabeel Razzaq, Bill Cook, Babar Ali, Hashim Saqib, Aerfa Amir, Yazan Aljabery, Salman Abdulaziz, Arshad Ghori","doi":"10.1051/ject/2025007","DOIUrl":"10.1051/ject/2025007","url":null,"abstract":"<p><strong>Introduction: </strong>Perfusion safety in cardiothoracic surgery is critical, particularly in Pakistan where variability in practice standards exists. This survey investigates the current perfusion practices among Pakistani perfusionists, focusing on the adherence to safety standards during cardiopulmonary bypass (CPB) procedures.</p><p><strong>Methods: </strong>The survey was conducted over two weeks to explore key areas of perfusion practice, including the use of bubble detectors, level detectors, arterial filters, and saturation monitoring during CPB procedures. Out of approximately 350 practicing perfusionists in Pakistan, 66 responded, resulting in a response rate of 18.9%. The data was collected through an online platform, ensuring anonymity and voluntary participation. The survey included mainly Yes/No questions. To ensure reliability and validity, the questionnaire was reviewed by experts, pilot tested, and refined based on feedback, ensuring it was effective in gathering meaningful insights.</p><p><strong>Results: </strong>The survey results indicate a variable use of essential safety devices such as bubble and level detectors, arterial filters, and continuous venous saturation and cerebral saturation monitoring. While some perfusionists adhere to recommended safety protocols, gaps in the use of critical monitoring equipment were evident.</p><p><strong>Conclusion: </strong>The findings highlight the need for standardized perfusion practices in Pakistan to ensure safety and efficacy during CPB. Addressing the gaps in the use of safety and monitoring equipment could lead to improved patient outcomes. Further research is needed to explore the barriers to uniform safety standards and to develop strategies for enhancing perfusion safety across the country.</p>","PeriodicalId":519952,"journal":{"name":"The journal of extra-corporeal technology","volume":"57 2","pages":"82-88"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12169702/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144311162","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":"Clinical evaluation of SafeCEC^® one-way valve in hemolysis during CPB: Pilot study.","authors":"Henrique Madureira da Rocha Coutinho, Joaquim Henrique de Souza Aguiar Coutinho, José Hamilton Torres, Rafaela Mourão Casanova, Gustavo Kikuta, Edison Emídio Reis","doi":"10.1051/ject/2025010","DOIUrl":"10.1051/ject/2025010","url":null,"abstract":"<p><strong>Introduction: </strong>In cardiopulmonary bypass (CPB), blood circulation is temporarily maintained by an artificial blood-pumping device during cardiac surgery. Worldwide, approximately half of the CPB procedures utilize either centrifugal or roller pumps (Wu P et al. Front Physiol 12, 699891). Centrifugal pumps, while non-occlusive, pose a risk of blood reflux if there is a system failure, which endangers patient safety (Souza MHL, Elias DO. Fundamentos da Circulação Extracorpórea 2006; 186-192). SafeCEC^®, a one-way valve, offers a potential solution to this risk by preventing arterial line reflux. This pilot study aims to evaluate patient safety by analyzing hemolysis as an evaluation parameter. Plasma free hemoglobin is chosen to measure patient safety with the use of the product, ensuring it does not cause additional hemolysis during extracorporeal circulation.</p><p><strong>Materials and methods: </strong>After approval by the Ethics Committee, 31 patients undergoing CPB with a centrifugal pump were included in the study. The patients were randomly divided into two groups: group A, where SafeCEC^® was incorporated into the arterial line, and group B, which used the conventional circuit. Hemolysis was assessed by analyzing plasma free hemoglobin in blood samples collected before CPB, after CPB, and 24 h after weaning from CPB.</p><p><strong>Results: </strong>This device has been shown to be effective in controlling blood reflux, eliminating the need for arterial line clamps. Analysis of plasma free hemoglobin levels revealed no significant differences between the groups with or without SafeCEC^®.</p><p><strong>Conclusion: </strong>The SafeCEC^® one-way valve effectively prevents reflux without contributing to blood damage, as indicated by the absence of significant hemolysis. This pilot study demonstrates that the SafeCEC^® is both safe and effective for its intended use.</p>","PeriodicalId":519952,"journal":{"name":"The journal of extra-corporeal technology","volume":"57 2","pages":"105-112"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12169719/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144311158","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":"Is hyperoxia in early pediatric veno-veno extracorporeal life support associated with mortality?","authors":"Asaad G Beshish, Paola Rodriguez-Morales, Rebecca Shamah, Joshua Qian, Kasey Keane-Lerner, Tawanda Zinyandu, Joel Davis, Joshua M Rosenblum, Heather K Viamonte","doi":"10.1051/ject/2024013","DOIUrl":"10.1051/ject/2024013","url":null,"abstract":"<p><strong>Background: </strong>Data is limited regarding the effects of supraphysiologic blood oxygen tension (hyperoxia) in patients requiring extracorporeal life support (ECLS). We sought to evaluate the association between hyperoxia and outcomes in pediatric patients requiring veno-venous (VV) ECLS.</p><p><strong>Methods: </strong>Retrospective single-center study at an academic children's hospital, Children's Healthcare of Atlanta, Emory University School of Medicine that included all patients 0-18 years who required VV-ECLS between 01/2014 and 12/2019.</p><p><strong>Results: </strong>During the study period 110 VV-ECLS runs occurred in 110 patients. Using a receiver operating characteristic curve, a mean partial pressures of oxygen (PaO₂) of 122 mmHg in the first 48 hours of ECLS was determined to have the optimal discriminatory ability with regard to mortality (sensitivity 41% and specificity 86%). Of the VV-ECLS runs, 68 (61.8%) had PaO₂ > 122 mmHg (hyperoxia group). The hyperoxia group tended to be older (105.4 vs. 1.6 months, p = 0.001), had higher rates of hemorrhagic complications (69.6% vs. 25.3%, p = 0.0001), and higher mortality rate (57.9% vs. 19.5%, p = 0.002). Adjusting for confounders, the hyperoxia group had higher odds of mortality (OR: 7.97, 95% CI: 1.72-36.86, p = 0.0079).</p><p><strong>Conclusion: </strong>Children exposed to hyperoxia during the first 48 h of VV-ECLS were 8 times more likely to die than those who were not after adjusting for confounders (age group, body surface area, and indication for ECLS). Multicenter and prospective evaluation of this modifiable risk factor is imperative to improving the care of this high-risk cohort.</p>","PeriodicalId":519952,"journal":{"name":"The journal of extra-corporeal technology","volume":"57 2","pages":"59-65"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12169720/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144311161","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":"The PediPERForm Learning Network congenital perfusion registry.","authors":"Brian L Mejak, James A Reagor, Vince F Olshove, Donald S Likosky","doi":"10.1051/ject/2024037","DOIUrl":"10.1051/ject/2024037","url":null,"abstract":"<p><p>Medical procedural registries are uniquely positioned to support shared decision-making through risk prediction modeling, support quality assessment and improvement through performance benchmarking, and provide public reporting of evidence-based practices and outcomes. For example, the Centers for Disease Control and Prevention (CDC) consulted the Extracorporeal Life Support Organization (ELSO) registry to assess the severity of the swine flu outbreak in 2009-2010. The development and growth of The Society of Thoracic Surgeons Congenital Heart Surgery Database (STS-CHSD) has positively contributed to the congenital heart surgery community by developing objective mortality STAT categories and complexity stratification for operations, a common nomenclature for classifying operations and reporting the costs associated with complications for nine benchmark operations. Within the setting of adult cardiac surgery, the Perfusion Down Under Collaborative has used its registry to develop quality improvement initiatives, including those related to the management of arterial outlet temperature, glucose, and arterial pCO₂. The PERForm registry leverages data from nearly 50 US hospitals to support targeted quality improvement initiatives within the setting of adult cardiac surgery. The PERForm registry participants receive benchmark reports and participate in quarterly collaborative learning meetings noted for unblinding hospital performance data. In 2014, with no current congenital cardiopulmonary bypass (CPB) registries, various experts within the congenital perfusion community and leaders from the PERForm registry began working to develop a pediatric perfusion registry. From this work, the PediPERForm Learning Network (PLN) and its associated congenital perfusion registry became active and began collecting data in October 2021.</p>","PeriodicalId":519952,"journal":{"name":"The journal of extra-corporeal technology","volume":"57 2","pages":"66-73"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12169737/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144311166","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":"The complexities of MCS - How far is too far?","authors":"Salman Pervaiz Butt, Drisya Paul, Umer Darr, Gopal Bhatnagar","doi":"10.1051/ject/2025012","DOIUrl":"10.1051/ject/2025012","url":null,"abstract":"","PeriodicalId":519952,"journal":{"name":"The journal of extra-corporeal technology","volume":"57 2","pages":"115-116"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12169699/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144311165","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":"Hematocrit and total protein elimination as quality control parameters of cell salvage.","authors":"Debora Dörffel, Edda Klotz, Patrick Wagner, Karsten Ehrig, Karin Pretzel, Falko Hanisch, Axel Pruß","doi":"10.1051/ject/2025013","DOIUrl":"10.1051/ject/2025013","url":null,"abstract":"<p><strong>Background: </strong>The use of cell salvage reduces homologous blood transfusions during operations and avoids associated complications. Therefore, autotransfusion is an integral part of Patient Blood Management (PBM). The quality control of cell salvage in Germany is performed by checking the target values of a hematocrit in the autotransfusion blood (target: over 50%) and a total protein elimination (target: over 90%). The aim of this study was to identify intraoperative circumstances leading to deviations from the target values.</p><p><strong>Methods: </strong>This retrospective data analysis includes the use of the cell saver at the Charité - Universitätsmedizin Berlin, Campus Charité Mitte and Campus Benjamin Franklin from 01.01.2019 to 29.03.2022, in which autotransfusion occurred. In addition to the hematocrit and total protein elimination, the age and gender of the patients, as well as the surgical diagnosis, were included to investigate possible factors influencing compliance with the target values. The data were statistically analyzed using SPSS.</p><p><strong>Results: </strong>A total patient collective of 238 cell salvage applications (154 men, 84 women) was examined. The target values for quality control were achieved on average. The target value for hematocrit was not achieved in about 22% and for total protein elimination in about 8% of cell salvage applications. The age and gender of the patient, as well as the surgical diagnosis, had very little to no influence on compliance with the target values. The target values were not met primarily when the emergency option of the cell saver was used, when the collection volume was too low or when the collection volume was heavily diluted with rinsing fluid.</p><p><strong>Conclusion: </strong>The target values for quality control were achieved in most of the cell salvage applications examined and are suitable for ensuring the quality of autotransfusion. Special clinical circumstances may lead to the treating anesthetist having to accept deviating collection volumes or washing processes.</p>","PeriodicalId":519952,"journal":{"name":"The journal of extra-corporeal technology","volume":"57 2","pages":"89-95"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12169732/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144311160","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":"Personal healthcare.","authors":"Raymond K Wong","doi":"10.1051/ject/2025020","DOIUrl":"10.1051/ject/2025020","url":null,"abstract":"","PeriodicalId":519952,"journal":{"name":"The journal of extra-corporeal technology","volume":"57 2","pages":"58"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12169714/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144311163","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":"The utility of sTREM-1 and presepsin to predict infection in pediatric patients receiving mechanical circulatory support.","authors":"Robert Murray, Jianli Bi, Robin Alexander, Md Rejuan Haque, Brian Beckman, Ruth Seabrook, W Joshua Frazier, Andrew R Yates","doi":"10.1051/ject/2025008","DOIUrl":"10.1051/ject/2025008","url":null,"abstract":"<p><strong>Background: </strong>It is difficult to clinically detect a new infection in patients with Mechanical Circulatory Support (MCS; including veno-arterial and veno-veno extracorporeal membrane oxygenation, and ventricular assist devices). The prompt, accurate identification of new infection utilizing plasma biomarkers could prompt earlier initiation of antimicrobial agents and may improve outcomes.</p><p><strong>Methods: </strong>We utilized ELISA to evaluate novel biomarkers, soluble Triggering Receptor Expressed on Myeloid cells (sTREM-1) and Presepsin, as well as existing biomarkers (C-Reactive Protein (CRP) and Procalcitonin) before MCS, daily for the first week of MCS and for the 72 h in advance of the development of a new infection for patients prospectively enrolled in a biobank and who developed a culture positive infection.</p><p><strong>Results: </strong>Serial samples from 18 patients were analyzed. On average post-cannulation Presepsin and sTREM-1 values were not significantly different, however they have higher baseline values than reported in other patient populations. On average during periods of infection, Presepsin was 41% lower (51,462-30,188 pg/mL) (P = 0.001) and procalcitonin was 51% lower (0.77-0.38 ng/mL) (P < 0.001) compared to non-infected periods. Neither CRP or sTREM-1 were significantly different between infected and un-infected periods.</p><p><strong>Conclusion: </strong>Presepsin and Procalcitonin decreased in advance of the development of a new infection in the MCS patient population, a direction of change different than expected. These findings highlight the importance of biomarker studies specifically performed in the MCS patient population, and the potential lack of translatability of biomarkers in other patient populations to the MCS patient population.</p>","PeriodicalId":519952,"journal":{"name":"The journal of extra-corporeal technology","volume":"57 2","pages":"96-104"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12169701/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144311167","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":"Preconditioning before and during oxygenators use: \"The Road to Extinction of High-pressure Excursion\".","authors":"Ignazio Condello","doi":"10.1051/ject/2025009","DOIUrl":"10.1051/ject/2025009","url":null,"abstract":"","PeriodicalId":519952,"journal":{"name":"The journal of extra-corporeal technology","volume":"57 2","pages":"113-114"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12169700/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144311164","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":"Comparative analysis of perioperative outcomes between hybrid system and MiECC: A prospective pilot study.","authors":"Kaan Kırali, Mehmet Aksüt, Özge Altaş, Mustafa Emre Gürcü, Sibel Aydın","doi":"10.1051/ject/2025001","DOIUrl":"10.1051/ject/2025001","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Minimally invasive extracorporeal circulation (MiECC) has been introduced to mitigate the inflammatory response and reduce blood transfusion needs compared to conventional cardiopulmonary bypass (CPB) perioperatively. A hybrid system (HS) that merges aspects of both traditional CPB and MiECC aims to optimize patient perioperative outcomes. This study focuses on comparing the postoperative transfusion rates, intensive care unit (ICU) course, and biochemical parameters between the HS and MiECC.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;This prospective, randomized, controlled, single-center study was conducted at Koşuyolu High Specialization Education and Research Hospital, Istanbul from February 2024 to June 2024. Forty patients undergoing isolated coronary artery bypass grafting (CABG) were included, with 20 patients in the HS-group and 20 in the MiECC-group. Data on oxygen delivery management, hemoglobin and platelet values trends, biochemical parameters, the number of red blood cells and platelet units transfused postoperatively, and ICU stay duration were collected.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The CPB time was not significantly shorter in the HS group compared to the MiECC group (93.35 ± 33.06 min vs. 108.65 ± 30.02 min, p = 0.134). Hemoglobin levels did not differ significantly between the groups preoperatively, perioperatively, or postoperatively at 6, 12, and 24 h no difference in red blood cells unit transfusion. Indexed oxygen delivery did not differ significantly between the HS and MiECC groups (311.60 ± 28.29 mL/min/m&lt;sup&gt;2&lt;/sup&gt; vs. 332.25 ± 57.04 mL/min/m&lt;sup&gt;2&lt;/sup&gt;, p = 0.275). Partial pressure of oxygen was higher in the MiECC group (210.90 ± 49.64 mmHg vs. 177.70 ± 70.41 mmHg, p = 0.093), but this difference was also not statistically significant. Biochemical parameters showed notable differences. Postoperative lactate levels were significantly lower in the HS group (2.85 ± 1.20 mmol/L vs. 4.04 ± 1.40 mmol/L, p = 0.009). Conversely, Lactate Dehydrogenase levels during and after CPB were, lower in the MiECC group. Postoperative 6th-hour troponin levels were significantly lower in the HS group (3.188 ± 2.684 ng/mL vs. 4.645 ± 3.422 ng/mL, p = 0.038). Mechanical ventilation duration, ICU stay, and hospital stay were comparable between the two groups, with no significant differences observed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The hybrid system demonstrated comparable results to the MiECC in patients undergoing isolated CABG. No significant differences were observed in CPB time or postoperative blood transfusion requirements. However, the HS group showed favorable biochemical parameters, including significantly lower postoperative lactate levels and troponin levels at 6 h. Indexed oxygen delivery and partial pressure of oxygen were similar between groups, and ICU and hospital stay durations were comparable. These findings suggest that the hybrid system offers outcomes on par with the MiECC appr","PeriodicalId":519952,"journal":{"name":"The journal of extra-corporeal technology","volume":"57 2","pages":"74-81"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12169718/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144311159","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}