The journal of extra-corporeal technology最新文献

{"title":"Comparison of clinical outcomes between pulsatile and non-pulsatile perfusion during cardiopulmonary bypass: A prospective randomized study.","authors":"Aakriti Sharma, Prajjwol Luitel, Prabhat Khakural, Ranjan Sapkota","doi":"10.1051/ject/2026007","DOIUrl":"10.1051/ject/2026007","url":null,"abstract":"<p><strong>Background: </strong>The clinical benefits of pulsatile perfusion during cardiopulmonary bypass (CPB) remain a subject of debate. This study aimed to compare clinical outcomes between pulsatile and non-pulsatile perfusion during CPB in patients undergoing elective cardiac surgery.</p><p><strong>Materials and methods: </strong>Eighty patients undergoing elective atrial septal defect (ASD) closure or mitral valve replacement (MVR) between July 2019 and July 2020 were randomized to two groups: pulsatile perfusion (PP) group and non-pulsatile perfusion (NP) group. All surgeries were performed by a single surgical team. In the PP group, pulsatile flow was maintained at 60-80 per minute for adults and 80-120 per minute for pediatric patients, pulse pressure was maintained higher than 15 mm Hg, while all other intraoperative management and perioperative protocols were kept consistent between groups. The two groups were compared in terms of length of ICU stay, hospital stay, renal function test, liver function test, and complications.</p><p><strong>Results: </strong>77 patients with a mean age of 33.8 ± 15.9 were included in the final analysis. The groups were similar in demographics, clinical and intra-operative variables, except body surface area and baseline creatinine, which were higher in the pulsatile group. Length of ICU stay, hospital stay, liver function tests, renal function tests, and complications were similar across both groups, except for higher urea (p-value 0.049) in the pulsatile group.</p><p><strong>Conclusions: </strong>This study did not demonstrate significant differences in clinical outcomes between pulsatile and non-pulsatile flow during CPB in elective cardiac surgery. Routine use of pulsatile flow cannot be recommended based on current findings. The study was limited by its restriction to patients undergoing ASD closure or MVR surgery and the dominance of younger patients without major comorbidities.</p>","PeriodicalId":519952,"journal":{"name":"The journal of extra-corporeal technology","volume":"58 2","pages":"117-123"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13281284/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148280676","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 pilot study of the impact of enhanced cardiac index coupled with pulsatile flow on goal direct perfusion during cardiopulmonary bypass.","authors":"Mostafa Bagherinasab, Sahra Rezaei, Ali Reza Moradi, Bagher Aghal, Julie Steele-Pruett, Nathaniel H Darban","doi":"10.1051/ject/2025060","DOIUrl":"10.1051/ject/2025060","url":null,"abstract":"<p><strong>Introduction: </strong>Providing sufficient organ perfusion during cardiopulmonary bypass (CPB) is a common research topic among extracorporeal technology researchers. The application of an elevated cardiac index (CI) to enhance CPB flow, coupled with the adoption of pulsatile flow, constitutes a novel approach designed to improve organ perfusion and oxygen delivery (DO2). this study aims to assess the effects of increased CI and pulsatile flow on organ perfusion during CPB.</p><p><strong>Material and methods: </strong>In this pilot study, thirty patients scheduled for on-pump coronary artery bypass graft (CABG) surgery with an estimated prolonged CPB time were enrolled. Patients were randomly divided into two study groups. Patients in the control group were managed with a CI of 2.4 L/min/m², while patients in the study group received a CI equal to 2.6 to 3 L/min/m² with pulsatile flow (PF) throughout the bypass run. Lactate fluctuations, creatinine variation, inotrope needs, blood transfusion requirements, ICU and hospital length of stay were assessed and noted.</p><p><strong>Results: </strong>Participants in the study group exhibited lower creatinine levels throughout the assessment period; however, this difference did not reach statistical significance (P > 0.05). Participants in the study group consistently exhibited significantly lower lactate concentrations over the course of the investigation (P < 0.05). Patients in the study groups experienced a reduced duration of both ICU and hospital lengths of stay; however, this difference did not reach statistical significance (P > 0.05).</p><p><strong>Conclusion: </strong>This prospective study concludes that an increased CI in conjunction with PF during CPB can markedly enhance organ perfusion, as evidenced by a statistically significant reduction in lactate production observed throughout the duration of the bypass.</p>","PeriodicalId":519952,"journal":{"name":"The journal of extra-corporeal technology","volume":"58 2","pages":"110-116"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13281327/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148280687","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":"Considerations to practice a safe and minimal administration of heparin and protamine during cardiopulmonary bypass.","authors":"Min-Ho Lee, Kenneth G Shann, Tami Rosenthal","doi":"10.1051/ject/2026002","DOIUrl":"10.1051/ject/2026002","url":null,"abstract":"<p><p>A critical aspect of cardiopulmonary bypass (CPB) is achieving full anticoagulation to prevent thrombosis and consumptive coagulation (CCA). Systemic anticoagulation with heparin during CPB should be completely neutralized by administering protamine to restore normal hemostasis. Activated clotting time (ACT) is a major marker of anticoagulation management during CPB. However, studies have shown that ACT measurements can vary predictably with different point-of-care testing ACT devices, suggesting the importance of considering the ACT device when determining the target ACT. Otherwise, the amount of heparin used and circulating during CPB can be unnecessarily high. Calculating an optimal protamine dose (PD) is challenging. Yet, newer strategies and heparin concentration-based dosing indicate that average doses of 60-90 mg/m² are generally sufficient. This equates to a protamine-to-heparin ratio of approximately 0.5-0.8:1 of the first heparin bolus to establish the target ACT before going on CPB or a 0.3-0.5:1 of the total heparin dose during CPB. PD exceeding 90 mg/m² may result in residual free protamine. Excessive use of heparin and protamine has been associated with increased post-operative bleeding. This review discusses several considerations in planning an anticoagulation strategy during CPB, focusing on the predictable differences of ACT devices and strategies to determine the optimal PD. The aim is to administer a safe and minimal amount of heparin to protect the CPB circuit and patient from thrombosis and CCA, and to administer the optimal amount of protamine to completely neutralize the circulating heparin without leaving residual free protamine.</p>","PeriodicalId":519952,"journal":{"name":"The journal of extra-corporeal technology","volume":"58 2","pages":"164-171"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13281330/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148280703","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":"Toward standardized guidelines for distal perfusion cannulae in V-A ECMO and ECPELLA: timing, sizing, monitoring, and management.","authors":"Salman Pervaiz Butt, Salman Abdulaziz, Nabeel Razzaq, Arun Kumar, Mehnaz Farheen, Rania Khalil, Vivek Kakar, Umer Darr, Gopal Bhatnagar","doi":"10.1051/ject/2025065","DOIUrl":"10.1051/ject/2025065","url":null,"abstract":"","PeriodicalId":519952,"journal":{"name":"The journal of extra-corporeal technology","volume":"58 2","pages":"202-204"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13281302/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148280729","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":"Scoping review of contemporary adult venoarterial extracorporeal membrane oxygenation (VA ECMO) selection criteria and decision-making mechanisms.","authors":"Amrita K Johal","doi":"10.1051/ject/2026009","DOIUrl":"10.1051/ject/2026009","url":null,"abstract":"<p><p>Adult venoarterial extracorporeal membrane oxygenation (VA ECMO) is a costly life support therapy, where patient selection remains a significant hinge-point in determining patient outcomes. Despite this, few sites have formalized patient selection criteria, and even fewer have a robust multidisciplinary ECMO team to determine patient candidacy. Analyzing current literature revealed weaknesses in existing research on VA ECMO patient selection criteria. Significant issues include the use of small sample sizes, lack of randomized controlled trials, lack of personalization of ECMO initiation decisions, study heterogeneity, and inclusion of patients who received ECMO without including patients who were considered for but not given ECMO. Among the available studies, the Survival After Venoarterial ECMO (SAVE) score has shown the greatest promise in selecting VA ECMO patients, excluding those undergoing extracorporeal cardiopulmonary resuscitation (ECPR) and postcardiotomy (PC) ECMO. The SAVE score has demonstrated good discrimination in non-ECPR and non-PC ECMO groups. Further research is needed on the predictive value of SAVE score risk classes and the discrimination of the SAVE score excluding PC ECMO and ECPR groups. The modified SAVE score, which also includes lactate assessment, has shown the greatest promise for selecting ECPR and PC ECMO patients for VA ECMO. The modified SAVE score requires more external validation. Site-level research indicates that consultation with a multidisciplinary ECMO team, which collectively makes decisions about ECMO candidacy, has resulted in significantly improved patient survival outcomes compared with a one- or two-physician decision-making mechanism for VA ECMO initiation. The ECMO team approach is a rich area for future research, and sites should publish their patient outcomes before and after implementation.</p>","PeriodicalId":519952,"journal":{"name":"The journal of extra-corporeal technology","volume":"58 2","pages":"146-163"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13281281/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148280753","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":"Evaluation of accuracy of platelet rich plasma preparation devices for cardiac surgery: A prospective, randomized, single blinded study.","authors":"Larry Garrison, Daniel Nicks, Samantha Nicks, Jonah Green, Huong Pham, Steve Wysocki","doi":"10.1051/ject/2026004","DOIUrl":"10.1051/ject/2026004","url":null,"abstract":"<p><strong>Background: </strong>Applying platelet rich plasma (PRP) to the sternum immediately prior to approximation has been shown to enhance wound healing, lower the incidence of sternal wound infections, reduce costs associated with treating these infections and decrease post-operative pain scores. Multiple investigations have reported device specific outcomes regarding PRP preparation yields from healthy volunteer blood donors, all with initial platelet counts in the normal range. What is missing from the literature is how accurately PRP preparations reflect device-specific yield target values, particularly under the clinical conditions encountered routinely in the cardiac surgery arena.</p><p><strong>Methods: </strong>The Magellan^® group (30 cases) and the Angel^® group (30 cases) comprised the two study groups (2 groups, 60 total cases, 120 samples total). Pre and post processing blood samples from each group were analyzed for platelet counts. Platelet count increases were assessed for accuracy when compared to a specific target.</p><p><strong>Results: </strong>Individual yields from each tested device demonstrated some degree of limited variability. However, both groups mean values achieved and slightly exceeded the target value of a six-fold increase; Magellan group (M = 6.58, SD = 1.33), Angel group (M = 6.31, SD = 0.93).</p><p><strong>Conclusion: </strong>Both devices, on average, appear capable of accurately preparing PRP to meet the specific target value of a six-fold increase over baseline under conditions routinely encountered in cardiac surgery.</p>","PeriodicalId":519952,"journal":{"name":"The journal of extra-corporeal technology","volume":"58 2","pages":"124-127"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13281295/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148280767","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 decision-making analysis of extracorporeal membrane oxygenation candidacy based on a survey of pediatric critical care fellow and attending physicians☆.","authors":"Ish Sethi, Brenna C McCabe, Ryan W Morgan, Samuel Rosenblatt, Jessica C Fowler, Wynne E Morrison, Adam S Himebauch","doi":"10.1051/ject/2025056","DOIUrl":"10.1051/ject/2025056","url":null,"abstract":"<p><strong>Background: </strong>Extracorporeal membrane oxygenation (ECMO) candidacy decisions for children with respiratory failure can be variable among pediatric critical care attending physicians, and prior studies showed that baseline functional status and underlying neurological conditions influence this decision. However, there are limited data regarding factors influencing pediatric critical care fellows' ECMO candidacy decisions and their alignment with attending physicians. This study aimed to identify patient characteristics influencing fellows' ECMO candidacy decisions and measure concordance with attending decisions.</p><p><strong>Methods: </strong>This study was a planned secondary analysis of a prospective, single-center, cross-sectional study at a quaternary pediatric ECMO referral center. Pediatric critical care fellows and attending physicians caring for children admitted with acute respiratory failure were surveyed within 72 h of initiation or escalation of respiratory support. The primary exposure was patient functional status at admission, measured by the functional status score (FSS), and was categorized as Normal/Mild Dysfunction (FSS 6-9) or Moderate/Severe Dysfunction (FSS >10). Multivariate logistic regression clustered by fellow evaluated factors influencing ECMO candidacy assessments. Cohen's kappa measured concordance between fellow and attending decisions.</p><p><strong>Results: </strong>Eighty surveys were completed by 21 pediatric critical care fellows. Fellows identified 19% of patients as ECMO non-candidates. After adjustment for age, moderate/severe admission dysfunction significantly reduced the odds of ECMO candidacy (aOR 0.11, 95% CI 0.03-0.51, p = 0.005). Overall, concordance between fellows and attendings was moderate (κ = 0.56), with junior fellows having minimal agreement (κ = -0.12). Fellows focused primarily on baseline functional status and comorbidities, while attendings considered additional factors, including long-term prognosis, organ failure irreversibility, and ECMO-related risks in candidacy assessments.</p><p><strong>Conclusion: </strong>Admission functional status influences pediatric critical care fellows' ECMO candidacy decisions, with moderate concordance observed between fellows and attending physicians. The identified discrepancies emphasize the importance of structured education and targeted mentorship programs to enhance consistency in ECMO candidacy assessments, especially among junior trainees.</p>","PeriodicalId":519952,"journal":{"name":"The journal of extra-corporeal technology","volume":"58 2","pages":"139-145"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13281282/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148280656","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":"Extracorporeal carbon dioxide removal (ECCO₂R) in post lung transplant patients.","authors":"Mariana N Zavala Gómez, Elisa Chinchilla Lopez, Ricardo Garza Trevino, Paola Borbolla, Sebastian Bernal Heinzel, Gilberto Lozano Miranda, Allan Méndez, Uriel Chavarria Martinez, Manuel Wong, Adrián Camacho Ortiz, Lilia M Rizo Topete, Sergio Sánchez Salazar","doi":"10.1051/ject/2025063","DOIUrl":"10.1051/ject/2025063","url":null,"abstract":"<p><p>Extracorporeal carbon dioxide removal (ECCO₂R) has emerged as a promising adjunctive therapy to mitigate hypercapnia and reduce invasive mechanical ventilation (IMV) settings. We present the cases of two post-lung transplant patients with severe hypercapnia and respiratory failure who were successfully treated with the ECCO₂R. In both cases, we used a venovenous ECCO₂R (V-ECCO₂R) system, employing the Prismalung™ oxygenator integrated into a Prismaflex™ continuous renal replacement therapy (CRRT) platform. This technique proved efficacy in correcting hypercapnia, improving ventilatory parameters, and facilitating lung-protective strategies in post-lung transplant patients with respiratory failure. This technique represents a valuable adjunct to conventional mechanical ventilation, particularly in cases where hypercapnia poses a risk to graft function and patient stability. Further studies are warranted to establish optimal patient selection and refine treatment protocols for ECCO₂R implementation in critical care settings.</p>","PeriodicalId":519952,"journal":{"name":"The journal of extra-corporeal technology","volume":"58 2","pages":"172-179"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13281301/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148280737","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":"Strategic decision-making for redo cardiac surgical patients with biventricular heart failure - description of a surgical technique.","authors":"Svetlana Novikova, Shyryn Kenzhebekova, Maksat Faizulla, Abdurashid Mussayev, Nail Khissamutdinov, Zhuldyz Nurmykhametova, Yuriy Pya","doi":"10.1051/ject/2025059","DOIUrl":"10.1051/ject/2025059","url":null,"abstract":"<p><strong>Background: </strong>Left ventricular assist devices (LVADs) play a critical role in managing end-stage heart failure (HF), serving as a bridge to transplantation (BTT) or as destination therapy (DT). Patients with prior mechanical valve replacements who later require LVAD support present unique surgical challenges, including increased thrombotic risk, hemodynamic mismatch, and prolonged operative time. To address these concerns, direct balloonexpandable transcatheter heart valve (B/Ex-THV) implantation offers a minimally invasive alternative for high-risk redo cases.</p><p><strong>Objective: </strong>To evaluate the feasibility, safety, and hemodynamic performance of direct B/Ex-THV implantation combined with HeartMate 3 LVAD in high-risk patients with prior mechanical valve surgery or native aortic valve disease.</p><p><strong>Methods: </strong>This retrospective case series included 16 patients undergoing concomitant HeartMate 3 LVAD and direct B/Ex-THV implantation between April 2022 and October 2023. Nine patients received THVs anchored within prior mechanical prostheses (valve-in-frame), while seven underwent implantation into the native aortic annulus (valve-in-ring). Procedural metrics, hemodynamic outcomes, complications, and survival were analyzed.</p><p><strong>Results: </strong>All procedures were successfully completed. The valve-in-frame group demonstrated stable mid-term hemodynamics with low mean gradients (5.0 ± 1.3mmHg) and preserved effective orifice area. No significant paravalvular leak or structural deterioration was observed. At 30 days, 93.75% of patients survived; 12 and 24-month survival rates were both 75%. No valve migration, thrombosis, or hemolysis occurred. One patient who underwent valve-in-frame implantation subsequently underwent successful orthotopic heart transplantation 12 months later.</p><p><strong>Conclusion: </strong>Direct B/Ex-THV implantation with concurrent LVAD surgery is a feasible and safe strategy in complex redo patients. It minimizes ischemic time, preserves hemodynamic function, and aligns with ISHLT recommendations, offering a promising approach for managing advanced HF in patients with previous valve interventions.</p>","PeriodicalId":519952,"journal":{"name":"The journal of extra-corporeal technology","volume":"58 2","pages":"184-194"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13281329/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148280717","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":"Simulation use in perfusion education: A 2025 survey of United States programs.","authors":"Jared Bienstock, Bruce Searles, Edward Darling","doi":"10.1051/ject/2025070","DOIUrl":"10.1051/ject/2025070","url":null,"abstract":"<p><strong>Background: </strong>Simulation-based education (SBE) is increasingly used in training students in allied healthcare, yet data on its role in United States (U.S.) perfusion programs are limited. This study surveyed perfusion programs with the purpose of assessing simulation use, curricular integration, challenges, and future directions.</p><p><strong>Methods: </strong>A 22-question validated survey was distributed via REDCap to all 23 perfusion program directors in the U.S. between March and April 2025. Questions addressed demographics, simulation infrastructure, curricular integration, challenges, and future directions.</p><p><strong>Results: </strong>The response rate was 100%. All programs use at least one simulation modality, and 82.6% use high-fidelity simulation. Most programs (69.6%) fully embed simulation into credit-bearing courses, and 73.9% grade student performance. 60.9% of programs report that they have a dedicated simulation space. 56.5% report a lack of a dedicated budget. Common challenges identified were time constraints (73.9%) and limited faculty manpower (65.2%). While all programs teach adult CPB using simulation, the incorporation of pediatric CPB, ECMO, and IABP simulation is less common.</p><p><strong>Conclusion: </strong>SBE is widely adopted in perfusion programs across the U.S., but standardization, faculty training, and curricular integration are necessary to optimize its impact.</p>","PeriodicalId":519952,"journal":{"name":"The journal of extra-corporeal technology","volume":"58 2","pages":"102-109"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13281300/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148280801","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}