The journal of extra-corporeal technology最新文献

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

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

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

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

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

{"title":"Navigating polycythemia vera and factor X deficiency on cardiopulmonary bypass for coronary artery bypass grafting: a case report.","authors":"Jenna L Cornibe, Arthur H Katz","doi":"10.1051/ject/2025016","DOIUrl":"10.1051/ject/2025016","url":null,"abstract":"<p><p>Published literature about patients with polycythemia vera (PV) undergoing cardiac surgery while utilizing cardiopulmonary bypass (CPB) is scarce, even more so when coupled with an additional rare bleeding disorder. These patients require a multidisciplinary approach to achieve optimal clinical management. Several cases have been reported of oxygenator failure or thrombosis within the extracorporeal circuit. We present a successful CPB run on a patient with coexisting PV and Factor X deficiency undergoing coronary artery bypass grafting.</p>","PeriodicalId":519952,"journal":{"name":"The journal of extra-corporeal technology","volume":"57 3","pages":"174-177"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12435812/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071525","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":"Successful use of pulsatile flow and goal directed perfusion in a high-risk patient.","authors":"Mostafa Bagherinasab, Nathaniel H Darban","doi":"10.1051/ject/2025002","DOIUrl":"10.1051/ject/2025002","url":null,"abstract":"<p><p>The development of multi-organ failure resulting from cardiopulmonary bypass (CPB) is acknowledged as a significant contributor to increased morbidity and mortality rates during the postoperative period. This report discusses a patient who presents with multiple comorbidities, including renal failure, reduced ejection fraction, and a history of hypertension, and is being considered for coronary artery bypass grafting (CABG) along with aortic valve replacement surgery. The administration of CPB was customized to address the unique comorbid conditions of the patient, highlighting the critical objective of maintaining an oxygen delivery index (DO₂i) exceeding 280 mL/min/m², while also integrating pulsatile flow methodologies. The management of CPB, as previously discussed, resulted in a notable enhancement of kidney function, accompanied by a reduction in the patient's lactate levels post-surgery.</p>","PeriodicalId":519952,"journal":{"name":"The journal of extra-corporeal technology","volume":"57 3","pages":"160-163"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12435815/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071510","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 novel strategy for conversion from pediatric V-A ECMO to CPB circuit.","authors":"Amita Lal, David Machin, William Lansdowne","doi":"10.1051/ject/2025027","DOIUrl":"10.1051/ject/2025027","url":null,"abstract":"<p><p>This article describes two novel strategies to convert a veno-arterial extracorporeal membrane oxygenator (V-A ECMO) supported pediatric patient circuit to a cardiopulmonary bypass (CPB) circuit. Modification of the existing ECMO circuit incorporated a venous reservoir, cardioplegia circuit, ultrafiltration circuit, and cardiotomy suckers, allowing all aspects of cardiac surgery to be performed. This approach eliminated the need for conversion to an additional CPB circuit, thereby reducing surface area exposure and blood product requirement. We found that these patients had no major post-operative coagulopathies or observable neurological dysfunction.</p>","PeriodicalId":519952,"journal":{"name":"The journal of extra-corporeal technology","volume":"57 3","pages":"164-167"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12435824/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071513","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: Development and validation of a checklist for cardiopulmonary bypass.","authors":"Valdir Assis Dos Reis Filho, Karina Aparecida Antonelli Novello, Mariana Letícia Matias","doi":"10.1051/ject/2025037","DOIUrl":"10.1051/ject/2025037","url":null,"abstract":"","PeriodicalId":519952,"journal":{"name":"The journal of extra-corporeal technology","volume":"57 3","pages":"184"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12435816/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071522","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":"Indication, technical considerations, and outcome of remote central cannulation for repeat extracorporeal membrane oxygenation in congenital diaphragmatic hernia: a case report.","authors":"Enrico Danzer, Sabrina J Flohr, Holly L Hedrick, Geoffrey L Bird, Jonathan M Chen, Natalie E Rintoul","doi":"10.1051/ject/2025019","DOIUrl":"10.1051/ject/2025019","url":null,"abstract":"<p><p>Repeat extracorporeal membrane oxygenation (ECMO) is rare in children with congenital diaphragmatic hernia (CDH). Improving our understanding of the potential survival benefits, complications, and surgical challenges associated with this procedure is essential for enhancing decision-making regarding multicourse ECMO in CDH. We report the case of a now 3-year-old girl who required cannulation through median sternotomy 5 months after her initial neonatal ECMO treatment via cervical venoarterial cannulation. This second run of ECMO was performed due to an acute exacerbation of pulmonary hypertension caused by urosepsis. This case illustrates that repeat ECMO should be considered for selected CDH patients when a reversible cause for clinical deterioration is identified. We also emphasize the importance of interdisciplinary decision-making, considering alternative cannulation methods, and providing appropriate family counseling. It is crucial to balance the potential survival benefits of repeat ECMO against the increased risks of morbidity.</p>","PeriodicalId":519952,"journal":{"name":"The journal of extra-corporeal technology","volume":"57 3","pages":"168-170"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12435807/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071568","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}