ASAIO Journal最新文献

Enhancing Survival Prediction After Venoarterial Extracorporeal Membrane Oxygenation Using Machine Learning. 利用机器学习增强静脉体外膜氧合后的生存预测。

IF 3.1 3区医学

ASAIO Journal Pub Date : 2025-06-02 DOI: 10.1097/MAT.0000000000002475

Albert Leng, Preetham Bachina, Olivia Liu, Benjamin Shou, Charles Racz, David A Giliver, Ilya Shpitser, Glenn J R Whitman, Sung-Min Cho

{"title":"Enhancing Survival Prediction After Venoarterial Extracorporeal Membrane Oxygenation Using Machine Learning.","authors":"Albert Leng, Preetham Bachina, Olivia Liu, Benjamin Shou, Charles Racz, David A Giliver, Ilya Shpitser, Glenn J R Whitman, Sung-Min Cho","doi":"10.1097/MAT.0000000000002475","DOIUrl":"https://doi.org/10.1097/MAT.0000000000002475","url":null,"abstract":"In-hospital mortality after venoarterial extracorporeal membrane oxygenation (VA-ECMO) remains high. This study compared the performance of the Survival after Venoarterial ECMO (SAVE) score with machine learning (ML) models incorporating rich electronic medical record data to evaluate survival for patients on VA-ECMO support. We retrospectively reviewed adults undergoing VA-ECMO (2016-2022) at a single tertiary care center. The CatBoost algorithm was trained using leave-one-out cross-validation (LOOCV) on 74 extracted vital signs, laboratory values, and ventilator settings. Shapley Additive Explanations (SHAP) was used to identify key predictive features for logistic regression. Overall, 194 VA-ECMO patients (median age = 58 years, 36.6% female) were included, with 133 (69%) experiencing mortality. The SAVE score was compared to two predictive models: a pre-ECMO model (≤ 24 hours before cannulation) and an on-ECMO model (including up to the first 48 hours of ECMO). The LOOCV area under the receiver-operator characteristics curves (AUC) for the SAVE score, pre-ECMO, and on-ECMO models was 0.73, 0.77, and 0.83, respectively. Logistic regressions using ML-identified variables showed stepwise AUC improvements: 0.82 (pre-ECMO), 0.86 (on-ECMO), and 0.89 (combined). A novel, interpretable ML model predicted survival for VA-ECMO patients with accuracy comparable to the SAVE score. Incorporating on-ECMO variables significantly increased predictive performance and revealed novel variables associated with survival.","PeriodicalId":8844,"journal":{"name":"ASAIO Journal","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144198221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Clinical Practice With Preprimed Extracorporeal Membrane Oxygenation: Safety, Sterility, and Functionality. 体外膜充氧的临床实践：安全性、无菌性和功能性。

IF 3.1 3区医学

ASAIO Journal Pub Date : 2025-06-01 Epub Date: 2024-12-16 DOI: 10.1097/MAT.0000000000002361

Mauro Renghini, Debora Maddinelli, Anna Papeo, Carmine Puglia, Andrea Montisci, Sergio Cattaneo, Stefano Benussi

{"title":"Clinical Practice With Preprimed Extracorporeal Membrane Oxygenation: Safety, Sterility, and Functionality.","authors":"Mauro Renghini, Debora Maddinelli, Anna Papeo, Carmine Puglia, Andrea Montisci, Sergio Cattaneo, Stefano Benussi","doi":"10.1097/MAT.0000000000002361","DOIUrl":"10.1097/MAT.0000000000002361","url":null,"abstract":"This 5 year retrospective study presents the clinical experience with preprimed extracorporeal membrane oxygenation (ECMO) circuits used in a Single Hub Center Hospital, focusing on sterility, functionality, and safety. The ECMO program has been active since 2019, with a total of 223 circuits managed. Our preassembled and preprimed ECMO circuits were stored in a sterile environment and continuously circulated until implantation. Sterility and functionality testing was performed at the end of circuit preparation, every 7 days, and before implantation. Our results show that only 2 (0.3%) of the 570 samples tested positive for bacteria, and all implanted devices demonstrated satisfactory gas transfer performance. None of the ECMO devices demonstrated any loss of early functionality after implantation. The longest storage period of a preprimed circuit was 73 days, with no positive culture results. Our study highlights the importance of preassembled and preprimed ECMO circuits in improving clinical practice in emergency situations, highlighting their safety and potential to improve clinical practice. Furthermore, our findings suggest that standardizing guidelines for prepriming and storage of ECMO circuits can help minimize the risk of contamination.","PeriodicalId":8844,"journal":{"name":"ASAIO Journal","volume":" ","pages":"454-460"},"PeriodicalIF":3.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142827233","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A Smart Computational Tool for Personalized Coronary Blood Flow Settings During Normothermic Ex Situ Heart Perfusion. 一个智能的计算工具，个性化冠状动脉血流设置在常温非原位心脏灌注。

IF 3.1 3区医学

ASAIO Journal Pub Date : 2025-06-01 Epub Date: 2025-02-20 DOI: 10.1097/MAT.0000000000002394

Jorik H Amesz, Niki L Lupgens, Dirk J Duncker, Lisa E Sluijter-Rozendaal, Dwight Dumay, Olivier C Manintveld, Yannick J H J Taverne

{"title":"A Smart Computational Tool for Personalized Coronary Blood Flow Settings During Normothermic Ex Situ Heart Perfusion.","authors":"Jorik H Amesz, Niki L Lupgens, Dirk J Duncker, Lisa E Sluijter-Rozendaal, Dwight Dumay, Olivier C Manintveld, Yannick J H J Taverne","doi":"10.1097/MAT.0000000000002394","DOIUrl":"10.1097/MAT.0000000000002394","url":null,"abstract":"Myocardial edema significantly develops during current subnormothermic ex situ heart perfusion (ESHP) procedures, resulting in myocardial function decline during prolonged perfusion. A relatively high coronary blood flow (CBF) during ESHP is thought to be responsible for this high degree of myocardial edema formation. In this study, we present a novel tool to calculate CBF based on individual donor (sex and body weight) and perfusate (hemoglobin concentration, oxygen saturation, partial pressure of oxygen [PO 2 ]) characteristics. The tool continuously evaluates the balance between myocardial oxygen consumption (MVO 2 ) and delivery to facilitate adequate and preventing excess perfusion. Taking this personalized approach, the CBF can potentially be lowered while still providing sufficient oxygen to the donor heart. Furthermore, the tool automatically calculates MVO 2 , ΔPO 2 , and coronary vascular resistance during ESHP, which aids in the qualitative assessment of the heart before transplantation.","PeriodicalId":8844,"journal":{"name":"ASAIO Journal","volume":" ","pages":"e90-e93"},"PeriodicalIF":3.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12122086/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143466847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Ventricular Assist Device Implantation in a Patient Congenitally Corrected Transposition of the Great Arteries With I, D, D. 为一名患有 I、D、D 先天性大动脉转位的患者植入心室辅助装置

IF 3.1 3区医学

ASAIO Journal Pub Date : 2025-06-01 Epub Date: 2025-02-28 DOI: 10.1097/MAT.0000000000002388

Yongfeng Sun, Yuehang Yang, Jing Zhang, Jiawei Shi, Cheng Zhou

{"title":"Ventricular Assist Device Implantation in a Patient Congenitally Corrected Transposition of the Great Arteries With I, D, D.","authors":"Yongfeng Sun, Yuehang Yang, Jing Zhang, Jiawei Shi, Cheng Zhou","doi":"10.1097/MAT.0000000000002388","DOIUrl":"10.1097/MAT.0000000000002388","url":null,"abstract":"Congenitally corrected transposition of the great arteries (ccTGA) is a rare congenital heart anomaly that often leads to systemic heart failure, necessitating mechanical circulatory support or transplantation. We report a case of a 54 year old male diagnosed with dextrocardia and ccTGA (I, D, D), who had been suffering from congestive heart failure for over 7 years. Despite receiving intensive treatment, his condition deteriorated. Preoperative evaluation revealed significant systemic right ventricular dysfunction with severe valvular regurgitation and pulmonary hypertension. The surgical approach included tricuspid and aortic bioprosthetic valve replacement, mitral valve annuloplasty, and right thoracic ventricular assist device (VAD) implantation. The patient recovered well postoperatively and was discharged on postoperative day 39 with New York Heart Association (NYHA) class I. This case demonstrates the feasibility of using VAD in right heart ccTGA as a bridge to transplantation or destination therapy, emphasizing the importance of meticulous preoperative planning and intraoperative management for successful outcomes.","PeriodicalId":8844,"journal":{"name":"ASAIO Journal","volume":" ","pages":"e97-e99"},"PeriodicalIF":3.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12122087/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143522354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Surgical Intervention for Outflow Graft Obstruction in Patients With Magnetically Levitated Centrifugal-Flow Left Ventricular Assist Devices. 采用磁悬浮离心流左心室辅助装置患者流出部移植物梗阻的手术干预。

IF 3.1 3区医学

ASAIO Journal Pub Date : 2025-06-01 Epub Date: 2025-03-06 DOI: 10.1097/MAT.0000000000002412

Krish C Dewan, Alejandro Alvarez Lobo, Jacob N Schroder, Jeffrey E Keenan, Adam D DeVore, Stuart D Russell, Carmelo A Milano

{"title":"Surgical Intervention for Outflow Graft Obstruction in Patients With Magnetically Levitated Centrifugal-Flow Left Ventricular Assist Devices.","authors":"Krish C Dewan, Alejandro Alvarez Lobo, Jacob N Schroder, Jeffrey E Keenan, Adam D DeVore, Stuart D Russell, Carmelo A Milano","doi":"10.1097/MAT.0000000000002412","DOIUrl":"10.1097/MAT.0000000000002412","url":null,"abstract":"Outflow graft obstruction (OGO) is an under-reported but severe complication after insertion of magnetically levitated centrifugal-flow left ventricular assist devices (LVADs). The optimal treatment and long-term outcomes have not been well-described. We report a retrospective single high-volume center's experience with surgical exploration for OGO from June 2019 to October 2023. Outflow graft obstruction was identified in 19 LVAD recipients from a total experience of 550 LVAD implants (3.3%). Median time of LVAD support to development of OGO was 32.5 months (interquartile range [IQR], 28-47.5). Low-flow alarms were the most common presentation, followed by dyspnea on exertion, and syncope. Computed tomography angiography (CTA) and echocardiography were the most common diagnostic modalities. Aortic valve opening with every beat and worsened mitral insufficiency were both more common at presentation compared to prior echocardiographic studies. Surgical excision of the bend relief (BR) and evacuation of proteinaceous material between the BR and the outflow graft immediately improved hemodynamics and LVAD function. There were no in-hospital mortalities, and all patients were discharged home after a median length of stay of 9 days (IQR, 10-21). All but four patients were alive at median follow-up 21 months. Thirteen of the 19 patients were readmitted a total of 50 times, none for recurrent OGO.","PeriodicalId":8844,"journal":{"name":"ASAIO Journal","volume":" ","pages":"437-444"},"PeriodicalIF":3.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143566008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Right Ventricular Injury Definition and Management in Veno-Venous Extracorporeal Membrane Oxygenation. 静脉-静脉体外膜氧合右室损伤的定义和处理。

IF 3.1 3区医学

ASAIO Journal Pub Date : 2025-06-01 Epub Date: 2025-01-09 DOI: 10.1097/MAT.0000000000002369

Siddharth Pawan Dugar, Ryota Sato, Matthew Charlton, Daisuke Hasegawa, Marta Velia Antonini, Prashant Nasa, Hakeem Yusuff, Marcus J Schultz, Mary Pat Harnegie, Kollengode Ramanathan, Kiran Shekar, Matthieu Schmidt, Vasileios Zochios, Abhijit Duggal

{"title":"Right Ventricular Injury Definition and Management in Veno-Venous Extracorporeal Membrane Oxygenation.","authors":"Siddharth Pawan Dugar, Ryota Sato, Matthew Charlton, Daisuke Hasegawa, Marta Velia Antonini, Prashant Nasa, Hakeem Yusuff, Marcus J Schultz, Mary Pat Harnegie, Kollengode Ramanathan, Kiran Shekar, Matthieu Schmidt, Vasileios Zochios, Abhijit Duggal","doi":"10.1097/MAT.0000000000002369","DOIUrl":"10.1097/MAT.0000000000002369","url":null,"abstract":"Right ventricular injury (RVI) in respiratory failure receiving veno-venous extracorporeal membrane oxygenation (VV ECMO) is associated with significant mortality. A scoping review is necessary to map the current literature and guide future research regarding the definition and management of RVI in patients receiving VV ECMO. We searched for relevant publications on RVI in patients receiving VV ECMO in Medline, EMBASE, and Web of Science. Of 1,868 citations screened, 30 studies reported on RVI (inclusive of right ventricular dilation, right ventricular dysfunction, and right ventricular failure) during VV ECMO. Twenty-three studies reported on the definition of RVI including echocardiographic indices of RV function and dimensions, whereas 13 studies reported on the management of RVI, including veno-pulmonary (VP) ECMO, veno-arterial (VA) ECMO, positive inotropic agents, pulmonary vasodilators, ultra-lung-protective ventilation (Ultra-LPV), and optimization of positive end-expiratory pressure (PEEP). The definitions of RVI in patients receiving VV ECMO used in the literature are heterogeneous. Despite the high incidence of RVI during VV ECMO support and its strong association with mortality, studies investigating therapeutic strategies for RVI are also lacking. To fill the existing knowledge gaps, a consensus on the definition of RVI and research investigating RV-targeted therapies during VV ECMO is urgently warranted.","PeriodicalId":8844,"journal":{"name":"ASAIO Journal","volume":" ","pages":"482-491"},"PeriodicalIF":3.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142943015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Comparison of Different Membranes for Continuous Renal Replacement Therapies: An In Vitro Study. 连续肾替代治疗中不同膜的比较：一项体外研究。

IF 3.1 3区医学

ASAIO Journal Pub Date : 2025-06-01 Epub Date: 2025-02-05 DOI: 10.1097/MAT.0000000000002387

Benjamin Malard, Michael Hulko, Julia Koch, Rose Speidel, Dominique Pouchoulin, Jorge Echeverri, Lenar Yessayan

{"title":"Comparison of Different Membranes for Continuous Renal Replacement Therapies: An In Vitro Study.","authors":"Benjamin Malard, Michael Hulko, Julia Koch, Rose Speidel, Dominique Pouchoulin, Jorge Echeverri, Lenar Yessayan","doi":"10.1097/MAT.0000000000002387","DOIUrl":"10.1097/MAT.0000000000002387","url":null,"abstract":"Inflammatory mediators play a major role in the development and progression of acute kidney injury (AKI). Continuous renal replacement therapy (CRRT) removes these mediators from the blood using AN69-M, AN69-ST, and HF1400 filters to target low and middle-molecular weight molecules. We characterized the in vitro removal performance of each filter in a 72 hour simulated CRRT procedure. Urea clearance with AN69-M and AN69-ST remained stable (52.4 and 51.2 ml/minute, respectively) but decreased with HF1400 (47.0 ml/minute; p < 0.001). Vancomycin clearance remained stable for AN69 filters but decreased for HF1400. Interleukin (IL)-8 was removed primarily via adsorption with the AN69 filters (92.2 and 91.2 ml/minute for AN69-M and AN69-ST, respectively), but clearance was significantly lower with HF1400 (8.4 ml/minute). Tumor necrosis factor (TNF)-α clearance was higher with AN69-ST compared with AN69-M or HF1400 (10.3, 1.8, and 2.3 ml/minute, respectively). β 2 -microglobulin clearance was higher with both AN69-based filters. The hydrogel water repartition of AN69 filters was different, with a higher percentage of bound water in AN69-ST versus AN69-M (30.5% ± 0.2% and 19.3% ± 1.5%, respectively; p < 0.05). These results suggest that clearance profiles of CRRT filters differ according to their properties; further investigation is needed to translate this into clinical improvements.","PeriodicalId":8844,"journal":{"name":"ASAIO Journal","volume":" ","pages":"510-518"},"PeriodicalIF":3.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12122088/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143187751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Thrombocytopenia During Venovenous Extracorporeal Membrane Oxygenation in Adult Patients With Bacterial, Viral, and COVID-19 Pneumonia. 成人细菌性、病毒性和COVID-19肺炎患者静脉-静脉体外膜氧合期间血小板减少。

IF 3.1 3区医学

ASAIO Journal Pub Date : 2025-06-01 Epub Date: 2025-01-28 DOI: 10.1097/MAT.0000000000002383

Karla Lehle, Alois Philipp, Lars Krenkel, Michael Gruber, Karl-Anton Hiller, Thomas Müller, Matthias Lubnow

{"title":"Thrombocytopenia During Venovenous Extracorporeal Membrane Oxygenation in Adult Patients With Bacterial, Viral, and COVID-19 Pneumonia.","authors":"Karla Lehle, Alois Philipp, Lars Krenkel, Michael Gruber, Karl-Anton Hiller, Thomas Müller, Matthias Lubnow","doi":"10.1097/MAT.0000000000002383","DOIUrl":"https://doi.org/10.1097/MAT.0000000000002383","url":null,"abstract":"Contact of blood with artificial surfaces triggers platelet activation. The aim was to compare platelet kinetics after venovenous extracorporeal membrane oxygenation (V-V ECMO) start and after system exchange in different etiologies of acute lung failure. Platelet counts and coagulation parameters were analyzed from adult patients with long and exchange-free (≥8 days) ECMO runs (n = 330) caused by bacterial (n = 142), viral (n = 76), or coronavirus disease 2019 (COVID-19) (n = 112) pneumonia. A subpopulation requiring a system exchange and with long, exchange-free runs of the second oxygenator (≥7 days) (n = 110) was analyzed analogously. Patients with COVID-19 showed the highest platelet levels before ECMO implantation. Independent of the underlying disease and ECMO type, platelet counts decreased significantly within 24 hours and reached a steady state after 5 days. In the subpopulation, at the day of a system exchange, platelet counts were lower compared with ECMO start, but without differences between underlying diseases. Subsequently, platelets remained unchanged in the bacterial pneumonia group, but increased in the COVID-19 and viral pneumonia groups within 2-4 days, whereas D-dimers decreased and fibrinogen levels increased. Thus, overall platelet counts on V-V ECMO show disease-specific initial dynamics followed by an ongoing consumption by the ECMO device, which is not boosted by new artificial surfaces after a system exchange.","PeriodicalId":8844,"journal":{"name":"ASAIO Journal","volume":"71 6","pages":"498-509"},"PeriodicalIF":3.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144198222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A Predictive Marker for Right Heart Failure After Left Ventricular Assist Device Implantation: The Direct Bilirubin to Total Bilirubin Ratio. 左心室辅助装置植入后右心衰的预测指标：直接胆红素与总胆红素比值。

IF 3.1 3区医学

ASAIO Journal Pub Date : 2025-06-01 Epub Date: 2025-03-06 DOI: 10.1097/MAT.0000000000002398

Ping Qing, Sheng Zhao, Xingtong Zhou, Juan Du, Liang Zou, Fujian Duan, Haibo Chen, Xianqiang Wang, Shengshou Hu

{"title":"A Predictive Marker for Right Heart Failure After Left Ventricular Assist Device Implantation: The Direct Bilirubin to Total Bilirubin Ratio.","authors":"Ping Qing, Sheng Zhao, Xingtong Zhou, Juan Du, Liang Zou, Fujian Duan, Haibo Chen, Xianqiang Wang, Shengshou Hu","doi":"10.1097/MAT.0000000000002398","DOIUrl":"10.1097/MAT.0000000000002398","url":null,"abstract":"Early right heart failure (RHF) after left ventricular assist device (LVAD) implantation poses significant morbidity and mortality risks. Existing RHF prediction scores are complex, typically requiring multiple indicators and evaluation steps. This research aimed to explore a more feasible predictor for initial screening of early RHF. This multicenter, retrospective analysis included 83 consecutively enrolled patients undergoing continuous-flow LVAD implantation. Multivariable logistic regression identified independent predictors of early RHF, whereas receiver operating characteristic (ROC) curve analysis assessed predictive value. Among the 83 patients, 21 (25.3%) experienced early RHF. Logistic regression analyses revealed that the direct bilirubin to total bilirubin (DBIL/TBIL) ratio on admission was significantly correlated with early RHF (adjusted odds ratio [OR]: 2.41, 95% confidence interval [CI]: 1.35-4.31, p = 0.003). The DBIL/TBIL ratio on admission exhibited the highest area under the receiver operating characteristic curve (AUC) (0.767, 95% CI: 0.661-0.852). Internal validation using bootstrap techniques resulted in a mean AUC of 0.767 (95% CI: 0.640-0.879), whereas external validation in a cohort of 31 patients demonstrated an AUC of 0.682 (95% CI: 0.491-0.837). An optimal DBIL/TBIL ratio threshold of 0.52 yielded 76.19% sensitivity and 79.03% specificity for early RHF prediction. In subgroups with different TBIL levels, sensitivity and specificity were 70.0% and 86.67% for TBIL greater than or equal to 2 mg/dl, and 81.82% and 76.60% for TBIL less than 2 mg/dl, respectively. The DBIL/TBIL ratio upon admission is a viable predictor of early RHF following LVAD implantation, demonstrating acceptable predictive efficacy.","PeriodicalId":8844,"journal":{"name":"ASAIO Journal","volume":" ","pages":"472-481"},"PeriodicalIF":3.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12122093/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143566003","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Closed-Loop Automated Control System of Extracorporeal Membrane Oxygenation and Left Ventricular Assist Device Support in Cardiogenic Shock. 心源性休克中体外膜氧合和左心室辅助装置支持的闭环自动控制系统。

IF 3.1 3区医学

ASAIO Journal Pub Date : 2025-06-01 Epub Date: 2024-12-17 DOI: 10.1097/MAT.0000000000002359

Takashi Unoki, Kazunori Uemura, Shohei Yokota, Hiroki Matsushita, Midori Kakuuchi, Hidetaka Morita, Kei Sato, Yuki Yoshida, Kazumasu Sasaki, Yasuyuki Kataoka, Takuya Nishikawa, Masafumi Fukumitsu, Toru Kawada, Kenji Sunagawa, Joe Alexander, Keita Saku

{"title":"Closed-Loop Automated Control System of Extracorporeal Membrane Oxygenation and Left Ventricular Assist Device Support in Cardiogenic Shock.","authors":"Takashi Unoki, Kazunori Uemura, Shohei Yokota, Hiroki Matsushita, Midori Kakuuchi, Hidetaka Morita, Kei Sato, Yuki Yoshida, Kazumasu Sasaki, Yasuyuki Kataoka, Takuya Nishikawa, Masafumi Fukumitsu, Toru Kawada, Kenji Sunagawa, Joe Alexander, Keita Saku","doi":"10.1097/MAT.0000000000002359","DOIUrl":"10.1097/MAT.0000000000002359","url":null,"abstract":"Venoarterial extracorporeal membrane oxygenation (VA-ECMO) benefits patients with cardiogenic shock (CS) but can increase left ventricular afterload and exacerbate pulmonary edema. Adding a percutaneous left ventricular assist device (LVAD) to VA-ECMO can optimize the hemodynamics. Because managing VA-ECMO and LVAD simultaneously is complex and labor-intensive, we developed a closed-loop automated control system for VA-ECMO and LVAD. Based on the circulatory equilibrium framework, this system automatically adjusts VA-ECMO and LVAD flows and cardiovascular drug and fluid dosages to achieve target arterial pressure (AP, 70 mm Hg), left atrial pressure ( PLA , 14 mm Hg), and total systemic flow ( Ftotal , 120-140 ml/min/kg). In seven anesthetized dogs with CS, VA-ECMO significantly increased AP and PLA from 24 (23-27) to 71 (63-77) mm Hg and 20.1 (16.3-22.1) to 43.0 (25.7-51.4) mm Hg, respectively. Upon system activation, PLA was promptly reduced. At 60 min postactivation, the system-controlled AP to 69 (65-74) mm Hg, PLA to 12.5 (12.0-13.4) mm Hg, and Ftotal to 117 (114-132) ml/min/kg while adjusting VA-ECMO flow to 59 (12-60) ml/min/kg, LVAD flow to 68 (54-78) ml/min/kg, and cardiovascular drug and fluid dosages. This system automatically optimizes VA-ECMO and LVAD hemodynamics, making it an attractive tool for rescuing patients with CS.","PeriodicalId":8844,"journal":{"name":"ASAIO Journal","volume":" ","pages":"461-471"},"PeriodicalIF":3.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142833715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0