ASAIO JournalPub Date : 2025-08-27DOI: 10.1097/MAT.0000000000002542
Hitesh S Sandhu, Kimberly Fan, Samir Shah, Xiaomeng Yuan, Laurel Metzler, Jennifer McArthur, Dai Kimura, Melissa Hines, Caitlin Hurley, Akshay Sharma, Katy Rower, Haitao Pan, Jeffery Brown, R Ray Morrison, Saad Ghafoor
{"title":"Pediatric Critical Hematology Oncology Referral Pathway for Extracorporeal Life Support: Standardized Evaluation and Transfer Can Improve Survival.","authors":"Hitesh S Sandhu, Kimberly Fan, Samir Shah, Xiaomeng Yuan, Laurel Metzler, Jennifer McArthur, Dai Kimura, Melissa Hines, Caitlin Hurley, Akshay Sharma, Katy Rower, Haitao Pan, Jeffery Brown, R Ray Morrison, Saad Ghafoor","doi":"10.1097/MAT.0000000000002542","DOIUrl":"https://doi.org/10.1097/MAT.0000000000002542","url":null,"abstract":"<p><p>Over the last decade, extracorporeal life support (ECLS) use for patients with a hematologic or oncologic diagnosis or who have undergone hematopoietic cell transplant has increased, with steadily improving outcomes. To standardize our approach to early evaluation and identification of ECLS candidates, we developed the Critical Hematology Oncology Referral Pathway for Extracorporeal Life Support (CHORPE). We performed a retrospective chart review of patients transferred between two pediatric hospitals for ECLS evaluation. Forty-six patients were transferred for ECLS evaluation: 17 pre-CHORPE, 28 post-CHORPE implementation, and 1 index patient between January 2010 and December 2021. Six were placed on ECLS in the preprocess group; three survived decannulation, but none survived to hospital discharge. In the post-process group, nine were placed on ECLS, with six surviving to decannulation and transfer back to the referring hospital (odds ratios [OR] = 24, p = 0.01) and five surviving to hospital discharge (OR = 15.9, p = 0.03). In the post-process group, there were fewer complications during transfer (p = 0.0228), and clinical improvement was the reason for not going on ECLS (p = 0.0120). A standardized approach to ECLS candidacy evaluation, early identification, and safe transfer with continuity of care is associated with improved survival after ECLS.</p>","PeriodicalId":8844,"journal":{"name":"ASAIO Journal","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144940489","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}
ASAIO JournalPub Date : 2025-08-26DOI: 10.1097/MAT.0000000000002533
Frida Nilsson, Monica Emendi, Lars Mikael Broman, Lisa Prahl Wittberg
{"title":"Protruding Objects in the Membrane Lung Outlet May Increase Thrombogenicity: Fluid Dynamical Insights.","authors":"Frida Nilsson, Monica Emendi, Lars Mikael Broman, Lisa Prahl Wittberg","doi":"10.1097/MAT.0000000000002533","DOIUrl":"https://doi.org/10.1097/MAT.0000000000002533","url":null,"abstract":"<p><p>Thrombosis in extracorporeal membrane oxygenation (ECMO) circuit components remains a challenge. Besides blood state and surface properties, flow plays a critical role in hemostasis. In this work, we aimed to study the fluid dynamics of a membrane lung (ML) outlet due to its complex design with pins protruding into the blood flow stream (temperature sensor and cap of purge line), with respect to the potential risk of flow-induced coagulation activation. Large eddy simulations were carried out for blood flow of 1 and 4 L/min. Recirculation bubbles and strong vortical structures developed in this geometry. These flow structures were similar to characteristics of flow past bluff bodies, which facilitate entrapment of platelets that may be activated by the elongational shear rates (> 2,000 s-1), observed near the surface of the temperature sensor for the 4 L/min case. Moreover, a thrombus, extracted from an ECMO circuit, was analyzed by scanning electron microscopy. It is concluded that a review of devices used for ECMO with auxiliary objects protruding into the bloodstream is warranted for improvement of design to reduce the risk of blood trauma and coagulation activation.</p>","PeriodicalId":8844,"journal":{"name":"ASAIO Journal","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144940554","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}
ASAIO JournalPub Date : 2025-08-25DOI: 10.1097/MAT.0000000000002538
Yutaka Shishido, Kaitlyn M Tracy, Michael Cortelli, Victoria Simon, Kimya Raietparvar, TiOluwanimi Adesanya, Mark Petrovic, Elizabeth Simonds, Andrew Kumpfbeck, Yerin Woo, Brandon Petree, Enock Adjei, Jody K Peters, W Christian Crannell, Caitlin T Demarest, Rei Ukita, Jiancong Liang, Michael D Rizzarri, Martin I Montenovo, Joseph F Magliocca, Seth J Karp, M Ameen Rauf, Matthew Bacchetta
{"title":"Comparison of Cellular and Acellular Perfusate in the Dynamic Organ Storage System Using a Porcine Donation After Circulatory Death Model.","authors":"Yutaka Shishido, Kaitlyn M Tracy, Michael Cortelli, Victoria Simon, Kimya Raietparvar, TiOluwanimi Adesanya, Mark Petrovic, Elizabeth Simonds, Andrew Kumpfbeck, Yerin Woo, Brandon Petree, Enock Adjei, Jody K Peters, W Christian Crannell, Caitlin T Demarest, Rei Ukita, Jiancong Liang, Michael D Rizzarri, Martin I Montenovo, Joseph F Magliocca, Seth J Karp, M Ameen Rauf, Matthew Bacchetta","doi":"10.1097/MAT.0000000000002538","DOIUrl":"https://doi.org/10.1097/MAT.0000000000002538","url":null,"abstract":"","PeriodicalId":8844,"journal":{"name":"ASAIO Journal","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144940798","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}
ASAIO JournalPub Date : 2025-08-25DOI: 10.1097/MAT.0000000000002540
Caroline Holton, Johanna Orrick, Debra Newton, Jenna O Miller
{"title":"Large Single-Center Experience With Extubation During Neonatal and Pediatric Extracorporeal Membrane Oxygenation.","authors":"Caroline Holton, Johanna Orrick, Debra Newton, Jenna O Miller","doi":"10.1097/MAT.0000000000002540","DOIUrl":"https://doi.org/10.1097/MAT.0000000000002540","url":null,"abstract":"<p><p>Extubation of select neonatal and pediatric patients supported with extracorporeal membrane oxygenation (ECMO) may avoid ventilator-induced lung injury, decrease neurosedative exposure, and improve rehabilitation. A single-center retrospective cohort study was performed to describe our experience with extubation of ECMO patients in the cardiac intensive care unit (CICU), pediatric intensive care unit (PICU), and neonatal intensive care unit (NICU). This is the largest reported single-center cohort of extubated pediatric patients to our knowledge. From 2013 to 2022, we extubated 8.6% of all ECMO runs, resulting in a total of 40 patients extubated on ECMO. Extubated patients tended to be older, cannulated for pulmonary support, and tended to have longer runs. Survival to hospital discharge for extubated ECMO patients was 75%, significantly higher than the non-extubated cohort (p = 0.044). After adjustment for duration of ECMO run, extubated patients had more gastrointestinal (GI) hemorrhage and continuous renal replacement therapy (CRRT) usage, but did not have more mechanical, neurologic, cardiovascular, or pulmonary complications. With 10 years of data on extubation on ECMO, we present evidence that extubation on ECMO is feasible and can be done safely.</p>","PeriodicalId":8844,"journal":{"name":"ASAIO Journal","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144940422","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}
ASAIO JournalPub Date : 2025-08-22DOI: 10.1097/MAT.0000000000002530
Kimberly A Pyke-Grimm, Michelle Brown, Alaa Youssef, Mariel Spengler, Seth A Hollander, Chris Feudtner, Danton Char
{"title":"Clinician Perspectives on Compassionate Deactivation of Pediatric Ventricular Assist Devices.","authors":"Kimberly A Pyke-Grimm, Michelle Brown, Alaa Youssef, Mariel Spengler, Seth A Hollander, Chris Feudtner, Danton Char","doi":"10.1097/MAT.0000000000002530","DOIUrl":"https://doi.org/10.1097/MAT.0000000000002530","url":null,"abstract":"<p><p>Following ventricular assist device (VAD) placement, families and clinicians often have differing perspectives. When adverse events reduce patients' quality of life, families and clinicians question the desirability of continuing VAD support. Given the increasing use of VAD in pediatrics, pediatric-specific guidelines for the process of compassionate deactivation (CD) of VAD are needed, based in part on the perspectives of pediatric heart failure clinicians. In this qualitative study, we used a semi-structured interview guide focused on CD. Twenty-one clinicians participated. The central theme characterizing the process of CD-VAD is Making the Decision to CD-VAD . Five categories emerged: 1) communication strategies, 2) relationships and trust, 3) importance of time, 4) emotional toll, and 5) redirecting care. Consensus in decision-making was achieved through collective discussions among staff and care team meetings, including families. Clinicians reported experiencing moral and emotional distress, primarily due to witnessing patient suffering, triggered by close relationships with patients and families, and discord around CD decisions. This study clarifies challenges posed by CD-VAD. Understanding these challenges is a necessary first step in the development of guidance to provide cardiac care integrated with pediatric palliative care (PPC) for children with implanted VAD, and to respond appropriately to circumstances where CD may be warranted.</p>","PeriodicalId":8844,"journal":{"name":"ASAIO Journal","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144940816","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}
ASAIO JournalPub Date : 2025-08-22DOI: 10.1097/MAT.0000000000002539
Friederike M Krechel, Judith Leyens, Eva Schoenenborn, Ramona Dolscheid-Pommerich, Bartolomeo Bo, Tamene Melaku, Christoph Berg, Andreas Mueller, Florian Kipfmueller
{"title":"Inflammatory Markers During Extracorporeal Membrane Oxygenation in Neonates With Congenital Diaphragmatic Hernia.","authors":"Friederike M Krechel, Judith Leyens, Eva Schoenenborn, Ramona Dolscheid-Pommerich, Bartolomeo Bo, Tamene Melaku, Christoph Berg, Andreas Mueller, Florian Kipfmueller","doi":"10.1097/MAT.0000000000002539","DOIUrl":"https://doi.org/10.1097/MAT.0000000000002539","url":null,"abstract":"<p><p>This study aimed to assess whether the proinflammatory markers procalcitonin (PCT), C-reactive protein (CRP), or interleukin 6 (IL-6) are associated with mortality in neonates with congenital diaphragmatic hernia (CDH) requiring extracorporeal membrane oxygenation (ECMO). Congenital diaphragmatic hernia neonates receiving venovenous ECMO between December 2012 and June 2022 were retrospectively reviewed and grouped by survival status. Longitudinal CRP, PCT, and IL-6 levels during the first 10 days on ECMO were analyzed using the Mann-Whitney U test. A PCT cut-off was determined to define a \"high inflammatory response group,\" further evaluated with Kaplan-Meier curves and the log-rank test. Independent mortality risk factors were identified using Cox regression. Among nonsurvivors, PCT values were significantly higher on day 2 (p = 0.028), day 3 (p = 0.028), day 6 (p = 0.031), and day 10 (p = 0.017) after ECMO initiation. Infants in the high inflammatory response group had significantly shorter survival time (p = 0.006). C-Reactive protein and IL-6 were not significantly associated with mortality. In multivariable Cox regression analysis, high PCT on day 2 of ECMO (hazard ratio: 1.022; 95% confidence interval [CI]: 1.004-1.040) and severe pulmonary hypertension (hazard ratio: 3.270; 95% CI: 1.245-8.588) were independently associated with mortality. High PCT in CDH neonates receiving ECMO is significantly associated with increased mortality and reduced survival time.</p>","PeriodicalId":8844,"journal":{"name":"ASAIO Journal","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144939730","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}
ASAIO JournalPub Date : 2025-08-22DOI: 10.1097/MAT.0000000000002532
Andrew Kalra, Jin Kook Kang, Christopher Wilcox, Patricia Brown, Eva Ritzl, Joseph E Bavaria, Akram M Zaaqoq, Daniel Brodie, Glenn J R Whitman, Sung-Min Cho
{"title":"Incidence, Risk Factors, and Outcomes of Seizures in Extracorporeal Cardiopulmonary Resuscitation Patients: An Analysis of the Extracorporeal Life Support Organization Registry.","authors":"Andrew Kalra, Jin Kook Kang, Christopher Wilcox, Patricia Brown, Eva Ritzl, Joseph E Bavaria, Akram M Zaaqoq, Daniel Brodie, Glenn J R Whitman, Sung-Min Cho","doi":"10.1097/MAT.0000000000002532","DOIUrl":"https://doi.org/10.1097/MAT.0000000000002532","url":null,"abstract":"<p><p>Extracorporeal cardiopulmonary resuscitation (ECPR) for refractory cardiac arrest is increasing in usage, but risk factors for seizures are largely unknown. We included adult ECPR patients in the Extracorporeal Life Support Organization Registry from 512 extracorporeal membrane oxygenation (ECMO) centers (2013-2023). Seizures were determined clinically or by electroencephalogram. Acute brain injury included ischemic stroke, hypoxic-ischemic brain injury, and intracranial hemorrhage. Among 13,783 ECPR patients (median age = 56.7 years, 69% = male), 346 (3%) experienced seizures. Of these, 204 (59%) were clinically detected, 193 (56%) were electroencephalogram (EEG)-detected, and 51 (15%) were detected by both. From 2013 to 2023, ECPR cases increased (n = 442 to 1,123; p < 0.001) while seizure incidence declined (5-3%; p = 0.02). Mortality was higher among patients with seizures (77% vs. 69%; p < 0.001). Patients with seizures died earlier (7.3 days) than patients without 15 seizures (10.8 days, p < 0.0001). In multivariable logistic regression, ABI (adjusted odds ratio [aOR] = 2.65, 95% confidence interval [CI] = 1.89-3.67), moderate hyperoxia (aOR = 1.60, 95% CI = 1.05-2.39), arrhythmia (aOR = 1.44, 95% CI = 1.00-2.03), and partial pressure of carbon dioxide (ΔPaCO 2 ) (aOR = 1.12, 95% CI = 1.06-1.17) were significant risk factors for seizures. In multivariable logistic regression, after adjusting for ABI, seizures (aOR = 2.32, 95% CI = 1.09-4.95) increased the risjk of 90 day mortality. Extracorporeal cardiopulmonary resuscitation use increased from 2013 to 2023, with decreasing incidence of seizures, although this trend may be influenced by underreporting and evolving EEG practices. Seizures were an independent risk factor for 90 day mortality.</p>","PeriodicalId":8844,"journal":{"name":"ASAIO Journal","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144940804","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}
ASAIO JournalPub Date : 2025-08-22DOI: 10.1097/MAT.0000000000002536
Antony P McNamee, Daniel Timms, Frank Nestler, Nicole Bartnikowski, Geoff D Tansley, Eric Wu, Michael J Simmonds
{"title":"In Vitro Hemocompatibility of the BiVACOR Total Artificial Heart Near the Boundaries of Clinical Operation.","authors":"Antony P McNamee, Daniel Timms, Frank Nestler, Nicole Bartnikowski, Geoff D Tansley, Eric Wu, Michael J Simmonds","doi":"10.1097/MAT.0000000000002536","DOIUrl":"https://doi.org/10.1097/MAT.0000000000002536","url":null,"abstract":"<p><p>Current mechanical circulatory support demonstrates excellent in vitro hemocompatibility when operated at the design point, although clinical requirements demand devices be used \"off design,\" which may introduce higher stresses or residence times of blood. We evaluated the in vitro hemocompatibility of the BiVACOR total artificial heart (TAH) when operated at the boundaries of clinical need. Cattle blood was circulated in an in vitro blood loop at 3.0 L/min (low flow [LF]) or 12.0 L/min (high flow [HF]) in a pulsatile manner (+900 rev/min at 1 Hz) for 6 h using the TAH, for comparisons with a clinical comparator device operated in continuous flow. In LF, the normalized index of hemolysis (NIH) was 0.003 ± 0.002 g/100 L for the TAH, which was higher than the comparator (0.001 ± 0.001 g/100 L). In HF conditions, NIH was not different between devices: the TAH generated 0.004 ± 0.002 g/100 L and the comparator 0.002 ± 0.003 g/100 L. BiVACOR's TAH generated similar hemocompatibility to a clinically approved comparator, despite the TAH generating a clinically meaningful pulse pressure. Given that the TAH requires blood to transit the pump approximately twice as frequently as the comparator, these findings are promising for future applications.</p>","PeriodicalId":8844,"journal":{"name":"ASAIO Journal","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144940806","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}
ASAIO JournalPub Date : 2025-08-22DOI: 10.1097/MAT.0000000000002528
August Lundquist, Elira Maksuti, Dirk W Donker, Michael Broomé
{"title":"Patient-Specific Size and Age Scaling in a Zero Dimensional Cardiovascular Model.","authors":"August Lundquist, Elira Maksuti, Dirk W Donker, Michael Broomé","doi":"10.1097/MAT.0000000000002528","DOIUrl":"https://doi.org/10.1097/MAT.0000000000002528","url":null,"abstract":"<p><p>Computational cardiovascular models hold promise for simulations in education and bedside clinical decision support. To enhance patient-specific modeling, individual anthropometrics are imperative, as physiology varies with body size due to fundamental energetic relations expressed in allometric scaling laws. We hypothesize that computational cardiovascular models can be advanced towards individualization by implementing scaling laws based on patient age, weight, height, and sex. A scaling methodology was developed for the lumped-parameter cardiovascular model Aplysia Cardiovascular Lab. Male and female subjects were based on Swedish growth charts from birth to adult size and simulated to test model realism. Realistic physiology was generated for underweight, overweight, and average male and female patients from birth to 80 years. Model output included comprehensive measures of hemodynamics, cardiac function, respiratory function, gas exchange, ventilatory mechanics, and energy expenditure. In comparison to published data, aggregate Z scores for infant, pediatric, and geriatric simulations were 1.16, 0.69, and 0.10, respectively. Allometric scaling laws can be used to generate parameter sets of males and females of disparate sizes and ages in line with published data. This sets the stage for modeling diverse patient populations and novel approaches toward individualized clinical applications.</p>","PeriodicalId":8844,"journal":{"name":"ASAIO Journal","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144940419","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}