Pub Date : 2024-02-01Epub Date: 2024-01-02DOI: 10.1177/03913988231218884
Jiaming Wang, Mingchong Liu, Chensong Yang, Yutao Pan, Shengchao Ji, Ning Han, Guixin Sun
Bone defects or bone discontinuities caused by trauma, infection, tumours and other diseases have led to an increasing demand for bone grafts and biomaterials. Autologous bone grafts, bone grafts with vascular tips, anastomosed vascular bone grafts and autologous bone marrow components are all commonly used in clinical practice, while oversized bone defects require the use of bone tissue engineering-related biomaterials to repair bone defects and promote bone regeneration. Currently, inorganic components such as polysaccharides and bioceramics, as well as a variety of bioactive proteins, metal ions and stem cells can be loaded into hydrogels or 3D printed scaffold materials to achieve better therapeutic results. In this review, we provide an overview of the types of materials, applications, potential mechanisms and current developments in the repair of bone defects.
{"title":"Biomaterials for bone defect repair: Types, mechanisms and effects.","authors":"Jiaming Wang, Mingchong Liu, Chensong Yang, Yutao Pan, Shengchao Ji, Ning Han, Guixin Sun","doi":"10.1177/03913988231218884","DOIUrl":"10.1177/03913988231218884","url":null,"abstract":"<p><p>Bone defects or bone discontinuities caused by trauma, infection, tumours and other diseases have led to an increasing demand for bone grafts and biomaterials. Autologous bone grafts, bone grafts with vascular tips, anastomosed vascular bone grafts and autologous bone marrow components are all commonly used in clinical practice, while oversized bone defects require the use of bone tissue engineering-related biomaterials to repair bone defects and promote bone regeneration. Currently, inorganic components such as polysaccharides and bioceramics, as well as a variety of bioactive proteins, metal ions and stem cells can be loaded into hydrogels or 3D printed scaffold materials to achieve better therapeutic results. In this review, we provide an overview of the types of materials, applications, potential mechanisms and current developments in the repair of bone defects.</p>","PeriodicalId":13932,"journal":{"name":"International Journal of Artificial Organs","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139080529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-01Epub Date: 2024-01-05DOI: 10.1177/03913988231220844
Jose E Cardier, Dylana Diaz-Solano, Olga Wittig, Giuseppe Sierra, Jose Pulido, Rita Moreno, Soraima Fuentes, Fredy Leal
Background: Congenital pseudoarthrosis of the tibia (CPT) is an uncommon disease associated with failure to achieve bone union and recurrent fractures. There is evidence showing that CPT is associated with decreased osteogenesis. Based on the capacity of mesenchymal stromal cells (MSCs) to induce osteogenesis, we develop an osteogenic organoid (OstO) constituted by these cells, and other components of the bone niche, for inducing bone formation in a child diagnosed with CPT.
Aim: To evaluate the capacity of an OstO to induce bone formation in a patient with CPT.
Methods: The OstO was fabricated with allogeneic bone marrow MSCs from a healthy donor, collagen microbeads (CM) and PRP clot. The CM and PRP function as extracellular matrix and scaffolds for MSC. The OstO was placed at the site of non-union. Internal and external fixation was placed in the tibia. Radiological evaluation was performed after MSCs transplantation.
Results: After 4 months of MSCs transplantation, radiographic imaging showed evidence of osteogenesis at the site of CPT lesion. The tibia showed bone consolidation and complete healing of the non-union CPT lesion after 6 months. Functional improvement was observed after 1 year of MSC transplantation.
Conclusions: The OstO is a bone-like niche which promote osteogenesis in patients with failure in bone formation, such as CPT. To our knowledge, these results provide the first evidence showing CPT healing induced by an OstO constituted by allogeneic MSCs. Future studies incorporating a larger number of patients may confirm these results.
{"title":"Osteogenic organoid for bone regeneration: Healing of bone defect in congenital pseudoarthrosis of the tibia.","authors":"Jose E Cardier, Dylana Diaz-Solano, Olga Wittig, Giuseppe Sierra, Jose Pulido, Rita Moreno, Soraima Fuentes, Fredy Leal","doi":"10.1177/03913988231220844","DOIUrl":"10.1177/03913988231220844","url":null,"abstract":"<p><strong>Background: </strong>Congenital pseudoarthrosis of the tibia (CPT) is an uncommon disease associated with failure to achieve bone union and recurrent fractures. There is evidence showing that CPT is associated with decreased osteogenesis. Based on the capacity of mesenchymal stromal cells (MSCs) to induce osteogenesis, we develop an osteogenic organoid (OstO) constituted by these cells, and other components of the bone niche, for inducing bone formation in a child diagnosed with CPT.</p><p><strong>Aim: </strong>To evaluate the capacity of an OstO to induce bone formation in a patient with CPT.</p><p><strong>Methods: </strong>The OstO was fabricated with allogeneic bone marrow MSCs from a healthy donor, collagen microbeads (CM) and PRP clot. The CM and PRP function as extracellular matrix and scaffolds for MSC. The OstO was placed at the site of non-union. Internal and external fixation was placed in the tibia. Radiological evaluation was performed after MSCs transplantation.</p><p><strong>Results: </strong>After 4 months of MSCs transplantation, radiographic imaging showed evidence of osteogenesis at the site of CPT lesion. The tibia showed bone consolidation and complete healing of the non-union CPT lesion after 6 months. Functional improvement was observed after 1 year of MSC transplantation.</p><p><strong>Conclusions: </strong>The OstO is a bone-like niche which promote osteogenesis in patients with failure in bone formation, such as CPT. To our knowledge, these results provide the first evidence showing CPT healing induced by an OstO constituted by allogeneic MSCs. Future studies incorporating a larger number of patients may confirm these results.</p>","PeriodicalId":13932,"journal":{"name":"International Journal of Artificial Organs","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139106107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: To systematically evaluate the clinical efficacy of pulmonary rehabilitation in patients with mechanical ventilation in an intensive care unit (ICU).
Methods: Relevant studies were identified in the PubMed, Web of Science, National Library of Medicine, China National Knowledge Infrastructure and Wanfang databases. A meta-analysis was performed after screening based on the inclusion and exclusion criteria, data extraction and literature quality evaluation.
Results: In total, 19 studies involving 2181 participants were included. The results of the meta-analysis revealed that compared with patients with conventional rehabilitation measures, patients with pulmonary rehabilitation measures had a higher offline success rate (relative risk (RR) = 1.16; 95% confidence interval (CI): 1.09, 1.24; p < 0.00001) and higher arterial oxygen partial pressure levels (mean difference (MD) = 8.96; 95%CI: 5.98, 11.94; p < 0.0001) and these measures significantly shortened the duration of mechanical ventilation (standardised MD (SMD) = -1.08; 95%CI: -1.58, -0.59; p < 0.0001) and ICU stay (SMD = -1.41; 95%CI: -1.94, -0.88; p < 0.0001). Aspiration significantly reduced the incidence of ventilator-associated pneumonia (RR = 0.35; 95%CI: 0.24, 0.51; p < 0.00001) and deep vein thrombosis (RR = 0.32; 95%CI: 0.13, 0.76; p = 0.01) in ICU patients with mechanical ventilation.
Conclusion: Pulmonary rehabilitation measures can improve the success rate of weaning from mechanical ventilation in ICU patients, shorten the time of mechanical ventilation and ICU hospitalisation and reduce the incidence of related adverse reactions, but the impact on mortality requires further study.
目的:系统评估重症监护病房机械通气患者肺康复治疗的临床疗效:系统评估肺康复治疗在重症监护病房(ICU)机械通气患者中的临床疗效:在 PubMed、Web of Science、美国国家医学图书馆、中国国家知识基础设施和万方数据库中查找相关研究。根据纳入和排除标准进行筛选、数据提取和文献质量评估后,进行荟萃分析:结果:共纳入 19 项研究,涉及 2181 名参与者。荟萃分析结果显示,与采用常规康复措施的患者相比,采用肺康复措施的 ICU 患者机械通气的脱机成功率更高(相对风险(RR)= 1.16;95% 置信区间(CI):1.09,1.24;P P P P = 0.01):肺康复措施可提高 ICU 患者机械通气断流的成功率,缩短机械通气和 ICU 住院时间,降低相关不良反应的发生率,但对死亡率的影响还需进一步研究。
{"title":"Clinical effect of pulmonary rehabilitation in patients with mechanical ventilation: A meta-analysis.","authors":"Yang Yang, Rong-Ju Zhang, Xi-Na Yuan, Yue-Qin Gu, Yong-Nan Li, Shu-Ping Wu, Yan-Shuang Cheng","doi":"10.1177/03913988231218116","DOIUrl":"10.1177/03913988231218116","url":null,"abstract":"<p><strong>Objective: </strong>To systematically evaluate the clinical efficacy of pulmonary rehabilitation in patients with mechanical ventilation in an intensive care unit (ICU).</p><p><strong>Methods: </strong>Relevant studies were identified in the PubMed, Web of Science, National Library of Medicine, China National Knowledge Infrastructure and Wanfang databases. A meta-analysis was performed after screening based on the inclusion and exclusion criteria, data extraction and literature quality evaluation.</p><p><strong>Results: </strong>In total, 19 studies involving 2181 participants were included. The results of the meta-analysis revealed that compared with patients with conventional rehabilitation measures, patients with pulmonary rehabilitation measures had a higher offline success rate (relative risk (RR) = 1.16; 95% confidence interval (CI): 1.09, 1.24; <i>p</i> < 0.00001) and higher arterial oxygen partial pressure levels (mean difference (MD) = 8.96; 95%CI: 5.98, 11.94; <i>p</i> < 0.0001) and these measures significantly shortened the duration of mechanical ventilation (standardised MD (SMD) = -1.08; 95%CI: -1.58, -0.59; <i>p</i> < 0.0001) and ICU stay (SMD = -1.41; 95%CI: -1.94, -0.88; <i>p</i> < 0.0001). Aspiration significantly reduced the incidence of ventilator-associated pneumonia (RR = 0.35; 95%CI: 0.24, 0.51; <i>p</i> < 0.00001) and deep vein thrombosis (RR = 0.32; 95%CI: 0.13, 0.76; <i>p</i> = 0.01) in ICU patients with mechanical ventilation.</p><p><strong>Conclusion: </strong>Pulmonary rehabilitation measures can improve the success rate of weaning from mechanical ventilation in ICU patients, shorten the time of mechanical ventilation and ICU hospitalisation and reduce the incidence of related adverse reactions, but the impact on mortality requires further study.</p>","PeriodicalId":13932,"journal":{"name":"International Journal of Artificial Organs","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139377548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Venovenous artificial placenta (VVAP) may mimic the intrauterine environment for maintaining fetal circulation. However, changes in ventricular function in fetal goats undergoing VVAP support remain unclear.
Methods: Pump-assisted VVAPs were established in five fetal goats for 9 h. The myocardial performance index (Tei index), cardiac output (CO), and blood biochemical parameters were measured during VVAP support.
Results: An increasing trend of the right ventricular (RV) Tei index was seen during VVAP support (p for trend < 0.01). The right ventricular cardiac output (RVCO) increased after the initiation of VVAP, while a significant trend of reduction was observed after 3 h (p for trend = 0.03). During VVAP support, we observed remarkable elevations of plasma cTnI and arterial lactic acid, which were positively correlated with the RV Tei index, but not the left ventricular (LV) Tei index, LVCO, and RVCO.
Conclusions: The RVCO increases initially while a tendency of decrease could be observed during VVAP support. Special attention should be paid to right ventricular dysfunction during VVAP support.
{"title":"The alterations of cardiac function during venovenous artificial placenta support in fetal goats.","authors":"Guanhua Li, Mingliang Li, Yun Teng, Li Zhang, Chengcheng Pang, Jianfeng Tan, Jimei Chen, Jian Zhuang, Chengbin Zhou","doi":"10.1177/03913988231215905","DOIUrl":"10.1177/03913988231215905","url":null,"abstract":"<p><strong>Introduction: </strong>Venovenous artificial placenta (VVAP) may mimic the intrauterine environment for maintaining fetal circulation. However, changes in ventricular function in fetal goats undergoing VVAP support remain unclear.</p><p><strong>Methods: </strong>Pump-assisted VVAPs were established in five fetal goats for 9 h. The myocardial performance index (Tei index), cardiac output (CO), and blood biochemical parameters were measured during VVAP support.</p><p><strong>Results: </strong>An increasing trend of the right ventricular (RV) Tei index was seen during VVAP support (<i>p</i> for trend < 0.01). The right ventricular cardiac output (RVCO) increased after the initiation of VVAP, while a significant trend of reduction was observed after 3 h (<i>p</i> for trend = 0.03). During VVAP support, we observed remarkable elevations of plasma cTnI and arterial lactic acid, which were positively correlated with the RV Tei index, but not the left ventricular (LV) Tei index, LVCO, and RVCO.</p><p><strong>Conclusions: </strong>The RVCO increases initially while a tendency of decrease could be observed during VVAP support. Special attention should be paid to right ventricular dysfunction during VVAP support.</p>","PeriodicalId":13932,"journal":{"name":"International Journal of Artificial Organs","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138796394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01Epub Date: 2023-12-23DOI: 10.1177/03913988231215631
Anna Krakowiak, Beata Janasik, Łukasz Sadowski, Katarzyna Szwabe, Tomasz Wiśniewski, Małgorzata Anna Rak, Waldemar Machała
Introduction: The study aims to present a case of acute mercuric chloride poisoning treated successfully with continuous renal replacement therapy using the CytoSorb filter.
Case description: A 21-year-old female patient after a suicide attempt by intentional ingestion of mercuric chloride, was admitted to the hospital with features of multiple organ damage for specific treatment. The performed laboratory tests confirmed high levels of mercury in the blood (1051 μg/L) and urine (22,960 μg/L). Due to acute renal failure, continuous renal replacement therapy (CRRT) CVVHD Ci-Ca was initiated; the procedure was then converted to CVVHDF Ci-Ca with ultrafiltration to optimise therapy, and CytoSorb was added to the artificial kidney system on day 3. Specific antidote therapy (DMPS) was administered concurrently. The ongoing treatment resulted in a reduction in subjective complaints, a decrease in blood mercury levels to 580 μg/L, and an improvement in parenchymal organ function.
Conclusion: In the event of poisoning with inorganic mercury compounds (mercuric chloride), continuous renal replacement therapy using the CytoSorb filter as an extracorporeal blood purification method may be considered.
{"title":"The use of CytoSorb in acute oral mercuric chloride poisoning at a potentially lethal dose.","authors":"Anna Krakowiak, Beata Janasik, Łukasz Sadowski, Katarzyna Szwabe, Tomasz Wiśniewski, Małgorzata Anna Rak, Waldemar Machała","doi":"10.1177/03913988231215631","DOIUrl":"10.1177/03913988231215631","url":null,"abstract":"<p><strong>Introduction: </strong>The study aims to present a case of acute mercuric chloride poisoning treated successfully with continuous renal replacement therapy using the CytoSorb filter.</p><p><strong>Case description: </strong>A 21-year-old female patient after a suicide attempt by intentional ingestion of mercuric chloride, was admitted to the hospital with features of multiple organ damage for specific treatment. The performed laboratory tests confirmed high levels of mercury in the blood (1051 μg/L) and urine (22,960 μg/L). Due to acute renal failure, continuous renal replacement therapy (CRRT) CVVHD Ci-Ca was initiated; the procedure was then converted to CVVHDF Ci-Ca with ultrafiltration to optimise therapy, and CytoSorb was added to the artificial kidney system on day 3. Specific antidote therapy (DMPS) was administered concurrently. The ongoing treatment resulted in a reduction in subjective complaints, a decrease in blood mercury levels to 580 μg/L, and an improvement in parenchymal organ function.</p><p><strong>Conclusion: </strong>In the event of poisoning with inorganic mercury compounds (mercuric chloride), continuous renal replacement therapy using the CytoSorb filter as an extracorporeal blood purification method may be considered.</p>","PeriodicalId":13932,"journal":{"name":"International Journal of Artificial Organs","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139032267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01Epub Date: 2023-11-19DOI: 10.1177/03913988231212405
Hilal Peker Ozturk, Simel Ayyıldız
Objectives: To manage the mandibular traumas, for the expression of the complex anatomy or pathology in education of health sciences related branches, a model of the traumatized mandible is indispensable. For these, different 3D-print-technologies can be used. The aim of this study is, to measure how close these 3D-printed-models are to human-mandible (trueness) and the effectiveness of CT and CBCT at this point.
Study design: One-dry-human-mandible and 10-models manufactured by five different 3D-printers in four different-kinds of additive-manufacturing technology (Fused-Deposition-Modeling (FDM), Stereolithography (SLA), Binder-jetting (BJ), Polyjet (PJ)) were used, five-anatomic-landmarks and eight-distances were measured and evaluated. Mandible's data were constructed based on DICOM-3.0 data from CBCT and CT scans. Images were opened in MIMICS (software-program).
Results: Study compared the devices that produced models with the same dry human-mandible. It was seen that the model with the highest margin of error (132.5 mm) was manufactured by Fused-deposition-modeling device using CT-data. In terms of distance to real-data, the model with the lowest error was generated by Binder-Jetting (ZCorp) with CBCT-data. Models produced with CBCT-data are closer to dry-human-mandible than models with CT-data.
Conclusion: The current study shows that CBCT generates significantly better data than CT in producing mandibular models. The first choice for manufacturing of human mandible is BJ and the second choice is the technology of SLA.
{"title":"Comparison of different 3D printers in terms of dimensional stability by image data of a dry human mandible obtained from CBCT and CT.","authors":"Hilal Peker Ozturk, Simel Ayyıldız","doi":"10.1177/03913988231212405","DOIUrl":"10.1177/03913988231212405","url":null,"abstract":"<p><strong>Objectives: </strong>To manage the mandibular traumas, for the expression of the complex anatomy or pathology in education of health sciences related branches, a model of the traumatized mandible is indispensable. For these, different 3D-print-technologies can be used. The aim of this study is, to measure how close these 3D-printed-models are to human-mandible (trueness) and the effectiveness of CT and CBCT at this point.</p><p><strong>Study design: </strong>One-dry-human-mandible and 10-models manufactured by five different 3D-printers in four different-kinds of additive-manufacturing technology (Fused-Deposition-Modeling (FDM), Stereolithography (SLA), Binder-jetting (BJ), Polyjet (PJ)) were used, five-anatomic-landmarks and eight-distances were measured and evaluated. Mandible's data were constructed based on DICOM-3.0 data from CBCT and CT scans. Images were opened in MIMICS (software-program).</p><p><strong>Results: </strong>Study compared the devices that produced models with the same dry human-mandible. It was seen that the model with the highest margin of error (132.5 mm) was manufactured by Fused-deposition-modeling device using CT-data. In terms of distance to real-data, the model with the lowest error was generated by Binder-Jetting (ZCorp) with CBCT-data. Models produced with CBCT-data are closer to dry-human-mandible than models with CT-data.</p><p><strong>Conclusion: </strong>The current study shows that CBCT generates significantly better data than CT in producing mandibular models. The first choice for manufacturing of human mandible is BJ and the second choice is the technology of SLA.</p>","PeriodicalId":13932,"journal":{"name":"International Journal of Artificial Organs","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138046871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01Epub Date: 2023-12-05DOI: 10.1177/03913988231214180
McKenzie Sicke, Shan Modi, Yeahwa Hong, Michael Bashline, Wyatt Klass, Ed Horn, Barinder S Hansra, Raj Ramanan, Jeffrey Fowler, Nikita Sumzin, Ryan M Rivosecchi, Rahul Chaudhary, Luke A Ziegler, Nicholas R Hess, Nishant Agrawal, David J Kaczorowski, Gavin W Hickey
Background: Despite historical differences in cardiogenic shock (CS) outcomes by etiology, outcomes by CS etiology have yet to be described in patients supported by temporary mechanical circulatory support (MCS) with Impella 5.5.
Objectives: This study aims to identify differences in survival and post-support destination for these patients in acute myocardial infarction (AMI) and acute decompensated heart failure (ADHF) CS at a high-volume, tertiary, transplant center.
Methods: A retrospective review of patients who received Impella 5.5 at our center from November 2020 to June 2022 was conducted.
Results: Sixty-seven patients underwent Impella 5.5 implantation for CS; 23 (34%) for AMI and 44 (66%) for ADHF. AMI patients presented with higher SCAI stage, pre-implant lactate, and rate of prior MCS devices, and fewer days from admission to implantation. Survival was lower for AMI patients at 30 days, 90 days, and discharge. No difference in time to all-cause mortality was found when excluding patients receiving transplant. There was no significant difference in complication rates between groups.
Conclusions: ADHF-CS patients with Impella 5.5 support have a significantly higher rate of survival than patients with AMI-CS. ADHF patients were successfully bridged to heart transplant more often than AMI patients, contributing to increased survival.
{"title":"Cardiogenic shock etiology and exit strategy impact survival in patients with Impella 5.5.","authors":"McKenzie Sicke, Shan Modi, Yeahwa Hong, Michael Bashline, Wyatt Klass, Ed Horn, Barinder S Hansra, Raj Ramanan, Jeffrey Fowler, Nikita Sumzin, Ryan M Rivosecchi, Rahul Chaudhary, Luke A Ziegler, Nicholas R Hess, Nishant Agrawal, David J Kaczorowski, Gavin W Hickey","doi":"10.1177/03913988231214180","DOIUrl":"10.1177/03913988231214180","url":null,"abstract":"<p><strong>Background: </strong>Despite historical differences in cardiogenic shock (CS) outcomes by etiology, outcomes by CS etiology have yet to be described in patients supported by temporary mechanical circulatory support (MCS) with Impella 5.5.</p><p><strong>Objectives: </strong>This study aims to identify differences in survival and post-support destination for these patients in acute myocardial infarction (AMI) and acute decompensated heart failure (ADHF) CS at a high-volume, tertiary, transplant center.</p><p><strong>Methods: </strong>A retrospective review of patients who received Impella 5.5 at our center from November 2020 to June 2022 was conducted.</p><p><strong>Results: </strong>Sixty-seven patients underwent Impella 5.5 implantation for CS; 23 (34%) for AMI and 44 (66%) for ADHF. AMI patients presented with higher SCAI stage, pre-implant lactate, and rate of prior MCS devices, and fewer days from admission to implantation. Survival was lower for AMI patients at 30 days, 90 days, and discharge. No difference in time to all-cause mortality was found when excluding patients receiving transplant. There was no significant difference in complication rates between groups.</p><p><strong>Conclusions: </strong>ADHF-CS patients with Impella 5.5 support have a significantly higher rate of survival than patients with AMI-CS. ADHF patients were successfully bridged to heart transplant more often than AMI patients, contributing to increased survival.</p>","PeriodicalId":13932,"journal":{"name":"International Journal of Artificial Organs","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10824236/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138487439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01Epub Date: 2023-11-29DOI: 10.1177/03913988231213511
Yael Lichter, Amir Gal Oz, Uri Carmi, Nimrod Adi, Asaph Nini, Yoel Angel, Andrey Nevo, Daniel Aviram, Itay Moshkovits, Noam Goder, Dekel Stavi
Background: The exposure of blood to the artificial circuit during extracorporeal membrane oxygenation (ECMO) can induce an inflammatory response. C-reactive protein (CRP) is a commonly used biomarker of systemic inflammation.
Methods: In this retrospective observational study, we analyzed results of daily plasma CRP measurements in 110 critically ill patients, treated with ECMO. We compared CRP levels during the first 5 days of ECMO operation, between different groups of patients according to ECMO configurations, Coronavirus disease 2019 (COVID-19) status, and mechanical ventilation parameters.
Results: There was a statistically significant decrease in CRP levels during the first 5 days of veno-venous (VV) ECMO (173 ± 111 mg/L, 154 ± 107 mg/L, 127 ± 97 mg/L, 114 ± 100 mg/L and 118 ± 90 mg/L for days 1-5 respectively, p < 0.001). Simultaneously, there was a significant reduction in ventilatory parameters, as represented by the mechanical power (MP) calculation, from 24.02 ± 14.53 J/min to 6.18 ± 4.22 J/min within 3 h of VV ECMO initiation (p < 0.001). There was non-significant trend of increase in CRP level during the first 5 days of veno arterial (VA) ECMO (123 ± 80 mg/L, 179 ± 91 mg/L, 203 ± 90 mg/L, 179 ± 95 mg/L and 198 ± 93 for days 1-5 respectively, p = 0.126) and no significant change in calculated MP (from 14.28 ± 8.56 J/min to 10.81 ± 8.09 J/min within 3 h if ECMO initiation, p = 0.071).
Conclusions: We observed a significant decrease in CRP levels during the first 5 days of VV ECMO support, and suggest that the concomitant reduction in ventilatory MP may have mitigated the degree of alveolar stress and strain that could have contributed to a decrease in the systemic inflammatory process.
背景:体外膜氧合(ECMO)过程中,血液暴露于人工回路可诱导炎症反应。c反应蛋白(CRP)是一种常用的全身性炎症的生物标志物。方法:在这项回顾性观察性研究中,我们分析了110例经ECMO治疗的危重患者的每日血浆CRP测量结果。我们根据ECMO配置、2019冠状病毒病(COVID-19)状态和机械通气参数,比较不同组患者在ECMO手术前5天的CRP水平。结果:静脉-静脉(VV) ECMO前5天CRP水平下降有统计学意义(1-5天分别为173±111 mg/L、154±107 mg/L、127±97 mg/L、114±100 mg/L和118±90 mg/L, p p p = 0.126),计算MP变化无统计学意义(ECMO启动后3 h内从14.28±8.56 J/min降至10.81±8.09 J/min, p = 0.071)。结论:我们观察到在VV ECMO支持的前5天CRP水平显著下降,并提示伴随的通气MP降低可能减轻了肺泡应激和应变的程度,这可能有助于减少全身炎症过程。
{"title":"Kinetics of C-reactive protein during extracorporeal membrane oxygenation.","authors":"Yael Lichter, Amir Gal Oz, Uri Carmi, Nimrod Adi, Asaph Nini, Yoel Angel, Andrey Nevo, Daniel Aviram, Itay Moshkovits, Noam Goder, Dekel Stavi","doi":"10.1177/03913988231213511","DOIUrl":"10.1177/03913988231213511","url":null,"abstract":"<p><strong>Background: </strong>The exposure of blood to the artificial circuit during extracorporeal membrane oxygenation (ECMO) can induce an inflammatory response. C-reactive protein (CRP) is a commonly used biomarker of systemic inflammation.</p><p><strong>Methods: </strong>In this retrospective observational study, we analyzed results of daily plasma CRP measurements in 110 critically ill patients, treated with ECMO. We compared CRP levels during the first 5 days of ECMO operation, between different groups of patients according to ECMO configurations, Coronavirus disease 2019 (COVID-19) status, and mechanical ventilation parameters.</p><p><strong>Results: </strong>There was a statistically significant decrease in CRP levels during the first 5 days of veno-venous (VV) ECMO (173 ± 111 mg/L, 154 ± 107 mg/L, 127 ± 97 mg/L, 114 ± 100 mg/L and 118 ± 90 mg/L for days 1-5 respectively, <i>p</i> < 0.001). Simultaneously, there was a significant reduction in ventilatory parameters, as represented by the mechanical power (MP) calculation, from 24.02 ± 14.53 J/min to 6.18 ± 4.22 J/min within 3 h of VV ECMO initiation (<i>p</i> < 0.001). There was non-significant trend of increase in CRP level during the first 5 days of veno arterial (VA) ECMO (123 ± 80 mg/L, 179 ± 91 mg/L, 203 ± 90 mg/L, 179 ± 95 mg/L and 198 ± 93 for days 1-5 respectively, <i>p</i> = 0.126) and no significant change in calculated MP (from 14.28 ± 8.56 J/min to 10.81 ± 8.09 J/min within 3 h if ECMO initiation, <i>p</i> = 0.071).</p><p><strong>Conclusions: </strong>We observed a significant decrease in CRP levels during the first 5 days of VV ECMO support, and suggest that the concomitant reduction in ventilatory MP may have mitigated the degree of alveolar stress and strain that could have contributed to a decrease in the systemic inflammatory process.</p>","PeriodicalId":13932,"journal":{"name":"International Journal of Artificial Organs","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10787388/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138459784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01Epub Date: 2023-12-05DOI: 10.1177/03913988231214934
Fausto Biancari, Timo Mäkikallio, Antonio Loforte, Alexander Kaserer, Vito G Ruggieri, Sung-Min Cho, Jin Kook Kang, Magnus Dalén, Henryk Welp, Kristján Jónsson, Sigurdur Ragnarsson, Francisco J Hernández Pérez, Giuseppe Gatti, Khalid Alkhamees, Antonio Fiore, Andrea Lechiancole, Stefano Rosato, Cristiano Spadaccio, Matteo Pettinari, Andrea Perrotti, Sebastian D Sahli, Camilla L'Acqua, Amr A Arafat, Monirah A Albabtain, Mohammed M AlBarak, Mohamed Laimoud, Ilija Djordjevic, Ihor Krasivskyi, Robertas Samalavicius, Agne Jankuviene, Marta Alonso-Fernandez-Gatta, Markus J Wilhelm, Tatu Juvonen, Giovanni Mariscalco
Introduction: Patients requiring postcardiotomy veno-arterial extracorporeal membrane oxygenation (V-A-ECMO) have a high risk of early mortality. In this analysis, we evaluated whether any interinstitutional difference exists in the results of postcardiotomy V-A-ECMO.
Methods: Studies on postcardiotomy V-A-ECMO were identified through a systematic review for individual patient data (IPD) meta-analysis. Analysis of interinstitutional results was performed using direct standardization, estimation of observed/expected in-hospital mortality ratio and propensity score matching.
Results: Systematic review of the literature yielded 31 studies. Data from 10 studies on 1269 patients treated at 25 hospitals were available for the present analysis. In-hospital mortality was 66.7%. The relative risk of in-hospital mortality was significantly higher in six hospitals. Observed versus expected in-hospital mortality ratio showed that four hospitals were outliers with significantly increased mortality rates, and one hospital had significantly lower in-hospital mortality rate. Participating hospitals were classified as underperforming and overperforming hospitals if their observed/expected in-hospital mortality was higher or lower than 1.0, respectively. Among 395 propensity score matched pairs, the overperforming hospitals had significantly lower in-hospital mortality (60.3% vs 71.4%, p = 0.001) than underperforming hospitals. Low annual volume of postcardiotomy V-A-ECMO tended to be predictive of poor outcome only when adjusted for patients' risk profile.
Conclusions: In-hospital mortality after postcardiotomy V-A-ECMO differed significantly between participating hospitals. These findings suggest that in many centers there is room for improvement of the results of postcardiotomy V-A-ECMO.
{"title":"Inter-institutional analysis of the outcome after postcardiotomy veno-arterial extracorporeal membrane oxygenation.","authors":"Fausto Biancari, Timo Mäkikallio, Antonio Loforte, Alexander Kaserer, Vito G Ruggieri, Sung-Min Cho, Jin Kook Kang, Magnus Dalén, Henryk Welp, Kristján Jónsson, Sigurdur Ragnarsson, Francisco J Hernández Pérez, Giuseppe Gatti, Khalid Alkhamees, Antonio Fiore, Andrea Lechiancole, Stefano Rosato, Cristiano Spadaccio, Matteo Pettinari, Andrea Perrotti, Sebastian D Sahli, Camilla L'Acqua, Amr A Arafat, Monirah A Albabtain, Mohammed M AlBarak, Mohamed Laimoud, Ilija Djordjevic, Ihor Krasivskyi, Robertas Samalavicius, Agne Jankuviene, Marta Alonso-Fernandez-Gatta, Markus J Wilhelm, Tatu Juvonen, Giovanni Mariscalco","doi":"10.1177/03913988231214934","DOIUrl":"10.1177/03913988231214934","url":null,"abstract":"<p><strong>Introduction: </strong>Patients requiring postcardiotomy veno-arterial extracorporeal membrane oxygenation (V-A-ECMO) have a high risk of early mortality. In this analysis, we evaluated whether any interinstitutional difference exists in the results of postcardiotomy V-A-ECMO.</p><p><strong>Methods: </strong>Studies on postcardiotomy V-A-ECMO were identified through a systematic review for individual patient data (IPD) meta-analysis. Analysis of interinstitutional results was performed using direct standardization, estimation of observed/expected in-hospital mortality ratio and propensity score matching.</p><p><strong>Results: </strong>Systematic review of the literature yielded 31 studies. Data from 10 studies on 1269 patients treated at 25 hospitals were available for the present analysis. In-hospital mortality was 66.7%. The relative risk of in-hospital mortality was significantly higher in six hospitals. Observed versus expected in-hospital mortality ratio showed that four hospitals were outliers with significantly increased mortality rates, and one hospital had significantly lower in-hospital mortality rate. Participating hospitals were classified as underperforming and overperforming hospitals if their observed/expected in-hospital mortality was higher or lower than 1.0, respectively. Among 395 propensity score matched pairs, the overperforming hospitals had significantly lower in-hospital mortality (60.3% vs 71.4%, <i>p</i> = 0.001) than underperforming hospitals. Low annual volume of postcardiotomy V-A-ECMO tended to be predictive of poor outcome only when adjusted for patients' risk profile.</p><p><strong>Conclusions: </strong>In-hospital mortality after postcardiotomy V-A-ECMO differed significantly between participating hospitals. These findings suggest that in many centers there is room for improvement of the results of postcardiotomy V-A-ECMO.</p>","PeriodicalId":13932,"journal":{"name":"International Journal of Artificial Organs","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138487441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Crush syndrome-related acute kidney injury in earthquake victims, time to consider new therapeutical options?","authors":"Gonzalo Ramírez-Guerrero, Thiago Reis, Matteo Marcello, Massimo de Cal, Claudio Ronco","doi":"10.1177/03913988231191954","DOIUrl":"10.1177/03913988231191954","url":null,"abstract":"","PeriodicalId":13932,"journal":{"name":"International Journal of Artificial Organs","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10005516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}