Journal of Artificial Organs最新文献

Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly being employed to treat patients with refractory septic shock. Despite its growing use, there is a notable absence of prognostic assessment tools specifically designed for septic shock patients who have received VA-ECMO therapy. The aim of this study is to develop and validate a prognostic model for patients with refractory septic shock undergoing VA-ECMO, and to identify those who may derive the greatest benefit from this treatment. This single-center, retrospective cohort study was conducted at a comprehensive intensive care unit in China. Adult patients with refractory septic shock who received VA-ECMO treatment were included. Two hundred consecutive patients were randomly divided into training and validation cohorts in a 7:3 ratio. Least absolute shrinkage and selection operator regression analysis was employed to select relevant variables for the logistic regression model, and its performance was tested in both training and validation cohorts based on discrimination, calibration, and net benefit. Between January 2019 and September 2024, 293 patients were screened, 200 of whom were eligible and were divided into development (n = 140) and validation (n = 60) cohorts. The 28-day survival rate was 23.0%, and median duration of ECMO run was 6.0 days (IQR 2.0-8.0). Age, APACHE II score at ICU admission, immunosuppression status, hypertension, IL-6, and APTT measured within 6 h before ECMO initiation were the six predictors included in the nomograms. The nomogram demonstrated strong discriminative power in the training cohort (area under the curve [AUC]: 0.873, 95% CI 0.812-0.929), as well as in the validation cohort (area under the curve [AUC]: 0.818 (95% CI 0.687-0.920). The model's reliability in predicting outcomes was evident from the high consistency between predicted probabilities and observed proportions during calibration. Decision curve analysis indicated that the model's clinical benefit was advantageous. The novel validated nomogram is designed to predict outcomes after VA-ECMO treatment in individuals with refractory septic shock. It can support physicians in performing precise mortality risk evaluations and making more informed decisions regarding the application of VA-ECMO treatment.

Once a pump stoppage of left ventricular assist device (LVAD) occurs, the hemodynamic status catastrophically collapses. Usage of an extracorporeal membrane oxygenation system (ECMO) can help organ perfusion, including in the brain; however, blood flow is regurgitated into the left ventricle through the outflow graft of LVAD, resulting in irreversible respiratory failure. This phenomenon might be further aggravated in LVAD patients with aortic valve closure because of no ejection flow through it at all. We experienced a case of successful resuscitation from restart failure of HeartWare LVAD pump during controller exchange in a patient with aortic valve closure. An 18Fr cannula was inserted into the lateral wall of the left ventricle as a vent prior to the outflow graft clamping. The patient was discharged with no neurological disorder. In addition to usual usage of peripheral ECMO system, as well as cardiopulmonary resuscitation, emergency left ventricle venting can contribute to recovery from fatal complication by reducing the abrupt increase of left ventricle pressure.

In glucose management using continuous insulin infusion, artificial pancreas systems prevent blood glucose fluctuations and severe hypoglycemia using insulin pumps and continuous glucose monitoring. Advances in both insulin pumps and continuous glucose monitoring have enabled the transition from sensor augmented pump therapy, where insulin delivery is manually adjusted, to hybrid closed-loop insulin pump therapy, which automatically adjusts basal insulin infusion. Furthermore, fully automated insulin delivery systems that adjust insulin based on variations due to meals and exercise are now possible. These systems have been primarily applied to patients with type 1 diabetes but are now expanding to all insulin-dependent patients. Wearable artificial pancreas systems measure glucose levels in subcutaneous tissue fluid, while bedside artificial pancreas systems measure glucose levels in venous blood, making them suitable for managing the highly variable blood glucose levels of perioperative and critically ill patients. Future developments are anticipated to integrate the benefits of both wearable and bedside systems.

Critically acute and ill and Obstetrical patients constitute a unique clinical population with a high mortality rate. Extracorporeal membrane oxygenation (ECMO) is gradually being used in obstetrical acute and critically ill patients and has shown great advantages. PubMed, Embase, Web of Science, Chinese CNKI Database, and Cochrane Library databases were systematically searched from the earliest available date to March 15, 2024, to obtain relevant studies on extracorporeal membrane oxygenation in obstetric patients. After screening the literature, data were independently extracted and summarized using random effects or fixed effects models, depending on the magnitude of heterogeneity. A total of 38 studies (917 patients) were included. The overall survival rate for critically ill obstetric patients supported by ECMO was 65% (56-74%). Among these, the survival rates for antepartum and postpartum patients were 70% (55-84%) and 63% (47-78%) respectively. The survival rates of obstetric patients supported by VV-ECMO and VA-ECMO were 70% (56-83%) and 56% (44-68%), respectively. This article systematically reports the survival rate of critically ill obstetric patients under ECMO support. The survival rate for these patients is significantly higher than the overall survival rate of all patients receiving ECMO support. Survival rates were similar for prenatal and postpartum patients but survival rates for patients supported by VV-ECMO were significantly higher than those supported by VA-ECMO. Further research is needed to explore the benefits of ECMO for obstetric patients with different disease types.

Increasing interest in home dialysis treatments are driven by better outcomes, less complications, patients desire and economic reasons. We compared 26 prevalent home hemodialysis (HHD) patients with 52 matched institutional hemodialysis patients (IHD) in survival and morbidity. Median age for HHD and IHD patients was 55,7 and 56 years respectively, and 77% were men. HHD patients had significantly better anemia control (Hgb level 12.2 ± 1.7 vs. 10.8 ± 1.3gr/dl; p = 0,001 respectively), and significantly higher albumin and cholesterol levels than IHD (42.5 ± 2 vs. 39 ± 3 g/l, p = 0.001; 5.1 ± 1 vs.4.7 ± 0.8 mmol/l, p = 0.05, respectively). During the nine years of follow up, there was no difference between groups in overall number of hospitalization (3.7 ± 3.3 vs. 3.9 ± 2.8; p = 0.47), nor in annual admission rate for everyone cause (0.5 ± 0.4 vs. 0.6 ± 0.4, p = 0.28), but IHD patients stayed longer in hospital (7.4 ± 9.8 days vs. 9.3 ± 8.7 days; p = 0.05). Cause-specific morbidity showed that IHD patients had more frequent annual admission rate for cardiovascular diseases (CVD) than HHD (0.4 ± 0.3 vs. 0.2 ± 0.1 respectively, p = 0.05), while there were no differences for infections (0.3 ± 0.3 vs. 0.3 ± 0.2 respectively, p = 0.9) nor vascular access (VA) dysfunction (0.4 ± 0.3 vs. 0.3 ± 0.3 respectively, p = 0.3). Also annual in-hospital stay for CVD (3.0 ± 3.1 vs. 4.0 ± 4.5 days; p = 0.5), infection (6,4 ± 7,5 vs. 5,7 ± 7,6 days; p = 0,6) and VA dysfunction (6.0 ± 7.0 vs. 7.7 ± 7.8 days; p = 0,5) did not differ between HHD and IHD group. As revealed by Kaplan Meier curve, survival in HHD and IHD patients were 92.3% vs. 90.4% at 3 years, 84.6% vs. 70.2% at 5 years, and 55.7% vs. 50% at 9 years (log-rank test p = 0,5). HHD provides better anemia and nutrition control; shorter hospitalizations and less frequent hospitalizations for CVD.

Mechanical circulatory support devices (MCSDs) have emerged as life-saving interventions for patients with end-stage heart failure. However, the non-physiological shear stress (NPSS) generated by MCSDs is a known precipitant of platelet dysfunction, augmenting risks of thrombotic and bleeding complications. Addressing this issue necessitates innovative approaches to attenuate platelet dysfunction, thereby enhancing the safety of MCSDs. This review synthesizes knowledge pertaining to the normal hemostatic process, the implications of NPSS on platelet function, the array of markers extensively employed to assess platelet dysfunction, and relevant detection assays, within the scope of MCSDs-related hemocompatibility. NPSS can induce platelet activation and receptor shedding, causing both thrombosis and bleeding. The use of fluorescence-activated cell sorting (FACS) to monitor changes in markers, including platelet surface receptors, P-selectin, platelet monocyte aggregation (PMA), platelet-derived microparticles (PDMPs), and phosphatidylserine (PS), Enzyme-Linked Immunosorbent Assay (ELISA) for platelet secretion analysis, and the modified prothrombinase platelet activity state (PAS) for thrombin assessment, are central to investigating these consequences. PS and thrombin, particularly, present unique responses to NPSS, underscoring their potential as targeted markers for platelet dysfunction research. Additionally, assessments of morphological shifts and platelet aggregation, through scanning electron microscopy (SEM) and fluorescence microscopy provide a more visualized evaluation of NPSS-mediated platelet dysfunction. Combining distinct markers and assays is essential to understanding and potentially mitigating NPSS-induced complications in MCSD therapy. Future research should focus on validating NPSS-specific biomarkers, standardizing detection methodologies, and elucidating interactions with MCSD-induced hemolysis and coagulopathy, ultimately improving safety and efficacy.

Early recognition of the signs of hypotension may lead to prompt intervention by medical professionals, reducing the risk of intradialytic hypotension. The study included two patients on dialysis, one with stable hemodynamics (Case 1) and one who developed hypotensive shock (Case 2), in whom noninvasive continuous hemodynamic monitoring using shunt-side estimated continuous cardiac output (esCCO) was performed. Noninvasive blood pressure (BP), heart rate, esCCO, estimated stroke volume, systemic vascular resistance, and decrease in blood volume of each patient before and after dialysis were evaluated in chronological order. In Case 1, esCCO decreased transiently with the decrease in blood volume, but with the adaptive change in heart rate and estimated stroke volume, the BP remained stable at the end. In Case 2, there was a rapid decrease in esCCO after the systemic vascular resistance compensation reached its limit, and esCCO decreased 30 min before a decrease in noninvasive BP became evident. These results indicate that shunt-side esCCO monitoring may detect signs of hypotension that cannot be detected using conventional BP monitoring systems. Monitoring using shunt-side esCCO may be a prospective method for intradialytic hemodynamic management.

Severe aortic insufficiency (AI) is a common complication associated with prolonged continuous-flow left ventricular assist device (CF-LVAD) therapy. This study aimed to investigate the clinical outcomes after surgical correction of de novo AI after LVAD implantation. A total of 190 patients underwent CF-LVAD implantation between January 2013 and June 2022. Of these, 24 had trivial or no AI before LVAD implantation and developed moderate or greater de novo AI after LVAD implantation. Patients who underwent aortic valve surgery before or concomitant with LVAD surgery were excluded. Among the 24 patients, surgeries were indicated for medically refractory de novo AI in 11 patients, who were included. The primary outcome was postoperative improvement in hemodynamics as assessed by right heart catheter examination, and the secondary endpoints were 3-year survival and freedom from death and/or heart failure readmission rates. The correction of de novo AI was accomplished with aortic valve closure using a bovine pericardial patch in 10 patients and prosthetic valve replacement in one patient. Significant differences (all p < 0.01) in pre- vs. post-surgery pulmonary artery wedge pressure, cardiac index, and mixed venous blood oxygen saturation were found. The mean follow-up period after LVAD implantation was 1413 days, and the 3-year survival rate was 90.9%. Three-year freedom from postoperative moderate or greater AI rate and freedom from heart failure readmission rate were both 90.9%. Postoperative hemodynamic status and survival outcomes are favorable in patients who underwent surgical aortic valve repair de novo AI after LVAD implantation.

Heart transplantation remains the definitive treatment for end-stage heart failure, but donor shortages persist globally. This review aims to evaluate the current status, enabling technologies, ethical considerations, and future prospects of donation after circulatory death (DCD) heart transplantation in the Asia-Pacific region. A comprehensive narrative review was conducted using published literature and country-specific reports to assess global and regional trends in DCD heart transplantation. Particular focus was given to enabling technologies (e.g., thoracoabdominal normothermic regional perfusion [taNRP] and ex situ machine perfusion), legal and ethical frameworks, and implementation barriers across countries in the Asia-Pacific. While countries such as the UK, US, and Australia have achieved comparable survival outcomes between DCD and donation after brain death (DBD) heart transplantation, most Asia-Pacific countries remain in early stages. Australia leads the region with over 70 successful DCD heart transplants using the Organ Care System. Japan lacks legal clarity and clinical protocols for withdrawal of life-sustaining therapy, restricting DCD to kidney transplants. China employs a hybrid DBCD model but faces logistical and ethical constraints. In South Korea, India, and others, DCD heart programs are not yet established. High cost and limited availability of enabling technologies, alongside ethical controversy surrounding taNRP, are key barriers. Broader adoption of DCD heart transplantation in Asia-Pacific countries requires legal reform, ethical consensus, cost-effective perfusion strategies, and public engagement. Coordinated efforts across technological, societal, and regulatory domains are essential to expand access to this life-saving modality.

This study investigated return to work (RTW) patterns following total hip arthroplasty (THA), focusing on factors influencing RTW, RTW timing, and the relationship between postoperative employment and patient-reported outcome measures (PROMs). This retrospective cohort study included 310 patients who underwent THA between 2012 and 2016 in Japan. Mailed surveys assessed employment status, occupation type, RTW timing, and PROMs, including the Oxford Hip Score, Forgotten Joint Score-12, visual analog scale (VAS) for satisfaction, and Ikigai-9 for life purpose. Regression analyses were performed to identify predictive factors. Employment rates were 55% preoperatively and 45% postoperatively, with an overall RTW rate of 81%. Younger age (≤ 62 years) significantly predicted RTW (odds ratio, 0.94; p < 0.01). Among those returning to work, 66% did so within 3 months. Sedentary workers had a significantly higher RTW rate within 1 month (40.8%, p = 0.022), however, overall RTW rates did not differ significantly across occupational categories (p = 0.590). Anxiety about dislocation was the most common reason for delayed RTW. Postoperative employment significantly correlated with higher VAS satisfaction (β = 2.31, p = 0.01) and Ikigai-9 scores (β = 1.28, p < 0.01). The RTW rate was 81%, with higher rates in younger age. Sedentary work was associated with earlier RTW. Addressing anxiety about dislocation through appropriate education and rehabilitation may facilitate RTW after THA. Postoperative employment was linked to higher satisfaction and Ikigai for life purpose. Communicating these findings may improve patient RTW rates, satisfaction, and overall well-being.