Rebekah KH Shappley, Christen M Holder, Constance E Poplos, Pilar Anton-MArtin, Thomas Spentzas, Toni M Whitaker, Swati Karmarkar, Samir H Shah, Hitesh Singh Sandhu
Background: The study objective was to characterize compliance with Standardized Therapy after ECMO Program (STEP), an intentional discharge pathway for extracorporeal membrane oxygenation (ECMO) survivors in a US pediatric hospital. Methods: The program identified pediatric ECMO survivors before discharge, reviewed and requested appropriate consultations, educated families on ECMO sequelae, and sent ECMO summaries to pediatricians.Compliance with institutional post-ECMO guidelines was evaluated before and after STEP implementation. Results: We identified 77 ECMO survivors to hospital discharge (36 [46.8%] before and 41 [53.2%] after STEP implementation). There was a significant increase in complete (38.8% .vs 74.2%, p < 0.001) and time-appropriate neurodevelopmental testing (71.4% vs. 95.6%, p = 0.03). Significant increase in inpatient evaluations by neurology (52.7% vs. 75.6%, p = 0.03) and audiology (66.7% vs. 87.8%, p = 0.02), and in referrals for outpatient audiology (66.6 vs. 95.1%, p = 0.002), physical therapy (P.T.) (63.8% vs. 95.1%, p = 0.001), occupational therapy (O.T.) (63.8% vs. 95.1%, p = 0.001) and speech-language pathology (S.L.P.) (55.5% vs. 95.1%, p < 0.001) were noted. Conclusion: Implementing an intentional discharge pathway for pediatric ECMO survivors (STEP) successfully increases inpatient and outpatient compliance with hospital and Extracorporeal life support organization (ELSO) follow-up guidelines. It leads to timely and complete neurodevelopmental evaluation.
背景：该研究旨在了解美国一家儿科医院的体外膜氧合（ECMO）幸存者对 "ECMO后标准化治疗计划"（STEP）--一种有意的出院途径--的依从性。方法：该计划在出院前确定儿科 ECMO 幸存者，审查并请求适当的咨询，向家属宣传 ECMO 后遗症，并向儿科医生发送 ECMO 总结。结果：我们确认了 77 名出院的 ECMO 幸存者（实施 STEP 前为 36 人 [46.8%]，实施 STEP 后为 41 人 [53.2%]）。完整的（38.8% 对 74.2%，p < 0.001）和适时的神经发育测试（71.4% 对 95.6%，p = 0.03）明显增加。神经内科（52.7% vs. 75.6%，P = 0.03）和听力科（66.7% vs. 87.8%，P = 0.02）的住院评估以及听力科门诊（66.6% vs. 95.1%，P = 0.002）、物理治疗（P.T.）（63.8% vs. 95.1%，p = 0.001）、职业治疗（O.T.）（63.8% vs. 95.1%，p = 0.001）和言语病理学（S.L.P.）（55.5% vs. 95.1%，p < 0.001）。结论为儿科 ECMO 幸存者实施有意的出院路径（STEP）可成功提高住院和门诊病人对医院和体外生命支持组织（ELSO）随访指南的依从性。它能及时、完整地评估神经发育情况。
{"title":"Standardized Therapies after ECMO Program (STEP); A Novel Approach to Pediatric post-ECMO Care","authors":"Rebekah KH Shappley, Christen M Holder, Constance E Poplos, Pilar Anton-MArtin, Thomas Spentzas, Toni M Whitaker, Swati Karmarkar, Samir H Shah, Hitesh Singh Sandhu","doi":"10.1051/ject/2024009","DOIUrl":"https://doi.org/10.1051/ject/2024009","url":null,"abstract":"Background: The study objective was to characterize compliance with Standardized Therapy after ECMO Program (STEP), an intentional discharge pathway for extracorporeal membrane oxygenation (ECMO) survivors in a US pediatric hospital. \u0000Methods: The program identified pediatric ECMO survivors before discharge, reviewed and requested appropriate consultations, educated families on ECMO sequelae, and sent ECMO summaries to pediatricians.Compliance with institutional post-ECMO guidelines was evaluated before and after STEP implementation. \u0000Results: We identified 77 ECMO survivors to hospital discharge (36 [46.8%] before and 41 [53.2%] after STEP implementation). There was a significant increase in complete (38.8% .vs 74.2%, p < 0.001) and time-appropriate neurodevelopmental testing (71.4% vs. 95.6%, p = 0.03). Significant increase in inpatient evaluations by neurology (52.7% vs. 75.6%, p = 0.03) and audiology (66.7% vs. 87.8%, p = 0.02), and in referrals for outpatient audiology (66.6 vs. 95.1%, p = 0.002), physical therapy (P.T.) (63.8% vs. 95.1%, p = 0.001), occupational therapy (O.T.) (63.8% vs. 95.1%, p = 0.001) and speech-language pathology (S.L.P.) (55.5% vs. 95.1%, p < 0.001) were noted. \u0000Conclusion: Implementing an intentional discharge pathway for pediatric ECMO survivors (STEP) successfully increases inpatient and outpatient compliance with hospital and Extracorporeal life support organization (ELSO) follow-up guidelines. It leads to timely and complete neurodevelopmental evaluation.","PeriodicalId":309024,"journal":{"name":"The Journal of ExtraCorporeal Technology","volume":"18 14","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141107111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Babar Ali, Salman Pervaiz Butt, Mohammad Ghazi Nour Ghazi Nour, Mohammad Bagher Khosravi, Naeimehossadat Asmarian, Ali Raza Shoul, Arun Kumar, Umer Darr, Gopal Bhatnagar
Background: The del Nido Cardioplegia Solution is a widely used method for myocardial protection in various settings. However, there is limited evidence of its effectiveness in adult cardiac surgery, and the baseline solution, Plasma Lyte A, is not readily available, leading to the use of alternative baseline solutions. This study aims to investigate the effectiveness of routine del Nido cardioplegia in adult cardiac surgery and the impact of different baseline solutions on myocardial protection and other perioperative outcomes. Methods: This study was a prospective, double-blind randomized parallel group clinical trial conducted at a single tertiary care hospital in Iran. A total of 187 adult patients were evaluated for eligibility, of which 120 met the inclusion criteria for elective isolated CABG surgery. The patients were randomly assigned to three groups, with each group consisting of 40 patients. The control group received normal saline-based routine del Nido cardioplegia, Intervention Group A received ringer lactate-based del Nido cardioplegia, and Intervention Group B received plain ringer-based del Nido cardioplegia. The levels of CK-MB, Troponin T, Troponin I, and lactate were primarily assessed at four different times: after anesthesia induction (Baseline), 2 hours, 12 hours, and 24 hours. Results: Preoperative demographic and clinical characteristics were the same among groups with insignificant differences (p > 0.05). There was no significant difference among groups based on CK-MB, Troponin T, Troponin I, and lactate levels (p=0.078, 0.143, 0.311, and 0.129 respectively). However, there was a significant difference in the time effect of Troponin T and Lactate (p=0.034, p= < 0.001). Conclusion: Normal saline, Ringer lactate, and plain Ringer provide comparable myocardial protection in adult-isolated CABG surgery with modified del Nido cardioplegia. Larger studies are needed to identify the best alternative to Plasma Lyte A while maintaining del Nido Cardioplegia as the control.
背景：德尔尼多心脏麻痹溶液是在各种情况下广泛使用的心肌保护方法。然而，有关其在成人心脏手术中有效性的证据有限，而且基线溶液 Plasma Lyte A 不易获得，导致人们不得不使用其他基线溶液。本研究旨在调查常规 del Nido 心脏麻痹在成人心脏手术中的有效性，以及不同基线溶液对心肌保护和其他围手术期结果的影响：本研究是一项前瞻性、双盲随机平行分组临床试验，在伊朗一家三级医院进行。共对 187 名成年患者进行了资格评估，其中 120 名患者符合择期孤立心血管移植手术的纳入标准。患者被随机分配到三组，每组 40 人。对照组接受以生理盐水为基础的常规德尔尼多心脏麻痹，干预组 A 接受以乳酸林格氏盐为基础的德尔尼多心脏麻痹，干预组 B 接受以普通林格氏盐为基础的德尔尼多心脏麻痹。CK-MB、肌钙蛋白 T、肌钙蛋白 I 和乳酸盐的水平主要在四个不同时间进行评估：麻醉诱导后（基线）、2 小时、12 小时和 24 小时：各组术前人口统计学和临床特征相同，差异不显著（P > 0.05）。根据 CK-MB、肌钙蛋白 T、肌钙蛋白 I 和乳酸水平，各组间无明显差异（P 分别为 0.078、0.143、0.311 和 0.129）。然而，肌钙蛋白 T 和乳酸盐的时间效应存在显著差异（p=0.034，p= <0.001）：结论：正常生理盐水、乳酸林格液和普通林格液在使用改良del Nido心脏麻痹的成人孤立CABG手术中可提供相当的心肌保护。需要进行更大规模的研究，以确定血浆 Lyte A 的最佳替代品，同时保留德尔尼多心脏麻痹作为对照。
{"title":"Comparison of routine del Nido cardioplegia vs two types of modified del Nido cardioplegias for myocardial protection among patients undergoing coronary artery bypass grafting (CABG) surgeries: a randomized double-blind clinical trial.","authors":"Babar Ali, Salman Pervaiz Butt, Mohammad Ghazi Nour Ghazi Nour, Mohammad Bagher Khosravi, Naeimehossadat Asmarian, Ali Raza Shoul, Arun Kumar, Umer Darr, Gopal Bhatnagar","doi":"10.1051/ject/2024011","DOIUrl":"https://doi.org/10.1051/ject/2024011","url":null,"abstract":"Background: The del Nido Cardioplegia Solution is a widely used method for myocardial protection in various settings. However, there is limited evidence of its effectiveness in adult cardiac surgery, and the baseline solution, Plasma Lyte A, is not readily available, leading to the use of alternative baseline solutions. This study aims to investigate the effectiveness of routine del Nido cardioplegia in adult cardiac surgery and the impact of different baseline solutions on myocardial protection and other perioperative outcomes.\u0000Methods: This study was a prospective, double-blind randomized parallel group clinical trial conducted at a single tertiary care hospital in Iran. A total of 187 adult patients were evaluated for eligibility, of which 120 met the inclusion criteria for elective isolated CABG surgery. The patients were randomly assigned to three groups, with each group consisting of 40 patients. The control group received normal saline-based routine del Nido cardioplegia, Intervention Group A received ringer lactate-based del Nido cardioplegia, and Intervention Group B received plain ringer-based del Nido cardioplegia. The levels of CK-MB, Troponin T, Troponin I, and lactate were primarily assessed at four different times: after anesthesia induction (Baseline), 2 hours, 12 hours, and 24 hours.\u0000Results: Preoperative demographic and clinical characteristics were the same among groups with insignificant differences (p > 0.05). There was no significant difference among groups based on CK-MB, Troponin T, Troponin I, and lactate levels (p=0.078, 0.143, 0.311, and 0.129 respectively). However, there was a significant difference in the time effect of Troponin T and Lactate (p=0.034, p= < 0.001).\u0000Conclusion: Normal saline, Ringer lactate, and plain Ringer provide comparable myocardial protection in adult-isolated CABG surgery with modified del Nido cardioplegia. Larger studies are needed to identify the best alternative to Plasma Lyte A while maintaining del Nido Cardioplegia as the control.","PeriodicalId":309024,"journal":{"name":"The Journal of ExtraCorporeal Technology","volume":"120 50","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140977456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: myocardial protection with cardioplegia solution is one of the precautions during coronary bypass grafting surgery (CABG) with cardiopulmonary bypass (CPB) to reduce myocardial damage and ischemia/reperfusion injuries. Unfortunately, the major component of the del Nido cardioplegia solution, Plasma-Lyte A, is unreachable in Iran due to high cost. Therefore, we have utilized lactate Ringer's solution as the base solution for our modified del Nido solution (LR DN). Study design and methods: the present clinical trial was performed on 18-75 year old patients (EF>35%) undergoing CABG with CPB in Imam Hossein hospital Tehran-Iran in 2021. Patients were randomly allocated to LR DN (modified del Nido cardioplegia) and PL DN (standard del Nido cardioplegia solution) groups. Serum level of cardiac troponin I (cTnI) at baseline, declamp, ICU admission, and 24 hours after admission, the type and dosage of inotrope agents, EF, rate of arrhythmia after clamp removal and lactate level were measured and compared between groups. Results: 109 patients were recruited. There were no statistically significant differences between the PL DN cardioplegia and LR DN groups for cardiopulmonary bypass times, cardiac enzymes, transfusion requirements, and arterial blood gases. However, postoperative serum levels of cTnI among patients in the LR DN group was significantly higher than patients of the PL DN group after ICU admission and 24 hours postoperatively. Also, more patients needed epinephrine administration in the operating room in the LR DN group (29.8% vs. 11.5%; p: 0.019 vs. PL DN group). Conclusion: we concluded that standard del Nido cardioplegia solution offers better myocardial protection compared with Ringer's lactate-based del Nido cardioplegia in adult patients undergoing CABG with CPB. We recommend using standard del Nido cardioplegia with a base of Plasma-Lyte A for patients presenting for CABG surgery.
导言：使用心脏麻痹溶液保护心肌是使用心肺旁路（CPB）进行冠状动脉旁路移植手术（CABG）期间的预防措施之一，以减少心肌损伤和缺血/再灌注损伤。遗憾的是，由于价格昂贵，伊朗无法获得 del Nido 心脏麻痹溶液的主要成分血浆-Lyte A。研究设计和方法：本临床试验于 2021 年在伊朗德黑兰伊玛目侯赛因医院对 18-75 岁（EF>35%）接受 CPB 的 CABG 患者进行。患者被随机分配到 LR DN（改良德尔尼多心脏麻痹液）组和 PL DN（标准德尔尼多心脏麻痹液）组。测量基线、解钳、入 ICU 和入院后 24 小时的血清心肌肌钙蛋白 I (cTnI)水平、肌力药物的类型和剂量、EF、解钳后的心律失常发生率和乳酸水平，并进行组间比较：结果：共招募了 109 名患者。在心肺旁路时间、心肌酶、输血需求和动脉血气方面，PL DN 强心剂组和 LR DN 强心剂组之间没有明显的统计学差异。然而，在进入重症监护室后和术后 24 小时内，LR DN 组患者的术后血清 cTnI 水平明显高于 PL DN 组患者。结论：我们得出结论，在使用 CPB 进行 CABG 的成人患者中，标准德尔尼多心脏麻痹溶液与基于林格乳酸盐的德尔尼多心脏麻痹相比，能提供更好的心肌保护。我们建议接受 CABG 手术的患者使用以血浆-Lyte A 为基础的标准德尔尼多心脏麻痹液。
{"title":"Traditional vs. modified Ringer lactate-based del Nido cardioplegia impacts on clinical outcomes in patients undergoing coronary artery bypass grafting: results from a clinical trial","authors":"Naser Kachoueian, Farhad Gorjipour, Salimeh Janghorban, Majid Torkashvand, Mohammad Parsa Mahjoob, Hossein Aslani, Mohamadjavad Mehrabanian, Fazel Gorjipour","doi":"10.1051/ject/2024010","DOIUrl":"https://doi.org/10.1051/ject/2024010","url":null,"abstract":"Introduction: myocardial protection with cardioplegia solution is one of the precautions during coronary bypass grafting surgery (CABG) with cardiopulmonary bypass (CPB) to reduce myocardial damage and ischemia/reperfusion injuries. Unfortunately, the major component of the del Nido cardioplegia solution, Plasma-Lyte A, is unreachable in Iran due to high cost. Therefore, we have utilized lactate Ringer's solution as the base solution for our modified del Nido solution (LR DN).\u0000Study design and methods: the present clinical trial was performed on 18-75 year old patients (EF>35%) undergoing CABG with CPB in Imam Hossein hospital Tehran-Iran in 2021. Patients were randomly allocated to LR DN (modified del Nido cardioplegia) and PL DN (standard del Nido cardioplegia solution) groups. Serum level of cardiac troponin I (cTnI) at baseline, declamp, ICU admission, and 24 hours after admission, the type and dosage of inotrope agents, EF, rate of arrhythmia after clamp removal and lactate level were measured and compared between groups.\u0000Results: 109 patients were recruited. There were no statistically significant differences between the PL DN cardioplegia and LR DN groups for cardiopulmonary bypass times, cardiac enzymes, transfusion requirements, and arterial blood gases. However, postoperative serum levels of cTnI among patients in the LR DN group was significantly higher than patients of the PL DN group after ICU admission and 24 hours postoperatively. Also, more patients needed epinephrine administration in the operating room in the LR DN group (29.8% vs. 11.5%; p: 0.019 vs. PL DN group).\u0000Conclusion: we concluded that standard del Nido cardioplegia solution offers better myocardial protection compared with Ringer's lactate-based del Nido cardioplegia in adult patients undergoing CABG with CPB. We recommend using standard del Nido cardioplegia with a base of Plasma-Lyte A for patients presenting for CABG surgery.","PeriodicalId":309024,"journal":{"name":"The Journal of ExtraCorporeal Technology","volume":"20 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140976670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract While the process of teaching student perfusionists has been in development since the 1950s, the publication of the processes to improve perfusion clinical education has been largely lacking. Publications regarding education from other allied health and medical fields have shown the value of student-centered learning. The use of reflective practice to move perfusion students from thinking on actions after cardiopulmonary bypass (CPB) to reflecting and reacting on actions during CPB is better encouraged by moving from a teacher-centered to student-centered clinical model. Our institution’s teaching process has developed into a multi-point procedure with the goal of making our students into reflective practicing clinicians. Student preceptor evaluations were reversed to allow the student to evaluate themselves first, with feedback from the preceptor given subsequently. Additionally, a biweekly student educational session, where the student chooses a topic and reviews current evidence-based practice, was instituted. The clinical program director serves as the moderator and clinical expert to facilitate problem-based learning during the sessions. Students were also given 3 skill/experience levels with goals to reach and move through during the rotation. These student levels were also helpful to our preceptors in knowing what each student’s skill level was throughout their rotation. Overall, moving from a teacher-centered to a student-centered clinical rotation has been helpful in making students familiar with reflective practice, self-evaluation, evidence-based practice, and problem-based learning. The incorporation of these processes will hopefully lead students to becoming lifelong reflective perfusionists.
{"title":"Adapting and Applying Student-centered Learning in a Perfusion Clinical Rotation","authors":"James R Neal, Caitlin Blau, Clint Colby","doi":"10.1051/ject/2024001","DOIUrl":"https://doi.org/10.1051/ject/2024001","url":null,"abstract":"Abstract\u0000 \u0000While the process of teaching student perfusionists has been in development since the 1950s, the publication of the processes to improve perfusion clinical education has been largely lacking. Publications regarding education from other allied health and medical fields have shown the value of student-centered learning. The use of reflective practice to move perfusion students from thinking on actions after cardiopulmonary bypass (CPB) to reflecting and reacting on actions during CPB is better encouraged by moving from a teacher-centered to student-centered clinical model. \u0000 \u0000Our institution’s teaching process has developed into a multi-point procedure with the goal of making our students into reflective practicing clinicians. Student preceptor evaluations were reversed to allow the student to evaluate themselves first, with feedback from the preceptor given subsequently. Additionally, a biweekly student educational session, where the student chooses a topic and reviews current evidence-based practice, was instituted. The clinical program director serves as the moderator and clinical expert to facilitate problem-based learning during the sessions. Students were also given 3 skill/experience levels with goals to reach and move through during the rotation. These student levels were also helpful to our preceptors in knowing what each student’s skill level was throughout their rotation.\u0000Overall, moving from a teacher-centered to a student-centered clinical rotation has been helpful in making students familiar with reflective practice, self-evaluation, evidence-based practice, and problem-based learning. The incorporation of these processes will hopefully lead students to becoming lifelong reflective perfusionists.","PeriodicalId":309024,"journal":{"name":"The Journal of ExtraCorporeal Technology","volume":"62 19","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139836694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract While the process of teaching student perfusionists has been in development since the 1950s, the publication of the processes to improve perfusion clinical education has been largely lacking. Publications regarding education from other allied health and medical fields have shown the value of student-centered learning. The use of reflective practice to move perfusion students from thinking on actions after cardiopulmonary bypass (CPB) to reflecting and reacting on actions during CPB is better encouraged by moving from a teacher-centered to student-centered clinical model. Our institution’s teaching process has developed into a multi-point procedure with the goal of making our students into reflective practicing clinicians. Student preceptor evaluations were reversed to allow the student to evaluate themselves first, with feedback from the preceptor given subsequently. Additionally, a biweekly student educational session, where the student chooses a topic and reviews current evidence-based practice, was instituted. The clinical program director serves as the moderator and clinical expert to facilitate problem-based learning during the sessions. Students were also given 3 skill/experience levels with goals to reach and move through during the rotation. These student levels were also helpful to our preceptors in knowing what each student’s skill level was throughout their rotation. Overall, moving from a teacher-centered to a student-centered clinical rotation has been helpful in making students familiar with reflective practice, self-evaluation, evidence-based practice, and problem-based learning. The incorporation of these processes will hopefully lead students to becoming lifelong reflective perfusionists.
{"title":"Adapting and Applying Student-centered Learning in a Perfusion Clinical Rotation","authors":"James R Neal, Caitlin Blau, Clint Colby","doi":"10.1051/ject/2024001","DOIUrl":"https://doi.org/10.1051/ject/2024001","url":null,"abstract":"Abstract\u0000 \u0000While the process of teaching student perfusionists has been in development since the 1950s, the publication of the processes to improve perfusion clinical education has been largely lacking. Publications regarding education from other allied health and medical fields have shown the value of student-centered learning. The use of reflective practice to move perfusion students from thinking on actions after cardiopulmonary bypass (CPB) to reflecting and reacting on actions during CPB is better encouraged by moving from a teacher-centered to student-centered clinical model. \u0000 \u0000Our institution’s teaching process has developed into a multi-point procedure with the goal of making our students into reflective practicing clinicians. Student preceptor evaluations were reversed to allow the student to evaluate themselves first, with feedback from the preceptor given subsequently. Additionally, a biweekly student educational session, where the student chooses a topic and reviews current evidence-based practice, was instituted. The clinical program director serves as the moderator and clinical expert to facilitate problem-based learning during the sessions. Students were also given 3 skill/experience levels with goals to reach and move through during the rotation. These student levels were also helpful to our preceptors in knowing what each student’s skill level was throughout their rotation.\u0000Overall, moving from a teacher-centered to a student-centered clinical rotation has been helpful in making students familiar with reflective practice, self-evaluation, evidence-based practice, and problem-based learning. The incorporation of these processes will hopefully lead students to becoming lifelong reflective perfusionists.","PeriodicalId":309024,"journal":{"name":"The Journal of ExtraCorporeal Technology","volume":"22 24","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139777006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The Checklist Checkup & Checklist fatigue- Say what? How does it impact clinical perfusion practice.","authors":"Bharat Datt","doi":"10.1051/ject/2023046","DOIUrl":"https://doi.org/10.1051/ject/2023046","url":null,"abstract":"","PeriodicalId":309024,"journal":{"name":"The Journal of ExtraCorporeal Technology","volume":"82 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138998659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Z. Nurmykhametova, T. Lesbekov, R. Kaliyev, Bolat Bekishev, Nilufar Jabayeva, S. Novikova, L. Faizov, I. Vakhrushev, Yuriy Pya
Background: Left ventricular assist device (LVAD) candidates are at increased risk of immune dysregulation and infectious complications. To attenuate the elevated proinflammatory cytokine levels and associated adverse clinical outcomes, it has been postulated that extracorporeal blood purification could improve the overall survival rate and morbidity of patients undergoing LVAD implantation. Methods: We retrospectively reviewed prospectively collected data of 15 patients who underwent LVAD implantation at our center between January 2021 and March 2022. Of these, 15 (100%) who received HeartMate 3™ (St. Jude Medical, Abbott, MN, USA) device were eligible. Intraoperatively, patients were single randomized 1:1:1 to three groups: group 1, patients who received Cytosorb therapy (n=5; installed in the CPB circuit); group 2, patients who received Jafron HA330 (n=5; installed in the CPB circuit); and control group 3, patients who did not receive filter (n=5; usual care, neither Cytosorb nor Jafron during CPB). Baseline patient characteristics and intraoperative data were compared between the groups. Blood sample analyses were performed to assess the levels of inflammatory markers (IL-1, 6, 8; CRP, Leukocyte, Lactate, PCT, NT-proBNP, TNF-α) in both preoperative and postoperative data. Results: Baseline patient characteristics were similar in all three groups. We found that IL1α; IL 6; IL8; Lactatedehydrogenase, PCT, pro-BNP, CRP; Leukocyte, and TNFα levels significantly increased with LVAD implantation and that neither Cytosorb nor Jafron influenced this response. In-hospital mortality and overall survival during follow-up were similar among the groups. Conclusion: Our preliminary results showed that hemoadsorption therapy using Cytosorb or Jafron hemoadsorption (HA) 330 may not be clinically beneficial for patients with advanced heart failure undergoing LVAD implantation. Large prospective studies are needed to evaluate the potential role of HA therapy in improving outcomes in patients undergoing LVAD implantation.
{"title":"Preliminary report of extracorporeal blood purification therapy in patients receiving LVAD: Cytosorb or Jafron HA330","authors":"Z. Nurmykhametova, T. Lesbekov, R. Kaliyev, Bolat Bekishev, Nilufar Jabayeva, S. Novikova, L. Faizov, I. Vakhrushev, Yuriy Pya","doi":"10.1051/ject/2023048","DOIUrl":"https://doi.org/10.1051/ject/2023048","url":null,"abstract":"Background: Left ventricular assist device (LVAD) candidates are at increased risk of immune dysregulation and infectious complications. To attenuate the elevated proinflammatory cytokine levels and associated adverse clinical outcomes, it has been postulated that extracorporeal blood purification could improve the overall survival rate and morbidity of patients undergoing LVAD implantation.\u0000Methods: We retrospectively reviewed prospectively collected data of 15 patients who underwent LVAD implantation at our center between January 2021 and March 2022. Of these, 15 (100%) who received HeartMate 3™ (St. Jude Medical, Abbott, MN, USA) device were eligible. Intraoperatively, patients were single randomized 1:1:1 to three groups: group 1, patients who received Cytosorb therapy (n=5; installed in the CPB circuit); group 2, patients who received Jafron HA330 (n=5; installed in the CPB circuit); and control group 3, patients who did not receive filter (n=5; usual care, neither Cytosorb nor Jafron during CPB). Baseline patient characteristics and intraoperative data were compared between the groups. Blood sample analyses were performed to assess the levels of inflammatory markers (IL-1, 6, 8; CRP, Leukocyte, Lactate, PCT, NT-proBNP, TNF-α) in both preoperative and postoperative data.\u0000Results: Baseline patient characteristics were similar in all three groups. We found that IL1α; IL 6; IL8; Lactatedehydrogenase, PCT, pro-BNP, CRP; Leukocyte, and TNFα levels significantly increased with LVAD implantation and that neither Cytosorb nor Jafron influenced this response. In-hospital mortality and overall survival during follow-up were similar among the groups.\u0000Conclusion: Our preliminary results showed that hemoadsorption therapy using Cytosorb or Jafron hemoadsorption (HA) 330 may not be clinically beneficial for patients with advanced heart failure undergoing LVAD implantation. Large prospective studies are needed to evaluate the potential role of HA therapy in improving outcomes in patients undergoing LVAD implantation.","PeriodicalId":309024,"journal":{"name":"The Journal of ExtraCorporeal Technology","volume":"98 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139005520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mr. Salman Pervaiz Butt, Nabeel Razzaq, Yasir Saleem, Bill Cook, Salman Abdulaziz
Introduction: The optimal timing for extracorporeal membrane oxygenation (ECMO) circuit change-out is crucial for the successful management of patients with severe cardiopulmonary failure. This comprehensive review examines the various factors that influence the timing of oxygenator replacement in the ECMO circuit. By considering these factors, clinicians can make informed decisions to ensure timely and effective change-out, enhancing patient outcomes and optimizing the delivery of ECMO therapy. Methodology: A thorough search of relevant studies on ECMO circuit and oxygenator change-out was conducted using multiple scholarly databases and relevant keywords. Studies published between 2017 and 2023 were included, resulting in 40 studies that met the inclusion criteria. Discussion: Thrombosis within the membrane oxygenator and its impact on dysfunction were identified as significant contributors, highlighting the importance of monitoring coagulation parameters and gas exchange. Several factors, including fibrinogen levels, pre and post-membrane blood gases, plasma free hemoglobin, D-dimers, platelet function, flows and pressures, and anticoagulation strategy, were found to be important considerations when determining the need for an oxygenator or circuit change-out. The involvement of a multidisciplinary team and thorough preparation were also highlighted as crucial aspects in this process. Conclusion: In conclusion, managing circuit change-outs in ECMO therapy requires considering factors such as fibrinogen levels, blood gases, plasma free hemoglobin, D-dimers, platelet function, flows, pressures, and anticoagulation strategy. Monitoring these parameters allows for early detection of issues, timely interventions, and optimized ECMO therapy. Standardized protocols, personalized anticoagulation approaches, and non-invasive monitoring techniques can improve safety and effectiveness of circuit change-outs. Further research and collaboration are needed to advance ECMO management and enhance patient outcomes.
{"title":"Improving ECMO Therapy: Monitoring Oxygenator Functionality and Identifying Key Indicators, Factors, and Considerations for Changeout","authors":"Mr. Salman Pervaiz Butt, Nabeel Razzaq, Yasir Saleem, Bill Cook, Salman Abdulaziz","doi":"10.1051/ject/2023047","DOIUrl":"https://doi.org/10.1051/ject/2023047","url":null,"abstract":"Introduction:\u0000The optimal timing for extracorporeal membrane oxygenation (ECMO) circuit change-out is crucial for the successful management of patients with severe cardiopulmonary failure. This comprehensive review examines the various factors that influence the timing of oxygenator replacement in the ECMO circuit. By considering these factors, clinicians can make informed decisions to ensure timely and effective change-out, enhancing patient outcomes and optimizing the delivery of ECMO therapy.\u0000 \u0000Methodology:\u0000A thorough search of relevant studies on ECMO circuit and oxygenator change-out was conducted using multiple scholarly databases and relevant keywords. Studies published between 2017 and 2023 were included, resulting in 40 studies that met the inclusion criteria.\u0000 \u0000Discussion:\u0000Thrombosis within the membrane oxygenator and its impact on dysfunction were identified as significant contributors, highlighting the importance of monitoring coagulation parameters and gas exchange. Several factors, including fibrinogen levels, pre and post-membrane blood gases, plasma free hemoglobin, D-dimers, platelet function, flows and pressures, and anticoagulation strategy, were found to be important considerations when determining the need for an oxygenator or circuit change-out. The involvement of a multidisciplinary team and thorough preparation were also highlighted as crucial aspects in this process.\u0000 \u0000Conclusion:\u0000In conclusion, managing circuit change-outs in ECMO therapy requires considering factors such as fibrinogen levels, blood gases, plasma free hemoglobin, D-dimers, platelet function, flows, pressures, and anticoagulation strategy. Monitoring these parameters allows for early detection of issues, timely interventions, and optimized ECMO therapy. Standardized protocols, personalized anticoagulation approaches, and non-invasive monitoring techniques can improve safety and effectiveness of circuit change-outs. Further research and collaboration are needed to advance ECMO management and enhance patient outcomes.","PeriodicalId":309024,"journal":{"name":"The Journal of ExtraCorporeal Technology","volume":"33 15","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139006624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Richard Owens, Madeline Loftin, Kellen Rosten, Douglas Fisher, Blake Denison, Erin Gottlieb, Charles Fraser
Early cardiac surgery in neonates and infants with congenital heart disease has been performed since the middle to late years of the twentieth century. To date there are very few reports of successful congenital heart surgery using cardiopulmonary bypass (CPB) in premature babies less than 1000grams with serious congenital heart disease. Limited information is available in the literature describing perfusion techniques for this extremely fragile patient population. Miniaturization of the CPB circuit contributes multiple factors that affect this population significantly. These factors include the reduction of patient to circuit ratios, volume of distribution of pharmacological agents, management of pressure gradients within the CPB system and increased tactile control by the attending perfusionist. Careful management of the physiological environment of the patient is of utmost importance and can mitigate risks during CPB, including volume shifts into the interstitial space, electrolyte, and acid-base imbalance, and intracranial hemorrhage. We report perfusion techniques successfully utilized during the surgical repair of transposition of the great arteries for an 800g, 28-week-old neonate. CPB techniques for the smallest and youngest patients may be executed safely when proper physical, chemical and perfusion process adjustments are made and managed meticulously.
{"title":"Perfusion techniques for an 800g premature neonate undergoing Arterial Switch Procedure for Transposition of the Great Arteries","authors":"Richard Owens, Madeline Loftin, Kellen Rosten, Douglas Fisher, Blake Denison, Erin Gottlieb, Charles Fraser","doi":"10.1051/ject/2023045","DOIUrl":"https://doi.org/10.1051/ject/2023045","url":null,"abstract":"Early cardiac surgery in neonates and infants with congenital heart disease has been performed since the middle to late years of the twentieth century. To date there are very few reports of successful congenital heart surgery using cardiopulmonary bypass (CPB) in premature babies less than 1000grams with serious congenital heart disease. Limited information is available in the literature describing perfusion techniques for this extremely fragile patient population. Miniaturization of the CPB circuit contributes multiple factors that affect this population significantly. These factors include the reduction of patient to circuit ratios, volume of distribution of pharmacological agents, management of pressure gradients within the CPB system and increased tactile control by the attending perfusionist. Careful management of the physiological environment of the patient is of utmost importance and can mitigate risks during CPB, including volume shifts into the interstitial space, electrolyte, and acid-base imbalance, and intracranial hemorrhage. We report perfusion techniques successfully utilized during the surgical repair of transposition of the great arteries for an 800g, 28-week-old neonate. CPB techniques for the smallest and youngest patients may be executed safely when proper physical, chemical and perfusion process adjustments are made and managed meticulously.","PeriodicalId":309024,"journal":{"name":"The Journal of ExtraCorporeal Technology","volume":" 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138610127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Emily A Hayes, Ashley B Walczak, Erin Goodhue Meyer, Kathleen K Nichol, Matthew A Deitemyer, V. Duffy, Michelle Moore Padilla, Robert J Gajarski, D. Nandi
Background: Highly sensitized pediatric patients awaiting heart transplantation experience longer wait times and higher waitlist mortality. To improve the likelihood of successful transplantation, various strategies have been utilized, including peri-operative plasmapheresis, to broaden potential donor pools. Methods: This in vitro study utilized two membrane-based plasmapheresis (MP, Prismaflex) and two centrifuge-based plasmapheresis (CP, Spectra Optia, Terumo BCT) circuits incorporated into four separate extracorporeal (EC) circuits primed with high titer, highly sensitized type O donor whole blood. Assays were performed to determine baseline anti-A and B isohemagglutinin titers (IT) and anti-human leukocyte antigen (HLA) antibodies and then at 30-minute increments until completion of the run at two hours. Results: There was a decrease in anti-A and anti-B IgM and IgG titers with both MP and CP. Mean anti-A and anti-B titer reduction was by 4.625 titers (93.7% change) and 4.375 titers (93.8% change) using MP and CP, respectively. At two hours of apheresis, CP reduced mean fluorescence intensity (MFI) by 2-3.5 fold and MP reduced MFI by 1.7-2.5 fold. Conclusions: In this in vitro plasmapheresis model of IT and anti-HLA antibody reduction, both MP and CP can be used quickly and effectively to reduce circulating antibodies, and CP may have some greater degree of efficiency. Further in vivo research on incorporating CP or MP into EC circuits at the time of transplant is needed. However, with further clinical research, there is potential to broaden potential donors and improve patient safety in sensistized patients.
{"title":"An in Vitro Comparison of Intra-Operative Isohemagglutinin and Human Leukocyte Antigen Removal Techniques in Pediatric Heart Transplant","authors":"Emily A Hayes, Ashley B Walczak, Erin Goodhue Meyer, Kathleen K Nichol, Matthew A Deitemyer, V. Duffy, Michelle Moore Padilla, Robert J Gajarski, D. Nandi","doi":"10.1051/ject/2023034","DOIUrl":"https://doi.org/10.1051/ject/2023034","url":null,"abstract":"Background: Highly sensitized pediatric patients awaiting heart transplantation experience longer wait times and higher waitlist mortality. To improve the likelihood of successful transplantation, various strategies have been utilized, including peri-operative plasmapheresis, to broaden potential donor pools.\u0000Methods: This in vitro study utilized two membrane-based plasmapheresis (MP, Prismaflex) and two centrifuge-based plasmapheresis (CP, Spectra Optia, Terumo BCT) circuits incorporated into four separate extracorporeal (EC) circuits primed with high titer, highly sensitized type O donor whole blood. Assays were performed to determine baseline anti-A and B isohemagglutinin titers (IT) and anti-human leukocyte antigen (HLA) antibodies and then at 30-minute increments until completion of the run at two hours.\u0000Results: There was a decrease in anti-A and anti-B IgM and IgG titers with both MP and CP. Mean anti-A and anti-B titer reduction was by 4.625 titers (93.7% change) and 4.375 titers (93.8% change) using MP and CP, respectively. At two hours of apheresis, CP reduced mean fluorescence intensity (MFI) by 2-3.5 fold and MP reduced MFI by 1.7-2.5 fold.\u0000Conclusions: In this in vitro plasmapheresis model of IT and anti-HLA antibody reduction, both MP and CP can be used quickly and effectively to reduce circulating antibodies, and CP may have some greater degree of efficiency. Further in vivo research on incorporating CP or MP into EC circuits at the time of transplant is needed. However, with further clinical research, there is potential to broaden potential donors and improve patient safety in sensistized patients.","PeriodicalId":309024,"journal":{"name":"The Journal of ExtraCorporeal Technology","volume":"220 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134555740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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