Pub Date : 2024-03-01Epub Date: 2024-03-15DOI: 10.1051/ject/2024002
Raymond K Wong
{"title":"First year update as cardiovascular perfusion's open access international journal.","authors":"Raymond K Wong","doi":"10.1051/ject/2024002","DOIUrl":"10.1051/ject/2024002","url":null,"abstract":"","PeriodicalId":39644,"journal":{"name":"Journal of Extra-Corporeal Technology","volume":"56 1","pages":"1"},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10941836/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140132826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-01Epub Date: 2023-12-15DOI: 10.1051/ject/2023037
Jose M Cardenas, Santiago Borasino, Joseph Timpa, Jeremy Hawkins, Martha McBride, William Rushton, Jordan Newman, Erika Mendoza, Robert Sorabella, Jonathan Byrnes
Calcium channel blocker (CCB) toxicity carries a high mortality and is the sixth most fatal drug class reported to US poison centers. Amlodipine overdose is characterized by a life-threatening arterial vasodilation that compromises organ perfusion. The management of CCB intoxication is focused on maintaining adequate organ perfusion. In cases refractory to medical therapies, hemodynamic support with extracorporeal membrane oxygenation (ECMO) is warranted necessitating higher flows than usual to compensate for the vasodilation and requiring central cannulation. We present a case of a 12-year-old with severe dihydropyridine CCB ingestion, refractory to medical management and successfully treated with central ECMO cannulation. The patient was discharged home with no significant disability. Central ECMO cannulation may be helpful to facilitate adequate flows in vasodilatory shock such as CCB overdose.
{"title":"Central ECMO cannulation for severe dihydropyridine calcium channel blocker overdose.","authors":"Jose M Cardenas, Santiago Borasino, Joseph Timpa, Jeremy Hawkins, Martha McBride, William Rushton, Jordan Newman, Erika Mendoza, Robert Sorabella, Jonathan Byrnes","doi":"10.1051/ject/2023037","DOIUrl":"https://doi.org/10.1051/ject/2023037","url":null,"abstract":"<p><p>Calcium channel blocker (CCB) toxicity carries a high mortality and is the sixth most fatal drug class reported to US poison centers. Amlodipine overdose is characterized by a life-threatening arterial vasodilation that compromises organ perfusion. The management of CCB intoxication is focused on maintaining adequate organ perfusion. In cases refractory to medical therapies, hemodynamic support with extracorporeal membrane oxygenation (ECMO) is warranted necessitating higher flows than usual to compensate for the vasodilation and requiring central cannulation. We present a case of a 12-year-old with severe dihydropyridine CCB ingestion, refractory to medical management and successfully treated with central ECMO cannulation. The patient was discharged home with no significant disability. Central ECMO cannulation may be helpful to facilitate adequate flows in vasodilatory shock such as CCB overdose.</p>","PeriodicalId":39644,"journal":{"name":"Journal of Extra-Corporeal Technology","volume":"55 4","pages":"206-208"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10723573/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138807873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-01Epub Date: 2023-12-15DOI: 10.1051/ject/2023043
Patrick W Weerwind, Nousjka P A Vranken
{"title":"Extracorporeal cardiopulmonary resuscitation: lifesaving for the right patient, at the right time and in the right place.","authors":"Patrick W Weerwind, Nousjka P A Vranken","doi":"10.1051/ject/2023043","DOIUrl":"10.1051/ject/2023043","url":null,"abstract":"","PeriodicalId":39644,"journal":{"name":"Journal of Extra-Corporeal Technology","volume":"55 4","pages":"157-158"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10723523/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138807779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Laura R Dell'Aiera, David Fitzgerald, David Fisher, Norman Gill
Background Access to quality healthcare education across the world is disproportionate. This study explores the potential for health professions education to be delivered online to reach international students. Methods Exploratory mixed methods were used to identify the barriers, facilitators, and early outcomes of online international health professions education. Results Qualitative analysis yielded four primary and nine subthemes. Multiple interventions were implemented in the planning of a novel online international Extracorporeal Science (ECS) program based on these themes. Quantitative data from the first semester of the ECS program was collected along with data from the traditional entry-level program and historic data from previous entry-level cohorts. No significant correlations or differences were found between students. Student satisfaction surveys were determined to be equivalent for each group. Mixed data analysis revealed exceptional student satisfaction in areas where qualitative feedback was incorporated in the program design. Conclusions Online international education may be a viable option in the health professions. Barriers and facilitators to this mode of education were identified and utilized in designing one such program. Early outcomes from the novel ECS program reveal that the student performance and satisfaction are equivalent to those of a traditional in-person training program.
{"title":"Examining Online International Health Professions Education: A Mixed Methods Review of Barriers, Facilitators, and Early Outcomes","authors":"Laura R Dell'Aiera, David Fitzgerald, David Fisher, Norman Gill","doi":"10.1051/ject/2023044","DOIUrl":"https://doi.org/10.1051/ject/2023044","url":null,"abstract":"Background Access to quality healthcare education across the world is disproportionate. This study explores the potential for health professions education to be delivered online to reach international students. Methods Exploratory mixed methods were used to identify the barriers, facilitators, and early outcomes of online international health professions education. Results Qualitative analysis yielded four primary and nine subthemes. Multiple interventions were implemented in the planning of a novel online international Extracorporeal Science (ECS) program based on these themes. Quantitative data from the first semester of the ECS program was collected along with data from the traditional entry-level program and historic data from previous entry-level cohorts. No significant correlations or differences were found between students. Student satisfaction surveys were determined to be equivalent for each group. Mixed data analysis revealed exceptional student satisfaction in areas where qualitative feedback was incorporated in the program design. Conclusions Online international education may be a viable option in the health professions. Barriers and facilitators to this mode of education were identified and utilized in designing one such program. Early outcomes from the novel ECS program reveal that the student performance and satisfaction are equivalent to those of a traditional in-person training program.","PeriodicalId":39644,"journal":{"name":"Journal of Extra-Corporeal Technology","volume":"4 11","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136227167","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}
Peter Chris Michalakes, Walter F DeNino, Maxwell E Afari, Bram J Geller
Extracorporeal Cardiopulmonary Resuscitation (ECPR) is an emerging approach to cardiac arrest. We present two contrasting cases from a high-volume extracorporeal membrane oxygenation (ECMO) center (defined as greater than 30 ECMO cases per year) without a 24/7 ECPR program to highlight how to establish an ECPR program with a focus on patient selection and outcome optimization. In one case, a patient presented with cardiac arrest during initial triage for chest pain within the emergency department, and in the other case, a patient experienced an out-of-hospital cardiac arrest with prolonged no-flow and low-flow time. Despite the lack of a 24/7 ECPR program at the presenting center, both patients received an ECPR evaluation, as both patients presented while all services necessary for ECMO cannulation were available. The in-hospital cardiac arrest patient was successfully cannulated for ECMO during cardiopulmonary resuscitation and survived with few complications. The out-of-hospital cardiac arrest patient was deemed a poor candidate for ECPR and expired soon after presentation. These two cases highlight the complex decision-making in ECPR and further illustrate how to create ECPR protocols at a high-volume ECMO center before resources are available for 24/7 ECPR program.
{"title":"Building an Extracorporeal Cardiopulmonary Resuscitation Program at a High-Volume Extracorporeal Membrane Oxygenation Center","authors":"Peter Chris Michalakes, Walter F DeNino, Maxwell E Afari, Bram J Geller","doi":"10.1051/ject/2023042","DOIUrl":"https://doi.org/10.1051/ject/2023042","url":null,"abstract":"Extracorporeal Cardiopulmonary Resuscitation (ECPR) is an emerging approach to cardiac arrest. We present two contrasting cases from a high-volume extracorporeal membrane oxygenation (ECMO) center (defined as greater than 30 ECMO cases per year) without a 24/7 ECPR program to highlight how to establish an ECPR program with a focus on patient selection and outcome optimization. In one case, a patient presented with cardiac arrest during initial triage for chest pain within the emergency department, and in the other case, a patient experienced an out-of-hospital cardiac arrest with prolonged no-flow and low-flow time. Despite the lack of a 24/7 ECPR program at the presenting center, both patients received an ECPR evaluation, as both patients presented while all services necessary for ECMO cannulation were available. The in-hospital cardiac arrest patient was successfully cannulated for ECMO during cardiopulmonary resuscitation and survived with few complications. The out-of-hospital cardiac arrest patient was deemed a poor candidate for ECPR and expired soon after presentation. These two cases highlight the complex decision-making in ECPR and further illustrate how to create ECPR protocols at a high-volume ECMO center before resources are available for 24/7 ECPR program.","PeriodicalId":39644,"journal":{"name":"Journal of Extra-Corporeal Technology","volume":"61 3","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136107057","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}
JECT requires authors to disclose any commercial association that might pose a conflict of interest with the submitted manuscript by completing the Conflict of Interest statement listed below. It is the responsibility of the authors to fully disclose institutional or corporate affiliations that might constitute a conflict. Any association that results in financial exchange between the author(s) and a private corporation, or entity, must be disclosed. These include consultancies, stock ownership, patent-licensing or similar relationships. If commercial products are evaluated (not just listed in the methodology), the authors are required to include in their cover letter the following:
{"title":"Advocating for an Open Communication Culture in Perfusion and Cardiothoracic Community: A Call to Action.","authors":"Salman pervaiz Butt, Yasir Saleem, Bill Cook","doi":"10.1051/ject/2023041","DOIUrl":"https://doi.org/10.1051/ject/2023041","url":null,"abstract":"JECT requires authors to disclose any commercial association that might pose a conflict of interest with the submitted manuscript by completing the Conflict of Interest statement listed below. It is the responsibility of the authors to fully disclose institutional or corporate affiliations that might constitute a conflict. Any association that results in financial exchange between the author(s) and a private corporation, or entity, must be disclosed. These include consultancies, stock ownership, patent-licensing or similar relationships. If commercial products are evaluated (not just listed in the methodology), the authors are required to include in their cover letter the following:","PeriodicalId":39644,"journal":{"name":"Journal of Extra-Corporeal Technology","volume":"72 3","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135567277","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}
Katherine Kohlsaat, Kimberlee Gauvreau, Francis Fynn-Thompson, Sharon Boyle, Kevin Connor, William L. Regan, Gregory S. Matte, Meena Nathan
Background: A standard blood prime for cardiopulmonary bypass (CPB) in congenital cardiac surgery may possess non-physiologic values for electrolytes, glucose, and lactate. Pre-bypass Ultrafiltration (PBUF) can make these values more physiologic and standardized prior to bypass initiation. We aimed to determine if using PBUF on blood primes including packed red blood cells and thawed plasma would make prime values more predictable and physiologic. Additionally, we aimed to evaluate whether the addition of PBUF had an impact on outcome measures. Methods: Retrospective review of consecutive patients ≤ 1 year of age undergoing an index cardiac operation on CPB between 8/2017-9/2021. As PBUF was performed at the perfusionists’ discretion, a natural grouping of patients that received PBUF vs. those that did not occurred. Differences in electrolytes, glucose, and lactate were compared at specific time-points using Fisher’s exact test for categorical variables and the Wilcoxon rank sum test for continuous variables. Clinical outcomes were also assessed. Results: In both cohorts, the median age at surgery was 3 months and 47% of patients were female; 308/704 (44%) of PBUF group and 163/414 (39%) of the standard prime group had at least one preoperative risk factor. The proportion of PBUF circuits which demonstrated more physiologic values for glucose (318 [45%]), sodium (434, [62%]), potassium (688 [98%]), lactate (612 [87%]) and osmolality (595 [92%]) was significantly higher when compared to standard prime circuit levels for glucose (8 [2%]), sodium (13 [3%], potassium (150 [36%]), lactate (56 [13%]) and osmolality (23 [6%]) prior to CPB initiation. There were no differences in clinical outcomes or rates of major adverse events between the two cohorts. Conclusions: PBUF creates standardized and more physiologic values for electrolytes, glucose, and lactate before the initiation of bypass without significant impacts on in-hospital outcomes.
{"title":"Impact of Pre-Bypass Ultrafiltration on Prime Values and Clinical Outcomes in Neonatal and Infant Cardiopulmonary Bypass","authors":"Katherine Kohlsaat, Kimberlee Gauvreau, Francis Fynn-Thompson, Sharon Boyle, Kevin Connor, William L. Regan, Gregory S. Matte, Meena Nathan","doi":"10.1051/ject/2023039","DOIUrl":"https://doi.org/10.1051/ject/2023039","url":null,"abstract":"Background: A standard blood prime for cardiopulmonary bypass (CPB) in congenital cardiac surgery may possess non-physiologic values for electrolytes, glucose, and lactate. Pre-bypass Ultrafiltration (PBUF) can make these values more physiologic and standardized prior to bypass initiation. We aimed to determine if using PBUF on blood primes including packed red blood cells and thawed plasma would make prime values more predictable and physiologic. Additionally, we aimed to evaluate whether the addition of PBUF had an impact on outcome measures. Methods: Retrospective review of consecutive patients ≤ 1 year of age undergoing an index cardiac operation on CPB between 8/2017-9/2021. As PBUF was performed at the perfusionists’ discretion, a natural grouping of patients that received PBUF vs. those that did not occurred. Differences in electrolytes, glucose, and lactate were compared at specific time-points using Fisher’s exact test for categorical variables and the Wilcoxon rank sum test for continuous variables. Clinical outcomes were also assessed. Results: In both cohorts, the median age at surgery was 3 months and 47% of patients were female; 308/704 (44%) of PBUF group and 163/414 (39%) of the standard prime group had at least one preoperative risk factor. The proportion of PBUF circuits which demonstrated more physiologic values for glucose (318 [45%]), sodium (434, [62%]), potassium (688 [98%]), lactate (612 [87%]) and osmolality (595 [92%]) was significantly higher when compared to standard prime circuit levels for glucose (8 [2%]), sodium (13 [3%], potassium (150 [36%]), lactate (56 [13%]) and osmolality (23 [6%]) prior to CPB initiation. There were no differences in clinical outcomes or rates of major adverse events between the two cohorts. Conclusions: PBUF creates standardized and more physiologic values for electrolytes, glucose, and lactate before the initiation of bypass without significant impacts on in-hospital outcomes.","PeriodicalId":39644,"journal":{"name":"Journal of Extra-Corporeal Technology","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135666707","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}
The surgical management of prosthetic valvular endocarditis (PVE) can be challenging. We report a case of a 46-year-old female patient who had a history of four cardiac operations. We chose a mitral valve replacement via right thoracotomy to enables optimal exposure of mitral valve (MV). Because of multi-reoperations, we employed systemic hyperkalemia for cardiac arrest to protect heart during cardiopulmonary bypass (CPB) without aortic cross-clamping. Here, we present a complex operation that performed management of CPB under hyperkalemia and the patient had a good postoperative recovery.
{"title":"Fifth-Time Redo Mitral Valve Replacement via Right Thoracotomy under Systemic Hyperkalemia Cardiopulmonary Bypass without Aortic Cross-clamp","authors":"Tomohisa Takeichi, Takanori Tanaka, Yoshihisa Morimoto, Akitoshi Yamada","doi":"10.1051/ject/2023040","DOIUrl":"https://doi.org/10.1051/ject/2023040","url":null,"abstract":"The surgical management of prosthetic valvular endocarditis (PVE) can be challenging. We report a case of a 46-year-old female patient who had a history of four cardiac operations. We chose a mitral valve replacement via right thoracotomy to enables optimal exposure of mitral valve (MV). Because of multi-reoperations, we employed systemic hyperkalemia for cardiac arrest to protect heart during cardiopulmonary bypass (CPB) without aortic cross-clamping. Here, we present a complex operation that performed management of CPB under hyperkalemia and the patient had a good postoperative recovery.","PeriodicalId":39644,"journal":{"name":"Journal of Extra-Corporeal Technology","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135805237","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}
for efficient and adaptable life support systems in the
{"title":"A Multipurpose Extracorporeal Life Support Circuit: A Concept for multiorgan transplant and circulatory support service Healthcare providers","authors":"Salman Pervaiz Butt, Nuno Raposo, Yasir Saleem","doi":"10.1051/ject/2023038","DOIUrl":"https://doi.org/10.1051/ject/2023038","url":null,"abstract":"for efficient and adaptable life support systems in the","PeriodicalId":39644,"journal":{"name":"Journal of Extra-Corporeal Technology","volume":"51 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135043418","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}
Nitish Khurana, Till Sünner, Oliver Hubbard, Carina E. Imburgia, Venkata Yellepeddi, Hamidreza Ghandehari, Kevin M. Watt
Background: Extracorporeal membrane oxygenation (ECMO) is a cardiopulmonary bypass device that provides life-saving complete respiratory and cardiac support in patients with cardiorespiratory failure. The majority of drugs prescribed to patients on ECMO lack dosing strategy optimized for ECMO patients. Several studies demonstrated that dosing is different in this population because the ECMO circuit components can adsorb drugs and affect drug exposure substantially. Saturation of ECMO circuit components by drug disposition has been posited but has not been proven. In this study, we have attempted to determine if propofol adsorption is saturable in ex vivo ECMO circuits. Methods: We injected ex vivo ECMO circuits with propofol, a drug that is highly adsorbed to the ECMO circuit components. Propofol was injected as a bolus dose (50 µg/mL) and a continuous infusion dose (6 mg/hr) to investigate the saturation of the ECMO circuit. Results: After the bolus dose, only 27% of propofol was recovered after 30 minutes which is as expected. However, >80% propofol was recovered after the infusion dose which persisted even when the infusion dose was discontinued. Conclusion: Our results suggest that if ECMO circuits are dosed directly with propofol, drug adsorption can be eliminated as a cause for altered drug exposure.
{"title":"Direct and Continuous Dosing of Propofol can Saturate Ex vivo ECMO Circuit to Improve Propofol Recovery","authors":"Nitish Khurana, Till Sünner, Oliver Hubbard, Carina E. Imburgia, Venkata Yellepeddi, Hamidreza Ghandehari, Kevin M. Watt","doi":"10.1051/ject/2023036","DOIUrl":"https://doi.org/10.1051/ject/2023036","url":null,"abstract":"Background: Extracorporeal membrane oxygenation (ECMO) is a cardiopulmonary bypass device that provides life-saving complete respiratory and cardiac support in patients with cardiorespiratory failure. The majority of drugs prescribed to patients on ECMO lack dosing strategy optimized for ECMO patients. Several studies demonstrated that dosing is different in this population because the ECMO circuit components can adsorb drugs and affect drug exposure substantially. Saturation of ECMO circuit components by drug disposition has been posited but has not been proven. In this study, we have attempted to determine if propofol adsorption is saturable in ex vivo ECMO circuits. Methods: We injected ex vivo ECMO circuits with propofol, a drug that is highly adsorbed to the ECMO circuit components. Propofol was injected as a bolus dose (50 µg/mL) and a continuous infusion dose (6 mg/hr) to investigate the saturation of the ECMO circuit. Results: After the bolus dose, only 27% of propofol was recovered after 30 minutes which is as expected. However, >80% propofol was recovered after the infusion dose which persisted even when the infusion dose was discontinued. Conclusion: Our results suggest that if ECMO circuits are dosed directly with propofol, drug adsorption can be eliminated as a cause for altered drug exposure.","PeriodicalId":39644,"journal":{"name":"Journal of Extra-Corporeal Technology","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136263873","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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