Perfusion-Uk最新文献

BackgroundVeno-Arterial Extracorporeal Life Support (VA ECMO) is a critical intervention for patients with cardiogenic shock, serving as bridge to recovery, transplantation, or long-term therapies. The complexity of VA ECMO and its associated risks underscore the need for reliable prognostic markers to guide patient management. This study aimed to evaluate whether cholesterol levels could serve as a specific marker for ICU survival in patients with cardiogenic shock treated with VA ECMO.MethodsA retrospective observational study was conducted at Catharina Hospital Eindhoven, The Netherlands, between January 2013 and November 2019. Data from 67 patients treated with VA ECMO were analyzed. Cholesterol levels were measured daily from day 1 to day 5 after VA ECMO initiation. Demographic data, comorbidities, and outcomes were extracted from the patient data management system. Statistical analysis was performed, with a focus on non-normality of data distribution and the predictive value of cholesterol levels on ICU survival.ResultsThe study identified a significant association between higher cholesterol levels on the first day of VA ECMO treatment and increased ICU survival. A cholesterol threshold of 2.0 mmol/L was found to be an independent predictor of survival, with patients above this threshold having a higher survival rate. Multivariate logistic regression analysis confirmed the significance of this cholesterol threshold in predicting ICU survival.ConclusionCholesterol levels measured on the first day after the initiation of VA ECMO are a significant indicator of ICU survival in patients with cardiogenic shock. A threshold of 2.0 mmol/L is particularly predictive, offering a potential prognostic tool for clinicians managing these critically ill patients.

AimTo characterize the impact of BMI (body mass index) on HIBI (hypoxic-ischemic brain injury) in patients receiving ECPR, with the hypothesis that elevated BMI is associated with increased risk of HIBI.MethodsThe Extracorporeal Life Support Organization (ELSO) registry was queried for patients who received ECPR during 2020-2024. Patients were categorized into 5 standard BMI groups. Normal Weight was used as the reference group. Generalized additive model (GAM) analysis was performed to identify the BMI range with greatest predicted HIBI risk. Multivariable logistic regression was used to compare odds of HIBI and post-HIBI mortality between standard BMI groups and Normal Weight.ResultsOf 6413 included patients (median age = 57.4, 68.6% male, median BMI = 28.1), 10.5% of Class 1 Obesity patients experienced HIBI compared to 5.0% of Normal Weight patients, 9.6% of Class 2 Obesity patients, 6.3% of Overweight patients, and 3.6% of Underweight patients (p < 0.001). GAM analysis showed a non-linear relationship between BMI and HIBI with highest predicted HIBI risk for Class 1 Obesity patients, which was confirmed by multivariable regression (adjusted odds ratio (aOR) = 1.86, 95%CI = 1.09, 3.20, p = 0.02). HIBI led to >90% mortality in all BMI categories, with increased odds of post-HIBI mortality for Class 1 Obesity patients compared to Normal Weight (aOR = 1.97, 95%CI = 1.14, 3.47, p = 0.016). There was no significant difference in odds of HIBI or post-HIBI mortality for any other BMI category compared to Normal Weight.ConclusionsECPR patients with Class 1 Obesity had increased odds of HIBI and post-HIBI mortality compared to Normal Weight patients after adjusting for covariates.

IntroductionCardiopulmonary bypass (CPB) plays a central role in pediatric cardiac surgery, yet standardized quality indicators (QIs) specific to pediatric practice remain underutilized across institutions.MethodsA comprehensive review of literature from 2010 to 2025 was conducted using PubMed, Embase, and the Cochrane Library. Eligible studies included randomized trials, observational research, and meta-analyses.ResultsDO₂i > 340 mL/min/m² in neonates and >400 mL/min/m² in infants was associated with a lower risk of acute kidney injury (AKI). Lactate >3 mmol/L predicted major morbidity, while MAP >40-45 mmHg correlated with adequate perfusion. Maintaining Hct ≥25% and a fluid balance within ±5% of baseline also supported improved postoperative outcomes. The integration of real-time multimodal monitoring, including NIRS and venous oxygen metrics, enhances individualized perfusion management.ConclusionAdopting and standardizing QIs in pediatric CPB supports early detection of inadequate perfusion and enhances surgical safety. A structured, multimodal QI framework can facilitate institutional benchmarking, improve patient outcomes, and guide future innovation in pediatric perfusion practices.

BackgroundPostoperative bleeding due to acquired coagulopathy is a common and serious complication following cardiac surgery. Fresh frozen plasma (FFP) and prothrombin complex concentrate (PCC) are the principal therapies used to correct coagulopathy in this setting. However, their comparative effectiveness and safety remain uncertain.MethodsMEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were systematically searched through March 2025 to identify randomized controlled trials (RCTs) comparing PCC and FFP in adult cardiac surgery patients with postoperative coagulopathy. All analyses were performed using Review Manager (Version 5.4; Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2020).ResultsFour RCTs including a total of 671 patients were eligible for inclusion. Compared to FFP, PCC was associated with significantly lower chest tube drainage volume (mean difference [MD], -162.14; 95% CI: -264.47 to -59.81 mL; P = 0.002; I² = 49%), reduced RBC transfusion rate (risk ratio [RR], 0.77; 95% CI: 0.65 to 0.91; P = 0.002; I² = 27%), and fewer mean RBC units administered (MD, -0.86 units; 95% CI: -1.23 to -0.49 units; P < 0.001; I² = 0%). No significant differences were found between groups in the rates of reoperation for bleeding, thromboembolic events, stroke or transient ischemic attack, acute kidney injury, or mortality. Length of stay in the intensive care unit and hospital were also comparable between groups.ConclusionPCC demonstrates superior hemostatic efficacy compared to FFP in adult cardiac surgery patients, while maintaining a comparable safety profile. These findings support its use as a more effective and practical alternative for managing postoperative coagulopathy in this population.

ObjectiveThis scoping review aimed to examine current literature on the use of point-of-care ultrasound (POCUS) in paediatric patients supported by extracorporeal membrane oxygenation (ECMO). It assessed existing evidence, summarised key findings, explored theoretical limitations, and identified knowledge gaps.MethodsA comprehensive search of Medline, CINAHL, Embase, and the Cochrane Library was conducted using a strategy developed with an academic librarian. Studies involving patients aged 0-18 years receiving any form of extracorporeal life support were included; in-utero interventions and non POCUS scans were excluded. Data on participants, context, concepts, study design, and outcomes were extracted and presented in tabular and narrative form.ConclusionThis review highlights the increasing use of POCUS in paediatric ECMO care, despite a limited and heterogeneous evidence base. Physiological differences in ECMO patients challenge the direct application of findings from non-ECMO studies. The absence of standardised protocols and governance frameworks limits consistency and reliability. Developing unified guidelines and strengthening paediatric-specific research are essential to support safe and effective integration of POCUS into clinical practice.

IntroductionNeonatal aortic arch surgery is associated with neurological morbidity of varying severity which is detected and potentially limited through neuroprotective strategies. We conducted a survey of healthcare professionals at all neonatal cardiac surgery centres in the United Kingdom and Ireland to determine current intraoperative neuromonitoring and neuroprotection practice.MethodsAn online cross-sectional survey was sent to congenital cardiac surgeons, cardiac anaesthetists, clinical perfusion scientists, and clinical neurophysiology professionals in all 12 level 1 paediatric cardiac surgical centres. Information was sought on their current clinical practice in neonates undergoing aortic arch surgery, including pharmacological management, cardiopulmonary bypass, acid-base and blood pressure management, neuromonitoring, and hypothermic circulatory arrest, and the feasibility and willingness to participate in a future clinical trial of neuroprotective strategies in these patients.ResultsWe received 55 (34%) responses, including representatives of all four clinical disciplines in 9 (75%) centres. Cooling to a nasopharyngeal temperature of 18°C before hypothermic circulatory arrest, selective antegrade cerebral perfusion, and near-infrared spectroscopy (NIRS) monitoring are common practice, whereas pharmacology, acid-base management, blood pressure and flow parameters, and NIRS-based interventions vary. In 7 (58%) centres, respondents from all four disciplines were willing to consider participation in a future clinical trial on neuroprotection.ConclusionsAspects of intraoperative neuroprotection and neuromonitoring are common across centres, although key areas of practice differ between practitioners and institutions. Most respondents were willing to participate in a future multi-centre clinical trial, which suggests clinical equipoise in the optimal strategy to protect the neonatal brain during aortic arch surgery.

Negative pressure ventilation (NPV) has been used to assist patients with respiratory failure. Venovenous extracorporeal membrane oxygenation (V-V ECMO) supports patients with acute lung injury who do not respond to conventional therapy. Some patients remain on prolonged ECMO support without access to lung transplantation. We report a 40-year-old woman cannulated for V-V ECMO due to refractory hypoxemia (PaO₂/FiO₂ of 58) on hospital day 20 for ARDS from bacteremia and native mitral valve endocarditis. After 108 days, she continued to require ventilator and ECMO support. Applying a negative-pressure Cuirass device in combination with positive pressure ventilation (PPV) improved her carbon dioxide clearance, enhanced overall ventilation/perfusion matching, and facilitated decannulation. Using NPV to assist in V-V ECMO weaning is a novel application of a legacy technology. This case shows NPV as an effective adjunct to PPV for patients on prolonged ECMO support with no other options.

IntroductionCurrent extracorporeal membrane oxygenation (ECMO) monitoring methods for circuit obstructions have limitations. In this study, we test the hypothesis that changes in flow in a pre-existing shunt tubing of the ECMO circuit can be used as a predictor of obstructions for both venovenous (V-V) and venoarterial ECMO (V-A ECMO) circuits using a computational hemodynamic model.MethodsA custom computational hemodynamic model (CHM) representing the blood flow within the V-A ECMO and V-V ECMO circuit and native cardiovascular system was developed for a hemodynamic parametric analysis. Several degrees of obstructions within the oxygenator and outlet cannula were simulated, and the flow in the ECMO circuit and shunt was monitored to assess its sensitivity to circuit obstructions. Over 500 cases were analyzed to investigate various clinically-relevant levels of ECMO support (2 - 5.5 L/min).ResultsOur model demonstrated that shunt flow changed linearly with increasing oxygenator obstruction for all oxygenator obstruction scenarios tested, which matched experimental data. Similar relationships were also seen for all outflow cannula obstructions.ConclusionsThe findings are consistent with our hypothesis, indicating the sensitivity of the shunt flow rate as a predictor of ECMO circuit obstructions for both V-A and V-V ECMO circuits. The data supports that shunt flow responds to hemodynamic changes throughout the ECMO-patient circuit and thus can be used as an early indicator for ECMO system obstructions regardless of V-A or V-V ECMO setup, indicating its robustness as an early warning indicator of ECMO system obstructions.

IntroductionVentricular assist devices (VADs) are used in children usually as a bridge to transplantation and occasionally also as a bridge to recovery, e.g., for acute myocarditis. However, in cases of recovery, weaning criteria are not well defined and protocols are scarce.Case reportWe report our first experience with weaning of biventricular assist device (EXCOR® Pediatric, Berlin Heart GmbH, Germany) in a 3-year-old boy due to recovery.DiscussionThe weaning and explantation processes were based on clinical experience, local hospital practices, and collaboration with the Berlin Heart team.ConclusionRegular echocardiographic assessments, weaning attempts, and downsizing of the EXCOR pumps may facilitate device weaning.