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Long-term outcomes of patients bridged to recovery with venoarterial extracorporeal life support. 使用静脉-动脉体外生命支持桥接至康复的患者的长期结果。
IF 1.1 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-01 Epub Date: 2023-10-20 DOI: 10.1177/02676591231206524
Gabriel Dardik, Yuming Ning, Paul Kurlansky, Guillermo Almodovar Cruz, Alice Vinogradsky, Justin Fried, Veli K Topkara, Koji Takeda

Objective: Our study examines the long-term outcomes of patients discharged from the hospital without heart replacement therapy (HRT) after recovery from cardiogenic shock using venoarterial extracorporeal life support (VA-ECLS).

Methods: We retrospectively reviewed 615 cardiogenic shock patients who recovered from VA-ECLS at our institution between January 2015 and July 2021. Of those, 166 patients (27.0%) who recovered from VA-ECLS without HRT were included in this study. Baseline characteristics, discharge labs, vitals, electrocardiograms and echocardiograms were assessed. Patients were contacted to determine vital status. The primary outcome was post-discharge mortality.

Results: Of 166 patients, 158 patients (95.2%) had post-discharge follow-up, with a median time of follow-up of 2 years (IQR: [1 year, 4 years]). At discharge, the median ejection fraction (EF) was 52.5% (IQR: [32.5, 57.5]). At discharge, 92 patients (56%) were prescribed β-blockers, 28 (17%) were prescribed an ACE inhibitor, ARB or ARNI, and 50 (30%) were prescribed loop diuretics. Kaplan-Meier analysis showed a 1-year survival rate of 85.6% (95% CI: [80.1%, 91.2%]) and a 5-year survival rate of 60.6% (95% CI: [49.9%, 71.3%]). A Cox regression model demonstrated that a history of congestive heart failure (CHF) was strongly predictive of increased mortality hazard (HR = 1.929; p = 0.036), while neither discharge EF nor etiology of VA-ECLS were associated with increased post-discharge mortality.

Conclusions: Patients discharged from the hospital after full myocardial recovery from VA-ECLS support without HRT should have close outpatient follow-up due to the risk of recurrent heart failure and increased mortality in these patients.

目的:我们的研究考察了使用静脉-动脉体外生命支持(VA-ECLS)从心源性休克中恢复后未经心脏替代疗法(HRT)出院的患者的长期结果。方法:我们回顾性分析了2015年1月至2021年7月期间在我院从VA-ECLS中康复的615名心源性休克患者。在这些患者中,166名(27.0%)在没有激素替代疗法的情况下从VA-ECLS中康复的患者被纳入本研究。评估基线特征、出院实验室、生命体征、心电图和超声心动图。联系患者以确定生命状态。主要结果是出院后死亡率。结果:在166名患者中,158名患者(95.2%)进行了出院后随访,中位随访时间为2年(IQR:[1年,4年])。出院时,中位射血分数(EF)为52.5%(IQR:[32.5,57.5])。出院时,92名患者(56%)服用β-受体阻滞剂,28名患者(17%)服用ACE抑制剂ARB或ARNI,50名患者(30%)服用环路利尿剂。Kaplan-Meier分析显示,1年生存率为85.6%(95%可信区间:[80.1%,91.2%]),5年存活率为60.6%(95%置信区间:[49.9%,71.3%])。Cox回归模型表明,充血性心力衰竭(CHF)病史可有力地预测死亡风险的增加(HR=1.929;p=0.036),而出院EF和VA-ECLS的病因均与出院后死亡率增加无关。结论:从VA-ECLS支持中完全恢复心肌而不使用HRT出院的患者应密切门诊随访,因为这些患者有复发性心力衰竭和死亡率增加的风险。
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引用次数: 0
Balloon atrial septostomy versus left atrial cannulation for left heart decompression in children with dilated cardiomyopathy and myocarditis on extracorporeal membrane oxygenation: An ELSO registry analysis. 对使用体外膜氧合的扩张型心肌病和心肌炎患儿进行左心减压时,球囊心房间隔成形术与左心房插管术的比较:ELSO 登记分析。
IF 1.1 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-01 Epub Date: 2023-12-05 DOI: 10.1177/02676591231220816
Tanya Perry, Jason W Greenberg, David S Cooper, Reanna Smith, Alexis L Benscoter, Wonshill Koh, Thomas D Ryan, David G Lehenbauer, Tyler N Brown, Farhan Zafar, Ravi R Thiagarajan, Todd M Sweberg, David Ls Morales

Introduction: In children with myocarditis or dilated cardiomyopathy (DCM) on extracorporeal membrane oxygenation (ECMO) for cardiogenic shock, it is often necessary to decompress the left heart to minimize distension and promote myocardial recovery. We compare outcomes in those who underwent balloon atrial septostomy (BAS) versus direct left atrial (LA) drainage for left heart decompression in this population.

Methods: Retrospective study of the Extracorporeal Life Support Organization (ELSO) multicenter registry of patients ≤ 18 years with myocarditis or DCM on ECMO who underwent LA decompression. Descriptive and univariate statistics assessed association of patient factors with decompression type. Multivariable logistic regression sought independent associations with outcomes.

Results: 369 pediatric ECMO runs were identified. 52% myocarditis, 48% DCM, overall survival 74%. 65% underwent BAS and 35% LA drainage. Patient demographics including age, weight, gender, race/ethnicity, diagnosis, pre-ECMO pH, mean airway pressure, and arrest status were similar. 89% in the BAS group were peripherally cannulated onto ECMO, versus 3% in the LA drainage group (p < .001). On multivariable analysis, LA drainage (OR 3.96; 95% CI, 1.47-10.711; p = .007), renal complication (OR 2.37; 95% CI, 1.41-4.01; p = .001), cardiac complication (OR 3.14; 95% CI, 1.70-5.82; p < .001), and non-white race/ethnicity (OR 1.75; 95% CI, 1.04-2.94; p = .035) were associated with greater odds of mortality. There was a trend toward more episodes of pulmonary hemorrhage in BAS (n = 17) versus LA drainage group (n = 3), p = .08. Comparing only those with central cannulation, LA drainage group was more likely to be discontinued from ECMO due to recovery (72%) versus the BAS group (48%), p = .032.

Conclusions: In children with myocarditis or DCM, there was a three times greater likelihood for mortality with LA drainage versus BAS for LA decompression. When adjusted for central cannulation groups only, there was better recovery in the LA drainage group and no difference in mortality. Further prospective evaluation is warranted.

导言:心肌炎或扩张型心肌病(DCM)患儿在接受体外膜氧合(ECMO)治疗心源性休克时,通常需要对左心减压,以尽量减少扩张,促进心肌恢复。我们比较了接受球囊心房隔膜切开术(BAS)和直接左心房引流术进行左心减压的患者的疗效:对体外生命支持组织(ELSO)多中心登记的接受 LA 减压术的 18 岁以下心肌炎或 DCM ECMO 患者进行回顾性研究。描述性和单变量统计评估了患者因素与减压类型的关联。多变量逻辑回归寻求与结果的独立关联:确定了 369 例小儿 ECMO 运行。52%患有心肌炎,48%患有DCM,总存活率为74%。65% 接受了 BAS,35% 接受了 LA 引流。包括年龄、体重、性别、种族/民族、诊断、ECMO 前 pH 值、平均气道压力和停搏状态在内的患者人口统计学特征相似。BAS 组 89% 的患者经外周插管进入 ECMO,而 LA 引流组只有 3%(P < .001)。在多变量分析中,LA 引流(OR 3.96;95% CI,1.47-10.711;p = .007)、肾脏并发症(OR 2.37;95% CI,1.41-4.01;p = .001)、心脏并发症(OR 3.14;95% CI,1.70-5.82;p < .001)和非白人种族/民族(OR 1.75;95% CI,1.04-2.94;p = .035)与更高的死亡几率相关。BAS 组(n = 17)与 LA 引流组(n = 3)相比,有肺出血次数增多的趋势,p = .08。仅对中央插管的患儿进行比较,LA 引流组因康复而停止 ECMO 的几率(72%)高于 BAS 组(48%),P = 0.032:结论:在心肌炎或 DCM 患儿中,LA 引流的死亡率是 LA 减压 BAS 的三倍。如果仅对中心插管组进行调整,LA 引流组的恢复情况更好,但死亡率没有差异。有必要进行进一步的前瞻性评估。
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引用次数: 0
Mortality on extracorporeal membrane oxygenation: Evaluation of independent risk factors and causes of death during venoarterial and venovenous support. 体外膜肺氧合的死亡率:静脉-动脉和静脉-静脉支持期间独立危险因素和死亡原因的评估。
IF 1.1 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-01 Epub Date: 2023-11-07 DOI: 10.1177/02676591231212997
Johannes Deinzer, Alois Philipp, Lukasz Kmiec, Jing Li, Sigrid Wiesner, Sebastian Blecha, Walter Petermichl, Matthias Lubnow, Daniele Camboni, Christof Schmid, Andrea Stadlbauer

Introduction: Most patients on extracorporeal membrane oxygenation (ECMO) decease during therapy on the system. However, the actual causes of death have not been studied sufficiently. This study analyses the etiology, prevalence, and risk factors for the outcome variable death during ongoing ECMO for all patients and divided according to venoarterial (VA) or venovenous (VV) support.

Methods: We retrospectively analysed all patients receiving ECMO support at our institution between March 2006 to January 2021. Only the patients deceased during ongoing support were included.

Results: 2016 patients were placed on VA (n = 1168; 58%) or VV (n = 848; 42%) ECMO; 759 patients (37.7%) deceased on support. The causes of death differed between the support types: VA ECMO patients mostly died from cerebral ischemia (34%), low-cardiac output (LCO; 24.1%) and multi-organ failure (MOF; 21.6%), whereas in VV ECMO cases, refractory respiratory failure (28.2%), and sepsis (20.4%) dominated. Multivariate regression analysis revealed cardiopulmonary resuscitation (CPR) and acidosis prior to ECMO as risk factors for dying on VA ECMO, while high inotropic doses pre-ECMO, a high fraction of inspired oxygen on day 1, elevated lactate dehydrogenase, and international normalized ratio levels lead to an unfavourable outcome in VV ECMO patients.

Conclusion: Even in highly experienced centers, ECMO mortality remains high and occurs mainly on support or 24 h after its termination. The causes of death differ between VV and VA ECMO, depending on the underlying diseases responsible for the need of extracorporeal support.

简介:大多数体外膜肺氧合(ECMO)患者在系统治疗期间死亡。然而,对实际死亡原因的研究还不够充分。本研究分析了所有患者在进行ECMO期间结果可变死亡的病因、患病率和危险因素,并根据静脉动脉(VA)或静脉静脉(VV)支持进行了划分。方法:我们回顾性分析了2006年3月至2021年1月期间在我院接受ECMO支持的所有患者。仅包括在持续支持期间死亡的患者。结果:2016名患者接受了VA(n=1168;58%)或VV(n=848;42%)ECMO;759名患者(37.7%)在支持下死亡。不同支持类型的死亡原因不同:VA ECMO患者大多死于脑缺血(34%)、低心输出量(LCO;24.1%)和多器官衰竭(MOF;21.6%),而VV ECMO患者主要死于难治性呼吸衰竭(28.2%)和败血症(20.4%)。多元回归分析显示,ECMO前心肺复苏(CPR)和酸中毒是VA ECMO死亡的危险因素,而ECMO前的高肌力剂量、第1天的高吸氧量、乳酸脱氢酶升高和国际标准化比值水平导致VV ECMO患者的不良结局。结论:即使在经验丰富的中心,ECMO的死亡率仍然很高,主要发生在支持或终止后24小时。VV和VA ECMO的死因不同,这取决于需要体外支持的潜在疾病。
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引用次数: 0
Angiotensin-II for vasoplegia following cardiac surgery. 血管紧张素- ii用于心脏手术后血管截瘫。
IF 1.1 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-01 Epub Date: 2023-11-13 DOI: 10.1177/02676591231215920
Andrew J Johnson, William Tidwell, Andrew McRae, C Patrick Henson, Antonio Hernandez

Introduction: The objective of this study was to describe the implementation and outcomes of a protocol outlining angiotensin-II utilization for vasoplegia following cardiac surgery.

Methods: This was a retrospective chart review at a single-center university hospital. Included patients received angiotensin-II for vasoplegia refractory to standard interventions, including norepinephrine 20 mcg/min and vasopressin 0.04 units/min, following cardiac surgery between April 2021 and April 2022.

Results: 30 patients received angiotensin-II for refractory vasoplegia. Adjunctive agents at angiotensin-II initiation included corticosteroids (26 patients; 87%), epinephrine (26 patients; 87%), dobutamine (17 patients; 57%), dopamine (9 patients; 30%), milrinone (2 patients; 7%), and hydroxocobalamin (4 patients; 13%). At 3 hours, the median mean arterial pressure increased from baseline (70 vs 61.5 mmHg, p = .0006). Median norepinephrine doses at angiotensin-II initiation, 1 hour, 3 hours, and angiotensin-II discontinuation were 0.22, 0.16 (p = .0023), 0.10 (p < .0001), and 0.07 (p < .0001) mcg/kg/min. Median dobutamine doses decreased throughout angiotensin-II infusion from eight to six mcg/kg/min (p = .0313). Other vasoactive medication doses were unchanged. Three patients (10%) subsequently received hydroxocobalamin. Thirteen (43.3%) and five (16.7%) patients experienced mortality by day 28 and venous or arterial thrombosis events, respectively.

Conclusions: The administration of angiotensin-II to vasoplegic patients following cardiac surgery was associated with increased mean arterial pressure, reduced norepinephrine dosages, and reduced dobutamine dosages.

简介:本研究的目的是描述一项概述血管紧张素- ii在心脏手术后血管截瘫中的应用的方案的实施和结果。方法:回顾性分析某大学单中心医院的病历。纳入的患者在2021年4月至2022年4月期间接受心脏手术后接受血管紧张素- ii治疗血管截截症,标准干预措施包括去甲肾上腺素20微克/分钟和血管加压素0.04单位/分钟。结果:30例患者接受血管紧张素ii治疗难治性血管截瘫。血管紧张素- ii起始的辅助药物包括皮质类固醇(26例;87%),肾上腺素(26例;87%),多巴酚丁胺(17例;57%),多巴胺(9例;30%),米力酮(2例;7%)和羟钴胺素(4例;13%)。3小时时,中位平均动脉压较基线升高(70 vs 61.5 mmHg, p = 0.0006)。血管紧张素- ii起始、1小时、3小时和血管紧张素- ii停药时去甲肾上腺素的中位剂量分别为0.22、0.16 (p = 0.0023)、0.10 (p < 0.0001)和0.07 (p < 0.0001) mcg/kg/min。在血管紧张素- ii输注过程中,多巴酚丁胺的中位剂量从8微克/千克/分钟降至6微克/分钟(p = .0313)。其他血管活性药物剂量不变。3例患者(10%)随后接受羟钴胺素治疗。13例(43.3%)和5例(16.7%)患者分别在第28天死亡和静脉或动脉血栓形成事件。结论:心脏手术后血管瘫痪患者给予血管紧张素- ii与平均动脉压升高、去甲肾上腺素剂量减少和多巴酚丁胺剂量减少有关。
{"title":"Angiotensin-II for vasoplegia following cardiac surgery.","authors":"Andrew J Johnson, William Tidwell, Andrew McRae, C Patrick Henson, Antonio Hernandez","doi":"10.1177/02676591231215920","DOIUrl":"10.1177/02676591231215920","url":null,"abstract":"<p><strong>Introduction: </strong>The objective of this study was to describe the implementation and outcomes of a protocol outlining angiotensin-II utilization for vasoplegia following cardiac surgery.</p><p><strong>Methods: </strong>This was a retrospective chart review at a single-center university hospital. Included patients received angiotensin-II for vasoplegia refractory to standard interventions, including norepinephrine 20 mcg/min and vasopressin 0.04 units/min, following cardiac surgery between April 2021 and April 2022.</p><p><strong>Results: </strong>30 patients received angiotensin-II for refractory vasoplegia. Adjunctive agents at angiotensin-II initiation included corticosteroids (26 patients; 87%), epinephrine (26 patients; 87%), dobutamine (17 patients; 57%), dopamine (9 patients; 30%), milrinone (2 patients; 7%), and hydroxocobalamin (4 patients; 13%). At 3 hours, the median mean arterial pressure increased from baseline (70 vs 61.5 mmHg, <i>p</i> = .0006). Median norepinephrine doses at angiotensin-II initiation, 1 hour, 3 hours, and angiotensin-II discontinuation were 0.22, 0.16 (<i>p</i> = .0023), 0.10 (<i>p</i> < .0001), and 0.07 (<i>p</i> < .0001) mcg/kg/min. Median dobutamine doses decreased throughout angiotensin-II infusion from eight to six mcg/kg/min (<i>p</i> = .0313). Other vasoactive medication doses were unchanged. Three patients (10%) subsequently received hydroxocobalamin. Thirteen (43.3%) and five (16.7%) patients experienced mortality by day 28 and venous or arterial thrombosis events, respectively.</p><p><strong>Conclusions: </strong>The administration of angiotensin-II to vasoplegic patients following cardiac surgery was associated with increased mean arterial pressure, reduced norepinephrine dosages, and reduced dobutamine dosages.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"1676-1684"},"PeriodicalIF":1.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11487862/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89720248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Influence of minimal invasive extracorporeal circuits on dialysis dependent patients undergoing cardiac surgery. 微创体外循环对心脏手术依赖透析患者的影响。
IF 1.1 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-01 Epub Date: 2023-11-17 DOI: 10.1177/02676591231216794
Thai Duy Nguyen, Mohammed Morjan, Khaldoun Ali, Ingo Breitenbach, Wolfgang Harringer, Aschraf El-Essawi

Introduction: Cardiac surgery in patients on chronic renal dialysis is associated with significant morbidity and mortality. Minimally invasive extracorporeal circuits (MiECC) have shown a positive impact on patient outcome in different high-risk populations. This retrospective study compares the outcome of these high-risk patients undergoing heart surgery either with a MiECC or a conventional extracorporeal circulation (CECC).

Methods: This is a single-center experience including 131 consecutive dialysis dependent patients undergoing cardiac surgery between January 2006 and December 2016. A propensity score matching was employed leaving 30 matched cases in each group.

Results: After propensity score matching the 30-day mortality was significantly lower in the MiECC group (n = 3 (10%) vs n = 10 (33%) in the CECC group, p = .028). Further, intraoperative transfused units of packed red blood cells were lower in the MiECC group (1.4 ± 1.8 units vs 2.8 ± 1.7, p < .001).

Conclusions: There are evident advantages to using MiECC in dialysis dependent patients, especially regarding mortality. These findings necessitate additional research in MiECC usage in high-risk populations.

慢性肾透析患者的心脏手术与显著的发病率和死亡率相关。微创体外电路(MiECC)对不同高危人群的患者预后有积极影响。这项回顾性研究比较了这些高危患者接受心脏手术的结果,无论是MiECC还是传统的体外循环(CECC)。方法:这是一项单中心研究,包括2006年1月至2016年12月期间接受心脏手术的131例连续透析依赖患者。采用倾向评分匹配,每组留下30个匹配病例。结果:倾向评分与30天死亡率匹配后,MiECC组的死亡率显著降低(n = 3(10%)比CECC组的n = 10 (33%), p = 0.028)。此外,MiECC组术中输血的填充红细胞单位较低(1.4±1.8单位vs 2.8±1.7单位,p < 0.001)。结论:在透析依赖患者中使用MiECC有明显的优势,特别是在死亡率方面。这些发现需要对高危人群使用MiECC进行进一步的研究。
{"title":"Influence of minimal invasive extracorporeal circuits on dialysis dependent patients undergoing cardiac surgery.","authors":"Thai Duy Nguyen, Mohammed Morjan, Khaldoun Ali, Ingo Breitenbach, Wolfgang Harringer, Aschraf El-Essawi","doi":"10.1177/02676591231216794","DOIUrl":"10.1177/02676591231216794","url":null,"abstract":"<p><strong>Introduction: </strong>Cardiac surgery in patients on chronic renal dialysis is associated with significant morbidity and mortality. Minimally invasive extracorporeal circuits (MiECC) have shown a positive impact on patient outcome in different high-risk populations. This retrospective study compares the outcome of these high-risk patients undergoing heart surgery either with a MiECC or a conventional extracorporeal circulation (CECC).</p><p><strong>Methods: </strong>This is a single-center experience including 131 consecutive dialysis dependent patients undergoing cardiac surgery between January 2006 and December 2016. A propensity score matching was employed leaving 30 matched cases in each group.</p><p><strong>Results: </strong>After propensity score matching the 30-day mortality was significantly lower in the MiECC group (<i>n</i> = 3 (10%) vs <i>n</i> = 10 (33%) in the CECC group, <i>p</i> = .028). Further, intraoperative transfused units of packed red blood cells were lower in the MiECC group (1.4 ± 1.8 units vs 2.8 ± 1.7, <i>p</i> < .001).</p><p><strong>Conclusions: </strong>There are evident advantages to using MiECC in dialysis dependent patients, especially regarding mortality. These findings necessitate additional research in MiECC usage in high-risk populations.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"1708-1714"},"PeriodicalIF":1.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11492210/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136400033","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Ambulatory extracorporeal membrane oxygenation simulator: The next frontier in clinical training. 非卧床体外膜氧合模拟器:临床培训的下一个前沿。
IF 1.1 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-01 Epub Date: 2023-09-14 DOI: 10.1177/02676591231201527
Aya N Sayed, Mohammad Noorizadeh, Yahya Alhomsi, Faycal Bensaali, Nader Meskin, Ali Ait Hssain

Background: Current medical simulators for extracorporeal membrane oxygenation (ECMO) are expensive and rely on low-fidelity methodologies. This creates a challenge that demands a new approach to eliminate high costs and integrate with critical care environments, especially in light of the scarce resources and supplies available after the COVID-19 pandemic.

Methods: To address this challenge, we examined the current state-of-the-art medical simulators and collaborated closely with Hamad Medical Corporation (HMC), the primary healthcare provider in Qatar, to establish criteria for advancing the cutting-edge ECMO simulation. This article presents a comprehensive ambulatory high-realism and cost-effective ECMO simulator.

Results: Over the past 3 years, we have surveyed relevant literature, gathered data, and continuously developed a prototype of the system modules and the accompanying tablet application. By doing so, we have successfully addressed the issue of cost and fidelity in ECMO simulation, providing an effective tool for medical professionals to improve their understanding and treatment of patients requiring ECMO support.

Conclusions: This paper will focus on presenting an overall ambulatory ECMO simulator, detailing the various sub-systems and emphasizing the modular casing of the physical components and the simulated patient monitor.

背景:目前用于体外膜肺氧合(ECMO)的医疗模拟器价格昂贵,且依赖于低保真方法。这就提出了一个挑战,需要一种新的方法来消除高昂的成本并与重症监护环境相结合,尤其是在 COVID-19 大流行后可用资源和用品稀缺的情况下:为了应对这一挑战,我们研究了当前最先进的医学模拟器,并与卡塔尔的主要医疗服务提供商哈马德医疗公司(Hamad Medical Corporation,HMC)密切合作,制定了推进尖端 ECMO 模拟的标准。本文介绍了一种全面的非卧床高逼真度、高性价比 ECMO 模拟器:在过去 3 年中,我们调查了相关文献,收集了数据,并不断开发出系统模块原型和配套的平板电脑应用程序。通过这些工作,我们成功解决了 ECMO 模拟的成本和逼真度问题,为医疗专业人员提供了一个有效的工具,帮助他们更好地理解和治疗需要 ECMO 支持的患者:本文将重点介绍一个整体的非卧床 ECMO 模拟器,详细介绍各个子系统,并强调物理组件和模拟病人监护仪的模块化外壳。
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引用次数: 0
Standardized nomenclature for peripheral percutaneous cannulation of the pulmonary artery in extracorporeal membrane oxygenation: Current uptake and recommendations for improvement. 体外膜肺氧合肺动脉外周经皮插管的标准名称:目前的吸收和改进建议。
IF 1.1 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-01 Epub Date: 2023-11-06 DOI: 10.1177/02676591231210457
J Michael Brewer, L Mikael Broman, Justyna Swol, Roberto Lorusso, Steven A Conrad, Marc O Maybauer

The rising application of extracorporeal membrane oxygenation (ECMO) has emphasized the need for consistent and standardized terminology, especially concerning peripheral percutaneous cannulation of the pulmonary artery (PPC-PA). The Extracorporeal Life Support Organization (ELSO) Nomenclature Task Force produced the ELSO Maastricht Treaty for extracorporeal life support (ECLS) Nomenclature to address this challenge. However, adherence to nomenclature recommendations has been poor in publications describing PPC-PA. We aim to describe common nomenclature errors and provide a user-guide for abbreviations that can be used by authors, reviewers, and journal staff to ensure properadherence to standardized nomenclature in publications describing PPC-PA.

体外膜肺氧合(ECMO)的日益广泛的应用强调了对一致性和标准化术语的需求,尤其是关于外周经皮肺动脉插管(PPC-PA)的术语。体外生命支持组织(ELSO)命名工作组制定了ELSO体外生命支持马斯特里赫特条约(ECLS)命名法,以应对这一挑战。然而,在描述PPC-PA的出版物中,对命名建议的遵守程度一直很低。我们旨在描述常见的命名错误,并为作者、审稿人和期刊工作人员提供缩写用户指南,以确保在描述PPC-PA的出版物中与标准化命名法保持适当一致。
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引用次数: 0
A prospective feasibility trial exploring novel biomarkers for neurotoxicity after isolated limb perfusion. 一项前瞻性可行性试验,旨在探索离体肢体灌注后神经毒性的新生物标志物。
IF 1.1 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-01 Epub Date: 2023-11-07 DOI: 10.1177/02676591231213506
Anna Corderfeldt Keiller, Markus Axelsson, Gudrun Bragadottir, Kaj Blennow, Henrik Zetterberg, Roger Olofsson Bagge

Background: Isolated limb perfusion (ILP) is a regional cancer treatment in which high-dose chemotherapy is administered in an isolated extremity. The main side effect is regional toxicity, which occasionally leads to nerve damage. Measuring neuroaxonal biomarkers, might be a method predicting such complications. Therefore, the primary aim of the study is to investigate if neuronal biomarkers are measurable and alters in an isolated extremity during ILP. Secondly, if postoperative regional toxicity, alterations in sensitivity, and/or muscle strength are correlated to the biomarker levels.

Methods: Eighteen scheduled ILP-patients were included in the study. Glial fibrillary acidic protein (GFAP), neurofilament light (NfL), and tau concentrations were measured in plasma sampled preoperatively, at the start and end of the ILP, on days 3 and 30, using ultrasensitive Single molecule array (Simoa) technology. The patients were assessed by a physiotherapist pre- and postoperatively.

Results: At ILP end, significantly higher NfL and tau levels were measured in the extremity than in the corresponding systemic circulation (NfL; 17 vs 6 ng/L, p < .01, tau; 1.8 vs 0.6 ng/L, p < .01), and the extremity levels were significantly increased at ILP end (NfL; 66 ± 37%, p < .001, tau; 75 ± 45%, p = .001). On days 3 and 30, significantly increased NfL and GFAP levels were measured systemically (NfL day 3: 69 ± 30%, p < .001; day 30: 76 ± 26%, p < .001; GFAP day 3: 33 ± 22%, p < .002; day 30: 33 ± 23%, p ≤ .004). Finally, no significant correlations were found between regional toxicity or between postoperative muscle or sensitivity decrease and biomarker release.

Conclusion: During ILP, NfL and tau levels increased significantly. No obvious correlations were observed between biomarker release and regional toxicity or decreased muscle strength or sensitivity, although large-scale studies are warranted.

背景:孤立肢体灌注(ILP)是一种区域性癌症治疗方法,在孤立肢体进行高剂量化疗。主要副作用是局部毒性,偶尔会导致神经损伤。测量神经轴突生物标志物可能是预测此类并发症的一种方法。因此,该研究的主要目的是研究神经元生物标志物在ILP过程中是否可以在孤立的肢体中测量和改变。其次,如果术后局部毒性、敏感性和/或肌肉力量的改变与生物标志物水平相关。方法:将18例ILP患者纳入研究。使用超灵敏单分子阵列(Simoa)技术,在术前、ILP开始和结束时、第3天和第30天采集的血浆中测量胶质原纤维酸性蛋白(GFAP)、神经丝光(NfL)和tau浓度。患者在术前和术后由理疗师进行评估。结果:在ILP结束时,测量到的肢体NfL和tau水平显著高于相应的系统循环中的NfL;17 vs 6 ng/L,p<0.01,tau;1.8 vs 0.6 ng/L,p<0.01),并且在ILP终止时肢体水平显著增加(NfL:66±37%,p<0.001,tau;75±45%,p=0.001)。在第3天和第30天,系统测量显著增加的NfL和GFAP水平(NfL第3天:69±30%,p<.001;第30天:76±26%,p<.001;GFAP第3天:33±22%,p<0.002;第30天:33±23%,p≤.004)。最后,未发现区域毒性之间或术后肌肉或敏感性降低与生物标志物释放之间存在显著相关性。结论:在ILP过程中,NfL和tau水平显著升高。尽管有必要进行大规模研究,但在生物标志物释放与区域毒性或肌肉力量或敏感性下降之间没有观察到明显的相关性。
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引用次数: 0
Systolic anterior motion of a transatrial transcatheter mitral valve replacement causing left ventricular outflow tract obstruction. 经导管二尖瓣置换术引起左心室流出道阻塞的收缩性前向运动。
IF 1.1 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-01 Epub Date: 2023-10-12 DOI: 10.1177/02676591231206526
Jonathan Afoke, Juan Crestanello

Transatrial transcatheter mitral valve replacement is a hybrid strategy involving placing the patient on cardiopulmonary bypass and direct implantation of a transcatheter valve in a calcified annulus for mitral annular calcification. We report a rare phenomenon of systolic anterior motion of the leaflets of a transcatheter heart valve prosthesis used for mitral valve replacement causing left ventricular outflow tract obstruction. Although reported in transcatheter mitral valve replacement, we believe this is the first report of left ventricular outflow tract obstruction after transatrial mitral valve replacement and discuss the pre-disposing risk factors.

经导管二尖瓣置换术是一种混合策略,包括将患者置于体外循环和直接将经导管瓣膜植入钙化环中以治疗二尖瓣环钙化。我们报告了一种罕见的现象,即用于二尖瓣置换术的经导管心脏瓣膜假体的小叶收缩前移导致左心室流出道阻塞。尽管在经导管二尖瓣置换术中有报道,但我们认为这是经导管二尖瓣替换术后左心室流出道梗阻的首次报道,并讨论了处理前的危险因素。
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引用次数: 0
Heparin consumption and inflammatory response according to the coating of cardiopulmonary bypass circuits in cardiac surgery: A retrospective analysis. 心脏手术中根据体外循环回路涂层的肝素消耗和炎症反应:回顾性分析。
IF 1.1 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-01 Epub Date: 2023-11-09 DOI: 10.1177/02676591231215282
Laurent Mathieu, Antoine Beurton, Nicolas Rougier, Maude Flambard, Christine Germain, Mathieu Pernot, Alexandre Ouattara

Introduction: There are several types of surface treatments (coatings) aimed at improving the biocompatibility of cardiopulmonary bypass (CPB) circuit. Some coatings appear to require higher doses of heparin to maintain anticoagulation goals, and some of them might induce postoperative coagulopathy. In this study, we compared the amount of heparin required, postoperative bleeding, and inflammatory response according to three types of coatings.

Method: We retrospectively included 300 consecutive adult patients who underwent cardiac surgery with CPB and received one of three coatings (Phisio®, Trillium®, and Xcoating™). Our primary objective was to compare, according to coating, the amount of heparin required to maintain an ACT > 400s during CPB. Our secondary objectives were to compare postoperative bleeding for 48 h and CRP rate.

Results: Baseline characteristics were comparable between groups except for age and preoperative CRP. We did not find a significant difference between the 3 coatings regarding the amount of heparin reinjected. However, we found less postoperative bleeding with the Xcoating™ circuit compared to the Phisio® circuit (-149 mL [-289; -26.5]; p = 0.02) and a lower elevation of CRP with the Phisio® circuit (2.8 times higher than preoperative CRP) compared to Trillium® (4.9 times higher) and Xcoating™ (6.4 times higher); p < 10-3.

Conclusion: The choice of coating did not influence the amount of heparin required during CPB; however, the post-CPB inflammatory syndrome may be impacted by this choice.

引言:有几种类型的表面处理(涂层)旨在提高体外循环(CPB)电路的生物相容性。一些涂层似乎需要更高剂量的肝素来维持抗凝目标,其中一些涂层可能会导致术后凝血障碍。在这项研究中,我们比较了三种涂层所需的肝素量、术后出血和炎症反应。方法:我们回顾性纳入了300名连续接受CPB心脏手术并接受三种涂层(Phisio®、Trillium®和Xcoating™). 我们的主要目的是根据涂层,比较CPB期间维持ACT>400s所需的肝素量。我们的次要目标是比较术后48小时出血和CRP的发生率。结果:除年龄和术前CRP外,各组的基线特征具有可比性。我们没有发现三种涂层在肝素再注射量方面存在显著差异。然而,我们发现Xcoating术后出血较少™ 与Phisio®循环相比(-149 mL[-289;-26.5];p=0.02),与Trillium®(4.9倍)和Xcoating相比,Phisio?循环的CRP升高更低(比术前CRP高2.8倍)™ (高6.4倍);结论:涂层的选择不影响CPB所需肝素的量;然而,CPB后炎症综合征可能会受到这种选择的影响。
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引用次数: 0
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Perfusion-Uk
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