Pub Date : 2024-08-06DOI: 10.1177/02676591241268703
Kohei Nagashima, Hiroya Kano
Introduction: This study aimed to examine the educational challenges faced by perfusionists in Japan. Although Japan has over 400 cardiovascular surgery centers, it performs fewer surgeries than by countries such as Germany and the United States. We focused on challenges related to varying caseloads and working conditions.
Methods: We conducted an online survey containing 24 questions using Google Forms from January to June 2022, targeting perfusionists in Japan. The 24-question survey spanned various educational topics and was approved by the Morinomiya University of Medical Sciences Ethics Committee.
Results: Responses were received from 129 perfusionists across 77 institutions. Approximately 70% of these centers managed less than 200 cardiopulmonary bypass (CPB) cases per year, with a similar proportion of perfusionists handling under 50 CPB cases annually. Challenges in Japanese perfusionist education include enhancing communication and troubleshooting skills and the need for instructors with a broad teaching experience.
Conclusions: This study emphasizes the significant differences in caseload and work environments for perfusionists among Japanese institutions. Perfusionists, who often work in clinical engineering, have various responsibilities. These findings highlight the need for improved communication, problem-solving skills, and the implementation of modern teaching technologies. Additionally, this study highlights the complexities of training Japanese perfusionists and underscores the need for more practical, technology-driven educational methods. Addressing these issues is crucial for improving Japan's healthcare standards and could influence global perfusionist education.
{"title":"Perfusionist education in Japan: A survey of challenges and current status.","authors":"Kohei Nagashima, Hiroya Kano","doi":"10.1177/02676591241268703","DOIUrl":"https://doi.org/10.1177/02676591241268703","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to examine the educational challenges faced by perfusionists in Japan. Although Japan has over 400 cardiovascular surgery centers, it performs fewer surgeries than by countries such as Germany and the United States. We focused on challenges related to varying caseloads and working conditions.</p><p><strong>Methods: </strong>We conducted an online survey containing 24 questions using Google Forms from January to June 2022, targeting perfusionists in Japan. The 24-question survey spanned various educational topics and was approved by the Morinomiya University of Medical Sciences Ethics Committee.</p><p><strong>Results: </strong>Responses were received from 129 perfusionists across 77 institutions. Approximately 70% of these centers managed less than 200 cardiopulmonary bypass (CPB) cases per year, with a similar proportion of perfusionists handling under 50 CPB cases annually. Challenges in Japanese perfusionist education include enhancing communication and troubleshooting skills and the need for instructors with a broad teaching experience.</p><p><strong>Conclusions: </strong>This study emphasizes the significant differences in caseload and work environments for perfusionists among Japanese institutions. Perfusionists, who often work in clinical engineering, have various responsibilities. These findings highlight the need for improved communication, problem-solving skills, and the implementation of modern teaching technologies. Additionally, this study highlights the complexities of training Japanese perfusionists and underscores the need for more practical, technology-driven educational methods. Addressing these issues is crucial for improving Japan's healthcare standards and could influence global perfusionist education.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141894761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-06DOI: 10.1177/02676591241272058
Andres Ferre, Andres Giglio, Nicolette Van Sint Jan, Javiera Garcia, Martin Benites, Karen Vergara, María Galleguillos, Jorge Dreyse, Pablo Hasbun
Objective: To explore the experiences of clinical and non-clinical staff in an intensive care unit regarding the perceived benefits and drawbacks of using in situ simulation as a training tool.
Methods: A descriptive phenomenological qualitative study was conducted among clinical and nonclinical ICU personnel. Simulations and interviews were conducted until data saturation was achieved. The interviews were recorded, transcribed verbatim for analysis, and interpreted using the Colaizzi method.
Results: Ten participant interviews generated data saturation. ISS was found to be feasible and beneficial in the ICU, facilitating experiential and emotion-based learning in real-world environments. Eight result categories were identified: simulation benefits, simulation benefits in real conditions, scenario authenticity, interference with usual work, ISS sessions, high-fidelity generating affective bonding, ISS as knowledge reinforcement, and recommendations for improvement. The fundamental structure revealed that ISS is perceived as an authentic and emotionally impactful team simulation modality that promotes experiential learning, reflection, and care improvement opportunities within the complex sociotechnical system of the ICU.
Conclusions: All interviewees considered ISS to be a feasible simulation tool that should be implemented in the ICU to improve knowledge and skills, thereby enhancing teamwork.
目的探讨重症监护病房临床和非临床人员对使用原位模拟作为培训工具的利弊的看法:对重症监护室的临床和非临床人员进行了描述性现象学定性研究。模拟和访谈一直进行到数据饱和为止。对访谈进行记录、逐字转录分析,并使用科莱兹方法进行解释:结果:10 个参与者的访谈达到了数据饱和。研究发现,在重症监护室中开展 ISS 是可行且有益的,可促进在真实世界环境中进行体验式和情感式学习。共确定了八个结果类别:模拟效益、真实条件下的模拟效益、情景真实性、对日常工作的干扰、ISS课程、高保真产生情感纽带、ISS作为知识强化以及改进建议。基本结构显示,ISS 被认为是一种真实的、对情感有影响的团队模拟模式,可在重症监护室这个复杂的社会技术系统中促进体验式学习、反思和护理改进机会:所有受访者都认为 ISS 是一种可行的模拟工具,应在重症监护室实施,以提高知识和技能,从而加强团队合作。
{"title":"In situ simulation in the intensive care unit: A phenomenological study of staff experiences.","authors":"Andres Ferre, Andres Giglio, Nicolette Van Sint Jan, Javiera Garcia, Martin Benites, Karen Vergara, María Galleguillos, Jorge Dreyse, Pablo Hasbun","doi":"10.1177/02676591241272058","DOIUrl":"https://doi.org/10.1177/02676591241272058","url":null,"abstract":"<p><strong>Objective: </strong>To explore the experiences of clinical and non-clinical staff in an intensive care unit regarding the perceived benefits and drawbacks of using in situ simulation as a training tool.</p><p><strong>Methods: </strong>A descriptive phenomenological qualitative study was conducted among clinical and nonclinical ICU personnel. Simulations and interviews were conducted until data saturation was achieved. The interviews were recorded, transcribed verbatim for analysis, and interpreted using the Colaizzi method.</p><p><strong>Results: </strong>Ten participant interviews generated data saturation. ISS was found to be feasible and beneficial in the ICU, facilitating experiential and emotion-based learning in real-world environments. Eight result categories were identified: simulation benefits, simulation benefits in real conditions, scenario authenticity, interference with usual work, ISS sessions, high-fidelity generating affective bonding, ISS as knowledge reinforcement, and recommendations for improvement. The fundamental structure revealed that ISS is perceived as an authentic and emotionally impactful team simulation modality that promotes experiential learning, reflection, and care improvement opportunities within the complex sociotechnical system of the ICU.</p><p><strong>Conclusions: </strong>All interviewees considered ISS to be a feasible simulation tool that should be implemented in the ICU to improve knowledge and skills, thereby enhancing teamwork.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141898672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-04DOI: 10.1177/02676591241268706
Mitchell A Luangrath, Madhuradhar Chegondi, Aditya Badheka
Introduction: The use of extracorporeal membrane oxygenation (ECMO) in children continues to increase nationally, including patients with methicillin-resistant Staphylococcus aureus (MRSA) infection. Survival of pediatric patients with MRSA sepsis has not improved over the last 20 years. We sought to review our institutional experience and outcomes of ECMO support among children with MRSA infection.Methods: Children aged 0-19 years who received ECMO support from October 2014 to June 2021 were reviewed retrospectively. Patients with laboratory confirmed MRSA infections were identified.Results: Out of 88 unique pediatric patients requiring ECMO support, eight patients had documented MRSA infections. The duration of mechanical ventilation prior to ECMO initiation was an average of seven days (range 0.7 to 21.8 days). The median ECMO duration was 648.1 h (range 15.5 to 1580.5 h). Five patients were successfully decannulated; however, only two patients survived to discharge. The two surviving patients were both cannulated via VV-ECMO. Mechanical ventilation prior to ECMO was 4.5 and 21.8 days in these cases with run durations of 18.9 and 29.9 days, respectively.Conclusions: Our institutional survival of patients with MRSA on ECMO is lower than what has been reported in recent database studies, but notably, 62.5% were successfully decannulated. While both surviving patients were supported with VV-ECMO, there was no other clear trend in factors that contributed to survival. MRSA continues to be a source of significant morbidity and mortality among pediatric patients. On-going investigation of outcomes and factors contributing to survival in patients with MRSA infection on ECMO is warranted.
{"title":"Outcome of extracorporeal membrane oxygenation support among children with methicillin-resistant <i>Staphylococcus aureus</i> infection: A single-center experience.","authors":"Mitchell A Luangrath, Madhuradhar Chegondi, Aditya Badheka","doi":"10.1177/02676591241268706","DOIUrl":"https://doi.org/10.1177/02676591241268706","url":null,"abstract":"<p><p><i>Introduction:</i> The use of extracorporeal membrane oxygenation (ECMO) in children continues to increase nationally, including patients with methicillin-resistant <i>Staphylococcus aureus</i> (MRSA) infection. Survival of pediatric patients with MRSA sepsis has not improved over the last 20 years. We sought to review our institutional experience and outcomes of ECMO support among children with MRSA infection.<i>Methods:</i> Children aged 0-19 years who received ECMO support from October 2014 to June 2021 were reviewed retrospectively. Patients with laboratory confirmed MRSA infections were identified.<i>Results:</i> Out of 88 unique pediatric patients requiring ECMO support, eight patients had documented MRSA infections. The duration of mechanical ventilation prior to ECMO initiation was an average of seven days (range 0.7 to 21.8 days). The median ECMO duration was 648.1 h (range 15.5 to 1580.5 h). Five patients were successfully decannulated; however, only two patients survived to discharge. The two surviving patients were both cannulated via VV-ECMO. Mechanical ventilation prior to ECMO was 4.5 and 21.8 days in these cases with run durations of 18.9 and 29.9 days, respectively.<i>Conclusions:</i> Our institutional survival of patients with MRSA on ECMO is lower than what has been reported in recent database studies, but notably, 62.5% were successfully decannulated. While both surviving patients were supported with VV-ECMO, there was no other clear trend in factors that contributed to survival. MRSA continues to be a source of significant morbidity and mortality among pediatric patients. On-going investigation of outcomes and factors contributing to survival in patients with MRSA infection on ECMO is warranted.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141890681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01DOI: 10.1177/02676591241270925
John M Toomasian
{"title":"The maturation of perfusion education.","authors":"John M Toomasian","doi":"10.1177/02676591241270925","DOIUrl":"https://doi.org/10.1177/02676591241270925","url":null,"abstract":"","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141876508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01DOI: 10.1177/02676591241268428
Richard Crook, Marc Cohen, Branko Mimic, Matthew Fenton, Richard Issitt
Intraoperative anti-A/B immunoadsorption (ABO-IA) was recently introduced for ABO-incompatible (ABOi) heart transplantation. Here we report the first case of a patient transplanted with ABO-IA, that was of an age and weight that required two ABO-IA columns run in parallel, to enable the reduction in antibody titres to a sufficiently low level in the time available during implantation of the donor organ.
{"title":"Dual immunoadsorption for ABO-incompatible heart transplantation in a 35 kg child.","authors":"Richard Crook, Marc Cohen, Branko Mimic, Matthew Fenton, Richard Issitt","doi":"10.1177/02676591241268428","DOIUrl":"https://doi.org/10.1177/02676591241268428","url":null,"abstract":"<p><p>Intraoperative anti-A/B immunoadsorption (ABO-IA) was recently introduced for ABO-incompatible (ABOi) heart transplantation. Here we report the first case of a patient transplanted with ABO-IA, that was of an age and weight that required two ABO-IA columns run in parallel, to enable the reduction in antibody titres to a sufficiently low level in the time available during implantation of the donor organ.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141876505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01DOI: 10.1177/02676591241271984
Yu Hohri, Yanling Zhao, Hiroo Takayama, Alice V Vinogradsky, Paul Kurlansky, Justin Fried, Koji Takeda
Objectives: Veno-arterial extracorporeal life support (V-A ECLS) is increasingly being utilized for postcardiotomy shock (PCS), though data describing the relationship between type of indexed operation and outcomes are limited. This study compared V-A ECLS outcomes across four major cardiovascular surgical procedures.
Methods: This was a single-center retrospective study of patients who required V-A ECLS for PCS between 2015 and 2022. Patients were stratified by the type of indexed operation, which included aortic surgery (AoS), coronary artery bypass grafting (CABG), valve surgery (Valve), and combined CABG and valve surgery (CABG + Valve). Factors associated with postoperative outcomes were assessed using logistic regression.
Results: Among 149 PCS patients who received V-A ECLS, there were 35 AoS patients (23.5%), 29 (19.5%) CABG patients, 59 (39.6%) Valve patients, and 26 (17.4%) CABG + Valve patients. Cardiopulmonary bypass times were longest in the AoS group (p < 0.01). Regarding causes of PCS, AoS patients had a greater incidence of ventricular failure, while the CABG group had a higher incidence of ventricular arrhythmia (p = 0.04). Left ventricular venting was most frequently utilized in the Valve group (p = 0.07). In-hospital mortality was worst among CABG + Valve patients (p < 0.01), and the incidence of acute kidney injury was highest in the AoS group (p = 0.03). In multivariable logistic regression, CABG + Valve surgery (odds ratio (OR) 4.20, 95% confidence interval 1.30-13.6, p = 0.02) and lactate level at ECLS initiation (OR, 1.17; 95% CI, 1.06-1.29; p < 0.01) were independently associated with mortality.
Conclusions: We demonstrate that indications, management, and outcomes of V-A ECLS for PCS vary by type of indexed cardiovascular surgery.
{"title":"Relationship between indexed surgery and postcardiotomy extracorporeal life support outcomes.","authors":"Yu Hohri, Yanling Zhao, Hiroo Takayama, Alice V Vinogradsky, Paul Kurlansky, Justin Fried, Koji Takeda","doi":"10.1177/02676591241271984","DOIUrl":"https://doi.org/10.1177/02676591241271984","url":null,"abstract":"<p><strong>Objectives: </strong>Veno-arterial extracorporeal life support (V-A ECLS) is increasingly being utilized for postcardiotomy shock (PCS), though data describing the relationship between type of indexed operation and outcomes are limited. This study compared V-A ECLS outcomes across four major cardiovascular surgical procedures.</p><p><strong>Methods: </strong>This was a single-center retrospective study of patients who required V-A ECLS for PCS between 2015 and 2022. Patients were stratified by the type of indexed operation, which included aortic surgery (AoS), coronary artery bypass grafting (CABG), valve surgery (Valve), and combined CABG and valve surgery (CABG + Valve). Factors associated with postoperative outcomes were assessed using logistic regression.</p><p><strong>Results: </strong>Among 149 PCS patients who received V-A ECLS, there were 35 AoS patients (23.5%), 29 (19.5%) CABG patients, 59 (39.6%) Valve patients, and 26 (17.4%) CABG + Valve patients. Cardiopulmonary bypass times were longest in the AoS group (<i>p</i> < 0.01). Regarding causes of PCS, AoS patients had a greater incidence of ventricular failure, while the CABG group had a higher incidence of ventricular arrhythmia (<i>p</i> = 0.04). Left ventricular venting was most frequently utilized in the Valve group (<i>p</i> = 0.07). In-hospital mortality was worst among CABG + Valve patients (<i>p</i> < 0.01), and the incidence of acute kidney injury was highest in the AoS group (<i>p</i> = 0.03). In multivariable logistic regression, CABG + Valve surgery (odds ratio (OR) 4.20, 95% confidence interval 1.30-13.6, <i>p</i> = 0.02) and lactate level at ECLS initiation (OR, 1.17; 95% CI, 1.06-1.29; <i>p</i> < 0.01) were independently associated with mortality.</p><p><strong>Conclusions: </strong>We demonstrate that indications, management, and outcomes of V-A ECLS for PCS vary by type of indexed cardiovascular surgery.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141876507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01DOI: 10.1177/02676591241272009
Kyriakos Anastasiadis, Polychronis Antonitsis, Georgios Papazisis, Bettina Haidich, Andreas Liebold, Prakash Punjabi, Serdar Gunaydin, Aschraf El-Essawi, Vivek Rao, Cyril Serrick, Ignazio Condello, Giuseppe Nasso, Sahin Bozok, Ahmet Daylan, Helena Argiriadou, Apostolos Deliopoulos, Georgios Karapanagiotidis, Fatma Ashkanani, Narain Moorjani, Alex Cale, Gabor Erdoes, Mark Bennett, Pascal Starinieri, Thierry Carrel, John Murkin
Introduction: The ultimate answer to the question whether minimal invasive extracorporeal circulation (MiECC) represents the optimal perfusion technique in contemporary clinical practice remains elusive. The present study is a real-world study that focuses on specific perfusion-related clinical outcomes after cardiac surgery that could potentially be favourably affected by MiECC and thereby influence the future clinical practice.
Methods: The MiECS study is an international, multi-centre, two-arm randomized controlled trial. Patients undergoing elective or urgent coronary artery bypass grafting (CABG), aortic valve replacement (AVR) or combined procedure (CABG + AVR) using extracorporeal circulation will be randomized to MiECC or contemporary conventional cardiopulmonary bypass (cCPB). Use of optimized conventional circuits as controls is acceptable. The study design includes a range of features to prevent bias and is registered at clinicaltrials.gov (NCT05487612).
Results: The primary outcome is a composite of postoperative serious adverse events that could be related to perfusion technique occurring up to 30 days postoperatively. Secondary outcomes include use of blood products, ICU and hospital length of stay (30 days) as well as health-related quality of life (30 and 90 days).
Conclusions: The MiECS trial has been designed to overcome perceived limitation of previous trials of MiECC. Results of the proposed study could affect current perfusion practice towards advancement of patient care.
{"title":"Minimally invasive extracorporeal circulation versus conventional cardiopulmonary bypass in patients undergoing cardiac surgery (MiECS): Rationale and design of a multicentre randomised trial.","authors":"Kyriakos Anastasiadis, Polychronis Antonitsis, Georgios Papazisis, Bettina Haidich, Andreas Liebold, Prakash Punjabi, Serdar Gunaydin, Aschraf El-Essawi, Vivek Rao, Cyril Serrick, Ignazio Condello, Giuseppe Nasso, Sahin Bozok, Ahmet Daylan, Helena Argiriadou, Apostolos Deliopoulos, Georgios Karapanagiotidis, Fatma Ashkanani, Narain Moorjani, Alex Cale, Gabor Erdoes, Mark Bennett, Pascal Starinieri, Thierry Carrel, John Murkin","doi":"10.1177/02676591241272009","DOIUrl":"https://doi.org/10.1177/02676591241272009","url":null,"abstract":"<p><strong>Introduction: </strong>The ultimate answer to the question whether minimal invasive extracorporeal circulation (MiECC) represents the optimal perfusion technique in contemporary clinical practice remains elusive. The present study is a real-world study that focuses on specific perfusion-related clinical outcomes after cardiac surgery that could potentially be favourably affected by MiECC and thereby influence the future clinical practice.</p><p><strong>Methods: </strong>The MiECS study is an international, multi-centre, two-arm randomized controlled trial. Patients undergoing elective or urgent coronary artery bypass grafting (CABG), aortic valve replacement (AVR) or combined procedure (CABG + AVR) using extracorporeal circulation will be randomized to MiECC or contemporary conventional cardiopulmonary bypass (cCPB). Use of optimized conventional circuits as controls is acceptable. The study design includes a range of features to prevent bias and is registered at clinicaltrials.gov (NCT05487612).</p><p><strong>Results: </strong>The primary outcome is a composite of postoperative serious adverse events that could be related to perfusion technique occurring up to 30 days postoperatively. Secondary outcomes include use of blood products, ICU and hospital length of stay (30 days) as well as health-related quality of life (30 and 90 days).</p><p><strong>Conclusions: </strong>The MiECS trial has been designed to overcome perceived limitation of previous trials of MiECC. Results of the proposed study could affect current perfusion practice towards advancement of patient care.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141876506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01DOI: 10.1177/02676591241268402
Shan P Modi, Brandon D'Aloiso, Amber Palmer, Stephanie Smith, Peter Arlia, Michael Anselmi, Pablo Sanchez, Raj Ramanan
Introduction: Polymethylpentene (PMP) oxygenators serve as the primary oxygenator type utilized for ECMO. With the number of PMP oxygenators available, it has become increasingly important to determine differences among each oxygenator type that can lead to varying metrics of oxygenator dysfunction.
Methods: This study was a retrospective, single-center analysis of adult patients supported on ECMO between December 2020 to December 2021 with varying PMP oxygenators including the Medtronic Nautilus Smart (Minneapolis, MA), the Eurosets AMG PMP (Medolla, Italy) and Getinge Quadrox-iD and the Getinge Cardiohelp HLS Module Advanced System (Gothenberg, Sweden).
Results: A total of 19 patients were included in our study. 10 patients (52.6%) were supported with a Medtronic Nautilus Smart oxygenator, 5 patients (26.3%) were supported with an Eurosets AMG PMP Oxygenator, and 4 patients (21.1%) were supported with either a Getinge Quadrox-iD oxygenator or Getinge Cardiohelp HLS system. Patients supported with Eurosets AMG PMP oxygenators experienced higher resistance and lower post-oxygenator PaO2 in comparison to other cohorts (p < .02 and < .002 respectively). There was no difference in measured oxygen transfer between cohorts (p = .667). Two patients, both supported by Eurosets AMG PMP, experienced oxygenator failure (p = .094).
Conclusion: Radial flow oxygenators are prone to higher resistance and lower post-oxygenator PaO2when compared to transverse flow oxygenators. Future larger multicenter studies are required to fully discern the differences between flow-varying polymethylpentene oxygenators and their appropriate cutoffs for oxygenator dysfunction.
{"title":"Comparative analysis of oxygenator dysfunction in polymethylpentene oxygenators: A pilot study.","authors":"Shan P Modi, Brandon D'Aloiso, Amber Palmer, Stephanie Smith, Peter Arlia, Michael Anselmi, Pablo Sanchez, Raj Ramanan","doi":"10.1177/02676591241268402","DOIUrl":"https://doi.org/10.1177/02676591241268402","url":null,"abstract":"<p><strong>Introduction: </strong>Polymethylpentene (PMP) oxygenators serve as the primary oxygenator type utilized for ECMO. With the number of PMP oxygenators available, it has become increasingly important to determine differences among each oxygenator type that can lead to varying metrics of oxygenator dysfunction.</p><p><strong>Methods: </strong>This study was a retrospective, single-center analysis of adult patients supported on ECMO between December 2020 to December 2021 with varying PMP oxygenators including the Medtronic Nautilus Smart (Minneapolis, MA), the Eurosets AMG PMP (Medolla, Italy) and Getinge Quadrox-iD and the Getinge Cardiohelp HLS Module Advanced System (Gothenberg, Sweden).</p><p><strong>Results: </strong>A total of 19 patients were included in our study. 10 patients (52.6%) were supported with a Medtronic Nautilus Smart oxygenator, 5 patients (26.3%) were supported with an Eurosets AMG PMP Oxygenator, and 4 patients (21.1%) were supported with either a Getinge Quadrox-iD oxygenator or Getinge Cardiohelp HLS system. Patients supported with Eurosets AMG PMP oxygenators experienced higher resistance and lower post-oxygenator PaO<sub>2</sub> in comparison to other cohorts (<i>p</i> < .02 and < .002 respectively). There was no difference in measured oxygen transfer between cohorts (<i>p</i> = .667). Two patients, both supported by Eurosets AMG PMP, experienced oxygenator failure (<i>p = .</i>094).</p><p><strong>Conclusion: </strong>Radial flow oxygenators are prone to higher resistance and lower post-oxygenator PaO<sub>2</sub>when compared to transverse flow oxygenators. Future larger multicenter studies are required to fully discern the differences between flow-varying polymethylpentene oxygenators and their appropriate cutoffs for oxygenator dysfunction.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141876504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-27DOI: 10.1177/02676591241268368
Richard A Jonas
{"title":"Management of fetal hemoglobin and risk of oxygen toxicity in the pump driven venovenous artificial placenta.","authors":"Richard A Jonas","doi":"10.1177/02676591241268368","DOIUrl":"https://doi.org/10.1177/02676591241268368","url":null,"abstract":"","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141767889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-26DOI: 10.1177/02676591241268367
Margaret Yang, Kim Derespina, Chantal Grant, Alfin Vicencio, Raghav Murthy, Shubhi Kaushik
Bronchopleural fistula (BPF) is a connection between the bronchus and pleural cavity. It is associated with high morbidity and mortality and management of BPF has not been well described in the pediatric population. We describe a 2-year-old girl who presented with fever and increased work of breathing, found to have atypical hemolytic uremic syndrome and Streptococcus necrotizing pneumonia with development of persistent air leak due to bronchopleural fistulas requiring extracorporeal membrane oxygenation (ECMO). Three endobronchial valves were placed with successful resolution of bronchopleural fistulas. She required tracheostomy for chronic respiratory failure and endobronchial valves were eventually removed. Approximately 3.5 months after discharge to acute care rehabilitation, tracheostomy was successfully decannulated. This case highlights the successful use of endobronchial valves for resolution of BPF while on ECMO as well as the importance of further studies on optimal candidates, timing and duration of intervention in addition to sequelae of endobronchial valve placement.
{"title":"Bronchopleural fistula management in a pediatric patient requiring extracorporeal membrane oxygenation.","authors":"Margaret Yang, Kim Derespina, Chantal Grant, Alfin Vicencio, Raghav Murthy, Shubhi Kaushik","doi":"10.1177/02676591241268367","DOIUrl":"https://doi.org/10.1177/02676591241268367","url":null,"abstract":"<p><p>Bronchopleural fistula (BPF) is a connection between the bronchus and pleural cavity. It is associated with high morbidity and mortality and management of BPF has not been well described in the pediatric population. We describe a 2-year-old girl who presented with fever and increased work of breathing, found to have atypical hemolytic uremic syndrome and Streptococcus necrotizing pneumonia with development of persistent air leak due to bronchopleural fistulas requiring extracorporeal membrane oxygenation (ECMO). Three endobronchial valves were placed with successful resolution of bronchopleural fistulas. She required tracheostomy for chronic respiratory failure and endobronchial valves were eventually removed. Approximately 3.5 months after discharge to acute care rehabilitation, tracheostomy was successfully decannulated. This case highlights the successful use of endobronchial valves for resolution of BPF while on ECMO as well as the importance of further studies on optimal candidates, timing and duration of intervention in addition to sequelae of endobronchial valve placement.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141762070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}