Perfusion-Uk最新文献

IntroductionVentricular assist devices (VADs) have emerged as essential tools for stage D heart failure, improving survival and quality of life by serving as a bridge to transplant, destination therapy, or bridge to decision. The successful implantation and management of VADs requires a multidisciplinary team, in which perfusionists have a critical role in ensuring proper oxygen delivery, hemodynamic support, and the smooth transition from extracorporeal support to the implanted device. The objective was to describe the institutional perfusion protocol for LVAD implantation and to characterize intraoperative perfusion parameters at a Latin American referral center.MethodsA retrospective observational cohort study was conducted including all patients who underwent LVAD implantation at a referral center in northeastern Colombia. Statistical analysis involved the use of descriptive statistics.ResultsA total of 33 patients underwent LVAD implantation, with a median age of 54 years and 51.52% of male. Ischemic cardiomyopathy was the leading etiology (27.27%). The median cardiopulmonary bypass (CPB) time was 153 min (IQR: 128-181). During cardiopulmonary bypass the median lactate levels were 1.8 mmol/L (IQR: 1.5-2.2), and the cardiac index ranged from a minimum CI of 2.3 to a maximum CI of 2.6 L/min/m².ConclusionsThis study highlights the vital role of cardiopulmonary perfusion in the successful implantation of long-term LVADs in advanced heart failure patients. Optimal intraoperative management, including controlled temperature, low lactate levels, and optimal cardiac index, emphasizes the need for standardized strategies and the expertise of perfusionists.

IntroductionThe benefits of veno-venous extracorporeal membrane oxygenation (VV-ECMO) for patients with acute respiratory distress syndrome (ARDS) are well established. However, cannulation-related vascular complications, while rare, can be life-threatening.Case ReportAn 82-year-old man with ARDS caused by pleural empyema and lung abscess required VV-ECMO for worsening acidemia and hypoxemia. During internal jugular vein cannulation, a purulent effusion abruptly emerged from the outflow catheter. CT revealed catheter perforation of the brachiocephalic vein with fistulization into the pleural empyema. ECMO support was re-established using an alternative configuration. Following surgical repair, the patient gradually recovered to ambulatory discharge.DiscussionCatheter penetration into a pleural empyema in the absence of congenital anomalies is extremely rare. Here, inflammation-related vascular fragility likely contributed. This highlights the importance of considering intrathoracic pathology when determining ECMO configuration.ConclusionPleural empyema may predispose patients to vascular complications associated with VV-ECMO. A tailored ECMO configuration is essential.

IntroductionAnticoagulation management during extracorporeal membrane oxygenation (ECMO) remains an important challenge, with bleeding rates reaching 30%. Activated partial thromboplastin time (aPTT) is the most used biomarker for heparin titration, however static values may not reflect real-time bleeding risk. We hypothesized that cumulative aPTT exposure offers superior predictive value for bleeding and mortality compared to traditional threshold-based approaches.MethodsIn this retrospective cohort study, we analyzed 109 adult ECMO patients at a single Canadian center (2006-2021). Serial aPTT values were recorded approximately every 6 h. The primary outcome was time to first major bleeding event (BARC ≥3), with death treated as a competing risk. We applied a joint longitudinal-survival modeling framework to evaluate associations between dynamic aPTT trajectories, including slope, variability, and cumulative exposure,and adverse outcomes. Models were adjusted for baseline covariates and compared using deviance information criterion (DIC) and time-dependent AUC.ResultsFifty-one patients (46.8%) experienced major bleeding. The best-performing model incorporated the cumulative exposure to elevated log-transformed aPTT, which significantly predicted both bleeding (HR 2.39, 95% CI: 1.17-4.88, p = 0.0084) and death (HR 7.88, 95% CI: 2.59-23.94, p < 0.0001). This model outperformed static or trend-based approaches (AUC 0.77 at 48 h). There results were robust to sensitivity analysis. Hematocrit and ECMO configuration were also significant covariates.ConclusionCumulative aPTT burden is a strong and independent predictor of bleeding and mortality in ECMO patients. These findings support a shift toward trajectory-based anticoagulation monitoring to enable safer, personalized management in this high-risk population.

ObjectiveTo evaluate the effects of dexmedetomidine administration and the use of del Nido cardioplegia in reducing the incidence of atrial fibrillation (AF) and delirium during the perioperative period.Methods448 patients were randomized into two groups: the treatment group received dexmedetomidine combined with del Nido cardioplegia, and the control group received normal saline placebo combined with Buckberg traditional cardioplegia. Each group included 224 patients. The occurrence of AF and delirium within 5 days after surgery, as well as other intraoperative and postoperative indicators, were noted.ResultsThere were no significant differences in preoperative indicators between the two groups. The incidences of AF and delirium events were significantly higher in the control group than in the treatment group.ConclusionWe found that del Nido cardioplegia combined with dexmedetomidine was safe in cardiac surgery with CPB and effectively reduced the incidence of postoperative AF and delirium.

BackgroundCOVID-19 causes a severe respiratory distress syndrome. Systemic inflammation and hypercoagulability are common. These findings are often evaluated with non-specific markers, including CRP, D-dimer, and fibrinogen. We sought to evaluate thromboelastography (TEG) to better understand this complex coagulopathy.MethodsWe conducted a prospective observational study analyzing TEG results in hospitalized patients with COVID-19. TEG was performed on admission and at pre-set intervals. Based on the TEG findings, patients were deemed "hypercoagulable" or "not hypercoagulable." Clinical outcomes were recorded.Results88 patients were evaluated. 78/88 (89%) were hypercoagulable. 10% of the hypercoagulable group (8/78) died compared to none in the non-hypercoagulable group (0/10), with thrombotic events occurring in 9% (8/88), a higher requirement for O2 support in 19% (17/88), and prolonged length of stay exceeding 4 days for 74% (65/88). No statistical significant differences were observed between the groups for any of the four adverse events. Patients with complete fibrinolysis shutdown (Ly30 = 0) had more thrombotic events than those with Ly30 > 0 (30% vs 0%, p = .03).ConclusionPatients with COVID-19 are often hypercoagulable based upon specific TEG parameters. While many TEG parameters are not associated with adverse outcomes, complete fibrinolysis shutdown is associated with an increased risk of thrombotic events. Further studies are warranted to assess the utility of TEG in this population.

ObjectivePediatric Veno-Arterial Extra Corporeal Membrane Oxygenation (VA ECMO) can be a lifesaving technology; however, it is associated with high mortality. A successful VA ECMO course requires attention to multiple aspects of patient care; yet often overlooked are ECMO flow parameters. Early, potentially modifiable, risk factors associated with patient mortality should be scrutinized in patients requiring VA ECMO.MethodRetrospective single center experience of pediatric patients requiring VA ECMO from January 2021 to October 2023. Laboratory and ECMO flow parameters were extracted from the patients record and analyzed. Risk factors were analyzed using a Cox proportion hazard regression, and a multivariate regression.Main ResultsThere were 45 patients studied. Overall survival was 51%. Upon uncorrected analysis there were no significant differences between the patients who survived and those who died during their hospital admission. Utilizing a Cox proportion hazard regression, platelet count, fibrinogen level, and creatinine level normalized to age within the first 24 hours of a patients ECMO course were significant risk factors for hospital mortality. We did not find that ECMO flow parameters were significantly associated with mortality within the first 24 hours.SignificanceAlthough we did not find a significant difference among ECMO flow parameters in this study, this work highlights that granular ECMO flow data can be incorporated to risk analysis profiles and potential modeling in pediatric VA ECMO. This study demonstrated that when controlling for ECMO flow parameters, kidney dysfunction and clotting regulation are associated with pediatric VA ECMO mortality.

IntroductionDuring surgery, blood is recovered from the surgical field and the autotransfusion device separates and washes the red blood cells (RBC's) after which these can be retransfused to the patient. Autotransfusion devices differ strongly in separation method and washing settings, which may lead to different RBC recovery rates and removal rates of contaminants. The objective of this study was to compare the autoLog IQ^TM (Medtronic) and the Xtra^® (LivaNova) in terms of RBC recovery, quality of the processed blood and processing time.MethodsHuman blood was heparinised and processed with both autotransfusion devices according to their standard protocols. Blood samples were taken from the collection reservoir and from the transfusion bag and analyzed for cell count, heparin removal and cell injury.ResultsThe RBC recovery rates for both devices was 93%. Heparin was almost completely removed in both devices with >99.9%. The autoLog IQ^TM showed significantly better removal of platelets (autoLog IQ vs Xtra; 86.1 ± 2.7 and 78.6 ± 4.4%, p = 0.01) and of leukocytes (autoLog IQ vs Xtra; 39.6 ± 2.7 and 13.4 ± 5.7%, p < 0.001). No other significant differences were observed in removal rates. The volume of RBC concentrated per minute was faster for the Xtra^® (autoLog IQ vs Xtra, 21 ± 3 and 27 ± 2 mL RBC/min, p = 0.007).ConclusionsIn this study both the autoLog IQ^TM and the Xtra^® showed similar RBC recovery rates of 93% and almost all heparin was eliminated. The washing quality of the autoLog IQ^TM device appears to be better, with better removal of platelets and leukocytes. Although both the autoLog IQ^TM and the Xtra^® devices use very different separation techniques and washing protocols, the difference in processing speed and various markers for cell damage in the end product seems trivial.

IntroductionWe sought to evaluate cerebral and somatic oximetry in an integrated tissue perfusion monitoring strategy.MethodThirty adult patients undergoing full-spectrum cardiac surgery with Minimal Invasive Extracorporeal Circulation (MiECC) were recruited. We simultaneously assessed the adequacy of tissue perfusion with near-infrared spectroscopy (NIRS) for cerebral and tissue oximetry, cerebral autoregulation monitoring (COx), sublingual microcirculation with video microscopy and real-time in-line metabolic monitoring during cardiopulmonary bypass. The primary endpoint of the study was to evaluate the diagnostic accuracy of NIRS cerebral desaturation in predicting a global perfusion-related adverse clinical event.ResultsCerebral oximetry showed the higher positive and negative predicting values (50% and 67%, respectively) in detecting a tissue perfusion-related adverse outcome. Somatic oximetry was related to higher values compared to cerebral (p < .001) and followed a different trend. ROC analysis calculated a cutoff value of 22 for right-sided cerebral desaturation and 32 for cumulative left- and right-sided desaturation as a sensitive predictor of hyperlactemia. Microcirculatory parameters were impaired after induction of anesthesia, while they were preserved during cardiopulmonary bypass.ConclusionsNIRS cerebral oximetry represents a useful tissue perfusion monitoring tool. An AUC cutoff value of 22 for a single hemisphere and 32 bilaterally correlate with hyperlactemia and may serve as alarm for prompt action.

IntroductionVeno-arterial extracorporeal life support (V-A ECLS) can be utilized to transport cardiogenic shock patients from a regional to a tertiary center. Mobile extracorporeal membrane oxygenation (ECMO) may be life-saving for critically ill patients to bridge to transplant or a higher level of care.MethodsThis study is a retrospective review of adult patients placed on V-A ECMO for cardiogenic shock between 2018 and 2022. Indications and outcomes were compared between patients who were cannulated at referring hospitals and transported via ambulance and those who were placed on VA-ECLS at our institution.Results547 patients with V-A ECMO placed due to cardiogenic shock were included. 94 patients were transported from referring hospitals, while 453 were placed on V-A ECMO at our institution. All were safely transported. In-hospital mortality was significantly higher in transport patients (49.1% vs 59.5%, p = .042). Transport patients had significantly higher rates of acute kidney injury requiring dialysis (27.8% vs 39.4%, p-value = .035) and cerebrovascular accident (6.2% vs 12.8%, p-value = .026). Kaplan-Meier curves showed 6-month survival was significantly lower in transport group (48.5% vs 37.3%, p = .021). Multivariate analysis demonstrated ECMO indication of AMI (OR 1.43, p-value = .037), ECPR (OR 2.45, p-value <.001), and history of COPD (OR 1.55, p-value = .014) were predictors of mortality within 12 months. Notably ECMO transport was not a significant risk factor.ConclusionsPatients transported on V-A ECMO had higher in-hospital mortality, as well as lower 1-year survival. Careful patient selection is required.

IntroductionCardiopulmonary bypass (CPB) is essential for cardiac surgery but poses risks, including gaseous micro emboli (GME). While the incidence of stroke-a common clinical consequence of embolism-ranges from 1-5% in cardiac surgery, prevalence of GME during CPB remain poorly understood.ObjectivesTo quantitatively compare GME incidence in the arterial line between cavoatrial and bicaval cannulation during open-heart surgery. Secondary exploratory objectives include evaluating the impact of venous reservoir volume on GME, and the correlation between GME in the venous and arterial lines.MethodsThis single center randomized controlled trial was conducted at Sahlgrenska University Hospital, Sweden. Patients ≥18 years undergoing planned aortic valve repair/replacement with cavoatrial cannulation, or mitral valve repair/replacement with bicaval cannulation, with or without coronary artery revascularization, were screened for eligibility. Patients were further randomized to either venous reservoir volume of ≥300 mL (control) or 200-300mL (intervention). GME detection was performed using GAMPT BCC300 with probes positioned at multiple locations within the CPB circuit.Results39 patients were included. No significant differences in GME quantity in the arterial line were observed between the cannulation methods (count p=.444; volume p=967). Similarly, no significant differences were found based on venous reservoir volume (count p=.074; volume p=.166). Furthermore, no significant correlation was observed between GME in venous line entering the arterial line (count p-value=492; volume p-value=.750). The CPB circuit effectively removed 99.14% of GME, with no adverse events reported.ConclusionNo significant differences were found in arterial GME count or volume between cavoatrial and bicaval cannulation during CPB. These findings underscore the importance of the bypass circuit's air-handling capacity, as well as the role of modern oxygenators and arterial line filters in effectively minimizing the passage of GME. Trial Registration:ClinicalTrials.gov Identifier: NCT05820828URL: https://clinicaltrials.gov/ct2/show/NCT05820828.