Pub Date : 2024-07-26DOI: 10.1177/02676591241268376
Prakash P Punjabi
{"title":"Extracorporeal life support: Marching onwards and upwards.","authors":"Prakash P Punjabi","doi":"10.1177/02676591241268376","DOIUrl":"https://doi.org/10.1177/02676591241268376","url":null,"abstract":"","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":"141767888","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: 10.1177/02676591241268389
Paolo Meani, Serena Todaro, Giacomo Veronese, Mariusz Kowalewski, Andrea Montisci, Ilaria Protti, Giuseppe Marchese, Christiaan Meuwese, Roberto Lorusso, Federico Pappalardo
The concept of left ventricular unloading has its foundation in heart physiology. In fact, the left ventricular mechanics and energetics represent the cornerstone of this approach. The novel sophisticated therapies for acute heart failure, particularly mechanical circulatory supports, strongly impact on the mechanical functioning and energy consuption of the heart, ultimately affecting left ventricle loading. Notably, extracorporeal circulatory life support which is implemented for life-threatening conditions, may even overload the left heart, requiring additional unloading strategies. As a consequence, the understanding of ventricular overload, and the associated potential unloading strategies, founds its utility in several aspects of day-by-day clinical practice. Emerging clinical and pre-clinical research on left ventricular unloading and its benefits in heart failure and recovery has been conducted, providing meaningful insights for therapeutical interventions. Here, we review the current knowledge on left ventricular unloading, from physiology and molecular biology to its application in heart failure and recovery.
{"title":"Science of left ventricular unloading.","authors":"Paolo Meani, Serena Todaro, Giacomo Veronese, Mariusz Kowalewski, Andrea Montisci, Ilaria Protti, Giuseppe Marchese, Christiaan Meuwese, Roberto Lorusso, Federico Pappalardo","doi":"10.1177/02676591241268389","DOIUrl":"https://doi.org/10.1177/02676591241268389","url":null,"abstract":"<p><p>The concept of left ventricular unloading has its foundation in heart physiology. In fact, the left ventricular mechanics and energetics represent the cornerstone of this approach. The novel sophisticated therapies for acute heart failure, particularly mechanical circulatory supports, strongly impact on the mechanical functioning and energy consuption of the heart, ultimately affecting left ventricle loading. Notably, extracorporeal circulatory life support which is implemented for life-threatening conditions, may even overload the left heart, requiring additional unloading strategies. As a consequence, the understanding of ventricular overload, and the associated potential unloading strategies, founds its utility in several aspects of day-by-day clinical practice. Emerging clinical and pre-clinical research on left ventricular unloading and its benefits in heart failure and recovery has been conducted, providing meaningful insights for therapeutical interventions. Here, we review the current knowledge on left ventricular unloading, from physiology and molecular biology to its application in heart failure and recovery.</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":"141762073","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 : 2024-07-25DOI: 10.1177/02676591241268395
Ajami Gikandi, Jean M Connors, Christoph G Nabzdyk, Marco A Zenati
This case report describes the perioperative course of a patient undergoing emergency repair of acute type A thoracic aortic dissection. Andexanet alfa was administered intraoperatively to obtain a dry operative field for right axillary artery exposure and cannulation. Andexanet alfa-induced heparin resistance resulted in cardiopulmonary bypass circuit and pericardial thrombosis requiring more than 400,000 units of unfractionated heparin and antithrombin III to overcome. Postoperatively, excessive chest tube output was observed secondary to protracted heparin rebound requiring continuous dosing of protamine. This case demonstrates the significant challenging perioperative, not just intraoperative, hazards associated with intraoperative andexanet alfa use during emergency cardiac surgery with cardiopulmonary bypass.
本病例报告描述了一名接受急性 A 型胸主动脉夹层紧急修补术的患者的围手术期过程。术中使用了安体舒通α,以获得干燥的手术野,进行右腋动脉暴露和插管。Andexanet alfa 引起的肝素抵抗导致心肺旁路回路和心包血栓形成,需要超过 400,000 单位的非分叶肝素和抗凝血酶 III 才能克服。术后,由于肝素反弹时间过长,需要持续服用原胺,因此观察到胸管输出量过多。该病例表明,在使用心肺旁路的急诊心脏手术中,术中使用安赛蜜α不仅在术中,而且在围手术期都会带来巨大的挑战性危害。
{"title":"Perioperative risks associated with administration of andexanet alfa during emergency cardiac surgery with circulatory arrest.","authors":"Ajami Gikandi, Jean M Connors, Christoph G Nabzdyk, Marco A Zenati","doi":"10.1177/02676591241268395","DOIUrl":"https://doi.org/10.1177/02676591241268395","url":null,"abstract":"<p><p>This case report describes the perioperative course of a patient undergoing emergency repair of acute type A thoracic aortic dissection. Andexanet alfa was administered intraoperatively to obtain a dry operative field for right axillary artery exposure and cannulation. Andexanet alfa-induced heparin resistance resulted in cardiopulmonary bypass circuit and pericardial thrombosis requiring more than 400,000 units of unfractionated heparin and antithrombin III to overcome. Postoperatively, excessive chest tube output was observed secondary to protracted heparin rebound requiring continuous dosing of protamine. This case demonstrates the significant challenging perioperative, not just intraoperative, hazards associated with intraoperative andexanet alfa use during emergency cardiac surgery with cardiopulmonary bypass.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141762072","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 : 2024-07-25DOI: 10.1177/02676591241267218
Andrew J Doyle, Andrew Retter, Kiran Parmar, Katarzyna Mayger, Nicholas Barrett, Luigi Camporota, Karen A Breen, Beverley J Hunt
Introduction: Bleeding and thrombotic events (BTE) are frequent during extracorporeal membrane oxygenation (ECMO). They occur at varying timepoints and may be affected by temporal changes in coagulation and fibrinolysis. We aimed to assess various coagulation and fibrinolytic markers over time and their relationship with BTE.
Methods: A single-centre prospective study was performed in 17 patients with severe respiratory failure receiving veno-venous ECMO. Blood samples were collected before and during ECMO, and around circuit decannulation.
Results: Prior to ECMO, D-Dimer, Plasmin-Antiplasmin complexes (PAP), Plasminogen-Activator Inhibitor-1 (PAI-1) and fibrinogen were elevated. There was an increase in D-Dimer and Prothrombin Fragments 1+2 (PF1+2) (729 to 1305pmol/L, p = .034) by day 1 and PAP increased by day 2 from baseline levels (median 1022 to 1797 µg/L, p = .023). There was a strong positive correlation in PAP, PF1+2 and thrombin-antithrombin complexes (TAT) to D-Dimer. BTE were frequent - 18% had major extracranial haemorrhage and 24% had intracranial haemorrhage. Over time, there was a progressive elevation PAP in patients developing subsequent extracranial haemorrhage, whereas D-Dimer, PAP and PF1+2 increased after intracranial haemorrhage.
Conclusions: There were early changes in coagulation activity during ECMO by PF1+2 followed by subsequent fibrinolysis by PAP. Changes in PAP, PF1+2 and TAT were associated with major haemorrhage.
{"title":"Temporal changes in markers of coagulation and fibrinolysis in adults during extracorporeal membrane oxygenation.","authors":"Andrew J Doyle, Andrew Retter, Kiran Parmar, Katarzyna Mayger, Nicholas Barrett, Luigi Camporota, Karen A Breen, Beverley J Hunt","doi":"10.1177/02676591241267218","DOIUrl":"https://doi.org/10.1177/02676591241267218","url":null,"abstract":"<p><strong>Introduction: </strong>Bleeding and thrombotic events (BTE) are frequent during extracorporeal membrane oxygenation (ECMO). They occur at varying timepoints and may be affected by temporal changes in coagulation and fibrinolysis. We aimed to assess various coagulation and fibrinolytic markers over time and their relationship with BTE.</p><p><strong>Methods: </strong>A single-centre prospective study was performed in 17 patients with severe respiratory failure receiving veno-venous ECMO. Blood samples were collected before and during ECMO, and around circuit decannulation.</p><p><strong>Results: </strong>Prior to ECMO, D-Dimer, Plasmin-Antiplasmin complexes (PAP), Plasminogen-Activator Inhibitor-1 (PAI-1) and fibrinogen were elevated. There was an increase in D-Dimer and Prothrombin Fragments 1+2 (PF1+2) (729 to 1305pmol/L, <i>p</i> = .034) by day 1 and PAP increased by day 2 from baseline levels (median 1022 to 1797 µg/L, <i>p</i> = .023). There was a strong positive correlation in PAP, PF1+2 and thrombin-antithrombin complexes (TAT) to D-Dimer. BTE were frequent - 18% had major extracranial haemorrhage and 24% had intracranial haemorrhage. Over time, there was a progressive elevation PAP in patients developing subsequent extracranial haemorrhage, whereas D-Dimer, PAP and PF1+2 increased after intracranial haemorrhage.</p><p><strong>Conclusions: </strong>There were early changes in coagulation activity during ECMO by PF1+2 followed by subsequent fibrinolysis by PAP. Changes in PAP, PF1+2 and TAT were associated with major haemorrhage.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141762074","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}
This case report describes the pharmacokinetics of levetiracetam in a critically ill patient supported on venovenous membrane oxygenation. While levetiracetam has emerged as a first line option to treat seizures in critically ill patients, there is limited information available regarding the impact of extracorporeal membrane oxygenation on the pharmacokinetics of this medication. This report contributes to the limited body of literature describing the pharmacokinetics of medications in extracorporeal membrane oxygenation.
{"title":"Levetiracetam pharmacokinetics in venovenous extracorporeal membrane oxygenation: A case report.","authors":"Diana Solomon, Devon Gaines, Lars-Kristofer Peterson","doi":"10.1177/02676591241268422","DOIUrl":"https://doi.org/10.1177/02676591241268422","url":null,"abstract":"<p><p>This case report describes the pharmacokinetics of levetiracetam in a critically ill patient supported on venovenous membrane oxygenation. While levetiracetam has emerged as a first line option to treat seizures in critically ill patients, there is limited information available regarding the impact of extracorporeal membrane oxygenation on the pharmacokinetics of this medication. This report contributes to the limited body of literature describing the pharmacokinetics of medications in extracorporeal membrane oxygenation.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141762071","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 : 2024-07-24DOI: 10.1177/02676591241264437
Goeto Dantes, Carolyn Davis, Katya Van Anderlecht, Joel Davis, Lisa Lima, Allison F Linden, Matthew Paden, Sarah Keene
Purpose: Preterm pediatric patients with bronchopulmonary dysplasia (BPD) represent a subgroup previously deemed high risk candidates for ECLS (extracorporeal life support) due to suspected high mortality or increased post ECLS morbidity. The aim of this study was to determine outcomes for patients with an established history of BPD who subsequently required ECLS.
Methods: A single center retrospective review was performed between 01/2010-06/2022 for patients less than 2 years of age, born prematurely (<32 weeks) with a subsequent diagnosis of BPD, and who required ECLS for respiratory failure. Demographic and clinical data, including ECLS data, were collected. Speech, language, feeding/swallowing, cognitive, hearing, vision, or motor function deficits were obtained with a median follow up of 42 months following discharge.
Results: Nineteen patients met criteria. The median birth weight and gestational age was 0.86 kg (IQR 0.73, 1.0) and 26 weeks (IQR 25, 27), respectively. The median chronological age at cannulation was 12.1 months. The most common etiologies for respiratory failure requiring ECLS were viral (68.4%) and bacterial (21.1%) pneumonia. Survival to decannulation was 78.9% (15/19) and survival to hospital discharge was 63.2% (12/19). Amongst survivors to discharge, 42% (5/12) required new or additional home oxygen and 50% (6/12) were noted to have neurodevelopmental/behavioral concerns on follow up at 1 year with 25% (3/12) with concerns beyond a year.
Conclusion: Patients with underlying BPD who require ECLS have comparable mortality and long-term neurodevelopmental outcomes to non-BPD patients with respiratory failure. This information can be useful when considering ECLS candidacy and providing family counseling.
{"title":"Extracorporeal life support use in patients with bronchopulmonary dysplasia: A single center case series.","authors":"Goeto Dantes, Carolyn Davis, Katya Van Anderlecht, Joel Davis, Lisa Lima, Allison F Linden, Matthew Paden, Sarah Keene","doi":"10.1177/02676591241264437","DOIUrl":"https://doi.org/10.1177/02676591241264437","url":null,"abstract":"<p><strong>Purpose: </strong>Preterm pediatric patients with bronchopulmonary dysplasia (BPD) represent a subgroup previously deemed high risk candidates for ECLS (extracorporeal life support) due to suspected high mortality or increased post ECLS morbidity. The aim of this study was to determine outcomes for patients with an established history of BPD who subsequently required ECLS.</p><p><strong>Methods: </strong>A single center retrospective review was performed between 01/2010-06/2022 for patients less than 2 years of age, born prematurely (<32 weeks) with a subsequent diagnosis of BPD, and who required ECLS for respiratory failure. Demographic and clinical data, including ECLS data, were collected. Speech, language, feeding/swallowing, cognitive, hearing, vision, or motor function deficits were obtained with a median follow up of 42 months following discharge.</p><p><strong>Results: </strong>Nineteen patients met criteria. The median birth weight and gestational age was 0.86 kg (IQR 0.73, 1.0) and 26 weeks (IQR 25, 27), respectively. The median chronological age at cannulation was 12.1 months. The most common etiologies for respiratory failure requiring ECLS were viral (68.4%) and bacterial (21.1%) pneumonia. Survival to decannulation was 78.9% (15/19) and survival to hospital discharge was 63.2% (12/19). Amongst survivors to discharge, 42% (5/12) required new or additional home oxygen and 50% (6/12) were noted to have neurodevelopmental/behavioral concerns on follow up at 1 year with 25% (3/12) with concerns beyond a year.</p><p><strong>Conclusion: </strong>Patients with underlying BPD who require ECLS have comparable mortality and long-term neurodevelopmental outcomes to non-BPD patients with respiratory failure. This information can be useful when considering ECLS candidacy and providing family counseling.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141753163","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 : 2024-07-24DOI: 10.1177/02676591241267228
Akram M Zaaqoq, Silver Heinsar, Hwan-Jin Yoon, Nicole White, Matthew J Griffee, Jacky Y Suen, Gianluigi L Bassi, Jonathon P Fanning, Ahmad Labib Shehatta, Peta M A Alexander, Jeffrey P Jacobs, Heidi J Dalton, Roberto Lorusso, Sung-Min Cho, Giles J Peek, John F Fraser
Objective: The outcomes of COVID-19 patients on venovenous extracorporeal membrane oxygenation (VV-ECMO) varied. We aim to investigate the variability concerning location and timeframe. We conducted a retrospective analysis of data from 351 institutions in 53 countries. The primary outcome was survival to hospital discharge or death up to 90 days from ECMO start. The associations between calendar time (month and year) of ECMO initiation and the primary outcome were examined by Cox regression modeling. Multivariable survival analyses were adjusted for the time of ECMO start, age, body mass index, APACHE II, SOFA, and the duration of mechanical ventilation before ECMO.
Results: 1060 adult COVID-19 patients enrolled in the COVID-19 Critical Care Consortium (COVID Critical) international registry and required VV-ECMO support. The study period is from January 2020 to December 2021. The median age was 51 years old, and 70% were male patients. Most patients were from Europe (39.3%) and North America (37.4%). The in-hospital mortality of the entire cohort was 47.12%. In North America and Europe, there was an increased probability of death from May 2020 through February 2021. Latin America showed a steady rate of survival until late in the study. South Asia, the Middle East, and Africa showed an increased chance of mortality around May 2020. In the Asian-Pacific region, after February 2021, there was an increased probability of death. The time of ECMO initiation and advanced patient age were associated with increased mortality.
Conclusion: Variability in the outcomes of COVID-19 patients on VV-ECMO existed within different regions. This variability reflects the differences in resources, policies, patient selection, management, and possibly COVID-19 virus subtypes. Our findings might help guide global response in the future by early adoption of patient selection protocols, worldwide policies, and delivery of resources.
{"title":"Worldwide application and valuation of extracorporeal membrane oxygenation support during the COVID-19 pandemic (WAVES).","authors":"Akram M Zaaqoq, Silver Heinsar, Hwan-Jin Yoon, Nicole White, Matthew J Griffee, Jacky Y Suen, Gianluigi L Bassi, Jonathon P Fanning, Ahmad Labib Shehatta, Peta M A Alexander, Jeffrey P Jacobs, Heidi J Dalton, Roberto Lorusso, Sung-Min Cho, Giles J Peek, John F Fraser","doi":"10.1177/02676591241267228","DOIUrl":"10.1177/02676591241267228","url":null,"abstract":"<p><strong>Objective: </strong>The outcomes of COVID-19 patients on venovenous extracorporeal membrane oxygenation (VV-ECMO) varied. We aim to investigate the variability concerning location and timeframe. We conducted a retrospective analysis of data from 351 institutions in 53 countries. The primary outcome was survival to hospital discharge or death up to 90 days from ECMO start. The associations between calendar time (month and year) of ECMO initiation and the primary outcome were examined by Cox regression modeling. Multivariable survival analyses were adjusted for the time of ECMO start, age, body mass index, APACHE II, SOFA, and the duration of mechanical ventilation before ECMO.</p><p><strong>Results: </strong>1060 adult COVID-19 patients enrolled in the COVID-19 Critical Care Consortium (COVID Critical) international registry and required VV-ECMO support. The study period is from January 2020 to December 2021. The median age was 51 years old, and 70% were male patients. Most patients were from Europe (39.3%) and North America (37.4%). The in-hospital mortality of the entire cohort was 47.12%. In North America and Europe, there was an increased probability of death from May 2020 through February 2021. Latin America showed a steady rate of survival until late in the study. South Asia, the Middle East, and Africa showed an increased chance of mortality around May 2020. In the Asian-Pacific region, after February 2021, there was an increased probability of death. The time of ECMO initiation and advanced patient age were associated with increased mortality.</p><p><strong>Conclusion: </strong>Variability in the outcomes of COVID-19 patients on VV-ECMO existed within different regions. This variability reflects the differences in resources, policies, patient selection, management, and possibly COVID-19 virus subtypes. Our findings might help guide global response in the future by early adoption of patient selection protocols, worldwide policies, and delivery of resources.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141762075","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 : 2024-07-21DOI: 10.1177/02676591241265052
Rachel Hillner, Luke Perry, Natalie Hill, Aditya V Badheka, Venkat Keshav Chivukula
Background: Pediatric heart failure is associated with high mortality rates and is a current clinical burden. There is only one FDA approved pediatric VAD, Berlin Heart EXCOR, for treatment. Thrombo-embolic complications are a significant clinical challenge, which can lead to devastating complications such as stroke and impair efficient EXCOR function. Currently, clinicians perform largely qualitative periodic assessment of EXCOR operation by observing the motion of a rapidly moving membrane, which can be prone to human error and can lead to missing out on crucial information.
Methods: In this study, we design and implement a quantitative early warning system for accurate and quantitative assessment of the EXCOR membrane, named EXCOR Membrane Motion Analyzer (EMMA). Using a combination of image analysis, computer vision and custom designed algorithm, we perform rigorous frame by frame analysis of EXCOR membrane video data. We developed specialized metrics to identify relative smoothness between successive peaks, time between peaks and overall smoothness indicators to quantify and compare between multiple cases.
Results: Our results demonstrate that EMMA can successfully identify the motion and wrinkles on each video frame and quantify the smoothness and identify the phases of each cardiac cycle. Moreover, EMMA can obtain the smoothness of each frame and the temporal evolution of membrane smoothness across all image frames for the video sequence.
Conclusions: EMMA allows for a fast, accurate, quantitative assessment to be completed and reduces user error. This enables EMMA to be used effectively as an early warning system to rapidly identify device abnormalities.
背景:小儿心力衰竭死亡率高,是当前的临床负担。目前只有一种经 FDA 批准的小儿 VAD(柏林心脏 EXCOR)可用于治疗。血栓栓塞并发症是一项重大的临床挑战,可导致中风等破坏性并发症,并损害 EXCOR 的有效功能。目前,临床医生主要通过观察快速移动的膜的运动来定期对 EXCOR 的运行情况进行定性评估,这很容易造成人为错误,并可能导致遗漏关键信息:在这项研究中,我们设计并实施了一种定量预警系统,用于对 EXCOR 膜进行准确的定量评估,该系统被命名为 EXCOR 膜运动分析仪(EMMA)。我们结合使用图像分析、计算机视觉和定制设计的算法,对 EXCOR 膜视频数据进行严格的逐帧分析。我们开发了专门的指标来识别连续峰值之间的相对平滑度、峰值之间的时间和整体平滑度指标,以量化和比较多个案例:我们的结果表明,EMMA 可以成功识别每个视频帧上的运动和皱纹,并量化平滑度和识别每个心动周期的阶段。此外,EMMA 还能获得视频序列中每个帧的平滑度以及所有图像帧中膜平滑度的时间演变:结论:EMMA 可以快速、准确地完成定量评估,并减少用户误差。这使得 EMMA 能够有效地用作快速识别设备异常的预警系统。
{"title":"EXCOR membrane motion analyzer (EMMA) to quantify and assess hemodynamic performance of the EXCOR pediatric heart assist device.","authors":"Rachel Hillner, Luke Perry, Natalie Hill, Aditya V Badheka, Venkat Keshav Chivukula","doi":"10.1177/02676591241265052","DOIUrl":"https://doi.org/10.1177/02676591241265052","url":null,"abstract":"<p><strong>Background: </strong>Pediatric heart failure is associated with high mortality rates and is a current clinical burden. There is only one FDA approved pediatric VAD, Berlin Heart EXCOR, for treatment. Thrombo-embolic complications are a significant clinical challenge, which can lead to devastating complications such as stroke and impair efficient EXCOR function. Currently, clinicians perform largely qualitative periodic assessment of EXCOR operation by observing the motion of a rapidly moving membrane, which can be prone to human error and can lead to missing out on crucial information.</p><p><strong>Methods: </strong>In this study, we design and implement a quantitative early warning system for accurate and quantitative assessment of the EXCOR membrane, named EXCOR Membrane Motion Analyzer (EMMA). Using a combination of image analysis, computer vision and custom designed algorithm, we perform rigorous frame by frame analysis of EXCOR membrane video data. We developed specialized metrics to identify relative smoothness between successive peaks, time between peaks and overall smoothness indicators to quantify and compare between multiple cases.</p><p><strong>Results: </strong>Our results demonstrate that EMMA can successfully identify the motion and wrinkles on each video frame and quantify the smoothness and identify the phases of each cardiac cycle. Moreover, EMMA can obtain the smoothness of each frame and the temporal evolution of membrane smoothness across all image frames for the video sequence.</p><p><strong>Conclusions: </strong>EMMA allows for a fast, accurate, quantitative assessment to be completed and reduces user error. This enables EMMA to be used effectively as an early warning system to rapidly identify device abnormalities.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141735506","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 : 2024-07-01Epub Date: 2023-04-17DOI: 10.1177/02676591231170978
Fausto Biancari, Alexander Kaserer, Andrea Perrotti, Vito G Ruggieri, Sung-Min Cho, Jin Kook Kang, Magnus Dalén, Henryk Welp, Kristján Jónsson, Sigurdur Ragnarsson, Francisco J Hernández Pérez, Giuseppe Gatti, Khalid Alkhamees, Antonio Loforte, Andrea Lechiancole, Stefano Rosato, Cristiano Spadaccio, Matteo Pettinari, Giovanni Mariscalco, Timo Mäkikallio, Sebastian D Sahli, Camilla L'Acqua, Amr A Arafat, Monirah A Albabtain, Mohammed M AlBarak, Mohamed Laimoud, Ilija Djordjevic, Ihor Krasivskyi, Robertas Samalavicius, Lina Puodziukaite, Marta Alonso-Fernandez-Gatta, Donat R Spahn, Antonio Fiore
Introduction: Postcardiotomy veno-arterial extracorporeal membrane oxygenation (V-A-ECMO) is associated with significant mortality. Identification of patients at very high risk for death is elusive and the decision to initiate V-A-ECMO is based on clinical judgment. The prognostic impact of pre-V-A-ECMO arterial lactate level in these critically ill patients has been herein evaluated.
Methods: A systematic review was conducted to identify studies on postcardiotomy VA-ECMO for the present individual patient data meta-analysis.
Results: Overall, 1269 patients selected from 10 studies were included in this analysis. Arterial lactate level at V-A-ECMO initiation was increased in patients who died during the index hospitalization compared to those who survived (9.3 vs 6.6 mmol/L, p < 0.0001). Accordingly, in hospital mortality increased along quintiles of pre-V-A-ECMO arterial lactate level (quintiles: 1, 54.9%; 2, 54.9%; 3, 67.3%; 4, 74.2%; 5, 82.2%, p < 0.0001). The best cut-off for arterial lactate was 6.8 mmol/L (in-hospital mortality, 76.7% vs. 55.7%, p < 0.0001). Multivariable multilevel mixed-effect logistic regression model including arterial lactate level significantly increased the area under the receiver operating characteristics curve (0.731, 95% CI 0.702-0.760 vs 0.679, 95% CI 0.648-0.711, DeLong test p < 0.0001). Classification and regression tree analysis showed the in-hospital mortality was 85.2% in patients aged more than 70 years with pre-V-A-ECMO arterial lactate level ≥6.8 mmol/L.
Conclusions: Among patients requiring postcardiotomy V-A-ECMO, hyperlactatemia was associated with a marked increase of in-hospital mortality. Arterial lactate may be useful in guiding the decision-making process and the timing of initiation of postcardiotomy V-A-ECMO.
引言:心切开术后静脉-动脉体外膜肺氧合(V-A-ECMO)与显著的死亡率相关。识别死亡风险极高的患者是难以捉摸的,启动V-A-ECMO的决定是基于临床判断。在此评估了这些危重患者的V-A-ECMO前动脉乳酸水平对预后的影响。方法:对目前的个体患者数据荟萃分析进行系统回顾,以确定关于心脏切开术后VA-ECMO的研究。结果:总体而言,从10项研究中选择的1269名患者被纳入该分析。与存活的患者相比,在指数住院期间死亡的患者在V-A-ECMO启动时的动脉乳酸水平增加(9.3 vs 6.6 mmol/L,p<0.0001)。因此,住院死亡率沿V-A-ECMO前动脉乳酸水平的五分位数增加(五分位数:1,54.9%;2,54.9%,3,67.3%;4,74.2%;5,82.2%,p<0.0001)。动脉乳酸的最佳临界值为6.8 mmol/L(住院死亡率为76.7%对55.7%,p<0.001)受试者操作特征曲线下面积(0.731,95%CI 0.702-0.760 vs 0.679,95%CI 0.648-0.711,DeLong检验p<0.0001)。分类和回归树分析显示,年龄在70岁以上且V-A-ECMO前动脉乳酸水平≥6.8mmol/L的患者的住院死亡率为85.2%,高乳血症与住院死亡率显著增加有关。动脉乳酸可能有助于指导心脏切开术后V-A-ECMO的决策过程和启动时间。
{"title":"Hyperlactatemia and poor outcome After postcardiotomy veno-arterial extracorporeal membrane oxygenation: An individual patient data meta-Analysis.","authors":"Fausto Biancari, Alexander Kaserer, Andrea Perrotti, Vito G Ruggieri, Sung-Min Cho, Jin Kook Kang, Magnus Dalén, Henryk Welp, Kristján Jónsson, Sigurdur Ragnarsson, Francisco J Hernández Pérez, Giuseppe Gatti, Khalid Alkhamees, Antonio Loforte, Andrea Lechiancole, Stefano Rosato, Cristiano Spadaccio, Matteo Pettinari, Giovanni Mariscalco, Timo Mäkikallio, Sebastian D Sahli, Camilla L'Acqua, Amr A Arafat, Monirah A Albabtain, Mohammed M AlBarak, Mohamed Laimoud, Ilija Djordjevic, Ihor Krasivskyi, Robertas Samalavicius, Lina Puodziukaite, Marta Alonso-Fernandez-Gatta, Donat R Spahn, Antonio Fiore","doi":"10.1177/02676591231170978","DOIUrl":"10.1177/02676591231170978","url":null,"abstract":"<p><strong>Introduction: </strong>Postcardiotomy veno-arterial extracorporeal membrane oxygenation (V-A-ECMO) is associated with significant mortality. Identification of patients at very high risk for death is elusive and the decision to initiate V-A-ECMO is based on clinical judgment. The prognostic impact of pre-V-A-ECMO arterial lactate level in these critically ill patients has been herein evaluated.</p><p><strong>Methods: </strong>A systematic review was conducted to identify studies on postcardiotomy VA-ECMO for the present individual patient data meta-analysis.</p><p><strong>Results: </strong>Overall, 1269 patients selected from 10 studies were included in this analysis. Arterial lactate level at V-A-ECMO initiation was increased in patients who died during the index hospitalization compared to those who survived (9.3 vs 6.6 mmol/L, <i>p</i> < 0.0001). Accordingly, in hospital mortality increased along quintiles of pre-V-A-ECMO arterial lactate level (quintiles: 1, 54.9%; 2, 54.9%; 3, 67.3%; 4, 74.2%; 5, 82.2%, <i>p</i> < 0.0001). The best cut-off for arterial lactate was 6.8 mmol/L (in-hospital mortality, 76.7% vs. 55.7%, <i>p</i> < 0.0001). Multivariable multilevel mixed-effect logistic regression model including arterial lactate level significantly increased the area under the receiver operating characteristics curve (0.731, 95% CI 0.702-0.760 vs 0.679, 95% CI 0.648-0.711, DeLong test <i>p</i> < 0.0001). Classification and regression tree analysis showed the in-hospital mortality was 85.2% in patients aged more than 70 years with pre-V-A-ECMO arterial lactate level ≥6.8 mmol/L.</p><p><strong>Conclusions: </strong>Among patients requiring postcardiotomy V-A-ECMO, hyperlactatemia was associated with a marked increase of in-hospital mortality. Arterial lactate may be useful in guiding the decision-making process and the timing of initiation of postcardiotomy V-A-ECMO.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9303411","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 : 2024-07-01Epub Date: 2023-04-21DOI: 10.1177/02676591231164878
Hyung Tae Sim, Min Seop Jo, Yong Jin Chang, Deog Gon Cho, Jong Woo Kim
Introduction: Although thrombolytic therapy is the standard treatment for massive pulmonary thromboembolism (PTE), it is often ineffective in patients with circulatory collapse. Surgical embolectomy is another treatment option, but whether it is absolutely necessary is controversial. We sought to evaluate the outcomes of patients with massive PTE treated with intensive critical care including extracorporeal membrane oxygenation (ECMO) without thrombolytic therapy or surgical embolectomy.
Methods: We analyzed 39 patients who were treated for massive PTE from January 2011 to June 2019. Massive PTE was treated with anticoagulation and hemodynamic support at an intensive care unit. ECMO was applied in patients with circulatory collapse. The computed tomography (CT) obstruction index and the ratio of the right ventricle to left ventricle short-axis diameters (RV/LV) were measured using serial CT angiography to confirm changes in pulmonary emboli and RV strain.
Results: Twenty-one patients were in cardiogenic shock, and 15 of them needed cardiopulmonary resuscitation (CPR). Fifteen patients were treated with ECMO and nine of them were weaned successfully. The overall in-hospital mortality was 23% (9/39). On the follow-up CT scan after 6 months, residual PTE was observed in 10 patients and their median CT obstruction index was 6.25 % (range 2.5-35). The initial mean RV/LV ratio was 1.8 ± 0.47 and the value measured at follow-up CT decreased to less than 1 (0.9 ± 0.1).
Conclusions: Intensive critical care with heparin alone and timely ECMO support without thrombolytic therapy could be an effective treatment option in patients with acute massive PTE.
{"title":"Outcome of massive pulmonary embolism treated only with extracorporeal membrane oxygenation and anticoagulation without thrombolytic therapy or surgical embolectomy.","authors":"Hyung Tae Sim, Min Seop Jo, Yong Jin Chang, Deog Gon Cho, Jong Woo Kim","doi":"10.1177/02676591231164878","DOIUrl":"10.1177/02676591231164878","url":null,"abstract":"<p><strong>Introduction: </strong>Although thrombolytic therapy is the standard treatment for massive pulmonary thromboembolism (PTE), it is often ineffective in patients with circulatory collapse. Surgical embolectomy is another treatment option, but whether it is absolutely necessary is controversial. We sought to evaluate the outcomes of patients with massive PTE treated with intensive critical care including extracorporeal membrane oxygenation (ECMO) without thrombolytic therapy or surgical embolectomy.</p><p><strong>Methods: </strong>We analyzed 39 patients who were treated for massive PTE from January 2011 to June 2019. Massive PTE was treated with anticoagulation and hemodynamic support at an intensive care unit. ECMO was applied in patients with circulatory collapse. The computed tomography (CT) obstruction index and the ratio of the right ventricle to left ventricle short-axis diameters (RV/LV) were measured using serial CT angiography to confirm changes in pulmonary emboli and RV strain.</p><p><strong>Results: </strong>Twenty-one patients were in cardiogenic shock, and 15 of them needed cardiopulmonary resuscitation (CPR). Fifteen patients were treated with ECMO and nine of them were weaned successfully. The overall in-hospital mortality was 23% (9/39). On the follow-up CT scan after 6 months, residual PTE was observed in 10 patients and their median CT obstruction index was 6.25 % (range 2.5-35). The initial mean RV/LV ratio was 1.8 ± 0.47 and the value measured at follow-up CT decreased to less than 1 (0.9 ± 0.1).</p><p><strong>Conclusions: </strong>Intensive critical care with heparin alone and timely ECMO support without thrombolytic therapy could be an effective treatment option in patients with acute massive PTE.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9442735","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}