Pub Date : 2024-07-01Epub Date: 2023-03-29DOI: 10.1177/02676591231168644
Daniel G Lee, Michal J Sobieszczyk, Alice E Barsoumian, Joseph E Marcus
Introduction: Extracorporeal membrane oxygenation (ECMO) is an increasingly used modality of life support with high risk for nosocomial infections. The accuracy of sepsis prediction tools in identifying blood stream infections (BSI) in this population is unknown as measurement of multiple variables commonly associated with infection are altered by the circuit.
Methods: This study compares all blood stream infections for patients receiving ECMO between January 2012 and December 2020 to timepoints when blood cultures were negative using the Sequential Organ Failure Assessment (SOFA), Logistic Organ Dysfunction Score (LODS), American Burn Association Sepsis Criteria (ABA), Systemic Inflammatory Response Syndrome (SIRS) scores.
Results: Of the 220 patients who received ECMO during the study period, 40 (18%) had 51 blood stream infections and were included in this study. Gram-positive infections composed 57% (n = 29) of infections with E. faecalis (n = 12, 24%) being the most common organism isolated. There were no significant differences in sepsis prediction scores at the time of infection compared to infection-free time points for SOFA (median (IQR) 7 (5-9) vs. 6 (5-8), p = 0.22), LODS (median (IQR) 12 (10-14) vs. 12 (10-13), p = 0.28), ABA (median (IQR) 2 (1-3) vs. 2 (1-3) p = 0.75), or SIRS (median (IQR) 3 (2-3) vs. 3 (2-3), p = 0.20).
Conclusions: Our data shows that previously published sepsis scores are elevated throughout a patient's ECMO course, and do not correlate with bacteremia. Better predictive tools are needed to determine the appropriate timing for blood cultures in this population.
{"title":"The utility of sepsis scores for predicting blood stream infections in extracorporeal membrane oxygenation.","authors":"Daniel G Lee, Michal J Sobieszczyk, Alice E Barsoumian, Joseph E Marcus","doi":"10.1177/02676591231168644","DOIUrl":"10.1177/02676591231168644","url":null,"abstract":"<p><strong>Introduction: </strong>Extracorporeal membrane oxygenation (ECMO) is an increasingly used modality of life support with high risk for nosocomial infections. The accuracy of sepsis prediction tools in identifying blood stream infections (BSI) in this population is unknown as measurement of multiple variables commonly associated with infection are altered by the circuit.</p><p><strong>Methods: </strong>This study compares all blood stream infections for patients receiving ECMO between January 2012 and December 2020 to timepoints when blood cultures were negative using the Sequential Organ Failure Assessment (SOFA), Logistic Organ Dysfunction Score (LODS), American Burn Association Sepsis Criteria (ABA), Systemic Inflammatory Response Syndrome (SIRS) scores.</p><p><strong>Results: </strong>Of the 220 patients who received ECMO during the study period, 40 (18%) had 51 blood stream infections and were included in this study. Gram-positive infections composed 57% (<i>n</i> = 29) of infections with <i>E. faecalis</i> (<i>n</i> = 12, 24%) being the most common organism isolated. There were no significant differences in sepsis prediction scores at the time of infection compared to infection-free time points for SOFA (median (IQR) 7 (5-9) vs. 6 (5-8), <i>p</i> = 0.22), LODS (median (IQR) 12 (10-14) vs. 12 (10-13), <i>p</i> = 0.28), ABA (median (IQR) 2 (1-3) vs. 2 (1-3) <i>p</i> = 0.75), or SIRS (median (IQR) 3 (2-3) vs. 3 (2-3), <i>p</i> = 0.20).</p><p><strong>Conclusions: </strong>Our data shows that previously published sepsis scores are elevated throughout a patient's ECMO course, and do not correlate with bacteremia. Better predictive tools are needed to determine the appropriate timing for blood cultures in this population.</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":"9557486","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: 2023-05-05DOI: 10.1177/02676591231174579
Sajad Hussain, Alexander G Swystun, Massimo Caputo, Gianni D Angelini, Hunaid A Vohra
Objectives: Early meta-analyses comparing minimally invasive mitral valve surgery (MIMVS) with conventional sternotomy (CS) have determined the safety of MIMVS. We performed this review and meta-analysis based on studies from 2014 onwards to examine the differences in outcomes between MIMVS and CS. Specifically, some outcomes of interest included renal failure, new onset atrial fibrillation, mortality, stroke, reoperation for bleeding, blood transfusion and pulmonary infection.
Methods: A systematic search was performed in six databases for studies comparing MIMVS with CS. Although the initial search identified 821 papers in total, nine studies were suitable for the final analysis. All studies included compared CS with MIMVS. The Mantel - Haenszel statistical method was chosen due the use of inverse variance and random effects. A meta-analysis was performed on the data.
Results: MIMVS had significantly lower odds of renal failure (OR: 0.52; 95% CI 0.37 to 0.73, p < 0.001), new onset atrial fibrillation (OR: 0.78; 95% CI 0.67 to 0.90, p < 0.001), reduced prolonged intubation (OR: 0.50; 95% CI 0.29 to 0.87, p = 0.01) and reduced mortality (OR: 0.58; 95% CI 0.38 to 0.87, p < 0.01). MIMVS had shorter ICU stay (WMD: -0.42; 95% CI -0.59 to -0.24, p < 0.001) and shorter time to discharge (WMD: -2.79; 95% CI -3.86 to -1.71, p < 0.001).
Conclusion: In the modern era, MIMVS for degenerative disease is associated with improved short-term outcomes when compared to the CS.
目的:早期荟萃分析比较了微创二尖瓣手术(MIMVS)和传统胸骨切开术(CS),确定了微创二尖瓣手术的安全性。我们对 2014 年以来的研究进行了回顾和荟萃分析,以研究 MIMVS 和 CS 在结果上的差异。具体而言,我们关注的一些结果包括肾衰竭、新发房颤、死亡率、中风、因出血再次手术、输血和肺部感染:方法:在六个数据库中对 MIMVS 与 CS 的比较研究进行了系统检索。尽管初步检索共发现了 821 篇论文,但有 9 项研究适合进行最终分析。所有纳入的研究都对 CS 与 MIMVS 进行了比较。由于使用了反方差和随机效应,因此选择了 Mantel - Haenszel 统计方法。对数据进行了荟萃分析:MIMVS明显降低了肾衰竭(OR:0.52;95% CI 0.37 至 0.73,p < 0.001)、新发心房颤动(OR:0.78;95% CI 0.67 至 0.90,p < 0.001)、延长插管时间(OR:0.50;95% CI 0.29 至 0.87,p = 0.01)和死亡率(OR:0.58;95% CI 0.38 至 0.87,p < 0.01)的几率。MIMVS的ICU住院时间更短(WMD:-0.42;95% CI -0.59至-0.24,p <0.001),出院时间更短(WMD:-2.79;95% CI -3.86至-1.71,p <0.001):结论:在现代社会,与 CS 相比,MIMVS 治疗退行性疾病可改善短期疗效。
{"title":"A review and meta-analysis of conventional sternotomy versus minimally invasive mitral valve surgery for degenerative mitral valve disease focused on the last decade of evidence.","authors":"Sajad Hussain, Alexander G Swystun, Massimo Caputo, Gianni D Angelini, Hunaid A Vohra","doi":"10.1177/02676591231174579","DOIUrl":"10.1177/02676591231174579","url":null,"abstract":"<p><strong>Objectives: </strong>Early meta-analyses comparing minimally invasive mitral valve surgery (MIMVS) with conventional sternotomy (CS) have determined the safety of MIMVS. We performed this review and meta-analysis based on studies from 2014 onwards to examine the differences in outcomes between MIMVS and CS. Specifically, some outcomes of interest included renal failure, new onset atrial fibrillation, mortality, stroke, reoperation for bleeding, blood transfusion and pulmonary infection.</p><p><strong>Methods: </strong>A systematic search was performed in six databases for studies comparing MIMVS with CS. Although the initial search identified 821 papers in total, nine studies were suitable for the final analysis. All studies included compared CS with MIMVS. The Mantel - Haenszel statistical method was chosen due the use of inverse variance and random effects. A meta-analysis was performed on the data.</p><p><strong>Results: </strong>MIMVS had significantly lower odds of renal failure (OR: 0.52; 95% CI 0.37 to 0.73, <i>p</i> < 0.001), new onset atrial fibrillation (OR: 0.78; 95% CI 0.67 to 0.90, <i>p</i> < 0.001), reduced prolonged intubation (OR: 0.50; 95% CI 0.29 to 0.87, <i>p</i> = 0.01) and reduced mortality (OR: 0.58; 95% CI 0.38 to 0.87, <i>p</i> < 0.01). MIMVS had shorter ICU stay (WMD: -0.42; 95% CI -0.59 to -0.24, <i>p</i> < 0.001) and shorter time to discharge (WMD: -2.79; 95% CI -3.86 to -1.71, <i>p</i> < 0.001).</p><p><strong>Conclusion: </strong>In the modern era, MIMVS for degenerative disease is associated with improved short-term outcomes when compared to the CS.</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":"9782464","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: 2023-03-11DOI: 10.1177/02676591231163018
Martin O Schmiady, Leszek P Bec, Mohammed Shallah, Andreas J Flammer, Paul R Vogt, Markus J Wilhelm
The global lack of donor shortage poses a major limitation for heart transplantation. New concepts with expanded donor inclusion criteria comprise extended transport distances and prolonged ischemic times with the aim of reaching a larger number of potential donors. Recent developments in cold storage solutions may allow more donor hearts with prolonged ischemic times to be use for transplantation in the future. We present our experience during a long-distance donor heart procurement with the longest reported transport distance and transport time in the current literature. This was made possible through the use of SherpaPak™, an innovative cold storage system which allows for controlled temperatures during transportation.
{"title":"Long-distance donor heart procurement using an innovative cold static storage system.","authors":"Martin O Schmiady, Leszek P Bec, Mohammed Shallah, Andreas J Flammer, Paul R Vogt, Markus J Wilhelm","doi":"10.1177/02676591231163018","DOIUrl":"10.1177/02676591231163018","url":null,"abstract":"<p><p>The global lack of donor shortage poses a major limitation for heart transplantation. New concepts with expanded donor inclusion criteria comprise extended transport distances and prolonged ischemic times with the aim of reaching a larger number of potential donors. Recent developments in cold storage solutions may allow more donor hearts with prolonged ischemic times to be use for transplantation in the future. We present our experience during a long-distance donor heart procurement with the longest reported transport distance and transport time in the current literature. This was made possible through the use of SherpaPak™, an innovative cold storage system which allows for controlled temperatures during transportation.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11191656/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9140893","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}
Objective: This study aimed to evaluate the relationship between plasma soluble ST2 (sST2) levels 24 h after extracorporeal membrane oxygenation (ECMO) initiation and continuous renal replacement therapy (CRRT) in patients receiving venoarterial ECMO (V-A ECMO) support.
Methods and results: Data of patients who received ECMO support for postcardiotomy cardiogenic shock between January 2017 and July 2019 were retrospectively collected from Beijing Anzhen Hospital, Capital Medical University. Ultimately, 116 patients were included in the present study for analysis. The concentration of sST2 was determined by enzyme-linked immunosorbent assay (ELISA). The log10 sST2 levels were higher in patients undergoing CRRT than those who did not (6.06 vs. 6.22, p = 0.019). Patients undergoing CRRT had a lower survival rate than those who did not (32.8% vs. 67.3%, p < 0.001). In the univariate logistic regression analysis, sST2, HCO3-, lactate, and creatinine levels 24 h after ECMO initiation were related to CRRT (p < 0.05). In the multivariate logistic regression analysis, HCO3- and sST2 were identified as independent risk factors for CRRT use in patients undergoing ECMO (p < 0.05). The area under receiver operator characteristic curve (AUC) for sST2 and HCO3- together was 0.72 (95% confidence interval (CI), 0.79-0.91), which was better than those of sST2 or HCO3- alone (0.63 vs. 0.67).
Conclusions: sST2 and HCO3-levels at 24 h after ECMO initiation were associated with CRRT and could predict CRRT use in postcardiotomy cardiogenic shock patients undergoing ECMO.
{"title":"Soluble ST2 predicts continuous renal replacement therapy in patients receiving venoarterial extracorporeal membrane oxygenation.","authors":"Chengcheng Shao, Yu Cao, Zengtao Wang, Xiaomeng Wang, Chenglong Li, Xing Hao, Liangshan Wang, Zhongtao Du, Feng Yang, Chunjing Jiang, Hong Wang, Yu Hao, Junyan Han, Xiaotong Hou","doi":"10.1177/02676591231169410","DOIUrl":"10.1177/02676591231169410","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to evaluate the relationship between plasma soluble ST2 (sST2) levels 24 h after extracorporeal membrane oxygenation (ECMO) initiation and continuous renal replacement therapy (CRRT) in patients receiving venoarterial ECMO (V-A ECMO) support.</p><p><strong>Methods and results: </strong>Data of patients who received ECMO support for postcardiotomy cardiogenic shock between January 2017 and July 2019 were retrospectively collected from Beijing Anzhen Hospital, Capital Medical University. Ultimately, 116 patients were included in the present study for analysis. The concentration of sST2 was determined by enzyme-linked immunosorbent assay (ELISA). The log<sub>10</sub> sST2 levels were higher in patients undergoing CRRT than those who did not (6.06 <i>vs</i>. 6.22, <i>p</i> = 0.019). Patients undergoing CRRT had a lower survival rate than those who did not (32.8% <i>vs</i>. 67.3%, <i>p</i> < 0.001). In the univariate logistic regression analysis, sST2, HCO<sub>3</sub><sup>-</sup>, lactate, and creatinine levels 24 h after ECMO initiation were related to CRRT (<i>p</i> < 0.05). In the multivariate logistic regression analysis, HCO<sub>3</sub><sup>-</sup> and sST2 were identified as independent risk factors for CRRT use in patients undergoing ECMO (<i>p</i> < 0.05). The area under receiver operator characteristic curve (AUC) for sST2 and HCO<sub>3</sub><sup>-</sup> together was 0.72 (95% confidence interval (CI), 0.79-0.91), which was better than those of sST2 or HCO<sub>3</sub><sup>-</sup> alone (0.63 <i>vs</i>. 0.67).</p><p><strong>Conclusions: </strong>sST2 and HCO<sub>3</sub><sup>-</sup>levels at 24 h after ECMO initiation were associated with CRRT and could predict CRRT use in postcardiotomy cardiogenic shock patients undergoing ECMO.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9290279","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: 10.1177/02676591231169852
Adel Alzahrani, Salahaden R Sultan, Mohammed Aslam
Introduction: Treatment decision of lower extremity peripheral arterial disease (PAD) is governed by the severity of stenosis. Tomographic 3D ultrasound (t3DUS) is a reliable imaging technique for measuring vessel stenosis. In this study we attempted to provide a precise measurement of superficial femoral artery (SFA) stenosis using t3DUS in patients with PAD.
Methods: t3DUS was used to measure maximum stenosis percentage in SFA from 50 patients with lower extremity PAD. The maximum stenosed segment in SFA was defined using Duplex 2DUS aliasing was noted. The peak systolic velocity (PSV) was measured at the maximum stenotic site and proximal to aliasing for calculating the velocity ratio. The association between blood flow velocity ratio and the degree of stenosis measured using Duplex 2DUS and t3DUS, respectively, was assessed using Spearman rank correlation.
Results: There was a strong positive correlation between velocity ratio and degree of stenosis in SFA measured using t3DUS (correlation value (r) = 0.99, p < 0.001). The correlation between Stenosis percentage and velocity ratio in SFA are as followed: <50:<2; 50-54:2-2.4; 55-59:2.5-2.9; 60-64:3-3.4; 65-69:3.5-3.9; 70-74:4-4.4; 75-79:4.5-4.9; >80:>5.
t3DUS can be used to provide precise measurement of the severity of SFA stenosis in patients with lower extremities arterial disease. The established criteria for grading SFA stenosis in this study can be applied to the current practice alongside Duplex 2DUS as it showed a strong positive correlation with velocity ratio. Further studies investigating the sensitivity and specificity of t3DUS in the assessment of stenosis in lower limbs arteries are required.
{"title":"Tomographic 3D ultrasound for grading stenosis of superficial femoral artery.","authors":"Adel Alzahrani, Salahaden R Sultan, Mohammed Aslam","doi":"10.1177/02676591231169852","DOIUrl":"10.1177/02676591231169852","url":null,"abstract":"<p><strong>Introduction: </strong>Treatment decision of lower extremity peripheral arterial disease (PAD) is governed by the severity of stenosis. Tomographic 3D ultrasound (t3DUS) is a reliable imaging technique for measuring vessel stenosis. In this study we attempted to provide a precise measurement of superficial femoral artery (SFA) stenosis using t3DUS in patients with PAD.</p><p><strong>Methods: </strong>t3DUS was used to measure maximum stenosis percentage in SFA from 50 patients with lower extremity PAD. The maximum stenosed segment in SFA was defined using Duplex 2DUS aliasing was noted. The peak systolic velocity (PSV) was measured at the maximum stenotic site and proximal to aliasing for calculating the velocity ratio. The association between blood flow velocity ratio and the degree of stenosis measured using Duplex 2DUS and t3DUS, respectively, was assessed using Spearman rank correlation.</p><p><strong>Results: </strong>There was a strong positive correlation between velocity ratio and degree of stenosis in SFA measured using t3DUS (correlation value <i>(r)</i> = 0.99, <i>p</i> < 0.001). The correlation between Stenosis percentage and velocity ratio in SFA are as followed: <50:<2; 50-54:2-2.4; 55-59:2.5-2.9; 60-64:3-3.4; 65-69:3.5-3.9; 70-74:4-4.4; 75-79:4.5-4.9; >80:>5.</p><p><p>t3DUS can be used to provide precise measurement of the severity of SFA stenosis in patients with lower extremities arterial disease. The established criteria for grading SFA stenosis in this study can be applied to the current practice alongside Duplex 2DUS as it showed a strong positive correlation with velocity ratio. Further studies investigating the sensitivity and specificity of t3DUS in the assessment of stenosis in lower limbs arteries are required.</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":"9318332","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: 2023-03-29DOI: 10.1177/02676591231168285
Hayato Taniguchi, Indrek Rätsep, Silver Heinsar, Keibun Liu, Marcela Cespedes, Jacky Y Suen, Gianluigi Li Bassi, John F Fraser, Jeffrey P Jacobs, Giles J Peek
Introduction: Iliopsoas haematoma (IPH) during extracorporeal membrane oxygenation (ECMO) is a rare bleeding complication that can be fatal due to its progression to abdominal compartment syndrome, but its incidence and risk factors are not well known. We have previously reported an IPH incidence rate of 16% in Japan. Among possible reasons for this high incidence, ethnicity has been hypothesised to play a role. Therefore, we used an international multi-centre cohort registry to test this hypothesis by determining the incidence rate of IPH.
Methods: This study was performed using the COVID-19 Critical Care Consortium database, conducted in 30 countries across five continents between 3 January 2020, and 20 June 2022.
Results: Overall, 1102 patients received ECMO for COVID-19-related acute respiratory distress syndrome. Of them, only seven were reported to have IPH, indicating an incidence rate of 0.64%, with comparable rates between the countries. The IPH group tended to have a higher mortality rate (71.4%) than the non-IPH group (51%).
Conclusions: Overall incidence of IPH in the studied COVID-19 ECMO cohort was 0.64%. Most cases were reported from Japan, Belgium, and Italy. In our study, this rare complication did not appear to be confined to Asian patients. Due to the high fatality rate, awareness about the occurrence of IPH should be recognised.
{"title":"Iliopsoas haematoma during extracorporeal membrane oxygenation: A registry report from the COVID-19 critical care consortium across 30 countries.","authors":"Hayato Taniguchi, Indrek Rätsep, Silver Heinsar, Keibun Liu, Marcela Cespedes, Jacky Y Suen, Gianluigi Li Bassi, John F Fraser, Jeffrey P Jacobs, Giles J Peek","doi":"10.1177/02676591231168285","DOIUrl":"10.1177/02676591231168285","url":null,"abstract":"<p><strong>Introduction: </strong>Iliopsoas haematoma (IPH) during extracorporeal membrane oxygenation (ECMO) is a rare bleeding complication that can be fatal due to its progression to abdominal compartment syndrome, but its incidence and risk factors are not well known. We have previously reported an IPH incidence rate of 16% in Japan. Among possible reasons for this high incidence, ethnicity has been hypothesised to play a role. Therefore, we used an international multi-centre cohort registry to test this hypothesis by determining the incidence rate of IPH.</p><p><strong>Methods: </strong>This study was performed using the COVID-19 Critical Care Consortium database, conducted in 30 countries across five continents between 3 January 2020, and 20 June 2022.</p><p><strong>Results: </strong>Overall, 1102 patients received ECMO for COVID-19-related acute respiratory distress syndrome. Of them, only seven were reported to have IPH, indicating an incidence rate of 0.64%, with comparable rates between the countries. The IPH group tended to have a higher mortality rate (71.4%) than the non-IPH group (51%).</p><p><strong>Conclusions: </strong>Overall incidence of IPH in the studied COVID-19 ECMO cohort was 0.64%. Most cases were reported from Japan, Belgium, and Italy. In our study, this rare complication did not appear to be confined to Asian patients. Due to the high fatality rate, awareness about the occurrence of IPH should be recognised.</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":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10064192/pdf/10.1177_02676591231168285.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9592362","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}
Pub Date : 2024-07-01Epub Date: 2023-05-03DOI: 10.1177/02676591231174581
Ignazio Condello
{"title":"Propofol during cardiopulmonary bypass for prolonged hypotensive use and potential adverse effects.","authors":"Ignazio Condello","doi":"10.1177/02676591231174581","DOIUrl":"10.1177/02676591231174581","url":null,"abstract":"","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":"9769000","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: 2023-04-09DOI: 10.1177/02676591231169853
Aleh Zhuk, Aliaksei Tsylko, Viktoryia Nazarava, Anna Migun
We present a case of successful veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in infant with SARS-COV-2 associated pneumonia. To the best of our knowledge, this patient was the youngest infant successfully discharged after the VA-ECMO for COVID-19. We report one complication of ECMO support, which was bleeding from the site of the radial artery cannulation. We followed up this patient for 6 months after the discharge: delayed psychomotor development and inability to swallow were noted. Follow-up CT 3 months after the discharge showed linear fibrosis of S5 lung segment.
{"title":"Extracorporeal membrane oxygenation in 34 days old infant with SARS-COV-2 associated pneumonia.","authors":"Aleh Zhuk, Aliaksei Tsylko, Viktoryia Nazarava, Anna Migun","doi":"10.1177/02676591231169853","DOIUrl":"10.1177/02676591231169853","url":null,"abstract":"<p><p>We present a case of successful veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in infant with SARS-COV-2 associated pneumonia. To the best of our knowledge, this patient was the youngest infant successfully discharged after the VA-ECMO for COVID-19. We report one complication of ECMO support, which was bleeding from the site of the radial artery cannulation. We followed up this patient for 6 months after the discharge: delayed psychomotor development and inability to swallow were noted. Follow-up CT 3 months after the discharge showed linear fibrosis of S5 lung segment.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9264060","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: 2023-05-08DOI: 10.1177/02676591231174773
Enrica Chiara Adami, Federica Magri, Chiara Plotti, Stefania Renzi, Giovanni Chiarini, Giuseppe De Cicco
Introduction: Hereditary Angioedema is a rare disease caused by C1 esterase inhibitor deficiency leading to diffuse and potentially life-threatening oedema formation. Preventing attacks is critical, particularly for patients undergoing cardiac surgery.
Case report: We report a case of a 71-years-old woman with a history of Hereditary Angioedema scheduled for open-heart surgery on Cardiopulmonary Bypass. Multidisciplinar teamwork and patient-targeted strategy were crucial to obtain a favorable outcome.
Discussion: Cardiac surgery is a major stressor for Angioedema attacks because of Complement cascade and inflammatory response activation leading to potential life-threatening oedema formation. In literature only few cases of complex open heart surgery under Cardiopulmonary Bypass are described.
Conclusion: Continuous updating and multidisciplinarity are key elements to manage patients with Hereditary Angioedema in cardiac surgery in order to reduce morbidity and mortality.
{"title":"Hereditary angioedema in cardiac surgery: Perioperative management considerations for a rare disease.","authors":"Enrica Chiara Adami, Federica Magri, Chiara Plotti, Stefania Renzi, Giovanni Chiarini, Giuseppe De Cicco","doi":"10.1177/02676591231174773","DOIUrl":"10.1177/02676591231174773","url":null,"abstract":"<p><strong>Introduction: </strong>Hereditary Angioedema is a rare disease caused by C1 esterase inhibitor deficiency leading to diffuse and potentially life-threatening oedema formation. Preventing attacks is critical, particularly for patients undergoing cardiac surgery.</p><p><strong>Case report: </strong>We report a case of a 71-years-old woman with a history of Hereditary Angioedema scheduled for open-heart surgery on Cardiopulmonary Bypass. Multidisciplinar teamwork and patient-targeted strategy were crucial to obtain a favorable outcome.</p><p><strong>Discussion: </strong>Cardiac surgery is a major stressor for Angioedema attacks because of Complement cascade and inflammatory response activation leading to potential life-threatening oedema formation. In literature only few cases of complex open heart surgery under Cardiopulmonary Bypass are described.</p><p><strong>Conclusion: </strong>Continuous updating and multidisciplinarity are key elements to manage patients with Hereditary Angioedema in cardiac surgery in order to reduce morbidity and mortality.</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":"9432392","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: 2023-05-24DOI: 10.1177/02676591231178413
Juan F Bulnes, Alejandro Martínez, Pablo Sepúlveda, Alberto Fuensalida, Santiago Besa, Luis Garrido, Gonzalo Martínez
Introduction: High-risk procedures in interventional cardiology include a wide spectrum of clinical and anatomical scenarios related to a higher periprocedural morbidity and mortality. The prophylactic use of short-term mechanical circulatory support (ST-MCS) may improve both the safety and efficacy of the intervention by leading to more stable procedural hemodynamics. However, the significant costs may limit its use in resource constrained settings. To overcome this limitation, we ideated a modified, low-cost, veno-arterial extracorporeal membrane oxygenator (V-A ECMO) setup.
Methods: We conducted an observational prospective study including all patients undergoing a high-risk interventional cardiology procedure at our institution under prophylactic ST-MCS using a modified, low-cost version of V-A ECMO, where some components of the standard V-A ECMO circuit were replaced by supplies used for cardiac surgical cardiopulmonary bypass, achieving a cost reduction of 72%. We assessed in-hospital and mid-term outcomes, including procedural success, post-procedure complications and mortality.
Results: Between March 2016 and December 2021, ten patients underwent high-risk IC procedures with prophylactic use of V-A ECMO. Isolated percutaneous intervention (PCI) was performed in six patients, isolated transcatheter aortic valve replacement (TAVR) in two, and a combined procedure (PCI + TAVR) in two. Mean ejection fraction was 34% (range 20-64%). Mean STS PROM was 16.2% (range 9.5-35.8%) and mean EuroScore was 23.7% (range 1.5-60%). The planned intervention was successfully performed in all cases. There were no reports of V-A ECMO malfunction. In nine patients the VA-ECMO was withdrawn immediately after the procedure but one patient required extended - 24 h - support with no significant issues. One patient experienced a periprocedural myocardial infarction and another developed a femoral pseudoaneurysm. In-hospital and 30-day survival were 100%, and 1-year survival was 80%.
Conclusions: High-risk procedures in interventional cardiology can be successfully performed under prophylactic ST-MCS using a modified, low-cost V-A ECMO, suitable for limited-resource settings.
{"title":"Outcomes of a modified, low-cost, veno-arterial extracorporeal membrane oxygenation (V-A ECMO) for elective, periprocedural support of high-risk percutaneous cardiac interventions: An experience from a latinamerican center.","authors":"Juan F Bulnes, Alejandro Martínez, Pablo Sepúlveda, Alberto Fuensalida, Santiago Besa, Luis Garrido, Gonzalo Martínez","doi":"10.1177/02676591231178413","DOIUrl":"10.1177/02676591231178413","url":null,"abstract":"<p><strong>Introduction: </strong>High-risk procedures in interventional cardiology include a wide spectrum of clinical and anatomical scenarios related to a higher periprocedural morbidity and mortality. The prophylactic use of short-term mechanical circulatory support (ST-MCS) may improve both the safety and efficacy of the intervention by leading to more stable procedural hemodynamics. However, the significant costs may limit its use in resource constrained settings. To overcome this limitation, we ideated a modified, low-cost, veno-arterial extracorporeal membrane oxygenator (V-A ECMO) setup.</p><p><strong>Methods: </strong>We conducted an observational prospective study including all patients undergoing a high-risk interventional cardiology procedure at our institution under prophylactic ST-MCS using a modified, low-cost version of V-A ECMO, where some components of the standard V-A ECMO circuit were replaced by supplies used for cardiac surgical cardiopulmonary bypass, achieving a cost reduction of 72%. We assessed in-hospital and mid-term outcomes, including procedural success, post-procedure complications and mortality.</p><p><strong>Results: </strong>Between March 2016 and December 2021, ten patients underwent high-risk IC procedures with prophylactic use of V-A ECMO. Isolated percutaneous intervention (PCI) was performed in six patients, isolated transcatheter aortic valve replacement (TAVR) in two, and a combined procedure (PCI + TAVR) in two. Mean ejection fraction was 34% (range 20-64%). Mean STS PROM was 16.2% (range 9.5-35.8%) and mean EuroScore was 23.7% (range 1.5-60%). The planned intervention was successfully performed in all cases. There were no reports of V-A ECMO malfunction. In nine patients the VA-ECMO was withdrawn immediately after the procedure but one patient required extended - 24 h - support with no significant issues. One patient experienced a periprocedural myocardial infarction and another developed a femoral pseudoaneurysm. In-hospital and 30-day survival were 100%, and 1-year survival was 80%.</p><p><strong>Conclusions: </strong>High-risk procedures in interventional cardiology can be successfully performed under prophylactic ST-MCS using a modified, low-cost V-A ECMO, suitable for limited-resource settings.</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":"9570470","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}