Perfusion-Uk最新文献

IntroductionAtrial fibrillation (AF) is the most common arrhythmia worldwide, yet long-term outcomes in conflict-affected regions are poorly understood. Gender-based disparities in AF outcomes have been reported in high-income countries but remain unexplored in fragile healthcare systems.MethodsWe conducted a retrospective cohort study at Latakia's University Hospital in Latakia, Syria between June/2021-November/2023. Adult patients admitted with primary AF were followed for 1 year to assess unplanned readmissions. Data on unplanned readmissions were defined as non-elective hospitalisations occurring within 1 year after index discharge. These were unscheduled admissions, usually prompted by recurrence of symptoms, acute decompensation, or cardiovascular events. Data were collected from medical records.ResultsOf the included 657 patients (52% male, median age 60 years), 422 (64%) had at least one unplanned readmission within 1 year. Cardiac causes accounted for 67% of readmissions, with recurrent AF responsible for 75% of those. Females had higher all-cause (73% vs 56%) and cardiovascular (53% vs 34%) readmission rates than males (both p < 0.001). On multivariable analysis, independent predictors of readmission included female sex (HR 1.7, 95% CI 1.4-2.0), age ≥60 (HR 3.7, 95% CI 2.9-4.6), diabetes mellites (DM) (HR 1.5, 95% CI 1.2-1.8), and congestive heart failure (CCF) (HR 3.3, 95% CI 2.6-4.6). Females were more likely to have two (44%) or three or more (44%) readmissions than males.ConclusionsOne-year readmissions after AF admission were high, particularly among females. Female gender was an independent risk factor, highlighting the need for gender-sensitive follow-up strategies in resource-limited settings.

BackgroundThe impact of the duration of invasive mechanical ventilation (IMV) before venovenous extracorporeal membrane oxygenation (VV ECMO) on patient outcomes in COVID-19 remains unclear.Methods and settingData from the COVID-19 Critical were used to investigate whether the duration of IMV prior to VV ECMO initiation was associated with ICU mortality between January 1st 2020 and December 31st, 2022. Multivariable Cox regression models were used to evaluate the role of the duration of IMV before ECMO on patient outcomes after adjusting for calendar date and key patient covariates.Results919 adult patients with median age 50 and severe COVID-19 infection requiring IMV and VV ECMO were included in the analysis. The ICU mortality for ECMO performed on the same day as IMV was 43%, compared to 47% when ECMO was initiated between 1 and 7 days and 54% when ECMO was initiated at 8+ days. The 8+ day group of IMV received more prone positioning (71%), neuromuscular blockade (80%), and vasopressor support (74%). The multivariable analysis showed the mortality risk increased when ECMO was initiated within the first 7 days from commencement of IMV (Hazard ratio, HR: 1.37; 95% CI: 1.08 to 1.73) or later (HR: 1.51; 1.02 to 2.22), compared with same-day initiation.ConclusionAnalysis indicated a positive association between time on IMV before VV ECMO initiation and ICU mortality, but effects sizes exhibited high uncertainty after adjusting for other patient characteristics. Further studies are needed to confirm our findings.

BackgroundMediastinal masses in children secondary to malignancy can cause significant airway and great vessel compression, leading to respiratory and cardiovascular compromise. Extracorporeal membrane oxygenation (ECMO) has been described as a bridge to diagnosis and treatment for masses causing cardiopulmonary instability.ObjectivesTo evaluate outcomes of pediatric oncologic patients requiring ECMO for mediastinal masses.MethodsWe conducted a sub-analysis of a previously published multicenter cohort study examining ECMO outcomes in pediatric hematologic and oncologic patients from 2009 to 2021. Patients less than 19 whose disease presented as a mediastinal mass were included. Presenting features, ECMO characteristics, and outcomes were analyzed.ResultsEleven patients with mediastinal masses were identified, 7 with solid tumors and 4 with hematologic malignancies. The indications for ECMO were combined cardiac and respiratory failure in 64%, respiratory failure in 27%, and cardiac failure in 9%. ECMO survival was 72% (8/11), and survival to hospital discharge was 45% (5/11). Upon separation into solid tumor and hematologic malignancy groups, the ECMO survival was 71% (5/7) and 75% (3/4), and survival to hospital discharge was 29% (2/7) and 75% (3/4), respectively. Patients with solid tumors had longer intensive care unit (ICU) lengths of stay (LOS) and hospital LOS.ConclusionsOur study supports ECMO cannulation for patients with mediastinal masses secondary to hematologic malignancies that require advanced cardiopulmonary support. However, due to poorer outcomes in solid tumors, ECMO candidacy should be carefully considered in this population.

BackgroundThe effect of the anticoagulant, dabigatran, and its antagonist, idarucizumab, on coagulation remains poorly quantified. There are few pharmacokinetic-pharmacodynamic data available to describe the interaction in humans or animals undergoing cardiopulmonary bypass.MethodsSix sheep were given intravenous dabigatran infusion while undergoing cardiopulmonary bypass. Blood samples were collected for thromboelastographic reaction time (R-time) and drug assay at 1. 5, 15, 30, 60, 90, and 120 min after starting dabigatran. Further reaction times were measured at 1 min, 5 min, 15 min, 60 min, 4 h and 24 h after initiation of idarucizumab infusion. Plasma dabigatran concentrations, the dabigatran- idarucizumab interaction and R-times were analyzed using an integrated pharmacokinetic-pharmacodynamic model with non-linear mixed effects.ResultsA 2-compartment model described dabigatran pharmacokinetics with a clearance (CL 0.0509 L/min/70 kg), intercompartment clearance (Q 0.229 L/min/70 kg), central volume of distribution (V1 3.89 L/70 kg), peripheral volume of distribution (V2 11.4 L/70 kg). The peripheral volume was 2.25 times larger during bypass. The effect compartment model estimates for an E_MAX model using reaction time had an effect site concentration (Ce₅₀ 40.8 mg/L) eliciting half of the maximal effect (E_MAX 180 min). A potency factor for the antagonist, idarucizumab (EA₅₀ 29.9 mg/L), moved the dabigatran response relationship to the left.ConclusionsDabigatran reversibly binds to the active site on the thrombin molecule, preventing activation of coagulation factors. Expansion of peripheral volume of distribution of dabigatran was observed during cardiopulmonary bypass, contributing to observed concentrations lower than predicted. A competitive interaction model adequately described dabigatran reversal by idarucizumab. These data and consequent parameter estimates inform future clinical studies in both animals and humans.

We report a case of successful treatment for a severe acute pulmonary hypertension crisis in a patient with Eisenmenger syndrome (ES) associated with patent ductus arteriosus following trauma-related spine surgery, utilizing both veno-arterial (V-A) and veno-venous (V-V) ECMO. The patient's clinical course was complicated by right ventricular failure amid a pulmonary hypertensive crisis, necessitating V-A ECMO support. Persistent hypoxia, despite improved right heart function, warranted transition to V-V ECMO. This case demonstrates that peripheral V-A ECMO can be safely employed to decompress the right heart in the presence of a significant PDA shunt. Furthermore, weaning from ECMO in these patients requires a much higher hematocrit in order to compensate for the chronic hypoxia.

PurposeTo reduce and avoid the use of exogenous blood products for neonates and infants, our center limits the use of packed red blood cells and does not use fresh frozen plasma in our cardiopulmonary bypass (CPB) circuit primes. This practice has resulted in several bloodless neonatal open heart surgical procedures including the entire post operative hospital stays. This case report describes a patient with Hypoplastic Left Heart Syndrome who underwent the Norwood procedure without the use of exogenous blood products. No other report of a bloodless Norwood procedure could be found in the literature.MethodsMiniaturized cardiopulmonary bypass circuitry, including shortened arterial and venous lines, minimized modified ultrafiltration and cardioplegia circuits, low holdup volume vents and autologous bypass circuit priming, was used to preserve adequate oxygen carrying capacity at CPB initiation and during the entire surgical procedure.OutcomeNo exogenous blood products were administered to this patient during their entire hospitalization.

Lower extremity ischemia in acute type A aortic dissection is associated with severe complications, including amputation, acute kidney injury, and increased mortality. Timely restoration of blood flow is critical to balance the risks of delayed extremity reperfusion against those of postponed central aortic repair. We present a multidisciplinary approach involving early extremity reperfusion without delaying central aortic repair, thereby minimizing ischemia-reperfusion injury while ensuring definitive aortic management.

IntroductionMobility and rehabilitation for patients supported on extracorporeal life support (ECLS) are high-risk and resource-intensive endeavors that currently lack a standardized framework to guide comprehensive program development. This paper introduces the framework to serve as a structured model that integrates best practice recommendations, relevant literature, and practical data from an ELSO Gold Level Center of Excellence program.MethodsInitially developed in response to the COVID-19 pandemic, the ECMO mobility program matured into a proactive and sustainable system through multidisciplinary collaboration, incorporation of current evidence, and iterative reflective practice. The resulting framework offers a structured, holistic approach to establishing effective ECLS mobility program.ResultsThe Mobility Under the Support of ECLS ("MUSECLS") framework comprised five interconnected domains, beginning with patient and family engagement and extending to institutional values and infrastructure. Implementation strategies and programmatic data from the originating ECMO center are used to illustrate practical application of the framework.ConclusionsThe MUSECLS framework provides a scalable and adaptable model to support the development or refinement of ECMO mobility and rehabilitation programs. It allows centers to tailor practices to local resources and populations while ensuring a comprehensive, evidence-informed approach. The framework is designed to remain applicable as clinical care and research in ECLS continue to advance.

IntroductionMycotic thoracic aneurysms in children are rare and carry high mortality, particularly when complicated by erosion into adjacent pulmonary structures. Early recognition and surgical intervention are essential to prevent catastrophic outcomes.Case ReportA 14-year-old presented with respiratory symptoms. Imaging revealed a large mycotic aneurysm of the aorta with compression of multiple mediastinal structures. During induction of anaesthesia, aneurysm rupture caused haemoptysis and hypovolemic arrest. Emergent femoral cannulation enabled initiation of cardiopulmonary bypass and novel use of endotracheal suction with autologous cell salvage facilitated surgical exposure and successful aneurysm repair.DiscussionThoracic mycotic aneurysms present diagnostic complexity and potential catastrophic outcomes. In this patient, rapid multidisciplinary coordination, dual-arterial cannulation and intraoperative blood-salvage techniques proved critical to restoring circulation and achieving surgical control.ConclusionThoracic mycotic aneurysms in children require extreme vigilance and adaptable surgical strategies. This case demonstrates that survival is possible with innovative management in the face of life-threatening complications.

BackgroundIn-situ internal mammary artery (IMA) grafting remains the gold standard in coronary artery bypass grafting (CABG), particularly for left anterior descending artery revascularisation. However, the role of free-IMA grafts-especially free right IMA (RIMA) and select cases of free left IMA (LIMA)-has expanded in response to anatomical and technical constraints. This narrative review synthesises current evidence on free-IMA use during CABG.MethodsA structured literature search was conducted using PubMed (1946-2025) and Embase (1974-2025), supplemented by Web of Science, Google Scholar, and thesis repositories. Studies were included if they reported outcomes related to free-IMA grafting, regardless of pump status or harvesting technique. Of 74 eligible studies, 9 chosen studies specifically reported free-RIMA outcomes and were analysed in detail.ResultsFree-RIMA grafting demonstrated excellent long-term patency (up to 96%) and favourable survival outcomes when used as composite or direct aorto-coronary grafts. Multi-arterial grafting (MAG) and total arterial grafting (TAG) strategies incorporating free-IMA conduits were associated with reduced major adverse cardiac events (MACE) and improved freedom from repeat revascularisation. Despite these benefits, uptake of free-IMA techniques remains low in Europe and North America, often limited by institutional preferences and operator experience.ConclusionCurrent evidence supports the selective use of free-IMA grafts in CABG, particularly when in-situ deployment is not feasible. Prospective studies are needed to validate long-term outcomes beyond 10 years, compare free-IMA with radial artery grafts, and define optimal arterial configurations for durable revascularisation.