Perfusion-Uk最新文献

IntroductionBlood transfusions during paediatric cardiac surgery with (cardiopulmonary bypass) CPB carry increased risks, including infection and immunological complications. This study evaluates blood product use in the Clinic for Paediatric Cardiology and Cardiac Surgery at the Children's University Hospital following the implementation of a revised blood management protocol from 2020 to 2023.MethodsA retrospective review of 135 paediatric patients who underwent congenital cardiac surgery with CPB was conducted. Patients were categorized into three age groups: Group 1 (<1 year), Group 2 (1 - 4 years), and Group 3 (>4 years). Data on erythrocyte, fresh frozen plasma (FFP), cryoprecipitate, and platelet use were analysed using the Kruskal-Wallis and Spearman's rho tests, with significance set at p < .05, and confidence interval (CI) of 95% quoted when applicable.ResultsErythrocyte use significantly declined over 4 years, with the largest reductions observed from 2020 to 2023 [p < .0001]. Older and heavier patients required fewer transfusions, with a significant inverse correlation between weight and erythrocyte use [Spearman's rho = -0.29, p = .001]. Platelet use also decreased significantly from 2020 to 2023 [p = .04], while FFP and cryoprecipitate use declined notably over the same period [p < 0.01].ConclusionOver 4 years, significant reductions in blood product use were observed, particularly for erythrocytes and platelets. Patients' age and weight were inversely related to erythrocyte transfusion needs. These trends may reflect improvements in surgical techniques and blood management protocols, with potential benefits for patient outcomes.

The use of extracorporeal membrane oxygenation (ECMO) to support the pregnant patient and fetus requires a complex decision-making process. Peripartum ECMO requires coordinated and informed decision-making between an interdisciplinary team of experts, incorporating the unique considerations and, at times, competing physiologic priorities of the pregnant patient. It is often confounded by a scarcity of local relevant experience engendered by its rare occurrence. No event has made the need for an organized approach to the utilization of ECMO in pregnant patients more pressing than the COVID pandemic. The conditions affecting pregnant patients that warrant ECMO consideration are high stakes and, at times, ethically challenging, although outcomes are favourable compared to the general population. This review provides background information and context, followed by a practical approach to the care and specific medical management of patients who are facing life-threatening conditions warranting ECMO while pregnant.

Venopulmonary ECMO (VP ECMO) is an advanced support strategy for patients with severe respiratory failure and right ventricular (RV) dysfunction, providing pulmonary protection by oxygenating blood and unloading the RV. This case discusses a 57-year-old female with septic cardiomyopathy, refractory cardiogenic shock, and ARDS, who developed progressive respiratory deterioration despite conventional treatment. Due to patient instability, she was placed on VP ECMO (femoral venous drainage and pulmonary artery reinfusion), guided exclusively by transesophageal echocardiography (TEE). The use of TEE enabled successful pulmonary artery cannulation without the need for fluoroscopic guidance. Additionally, a flotation catheter was used to facilitate guidewire placement, improving procedural success in this emergent situation. After initiating ECMO, the patient showed significant clinical improvement, with resolution of RV dilation and paradoxical septal motion. This case underscores the feasibility and safety of TEE-guided VP ECMO, suggesting that the flotation catheter technique could be beneficial in critical situations, warranting further investigation to establish clinical guidelines.

AimThis study evaluates the accuracy of a newly derived blood volume estimation formula based on the Boer equation for lean body mass, comparing its performance against the Nadler, Allen and Lemmens-Bernstein-Brodsky formulas.MethodsBlood volume estimation was evaluated using two datasets: the Retzlaff dataset, based on 78 healthy individuals, and the Allen dataset, derived from 81 subjects, two of European descent, the remainder Chinese 'medical, nursing and pedagogic students, technicians, clerks and family members' and one young Chinese physician. The formulas were compared using robust statistical methods, including the Wilcoxon Signed-Rank Test, permutation tests, Bland-Altman analysis, and Proportion Within Range.ResultsAcross all methods, the formula derived from the Boer equation showed the narrowest limits of agreement and smallest variability in most metrics, highlighting its potential as the most accurate and clinically useful tool for blood volume estimation. The Nadler formula also performed well but with slightly larger errors and bias.ConclusionThis study highlights the limitations of the Allen formula and demonstrates the superior performance of the Boer formula, which is derived from lean body mass. While the Allen formula performed well on its original dataset, it showed higher variability and less accuracy on more modern data. Both the Nadler and Boer formulas exhibited greater precision, with the Boer formula showing slightly lower variability. The study emphasizes the importance of using independent data sets for validation and addresses a critical gap in blood volume assessment by using robust techniques for analysis.

Introduction: Cardiopulmonary bypass (CPB) is utilized during cardiovascular surgery to maintain organ oxygen supply and blood perfusion instead of cardiopulmonary function. Three primary methods of artery cannulation used for CPB include ascending aortic cannulation (AscAoC), right axillary artery cannulation (rAxAC), and femoral artery cannulation (FAC).Methods: In this study, computational fluid dynamics simulation technology was employed to analyze aorta and main branches of 62 patients undergoing CPB with different arterial cannulation schemes, observing carotid artery (CarA) perfusion and characteristics.Conclusions: Results indicate that the total perfusion of bilateral CarAs using the three cannulation methods was sufficient when there was no significant variation in arterial morphology. Without considering the peripheral resistance and the body's autoregulatory function, the right CarA was less perfused than the left CarA under AscAoC and rAxAC, leading to perfusion imbalance. Especially heteroplastic patients with rAxAC may be at risk of the right CarA hypoperfusion during CPB. FAC provides balanced and adequate perfusion of both hemispheres without stenosis or dissection of the aorta.

BackgroundThe use of extracorporeal membrane oxygenation (ECMO) has expanded and is now widely applied to perioperative care in lung transplant. Respiratory failure after lung transplant is a clinical challenge where ECMO plays a critical role.MethodsThe Extracorporeal Life Support Organization registry was queried for patients 18 years and older who were treated with ECMO after lung transplant in 2010-2022. ECMO runs for more than 24 hours after lung transplant were included regardless of the timing of initiation. Univariable analyses were performed to compare procedural and patient characteristics across ECMO eras. Multivariable logistic regression was performed to identify predictors of surviving to discharge.ResultsOne-thousand nine-hundred and sixty-six patients met the inclusion criteria, and 1422 patients (72.3%) survived to discharge. The number of ECMO runs steadily increased throughout the study period, with a trend of improving survival. Higher annual center volume (Odds Ratio[OR]: 0.97, p < 0.001), longer ECMO duration (OR 1.01/day, p < 0.001), veno-arterial mode (OR 2.28, p < 0.001), initiation of ECMO >72 hours after transplant (OR 3.93, p < 0.001), and ventilator duration >5 days (1.55, p = 0.035) were associated with higher probability of survival to discharge.ConclusionsECMO after lung transplant has expanded over the last 12 years along with improved survival. The data suggest a potential benefit of early ECMO initiation in this patient population. High ECMO volume was associated with better outcomes, and expertise in ECMO is considered essential in lung transplant centers.

PurposeThis study evaluated the long-term outcomes and factors associated with survival in patients undergoing cardiac surgery with cardiopulmonary bypass at a children's cardiac center.MethodsA retrospective cohort study was conducted between 2001 and 2020 Outcomes included early or late survival and associated risk factors for survival.ResultsSurvival had a mean of 16.78 years (95% CI 16.50-17.06). The survival rates at 1, 5, 10, and 19 years were 91, 88, and 88%, respectively. Cox regression analysis indicated that age HR = 0.39, 95% CI [0.26-0.59], the RACHS-1 scale HR = 9.92, 95% CI [3.67-26.79], open chest HR = 1, 90, 95% CI [1.20-3.00], cardiac arrest HR = 3.91, 95% CI [2.40-6.36] and peritoneal dialysis HR = 6.71, 95% CI [4, 33-10.38], were independently associated with worse survival.Conclusionslong-term survival of children who undergo cardiac surgery at our single center was satisfactory. Age, higher RACHS score, delayed sternal closure, cardiac arrest, and peritoneal dialysis were strong predictors of adverse outcomes affecting early and long-term survival of pediatric cardiac surgery.

Objective: Positive fluid balance in patients on veno-venous extracorporeal membrane oxygenation (VV ECMO) is associated with increased mortality. Drainage insufficiency on VV ECMO is a common occurrence and managed with fluid administration. The use of multi-stage drainage cannulas may result in decreased drainage insufficiency, but it is unclear the effects this may have on patient fluid balance.Design: A historical cohort study was conducted on adult patients undergoing VV ECMO for acute respiratory failure in femoral-jugular configuration.Setting: Intensive Care Unit.Patients: Adult patients undergoing VV ECMO for acute respiratory failure.Interventions: Cumulative fluid balance in the first 7 days following initiation of VV ECMO was examined. The relationship between cumulative daily fluid balance over the first 7 days and type of drainage cannula was assessed using mixed methods linear regression.Measurements and Main Results: We included 82 consecutive patients between April 1st, 2020 and September 1st, 2022. 47 (57%) patients were treated with a single-stage drainage cannula. Our final model showed the use of a multi-stage cannula decreased fluid balance by 740 mL/day (95% CI: -1360 to -118, p = .02) compared to patients with a single-stage drainage cannula for the first 7 days.Conclusions: The use of multi-stage drainage cannulas resulted in improved fluid balance in patients on VV ECMO in the first 7 days.

BackgroundSimulation is increasingly utilized in the clinical training of healthcare professionals. Many perfusion programs in the United States use simulation to teach students both technical skills and effective communication. However, there is a lack of clarity regarding the optimal timing for introducing simulation into the curriculum and how to assess students' competencies. This study aims to evaluate whether combining simulation with didactic education is more effective than didactic education alone for learning perfusion-specific tasks, such as oxygenator changeouts.MethodsThis was a pilot, randomized controlled study conducted during November 2020. Subjects who were in their first year and enrolled in a cardiovascular perfusion program at the university were included. Subjects were randomly assigned to receive didactic education alone (control) or didactic in combination with the simulation training (experimental). Both groups received the didactic portion of the oxygenator change out procedure and the experimental group received supplemental simulation training. The primary outcome was oxygenator change-out completion time (recorded in minutes and seconds) to identify and change-out an oxygenator in a cardiopulmonary bypass circuit. The secondary outcome was total communication score and subject's overall performance assessment using the scoring system referenced by Burkhart et al.ResultsThe experimental group (n = 8) performed the oxygenator change-out significantly faster (363.63 ± 87.1 seconds vs 558.11 ± 185.75 seconds, p = .016) as compared to the control group (n = 9). However, there was no significant difference between the control and experimental groups in overall communication skills (p = .152) or the scoring system (p = .053) used to score subjects technical skills.ConclusionThe study findings revealed that the group receiving both didactic instruction and simulation performed an oxygenator change-out significantly faster than the group that received only didactic instruction. These results suggest that incorporating simulation of emergency scenarios into perfusion training can enhance students' speed in performing complex tasks, better preparing them for real clinical situations.