ASAIO Journal最新文献

Critically ill pediatric patients on continuous renal replacement therapy (CRRT) have high mortality rates ranging from 30% to 70%, due in part to altered drug exposure from drug-CRRT circuit interactions. Drug loss within CRRT circuits can occur through both clearance by the hemofilter and adsorption to circuit components. Although these interactions are known to exist, their impact on the pharmacokinetics of most drugs is unknown, resulting in limited drug dosing guidance and increased risk for suboptimal drug exposure. In this study, we administered amlodipine, fentanyl, fluconazole, methylprednisolone, and midazolam individually and in combination with ex vivo, closed-loop, blood-primed CRRT circuits to quantify drug-circuit interactions. Circuits were dosed to drug-specific therapeutic concentrations, and drug concentrations in both plasma and effluent were measured over time. For all drugs administered individually, variable extraction by the CRRT circuit was observed (mean plasma recovery 0.4-49%). For drugs coadministered into a circuit, significant decreases in extraction and increases in drug recovery (2.5-109%) were found, suggesting dosing adjustments may be needed. This study highlights the need for additional studies of drug coadministration within CRRT circuits to describe complex drug-circuit and drug-drug interactions to provide dosing guidance in pediatric CRRT patients.

The National Institute of Health (NIH) recommends that healthcare education material be written at a 6th-7th grade reading level. There are yet to be studies that investigate the readability of extracorporeal membrane oxygenation (ECMO) educational materials. Educational materials published by Extracorporeal Life Support Organization's platinum, gold, and silver centers of excellence in the United States were included. Each material was analyzed for content related to ECMO. These topics were also input into Google and the top 20 results were included in this study. Readability was measured using the Measure of Gobbledygook Readability Formula (SMOG), Coleman-Liau index, and Flesch-Kincaid grade level (FKGL). The average reading level for the educational material from the platinum centers was 8.54 for SMOG, 11.38 for Coleman-Liau, and 9.44 for FKGL. The average reading level of the gold centers' material was 9.11 for SMOG, 11.62 for Coleman-Liau, and 10.21 for FKGL. The average reading level of the silver centers' material was 8.82 for SMOG, 11.61 for Coleman-Liau, and 11.53 for FKGL. The average reading level of the internet search results was 9.11 for SMOG, 10.92 for Coleman-Liau, and 9.77 for FKGL. Extracorporeal membrane oxygenation education material had a readability level above the NIH's recommendation.

The SherpaPak Cardiac Transport System (SCTS) is a novel hypothermic organ transport device which maintains an optimal temperature range of 4-8°C during donor heart transport. Its use in many major transplant centers has increased over the last several years. We retrospectively examined 120 heart transplant patients, 60 using SCTS and 60 using traditional cold storage on ice (TCS), at the University of Kansas Medical Center (KUMC) between June 2020 and June 2023. Baseline characteristics were comparable except there were less males in TCS versus SCTS (70% vs. 85%; p = 0.049) and less diabetics (23% vs. 47%; p = 0.07). The TCS group had significantly shorter ischemic times than the SCTS group (177 vs. 204 min; p = 0.008). On analysis, no statistically significant difference was noted in primary graft dysfunction (PGD; 12% vs. 15%; p = 0.59), total length of stay (LOS; 19 vs. 17 days; p = 0.061), 1 year all-cause mortality (12% vs. 8.4%; p = 0.196), and 1 year cardiac allograft vasculopathy (CAV; 58% vs. 63%, p = 0.333] between these two groups. Multivariate analysis also showed no significant difference in PGD and LOS between groups. We conclude that despite having longer ischemic times in the SCTS group, the post-transplant outcomes were comparable to TCS.

Post-transplant lymphoproliferative disease (PTLD) represents the second most frequent malignancy in cardiac allograft recipients and constitutes up to 10% of de novo cancers. This study attempts to determine risk factors in adult heart transplant patients to develop a risk prediction model using the Scientific Registry of Transplant Recipients database and the lasso regression model. Data on 55,150 adult heart transplant patients (1987-2021) were extracted. The χ2/Wilcoxon tests were performed to identify significant variables (p < 0.05). The dataset was divided into two. One set was used for model development/validation, and the other for simulating external validation. Lasso logistic regression models were developed to predict disease at 1, 3, and 5 years post-transplant. Cyclosporine, positive donor Epstein-Barr Virus (EBV) IgG, induction with OKT3, and the donor's human leukocyte antigen (HLA) B38 antigen had a higher risk at 3 and 5 years post-transplant. African American recipients have a lower risk of developing PTLD as compared with other ethnic groups. This is the first report of a lasso regression model with good discriminatory power (c statistic of >0.7) in testing and validation cohorts. Future studies need to explore advanced modeling technologies and artificial intelligence systems capable of capturing patient diversity.

As left ventricular assist device (LVAD) use expands to include more critically ill patients, identifying and mitigating preoperative risk factors, such as peripheral arterial disease (PAD) and use of temporary mechanical circulatory support (tMCS) essential. This retrospective cohort study included patients who underwent HeartMate 3 (HM3) implantation from 2015 to 2023. Patients were divided into those with severe PAD and those without as well as the use of tMCS. The primary outcome was the incidence of vascular complications, defined as the development of dry gangrene, need for lower extremity amputation, or revascularization. Secondary outcomes included stroke, renal failure, death during implant hospitalization, and overall survival. Of the 197 patients who underwent HM3 implantation, 22 (11%) were identified as having severe PAD sonographically. Vascular complications were significantly more common in patients with severe PAD (23% vs. 4%, p = 0.005). There were no significant differences in other complications such as renal failure, stroke, or death during implant hospitalization. Multivariable unadjusted analysis revealed that both PAD, postoperative tMCS, and femoral cannulation site independently increased the odds of vascular complications, whereas in the adjusted model preoperative tMCS was associated with vascular complications. These findings underscore the importance of preoperative risk stratification and tailored perioperative management.

Identifying risk factors for mortality in veno-arterial extracorporeal membrane oxygenation (VA-ECMO) patients with postcardiotomy shock is challenging due to numerous influencing factors. This study investigates the role of sarcopenia in outcomes for these patients. We retrospectively analyzed 433 patients who underwent ECMO implantation at our institution between 2012 and 2023. Among those with VA-ECMO for postcardiotomy shock, 99 had preoperative computed tomography (CT) scans. We measured the psoas muscle area at the L3-L4 vertebra and the pectoralis muscle area at the level of the left common carotid artery. The primary endpoints were identifying mortality risk factors and assessing survival and weaning success in relation to sarcopenia. We measured 66 psoas and 98 pectoralis muscle areas, identifying 34 sarcopenic (34.3%) and 65 nonsarcopenic (65.7%) patients. Baseline characteristics were similar between groups, except for age. Mortality was significantly higher in the sarcopenic group (85.3% vs. 66.2%; p = 0.042). Multivariable regression analysis identified continuous renal replacement therapy and sarcopenia as independent predictors of mortality. Sarcopenia, as indicated by psoas or pectoralis muscle area, is a significant predictor of increased mortality following VA-ECMO implantation, suggesting its potential use for enhanced risk stratification.

Bleeding is a common complication of extracorporeal membrane oxygenation (ECMO), is multifactorial, and results in significant morbidity and mortality. Pulmonary hemorrhage represents a serious adverse event in pediatric patients on ECMO and remains a challenging complication to manage. Its occurrence highlights the importance of identifying treatments that address bleeding complications in this population. This retrospective cohort study, from January 2018 to August 2022, explores the use of inhaled tranexamic acid (TXA), a clot-stabilizing agent, in 53 pediatric ECMO patients with new pulmonary hemorrhage. Primary diagnoses included respiratory failure (34%) and structural abnormalities (34%), such as congenital heart defects, congenital diaphragmatic hernia, and tracheal stenosis, with viral pneumonia being the leading cause of respiratory failure (47%). Results indicated that 48 of 53 (91%) patients showed cessation of pulmonary hemorrhage within 48 hours of inhaled TXA administration as measured by a decrease in our institution-specific bleeding scale from moderate to minor or no bleeding. In ECMO-managed pediatric patients with pulmonary hemorrhage, treatment with inhaled TXA demonstrated safety, with no observed adverse effects, and showed promising signs of contributing to the cessation of bleeding.

In magnetically levitated rotodynamic blood pumps (RPBs), the impeller position depends on a balance of electromagnetic and fluid dynamic forces. The aim of this study was to describe the impeller position of the HeartMate 3 over a wide range of operating conditions and assess its potential impact on hemocompatibility. Three-dimensional impeller positions were measured using a transparent HeartMate 3 pump casing, laser distance measurements, and a high-speed camera. Accompanying computational fluid dynamic (CFD) hemocompatibility predictions of a displaced and centered impeller at a typical operating point were compared. Impeller positions vary substantially with different operating points with a maximum axial displacement of 223 µm at 7 L/min and 7,000 rpm and a maximum radial displacement of 145 µm at 0 L/min and 7,000 rpm. In CFD, a displaced impeller had only a minor influence on global pump parameters (<2%) at an operating point of 5 L/min and 6,000 rpm. However, deviations in local flow metrics of up to 9% were observed compared with a centered impeller simulation. We here provide the impeller position of the HeartMate 3 over the full operating range (0-9 L/min, 3,000-7,000 rpm) to support further research, including more extensive CFD simulations.

Thrombosis continues to be a significant complication during venovenous extracorporeal membrane oxygenation (V-V ECMO). Platelet activation markers might serve as indicators of inflammation and thrombogenesis. The aim was to identify these markers in ECMO patients. Blood from 10 ECMO patients (before, during, after ECMO) and 11 healthy volunteers were collected to determine platelet-neutrophil-aggregates (PNAs), platelet-monocyte-aggregates (PMAs), fibrinogen-binding, and P-selectin-expression on platelets by flow cytometry. Critical illness was associated with significantly elevated levels of PNAs and PMAs, increased P-selectin expression, reduced fibrinogen-binding, and restricted activation of platelets. Although PNAs and PMAs decreased significantly within 2 hours after the initiation of ECMO and remained at those levels, ECMO did not affect basal P-selectin expression and fibrinogen-binding. These results correlated with coagulation activation. Platelet markers before ECMO were not indicators for an imminent system exchange and end of therapy. In conclusion, platelet dysfunction during ECMO was mainly attributed to the critical illness. Extracorporeal membrane oxygenation support strengthened the restricted response of platelets to exogenous agonists (P-selectin). Furthermore, a decrease in PNAs/PMAs after ECMO started identified a reduced inflammatory response. There was no correlation of analyzed platelet parameters with the incidence of thrombotic complications.