ASAIO Journal最新文献

The use of cardiac devices, including mechanical circulatory support (MCS), cardiac implantable electronic devices (CIEDs), and pacing wires, has increased and significantly improved survival in patients with severe cardiac failure. However, these devices are frequently associated with acute brain injuries (ABIs) including ischemic strokes, intracranial hemorrhages, seizures, and hypoxic-ischemic brain injury which contribute substantially to morbidity and mortality. Computed tomography (CT) and magnetic resonance imaging (MRI), the standard imaging modalities for ABI diagnosis, can pose significant challenges in this patient population due to the risks associated with patient transportation and the incompatibility of ferromagnetic components of certain cardiac devices with high magnetic field of the MRI. This review discusses the application of Ultralow-field portable MRI (ULF-pMRI), which operates at much lower magnetic field (0.064 T), with the potential to allow safe bedside imaging of critically ill patients. In this review, we detail the clinical studies and research findings defining the safety, feasibility, and diagnostic utility of ULF-pMRI in detecting ABI in the critically ill. We further discuss the potential broader applications of ULF-pMRI, as a standard diagnostic tool for neurocritical care in patients with cardiac devices. The integration of such technology into current practice promises to enhance diagnostic accuracy, improve patient outcomes, and optimize healthcare resources.

Disclaimer: This Extracorporeal Life Support Organization guideline describes early rehabilitation or mobilization of patients on extracorporeal membrane oxygenation (ECMO). The guideline describes useful and safe practices put together by an international interprofessional team with extensive experience in the field of ECMO and ECMO rehabilitation or mobilization. The guideline is not intended to define the delivery of care or substitute sound clinical judgment. The guideline is subject to regular revision as new scientific evidence becomes available.

Adult patients with congenital heart disease (ACHD) requiring heart transplantation (HT) usually show complex anatomies, posing surgical challenges. Consequently, we analyzed technical aspects and early and long-term outcomes of additional surgical repairs during HT in ACHD. Forty patients were identified (23 males, median age: 38 years, interquartile range [IQR]: 26-50). Of these, 17 (42.5%) required additional surgical repair (7 systemic veins repair, 13 pulmonary arteries repair). These procedures were more associated with univentricular physiology ( p < 0.001) and prior Fontan palliation ( p < 0.001). Eight (20.0%) experienced 30 day mortality. At a median follow-up of 5.6 (IQR: 2.0-11.9) years, 5 (12.5%) patients died. Additional surgical repair did not affect postoperative 30 day and long-term follow-up mortality ( p = 0.451 and p = 0.330, respectively).

The use of an alteplase (Activase) purge solution to address Impella ventricular assist device "thrombosis" or "purge system occlusion" has been mainly documented with earlier generation Impella devices (CP, 2.5, 5.0). Here, we report the use of an alteplase purge solution to manage Impella 5.5 purge system occlusion in a 31-year-old male admitted to the cardiac care unit in cardiogenic shock and listed for a heart transplant. Throughout the purge system occlusion, the patient demonstrated hemodynamic stability and overall pump flow and cardiac output were preserved. Initially, there was a lack of response in purge flow and pressure observed at the lower concentration of alteplase purge solution (0.04 mg/ml), yet after using the alteplase 4 mg/50 ml purge (0.08 mg/ml) solution concentration, a response was seen. No bleeding or hemodynamic complications were observed. In addition, a suggested management workflow and review of the case reports and case series published to date regarding Impella purge system occlusion is included in this article.

Mortality remains elevated during venoarterial extracorporeal membrane oxygenation support (VA-ECMO) for cardiogenic shock and the role of inflammation is uncertain. By using the neutrophil-to-lymphocyte ratio (NLR), we investigated inflammatory dynamics during VA-ECMO and their relation to clinical outcomes. A single-center, retrospective cohort study was conducted. Patients receiving steroids or on-device support for less than 48 hours were excluded. Patients were grouped as those who did and did not have a persistent rise in NLR during the 24-48 hour interval after VA-ECMO placement. Overall, 253 patients comprised the study cohort. In-hospital mortality was 56%. Neutrophil-to-lymphocyte ratio was higher at 24 hours after VA-ECMO placement compared to pre-ECMO (Δ4.36, interquartile range [IQR]: -0.23 to 8.61, p < 0.001). Persistent increase in NLR during the 24-48 hour interval after VA-ECMO placement was associated with higher in-hospital mortality (adjusted hazard ratio [aHR]: 1.51, 95% confidence interval [CI]: 1.02-2.25, p = 0.04). The magnitude of this rise in NLR was incrementally related to greater in-hospital mortality (Δ0-5: 72%, aHR: 1.61, 95% CI: 1.03-2.54, p = 0.039; Δ>5: 79%, aHR: 1.64, 95% CI: 1.03-2.63, p = 0.037) in comparison 52%, for those with a drop in NLR. Venoarterial extracorporeal membrane oxygenation exacerbates inflammation, as evident by a rise in NLR, which is progressively higher in nonsurvivors.

Venoarterial extracorporeal membrane oxygenation (VA ECMO) may provide temporary hemodynamic support for patients with severe vasodilatory shock due to toxicologic ingestion. In a series of 10 cases of children less than 18 years of age who received VA ECMO support for toxicologic-induced vasodilatory shock, there were eight survivors and two nonsurvivors who died of significant neurologic injury. Upon initiation of ECMO support, survivors had decline in Vasoactive-Inotrope Scores (VIS). With the exception of one survivor who had a VIS range of 5-10, the seven remaining survivors had reduction in VIS by half at a median of 5.3 (interquartile range [IQR]: 3.7-12) hours. Nonsurvivors demonstrated no VIS reduction on ECMO before death. Six of 10 patients received continuous renal replacement therapy (CRRT) while on ECMO and potentially had augmentation of toxin clearance or treatment of severe acidosis as a result. Of the eight survivors, four patients had ECMO-related bleeding or thrombotic complications (three patients with stroke and one patient with extremity compartment syndrome). Venoarterial extracorporeal membrane oxygenation, with and without CRRT, may have potential utility and benefit in supporting poisoned patients with vasodilatory shock.