ASAIO Journal最新文献

The aortic pulsatility index (API) (systolic blood pressure-diastolic blood pressure/pulmonary capillary wedge pressure [PCWP]) integrates ventricular output with left ventricular (LV) filling pressures. It offers a surrogate for ventricular-arterial coupling and is associated with the need for advanced therapies and outcomes in decompensated heart failure. However, its use in patients in cardiogenic shock requiring temporary mechanical circulatory support (tMCS) is limited and requires invasive measurement of PCWP. This case series evaluates the concept of echo-API as a noninvasive tool to estimate API using Doppler echocardiography, and its feasibility in patients with cardiogenic shock on tMCS.

This study investigated factors influencing recirculation in veno-venous extracorporeal membrane oxygenation (VV ECMO) using a controlled bench model comprising a VV ECMO circuit and a mock circulatory loop with a porcine cadaver heart simulating human right heart anatomy. Several single-lumen cannula (SLC) configurations (15/21 Fr, 15/23 Fr, 17/21 Fr, 17/23 Fr) and double-lumen cannulae (DLC) from two manufacturers were evaluated. Different cannula positions (distance, rotation), ECMO flow (ECF), cardiac output (CO), central venous pressure (CVP) were assessed for their impact on recirculation, measured by ultrasound dilution method. In 31 experimental series (1,641 measurements), increasing CO consistently reduced recirculation, irrespective of cannulation configuration (SLC: R = -0.99; DLC: R = -0.87; p < 0.01), whereas elevating ECF increased it. CO/ECF ratio had a greater impact than CO or ECF alone, with higher values reducing recirculation in both SLC and DLC. In SLC, cannula size or retraction beyond a threshold distance had minimal effect on recirculation. However, in DLCs exact positioning is crucial, as suboptimal placement or rotation markedly increased recirculation.CO and CO/ECF ratio are key determinants of recirculation in all cannulation scenarios. In clinical settings, accurate monitoring of recirculation and CO is essential to optimize VV ECMO oxygen transfer efficiency and should become standard troubleshooting practice.

During extracorporeal membrane oxygenation (ECMO) decannulation, blood loss often occurs, leading to anemia and the need for blood transfusions. This article presents an improved ECMO pump-controlled blood reinfusion technique designed to address these challenges. The proposed method offers a simple and effective solution to minimize blood loss and reduce the need for additional blood transfusions during ECMO procedures. This technique significantly reduces blood loss and transfusion needs, offering a safer, more efficient approach to ECMO management in critical care.

The geometric configuration of fiber bundles plays a critical role in gas transfer for membrane oxygenators; however, experimentally studying its impact on gas transfer distribution is challenging. This study numerically examines oxygen and carbon dioxide transfer processes in a mini-oxygenator with a fiber bundle, focusing on the effects of inlet blood flow rate, fiber bundle cross-sectional area, fiber spacing, and wall effects. The numerical model, validated against existing data, was used to analyze blood gas parameter distribution under varying conditions. The findings indicate that an increase in blood inlet flow rate delays oxygen saturation and reduces the partial pressure of oxygen at the same location within the fiber bundle. Furthermore, the cross-sectional area perpendicular to the inlet flow direction, when maintaining a consistent fiber bundle volume, noticeably impacts gas exchange performance. Fiber spacing strongly affects carbon dioxide-related parameters but has negligible impact on oxygen-related parameters. The wall effect on gas transfer is limited to the outermost fiber layer adjacent to the wall. These studies elucidate the relationship between gas transfer performance and geometric factors, thereby providing insights for optimizing fiber bundle geometry in the design of membrane oxygenators to enhance efficiency and effectiveness.

Long-distance aeromedical transport of critically ill patients is an increasingly important component of modern intensive care. However, the combination of veno-arterial extracorporeal membrane oxygenation (VA ECMO) and renal replacement therapy (RRT) during an intercontinental flight had never been previously documented. This case report describes the first known case of a 27 year old patient with fulminant viral myocarditis and multi-organ failure who was successfully repatriated from Bangkok (Thailand) to Paris (France) while receiving both VA ECMO and 6 hours of in-flight sustained low-efficiency dialysis (SLED). This unprecedented 10,000 km mission illustrates both the feasibility and the life-saving potential of highly specialized mobile critical care in bridging patients to advanced therapies such as heart transplantation.

The aim of this study was to develop a scoring tool to estimate the probability of survival following extracorporeal rewarming in patients suffering hypothermic cardiac arrest. This is a multicenter retrospective study based on registry data. We included adult patients with hypothermic cardiac arrest not associated with asphyxia, with a core temperature of ≤28°C, who underwent extracorporeal rewarming. A multivariable logistic regression model was developed to serve as the predictive tool. Internal validation with bootstrap resampling was performed to adjust model parameters and reduce model optimism. Our study population included 141 patients. The survival rate was 46% (65/141). A total of 88% of the survivors (57/65) had a favorable neurological outcome (Cerebral Performance Category 1-2). The predictive model includes four variables. Outdoor occurrence of hypothermia and a higher hemoglobin level raise survival odds while higher concentrations of potassium and lactate reduce survival odds. The area under the receiver operating characteristic (ROC) curve was 0.812 and p value of the Hosmer-Lemeshow test was 0.8. We developed a prognostic model to estimate the probability of survival in adult patients with non-asphyxia-related hypothermic cardiac arrest. This model may aid in identifying candidates suitable for extracorporeal rewarming, though it should not be used as the sole deciding factor.

RenOx, a novel artificial lung and kidney assist device, combines gas exchange and dialysis fibers for integrated respiratory and renal support, with dialysis fibers intended for toxin clearance and filtration. However, when kidney support is not needed, dialysis fibers could be repurposed for additional respiratory support for patients in exacerbated cases, and to compensate losses in CO 2 transfer caused by the partial replacement of gas exchange fibers by dialysis fibers. We analyzed the feasibility of extracorporeal gas transfer via dialysis membranes with fully oxygenated and decarboxylated dialysis fluid in a closed circuit, quantifying O 2 and CO 2 exchange during standardized in-vitro tests with blood. Oxygenated dialysate was pumped through a dialyzer with a similar dialysis fiber area (0.6 m 2 ) to the RenOx (adult size). Gas transfer efficiency was evaluated at blood-to-dialysate flow ratios of 1, 3, and 6. Average CO 2 removal from 12 to 35 ml/L blood was achieved by adjusting blood-to-dialysate flow ratio, approaching the full metabolic requirement of adult patients (40 ml/L blood ). Maximum oxygen supply was 15 ml/L blood . Blood pH and hematocrit were within physiological range. This study proposes a simple method to enhance lung support in the RenOx, advancing research on CO 2 removal by dialysis.