ASAIO Journal最新文献

Extracorporeal carbon dioxide removal (ECCO₂R) prevents intubation and facilitates extubation in patients with hypercapnic respiratory failure. However, low-flow systems increase shear stress and need full anticoagulation, increasing the risk of circuit-related complications. We assessed the safety and efficacy of a high-caliber dual-lumen cannula, designed for jugular veno-venous extracorporeal membrane oxygenation (VV ECMO), repurposed for femoral vein insertion, with the aim of achieving higher blood-flow rates and more efficient CO₂ clearance. We retrospectively analyzed 16 intensive care unit (ICU) patients (62 years; 81% chronic obstructive pulmonary disease [COPD]) treated with ECCO₂R using a large-caliber dual-lumen cannula (20-23 Fr) inserted via the femoral vein. Key outcomes included changes in gas exchange, ventilatory support status, and complications. Extracorporeal carbon dioxide removal enabled rapid CO₂ clearance, with arterial carbon dioxide pressure (PaCO₂) decreasing from 68 [62-95] to 49 [45-56] mm Hg at 2 h, and pH increasing from 7.20 [7.16-7.27] to 7.36 [7.33-7.41]. Fifty-six percent of patients avoided intubation, whereas all intubated patients were extubated during ECCO₂R. The median support duration was 5 [4-7] days. No hemolysis was documented. One bleeding episode and one clotting event occurred; no thrombotic or cannulation-related complications were observed. Femoral vein cannulation with a large-caliber dual-lumen cannula for ECCO₂R appears feasible and safe. This strategy may offer technical and clinical advantages over conventional ECCO₂R systems, warranting prospective investigation.

Accurate survival prediction in peritoneal dialysis (PD) patients is essential for personalized treatment planning and shared decision-making. We developed and validated PD-PREDICT, an XGBoost-based model to generate dynamic mortality risk estimates in incident PD patients. We conducted a retrospective cohort study using data from the UK Renal Registry (UKRR), comprising 22,711 incident PD patients treated between January 1, 2007, and September 1, 2022. The development cohort (n = 14,650; January 2007-December 2016) was split into training and internal test sets. Temporal validation employed an independent UKRR cohort (n = 8,061; January 2017-December 2021). External validation used 2,180 patients from the Norwegian Renal Registry. Model performance was assessed by Harrell's concordance index ( C index), Integrated Brier Score (IBS), decision curve analysis, and 50 iteration bootstrap for C index stability. In the development cohort, PD-PREDICT achieved a training C index of 0.83 and test C index of 0.81 (IBS: 0.09). The decision tree baseline model yielded a test C index of 0.78 (IBS: 0.13). Bootstrap analysis confirmed C index stability (0.81; 95% confidence interval [CI], 0.79-0.83). Temporal validation produced a C index of 0.80, and external validation in Norway yielded 0.77. PD-PREDICT provides robust, dynamic mortality risk predictions for PD patients, outperforming traditional methods and maintaining accuracy across temporal and geographic validations.

We describe a modified Park's stitch technique incorporating systematic free margin alignment to achieve complete elimination of aortic regurgitation in patients with a left ventricular assist device. The technique involves a two-step approach: first, free margin alignment of all three cusps using single interrupted 6-0 polypropylene sutures placed at the nodules of Arantius to achieve precise coaptation, followed by conventional Park's stitch using mattress sutures with autologous pericardial pledgets for central closure. The alignment sutures remain in place to provide reinforcement. This modification addresses the central redundancy created by prolapsing or elongated cusps while maintaining the theoretical advantages of Park's stitch. In six consecutive patients (mean age, 56.5 years; 66.7% destination therapy), complete elimination of aortic insufficiency was immediately achieved with a median cross-clamp time of 30.5 min (interquartile range, 26.8-41.3 min). At follow-up (median, 8 months), five of the six patients had maintained zero regurgitation, while the remaining patient had developed only trivial regurgitation. This systematic approach to free margin alignment before Park's stitch may offer improved durability compared with conventional techniques, particularly for destination therapy patients requiring extended support.

Given a reasonable number of patients with contraindications to heparin, a safe and effective alternative to heparin as a purge fluid following Impella® temporary mechanical circulatory support implantation is desired. Here, we report the feasibility of a bicarbonate-based purge solution (BBPS) compared with a heparinized purge solution (HPS) without systemic anticoagulation in 43 Impella recipients between 2021 and 2023 at three centers in a single healthcare system. In a retrospective review of 43 consecutive Impella recipients, we compared major cardiovascular events (MACE), 30 day mortality, stroke, bleeding, and pump-adequate function between BBPS and HPS patients. Twenty patients on BBPS and 23 patients on HPS were included. They were supported on Impella 5.0 (n = 2), Impella 5.5 (n = 26), and Impella CP (n = 15) for a median of 7.3 days (interquartile range [IQR], 4.6-13.6). The prevalence of MACE, 30 day mortality, bleeding, stroke, and pump function was similar between groups. In this retrospective study, we found no differences in MACE, mortality at 30 days, stroke, bleeding, or pump function between groups exposed to BBPS and HPS. Bicarbonate-based purge solution seems a feasible and safe option for patients with contraindications to heparin use. Prospective studies are needed to confirm our findings.

Extracorporeal cardiopulmonary resuscitation (ECPR) using venoarterial extracorporeal membrane oxygenation (VA ECMO) is a life-saving intervention for selected patients in refractory cardiac arrest. Given the procedure's technical complexity and time-critical nature, simulation-based training has become essential to ensure both technical proficiency and effective team coordination. However, current commercial simulators are often prohibitively expensive and lack the capacity to integrate ECMO cannulation into standard advanced life support (ALS) scenarios, limiting their real-world applicability and dissemination. To address this gap, we developed a low-cost, customizable phantom using agar-agar, basic household materials, and repurposed medical components. Our model enables ultrasound-guided vascular access, cannula insertion, and initiation of extracorporeal blood flow. It can be easily embedded within ALS mannequins, allowing seamless integration into high-fidelity ECPR simulations. The phantom realistically reproduces key procedural steps and supports training under the high-stress, time-sensitive conditions typical of ECPR. Its adaptability allows use in both technical workshops and in situ simulations involving multidisciplinary teams. This accessible, eco-friendly solution provides a practical alternative to commercial models, promoting broader implementation of ECPR training programs. It represents a step forward in bridging the gap between theoretical knowledge and hands-on practice in critical care education.

Identifying reliable biomarkers associated with clinical outcomes in patients with acute respiratory distress syndrome (ARDS) receiving extracorporeal membrane oxygenation (ECMO) is essential. Elevated serum Krebs von den Lungen-6 (KL-6) has been linked to increased mortality in ARDS; however, its prognostic utility in ECMO remains unclear. This multicenter retrospective cohort study analyzed adult patients with severe ARDS who received veno-venous ECMO in 24 Japanese hospitals between 2012 and 2022. Serum KL-6 was measured within 3 days before or after ECMO initiation. The primary outcome was 90 day in-hospital mortality, and the secondary outcome was successful ECMO liberation. Among 373 patients, 265 (71.0%) survived, and 108 (29.0%) died. In multivariable Cox proportional hazards models using restricted cubic splines, higher KL-6 levels were significantly associated with increased 90 day mortality (p = 0.004), whereas lower KL-6 levels were significantly associated with successful liberation from ECMO (p < 0.001). These findings suggest that serum KL-6 measured around the time of ECMO initiation is associated with mortality and liberation outcomes in patients with, supporting its potential as a biomarker of disease severity.