ASAIO Journal最新文献

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.

Heart transplantation is a well-established treatment for end-stage heart failure, but many patients present in poor physical condition, complicating outcomes. The Impella 5.5 device, used in cardiogenic shock, may support pretransplant rehabilitation by stabilizing organ function and promoting functional improvement. This retrospective cohort study assessed the relationship between functional status, measured by standardized Activity Measure for Post-Acute Care Basic Mobility (AM-PAC) scores, and days alive outside the hospital within 30 days post-transplant (DAOH-30). Patients who received Impella 5.5 support before transplantation between January 2019 and October 2023 were included, excluding those without AM-PAC scores within 24 hours pretransplant. Among 65 patients, the median DAOH-30 was 15 days (interquartile range [IQR], 8-19). Higher pretransplant standardized AM-PAC scores correlate with increased DAOH-30 (adjusted coefficient 0.3; 95% confidence interval [CI] = 0.01-0.6; p = 0.04), as did AM-PAC score improvement during rehabilitation (adjusted coefficient 0.35; 95% CI = 0.01-0.6; p = 0.04). Extended rehabilitation was associated with greater functional gains. These findings suggest that better pretransplant functional status and rehabilitation-related improvements were associated with increased DAOH-30. The Impella 5.5 device facilitates rehabilitation and may enhance post-transplant outcomes. Further research should refine strategies to optimize rehabilitation and recovery in this high-risk population.

The use of ventricular assist devices (VADs) in children with restrictive (RCM) and hypertrophic cardiomyopathy (HCM) remains rare. We describe the outcomes of patients with RCM and HCM supported by VAD in the Advanced Cardiac Therapies Improving Outcomes Network (ACTION) registry from March 2012 to December 2024. Thirty-four patients were identified: 20 left-sided VAD (LVAD), 13 biventricular VAD (BiVAD), and 1 total artificial heart (TAH). Median age at implant was 2.5 years (0.3-17.5), weight was 11.8 kg (4.5-81.8), and body surface area (BSA) was 0.54 m 2 (0.26-2.01). Diagnoses included RCM in 25 (73.5%) patients and HCM in 9 (26.5%). Illness severity at implant was high with 38.2% Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profile 1, 41.2% on extracorporeal membrane oxygenation (ECMO), 52.9% on ventilator support, 88.2% treated with greater than or equal to 1 inotrope, and 52.9% supported with TPN. Four patients (11.8%) died on device, 25 (73.5%) were transplanted, 4 (11.8%) were alive on device, and 1 (2.9%) was transferred to another center. Patients who died all had HCM diagnosis, required BiVAD support, and experienced adverse events. The cause of death was inadequate support (1), infection (2), and multi-organ failure (1). Ventricular assist device support is a reasonable strategy for select RCM and HCM patients, although outcomes in HCM are less favorable.

The absolute blood volume of dialysis patients at the start of treatment can be calculated using a method that combines continuous relative blood volume measurement and dialysate infusion. In this study, we applied this method to patients undergoing intermittent infusion hemodiafiltration. The initial absolute blood volume was measured based on the relative blood volume changes observed during each of the five intermittent dialysate infusions (dilutions). Initial absolute blood volumes, determined via the first to fifth dilutions, were 4,288 ± 900, 4,377 ± 1,476, 4,170 ± 1,037, 4,009 ± 951, and 3,871 ± 929 ml (specific volumes were 79.5 ± 12.5, 81.2 ± 20.9, 78.2 ± 15.8, 75.1 ± 13.4, and 72.7 ± 13.9 ml/kg). The final absolute blood volumes were 3,813 ± 857, 3,953 ± 1,430, 3,764 ± 1,034, 3,611 ± 919, and 3,488 ± 908 ml (specific volumes were 71.1 ± 11.5, 73.0 ± 20.4, 70.3 ± 15.5, 67.3 ± 12.7, and 65.2 ± 13.2 ml/kg). The initial absolute blood volume measured using the fifth dilution was significantly lower than that of the first dilution ( p < 0.05). The use of intermittent infusion hemodiafiltration, along with relative blood volume measurement, is an easy method for determining absolute blood volume.

Although the goal of extracorporeal cardiopulmonary resuscitation (ECPR) remains survival with meaningful neurologic recovery, secondary contribution to organ donation is increasingly recognized. We identified standardized outcome metrics for quality improvement and reporting and explored the feasibility of developing an ECPR Cumulative Impact Index. Fourteen international ECPR experts completed a modified Delphi process to achieve these aims. Qualitative analysis of free-text responses further informed framework development. Consensus was not reached on a unified scoring index. However, participants endorsed several reporting domains with greater than 75% agreement, including cerebral performance categorization and modified Rankin score with organ donation as outcomes, and specific metric tracking pertaining to organ donation. Similarly, there was greater than 75% agreement not to stratify organ donation into neurological versus circulatory determination of death. Qualitative analysis explored five themes: death without donation, non-neurologically intact survival, organ donation benefit, score implementation, and ethical principles. Particular emphasis was placed on avoiding incentivization of cannulation solely for organ donation and understanding that the lived patient and family experience cannot be so simply summarized through numeric quantification. Ultimately, the panel agreed that while a unified ECPR beneficence score remains elusive, consensus-based outcome metrics offer a practical and ethically grounded framework for program evaluation.