ASAIO Journal最新文献

To examine the global epidemiology of extracorporeal membrane oxygenation discontinuation due to resource limitation (EDRL), assessing differences across geographic regions and between pre- and post-coronavirus disease 2019 (COVID-19) periods. Retrospective cohort analysis of all children and adults from international ECMO centers (2013-2023) in which ECMO was discontinued due to resource limitations. Of the 161,851 ECMO runs, 312 (0.19%) underwent EDRL. Of those, 25% occurred in children. Leading diagnoses were cardiogenic shock (n = 62, 20%) and COVID-19 (n = 33, 11%). Twelve percent survived post-EDRL and 29% were transported on ECMO for resource reallocation. Extracorporeal membrane oxygenation discontinuation due to resource limitations increased worldwide over time, particularly following COVID-19 (1.44 EDRLs per 1,000 ECMO runs vs. 2.44 EDRLs per 1,000 ECMO runs, p < 0.001), disproportionately to the overall increase in ECMO utilization (p = 0.019), especially in Europe (p < 0.001) and North America (p = 0.003). Latin America and Southwest Asia/Africa exhibited high proportions of EDRLs relative to ECMO runs (12.8 and 4.8 per 1,000 cannulations, respectively) and low post-EDRL survival rates (6.7% and 0%, respectively). Resource limitation remains a rare indication for ECMO decannulation, differs across global regions, and has grown over time disproportionately to the overall increase in ECMO use, particularly in Europe and North America and with the onset of the COVID-19 pandemic.

Chondrocytes are a primary cell type used in articular cartilage tissue engineering due to their ability to be applied autologously, minimizing the risk of immune rejection. However, isolated chondrocytes often exhibit heterogeneity, including mixtures of viable, dead, and dedifferentiated cells, which may impact their functional properties. In this study, the hydrophobicity and surface tension components of chondrocytes isolated from healthy and osteoarthritis (OA) donors were explored using a drop shape analyzer and Young's-Dupré equation over a 21 day culture period. The results indicate that OA-derived chondrocytes consistently exhibited higher water contact angles than healthy chondrocytes, with statistically significant differences observed on days 0, 7, and 14 of culture. The amounts of all three components of surface tension in healthy chondrocytes were significantly higher than those in OA-derived chondrocytes, except for van der Waals forces on day 0. Additionally, the observed modulation of chondrocyte hydrophobicity over the 21 day culture period indicates a potential functional phenotype shift from OA state toward a healthier phenotype under standard culture conditions. These results not only highlight hydrophobicity and surface tension as potential biomarkers for distinguishing OA and healthy chondrocytes, but also suggest possible therapeutic strategies aimed at restoring OA chondrocytes to a healthy state.

Hydrogen has emerged as a therapeutic agent in inflammatory critical illnesses due to its potential to modulate inflammation and oxidative stress. However, its role in extracorporeal membrane oxygenation (ECMO), a life-saving intervention for severe cardiorespiratory failure associated with pronounced inflammation and oxidative stress, remains largely unexplored. This ex vivo study investigated whether ECMO could serve as an effective vehicle for hydrogen delivery. It also evaluated hydrogen's effects on oxidative stress, inflammation, and coagulation responses arising from the interaction between human blood and non-biological ECMO surfaces. Four healthy male volunteers each provided two blood donations, 6 months apart. We assigned human blood-filled ECMO circuits to two different sweep gas formulations: a CO₂-enriched gas mixture (n = 4) or a mixture of 2% hydrogen in CO₂-enriched gas (n = 4). At T0, stable hydrogen concentrations (9.82 ± 1.97 μmol/L) were achieved and maintained for 6 hours, confirming the reliability of the hydrogen delivery method. Hydrogen exposure significantly reduced collagen (p = 0.01), TRAP-6 (p = 0.04), and ADP-induced (p = 0.04) platelet aggregation and showed a trend toward reduction in oxidative stress markers. In conclusion, this preliminary ex vivo study demonstrates the feasibility of delivering hydrogen gas via the sweep gas of a clinically established ECMO machine and its initial effects on blood, warranting further investigation in larger preclinical animal models.

Delays in mechanical circulatory support (MCS) for cardiogenic shock can be critical. However, timely access to a hybrid operating room or C-arm fluoroscopy for urgent axillary Impella 5.5 (Abiomed, Danvers, MA) implantation remains a barrier. To address this, we developed a fluoroscopy-free axillary Impella 5.5 implantation technique using transesophageal echocardiography (TEE) guidance. From January 2023 to November 2024, 19 adults underwent the procedure. A preoperative flowchart ensured appropriate selection, with the right axillary artery as the preferred access. Transesophageal echocardiography-guided pigtail advancement, valve crossing, and device positioning. All implantations (100%) were successful without conversion to fluoroscopy-guided or ECMO. There were no strokes or major complications. All patients had optimal positioning and rapid hemodynamic improvement. These findings support the feasibility and safety of TEE-guided, fluoroscopy-free Impella 5.5 implantation. It offers a significant benefit for earlier implantation of MCS in patients with cardiogenic shock, especially in settings where limited or delayed access to fluoroscopic imaging resources is a barrier to timely intervention.

Del Nido Cardioplegia (DNC) is widely used in nontransplant cardiac surgery, but its role as a preservation solution in cardiac transplantation is unclear. We conducted a retrospective observational study of 61 patients undergoing heart transplant between January 2015 and December 2023. Only recipients with locally procured donor hearts were included. Recipients were grouped according to the type of preservative solution: DNC (n = 33) versus control (crystalloid + cold blood cardioplegia; n = 28). Patients in the DNC group were older and more frequently received hearts from donation after circulatory death. The Del Nido Cardioplegia group had lower troponin-T release at 48 hours (median [interquartile range {IQR}]: 1,062 [820] vs. 700 [345]; p = 0.03). Compared with the DNC, control group was related with longer ischemic (median [IQR]: 65 [55-83] vs. 80 [70.2-92.7] minutes; p = 0.002) and bypass times (median [IQR]: 90 [73.5-112] vs. 108 [97-118] minutes; p = 0.001). On-pump blood glucose levels and need for electrical defibrillation were lower with DNC. In heart transplantation using locally procured grafts, DNC appears to be a feasible preservation strategy. Del Nido Cardioplegia was associated with shorter operative times and lower troponin release in our initial experience. Further studies should be performed to confirm these promising results.

Heart transplantation using donation after circulatory death (DCD) has recently re-emerged alongside donation after brain death (DBD). This technique can potentially increase the number of available cardiac grafts. However, its clinical outcomes remain limited. We compared data from patients who received grafts from DCD versus DBD between 2012 and 2023. During this period, 131 adult patients underwent isolated heart transplantation. Of these, 25 (19%) were DCD donors. Donation after circulatory death donors were predominantly local (66% vs . 42%; p = 0.027). Donation after circulatory death graft recipients had fewer ventricular assist devices (12% vs . 35%; p = 0.025) and were less frequently urgent (12% vs . 39%; p = 0.009). Donation after circulatory death grafts had shorter myocardial ischemia and extracorporeal circulation times than DBD grafts (70 min [63.5-91] vs . 168 [83-219]; p < 0.001); (90 min [78-103) vs . 120 [96-148], p < 0.001). We observed no significant differences in the incidence of primary graft failure (16% vs . 22%; p = 0.526) or hospital mortality (8% vs . 14%; p = 0.410) between both groups. In conclusion, cardiac DCD demonstrates hospital outcomes comparable to those of cardiac DBD. Further long-term follow-up of these patients is necessary to determine their rejection, graft vascular disease, and mortality outcomes.