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Objective To investigate the regulatory effect of Xuebijing injection on inflammatory reaction during the preservation of isolated empty beating pig hearts with extracorporeal membrane oxygenation. Methods Twelve healthy Guangxi Bama miniature pigs were randomly divided into the Xuebijing group (n=6) and normal saline group (n=6). After the models were established in the Xuebijing group, Xuebijing injection was given at a dose of 5 mL/h through micropump in membrane oxygenator. In the normal saline group, an equivalent amount of 0.9% sodium chloride injection was pumped. Continuous pumping was performed for 8 h in both groups. The time of cardiac resuscitation and perfusion pressure, heart rate, perfusion flow rate after 8 h preservation were recorded in two groups. Pathological and ultrastructural changes of myocardial tissues in the left ventricular wall of hearts with cardiac arrest were observed after 8 h preservation. Serum levels of myocardial injury markers and inflammatory cytokines were detected in two groups at the beginning (T0), 2 h (T2), 4 h (T4), 6 h (T6) and 8 h (T8) after model establishment, respectively. The expression levels of NOD-like receptor protein 3(NLRP3), cysteinyl aspartate specific proteinase-1(Caspase-1), apoptosis-associated speck-like protein containing a CARD(ASC) messenger RNA (mRNA) in myocardial tissues were measured at T0, T2, T4, T6 and T8, respectively. Results There were no significant differences in the time of cardiac resuscitation and perfusion pressure, heart rate, perfusion flow rate after 8 h preservation between two groups (all P>0.05). Compared with the normal saline group, the levels of lactate dehydrogenase (LDH) at T4, creatine kinase (CK), LDH and α-hydroxybutyrate dehydrogenase (α-HBDH) at T6 and T8, tumor necrosis factor (TNF)-α at T4, T6 and T8, and interleukin (IL)-6, IL-18 and IL-1β at T0, T2, T4, T6 and T8 were lower, and the mRNA relative expression levels of NLRP3 and Caspase-1 at T2, T4 and T6, and Caspase-1 and ASC at T8 were lower in the Xuebijing group, respectively (all P<0.05). Hematoxylin-eosin staining and transmission electron microscopy showed that the degree of myocardial injury in the Xuebijing group was slighter than that in the normal saline group. Conclusions Xuebijing injection may effectively mitigate inflammatory response and exert certain myocardial protection effect during the ECMO preservation of isolated empty beating pig hearts. [ABSTRACT FROM AUTHOR]

Objective To observe the myocardial protective effect of donor heart preservation perfusate containing Xuebijing injection on the isolated beating pig heart preserved by extracorporeal membrane oxygenation (ECMO), and to explore its possible mechanism. Methods Twelve healthy adult Guangxi Bama miniature pigs were randomly divided into the control group and Xuebijing group, with 6 pigs in each group. The ECMO-preserved beating heart models were established in the control group and Xuebijing group. The models were continuously perfused with leukocyte-depleted oxygenated blood containing 50 mL Xuebijing injection and normal saline, respectively, to maintain the beating heart for 8 h. Heart rate, perfusion pressure and perfusion flow were recorded at 0 (T1), 2 (T2), 4 (T3), 6 (T4) and 8 h (T5) after perfusion. The levels of interleukin-1ẞ (IL-1ẞ), interleukin-6 (IL-6) and tumor necrosis factor-a (TNF-a) were detected by ELISA. The myocardial injury markers troponin I (cTnI), creatine kinase (CK), creatine kinase isoenzyme (CK-MB) and lactate dehydrogenase (LDH) were detected by automatic biochemical analyzer after heparinization and before perfusion (TO) and at T1-T5 time points. The ultrastructure of myocardial tissue in the two groups at T5 was observed under transmission electron microscope. Results There were no significant differences in heart rate, perfusion pressure or perfusion flow between the two groups at T1-T5 (all P>0.05). The levels of serum IL-1B, IL-6, TNF-a and perfusion fluid cTnT, CK, CK-MB and LDH at T3-T5 in the control group increased, and the levels of perfusion fluid cTnT, CK, CK-MB and LDH at T4-T5 in Xuebijing group increased in comparison with those at T1 time point in the same group (all P< 0.05). The levels of serum IL-1B, IL-6, TNF-x and cTnT in the Xuebijing group at T3-T5 were lower than those in the control group, and the levels of CK, CK-MB and LDH in the perfusion fluid at T2-T5 were lower than those in the control group (all P<0.05). Ultrastructure of myocardial tissue: In the control group, the ventricular muscle tissue showed moderate to severe degeneration and steatosis, the intracellular matrix was dissolved in a large area, the muscle fiber structure was disordered and broken in a large amount, the mitochondria were mostly swollen and uneven in size, and the cell membrane was dissolved and damaged. Compared with the control group, the cell structure damage in the Xuebijing group was relatively mild, the myocardial cells were slightly hypertrophic, the mitochondria were slightly swollen and uniform in size, and the muscle fibers were uniform in thickness and neatly arranged. Conclusions The addition of Xuebijing injection to the donor heart preservation perfusate has the myocardial protective effect on the isolated beating pig heart preserved by ECMO, and its mechanism may be related to the inhibition of inflammatory response and the reduction of mitochondrial damage in cardiomyocytes. [ABSTRACT FROM AUTHOR]

This article summarized the nursing management of an elderly patient with COVID-19 treated with extracorporeal membrane oxygenation(ECMO). Based on the monitoring on vital signs of the patient, comprehensive nursing interventions were carried out to prevent the bleeding, thrombosis, hemolysis, infection and other complications, as well as catheter-associated infection, during ECMO treatment. In addition, catheter maintenance, prone position ventilation, management of unplanned extubation, and prevention of pressure injuries and i were enhanced to ensure the safety of patient during ECMO treatment. (总结1例高龄新型冠状病毒感染患者行体外膜肺氧合(ECMO)治疗的护理经验。在完善生命体征监测的基础上, 积极预防ECMO治疗期间出血、栓塞、溶血等并发症和感染, 加强管道护理、俯卧位通气和非计划拔管的护理, 预防压力性损伤。)

Background Extracorporeal membrane oxygenation (ECMO) has been widely used in the treatment of various acute and critical heart and respiratory failure diseases. However, platelet (PLT) counts decrease significantly during the treatment, which increases the risk of bleeding and thus affecting the prognosis of patients. Therefore, the explore of changes in PLT counts during ECMO support can help prevent bleeding related risks caused by thrombocytopenia, thus improving the prognosis of patients. Objective To retrospectively analyse the changes of PLT counts during ECMO support under different support modes. Methods 40 adult patients received veno-venous ECMO (V-V ECMO) or veno-arterial ECMO (V-A ECMO) support from January 2019 to October 2021 at the heart center of the People's Hospital of Gaozhou were included as study subjects and divided into the death group (n=22) and survival group (n=18) according to the occurrence of death after ECMO. PLT and platelet infusion were collected at baseline, before ECMO, and during the intervention. Results The average age of patients was (49.0±17.8) years, and the average duration of ECMO support was (6.0±3.2) days. There was statistically significant difference in the proportion of ECMO intervention reasons between the operation group and the non-operation group (P

Objective To analyze the influencing factors of survival of patients with airway stenosis requiring clinical interventions after lung transplantation. Methods Clinical data of 66 patients with airway stenosis requiring clinical interventions after lung transplantation were retrospectively analyzed. Univariate and multivariate Cox’s regression models were adopted to analyze the influencing factors of survival of all patients with airway stenosis and those with early airway stenosis. Kaplan-Meier method was used to calculate the overall survival and delineate the survival curve. Results For 66 patients with airway stenosis, the median airway stenosis-free time was 72 (52,102) d, 27% (18/66) for central airway stenosis and 73% (48/66) for distal airway stenosis. Postoperative mechanical ventilation time [hazard ratio (HR) 1.037, 95% confidence interval (CI) 1.005-1.070, P=0.024] and type of surgery (HR 0.400, 95%CI 0.177-0.903, P=0.027) were correlated with the survival of patients with airway stenosis after lung transplantation. The longer the postoperative mechanical ventilation time, the higher the risk of mortality of the recipients. The overall survival of airway stenosis recipients undergoing bilateral lung transplantation was better than that of their counterparts after single lung transplantation. Subgroup analysis showed that grade 3 primary graft dysfunction (PGD) (HR 4.577, 95%CI 1.439-14.555, P=0.010) and immunosuppressive drugs (HR 0.079, 95%CI 0.022-0.287, P<0.001) were associated with the survival of patients with early airway stenosis after lung transplantation. The overall survival of patients with early airway stenosis after lung transplantation without grade 3 PGD was better compared with that of those with grade 3 PGD. The overall survival of patients with early airway stenosis after lung transplantation treated with tacrolimus was superior to that of their counterparts treated with cyclosporine. Conclusions Long postoperative mechanical ventilation time, single lung transplantation, grade 3 PGD and use of cyclosporine may affect the survival of patients with airway stenosis after lung transplantation. [ABSTRACT FROM AUTHOR]

To analyze a case of severe avian influenza A (H5N6) virus infection resulting in severe pneumonia and acute respiratory distress syndrome (ARDS) was admitted to Guilin Municipal Hospital of Traditional Chinese Medicine on July 6, 2023. The clinical data and treatment of this patient were analyzed retrospectively. The initial clinical manifestations of the patient were fever, cough, and expectoration, and the antigen test for influenza A virus was positive. Chest CT showed: double lung texture increased and thickened, and multiple patchy high-density shadows with air-containing bronchial shadows were found in the left lung, especially in the left upper lobe; a few patchy increased-density shadows were also seen in the lower lobe of the right lung, along with left-sided pleural effusion. Metagenomic next-generation metagenomic sequencing (mNGS) of bronchoalveolar lavage fluid was performed to identify the pathogen as influenza A virus H5N6. On the 4th day of admission, the patient's condition rapidly progressed to ARDS, which could not be improved by high-flow oxygen therapy, mechanical ventilation, and prone position ventilation. Subsequently, with the assistance of veno-venous extracorporeal membrane oxygenation (VV-ECMO), the patient's lung function gradually improved. Extracorporeal membrane oxygenation (ECMO) was withdrawn after 25 days, and the patient recovered and was discharged after a hospital stay of 41 days. Patients with severe avian influenza A (H5N6) usually have critical illness and rapid progression, often rapidly progressing to ARDS. When conventional mechanical ventilation cannot correct hypoxemia, VV-ECMO auxiliary treatment should be administered as early as possible. In addition, mNGS can help to quickly identify the diagnosis and differential diagnosis of avian influenza A (H5N6) in the early stage of the disease, particularly suitable for the diagnosis of severe and emergency infections. [ABSTRACT FROM AUTHOR]

Objective To explore the clinical value of trans thoracic echocardiography (TTE) and related clinical indexesin the evaluation of percutaneous coronary intervention (PCI) supported by arteriovenous extracorporeal membrane oxygenation (VA-ECMO) in the treatment of patients with acute myocardial ischemia complicated by refractory cardiogenic shock. Methods The clinical data of 70 patients with acute myocardial ischemia complicated by refractory cardiogenic shock treated with VA-ECMO in the First Hospital of Lanzhou University from January 2022 to April 2023 were analyzed retrospectively. According to the success of VA-ECMO withdrawal, the patients were divided into success group (54 cases) and failure group (16 cases). The general data, Intraoperative condition, hemodynamic and biochemical indexes of the two groups were compared, and the independent risk factors affecting the clinical outcome were analyzed. Results The time of ECMO assistance in the success group was significantly shorter than that in the failure group (P < 0.05). There was no significant difference inother general information between the two groups (all P > 0.05). There was no significant difference in preoperative TIMI grade, number of diseased vascular branches, use of IVUS, ECG results and SYNTAX score between the two groups (all P > 0.05). Compared with those before treatment, arterial oxygen saturation (SaO2), left ventricular stroke volume (LVSV), left ventricular ejection fraction (LVEF), mitral annulus systolic velocity (Sa), aortic orifice forward flow spectrum (AV), velocity-time integral (VTI) and tricuspid annulus systolic displacement (TAPSE ) increased significantly after ECMO plus PCI treatment (all P < 0.05). Left ventricular end systolic volume (LVESV) decreased significantly (P < 0.05). Compared with those in the failure group, the heart rate (HR), shock index (SI), blood lactic acid (Lac), C-reactive protein (CRP), aspartate aminotransferase (AST) and total bilirubin (TBIL) were lower in the success group (all P < 0.05). There was no significant difference in ECMO flow and SaO2 between the two groups(P > 0.05). Univariate logistic regression analysis showed that ECMO-supporting time, HR, Lac, CRP, AST and TBIL were the influencing factors of weaning failure in patients with acute myocardial ischemia complicated with refractory cardiogenic shock. Conclusion VA-ECMO combined with PCI can significantly improve cardiac function in patients with acute myocardial ischemia complicated by refractory cardiogenic shock. Echocardiographic parameters (LVESV, LVSV, LVEF, Sa, AV, VTI, TAPSE) and clinical indexes (HR, Lac, CRP, AST, TBIL) have certain clinical value for theprognosis. [ABSTRACT FROM AUTHOR]

Objective To summarize the effect of the timing of lung transplantation and related treatment measures on clinical prognosis of patients with paraquat poisoning. Methods Clinical data of a patient with paraquat poisoning undergoing bilateral lung transplantation were retrospectively analyzed. Clinical manifestations, auxiliary examination, diagnosis and treatment of this patient were summarized and analyzed. Results A 17-year-old adolescent was admitted to hospital due to nausea, vomiting, cough and systemic fatigue after oral intake of 20-30 mL of 25% paraquat. After symptomatic support treatment, the oxygen saturation was not improved, and pulmonary fibrosis continued to progress. Therefore, sequential bilateral lung transplantation was performed under extracorporeal membrane oxygenation (ECMO). After postoperative rehabilitation and active prevention and treatment for postoperative complications, the patient was discharged at postoperative 50 d. Conclusions The timing of lung transplantation after paraquat poisoning may be selected when the liver and kidney function start to recover. Active and targeted prevention of potential pathogen infection in perioperative period and early rehabilitation training contribute to improving clinical prognosis of lung transplant recipients. [ABSTRACT FROM AUTHOR]

Background The mortality of acute myocardial infarction complicated with cardiogenic shock (AMI-CS) is very high, timely and effective circulatory support is essential to save the lives of patients. It is important to explore the clinical efficacy, complications and prognosis of combined auxiliary sequence of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and intra-aortic balloon pumps (IABP) in patients with AMI-CS. Objective To observe the effect of the auxiliary sequence of VA-ECMO and IABP on the therapeutic effect and prognosis of patients with AMI-CS in the combination of VA-ECMO and IABP, explore the causes and significance of changes in relevant indicators, compare the incidence of complications, analyze the factors affecting prognosis, so as to find a relatively safe and effective mechanical circulatory support (MCS) method for patients with AMI-CS. Methods AMI-CS patients who received VA-ECMO combined with IABP in the Department of Intensive Care Medicine of the Second Affiliated Hospital of Zhengzhou University and Fuwai Central China Cardiovascular Hospital from 2021 to 2022 were retrospectively included as the study objects, and all patients were treated with the combined auxiliary mode of VA-ECMO and IABP, and divided into the group A (IABP followed by VA-ECMO, n=42) and group B (VA-ECMO followed by IABP or VA-ECMO combined with IABP at the same time, n=40). Baseline data, clinical indicators, treatment status, related complications and prognosis before, 24 h and 72 h after combination therapy were collected by the electronic medical record system. Results The results of two-factor repeated measures ANOVA showed that there were interactions of time and intergroup on mean arterial pressure (MAP), heart index (CI), arterial blood lactate (Lac), and troponin I (cTnI) (P0.05). The main effects of time on MAP, CI, GFR, Lac, cTnI and BNP were significant (P0.05). MAP, CI and GFR at 24 h and 72 h after treatment were higher than those before treatment, while Lac, cTnI and BNP were lower than those before treatment, the differences were statistically significant (P

ObjectiveTo establish a standardized and professional service quality evaluation index system for extracorporeal membrane oxygenation (ECMO) animal experimental platform. Methods The literature research and expert consultation were used to establish a factor set for the quality evaluation of ECMO animal experimental platform. Then, experts used the 1/9-9 scale method to compare and score pair-two indicators. Based on the principles of fuzzy analytic hierarchy process and expert scoring results, the ECMO animal experimental platform quality evaluation system was constructed. In order to verify the actual efficacy of this system, a case study was carried out on the ECMO animal experiment platform of FW Animal Experimental Center (FAEC) laboratory. Results A total of 10 experts were included in this study, the questionnaire recovery rate was 100%, the judgment coefficient (Ca) and familiarity coefficient (Cs) were both greater than 0.50, the expert authority was high (Cr>0.80), the validity test was P

As an extracorporeal circulation device, extracorporeal membrane oxygenation ( ECMO) is used to assist the treatment of critically ill patients with heart failure and severe respiratory failure. Antibiotics such as glycopeptides and cephalosporins are applied during ECMO treatment due to the concomitant bacterial infections, the use of ECMO could lead to changes in the pharmacokinetics (PK) of some antibiotics, which will in turn affect the clinical outcome of critically ill patients. Based on the published studies, the effects of ECMO on PK of antibiotics drugs are summarized, with a view to providing references for optimizing the administration dosage. [ABSTRACT FROM AUTHOR]

Objective To establish a standardized and professional service quality evaluation index system for extracorporeal membrane oxygenation (ECMO) animal experimental platform. Methods The literature research and expert consultation were used to establish a factor set for the quality evaluation of ECMO animal experimental platform. Then, experts used the 1/9-9 scale method to compare and score pair-two indicators. Based on the principles of fuzzy analytic hierarchy process and expert scoring results, the ECMO animal experimental platform quality evaluation system was constructed. In order to verify the actual efficacy of this system, a case study was carried out on the ECMO animal experiment platform of FW Animal Experimental Center (FAEC) laboratory. Results A total of 10 experts were included in this study, the questionnaire recovery rate was 100%, the judgment coefficient (Ca) and familiarity coefficient (Cs) were both greater than 0.50, the expert authority was high (Cr>0.80), the validity test was P<0.01, and the coordination was good. The quality evaluation system of ECMO animal experiment platform includes two levels. There are 4 first-level indicators, with professionalism, safety, functionality, and stability ranked from high to low in terms of their weights. There are 15 second-level indicators, and the top 5 weights are personnel's technical expertise, attractiveness of hardware facility, auditability of data, confidentiality capabilities of data, and professionalism in service process. To facilitate the popularization and application of the system, this study also proposed a "star" system to represent the evaluation results of an ECMO animal experimental platform quality. The quality evaluation system established in this study was used to evaluate the FAEC laboratory as a case study, and the evaluation result was five-star. The actual potency value of FAEC laboratory was 0.910, reaching the five-star level, but the average actual appraisal values of "service continuity" and "sufficiency of project completion" were lower than 0.80, which needs to be improved. Conclusion A standardized and professional ECMO animal experimental platform quality evaluation system was established in this study, which would provide a measurable basis for the demander to select the supplier and a method for the supplier to complete the animal experiment of ECMO research and development with high quality. [ABSTRACT FROM AUTHOR]

To retrospectively analyzethe incidence，risk factors，and prognosis of ventricular fibrillation/ventricular tachycardia(VF/VT)within 72 hours of extracorporeal cardiopulmonary resuscitation(ECPR)in patients supported by extracorporeal membrane oxygenation(ECMO). Methods：ECPR patients admitted to the Emergency Center of the First Affiliated Hospital of Nanjing Medical University from January 2017 to March 2023 were included. Patientswere divided into VF/VT group and nVF/VT group according to the occurrence of VF/VT within 72 hours of ECMO support. risk factors for VF/VT during ECMO support were analyzed through regression analysis，and the impact of VF/VT on clinical prognosis was explored. Results：A total of 95 patients with a mean age of(50.02±15.93)years were enrolled，with males accounting for 66.32%. The 28⁃day survival rate was 51.58%，and the incidence of VF/VT was 33.33%. Comparison among groups showed that the nVF/VT group had a higher rates of continuous renal replacement therapy，longer ECMO initiation time，and higher lactic acidlevels compared tothe VF/VT group.Troponin T(TnT)levels showed a trend of being higher in the VF/VT group，while the pH value was significantly lower in the VF/VT group compared to the nVF/VT group. Stepwise multivariable logistic regression analysis showed that the risk of maintaining high TNT levels significantly increased after VF/ VToccurrence，with an odds ratio(OR)of 18.156(95%CI：3.620-91.059). Prolonged ECMO initiation time(OR=1.118，95%CI：1.060- 1.180)and decreased pH value(OR=0.005，95%CI：0.000-0.953)were identified as independent risk factors for VF/VT occurrence. Conclusion：In patients with ECPR，the risk of VF/VT occurring within 72 hours of ECMO support issignificantly increased in patients with severe acidosis or prolonged ECMO initiation time. The onset of VF/VT does not affect the clinical prognosis but may exacerbate myocardial injury. [ABSTRACT FROM AUTHOR]

Background: The application of palliative care is limited and challenging in intensive care units (ICUs) because of complex factors such as time constraints and unpredictable disease progression. Although research results and international consensus stress the early use of palliative care, utilization remains low, resulting in increased risks of ineffective medical care and poor quality of death. Improving this situation requires a comprehensive understanding of the palliative condition in ICUs. Purpose: This study was designed to investigate the utilization of hospice resources in adult ICUs and to compare this utilization between users and non-users. Methods: This retrospective correlation study recruited cases from the adult ICU database of a medical center in northern Taiwan between June and July 2022. Descriptive statistics, independent t-test and chi-square were used to analyze the data. Results: A total of 1,181 records were analyzed, including 458 (38.8%) females and 723 (61.2%) males. Two hundred and seventeen cases (18.4%) used hospice resources. Although 124 (10.4%) of the 1181 cases were identified as "in urgent need of hospice resources" (i.e., died within 30 days of ICU admission), 25 (20.2%) did not use these resources. Significant differences between the urgent-need cases who did and did not use hospice resources were found in terms of age, disease type, degree of frailty, cardiac arrest, infection, state of consciousness, intubation and tracheostomy status, inotropic and vasopressor medication, renal replacement, ECMO placement, delirium, and Acute Physiology and Chronic Health Evaluation III and Sequential Organ Failure Assessment Scores. Conclusions/ Implications for Practice: The roughly 20% of ICU patients in urgent needs of palliative care who did not utilize palliative care resources highlight the needs for continued discussion to better assist patients on palliative care decision-making. The findings show multifaceted differences between those who did and did not access palliative care. Future studies should design and test strategies to facilitate the identification of palliative care needs and ensure the effective allocation of palliative care resources in ICUs. [ABSTRACT FROM AUTHOR]

Extracorporeal membrane oxygenation (ECMO) is an advanced life support modality for patients with respiratory or cardiac failure. During ECMO, various factors impair coagulation function, resulting in an imbalance between procoagulation and anticoagulation, thus increasing the incidence of bleeding and posing a significant challenge to the development of clinical work. In this article, the epidemiology, causes, anticoagulation and monitoring of high-risk bleeding during ECMO were reviewed, aiming to provide reference for clinical practice. [ABSTRACT FROM AUTHOR]

Objective: To summarize the experiences of diagnosing and treating abdominal compartment syndrome (ACS) after patch repairing of neonatal congenital diaphragmatic hernia (CDH) under extracorporeal membrane oxygenation (ECMO).Methods: Retrospective reviews were conducted for the clinical data of ACS neonates due to CDH undergoing patch repairing under ECMO. Management and surgical procedure of ACS were systematically summarized. The databases of PubMed, Web of Science, Wanfang, China Academic Journals (CAJ) and China National Knowledge Infrastructure (CNKI) were searched with such keywords as "congenital diaphragmatic hernia", "extracorporeal membrane oxygenation" and "abdominal compartment syndrome" . Duplicate literatures were excluded and managements of ACS after patch repairing of neonatal CDH under ECMO summarized. Results: One fetus with left-side CDH ultrasonically detected in second trimester was diagnosed as severe pulmonary hypoplasia. He was transferred immediately into our unit after a delivery by cesarean section at 39+ 6 weeks. ECMO support was provided after 19-hour mechanical ventilation and laparotomy patch repair of CDH was performed at 2 days post-birth. ACS was detected and treated with decompressive laparotomy (DL) at 4 days after repairing CDH. And a wound protector was utilized for keeping abdominal open during DL.ECMO was withdrawn at Day 3 and abdominal closure occurred at Day 5 post-DL. He was discharged at Day 38 post-birth. No recurrence occurred during a follow-up period of 4 months. A total of 16 English literature reports were reviewed. Four reports described 6 cases of CDH with postoperative ACS and 4 of them underwent DL. While another 12 reports examined 47 cases ACS under ECMO support and 37 of them underwent DL. Conclusions: DL is effective for ACS during patch repair of neonatal CDH under ECMO. And wound protector is recommended for DL in neonates. [ABSTRACT FROM AUTHOR]

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Background Cardiogenic shock (CS) is the leading cause of death in patients with acute myocardial infarction (AMI) , and it is important to explore the efficacy of extracorporeal membrane oxygenation (ECMO) in AMI patients combined with CS.Objective To investigate the short-term prognostic value of early fluid balance and lactate clearance in AMI patients combined with CS treated with ECMO.Methods The clinical data of 49 hospitalized AMI patients combined with CS treated with ECMO from April 2017 to December 2022 in the First Affiliated Hospital of Zhengzhou University were retrospectively analyzed. The included patients were divided into the survival group (n=27) and death group (n=22) according to 30-day post-ECMO outcomes. Univariate and Multivariable Logistic regression analyses were used to evaluate the influencing factors of 30-day post-ECMO death. Receiver operating characteristic (ROC) curve was plotted to evaluate the predictive value of 24-h fluid balance, 24-h lactate clearance and their combination for 30-day post-ECMO outcomes. Delong test was used to compare the area under the ROC curve (AUC) .Results Age, creatinine level, the proportion of offender vessel as left main or left anterior descending branch, acute kidney injury and continuous renal replacement therapy, 24-h fluid balance, 24-h lactate with ECMO in the death group were higher than the survival group, and 24-h lactate clearance was lower than the survival group (P

Objective To summarize the clinical features of extracorporeal membrane oxygenation (ECMO) in pediatric intensive care unit (PICU) in a single center and analyze the influencing factors of clinical outcomes so as to provide experience for pediatric ECMO management. Methods A case-control trial was carried out on 35 children undergoing ECMO support from May 2018 to January 2022 in our department. According to the clinical outcomes, they were divided into survival group (n=22) and death group (n=13). Duration of mechanical ventilation, Pediatric Risk of Mortality Ⅲ (PRISM Ⅲ) score and results of laboratory tests before ECMO support, and incidence rates of comorbidities and/or complications during ECMO support were compared between the 2 groups. Univariate analysis and logistic regression analysis were used to explore the influencing factors of clinical outcomes in children with ECMO support. Results There were no significant differences in age distribution, gender, primary diseases, PICU hospitalization time, hospitalization cost, ECMO support mode, and potential of hydrogen (pH), alanine aminotransferase (ALT), aspartate aminotransferase (AST), creatinine (Cr), blood urea nitrogen (BUN), lactic acid (Lac), partial activated thromboplastin time (APTT) and prothrombin time (PT) before ECMO support between the 2 groups (all P>0.05). Compared with the survival group, the death group had lower body weight (P=0.004), higher PRISM Ⅲ score (P=0.001), longer duration of mechanical ventilation (P=0.009) and lower oxygenation index (OI) (P=0.039) before ECMO, and higher incidence of concomitant and/or combined acute kidney injury (AKI) (P=0.032) and higher use of renal replacement therapy during ECMO (P=0.024). Multivariate logistic regression analysis showed that PRISM Ⅲ score before ECMO support (OR=1.482, 95%CI: 1.043~2.105, P=0.028) and concomitant and/or combined AKI during ECMO (OR=0.055, 95%CI: 0.004~0.676, P=0.023) were independent risk factors for death in critically ill children supported by ECMO. Conclusion PRISM Ⅲ score before ECMO operation and concomitant and/or combined AKI during ECMO are independent risk factors for predicting death in critically ill children with ECMO support.

Objective To investigate the success rate， complications and influencing factors of extracorporeal membrane oxygenation （ECMO） puncture and catheterization under ultrasound guidance. Methods Clinical cases of veno-arterial ECMO were collected. The success rate and incidence of complications of ultrasound-guided percutaneous catheterization were analyzed. Meantime， gender， age， cardiac function （ejection fraction （EF） < 30%/EF≥30%）， target artery diameter （< 5.0 mm/≥5.0 mm）， success of one-time puncture， hypertension and other variables were included. Univariate and/or multivariate logistic regression analyses were used to analyze the influencing factors of the overall success rate and complications of catheterization in extracorporeal cardiopulmonary resuscitation （ECPR） patients （ECPR group） and non-ECPR patients （non-ECPR group）. Results 65 cases of veno-arterial ECMO were included in the study， with an average age of （49.3±18.2） years. 23 cases were assigned in the ECPR group and 42 cases in the non-ECPR group. The overall success rate of ultrasound-guided ECMO catheterization was 86%， 78% in the ECPR group and 91% in non-ECPR group. 13 cases developed hematoma and 5 cases of distal limb ischemia after puncture.Logistic regression analyses showed that the target artery diameter and the success of one-time puncture were the influencing factors for the success rate of overall puncture and catheterization， and the success of one-time puncture was also the influencing factor for the incidence rate of hematoma （all P < 0.05）. In subgroup analysis， the diameter of target artery was found to be a factor affecting the success rate of puncture and catheterization in the ECPR group （P < 0.05）， whereas no statistically significant factor was found in the non-ECPR group （all P > 0.05）. Conclusions Percutaneous ultrasound-guided ECMO catheterization has a high success rate and safety. For non-ECPR patients and those with target artery diameter of ≥5 mm， percutaneous ultrasound-guided ECMO catheterization is the optimal option. Successful one-time puncture should be guaranteed， which can not only improve the success rate of final puncture and catheterization， but also reduce the incidence of hematoma.

Achieving return of spontaneous circulation and improving survival during out-of-hospital cardiac arrest (OHCA) is challenging. It has been established that extracorporeal cardiopulmonary resuscitation (ECPR) can be an alternative rescue therapy when conventional cardiopulmonary resuscitation (CCPR) fails to re-establish circulation. Pre-hospital ECPR can reduce the time of inadequate circulation as much as possible. However, the implementation of pre-hospital ECPR needs huge investment, and due to the limitations of site conditions, clinical promotion and application are difficult. Therefore, team cooperation, implementation process and the best beneficiaries of the pre-hospital ECPR still need further study. At present, some medical institutions at home and abroad have carried out the pre-hospital ECPR strategy and achieved some success. Herein, we review the current situation and the prospect of applying prehospital ECPR.

Objective To explore the clinical outcomes and prognostic factors associated with infants of congenital diaphragmatic hernia (CDH) under multidisciplinary treatments. Methods The relevant clinical data were collected from 103 cases of prenatally diagnosed CDH treated from January 2016 to Augnst 2022. Based upon whether or not fulfilling the criteria for using extracorporeal membrane oxygenation ( ECMO) within 24h post-birth, they were assigned into two groups of ECMO-indicated ( n = 39) and non-ECMO-indicated ( n = 64). Clinical outcomes, echocardiographic findings and independent risk factors were examined for mortality in ECMO-indicated group. Results The overall discharge mortality rate was 29. 1 % ( 95% CI: 20. 6% - 38. 9% ). And mortality rate in ECMO-indicated group was higher than that in non-indicated group [ 53. 9% ( 95% CI :37. 2%-69. 9%) vs. 14. 1 % ( 95% C/: 6. 6%- 25%)]. The median duration of invasive ventilator use in survivors was 336. 5 ( 160. 5, 578. 5) hours with a median hospital stay of 37. 5 ( 22. 8, 51. 3) days. In contrast, 177. O( 121. 0 - 311. 0) hours and 25 ( 19,34) days in non-indicated group respectively. Proportion of right-sided diaphragmatic hernia, occurrence of hepatic hernia and extent of diaphragmatic defect were higher in ECMO-indicated group ( P < 0. 05). Early pulmonary hypertension of ECMO-indicated group was more severe (P <0.01) with higher incidences of right heart enlargement (69. 7% vs. 27. 3%, P <0.01) and left ventricular dysfunction ( 18. 2% vs. 0, P < 0. 0l). Multivariate regression analysis revealed that for ECMO-indicated group, a diagnostic gestational age of 25 weeks, PaCO2 and oxygenation index ( OI) are independent morality risk factors ( P < 0. 05). Conclusion Despite non-using ECMO, our center achieved a mortality rate comparable to that of international high-volume treatment centers for high-risk CDH patients through strengthening an integrated management model before, during and after childbirth. ECMO-indicated CDH patients have more severe pulmonary arterial hypertension and a higher incidence of heart dysfunction. In addition, gestational age at diagnosis < 25 weeks, PCO2 and OI were independent risk factors for mortality in this cohort of patients. [ABSTRACT FROM AUTHOR]

Acute lung injury/acute respiratory distress syndrome (ALI/ARDS) is a common complication after liver transplantation, which could prolong the length of postoperative intensive care unit stay, affect clinical efficacy of liver transplantation and even lead to the death of recipients. ALI/ARDS has attracted extensive attention from liver transplant surgeons in clinical practice. ALI/ARDS after liver transplantation may be directly caused by pulmonary factors (such as mechanical ventilation-related lung injury, lung infection and aspiration, etc.) or indirectly induced by nonpulmonary factors (such as severe infection outside the lungs, blood transfusion and ischemia-reperfusion injury, etc.). In this article, the diagnostic criteria, incidence, mechanism, risk factors, laboratory and clinical diagnostic approaches and treatment of ALI/ARDS after liver transplantation were reviewed, aiming to deepen the understanding and cognition of ALI/ARDS during the perioperative period of liver transplantation and provide reference for the diagnosis and treatment of ALI/ARDS following liver transplantation. [ABSTRACT FROM AUTHOR]

Objective To investigate the application of critical ultrasound in evaluating the systolic movement（Sm）peak velocity of mitral annula before weaning vein artery extracorporeal membrane oxygenation（VAECMO）. Methods The weaning test was conducted in 40 patients who received VA-ECMO treatment in General Hospital of Ningxia Medical University from February 2019 to February 2023. There were 28 cases having successfully weaning VAECMO（group A）and 12 cases failing to wean（group B）. Before weaning test, Sm, left ventricular ejection fraction（LVEF）, and left ventricular end diastolic diameter（LVEDD）were measured by critical ultrasonography, and the data of two group were analyzed compared. The predicting values of Sm measured by critical ultrasonography for successful weaning were evaluated with ROC curve. Results Before the weaning test, the Sm of group A were higher than those of group B（P < 0.05）. While there was no significant difference in LVEDD between the two groups before weaning test（P > 0.05）. The area under ROC curve（AUC）of Tei index, Sm and LVEF were 0.896, 0.479, respectively. The difference of Sm was statistically significant between two groups（all P < 0.05）, and the optimal cut-off values were 0.821 and 0.321, respectively. Conclusion Critical ultrasound evaluation of Sm can be used to predict successful weaning of VAECMO in ICU patients. [ABSTRACT FROM AUTHOR]

Background & Problems: Extracorporeal membrane oxygenation (ECMO) is an intervention that replaces cardiopulmonary function temporarily to reduce injury to vital organs. As important members of the ECMO medical team, intensive care unit nurses must be well trained and alert to possible critical events. Failure to troubleshoot and manage ECMO promptly and correctly significantly increases the risk of mortality. A previous ECMO critical event in our unit resulted in lingering concerns and stress among nurses related to implementing this intervention. A survey conducted among our medical intensive care unit (MICU) nurses identified an implementation accuracy level for ECMO critical event management of only 59.1%. This poor result was attributed to a lack of technical assessment standards, in-service training, clinical experience, and instruction materials and the failure to offer online courses. Purpose: This study was designed to increase the accuracy of ECMO critical event management implementation among intensive care unit nurses to > 86%. Resolutions: We conducted a problem-based training project to improve ECMO critical event management that: introduced a technical assessment sheet and technical simulation exercise, organized in-service training, implemented irregular simulation exercises, and produced multiple different instructional materials. Result: The accuracy of ECMO critical event management implementation among the intensive care unit nurses increased from 59.1% pretest to 95.9% posttest. Conclusion: This project improved the ECMO care ability of MICU nurses in our hospital significantly, resulting in increased ECMO critical event management implementation accuracy, better patient care, higher nursing staff confidence, and lower perceived stress among nursing staff. [ABSTRACT FROM AUTHOR]

Objective To evaluate the effect of donor age on short-term survival of patients with idiopathic pulmonary fibrosis (IPF) after lung transplantation. Methods Clinical data of 235 IPF donors and recipients of lung transplantation were retrospectively analyzed. Univariate and multivariate Cox proportional hazard regression models were employed to analyze the correlation between donor age and short-term mortality rate of IPF patients after lung transplantation. Kaplan-Meier was used to draw the survival curve. Results Univariate Cox regression analysis showed that donor age was correlated with the 1-year fatality of IPF patients after lung transplantation. The 1-year fatality of recipients after lung transplantation was increased by 0.020 times if donor age was increased by 1 year (P=0.009). Oxygenation index of the donors, preoperative oxygenation index, preoperative lung allocation score, preoperative N-terminal pro brain natriuretic peptide, pattern of transplantation, pattern of intraoperative extracorporeal membrane oxygenation and intraoperative blood transfusion volume of the recipients were correlated with 1-year fatality after lung transplantation (all P<0.1). Multivariate Cox regression analysis demonstrated that there was no correlation between donor age and 30-, 90-, 180-d and 1-year fatality of IPF patients after lung transplantation (all P>0.05). Sensitivity analysis showed that there was no significant difference in 30-, 90-, 180-d and 1-year fatality after lung transplantation among donors aged<18, 18-33, 34-49 and ≥50 years (all P>0.05). Conclusions Donor age exerts no effect upon short-term survival of IPF patients after lung transplantation. Considering the mechanical ventilation time, oxygenation index, infection and other factors of donors, the age range of lung transplant donors may be expanded. [ABSTRACT FROM AUTHOR]

Objective To investigate the success rate, complications and influencing factors of extracorporeal membrane oxygenation (ECMO) puncture and catheterization under ultrasound guidance. Methods Clinical cases of veno-arterial ECMO were collected. The success rate and incidence of complications of ultrasound-guided percutaneous catheterization were analyzed. Meantime, gender, age, cardiac function (ejection fraction (EF) < 30%/EF 30%), target artery diameter (< 5.0 mm/ 5.0 mm), success of one-time puncture, hypertension and other variables were included. Univariate and/or multivariate logistic regression analyses were used to analyze the influencing factors of the overall success rate and complications of catheterization in extracorporeal cardiopulmonary resuscitation (ECPR) patients (ECPR group) and non-ECPR patients (non-ECPR group). Results 65 cases of veno-arterial ECMO were included in the study, with an average age of(49.3 ± 18.2) years. 23 cases were assigned in the ECPR group and 42 cases in the non-ECPR group. The overall success rate of ultrasound-guided ECMO catheterization was 86%, 78% in the ECPR group and 91 % in non-ECPR group. 13 cases developed hematoma and 5 cases of distal limb ischemia after puncture.Logistic regression analyses showed that the target artery diameter and the success of one-time puncture were the influencing factors for the success rate of overall puncture and catheterization, and the success of one-time puncture was also the influencing factor for the incidence rate of hematoma (all P < 0.05). In subgroup analysis, the diameter of target artery was found to be a factor affecting the success rate of puncture and catheterization in the ECPR group (P < 0.05), whereas no statistically significant factor was found in the non-ECPR group (all P > 0.05). Conclusions Percutaneous ultrasound-guided ECMO catheterization has a high success rate and safety. For non-ECPR patients and those with target artery diameter of 5 mm, percutaneous ultrasound-guided ECMO catheterization is the optimal option. Successful one-time puncture should be guaranteed, which can not only improve the success rate of final puncture and catheterization, but also reduce the incidence of hematoma. [ABSTRACT FROM AUTHOR]

This article retrospectively analyzed the treatment process of 3 patients with fulminant myocarditis, and sort out the clinical care points after the predictive application of extracorporeal membrane oxygenation (ECMO). Based on the nursing risk assessment and predictive application of ECMO, comprehensive interventions such as ECMO management, vital sign monitoring, complication prevention, pain care, psychological care, diet and sleep management were carried out. Patients with fulminant myocarditis can use ECMO adjuvant therapy in the early stages of disease development, which can not only control the progression of the disease, but also have an ideal therapeutic effect. (本文总结预见性应用体外膜肺氧合(ECMO)救治3例暴发性心肌炎(FM)患者的护理经验。医护人员通过正确评估患者病情, 预见性给予ECMO辅助治疗, 同时做好ECMO的管理、生命体征的监测、并发症的预防、疼痛的护理、心理干预、饮食及睡眠调整, 进而有效控制病情发展, 促进患者康复。)

Objective To analyze the blood transfusion strategies in extracorporeal membrane oxygenation (ECMO) recievers in our hospital, so as to explore the clinical application and efficacy of blood transfusion in patients on ECMO. Methods Data from patients on ECMO treatment in our hospital from October 2017 to October 2021 was collected. The blood transfusion data and coagulation monitoring indexes during different ECMO modes were analyzed, and the efficacy of blood transfusion was evaluated. Results No difference in the number of blood transfusions was noticed by ECMO treatment modes.The transfusion units of red blood cells, plasma and platelets in VA mode were (28.35±14.60) U, (7 367.78±5 194.33) mL and (7.04±5.10) therapeutic volumes, which were higher than those in VV mode, i. e. (18.67±21.50) U, (4 836.67±6 640.50) mL and (3.60±7.47) therapeutic dose, respectively.In VA-ECMO mode, the Hb level and platelet count before ECMO treatment were (126.44±23.9) g/L and (223.84±67.62) × 109/L, which were significantly higher than those after treatment (91.02±21.48) g/L and (172.86±127.73)×109/L.In VV-ECMO mode, the APTT before ECMO treatment was (35.28±8.73) s, which was shorter than that after treatment (41.96±13.69) s. The levels of fibrinogen, Hb and platelet count were (3.80±1.85) g/L, (123.81±33.77) g/L and (175.72±98.91)×109/L, which were significantly higher than the levels after treatment (2.78±1.08) g/L, (92.31±17.38) g/L and (125.31±98.14)×109/L, respectively. Conclusion There are differences in the amount of blood transfusion among different modes of ECMO treatment. As blood transfusion is a necessary support to ensure ECMO treatment, the monitoring of coagulation index is conducive to reduce blood transfusion, improve the efficiency of blood transfusion and benefit to patient safety.

Background Acute myocardial infarction (AMI) complicated with cardiogenic shock (CS) is a common emergency and severe disease in the department of cardiology. Timely and effective hemodynamic support is one of the important means to save the lives of such patients. Research on intraaortic balloon pumping (IABP) combined with extracorporeal membrane oxygenation (ECMO) had important clinical significance for the efficacy of these patients. Objective To explore the efficacy of IABP combined with ECMO in patients with AMI and CS and the inflencing factor of the need for ECMO support in patients with AMI and CS. Methods A total of 91 patients with AMI and CS treated with IABP in the Coronary Care Unit (CCU ward) of the First Affiliated Hospital of Zhengzhou University from October 2014 to October 2020 were collected and divided into IABP group (n=65) and IABP+ECMO group (n=26) according to the use of ECMO. The clinical data of the patients in both groups were collected and analyzed. The 12-months survival rate of patients discharged from hospital was followed up. The inflecting factors of AMI patients complicated with CS treated with IABP needed ECMO support by Multivariate logistic regression analysis. Results Rate of cardiac arrest after IABP, VIS level at 24 h, survival rate at 12 months after discharge and proportion of continuous renal replacement therapy (CRRT) , tracheal intubation, pulmonary infection, lower extremity ischemia, acute kidney injury and gastrointestinal bleeding, 12-month survival rate after discharge, the use ratio of epinepHrine and norepinepHrine in IABP group were lower than those in IABP+ECMO group (P0.05) . The group and time had significant interaction effects on lactic acid and pH (P0.05) . The main effect of group on systolic blood pressure, diastolic blood pressure, heart rate, lactic acid and pH was not significant (P>0.05) . Systolic blood pressure, pH at 24 h after treatment and 72 h after treatment were higher than that before treatment in both groups (P

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Background & Problems: The ext racorporeal membrane oxygenat ion (ECMO) system can provide cardiopulmonary support to and reduce the mortality rate in severely ill newborns. According to our investigation, completion rate of the care process among staff nurses was only 63.5% in our ward. We assumed that the reasons for the above problems included: lack of care awareness, unfamiliarity with the ECMO operation process, inadequate instruments preparation, improper ECMO pipeline fixation, lack of designated space in the unit for placing ECMO supplies, lack of specialty care guidelines, lack of a regular inspection system, and lack of regular on-the-job education. Purpose: Improve awareness related to assisting ECMO placement among nurses in the neonatal intensive care unit and the completeness of care. Resolutions: 1. Create a care process guidebook describing the procedures for ECMO system placement in newborns to help nurse accomplish proper placement. 2. Establish the ECMO system consumables checklist and install an ECMO system-specialized toolbox to reduce the preparation time and smooth the process. 3. Regularly organize comprehensive nurse training and develop performance indicators to enhance ECMO system placement awareness and skills. Results: The cognitive accuracy rate for the assisted placement of ECMO among nurses in the neonatal intensive care unit increased from 51.9% before improvement to 89.9% afterward. Also, the complete care rate of ECMO placement increased from 63.5% before improvement to 100% afterward. Conclusion: This project effectively improved the accuracy rate of nurses involved in assisting with ECMO placement, made the ECMO system placement process easier to implement, improved the care process completion rate, and improved newborn care quality. [ABSTRACT FROM AUTHOR]

Objective To evaluate the effect of preoperative pulmonary artery pressure on perioperative prognosis of the recipients with end-stage heart failure undergoing heart transplantation. Methods Clinical data of 105 recipients receiving heart transplantation were retrospectively analyzed. The mean pulmonary artery pressure (mPAP) was used as the diagnostic criterion. The optimal cut-off value of mPAP for predicting perioperative prognosis of heart transplant recipients was determined. According to the optimal cut-off value of mPAP, all recipients were divided into the low mPAP group (n=66) and high mPAP group (n=39). Intraoperative indexes (cardiopulmonary bypass time, aortic occlusion time, assisted circulation time and cold ischemia time of donor heart) and postoperative indexes [intra-aortic balloon pump (IABP) support rate, IABP support time, extracorporeal membrane oxygenation (ECMO) support rate, ECMO support time, mechanical ventilation time, length of ICU stay, incidence of moderate and severe tricuspid regurgitation and perioperative mortality rate] were compared between the low and high mPAP groups. The prognosis of the two groups was compared. Results The optimal cut-off value of mPAP in predicting clinical prognosis of heart transplant recipients was 30.5 mmHg. In the high mPAP group, the ECMO support rate and perioperative mortality rate were higher than those in the low mPAP group (both P<0.05). No significant differences were observed in the cardiopulmonary bypass time, aortic occlusion time, assisted circulation time, cold ischemia time of donor heart, IABP support rate, IABP support time, ECMO support time, mechanical ventilation time, length of ICU stay and incidence of moderate and severe tricuspid regurgitation between two groups (all P>0.05). No significant differences were noted in the 1-, 2-, 3- and 4- survival rates between two groups (all P>0.05). Conclusions Preoperative mPAP in patients with end-stage heart failure is intimately correlated with perioperative prognosis of heart transplant recipients. The optimal cut-off value of mPAP in predicting perioperative prognosis of heart transplant recipients is 30.5 mmHg. In the high mPAP group, perioperative ECMO support rate and perioperative mortality rate are high, which do not affect the medium and long-term prognosis of the recipients undergoing heart transplantation. [ABSTRACT FROM AUTHOR]

Objective To evaluate the effect of extracorporeal membrane oxygenation (ECMO) on early allograft dysfunction (EAD) after heart transplantation. Methods Clinical data of 614 heart transplant recipients were retrospectively analyzed. All recipients were divided into the ECMO group (n=43) and non-ECMO group (n=571) according to postoperative application of ECMO. In the ECMO group, the conditions of recipients undergoing ECMO after heart transplantation were summarized. Perioperative status and long-term prognosis of recipients were compared [ABSTRACT FROM AUTHOR]

Objective To study the value of ultrasound dynamic monitoring of hemodynamics in the treatment mode of veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Methods A total of 42 patients who received VA-ECMO support treatment in our hospital were selected as study subjects, including 26 patients with successful offline (successful group) and 16 patients with failed offline (failed group). All patients were monitored dynamically by ultrasound before VA-ECMO establishment, before and after offline, hemodynamics, biochemical indexes, left ventricular ejection fraction (LVEF), left ventricular outflow tract velocity time integral (LVOT-VTI) and LatSa were monitored and compared. Results The levels of cTnI, LDH and CK in the successful group were significantly lower than those before establishment (P <0. 05), while those in the failed group were significantly higher than those before establishment (P <0. 05). The LVEF and LVOT-VTI of the successful group were significantly higher than those before offline (P <0. 05), and the LVEF in the failed group was significantly lower than those before offline (P <0. 05). Pearson linear correlation analysis was used to analyze systolic blood pressure, diastolic blood pressure, cTnI, LDH, CK, LVEF, and LVOT-VTI in the successful group. It was found that systolic blood pressure, diastolic blood pressure, LVEF and LVOT-VTI were positively correlated (P <0. 05);cTnI, LDH, and CK were negatively correlated (P < 0. 05). Conclusion Ultrasound dynamic monitoring of hemodynamics is an indispensable auxiliary examination for patients with VA-ECMO support treatment. The recovery of hemodynamics can be used as an important indicator for offline treatment of VA-ECMO support treatment, which can more accurately evaluate the treatment effect of patients. [ABSTRACT FROM AUTHOR]

Objective To identify the risk factors of prolonged mechanical ventilation (PMV) after lung transplantation. Methods Clinical data of 90 recipients undergoing lung transplantation were retrospectively analyzed. According to the duration of invasive mechanical ventilation after operation, all recipients were divided into the PMV group (ventilation duration>48 h, n=30) and control group (ventilation duration≤48 h, n=60). Perioperative parameters were compared between two groups, including preoperative parameters [serum creatinine, estimated glomerular filtration rate (eGFR)], intraoperative parameters (cold ischemia time of donor lung, blood loss), and postoperative parameters [the first red blood cell, white blood cell, platelet count, hemoglobin, C-reactive protein, serum creatinine, total bilirubin, alanine aminotransferase (ALT), oxygenation index, eGFR and the mean arterial pressure in intensive care unit (ICU)]. The risk factors of PMV after lung transplantation were assessed by multivariate logistic regression analysis. Results Preoperative serum creatinine level in the PMV group was 62 (53, 67) μmol/L, significantly higher than 57 (47, 62) μmol/L in the control group. Preoperative eGFR in the PMV group was 97 (93, 107) mL/min, significantly lower than 106 (102, 116) mL/min in the control group. The first postoperative oxygenation index in the PMV group was 196 (157, 286) mmHg, significantly lower than 250 (199, 354) mmHg in the control group (all P<0.05). Multivariate analysis showed that the first increase of postoperative total bilirubin, the first decrease of postoperative oxygenation index and preoperative eGFR decrease were the independent risk factors for PMV following lung transplantation. Conclusions The first increase of postoperative total bilirubin, the first decrease of postoperative oxygenation index and preoperative eGFR decrease are the independent risk factors for PMV after lung transplantation. [ABSTRACT FROM AUTHOR]

Objective To compare the clinical efficacy between Clamshell incision and bilateral posterolateral incision in the sequential double lung transplantation for end-stage lung disease. Methods Clinical data of 120 recipients undergoing double lung transplantation were retrospectively analyzed. All recipients were divided into bilateral posterolateral incision group (n=108) and Clamshell incision group (n=12) according to different surgical methods. Intraoperative parameters were collected and statistically compared between two groups, including operation time, amount of blood loss, amount of blood transfusion, use of extracorporeal membrane oxygenation (ECMO) or not, cold ischemia time on the first side, and cold ischemia time on the second side. Postoperative parameters were also compared between two groups, including the length of hospital stay, length of intensive care unit (ICU) stay, tracheal intubation duration, ECMO duration, forced vital capacity (FVC), forced expiratory volume in one second (FEV1), incidence of anastomotic stenosis, incidence of bronchopleural fistula, perioperative fatality, and 6-minute walk test for the first time after operation. Results In the Clamshell incision group, the amount of blood loss and blood transfusion was significantly higher than those in the bilateral posterolateral incision group (both P<0.05). The proportion of ECMO and cold ischemia time on the second side in the Clamshell incision group were significantly lower or shorter than those in the bilateral posterolateral incision group (both P<0.05). In the Clamshell incision group, the tracheal intubation duration and ECMO duration were significantly shorter compared with those in bilateral posterolateral incision group (both P<0.05). Conclusions Both Clamshell incision and bilateral posterolateral incision are safe and effective in sequential double lung transplantation. Bilateral posterolateral incision approach can significantly reduce the amount of blood loss and blood transfusion of the recipients without significantly prolonging the operation time. Compared with bilateral posterolateral incision approach, the cold ischemia time of lung graft, tracheal intubation duration and ECMO duration are significantly shortened via the Clamshell incision. [ABSTRACT FROM AUTHOR]

Objective: To analyze the clinical manifestations and treatment method of hypoxemia patients treated with of extracorporeal membrane oxygenation (ECMO) combined with aortic balloon pump (IABP), and to improve the management, identification and analysis abilities of the clinicians for hypoxemia during the treatment of ECMO combined with IABP. Methods: The clinical data of one patient with cardiogenic shock complicated with hypoxemia treated with ECMO and IABP were collected, the etiology and treatment method of hypoxemia were analyzed, and the related literatures were reviewed. Results: The patient, 48-year-old male, was hospitalized because of paroxysmal precordial pain for 1 d and exacerbation for 4 h. The coronary angiography was performed 1 h after hospitalization, and the proximal anterior descending branch occlusion was found, and the anterior descending branch stent was implanted. The patients’s intraoperative blood pressure was 92/60 mmHg and the heart rate was 110 min－1, and the IABP (1∶1 counterpulsation)was installed. The heart failure occurred in the patient on the second day after operation, and the patient failed the routine cardiotonic and diuretic treatments and was transferred to Intensive Care Unit (ICU)Department for the ECMO support. On the second day of ECMO support, the patient had a sudden aggravation in the circulation and respiration (the heart rate was raised up to 150－ 160 min－1, the blood pressure was dropped to 98/79 mmHg, the respiratory rate was increased to 35 min－1 ), and the percutaneous arterial oxygen saturation (SpO2) was dropped to 89%. The bedside ultrasound examination results showed that and there was a weak motivation of ventricular of heart and the left ventricle was full. After investigation, it was considered to be caused by membranous pulmonary edema and high frequency of the IABP counterpulsation. The oxygenation state was obviously improved after optimizing the mechanical ventilation setting, the ECMO sweep flow was switched to 10 L·min－1, and a mass of water droplets were discharged from the membrane exhaust hole; after the IABP counterpulsation frequency was set as 1∶2, the patient’s condition was significantly relieved; finally the ECMO and IABP were successfully removed, and the patient recovered and was discharged from hospital. Conclusion: The non-alarm malfunction and improper setting of the extracorporeal equipment can lead to the decreasing of the support performance and aggravation of the disease; when the abnormity occurs, the essential vital signs of the patient should be maintained, then the malfunctions of the equipment should be checked quickly. [ABSTRACT FROM AUTHOR]

Objective To study the clinical value of extracorporeal membrane oxygenation (ECMO) in the treatment of persistent pulmonary hypertension of the newborn (PPHN). Methods A retrospective analysis was performed on the medical data of 11 neonates with PPHN who were treated with ECMO in the Neonatal Intensive Care Unit of Zhongshan People's Hospital from January 2015 to December 2021, involving the neonates' general information, clinical diagnosis, laboratory results, duration of ECMO treatment, complications during ECMO treatment, length of hospital stay, and outcome. Results Of the 11 neonates, 10 (91%) had successful weaning from ECMO, and 8 (73%) survived. For the 11 neonates, the mean duration of ECMO treatment was (81±50) hours (range: 26 to 185 hours), the mean duration of ventilator use was (198±105) hours (range: 57 to 392 hours), and the mean length of hospital stay was (22±15) days (range: 2 to 49 days). The oxygenation index and blood lactate level were significantly improved after 24 hours of ECMO treatment among the 11 neonates (P<0.05). Ten neonates had significantly reduced pulmonary artery pressure after 24 hours of ECMO treatment (P<0.05). One neonate had a progressive increase in the pulmonary artery pressure during EMCO treatment, succumbing to death. This neonate was diagnosed with alveolar capillary dysplasia based on the histopathological findings of the lung tissue and whole-exome sequencing results. Among the 11 children, 5 had intracranial hemorrhage, 1 had disseminated intravascular coagulation, 1 had gastric hemorrhage, 2 had pulmonary hemorrhage, 1 had renal insufficiency, and 3 had bleeding at the puncture site during ECMO treatment. Conclusions ECMO is effective for the treatment of PPHN, however, the high incidence of complications of ECMO treatment suggests that it is important to carefully assess the indications and timing of ECMO treatment and improve the management of ECMO, which can improve the weaning rate and survival rate. [ABSTRACT FROM AUTHOR]

Pregnancy-associated pulmonary embolism (PE) is a type of venous thromboembolism (VTE) that seriously threatens the lives of pregnant women and has gained more attention in clinical practice. Due to physiological and anatomical characteristics, the incidence of VTE during pregnancy and postpartum is significantly higher than that during non-pregnancy periods. Currently, guidelines widely acknowledge the exploration of appropriate risk assessment models to evaluate the risk of pregnancy-associated VTE and to take corresponding preventive measures from mechanical to medication methods according to different risk levels. For patients suspected of PE, initial assessments can be made based on whether they exhibit clinical manifestations of deep vein thrombosis, with options including vascular compression ultrasonography or chest X-ray examination. Confirmation relies on CT pulmonary angiography or V/Q imaging. For patients with shock, echocardiography can be quickly used for the diagnosis and differential diagnosis of PE. The management of pregnancy-associated pulmonary embolism PE depends on the patient's hemodynamic status, with options including reperfusion therapy or anticoagulation therapy. Extracorporeal membrane oxygenation may also be beneficial in high risk patients. The overall evidence level for the prevention and management of pregnancy-associated PE is low, and further exploration in clinical practice is still needed to promote the safety of pregnant women.

With a rapid technological development of mechanical circulatory support (MCS), extracorporeal membrane oxygenation (ECMO) has been applied for such emergencies as cardiogenic shock, hypoxemia, respiratory failure and cardiopulmonary resuscitation. In recent years, its application during perioperative period of pediatric congenital heart disease (CHD) has attracted widespread attention, along with some limitations and complications. This review summarized the application progress of ECMO technology during perioperative period and discussed its indications, contraindications, complications and coping strategies in CHD children. [ABSTRACT FROM AUTHOR]

To summarize the indications and anticoagulation managements of extracorporeal membrane oxygenation ( ECMO) for hemoptysis patients. Methods A successful case of ECMO in the treatment of massive hemoptysis at our hospital was analyzed and the relevant literature retrieved for reviewing. The databases of PubMed, Science Citation Index and Embase were searched with the keywords of" massive hemoptysis; extracorporeal membrane oxygenation" or "hemoptysis; ECMO" in Wanfang, CNKI and Biomedical Literature Service System. The searching time was up to June 2021. Adult cases and duplicate literature were excluded and the search results summarized. Results A total of 6 literatures and 13 children were retrieved along with 1 child at our department. A total of 14 children were analyzed. There were 6 boys and 8 girls with an average age of 8.9 ( 5/ 52 - 15 ) years. The etiologies were sepsis ( 푛 = 2), autoimmune disease ( 푛 = 8 ), fungal infection ( 푛 = 1), vascular malformation ( 푛 = 2) and pulmonary hemosiderosis ( 푛 = 1 ) . AH 14 children received ECMO treatment due to massive hemoptysis and respiratory failure with an average on-machine time of 6.4 days. One child underwent arterial-venous ( V -A) mode due to cardiac arrest while the remainders venous-venous ( V - V) mode. Heparin anticoagulation was confirmed ( 푛 = 13) and unknown ( 푛 = 1) . Hemostatic agent of tranexamic acid was used ( 푛 = 1), not used ( 푛 = 11 ) and unknown ( 푛 = 2). Four cases were operated, including lobectomy ( 푛 = 2), endovascular stenting plus vascular embolization (푛 = 1) and vascular embolization ( 푛 = 1). The remainders were not operated. No massive bleeding occurred during ECMO. Conclusion Massive hemoptysis is rare in children. For children with life-threatening massive hemoptysis, ECMO provides a new possible rescue method. Furthermore, ECMO under systemic heparinization poses no elevated risk of bleeding. [ABSTRACT FROM AUTHOR]

This paper summarized the nursing experience of a patient with multiple valvular heart disease treated by extracorporeal membrane oxygenation (ECMO) combined with continuous renal replacement therapy (CRRT)after emergency redo thoracotomy. Key points of nursing included observation on vital signs, cardiac function maintenance, ECMO-related care, airway management and CRRT-related care. (本文总结1例重症联合瓣膜病患者术后紧急二次开胸后行体外膜肺氧合(ECMO)联合连续肾脏替代疗法(CRRT)救治的护理体会, 包括生命体征的监测、心功能维护、ECMO护理、气道护理、CRRT护理等, 通过严密的护理措施, 以确保患者得到有效救治。)

Objective To evaluate the feasibility and safety of tracheal extubation in operating room for patients with end-stage chronic obstructive pulmonary disease (COPD) after single-lung transplantation. Methods Clinical data of 57 recipients who underwent single-lung transplantation due to end-stage COPD were retrospectively analyzed. According to the evaluation indexes of tracheal extubation in operating room established by our hospital, 17 recipients eligible for tracheal extubation in operating room were assigned into the operating room extubation group (OR extubation group) and 40 recipients receiving tracheal extubation in intensive care unit (ICU) were allocated in the ICU extubation group. The evaluation results of intraoperative tracheal extubation and postoperative recovery were compared between two groups. Results Compared with the ICU extubation group, recipients in the OR extubation group had higher oxygenation index, lower arterial partial pressure of carbon dioxide (PaCO 2), lower blood lactic acid level, less fluctuation range of blood pressure and fewer cases receiving extracorporeal membrane oxygenation (ECMO) during operation (all P<0.05). Two recipients in the OR extubation group received repeated tracheal intubation at 6 and 8 h after returning to ICU, and tracheal extubation at postoperative 6 and 9 d. In the OR extubation group, time of postoperative mechanical ventilation, length of postoperative ICU and hospital stay of the recipients were shorter than those in the ICU extubation group (all P<0.05). The incidence of grade 3 primary graft dysfunction (PGD), atrial tachyarrhythmia, continuous renal replacement therapy and 1-year survival rate did not significantly differ between two groups (all P>0.05). Conclusions The tracheal extubation regimen in the operating room for COPD patients after single-lung transplantation established by our hospital is safe and feasible, which shortens the time of postoperative mechanical ventilation, the length of postoperative ICU and hospital stay, whereas does not increase the incidence of postoperative complications. [ABSTRACT FROM AUTHOR]

Organ donation after citizen’s death has become the main source of organ donation in China. However, the complexity of donor quality and the increasing proportion of expanded criteria donor (ECD) exert significant impact upon the availability of donor kidney and the long-term prognosis of recipients after kidney transplantation. Strengthening the quality maintenance and evaluation of donor kidney is of great significance for improving the quality of donor kidney, increasing the procurement and utilization of donor kidney and prolonging the long-term survival of recipients and kidney allografts. As one of the major approaches of organ preservation, machine perfusion preservation may not only prolong the preservation time and improve the quality of donor kidney, but also play a critical role in the repair and function evaluation of donor kidney. Based on literature review, several hot issues, corresponding treatment strategies and research progress on machine perfusion in the quality maintenance of donor kidney from organ donation after citizen’s death were reviewed in this article, aiming to provide reference for selecting the optimal preservation method of donor kidney and enhancing the quality and utilization rate of ECD donor kidney. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect of extracorporeal membrane oxygenation (ECMO) combined with continuous renal replacement therapy (CRRT) on the pharmacokinetics/pharmacodynamics (PK/PD) of vancomycin and the role of clinical pharmacists in anti-infect ion treatment. Methods: The clinical pharmacist gave pharmaceutical care and consultation to a fulminant myocarditis patient treated with a combination of ECMO and CRRT, and an individualized medication regimen was developed for the patient by using blood concentration monitoring of vancomycin. Results: Based on the blood concentration monitoring, the clinical pharmacist actively carried out pharmaceutical consultation, analyzed the effects of ECMO and CRRT on the PK/PD of vancomycin, and assisted clinicians to adjust the treatment regimen in time to ensure treatment effects. Conclusion: In severe infective patients treated with a combination of ECMO and CRRT, the blood concentration of antibacterials would occasionally change significantly. Pharmaceutical care by clinical pharmacists using blood co nee nt ration monitoring could ensure the effectiveness and safety of the patients in ECMO and CRRT anti-infective treatment. [ABSTRACT FROM AUTHOR]

Lung transplantation is the only effective treatment of end-stage lung diseases. Nevertheless, shortage of donor lungs has become increasingly prominent worldwide. A large quantity of patients died while waiting for lung transplantation. Urgent lung transplantation is a prioritized allocation strategy for donor lung transplantation according to the urgency of diseases, aiming to shorten the waiting time for donor lungs and reduce the fatality of patients on the waiting list for lung transplantation. However, no consensus has been reached worldwide on the definition, criteria and application of the terminology of urgent lung transplantation. In addition, the survival and net benefits of lung transplant recipients based on this allocation system are still controversial. On the basis of previous clinical research on urgent lung transplantation, the definition criteria, risk factors, survival outcomes, limitations and optimization measures were explicitly elucidated in this article, aiming to provide theoretical reference for comprehensive evaluation of the feasibility of urgent lung transplantation and further optimizing the allocation system of donor lungs. [ABSTRACT FROM AUTHOR]

Extracorporeal membrane oxygenation（ ECMO） is a technique that saves patients with severe heart and lung failure through long-term cardiopulmonary support. As an important risk factor for invasive fungal infection, the application of ECMO will also increase the mortality of patients with invasive fungal infection. Due to the extracorporeal circulation circuit, the pharmacokinetics（ PK）/pharmacodynamics（ PD） of antifungal drugs in ECMO patients have undergone major changes. This article summarizes the possible influencing factors of the PK/PD of drugs in ECMO patients, and introduces the characteristics of ECMO patients, the adjustment of antifungal treatment regimens and related population PK and physiological PK modeling studies, with the aim of providing reference for dosing application in similar patients. In the absence of prospective, multi center randomized controlled studies, therapeutic drug monitoring of antifungal drugs in ECMO patients is a more reasonable option [ABSTRACT FROM AUTHOR]

Lung transplantation is the only effective approach to treat end-stage lung diseases. Nevertheless, early prognosis of lung transplant recipients is significantly worse than that of other solid organ transplant recipients. Primary graft dysfunction (PGD) is one of the main causes affecting clinical prognosis of the recipients. PGD is an early acute lung injury after lung transplantation, which is the main cause of early death of lung transplant recipients. Risk factors of PGD after lung transplantation consist of donor, recipient and operation, etc. In this article, the risk factors of PGD after lung transplantation were reviewed, aiming to provide reference for clinical practice. [ABSTRACT FROM AUTHOR]