17,399 results on '"EXTRACORPOREAL membrane oxygenation"'
Search Results
2. Patent Application Titled "Multiple Mode Treatment Devices Methods and Systems" Published Online (USPTO 20240181145).
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PATENT applications ,FLUID therapy ,RENAL replacement therapy ,INTERNET publishing ,OXYGENATORS ,EXTRACORPOREAL membrane oxygenation - Abstract
A patent application titled "Multiple Mode Treatment Devices Methods and Systems" has been published online by the US Patent and Trademark Office. The patent application, filed by inventor Dennis M. Treu, is assigned to NxStage Medical Inc. The application describes extracorporeal blood treatment devices and systems that can provide treatments for extracorporeal blood treatment (ECBT) and extracorporeal membrane oxygenation (ECMO) using the same permanent system with disposable components. The system includes multiple non-blood pumps that can achieve higher flow volume for ECMO compared to the single blood pump used for ECBT. The patent application also discusses volumetric fluid balancing and temperature maintenance in extracorporeal blood treatment systems. [Extracted from the article]
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- 2024
3. Patent Issued for Connector assembly and methods of use (USPTO 11969535).
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EXTRACORPOREAL membrane oxygenation ,PATENTS - Abstract
A patent has been issued to CytoSorbents Corporation for a connector assembly and methods of use in extracorporeal circuit (ECC) systems. ECC systems are used to provide cardiac and respiratory support to patients, but existing systems do not effectively purify blood while operating. The patent describes devices and methods for introducing, removing, and replacing components of an ECC system during continued operation. The connector assembly includes closure mechanisms to occlude the lumen, and the methods can be used with various ECC systems. [Extracted from the article]
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- 2024
4. Patent Issued for Method and apparatus for catheter-based extracorporeal membrane oxygenation (ECMO) (USPTO 11964091).
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EXTRACORPOREAL membrane oxygenation ,VENA cava inferior ,RIGHT heart atrium ,CORONARY artery bypass - Abstract
Vantis Vascular Inc. has been issued a patent for a method and apparatus for catheter-based extracorporeal membrane oxygenation (ECMO). The patent describes a system that delivers ECMO therapies to patients using percutaneously delivered catheters. The method involves advancing catheters through the heart region, removing oxygen-poor blood through a venous catheter positioned in the inferior vena cava, and returning oxygenated blood through an arterial catheter in the aorta. The invention aims to improve upon conventional ECMO procedures, which can be associated with complications and higher mortality rates. [Extracted from the article]
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- 2024
5. Successful treatment of propofol-related infusion syndrome in critically ill patient receiving low-dose propofol infusion: a case report
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Tae Sun Ha and Nahyeon Park
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business.industry ,Sedation ,medicine.medical_treatment ,Hemodynamics ,Critical Care and Intensive Care Medicine ,Critical Care Nursing ,Chest pain ,medicine.disease ,Propofol infusion syndrome ,Intensive care ,Anesthesia ,medicine ,Extracorporeal membrane oxygenation ,medicine.symptom ,Complication ,Propofol ,business ,medicine.drug - Abstract
Propofol is widely used to sedate agitated patients in intensive care units. However, it can cause a rare but fatal complication, propofol-related infusion syndrome (PRIS). The pathophysiology of PRIS is not clear, and there is no definitive diagnosis and treatment. We report a successfully treated case of PRIS in a critically ill patient receiving low-dose propofol infusion. A 59-year-old male patient complaining of sudden chest pain repeatedly collapsed in an ambulance and the emergency room, and veno-arterial extracorporeal membrane oxygenation was delivered. He was diagnosed with a total occluded left anterior descending coronary artery in coronary angiography. On day 20, he showed arrhythmia, increased creatinine kinase (CK), and increased CK-MB and troponin I, accompanied by unstable hemodynamic status despite high-dose vasopressors. He was administered propofol for 20 days at an average dose of 1.3 mg/kg/hr owing to issues with agitation and ventilator synchrony. We strongly suspected PRIS and immediately discontinued propofol infusion, and he was successfully treated with aggressive supportive care. PRIS can occur in patients administered propofol for a prolonged period at low doses. Thus, clinicians should use propofol with caution for PRIS and change to alternative sedatives for long-term sedation.
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- 2023
6. Risk stratification of patients listed for heart transplantation while supported with extracorporeal membrane oxygenation
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Juan Betuel Ivey-Miranda, Marta Farrero-Torres, Matthew D. Griffin, Edith Liliana Posada-Martínez, Lavanya Bellumkonda, Christopher Maulion, and Jeffrey M. Testani
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Pulmonary and Respiratory Medicine ,Heart transplantation ,Mechanical ventilation ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Cardiogenic shock ,030204 cardiovascular system & hematology ,medicine.disease ,03 medical and health sciences ,surgical procedures, operative ,0302 clinical medicine ,030228 respiratory system ,Internal medicine ,Ventricular assist device ,medicine ,Extracorporeal membrane oxygenation ,Surgery ,Risk factor ,Cardiology and Cardiovascular Medicine ,business ,Body mass index ,Dialysis - Abstract
Objectives Extracorporeal membrane oxygenation (ECMO) is used to support patients in severe cardiogenic shock. In the absence of recovery, these patients may need to be listed for heart transplant (HT), which offers the best long-term prognosis. However, posttransplantation mortality is significantly elevated in patients who receive ECMO. The objective of the present study was to describe and risk-stratify different profiles of patients listed for HT supported by ECMO. Methods Patients listed for HT in the United Network for Organ Sharing database were analyzed. The primary outcome was 1-year survival and was assessed in patients bridged to transplant with ECMO (ECMOBTT) and patients who were previously supported on ECMO but had it removed before HT (ECMOREMOVED). Results Among 65,636 adult candidates listed for HT (between 2001 and 2017), 712 were supported on ECMO, 292 of whom (41%) underwent HT (ECMOBTT, n = 202; ECMOREMOVED, n = 90). Most of the patients with ECMOREMOVED were transplanted with a ventricular assist device. In ECMOBTT, recipient age (each 10-year increase), time on the waitlist (both defined as minor risk factors), need for dialysis, and need for mechanical ventilation (both defined as major risk factors) were independent predictors of mortality. ECMOREMOVED and ECMOBTT with no risk factors showed 1-year survival comparable to that in patients who were never supported on ECMO. Compared with patients who were never on ECMO, patients in ECMOBTT group with minor risk factors, 1 major risk factor, and 2 major risk factors had ~2-, ~5-, and >10-fold greater 1-year mortality, respectively (P Conclusions The HT recipients in the ECMOREMOVED and ECMOBTT groups with no risk factors showed similar survival as the HT recipients who were never supported on ECMO. In the ECMOBTT group, posttransplantation mortality increased significantly with increasing risk factors.
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- 2023
7. Venovenous extracorporeal membrane oxygenation in patients with COVID-19 respiratory failure
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Bo Soo Kim, Rakesh C. Arora, Subhasis Chatterjee, J.W. Awori Hayanga, HelenMari Merritt-Genore, Jonathan W. Haft, and Rita Milewski
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Pulmonary and Respiratory Medicine ,2019-20 coronavirus outbreak ,Extracorporeal membrane oxygenation ,Coronavirus disease 2019 (COVID-19) ,business.industry ,medicine.medical_treatment ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,COVID-19 ,Article ,Adult respiratory distress syndrome ,Respiratory failure ,Anesthesia ,medicine ,Surgery ,In patient ,Cardiology and Cardiovascular Medicine ,business - Published
- 2023
8. Remdesivir and GS-441524 Extraction by Ex Vivo Extracorporeal Life Support Circuits
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Kevin M. Watt, Danielle J Green, Autumn M Mcknite, Joseph E. Rower, Walter E Kelley, Christopher A. Reilly, and Carina E Imburgia
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Adenosine ,medicine.medical_treatment ,Biomedical Engineering ,Biophysics ,Bioengineering ,Extracorporeal ,Biomaterials ,Extracorporeal Membrane Oxygenation ,medicine ,Extracorporeal membrane oxygenation ,Humans ,In patient ,Dosing ,Renal replacement therapy ,Alanine ,business.industry ,COVID-19 ,General Medicine ,Adenosine Monophosphate ,COVID-19 Drug Treatment ,Renal Replacement Therapy ,Life support ,Anesthesia ,Drug adsorption ,business ,Ex vivo - Abstract
Patients with severe, COVID-related multi-organ failure often require extracorporeal life support (ECLS) such as extracorporeal membrane oxygenation (ECMO) or continuous renal replacement therapy (CRRT). An ECLS can alter drug exposure via multiple mechanisms. Remdesivir (RDV) and its active metabolite GS-441524 are likely to interact with ECLS circuits, resulting in lower than expected exposures. We evaluated circuit-drug interactions in closed loop, ex vivo ECMO and CRRT circuits. We found that mean (standard deviation) recovery of RDV at 6 hours after dosing was low in both the ECMO (33.3% [2.0]) and CRRT (3.5% [0.4]) circuits. This drug loss appears to be due primarily to drug adsorption by the circuit materials and potentially due to metabolism in the blood. GS-441524 recovery at 6 hours was high in the ECMO circuit 75.8% (16.5); however, was not detectable at 6 hours in the CRRT circuit. Loss in the CRRT circuit appears to be due primarily to efficient hemodiafiltration. The extent of loss for both molecules, especially in CRRT, suggests that in patients supported with ECMO and CRRT, RDV dosing adjustments are needed.
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- 2023
9. Pre-emptive veno-venous ECMO in advanced tracheal malignancy prior to tracheal stenting
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Adil H. Al Kindi, Ahmed Fahmy Mandisha, Rashid Al Sukaiti, and Mohammad Salman Siddiqi
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medicine.medical_specialty ,medicine.medical_treatment ,Malignancy ,Extracorporeal Membrane Oxygenation ,Jugular vein ,Extracorporeal membrane oxygenation ,Medicine ,Humans ,Flexible bronchoscopy ,business.industry ,General Medicine ,Oxygenation ,respiratory system ,Airway obstruction ,Middle Aged ,medicine.disease ,Surgery ,Airway Obstruction ,Trachea ,surgical procedures, operative ,Left femoral vein ,Breathing ,Female ,Stents ,Tracheal Neoplasms ,business - Abstract
Extracorporeal membrane oxygenation (ECMO) is helpful in providing ventilatory support when other conventional methods of ventilation fail. We report a case of successful management of advanced tracheal malignancy with impeding airway obstruction where veno-venous ECMO (VV-ECMO) was instituted prior to performing critical endotracheal procedure. After securing the VV-ECMO through right jugular vein and left femoral vein under local anaesthesia, the tracheal stent placement was conducted under flexible bronchoscope and fluoroscope control. Oxygenation and carbon dioxide levels were maintained by the ECMO. VV-ECMO is a useful adjunct in the management of subglottic difficult airway obstruction due to complex tracheal pathology where conventional ventilation may not be possible or adequate.
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- 2023
10. Intensive Care Unit Occupancy in Japan, 2015–2018: A Nationwide Inpatient Database Study
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Hiroki Matsui, Hideo Yasunaga, Ryosuke Kumazawa, Hiroyuki Ohbe, and Yusuke Sasabuchi
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medicine.medical_specialty ,Occupancy ,Epidemiology ,health care facilities, manpower, and services ,medicine.medical_treatment ,030209 endocrinology & metabolism ,Detailed data ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Japan ,law ,Extracorporeal membrane oxygenation ,Humans ,Medicine ,030212 general & internal medicine ,Bed Occupancy ,Mechanical ventilation ,Inpatients ,Critically ill ,business.industry ,Database study ,General Medicine ,Respiration, Artificial ,Intensive care unit ,Intensive Care Units ,Emergency medicine ,business - Abstract
Background Detailed data on intensive care unit (ICU) occupancy in Japan are lacking. Using a nationwide inpatient database in Japan, we aimed to assess ICU bed occupancy to guide critical care utilization planning. Methods We identified all ICU patients admitted from January 1, 2015 to December 31, 2018 to ICU-equipped hospitals participating in the Japanese Diagnosis Procedure Combination inpatient database. We assessed the trends in daily occupancy by counting the total number of occupied ICU beds on a given day divided by the total number of licensed ICU beds in the participating hospitals. We also assessed ICU occupancy for patients with mechanical ventilation, patients with extracorporeal membrane oxygenation, and patients without life-supportive therapies. Results Over the 4 study years, 1,379,618 ICU patients were admitted to 495 hospitals equipped with 5,341 ICU beds, accounting for 75% of all ICU beds in Japan. Mean ICU occupancy on any given day was 60%, with a range of 45.0% to 72.5%. Mean ICU occupancy did not change over the 4 years. Mean ICU occupancy was about 9% higher on weekdays than on weekends and about 5% higher in the coldest season than in the warmest season. For patients with mechanical ventilation, patients with extracorporeal membrane oxygenation, and patients without life-supportive therapies, mean ICU occupancy was 24%, 0.5%, and 30%, respectively. Conclusion Only one-fourth of ICU beds were occupied by mechanically ventilated patients, suggesting that the critical care system in Japan has substantial surge capacity under normal temporal variation to care for critically ill patients.
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- 2022
11. Management of Neonates Admitted With Tetralogy of Fallot: Changing Patterns Across the United States
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James F. Cnota, Andrew N. Redington, David L.S. Morales, David G. Lehenbauer, David S. Winlaw, Farhan Zafar, Karthik Thangappan, James S. Tweddell, Sarosh P. Batlivala, and Stephen Fatuzzo
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Pulmonary and Respiratory Medicine ,Pediatrics ,medicine.medical_specialty ,Percutaneous ,Pediatric health ,medicine.medical_treatment ,Psychological intervention ,Extracorporeal membrane oxygenation ,Humans ,Medicine ,Hospital Mortality ,Child ,Ductus Arteriosus, Patent ,Retrospective Studies ,Tetralogy of Fallot ,business.industry ,Infant, Newborn ,Stent ,medicine.disease ,United States ,Hospitalization ,Treatment Outcome ,Parenteral nutrition ,Cohort ,Stents ,Surgery ,Cardiology and Cardiovascular Medicine ,business - Abstract
This study describes the evolving in-hospital management strategies for neonates who are diagnosed with tetralogy of Fallot (ToF).The Pediatric Health Information System (PHIS) database was used to identify admitted patients aged 0 to 1 month old with ToF from 2010 through 2019; era 1, 2010 through 2014; and era 2, 2015 through 2019. International Classification of Diseases codes were used to identify related interventions that occurred during this admission but not necessarily as a neonate: full repair, systemic-to-pulmonary shunt, and percutaneous stent in the right ventricular outflow tract and/or patent ductus arteriosus.Among 6021 neonates diagnosed with ToF, 2030 (34%) underwent an intervention: 60% had total repair, 31% systemic-to-pulmonary shunt, and 9% percutaneous stent. In the no-intervention cohort, in-hospital mortality was 9%. In-hospital mortality between repair (6%), shunt (6%), and stent (3%) patients (P = .446) did not differ. Regarding regional practices, no intervention was most frequently used in the Midwest (69% vs 65% average for all other regions [avg], P = .075) while interventions overall were performed most frequently in the West (36% vs 33.5% avg, P = .075). Among the interventions, full repair was most frequent in the Northeast (76% vs 57% avg, P.001), shunt was most frequent in the Midwest (39% vs 28% avg, P.001), and stent was most frequent in the South (11% vs 7% avg, P = .083). Between eras 1 and 2, the type of intervention changed: full repair (52% vs 69%, P.001) and stent (1% vs 16%, P.001) increased, while shunt decreased (47% vs 15%, P.001).Although most neonates admitted with ToF are discharged with no intervention, more than one-third undergo some intervention with a 3% to 6% mortality. The proportion of these patients who undergo an intervention is unchanged during the past decade, but the types of intervention have changed, and significant regional differences exist.
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- 2022
12. "Extracorporeal Life Support System With Blood Recirculation Pathway" in Patent Application Approval Process (USPTO 20240033408).
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EXTRACORPOREAL membrane oxygenation ,PATENT applications ,OXYGENATORS - Abstract
The patent application by CardiacAssist Inc. describes an extracorporeal life support system that artificially supports the heart and lung function. The system includes multiple devices such as a blood reservoir, blood pump, oxygenator, blood filter, heat exchanger, and oxygen sensors. It aims to maximize the oxygen content in the blood by recirculating a portion of the oxygenated blood back into the oxygenator for additional oxygenation. The patent application provides detailed descriptions of different configurations of the system. [Extracted from the article]
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- 2024
13. "Mbl-Coated Substrates Having Anti-Thrombogenic Properties" in Patent Application Approval Process (USPTO 20240001019).
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PATENT applications ,MANNOSE-binding lectins ,OXYGENATORS ,MEDICAL equipment ,THERAPEUTICS ,MEMBRANE filters ,EXTRACORPOREAL membrane oxygenation - Abstract
A patent application has been filed for a new invention that aims to improve the effectiveness and safety of extracorporeal membrane oxygenation (ECMO), a medical technique used to support cardiac and respiratory functions in patients. The invention involves coating filters used in ECMO devices with a protein called mannose-binding lectin (MBL), which has been found to reduce unintended platelet activation and blood clotting. This coating also protects against antibiotic depletion and may be particularly beneficial for patients with MBL deficiency. The invention has potential applications in various medical devices and procedures, offering the possibility of enhancing the outcomes of medical treatments. [Extracted from the article]
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- 2024
14. Patent Application Titled "Expandable Ecmo Extension Cannula System" Published Online (USPTO 20230398279).
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PATENT applications ,CATHETERS ,EXTRACORPOREAL membrane oxygenation ,INTERNET publishing ,THORACIC aorta - Abstract
The USPTO has published a patent application titled "Expandable Ecmo Extension Cannula System" by Navin K. Kapur, assigned to Tufts Medical Center Inc. The invention aims to enhance the delivery of oxygenated blood in venous-arterial extracorporeal membrane oxygenation (VA-ECMO) systems. The system includes a kit with a cannula and an extension cannula that improves blood flow to the thoracic aorta, cerebral oxygenation, arterial pulsatility, and reduces the risk of organ injury. The expandable ECMO extension cannula system is designed to improve systemic perfusion in patients by delivering blood flow from the ECMO machine through the cannula. The system also includes sensors to measure pressure, flow, or oxygen saturation within the patient's vasculature. [Extracted from the article]
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- 2024
15. Extracorporeal Membrane Oxygenation and Nursing Care
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Lokman Hekim Universitesi Saglik Bilimleri Fakultesi, Hemsirelik Bolumu, Ankara, Turkiye, Sevilay Şenol Çelik, Zeliha Ozdemir Koken, and Hafize Savas
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medicine.medical_specialty ,Nursing care ,business.industry ,medicine.medical_treatment ,Extracorporeal membrane oxygenation ,medicine ,Intensive care medicine ,business - Published
- 2022
16. Open abdomen during extracorporeal membrane oxygenation is a safe and effective treatment for abdominal compartment syndrome
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Joshua W. Brown, Brielle Warnock, Matthew L Friedman, Brian W. Gray, Michael J. Hobson, and Eamaan Turk
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Inotrope ,medicine.medical_specialty ,Abdominal compartment syndrome ,medicine.medical_treatment ,Extracorporeal Membrane Oxygenation ,Abdomen ,Extracorporeal membrane oxygenation ,Humans ,Medicine ,Effective treatment ,Respiratory system ,Child ,Open abdomen ,Retrospective Studies ,business.industry ,Abdominal Cavity ,General Medicine ,medicine.disease ,Surgery ,body regions ,Treatment Outcome ,surgical procedures, operative ,medicine.anatomical_structure ,Pediatrics, Perinatology and Child Health ,Cohort ,Intra-Abdominal Hypertension ,business - Abstract
Background/Purpose Decompressive laparotomy and open abdomen for abdominal compartment syndrome have been historically avoided during Extracorporeal Membrane Oxygenation (ECMO) due to seemingly elevated risks of bleeding and infection. Our goal was to evaluate a cohort of pediatric respiratory ECMO patients who underwent decompressive laparotomy with open abdomen at a single institution and to compare these patients to ECMO patients without open abdomen. Methods We reviewed all pediatric respiratory ECMO (30 days-18 years) patients treated with decompressive laparotomy with open abdomen at Riley Hospital for Children (1/2000-12/2019) and compared these patients to concurrent respiratory ECMO patients with closed abdomen. We excluded patients with surgical cardiac disease. We assessed demographics, ECMO data, and outcomes and defined significance as p=0.05. Results 6 of 81 ECMO patients were treated with decompressive laparotomy and open abdomen. Open and closed abdomen groups had similar age (p=0.223) and weight (0.286) at cannulation, but the open abdomen group had a higher reliance on vasoactive medications (Vasoactive Inotropic Score, p=0.040). Open abdomen group survival was similar to closed abdomen patients (66.7%, vs 62.7%, p=1). Open abdomen patients had lower incidence of ECMO complications (33.3% vs 83.6%, p=0.014), but the groups had similar bleeding complications (p=0.412) and PRBC transfusion volume (p=0.941). Conclusion/Impact Pediatric ECMO patients with open abdomen after decompressive laparotomy had similar survival, blood products administered, and complications as those with a closed abdomen. An open abdomen is not a contra-indication to ECMO support in pediatric respiratory patients and should be considered in select patients.
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- 2022
17. The Genetically Engineered Heart as a Bridge to Allotransplantation in Infants Just Around the Corner?
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Jeremy B. Foote, Silvio H. Litovsky, Hidetaka Hara, Luz A. Padilla, Carlisle O’Meara, Jack H. Crawford, Robert J. Dabal, Robert A Sorabella, Takayuki Yamamoto, Gregory P. Walcott, Leslie A. Rhodes, Abhijit Jagdale, David Ayares, David C. Cleveland, Waldemar F. Carlo, Hayato Iwase, David C. Mauchley, Mohamed H Bikhet, Joey Timpa, and David K. C. Cooper
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Graft Rejection ,Pulmonary and Respiratory Medicine ,Cardiac function curve ,medicine.medical_specialty ,Adenosine ,Swine ,Allopurinol ,medicine.medical_treatment ,Organ Preservation Solutions ,Transplantation, Heterologous ,law.invention ,Raffinose ,law ,Internal medicine ,medicine ,Cardiopulmonary bypass ,Extracorporeal membrane oxygenation ,Animals ,Humans ,Insulin ,Heart transplantation ,Thymoglobulin ,business.industry ,Graft Survival ,Infant ,Immunosuppression ,Glutathione ,Tissue Donors ,Transplantation ,Cardiology ,Heart Transplantation ,Surgery ,Genetic Engineering ,Cardiology and Cardiovascular Medicine ,business ,Papio ,Allotransplantation - Abstract
Background Mortality for infants on the heart transplant wait list remains unacceptably high, and available mechanical circulatory support is suboptimal. Our goal is to demonstrate the feasibility of utilizing genetically engineered pig (GEP) heart as a bridge to allotransplantation by transplantation of a GEP heart in a baboon. Methods Four baboons underwent orthotopic cardiac transplantation from GEP donors. All donor pigs had galactosyl-1,3-galactose knocked out. Two donor pigs had human complement regulatory CD55 transgene and the other 2 had human complement regulatory CD46 and thrombomodulin. Induction immunosuppression included thymoglobulin, and Anti-CD20. Maintenance immunosuppression was Rapamycin, AntiCD-40 and methylprednisolone. One donor heart was preserved with University of Wisconsin (UW) solution and the other three with del Nido solution. Results All baboons weaned from cardiopulmonary bypass. B217 received a donor heart preserved with UW. Ventricular arrhythmias and depressed cardiac function resulted in early death. All recipients of del Nido preserved hearts easily weaned from cardiopulmonary bypass with minimal inotropic support. B15416 and B1917 survived for 90 days and 241 days respectively. Histopathology in B15416 revealed no significant myocardial rejection but cellular infiltrate around Purkinje fibers. Histopathology in B1917 was consistent with severe rejection. B37367 had uneventful transplant but developed significant respiratory distress with a cardiac arrest. Conclusions Survival of B15416 and B1917 demonstrates the feasibility of pursuing additional research to document the ability to bridge an infant to cardiac allotransplant with a GEP heart.
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- 2022
18. Effect of Body Mass Index on the Clinical Outcomes of Adult Patients Treated With Venoarterial ECMO for Cardiogenic Shock
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Charles Vidal, Dorothée Valance, Jérôme Allyn, Nicolas Allou, Léandre Girard, Amélie Renou, Gilbert Dubois, Marjolaine Davineau, Berenice Puech, Céline Gonzalez, Eric Braunberger, and Fares Djemili
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Adult ,medicine.medical_specialty ,medicine.medical_treatment ,Shock, Cardiogenic ,Body Mass Index ,law.invention ,Extracorporeal Membrane Oxygenation ,Thinness ,Refractory ,law ,Internal medicine ,medicine ,Extracorporeal membrane oxygenation ,Humans ,Obesity ,Contraindication ,Retrospective Studies ,business.industry ,Cardiogenic shock ,Overweight ,medicine.disease ,Intensive care unit ,surgical procedures, operative ,Anesthesiology and Pain Medicine ,Observational study ,Underweight ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Body mass index - Abstract
Current guidelines consider obesity to be a relative contraindication to venoarterial extracorporeal membrane oxygenation (VA-ECMO) for refractory cardiogenic shock. The authors investigated the effect of body mass index (BMI) on clinical outcomes in patients treated with VA-ECMO for cardiogenic shock.This was a retrospective and observational study.University hospital.The study comprised 150 adult patients who underwent VA-ECMO for cardiogenic shock.The primary outcome was intensive care unit (ICU) mortality. Of the 150 included patients, 10 were underweight (BMI18.5 kg/m²), 62 were normal weight (BMI = 18.5-24.9 kg/m²), 34 were overweight (BMI = 25.0-29.9 kg/m²), 34 were obese class I (BMI = 30.0-34.9 kg/m²), and 10 were obese class II (BMI = 35.0-39.9 kg/m²). All-cause ICU mortality was 62% (underweight, 70%; normal weight, 53%; overweight, 65%; class I obese, 71%; class II obese, 70%). After multivariate logistic regression, BMI was not associated with ICU mortality (adjusted odds ratio [aOR] 0.99 [0.92-1.07], p = 0.8). Analysis by BMI category showed unfavorable mortality trends in underweight patients (aOR 3.58 [0.82-19.6], p = 0.11) and class I obese patients (aOR 2.39 [0.95-6.38], p = 0.07). No statistically significant differences were found among BMI categories in the incidences of complications.The results suggested that BMI alone should not be considered an exclusion criterion for VA-ECMO. The unfavorable trend observed in underweight patients could be the result of malnutrition.
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- 2022
19. Ultrasound-Enhancing Agent Enables Transthoracic Echocardiography in Patients With Delayed Sternal Closure
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Patrick Collins and Hazem Lashin
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medicine.medical_specialty ,business.industry ,Ultrasound ,Shock, Cardiogenic ,Closure (topology) ,ECMO - Extracorporeal membrane oxygenation ,Cardiac surgery ,Extracorporeal Membrane Oxygenation ,Anesthesiology and Pain Medicine ,Low cardiac output syndrome ,Echocardiography ,Internal medicine ,Contrast echocardiography ,Cardiology ,Humans ,Medicine ,In patient ,Cardiology and Cardiovascular Medicine ,business ,Ultrasonography - Published
- 2022
20. Strategies for Mechanical Right Ventricular Support During Left Ventricular Assist Device Implant
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Leora T. Yarboro, Zachary K. Wegermann, Vinod H. Thourani, Nicholas R. Teman, Vinay Badhwar, Sean M. O'Brien, J. Matthew Brennan, Jared P. Beller, Maria V. Grau-Sepulveda, J. Hunter Mehaffey, Gorav Ailawadi, and Francis D. Pagani
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Pulmonary and Respiratory Medicine ,Inotrope ,medicine.medical_specialty ,Ventricular Dysfunction, Right ,medicine.medical_treatment ,Extracorporeal Membrane Oxygenation ,Internal medicine ,medicine ,Extracorporeal membrane oxygenation ,Humans ,Retrospective Studies ,Heart Failure ,business.industry ,medicine.disease ,Right Ventricular Assist Device ,Treatment Outcome ,Ventricular assist device ,Heart failure ,Circulatory system ,Cardiology ,Right ventricular failure ,Surgery ,Heart-Assist Devices ,Implant ,Cardiology and Cardiovascular Medicine ,business - Abstract
Refractory right ventricular failure at the time of left ventricular assist device implantation requires treatment with supplemental mechanical circulatory support. However, the optimal strategy for support remains unknown.All patients undergoing first-time durable left ventricular assist device implantation with a contemporary device were selected from The Society of Thoracic Surgeons National Database (2011 to 2019). Patients requiring right ventricular assist device (RVAD) or venoarterial extracorporeal membrane oxygenation (VA-ECMO) were included in the analysis. Patients were stratified by RVAD or VA-ECMO and by timing of placement (intraoperative vs postoperative).In all, 18 423 left ventricular assist device implants were identified, of which 940 (5.1%) required RVAD (n = 750) or VA-ECMO (n = 190) support. Patients receiving an RVAD more frequently had preoperative inotrope requirement (76% vs 62%, P.01) and severe tricuspid regurgitation (20% vs 13%, P.01). The RVAD patients had lower rates of postoperative renal failure (40% vs 51%, P = .02) and limb ischemia (4% vs 13%, P.01), as well as significantly less operative mortality (41% vs 54%, P.01). After risk adjustment with propensity score analysis, support with VA-ECMO was associated with a higher risk of mortality (risk ratio 1.46; 95% confidence interval, 1.21 to 1.77; P.01) compared with patients receiving an RVAD. Importantly, institution of right ventricular support postoperatively was associated with higher mortality (1.43, P.01) compared with intraoperative initiation.Patients with severe right ventricular failure in the setting of durable left ventricular assist device implantation may benefit from the use of RVAD over VA-ECMO. Regardless of the type of support, initiation at the index operation was associated with improved outcomes.
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- 2022
21. Extracorporeal Membrane Oxygenator Failure in a Patient With Gestational Trophoblastic Neoplasm: Possible Mechanisms and Considerations in Critical Care
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Lucian A. Durham, Nathan J. Smith, Lindsey A. McAlarnen, E. Bishop, M. Tracy Zundel, and Beth A. Nance
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medicine.medical_specialty ,Critical Care ,Coronavirus disease 2019 (COVID-19) ,business.industry ,medicine.medical_treatment ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Extracorporeal membrane oxygenator ,medicine.disease ,Surgery ,Extracorporeal Membrane Oxygenation ,Anesthesiology and Pain Medicine ,Pregnancy ,Extracorporeal membrane oxygenation ,medicine ,Trophoblastic neoplasm ,Humans ,Gestation ,Female ,Gestational Trophoblastic Disease ,Cardiology and Cardiovascular Medicine ,business ,Oxygenator ,Etoposide ,Oxygenators, Membrane ,medicine.drug - Published
- 2022
22. ECMO for TACO Secondary to Massive Post-Cesarean Section Hemorrhage
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K. Gage Parr, Hanan Tafesse, Anna BuAbbud, Salim Aziz, Geetha Shanmugam, and Beverly Long
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Disseminated intravascular coagulation ,Fetus ,Pregnancy ,Mitral regurgitation ,Cesarean Section ,business.industry ,Caesarean delivery ,Hemorrhage ,Oxygenation ,Hypoxia (medical) ,medicine.disease ,Pulmonary edema ,Extracorporeal Membrane Oxygenation ,surgical procedures, operative ,Anesthesiology and Pain Medicine ,Anesthesia ,Humans ,Medicine ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Extra-corporeal membrane oxygenation (ECMO) can be used to treat patients with severe cardiac and/or pulmonary failure. ECMO has been used during pregnancy, at the time of delivery and in the post-partum period with favorable maternal and fetal outcomes.1 In our case, ECMO was initiated intra-operatively during hemorrhagic shock associated with a caesarean delivery, and accompanied by severe pulmonary edema, mitral regurgitation, hypoxia, and cardiac arrest. Research has shown that there is an optimal timing for ECMO initiation. Favorable outcomes are often seen with early initiation.2 This is especially true in pregnancy, when both maternal and fetal health are at stake.2
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- 2022
23. Venovenous Extracorporeal Membrane Oxygenation During Bilateral Lung Transplantation for a Patient With Eisenmenger Syndrome Complicated With Giant Pulmonary Artery Aneurysm, Azygos Continuation, and Central Airway Obstruction
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Kazutomo Saito, Yusuke Takei, Hisashi Oishi, Hiroaki Toyama, Tomoyuki Suzuki, Yutaka Ejima, Yoshinori Okada, Yoshikatsu Saiki, Masanori Yamauchi, and Kazuhiro Takahashi
- Subjects
Pulmonary artery aneurysm ,medicine.medical_specialty ,S syndrome ,business.industry ,medicine.medical_treatment ,Bilateral lung transplantation ,Anesthesiology and Pain Medicine ,Internal medicine ,medicine ,Cardiology ,Extracorporeal membrane oxygenation ,Central airway ,Cardiology and Cardiovascular Medicine ,business ,Azygos continuation - Published
- 2022
24. Postoperative Bronchial Complications After Lung Transplantation Related to Anastomosis Suture
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Suresh Keshavamurthy, Abul Kashem, Kenji Minakata, Yoshiya Toyoda, Huaqing Zhao, Norihisa Shigemura, Stacey Brann, Gengo Sunagawa, Jacob Levy, and E. Leotta
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,medicine.medical_treatment ,Anastomosis ,Pulmonary function testing ,law.invention ,Idiopathic pulmonary fibrosis ,Postoperative Complications ,law ,medicine ,Cardiopulmonary bypass ,Extracorporeal membrane oxygenation ,Humans ,Lung transplantation ,Retrospective Studies ,Lung ,Sutures ,business.industry ,Anastomosis, Surgical ,Suture Techniques ,respiratory system ,medicine.disease ,Surgery ,medicine.anatomical_structure ,Cardiology and Cardiovascular Medicine ,business ,Lung Transplantation ,Lung allocation score - Abstract
BACKGROUND Postoperative bronchial anastomotic complications are not uncommon in lung transplant recipients. We investigated 2 surgical techniques (continuous and interrupted sutures) during bronchial anastomosis, comparing survival and postoperative bronchial complications. METHODS We retrospectively analyzed 421 patients who were transplanted in our center (February 2012 to March 2018). Patients were divided according to bronchial anastomotic technique (continuous or interrupted). Demographics and clinical parameters were compared for significance (P < .05). Comparison of postoperative morbidity included bronchial complications, venovenous extracorporeal membrane oxygenation support, and intervention requirements. Survival was assessed using Kaplan-Meier curve and log-rank tests (P < .05). RESULTS Of the 421 patients, 290 underwent bronchial anastomoses with continuous suture; 44 of these patients had postoperative bronchial complications (15.2%). Contrarily, 131 patients underwent the interrupted suture technique; 9 patients in this group had postoperative bronchial complications (6.9%). Demographics and clinical parameters included age, sex, ethnicity, etiology, lung allocation score, body mass index, donor age, lung transplant type, cardiopulmonary bypass usage, surgical approaches, and median length of stay. Postoperative complications (continuous vs interrupted) were bronchial complications (P = .017), venovenous extracorporeal membrane oxygenation support (P = .41), venoarterial extracorporeal membrane oxygenation support (P = .38), and complications requiring dilatation with stent placement (P = .09). Kaplan-Meier curve showed better survival in the interrupted group (P = .0002). CONCLUSIONS Our study demonstrated the comparable postoperative results between the continuous and interrupted technique.
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- 2022
25. Venoarterial Extracorporeal Membrane Oxygenation in Severe Drug Intoxication: A Retrospective Comparison of Survivors and Nonsurvivors
- Author
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André Vincentelli, Jerome Cuny, Natacha Rousse, Thibault Duburcq, Julien Poissy, Sebastien Preau, Julien Goutay, Agnes Mugnier, Erika Parmentier-Decrucq, and Mouhamed Moussa
- Subjects
business.industry ,medicine.medical_treatment ,Shock, Cardiogenic ,Biomedical Engineering ,Biophysics ,Bioengineering ,General Medicine ,Cardiovascular shock ,Biomaterials ,Extracorporeal Membrane Oxygenation ,surgical procedures, operative ,Refractory ,Anesthesia ,Hospital discharge ,Extracorporeal membrane oxygenation ,medicine ,Clinical endpoint ,Humans ,In patient ,Lactic Acid ,Survivors ,Drug intoxication ,business ,Survival rate ,Retrospective Studies - Abstract
Selecting patients most likely to benefit from venoarterial extracorporeal membrane oxygenation (V-A ECMO) to treat refractory drug-induced cardiovascular shock remains a difficult challenge for physicians. This study reported short-term survival outcomes and factors associated with mortality in V-A ECMO-treated patients for poisoning. Twenty-two patients placed on V-A ECMO after drug intoxication from January 2014 to December 2020 were retrospectively analyzed. he primary endpoint of this study was survival at hospital discharge. Univariate descriptive analysis was performed to compare survivors and nonsurvivors during hospitalization. The overall survival at hospital discharge was 45.4% (n = 10/22). Survival rate tended to be higher in patients treated for refractory shock (n = 7/10) compared with those treated for refractory cardiac arrest (n = 3/12, p = 0.08). Low-flow duration and time from admission to ECMO cannulation were shorter in survivors (p = 0.02 and p = 0.03, respectively). Baseline characteristics before ECMO, including the class of drugs involved in the poisoning, between survivors and nonsurvivors were not statistically different except pH, bicarbonate, serum lactate, Sequential Organ Failure Assessment, and Survival After Veno-arterial-ECMO (SAVE) score. All patients with SAVE-score risk classes II/III survived whereas 85.7% (n = 12/14) of those with SAVE-score risk classes IV/V died. A lactic acid >9 mmol/L predicts mortality with a sensitivity/specificity ratio of 83.3%/100%. V-A ECMO for severe drug intoxication should be reserved for highly selected poisoned patients who do not respond to conventional therapies. Shortening the timing of V-A ECMO initiation should be a key priority in improving outcomes. Low-flow time >60min, lactic acid >9mmol/L, and SAVE-score may be good indicators of a worse prognosis.
- Published
- 2022
26. Living-Donor Lung Transplantation for Post–COVID-19 Respiratory Failure
- Author
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Itsuki Yuasa, Satona Tanaka, Daisuke Nakajima, Hiroshi Date, Miki Nagao, Masatsugu Hamaji, Yojiro Yutaka, Jumpei Takamatsu, Kazuhiro Yamazaki, and Akihiro Ohsumi
- Subjects
Pulmonary and Respiratory Medicine ,Mechanical ventilation ,Coronavirus disease 2019 (COVID-19) ,business.industry ,medicine.medical_treatment ,Case Report ,law.invention ,Collapsed Lung ,surgical procedures, operative ,Respiratory failure ,law ,Anesthesia ,medicine ,Extracorporeal membrane oxygenation ,Cardiopulmonary bypass ,Lung transplantation ,Surgery ,Respiratory function ,Cardiology and Cardiovascular Medicine ,business - Abstract
We report the first case of coronavirus disease 2019 (COVID-19)-associated respiratory failure requiring urgent living-donor lobar lung transplantation (LDLLTx). A 57-year-old woman with a positive viral status developed severe hypoxia requiring extracorporeal membrane oxygenation (ECMO). Her respiratory function deteriorated, with almost totally collapsed lungs. All of her other organs functioned well. After 104 days on ECMO, she received urgent LDLLTx under cardiopulmonary bypass. The grafts worked well, and she was weaned off cardiopulmonary bypass after reperfusion. LDLLTx is an option for selected patients with post-COVID-19 end-stage respiratory failure. Coronavirus disease 2019 (COVID-19) has spread worldwide since December 2019 due to the unprecedented pandemic.1 Patients with end-stage COVID-19-related respiratory failure require mechanical ventilation and/or extracorporeal membrane oxygenation (ECMO). In some countries, lung transplantation (LTx) has become a treatment option for irreversible lung function deterioration.2,3 We report the first successful case of severe respiratory failure caused by COVID-19 treated with urgent living-donor lobar lung transplantation (LDLLTx).
- Published
- 2022
27. Venoarterial Extracorporeal Membrane Oxygenation for Life-Threatening Complications of Percutaneous Coronary and Structural Heart Interventions
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Judit Karacsonyi, Emmanouil S. Brilakis, Muhammad Hammadah, and Vennela Avula
- Subjects
medicine.medical_specialty ,Acute coronary syndrome ,business.industry ,Cardiogenic shock ,medicine.medical_treatment ,Percutaneous coronary intervention ,General Medicine ,medicine.disease ,Coronary artery disease ,Valve replacement ,Internal medicine ,cardiovascular system ,medicine ,Cardiology ,Extracorporeal membrane oxygenation ,Myocardial infarction ,Cardiology and Cardiovascular Medicine ,business ,Cardiac catheterization - Abstract
Percutaneous coronary or structural heart interventions may lead to complications, such as perforation and acute vessel closure that may in turn lead to cardiac arrest or cardiogenic shock. Moreover, acute coronary syndrome patients presenting with cardiogenic shock can be challenging to treat due to hemodynamic instability. In such cases, venoarterial extracorporeal membrane oxygenation (V-A ECMO) can provide hemodynamic stabilization and oxygenation allowing successful treatment of the complication or culprit lesion in acute coronary syndrome patients. We present 3 cases illustrating successful emergent use of V-A ECMO in the cardiac catheterization laboratory in the setting of acute left main dissection during a chronic total occlusion intervention, cardiogenic shock in the setting of non-ST segment elevation myocardial infarction and multivessel coronary artery disease, and aortic annular rupture during transcatheter aortic valve replacement.
- Published
- 2022
28. Two-Stage Arterial Switch for Transposition of the Great Vessels in Older Children
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Yabing Duan, Chuhao Du, Shuo Dong, Yangxue Sun, and Jun Yan
- Subjects
Pulmonary and Respiratory Medicine ,congenital, hereditary, and neonatal diseases and abnormalities ,medicine.medical_specialty ,Transposition of Great Vessels ,medicine.medical_treatment ,Ventricular Function, Left ,law.invention ,Postoperative Complications ,law ,medicine.artery ,Internal medicine ,medicine ,Extracorporeal membrane oxygenation ,Humans ,Stage (cooking) ,Child ,Retrospective Studies ,Ejection fraction ,business.industry ,Infant ,Stroke Volume ,Arteries ,Transposition of the great vessels ,medicine.disease ,Intensive care unit ,Arterial Switch Operation ,Treatment Outcome ,Great arteries ,Pulmonary artery ,Ventricular pressure ,Cardiology ,Surgery ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
This study investigated a 2-stage arterial switch operation (ASO) to treat transposition of the great arteries (TGA) with intact ventricular septum (TGA-IVS) in late referral patients.We retrospectively analyzed patients with TGA-IVS or TGA with restricted ventricular septal defects who had undergone 2-stage ASO at our institution from February 2007 to August 2018. Included were 41 patients: 21 (51.2%) who had undergone long-term 2-stage ASO and 20 (48.8%) who had undergone rapid 2-stage ASO.The long-term 2-stage group was older at ASO (3.5 vs 25 months; P.001). Results were more satisfactory in the long-term group than in the rapid group for intensive care unit time (P = .004), mechanical ventilation time (P = .004), and length of stay (P = .007). No in-hospital death occurred in the long-term group, and the postoperative course was more manageable in the long-term group than in the rapid group. However, the risk of significant neoaortic regurgitation was lower in the rapid group, which also had a better left ventricular ejection fraction.The long-term group achieved better early-term outcomes than the rapid group. However, a high risk of neoaortic regurgitation and myocardial dysfunction was also noted.
- Published
- 2022
29. Improved Outcomes of Infant Lung Transplantation Over 3 Decades
- Author
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Taylor C. Merritt, Dilip S. Nath, Matthew W. Canter, Horacio G Carvajal, Aaron M. Abarbanell, and Pirooz Eghtesady
- Subjects
Pulmonary and Respiratory Medicine ,Pediatrics ,medicine.medical_specialty ,medicine.medical_treatment ,Idiopathic Pulmonary Hypertension ,Bronchiolitis obliterans ,law.invention ,Extracorporeal Membrane Oxygenation ,law ,Extracorporeal membrane oxygenation ,Humans ,Medicine ,Lung transplantation ,Child ,Bronchiolitis Obliterans ,Lung ,Retrospective Studies ,Mechanical ventilation ,business.industry ,Infant ,medicine.disease ,Intensive care unit ,Pulmonary hypertension ,Patient Discharge ,Treatment Outcome ,medicine.anatomical_structure ,Surgery ,Cardiology and Cardiovascular Medicine ,business ,Lung Transplantation - Abstract
Lung transplantation is the definitive surgical treatment for end-stage lung disease. However, infants comprise less than 5% of pediatric cases. This study sought to provide an overview of infant lung transplantation outcomes over the past 3 decades by using linked United Network for Organ Sharing (UNOS) and Pediatric Health Information System (PHIS) data.Infants undergoing lung transplantation from 1989 to 2020 in UNOS were reviewed. UNOS and PHIS records for patients who underwent lung transplantation from 1995 to 2020 were linked using date of birth, sex, and date of surgery ± 3 days. The study assessed underlying diagnoses, pretransplant and posttransplant extracorporeal membrane oxygenation support, retransplant-free survival to discharge, hospital experience (≥1 annual transplant for ≥4 years in a 5-year period), operative decade, bronchiolitis obliterans syndrome, long-term survival, and functional status at latest follow-up.A total of 112 lung transplants were performed in 109 infants over 31 years. Of these, 21 patients died before discharge, and 2 underwent repeat transplantation during the same admission. The study linked 80.6% (83 of 103) of UNOS and PHIS records. Hospital survival was lower for infants with idiopathic pulmonary hypertension and those who underwent transplant procedures at less experienced centers. All 7 infants requiring postoperative extracorporeal membrane oxygenation support died. Median freedom from bronchiolitis obliterans syndrome was 8.1 years (interquartile range, 4.6 to 11.6 years). After discharge, median survival was 10.3 years (interquartile range, 6.3 to 14.4 years), with improved 10-year survival for those patients who underwent transplantation from 2010 to 2020 (87.3%) vs 2000 to 2009 (52.4%; P = .098) and 1989 to 1999 (34.1%; P = .004). A total of 84.6% (33 of 39) of survivors had minor or no restrictions at latest follow-up.Carefully selected infants experience promising short- and long-term outcomes after lung transplantation.
- Published
- 2022
30. Post Heart Transplantation Outcomes of Patients Supported on Biventricular Mechanical Support
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Sabeena Arora, Joseph Radojevic, Ayyaz Ali, Douglas L. Jennings, Jonathan Hammond, Jason Gluck, Abhishek Jaiswal, William L. Baker, Naga Vaishnavi Gadela, A. Scatola, Oisharya Dasgupta, and David A. Baran
- Subjects
Adult ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Biomedical Engineering ,Biophysics ,Bioengineering ,Biomaterials ,Internal medicine ,Cox proportional hazards regression ,medicine ,Extracorporeal membrane oxygenation ,Humans ,Retrospective Studies ,Heart Failure ,Heart transplantation ,business.industry ,Mortality rate ,General Medicine ,Treatment Outcome ,surgical procedures, operative ,Propensity score weighting ,Cardiology ,Heart Transplantation ,Support system ,Heart-Assist Devices ,business - Abstract
With the implementation of the new heart transplant (HT) allocation system, patients requiring biventricular support systems have the highest priority, a shorter waitlist time, and a higher frequency of HT. However, the short-term and long-term outcomes of such patients are often disputed. Hence, we examined the outcomes of these patients who underwent HT before change in allocation scheme. Additionally, we compared post-HT outcomes of extracorporeal membrane oxygenation (ECMO) with other nondischargeable biventricular (BiVAD) supported patients. We identified adult ECMO or BiVAD supported HT recipients between 2000 and 2018 in the Scientific Registry of Transplant Recipients database. We compared survival with the Kaplan-Meier method. Using overlap propensity score weighting, we constructed Cox proportional hazards regression models to determine the risk-adjusted influence of BiVAD versus ECMO on survival. Of the 730 patients HT recipients; 528 (72.3%) and 202 (27.7%) were bridged with BiVAD and ECMO, respectively. For BiVAD versus ECMO patients, the 30-day, 1-year, 3-year, and 5-year mortality rates were 8.0% versus 14.4%, 16.3% versus 21.3%, 22.4% versus 25.3%, and 26.3% versus 25.7%, respectively. Risk-adjusted post-HT survival of BiVAD and ECMO patients at 30-day (HR 1.24 [95% CI, 0.68-2.27]; P = 0.4863), 1-year (HR 1.29 [95% CI, 0.80-2.09]; P = 0.3009), 3-year (HR 1.27 [95% CI, 0.83-1.94]; P = 0.2801), and 5-year (HR 1.35, 95% CI, 0.90-2.05; P = 0.1501) were similar. Around three-fourth of the ECMO or BiVAD supported patients were alive at 5-years post-HT. The short-term and long-term post-HT survivals of groups were comparable.
- Published
- 2022
31. Severe thrombocytopenia in adults undergoing extracorporeal membrane oxygenation is predictive of thrombosis
- Author
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Sven R. Olson, Luke Masha, Owen J. T. McCarty, Joseph J. Shatzel, Michael Oakes, David Zonies, Patricia Liu, Ramin Amirsoltani, Vikram Raghunathan, and Tia C L Kohs
- Subjects
Adult ,medicine.medical_specialty ,medicine.medical_treatment ,macromolecular substances ,Article ,Cohort Studies ,Extracorporeal Membrane Oxygenation ,Internal medicine ,medicine ,Extracorporeal membrane oxygenation ,Humans ,Platelet ,Prospective Studies ,Retrospective Studies ,business.industry ,Anticoagulants ,Thrombosis ,Hematology ,General Medicine ,medicine.disease ,Thrombocytopenia ,Severe thrombocytopenia ,surgical procedures, operative ,Circulatory system ,Cardiology ,business - Abstract
Extracorporeal membrane oxygenation (ECMO) provides lifesaving circulatory support and gas exchange, although hematologic complications are frequent. The relationship between ECMO and severe thrombocytopenia (platelet count
- Published
- 2023
32. Right Ventricular Assist Device With Extracorporeal Membrane Oxygenation for Bridging Right Ventricular Heart Failure to Lung Transplantation: A Single-Center Case Series and Literature Review
- Author
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Geun Dong Lee, Chuiyong Pak, Pil Je Kang, Sung-Ho Jung, Se Hoon Choi, Jae Guk Lee, Sang-Bum Hong, Dong Kyu Oh, and Ho Cheol Kim
- Subjects
Heart Failure ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Single Center ,medicine.disease ,Surgery ,Right Ventricular Assist Device ,Extracorporeal Membrane Oxygenation ,Treatment Outcome ,surgical procedures, operative ,Anesthesiology and Pain Medicine ,Respiratory failure ,Heart failure ,medicine ,Extracorporeal membrane oxygenation ,Humans ,Lung transplantation ,Heart-Assist Devices ,Cardiology and Cardiovascular Medicine ,Complication ,business ,Survival rate ,Lung Transplantation ,Retrospective Studies - Abstract
Objective Right ventricular heart failure (RVHF) is a critical complication in patients with respiratory failure, particularly among those who transitioned to lung transplantation using venovenous (VV) extracorporeal membrane oxygenation (ECMO). In these patients, both cardiac and respiratory functions are supported using venoarterial or venoarterial-venous ECMO. However, these modalities increase the risk of device-related complications, such as thromboembolism, bleeding, and limb ischemia, and they may disturb early rehabilitation. Due to these limitations, a right ventricular assist device with an oxygenator (Oxy-RVAD) using ECMO may be considered for patients with RVHF with VV ECMO. Design A retrospective case series and literature review. Setting A single tertiary care university hospital. Participants The study comprised lung transplantation candidates on ECMO bridging who developed right-sided heart failure. Interventions An RVAD with ECMO. Measurements and Main Results Of eight patients who underwent the study protocol, seven were bridged successfully to lung transplantation (BTT), and all patients with BTT were discharged, with a 30-day survival rate of 100% (7/7 patients). The 180-day survival rate was 85% (6/7 patients). Conclusions The study suggested that Oxy-RVAD using ECMO may be a viable option for bridging patients with RVHF to lung transplantation. Trial Registration Retrospectively registered.
- Published
- 2022
33. Risk Factors for Perioperative Morbidity in Adults Undergoing Cardiac Surgery at Children’s Hospitals
- Author
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Javier J. Lasa, Katherine B. Salciccioli, Parag Jain, Nancy S. Ghanayem, Francis Kim, Peter R. Ermis, Timothy B. Cotts, Danielle Guffey, Stephanie Fuller, Michael Gaies, Jinyoung Byun, and Andrew L. Smith
- Subjects
Adult ,Heart Defects, Congenital ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,medicine.medical_treatment ,Postoperative Complications ,Risk Factors ,medicine ,Extracorporeal membrane oxygenation ,Humans ,Renal replacement therapy ,Cardiac Surgical Procedures ,Child ,Stroke ,Dialysis ,Retrospective Studies ,business.industry ,Thoracic Surgery ,Perioperative ,Length of Stay ,Hospitals, Pediatric ,medicine.disease ,Cardiac surgery ,Respiratory failure ,Emergency medicine ,Coronary care unit ,Kidney Diseases ,Surgery ,Morbidity ,Cardiology and Cardiovascular Medicine ,business - Abstract
Increasing numbers of adults with congenital heart disease (ACHD) undergo cardiac surgical procedures in children's hospitals, yet surgical outcomes data are limited. We sought to better understand the impact of preoperative risk factors on postoperative complications and cardiac intensive care unit (CICU) length of stay (LOS).Surgical CICU admissions for patients aged 18 years and older in the Pediatric Cardiac Critical Care Consortium registry from August 2014 to January 2019 in 34 hospitals were included. Primary outcomes included prolonged LOS (defined as LOS ≥90th percentile) and major complications (cardiac arrest, extracorporeal membrane oxygenation, arrhythmia requiring intervention, stroke, renal replacement therapy, infection, and reoperation/reintervention).We analyzed 1764 surgical CICU admissions. Prolonged LOS was 7 days or longer. Eighteen patients (1.0%) died, of whom 9 (0.5%) died before the LOS cutoff and were excluded from analysis. Of 1755 CICU admissions, 8.8% (n = 156) had prolonged LOS, and 23.3% (n = 413) had 1 or more major complications. Several variables, including The Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery 4/5 operation, 3 or more previous sternotomies, and preoperative renal dysfunction/dialysis were independent risk factors for both prolonged LOS and major complications (P.05). Preoperative ventilation was associated with increased odds of prolonged LOS and preoperative arrhythmia with major complications.This analysis of postoperative ACHD care in pediatric CICUs found high complexity operations, 3 or more previous sternotomies, preoperative arrhythmias, renal dysfunction, and respiratory failure are associated with prolonged LOS and/or major complications. Future quality improvement initiatives focused on preoperative optimization and implementation of adult-specific perioperative protocols may mitigate morbidity in these patients undergoing cardiac surgical procedures at children's hospitals.
- Published
- 2022
34. Severe Pulmonary Hemorrhage in a Neonate With Hypoxic Ischemic Encephalopathy and Sepsis Managed on Extracorporeal Membrane Oxygenation
- Author
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Daniel Conway, Swosti Joshi, Ogechukwu Menkiti, and Vilmaris Quinones Cardona
- Subjects
medicine.medical_treatment ,Biomedical Engineering ,Biophysics ,Hemorrhage ,Bioengineering ,Hypoxic Ischemic Encephalopathy ,Biomaterials ,Sepsis ,Extracorporeal Membrane Oxygenation ,Extracorporeal membrane oxygenation ,Humans ,Medicine ,business.industry ,Infant, Newborn ,Infant ,Dornase alfa ,General Medicine ,Hypothermia ,medicine.disease ,Pneumonia ,surgical procedures, operative ,Respiratory failure ,Anesthesia ,Hypoxia-Ischemia, Brain ,Pulmonary hemorrhage ,medicine.symptom ,Respiratory Insufficiency ,business ,medicine.drug - Abstract
Pulmonary hemorrhage (PH) is an infrequent and potentially fatal event in term neonates. Reports of successful management of PH on extracorporeal membrane oxygenation (ECMO) are limited, given the accentuated risk of mortality imposed by the use of heparin to prevent thrombosis on ECMO. We present a case of a term neonate with hypoxic ischemic encephalopathy undergoing controlled hypothermia who developed hypoxic respiratory failure, hemodynamic instability, Enterobacter cloacae pneumonia and sepsis complicated by severe PH who required support with veno-arterial ECMO. We describe the therapeutic strategies used on veno-arterial ECMO to successfully manage this infant, including clamping the endotracheal tube, aggressive correction of coagulopathy, and use of dornase alfa, as well as elaborate on the subtle changes in ECMO parameters during the run that preceded worsening pneumonia with sepsis.
- Published
- 2022
35. Thoracoabdominal Normothermic Perfusion in Donation After Circulatory Death
- Author
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Shaheed Merani, Marian Urban, John Y. Um, Aleem Siddique, Kim F. Duncan, Lance Fristoe, Anthony W. Castleberry, Nicholas W. Markin, M. Megan Chacon, and Ryan Robertson
- Subjects
Pulmonary and Respiratory Medicine ,Tissue and Organ Procurement ,business.industry ,medicine.medical_treatment ,Regional perfusion ,Organ Preservation ,Circulatory death ,Tissue Donors ,Donation after brain death ,Death ,Perfusion ,Normothermic perfusion ,Donation ,Anesthesia ,Extracorporeal membrane oxygenation ,Heart Transplantation ,Humans ,Medicine ,Surgery ,Cardiology and Cardiovascular Medicine ,business - Abstract
Donation after circulatory death (DCD) is emerging as an alternative pathway to donation after brain death (DBD) to expand the cardiac organ donor pool.1 We describe the surgical technique and circuit configuration for in-situ organ reperfusion with thoracoabdominal normothermic regional perfusion (TA-NRP) using portable venoarterial extracorporeal membrane oxygenation (VA-ECMO).
- Published
- 2022
36. A Narrative Review of Nutrition Therapy in Patients Receiving Extracorporeal Membrane Oxygenation
- Author
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Terpsi Karpasiti
- Subjects
Adult ,medicine.medical_specialty ,Critical Illness ,medicine.medical_treatment ,Biomedical Engineering ,Biophysics ,MEDLINE ,Nutritional Status ,Bioengineering ,CINAHL ,law.invention ,Biomaterials ,Enteral Nutrition ,Extracorporeal Membrane Oxygenation ,Randomized controlled trial ,law ,medicine ,Extracorporeal membrane oxygenation ,Humans ,In patient ,Medical nutrition therapy ,Intensive care medicine ,business.industry ,General Medicine ,surgical procedures, operative ,Parenteral nutrition ,Observational study ,Respiratory Insufficiency ,business - Abstract
The use of extracorporeal membrane oxygenation (ECMO) in patients with severe cardiorespiratory failure has seen significant growth in the last decade. Despite this, there is paucity of data surrounding the optimum nutritional management for ECMO patients. This review aimed to describe current nutrition practices in patients receiving ECMO, critically appraise available studies and identify areas for future research. A literature search was conducted in PubMed, MEDLINE, and CINAHL Plus to identify all randomized trials and observational studies published between July 2000 and July 2020 investigating nutrition practices in critically ill adults receiving ECMO. The primary outcomes were nutritional adequacy, gastrointestinal complications, and physical function. Secondary outcomes included mortality, length of stay, and duration on ECMO support. From a total of 31 studies identified, 12 met the inclusion criteria. Nine observational studies were reviewed following eligibility assessment. Early enteral nutrition was deemed safe and feasible for ECMO patients; however, meeting nutritional targets was challenging. Utilizing alternative nutrition routes is an option, although risks and benefits should be taken into consideration. Data on gastrointestinal complications and other clinical outcomes were inconsistent, and no data were identified investigating the effects of nutrition on the physical and functional recovery of ECMO patients. Nutrition therapy in ECMO patients should be provided in line with current guidelines for nutrition in critical illness until further data are available. Further prospective, randomized studies investigating optimum nutrition practices and effects on clinical and functional outcomes are urgently required.
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- 2022
37. Is Foot Drop an Underreported Sequela of Extracorporeal Membrane Oxygenation?
- Author
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Biswajit Kar, Ismael A. Salas de Armas, Christa Gilley, Amanda Bergeron, Igor D. Gregoric, Kayla Kutilek, Lisa Janowiak, Kischa Smith, and Sriram Nathan
- Subjects
Foot drop ,medicine.medical_specialty ,medicine.medical_treatment ,Population ,Biomedical Engineering ,Biophysics ,Bioengineering ,Catheterization ,Biomaterials ,Extracorporeal Membrane Oxygenation ,Quality of life ,medicine ,Extracorporeal membrane oxygenation ,Humans ,Prospective Studies ,Peroneal Neuropathies ,education ,Retrospective Studies ,education.field_of_study ,Rehabilitation ,business.industry ,Sequela ,General Medicine ,medicine.disease ,Surgery ,surgical procedures, operative ,Quality of Life ,medicine.symptom ,Complication ,business ,Common peroneal nerve - Abstract
Foot drop in the absence of limb ischemia is a chronic complication in peripheral venoarterial extracorporeal membrane oxygenation (V-A ECMO) survivors; however, there is little published regarding the incidence and functional outcomes of this condition. Common peroneal nerve is the most common cause of foot drop, a condition that leads to significant debility and requires extensive physical therapy and rehabilitation, thereby affecting the patient's quality of life. We completed a retrospective review of 153 patients who received femoral cannulation for V-A ECMO support for greater than 1 hour. The incidence of foot drop in our V-A ECMO population was 7.8% (12/153). Importantly, only two patients with foot drop were discharged home. The majority (10/12) of patients with foot drop required in-patient rehabilitation; five patients were nonambulatory, and five patients required an ankle foot orthosis assistive device. This study identifies foot drop as a relevant complication in peripherally cannulated V-A ECMO survivors and provides an initial incidence rate. By raising awareness of this complication in the V-A ECMO population, an early diagnosis is possible, which can enable appropriate rehabilitation. Prospective trials are needed to identify possible risk factors of foot drop and methods to reduce this complication of V-A ECMO.
- Published
- 2022
38. Extracorporeal Membrane Oxygenation for Pediatric Toxin Exposures: Review of the Extracorporeal Life Support Organization Registry
- Author
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Christine Koshel, Peter Rycus, Peta M. A. Alexander, and Omar Alibrahim
- Subjects
Adult ,Inotrope ,medicine.medical_treatment ,Biomedical Engineering ,Biophysics ,Bioengineering ,Nitric Oxide ,Extracorporeal ,Biomaterials ,Extracorporeal Membrane Oxygenation ,medicine ,Extracorporeal membrane oxygenation ,Humans ,Ingestion ,Registries ,Child ,Retrospective Studies ,business.industry ,General Medicine ,Treatment Outcome ,Respiratory failure ,Shock (circulatory) ,Life support ,Anesthesia ,Arterial blood ,medicine.symptom ,Respiratory Insufficiency ,business - Abstract
Evidence for the use of extracorporeal membrane oxygenation (ECMO) in children with refractory respiratory failure or shock following ingestion or toxin exposure, has been confined to single-center experiences, individual case reports, and extrapolated from adult cohorts; no pediatric multicenter cohorts exist. The objective of this retrospective review of the Extracorporeal Life Support Organization registry is to describe pediatric ECMO use following ingestion or toxin exposure, and define factors associated with mortality. Twenty-eight children between the ages of 30 days and 18 years met inclusion criteria between January 1, 2008 and December 31, 2017. The primary outcome measure was mortality before hospital discharge, which occurred in 32% of patients. Factors associated with in-hospital mortality included pre-ECMO use of inhaled nitric oxide (44.4% vs. 5.3%, p = 0.026), lower pre-ECMO arterial blood gas pH (6.97 [6.80-7.17] vs. 7.20 [7.15-7.32], p = 0.034), and higher pre-ECMO PaCO2 (79 [57-85] vs. 49 [38-63], p = 0.014). Receipt of inotropic support during ECMO was more common in nonsurvivors (66.7% vs. 21.1%, p = 0.035). Extracorporeal membrane oxygenation should be considered in the most severe pediatric toxin exposures as a bridge to recovery, providing time for both toxin elimination and end-organ recovery.
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- 2022
39. Indwelling Central Venous Catheters Drive Bloodstream Infection During Veno-venous Extracorporeal Membrane Oxygenation Support
- Author
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Satoshi Watanabe, Adwaiy Manerikar, Ankit Bharat, Rafael Garza-Castillon, Azad S. Karim, Samuel Kim, Mark Saine, Viswajit Kandula, Chitaru Kurihara, David D. Odell, and Sanket Thakkar
- Subjects
Catheterization, Central Venous ,medicine.medical_treatment ,Biomedical Engineering ,Biophysics ,Bioengineering ,law.invention ,Biomaterials ,Catheters, Indwelling ,Extracorporeal Membrane Oxygenation ,law ,Sepsis ,Bloodstream infection ,Extracorporeal membrane oxygenation ,Central Venous Catheters ,Humans ,Medicine ,In patient ,Single institution ,Oxygenator ,business.industry ,Incidence ,Incidence (epidemiology) ,General Medicine ,equipment and supplies ,bacterial infections and mycoses ,Intensive care unit ,Intensive Care Units ,surgical procedures, operative ,Anesthesia ,business ,Complication ,human activities - Abstract
Blood stream infection (BSI) is a potentially lethal complication in patients receiving extracorporeal membrane oxygenation (ECMO). It may be particularly common in patients with veno-venous ECMO due to their long hospitalization in the intensive care unit. Given that these patients have concurrent indwelling central venous catheters (CVC), it is unclear whether the ECMO circuit, CVC, or both, contribute to BSI. This study evaluated the risk factors associated with BSI in patients receiving veno-venous ECMO in a single institution study of 61 patients from 2016 through 2019. All ECMO catheters and the circuit oxygenator fluid were aseptically collected and analyzed for microorganisms at the time of decannulation. New BSI was diagnosed in 15 (24.6%) patients and increased mortality by threefold. None of the ECMO catheters or oxygenator fluid were culture positive. BSI increased with CVC use of over 8 days and was significantly lowered when CVC were exchanged by day 8 compared with patients with exchanges at later points (15.0% vs. 42.8%, p = 0.02). Median length of CVC use in the BSI-negative and BSI-positive group were 6.3 ± 5.0 and 9.4 ± 5.1, respectively (p = 0.04). In summary, BSI is a potentially lethal complication in patients receiving ECMO. Indwelling CVC, not the ECMO circuitry, is the likely contributor for BSI, and exchanging CVC by day 8 can reduce the incidence of BSI.
- Published
- 2022
40. The Role of Extracorporeal Membrane Oxygenation in the Anesthetic Management of Superior Vena Cava Syndrome: Is it Time to Use a Scoring System?
- Author
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Michael Cline, Lori Meyers, Michael Essandoh, Hamdy Awad, Bethany Potere, Racha Boulos, Matthew C. Henn, Ryan Dalton, Ashley Taylor, and Peter J. Kneuertz
- Subjects
Superior Vena Cava Syndrome ,2019-20 coronavirus outbreak ,Vena Cava, Superior ,Superior vena cava syndrome ,Scoring system ,business.industry ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,medicine.medical_treatment ,SVC SYNDROME ,Anesthetic management ,Mediastinal mass ,Extracorporeal Membrane Oxygenation ,Anesthesiology and Pain Medicine ,Anesthesia ,Extracorporeal membrane oxygenation ,medicine ,Humans ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Anesthetics - Published
- 2022
41. Utilization of Veno-Arterial Extracorporeal Life Support for Acute Respiratory Distress Syndrome After Liver Transplant
- Author
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Amit K. Mathur, Emmanouil Giorgakis, Esteban Calderon, Bhavesh M. Patel, Adyr A. Moss, Winston R. Hewitt, Andrew L. Singer, Kunam S. Reddy, Marwan Sheckley, and Ayan Sen
- Subjects
Transplantation ,business.industry ,medicine.medical_treatment ,Acute kidney injury ,medicine.disease ,Extracorporeal ,Liver disease ,Respiratory failure ,Anesthesia ,medicine ,Coagulopathy ,Extracorporeal membrane oxygenation ,Renal replacement therapy ,business ,Kidney disease - Abstract
In this report, we present a case of successful long-term salvage of a patient with transfusion-related acute lung injury associated with acute respiratory distress syndrome immediately after a liver transplant. The patient was a 29-year-old man with end-stage liver disease due to sclerosing cholangitis who underwent liver transplant. After organ reperfusion, there was evidence of liver congestion, acidosis, coagulopathy, and acute kidney injury. He received 61 units of blood products. Continuous renal replacement therapy was initiated intraoperatively. On arrival to the intensive care unit, the patient was on high-dose pressors, and the patient developed respiratory failure and was immediately placed on veno-arterial extracorporeal membrane oxygenation via open femoral exposure. The patient presented with severe coagulopathy and early allograft dysfunction; therefore, no systemic heparin was administered and no thrombotic events occurred. He required extracorporeal membrane oxygenation support until posttransplant day 4, when resolution of the respiratory and cardiac dysfunction was noted. At 2 years after liver transplant, the patient has normal liver function, normal cognitive function, and stage V chronic kidney disease. We conclude that extracorporeal membrane oxygenation is a valuable therapeutic approach in patients with cardiorespiratory failure after liver transplant.
- Published
- 2022
42. Multi-institutional Analysis of 200 COVID-19 Patients Treated With Extracorporeal Membrane Oxygenation: Outcomes and Trends
- Author
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James D. St. Louis, Vinay Badhwar, Jeffrey P. Jacobs, Marvin J. Slepian, Eric A. Tesdahl, Keshava Rajagopal, Kirti Patel, Tom Coley, Faisal H. Cheema, Anthony K. Sestokas, J.W. Awori Hayanga, Michael S. Firstenberg, Alfred H. Stammers, and Linda B. Mongero
- Subjects
Pulmonary and Respiratory Medicine ,Complete data ,Convalescent plasma ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Critically ill ,medicine.medical_treatment ,Hydroxychloroquine ,Continuous variable ,surgical procedures, operative ,Anesthesia ,Extracorporeal membrane oxygenation ,Medicine ,Surgery ,Cardiology and Cardiovascular Medicine ,business ,Intravenous steroids ,medicine.drug - Abstract
BACKGROUND: The role of ECMO in the management of patients with COVID-19 continues to evolve. The purpose of this manuscript is to review a multi-institutional clinical experience in 200 consecutive patients at 29 hospitals with confirmed COVID-19 supported with ECMO. METHODS: This analysis includes our first 200 COVID-19 patients with complete data who were supported with and separated from ECMO. These patients were cannulated between March 17 and December 9, 2020. Differences by mortality group were assessed using chi-square tests for categorical variables and Kruskal-Wallis rank sum tests and Welch's ANOVA for continuous variables. RESULTS: Median ECMO time was 15 days (IQR=9-28). All 200 patients have separated from ECMO: 90 patients (45%) survived and 110 patients (55%) died. Survival with veno-venous ECMO was 87 of 188 patients (46.3%), while survival with veno-arterial ECMO was 3 of 12 patients (25%). Of 90 survivors, 77 have been discharged from the hospital and 13 remain hospitalized at the ECMO-providing hospital. Survivors had lower median age (47 versus 56 years, p
- Published
- 2022
43. Clinical characteristics of influenza with or without Streptococcus pneumoniae co-infection in children
- Author
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Ting-Yu Yen, Li-Min Huang, Li-Lun Chen, Yun-Chung Liu, Luan-Yin Chang, Tzu-Yun Hsing, Hsiao-Chi Lin, Fei-Pei Lai, Ping-Ing Lee, Yu-Cheng Liu, Chun-Yi Lu, and Jong-Min Chen
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,medicine.disease_cause ,Pneumococcal Infections ,law.invention ,law ,Intensive care ,Internal medicine ,Influenza, Human ,Streptococcus pneumoniae ,medicine ,Extracorporeal membrane oxygenation ,Humans ,Child ,Retrospective Studies ,Mechanical ventilation ,medicine.diagnostic_test ,Coinfection ,business.industry ,Medical record ,Sodium ,Bacterial Infections ,General Medicine ,Intensive care unit ,C-Reactive Protein ,Chest radiograph ,business ,Co infection - Abstract
Background/purpose Influenza is frequently complicated with bacterial co-infection. This study aimed to disclose the significance of Streptococcus pneumoniae co-infection in children with influenza. Methods We retrospectively reviewed medical records of pediatric patients hospitalized for influenza with or without pneumococcal co-infection at the National Taiwan University Hospital from 2007 to 2019. Clinical characteristics and outcomes were compared between patients with and without S. pneumoniae co-infection. Results There were 558 children hospitalized for influenza: 494 had influenza alone whereas 64 had S. pneumoniae co-infection. Patients with S. pneumoniae co-infection had older ages, lower SpO2, higher C-Reactive Protein (CRP), lower serum sodium, lower platelet counts, more chest radiograph findings of patch and consolidation on admission, longer hospitalization, more intensive care, longer intensive care unit (ICU) stay, more mechanical ventilation, more inotropes/vasopressors use, more surgical interventions including video-assisted thoracoscopic surgery (VATS) and extracorporeal membrane oxygenation (ECMO), and higher case-fatality rate. Conclusion Compared to influenza alone, patients with S. pneumoniae co-infection had more morbidities and mortalities. Pneumococcal co-infection is considered when influenza patients have lower SpO2, lower platelet counts, higher CRP, lower serum sodium, and more radiographic patches and consolidations on admission.
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- 2022
44. Extracorporeal Membrane Oxygenation and Perfluorocarbon in a Therapy Refractory Case of Acute Respiratory Distress Syndrome
- Author
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Sven Bercker, Jeanette Henkelmann, Sven Laudi, and Maria T. Voelker
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Pulmonary and Respiratory Medicine ,ARDS ,genetic structures ,Perflubron ,business.industry ,Alveolar proteinosis ,medicine.medical_treatment ,macromolecular substances ,Oxygenation ,Acute respiratory distress ,medicine.disease ,chemistry.chemical_compound ,chemistry ,Refractory ,Edema ,Anesthesia ,Extracorporeal membrane oxygenation ,Medicine ,Surgery ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Perfluorocarbons are oxygen-carrying, dense liquids initially intended for the use in partial or total liquid ventilation in patients with severe acute respiratory distress syndrome (ARDS), but did not show beneficial effects in clinical studies. However, perfluorocarbons may be used for lung lavage in severe alveolar proteinosis. In ARDS, oxygenation may be so severely compromised that the use of non-oxygenated perfluorocarbons may not be possible. We report of a case of severe non-resolving ARDS treated with extracorporeal membrane oxygenation (ECMO) to secure oxygenation, using perfluorocarbon in a single instillation to aid the clearance of debris and proteinacous edema.
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- 2022
45. Outcomes of Extracorporeal Membrane Oxygenation in Patients With Severe Acute Respiratory Distress Syndrome Caused by COVID-19 Versus Influenza
- Author
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Emily Shih, Gary S. Schwartz, J. Michael DiMaio, Kara Monday, Britton Blough, Jasjit K. Banwait, John J. Squiers, Dan M. Meyer, and Timothy J. George
- Subjects
Pulmonary and Respiratory Medicine ,ARDS ,Coronavirus disease 2019 (COVID-19) ,medicine.medical_treatment ,Acute respiratory distress ,Extracorporeal Membrane Oxygenation ,Refractory ,Interquartile range ,Influenza, Human ,medicine ,Clinical endpoint ,Extracorporeal membrane oxygenation ,Humans ,In patient ,Retrospective Studies ,Respiratory Distress Syndrome ,SARS-CoV-2 ,business.industry ,COVID-19 ,medicine.disease ,surgical procedures, operative ,Anesthesia ,Original Article ,Surgery ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background Extracorporeal membrane oxygenation (ECMO) can be effective for refractory acute respiratory distress syndrome (ARDS) in patients with influenza, but its utility in patients with coronavirus disease 2019 (COVID-19) is uncertain. We compared outcomes of patients with refractory ARDS from COVID-19 and influenza placed on ECMO. Methods We conducted a retrospective analysis of 120 patients with refractory ARDS due to COVID-19 or influenza placed on ECMO at 2 referral centers from January 2013 to October 2020. Patient characteristics and clinical outcomes were compared. The primary endpoint was survival to discharge. Results Baseline characteristics and comorbidities were similar. During the study period, 53 patients with COVID-19 and 67 patients with influenza were supported. Venovenous ECMO was the predominant initial cannulation strategy in both groups (COVID 92.5% vs influenza 95.5%; P = .5). Survival to hospital discharge was 62.3% (33 of 53 patients) in the COVID-19 group and 64.2% (43 of 67 patients) in the influenza group (P = .8). In patients successfully decannulated, median length of time on ECMO was longer in COVID-19 patients (14 [interquartile range (IQR), 9-30] days vs influenza 10.5 [IQR, 6.8-14.3] days; P = .004). Among patients discharged alive, COVID-19 patients had longer overall length of stay (COVID-19 37 [IQR, 27-62] days vs influenza 13.5 [IQR, 9.3-24] days; P = .007). Conclusions In patients with refractory ARDS from COVID-19 or influenza placed on ECMO, there was no significant difference in survival to hospital discharge. In patients surviving to decannulation, the duration of ECMO support and total length of stay were longer in COVID-19 patients.
- Published
- 2022
46. Massive perinatal left ventricle infarction treated with tissue plasminogen activator: No ECMO – A case report
- Author
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N. Vijayakumar, Osamah Aldoss, B M Nijres, J Buysse, R Khan, and Mohsen Karimi
- Subjects
medicine.medical_specialty ,Heart Ventricles ,medicine.medical_treatment ,Myocardial Infarction ,Infarction ,Tissue plasminogen activator ,Extracorporeal Membrane Oxygenation ,Pregnancy ,Internal medicine ,Extracorporeal membrane oxygenation ,medicine ,Humans ,cardiovascular diseases ,Myocardial infarction ,Thrombus ,business.industry ,Infant, Newborn ,Thrombosis ,Hypothermia ,medicine.disease ,medicine.anatomical_structure ,Tissue Plasminogen Activator ,Heart failure ,Pediatrics, Perinatology and Child Health ,Cardiology ,Female ,medicine.symptom ,business ,medicine.drug ,Artery - Abstract
Neonatal myocardial infarction due to coronary thrombus is a rare cause of acute heart failure and is associated with high morbidity and mortality. We present a rare case of a full-term newborn who developed coronary artery thrombus treated with intracoronary recombinant tissue plasminogen activator infusion while undergoing therapeutic hypothermia. Also, we describe a unique treatment strategy to support systemic circulation sparing the patient from neonatal extracorporeal membrane oxygenation and its complications. Neonatal myocardial infarction should be suspected and ruled out in sick newborns.
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- 2022
47. Posterior Mediastinal Mass Resection Requiring Venoarterial and Venovenous Extracorporeal Membrane Oxygenation Support
- Author
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Nicholas J. Josten, Aaron M. Cheng, and Pingping Song
- Subjects
medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Mediastinal mass ,030204 cardiovascular system & hematology ,Surgery ,Resection ,03 medical and health sciences ,0302 clinical medicine ,Anesthesiology and Pain Medicine ,030202 anesthesiology ,Superior vena cava ,medicine.artery ,Pulmonary artery ,Anesthetic ,Right heart ,Extracorporeal membrane oxygenation ,Medicine ,Cardiology and Cardiovascular Medicine ,business ,Airway ,medicine.drug - Abstract
Summary Management of a mediastinal mass resection remains a challenging anesthetic scenario due to its compression on airway and major cardiovascular structures. In general, anterior mediastinal masses cause the most severe and often life-threatening complications due to the gravity effect leading to high degree of compression on the trachea, the superior vena cava, the pulmonary artery or the right heart. Posterior mediastinal mass is usually considered at lower risk because of its anatomical distance from those vital structures. Here the authors present a case of a large posterior mediastinal mass leading to severe cardiopulmonary compromise, requiring veno-arterial extracorporeal membrane oxygenation (ECMO) for surgical resection and veno-venous ECMO support for postoperative management. Though rare, posterior mediastinal masses can cause cardiopulmonary collapse with anesthesia induction, specifically with a large size tumor. Patient's positioning, physiological state and anesthetic drugs can pose dynamic changes on the severity of airway and vascular compression. It is important to recognize the potential risks of inducing anesthesia and use a multidisciplinary approach with meticulous planning for alternative management strategies that can be applied according to the patient's clinical condition.
- Published
- 2022
48. Racial Bias in Pulse Oximetry Measurement Among Patients About to Undergo Extracorporeal Membrane Oxygenation in 2019-2020
- Author
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Theodore J. Iwashyna, Ryan P. Barbaro, Robert P. Dickson, Valeria S.M. Valbuena, Thomas S. Valley, Dru Claar, and Michael W. Sjoding
- Subjects
Pulmonary and Respiratory Medicine ,ARDS ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,Retrospective cohort study ,Odds ratio ,Critical Care and Intensive Care Medicine ,medicine.disease ,Occult ,Hypoxemia ,Pulse oximetry ,Respiratory failure ,Internal medicine ,medicine ,Cardiology ,Extracorporeal membrane oxygenation ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background Pulse oximeters may produce less accurate results in non-White patients. Research Question Do pulse oximeters detect arterial hypoxemia less effectively in Black, Hispanic, and/or Asian patients than in White patients in respiratory failure and about to undergo extracorporeal membrane oxygenation (ECMO)? Study Design and Methods Data on adult patients with respiratory failure readings 6 h before ECMO from 324 centers, January 2019 to July 2020, were provided by the Extracorporeal Life Support Organization registry. Our primary analysis was of rates of occult hypoxemia—low arterial oxygen saturation (Sa o 2 ≤ 88%) on arterial blood gas measurement despite a pulse oximetry reading in the range of 92% to 96%. Results The rate of pre-ECMO occult hypoxemia, that is, arterial oxygen saturation (Sa o 2) ≤ 88%, was 10.2% (95% CI, 6.2%-15.3%) for 186 White patients with peripheral oxygen saturation (Sp o 2) of 92% to 96%; 21.5% (95% CI, 11.3%-35.3%) for 51 Black patients (P = .031 vs White); 8.6% (95% CI, 3.2%-17.7%) for 70 Hispanic patients (P = .693 vs White); and 9.2% (95% CI, 3.5%-19.0%) for 65 Asian patients (P = .820 vs White). Black patients with respiratory failure had a statistically significantly higher risk of occult hypoxemia with an OR of 2.57 (95% CI, 1.12-5.92) compared with White patients (P = .026). The risk of occult hypoxemia for Hispanic and Asian patients was equivalent to that of White patients. In a secondary analysis of patients with Sa o 2 ≤ 88% despite Sp o 2 > 96%, Black patients had more than three times the risk compared with White patients (OR, 3.52; 95% CI, 1.12-11.10; P = .032). Interpretation Compared with White patients, the prevalence of occult hypoxemia was higher in Black patients than in White patients about to undergo ECMO for respiratory failure, but it was comparable in Hispanic and Asian patients compared with White patients.
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- 2022
49. Prolonged Extracorporeal Membrane Oxygenation Support as a Bridge to Heart Transplant
- Author
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İshak Şan, Burak Bekgöz, Sinan Sabit Kocabeyoglu, Umit Kervan, Mehmet Karahan, Ali Ozatik, and Dogan Emre Sert
- Subjects
Transplantation ,medicine.medical_specialty ,Percutaneous ,business.industry ,medicine.medical_treatment ,Respiratory support ,Surgery ,Bridge (graph theory) ,Donor heart ,Ventricular assist device ,Extracorporeal membrane oxygenation ,Medicine ,Right ventricular failure ,Implant ,business - Abstract
Heart transplant is in high demand, but the wait list exceeds 6 months in Turkey. Until a donor heart can be procured, venoarterial extracorporeal membrane oxygenation is an important support option to bridge patients on the wait list or as a rescue therapy for patients with right ventricular failure after implant of left ventricular assist device; it is less expensive than other options, provides benefits such as simple percutaneous insertion, and requires neither sternotomy nor biventricular and respiratory support. We present a case of a patient bridged to transplant with 5 months of extracorporeal membrane oxygenation support.
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- 2022
50. Evaluating the evidence for angiotensin II for the treatment of vasoplegia in critically ill cardiothoracic surgery patients
- Author
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Erica D. Wittwer, Jonathan H Chow, Patrick M. Wieruszewski, and Ashish Khanna
- Subjects
Pulmonary and Respiratory Medicine ,Clinical Trials as Topic ,medicine.medical_specialty ,Cardiopulmonary Bypass ,business.industry ,Critically ill ,Angiotensin II ,Critical Illness ,Extracorporeal Membrane Oxygenation ,Postoperative Complications ,Cardiothoracic surgery ,Anesthesia ,Shock (circulatory) ,Vasoplegia ,medicine ,Humans ,Vasoconstrictor Agents ,Surgery ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Published
- 2022
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