J Extra Corpor Technol
· 2025 Sep · PMID 40953240
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BACKGROUND: Data is limited regarding the effects of supraphysiologic blood oxygen tension in patients requiring extracorporeal life support (ECLS). We sought to evaluate the association between hyperoxia and outcomes in...BACKGROUND: Data is limited regarding the effects of supraphysiologic blood oxygen tension in patients requiring extracorporeal life support (ECLS). We sought to evaluate the association between hyperoxia and outcomes in pediatric patients requiring veno-arterial (VA) ECLS. METHODS: Retrospective single-center study at an academic children's hospital that included all patients 0-18 years who required VA-ECLS between 01/2014 and 12/2019. RESULTS: During the study period, 229 VA-ECLS runs occurred in 229 patients. The majority of patients were neonates (73.4%), with cardiac being the most common indication (48.9%). The median time from admission to cannulation was 78.5 h (IQR 14, 356) with a median ECLS duration of 111.5 h (IQR 65.5, 184.5). The overall mortality rate was 44.5%. Using a receiver operating curve, a mean PaO of 233 mmHg in the first 48 h of ECLS was determined to have the optimal discriminatory ability for mortality (sensitivity 36% and specificity 76%). Of the VA-ECLS cohort, 68 (29.7%) had a mean PaO > 233 mmHg (hyperoxia group). The hyperoxia group tended to be older (median age 4.6 vs 1.5 months, p = 0.019), had a primary cardiac indication for VA-ECLS (60% vs 44%, p = 0.0004), and had a higher mortality rate (54% vs 40%, p = 0.050). In the multivariable analysis, after adjusting for covariables, the data demonstrated increased odds of mortality (aOR 2.02, 95% CI [1.03, 3.97], p = 0.03). The odds of development of stage II or III acute kidney injury (AKI) (aOR 2.04, 95% CI [0.82, 5.50]), but that did not reach statistical significance (p = 0.120). CONCLUSION: There is evidence that hyperoxia during the first 48 h of VA-ECLS may be associated with mortality and development of acute kidney injury, although this did not reach statistical significance. Multicenter and prospective evaluation of this modifiable risk factor is imperative to improve the care of this high-risk cohort.
Diop S, Nader M, Fadel E
… +4 more, Kassab MC, Ghadbane H, Ion I, Thes J
J Extra Corpor Technol
· 2025 Sep · PMID 40953239
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BACKGROUND: During deep hypothermic circulatory arrest (DHCA) for pulmonary artery endarterectomy (PAE), the blood volume stored in the cardiotomy reservoir circulates through the oxygenator via the arterial shunt line,...BACKGROUND: During deep hypothermic circulatory arrest (DHCA) for pulmonary artery endarterectomy (PAE), the blood volume stored in the cardiotomy reservoir circulates through the oxygenator via the arterial shunt line, where it remains oxygenated and decarboxylated. The aim of the study was to investigate the change in the acid-base balance of the blood contained in the cardiotomy reservoir during DHCA. METHODS: A four-month retrospective analysis was conducted on patients undergoing PAE. The sweep gas inflow and the inspired fraction of O were kept constant throughout the duration of DHCA. Arterial blood gases were sampled at the beginning and at the end of the DHCA and were analyzed according to the alpha-stat and pH-stat strategies. RESULTS: Twenty-four patients were included with a mean age of 59.2 (±15.7) years. The mean duration of DHCA was 15.2 (±4.1) min and the mean sweep gas inflow was 1.4 (±0.8) L/min. Initial pH and PaCO were 7.31 (±0.09) and 43.2 (±9.9) mmHg, respectively, and final pH and PaCO were 7.51 (± 0.14), p < 0.001 and 23.4 (±11.9) mmHg, p < 0.001. There was a significant correlation between the sweep gas inflow and the post-DHCA pH (r = 0.797). CONCLUSION: The pH increases significantly during the DHCA according to the sweep gas inflow. Decreasing the sweep gas inflow between 0.5 and 1.0 L/min allows for limiting the pH variation during the DHCA period.
J Extra Corpor Technol
· 2025 Sep · PMID 40953238
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BACKGROUND: Acute Type A aortic dissection (ATAAD) is a critical cardiovascular emergency characterized by high mortality rates and complex management challenges. The presence of a tear in the ascending aorta often exten...BACKGROUND: Acute Type A aortic dissection (ATAAD) is a critical cardiovascular emergency characterized by high mortality rates and complex management challenges. The presence of a tear in the ascending aorta often extends into the aortic arch and descending thoracic aorta, leading to malperfusion syndrome, a severe condition resulting from obstructed blood flow to vital organs. Despite the high risks associated with ATAAD, the use of Peripheral Veno-Arterial (VA), Extracorporeal Membrane Oxygenation (ECMO) remains controversial. This intervention aims to maintain systemic circulation and organ perfusion, potentially stabilizing patients prior to surgical repair. MATERIALS AND METHODS: A narrative review of the literature was conducted through a comprehensive search of PubMed and Embase databases, covering the period from January 2000 to March 2025. Keywords included "ECMO", "Type A Aortic Dissection", "malperfusion", and "bridge to surgery", among others. Although this is a narrative review, the methodology was guided by the PRISMA guidelines to ensure transparency and reproducibility in the selection and reporting of the included studies. RESULTS: Ten relevant articles were identified, including observational studies, case series, and reviews. This narrative review presents the role of peripheral VA ECMO in managing ATAAD, focusing on the timing of ECMO initiation and its implications for patient outcomes. The approach emphasizes rapid deployment following confirmation that the iliac and femoral arteries are free from dissection involvement, ensuring safe cannulation and effective circulatory support. The discussion also explores ECMO's role as a bridge to surgery, detailing its impact on preventing malperfusion to critical organs such as the brain, kidneys, and splanchnic organs. CONCLUSION: While VA ECMO offers a potential lifeline for patients with severe ATAAD, its application must be carefully considered within an integrated treatment strategy. The ongoing debate and emerging research underscore the need for further studies to define clear guidelines and optimize ECMO's use in this high-risk patient population. The balance between preventing malperfusion and managing increased myocardial workload presents a complex clinical challenge, necessitating continued investigation and dialogue within the medical community.
Coutinho HMDR, Coutinho JHSA, Torres JH
… +3 more, Casanova RM, Kikuta G, Reis EE
J Extra Corpor Technol
· 2025 Jun · PMID 40523138
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INTRODUCTION: In cardiopulmonary bypass (CPB), blood circulation is temporarily maintained by an artificial blood-pumping device during cardiac surgery. Worldwide, approximately half of the CPB procedures utilize either...INTRODUCTION: In cardiopulmonary bypass (CPB), blood circulation is temporarily maintained by an artificial blood-pumping device during cardiac surgery. Worldwide, approximately half of the CPB procedures utilize either centrifugal or roller pumps (Wu P et al. Front Physiol 12, 699891). Centrifugal pumps, while non-occlusive, pose a risk of blood reflux if there is a system failure, which endangers patient safety (Souza MHL, Elias DO. Fundamentos da Circulação Extracorpórea 2006; 186-192). SafeCEC, a one-way valve, offers a potential solution to this risk by preventing arterial line reflux. This pilot study aims to evaluate patient safety by analyzing hemolysis as an evaluation parameter. Plasma free hemoglobin is chosen to measure patient safety with the use of the product, ensuring it does not cause additional hemolysis during extracorporeal circulation. MATERIALS AND METHODS: After approval by the Ethics Committee, 31 patients undergoing CPB with a centrifugal pump were included in the study. The patients were randomly divided into two groups: group A, where SafeCEC was incorporated into the arterial line, and group B, which used the conventional circuit. Hemolysis was assessed by analyzing plasma free hemoglobin in blood samples collected before CPB, after CPB, and 24 h after weaning from CPB. RESULTS: This device has been shown to be effective in controlling blood reflux, eliminating the need for arterial line clamps. Analysis of plasma free hemoglobin levels revealed no significant differences between the groups with or without SafeCEC. CONCLUSION: The SafeCEC one-way valve effectively prevents reflux without contributing to blood damage, as indicated by the absence of significant hemolysis. This pilot study demonstrates that the SafeCEC is both safe and effective for its intended use.
Murray R, Bi J, Alexander R
… +5 more, Haque MR, Beckman B, Seabrook R, Frazier WJ, Yates AR
J Extra Corpor Technol
· 2025 Jun · PMID 40523137
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BACKGROUND: It is difficult to clinically detect a new infection in patients with Mechanical Circulatory Support (MCS; including veno-arterial and veno-veno extracorporeal membrane oxygenation, and ventricular assist dev...BACKGROUND: It is difficult to clinically detect a new infection in patients with Mechanical Circulatory Support (MCS; including veno-arterial and veno-veno extracorporeal membrane oxygenation, and ventricular assist devices). The prompt, accurate identification of new infection utilizing plasma biomarkers could prompt earlier initiation of antimicrobial agents and may improve outcomes. METHODS: We utilized ELISA to evaluate novel biomarkers, soluble Triggering Receptor Expressed on Myeloid cells (sTREM-1) and Presepsin, as well as existing biomarkers (C-Reactive Protein (CRP) and Procalcitonin) before MCS, daily for the first week of MCS and for the 72 h in advance of the development of a new infection for patients prospectively enrolled in a biobank and who developed a culture positive infection. RESULTS: Serial samples from 18 patients were analyzed. On average post-cannulation Presepsin and sTREM-1 values were not significantly different, however they have higher baseline values than reported in other patient populations. On average during periods of infection, Presepsin was 41% lower (51,462-30,188 pg/mL) (P = 0.001) and procalcitonin was 51% lower (0.77-0.38 ng/mL) (P < 0.001) compared to non-infected periods. Neither CRP or sTREM-1 were significantly different between infected and un-infected periods. CONCLUSION: Presepsin and Procalcitonin decreased in advance of the development of a new infection in the MCS patient population, a direction of change different than expected. These findings highlight the importance of biomarker studies specifically performed in the MCS patient population, and the potential lack of translatability of biomarkers in other patient populations to the MCS patient population.
Dörffel D, Klotz E, Wagner P
… +4 more, Ehrig K, Pretzel K, Hanisch F, Pruß A
J Extra Corpor Technol
· 2025 Jun · PMID 40523136
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BACKGROUND: The use of cell salvage reduces homologous blood transfusions during operations and avoids associated complications. Therefore, autotransfusion is an integral part of Patient Blood Management (PBM). The quali...BACKGROUND: The use of cell salvage reduces homologous blood transfusions during operations and avoids associated complications. Therefore, autotransfusion is an integral part of Patient Blood Management (PBM). The quality control of cell salvage in Germany is performed by checking the target values of a hematocrit in the autotransfusion blood (target: over 50%) and a total protein elimination (target: over 90%). The aim of this study was to identify intraoperative circumstances leading to deviations from the target values. METHODS: This retrospective data analysis includes the use of the cell saver at the Charité - Universitätsmedizin Berlin, Campus Charité Mitte and Campus Benjamin Franklin from 01.01.2019 to 29.03.2022, in which autotransfusion occurred. In addition to the hematocrit and total protein elimination, the age and gender of the patients, as well as the surgical diagnosis, were included to investigate possible factors influencing compliance with the target values. The data were statistically analyzed using SPSS. RESULTS: A total patient collective of 238 cell salvage applications (154 men, 84 women) was examined. The target values for quality control were achieved on average. The target value for hematocrit was not achieved in about 22% and for total protein elimination in about 8% of cell salvage applications. The age and gender of the patient, as well as the surgical diagnosis, had very little to no influence on compliance with the target values. The target values were not met primarily when the emergency option of the cell saver was used, when the collection volume was too low or when the collection volume was heavily diluted with rinsing fluid. CONCLUSION: The target values for quality control were achieved in most of the cell salvage applications examined and are suitable for ensuring the quality of autotransfusion. Special clinical circumstances may lead to the treating anesthetist having to accept deviating collection volumes or washing processes.
Butt SP, Razzaq N, Cook B
… +6 more, Ali B, Saqib H, Amir A, Aljabery Y, Abdulaziz S, Ghori A
J Extra Corpor Technol
· 2025 Jun · PMID 40523135
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INTRODUCTION: Perfusion safety in cardiothoracic surgery is critical, particularly in Pakistan where variability in practice standards exists. This survey investigates the current perfusion practices among Pakistani perf...INTRODUCTION: Perfusion safety in cardiothoracic surgery is critical, particularly in Pakistan where variability in practice standards exists. This survey investigates the current perfusion practices among Pakistani perfusionists, focusing on the adherence to safety standards during cardiopulmonary bypass (CPB) procedures. METHODS: The survey was conducted over two weeks to explore key areas of perfusion practice, including the use of bubble detectors, level detectors, arterial filters, and saturation monitoring during CPB procedures. Out of approximately 350 practicing perfusionists in Pakistan, 66 responded, resulting in a response rate of 18.9%. The data was collected through an online platform, ensuring anonymity and voluntary participation. The survey included mainly Yes/No questions. To ensure reliability and validity, the questionnaire was reviewed by experts, pilot tested, and refined based on feedback, ensuring it was effective in gathering meaningful insights. RESULTS: The survey results indicate a variable use of essential safety devices such as bubble and level detectors, arterial filters, and continuous venous saturation and cerebral saturation monitoring. While some perfusionists adhere to recommended safety protocols, gaps in the use of critical monitoring equipment were evident. CONCLUSION: The findings highlight the need for standardized perfusion practices in Pakistan to ensure safety and efficacy during CPB. Addressing the gaps in the use of safety and monitoring equipment could lead to improved patient outcomes. Further research is needed to explore the barriers to uniform safety standards and to develop strategies for enhancing perfusion safety across the country.
Kırali K, Aksüt M, Altaş Ö
… +2 more, Gürcü ME, Aydın S
J Extra Corpor Technol
· 2025 Jun · PMID 40523134
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BACKGROUND: Minimally invasive extracorporeal circulation (MiECC) has been introduced to mitigate the inflammatory response and reduce blood transfusion needs compared to conventional cardiopulmonary bypass (CPB) periope...BACKGROUND: Minimally invasive extracorporeal circulation (MiECC) has been introduced to mitigate the inflammatory response and reduce blood transfusion needs compared to conventional cardiopulmonary bypass (CPB) perioperatively. A hybrid system (HS) that merges aspects of both traditional CPB and MiECC aims to optimize patient perioperative outcomes. This study focuses on comparing the postoperative transfusion rates, intensive care unit (ICU) course, and biochemical parameters between the HS and MiECC. MATERIALS AND METHODS: This prospective, randomized, controlled, single-center study was conducted at Koşuyolu High Specialization Education and Research Hospital, Istanbul from February 2024 to June 2024. Forty patients undergoing isolated coronary artery bypass grafting (CABG) were included, with 20 patients in the HS-group and 20 in the MiECC-group. Data on oxygen delivery management, hemoglobin and platelet values trends, biochemical parameters, the number of red blood cells and platelet units transfused postoperatively, and ICU stay duration were collected. RESULTS: The CPB time was not significantly shorter in the HS group compared to the MiECC group (93.35 ± 33.06 min vs. 108.65 ± 30.02 min, p = 0.134). Hemoglobin levels did not differ significantly between the groups preoperatively, perioperatively, or postoperatively at 6, 12, and 24 h no difference in red blood cells unit transfusion. Indexed oxygen delivery did not differ significantly between the HS and MiECC groups (311.60 ± 28.29 mL/min/m vs. 332.25 ± 57.04 mL/min/m, p = 0.275). Partial pressure of oxygen was higher in the MiECC group (210.90 ± 49.64 mmHg vs. 177.70 ± 70.41 mmHg, p = 0.093), but this difference was also not statistically significant. Biochemical parameters showed notable differences. Postoperative lactate levels were significantly lower in the HS group (2.85 ± 1.20 mmol/L vs. 4.04 ± 1.40 mmol/L, p = 0.009). Conversely, Lactate Dehydrogenase levels during and after CPB were, lower in the MiECC group. Postoperative 6th-hour troponin levels were significantly lower in the HS group (3.188 ± 2.684 ng/mL vs. 4.645 ± 3.422 ng/mL, p = 0.038). Mechanical ventilation duration, ICU stay, and hospital stay were comparable between the two groups, with no significant differences observed. CONCLUSIONS: The hybrid system demonstrated comparable results to the MiECC in patients undergoing isolated CABG. No significant differences were observed in CPB time or postoperative blood transfusion requirements. However, the HS group showed favorable biochemical parameters, including significantly lower postoperative lactate levels and troponin levels at 6 h. Indexed oxygen delivery and partial pressure of oxygen were similar between groups, and ICU and hospital stay durations were comparable. These findings suggest that the hybrid system offers outcomes on par with the MiECC approach, with potential benefits in terms of biochemical markers. Further studies with larger sample sizes are needed to validate these results and explore possible advantages in broader clinical settings.
J Extra Corpor Technol
· 2025 Jun · PMID 40523133
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Medical procedural registries are uniquely positioned to support shared decision-making through risk prediction modeling, support quality assessment and improvement through performance benchmarking, and provide public re...Medical procedural registries are uniquely positioned to support shared decision-making through risk prediction modeling, support quality assessment and improvement through performance benchmarking, and provide public reporting of evidence-based practices and outcomes. For example, the Centers for Disease Control and Prevention (CDC) consulted the Extracorporeal Life Support Organization (ELSO) registry to assess the severity of the swine flu outbreak in 2009-2010. The development and growth of The Society of Thoracic Surgeons Congenital Heart Surgery Database (STS-CHSD) has positively contributed to the congenital heart surgery community by developing objective mortality STAT categories and complexity stratification for operations, a common nomenclature for classifying operations and reporting the costs associated with complications for nine benchmark operations. Within the setting of adult cardiac surgery, the Perfusion Down Under Collaborative has used its registry to develop quality improvement initiatives, including those related to the management of arterial outlet temperature, glucose, and arterial pCO. The PERForm registry leverages data from nearly 50 US hospitals to support targeted quality improvement initiatives within the setting of adult cardiac surgery. The PERForm registry participants receive benchmark reports and participate in quarterly collaborative learning meetings noted for unblinding hospital performance data. In 2014, with no current congenital cardiopulmonary bypass (CPB) registries, various experts within the congenital perfusion community and leaders from the PERForm registry began working to develop a pediatric perfusion registry. From this work, the PediPERForm Learning Network (PLN) and its associated congenital perfusion registry became active and began collecting data in October 2021.
Beshish AG, Rodriguez-Morales P, Shamah R
… +6 more, Qian J, Keane-Lerner K, Zinyandu T, Davis J, Rosenblum JM, Viamonte HK
J Extra Corpor Technol
· 2025 Jun · PMID 40523132
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BACKGROUND: Data is limited regarding the effects of supraphysiologic blood oxygen tension (hyperoxia) in patients requiring extracorporeal life support (ECLS). We sought to evaluate the association between hyperoxia and...BACKGROUND: Data is limited regarding the effects of supraphysiologic blood oxygen tension (hyperoxia) in patients requiring extracorporeal life support (ECLS). We sought to evaluate the association between hyperoxia and outcomes in pediatric patients requiring veno-venous (VV) ECLS. METHODS: Retrospective single-center study at an academic children's hospital, Children's Healthcare of Atlanta, Emory University School of Medicine that included all patients 0-18 years who required VV-ECLS between 01/2014 and 12/2019. RESULTS: During the study period 110 VV-ECLS runs occurred in 110 patients. Using a receiver operating characteristic curve, a mean partial pressures of oxygen (PaO) of 122 mmHg in the first 48 hours of ECLS was determined to have the optimal discriminatory ability with regard to mortality (sensitivity 41% and specificity 86%). Of the VV-ECLS runs, 68 (61.8%) had PaO > 122 mmHg (hyperoxia group). The hyperoxia group tended to be older (105.4 vs. 1.6 months, p = 0.001), had higher rates of hemorrhagic complications (69.6% vs. 25.3%, p = 0.0001), and higher mortality rate (57.9% vs. 19.5%, p = 0.002). Adjusting for confounders, the hyperoxia group had higher odds of mortality (OR: 7.97, 95% CI: 1.72-36.86, p = 0.0079). CONCLUSION: Children exposed to hyperoxia during the first 48 h of VV-ECLS were 8 times more likely to die than those who were not after adjusting for confounders (age group, body surface area, and indication for ECLS). Multicenter and prospective evaluation of this modifiable risk factor is imperative to improving the care of this high-risk cohort.
J Extra Corpor Technol
· 2025 Mar · PMID 40053860
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The perfusion profession is experiencing rapid advancement, creating an array of new opportunities for professional growth and educational expansion. However, this increase in demand is juxtaposed with a concerning limit...The perfusion profession is experiencing rapid advancement, creating an array of new opportunities for professional growth and educational expansion. However, this increase in demand is juxtaposed with a concerning limitation in the availability of positions for prospective students and may leave many qualified applicants without admission. This letter explores how implementing a national matching service alongside a centralized application service could streamline the application process for perfusion education programs in the United States. Over the last two decades, the number of available positions in perfusion education programs has surged significantly. This growth presents new challenges in recruitment due to varying requirements and timelines, often resulting in unstable matches. A national matching service could standardize acceptances, mitigate unfair practices, and enhance applicants' and program decision-making. By ensuring a fair and efficient system, the national matching service could support the growing need for qualified healthcare perfusionists and promote the perfusion profession's advancement.
J Extra Corpor Technol
· 2025 Mar · PMID 40053859
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The perfusion profession has recently experienced significant advancements in education and practice. Despite competition from other healthcare professions, the demand for perfusionists continues to grow. This work explo...The perfusion profession has recently experienced significant advancements in education and practice. Despite competition from other healthcare professions, the demand for perfusionists continues to grow. This work explores the evolving landscape of perfusion education programs in the United States over the past three decades, highlighting the growing number of accredited programs and rising applicant interest. Additionally, this letter further examines the potential benefits of implementing a centralized application service for perfusion education programs, which could streamline the application process and reduce associated costs for prospective students. By analyzing current trends, including a significant rise in the number of Certified Clinical Perfusionists and enrollment in perfusion education programs, this work underscores the importance of enhancing admission mechanisms to meet the future challenges of the profession. These findings suggest that adopting centralized application services may improve accessibility and efficiency in the application process, ultimately supporting the continued growth of the perfusion profession.
Rusnak D, Condello I, Dohtiar V
… +10 more, Varbanets S, Alieksieieva K, Luhovkin S, Palokha V, Zhoha V, Bukhnei N, Krashevska L, Kutsenko O, Kupina N, Vnukov O
J Extra Corpor Technol
· 2025 Mar · PMID 40053858
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BACKGROUND: In the conflict-affected setting of Kyiv, Ukraine, managing complex medical interventions presents significant challenges, especially for critically ill pediatric patients. This case report describes the prol...BACKGROUND: In the conflict-affected setting of Kyiv, Ukraine, managing complex medical interventions presents significant challenges, especially for critically ill pediatric patients. This case report describes the prolonged use of extracorporeal membrane oxygenation (ECMO) in a 12-year-old girl with severe congenital heart disease, including critical aortic stenosis and myocarditis. In the absence of a transplant system and with limited resources, alternative solutions were explored to balance the high risk of complications and maintain ECMO support over an extended period. METHODS: The patient received ECMO support for a total of 259 days, utilizing both VV-ECMO and VA-ECMO configurations. Due to wartime supply issues, polypropylene fiber oxygenators, specifically the Quadrox-i and Terumo Fx15 models, were used despite not being indicated for long-term use. Eleven oxygenators were employed, with a total of ten replacements due to thrombosis and technical malfunctions. Oxygenator models included EUROSETS Alone, Maquet PLS, Paragon, Terumo Fx15, and Quadrox-i. Frequent adjustments to ECMO parameters, infection control, and daily rehabilitation efforts were essential components of care. Weaning tests consistently indicated no recovery of cardiac function. RESULTS: Despite rigorous management, the oxygenators faced performance declines over time, including clotting, reduced oxygen exchange, and lower CO removal efficiency, necessitating frequent replacements, with a total of ten changes across the ECMO course. Oxygenator usage durations were as follows: EUROSETS (10, 32, 88, and 26 days), Paragon (78 days), Maquet PLS (14 days), Terumo Fx15 (5, 1, 3, and 2 days), and Quadrox-i (1 day). Notably, EUROSETS nr 3 achieved the longest duration of 88 days, while the Paragon oxygenator provided stable support for 78 days. In contrast, the Maquet PLS oxygenator lasted 14 days, and the Terumo Fx15 and Quadrox-i models required rapid replacement within 1-5 days due to accelerated wear and reduced efficacy. Ultimately, ECMO support was discontinued due to irreversible heart failure, with limited options for heart-lung transplantation in Ukraine's conflict-impacted healthcare system. The patient passed away following the cessation of ECMO support due to severe multi-organ dysfunction and complications. CONCLUSIONS: This case underscores the extraordinary challenges of prolonged ECMO use in a pediatric patient within a war zone, highlighting the resilience and adaptability required of healthcare teams in resource-limited settings. The logistical constraints imposed by a lack of suitable biomedical devices and the necessity to use suboptimal models due to supply shortages emphasize the need for international support and resource mobilization to sustain advanced medical care in conflict-affected regions.
Díaz Gómez RA, Alvarado Neves C, Karlezi de la Fuente CG
… +3 more, Bejarano Alva GC, Garcia Gomez D, Rodas García LF
J Extra Corpor Technol
· 2025 Mar · PMID 40053857
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Over the past two decades, extracorporeal membrane oxygenation (ECMO) has been increasingly used to support critical patients with cardiac and respiratory failure who fail to respond to conventional management. In refrac...Over the past two decades, extracorporeal membrane oxygenation (ECMO) has been increasingly used to support critical patients with cardiac and respiratory failure who fail to respond to conventional management. In refractory cardiac arrest, ECMO can restore perfusion in patients who meet specific criteria designed to maximize survival benefit and good neurological outcomes. In recent literature, there is no report of mobile ECMO in a case of prolonged cardiac arrest with direct cardiac massage. We describe our experience with a 34-year-old man with multiple traumatic injuries following a motor vehicle collision. He was treated in a trauma center hospital in the same city as our center. He was initially in stable condition (spontaneous ventilation with FiO2 0.21, no vasoactive drugs, Glasgow 15, no acute kidney injury or other organ dysfunction). One week after admission, a retained left hemopneumothorax required surgical intervention, as previous drainage was ineffective. Computed tomography imaging was also concerning for parencyhmal injury by the thoracotomy tube. Intraoperatively, when the patient was placed in lateral position, he experienced cardiac arrest, presumed to be secondary to pulmonary embolism. After 18 min, we were asked to rescue this patient with ECMO, as he had no contraindications to support. After 81 min of advanced life support, including direct cardiac massage, return of spontaneous circulation was achieved seconds after ECMO was initiated. He was then transported to our hospital. The patient achieved a favorable neurological outcome (Glasgow Coma Scale score of 15 at 24 h) and was discharged after a 2 month stay. This case highlights the potential benefits of prolonged cardiopulmonary resuscitation and ECMO in patients with refractory in-hospital cardiac arrest. In this case, proper ACLS and CPR allowed time for mobile ECMO support to be initiated from a remote center.
Takeichi T, Morimoto Y, Yamada A
… +10 more, Tanaka T, Fujiwara K, Sato M, Toma R, Mitsui K, Sugita T, Yamada H, Nakagaki K, Kuriyama H, Gan K
J Extra Corpor Technol
· 2025 Mar · PMID 40053856
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Minimally invasive cardiac surgery (MICS) for redo mitral valve surgery in the presence of severe atheroma and atherosclerotic diseased atherosclerotic and artheromic aorta presents significant challenges and increases t...Minimally invasive cardiac surgery (MICS) for redo mitral valve surgery in the presence of severe atheroma and atherosclerotic diseased atherosclerotic and artheromic aorta presents significant challenges and increases the risk of postoperative cerebral infarction. At our institution, to mitigate the risk of postoperative cerebral complications, we employ a strategy combining antegrade and retrograde perfusion during MICS for patients with atherosclerotic and artheromic aorta. However, the mixing zone during cardiopulmonary bypass (CPB) with combined antegrade and retrograde perfusion has not been thoroughly evaluated. In this case, we performed a completely endoscopic MICS redo mitral valve plasty (MVP). CPB was established using cannulation of both the ascending aorta (Asc Ao) and the femoral artery (FA). The patient received planned systemic hyperkalemia without an aortic cross clamp. In addition, due to aortic insufficiency, circulatory arrest was also needed. The patient experienced an uneventful post-operative recovery without any cerebral complication. Furthermore, we evaluated the mixing zone during the combined antegrade and retrograde perfusion using an arteriovenous circulation model. Our findings suggest that when performing perfusion via the Asc Ao and FA, it is advisable to select Asc Ao cannulation size reduced by one size against FA cannulation size to optimize the procedure.