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NEWS (4)

Perfusion.com Cardiovascular News Roundup: September 19, 2022

Weekly roundup of interesting reads for the perfusion community, this week including new reviews, COVID trials, transplant news, and interesting findings on blood groups.

NEWS (4)

Perfusion.com Cardiovascular News Roundup:
September 7, 2022

Weekly roundup of interesting reads for the perfusion community, this week including new reviews, COVID trials, transplant news, and interesting findings on blood groups.

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Awake Extracorporeal Life Support and Physiotherapy in Adult Patients: A Systematic Review of the Literature

Awake ECLS strategy associated with physiotherapy is performed regardless of cannulation approach. Ambulation, as main objective, is achieved in almost half the population examined. Prospective studies are needed to evaluate safety and efficacy of physiotherapy during Awake ECLS, and suitable patient selection. Guidelines are required to identify appropriate assessment/evaluation tools for Awake ECLS patients monitoring.

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Arterial Carbon Dioxide and Acute Brain Injury in Venoarterial Extracorporeal Membrane Oxygenation

In conclusion, in a cohort with granular arterial blood gas (ABG) data and a standardized neuromonitoring protocol, higher pre-cannulation PaCO2 and larger ΔPaCO2 were associated with increased prevalence of ICH.

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Effect of Hospital Case Volume on Clinical Outcomes of Patients Requiring Extracorporeal Membrane Oxygenation: A Territory-Wide Longitudinal Observational Study

In a territory-wide observational study, we observed that case volumes in extracorporeal membrane oxygenation centers were not associated with hospital mortality. Maintaining standards of care in low-volume centers is important and improves preparedness for surges in demand.

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Measuring the Resting Energy Expenditure in Children on Extracorporeal Membrane Oxygenation: A Prospective Pilot Study

REE measurements can be obtained by indirect calorimetry in children receiving ECMO support. ECMO may not provide metabolic rest for all children as a wide variation in REE was observed. For optimal care, individual testing should be considered to match calories provided with the metabolic demand.

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Trends, Advantages and Disadvantages in Combined Extracorporeal Lung and Kidney Support From a Technical Point of View

We conducted a review to provide technical background on existing techniques for extracorporeal lung and kidney support and give insight on important aspects to be addressed in the development of this novel highly integrated artificial lung device.

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Ten Overlooked Mistakes During Early Mobilisation in the Intensive Care Unit

Here are ten overlooked mistakes during early mobilisation in the ICU.

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Key Characteristics Impacting Survival of COVID-19 Extracorporeal Membrane Oxygenation.

Structural and patient-related factors, including age, comorbidities and ECMO case volume, determined the survival of COVID-19 ECMO. These factors combined with a more liberal ECMO indication during the 2nd wave may explain the reasonably overall low survival rate. Careful selection of patients and treatment in high volume ECMO centers was associated with higher odds of ICU survival.

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Thrombosis in Extracorporeal Membrane Oxygenation (ECMO) Circuits

Examination of ECMO circuits after removal is a useful quality improvement tool that can elucidate the cause of circuit problems, indicate patients at increased risk of thrombosis, and suggest areas for possible improvements.

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Central, Peripheral ECMO or CPB? Comparsion between Circulatory Support Methods Used during Lung Transplantation

The use of central extracorporeal membrane oxygenation should be favorized over peripheral cannulation or cardiopulmonary bypass. CPB should be no longer used during LuTx.

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Venoarterial Extracorporeal Membrane Oxygenation is A Viable Option as A Bridge to Heart Transplant

Recipients bridged with extracorporeal membrane oxygenation were estimated to survive 16.6 months less than nonmechanical circulatory support recipients. Bridge to heart transplant with extracorporeal membrane oxygenation is a viable option, and these patients should be considered transplant candidates.

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Research Trends and Hotspots of Extracorporeal Membrane Oxygenation: A 10-Year Bibliometric Study and Visualization Analysis

Inter-regional and inter-institutional cooperation and exchanges should be carried out among ECMO research teams and institutions. The suggested research direction is to further broaden the application scope of ECMO, while determining the ways to reduce the incidence of complications and the cost, cultivate specialized team talents, and promote the application thereof.

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To Balloon or Not to Balloon? The Effects of an Intra-Aortic Balloon-Pump on Coronary Artery Flow during Extracorporeal Circulation Simulating Normal and Low Cardiac Output Syndromes

Based on our in vitro study results, combining ECMO and IABP in a heart failure setup further improves coronary blood flow. This effect was more pronounced at a lower heart rate and decreased with heart failure, which might positively impact recovery from cardiac failure.

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Noninvasive Optical Measurement of Microvascular Cerebral Hemodynamics and Autoregulation in the Neonatal ECMO Patient

Our pilot results suggest that systemic measures alone cannot distinguish impaired CA from intact CA during ECMO. Furthermore, optical neuromonitoring could help determine patient-specific ECMO pump flows for optimal CA integrity, thereby reducing risk of secondary brain injury.

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Human Factors in ECLS – A Keystone for Safety and Quality – A Narrative Review for ECLS Providers

Expertise from other industries is extrapolated to improve patient safety through the application of simulation training to reduce error propagation and improve outcomes.

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Pregnant/Peripartum Women with COVID-19 High Survival with ECMO: An ELSO Registry Analysis

We investigated the survival and complications of pregnant/peripartum women with COVID19 supported with V-V ECMO reported to the Extracorporeal Life Support Organization (ELSO) Registry.

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Extracorporeal Membrane Oxygenation in the Forensic Setting: A Series of 19 Forensic Cases

As ECMO therapy has become increasingly available, it is of importance for medical examiners and death investigators to be familiar with the procedure as well as its limitations. Familiarity with ECMO and its sequelae allows for the proper documentation of postmortem findings and fosters an informed determination of the cause and manner of death.

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Intraoperative Management of Adult Patients on Extracorporeal Membrane Oxygenation: an Expert Consensus Statement From the Society of Cardiovascular Anesthesiologists—Part I, Technical Aspects of Extracorporeal Membrane Oxygenation

Extracorporeal membrane oxygenation (ECMO) is used to support patients with refractory cardiopulmonary failure. Given ECMO’s increased use in adults and the fact that many ECMO patients are cared for by anesthesiologists, the Society of Cardiovascular Anesthesiologists ECMO working group created an expert consensus statement that is intended to help anesthesiologists manage adult ECMO patients who are cared for in the operating room. In the first part of this 2-part series, technical aspects of ECMO are discussed, and related expert consensus statements are provided.

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Intraoperative Management of Adult Patients on Extracorporeal Membrane Oxygenation: an Expert Consensus Statement From the Society of Cardiovascular Anesthesiologists— Part II, Intraoperative Management and Troubleshooting

In the first stage of creating the expert consensus statement, topics related to intraoperative ECMO management were proposed by group members. A literature review for each topic was performed using MEDLINE, and articles published after 1980 were included at the discretion of group members. The specific search terms that were queried varied for each topic area.

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Limb Amputation Following Extracorporeal Membrane Oxygenation Therapy Among Survivors: A Nationwide Cohort Study from South Korea

In South Korea, 1.6% of ECMO survivors underwent limb amputation within 365 days after initiating ECMO therapy; however, it was not significantly associated with the 3-year all-cause mortality. Our findings warrant future studies on the impact on the quality of life and morbidity-related implications among patients who undergo limb amputation due to ECMO therapy.

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Adrenaline Improves Regional Cerebral Blood Flow, Cerebral Oxygenation and Cerebral Metabolism During CPR in A Porcine Cardiac Arrest Model Using Low-Flow Extracorporeal Support

This study shows that adrenaline administration during constant low systemic blood flow increases CePP, regional CBF, cerebral oxygenation and cerebral metabolism.

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The Use of Cerebral NIRS Monitoring to Identify Acute Brain Injury in Patients With VA-ECMO

Our results support that cerebral NIRS is a useful, real-time bedside neuromonitoring tool to detect ABI in VA-ECMO patients. A >25% drop from the baseline was sensitive in predicting ABI occurrence. Further research is needed to assess how to implement this knowledge to utilize NIRS in developing appropriate intervention strategy in VA-ECMO patients.

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Left Heart Decompression on Veno-Arterial Extracorporeal Membrane Oxygenation in Children With Dilated Cardiomyopathy and Myocarditis: An Extracorporeal Life Support Organization Registry Review

Retrospective review of the Extracorporeal Life Support Organization registry revealed an association between left heart decompression and greater odds of survival in children with myocarditis and dilated cardiomyopathy on extracorporeal membrane oxygenation. When comparing patients with dilated cardiomyopathy against those with myocarditis, we could not exclude a three-fold greater odds of survival associated with the use of left heart decompression. This finding warrants further prospective evaluation.