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ASAIO Journal
Journal Prestige (SJR): 0.771  Citation Impact (citeScore): 2 Number of Followers: 3  Hybrid journal (It can contain Open Access articles)ISSN (Print) 1058-2916 - ISSN (Online) 1538-943X Published by LWW Wolters Kluwer  [330 journals]
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- Hemodynamic Ramp Testing for Left Ventricular Assist Devices: Overcoming
Biology-
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Authors: Fu; Sheng; Samson, Rohan
Abstract: No abstract available
PubDate: Fri, 26 Jul 2024 00:00:00 GMT-
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- Meet the Authors
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Abstract:
No abstract available
PubDate: Fri, 26 Jul 2024 00:00:00 GMT-
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- Is Infection Prevention or Adhesion Prevention the Ultimate Choice'
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Authors: Sugimura; Yukiharu; Suzuki, Tomoyuki; Mehdiani, Arash; Akhyari, Payam
Abstract: No abstract available
PubDate: Mon, 08 Apr 2024 00:00:00 GMT-
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- Antibiotic Prophylaxis in Patients on Extracorporeal Membrane Oxygenation:
A Systematic Review-
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Authors: Sah; Ranjit; Shah, Sangam; Subedi, Prativa; Kashyap, Ashutosh; KC, Anil; Wosti, Deepa; Sanghavi, Devang; Bhattacharyya, Anirban; Guru, Pramod; Chaudhary, Sanjay
Abstract:
Despite the frequent use of prophylactic antibiotics in hospitals for extracorporeal membrane oxygenation (ECMO) patients, the Extracorporeal Life Support Organization (ELSO) Infectious Disease Task Force does not recommend routine antibiotic prophylaxis due to a lack of compelling evidence. We assessed the effectiveness of prophylactic antibiotics in ECMO patients. We conducted a comprehensive search of multiple databases from their inception up to September 6, 2023, on various databases using keywords like “antibiotics,” “prophylaxis,” “extracorporeal membrane oxygenation,” and “ECMO.” Newcastle-Ottawa Scale (NOS) was used to assess the quality of the included research. We collected data using Microsoft Excel version 2016, mean and standard deviations were calculated for continuous data, while frequencies and percentages were calculated for binomial data. A total of three studies was included in the review with a total of 8,954 participants, of which 4,483 (50.06%) received antibiotic prophylaxis, and 1,131 (25.22%) were female. The administration of antibiotics prophylactically was associated with reduction in rate of mortality, the risk of infections, and complications like acute kidney injury and diarrhea. Although there have been some benefits on antibiotic prophylaxis, prospective research, and possibly the creation of tailored, ECMO-specific bundles will be needed to identify efficient ways to prevent ECMO infection.
PubDate: Tue, 19 Mar 2024 00:00:00 GMT-
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- Prehabilitation Maximizing Functional Mobility in Patients With
Cardiogenic Shock Supported on Axillary Impella-
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Authors: Bhardwaj; Anju; Salas de Armas, Ismael A.; Bergeron, Amanda; Sauer, R. Michelle; Gilley, Christa; Reeves, Kathryn; Patarroyo-Aponte, Maria; Akay, Mehmet H.; Patel, Manish; Kumar, Sachin; Patel, Jayeshkumar; Marcano, Juan; Nathan, Sriram; Gregoric, Igor D.; Kar, Biswajit
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Physical therapy (PT) benefits for critically ill patients are well recognized; however, little data exist on PT in patients receiving temporary mechanical circulatory support. In this single-center retrospective study (February 2017–January 2022), we analyzed 37 patients who received an axillary Impella device (Abiomed, Danvers, MA) and PT to “prehabilitate” them before durable left ventricular assist device (dLVAD) implantation. The Activity Measure for Post-Acute Care (AM-PAC) Basic Mobility tool assessed the functional status at different points during admission. Immediately after Impella placement, the median AM-PAC score was 12.7 (interquartile range [IQR], 9–15), and the scores continued to significantly increase to 18.4 (IQR, 16–23) before dLVAD and up to 20.7 (IQR, 19–24) at discharge, indicating improved independence. No PT-related complications were reported. Thus, we hypothesize that critically ill patients initially deemed equivocal candidates may safely participate in PT while maximizing functional activities before dLVAD placement.
PubDate: Thu, 14 Mar 2024 00:00:00 GMT-
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- Dissolved Oxygen Relevantly Contributes to Systemic Oxygenation During
Venovenous Extracorporeal Membrane Oxygenation Support-
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Authors: Müller; Michael C.; Wilke, Sarah K.; Dobbermann, Andrej; Kirsten, Sascha; Ruß, Martin; Weber-Carstens, Steffen; Wollersheim, Tobias
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When determining extracorporeal oxygen transfer (VMLO2) during venovenous extracorporeal membrane oxygenation (VV ECMO) dissolved oxygen is often considered to play a subordinate role due to its poor solubility in blood plasma. This study was designed to assess the impact of dissolved oxygen on systemic oxygenation in patients with acute respiratory distress syndrome (ARDS) on VV ECMO support by differentiating between dissolved and hemoglobin-bound extracorporeal oxygen transfer. We calculated both extracorporeal oxygen transfer based on blood gas analysis using the measuring energy expenditure in extracorporeal lung support patients (MEEP) protocol and measured oxygen uptake by the native lung with indirect calorimetry. Over 20% of VMLO2 and over 10% of overall oxygen uptake (VO2 total) were realized as dissolved oxygen. The transfer of dissolved oxygen mainly depended on ECMO blood flow (BFML). In patients with severely impaired lung function dissolved oxygen accounted for up to 28% of VO2 total. A clinically relevant amount of oxygen is transferred as physically dissolved fraction, which therefore needs to be considered when determining membrane lung function, manage ECMO settings or guiding the weaning procedure.
PubDate: Wed, 06 Mar 2024 00:00:00 GMT-
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- The Impact of Pre-Heart Transplantation Blood Transfusion Varies Based on
Recipient MELD-XI Score-
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Authors: Nordan; Taylor; Lee, Hansuh H.; Chen, Frederick Y.; Couper, Gregory S.; Kawabori, Masashi
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Prior studies reveal adverse effects of transfusion on cardiac surgery, but little is known of transfusion impact on heart transplantation. First-time, single-organ adult heart transplant recipients between January 1, 2010, and December 31, 2020, were included, stratified above or below a model for end-stage liver disease excluding international normalized ratio (MELD-XI) score of 9.4, and propensity score matched to their nearest neighbor. A 90 day landmark analysis within each cohort was also performed. Unadjusted analysis showed transfusion recipients, MELD-XI ≥9.4, were more likely to experience post-heart transplantation mortality (Hazard Ratio (HR), 1.352 [95% Confidence Interval (CI), 1.239–1.477], p < 0.001), persisting after adjustment for potential confounders (adjusted HR, 1.211 [95% CI, 1.100–1.335], p < 0.001) and after propensity-score matching (HR, 1.174 [95% CI, 1.045–1.319], p = 0.007). Post-transplant length of stay was longer (25.9 vs. 23.2 days, p < 0.001). Post-transplant dialysis was more common (18.7 vs. 15.9%, p = 0.009). There was no survival difference on 90 day landmarked analysis (p = 0.108). With MELD-XI
PubDate: Wed, 06 Mar 2024 00:00:00 GMT-
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- In-Vivo Evaluation of a Novel Integrated Pediatric Pump Lung in a 30-Day
Ovine Animal Model-
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Authors: Leibowitz; Joshua L.; Awad, Morcos A.; Han, Dong; Shah, Aakash; Sun, Wenji; Zhang, Jiafeng; Griffith, Bartley P.; Wu, Zhongjun J.
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Recently there has been increased use of mechanical circulatory support in pediatric patients as a bridge to cardiopulmonary recovery or transplantation. However, there are few devices that are optimized and approved for use in pediatric patients. We designed and prototyped a novel integrated pediatric pump lung (PPL) that underwent 30 day in-vivo testing in seven juvenile Dorset Hybrid sheep. Devices were implanted in a right atrial to pulmonary artery configuration. Six of seven sheep survived with a device functioning for 25–35 days. The device flow rate was maintained at 2.08 ± 0.34 to 2.54 ± 0.16 L/min with oxygen transfer of 109.8 ± 24.8 to 151.2 ± 26.2 ml/min over the study duration. Aside from a postoperative drop in hematocrit, all hematologic and blood chemistry test values returned to normal ranges after 1–2 weeks postoperatively. Similarly, lactate dehydrogenase increased postoperatively and returned to baseline. In two sheep, there were early device failures due to oxygenator thrombosis on postoperative days zero and five; they then had oxygenator exchanges with subsequent devices performing stably for 30 days. This study demonstrated that the integrated PPL device exhibited stable performance and acceptable biocompatibility in a 30 day ovine model.
PubDate: Wed, 06 Mar 2024 00:00:00 GMT-
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- Venoarterial Extracorporeal Membrane Oxygenation Implementation in Septic
Shock Rat Model-
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Authors: Wang; Tianlong; Zhang, Mingru; Dong, Wenhao; Wang, Jing; Zhang, Han; Wang, Yuefu; Ji, Bingyang
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Septic shock, a global health concern, boasts high mortality rates. Research exploring the efficacy of venoarterial extracorporeal membrane oxygenation (VA-ECMO) in septic shock remains limited. Our study aimed to establish a rodent model employing VA-ECMO in septic shock rats, assessing the therapeutic impact of VA-ECMO on septic shock. Nineteen Sprague–Dawley rats were randomly assigned to sham, septic shock, and (septic shock + VA-ECMO; SSE) groups. Septic shock was induced by intravenous lipopolysaccharides, confirmed by a mean arterial pressure drop to 25–30% of baseline. Rats in the SSE group received 2 hours of VA-ECMO support and 60 minutes of post-weaning ventilation. Sham and septic shock groups underwent mechanical ventilation for equivalent durations. Invasive mean arterial pressure monitoring, echocardiographic examinations, and blood gas analysis revealed the efficacy of VA-ECMO in restoring circulation and ensuring adequate tissue oxygenation in septic shock rats. Post-experiment pathology exhibited the potential of VA-ECMO in mitigating major organ injury. In summary, our study successfully established a stable septic shock rat model with the implementation of VA-ECMO, offering a valuable platform to explore molecular mechanisms underlying VA-ECMO’s impact on septic shock.
PubDate: Thu, 29 Feb 2024 00:00:00 GMT-
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- Development and First Clinical Use of an Extracorporeal Artificial
Multiorgan System in Acute-on-Chronic Liver Failure Patients-
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Authors: Ahmad; Suhail; Novokhodko, Alexander; Liou, Iris W.; Smith, Nancy Colobong; Carithers, Robert L.; Reyes, Jorge; Bakthavatsalam, Ramasamy; Martin, Carl; Bhattacharya, Renuka; Du, Nanye; Hao, Shaohang; Gao, Dayong
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Multiple organ failure (MOF) is a common and deadly condition. Patients with liver cirrhosis with acute-on-chronic liver failure (AOCLF) are particularly susceptible. Excess fluid accumulation in tissues makes routine hemodialysis generally ineffective because of cardiovascular instability. Patients with three or more organ failures face a mortality rate of more than 90%. Many cannot survive liver transplantation. Extracorporeal support systems like MARS (Baxter, Deerfield, IL) and Prometheus (Bad Homburg, Germany) have shown promise but fall short in bridging patients to transplantation. A novel Artificial Multi-organ Replacement System (AMOR) was developed at the University of Washington Medical Center. AMOR removes protein-bound toxins through a combination of albumin dialysis, a charcoal sorbent column, and a novel rinsing method to prevent sorbent column saturation. It removes excess fluid through hemodialysis. Ten AOCLF patients with over three organ failures were treated by the AMOR system. All patients showed significant clinical improvement. Fifty percent of the cohort received liver transplants or recovered liver function. AMOR was successful in removing large amounts of excess body fluid, which regular hemodialysis could not. AMOR is cost-effective and user-friendly. It removes excess fluid, supporting the other vital organs such as liver, kidneys, lungs, and heart. This pilot study’s results encourage further exploration of AMOR for treating MOF patients.
PubDate: Wed, 28 Feb 2024 00:00:00 GMT-
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- Unresponsiveness of Activated Partial Thromboplastin Time to Bivalirudin
in Adults Receiving Extracorporeal Membrane Oxygenation-
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Authors: Jatis; Andrew J.; Nei, Scott D.; Seelhammer, Troy G.; Mara, Kristin C.; Wieruszewski, Patrick M.
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Activated partial thromboplastin time (aPTT) is the standard for monitoring bivalirudin but demonstrates a nonlinear response at higher drug concentrations. The objective of this study was to assess the relationship between bivalirudin dose and aPTT in patients receiving extracorporeal membrane oxygenation (ECMO) to determine a threshold where aPTT unresponsiveness occurs. Two hundred fourteen adults receiving bivalirudin during ECMO between 2018 and 2022 were included. Piecewise regression in a linear mixed effects model was used to determine a bivalirudin dose threshold of 0.21 mg/kg/hr for aPTT unresponsiveness. For doses of less than 0.21 mg/kg/hr (n = 135), every 0.1 mg/kg/hr dose increase led to an aPTT increase of 11.53 (95% confidence interval [CI] = 9.85–13.20) seconds compared to only a 3.81 (95% CI = 1.55–6.06) seconds increase when dose was greater than or equal to 0.21 mg/kg/hr (n = 79) (pinteraction < 0.001). In multivariable logistic regression, venovenous configuration (odds ratio [OR] = 2.83, 95% CI = 1.38–5.77) and higher fibrinogen concentration (OR = 1.22, 95% CI = 1.05–1.42) were associated with greater odds of unresponsiveness, whereas older age (OR = 0.79, 95% CI = 0.63–0.98), kidney dysfunction (OR = 0.48, 95% CI = 0.25–0.92), and a higher baseline aPTT (OR = 0.89, 95% CI = 0.82–0.97) were associated with lower odds. Alternative methods are necessary to ascertain bivalirudin’s hemostatic impact when doses exceed 0.21 mg/kg/hr during ECMO.
PubDate: Thu, 22 Feb 2024 00:00:00 GMT-
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- Hemodynamic Optimization by Invasive Ramp Test in Patients Supported With
HeartMate 3 Left Ventricular Assist Device-
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Authors: Rubinstein; Gal; Moeller, Cathrine M.; Lotan, Dor; Slomovich, Sharon; Fernandez-Valledor, Andrea; Oren, Daniel; Oh, Kyung T.; Fried, Justin A.; Clerkin, Kevin J.; Raikhelkar, Jayant K.; Topkara, Veli K.; Kaku, Yuji; Takeda, Koji; Naka, Yoshifumi; Burkhoff, Daniel; Latif, Farhana; Majure, David; Colombo, Paolo C.; Yuzefpolskaya, Melana; Sayer, Gabriel T.; Uriel, Nir
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In patients supported by the HeartMate 3 left ventricular assist device (HM3 LVAD), pump speed adjustments may improve hemodynamics. We investigated the hemodynamic implications of speed adjustments in HM3 recipients undergoing hemodynamic ramp tests. Clinically stable HM3 recipients who underwent routine invasive hemodynamic ramp tests between 2015 and 2022 at our center were included. Filling pressure optimization, defined as central venous pressure (CVP)
PubDate: Mon, 19 Feb 2024 00:00:00 GMT-
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- Durable Right Ventricular Assist Device HeartMate 3 Implant to the Right
Atrium for Right Ventricular Failure After LVAD Implant-
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Authors: Themistokles; Chamogeorgakis; Koliopoulou, Antigoni; Leontiadis, Evangelos; Gkouziouta, Angeliki; Bonios, Michael J.
Abstract:
No abstract available
PubDate: Mon, 19 Feb 2024 00:00:00 GMT-
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- Adsorption Mass Transfer Zone of Vancomycin in Cartridges With
Styrene-Divinylbenzene Sorbent-
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Authors: Reis; Thiago; Ronco, Claudio; Ramírez-Guerrero, Gonzalo; Marcello, Matteo; de Cal, Massimo; Neves, Francisco A. R.; Lorenzin, Anna
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Cartridges for hemoadsorption containing styrene-divinylbenzene sorbent are used for multiple conditions, such as intoxication. The mass transfer zone comprises the extension along the longitudinal span of the cartridge where adsorption occurs. The aim of this experiment is to evaluate the mass transfer zone for vancomycin in the HA380 cartridge. The experiment was carried out twice. A saline solution with vancomycin passed through a HA380-modified cartridge at 100 ml/min in a single-pass fashion. The cartridge had four openings along its longitudinal dimension, at 3, 6, 9, and 12 cm. In both experiments, the collection of aliquots occurred at minute 4, in the four openings and pre- and post-cartridge, and an additional sample from the effluent bag at the end of each experiment. In the second experiment, an additional sampling of the same six sites occurred at minute 14. The sigmoidal shape of the curve for the mass transfer zone of vancomycin was similar to the theoretical one. In experiment one, at minute 4, vancomycin clearance was 98.75 ml/min. In experiment two, vancomycin clearance at minutes 4 and 14 was 93.76 and 93.20 ml/min, respectively. This implies an adequate and optimal design of the HA380 cartridge.
PubDate: Mon, 12 Feb 2024 00:00:00 GMT-
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- Overcoming the Boundaries of Heart Warm Ischemia in Donation After
Circulatory Death: The Padua Case-
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Authors: Gerosa; Gino; Zanatta, Paolo; Angelini, Annalisa; Fedrigo, Marny; Bianco, Roberto; Pittarello, Demetrio; Lena, Tea; Pepe, Alessia; Toscano, Giuseppe; Zanella, Fabio; Feltrin, Giuseppe; Pradegan, Nicola; Tarzia, Vincenzo
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A 45 year old male obese patient with a previous history of repaired congenital heart disease developed worsening heart failure making heart transplantation listing mandatory. Unfortunately, due to his anthropometric measures, the search for a suitable brain-dead donor was unsuccessful. For this reason, he accepted to be enrolled in the controlled donation after circulatory death (cDCD) program. According to the Italian Law regulating death declaration after cardiac arrest (no-touch period of 20 minutes—one of the longest in the world), we faced a 34 minute cardiac asystole, after which the heart was recovered through a thoraco-abdominal normothermic regional perfusion excluding the epiaortic vessels. The heart was then preserved by means of cold static storage. Heart transplantation was performed successfully without any signs of primary graft failure. Postoperative endomyocardial biopsies were negative for acute cellular and antibody-mediated rejection. Furthermore, echocardiographic and cardiac magnetic resonance evaluation of the heart did not show any functional abnormalities. The patient was discharged on post-operative day (POD) #39 in good clinical conditions.
PubDate: Fri, 09 Feb 2024 00:00:00 GMT-
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- Clinical Effects of Nitric Oxide Added to the Oxygenator of Children on
Extracorporeal Membrane Oxygenation: Pre-Post Cohort Study-
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Authors: Pan; Kevin C.; Namachivayam, Siva P.; Chiletti, Roberto; Best, Derek; Horton, Stephen; Butt, Warwick
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Nitric oxide (NO) can be safely delivered through the sweep gas to the oxygenator of an extracorporeal membrane oxygenation (ECMO) circuit. It has theoretical benefits such as preventing platelet adhesion to surfaces, mitigating inflammatory response and protection against ischemia-reperfusion injury. In this uncontrolled before-after study of children on ECMO, the outcomes of those who received NO were compared with those who did not. Among 393 ECMO runs (from 337 patients), 192 of 393 (49%) received NO and 201 of 393 (51%) did not. The use of NO was associated with a 37% reduction in circuit change (adjusted risk ratio [aRR]: 0.63, 95% confidence interval [CI]: 0.42–0.93). The aRR (95% CI) for risk of neurologic injury was 0.72 (0.47–1.11). We observed potential heterogeneity of treatment effect for the risk of neurologic injury in children who had cardiac surgery: the risk with NO was lower in those who had cardiac surgery (aRR: 0.50, 95% CI: 0.26–0.96). There was no difference in survival between the study groups. In children managed with NO delivered through the ECMO circuit, we report a reduction in observed rate of circuit change and lower risk of neurologic injury in children who underwent cardiac surgery. Nitric oxide therapy on ECMO warrants prospective evaluation in children.
PubDate: Thu, 08 Feb 2024 00:00:00 GMT-
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- Percutaneous Stenting of a Stenotic Berlin Heart Outflow Cannula Graft in
a 2-Year-Old Child-
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Authors: Mejia; Ernesto; Cole, Jason; Soszyn, Natalie; Auerbach, Scott; Morgan, Gareth J.
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Left ventricular assist device (LVAD) outflow obstruction is a rare complication of long-term LVAD support. We present the first case of successful percutaneous stent implantation in a pediatric patient with LVAD outflow obstruction.
PubDate: Fri, 01 Dec 2023 00:00:00 GMT-
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