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Category: ECMO

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Comparative Analysis of Therapeutic Strategies in Post-Cardiotomy Cardiogenic Shock: Insight into a High-Volume Cardiac Surgery Center

This study compares treatment outcomes for post-cardiotomy cardiogenic shock (PCCS) at a high-volume center. It retrospectively analyzes 220 patients (3% of 7028) from 2018 to 2022, assessing outcomes between conservative treatments and additional mechanical support with ECMO. Findings show ECMO patients had lower in-hospital mortality (60% vs. 85%) and better end-organ recovery, despite higher complications like dialysis and myocardial infarction, suggesting ECMO’s potential to improve critical patient outcomes.

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ECMO Nexk

Alternative Venous Access Sites for Dual-Lumen Extracorporeal Membrane Oxygenation Cannulation

This multicenter case series examines the safety and feasibility of using alternative venous access sites for dual-lumen cannulas in veno-venous (VV) extracorporeal membrane oxygenation (ECMO) when the right internal jugular vein (RIJV) is inaccessible. Data from three high-volume ECMO centers were analyzed, involving 20 patients who required alternative access due to inaccessible RIJV. The study found no procedural complications with alternative sites, which included the left internal jugular, subclavian, and femoral veins. The outcomes were promising with half of the patients successfully bridged to lung transplantation or recovery, highlighting the viability of these alternative sites for critical ECMO support.

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ECMO Hat

Impact of Center Volume on In-Hospital Mortality in Adult Patients with Out-of-Hospital Cardiac Arrest Resuscitated Using Extracorporeal Cardiopulmonary Resuscitation: A Secondary Analysis of the SAVE-J II Study

This secondary analysis of the SAVE-J II study evaluates the correlation between center volume and in-hospital mortality for patients with out-of-hospital cardiac arrest (OHCA) treated with extracorporeal cardiopulmonary resuscitation (ECPR). Analyzing data from 36 Japanese centers, the study categorizes centers into three groups based on ECPR volume. Findings reveal that high-volume centers (≥21 sessions/year) show a significantly higher survival rate at discharge (33.4%) compared to medium (24.1%) and low-volume (26.8%) centers. Adjusted analysis suggests that patients at high-volume centers are more likely to survive, indicating a positive correlation between center volume and ECPR success.

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ECMO Tan Logo

Comparison of Conventional Methods with Pump-Controlled Retrograde Trial off for Weaning Adults with Cardiogenic Shock from Veno-Arterial Extracorporeal Membrane Oxygenation

This retrospective study evaluates the effectiveness of pump-controlled retrograde trial off (PCRTO) versus conventional weaning methods from veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in adults with cardiogenic shock. It found that the PCRTO method significantly improves survival rates to discharge compared to non-PCRTO methods (90% vs. 72%) and reduces the incidence of cardiogenic shock post-weaning (5% vs. 16%). PCRTO, offering a safe and reversible weaning process, emerges as a useful predictor for successful VA-ECMO weaning through a preload stress test, suggesting its viability as a preferred approach in clinical practice.

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Coronary ECMO

The Jena Method: Perfusionist Independent, Standby Wet-Primed Extracorporeal Membrane Oxygenation (ECMO) Circuit for Immediate Catheterization Laboratory and/or Hybrid Operating Room Deployment

The Jena Method introduces a revolutionary approach to deploying extracorporeal membrane oxygenation (ECMO) rapidly in emergency situations, without needing a perfusionist on hand. By maintaining a wet-primed ECMO system ready for immediate use, this method significantly reduces the initiation time for life-support procedures. Sterility and functionality of the ECMO components are maintained up to 14 days, ensuring patient safety. Training staff for independent ECMO setup and a pictorial guide facilitate quick and efficient deployment. Since its implementation in 2015, this method has demonstrated feasibility, safety, and the potential for widespread adoption in critical care settings, providing a significant advancement in emergency cardiac care.

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Blood Purification

Preliminary Report of Extracorporeal Blood Purification Therapy in Patients Receiving LVAD: Cytosorb or Jafron HA330

This study investigates the effects of extracorporeal blood purification therapy using Cytosorb and Jafron HA330 in patients undergoing Left Ventricular Assist Device (LVAD) implantation, aimed at mitigating immune dysregulation and infectious complications by reducing proinflammatory cytokine levels. Data from 15 patients receiving HeartMate 3™ LVADs were analyzed, with groups assigned to Cytosorb therapy, Jafron HA330, or control (usual care without filters). Results indicated that despite LVAD implantation increasing levels of various inflammatory markers, neither Cytosorb nor Jafron therapies had a significant impact on these markers, in-hospital mortality, or overall survival. The study suggests the need for larger, prospective studies to explore the potential benefits of hemoadsorption therapies in improving outcomes for LVAD patients.

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ECMO Changeout

Improving ECMO Therapy: Monitoring Oxygenator Functionality and Identifying Key Indicators, Factors, and Considerations for Changeout

This article reviews the crucial aspects of determining the optimal timing for extracorporeal membrane oxygenation (ECMO) circuit change-outs to enhance patient outcomes in severe cardiopulmonary failure management. It emphasizes the significance of monitoring coagulation parameters, gas exchange, fibrinogen levels, blood gases, plasma-free hemoglobin, D-dimers, platelet function, flows, pressures, and anticoagulation strategy. The article highlights thrombosis within the membrane oxygenator as a major concern and underlines the importance of a multidisciplinary team and thorough preparation in the change-out process, advocating for standardized protocols and personalized anticoagulation approaches to optimize ECMO therapy.

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Mini Heart

Challenges in the Monitoring of Therapeutic Plasma Exchange during Acute Heparin-Induced Thrombocytopenia in Adults under ECMO

This study reports on the complex process of managing therapeutic plasma exchange (TPE) in patients with acute heparin-induced thrombocytopenia (HIT) on extracorporeal membrane oxygenation (ECMO), aiming to remove HIT antibodies for thoracic surgery. It highlights two cases where repeated TPE sessions allowed for successful surgery with brief heparin re-exposure, despite challenges in monitoring HIT antibody titers and platelet activation. The study emphasizes the necessity of serial HIT screening, including immunological and functional assays, and suggests that adding platelet factor 4 (PF4) to the heparin-induced platelet activation assay (HIPA) could improve detection of platelet-activating antibodies, aiding in the management of HIT in ECMO patients.

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ECMO 6

Survival and Neurological Function in Patients Treated with ECMO and Therapeutic Hypothermia: Protocol for an Updated Systematic Review

This article outlines an updated protocol for a systematic review focused on evaluating the effects of extracorporeal membrane oxygenation (ECMO) and therapeutic hypothermia on survival rates and neurological function in cardiac arrest patients. Despite the widespread application of ECMO enhancing clinical outcomes, its effectiveness remains limited. Therapeutic hypothermia, aimed at maintaining body temperatures between 32°C and 36°C, offers potential neuroprotection and improved survival but is still controversial. This review aims to clarify these interventions’ impacts by systematically searching major databases and analyzing data from a variety of study designs.

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