This article comments on the research by Zhang et al on the role of advanced heart failure and transplant teams in extracorporeal membrane oxygenation(ECMO)management.The study by Zhang et al indicates that direct adv...This article comments on the research by Zhang et al on the role of advanced heart failure and transplant teams in extracorporeal membrane oxygenation(ECMO)management.The study by Zhang et al indicates that direct advanced heart failure and transplant involvement improves survival in ECMO patients,especially those on veno-arterial ECMO.However,the optimal approach varies due to multiple factors.This article discusses the clinical implications,research design limitations,and future directions to enhance ECMO care.展开更多
Extracorporeal membrane oxygenation(ECMO) has been developed for nearly 70 years,and it is the main technology to treat cardiopulmonary failure and continue to maintain life.As the core component of the ECMO system,th...Extracorporeal membrane oxygenation(ECMO) has been developed for nearly 70 years,and it is the main technology to treat cardiopulmonary failure and continue to maintain life.As the core component of the ECMO system,the gas exchange membrane possesses low gas permeability and plasma leakage at present.In addition,the membrane material exists low blood compatibility,causing the formation of thrombosis.Therefore,the membrane material with high gas permeability and blood compatibility are urgently needed.This paper summarizes the membrane development process,preparation method,and modification method.It provides a new idea for the preparation and coating modification as artificial lung membrane.展开更多
Extracorporeal therapies have a definite role in patients with acute liver failure,acute on-chronic liver failure,and progressive chronic liver disease.They act as a bridge-to-transplant in these patients.With the inc...Extracorporeal therapies have a definite role in patients with acute liver failure,acute on-chronic liver failure,and progressive chronic liver disease.They act as a bridge-to-transplant in these patients.With the increasing success of liver transplantation,the immediate postoperative complication spectrum continues to expand.Extracorporeal therapies can play an important role in managing these complications.However,the literature on extracorporeal therapies in the postliver transplant period is limited.This review article discussed various extracorporeal therapies that are still evolving or marred by limited evidence but can improve patient outcomes.These extracorporeal therapies can be divided into two subgroups:(1)Therapies for infective complications.Endotoxin and cytokine adsorption columns;and(2)Therapies for noninfective complications like small for size syndrome,primary allograft nonfunction,early allograft dysfunction,hyperacute rejection,hepatopulmonary syndrome,etc.(plasma exchange,double plasma molecular adsorption,molecular adsorbent recirculation system,and extracorporeal membrane oxygenation,among others).展开更多
BACKGROUND Cardiac arrest caused by acute pulmonary embolism(PE)is the most serious clinical circumstance,necessitating rapid identification,immediate cardiopulmonary resuscitation(CPR),and systemic thrombolytic thera...BACKGROUND Cardiac arrest caused by acute pulmonary embolism(PE)is the most serious clinical circumstance,necessitating rapid identification,immediate cardiopulmonary resuscitation(CPR),and systemic thrombolytic therapy.Extracorporeal CPR(ECPR)is typically employed as a rescue therapy for selected patients when conventional CPR is failing in settings where it can be implemented.CASE SUMMARY We present a case of a 69-year-old male who experienced a prolonged cardiac arrest in an ambulance with pulseless electrical activity.Upon arrival at the emergency department with ongoing manual chest compressions,bedside pointof-care ultrasound revealed an enlarged right ventricle without contractility.Acute PE was suspected as the cause of cardiac arrest,and intravenous thrombolytic therapy with 50 mg tissue plasminogen activator was administered during mechanical chest compressions.Despite 31 minutes of CPR,return of spontaneous circulation was not achieved until 8 minutes after initiation of Veno-arterial extracorporeal membrane oxygenation(ECMO)support.Under ECMO support,the hemodynamic status and myocardial contractility significantly improved.However,the patient ultimately did not survive due to intracerebral hemorrhagic complications,leading to death a few days later in the hospital.CONCLUSION This case illustrates the potential of combining systemic thrombolysis with ECPR for refractory cardiac arrest caused by acute PE,but it also highlights the increased risk of significant bleeding complications,including fatal intracranial hemorrhage.展开更多
Extracorporeal membrane oxygenation(ECMO)has emerged as a vital circulatory life support measure for patients with critical cardiac or pulmonary conditions unresponsive to conventional therapies.ECMO allows blood to b...Extracorporeal membrane oxygenation(ECMO)has emerged as a vital circulatory life support measure for patients with critical cardiac or pulmonary conditions unresponsive to conventional therapies.ECMO allows blood to be extracted from a patient and introduced to a machine that oxygenates blood and removes carbon dioxide.This blood is then reintroduced into the patient’s circulatory system.This process makes ECMO essential for treating various medical conditions,both as a standalone therapy and as adjuvant therapy.Veno-venous(VV)ECMO primarily supports respiratory function and indicates respiratory distress.Simultaneously,veno-arterial(VA)ECMO provides hemodynamic and respiratory support and is suitable for cardiac-related complications.This study reviews recent literature to elucidate the evolving role of ECMO in trauma care,considering its procedural intricacies,indications,contraindications,and associated complications.Notably,the use of ECMO in trauma patients,particularly for acute respiratory distress syndrome and cardiogenic shock,has demonstrated promising outcomes despite challenges such as anticoagulation management and complications such as acute kidney injury,bleeding,thrombosis,and hemolysis.Some studies have shown that VV ECMO was associated with significantly higher survival rates than conventional mechanical ventilation,whereas other studies have reported that VA ECMO was associated with lower survival rates than VV ECMO.ECMO plays a critical role in managing trauma patients,particularly those with acute respiratory failure.Further research is necessary to explore the full potential of ECMO in trauma care.Clinicians should have a clear understanding of the indications and contraindications for the use of ECMO to maximize its benefits in treating trauma patients.展开更多
BACKGROUND Veno-venous extracorporeal membrane oxygenation(V-V ECMO)is a lifesaving intervention for severe respiratory failure;however,its effectiveness depends on accurate cannulation-patients with anatomical variat...BACKGROUND Veno-venous extracorporeal membrane oxygenation(V-V ECMO)is a lifesaving intervention for severe respiratory failure;however,its effectiveness depends on accurate cannulation-patients with anatomical variations present with significant challenges during the procedure.CASE SUMMARY We describe the case of a 56-year-old woman with severe pulmonary infection and acute respiratory failure managed with V-V ECMO.During the initial cannulation,a 23Fr venous drainage cannula was inadvertently inserted into the middle hepatic vein(HV)instead of the inferior vena cava(IVC)owing to the enlargement of the HV(1.02 cm diameter)and its acute angle(77.78°)relative to the IVC.This misplacement led to extracorporeal membrane oxygenation(ECMO)flow issues which were resolved after repositioning the cannula under real-time ultrasonographic and fluoroscopic guidance.This correction stabilized the patient’s condition and restored effective ECMO function,preventing severe complications such as liver injury and liver failure.CONCLUSION In clinical practice,real-time ultrasonography and fluoroscopy are critical in preventing cannulation errors in patients with anatomical variations.Vigilant imaging and precise techniques are essential for optimizing ECMO management and effectively addressing complications.展开更多
This manuscript provides a commentary on the article by Zhang et al.Patients with heart and pulmonary failure who do not respond to standard treatment may benefit from extracorporeal membrane oxygenation(ECMO)support....This manuscript provides a commentary on the article by Zhang et al.Patients with heart and pulmonary failure who do not respond to standard treatment may benefit from extracorporeal membrane oxygenation(ECMO)support.Advanced heart failure and transplant cardiology(AHFTC)teams play an essential role in managing patients in cardiogenic shock.To determine whether ECMO patient management outcomes differ based on whether AHFTC physicians assume a direct or consultative role,a retrospective cohort study of 51 patients placed on veno-venous and veno-arterial(VA)ECMO between January 2015 and February 2023 was conducted.Results demonstrated a significantly higher 30-day postdischarge survival rate in the AHFTC direct involvement cohort compared to the consultative group(67%vs 30%)for all ECMO patients.This survival benefit was primarily attributable to VA ECMO patients(64%vs 20%).Direct involvement of AHFTC teams in patient selection and management may enhance survival in patients requiring VA ECMO for cardiogenic shock;however,further research is necessary to confirm these findings.展开更多
Background:Aortic atherosclerosis increases the risk of embolic events under extracorporeal circulation(ECC).To evaluate the hemodynamic impact of ECC on atheromatous plaques,an atherosclerosis animal model,which is a...Background:Aortic atherosclerosis increases the risk of embolic events under extracorporeal circulation(ECC).To evaluate the hemodynamic impact of ECC on atheromatous plaques,an atherosclerosis animal model,which is also eligible for ECC,is required.Methods:Twenty-nine New Zealand White rabbits received a pro-atherosclerotic diet(group diet,n=10),a pro-atherosclerotic diet and additional intraaortic balloon insufflation injury(group BI,n=9),or served as controls(n=10).After 3 or 6 months,aortic explants were analyzed by(immuno-)histology and RT-PCR.Results:Blood serum analyses revealed increased cholesterol-levels in groups diet and BI compared to controls(3 months:p=0.03 each,6 months:p<0.0001 each).Aortic inflammatory infiltration was significantly enhanced in groups diet(CD3 at 3 months:p<0.0001,6 months:p=0.02;CD68 at 3 months:p=0.01)and BI(CD3 at 3 months:p<0.0001,6 months:p=0.03;CD68 at 3 months:p=0.04,6 months:p=0.02).Increased intima hyperplasia occurred in both groups(p<0.0001 each).Macroscopic analyses after 3 and 6 months showed ubiquitous lumen-narrowing aortic plaques.Calcification of the intima and media was increased in groups diet(intima:p<0.0001 at 3 and 6 months;media at 3 months:p<0.0001,6 months:p=0.01)and BI(intima:p<0.0001 at 3 and 6 months;media at 3 months:p<0.0001,6 months:p=0.02).Extensive lipid accumulation was found in the intima in both treatment groups(p<0.0001 each).Conclusions:A rabbit model with high aortic calcific plaque burden—diet-induced with no implicit need of an additional intimal injury by an intraaortic balloon insufflation due to comparable outcome—exhibiting multiple pathophysiological aspects of human atherosclerosis has been designed and thoroughly characterized.It is suitable for use in future studies on the interaction between atherosclerotic plaques and the arterial blood flow under ECC.展开更多
BACKGROUND Venlafaxine,a serotonin-norepinephrine reuptake inhibitor,is widely prescribed for the treatment of major depressive disorder.At therapeutic dose,it is generally safe,with a low incidence of adverse effects...BACKGROUND Venlafaxine,a serotonin-norepinephrine reuptake inhibitor,is widely prescribed for the treatment of major depressive disorder.At therapeutic dose,it is generally safe,with a low incidence of adverse effects.However,massive venlafaxine inge-stion can cause serious cardiotoxicity,leading to life-threatening arrhythmias.CASE SUMMARY A 31-year-old woman with a history of depression ingested 14.8 g of venlafaxine along with 6 mg of estazolam and 6 mg of flunitrazepam.On admission,2 hours post-ingestion,she presented only with mild QTc prolongation.At 4 hours post-ingestion,she developed a generalized tonic-clonic seizure.Following endo-tracheal intubation,intravenous midazolam infusion was initiated and 50 g of activated charcoal was administered via a nasogastric tube.At 15 hours post-ingestion,she developed ventricular tachycardia that rapidly progressed to refr-actory ventricular fibrillation,which was successfully treated with veno-arterial extracorporeal membrane oxygenation.Toxicological analysis revealed serum ve-nlafaxine and O-desmethylvenlafaxine concentrations 17µg/mL and 10µg/mL,respectively,at 15 hours post-ingestion.CONCLUSION In cases of massive venlafaxine ingestion,continuous intensive monitoring,particularly of QTc,is essential for at least 24 hours,even when initial clinical signs are mild.If refractory ventricular arrhythmias occur,prompt ini-tiation of veno-arterial extracorporeal membrane oxygenation should be considered.展开更多
BACKGROUND Extracorporeal membrane oxygenation(ECMO)is mainly applied to patients with significant cardiorespiratory failure who do not respond to existing conventional treatments.Patients that are supported with veno...BACKGROUND Extracorporeal membrane oxygenation(ECMO)is mainly applied to patients with significant cardiorespiratory failure who do not respond to existing conventional treatments.Patients that are supported with veno-arterial ECMO(VA-ECMO)are considered very-high risk patients to participate in any type of physical therapy(PT)or mobilization.However,cumulative evidence suggests that early mobilization of critically ill patients is feasible,safe,and efficient under certain circumstances.AIM To summarize the existing evidence on the impact of early mobilization and physiotherapy on VA-ECMO patients.METHODS This is a scoping review that used systematic electronic literature searches(from inception until January 2025)on MEDLINE(PubMed),PEDro,DynaMed,CINAHL,Scopus,Science direct and Hellenic Academic Libraries.Snowball searching method was also applied.Eligible studies included those reporting patients on VA-ECMO who participated in early mobilization or PT,published in English and utilized any primary evidence study design.Studies on children,animals and patients placed on any other ECMO,secondary evidence,and‘grey’literature were excluded.RESULTS A total of 316 articles were retrieved and 13 were included in the study.Of those,1 study was a randomized control trial,4 retrospective studies,4 retrospective cohort studies,1 case series and 3 case reports.The sample size of the included studies ranged from 1 to 104 VA-ECMO patients,who were ambulated or received PT inter-ventions,and mobilization frequency ranged from 2 per day to 4 per week.Mobilization of VA-ECMO patients seems to be safe regardless the cannula’s position.PT and early mobilization were associated with better weaning from mechanical ventilation,gradual reduction of inotropes and functional capacity improvement after ECMO discharge.CONCLUSION Early mobilization in VA-ECMO seems to be safe and can potentially help reduce vasoconstrictors and speed up rehabilitation times.High quality research on early mobilization in VA-ECMO patients is warranted.展开更多
BACKGROUND:Extracorporeal membrane oxygenation(ECMO)is an effective measure for saving the lives of critically ill patients.Prompt identification of the risk factors for mortality among patients receiving ECMO and com...BACKGROUND:Extracorporeal membrane oxygenation(ECMO)is an effective measure for saving the lives of critically ill patients.Prompt identification of the risk factors for mortality among patients receiving ECMO and comprehensive analysis of the long-term prognosis of survivors are vital.This scoping review summarized the representative prognostic scoring systems,aiming to help clinicians in selecting an appropriate scoring system to avoid unnecessary medical resource consumption and reduce ECMO-associated mortality.METHODS:A comprehensive search of multiple databases,including PubMed,Embase,and the Cochrane Library,was conducted.After removing duplicate studies,a full-text review was performed,and all studies that reported score systems before and/or after ECMO support were included.This protocol adheres to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews(PRISMA-ScR)and has been registered with the Open Science Framework(osf.io/zp4ge).RESULTS:Among the 114 studies included,we identified three scores for patients receiving veno-venous ECMO(VV-ECMO),five scores for patients receiving veno-arterial ECMO(VA-ECMO),and three critical illness scores,which apply to both VV-and VA-ECMO conditions.All characteristics of these scoring systems,their advantages,and their limitations were summarized.CONCLUSION:The implementation of an ECMO scoring system helps to assess the condition of critically ill patients,predict outcome,and provide objective indicators to determine the optimal timing for ECMO intervention.Due to the limitations of the currently available scores,further efforts in improving and validating the ECMO scoring system are needed to achieve the goals of minimizing unnecessary consumption of medical resources and reducing mortality rates.展开更多
BACKGROUND:Preoperative liver function in children with congenital heart disease is often compromised to varying degrees because of the unique pathophysiology.We aimed to investigate the relationships between liver fu...BACKGROUND:Preoperative liver function in children with congenital heart disease is often compromised to varying degrees because of the unique pathophysiology.We aimed to investigate the relationships between liver function indicators at hospital admission and mortality in children receiving venoarterial extracorporeal membrane oxygenation(VA-ECMO)support following cardiac surgery.METHODS:We retrospectively analysed the clinical data of pediatric patients who received postcardiotomy VA-ECMO support at Fuwai Hospital between January 2010 and June 2020.Univariable and multivariable-adjusted Cox proportional hazard models were constructed to evaluate the risk factors associated with 30-day and 180-day mortality.The cut-off values for the liver function variables measured at hospital admission were categorized into high and low groups and then compared using Kaplan-Meier survival curves and log-rank tests.RESULTS:Our study included 96 pediatric patients who received VA-ECMO support after cardiotomy.Among the patients receiving VA-ECMO,the 30-day and 180-day mortality rates were 37.5% and 52.1%,respectively.The level of aspartate aminotransferase(AST)at admission was associated with 30-day mortality(hazard ratios[HRs]=1.852,95%CI 1.010-3.398,P=0.046).The AST and alkaline phosphatase(ALP)levels were predictors of 180-day mortality,with adjusted HRs of 1.799(95%CI 1.074-3.014;P=0.025)and 1.384(95%CI 1.050-1.825;P=0.021),respectively.The cut-off value for AST to predict mortality at 30 d was 77 U/L,and that for ALP to predict mortality at 180 d was 269 U/L.CONCLUSION:Liver function indicators,including AST and ALP,at hospital admission are associated with mortality risk in children with congenital heart disease receiving VA-ECMO after cardiac surgery.展开更多
BACKGROUND Pheochromocytoma(PHEO)is a type of tumor that originates from chromaffin cells in the adrenal medulla and is classified as an adrenal paraganglioma.PHEOs can secrete catecholamines,leading to a variety of s...BACKGROUND Pheochromocytoma(PHEO)is a type of tumor that originates from chromaffin cells in the adrenal medulla and is classified as an adrenal paraganglioma.PHEOs can secrete catecholamines,leading to a variety of symptoms.Accurate diagnosis and appropriate treatment selection are crucial for favorable outcomes in these cases.CASE SUMMARY The patient presented with unexplained chest tightness,palpitations,and pink sputum.Upon examination and analysis of laboratory results,a diagnosis of adrenal PHEO was established.The PHEO secreted high levels of catecholamines,causing sudden fluctuations in blood pressure and heart rate,leading to extre-mely unstable hemodynamics.Treatment with extracorporeal membrane oxygenation and intra-aortic balloon counterpulsation helped stabilize the patient’s vital signs,allowing for timely surgical intervention.CONCLUSION The combination of extracorporeal membrane oxygenation and intra-aortic balloon counterpulsation can enhance tissue perfusion,thus providing a solid foundation for the accurate diagnosis and effective surgical treatment of PHEO.展开更多
BACKGROUND:Intracranial hemorrhage (ICH),a severe complication among adults receiving extracorporeal membrane oxygenation (ECMO),is often related to poor outcomes.This study aimed to establish a predictive model for I...BACKGROUND:Intracranial hemorrhage (ICH),a severe complication among adults receiving extracorporeal membrane oxygenation (ECMO),is often related to poor outcomes.This study aimed to establish a predictive model for ICH in adults receiving ECMO treatment.METHODS:Adults who received ECMO between January 2017 and June 2022 were the subjects of a single-center retrospective study.Patients under the age of 18 years old,with acute ICH before ECMO,with less than 24 h of ECMO support,and with incomplete data were excluded.ICH was diagnosed by a head computed tomography scan.The outcomes included the incidence of ICH,in-hosptial mortality and 28-day mortality.Multivariate logistic regression analysis was used to identify relevant risk factors of ICH,and a predictive model of ICH with a nomogram was constructed.RESULTS:Among the 227 patients included,22 developed ICH during ECMO.Patients with ICH had higher in-hospital mortality (90.9%vs.47.8%,P=0.001) and higher 28-day mortality (81.8%vs.47.3%,P=0.001) than patients with non-ICH.ICH was associated with decreased grey-white-matter ratio (GWR)(OR=0.894,95%CI:0.841–0.951,P<0.001),stroke history (OR=4.265,95%CI:1.052–17.291,P=0.042),fresh frozen plasma (FFP) transfusion (OR=1.208,95%CI:1.037–1.408,P=0.015)and minimum platelet (PLT) count during ECMO support (OR=0.977,95%CI:0.958–0.996,P=0.019).The area under the receiver operating characteristic curve of the ICH predictive model was 0.843 (95%CI:0.762–0.924,P<0.001).CONCLUSION:ECMO-treated patients with ICH had a higher risk of death.GWR,stroke history,FFP transfusion,and the minimum PLT count were independently associated with ICH,and the ICH predictive model showed that these parameters performed well as diagnostic tools.展开更多
BACKGROUND Data on adsorptive extracorporeal membrane oxygenation(ECMO)(combined with HA380 hemoperfusion column)on the inflammatory factors in patients with cardiogenic shock(CS)remains limited.AIM To investigate the...BACKGROUND Data on adsorptive extracorporeal membrane oxygenation(ECMO)(combined with HA380 hemoperfusion column)on the inflammatory factors in patients with cardiogenic shock(CS)remains limited.AIM To investigate the effects of adsorptive ECMO on the inflammatory factors in patients with CS.METHODS A retrospective analysis was performed on 81 patients with CS caused by acute myocardial infarction,fulminant myocarditis,or cardiac surgery who required venoarterial ECMO support at TEDA International Cardiovascular Hospital from December 2020 to December 2024.Patients were divided into the conventional ECMO group(42 cases)and the adsorptive ECMO group(ECMO combined with hemoperfusion,39 cases).The adsorptive ECMO group received 2 columns of HA380 initiation on the first day(the first column connected within 2 hours of ECMO and the second after 12 hours of ECMO),followed by 1 column each day,with each column used for 4–6 hours,totaling 24–30 hours of treatment.Baseline data were compared between the two groups:Inflammatory factor levels(at 0,6,12,24,48,and 72 hours after ECMO or hemoperfusion initiation);ECMO support duration;successful weaning rate;continuous renal replacement therapy(CRRT)utilization;Sequential Organ Failure Assessment(SOFA)score;Vasoactive-Inotropic Score(VIS);systemic inflammatory response syndrome(SIRS)incidence;and in-hospital survival and 30-/90-day survival after discharge.RESULTS The adsorptive ECMO group showed significantly lower levels of C-reactive protein,interleukin(IL)-6,tumor necrosis factor(TNF)-α,and lactate from 6 to 72 hours compared with the conventional ECMO group(all P<0.05),with IL-6 decreasing by 94.4%and tumour necrosis factor alpha by 70.1%from baseline at 72 hours.The adsorptive ECMO group had a significantly shorter ECMO duration[114.0(75.0–139.0)hours vs 135.0(73.0–199.3)hours,P=0.032];higher successful weaning rate(66.7%vs 42.9%,P=0.032);a trend toward lower CRRT utilization(54.8%vs 38.5%,P=0.070);lower post-weaning SOFA score[7(6–8)vs 9(8–10),P<0.001];significantly reduced VIS(8.4±1.3 vs 9.8±1.6,P<0.001);and a trend toward lower SIRS incidence(10.3%vs 26.2%,P=0.065).There were no significant differences in complications,in-hospital survival(64.1%vs 52.4%,P=0.285);or 30-/90-day survival between the two groups(all P>0.05).CONCLUSION Adsorptive ECMO efficiently clears IL-6 and TNF-α,significantly improving ECMO weaning success rate and hemodynamics.However,it has no significant impact on survival,and its efficacy requires validation through prospective studies.展开更多
Human herpesvirus 6(HHV-6)is a common childhood infection but rarely causes severe complications.In immunocompetent children,conditions such as febrile convulsions and roseola infantum are typical,with occasional seve...Human herpesvirus 6(HHV-6)is a common childhood infection but rarely causes severe complications.In immunocompetent children,conditions such as febrile convulsions and roseola infantum are typical,with occasional severe manifestations like meningoencephalitis and myocarditis.展开更多
Veno-arterial extracorporeal membrane oxygenation(VA-ECMO)is a life support intervention for patients with refractory cardiogenic shock or severe cardiopulmonary failure.However,the choice of cannulation strategy rema...Veno-arterial extracorporeal membrane oxygenation(VA-ECMO)is a life support intervention for patients with refractory cardiogenic shock or severe cardiopulmonary failure.However,the choice of cannulation strategy remains contentious,partly due to insufficient understanding of hemodynamic characteristics associated with the site of arterial cannulation.In this study,a geometrical multiscale model was built to offer a mathematical tool for addressing the issue.The outflow cannula of ECMO was inserted into the ascending aorta in the case of central cannulation,whereas it was inserted into the right subclavian artery(RSA)or the left iliac artery(LIA)in the case of peripheral cannulation.Numerical simulations conducted on three patient-specific aortas demonstrated that the central cannulation outperformed the two types of peripheral cannulation in evenly delivering ECMO flow to branch arteries.Both the central and RSA cannulations could maintain an approximately normal hemodynamic state in the aortas,although the area of aortic walls exposed to abnormal wall shear stress(WSS)was considerably enlarged in comparison with the normal physiological condition.In contrast,the LIA cannulation not only led to insufficient delivery of ECMO flow to the right upper body(with ECMO flow fractions<0.5),but also induced marked flow disturbance in the aorta,causing about 40%of the abdominal aortic wall and over 65%of the resting aortic wall to suffer from high time-averaged WSS(>5 Pa)and low time-averaged WSS(<0.4 Pa),respectively.The LIA cannulation also resulted in significantly prolonged blood residence time(>40 s)in the ascending aorta,which,along with abnormal WSS,may considerably increase the risk of thrombosis.In summary,our numerical study elucidated the impact of arterial cannulation site in VA-ECMO intervention on aortic hemodynamics and ECMO flow distribution.The findings provide compensatory biomechanical information for traditional clinical studies and may serve as a theoretical reference for guiding the evaluation and selection of cannulation strategies in clinical practice.展开更多
BACKGROUND:Previous studies have reported that early computed tomography(CT)findings significantly contribute to the outcomes of cardiac arrest(CA)patients.This study aims to evaluate the association between chest CT ...BACKGROUND:Previous studies have reported that early computed tomography(CT)findings significantly contribute to the outcomes of cardiac arrest(CA)patients.This study aims to evaluate the association between chest CT features and prognosis in CA patients treated with extracorporeal cardiopulmonary resuscitation(ECPR).METHODS:A retrospective observational study was conducted on adult CA patients treated with ECPR in a tertiary hospital between March 2015 and June 2023.All the patients underwent a wholebody CT scan within 1 h of ECPR.Data regarding demographic and clinical characteristics were collected from electronic medical records.The presence of gravity-dependent distribution and CT scores based on chest CT scans were determined for each patient.The primary outcome was 28-day survival.Receiver operating characteristic(ROC)curves were used to evaluate the ability of chest CT features(gravitydependent distribution and CT scores)to predict poor outcomes.The cut-off value of the CT score was determined.Kaplan-Meier curves were used to compare 28-day survival between the low-and high-CT score groups,which were classified using the estimated cut-off value.RESULTS:Among the 100 patients included,74 were non-survivors.The non-survivor patients showed a higher presence of gravity-dependent distribution and higher CT scores than survivors(P<0.05).Patients with gravity-dependent distribution had significantly higher CT scores than those with non-gravity-dependent distribution(P<0.05).The combination of CT score and gravity-dependent distribution predicted poor outcomes better than considering the features individually,demonstrating moderate performance(AUC:0.693,95%CI:0.568-0.801).According to the survival analysis,the risk of death increased as the CT score rose,with an estimated cut-off value of≥11(P=0.016).CONCLUSION:Chest CT features were associated with poor outcomes in CA patients following ECPR.展开更多
Background Acute Myocardial Infarction(AMI)is a critical and commonly encountered condition in the field of cardiovascular medicine.When AMI is complicated by cardiogenic shock(CS),the clinical scenario becomes signif...Background Acute Myocardial Infarction(AMI)is a critical and commonly encountered condition in the field of cardiovascular medicine.When AMI is complicated by cardiogenic shock(CS),the clinical scenario becomes significantly more complex and perilous,with a marked increase in patient mortality.Currently,traditional thera-peutic approaches such as intra-aortic balloon pumping(IABP)have demonstrated efficacy in improving myocardi-al perfusion and hemodynamics.However,the supportive capacity of IABP is limited in patients with severe heart failure.In recent years,extracorporeal membrane oxygenation(ECMO),as an advanced extracorporeal circulatory support technology,has been increasingly utilized in clinical practice,offering a novel therapeutic option for pa-tients with severe heart failure.This study aimed to investigate the clinical efficacy of combining IABP and ECMO in patients with AMI complicated by CS,evaluating its impact on myocardial injury,hemodynamic stability,and clinical outcomes.Methods This study retrospectively analyzed the clinical data of 52 patients with AMI compli-cated by CS admitted to our hospital between May 2023 and May 2024.Based on the treatment methods,the pa-tients were divided into an ECMO group(n=26)and a non-ECMO group(n=26).Post-treatment comparisons were made between the two groups regarding myocardial injury markers such as cardiac troponin I,lactate,and creatine kinase-MB,hemodynamic parameters such as mean arterial pressure,cardiac output,and central venous pressure,and the incidence of complications such as acute kidney injury,bleeding,infection.The primary endpoint of this study was the post-treatment mortality rate and the incidence of complications.Secondary endpoints included changes in myocardial injury markers[cardiac troponin I(cTnI),lactic acid(LAC),creatine kinase isoenzymes(CK-MB)]and improvements in hemodynamic parameters[mean arterial pressure(MAP),cardiac output(CO),central venous pressure(CVP)].The results of multivariate regression analyses were used to explore the incidence of EC-MO complications.Results After treatment,the levels of myocardial injury markers such as cTnI,LAC,and CK-MB in ECMO group were significantly lower than non-ECMO group(P<0.05);MAP and CO in ECMO group were significantly higher than non-ECMO group,while CVP was significantly lower(P<0.05);the mortality rate and the incidence of complications in ECMO group were lower than non-ECMO group(P<0.05).Further multivariate re-gression analysis showed that age,smoking,hyperlipidaemia and diabetes could affect the incidence of ECMO complications(P<0.05).Conclusions The combined use of IABP and ECMO exhibits substantial therapeutic benefits,including the mitigation of myocardial injury,enhancement of hemodynamic stability,and improvement in clinical prognosis among patients with AMI complicated by CS.Clinicians applying ECMO therapy should pay particular attention to older patients or those with concomitant diabetes mellitus or hyperlipidemia,as they might re-quire more intensive monitoring and prophylactic measures to mitigate the occurrence of complications.展开更多
BACKGROUND Advanced heart failure and transplant(AHFTC)teams are crucial in the management of patients in cardiogenic shock.We sought to explore the impact of AHFTC physicians on outcomes in patients receiving extraco...BACKGROUND Advanced heart failure and transplant(AHFTC)teams are crucial in the management of patients in cardiogenic shock.We sought to explore the impact of AHFTC physicians on outcomes in patients receiving extracorporeal membrane oxygenation(ECMO)support.AIM To determine whether outcomes differ in the care of ECMO patients when AHFTC physicians serve in a primary vs consultative role.METHODS We conducted a retrospective cohort study of 51 patients placed on veno-venous(VV)and veno-arterial(VA)ECMO between January 2015 and February 2023 at our institution.We compared ECMO outcomes between teams managed primarily by intensivists vs teams where AHFTC physicians played a direct role in ECMO management,including patient selection.Our primary outcome measure was survival to 30 days post hospital discharge.RESULTS For combined VA and VV ECMO patients,survival to 30 days post discharge in the AHFTC cohort was significantly higher(67%vs 30%,P=0.01),largely driven by a significantly increased 30-day post discharge survival in VA ECMO patients in the AHFTC group(64%vs 20%,P=0.05).CONCLUSION This study suggests that patients in shock requiring VA ECMO support may have improved survival 30 days after hospital discharge when an AHFTC team serves in a direct role in the selection and management of patients.Further studies are needed to validate this impact.展开更多
基金Supported by National Natural Science Foundation of China,No.82200353Jiangsu Province Double Innovation Doctoral Program,No.JSSCBS20221948+3 种基金Suzhou Gusu Health Talent Program,No.(2022)043Suzhou Gusu Health Talent Plan Talent Research Project,No.GSWS2022014Jiangsu Province College Students’Innovation and Entrepreneurship Training Program Project,No.202410285087Zand“Boxi”Talent Casting Plan of the First Affiliated Hospital of Soochow University。
文摘This article comments on the research by Zhang et al on the role of advanced heart failure and transplant teams in extracorporeal membrane oxygenation(ECMO)management.The study by Zhang et al indicates that direct advanced heart failure and transplant involvement improves survival in ECMO patients,especially those on veno-arterial ECMO.However,the optimal approach varies due to multiple factors.This article discusses the clinical implications,research design limitations,and future directions to enhance ECMO care.
基金the support of this work by State Key Laboratory of Tribology in Advanced Equipment,Tsinghua University(61012205321)。
文摘Extracorporeal membrane oxygenation(ECMO) has been developed for nearly 70 years,and it is the main technology to treat cardiopulmonary failure and continue to maintain life.As the core component of the ECMO system,the gas exchange membrane possesses low gas permeability and plasma leakage at present.In addition,the membrane material exists low blood compatibility,causing the formation of thrombosis.Therefore,the membrane material with high gas permeability and blood compatibility are urgently needed.This paper summarizes the membrane development process,preparation method,and modification method.It provides a new idea for the preparation and coating modification as artificial lung membrane.
文摘Extracorporeal therapies have a definite role in patients with acute liver failure,acute on-chronic liver failure,and progressive chronic liver disease.They act as a bridge-to-transplant in these patients.With the increasing success of liver transplantation,the immediate postoperative complication spectrum continues to expand.Extracorporeal therapies can play an important role in managing these complications.However,the literature on extracorporeal therapies in the postliver transplant period is limited.This review article discussed various extracorporeal therapies that are still evolving or marred by limited evidence but can improve patient outcomes.These extracorporeal therapies can be divided into two subgroups:(1)Therapies for infective complications.Endotoxin and cytokine adsorption columns;and(2)Therapies for noninfective complications like small for size syndrome,primary allograft nonfunction,early allograft dysfunction,hyperacute rejection,hepatopulmonary syndrome,etc.(plasma exchange,double plasma molecular adsorption,molecular adsorbent recirculation system,and extracorporeal membrane oxygenation,among others).
基金Supported by Scientific Research Projects from Wuhan Municipal Health Commission of China,No.WX23B42.
文摘BACKGROUND Cardiac arrest caused by acute pulmonary embolism(PE)is the most serious clinical circumstance,necessitating rapid identification,immediate cardiopulmonary resuscitation(CPR),and systemic thrombolytic therapy.Extracorporeal CPR(ECPR)is typically employed as a rescue therapy for selected patients when conventional CPR is failing in settings where it can be implemented.CASE SUMMARY We present a case of a 69-year-old male who experienced a prolonged cardiac arrest in an ambulance with pulseless electrical activity.Upon arrival at the emergency department with ongoing manual chest compressions,bedside pointof-care ultrasound revealed an enlarged right ventricle without contractility.Acute PE was suspected as the cause of cardiac arrest,and intravenous thrombolytic therapy with 50 mg tissue plasminogen activator was administered during mechanical chest compressions.Despite 31 minutes of CPR,return of spontaneous circulation was not achieved until 8 minutes after initiation of Veno-arterial extracorporeal membrane oxygenation(ECMO)support.Under ECMO support,the hemodynamic status and myocardial contractility significantly improved.However,the patient ultimately did not survive due to intracerebral hemorrhagic complications,leading to death a few days later in the hospital.CONCLUSION This case illustrates the potential of combining systemic thrombolysis with ECPR for refractory cardiac arrest caused by acute PE,but it also highlights the increased risk of significant bleeding complications,including fatal intracranial hemorrhage.
文摘Extracorporeal membrane oxygenation(ECMO)has emerged as a vital circulatory life support measure for patients with critical cardiac or pulmonary conditions unresponsive to conventional therapies.ECMO allows blood to be extracted from a patient and introduced to a machine that oxygenates blood and removes carbon dioxide.This blood is then reintroduced into the patient’s circulatory system.This process makes ECMO essential for treating various medical conditions,both as a standalone therapy and as adjuvant therapy.Veno-venous(VV)ECMO primarily supports respiratory function and indicates respiratory distress.Simultaneously,veno-arterial(VA)ECMO provides hemodynamic and respiratory support and is suitable for cardiac-related complications.This study reviews recent literature to elucidate the evolving role of ECMO in trauma care,considering its procedural intricacies,indications,contraindications,and associated complications.Notably,the use of ECMO in trauma patients,particularly for acute respiratory distress syndrome and cardiogenic shock,has demonstrated promising outcomes despite challenges such as anticoagulation management and complications such as acute kidney injury,bleeding,thrombosis,and hemolysis.Some studies have shown that VV ECMO was associated with significantly higher survival rates than conventional mechanical ventilation,whereas other studies have reported that VA ECMO was associated with lower survival rates than VV ECMO.ECMO plays a critical role in managing trauma patients,particularly those with acute respiratory failure.Further research is necessary to explore the full potential of ECMO in trauma care.Clinicians should have a clear understanding of the indications and contraindications for the use of ECMO to maximize its benefits in treating trauma patients.
基金Supported by General Scientific Research Project of the Zhejiang Provincial Department of Education,No.Y201941857the Medical Science and Technology Project of Zhejiang Province,No.2019RC170.
文摘BACKGROUND Veno-venous extracorporeal membrane oxygenation(V-V ECMO)is a lifesaving intervention for severe respiratory failure;however,its effectiveness depends on accurate cannulation-patients with anatomical variations present with significant challenges during the procedure.CASE SUMMARY We describe the case of a 56-year-old woman with severe pulmonary infection and acute respiratory failure managed with V-V ECMO.During the initial cannulation,a 23Fr venous drainage cannula was inadvertently inserted into the middle hepatic vein(HV)instead of the inferior vena cava(IVC)owing to the enlargement of the HV(1.02 cm diameter)and its acute angle(77.78°)relative to the IVC.This misplacement led to extracorporeal membrane oxygenation(ECMO)flow issues which were resolved after repositioning the cannula under real-time ultrasonographic and fluoroscopic guidance.This correction stabilized the patient’s condition and restored effective ECMO function,preventing severe complications such as liver injury and liver failure.CONCLUSION In clinical practice,real-time ultrasonography and fluoroscopy are critical in preventing cannulation errors in patients with anatomical variations.Vigilant imaging and precise techniques are essential for optimizing ECMO management and effectively addressing complications.
文摘This manuscript provides a commentary on the article by Zhang et al.Patients with heart and pulmonary failure who do not respond to standard treatment may benefit from extracorporeal membrane oxygenation(ECMO)support.Advanced heart failure and transplant cardiology(AHFTC)teams play an essential role in managing patients in cardiogenic shock.To determine whether ECMO patient management outcomes differ based on whether AHFTC physicians assume a direct or consultative role,a retrospective cohort study of 51 patients placed on veno-venous and veno-arterial(VA)ECMO between January 2015 and February 2023 was conducted.Results demonstrated a significantly higher 30-day postdischarge survival rate in the AHFTC direct involvement cohort compared to the consultative group(67%vs 30%)for all ECMO patients.This survival benefit was primarily attributable to VA ECMO patients(64%vs 20%).Direct involvement of AHFTC teams in patient selection and management may enhance survival in patients requiring VA ECMO for cardiogenic shock;however,further research is necessary to confirm these findings.
基金German Heart Foundation/German Foundation of Heart Research。
文摘Background:Aortic atherosclerosis increases the risk of embolic events under extracorporeal circulation(ECC).To evaluate the hemodynamic impact of ECC on atheromatous plaques,an atherosclerosis animal model,which is also eligible for ECC,is required.Methods:Twenty-nine New Zealand White rabbits received a pro-atherosclerotic diet(group diet,n=10),a pro-atherosclerotic diet and additional intraaortic balloon insufflation injury(group BI,n=9),or served as controls(n=10).After 3 or 6 months,aortic explants were analyzed by(immuno-)histology and RT-PCR.Results:Blood serum analyses revealed increased cholesterol-levels in groups diet and BI compared to controls(3 months:p=0.03 each,6 months:p<0.0001 each).Aortic inflammatory infiltration was significantly enhanced in groups diet(CD3 at 3 months:p<0.0001,6 months:p=0.02;CD68 at 3 months:p=0.01)and BI(CD3 at 3 months:p<0.0001,6 months:p=0.03;CD68 at 3 months:p=0.04,6 months:p=0.02).Increased intima hyperplasia occurred in both groups(p<0.0001 each).Macroscopic analyses after 3 and 6 months showed ubiquitous lumen-narrowing aortic plaques.Calcification of the intima and media was increased in groups diet(intima:p<0.0001 at 3 and 6 months;media at 3 months:p<0.0001,6 months:p=0.01)and BI(intima:p<0.0001 at 3 and 6 months;media at 3 months:p<0.0001,6 months:p=0.02).Extensive lipid accumulation was found in the intima in both treatment groups(p<0.0001 each).Conclusions:A rabbit model with high aortic calcific plaque burden—diet-induced with no implicit need of an additional intimal injury by an intraaortic balloon insufflation due to comparable outcome—exhibiting multiple pathophysiological aspects of human atherosclerosis has been designed and thoroughly characterized.It is suitable for use in future studies on the interaction between atherosclerotic plaques and the arterial blood flow under ECC.
文摘BACKGROUND Venlafaxine,a serotonin-norepinephrine reuptake inhibitor,is widely prescribed for the treatment of major depressive disorder.At therapeutic dose,it is generally safe,with a low incidence of adverse effects.However,massive venlafaxine inge-stion can cause serious cardiotoxicity,leading to life-threatening arrhythmias.CASE SUMMARY A 31-year-old woman with a history of depression ingested 14.8 g of venlafaxine along with 6 mg of estazolam and 6 mg of flunitrazepam.On admission,2 hours post-ingestion,she presented only with mild QTc prolongation.At 4 hours post-ingestion,she developed a generalized tonic-clonic seizure.Following endo-tracheal intubation,intravenous midazolam infusion was initiated and 50 g of activated charcoal was administered via a nasogastric tube.At 15 hours post-ingestion,she developed ventricular tachycardia that rapidly progressed to refr-actory ventricular fibrillation,which was successfully treated with veno-arterial extracorporeal membrane oxygenation.Toxicological analysis revealed serum ve-nlafaxine and O-desmethylvenlafaxine concentrations 17µg/mL and 10µg/mL,respectively,at 15 hours post-ingestion.CONCLUSION In cases of massive venlafaxine ingestion,continuous intensive monitoring,particularly of QTc,is essential for at least 24 hours,even when initial clinical signs are mild.If refractory ventricular arrhythmias occur,prompt ini-tiation of veno-arterial extracorporeal membrane oxygenation should be considered.
文摘BACKGROUND Extracorporeal membrane oxygenation(ECMO)is mainly applied to patients with significant cardiorespiratory failure who do not respond to existing conventional treatments.Patients that are supported with veno-arterial ECMO(VA-ECMO)are considered very-high risk patients to participate in any type of physical therapy(PT)or mobilization.However,cumulative evidence suggests that early mobilization of critically ill patients is feasible,safe,and efficient under certain circumstances.AIM To summarize the existing evidence on the impact of early mobilization and physiotherapy on VA-ECMO patients.METHODS This is a scoping review that used systematic electronic literature searches(from inception until January 2025)on MEDLINE(PubMed),PEDro,DynaMed,CINAHL,Scopus,Science direct and Hellenic Academic Libraries.Snowball searching method was also applied.Eligible studies included those reporting patients on VA-ECMO who participated in early mobilization or PT,published in English and utilized any primary evidence study design.Studies on children,animals and patients placed on any other ECMO,secondary evidence,and‘grey’literature were excluded.RESULTS A total of 316 articles were retrieved and 13 were included in the study.Of those,1 study was a randomized control trial,4 retrospective studies,4 retrospective cohort studies,1 case series and 3 case reports.The sample size of the included studies ranged from 1 to 104 VA-ECMO patients,who were ambulated or received PT inter-ventions,and mobilization frequency ranged from 2 per day to 4 per week.Mobilization of VA-ECMO patients seems to be safe regardless the cannula’s position.PT and early mobilization were associated with better weaning from mechanical ventilation,gradual reduction of inotropes and functional capacity improvement after ECMO discharge.CONCLUSION Early mobilization in VA-ECMO seems to be safe and can potentially help reduce vasoconstrictors and speed up rehabilitation times.High quality research on early mobilization in VA-ECMO patients is warranted.
基金Natural Sciences Foundation of Gansu(No.23JRRA0972No.25RCKA013)+4 种基金Natural Sciences Foundation of Fujian(No.2022J05105)Science and Technology Planning Project of Chengguan District(No.2022RCCX0023)Cuiying Scientific and Technological Innovation Program of Lanzhou University Second Hospital(No.CY2022-MS-A03)Talent Introduction Plan of the Lanzhou University Second Hospital(No.YJRCKYQDJ-2021-02)Major Scientific Research Project on Health and Medical Science and Technology Innovation in Gansu Province(No.GSWSQNPY2024-13).
文摘BACKGROUND:Extracorporeal membrane oxygenation(ECMO)is an effective measure for saving the lives of critically ill patients.Prompt identification of the risk factors for mortality among patients receiving ECMO and comprehensive analysis of the long-term prognosis of survivors are vital.This scoping review summarized the representative prognostic scoring systems,aiming to help clinicians in selecting an appropriate scoring system to avoid unnecessary medical resource consumption and reduce ECMO-associated mortality.METHODS:A comprehensive search of multiple databases,including PubMed,Embase,and the Cochrane Library,was conducted.After removing duplicate studies,a full-text review was performed,and all studies that reported score systems before and/or after ECMO support were included.This protocol adheres to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews(PRISMA-ScR)and has been registered with the Open Science Framework(osf.io/zp4ge).RESULTS:Among the 114 studies included,we identified three scores for patients receiving veno-venous ECMO(VV-ECMO),five scores for patients receiving veno-arterial ECMO(VA-ECMO),and three critical illness scores,which apply to both VV-and VA-ECMO conditions.All characteristics of these scoring systems,their advantages,and their limitations were summarized.CONCLUSION:The implementation of an ECMO scoring system helps to assess the condition of critically ill patients,predict outcome,and provide objective indicators to determine the optimal timing for ECMO intervention.Due to the limitations of the currently available scores,further efforts in improving and validating the ECMO scoring system are needed to achieve the goals of minimizing unnecessary consumption of medical resources and reducing mortality rates.
基金supported by the CAMS Innovation Fund for Medical Sciences(2024-12M-C&T-B-045).
文摘BACKGROUND:Preoperative liver function in children with congenital heart disease is often compromised to varying degrees because of the unique pathophysiology.We aimed to investigate the relationships between liver function indicators at hospital admission and mortality in children receiving venoarterial extracorporeal membrane oxygenation(VA-ECMO)support following cardiac surgery.METHODS:We retrospectively analysed the clinical data of pediatric patients who received postcardiotomy VA-ECMO support at Fuwai Hospital between January 2010 and June 2020.Univariable and multivariable-adjusted Cox proportional hazard models were constructed to evaluate the risk factors associated with 30-day and 180-day mortality.The cut-off values for the liver function variables measured at hospital admission were categorized into high and low groups and then compared using Kaplan-Meier survival curves and log-rank tests.RESULTS:Our study included 96 pediatric patients who received VA-ECMO support after cardiotomy.Among the patients receiving VA-ECMO,the 30-day and 180-day mortality rates were 37.5% and 52.1%,respectively.The level of aspartate aminotransferase(AST)at admission was associated with 30-day mortality(hazard ratios[HRs]=1.852,95%CI 1.010-3.398,P=0.046).The AST and alkaline phosphatase(ALP)levels were predictors of 180-day mortality,with adjusted HRs of 1.799(95%CI 1.074-3.014;P=0.025)and 1.384(95%CI 1.050-1.825;P=0.021),respectively.The cut-off value for AST to predict mortality at 30 d was 77 U/L,and that for ALP to predict mortality at 180 d was 269 U/L.CONCLUSION:Liver function indicators,including AST and ALP,at hospital admission are associated with mortality risk in children with congenital heart disease receiving VA-ECMO after cardiac surgery.
文摘BACKGROUND Pheochromocytoma(PHEO)is a type of tumor that originates from chromaffin cells in the adrenal medulla and is classified as an adrenal paraganglioma.PHEOs can secrete catecholamines,leading to a variety of symptoms.Accurate diagnosis and appropriate treatment selection are crucial for favorable outcomes in these cases.CASE SUMMARY The patient presented with unexplained chest tightness,palpitations,and pink sputum.Upon examination and analysis of laboratory results,a diagnosis of adrenal PHEO was established.The PHEO secreted high levels of catecholamines,causing sudden fluctuations in blood pressure and heart rate,leading to extre-mely unstable hemodynamics.Treatment with extracorporeal membrane oxygenation and intra-aortic balloon counterpulsation helped stabilize the patient’s vital signs,allowing for timely surgical intervention.CONCLUSION The combination of extracorporeal membrane oxygenation and intra-aortic balloon counterpulsation can enhance tissue perfusion,thus providing a solid foundation for the accurate diagnosis and effective surgical treatment of PHEO.
基金supported by the National Natural Science Foundation of China (82072159)。
文摘BACKGROUND:Intracranial hemorrhage (ICH),a severe complication among adults receiving extracorporeal membrane oxygenation (ECMO),is often related to poor outcomes.This study aimed to establish a predictive model for ICH in adults receiving ECMO treatment.METHODS:Adults who received ECMO between January 2017 and June 2022 were the subjects of a single-center retrospective study.Patients under the age of 18 years old,with acute ICH before ECMO,with less than 24 h of ECMO support,and with incomplete data were excluded.ICH was diagnosed by a head computed tomography scan.The outcomes included the incidence of ICH,in-hosptial mortality and 28-day mortality.Multivariate logistic regression analysis was used to identify relevant risk factors of ICH,and a predictive model of ICH with a nomogram was constructed.RESULTS:Among the 227 patients included,22 developed ICH during ECMO.Patients with ICH had higher in-hospital mortality (90.9%vs.47.8%,P=0.001) and higher 28-day mortality (81.8%vs.47.3%,P=0.001) than patients with non-ICH.ICH was associated with decreased grey-white-matter ratio (GWR)(OR=0.894,95%CI:0.841–0.951,P<0.001),stroke history (OR=4.265,95%CI:1.052–17.291,P=0.042),fresh frozen plasma (FFP) transfusion (OR=1.208,95%CI:1.037–1.408,P=0.015)and minimum platelet (PLT) count during ECMO support (OR=0.977,95%CI:0.958–0.996,P=0.019).The area under the receiver operating characteristic curve of the ICH predictive model was 0.843 (95%CI:0.762–0.924,P<0.001).CONCLUSION:ECMO-treated patients with ICH had a higher risk of death.GWR,stroke history,FFP transfusion,and the minimum PLT count were independently associated with ICH,and the ICH predictive model showed that these parameters performed well as diagnostic tools.
基金Supported by the Priority Project of the Multi-Source Investment Fund Program,China,No.S21DYZD3172the Tianjin Key Medical Discipline(Specialty)Construction Project,China,No.TJYXZDXK-020A.
文摘BACKGROUND Data on adsorptive extracorporeal membrane oxygenation(ECMO)(combined with HA380 hemoperfusion column)on the inflammatory factors in patients with cardiogenic shock(CS)remains limited.AIM To investigate the effects of adsorptive ECMO on the inflammatory factors in patients with CS.METHODS A retrospective analysis was performed on 81 patients with CS caused by acute myocardial infarction,fulminant myocarditis,or cardiac surgery who required venoarterial ECMO support at TEDA International Cardiovascular Hospital from December 2020 to December 2024.Patients were divided into the conventional ECMO group(42 cases)and the adsorptive ECMO group(ECMO combined with hemoperfusion,39 cases).The adsorptive ECMO group received 2 columns of HA380 initiation on the first day(the first column connected within 2 hours of ECMO and the second after 12 hours of ECMO),followed by 1 column each day,with each column used for 4–6 hours,totaling 24–30 hours of treatment.Baseline data were compared between the two groups:Inflammatory factor levels(at 0,6,12,24,48,and 72 hours after ECMO or hemoperfusion initiation);ECMO support duration;successful weaning rate;continuous renal replacement therapy(CRRT)utilization;Sequential Organ Failure Assessment(SOFA)score;Vasoactive-Inotropic Score(VIS);systemic inflammatory response syndrome(SIRS)incidence;and in-hospital survival and 30-/90-day survival after discharge.RESULTS The adsorptive ECMO group showed significantly lower levels of C-reactive protein,interleukin(IL)-6,tumor necrosis factor(TNF)-α,and lactate from 6 to 72 hours compared with the conventional ECMO group(all P<0.05),with IL-6 decreasing by 94.4%and tumour necrosis factor alpha by 70.1%from baseline at 72 hours.The adsorptive ECMO group had a significantly shorter ECMO duration[114.0(75.0–139.0)hours vs 135.0(73.0–199.3)hours,P=0.032];higher successful weaning rate(66.7%vs 42.9%,P=0.032);a trend toward lower CRRT utilization(54.8%vs 38.5%,P=0.070);lower post-weaning SOFA score[7(6–8)vs 9(8–10),P<0.001];significantly reduced VIS(8.4±1.3 vs 9.8±1.6,P<0.001);and a trend toward lower SIRS incidence(10.3%vs 26.2%,P=0.065).There were no significant differences in complications,in-hospital survival(64.1%vs 52.4%,P=0.285);or 30-/90-day survival between the two groups(all P>0.05).CONCLUSION Adsorptive ECMO efficiently clears IL-6 and TNF-α,significantly improving ECMO weaning success rate and hemodynamics.However,it has no significant impact on survival,and its efficacy requires validation through prospective studies.
文摘Human herpesvirus 6(HHV-6)is a common childhood infection but rarely causes severe complications.In immunocompetent children,conditions such as febrile convulsions and roseola infantum are typical,with occasional severe manifestations like meningoencephalitis and myocarditis.
基金supported by the National Natural Science Foundation of China(Grant Nos.12372309,12061131015).
文摘Veno-arterial extracorporeal membrane oxygenation(VA-ECMO)is a life support intervention for patients with refractory cardiogenic shock or severe cardiopulmonary failure.However,the choice of cannulation strategy remains contentious,partly due to insufficient understanding of hemodynamic characteristics associated with the site of arterial cannulation.In this study,a geometrical multiscale model was built to offer a mathematical tool for addressing the issue.The outflow cannula of ECMO was inserted into the ascending aorta in the case of central cannulation,whereas it was inserted into the right subclavian artery(RSA)or the left iliac artery(LIA)in the case of peripheral cannulation.Numerical simulations conducted on three patient-specific aortas demonstrated that the central cannulation outperformed the two types of peripheral cannulation in evenly delivering ECMO flow to branch arteries.Both the central and RSA cannulations could maintain an approximately normal hemodynamic state in the aortas,although the area of aortic walls exposed to abnormal wall shear stress(WSS)was considerably enlarged in comparison with the normal physiological condition.In contrast,the LIA cannulation not only led to insufficient delivery of ECMO flow to the right upper body(with ECMO flow fractions<0.5),but also induced marked flow disturbance in the aorta,causing about 40%of the abdominal aortic wall and over 65%of the resting aortic wall to suffer from high time-averaged WSS(>5 Pa)and low time-averaged WSS(<0.4 Pa),respectively.The LIA cannulation also resulted in significantly prolonged blood residence time(>40 s)in the ascending aorta,which,along with abnormal WSS,may considerably increase the risk of thrombosis.In summary,our numerical study elucidated the impact of arterial cannulation site in VA-ECMO intervention on aortic hemodynamics and ECMO flow distribution.The findings provide compensatory biomechanical information for traditional clinical studies and may serve as a theoretical reference for guiding the evaluation and selection of cannulation strategies in clinical practice.
基金approved by the Ethics Committee of the First Affiliated Hospital of Nanjing Medical University(2020-SR-226).
文摘BACKGROUND:Previous studies have reported that early computed tomography(CT)findings significantly contribute to the outcomes of cardiac arrest(CA)patients.This study aims to evaluate the association between chest CT features and prognosis in CA patients treated with extracorporeal cardiopulmonary resuscitation(ECPR).METHODS:A retrospective observational study was conducted on adult CA patients treated with ECPR in a tertiary hospital between March 2015 and June 2023.All the patients underwent a wholebody CT scan within 1 h of ECPR.Data regarding demographic and clinical characteristics were collected from electronic medical records.The presence of gravity-dependent distribution and CT scores based on chest CT scans were determined for each patient.The primary outcome was 28-day survival.Receiver operating characteristic(ROC)curves were used to evaluate the ability of chest CT features(gravitydependent distribution and CT scores)to predict poor outcomes.The cut-off value of the CT score was determined.Kaplan-Meier curves were used to compare 28-day survival between the low-and high-CT score groups,which were classified using the estimated cut-off value.RESULTS:Among the 100 patients included,74 were non-survivors.The non-survivor patients showed a higher presence of gravity-dependent distribution and higher CT scores than survivors(P<0.05).Patients with gravity-dependent distribution had significantly higher CT scores than those with non-gravity-dependent distribution(P<0.05).The combination of CT score and gravity-dependent distribution predicted poor outcomes better than considering the features individually,demonstrating moderate performance(AUC:0.693,95%CI:0.568-0.801).According to the survival analysis,the risk of death increased as the CT score rose,with an estimated cut-off value of≥11(P=0.016).CONCLUSION:Chest CT features were associated with poor outcomes in CA patients following ECPR.
文摘Background Acute Myocardial Infarction(AMI)is a critical and commonly encountered condition in the field of cardiovascular medicine.When AMI is complicated by cardiogenic shock(CS),the clinical scenario becomes significantly more complex and perilous,with a marked increase in patient mortality.Currently,traditional thera-peutic approaches such as intra-aortic balloon pumping(IABP)have demonstrated efficacy in improving myocardi-al perfusion and hemodynamics.However,the supportive capacity of IABP is limited in patients with severe heart failure.In recent years,extracorporeal membrane oxygenation(ECMO),as an advanced extracorporeal circulatory support technology,has been increasingly utilized in clinical practice,offering a novel therapeutic option for pa-tients with severe heart failure.This study aimed to investigate the clinical efficacy of combining IABP and ECMO in patients with AMI complicated by CS,evaluating its impact on myocardial injury,hemodynamic stability,and clinical outcomes.Methods This study retrospectively analyzed the clinical data of 52 patients with AMI compli-cated by CS admitted to our hospital between May 2023 and May 2024.Based on the treatment methods,the pa-tients were divided into an ECMO group(n=26)and a non-ECMO group(n=26).Post-treatment comparisons were made between the two groups regarding myocardial injury markers such as cardiac troponin I,lactate,and creatine kinase-MB,hemodynamic parameters such as mean arterial pressure,cardiac output,and central venous pressure,and the incidence of complications such as acute kidney injury,bleeding,infection.The primary endpoint of this study was the post-treatment mortality rate and the incidence of complications.Secondary endpoints included changes in myocardial injury markers[cardiac troponin I(cTnI),lactic acid(LAC),creatine kinase isoenzymes(CK-MB)]and improvements in hemodynamic parameters[mean arterial pressure(MAP),cardiac output(CO),central venous pressure(CVP)].The results of multivariate regression analyses were used to explore the incidence of EC-MO complications.Results After treatment,the levels of myocardial injury markers such as cTnI,LAC,and CK-MB in ECMO group were significantly lower than non-ECMO group(P<0.05);MAP and CO in ECMO group were significantly higher than non-ECMO group,while CVP was significantly lower(P<0.05);the mortality rate and the incidence of complications in ECMO group were lower than non-ECMO group(P<0.05).Further multivariate re-gression analysis showed that age,smoking,hyperlipidaemia and diabetes could affect the incidence of ECMO complications(P<0.05).Conclusions The combined use of IABP and ECMO exhibits substantial therapeutic benefits,including the mitigation of myocardial injury,enhancement of hemodynamic stability,and improvement in clinical prognosis among patients with AMI complicated by CS.Clinicians applying ECMO therapy should pay particular attention to older patients or those with concomitant diabetes mellitus or hyperlipidemia,as they might re-quire more intensive monitoring and prophylactic measures to mitigate the occurrence of complications.
文摘BACKGROUND Advanced heart failure and transplant(AHFTC)teams are crucial in the management of patients in cardiogenic shock.We sought to explore the impact of AHFTC physicians on outcomes in patients receiving extracorporeal membrane oxygenation(ECMO)support.AIM To determine whether outcomes differ in the care of ECMO patients when AHFTC physicians serve in a primary vs consultative role.METHODS We conducted a retrospective cohort study of 51 patients placed on veno-venous(VV)and veno-arterial(VA)ECMO between January 2015 and February 2023 at our institution.We compared ECMO outcomes between teams managed primarily by intensivists vs teams where AHFTC physicians played a direct role in ECMO management,including patient selection.Our primary outcome measure was survival to 30 days post hospital discharge.RESULTS For combined VA and VV ECMO patients,survival to 30 days post discharge in the AHFTC cohort was significantly higher(67%vs 30%,P=0.01),largely driven by a significantly increased 30-day post discharge survival in VA ECMO patients in the AHFTC group(64%vs 20%,P=0.05).CONCLUSION This study suggests that patients in shock requiring VA ECMO support may have improved survival 30 days after hospital discharge when an AHFTC team serves in a direct role in the selection and management of patients.Further studies are needed to validate this impact.
