in-vitro-thrombosis-test-for-ventricular-assist-devices

<em>In Vitro</em> Thrombosis Test for Ventricular Assist Devices

The risk of thrombosis remains a significant concern in the development and clinical use of ventricular assist devices (VADs). Traditional assessments of ...

Hospital of the University of Pennsylvania

Impella (Abiomed Inc, Danvers, MA) is a temporary mechanical support device positioned across the aortic valve, and can be used to support patient before LVAD implantation. There are no data on the incidence of aortic insufficiency (AI) in patients supported with Impella as a bridge to durable LVAD implantation. We sought to assess the incidence of AI in patients with Impella support as a bridge to durable left ventricular assist device (LVAD) implantation.

Treatment With Impella Increases the Risk of De Novo Aortic Insufficiency Post Left Ventricular Assist Device Implant.

Anticoagulation may be a challenge in coronavirus disease 2019 (COVID-19) extracorporeal membrane oxygenation due to endothelial injury and dysregulation of coagulation, which may increase the risk of thrombotic and bleeding complications. This report was created to describe the authors' single institutional experience, with emphasis on the high rate of intracranial hemorrhage for the first 10 patients with COVID-19 placed on venovenous extracorporeal membrane oxygenation (VV ECMO).

A Case Series of Devastating Intracranial Hemorrhage During Venovenous Extracorporeal Membrane Oxygenation for COVID-19.

To assess societal preferences regarding allocation of extracorporeal membrane oxygenation (ECMO) as a rescue option for select patients with coronavirus disease 2019 (COVID-19).

How Should ECMO Be Used Under Conditions of Severe Scarcity? A Population Study of Public Perception.

Subacute groin complications associated with extracorporeal membrane oxygenation (ECMO) cannulation are well recognized, yet their effects on clinical outcomes remain unknown. This single-center, retrospective study reviewed all patients receiving venoarterial ECMO from 01/2017 to 02/2020. Cohorts analyzed included transplanted patients (TPs) and non-transplanted patients (N-TPs) who did or did not develop ECMO-related subacute groin complications. Standard descriptive statistics were used for comparisons. Logistic regressions identified associated risk factors. Overall, 82/367 (22.3%) ECMO patients developed subacute groin complications, including 25/82 (30.5%) seromas/lymphoceles, 32/82 (39.0%) hematomas, 18/82 (22.0%) infections, and 7/82 (8.5%) non-specified collections. Of these, 20/82 (24.4%) underwent surgical interventions, most of which were muscle flaps (14/20, 70.0%). TPs had a higher incidence of subacute groin complications than N-TPs (14/28, 50.0% vs. 68/339, 20.1%, P = 0.001). Seromas/lymphoceles more often developed in TPs than N-TPs (10/14, 71.4% vs. 15/68, 22.1%, P = 0.001). Most patients with subacute groin complications survived to discharge (60/68, 88.2%). N-TPs who developed subacute groin complications had longer post-ECMO lengths of stay than those who did not (34 days, IQR 16-53 days vs. 17 days, IQR 8-34 days, P < 0.001). Post-ECMO length of stay was also longer among patients who underwent related surgical interventions compared to those who did not (50 days, IQR 35-67 days vs. 29 days, IQR 16-49 days, P = 0.007). Transplantation was the strongest risk factor for developing subacute groin complications (OR 3.91, CI 1.52-10.04, P = 0.005). Subacute groin complications and related surgical interventions are common after ECMO cannulation and are associated with longer hospital stays. When surgical management is warranted, muscle flaps may reduce lengths of stay compared to other surgical interventions.

Subacute groin complications related to ECMO cannulation are associated with longer hospitalizations.

In a subset of patients with COVID-19 acute respiratory distress syndrome (ARDS), there is a need for extracorporeal membrane oxygenation (ECMO) for pulmonary support. The primary extracorporeal support tool for severe COVID-19 ARDS is venovenous (VV) ECMO; however, after hypoxemic respiratory failure resolves, many patients experience refractory residual hypercarbic respiratory failure. Extracorporeal carbon dioxide removal (ECCOR) for isolated hypercarbic type II respiratory failure can be used in select cases to deescalate patients from VV ECMO while the lung recovers the ability to exchange CO. The objective of this study was to describe the authors' experience in using ECCOR as a bridge from VV ECMO.

Extracorporeal Carbon Dioxide Removal to De-escalate Venovenous Extracorporeal Membrane Oxygenation in Severe COVID-19 Acute Respiratory Distress Syndrome.

Mechanical circulatory support (MCS) as a bridge to lung transplant is an infrequent but accepted pathway in patients who have refractory end-stage pulmonary failure. The American Association of Thoracic Surgeons Expert Consensus Guidelines, published in 2023, recommends venovenous (VV) extracorporeal membrane oxygenation (ECMO) as the initial configuration for those patients who have failed conventional medical therapy, including mechanical ventilation, while waiting for lung transplantation and needing MCS. Alternatively, venoarterial (VA) ECMO can be used in patients with acute right ventricular failure, hemodynamic instability, or refractory respiratory failure. With the advancement in percutaneous venopulmonary (VP) ECMO cannulation techniques, this option is becoming an attractive configuration as bridge to lung transplantation. This configuration enhances stability of the right ventricle, prevents recirculation with direct introduction of pulmonary artery oxygenation, and promotes hemodynamic stability during mobility, rehabilitation, and sedation-weaning trials before lung transplantation. Here, we present a case series of eight percutaneous VP ECMO as bridge to lung transplant with all patients mobilized, awake, and successfully transplanted with survival to hospital discharge.

Percutaneous Venopulmonary Extracorporeal Membrane Oxygenation as Bridge to Lung Transplantation.

Extracorporeal membrane oxygenation (ECMO) utilization for primary pulmonary hypertension (PPHTN) remains controversial. This multicenter, retrospective analysis of the Extracorporeal Life Support Organization Registry evaluated 221 PPHTN patients placed on ECMO in 2000-2019. Survival by ECMO indications and cannulation strategies were compared with Kaplan-Meier analyses. ECMO mortality risk factors were analyzed using Cox proportional hazards regressions. The overall rate of survival to ECMO decannulation was 140/221 (63.3%), of which 112/140 (80.0%) survived to hospital discharge. Survival to decannulation increased between 2000-2009 (14/30, 46.7%) and 2010-2019 (126/191, 66.0%, p = 0.041) alongside survival to hospital discharge (9/30, 30.0% vs. 103/191, 53.9%, p = 0.015). Survival to decannulation was similar when patients were supported with either venovenous-ECMO (VV-ECMO; 39/54, 72.2%) or venoarterial-ECMO (VA-ECMO) for respiratory failure (43/71, 60.6%, p = 0.174), although VV-ECMO was associated with fewer complications (25/54, 46% vs. 25/71, 35%, respectively, p = 0.039) and increased survival to hospital discharge (34/54, 63.0% vs. 33/71, 46.5%, p = 0.067). The strongest independent predictor of ECMO morality was isolated vasopressor use before cannulation (hazard ratio [HR]: 3.37 [95% confidence interval {CI95%}: 1.16-9.81], p = 0.026). Extracorporeal membrane oxygenation mortality risk was lower among patients bridged-to-transplantation (HR: 0.37 [CI95%: 0.14-0.97], p = 0.043), and was inversely correlated with pre-ECMO pH (HR: 0.03 [CI95%: 0.00-0.49], p = 0.013). Extracorporeal membrane oxygenation use for PPHTN has grown alongside improved outcomes. Early ECMO initiation may improve outcomes in select individuals with PPHTN.

Early Extracorporeal Membrane Oxygenation Initiation May Improve Outcomes in Select Patients With Primary Pulmonary Hypertension: An Extracorporeal Life Support Organization Registry Analysis.

Salim E. Olia

Department of Cardiovascular Surgery

Hospital of the University of Pennsylvania

In Vitro Thrombosis Test for Ventricular Assist Devices

Salim E. Olia

.css-o250i3{font-size:18px;font-family:Open Sans,sans-serif;line-height:21.6px;}Department of Cardiovascular Surgery

Hospital of the University of Pennsylvania

In Vitro Thrombosis Test for Ventricular Assist Devices

Department of Cardiovascular Surgery