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Lorusso R, De Piero ME, Mariani S, Di Mauro M, Folliguet T, Taccone FS, Camporota L, Swol J, Wiedemann D, Belliato M, Broman LM, Vuylsteke A, Kassif Y, Scandroglio AM, Fanelli V, Gaudard P, Ledot S, Barker J, Boeken U, Maier S, Kersten A, Meyns B, Pozzi M, Pedersen FM, Schellongowski P, Kirali K, Barrett N, Riera J, Mueller T, Belohlavek J, Lorusso R, De Piero ME, Mariani S, Di Mauro M, Folliguet T, Taccone FS, Camporota L, Swol J, Wiedemann D, Belliato M, Broman LM, Vuylsteke A, Kassif Y, Scandroglio AM, Fanelli V, Gaudard P, Ledot S, Barker J, Boeken U, Maier S, Kersten A, Meyns B, Pozzi M, Pedersen FM, Schellongowski P, Kirali K, Barrett N, Riera J, Mueller T, Belohlavek J, Lo Coco V, Van der Horst ICC, Van Bussel BCT, Schnabel RM, Delnoij T, Bolotin G, Lorini L, Schmiady MO, Schibilsky D, Kowalewski M, Pinto LF, Silva PE, Kornilov I, Blandino Ortiz A, Vercaemst L, Finney S, Roeleveld PP, Di Nardo M, Hennig F, Antonini MV, Davidson M, Jones TJ, Staudinger T, Mair P, Kilo J, Krapf C, Erbert K, Peer A, Bonaros N, Kotheletner F, Krenner Mag N, Shestakova L, Hermans G, Dauwe D, Meersseman P, Stockman B, Nobile L, Lhereux O, Nrasseurs A, Creuter J, De Backer D, Giglioli S, Michiels G, Foulon P, Raes M, Rodrigus I, Allegaert M, Jorens P, Debeucklare G, Piagnarelli M, Biston P, Peperstraete H, Vandewiele K, Germay O, Vandeweghe D, Havrin S, Bourgeois M, Lagny MG, Alois G, Lavios N, Misset B, Courcelle R, Timmermans PJ, Yilmaz A, Vantomout M, Lehaen J, Jassen A, Guterman H, Strauven M, Lormans P, Verhamme B, Vandewaeter C, Bonte F, Vionne D, Balik M, Blàha J, Lips M, Othal M, Bursa F, Spacek R, Christensen S, Jorgensen V, Sorensen M, Madsen SA, Puss S, Beljantsev A, Saiydoun G, Fiore A, Colson P, Bazalgette F, Capdevila X, Kollen S, Muller L, Obadia JF, Dubien PY, Ajrhourh L, Guinot PG, Zarka J, Besserve P, Malfertheiner MV, Dreier E, Heinze B, Akhyari P, Lichtenberg A, Aubin H, Assman A, Saeed D, Thiele H, Baumgaertel M, Schmitto JD, Ruslan N, Haverich A, Thielmann M, Brenner T, Ruhpawar A, Benk C, Czerny M, Staudacher DL, Beyersdorf F, Kalbhenn J, Henn P, Popov AF, Iuliu T, Muellenbach R, Reyher C, Rolfes C, Lotz G, Sonntagbauer M, Winkels H, Fichte J, Stohr R, Kalverkamp S, Karagiannidis C, Schafer S, Svetlitchny A, Fichte J, Hopf HB, Jarczak D, Groesdonk H, Rommer M, Hirsch J, Kaehny C, Soufleris D, Gavriilidis G, Pontikis K, Kyriakopoulou M, Kyriakoudi A, O'Brien S, Conrick-Martin I, Carton E, Makhoul M, Ben-Ari J, Hadash A, Kogan A, Kassif Lerner R, Abu-Shakra A, Matan M, Balawona A, Kachel E, Altshuler R, Galante O, Fuchs L, Almog Y, Ishay YS, Lichter Y, Gal-oz A, Carmi U, Nini A, Soroksky A, Dekel H, Rozman Z, Tayem E, Ilgiyaev E, Hochman Y, Miltau D, Rapoport A, Eden A, Kompanietz D, Yousif M, Golos M, Grazioli L, Ghitti D, Loforte A, Di Luca D, Baiocchi M, Pacini D, Cappai A, Meani P, Mondino M, Russo CF, Ranucci M, Fina D, Cotza M, Ballotta A, Landoni G, Nardelli P, Fominski EV, Brazzi L, Montrucchio G, Sales G, Simonetti U, Livigni S, Silengo D, Arena G, Sovatzis SS, Degani A, Riccardi M, Milanesi E, Raffa G, Martucci G, Arcadipane A, Panarello G, Chiarini G, Cattaneo S, Puglia C, Benussi S, Foti G, Giani M, Bombino M, Costa MC, Rona R, Avalli L, Donati A, Carozza R, Gasparri F, Carsetti A, Picichè M, Marinello A, Danzi V, Zanin A, Condello I, Fiore F, Moscarelli M, Nasso G, Speziale G, Sandrelli L, Montalto A, Musumeci F, Circelli A, Russo E, Agnoletti V, Rociola R, Milano AD, Pilato E, Comentale G, Montisci A, Alessandri F, Tosi A, Pugliese F, Giordano G, Carelli S, Grieco DL, Dell'Anna AM, Antonelli M, Ramoni E, Zulueta J, Del Giglio M, Petracca S, Bertini P, Guarracino F, De Simone L, Angeletti PM, Forfori F, Taraschi F, Quintiliani VN, Samalavicius R, Jankuviene A, Scupakova N, Urbonas K, Kapturauskas J, Soerensen G, Suwalski P, Linhares Santos L, Marques A, Miranda M, Teixeira S, Salgueiro A, Pereira F, Ketskalo M, Tsarenko S, Shilova A, Afukov I, Popugaev K, Minin S, Shelukhin D, Malceva O, Gleb M, Skopets A, Kornelyuk R, Kulikov A, Okhrimchuk V, Turchaninov A, Shelukhin D, Petrushin M, Sheck A, Mekulov A, Ciryateva S, Urusov D, Gorjup V, Golicnik A, Goslar T, Ferrer R, Martinez-Martinez M, Argudo E, Palmer N, De Pablo Sanchez R, Juan Higuera L, Arnau Blasco L, Marquez JA, Sbraga F, Fuset MP, De Gopegui PR, Claraco LM, De Ayala JA, Peiro M, Ricart P, Martinez S, Chavez F, Fabra M, Sandoval E, Toapanta D, Carraminana A, Tellez A, Ososio J, Milan P, Rodriguez J, Andoni G, Gutierrez C, Perez de la Sota E, Eixeres-Esteve A, Garcia-Maellas MT, Gutierrez-Gutierrez J, Arboleda-Salazar R, Santa Teresa P, Jaspe A, Garrido A, Castaneda G, Alcantara S, Martinez N, Perez M, Villanueva H, Vidal Gonzalez A, Paez J, Santon A, Perez C, Lopez M, Rubio Lopez MI, Gordillo A, Naranjo-Izurieta J, Munoz J, Alcalde I, Onieva F, Gimeno Costa R, Perez F, Madrid I, Gordon M, Albacete Moreno CL, Perez D, Lopez N, Martinenz D, Blanco-Schweizer P, Diez C, Perez D, Prieto A, Renedo G, Bustamante E, Cicuendez R, Citores R, Boado V, Garcia K, Voces R, Domezain M, Nunez Martinez JM, Vicente R, Martin D, Andreu A, Gomez Casal V, Chico I, Menor EM, Vara S, Gamacho J, Perez-Chomon H, Javier Gonzales F, Barrero I, Martin-Villen L, Fernandez E, Mendoza M, Navarro J, Colomina Climent J, Gonzales-Perez A, Muniz-Albaceita G, Amado L, Rodriguez R, Ruiz E, Eiras M, Grins E, Magnus R, Kanetoft M, Eidevald M, Watson P, Vogt PR, Steiger P, Aigner T, Weber A, Grunefelder J, Kunz M, Grapow M, Aymard T, Reser D, Agus G, Consiglio J, Haenggi M, Hansjoerg J, Iten M, Doeble T, Zenklusen U, Bechtold X, Faedda G, Iafrate M, Rohjer A, Bergamaschi L, Maessen J, Reis Miranda D, Endeman H, Gommers D, Meuwese C, Maas J, Van Gijlswijk MJ, Van Berg RN, Candura D, Van der Linden M, Kant M, Van der Heijden JJ, Scholten E, Van Belle-van Haren N, Lagrand WK, Vlaar AP, De Jong S, Cander B, Sargin M, Ugur M, Kaygin MA, Daly K, Agnew N, Head L, Kelly L, Anoma G, Russell C, Aquino V, Scott I, Flemming L, Gillon S, Moore O, Gelandt E, Auzinger G, Patel S, Loveridge R. In-hospital and 6-month outcomes in patients with COVID-19 supported with extracorporeal membrane oxygenation (EuroECMO-COVID): a multicentre, prospective observational study. Lancet Respir Med 2023; 11:151-162. [PMID: 36402148 PMCID: PMC9671669 DOI: 10.1016/s2213-2600(22)00403-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 09/18/2022] [Accepted: 09/23/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Extracorporeal membrane oxygenation (ECMO) has been widely used in patients with COVID-19, but uncertainty remains about the determinants of in-hospital mortality and data on post-discharge outcomes are scarce. The aims of this study were to investigate the variables associated with in-hospital outcomes in patients who received ECMO during the first wave of COVID-19 and to describe the status of patients 6 months after ECMO initiation. METHODS EuroECMO-COVID is a prospective, multicentre, observational study developed by the European Extracorporeal Life Support Organization. This study was based on data from patients aged 16 years or older who received ECMO support for refractory COVID-19 during the first wave of the pandemic-from March 1 to Sept 13, 2020-at 133 centres in 21 countries. In-hospital mortality and mortality 6 months after ECMO initiation were the primary outcomes. Mixed-Cox proportional hazards models were used to investigate associations between patient and management-related variables (eg, patient demographics, comorbidities, pre-ECMO status, and ECMO characteristics and complications) and in-hospital deaths. Survival status at 6 months was established through patient contact or institutional charts review. This study is registered with ClinicalTrials.gov, NCT04366921, and is ongoing. FINDINGS Between March 1 and Sept 13, 2020, 1215 patients (942 [78%] men and 267 [22%] women; median age 53 years [IQR 46-60]) were included in the study. Median ECMO duration was 15 days (IQR 8-27). 602 (50%) of 1215 patients died in hospital, and 852 (74%) patients had at least one complication. Multiorgan failure was the leading cause of death (192 [36%] of 528 patients who died with available data). In mixed-Cox analyses, age of 60 years or older, use of inotropes and vasopressors before ECMO initiation, chronic renal failure, and time from intubation to ECMO initiation of 4 days or more were associated with higher in-hospital mortality. 613 patients did not die in hospital, and 547 (95%) of 577 patients for whom data were available were alive at 6 months. 102 (24%) of 431 patients had returned to full-time work at 6 months, and 57 (13%) of 428 patients had returned to part-time work. At 6 months, respiratory rehabilitation was required in 88 (17%) of 522 patients with available data, and the most common residual symptoms included dyspnoea (185 [35%] of 523 patients) and cardiac (52 [10%] of 514 patients) or neurocognitive (66 [13%] of 512 patients) symptoms. INTERPRETATION Patient's age, timing of cannulation (<4 days vs ≥4 days from intubation), and use of inotropes and vasopressors are essential factors to consider when analysing the outcomes of patients receiving ECMO for COVID-19. Despite post-discharge survival being favourable, persisting long-term symptoms suggest that dedicated post-ECMO follow-up programmes are required. FUNDING None.
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Affiliation(s)
- Roberto Lorusso
- Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, Netherlands; Cardiovascular Research Institute Maastricht, Maastricht, Netherlands.
| | - Maria Elena De Piero
- Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, Netherlands,Cardiovascular Research Institute Maastricht, Maastricht, Netherlands
| | - Silvia Mariani
- Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, Netherlands,Cardiovascular Research Institute Maastricht, Maastricht, Netherlands
| | - Michele Di Mauro
- Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, Netherlands,Cardiovascular Research Institute Maastricht, Maastricht, Netherlands
| | - Thierry Folliguet
- Department of Cardiac Surgery, Assistance Publique–Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Fabio Silvio Taccone
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Luigi Camporota
- Department of Adult Critical Care, Guy's and St Thomas' NHS Foundation, Health Centre for Human and Applied Physiological Sciences, London, UK
| | - Justyna Swol
- Department of Medicine, Paracelsus Medical University, Nuremberg, Germany
| | - Dominik Wiedemann
- Department of Cardiac Surgery, Medical University Hospital of Vienna, Vienna, Austria
| | - Mirko Belliato
- Anestesia e Rianimazione II Cardiopolmonare, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Policlinico San Matteo, Pavia, Italy
| | - Lars Mikael Broman
- ECMO Centre Karolinska, Karolinska University Hospital, Stockholm, Sweden,Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Alain Vuylsteke
- ECMO Retrieval Service & Critical Care, Royal Papworth Hospital, NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, UK
| | - Yigal Kassif
- Heart Transplantation Unit, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Ramat Gan, Israel
| | - Anna Mara Scandroglio
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Vito Fanelli
- Department of Surgical Sciences, Anesthesia and Intensive Care Medicine, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Philippe Gaudard
- Department of Anesthesiology and Critical Care Medicine, Arnaud de Villeneuve Hospital, Centre Hospitalier Universitaire Montpellier, Montpellier, France,Le laboratoire de Physiologie et Médecine Expérimentale du Coeur et des Muscles (PhyMedExp), Université de Montpellier, INSERM, CNRS, Montpellier, France
| | - Stephane Ledot
- Intensive Care Unit, Royal Brompton & Harefield hospitals, London, UK
| | - Julian Barker
- Cardiothoracic Critical Care Unit, Whythenshawe Hospital, Manchester, UK
| | - Udo Boeken
- Department of Cardiac Surgery, Heinrich Heine University, Dusseldorf, Germany
| | - Sven Maier
- Department of Cardiovascular Surgery, Heart Center University Freiburg, Bad Krozingen, Germany,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Alexander Kersten
- Medizinische Klinik, Uniklinik Rheinisch-Westfälische Technische Hochschule, Aachen, Germany
| | - Bart Meyns
- Department of Cardiac Surgery, Universitair Ziekenhuis Leuven Gasthuisberg University Hospital, Leuven, Belgium
| | - Matteo Pozzi
- Department of Cardiac Surgery, Louis Pradel Hospital, Lyon, France
| | - Finn M Pedersen
- Cardiothoracic Intensive Care Unit, University Hospital, Copenhagen, Denmark
| | - Peter Schellongowski
- Department of Medicine I, Intensive Care Unit, Comprehensive Cancer Center, Center of Excellence in Medical Intensive Care, Medical University of Vienna, Vienna, Austria
| | - Kaan Kirali
- Cardiovascular Surgery Department, Kosuyolu High Specialization Education and Research Hospital, Istanbul, Türkiye
| | - Nicholas Barrett
- Department of Adult Critical Care, Guy's and St Thomas' NHS Foundation, Health Centre for Human and Applied Physiological Sciences, London, UK
| | - Jordi Riera
- Critical Care Department, Val d'Hebron Research Institute, Barcelona, Spain
| | - Thomas Mueller
- Department of Internal Medicine II, University Hospital of Regensburg, Regensburg, Germany
| | - Jan Belohlavek
- 2nd Department of Internal Medicine, Cardiovascular Medicine General Teaching Hospital, Prague, Czech Republic,1st Faculty of Medicine, Charles University, Prague, Czech Republic
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Amacher SA, Quitt J, Hammel E, Zenklusen U, Darwisch A, Siegemund M. Case Report: Left Ventricular Unloading Using a Mechanical CPR Device in a Prolonged Accidental Hypothermic Cardiac Arrest Treated by VA-ECMO - a Novel Approach. Front Cardiovasc Med 2021; 8:707663. [PMID: 34250052 PMCID: PMC8263907 DOI: 10.3389/fcvm.2021.707663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 06/03/2021] [Indexed: 11/17/2022] Open
Abstract
We recently treated a 36-year-old previously healthy male with a prolonged hypothermic (lowest temperature 22.3°C) cardiac arrest after an alcohol intoxication with a return of spontaneous circulation after 230min of mechanical cardiopulmonary resuscitation and rewarming by veno-arterial ECMO with femoral cannulation and retrograde perfusion of the aortic arch. Despite functional veno-arterial ECMO, we continued mechanical cardiopulmonary resuscitation (Auto Pulse™ device, ZOLL Medical Corporation, Chelmsford, USA) until return of spontaneous circulation to prevent left ventricular distention from persistent ventricular fibrillation. The case was further complicated by extensive trauma caused by mechanical cardiopulmonary resuscitation (multiple rib fractures, significant hemothorax, and a liver laceration requiring massive transfusion), lung failure necessitating a secondary switch to veno-venous ECMO, and acute kidney injury with the need for renal replacement therapy. Shortly after return of spontaneous circulation, the patient was already following commands and could be discharged 3 weeks later without neurologic, cardiac, or renal sequelae and being entirely well. Prolonged accidental hypothermic cardiac arrest might present with excellent outcomes when supported with veno-arterial ECMO. Until return of spontaneous circulation, one might consider continuing with mechanical cardiopulmonary resuscitation in addition to ECMO to allow some left ventricular unloading. However, the clinician should keep in mind that prolonged mechanical cardiopulmonary resuscitation may cause severe injuries.
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Affiliation(s)
- Simon A Amacher
- Intensive Care Medicine, University Hospital Basel, Basel, Switzerland
| | - Jonas Quitt
- Intensive Care Medicine, University Hospital Basel, Basel, Switzerland
| | - Eva Hammel
- Intensive Care Medicine, University Hospital Basel, Basel, Switzerland
| | - Urs Zenklusen
- Department of Cardiac Surgery, University Hospital Basel, Basel, Switzerland
| | - Ayham Darwisch
- Department of Cardiac Surgery, University Hospital Basel, Basel, Switzerland
| | - Martin Siegemund
- Intensive Care Medicine, University Hospital Basel, Basel, Switzerland.,Department of Clinical Research, University of Basel, Basel, Switzerland
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Schaeffer T, Pfister O, Mork C, Mohacsi P, Rueter F, Scheifele S, Morgen A, Zenklusen U, Doebele T, Maurer M, Erb J, Fassl J, Cueni N, Siegemund M, Pargger H, Gahl B, Osswald S, Eckstein F, Grapow M. 5-year results of a newly implemented mechanical circulatory support program for terminal heart failure patients in a Swiss non-cardiac transplant university hospital. J Cardiothorac Surg 2021; 16:64. [PMID: 33789723 PMCID: PMC8011141 DOI: 10.1186/s13019-021-01447-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 03/19/2021] [Indexed: 11/18/2022] Open
Abstract
Background In Switzerland, long-term circulatory support programs have been limited to heart transplant centers. In 2014, to improve the management of patients with end-stage heart failure not eligible for transplantation, we implemented a left ventricular assist device (LVAD) program for destination therapy at the University Hospital of Basel. Methods We described the program set-up with practical aspects. Patients aged 65 and above with therapy refractory end-stage heart failure without major contraindication for LVAD implantation were included. Younger patients with bridge-to-candidacy profile were also considered. Using the Kaplan-Meier estimate, we retrospectively analyzed the overall survival and freedom from major adverse events after LVAD implantation. We compared our results to internationally reported data. Results Between October 2014 and September 2019, 16 patients received an LVAD in our center. The mean age at implantation was 67.1 years. The mean EuroSCORE II was 24.4% and the median INTERMACS level was 4. Thirteen patients received an LVAD as destination therapy and three patients as bridge-to-candidacy. The overall survival was 87.5 and 70% at 1 and 2 years, respectively. Freedom from stroke was 81.3% at 1 and 2 years. Freedom from device infection was 67.7 and 58.7% at 1 and 2 years, respectively. Freedom from gastrointestinal bleeding was 75 and 56.3% at 1 and 2 years, respectively. Freedom from readmission was 50 and 31.3% and at 6 months and 1 year, respectively. Conclusions The Basel experience demonstrated the possible implementation of an LVAD program for destination therapy or bridge-to-candidacy in a non-transplant comprehensive heart-failure center with midterm survival results and freedom from major adverse events comparable to international registries. Patient selection remains crucial. Trial registration This study was registered on the ClinicalTrials.gov database (NCT04263012).
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Affiliation(s)
- Thibault Schaeffer
- Department of Cardiac Surgery, University Hospital of Basel, Basel, Switzerland
| | - Otmar Pfister
- Department of cardiology, University Hospital of Basel, Basel, Switzerland
| | - Constantin Mork
- Department of Cardiac Surgery, University Hospital of Basel, Basel, Switzerland
| | - Paul Mohacsi
- Department of Cardiac Surgery, University Hospital of Basel, Basel, Switzerland
| | - Florian Rueter
- Department of Cardiac Surgery, University Hospital of Basel, Basel, Switzerland
| | - Simon Scheifele
- Department of Cardiac Surgery, University Hospital of Basel, Basel, Switzerland
| | - Anne Morgen
- Department of Cardiac Surgery, University Hospital of Basel, Basel, Switzerland
| | - Urs Zenklusen
- Department of Cardiac Surgery, University Hospital of Basel, Basel, Switzerland
| | - Thomas Doebele
- Department of Cardiac Surgery, University Hospital of Basel, Basel, Switzerland
| | - Markus Maurer
- Department of Anesthesiology, University Hospital of Basel, Basel, Switzerland
| | - Joachim Erb
- Department of Anesthesiology, University Hospital of Basel, Basel, Switzerland
| | - Jens Fassl
- Institute of Cardiac Anesthesiology, Heart Center of the Technical University of Dresden, Dresden, Germany
| | - Nadine Cueni
- Department of Intensive Care, University Hospital of Basel, Basel, Switzerland
| | - Martin Siegemund
- Department of Intensive Care, University Hospital of Basel, Basel, Switzerland
| | - Hans Pargger
- Department of Intensive Care, University Hospital of Basel, Basel, Switzerland
| | - Brigitta Gahl
- Department of Cardiac Surgery, University Hospital of Basel, Basel, Switzerland
| | - Stefan Osswald
- Department of cardiology, University Hospital of Basel, Basel, Switzerland
| | - Friedrich Eckstein
- Department of Cardiac Surgery, University Hospital of Basel, Basel, Switzerland
| | - Martin Grapow
- Department of Cardiac Surgery, University Hospital of Basel, Basel, Switzerland. .,HerzZentrum Hirslanden Zürich, Witellikerstrasse 36, Zürich, Switzerland.
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Hunziker P, Zenklusen U. Lean Ad hoc Extracorporeal Membrane Oxygenation Systems for COVID-19. ASAIO J 2021; 67:12-17. [PMID: 32804773 DOI: 10.1097/mat.0000000000001278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Coronavirus disease (COVID-19) is overwhelming hospitals with patients requiring respiratory support, including ventilators and Extracorporeal Membrane Oxygenation (ECMO). Bottlenecks in device availability may contribute to mortality, and limited device availability even in ECMO centers has led to rationing recommendations. Therefore, we explored options for ad hoc construction of venovenous ECMO using readily available components, essentially, large cannulas, membrane oxygenators, and blood pumps. As thousands of certified cardiac Impella pumps are distributed worldwide, we assembled lean ECMO by embedding Impella pumps coaxially in tubes, combined with standard gas exchangers. Ad hoc integration of Impella blood pumps with gas exchange modules, large-bore venous cannulas, regular ECMO tubing, Y-pieces, and connectors led to lean ECMO systems with stable performance over several days. Oxygenation of 2.5-5 L of blood per minute is realistic. Benefit/risk analysis appears favorable if a patient needs respiratory support but required support systems in a center are exhausted. Ad hoc assembly of venovenous ECMO is feasible using Impella blood pumps, results in stable blood flow across gas exchange modules, and thus may offer another opportunity to oxygenate, "recover the lungs" and hopefully save lives in selected patients with severe COVID-19 disease even when conventional life support equipment is exhausted. The lean design also yields inspirations for future ECMO systems.
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Affiliation(s)
| | - Urs Zenklusen
- Perfusion Unit, Cardiac Surgery, University of Basel, Basel, Switzerland
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Santer D, Miazza J, Koechlin L, Rrahmani B, Doebele T, Zenklusen U, Gahl B, Eckstein FS, Reuthebuch O. CytoSorb in Endocarditis Patients Undergoing Valve Surgery. Thorac Cardiovasc Surg 2020. [DOI: 10.1055/s-0040-1705415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Koechlin L, Zenklusen U, Doebele T, Rrahmani B, Gahl B, Berdajs D, Grapow MTR, Eckstein FS, Reuthebuch O. Clinical implementation of a novel myocardial protection pathway in coronary artery bypass surgery with minimal extracorporeal circulation. Perfusion 2018; 34:277-284. [PMID: 30565517 DOI: 10.1177/0267659118815287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The aim of this study was to report the clinical implementation of the joint use of the Myocardial Protection System (MPS®) and the minimal extracorporeal circulation system (MiECC), in conjunction with an institutionally refined dose/volume-dependent microplegia in coronary artery bypass grafting (CABG). METHODS Patients with isolated CABG surgery were included. The final protocol to achieve cardioplegic arrest consisted of warm blood cardioplegia with 20 mmol potassium (K), 1.6 g magnesium (Mg) and 40 mg lidocaine per liter (L) blood. We prospectively collected intra- and postoperative data to monitor and validate this novel approach. RESULTS Eighty patients were operated accordingly. Mean (SD) aortic clamping time and extracorporeal perfusion time were 67.5 (22.6) and 101.1 (31.9) minutes, respectively. Failure to induce cardiac arrest was seen in six patients at the early stage of refinement of the formula. Median (IQR) high -sensitivity cardiac troponin T (hs-cTnT) on the first postoperative day (POD) and peak hs-cTnT were 262.5 ng/L (194.3-405.8) and 265.5 ng/L (194.3-405.8), respectively. Median (IQR) creatine kinase-myocardial type (CK-MB) on POD 1 and peak CK-MB were 14.2 µg/L (10.5-22.7) and 14.2 µg/L (10.7-23.2), respectively. Median (IQR) creatine kinase (CK) on POD 1 and peak CK were 517.5 U/L (389.3-849.8) and 597.5 U/L (455.0-943.0), respectively. No patient died during hospitalization. CONCLUSIONS The combination of this cardioplegic formula with MPS® and MiECC in CABG was safe and feasible. With the final chemical makeup, cardiac arrest was reliably achieved. Remarkably low postoperative cardiac markers indicate shielded cardiac protection during surgery.
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Affiliation(s)
- Luca Koechlin
- Department of Cardiac Surgery, University Hospital Basel, Basel, Switzerland
| | - Urs Zenklusen
- Department of Cardiac Surgery, University Hospital Basel, Basel, Switzerland
| | - Thomas Doebele
- Department of Cardiac Surgery, University Hospital Basel, Basel, Switzerland
| | - Bejtush Rrahmani
- Department of Cardiac Surgery, University Hospital Basel, Basel, Switzerland
| | - Brigitta Gahl
- Department of Cardiac Surgery, University Hospital Basel, Basel, Switzerland
| | - Denis Berdajs
- Department of Cardiac Surgery, University Hospital Basel, Basel, Switzerland
| | - Martin T R Grapow
- Department of Cardiac Surgery, University Hospital Basel, Basel, Switzerland
| | | | - Oliver Reuthebuch
- Department of Cardiac Surgery, University Hospital Basel, Basel, Switzerland
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Bolliger D, Zenklusen U, Tanaka KA. Point-of-care coagulation management algorithms during ECMO support: are we there yet? Minerva Anestesiol 2016; 82:1000-1009. [PMID: 27028451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Haemorrhagic and thromboembolic events are common and the main cause for morbidity and mortality in patients treated with extracorporeal membrane oxygenation (ECMO). Monitoring of an adequate anticoagulation is, therefore, essential in patients during ECMO therapy. This review aims to describe the current evidence and emerging data relating to anticoagulation therapy and point-of-care (POC) coagulation monitoring in ECMO patients. Central laboratory-based coagulation testing including activated partial thromboplastin time (aPTT), international normalized ratio (INR) of the prothrombin time (PT), and activated clotting time (ACT) is most commonly used for coagulation monitoring. Several lines of coagulation monitoring devices have been explored for POC assessment of anticoagulation and/or haemostasis during ECMO. POC-type ACT, aPTT and PT have a shorter turn-around time, but they might exhibit a relevant bias in agreement with laboratory-based coagulation tests, and sensitivity and specificity for intervention are variable compared with laboratory- based tests. Whole-blood viscoelastic coagulation tests including ROTEM® and TEG® and platelet function testing have been increasingly used for monitoring haemostasis in ECMO patients. However, no single laboratory-based or POC coagulation test can reliably predict the emergence of haemorrhagic or thrombotic events. Further, treatment algorithms based on POC testing are scarce for ECMO patients. Larger prospective studies are necessary to evaluate the usefulness of POC coagulation monitors or a combination of them in potentially improving anticoagulation and decreasing haemorrhagic and thromboembolic complications.
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Affiliation(s)
- Daniel Bolliger
- Department for Anesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland -
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Bolliger D, Filipovic M, Matt P, Tanaka KA, Gregor M, Zenklusen U, Seeberger MD, Lurati Buse G. Reduced aspirin responsiveness as assessed by impedance aggregometry is not associated with adverse outcome after cardiac surgery in a small low-risk cohort. Platelets 2015; 27:254-61. [PMID: 26367099 DOI: 10.3109/09537104.2015.1083969] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Reduced aspirin responsiveness (i.e. persistent high platelet reactivity in platelet function testing) might be associated with increased risk of myocardial ischemia and cardiac mortality in patients with coronary disease. However, the impact in patients undergoing coronary artery bypass grafting (CABG) is unclear. The aim of this prospective cohort study was to evaluate the predictive value of reduced aspirin responsiveness on cardiac and thromboembolic events in patients undergoing elective isolated CABG surgery with aspirin intake until at least two days before surgery. We included 304 patients in this prospective single-center cohort study. Impedance platelet aggregometry (Multiplate®) was performed directly before and on the first day after surgery. Reduced aspirin responsiveness was defined as area under the curve in ASPItest (AUCASPI) ≥300 U. The primary outcome was a composite of all-cause mortality and/or major adverse cardiac or thromboembolic events within 1 year. Reduced aspirin responsiveness was found in 13 and 24% of patients pre and postoperatively, respectively. There was no difference in the outcomes between patients with normal and reduced aspirin responsiveness in the preoperative measurement (log-rank test, p = 0.540). Multivariate analysis including logistic EuroSCORE I and postoperative troponin T levels did not show any association of reduced aspirin responsiveness with adverse outcome (hazard ratio, 0.576; (95% CI 0.128-2.585; p = 0.471). Similarly, postoperative reduced aspirin responsiveness was not associated with adverse events. To conclude, reduced aspirin responsiveness as evaluated by Multiplate® platelet function analyzer was not associated with increased incidence of major adverse cardiac and thromboembolic events and mortality after CABG surgery.
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Affiliation(s)
- Daniel Bolliger
- a Department of Anesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy , University Hospital Basel , Basel , Switzerland
| | - Miodrag Filipovic
- a Department of Anesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy , University Hospital Basel , Basel , Switzerland .,b Institute of Anesthesiology, Cantonal Hospital , St. Gallen , Switzerland
| | - Peter Matt
- c Division of Cardiac Surgery , University Hospital Basel , Basel , Switzerland
| | - Kenichi A Tanaka
- d Department of Anesthesiology, Cardiothoracic Anesthesia Division , University of Maryland , Baltimore , MD , USA , and
| | - Michael Gregor
- a Department of Anesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy , University Hospital Basel , Basel , Switzerland
| | - Urs Zenklusen
- a Department of Anesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy , University Hospital Basel , Basel , Switzerland .,c Division of Cardiac Surgery , University Hospital Basel , Basel , Switzerland
| | - Manfred D Seeberger
- a Department of Anesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy , University Hospital Basel , Basel , Switzerland .,e Institute for Anesthesiology and Intensive Care, Hirslanden Klinik , Zurich , Switzerland
| | - Giovanna Lurati Buse
- a Department of Anesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy , University Hospital Basel , Basel , Switzerland
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Bolliger D, Filipovic M, Seeberger E, Gregor M, Zenklusen U, Seeberger MD, Lurati Buse GA. Reduced aspirin responsiveness is not associated with adverse outcome after cardiac surgery. J Cardiothorac Vasc Anesth 2015. [DOI: 10.1053/j.jvca.2015.05.256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Rufa M, Antonitsis P, Winkler B, Kiessling AH, Ulrich C, Bennett MJ, Kehara H, Asopa S, Alexopoulos C, Zavaropoulos P, Alexopoulos C, Ganushchak YM, McLean LA, Borrelli U, Antonitsis P, Gifford D, Reineke D, Antonitsis P, Bennett M, Schubel J, Schubel J, Ulrich C, Schaarschmidt J, Tiliscan C, Bauer A, Hausmann H, Asteriou C, Argiriadou H, Deliopoulos A, Gatzos S, Anastasiadis K, Zenklusen U, Döbele T, Kohler B, Grapow M, Eckstein F, May M, Keller H, Diefenbach M, Reyher C, Moritz A, Bauer A, Eberle T, Schaarschmidt J, Lucy J, Hausmann H, Larsen M, Asopa S, Webb G, Wright A, Lloyd C, Takano T, Fujii T, Gomibuchi T, Nakahara K, Ohhashi N, Komatsu K, Ohtsu Y, Terasaki T, Wada Y, Seto T, Fukui D, Amano J, Bennett M, Webb G, Lloyd C, Hakim N, Zografos P, Protopapas E, Zavaropoulos P, Kirvassilis G, Sarris G, Alexopoulos C, Hakim N, Zografos P, Protopapas E, Kirvassilis G, Sarris G, Hakim N, Zografos P, Protopapas E, Zavaropoulos P, Kirvassilis G, Sarris G, Körver E, Yamamoto Y, Weerwind P, Medlam W, Bell J, Bennett R, Bennett R, Turner E, Jagannadham K, Westwood E, Silvestri A, Detroux M, Nottin R, Al-Attar N, Pappalardo A, Gabrielli M, Gripari C, Scala A, Mercurio S, Gustin G, Fasolo D, Deliopoulos A, Gatzos S, Mimikos S, Kleontas A, Grosomanidis V, Kyparissa M, Tossios P, Anastasiadis K, Colah S, Farid S, Irons J, Gilhouly M, Moorjani N, König T, Meszaros K, Sodeck G, Erdoes G, Englberger L, Czerny M, Carrel T, Mimikos S, Kostarelou G, Kleontas A, Deliopoulos A, Gatzos S, Foroulis C, Tossios P, Anastasiadis K, Asopa S, Webb G, Gomez-Cano M, Lloyd C, Xhymshiti A, Ulrich C, Schaarschmidt J, Eberle T, Rufa M, Bauer A, Hausmann H. 1st International Symposium on Minimal Invasive Extracorporeal Circulation Technologies, Thessaloniki, Greece, 13–14 June 2014001EMERGENCY CORONARY ARTERY BYPASS GRAFT SURGERY IN PATIENTS WITH OR WITHOUT ACUTE MYOCARDIAL INFARCTION USING THE MINIMAL INVASIVE EXTRACORPOREAL CIRCULATION002IS THERE A LEARNING CURVE WHEN USING MINIMAL INVASIVE EXTRACORPOREAL CIRCULATION IN CORONARY REVASCULARIZATION PROCEDURES?003MINIMAL EXTRACORPOREAL CIRCULATION ASSURES PERFORMANCE OUTCOME004CORONARY ARTERY REVASCULARIZATION WITH A MINIMAL EXTRACORPOREAL CIRCULATION TECHNIQUE: SHOTGUN ANALYSIS IN A PROSPECTIVE, RANDOMIZED TRIAL WITH THREE DIFFERENT PERFUSION TECHNIQUES005EFFECTS OF CELL SALVAGED AND DIRECTLY RETRANSFUSED MEDIASTINAL SHED BLOOD ON THE POSTOPERATIVE COMPETENCY OF THE COAGULATION SYSTEM AFTER CORONARY ARTERY BYPASS GRAFT SURGERY006THE RELATIVE INFLUENCE OF MINIATURIZED CARDIOPULMONARY BYPASS AND OTHER PERIOPERATIVE FACTORS ON BLOOD TRANSFUSION REQUIREMENT AFTER HEART SURGERY007LOWER PLATELET AGGREGATION MIGHT REDUCE PERIOPERATIVE BLEEDING IN MINI-CIRCUIT CARDIOPULMONARY BYPASS COMPARED TO CONVENTIONAL CARDIOPULMONARY BYPASS0085-YEAR EXPERIENCE OF BLOOD TRANSFUSION IN CORONARY ARTERY BYPASS GRAFT SURGERY PATIENTS USING MINIATURIZED EXTRACORPOREAL CIRCULATION009PAEDIATRIC CARDIAC EXTRACORPOREAL MEMBRANE OXYGENATION SUPPORT: IMPROVED OUTCOME WITH EVOLVING TECHNOLOGY AND PRACTICE REFINEMENTS OVER 16 YEARS010THE USE OF ARTERIOVENOUS PCO 2DIFFERENCE (Delta PCO 2) AS AN INDEX OF THE DENSITY OF CAPILLARY PERFUSION DURING PAEDIATRIC CARDIOPULMONARY BYPASS AND EXTRACORPOREAL MEMBRANE OXYGENATION011‘ETERNAL ECMO’: THE CHALLENGE OF PROLONGED POST-CARDIOTOMY EXTRACORPOREAL MEMBRANE OXYGENATION012A VERSATILE MINIMIZED SYSTEM: THE STEP TOWARDS SAFE PERFUSION013HOW WE DEVELOPED A SAFER MINI BYPASS SYSTEM WITH THE USE OF A STOCKERT HEART LUNG BYPASS MACHINE AND MEDTRONIC FUSION OXYGENATOR014MINIMALIZING THE CARDIOPULMONARY BYPASS CIRCUIT AND THE CONSOLE015IS THREE-STAGE VENOUS CANNULA SUPERIOR TO DUAL-STAGE DURING SURGERY WITH MINIMAL INVASIVE EXTRACORPOREAL CIRCULATION?016BENEFITS OF CLOSED MINIATURIZED CARDIOPULMONARY BYPASS017COGNITIVE BRAIN FUNCTION AFTER CORONARY BYPASS GRAFTING WITH MINIMIMAL INVASIVE EXTRACORPOREAL CIRCULATION018MINIMAL INVASIVE EXTRACORPOREAL CIRCULATION REDUCES GASEOUS MICROEMBOLI AND PRESERVES NEUROCOGNITIVE FUNCTION: A SINGLE-CENTRE PROSPECTIVE RANDOMIZED STUDY019THE INFLUENCE OF PERIOPERATIVE FACTORS TO GENERATE ‘OUTLIERS’ IN CARDIAC SURGERY ASSOCIATED ACUTE KIDNEY INJURY: A PRELIMINARY INVESTIGATION INCLUDING DIABETES AND METHOD OF CARDIOPULMONARY BYPASS020MINIMAL INVASIVE EXTRACORPOREAL CIRCULATION IN 64 COMPLEX CARDIAC PROCEDURES: IS IT FEASIBLE AND SAFE? Interact Cardiovasc Thorac Surg 2014. [DOI: 10.1093/icvts/ivu292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Fassl J, Matt P, Eckstein F, Filipovic M, Gregor M, Zenklusen U, Seeberger MD, Bolliger D. Transfusion of Allogeneic Blood Products in Proximal Aortic Surgery With Hypothermic Circulatory Arrest: Effect of Thromboelastometry-Guided Transfusion Management. J Cardiothorac Vasc Anesth 2013; 27:1181-8. [DOI: 10.1053/j.jvca.2013.02.009] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Indexed: 11/11/2022]
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Bolliger D, Dell-Kuster S, Seeberger MD, Tanaka KA, Gregor M, Zenklusen U, Tsakiris DA, Filipovic M. Impact of loss of high-molecular-weight von Willebrand factor multimers on blood loss after aortic valve replacement. Br J Anaesth 2012; 108:754-62. [PMID: 22311365 DOI: 10.1093/bja/aer512] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Severe aortic stenosis is associated with loss of the largest von Willebrand factor (vWF) multimers, which could affect primary haemostasis. We hypothesized that the altered multimer structure with the loss of the largest multimers increases postoperative bleeding in patients undergoing aortic valve replacement. METHODS We prospectively included 60 subjects with severe aortic stenosis. Before and after aortic valve replacement, vWF antigen, activity, and multimer structure were determined and platelet function was measured by impedance aggregometry. Blood loss from mediastinal drainage and the use of blood and haemostatic products were evaluated perioperatively. RESULTS Before operation, the altered multimer structure was present in 48 subjects (80%). Baseline characteristics and laboratory data were similar in all subjects. The median blood loss after 6 h was 250 (105-400) and 145 (85-240) ml in the groups with the altered and normal multimer structures, respectively (P=0.182). After 24 h, the cumulative loss was 495 (270-650) and 375 (310-600) ml in the groups with the altered and normal multimer structures, respectively (P=0.713). Multivariable analysis revealed no significant influence of multimer structure and platelet function on bleeding volumes after 6 and 24 h. After 24 h, there was no obvious difference in vWF antigen, activity, and multimer structure in subjects with and without the altered multimer structure before operation or in subjects with and without perioperative plasma transfusion. CONCLUSIONS The altered vWF multimer structure before operation was not associated with increased bleeding after aortic valve replacement. Our findings might be explained by perioperative release of vWF and rapid recovery of the largest vWF multimers.
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Affiliation(s)
- D Bolliger
- Department of Anaesthesia and Intensive Care Medicine, University Hospital Basel, Basel, Switzerland.
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Bolliger D, Funk S, Gregor M, Zenklusen U, Seeberger M. O-70 Goal-directed coagulation management using thromboelastometry in patients undergoing elective aortic surgery with deep hypothermic circulatory arrest: a retrospective cohort study. J Cardiothorac Vasc Anesth 2011. [DOI: 10.1053/j.jvca.2011.03.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Bolliger D, Seeberger MD, Tanaka KA, Dell-Kuster S, Gregor M, Zenklusen U, Grapow M, Tsakiris DA, Filipovic M. Pre-analytical effects of pneumatic tube transport on impedance platelet aggregometry. Platelets 2009; 20:458-65. [DOI: 10.3109/09537100903236462] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Bolliger D, Seeberger M, Tanaka K, Dell-Kuster S, Gregor M, Zenklusen U, Grapow M, Tsakiris D, Filipovic M. Pre-analytical effects of pneumatic tube transport on impedance platelet aggregometry. Platelets 2009. [DOI: 10.1080/09537100903236462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Strebel S, Kaufmann M, Baggi M, Zenklusen U. Cerebrovascular carbon dioxide reactivity during exposure to equipotent isoflurane and isoflurane in nitrous oxide anaesthesia. Br J Anaesth 1993; 71:272-6. [PMID: 8123406 DOI: 10.1093/bja/71.2.272] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
We have studied the effects of hypocapnia on cerebrovascular changes in two MAC-equivalent anaesthetic regimens, using the transcranial Doppler technique as an index of cerebral blood flow (CBF) in 24 healthy ASA I patients undergoing spinal surgery. Eight of the patients were subjected to carbon dioxide reactivity challenges in the awake state. Before surgery, the other 16 patients received, in random order, either 1.15% isoflurane in oxygen or 0.5% isoflurane with 70% nitrous oxide. Carbon dioxide reactivity was calculated for each group as the increase in flow velocity per kPa change in PE'CO2 (cm s-1 kPa-1). It was significantly greater for the isoflurane group (14.09 (SD 2.44) cm s-1 kPa-1) and significantly less for the isoflurane-nitrous oxide group (7.95 (1.32) cm s-1 kPa-1) compared with the awake group (11.24 (0.95) cm s-1 kPa-1). We conclude that cerebrovascular responsiveness to changes in arterial carbon dioxide concentration is influenced markedly by the anaesthetic procedure. Hyperventilation is more likely to affect CBF during isoflurane anaesthesia than during an MAC-equivalent isoflurane-nitrous oxide anaesthesia.
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Affiliation(s)
- S Strebel
- Department of Anaesthesia, University of Basel/Kantonsspital, Switzerland
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