Predicting processing time in drop-type cell-free and concentrated ascites reinfusion therapy (CART) remains difficult. We examined whether pre-processing total protein (TP) was associated with processing time after accounting for ascites amount, processing height, ascites etiology, and repeated sessions. We retrospectively analyzed 97 CART sessions in 51 patients. Log-transformed processing time was analyzed using a linear mixed-effects model including pre-processing TP, pre-processing ascites amount, processing height (140 or 200 cm), and ascites etiology as fixed effects, with patient as a random intercept. Receiver operating characteristic (ROC) analysis of pre-processing TP for an above-preferred-range session-averaged processing rate (>2,000 mL/h) was secondary and exploratory. Higher pre-processing TP (β = 0.259, 95
Patients with cardiogenic shock due to acute myocardial infarction (AMI) treated with ECPELLA support have a poor prognosis. Impaired left ventricular (LV) wall motion is observed in both infarcted and non-infarcted areas. Therapeutic hypothermia and mechanical LV unloading have different myocardial protective effects. This study aimed to evaluate myocardial protective effects of moderate therapeutic hypothermia combined with mechanical LV unloading in non-infarcted areas using a porcine AMI model. The coronary artery was ligated, and an extracorporeal ventricular assist device was driven under mean left atrial pressure of 5 mmHg. Cooling was initiated via the thermostatic bath of ECMO 30 min after LAD ligation. Moderate therapeutic hypothermia (30–31 °C) was maintained for 2 h. The final evaluation was performed 30 min after rewarming. In the control group, LV fractional shortening (FS) and LV posterior wall motion score (WMS) were declined. In the hypothermia group, LVFS and LV posterior WMS were preserved. In the posterior wall of hypothermia group, mitochondria structure was maintained, reactive oxygen species production was reduced, and sarcoplasmic/endoplasmic reticulum Ca2+-ATPase expression was maintained more than in the control group. Moderate therapeutic hypothermia combined with mechanical LV unloading might provide more myocardial protection in non-infarcted areas compared to mechanical LV unloading alone in a porcine AMI model.
Pediatric acute respiratory distress syndrome (PARDS) is an important cause of morbidity and mortality in pediatric intensive care units. We report successful prolonged venovenous extracorporeal membrane oxygenation (VV-ECMO) support in a child with severe PARDS and acute lymphoblastic leukemia (ALL). A 5-year-old boy with low-risk B-cell ALL developed severe refractory PARDS during induction therapy. VV-ECMO was initiated for profound hypoxemia and continued for 34 days, after which he was successfully decannulated. He was discharged after 235 days of hospitalization. This case suggests that prolonged VV-ECMO may be a feasible rescue strategy in carefully selected children with ALL when respiratory failure is potentially reversible and the oncological prognosis is favorable.
The main goal of the present study was to demonstrate the influence of draining cannulas’ position and high-flow extracorporeal CO2 removal (ECCO2R) configuration on recirculation and extracorporeal decarboxylation. This single-center retrospective study was conducted between January 2018 and May 2024. All patients who received a high-flow ECCO2R (extracorporeal blood flow ≥ 2 L/min) were included. Four configurations each used an ECMO device, two single-lumen cannulas, and an ipsilateral cannulation site: CENTRAL DRAINAGE configurations (central jugular-jugular and central femoro-femoral), DISTAL DRAINAGE configurations (distal jugular-jugular and distal femoro-femoral). Recirculation coefficient and CO2 elimination were assessed between these configurations. The influence of the configuration and recirculation coefficient on CO2 elimination was studied by multivariable mixed linear model. Eighteen patients were treated with high-flow ECCO2R. Extracorporeal blood flows (median of 2.6 L/min [IQR, 2.0‒2.6 L/min]) were comparable between the configurations (P = 0.33), although values higher than 2.5 L/min were observed in CENTRAL DRAINAGE configurations. Median CO2 elimination was 110 mL(STPD)/min (IQR, 83‒149 mL(STPD)/min). Recirculation coefficient was significantly higher with the DISTAL DRAINAGE configurations (59
Cardiac device–related infective endocarditis complicated by end-stage heart failure poses a major therapeutic challenge because complete hardware removal is essential, whereas transvenous lead extraction may be poorly tolerated in patients with severe ventricular dysfunction and shock. We report a 53-year-old man with long-standing dilated cardiomyopathy and cardiac resynchronization therapy–defibrillator infection who presented with methicillin-sensitive Staphylococcus aureus bacteremia, pocket infection, respiratory failure, acute kidney injury, and a clinical presentation consistent with mixed septic–cardiogenic shock. Transthoracic echocardiography showed severe left ventricular dilatation and an ejection fraction of 10
