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Perioperative Apixaban: Bleeding, Clotting, or Both?

Abstract Anticoagulation for Subclinical Atrial Fibrillation Recently, the ARTESIA study addressed this question in a randomized trial of 4,012 patients with subclinical atrial fibrillation identified by an implanted device, and..

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The role of inflammation and antithrombin supplementation on thromboelastographic parameters during veno-venous ECMO for respiratory failure

Abstract Introduction Extracorporeal membrane oxygenation (ECMO) may act as a driver or propagator of systemic inflammation. In turn, cytokine release can modify thromboelastographic (TEG) tests which are commonly used for..

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Extracorporeal membrane oxygenation from last resort to indispensable tool in the treatment of respiratory and/or circulatory failure

Abstract Extracorporeal membrane oxygenation (ECMO) continues to be an indispenable tool in critical care settings, in particular in patients with severe respiratory and/or cardiac failure. The COVID-19 pandemic highlighted the..

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Physiology of Extracorporeal Gas Exchange

Abstract Circulating venous blood outside the body, through an artificial lung (membrane oxygenator), andreturning oxygenated blood to the patient is extracorporeal gas exchange. Oxygen and carbondioxide exchange in a membrane..

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Does Size Matter? The Effect of Size of Distal Perfusion Catheter on Acute Limb Ischemia: A Meta-Analysis

Abstract Prevention of limb ischemia in patients with venoarterial extracorporeal membrane oxygenation (VA-ECMO) is primarily achieved through the use of distal perfusion catheters (DPC). Our objective was to assess the..

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A novel versatile concept of cardioplegia delivery in cardiac surgery: The ReverseTWO cardioplegia circuit system

Abstract Nowadays, the necessity of having a cardioplegia circuit capable of being adapted in order to administer different types of cardioplegia is strategically fundamental, both for the perfusionist and for..

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How to manage differential hypoxemia during veno-arterial extracorporeal membrane oxygenation

Abstract Over the past decade, veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has expanded rapidly as a salvage strategy to provide temporary circulatory and respiratory support allowing cardiac function recovery or bridging..

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A Pilot Study of Renin-Guided Angiotensin-II Infusion to Reduce Kidney Stress After Cardiac Surgery

Abstract BACKGROUND:  Vasoplegia is common after cardiac surgery, is associated with hyperreninemia, and can lead to acute kidney stress. We aimed to conduct a pilot study to test the hypothesis..

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The impact of small movements with dual lumen cannulae during venovenous extracorporeal membrane oxygenation: A computational fluid dynamics analysis

Abstract Background and objectives Venovenous Extracorporeal Membrane Oxygenation (VV ECMO) provides respiratory support to patients with severe lung disease failing conventional medical therapy. An essential component of the ECMO circuit..

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Epidemiology of anticoagulation for children supported by extracorporeal membrane oxygenation in the United States: A Pediatric Hospital Information System database…

Abstract Introduction Due to the risk of thrombosis, nearly all children supported by extracorporeal membrane oxygenation (ECMO) receive systemic anticoagulation. While heparin has traditionally been used, there are reports of..

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Mechanical ventilation during extracorporeal membrane oxygenation support – New trends and continuing challenges

Abstract Background The impact of mechanical ventilation on the survival of patients supported with veno-venous extracorporeal membrane oxygenation (V-V ECMO) due to severe acute respiratory distress syndrome (ARDS) remains still..

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ECMO Alone Versus ECPELLA in Patients Affected by Cardiogenic Shock: The Multicenter EVACS Study

Abstract The objective was to investigate the outcomes of concomitant venoarterial extracorporeal membrane oxygenation (ECMO) and left ventricular unloading with Impella (ECPELLA) compared with ECMO alone to treat patients affected..

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Prone positioning during extracorporeal membrane oxygenation for severe acute respiratory distress syndrome.

PRO Building solid evidence in intensive care medicine is challenging, mostly due to patient heterogeneity and concomitant treatment interactions. In the context of acute respiratory distress syndrome (ARDS), only two..

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The intricate physiology of veno-venous extracorporeal membrane oxygenation: an overview for clinicians

Abstract During veno-venous extracorporeal membrane oxygenation (V-V ECMO), blood is drained from the central venous circulation to be oxygenated and decarbonated by an artificial lung. It is then reinfused into..

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The physiology of venoarterial extracorporeal membrane oxygenation - A comprehensive clinical perspective

Abstract Venoarterial extracorporeal membrane oxygenation (VA ECMO) has become a standard of care for severe cardiogenic shock, refractory cardiac arrest and related impending multiorgan failure. The widespread clinical use of..

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Left ventricular unloading in patients supported with veno-arterial extra corporeal membrane oxygenation; an international EuroELSO survey

Abstract Introduction Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) improves end-organ perfusion in cardiogenic shock but may increase afterload, which can limit cardiac recovery. Left ventricular (LV) unloading strategies may aid..

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Evolution of distal limb perfusion management in adult peripheral venoarterial extracorporeal membrane oxygenation with femoral artery cannulation

Abstract Limb ischaemia is a clinically relevant complication of venoarterial extracorporeal membrane oxygenation (VA ECMO) with femoral artery cannulation. No selective distal perfusion or other advanced techniques were used in..

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Anticoagulation during extracorporeal membrane oxygenation: A narrative review

Abstract Extracorporeal Membrane Oxygenation (ECMO) is a technology that offers organ support for critically ill patients with respiratory and/or cardiac failure. Despite improvements in recent years in technology and the..

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Beta‑blockade in V‑V ECMO

Abstract We read with great interest Staudacher et al.’s illustra- tive cases of beta-blocker therapy on V-V ECMO [1]. The authors’ excellent work reminds us not to focus on the..

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Liver Injury Due to Penetration of the Common Iliac Vein by an Extracorporeal Membrane Oxygenation Cannula

Abstract Extracorporeal membrane oxygenation (ECMO) cannulas inserted through the femoral vein can stray into the ascending lumbar vein. No case has been reported in which the cannula has penetrated the..

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Mild and deep hypothermia differentially affect cerebral neuroinflammatory and cold shock response following cardiopulmonary bypass in rat

Abstract Introduction Targeted temperature management (TTM) is considered to be a neuroprotective strategy during cardiopulmonary bypass (CPB) assisted procedures, possibly through the activation of cold shock proteins. We therefore investigated..

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Why Simulation Matters: A Systematic Review on Medical Errors Occurring During Simulated Health Care

Abstract Background  Over the past decade, the implementation of simulation education in health care has increased exponentially. Simulation-based education allows learners to practice patient care in a controlled, psychologically safe..

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Perioperative Glycemic Management in Cardiac Surgery: A Narrative Review

Abstract Diabetes and hyperglycemic events in cardiac surgical patients are associated with postoperative morbidity and mortality. The causes of , the abnormal fluctuations in  concentrations, in the  include surgical stress, surgical techniques, medications..

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Procedural and Surgical Safety Checklists: Video in Clinical Anesthesia

Abstract It is estimated that many of the complications that occur within the hospital setting are associated with surgical procedures. While some complications, such as sepsis and bleeding, are affected..

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Development and validation of a machine learning prediction model for perioperative red blood cell transfusions in cardiac surgery

Abstract Objective Several machine learning (ML) models have been used in perioperative red blood cell (RBC) transfusion risk for cardiac surgery with limited  and no external validation. Hence, we sought to..

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Normothermic Regional Perfusion is an Emerging Cost-Effective Alternative in Donation After Circulatory Death (DCD) in Heart Transplantation

Abstract In donation after circulatory death (DCD) organ transplantation, normothermic regional perfusion (NRP) restores oxygenated blood flow following cardiac arrest and reverses warm ischemia. Recently, NRP has also been used..

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Comparison of Blood Concentration and Weight-Based Heparin and Protamine Dosing Strategies for Cardiopulmonary Bypass: A Systematic Review and Meta-Analysis

Abstract Background: The conventional method of heparin and protamine management during cardiopulmonary bypass (CPB) is based on total body weight which fails to account for the heterogeneous response to heparin in each patient...

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Antithrombin Levels and Heparin Responsiveness during Venoarterial Extracorporeal Membrane Oxygenation: A Prospective Single-center Cohort Study

Abstract Unfractionated heparin, administered during venoarterial extracorporeal membrane oxygenation to prevent thromboembolic events, largely depends on plasma antithrombin for its antithrombotic effects. Decreased heparin responsiveness seems frequent on extracorporeal membrane..

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Treatment Strategies and Outcomes of Right Ventricular Failure Post Left Ventricular Assist Device Implantation: An INTERMACS Analysis

Abstract Right heart failure (RHF) management after left ventricular assist device (LVAD) implantation includes inotropes, right ventricular mechanical support, and heart transplantation. The purpose of this study is to compare..

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Target flow deviations on the cardiopulmonary bypass cause postoperative delirium in cardiothoracic surgery—a retrospective study evaluating temporal fluctuations of perfusion…

Abstract OBJECTIVES Postoperative delirium (POD) is common, costly and associated with long-term morbidity and increased mortality. We conducted a cohort study to assess the contribution of cardiopulmonary bypass (CPB) to..

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