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[PMID]:28770972
[Au] Autor:Hummel J; Rücker G; Stiller B
[Ad] Endereço:Department of Congenital Heart Defects and Pediatric Cardiology, Heart Center, University of Freiburg, Mathildenstr. 1, Freiburg, Germany, 79106.
[Ti] Título:Prophylactic levosimendan for the prevention of low cardiac output syndrome and mortality in paediatric patients undergoing surgery for congenital heart disease.
[So] Source:Cochrane Database Syst Rev;8:CD011312, 2017 08 02.
[Is] ISSN:1469-493X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Low cardiac output syndrome remains a serious complication, and accounts for substantial morbidity and mortality in the postoperative course of paediatric patients undergoing surgery for congenital heart disease. Standard prophylactic and therapeutic strategies for low cardiac output syndrome are based mainly on catecholamines, which are effective drugs, but have considerable side effects. Levosimendan, a calcium sensitiser, enhances the myocardial function by generating more energy-efficient myocardial contractility than achieved via adrenergic stimulation with catecholamines. Thus potentially, levosimendan is a beneficial alternative to standard medication for the prevention of low cardiac output syndrome in paediatric patients after open heart surgery. OBJECTIVES: To review the efficacy and safety of the postoperative prophylactic use of levosimendan for the prevention of low cardiac output syndrome and mortality in paediatric patients undergoing surgery for congenital heart disease. SEARCH METHODS: We identified trials via systematic searches of CENTRAL, MEDLINE, Embase, and Web of Science, as well as clinical trial registries, in June 2016. Reference lists from primary studies and review articles were checked for additional references. SELECTION CRITERIA: We only included randomised controlled trials (RCT) in our analysis that compared prophylactic levosimendan with standard medication or placebo, in infants and children up to 18 years of age, who were undergoing surgery for congenital heart disease. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data and assessed risk of bias according to a pre-defined protocol. We obtained additional information from all but one of the study authors of the included studies. We used the five GRADE considerations (study limitations, consistency of effect, imprecision, indirectness, and publication bias) to assess the quality of evidence from the studies that contributed data to the meta-analyses for the prespecified outcomes. We created a 'Summary of findings' table to summarise the results and the quality of evidence for each outcome. MAIN RESULTS: We included five randomised controlled trials with a total of 212 participants in the analyses. All included participants were under five years of age. Using GRADE, we assessed there was low-quality evidence for all analysed outcomes. We assessed high risk of performance and detection bias for two studies due to their unblinded setting. Levosimendan showed no clear effect on risk of mortality (risk ratio (RR) 0.47, 95% confidence interval (CI) 0.12 to 1.82; participants = 123; studies = 3) and no clear effect on low cardiac output syndrome (RR 0.64, 95% CI 0.39 to 1.04; participants = 83; studies = 2) compared to standard treatments. Data on time-to-death were not available from any of the included studies.There was no conclusive evidence on the effect of levosimendan on the secondary outcomes. The length of intensive care unit stays (mean difference (MD) 0.33 days, 95% CI -1.16 to 1.82; participants = 188; studies = 4), length of hospital stays (MD 0.26 days, 95% CI -3.50 to 4.03; participants = 75; studies = 2), duration of mechanical ventilation (MD -0.04 days, 95% CI -0.08 to 0.00; participants = 208; studies = 5), and the risk of mechanical circulatory support or cardiac transplantation (RR 1.49, 95% CI 0.19 to 11.37; participants = 60; studies = 2) did not clearly differ between the groups. Published data about adverse effects of levosimendan were limited. A meta-analysis of hypotension, one of the most feared side effects of levosimendan, was not feasible because of the heterogeneous expression of blood pressure values. AUTHORS' CONCLUSIONS: The current level of evidence is insufficient to judge whether prophylactic levosimendan prevents low cardiac output syndrome and mortality in paediatric patients undergoing surgery for congenital heart disease. So far, no significant differences have been detected between levosimendan and standard inotrope treatments in this setting.The authors evaluated the quality of evidence as low, using the GRADE approach. Reasons for downgrading were serious risk of bias (performance and detection bias due to unblinded setting of two RCTs), serious risk of inconsistency, and serious to very serious risk of imprecision (small number of included patients, low event rates).
[Mh] Termos MeSH primário: Baixo Débito Cardíaco/prevenção & controle
Cardiotônicos/uso terapêutico
Cardiopatias Congênitas/cirurgia
Hidrazonas/uso terapêutico
Complicações Pós-Operatórias/prevenção & controle
Piridazinas/uso terapêutico
[Mh] Termos MeSH secundário: Circulação Assistida/estatística & dados numéricos
Baixo Débito Cardíaco/etiologia
Baixo Débito Cardíaco/mortalidade
Pré-Escolar
Cardiopatias Congênitas/mortalidade
Seres Humanos
Lactente
Unidades de Terapia Intensiva Pediátrica/estatística & dados numéricos
Tempo de Internação/estatística & dados numéricos
Complicações Pós-Operatórias/mortalidade
Ensaios Clínicos Controlados Aleatórios como Assunto
Respiração Artificial/estatística & dados numéricos
Síndrome
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; RESEARCH SUPPORT, NON-U.S. GOV'T; REVIEW
[Nm] Nome de substância:
0 (Cardiotonic Agents); 0 (Hydrazones); 0 (Pyridazines); 349552KRHK (simendan)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170920
[Lr] Data última revisão:
170920
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170804
[St] Status:MEDLINE
[do] DOI:10.1002/14651858.CD011312.pub3


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[PMID]:28512680
[Au] Autor:Qureshi MB; Glower J; Ewert DL; Koenig SC
[Ad] Endereço:Department of Electrical and Computer Engineering, North Dakota State University, Fargo, ND, 58102, USA.
[Ti] Título:A Novel Idea to Improve Cardiac Output of Mechanical Circulatory Support Devices by Optimizing Kinetic Energy Transfer Available in Forward Moving Aortic Blood Flow.
[So] Source:Cardiovasc Eng Technol;8(2):131-144, 2017 Jun.
[Is] ISSN:1869-4098
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Mechanical circulatory support devices (MCSDs) have gained widespread clinical acceptance as an effective heart failure (HF) therapy. The concept of harnessing the kinetic energy (KE) available in the forward aortic flow (AOF) is proposed as a novel control strategy to further increase the cardiac output (CO) provided by MCSDs. A complete mathematical development of the proposed theory and its application to an example MCSDs (two-segment extra-aortic cuff) are presented. To achieve improved device performance and physiologic benefit, the example MCSD timing is regulated to maximize the forward AOF KE and minimize retrograde flow. The proof-of-concept was tested to provide support with and without KE control in a computational HF model over a wide range of HF test conditions. The simulation predicted increased stroke volume (SV) by 20% (9 mL), CO by 23% (0.50 L/min), left ventricle ejection fraction (LVEF) by 23%, and diastolic coronary artery flow (CAF) by 55% (3 mL) in severe HF at a heart rate (HR) of 60 beats per minute (BPM) during counterpulsation (CP) support with KE control. The proposed KE control concept may improve performance of other MCSDs to further enhance their potential clinical benefits, which warrants further investigation. The next step is to investigate various assist technologies and determine where this concept is best applied. Then bench-test the combination of kinetic energy optimization and its associated technology choice and finally test the combination in animals.
[Mh] Termos MeSH primário: Circulação Assistida/instrumentação
Insuficiência Cardíaca/terapia
[Mh] Termos MeSH secundário: Débito Cardíaco
Contrapulsação
Insuficiência Cardíaca/fisiopatologia
Frequência Cardíaca
Modelos Teóricos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170921
[Lr] Data última revisão:
170921
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170518
[St] Status:MEDLINE
[do] DOI:10.1007/s13239-017-0305-2


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[PMID]:28271553
[Au] Autor:Alkhouli M; Al Mustafa A; Chaker Z; Alqahtani F; Aljohani S; Holmes DR
[Ad] Endereço:WVU Heart and Vascular Institute, West Virginia University School of Medicine, Morgantown, West Virginia.
[Ti] Título:Mechanical circulatory support in patients with severe aortic stenosis and left ventricular dysfunction undergoing percutaneous coronary intervention.
[So] Source:J Card Surg;32(4):245-249, 2017 Apr.
[Is] ISSN:1540-8191
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Management of obstructive coronary artery disease in patients with aortic stenosis and severe left ventricular dysfunction is challenging. Mechanical circulatory support at the time of percutaneous coronary interventions may be necessary in these extreme-risk patients. We present a case in which the TandemHeart was used to support a patient with severe aortic stenosis, severe protected left main and circumflex disease, and severe cardiomyopathy and review the literature on this subject.
[Mh] Termos MeSH primário: Estenose da Valva Aórtica/cirurgia
Circulação Assistida/instrumentação
Coração Auxiliar
Cuidados Intraoperatórios/métodos
Intervenção Coronária Percutânea
Disfunção Ventricular Esquerda/cirurgia
[Mh] Termos MeSH secundário: Idoso
Estenose da Valva Aórtica/complicações
Estenose da Valva Aórtica/diagnóstico por imagem
Circulação Assistida/métodos
Angiografia Coronária
Seres Humanos
Masculino
Índice de Gravidade de Doença
Disfunção Ventricular Esquerda/complicações
Disfunção Ventricular Esquerda/diagnóstico por imagem
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170714
[Lr] Data última revisão:
170714
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170309
[St] Status:MEDLINE
[do] DOI:10.1111/jocs.13116


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[PMID]:28262914
[Au] Autor:Hummel J; Rücker G; Stiller B
[Ad] Endereço:Department of Congenital Heart Defects and Pediatric Cardiology, Heart Center, University of Freiburg, Mathildenstr. 1, Freiburg, Germany, 79106.
[Ti] Título:Prophylactic levosimendan for the prevention of low cardiac output syndrome and mortality in paediatric patients undergoing surgery for congenital heart disease.
[So] Source:Cochrane Database Syst Rev;3:CD011312, 2017 Mar 06.
[Is] ISSN:1469-493X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Low cardiac output syndrome remains a serious complication, and accounts for substantial morbidity and mortality in the postoperative course of paediatric patients undergoing surgery for congenital heart disease. Standard prophylactic and therapeutic strategies for low cardiac output syndrome are based mainly on catecholamines, which are effective drugs, but have considerable side effects. Levosimendan, a calcium sensitiser, enhances the myocardial function by generating more energy-efficient myocardial contractility than achieved via adrenergic stimulation with catecholamines. Thus potentially, levosimendan is a beneficial alternative to standard medication for the prevention of low cardiac output syndrome in paediatric patients after open heart surgery. OBJECTIVES: To review the efficacy and safety of the postoperative prophylactic use of levosimendan for the prevention of low cardiac output syndrome and mortality in paediatric patients undergoing surgery for congenital heart disease. SEARCH METHODS: We identified trials via systematic searches of CENTRAL, MEDLINE, Embase, and Web of Science, as well as clinical trial registries, in June 2016. Reference lists from primary studies and review articles were checked for additional references. SELECTION CRITERIA: We only included randomised controlled trials (RCT) in our analysis that compared prophylactic levosimendan with standard medication or placebo, in infants and children up to 18 years of age, who were undergoing surgery for congenital heart disease. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data and assessed risk of bias according to a pre-defined protocol. We obtained additional information from all but one of the study authors of the included studies. We used the five GRADE considerations (study limitations, consistency of effect, imprecision, indirectness, and publication bias) to assess the quality of evidence from the studies that contributed data to the meta-analyses for the prespecified outcomes. We created a 'Summary of findings' table to summarise the results and the quality of evidence for each outcome. MAIN RESULTS: We included five randomised controlled trials with a total of 212 participants in the analyses. All included participants were under five years of age. Using GRADE, we assessed there was low-quality evidence for all analysed outcomes. We assessed high risk of performance and detection bias for two studies due to their unblinded setting. Levosimendan showed no clear effect on risk of mortality (risk ratio (RR) 0.47, 95% confidence interval (CI) 0.12 to 1.82; participants = 123; studies = 3) and no clear effect on low cardiac output syndrome (RR 0.64, 95% CI 0.39 to 1.04; participants = 83; studies = 2) compared to standard treatments. Data on time-to-death were not available from any of the included studies.There was no conclusive evidence on the effect of levosimendan on the secondary outcomes. The levosimendan groups had shorter length of intensive care unit stays (mean difference (MD) 0.33 days, 95% CI -1.16 to 1.82; participants = 188; studies = 4; I² = 35%), length of hospital stays (0.26 days, 95% CI -3.50 to 4.03; participants = 75; studies = 2), and duration of mechanical ventilation (MD -0.04 days, 95% CI -0.08 to 0.00; participants = 208; studies = 5; I² = 0%). The risk of mechanical circulatory support or cardiac transplantation favoured the levosimendan groups (RR 1.49, 95% CI 0.19 to 11.37; participants = 60; studies = 2). Published data about adverse effects of levosimendan were limited. A meta-analysis of hypotension, one of the most feared side effects of levosimendan, was not feasible because of the heterogeneous expression of blood pressure values. AUTHORS' CONCLUSIONS: The current level of evidence is insufficient to judge whether prophylactic levosimendan prevents low cardiac output syndrome and mortality in paediatric patients undergoing surgery for congenital heart disease. So far, no significant differences have been detected between levosimendan and standard inotrope treatments in this setting.The authors evaluated the quality of evidence as low, using the GRADE approach. Reasons for downgrading were serious risk of bias (performance and detection bias due to unblinded setting of two RCTs), serious risk of inconsistency, and serious to very serious risk of imprecision (small number of included patients, low event rates).
[Mh] Termos MeSH primário: Baixo Débito Cardíaco/prevenção & controle
Cardiotônicos/uso terapêutico
Cardiopatias Congênitas/cirurgia
Hidrazonas/uso terapêutico
Complicações Pós-Operatórias/prevenção & controle
Piridazinas/uso terapêutico
[Mh] Termos MeSH secundário: Circulação Assistida/estatística & dados numéricos
Baixo Débito Cardíaco/etiologia
Baixo Débito Cardíaco/mortalidade
Unidades de Cuidados Coronarianos/estatística & dados numéricos
Cardiopatias Congênitas/mortalidade
Seres Humanos
Tempo de Internação/estatística & dados numéricos
Complicações Pós-Operatórias/mortalidade
Ensaios Clínicos Controlados Aleatórios como Assunto
Respiração Artificial/estatística & dados numéricos
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Nm] Nome de substância:
0 (Cardiotonic Agents); 0 (Hydrazones); 0 (Pyridazines); 349552KRHK (simendan)
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170913
[Lr] Data última revisão:
170913
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170307
[St] Status:MEDLINE
[do] DOI:10.1002/14651858.CD011312.pub2


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[PMID]:28235229
[Au] Autor:Langheim E; Reiss N; Cordes C; Knoglinger E; Glatz J; Willemsen D
[Ad] Endereço:Reha-Zentrum Seehof, Teltow.
[Ti] Título:[Cardiac Rehabilitation in Patients with Mechanical Circulatory Support].
[Ti] Título:Mechanische Herzunterstützungssysteme in der kardiologischen Rehabilitation..
[So] Source:Dtsch Med Wochenschr;142(4):282-289, 2017 Feb.
[Is] ISSN:1439-4413
[Cp] País de publicação:Germany
[La] Idioma:ger
[Ab] Resumo:Heart failure in a terminal stage is usually treated with a heart transplant or with implantation of ventricular assist devices (VAD). VAD treatment is increasingly chosen as a permanent therapy. The growing number of VAD implants leads to an increased need for rehabilitation programs. The development of standards is essential. So far only a few single center reports with a limited number of patients have been published. Guidelines on this subject are not available. A working group of German rehabilitation physicians was installed in order to analyze the problems and to develop strategies for the process of rehabilitation of VAD-patients, ending in a consensus statement 1.The most important aspects of rehabilitation aiming at the safest possible participation in everyday life with a VAD are summarized here.
[Mh] Termos MeSH primário: Circulação Assistida/reabilitação
Circulação Assistida/normas
Reabilitação Cardíaca/normas
Cardiologia/normas
Coração Auxiliar/normas
Guias de Prática Clínica como Assunto
[Mh] Termos MeSH secundário: Circulação Assistida/instrumentação
Reabilitação Cardíaca/métodos
Medicina Baseada em Evidências
Alemanha
Seres Humanos
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1704
[Cu] Atualização por classe:170403
[Lr] Data última revisão:
170403
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170225
[St] Status:MEDLINE
[do] DOI:10.1055/s-0042-103708


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[PMID]:28093806
[Au] Autor:Bacha EA; Chai P; Ündar A
[Ad] Endereço:Division of Cardiac, Thoracic & Vascular Surgery, Columbia University Medical Center, New York, NY, USA.
[Ti] Título:Outcomes of the Twelfth International Conference on Pediatric Mechanical Circulatory Support Systems and Pediatric Cardiopulmonary Perfusion.
[So] Source:Artif Organs;41(1):7-10, 2017 Jan.
[Is] ISSN:1525-1594
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Circulação Extracorpórea
Pediatria
[Mh] Termos MeSH secundário: Circulação Assistida/educação
Circulação Assistida/instrumentação
Circulação Assistida/métodos
Distinções e Prêmios
Ponte Cardiopulmonar/educação
Ponte Cardiopulmonar/instrumentação
Ponte Cardiopulmonar/métodos
Criança
Congressos como Assunto
Circulação Extracorpórea/educação
Circulação Extracorpórea/instrumentação
Circulação Extracorpórea/métodos
Seres Humanos
New York
Pediatria/educação
Pediatria/instrumentação
Pediatria/métodos
[Pt] Tipo de publicação:EDITORIAL
[Em] Mês de entrada:1701
[Cu] Atualização por classe:170127
[Lr] Data última revisão:
170127
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170118
[St] Status:MEDLINE
[do] DOI:10.1111/aor.12896


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[PMID]:27928595
[Au] Autor:Schäfer A; Bauersachs J
[Ad] Endereço:Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland. Schaefer.andreas@mh-hannover.de.
[Ti] Título:[Left ventricular unloading in cardiogenic shock].
[Ti] Título:Linksventrikuläres Unloading im kardiogenen Schock..
[So] Source:Herz;42(1):18-26, 2017 Feb.
[Is] ISSN:1615-6692
[Cp] País de publicação:Germany
[La] Idioma:ger
[Ab] Resumo:Cardiogenic shock is an acute life-threatening condition, which results in impaired end-organ perfusion and oxygenation. Invasive ventilation and medicinal treatment with inotropes or vasopressors are necessary in most cases; however, they are also associated with reduced long-term prognosis. Frequently, medical treatment is not even sufficient to stabilize the patient; therefore, dedicated mechanical circulatory support devices that actively reduce the load on the left ventricle were developed to allow myocardial recovery or to gain time until definitive treatment. These systems are now available for implementation at large centers.
[Mh] Termos MeSH primário: Circulação Assistida/instrumentação
Coração Auxiliar
Choque Cardiogênico/diagnóstico
Choque Cardiogênico/terapia
Disfunção Ventricular Esquerda/diagnóstico
Disfunção Ventricular Esquerda/terapia
[Mh] Termos MeSH secundário: Circulação Assistida/métodos
Desenho de Equipamento
Medicina Baseada em Evidências
Seres Humanos
Choque Cardiogênico/complicações
Resultado do Tratamento
Disfunção Ventricular Esquerda/etiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171010
[Lr] Data última revisão:
171010
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161209
[St] Status:MEDLINE
[do] DOI:10.1007/s00059-016-4512-7


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[PMID]:27859378
[Au] Autor:Chopski SG; Moskowitz WB; Stevens RM; Throckmorton AL
[Ad] Endereço:BioCirc Research Laboratory, School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA.
[Ti] Título:Mechanical Circulatory Support Devices for Pediatric Patients With Congenital Heart Disease.
[So] Source:Artif Organs;41(1):E1-E14, 2017 Jan.
[Is] ISSN:1525-1594
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The use of mechanical circulatory support (MCS) devices is a viable therapeutic treatment option for patients with congestive heart failure. Ventricular assist devices, cavopulmonary assist devices, and total artificial heart pumps continue to gain acceptance as viable treatment strategies for both adults and pediatric patients as bridge-to-transplant, bridge-to-recovery, and longer-term circulatory support alternatives. We present a review of the current and future MCS devices for patients having congenital heart disease (CHD) with biventricular or univentricular circulations. Several devices that are specifically designed for patients with complex CHD are in the development pipeline undergoing rigorous animal testing as readiness experiments in preparation for future clinical trials. These advances in the development of new blood pumps for patients with CHD will address a significant unmet clinical need, as well as generally improve innovation of the current state of the art in MCS technology.
[Mh] Termos MeSH primário: Circulação Assistida
Oxigenação por Membrana Extracorpórea
Cardiopatias Congênitas/terapia
Coração Artificial
[Mh] Termos MeSH secundário: Animais
Circulação Assistida/instrumentação
Circulação Assistida/métodos
Criança
Desenho de Equipamento
Oxigenação por Membrana Extracorpórea/instrumentação
Oxigenação por Membrana Extracorpórea/métodos
Cardiopatias Congênitas/patologia
Cardiopatias Congênitas/cirurgia
Ventrículos do Coração/patologia
Ventrículos do Coração/cirurgia
Seres Humanos
Pediatria/instrumentação
Pediatria/métodos
Função Ventricular
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1701
[Cu] Atualização por classe:170127
[Lr] Data última revisão:
170127
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161119
[St] Status:MEDLINE
[do] DOI:10.1111/aor.12760


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[PMID]:27751862
[Au] Autor:Vase H; Christensen S; Christiansen A; Therkelsen CJ; Christiansen EH; Eiskjær H; Poulsen SH
[Ad] Endereço:Department of Cardiology, Aarhus University Hospital, Denmark. Electronic address: henrikvase@dadlnet.dk.
[Ti] Título:The Impella CP device for acute mechanical circulatory support in refractory cardiac arrest.
[So] Source:Resuscitation;112:70-74, 2017 Mar.
[Is] ISSN:1873-1570
[Cp] País de publicação:Ireland
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Mechanical circulatory support may be considered as a therapeutic option in selected patients with refractory cardiac arrest (rCA). Animal studies suggest a potential role for the Impella left ventricular assist device in this setting, but so far no human data have been published. METHODS: Eight patients with rCA were treated with the Impella CP device at our institution from November 2014 to October 2015. The Impella CP was used at the discretion of the treating physicians in patients with rCA and pulseless electrical activity with presumed primary left ventricular failure. These patients were compared to 12 patients with cardiogenic shock also treated with the Impella device during the same period. RESULTS: All cardiac arrests were witnessed with a no-flow time of 0min, six in-hospital and two out-of-hospital. Low-flow time was 50±52min (SD). The Impella device was successfully inserted in all patients with rCA and circulation was re-established. Survival rate to hospital discharge with good neurological outcome was similar among patients with rCA and cardiogenic shock treated with the Impella device (50% vs. 58%). Major vascular complications after Impella insertion occurred more frequently among patients with rCA compared to patients with cardiogenic shock (50% vs. 0%, P<0.05). CONCLUSION: Mechanical support with the Impella CP device is a feasible and promising treatment option for selected patients with rCA. Further studies are warranted to determine the full potential and optimal patient selection compared to other modalities of mechanical circulatory support.
[Mh] Termos MeSH primário: Circulação Assistida/instrumentação
Parada Cardíaca/terapia
Coração Auxiliar
[Mh] Termos MeSH secundário: Suporte Vital Cardíaco Avançado
Idoso
Cateteres Cardíacos
Parada Cardíaca/mortalidade
Seres Humanos
Masculino
Meia-Idade
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170713
[Lr] Data última revisão:
170713
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161025
[St] Status:MEDLINE


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[PMID]:27653754
[Au] Autor:Yap CH; Lai CQ; Loh IG; Ong TZ
[Ad] Endereço:Department of Biomedical Engineering, National University of Singapore, Singapore.
[Ti] Título:Nonlinear Flow Rate Response to Pumping Frequency and Reduced Hemolysis in the Drastically Under-Occluded Pulsatile Roller Pump.
[So] Source:Artif Organs;41(2):178-185, 2017 Feb.
[Is] ISSN:1525-1594
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Roller pumps are widely used in many medical procedures including cardiopulmonary bypass, left/right ventricular assist, and hemodialysis. However, to date, the problem of the roller pumping mechanism causing significant hemolysis remains unresolved. It has been shown that with under-occlusion of the roller pump, hemolysis can be reduced, but significant reduction of the mean flow rate also takes place due to backflow through the under-occlusion. We performed an investigation of the flow dynamics of an under-occluded roller pump which featured significantly higher amount of under-occlusion than previously investigated. Our results showed that the mean flow rate produced by the pump has a strong, nonlinear dependence on pumping frequency. Mean flow rate generally increases with the pumping frequency and the degree of maximum occlusion except at certain frequencies where sharp reductions were observed. These frequencies coincide with the fundamental frequency of the system and its harmonics, bearing resemblance to the impedance pump, suggesting that the drastically under-occluded roller pump is a unique device that employs the pumping mechanisms of both roller pumping and impedance pumping. At the appropriate frequencies, this under-occluded roller pump could sustain sufficiently high flow rates for clinical uses. Blood damage potential of the under-occluded roller pump was compared to a fully occluded roller pump via the assay of free-plasma hemoglobin, and it was found that the under-occlusion reduced hemolysis by about half for any given flow rate. The drastically under-occluded roller pumping reported in this study, therefore, has the potential of being translated into an improved clinical blood pump.
[Mh] Termos MeSH primário: Circulação Assistida/efeitos adversos
Eritrócitos/patologia
Hemólise
[Mh] Termos MeSH secundário: Animais
Circulação Assistida/instrumentação
Velocidade do Fluxo Sanguíneo
Desenho de Equipamento
Hidrodinâmica
Dinâmica não Linear
Fluxo Pulsátil
Suínos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1702
[Cu] Atualização por classe:170216
[Lr] Data última revisão:
170216
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160923
[St] Status:MEDLINE
[do] DOI:10.1111/aor.12731



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