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Sagir G. Ahmed - One of the best experts on this subject based on the ideXlab platform.
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Anaerobic storage of red blood cells: the need for caution regarding donor red cells with sickle cell trait
Vox Sanguinis, 2011Co-Authors: Sagir G. AhmedAbstract:Dear Sir, We read with interest the review article entitled “Anaerobic storage of red blood cells” written by Yoshida and Shevkoplyas from the United States, which was published in a recent issue of Blood Transfusion1. The article extolled the virtues and potential advantages of anaerobic red cell storage over conventional storage with respect to mitigation of oxidative red cell damage thus allowing for extended storage with good post-transfusion red cell viability, which could be augmented by the addition of metabolite precursor supplements during storage as demonstrated by many studies1. However, despite an extensive review of the research literature, the authors did not take into consideration the implications of anaerobic storage on the viability of red blood cells from donors with sickle cell trait. Individuals with sickle cell trait have red cells with the HbAS genotype and contain about 40% HbS and 60% HbA2. The abundance of HbA prevents sickling in vivo under normal physiological conditions2. However, studies have shown that sickle cell trait blood stored under conventional conditions (i.e. not anaerobic) has poor filterability during leucodepletion procedures3. Furthermore, it has been demonstrated that the filterability of units of blood from donors with sickle cell trait can be improved by enhanced oxygenation, suggesting that some degree of red cell sickling could occur even during conventional storage and is responsible for the poor filterability indices associated with sickle cell trait3. If conventional storage causes some sickling of sickle cell trait red cells, it is easy to believe that anaerobic storage might trigger massive sickling of such cells as a result of the deliberate deoxygenation during storage. Both deoxygenation and sickling can cause membrane damage of HbS-containing red cells4. Hence, we infer that the deoxygenation associated with anaerobic storage would lead to sickling of sickle cell trait red cells and ultimately result in membrane damage that may adversely affect the cells’ post-transfusion viability. From a clinical perspective, transfusing sickled red cells could be harmful, especially to recipients with sickle cell disease or Cardiopulmonary Insufficiency. There is, therefore, an urgent need to investigate the impact of anaerobic storage on sickle cell trait red cells. Until this is fully investigated, we believe that the advantages of anaerobic red cell storage may be outweighed by the adverse risk of inducing massive sickling. This is particularly important in African nations that have a high prevalence of sickle cell trait among their donor populations5. Hence, anaerobic red cell storage must be considered with caution and scepticism among ethnic populations with a high prevalence of sickle cell haemoglobinopathy.
Richard K Firmin - One of the best experts on this subject based on the ideXlab platform.
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thoratec centrimag for temporary treatment of refractory cardiogenic shock or severe Cardiopulmonary Insufficiency a systematic literature review and meta analysis of observational studies
Asaio Journal, 2014Co-Authors: Oleg Borisenko, Gillian Wylie, John R Payne, Staffan Bjessmo, Jon Smith, Nizar Yonan, Richard K FirminAbstract:The aim of the study was to systematically evaluate effect of CentriMag heart pump (Thoratec Corporation) as temporary ventricular assist device (VAD) and part of extracorporeal membrane oxygenation (ECMO) system on outcomes in patients with cardiac or cardiac-respiratory failure. A systematic search was conducted in five databases for the period 2003 to 2012. Fifty-three publications with data for 999 patients, supported with CentriMag, were included. In 72% studies, CentriMag was used as a VAD and in 25% as part of ECMO circuit. Mean duration of VAD support was 25.0 days in precardiotomy group, 10.9 days in postcardiac surgery cardiogenic shock group, 8.8 days in post-transplant graft failure and rejection group, and 16.0 days in post-LVAD placement right ventricular failure group. Survival on support was 82% (95% CI 70–92) for VAD support in precardiotomy cardiogenic shock indication, 63% (95% CI 46–78) in VAD support in postcardiac surgery cardiogenic shock indication, 62% (95% CI 46–76) in VAD support in post-transplant graft rejection or failure indication, and 83% (95% CI 73–92) in VAD support in post-LVAD placement right ventricular failure indication. CentriMag is an effective technology for temporary support of patients with cardiac and cardiorespiratory failure.
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thoratec centrimag for temporary treatment of refractory cardiogenic shock or severe Cardiopulmonary Insufficiency in adult and pediatric patients a systematic literature review and meta analysis of observational studies
Journal of Heart and Lung Transplantation, 2014Co-Authors: Richard K Firmin, Oleg Borisenko, John R Payne, Staffan Bjessmo, Nizar Yonan, J H Smith, G WyllieAbstract:s S249 Purpose: Extracorporeal Cardiopulmonary resuscitation (ECPR) has recently been gaining popularity. We document our experience with ECPR following in-hospital cardiac arrest. Methods: This is a retrospective review of 47 adult patients who received ECPR from March 2007 to July 2013 at our institution. The primary outcome of interest was survival to discharge. Results: Mean age was 57.5 ± 16.4 years and 59.8% of the patients were male. Duration of CPR was 29.6 ± 15.9 minutes. CPR was performed for less than 20 min in 11 patients, between 20-40 min in 12 patients, and for more than 40 min in 10. Overall 29.8% survived to discharge. Only age was found to be significantly different between those who survived to discharge and those who did not (50.4 ± 15.1 years in survivors, 60.5 ± 15.0 years in nonsurvivors, p= 0.05). Myocardial recovery was achieved in 17% of patients (8) and 31.9% (15) were transitioned to another ventricular assist device. Causes of death included multi-system organ failure in 13 patients (27.7%), neurologic non-recovery in 10 patients (21.3%), and cardiac failure in 9 (19.1%). Bivariate analysis revealed age (OR: 1.05, CI: 1.00 1.09, p= 0.04) and etiology of AMI (OR: 0.24, CI: 0.06 0.95, p= 0.04) to be significant predictors and protective factors, respectively, for in hospital mortality. Duration of CPR was not a significant predictor of worse outcomes (OR: 0.96, CI: 0.92 1.02, p= 0.21). Survival to discharge was 27.7% with CPR 40min. Conclusion: Approximately 30% of patients undergoing ECPR survived to discharge. Those with younger age and cardiac arrest in the setting of AMI have better outcomes. Extended duration of CPR was not a predictor of in hospital mortality. Further investigation will help identify the patient population that will maximally benefit from ECPR.
G Wyllie - One of the best experts on this subject based on the ideXlab platform.
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thoratec centrimag for temporary treatment of refractory cardiogenic shock or severe Cardiopulmonary Insufficiency in adult and pediatric patients a systematic literature review and meta analysis of observational studies
Journal of Heart and Lung Transplantation, 2014Co-Authors: Richard K Firmin, Oleg Borisenko, John R Payne, Staffan Bjessmo, Nizar Yonan, J H Smith, G WyllieAbstract:s S249 Purpose: Extracorporeal Cardiopulmonary resuscitation (ECPR) has recently been gaining popularity. We document our experience with ECPR following in-hospital cardiac arrest. Methods: This is a retrospective review of 47 adult patients who received ECPR from March 2007 to July 2013 at our institution. The primary outcome of interest was survival to discharge. Results: Mean age was 57.5 ± 16.4 years and 59.8% of the patients were male. Duration of CPR was 29.6 ± 15.9 minutes. CPR was performed for less than 20 min in 11 patients, between 20-40 min in 12 patients, and for more than 40 min in 10. Overall 29.8% survived to discharge. Only age was found to be significantly different between those who survived to discharge and those who did not (50.4 ± 15.1 years in survivors, 60.5 ± 15.0 years in nonsurvivors, p= 0.05). Myocardial recovery was achieved in 17% of patients (8) and 31.9% (15) were transitioned to another ventricular assist device. Causes of death included multi-system organ failure in 13 patients (27.7%), neurologic non-recovery in 10 patients (21.3%), and cardiac failure in 9 (19.1%). Bivariate analysis revealed age (OR: 1.05, CI: 1.00 1.09, p= 0.04) and etiology of AMI (OR: 0.24, CI: 0.06 0.95, p= 0.04) to be significant predictors and protective factors, respectively, for in hospital mortality. Duration of CPR was not a significant predictor of worse outcomes (OR: 0.96, CI: 0.92 1.02, p= 0.21). Survival to discharge was 27.7% with CPR 40min. Conclusion: Approximately 30% of patients undergoing ECPR survived to discharge. Those with younger age and cardiac arrest in the setting of AMI have better outcomes. Extended duration of CPR was not a predictor of in hospital mortality. Further investigation will help identify the patient population that will maximally benefit from ECPR.
Oleg Borisenko - One of the best experts on this subject based on the ideXlab platform.
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thoratec centrimag for temporary treatment of refractory cardiogenic shock or severe Cardiopulmonary Insufficiency a systematic literature review and meta analysis of observational studies
Asaio Journal, 2014Co-Authors: Oleg Borisenko, Gillian Wylie, John R Payne, Staffan Bjessmo, Jon Smith, Nizar Yonan, Richard K FirminAbstract:The aim of the study was to systematically evaluate effect of CentriMag heart pump (Thoratec Corporation) as temporary ventricular assist device (VAD) and part of extracorporeal membrane oxygenation (ECMO) system on outcomes in patients with cardiac or cardiac-respiratory failure. A systematic search was conducted in five databases for the period 2003 to 2012. Fifty-three publications with data for 999 patients, supported with CentriMag, were included. In 72% studies, CentriMag was used as a VAD and in 25% as part of ECMO circuit. Mean duration of VAD support was 25.0 days in precardiotomy group, 10.9 days in postcardiac surgery cardiogenic shock group, 8.8 days in post-transplant graft failure and rejection group, and 16.0 days in post-LVAD placement right ventricular failure group. Survival on support was 82% (95% CI 70–92) for VAD support in precardiotomy cardiogenic shock indication, 63% (95% CI 46–78) in VAD support in postcardiac surgery cardiogenic shock indication, 62% (95% CI 46–76) in VAD support in post-transplant graft rejection or failure indication, and 83% (95% CI 73–92) in VAD support in post-LVAD placement right ventricular failure indication. CentriMag is an effective technology for temporary support of patients with cardiac and cardiorespiratory failure.
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thoratec centrimag for temporary treatment of refractory cardiogenic shock or severe Cardiopulmonary Insufficiency in adult and pediatric patients a systematic literature review and meta analysis of observational studies
Journal of Heart and Lung Transplantation, 2014Co-Authors: Richard K Firmin, Oleg Borisenko, John R Payne, Staffan Bjessmo, Nizar Yonan, J H Smith, G WyllieAbstract:s S249 Purpose: Extracorporeal Cardiopulmonary resuscitation (ECPR) has recently been gaining popularity. We document our experience with ECPR following in-hospital cardiac arrest. Methods: This is a retrospective review of 47 adult patients who received ECPR from March 2007 to July 2013 at our institution. The primary outcome of interest was survival to discharge. Results: Mean age was 57.5 ± 16.4 years and 59.8% of the patients were male. Duration of CPR was 29.6 ± 15.9 minutes. CPR was performed for less than 20 min in 11 patients, between 20-40 min in 12 patients, and for more than 40 min in 10. Overall 29.8% survived to discharge. Only age was found to be significantly different between those who survived to discharge and those who did not (50.4 ± 15.1 years in survivors, 60.5 ± 15.0 years in nonsurvivors, p= 0.05). Myocardial recovery was achieved in 17% of patients (8) and 31.9% (15) were transitioned to another ventricular assist device. Causes of death included multi-system organ failure in 13 patients (27.7%), neurologic non-recovery in 10 patients (21.3%), and cardiac failure in 9 (19.1%). Bivariate analysis revealed age (OR: 1.05, CI: 1.00 1.09, p= 0.04) and etiology of AMI (OR: 0.24, CI: 0.06 0.95, p= 0.04) to be significant predictors and protective factors, respectively, for in hospital mortality. Duration of CPR was not a significant predictor of worse outcomes (OR: 0.96, CI: 0.92 1.02, p= 0.21). Survival to discharge was 27.7% with CPR 40min. Conclusion: Approximately 30% of patients undergoing ECPR survived to discharge. Those with younger age and cardiac arrest in the setting of AMI have better outcomes. Extended duration of CPR was not a predictor of in hospital mortality. Further investigation will help identify the patient population that will maximally benefit from ECPR.
Graham R Barr - One of the best experts on this subject based on the ideXlab platform.
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rethinking chronic obstructive pulmonary disease chronic pulmonary Insufficiency and combined Cardiopulmonary Insufficiency
Annals of the American Thoracic Society, 2018Co-Authors: Graham R BarrAbstract:Almost 70 years ago, Drs. Baldwin, Cournand, and Richards defined chronic pulmonary Insufficiency by the presence of respiratory symptoms, radiologic evidence of pulmonary emphysema on chest radiography, and physiologic gas trapping. A decade later, airflow obstruction on spirometry was added to the definition and Insufficiency became a disease. Contemporary studies are reviving the diagnostic approach described by these early luminaries, with researchers finding that symptomatic smokers with preserved spirometry have increased exacerbations and that smokers and non-smokers with normal spirometry but emphysema on chest computed tomography have increased mortality. Hence, the Baldwin-Cournand-Richards concept of disease defined by respiratory symptoms, radiologic findings, and physiology-regardless of spirometric criteria-is being rediscovered. Baldwin, Cournand, and Richards also stated that "functionally, it is obvious that the pulmonary and circulatory apparatus are one unit," and they defined combined Cardiopulmonary Insufficiency as chronic pulmonary Insufficiency with (left or right) cardiac and pulmonary artery enlargement. They appreciated the complexity of these interactions, which include the potential role of gas trapping in heart failure with reduced ejection fraction; the impact of emphysema on blood flow in heart failure with preserved ejection fraction; multiple contributions to cor pulmonale with increased pulmonary artery pressure; and cor pulmonale parvus in emphysema; all of which may be amenable to specific therapeutic interventions. Given the complexity of heart-lung interactions originally identified by Baldwin, Cournand, and Richards and the potentially large therapeutic opportunities, large-scale studies are still warranted to find specific therapies for subphenotypes of combined Cardiopulmonary Insufficiency.