Cannulation Method Research Articles

Minimally Invasive Central Cannulation for Extracorporeal Life Support: The Uniportal and Subxiphoid Approach.

Extracorporeal life support (ECLS) for circulatory and/or respiratory failure is improving. Currently, invasive sternotomies or rib-spreading thoracotomies are used for central cannulation of the heart and great vessels. Although peripheral cannulation of the extremities is often used, this approach may result in immobility and unintentional dislodgement. Less invasive methods for central cannulation are needed to achieve long-term ECLS. The objective of this study was to develop 2 different minimally invasive approaches for central thoracic cannulation. Porcine hearts were positioned in a plastic thoracic model. An endoscopic camera and multiple endoscopic instruments were used. Both access points, uniportal (lateral) and subxiphoidal, were simulatively investigated. A novel cannulation method using purse string sutures, a custom-made endoscopic puncture tool, guidewires, and dilator-assisted cannulas was developed. Simulations were tested in a closed circuit regarding leak tightness. The uniportal approach allowed a cannulation of the aorta, inferior vena cava, right atrium, and main pulmonary artery. Cannulation of the right branches of the pulmonary artery and vein was also possible. From the subxiphoid approach, cannulation of the aorta, main pulmonary artery, and both atria were possible. Subsequent evaluation and leakage tests revealed no damage to the surrounding structures and tightly sealed cannulation sites. The uniportal approach was also successfully performed in a human cadaver to connect the aorta and right atrium with cannulas from the subxiphoidal space. Both uniportal and subxiphoid central cannulation of potential sites for ECLS were feasible. This study encourages further investigation and potential clinical translation of minimally invasive central organ support.

Central Venous Catheter Cannulation in Pediatric Anesthesia and Intensive Care: A Prospective Observational Trial.

Currently, ultrasound-guided central venous catheter (CVC) insertion is recommended in pediatric patients. However, the clinical practice may vary. The primary aim of this study was the overall success rate and the first attempt success rate in ultrasound-guided CVC insertion versus anatomic-based CVC insertion in pediatric patients. The secondary aim was the incidence of associated complications and the procedural time. The physician could freely choose the cannulation method and venous approach. Data were collected for 10 months. Overall, 179 patients were assessed for eligibility and 107 patients were included. In almost half of the patients (48.6%), the percutaneous puncture was performed by real-time ultrasound navigation. In 51.4% of the patients, the puncture was performed by the landmark method. The overall success rate was 100% (n = 52) in the real-time ultrasound navigation group, 96.4% (n = 53) in the landmark insertion group, (p = 0.496). The first percutaneous puncture success rate was 57.7% (n = 30) in the real-time ultrasound navigation group and 45.5% (n = 25) in the landmark insertion group, (p = 0.460). The data show a higher overall success rate and the first success rate in the US-guided CVC insertion group, but the difference was not statistically significant.

Totally percutaneous endovascular repair for ruptured abdominal aortic aneurysms.

The PEVAR Trial demonstrated that compared to open femoral exposure, elective percutaneous endovascular AAA repair (ePEVAR) is associated with decreased perioperative morbidity and access site complications. We hypothesized that PEVAR for ruptured AAA (rPEVAR) may also improve perioperative morbidity compared to open femoral exposure (rEVAR). There are currently no reports that evaluate the utility and outcomes of rPEVAR. From 2015 to 2021, all patients who underwent an endovascular repair of a ruptured AAA at a single institution were included in the study and grouped into rPEVAR and rEVAR. Demographics, procedural details (successful preclose technique, conversion to femoral cutdown), postoperative variables (blood transfusion, ICU and hospital length of stay) and short-term outcomes (30-day major adverse events (30-day MAE) and 30-day femoral access-site complications (30-day FAAC)) were collected and compared with 50 historical ePEVAR patients from the PEVAR Trial. Statistical significance was determined using χ 2 or Fisher's exact test for categorical variables, and Mann-Whitney U-test for continuous variables. 35 patients were identified (21 rPEVAR; 14 rEVAR), 86% were male with a mean age of 72 ± 9 years. All patients underwent emergent endovascular aortic repair with 100% technical success. Seventeen patients (49%) presented with evidence of hemorrhagic shock and 22 patients (63%) had blood transfusion. 30-day MAE occurred in 12 patients (34%) (7 rPEVAR; 5 rEVAR). There was no difference in demographic, perioperative outcomes and 30-day MAE rate between rPEVAR and rEVAR patients. Compared to ePEVAR patient (from PEVAR trial), rPEVAR patients had higher rate of 30-day MAE (34% vs. 6%; p < 0.006) but no difference in 30-day FAAC (19% vs. 12%; p = 0.54). The success rate of the preclose technique was higher in ePEVAR compared to rPEVAR (96% vs. 76%; p = 0.02), but the rate of conversion to femoral cutdown was similar between the two groups (10% vs. 4%; p = 0.57). Emergent rPEVAR appears to have similar outcomes when compared to rEVAR. Although patients undergoing rPEVAR have higher 30-day major adverse events rate compared to ePEVAR, the method of percutaneous femoral cannulation does not appear to increase the overall procedural or 30-day femoral artery access-site complications.

In-plane guided upper arm arteriovenous fistula cannulation with color ultrasound.

The blood vessel in the upper extremity arteriovenous fistula (AVF) is deep in the tissue, and cannulation in AVF is frequently associated with blood oozing, hematoma, or aneurysm. This study evaluated the performance of color ultrasound in-plane guided cannulation technique during upper extremity high-AVF cannulation in patients with hemodialysis. A total of 40 patients with hemodialysis who needed cannulation in upper extremity AVF were recruited in the study, and the patients were randomly divided into observation group and control group. Color Doppler ultrasound was used to guide cannulation in the observation group and in the control group blind cannulation method was applied. The success rate of one-time cannulation, the incidence of subcutaneous hematoma, oozing, and pain caused by incorrect fistula cannulation as well as the satisfaction score of the patients were compared to evaluate the effect and advantages of color ultrasound-guided cannulation. The one-time success rate of internal fistula cannulation in the observation group (98.71%) was significantly higher than that in the control group (88.27%). The incidence rates of hematoma, oozing, pain, and total failure events were significantly reduced in the observation group. The average satisfaction degree in the observation group was also significantly higher than that of the control group. Ultrasonic-guided cannulation effectively enhances the success rate of cannulation in upper extremity AVF, reduces the incidence of cannulation failures, and improves the satisfaction level in the patients.

Minimally invasive apical cannulation and cannula design for short-term mechanical circulatory support devices

BackgroundRefractory cardiogenic shock is still a major clinical challenge with high mortality rates, although several devices can be used to conquer this event. These devices have different advantages and disadvantages originating from their insertion or cannulation method, therefore many complications can occur during their use. The aim of our study was to develop and create prototypes of a novel minimal invasively insertable, transapical cannula for surgical ventricular assist devices, which uniquely incorporates the inflow and outflow routes for the blood of the patient in itself, therefore it enables the use for only one cannula for patients in cardiogenic shock.MethodsTo define the available space for the planned cannula in the left ventricle and ascending aorta, we analyzed computed tomography scans of 24 heart failure patients, who were indicated to left ventricular assist device therapy. Parallel to these measurements, hydrodynamical calculations were performed to determine the sizes of the cannulas, which were necessary to provide effective cardiac output.ResultsAfter the designing steps, we produced prototypes of double-lumened, tube-in-tube apically insertable devices for three different patient groups, which included a separated venous and an arterial part using 3D modelling and printing technology. All the created cannulas are able to provide 5 l/min circulatory support.ConclusionAs a result of our research we created a sizing method based on the specific analysis of computed tomography pictures of end stage heart failure patients and a cannula concept, which can provide effective antegrade flow for patients in cardiogenic shock. We believe the improved version of our tool could have a significant therapeutic role in the future after further development based on animal and in vivo tests.

Echo-guided seldinger technique facilitates ascending aorta cannulation in type A aortic dissection

BackgroundThe ascending aorta is the most simple and rapid arterial access for the establishment of antegrade systemic perfusion. In acute type A aortic dissection, prompt establishment of antegrade central perfusion, especially in unstable hemodynamic emergency operations, help to diminish organ malperfusion and to prevent retrograde embolism. The effectiveness as well as the safety of antegrade perfusion under ultrasonographic guidance through the dissected ascending aorta was evaluated for the repair of type A aortic dissection utilizing a new echo stabilizer.ResultsAscending aortic cannulation was successfully performed in 64 consecutive patients, using the Seldinger technique, with the hands-free continuous-echo monitoring, utilizing a new stabilizer. Epiaortic 2-Dimensional and color Doppler imaging provided real-time monitoring for the placement and proper perfusion of ascending aorta cannulation.ConlusionsAscending aorta can routinely provide a rapid and reliable route of antegrade central systemic perfusion in type A acute aortic dissection. The echo-guided stabilizer-assisted cannulation method can safely provide a rapid and reliable route for antegrade central perfusion during in type A dissections repair.

Pilot Study of the Impact of a Head-Mounted Display and Probe Fixation for Ultrasound-Guided Peripheral Intravenous Cannulation

Highlights Abstract Background: Ultrasound is an efficient and effective technique to aid intravenous cannulation, in which good hand-eye coordination is crucial. To reduce the difficulty, the ultrasound image should be projected and visible in front of the practitioner during cannulation, and the probe should be stabilized on the target vein. The current study investigates the impact of a head-mounted display and probe fixation for ultrasound-guided peripheral intravenous cannulation success and time needed to successful insertion. Materials and Methods: This nonclinical pilot study included 49 nurse anesthetists. They were divided into an intervention group (cannulation with a head-mounted display and probe stabilizer for ultrasound-guided peripheral intravenous cannulation, n = 24) and control group (conventional method of ultrasound-guided cannulation, n = 25). Participants performed 20 procedures each on phantoms, with focus on first attempt cannulation success and time taken to completion of successful cannulation. Results: In the intervention group, 98% succeeded on their very first attempt at cannulation, compared to 52% in the control group (P &amp;lt; 0.001). Time to successful cannulation on the first attempt was 1.13 ± 0.4 minutes in the intervention group, compared with 1.69 ± 0.8 minutes in the control group (P = 0.003). Overall, first attempt cannulation success was 92% in the intervention group and 90% for the control group (P = 0.359). Times required for successful cannulation was reduced by 0.08 minutes in the intervention group (P &amp;lt; 0.001). Conclusions: This pilot study is the first describing the use of a head-mounted display and probe fixation for ultrasound-guided peripheral intravenous cannulation, which resulted in an increased success rate and decreased time to cannulation success.

Acute limb ischemia after femoro-femoral extracorporeal life support implantation: A comparison of surgical, percutaneous, or combined vascular access in 402 patients.

Extracorporeal life support (ECLS) is a salvage treatment for acute circulatory failure. Our high-volume tertiary centre performs more than 100 implants annually and provides ECLS-transports. With this study, we aimed to analyze the incidence and risk factors of limb ischemia depending on the vascular access. Between January 1, 2007, and December 31, 2018, 937 patients received an ECLS. Preoperative, intraoperative, in-hospital and up to 5 years follow-up data were collected. Outcome measures were limb ischemia and survival. In total, 402 femoro-femoral veno-arterial ECLS patients were identified. Mean age was 56 ± 16.7 years, 26.9% were female, 7.9% had a history of peripheral vascular disease. Cannulation was performed percutaneously in 82.1% (n=330), surgically in 5.7% (n=23) and combined in 12.2% (n=49). Mortality was not significantly different between the groups (51.1% percutaneous, 43.5% surgical, 44.9% combined [p=0.89]). There was no significant difference in limb ischemia either, but a trend toward an increased frequency in the percutaneous group (p=0.0501). No amputation was necessary. Limb ischemia slightly increased in-hospital mortality (54.6%) but did not affect long-term survival beyond 30 days. Univariate analysis adjusted for cannulation methods revealed younger age and female gender as risk factors of limb ischemia and younger age for limb ischemia after percutaneous cannulation. Our study shows that percutaneous, surgical, and combined vascular access techniques for ECLS implantation are associated with comparable and low incidence of limb ischemia which slightly increases in-hospital mortality. Special precaution has to be taken in young and female patients.

Ex vivo dual perfusion of an isolated human placenta cotyledon: Towards protocol standardization and improved inter-centre comparability

Since the full development of the ex vivo dual perfusion model of the human placenta cotyledon, the technique has provided essential insight into how nutrients, lipids, gases, immunoglobulins, endocrine agents, pharmaceuticals, chemicals, nanoparticles, micro-organisms and parasites might traverse the maternofetal barrier. Additionally, the model has been instrumental in gaining a better understanding of the regulation of vascular tone, endocrinology and metabolism within this organ. The human placenta is unique amongst species in its anatomy and transfer modalities. This orthologous diversity therefore requires an appropriate consideration of placental transfer rates of compounds, particles and micro-organisms specific to humans.Different research centres have adapted this model with a wide variation in perfusion parameters, including in the establishment of perfusion, perfusate composition, gassing regime, cannulation method, flow rates, perfused tissue mass, and also in the application of quality control measures. The requirement to harmonise and standardise perfusion practice between centres is largely driven by the need to obtain consistency in our understanding of placental function, but also in the qualification of the model for acceptance by regulatory agencies in drug and toxicology testing.A pilot study is proposed, aiming to describe how existing inter-centre variation in perfusion methodology affects placental metabolism, protein synthesis, oxygen consumption, the materno-fetal transfer of key molecular markers, and placental structure.

The impact of needle location on clinical outcome of radiofrequency rhizotomy for trigeminal neuralgia.

Radiofrequency thermocoagulation trigeminal rhizotomy (RT-TR) through the foramen ovale is a minimally invasive treatment for trigeminal neuralgia. Navigation of magnetic resonance imaging (MRI) and CT fusion imaging is a well-established method for cannulation of the Gasserian ganglion. In this study, we use the inline measurements from fusion image to analyze the anatomical parameters between the actual and simulation trajectories and compare the short- and intermediate-term outcomes according to determinable factors. The study included thirty-six idiopathic neuralgia patients who had undergone RT-TR with MRI and CT fusion image as a primary modality or repeated procedures. Among thirty-six treated patients, the inline length of the trigeminal cistern was longer for the simulated trajectory (8.4 ± 2.4 versus 6.5 ± 2.8 mm; p < 0.05), and the predominant structure at risk extrapolated from the inline trajectory was the brainstem, which signified a more medially directed route, in contrast with the equal weighting of temporal lobe and brainstem for the actual trajectory. The preoperative visual analogue scale (VAS) was 9.3 ± 1.0, which decreased to 2.5 ± 2.6 and 2.9 ± 3.1 at first (mean, 3 months) and second (mean, 14 months) postoperative follow-up, respectively. The postoperative VAS scores at the two follow-ups were not statistically significant without a covariate analysis. After adjustment for covariate risk factors, the second follow-up sustained therapeutic benefit was evident in patients with no prior history of related treatment, an ablation temperature greater than 70 °C, and needle location within or adjacent to the trigeminal cistern. This preliminary study demonstrated that the needle location between cistern and ganglion also plays a significant role in better intermediate-term results.

Near-infrared system's efficiency for peripheral intravenous cannulation in a level III neonatal intensive care unit: a cross-sectional study.

Venipuncture is a painful and invasive procedure for hospitalised newborns and represents a challenge for neonatal healthcare professionals. This study evaluated the most efficient cannulation method based on the proportion of success at the first attempt, standard care or near-infrared (NIR) device use, and pain assessment. An observational study with two arms was conducted in the neonatal intensive care unit (NICU) of a tertiary-care university hospital in Italy. All newborns undergoing peripheral vein cannulation and only nurses with more than 5 years of professional experience in the NICU were eligible for the first arm. Only newborns with a body weight of >2500 g at cannulation and all nurses working in the NICU were involved in the second arm. In the first arm of the study, no statistically significant differences between the NIR and control groups were found in terms of proportion of successful at the first attempt 60.6% (confidence interval [CI] 95%: 48.8; 72.4) vs. 56.1% (CI 95%: 44.1; 68.0) and the mean premature infant pain profile score 6.3 (CI 95%: 5.4-7.1) vs. 5.8 (CI 95%: 5.0-6.6). In the second arm, only among less experienced nurses (<1 year), we observed a significant increase in the proportion of success in the NIR group compared with the control group, nearly tripling the success rate (72.7% [54.1; 91.3] vs. 23.1% [0.2; 46.0]). Conclusion: This study reported no differences between the NIR and control groups. The results also suggest that using a NIR device may be advantageous for healthcare professionals with less experience during first-time cannulation. What is Known: • Venipuncture is a painful procedure commonly used to place a peripheral venous catheter for administering nutrients or drugs. • Near-infrared light facilitates the visualisation of veins and consequently, the performance of cannulation in the paediatric population. What is New: • The near-infrared light device was not associated with fewer attempts and a lower premature infant pain profile score in placing venous access in newborns than the traditional method. • The near-infrared light device could help nurses with less professional experience place a peripheral venous catheter.

Observation on Application Effect of Arterial Puncture and Catheterization under Guidance of Intelligent Medical Care Ultrasound in Clinical Anesthesia.

In clinical anesthesia and the rescue of critically ill patients, arterial puncture and catheterization are the most commonly chosen ways to establish central arterial access for patients. Invasive arterial puncture and catheterization facilitate the grasp of real-time vital sign information of patients during surgery, which strengthens patient monitoring during surgery and improves safety. However, the traditional method of arterial puncture and cannulation through palpation of the radial artery is often prone to complications related to mechanical injury, such as hemorrhage, hematoma, and accidental perforation of the artery. Studies have shown that ultrasound-guided radial artery puncture and cannulation can shorten the puncture cannulation time, reduce the incidence of complications related to puncture cannulation, and improve the success rate of puncture cannulation. In order to verify it, this paper uses the experimental group and the control group to conduct comparative experiments and uses the neural network method to evaluate the effects of the two methods. As a more mature method of artificial intelligence, BP neural network is widely used in a wide range of applications and has the characteristics of strong generalization ability and fast convergence, so we choose it as the base model. The specific work of this paper is as follows: (1) in-depth study of the relevant theory of BP neural network (BPNN), focusing on the structure of BPNN and the working principle of algorithm; the problems to be solved in the clinical anesthesia effect evaluation have laid a theoretical foundation for the establishment of an improved BPNN evaluation model in the following chapters. (2) introduce the basic principle of genetic neural network, analyze the benefits of combining genetic neural network and BPNN; introduce in detail the process of genetic algorithm to optimize the weights and thresholds of BPNN, and establish a GA-BP evaluation model. The test proves the feasibility and superiority of the model.

Outcomes by cannulation methods for venovenous extracorporeal membrane oxygenation during COVID-19: Amulticenter retrospective study.

In a multicenter, retrospective analysis of 435 patients with refractory COVID-19 placed on V-V ECMO, cannulation by a single, dual-lumen catheter with directed outflow to the pulmonary artery was associated with lower inpatient mortality.

Comparison of Success Rates of Different Methods of Ultrasound-Guided Radial Artery Cannulation (Short-Axis and Long-Axis Methods) Against the Traditional Palpatory Method: A Prospective Randomized Study.

ObjectiveRecent meta-analysis comparing the success rates of various methods of arterial cannulation in adult patients found heterogeneity in the available data. Hence, we did this study to evaluate and compare the success rate of palpatory method with that of ultrasound guided methods of radial artery cannulation. The aim is to compare the first-attempt success rate of the palpatory method with that of ultrasound-guided radial artery cannulation techniques, namely, the short-axis out-of-plane and the long-axis in-plane methods.MethodsThis is a prospective, randomized, parallel-arm study. Ninety patients aged from 18 to 50 years (presenting for various surgeries requiring radial artery cannulation for invasive blood pressure monitoring or frequent arterial blood gas analysis) were divided into 3 groups. Each group had one of the 3 techniques of radial arterial cannulation, namely palpatory, short-axis ultrasound method, and long-axis ultrasound method. The parameters analyzed were first-attempt success rate, number of attempts needed, cannulation time, need for crossover of technique, and incidence of complications. Multivariate analysis was done with one-way ANOVA, with Tukey's post hoc test. For categorical data, the chi-square test was used. The probability value of .05 was considered as a significant level.ResultsThe first-attempt success rate was 76.7% in the long-axis method, 86.7% in the short-axis method, and 56.7% in the palpatory method. The short-axis method has been shown to have a shorter cannulation time, fewer attempts needed for successful cannulation, and lower need for crossover of techniques when the first 2 attempts fail.Conclusions: We conclude that the ultrasound-guided short-axis method of radial artery cannulation is associated with higher first-attempt success rate compared to the traditional palpatory method.

Impact of COVID-19 on ERCP Practice: A Center Experience from North Africa

Background: The COVID-19 pandemic has negatively influenced gastrointestinal endoscopy practice worldwide. We aimed to evaluate its impact on the ERCP practice. Methods: A cross-sectional study was conducted to analyze all ERCPs performed during 2020 in our unit by comparing the first trimester of the year or the pre-pandemic period with the rest of the year or the pandemic period. Results: We performed 149 ERCPs with 65 ERCPs (43.6%) during the pre-pandemic period and 84 ERCPs (56.4%) during the pandemic period. ERCPs volumes decreased by 57% during the pandemic period in comparison with the pre-pandemic period. The most ERCP indications were common bile duct stones and malignant biliary strictures with an increase in numbers of acute cholangitis during the pandemic period (p=0.035). There was no difference regarding cannulation methods and technical success between the two periods. Conclusion: The COVID-19 pandemic has drastically affected the ERCP practice in our unit with a significant decrease in the ERCP volumes with an increase in the urgent ERCP indications.

Nurses and Efficacy of Ultrasound-Guided Versus Traditional Venous Access: A Systemic Review and Meta-Analysis

BackgroundUltrasound-guided venous cannulation is an increasingly popular tool for peripheral intravenous catheter placement among nursing providers as opposed to standard of care landmark-based placement methods. This systematic review and meta-analysis assessed the use of ultrasound-guided versus landmark-based catheter cannulation among nursing providers across existing literature. MethodsPubMed, Scopus, and Embase were searched for eligible studies from their beginning to June 11, 2021. Outcomes were the rate of first successful placement, procedure length, and number of total attempts. Bias and study quality were assessed using the Cochrane’s Risk of Bias and the Newcastle-Ottawa Scale tools, respectively. Random-effects meta-analysis and assessed heterogeneity via Q-statistics and I2 values were used. ResultsThe meta-analysis included 7 randomized clinical studies and 527 patients; 276 (52%) underwent ultrasound-guided cannulation and were associated with 2 times higher likelihood (odds ratio, 2.08; 95% confidence interval, 1.43-3.0; P < .001; I2 < 0.001; 95% confidence interval, 0-18) of first successful placement by nurse clinicians. Ultrasound-guided venous cannulation by nurses was associated with similar number of attempts, procedure length, and patients’ satisfaction, compared with standard-of-care cannulation. ConclusionsThis study demonstrated the advantage of nurses’ ultrasound-guided venous cannulation over landmark-based cannulation methods for first successful placement, although other outcomes were not significantly different between methods. Additional multisite studies with adequately powered sample sizes are necessary to confirm these findings.

Vascular complications based on mode of extracorporeal membrane oxygenation

BackgroundVascular complications remain a prevalent and devastating complication of extracorporeal membrane oxygenation (ECMO). Risks for vascular complications have risen as the volume and medical complexity of ECMO cases has rapidly increased in recent years. This study assesses occurrence and clinical impact of vascular complications across all ECMO modes and cannulation methods in a high-volume academic center. MethodsA retrospective single-institution review was performed of all ECMO cannulations for central or peripheral venovenous (VV) or venoarterial (VA) ECMO in 2019-2020. Patients who expired during cannulation were excluded. Primary outcomes of vascular consultation rates at or after ECMO placement, limb loss, and mortality were assessed during index hospitalization. ResultsA total of 229 patients were identified during the 2-year study period. VA ECMO was used in the majority of patients (n = 137, 60%), with 83% (N = 114) undergoing peripheral cannulation. Vascular surgery was consulted in 54 (23.6%) patients. Complication rates ranged from 33.9% in peripheral VA cannulation to 7% in jugular VV cannulation. Overall, 65% of vascular consults required operative intervention; interventions were highest in peripheral VA ECMO (n = 30 of 114, 26.3%). Across all ECMO types, acute limb ischemia (ALI) was the most common complication (n = 38, 16.5%), with rates ranging from 26.1% in central VA ECMO to 4.8% in jugular VV ECMO. Distal antegrade perfusion catheters (DPCs) were employed in n = 68 of 114 (59.6%) of all peripheral VA ECMO cases. Prophylactic DPCs were found to be incorrectly placed in 10.2% (n = 7 of 68) of cases, which obscured the ability to fully evaluate the effect of prophylactic DPCs on reducing rates of ALI. Major amputation (Below Knee Amputation/Above Knee Amputation) occurred in six peripheral VA patients (5.3%), two central VA patients (8.65), and two femoral-femoral VV patients (4%). Patients with ALI experienced significantly lower rates of in-hospital survival in Kaplan-Meier analysis (32.5% vs 54%, log-rank = 0.023). ConclusionsThis study highlights the prevalence of vascular complications, and their associated mortality impact, across all modes of ECMO and additionally identifies several areas for institutional performance improvement. ALI was the most common complication across all cohorts and was associated with decreased in-hospital survival. The impact of DPC on ALI was difficult to elucidate due to nonstandardized placement patterns and selective use. In the care of these medically complex patients on multidisciplinary teams, review of outcomes and group discussions targeting areas for improvement are critical to success; in this study, findings resulted in the development of a lower extremity perfusion management protocol.

Chemerin fragments show different effects on systemic blood pressure dependent on carboxyl-terminal cleavage site

Chemerin is an adipocytokine whose concentration in blood correlates positively with blood pressure (BP). We have recently revealed that acute intracerebroventricular (i.c.v.) injection of chemerin-9, an active fragment of human chemerin, increased systemic BP in normal Wistar rats, suggesting that chemerin is involved in the central nervous control of peripheral BP. After secreted as an inactive form as prochemerin, a mature form of active chemerin is produced through the cleavage of its carboxyl (C)-terminus by proteases. Although the activity of cleaved products of chemerin has been examined in vitro, in vivo effects remained to be elusive. In order to explore them, we performed acute i.c.v. injection of mouse chemerin-9 (mChemerin-9; 148F-156S), mouse chemerin-8 (mChemerin-8; 148F-155F), and mouse chemerin-7 (mChemerin-7; 148F-154A) into Wistar rats, and examined the effects on systemic BP. After chemerin fragment (1-30 nmol/head, i.c.v.) was cumulatively administered, systemic BP was measured by a cannulation method under an isoflurane anesthesia. mChemerin-9 but not mChemerin-8 and -7 induced a pressor response, which was concentration-dependent. In conclusion, we for the first time demonstrated that mChemerin-9 that corresponds to the C-terminal nine amino acids of active mouse chemerin156S increased systemic BP in rats, and also that chemerin fragments showed different effects on systemic BP dependent on how their C-terminus was cleaved.

A method for intracerebroventricular cannulation of young broiler chicks

The site-specific administration of neuroactive substances or pharmacological agents is a routine practice in neurological studies. To facilitate chronic treatments intercranial cannulae are often implanted in the skull. These surgical procedures are widely described and well-documented for rodents, as the most common animal model, and even refined over the years. However, precise descriptions of proper procedure for third ventricle cannulation in young broiler chicks is not readily available. This absence is surprising, as chicken models are often used in the investigation of physiological control of the metabolism and ingestion. Furthermore, as a commercial animal, there is also a particular interest in elucidating the central regulation of feed intake and metabolism to optimize feeding and living conditions for broilers. The brain nuclei that serve as the regulatory centers of feeding and metabolism are the arcuate nucleus, the ventromedial hypothalamic nucleus, and the lateral hypothalamus, which are all located near the third ventricle. Here, we provide a full protocol for intracerebroventricular (i.c.v.) cannulation of 7-day old broiler chicks, as well as a review of some of the advances made in rodent i.c.v. cannulations and whether these advances are applicable to cannulations in chickens. Using the surgical procedure described here, we were able to achieve a success rate of proper implantation of 88%, with a mortality rate of less than 1% (n = 224).•Detailed procedure for i.c.v. canula implantation in the third ventricle of 7d-old broiler chicks.•Cement cap with anchoring screws is necessary in broilers, glue does not provide sufficient stability.•Carboxylate cement and self-adhesive resin cement were tested as an alternative for methyl methacrylate cement.

Perfusion Strategy for Minimally Invasive Cardiac Surgery

Minimally invasive cardiac surgery (MICS) has a number of proven advantages compared to median sternotomy. Safe cannulation and perfusion are some of the main components of the success of MICS.&#x0D; The aim. To present our perfusion strategy and describe the methods of cannulation, technical features, contraindications and potential complications.&#x0D; Materials and methods. We examined the results of 1088 adult patients who underwent primary cardiac surgery in our hospital (coronary artery bypass grafting, valve surgery, aortic surgery, left ventricle repair, congenital cardiac surgery and combined procedures) from July 2017 to May 2021. Of these, 851 patients were qualified for MICS. To select a safe cannulation strategy, we performed contrast enhanced computed tomography (CT) of the aorta and main branches for all the patients, also we calculated the body surface area according to the DuBois and DuBois formula.&#x0D; Results. We performed 838 minimally invasive on-pump procedures, which is 98.5% of all patients qualified for MICS. According to the results of the preoperative CT scan, 13 (1.5%) patients were not operated with the minimally invasive approach due to the hazards related to the provision of cardiopulmonary bypass. Peripheral cannulation was performed in 754 (90%) patients and an alternative cannulation site was selected in 62 (8.2%) patients based on preoperative CT data. There were 10 (1.32%) patients who developed major complications (stroke, acute aortic dissection, acute renal failure requiring hemodialysis) after peripheral cannulation.&#x0D; Conclusions. Preoperative CT scan is mandatory for planning a perfusion strategy in minimally invasive cardiac surgery. The required surgical techniques should include cannulation of the right and left femoral and right axillary arteries.