Pump Oxygenator Research Articles

Research on Sports Injury Rehabilitation Detection Based on IoT Models for Digital Health Care.

Physical therapists specializing in sports rehabilitation detection help injured athletes recover from their wounds and avoid further harm. Sports rehabilitators treat not just commonplace sports injuries but also work-related musculoskeletal injuries, discomfort, and disorders. Sensor-equipped Internet of Things (IoT) monitors the real-time location of medical equipment such as scooters, cardioverters, nebulizer treatments, oxygenation pumps, or other monitor gear. Analysis of medicine deployment across sites is possible in real time. Health care delivery based on digital technology to improve access, affordability, and sustainability of medical treatment is known as digital health care. The challenging characteristics of such sports injury rehabilitation for digital health care are playing position, game strategies, and cybersecurity. Hence, in this research, health care IoT-enabled body area networks (HIoT-BAN) have been designed to improve sports injury rehabilitation detection for digital health care. The health care sector may benefit significantly from IoT adoption since it allows for enhanced patient safety; health care investment management includes controlling the hospital's pharmaceutical stock and monitoring the heat and humidity levels. Digital health describes a group of programmers made to aid health care delivery, whether by assisting with clinical decision-making or streamlining back-end operations in health care institutions. A HIoT-BAN effectively predicts the rise in sports injury rehabilitation detection with faster digital health care based on IoT. The research concludes that the HIoT-BAN effectively indicates sports injury rehabilitation detection for digital health care. The experimental analysis of HIoT-BAN outperforms the IoT method in terms of performance, accuracy, prediction ratio, and mean square error rate.

Predesign of a Radial Inflow Turbine That Uses Supercritical Methane for a Mid-Scale Thruster for Upper Stage Application

The worldwide concern regarding the harmful effects of old polluting and toxic propellants has led to increased interest in new, green propellants and higher efficiency thrusters. This fact requires that a new generation of turbopumps, fit for these propellants, is developed. This paper focuses on the design of a radial inflow turbine, which was developed to power a single-shaft turbopump system for a 30 kN upper stage expander cycle thruster engine. The objective was to create a high-efficiency, compact, cheap-to-manufacture, 3D-printable turbine suitable to simultaneously power the methane and Oxygen pumps that feed the thruster. The total power consumed by the pumps for which this turbine was designed is 152 kW. The solution proposed in this paper includes measures such as elimination of the bladed diffuser, which was carried out to reduce the weight and the overall dimensions of the turbine. Comparing it with an axial turbine with the same power output, it has lower overall dimensions because it does not require a direction change at the inlet to the turbine bladed components, it does not require a stator to work, and its casing has a conical shape and is not cylindrical like the axial construction one. The proposed design has been analysed by CFD, which revealed that it can power the pumps. Analysis performed in off-design conditions indicated that the turbine has the best efficiency if the rotation speed and mass flow are varied at the same time. A breadboard model of the turbopump for which the turbine in this paper has been designed has been built using plastic and tested at pressures up to 6 bars using compressed air. The results indicate that above 1.5 bars of inlet pressure the turbine can overcome the internal resistances of the components and the rotor starts to spin. No indication of imbalance of the rotor was observed at maximum test pressure. Two configurations of the seals between the turbine and the adjacent pump have been tested, indicating that labyrinth seals must be doubled by floating ring seals.

Gradient design for Si-based microspheres as ultra-stable Li-storage anode

High-capacity Si-based microspheres are being spotlighted as a promising substitute for commercial spherical graphite anodes in the development of high-energy lithium-ion batteries. Nevertheless, the formidable challenge of their severe mechanochemical degradation during the (de)lithiation process remains unaddressed currently. Herein, we present a Si-based microsphere prepared by the oxygen pumping mechanism under a cost-efficiently low-temperature (250 °C) molten salt reduction environment. By optimally controlling oxygen gradient distribution, the resulted Si-based microspheres exhibit the unique coherent architecture ranging from ordered crystalline Si core to disordered SiO2(v) shell. Their structural coherence but regional difference in function achieves a perfect combination of structural compatibility and optimized chemo-mechanical effect, endowing the obtained Si-based microspheres with a nearly intact morphology after 1500 cycles and a 97% capacity retention after 1000 cycles at 2 A g-1. Our design broadens research directions for Si anode material design, which will accelerate the practical application of micro-sized Si anode materials.

Aortic Thrombus Formation in the Mixing Zone of a Patient With Acute Myocarditis

A 66-year-old man presented with chills, exertional dyspnea, and palpitations; he later developed a fever. Because of his elevated cardiac enzymes and electrocardiography and coronary angiography findings, he was diagnosed with acute myocarditis. Given his unstable hemodynamics, an intra-aortic balloon pump was inserted; however, he experienced a hemodynamic collapse due to refractory ventricular fibrillation. He was then cannulated with venoarterial extracorporeal membrane oxygenation and microaxial flow pump and underwent steroid pulse therapy. His lactate levels were elevated, and computed tomography imaging revealed an aortic thrombus possibly formed in the mixing zone of the venoarterial extracorporeal membrane oxygenation and microaxial flow pump. Based on the antibody test results, he was diagnosed with heparin-induced thrombocytopenia; thus, heparin was replaced with argatroban. Surgical intervention restored the arterial flow. The patient was stabilized and discharged on day 47.

European practices on antithrombotic management during percutaneous mechanical circulatory support in adults: insights from an international survey

Abstract Background Bleeding and thrombotic complications remain a major concern in cardiogenic shock (CS) patients undergoing percutaneous mechanical circulatory support (pMCS) with veno-arterial extracorporeal membrane oxygenation (V-A ECMO) and/or microaxial flow pumps like the Impella. Antithrombotic practices strongly determine the coagulopathic risk, but standardized protocols are lacking in this context. Purpose This survey outlines European practices on antithrombotic management in adults on pMCS for CS, making an initial effort to standardize practices, inform future trials, and enhance outcomes. Methods This online cross-sectional survey was distributed through digital newsletters and social media platforms by the Association of Acute Cardiovascular Care (ACVC) of the ESC and the European branch of the Extracorporeal Life Support Organization (EuroELSO). The survey was accessible from April 17th to May 23rd, 2023. The target population were European clinicians involved in care for adults on pMCS. Results We included 105 responses from 26 European countries. In 72.4% of the European respondents’ institutions, a standardized local anticoagulation protocol is present, with unfractionated heparin (UFH) being the predominantly used anticoagulant (Impella: 97.0%; V-A ECMO: 96.1%). Similarly, the purge solution during Impella support is most frequently UFH-based (84.1%). A bicarbonate-based purge solution (BBPS) as standard purge is reported by only 1.6%. UFH titration based on the activated partial thromboplastin time (APTT) alone is the most common practice either for Impella (43.1%) and for V-A ECMO (32.9%). A minority of 16.9% and 13.2% indicate relying on activated clotting time (ACT) for UFH-titration during Impella and V-A ECMO support, respectively. UFH-titration protocols are anti-Xa based for 12.3% (Impella) and 10.5% (V-A ECMO) of the respondents. An UFH anticoagulant protocol based on APTT and anti-Xa in parallel is the preferred option for 10.8% (Impella) and 14.5% (V-A ECMO) of the respondents. Anticoagulant targets for APTT, ACT and anti-Xa varied across institutions. The majority (83.8%) does not alter their anticoagulation management in case of combined Impella plus V-A ECMO-approach (ECMELLA). Typical thresholds for transfusion or administration of blood products without acute bleeding as indication vary substantially and are frequently not predefined. Following acute coronary syndrome without percutaneous coronary intervention (PCI), 54.0% and 42.7% administered dual antiplatelet therapy during Impella and V-A ECMO support, increasing to 93.7% and 84.0% after PCI. Conclusions Our survey validated the considerable variation in antithrombotic management in adults in CS on pMCS across European centres. There is a pressing demand for a standardized approach to antithrombotic management in this context to mitigate the impact of coagulopathic complications and, consequently, enhance outcomes.Figure 1.Figure 2.

Engineering Lattice Oxygen Regeneration of NiFe Layered Double Hydroxide Enhances Oxygen Evolution Catalysis Durability.

The lattice oxygen mechanism (LOM) endows NiFe layered double hydroxide (NiFe-LDH) with superior oxygen evolution reaction (OER) activity, yet the frequent evolution and sluggish regeneration of lattice oxygen intensify the dissolution of active species. Herein, we overcome this challenge by constructing the NiFe hydroxide/Ni4Mo alloy (NiFe-LDH/Ni4Mo) heterojunction electrocatalyst, featuring the Ni4Mo alloy as the oxygen pump to provide oxygenous intermediates and electrons for NiFe-LDH. The released lattice oxygen can be timely offset by the oxygenous species during the LOM process, balancing the regeneration of lattice oxygen and assuring the enhancement of the durability. In consequence, the durability of NiFe-LDH is significantly enhanced after the modification of Ni4Mo with an impressive durability for over 60 h, much longer than that of NiFe-LDH counterpart with only 10 h. In situ spectra and first-principle simulations reveal that the adsorption of OH- is significantly strengthened owing to the introduction of Ni4Mo, ensuring the rapid regeneration of lattice oxygen. Moreover, NiFe-LDH/Ni4Mo-based anion exchange membrane water electrolyzer (AEMWE) presents an impressive durability for over 150 h at 100 mA cm-2. The oxygen pump strategy opens opportunities to balance the evolution and regeneration of lattice oxygen, enhancing the durability of efficient OER catalysts.

Engineering Lattice Oxygen Regeneration of NiFe Layered Double Hydroxide Enhances Oxygen Evolution Catalysis Durability

The lattice oxygen mechanism (LOM) endows NiFe layered double hydroxide (NiFe‐LDH) with superior oxygen evolution reaction (OER) activity, yet the frequent evolution and sluggish regeneration of lattice oxygen intensify the dissolution of active species. Herein, we overcome this challenge by constructing the NiFe hydroxide/Ni4Mo alloy (NiFe‐LDH/Ni4Mo) heterojunction electrocatalyst, featuring the Ni4Mo alloy as the oxygen pump to provide oxygenous intermediates and electrons for NiFe‐LDH. The released lattice oxygen can be timely offset by the oxygenous species during the LOM process, balancing the regeneration of lattice oxygen and assuring the enhancement of the durability. In consequence, the durability of NiFe‐LDH is significantly enhanced after the modification of Ni4Mo with an impressively durability for over 60 h, much longer than that of NiFe‐LDH counterpart with only 10 h. In‐situ spectra and first‐principle simulations reveal that the adsorption of OH− is significantly strengthened owing to the introduction of Ni4Mo, ensuring the rapid regeneration of lattice oxygen. Moreover, NiFe‐LDH/Ni4Mo‐based anion exchange membrane water electrolyzer (AEMWE) presents an impressive durability for over 150 h at 100 mA cm−2. The oxygen pump strategy opens opportunities to balance the evolution and regeneration of lattice oxygen, enhancing the durability of efficient OER catalysts.

Ultra-Low-Field Portable MRI and Extracorporeal Membrane Oxygenation: Preclinical Safety Testing.

Conventional MRI is incompatible with extracorporeal membrane oxygenation (ECMO) cannulas and pumps. Ultra-low-field portable MRI (ULF-pMRI) with 0.064 Tesla may provide a solution, but its safety and compatibility is unknown. ULF-pMRI does not cause significant displacement and heating of ECMO cannulas and does not affect ECMO pump function. ECMO cannulas in various sizes were tested ex vivo using phantom models to assess displacement force and heating according to the American Society for Testing and Materials criteria. ECMO pump function was assessed by pump flow and power consumption. In vivo studies involved five female domestic pigs (20-42 kg) undergoing different ECMO configurations (peripheral and central cannulation) and types of cannulas with an imaging protocol consisting of T2-weighted, T1-weighted, FLuid-Attenuated Inversion Recovery, and diffusion-weighted imaging sequences. Phantom models demonstrated that ECMO cannulas, both single lumen with various sizes (15-24-Fr) and double lumen cannula, had average displacement force less than gravitational force within 5 gauss safety line of ULF-pMRI and temperature changes less than 1°C over 15 minutes of scanning and ECMO pump maintained stable flow and power consumption immediately outside of the 5 gauss line. All pig models showed no visible motion due to displacement force or heating of the cannulas. ECMO flow and the animals' hemodynamic status maintained stability, with no changes greater than 10%, respectively. ULF-pMRI is safe and feasible for use with standard ECMO configurations, supporting its clinical application as a neuroimaging modality in ECMO patients.

Ambulation in patients with peripheral veno-arterial extracorporeal membrane oxygenation and concomitant femoral intra-aortic balloon pump support.

The mobilization and ambulation of patients with severe cardiogenic shock supported with peripheral veno-arterial extracorporeal membrane oxygenation (pVA-ECMO) and concomitant femoral intra-aortic balloon pump (IABP) support is not well-described. This technical paper describes an ambulation protocol to prevent deconditioning in this critically ill patient population. A protocol for the ambulation of patients with pVA-ECMO and concomitant IABP support was created in December 2022 and implemented at a single center. To initiate ambulation, patients were initially placed in a vertical position utilizing the VitalGo Total Lift Bed (VitalGo Systems, Miramar, FL) with mechanical circulatory support device monitoring performed by a critical care multidisciplinary team. Retrospective analysis of successfully ambulated patients was performed from December 2022 to January 2024. A total of 35 patients out of 112 patients with ECMO support were ambulated in the study period. Four of these patients had pVA-ECMO with concomitant IABP support with this cohort completing a total of 11 sessions during the study period. Patients ambulated an average of 200 feet per session without any adverse events, including cannula and balloon pump migration or displacement. Three of the four patients studied were either bridged to an advanced therapy including orthotopic heart transplant or durable left ventricular assist device or were discharged. A protocol for ambulation of CS patients with pVA-ECMO support and concomitant femoral IABP support is feasible and can safely be implemented in this critically ill patient population. Further multicenter studies are necessary to determine the overall impact of ambulation on patient outcomes.

Dual-activity nanozyme as an oxygen pump to alleviate tumor hypoxia and enhance photodynamic/ NIR-II photothermal therapy for sniping oral squamous cell carcinoma

Oral squamous cell carcinoma (OSCC) is the most common malignant tumor in the head and neck region, and its treatment is limited by hypoxia and inadequate oxygen supply. Continuous oxygen delivery combined with photodynamic therapy (PDT) is the key to addressing this issue. Here, a dual-enzyme activity sea urchin-like Au@Pt-Ce6-HN-1 nanoplatform was designed to serve as an "oxygen pump" to alleviate tumor hypoxia for synergistic photodynamic/photothermal therapy (PTT). In this design, the photosensitizer chlorin e6 (Ce6) is covalently linked to the Au@Pt nanozyme for PDT treatment. The Au@Pt nanozyme exhibits catalase-like activity, continuously decomposing H2O2 in the tumor microenvironment to enhance O2 levels, thereby achieving efficient PDT. Furthermore, Au@Pt can perform PTT and increase oxygen levels under NIR-II light to further promote PDT. The Au@Pt nanozyme also exhibits peroxidase-like activity, generating ·OH for chemodynamic therapy (CDT). Additionally, HN-1 guides the direction of "sniping" OSCC, and its high specificity benefits Au@Pt-Ce6-HN-1 at the tumor site. Au@Pt-Ce6-HN-1 exhibits bright fluorescence (FL), strong CT signal, and photothermal imaging capabilities, laying the foundation for subsequent guided PDT/PTT. This nanoplatform, which combines advantages such as continuous oxygen production, tumor targeting, and multimodal imaging, is expected to provide valuable insights into the treatment of OSCC. Statement of significanceAccurate clinical diagnosis and treatment of OSCC are challenging. We report a dual-enzyme activity sea urchin-like Au@Pt-Ce6-HN-1 nanoplatform, serving as an "oxygen pump" to guide photodynamic therapy (PDT) and photothermal therapy (PTT) for OSCC. This nanoplatform targets OSCC for preoperative CT diagnosis and offers fluorescence visualization for surgical navigation, demonstrating potential in clinical cancer detection and surgery guidance. This innovative approach addresses OSCC hypoxia and enhances treatment efficacy through continuous oxygen production, tumor targeting, and multimodal imaging, significantly improving patient outcomes in OSCC treatment.

ECMO versus IABP for patients with STEMI complicated by cardiogenic shock undergoing primary PCI: a Chinese National Study and propensity-matched analysis

ObjectiveThis study investigated the association between the utilization of extracorporeal membrane oxygenation (ECMO) or intra-aortic balloon pump (IABP) and in-hospital mortality among patients with ST-segment elevation myocardial infarction (STEMI) complicated by cardiogenic shock undergoing primary percutaneous coronary intervention (PCI). MethodsData encompassing 9635 cases of STEMI complicated by cardiogenic shock and treated with primary PCI using ECMO/IABP support were retrieved from the Chinese Cardiovascular Association database (2019–2021). We conducted an analysis to assess the in-hospital survival disparities among percutaneous mechanical circulatory device recipients and explore the potential advantages of ECMO through multivariable logistic regression analysis within a propensity score–matched (1:2) cohort population. ResultsECMO was administered to 2028 patients, whereas IABP was used in 7607 patients. Patients supported by ECMO showed a lower in-hospital mortality than those supported by IABP (7.2% versus 15.1%, p < 0.001). Within the propensity-matched (case: control = 1:2) cohort, we noted a 34% reduced risk of in-hospital mortality among patients supported by ECMO compared with those supported by IABP (7.7% versus 11.7%; odds ratio = 0.66; 95% CI, 0.53–0.80; p < 0.001) independent of age, sex, systolic blood pressure, obesity, smoke, hypertension, diabetes, dyslipidemia, family history of coronary artery disease, coronary artery disease, stroke, atrial filiation, peripheral artery disease, chronic kidney disease, vascular lesion sites, 3A-grade hospital, and regional distributions in China. ConclusionAmong patients undergoing primary PCI for STEMI complicated by cardiogenic shock, ECMO was associated with better in-hospital survival than IABP.

A smart monitoring and observation framework for aquaponics ecosystem

Aquaponics is a sustainable and efficient agricultural system that integrates aquaculture with agriculture. This system integrates Internet of Things (IoT) technology in aquaponics systems with the potential to change sustainable agriculture by combining farming of fish (aquaculture) and soilless cultivation of plants (hydroponics) into a single, efficient ecosystem. This paper explores the design and development of a smart aquaponics system that allows aquaponic farming at commercial scale feasible, leveraging IoT to continuously gather data through various sensors, monitor environmental conditions, and automate control processes. The proposed system architecture is based on a three-tier model, ensuring scalability and maintainability. The proposed system consists of a three-layer architecture: the Perception Layer for measuring different environmental factors and controlling them, the Network Layer for data transmission, and the Application Layer for data storage, manipulation, and user interaction. The key components include sensors for monitoring pH, humidity, temperature, sunlight, oxygen levels, and water proximity; devices such as lights, water pumps, fans, and oxygen pumps for environmental control; and an ESP8266 microcontroller for system management. The system's software is developed using C# DOT NET CORE 8.0, React, MySQL, C, and Arduino. The system allows users the ability to maintain optimal conditions for fish and plant growth, notify users of irregularities, and allow remote control through a web application, proving it to be an intelligent, flexible, low-cost, and stable solution for large-scale aquaponics.

Comparison of ECMO, IABP and ECMO + IABP in the Postoperative Period in Patients with Postcardiotomy Shock.

Background: This study aims to assess the outcomes and complications of patients who received veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and intra-aortic balloon pump (IABP) support after cardiac surgery at Ankara University Heart Center between 2000 and 2023. Methods: We have carried out a retrospective analysis that included 255 patients. Among them, 98 received IABP, 103 received VA-ECMO, and 54 received both VA-ECMO and IABP. Preoperative and postoperative assessments were carried out, including evaluations of left ventricular function and serum creatinine levels. Primary outcomes included 30-day survival and successful VA-ECMO weaning. Complications such as bleeding, sepsis, liver failure, wound infection, and peripheral ischemia were also assessed. Results: The weaning rate from VA-ECMO was significantly higher in the combined VA-ECMO and IABP group (81.4%) compared with the other groups (p = 0.004). One-year survival was also higher in the combined group (75.9%) (p = 0.002). Complications or renal function did not differ significantly among the groups. The primary indication for mechanical support was coronary artery bypass grafting. Conclusions: In conclusion, the combined use of VA-ECMO and IABP therapy led to improved weaning and survival rates without increasing the risk of complications. These findings suggest that a combined approach may be beneficial for selected patients with severe cardiac dysfunction post surgery.

ГИПОКСИЯ И АНОКСИЯ В ГДАНЬСКОЙ ВПАДИНЕ БАЛТИЙСКОГО МОРЯ В 2021–2023 гг.

The central part of Gdansk Deep experienced summer-autumn dissolved oxygen minima within 2021–2023, while along the periphery of the Deep no seasonality was detected. Intrusions of transformed North Sea waters with a low oxygen content can partially aerate the bottom layer and cause anoxic waters to detach from the bottom. In the near-slope southeastern part of the Deep, in autumn-winter storm conditions, amplitude vertical fluctuations in oxygen concentration can occur – from the rise of hypoxic waters above the halocline, to the complete elimination of hypoxia as a result of near-slope downwelling, which acts as an “oxygen pump”. The hydrological and hydrochemical characteristics of intrusions of transformed North Sea waters penetrating into the Gdansk Basin and influencing the dynamics of the nepheloid layer of biogeochemical origin, arising at the boundary of oxidizing and reducing conditions, have been clarified.

Oxygen Ion Pumping across Atomically Designed Oxide Heterointerfaces

AbstractComplex oxide heterointerfaces and heterostructures have demonstrated enormous emergent phenomena over the last decades, attributed to the reconstructions of mis‐matched crystalline structure, polarity, and spin ordering across the heterointerfaces. This work employs the heterostructures of La0.7Sr0.3MnO3 and CaFeO2.5 as model system to demonstrate an interface‐specific oxygen migration/reconstruction across the interfaces due to the mismatched chemical potential, which dramatically influences the ferromagnetic and electronic states of La0.7Sr0.3MnO3 layer. Specifically, the alternative stacking of octahedral (Oh) and tetrahedral (Td) layers in CaFeO2.5 are used to form two distinct heterointerfaces, namely the Oh‐Td and the Oh‐Oh interfaces with the adjacent La0.7Sr0.3MnO3 layer. Interestingly, the oxygen ion migrates toward opposite directions across the interface for these two cases, in which the CaFeO2.5 layer acts as an “oxygen pump” and manipulates the oxygen contents of its adjacent La0.7Sr0.3MnO3 layers. Such manipulation leads to a dramatically changed ferromagnetic transition temperature for the heterostructure with the Oh‐Td and Oh‐Oh interface. This work establishes a feasible and efficient strategy to control the oxygen ionic distribution through atomic‐scale interface design and opens up new opportunities to exploit emergent states at the complex oxide heterostructures through selective oxygen ion evolution.

Oscillatory Active State of a Pd Nanocatalyst Identified by In Situ Capture of the Instantaneous Structure-Activity Change at the Atomic Scale.

Identifying the active phase with the highest activity, which is long-believed to be a steady state of the catalyst, is the basis of rational design of heterogeneous catalysis. In this work, we performed detailed in situ investigations, successfully capturing the instantaneous structure-activity change in oscillating Pd nanocatalysts during methane oxidation, which reveals an unprecedented oscillatory active state. Combining in situ quantitative environmental transmission electron microscopy and highly sensitive online mass spectrometry, we identified two distinct phases for the reaction: one where the Pd nanoparticles refill with oxygen, and the other, a period of abrupt pumping of oxygen and boosted methane oxidation within about 1 s. It is the rapid reduction process that shows the highest activity for total oxidation of methane, not a PdO or Pd steady state under the conditions applied here (methane:oxygen = 5:1). This observation challenges the traditional understanding of the active phase and requires a completely different strategy for catalyst optimization.

Beyond one-size-fits-all in cardiogenic shock: impella, extracorporeal membrane oxygenation or tailored use of mechanical circulatory support?

This article offers an overview of recent randomized controlled trials (RCTs) testing the efficacy of veno-arterial extracorporeal membrane oxygenation (VA ECMO) and microaxial flow pump (mAFP) in treating cardiogenic shock, including findings from the DanGer shock trial. It summarizes the clinical implications and limitations of these studies and key decision-making considerations for cardiogenic shock device use. Despite important limitations in all published RCTs, the routine use of VA ECMO for acute myocardial infarction related cardiogenic shock did not demonstrate benefit and should be reserved for selected patients with extreme forms of cardiogenic shock. Conversely, mAFP (Impella CP) appears promising for cardiogenic shock due to ST elevation myocardial infarction. A stepwise approach - initial mAFP use for cardiogenic shock with left ventricular failure, supplemented by VA ECMO if mAFP is inadequate or if severe right ventricular failure is present - may be preferable, but requires validation through RCTs. High complication rates in device arms underscore the need for careful patient selection, preventive strategies, education for centers and operators, and further research. Recent trials offer insights into mechanical circulatory support in cardiogenic shock, but their real-world applicability is limited. Despite potential benefits, the use of VA ECMO and mAFP is associated with significant complication rates, emphasizing the need for personalized use.

Acute brain injury risk prediction models in venoarterial extracorporeal membrane oxygenation patients with tree-based machine learning: An Extracorporeal Life Support Organization Registry analysis

ObjectiveWe aimed to determine if machine learning can predict acute brain injury and to identify modifiable risk factors for acute brain injury in patients receiving venoarterial extracorporeal membrane oxygenation. MethodsWe included adults (age ≥18 years) receiving venoarterial extracorporeal membrane oxygenation or extracorporeal cardiopulmonary resuscitation in the Extracorporeal Life Support Organization Registry (2009-2021). Our primary outcome was acute brain injury: central nervous system ischemia, intracranial hemorrhage, brain death, and seizures. We used Random Forest, CatBoost, LightGBM, and XGBoost machine learning algorithms (10-fold leave-1-out cross-validation) to predict and identify features most important for acute brain injury. We extracted 65 total features: demographics, pre-extracorporeal membrane oxygenation/on-extracorporeal membrane oxygenation laboratory values, and pre-extracorporeal membrane oxygenation/on-extracorporeal membrane oxygenation settings. ResultsOf 35,855 patients receiving venoarterial extracorporeal membrane oxygenation (nonextracorporeal cardiopulmonary resuscitation) (median age of 57.8 years, 66% were male), 7.7% (n = 2769) experienced acute brain injury. In venoarterial extracorporeal membrane oxygenation (nonextracorporeal cardiopulmonary resuscitation), the area under the receiver operator characteristic curves to predict acute brain injury, central nervous system ischemia, and intracranial hemorrhage were 0.67, 0.67, and 0.62, respectively. The true-positive, true-negative, false-positive, false-negative, positive, and negative predictive values were 33%, 88%, 12%, 67%, 18%, and 94%, respectively, for acute brain injury. Longer extracorporeal membrane oxygenation duration, higher 24-hour extracorporeal membrane oxygenation pump flow, and higher on-extracorporeal membrane oxygenation partial pressure of oxygen were associated with acute brain injury. Of 10,775 patients receiving extracorporeal cardiopulmonary resuscitation (median age of 57.1 years, 68% were male), 16.5% (n = 1787) experienced acute brain injury. The area under the receiver operator characteristic curves for acute brain injury, central nervous system ischemia, and intracranial hemorrhage were 0.72, 0.73, and 0.69, respectively. Longer extracorporeal membrane oxygenation duration, older age, and higher 24-hour extracorporeal membrane oxygenation pump flow were associated with acute brain injury. ConclusionsIn the largest study predicting neurological complications with machine learning in extracorporeal membrane oxygenation, longer extracorporeal membrane oxygenation duration and higher 24-hour pump flow were associated with acute brain injury in nonextracorporeal cardiopulmonary resuscitation and extracorporeal cardiopulmonary resuscitation venoarterial extracorporeal membrane oxygenation.

European practices on antithrombotic management during percutaneous mechanical circulatory support in adults: an international survey of the ACVC Association of the ESC joint with EuroELSO

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Fonds Wetenschappelijk Onderzoek Flanders. Background/introduction Bleeding and thrombotic complications impair the outcomes of patients on percutaneous mechanical circulatory support (pMCS) with veno-arterial extracorporeal membrane oxygenation (V-A ECMO) and/or microaxial flow pumps such as the Impella™. Very recent MCS-trials still show a 23.9% moderate/major bleeding incidence during V-A ECMO. Antithrombotic practices are an important determinant of the meticulous coagulopathic risk management, but guidelines here are non-existing. Purpose Providing an overview of the current European practices in antithrombotic management in adults on pMCS is a first but crucial step to design trials, standardize practice and improve outcome. Methods This online cross-sectional survey was distributed via a digital newsletter and social media platforms through the Association of Acute Cardiovascular Care (ACVC) and the European Extracorporeal Life Support Organization (EuroELSO). The survey was accessible between 17.04 and 23.05.2023. The target population were European clinicians involved in adult critical care and pMCS-management. Results We included responses from 105 different units from 26 European countries. 72.4% Of the European responders have an institutional anticoagulation protocol installed. Unfractionated heparin is the predominantly used anticoagulant (Impella™: 97.0% and V-A ECMO: 96.1%). Argatroban is the preferred alternative in case of heparin-induced thrombocytopenia (Impella™: 52.3% and V-A ECMO: 50.7%). 10.8% And 14.5% of the anticoagulation protocols rely on anti-factor-Xa assay with activated partial thromboplastin time (APTT) in parallel for Impella™ and V-A ECMO, respectively. Up to 43.1% (Impella™) and 32.9% (V-A ECMO) of the European respondents rely on a monitoring strategy with APTT alone. Anticoagulant targets for heparin vary significantly between institutions. 54.0% And 42.7% of the European survey participants administer dual antiplatelet therapy (DAPT) during Impella™ and V-A ECMO support after acute coronary syndrome without percutaneous coronary intervention (PCI), increasing to 93.7% and 84.0% after recent PCI, respectively. Typical thresholds for transfusion or administration of blood products without acute bleeding also vary substantially and are frequently not predefined. Conclusion Large heterogeneity in antithrombotic practices is observed across Europe. Consequently, device-associated coagulopathic complications may largely vary due to non-standardized management and heterogeneity between institutions. This survey underpins the importance of urgent prospective trials investigating important basic questions concerning antithrombotic therapy during pMCS (anticoagulation targets, monitoring strategy, concomitant use of DAPT among others).

Strain- and humidity-insensitive, stretchable hydrogel-based oxygen sensor with corrosion-free electrodes for wireless oxygen detection

As the public puts higher and higher demands on wearing comfort, wearable gas sensors rapidly advance toward intrinsic flexibility and stretchability. However, many challenges arise during the development of intrinsically stretchable sensors. The deformation of the sensor following the movement of the wearer and uncertain changes in environmental humidity can cause additional interference signals. In addition, severe electrode corrosion also challenges the long-term continuous monitoring of sensors. Here, a stretchable strain- and humidity-insensitive O2 sensor is proposed by adopting a serpentine hydrogel fiber structure and hydrophobic elastomer encapsulation strategy. Besides, the introduction of the Pt/C electrode and salt immersion strategy effectively eliminate electrode corrosion and electrolyte consumption, significantly prolonging hydrogel sensor's lifespan. Importantly, we propose, for the first time, an oxygen pump mechanism to elucidate positive current transferring and electrode corrosion-free in hydrogel oxygen sensors, which is further validated through well-designed experiments. Optimized sensor exhibits a wide detection range (30 ppm-100%), linear sensitivity (0.03%/ppm), exceptional repeatability and remarkable tolerance towards environmental variations. Integrating oxygen sensor with Bluetooth circuit further enables wireless monitoring of oxygen while confirming its practicality. This research provides insights into improving the interference immunity and longevity of flexible oxygen sensors while showcasing their potential in wearable applications.