Publications by authors named "Pellegrino V"
Objective: Extracorporeal membrane oxygenation (ECMO) is a high-risk procedure with significant morbidity and mortality and there is an uncertain volume-outcome relationship, especially regarding long-term functional outcomes. The aim of this study was to examine the association between ECMO centre volume and long-term death and disability outcomes.
Design Setting And Participants: This is a registry-embedded observational cohort study.
A critical factor in thrombus formation during venoarterial extracorporeal membrane oxygenation (VA ECMO) is prothrombotic flow dynamics generated by the drainage cannula's design. This study aimed to create and evaluate a novel drainage cannula design which optimized blood flow dynamics to reduce thrombus formation. Computational fluid dynamics (CFD) was used to iteratively vary drainage cannula design parameters such as inner wall shape and side hole shape.
View Article and Find Full Text PDFThis study aimed to describe the population pharmacokinetics of caspofungin in critically ill patients receiving extracorporeal membrane oxygenation (ECMO) and to identify dosing regimens with a high likelihood of achieving effective exposures. Serial blood samples were collected over a single-dosing interval during ECMO. Total plasma concentrations were measured by a validated chromatographic assay.
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- The study explored the effects of conservative versus liberal oxygen strategies on patients receiving venoarterial extracorporeal membrane oxygenation (VA-ECMO) in the ICU, aiming to find a balance between avoiding hyperoxia and preventing hypoxia.
- A total of 300 patients were randomly assigned to either conservative (target SaO 92-96%) or liberal oxygen (target SaO 97-100%), but both groups showed similar outcomes in ICU-free days and mortality rates at days 28 and 60.
- The conservative group had significantly more major protocol deviations compared to the liberal group, but overall, the two oxygen strategies did not differ in their impact on patient recovery in the ICU.
Article Synopsis
- The study looks at how the location where doctors put tubes in the arteries for heart support affects brain health after surgery.
- They compared three methods: using the aorta, subclavian/axillary arteries, and femoral artery to see which had the least brain problems.
- Results showed that patients using the subclavian/axillary method had more major brain issues compared to the others, and also had more seizures after the surgery.
Article Synopsis
- ECLS cannulation in post-cardiotomy patients is uncommon in general wards, with only 39 out of 2058 patients studied undergoing the procedure while at the hospital.
- The majority of these patients faced complications like acute kidney injury and arrhythmias, with a high in-hospital mortality rate of 84.6%, predominantly due to persistent heart failure.
- Findings suggest that ECLS cannulation mainly affects low-risk patients who experience cardiac arrest post-surgery, indicating a need for further research into improving outcomes.
Objectives: To determine the actual cost and drivers of the cost of an extracorporeal cardiopulmonary resuscitation (E-CPR) care cycle.
Perspective: A time-driven activity-based costing study conducted from a healthcare provider perspective.
Setting: A quaternary care ICU providing around-the-clock E-CPR service for out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA) in Australia.
Canine liposarcoma is an uncommon tumor that shares morphological similarities with its human counterpart. In dogs, the genetic features of this tumor are unknown and, based on immunohistochemical studies, amplification of the gene MDM2 and the mutation of TP53 are suspected. In this study 51 cases of primary liposarcomas were immunohistochemically stained for MDM2 and p53 and subjected to fluorescent in situ hybridization and next-generation sequencing to detect MDM2 amplification and TP53 mutations, respectively.
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- * Conducted across 34 centers globally from 2000 to 2020, the study included over 2,000 adult patients split into different ECMO duration groups, revealing higher complications and mortality rates associated with longer ECMO durations.
- * The findings suggest that while most in-hospital complications increase with ECMO duration, post-discharge survival rates remain similar across groups, with specific risk factors like age and pre-existing conditions affecting long-term survival for those on ECMO longer than 7 days.
Objectives: Although cardiogenic shock requiring extracorporeal life support after cardiac surgery is associated with high mortality, the impact of sex on outcomes of postcardiotomy extracorporeal life support remains unclear with conflicting results in the literature. We compare patient characteristics, in-hospital outcomes, and overall survival between females and males requiring postcardiotomy extracorporeal life support.
Methods: This retrospective, multicenter (34 centers), observational study included adults requiring postcardiotomy extracorporeal life support between 2000 and 2020.
Article Synopsis
- The text indicates that there is a correction to a previously published article.
- The article is identified by its Digital Object Identifier (DOI): 10.1016/j.ccrj.2023.06.001.
- The correction aims to address inaccuracies or mistakes in the original publication.
Background: Tirbanibulin 1% ointment is approved for the field treatment of Olsen grade I actinic keratoses (AKs) of the face and scalp.
Methods: We performed a multicenter retrospective study involving 15 dermatologic units in Italy to investigate the efficacy and tolerability of tirbanibulin in a real-life setting. 250 patients were enrolled.
Introduction: Survival from refractory out of hospital cardiac arrest (OHCA) without timely return of spontaneous circulation (ROSC) utilising conventional advanced cardiac life support (ACLS) therapies is dismal. CHEER3 was a safety and feasibility study of pre-hospital deployed extracorporeal membrane oxygenation (ECMO) during cardiopulmonary resuscitation (ECPR) for refractory OHCA in metropolitan Australia.
Methods: This was a single jurisdiction, single-arm feasibility study.
This multicenter study describes the population pharmacokinetics (PK) of fluconazole in critically ill patients receiving concomitant extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT) and includes an evaluation of different fluconazole dosing regimens for achievement of target exposure associated with maximal efficacy. Serial blood samples were obtained from critically ill patients on ECMO and CRRT receiving fluconazole. Total fluconazole concentrations were measured in plasma using a validated chromatographic assay.
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- - This review focuses on three main objectives: understanding factors affecting oxygen levels in patients on ECMO, examining how hyperoxia impacts patient outcomes, and offering practical guidance on adjusting oxygen levels during treatment.
- - Research included observational and interventional studies as well as guidelines from the Extracorporeal Life Support Organization to gather evidence about hyperoxia and clinical results.
- - Findings indicate that both the ECMO machine and a patient’s natural heart and lung function influence systemic oxygenation, with high risks of hyperoxia emerging during treatment, which can increase the chances of in-hospital mortality.
Article Synopsis
- The study compares COVID-19 patients and non-COVID-19 viral pneumonitis patients receiving VV-ECMO in seven Australian ICUs, focusing on their characteristics, treatment, and 6-month outcomes.
- Patients with COVID-19 were generally older, experienced a longer time from intubation to ECMO, but had comparable illness severity scores to those with other viral pneumonitis.
- Despite similar functional outcomes and mortality rates after six months, COVID-19 patients had significantly longer ICU and hospital stays, suggesting potential resource challenges for healthcare systems.
To compare the outcomes of patients with refractory out-of-hospital cardiac arrest (OHCA) transported to a hospital that provides extracorporeal membrane oxygenation (ECMO) during cardiopulmonary resuscitation (ECPR) with patients transported to hospitals without ECPR capability. Retrospective review of patient care records in a pre-hospital and hospital setting. Adult patients with OHCA who left the scene and arrived with cardiopulmonary resuscitation in progress at 16 hospitals in Melbourne, Australia, between January 2016 and December 2019.
View Article and Find Full Text PDFObjectives: To determine the concordance between activated partial thromboplastin time (aPTT) and anti-factor-Xa (anti-Xa) in adults undergoing extracorporeal membrane oxygenation (ECMO) and to identify the factors associated with discordant paired aPTT/anti-Xa.
Design: Pre-planned secondary analysis of the Low-Dose Heparin in Critically Ill Patients Undergoing Extracorporeal Membrane Oxygenation pilot randomized unblinded, parallel-group controlled trial.
Setting: Two ICUs in two university hospitals.
Article Synopsis
- Endomyocardial biopsy (EMB) is important for diagnosing fulminant myocarditis in adults, but its timing and effects on patient outcomes are still being studied.
- In a study involving 419 patients across 36 centers, those who had an early EMB (within 2 days of ICU admission) showed significantly better survival rates (63%) without needing heart transplants or LVAD compared to those with delayed EMB (40%).
- The research suggests that early EMB is associated with lower mortality rates and better overall outcomes, supporting its prompt use in ICU patients suspected of having fulminant myocarditis.
Introduction: Critically ill patients supported with venoarterial extracorporeal membrane oxygenation (VA ECMO) are at risk of developing severe arterial hyperoxia, which has been associated with increased mortality. Lower saturation targets in this population may lead to deleterious episodes of severe hypoxia. This manuscript describes the protocol and statistical analysis plan for the Blend to Limit OxygEN in ECMO: A RanDomised ControllEd Registry (BLENDER) Trial.
View Article and Find Full Text PDFBackground: A multidisciplinary group of stakeholders were used to identify: (1) the core competencies of a training program required to perform in-hospital ECPR initiation (2) additional competencies required to perform pre-hospital ECPR initiation and; (3) the optimal training method and maintenance protocol for delivering an ECPR program.
Methods: A modified Delphi process was undertaken utilising two web based survey rounds and one virtual meeting. Experts rated the importance of different aspects of ECPR training, competency and governance on a 9-point Likert scale.
Purpose: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is a complex and high-risk life support modality used in severe cardiorespiratory failure. ECMO survival scores are used clinically for patient prognostication and outcomes risk adjustment. This study aims to create the first artificial intelligence (AI)-driven ECMO survival score to predict in-hospital mortality based on a large international patient cohort.
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