Acute and Critical Care

Review Articles

Basic science and research
Extracorporeal circulation models in small animals: beyond the limits of preclinical research: Mukhammad Kayumov, Reverien Habimana, Dowan Kim, Francis O Obiweluozor, In Seok Jeong, Hwa Jin Cho; Acute Crit Care. 2023;38(1):1-7. Published online February 28, 2023; DOI: https://doi.org/10.4266/acc.2023.00381

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Abstract PDF: Extracorporeal membrane oxygenation (ECMO) use has remarkably increased in recent years. Although ECMO has become essential for patients with refractory cardiac and respiratory failure, extracorporeal circulation (ECC) is associated with significant complications. Small-animal models of ECC have been developed and widely used to better understand ECC-induced pathophysiology. This review article summarizes the development of small-animal ECC models, including the animal species, circuit configuration, priming, perioperative procedures, cannulation, and future perspectives of small-animal ECMO models.

Basic science and research
Sepsis-induced cardiac dysfunction: a review of pathophysiology: Reverien Habimana, Insu Choi, Hwa Jin Cho, Dowan Kim, Kyoseon Lee, Inseok Jeong; Acute Crit Care. 2020;35(2):57-66. Published online May 31, 2020; DOI: https://doi.org/10.4266/acc.2020.00248

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26 Citations

It is well known that cardiac dysfunction in sepsis is associated with significantly increased mortality. The pathophysiology of sepsis-induced cardiac dysfunction can be summarized as involving impaired myocardial circulation, direct myocardial depression, and mitochondrial dysfunction. Impaired blood flow to the myocardium is associated with microvascular dysfunction, impaired endothelium, and ventriculo-arterial uncoupling. The mechanisms behind direct myocardial depression consist of downregulation of β-adrenoceptors and several myocardial suppressants (such as cytokine and nitric oxide). Recent research has highlighted that mitochondrial dysfunction, which results in energy depletion, is a major factor in sepsis-induced cardiac dysfunction. Therefore, the authors summarize the pathophysiological process of cardiac dysfunction in sepsis based on the results of recent studies.

Citations

Citations to this article as recorded by

A case of sepsis‐induced cardiomyopathy successfully treated with venoarterial extracorporeal membrane oxygenation
Keigo Sato, Akihiro Naito, Taichi Shiratori, Masahiro Yamamoto, Kenichi Shimane, Manabu Mikami, Mariko Senda, Haruki Kume, Motofumi Suzuki
IJU Case Reports.2023; 6(1): 26. CrossRef
Therapeutic potentials of stem cell–derived exosomes in cardiovascular diseases
Saiprahalad Mani, Narasimman Gurusamy, Thennavan Ulaganathan, Autumn J Paluck, Satish Ramalingam, Johnson Rajasingh
Experimental Biology and Medicine.2023; : 153537022311519. CrossRef
CLINICAL, MOLECULAR, AND EXOSOMAL MECHANISMS OF CARDIAC AND BRAIN DYSFUNCTION IN SEPSIS
Daniel C. Morris, Zheng Gang Zhang, Anja K. Jaehne, Jing Zhang, Emanuel P. Rivers
Shock.2023; 59(2): 173. CrossRef
Circulating protein and lipid markers of early sepsis diagnosis and prognosis: a scoping review
Gemma Barber, Jelena Tanic, Aleksandra Leligdowicz
Current Opinion in Lipidology.2023; 34(2): 70. CrossRef
Extracellular Histone-Induced Protein Kinase C Alpha Activation and Troponin Phosphorylation Is a Potential Mechanism of Cardiac Contractility Depression in Sepsis
Simon T. Abrams, Yasir Alhamdi, Min Zi, Fengmei Guo, Min Du, Guozheng Wang, Elizabeth J. Cartwright, Cheng-Hock Toh
International Journal of Molecular Sciences.2023; 24(4): 3225. CrossRef
High serum nitrates levels in non-survivor COVID-19 patients
L. Lorente, F. Gómez-Bernal, M.M. Martín, J.A. Navarro-Gonzálvez, M. Argueso, A. Perez, L. Ramos-Gómez, J. Solé-Violán, J.A. Marcos y Ramos, N. Ojeda, A. Jiménez
Medicina Intensiva.2022; 46(3): 132. CrossRef
Vital signs as physiomarkers of neonatal sepsis
Brynne A. Sullivan, Karen D. Fairchild
Pediatric Research.2022; 91(2): 273. CrossRef
Fluid therapy for severe malaria
Laura C Kalkman, Thomas Hänscheid, Sanjeev Krishna, Martin P Grobusch
The Lancet Infectious Diseases.2022; 22(6): e160. CrossRef
High serum nitrates levels in non-survivor COVID-19 patients
L. Lorente, F. Gómez-Bernal, M.M. Martín, J.A. Navarro-Gonzálvez, M. Argueso, A. Perez, L. Ramos-Gómez, J. Solé-Violán, J.A. Marcos y Ramos, N. Ojeda, A. Jiménez
Medicina Intensiva (English Edition).2022; 46(3): 132. CrossRef
Expression of Peripheral Blood DCs CD86, CD80, and Th1/Th2 in Sepsis Patients and Their Value on Survival Prediction
Ke Du, Shaobo Hao, Heyun Luan, Min Tang
Computational and Mathematical Methods in Medicine.2022; 2022: 1. CrossRef
Recombinant Activated Protein C (rhAPC) Affects Lipopolysaccharide-Induced Mechanical Compliance Changes and Beat Frequency of mESC-Derived Cardiomyocyte Monolayers
Aysegül Temiz Artmann, Eylem Kurulgan Demirci, Ipek Seda Fırat, Hakan Oflaz, Gerhard M. Artmann
Shock.2022; 57(4): 544. CrossRef
Acute cholecystitis associated with sepsis-induced ischemic cardiomyopathy
Ke-Shiuan Ju, Ying-Shih Su, Wen-Sen Lee
Journal of Infection.2022; 84(6): 834. CrossRef
An Overview on Mitochondrial-Based Therapies in Sepsis-Related Myocardial Dysfunction: Mitochondrial Transplantation as a Promising Approach
Behnaz Mokhtari, Rana Yavari, Reza Badalzadeh, Ata Mahmoodpoor, Jayaraman Tharmalingam
Canadian Journal of Infectious Diseases and Medical Microbiology.2022; 2022: 1. CrossRef
Pathological role of the calcium‐sensing receptor in sepsis‐induced hypotensive shock: Therapeutic possibilities and unanswered questions
Ankita Sood, Gaaminepreet Singh, Thakur G. Singh, Kirti Gupta
Drug Development Research.2022; 83(6): 1241. CrossRef
Diminazene aceturate mitigates cardiomyopathy by interfering with renin-angiotensin system in a septic rat model
Zhaoqing Lu, Di Wu, Zheng Wang, Hanyu Zhang, Yufan Du, Guoxing Wang
BMC Pharmacology and Toxicology.2022;[Epub] CrossRef
Serum Sestrin2 Was Lower in Septic Shock Patients with Cardiomyopathy
Rongjin Huang, Feng Chen, Aiying Zeng, Jun Ke, Shirong Lin, QiXing Chen
Disease Markers.2022; 2022: 1. CrossRef
Tidy up - The unfolded protein response in sepsis
Wolfgang Vivas, Sebastian Weis
Frontiers in Immunology.2022;[Epub] CrossRef
Jujuboside A attenuates sepsis-induced cardiomyopathy by inhibiting inflammation and regulating autophagy
Zi Wang, Danrui Xiao, Qingqi Ji, Yanjie Li, Zhaohua Cai, Liang Fang, Huanhuan Huo, Guo Zhou, Xiangming Yan, Linghong Shen, Ben He
European Journal of Pharmacology.2022; : 175451. CrossRef
DAMPs Released from Proinflammatory Macrophages Induce Inflammation in Cardiomyocytes via Activation of TLR4 and TNFR
Carolina Neu, Yvonne Thiele, Fabienne Horr, Christian Beckers, Nadine Frank, Gernot Marx, Lukas Martin, Sandra Kraemer, Elisabeth Zechendorf
International Journal of Molecular Sciences.2022; 23(24): 15522. CrossRef
Mitochondrial transplantation protects against sepsis-induced myocardial dysfunction by modulating mitochondrial biogenesis and fission/fusion and inflammatory response
Behnaz Mokhtari, Masoud Hamidi, Reza Badalzadeh, Ata Mahmoodpoor
Molecular Biology Reports.2022;[Epub] CrossRef
Targeting the TXNIP‐NLRP3 interaction with PSSM1443 to suppress inflammation in sepsis‐induced myocardial dysfunction
Linhua Wang, Hongsheng Zhao, Huifen Xu, Xiangxin Liu, Xinlong Chen, Qingyun Peng, Mingbing Xiao
Journal of Cellular Physiology.2021; 236(6): 4625. CrossRef
Sepsis—Pathophysiology and Therapeutic Concepts
Dominik Jarczak, Stefan Kluge, Axel Nierhaus
Frontiers in Medicine.2021;[Epub] CrossRef
Rho-Proteins and Downstream Pathways as Potential Targets in Sepsis and Septic Shock: What Have We Learned from Basic Research
Maria Luísa da Silveira Hahmeyer, José Eduardo da Silva-Santos
Cells.2021; 10(8): 1844. CrossRef
Deep-learning model for screening sepsis using electrocardiography
Joon-myoung Kwon, Ye Rang Lee, Min-Seung Jung, Yoon-Ji Lee, Yong-Yeon Jo, Da-Young Kang, Soo Youn Lee, Yong-Hyeon Cho, Jae-Hyun Shin, Jang-Hyeon Ban, Kyung-Hee Kim
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine.2021;[Epub] CrossRef
Levosimendan versus dobutamine for sepsis-induced cardiac dysfunction: a systematic review and meta-analysis
Dong-Hua Liu, Yi-Le Ning, Yan-Yan Lei, Jing Chen, Yan-Yan Liu, Xin-Feng Lin, Zhong-Qi Yang, Shao-Xiang Xian, Wei-Tao Chen
Scientific Reports.2021;[Epub] CrossRef
Exosomes Derived from miR-146a-5p-Enriched Mesenchymal Stem Cells Protect the Cardiomyocytes and Myocardial Tissues in the Polymicrobial Sepsis through Regulating MYBL1
Chun Liu, Jianhua Xue, Bo Xu, Aixian Zhang, Lili Qin, Jiajia Liu, Yang Yang, Antonio C. Campos de Carvalho
Stem Cells International.2021; 2021: 1. CrossRef

Case Report

Cardiology/Pediatric
Transfusion Associated Hyperkalemia and Cardiac Arrest in an Infant after Extracorporeal Membrane Oxygenation: Do Wan Kim, Kyeong Ryeol Cheon, Duck Cho, Kyo Seon Lee, Hwa Jin Cho, In Seok Jeong; Korean J Crit Care Med. 2015;30(2):132-134. Published online May 31, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.2.132

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Abstract PDF

Cardiac arrest associated with hyperkalemia during red blood cell transfusion is a rare but fatal complication. Herein, we report a case of transfusion-associated cardiac arrest following the initiation of extracorporeal membrane oxygenation support in a 9-month old infant. Her serum potassium level was increased to 9.0 mEq/L, soon after the newly primed circuit with pre-stored red blood cell (RBC) was started and followed by sudden cardiac arrest. Eventually, circulation was restored and the potassium level decreased to 5.1 mEq/L after 5 min. Extracorporeal membrane oxygenation (ECMO) priming is a relatively massive transfusion into a pediatric patient. Thus, to prevent cardiac arrest during blood-primed ECMO in neonates and infants, freshly irradiated and washed RBCs should be used when priming the ECMO circuit, to minimize the potassium concentration. Also, physicians should be aware of all possible complications associated with transfusions during ECMO.

Citations

Citations to this article as recorded by

Transfusion-associated graft-versus-host disease, transfusion-associated hyperkalemia, and potassium filtration: advancing safety and sufficiency of the blood supply
Kenneth E. Nollet, Alain M. Ngoma, Hitoshi Ohto
Transfusion and Apheresis Science.2022; 61(2): 103408. CrossRef
Transfusion-Associated Hyperkalemic Cardiac Arrest in Neonatal, Infant, and Pediatric Patients
Morgan Burke, Pranava Sinha, Naomi L. C. Luban, Nikki Gillum Posnack
Frontiers in Pediatrics.2021;[Epub] CrossRef
Double-filtered leukoreduction as a method for risk reduction of transfusion-associated graft-versus-host disease
Sejong Chun, Minh-Trang Thi Phan, Saetbyul Hong, Jehoon Yang, Yeup Yoon, Sangbin Han, Jungwon Kang, Mark H. Yazer, Jaehyun Kim, Duck Cho, Senthilnathan Palaniyandi
PLOS ONE.2020; 15(3): e0229724. CrossRef
Anticoagulation Therapy during Extracorporeal Membrane Oxygenator Support in Pediatric Patients
Hwa Jin Cho, Do Wan Kim, Gwan Sic Kim, In Seok Jeong
Chonnam Medical Journal.2017; 53(2): 110. CrossRef
Blood Transfusion Strategies in Patients Supported by Extracorporeal Membrane Oxygenation
Yoon Hee Kim
The Korean Journal of Critical Care Medicine.2015; 30(3): 139. CrossRef

Original Article

Cardiology/Neurology
Efficacy of Electroencephalographic Monitoring for the Evaluation of Intracranial Injury during Extracorporeal Membrane Oxygenation Support in Neonates and Infants: In Seok Jeong, Young Jong Woo, Do Wan Kim, Nan Yeol Kim, Hwa Jin Cho, Jae Sook Ma; Korean J Crit Care Med. 2014;29(2):70-76. Published online May 31, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.2.70

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2 Citations

Abstract PDF

Background
Neurological complications are a serious concern during extracorporeal membrane oxygenation (ECMO) support in neonates and infants. However, evaluating brain injury during ECMO has limitations. Herein, we report our experience with bedside electroencephalographic monitoring during ECMO support and compared this to post-ECMO brain imaging studies and immediate neurologic outcomes.
Methods
We retrospectively reviewed the data for 18 children who underwent ECMO. From these subjects, we reviewed the medical records of 10 subjects who underwent bedside EEG monitoring during ECMO support. We collected data on patient demographics, clinical details of the ECMO course, electroencephalographic monitoring, brain imaging results, and neurologic outcomes.
Results
The median age was 4 months (range: 7 days-22 months), the median weight was 5 (3.6-12) kg, and the median length of ECMO therapy was 86 (27-206) hours. Eight patients (80%) were weaned successfully, and seven (70%) survived to discharge. Those with normal to mildly abnormal electroencephalographic findings had non-specific to mildly abnormal brain computed tomography findings and no neurologic impairment. Those patients with a moderately to severely abnormal electroencephalograph had markedly abnormal brain computed tomography findings and remained neurologically impaired.
Conclusions
Normal electroencephalographic findings are closely related to normal or mild neurologic impairment. Our results indicate that electroencephalographic monitoring during ECMO support can be a feasible tool for evaluating brain injury although further prospective studies are needed.

Citations

Citations to this article as recorded by

Neurological monitoring in ECMO patients: current state of practice, challenges and lessons
Hassan Aboul-Nour, Ammar Jumah, Hafsa Abdulla, Amreeta Sharma, Bradley Howell, Namita Jayaprakash, Jayna Gardner-Gray
Acta Neurologica Belgica.2023;[Epub] CrossRef
Neurological Monitoring and Complications of Pediatric Extracorporeal Membrane Oxygenation Support
Ahmed S. Said, Kristin P. Guilliams, Melania M. Bembea
Pediatric Neurology.2020; 108: 31. CrossRef

Case Report

Fatal Left Ventricular Thrombosis in an Infant Receiving Extracorporeal Membrane Oxygenation Support: A Case Report: Hwa Jin Cho, Byung Young Kim, Eun Song Song, Sang Gi Oh, Bong Suk Oh, In Seok Jeong; Korean J Crit Care Med. 2013;28(2):123-126.; DOI: https://doi.org/10.4266/kjccm.2013.28.2.123

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15 Download
2 Citations

Abstract PDF

Thromboembolism in patients receiving extracorporeal membrane oxygenation (ECMO) support is a feared complication. Systemic anticoagulation during ECMO in patients with a massively dilated left ventricle (LV) and decreased LV systolic function is still debated. Hearin, we report a case of a 5-month old infant on ECMO support who had fatal thrombus formation in the massively dilated LV and a consequent thromboembolic event.

Citations

Citations to this article as recorded by

Activated Partial Thromboplastin Time Versus Anti-Factor Xa Monitoring of Heparin Anticoagulation in Adult Venoarterial Extracorporeal Membrane Oxygenation Patients
Caitlin E. Kulig, Kendra J. Schomer, Hugh B. Black, William E. Dager
ASAIO Journal.2021; 67(4): 411. CrossRef
Anticoagulation Therapy during Extracorporeal Membrane Oxygenator Support in Pediatric Patients
Hwa Jin Cho, Do Wan Kim, Gwan Sic Kim, In Seok Jeong
Chonnam Medical Journal.2017; 53(2): 110. CrossRef

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