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  • 1
    In: European Journal of Heart Failure, Wiley, Vol. 19, No. S2 ( 2017-05), p. 110-116
    Abstract: Elevated levels of plasma free hemoglobin ( fHb ) indicate red blood cell ( RBC ) damage. The aim of this study was to analyze the prevalence of hemolysis and metabolic acidosis in patients on extracorporeal life support ( ECLS ) and to investigate whether it is a marker for outcome. Methods and Results This retrospective analysis included 215 adult patients with cardiac failure treated with ECLS . The cohort was divided into three groups: ECLS (1) during ongoing cardiopulmonary resuscitation ( CPR , n = 110); (2) after CPR with return of spontaneous circulation and sustained cardiogenic shock (n = 45); (3) in severe cardiogenic shock without previous CPR (n = 60). Lactate, arterial pH value and fHb were measured daily before (pre‐ fHb ) and during ECLS . CPR caused a pronounced increase in pre‐ fHb (group1, 318 (138/586) mg/L; group2, 212 (107/439) mg/L; group3, 79 (53/232) mg/L; p 〈 0.001). Within 24 hours on ECLS , fHb declined significantly. Compared to group 3 without CPR , group1 and 2 had a lower pH value (group1, 7.10 (6.93/7.20); group2, 7.21 (7.16/7.27); group3, 7.28 (7.20/7.35); p 〈 0.001), and an increased lactate level (group1, 88 (55/129) mg/ dL ; group2, 76 (36/111) mg/ dL ; group3, 52 (25/83) mg/ dL ; p 〈 0.0001). Multivariante analysis showed that pre‐ fHb had no prognostic value for survival. Only a low pre‐lactate was a surrogate marker for successful weaning (p 〈 0.0001) and discharge from hospital (p = 0.0028). Conclusions CPR was associated with a strongly increased fHb irrespective of ECLS . Implantation of ECLS did not aggravate hemolysis but instead decreased it within 24 hours. In this study low pre‐ fHb had no predictive value for survival.
    Type of Medium: Online Resource
    ISSN: 1388-9842 , 1879-0844
    URL: Issue
    Language: English
    Publisher: Wiley
    Publication Date: 2017
    detail.hit.zdb_id: 1500332-2
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  • 2
    In: Artificial Organs, Wiley, Vol. 47, No. 5 ( 2023-05), p. 882-890
    Abstract: The outcome after veno‐venous extracorporeal membrane oxygenation in elderly patients is supposed to be unsatisfactory. Our primary aim was to determine the influence of advanced age on short‐ and long‐term outcomes; the secondary aim was to analyze risk factors for impaired outcomes. Methods Between January 2006 and June 2020, 755 patients received V‐V ECMO support at our department. Patients were grouped according to age (18–49.9, 50–59.9, 60–69.9, ≥70 years old), and then retrospectively analyzed for short‐ and long‐term outcomes. Risk factors for in‐hospital mortality and death during follow‐up were assessed using multivariate regression analysis. Results Duration of V‐V ECMO support was comparable between all groups median (8–10 days, p  = 0.256). Likewise, the weaning rate was comparable in all age groups 68.2%–76.5%; ( p  = 0.354), but in‐hospital mortality was significantly climbing with increasing age ( 〈 50 years 30.1%/ n  = 91 vs. 50–59.9 years 37.1%/ n  = 73, vs. 60–69.9 years 45.6%/ n  = 78 vs. ≥70 years 51.8%/ n  = 44; p   〈  0.001). Older age groups also showed significantly reduced cerebral performance category scores. The multivariate logistic analysis yielded age, acute and chronic hemodialysis, bilirubin on day 1 of support, malignancy, and primary lung disease as relevant risk factors for in‐hospital mortality. Age, coronary artery disease, presence of another primary lung disease, malignancy, and immunosuppression were risk factors for death during follow‐up. Conclusion In V‐V ECMO patients, advanced age is associated with more comorbidity, impaired short‐ and long‐term outcome, and worse neurological outcome.
    Type of Medium: Online Resource
    ISSN: 0160-564X , 1525-1594
    URL: Issue
    Language: English
    Publisher: Wiley
    Publication Date: 2023
    detail.hit.zdb_id: 2003825-2
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  • 3
    In: Artificial Organs, Wiley, Vol. 47, No. 4 ( 2023-04), p. 740-748
    Abstract: Use of veno‐arterial extracorporeal membrane oxygenation (VA‐ECMO) in elderly patients is controversial because of presumed poor outcome. Our primary aim was to determine the influence of advanced age on short‐ and long‐term outcome; the secondary aim was to analyze risk factors for impaired outcome. Methods Between January 2006 and June 2020, 645 patients underwent VA‐ECMO implantation in our department. The patients were categorized into four groups: 〈 50, 50–59.9, 60–69.9 and ≥70 years old. Data were retrospectively analyzed for short‐ and long‐term outcome. Risk factors for in‐hospital mortality and mortality during follow‐up were assessed using multivariate regression analysis. Results VA‐ECMO support duration was comparable in all age groups (median 3 days). Weaning rates were 60.8%/ n  = 104 ( 〈 50 years), 51.4%/ n  = 90 (50–59.9 years), 58.8%/ n  = 107 (60–69.9), and 67.5%/ n  = 79 (≥70, p  = 0.048). Hospital mortality was highest in the patients aged 50–59.9 years (68%/ n  = 119), but not in the elderly patients (60–69.9, ≥70:62.1%/ n  = 113, 58,1%/ n  = 68). At discharge, the cerebral performance category scores were superior in the patients 〈 50 years. Multivariate logistic regression analysis revealed chronic kidney failure requiring hemodialysis, duration of cardiopulmonary resuscitation, and elevated blood lactate levels before VA‐ECMO, but not age as predictors of in‐hospital mortality. Cox's regression disclosed age as relevant risk factor for death during follow‐up. The patients' physical ability was comparable in all age groups. Conclusion VA‐ECMO support should not be declined in patients only because of advanced age. Mortality and neurological status at hospital discharge and during follow‐up were comparable in all age groups.
    Type of Medium: Online Resource
    ISSN: 0160-564X , 1525-1594
    URL: Issue
    Language: English
    Publisher: Wiley
    Publication Date: 2023
    detail.hit.zdb_id: 2003825-2
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  • 4
    In: Catheterization and Cardiovascular Interventions, Wiley, Vol. 82, No. 4 ( 2013-10)
    Abstract: To report our center's experience using veno‐arterial extracorporeal membrane oxygenation (vaECMO) in transcatheter aortic valve implantation (TAVI). Background In TAVI, short‐term mortality closely relates to life threatening procedural complications. VaECMO can be used to stabilize the patient in emergency situations. However, for the prophylactic use of vaECMO in very high‐risk patients undergoing TAVI there is no experience. Methods From January 2009 to August 2011, we performed 131 TAVI. Emergency vaECMO was required in 8 cases (7%): ventricular perforation ( n  = 3), hemodynamic instability/cardiogenic shock ( n  = 4), hemodynamic deterioration due to ventricular tachycardia ( n  = 1). Since August 2011, during 83 procedures, prophylactic vaECMO was systematically used in very high‐risk patients ( n  = 9, 11%) and emergency ECMO in one case (1%) due to ventricular perforation. Results Median logistic EuroScore in prophylactic vaECMO patients was considerably higher as compared to the remaining TAVI population (30% vs. 15%, P  = 0.0003) while in patients with emergency vaECMO it was comparable (18% vs. 15%, P  = 0.08). Comparing prophylactic to emergency vaECMO, procedural success and 30‐day mortality were 100% vs. 44% ( P  = 0.03) and 0% vs. 44% ( P  = 0.02), respectively. Major vascular complications and rate of life threatening bleeding did not differ between both groups (11% vs. 11%, P  = 0.99 and 11% vs. 33%, P  = 0.3) and were not vaECMO‐related. Conclusions Life‐threatening complications during TAVI can be managed using emergency vaECMO but mortality remains high. The use of prophylactic vaECMO in very high‐risk patients is safe and may be advocated in selected cases. © 2013 Wiley Periodicals, Inc.
    Type of Medium: Online Resource
    ISSN: 1522-1946 , 1522-726X
    URL: Issue
    Language: English
    Publisher: Wiley
    Publication Date: 2013
    detail.hit.zdb_id: 2001555-0
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  • 5
    In: European Journal of Organic Chemistry, Wiley, Vol. 2003, No. 5 ( 2003-03), p. 855-862
    Abstract: The stereoselective Pd‐catalyzed allylation of MBA [5‐(2′‐hex‐3′‐ynyl)‐1‐methylbarbituric acid] gives the commercial injection narcotic methohexital, which exists as four isomers: two diastereomeric pairs of enantiomers. The isomer composit ion produced depends on three stereochemical parameters: catalyst control, substrate control, and kinetic resolution. Judicious choice of these parameters allowed the synthesis of methohexital samples with greatly differing isomer compositions, and these samples were investigated with respect to their anaesthetic doses in rats. Some isomer compositions obtained were much more active than the commercially used drug and showed fewer side effects. As a consequence of the determination of the absolute configuration of the methohexital ( S b R h ) isomer, the unknown configuration of the trade product, the so‐called α‐racemate, can be established as ( R b S h ) and ( S b R h ). (© Wiley‐VCH Verlag GmbH & Co. KGaA, 69451 Weinheim, Germany, 2003)
    Type of Medium: Online Resource
    ISSN: 1434-193X , 1099-0690
    URL: Issue
    RVK:
    Language: English
    Publisher: Wiley
    Publication Date: 2003
    detail.hit.zdb_id: 1475010-7
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  • 6
    In: eJHaem, Wiley, Vol. 1, No. 1 ( 2020-07), p. 376-383
    Abstract: The clinical course of coronavirus disease 2019 (COVID‐19) varies from mild symptoms to acute respiratory distress syndrome, hyperinflammation, and coagulation disorder. The hematopoietic system plays a critical role in the observed hyperinflammation, particularly in severely ill patients. We conducted a prospective diagnostic study performing a blood differential analyzing morphologic changes in peripheral blood of COVID‐19 patients. COVID‐19 associated morphologic changes were defined in a training cohort and subsequently validated in a second cohort (n = 45). Morphologic aberrations were further analyzed by electron microscopy (EM) and flow cytometry of lymphocytes was performed. We included 45 COVID‐19 patients in our study (median age 58 years; 82% on intensive care unit). The blood differential showed a specific pattern of pronounced multi‐lineage aberrations in lymphocytes (80%) and monocytes (91%) of patients. Overall, 84%, 98%, and 98% exhibited aberrations in granulopoiesis, erythropoiesis, and thrombopoiesis, respectively. Electron microscopy revealed the ultrastructural equivalents of the observed changes and confirmed the multi‐lineage aberrations already seen by light microscopy. The morphologic pattern caused by COVID‐19 is characteristic and underlines the serious perturbation of the hematopoietic system. We defined a hematologic COVID‐19 pattern to facilitate further independent diagnostic analysis and to investigate the impact on the hematologic system during the clinical course of COVID‐19 patients.
    Type of Medium: Online Resource
    ISSN: 2688-6146 , 2688-6146
    URL: Issue
    Language: English
    Publisher: Wiley
    Publication Date: 2020
    detail.hit.zdb_id: 3021452-X
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  • 7
    In: Artificial Organs, Wiley, Vol. 46, No. 9 ( 2022-09), p. 1912-1922
    Abstract: Multiple organ failure is a common complication in patients undergoing ECLS significantly affecting patient outcomes. Gaining knowledge about the mechanisms of onset, clinical course, risk factors, and potential therapeutic targets is highly desirable. Methods Data of 354 patients undergoing ECLS with one‐, two, three‐, and four organ failures were retrospectively analyzed. Incidence of multiple organ dysfunction (MODS), its impact on survival, risk factors for its occurrence, and the impact of proinflammatory mediators on the occurrence of MODS in patients undergoing ECLS were investigated. Results The median follow‐up was 66 (IQR 6; 820) days. 245 (69.2%) patients could be weaned from ECLS, 30‐day survival and 1‐year survival were 194 (54.1%) and 157 (44.4%), respectively. The duration of mechanical support was 4 (IQR 2; 7) days in the median. Increasing severity of MODS resulted in significant prolongation of mechanical circulatory support and worsening of the outcome. Liver dysfunction had the strongest impact on patient mortality (OR = 2.5) and survival time (19 vs 367 days). The serum concentration of analyzed interleukins rose significantly with each, additional organ affected by dysfunction ( p   〈  0.001). All analyzed proinflammatory cytokines showed significant predictivity relative to the occurrence of MODS with interleukin 8 serum level prior to ECLS showing the strongest predictive potential for the occurrence of MODS (AUC 0.78). Conclusion MODS represents a frequent complication in patients undergoing ECLS with a significant impact on survival. Proinflammatory cytokines show prognostic capacity regarding the occurrence and severity of multi‐organ dysfunction.
    Type of Medium: Online Resource
    ISSN: 0160-564X , 1525-1594
    URL: Issue
    Language: English
    Publisher: Wiley
    Publication Date: 2022
    detail.hit.zdb_id: 2003825-2
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  • 8
    In: Artificial Organs, Wiley, Vol. 37, No. 2 ( 2013-02), p. 150-156
    Type of Medium: Online Resource
    ISSN: 0160-564X
    URL: Issue
    Language: English
    Publisher: Wiley
    Publication Date: 2013
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  • 9
    In: Artificial Organs, Wiley, Vol. 44, No. 8 ( 2020-08), p. 837-845
    Abstract: Extracorporeal life support is increasingly used in the treatment of patients presenting with cardiogenic shock or in need of cardiopulmonary resuscitation. Identifying therapeutic targets and factors associated with the prognosis are highly desirable. The present study analyzed the impact of interleukin 6 and 8 on the outcome of patients undergoing venoarterial extracorporeal membrane oxygenation (VA ECMO). Interleukin 6 and 8 serum levels of 329 patients were analyzed prior to, on days 1 and 5 of VA ECMO therapy. Interleukin 6 and 8 serum levels of surviving and nonsurviving patients were compared. At time points with significant differences, receiver operating characteristics and cutoff levels were analyzed to determine the prognostic value of interleukin serum levels. Survival analysis was performed to compare patients above and below cutoff levels. Interleukin 6 serum levels were significantly elevated in nonsurviving patients prior to VA ECMO initiation. Interleukin 6 and 8 serum levels in nonsurviving patients were significantly elevated on day 1 of VA ECMO. Receiver operating characteristics analysis revealed significant prognostic impact of interleukin 6 and 8 on day 1 of VA ECMO (AUC 0.70 and 0.72). Survival analysis comparing patients above and below the cutoff showed a 1‐year survival of 32.6% for IL6 and 20.8% for IL8 above, as well as 66.9% for IL6 and 61.9% for IL8 below the cutoff ( P   〈  .05). Interleukin 6 and 8 serum levels demonstrated prognostic value early in VA ECMO therapy. The technical applicability of interleukin reduction raises interest in interleukins 6 and 8 as therapeutic targets.
    Type of Medium: Online Resource
    ISSN: 0160-564X , 1525-1594
    URL: Issue
    Language: English
    Publisher: Wiley
    Publication Date: 2020
    detail.hit.zdb_id: 2003825-2
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