Artificial Organs and Extracorporeal Organ Support

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Intensive Care".

Deadline for manuscript submissions: closed (20 August 2023) | Viewed by 6986

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Guest Editor
Department of Anaesthesiology and Intensive Care Medicine, Medical University Innsbruck, Innsbruck, Austria
Interests: critical care; intensive care; transplantation; anaesthesia; emergency medicine; cardiology
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Special Issue Information

Dear Colleagues,

The outstanding development of medical science, artificial materials, biomaterials, nanotechnology, and bioengineering in recent decades has led to improved patient outcomes and reduced mortality. Further advancement in this more than decades-old care concept is warranted. Multidisciplinary care of patients is an integral part of every modern healthcare system, ensuring improved outcomes and reduced mortality, which are guaranteed by the prompt development of diverse diagnostic and therapeutic modalities and supported by the continuous education of health workers. The replacement of diseased or damaged organs with artificially engineered ones is increasing compared to the need for medicine, surgery, or the support of organisms during the critical phases of disease. The development of extracorporeal organ support and artificial organs is a multi-disciplinary challenge, bringing together different scientists and clinicians in their respective areas of expertise. 

This Special Issue on “Artificial Organs and Extracorporeal Organ Support” welcomes the submission of work related to the most recent developments and the challenges addressing innovative therapeutic and diagnostic strategies in the care of patients. We invite all researchers from associated disciplines who focus on the care of acutely ill patients to submit original articles or reviews in their area of expertise, enhancing the multi-disciplinarity of modern critical care.

Dr. Sasa Rajsic
Dr. Benedikt Treml
Dr. Robert Breitkopf
Guest Editors

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Keywords

  • extracorporeal organ support
  • artificial organs
  • critical care
  • diagnosis
  • treatment

Published Papers (4 papers)

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Research

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15 pages, 635 KiB  
Article
Liver-Support Therapies in Critical Illness—A Comparative Analysis of Procedural Characteristics and Safety
by Daniel Göth, Christoph F. Mahler, Florian Kälble, Claudius Speer, Louise Benning, Felix C. F. Schmitt, Maximilian Dietrich, Ellen Krautkrämer, Martin Zeier, Uta Merle, Christian Morath, Mascha O. Fiedler, Markus A. Weigand and Christian Nusshag
J. Clin. Med. 2023, 12(14), 4669; https://doi.org/10.3390/jcm12144669 - 13 Jul 2023
Cited by 3 | Viewed by 1950
Abstract
Extracorporeal liver-support therapies remain controversial in critically ill patients, as most studies have failed to show an improvement in outcomes. However, heterogeneous timing and inclusion criteria, an insufficient number of treatments, and the lack of a situation-dependent selection of available liver-support modalities may [...] Read more.
Extracorporeal liver-support therapies remain controversial in critically ill patients, as most studies have failed to show an improvement in outcomes. However, heterogeneous timing and inclusion criteria, an insufficient number of treatments, and the lack of a situation-dependent selection of available liver-support modalities may have contributed to negative study results. We retrospectively investigated the procedural characteristics and safety of the three liver-support therapies CytoSorb, Molecular Adsorbent Recirculating System (MARS) and therapeutic plasma exchange (TPE). Whereas TPE had its strengths in a shorter treatment duration, in clearing larger molecules, affecting platelet numbers less, and improving systemic coagulation and hemodynamics, CytoSorb and MARS were associated with a superior reduction in particularly small protein-bound and water-soluble substances. The clearance magnitude was concentration-dependent for all three therapies, but additionally related to the molecular weight for CytoSorb and MARS therapy. Severe complications did not appear. In conclusion, a better characterization of disease-driving as well as beneficial molecules in critically ill patients with acute liver dysfunction is crucial to improve the use of liver-support therapy in critically ill patients. TPE may be beneficial in patients at high risk for bleeding complications and impaired liver synthesis and hemodynamics, while CytoSorb and MARS may be considered for patients in whom the elimination of smaller toxic compounds is a primary objective. Full article
(This article belongs to the Special Issue Artificial Organs and Extracorporeal Organ Support)
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11 pages, 3459 KiB  
Article
Initial Tumor Necrosis Factor-Alpha and Endothelial Activation Are Associated with Hemorrhagic Complications during Extracorporeal Membrane Oxygenation
by Jin Ho Jang, Kyung-Hwa Shin, Hye Rin Lee, Eunjeong Son, Seung Eun Lee, Hee Yun Seol, Seong Hoon Yoon, Taehwa Kim, Woo Hyun Cho, Doosoo Jeon, Yun Seong Kim and Hye Ju Yeo
J. Clin. Med. 2023, 12(13), 4520; https://doi.org/10.3390/jcm12134520 - 6 Jul 2023
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Abstract
Studies on inflammatory markers, endothelial activation, and bleeding during extracorporeal membrane oxygenation (ECMO) are lacking. Blood samples were prospectively collected after ECMO initiation from 150 adult patients who underwent ECMO for respiratory failure between 2018 and 2021. After excluding patients who died early [...] Read more.
Studies on inflammatory markers, endothelial activation, and bleeding during extracorporeal membrane oxygenation (ECMO) are lacking. Blood samples were prospectively collected after ECMO initiation from 150 adult patients who underwent ECMO for respiratory failure between 2018 and 2021. After excluding patients who died early (within 48 h), 132 patients were finally included. Their tumor necrosis factor-alpha (TNF-α), tissue factor (TF), soluble thrombomodulin (sTM), and E-selectin levels were measured. A Cox proportional hazards regression model was used to estimate the hazard ratio for hemorrhagic complications during ECMO. The 132 patients were divided into hemorrhagic (n = 23, H group) and non-complication (n = 109, N group) groups. The sequential organ failure assessment score, hemoglobin level, and ECMO type were included as covariates in all Cox models to exclude the effects of clinical factors. After adjusting for these factors, initial TNF-α, TF, sTM, E-selectin, and activated protein C levels were significantly associated with hemorrhagic complications (all p < 0.001). TNF-α, TF, and E-selectin better predicted hemorrhagic complications than the model that included only the aforementioned clinical factors (clinical factors only (area under the curve [AUC]: 0.804), reference; TNF-α (AUC: 0.914); TF (AUC: 0.915); E-selectin (AUC: 0.869)). Conclusions: TNF-α levels were significantly predictive of hemorrhagic complications during ECMO. Full article
(This article belongs to the Special Issue Artificial Organs and Extracorporeal Organ Support)
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14 pages, 1064 KiB  
Article
Association of aPTT-Guided Anticoagulation Monitoring with Thromboembolic Events in Patients Receiving V-A ECMO Support: A Systematic Review and Meta-Analysis
by Sasa Rajsic, Robert Breitkopf, Benedikt Treml, Dragana Jadzic, Christoph Oberleitner, Ulvi Cenk Oezpeker, Nicole Innerhofer and Zoran Bukumiric
J. Clin. Med. 2023, 12(9), 3224; https://doi.org/10.3390/jcm12093224 - 30 Apr 2023
Cited by 7 | Viewed by 1684
Abstract
Background: The initiation of extracorporeal membrane oxygenation (ECMO) is associated with complex inflammatory and coagulatory processes, raising the need for systemic anticoagulation. The balance of anticoagulatory and procoagulant factors is essential, as therapeutic anticoagulation confers a further risk of potentially life-threatening bleeding. Therefore, [...] Read more.
Background: The initiation of extracorporeal membrane oxygenation (ECMO) is associated with complex inflammatory and coagulatory processes, raising the need for systemic anticoagulation. The balance of anticoagulatory and procoagulant factors is essential, as therapeutic anticoagulation confers a further risk of potentially life-threatening bleeding. Therefore, our study aims to systematize and analyze the most recent evidence regarding anticoagulation monitoring and the thromboembolic events in patients receiving veno-arterial ECMO support. Methods: Using the PRISMA guidelines, we systematically searched the Scopus and PubMed databases up to October 2022. A weighted effects model was employed for the meta-analytic portion of the study. Results: Six studies comprising 1728 patients were included in the final analysis. Unfractionated heparin was used for anticoagulation, with an activated partial thromboplastin time (aPTT) monitoring goal set between 45 and 80 s. The majority of studies aimed to investigate the incidence of adverse events and potential risk factors for thromboembolic and bleeding events. None of the authors found any association of aPTT levels with the occurrence of thromboembolic events. Finally, the most frequent adverse events were hemorrhage (pooled 43%, 95% CI 28.4; 59.5) and any kind of thrombosis (pooled 36%, 95% CI 21.7; 53.7), and more than one-half of patients did not survive to discharge (pooled 54%). Conclusions: Despite the tremendous development of critical care, aPTT-guided systemic anticoagulation is still the standard monitoring tool. We did not find any association of aPTT levels with thrombosis. Further evidence and new trials should clarify the true incidence of thromboembolic events, along with the best anticoagulation and monitoring strategy in veno-arterial ECMO patients. Full article
(This article belongs to the Special Issue Artificial Organs and Extracorporeal Organ Support)
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Review

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13 pages, 626 KiB  
Review
Blood Purification in Patients with Sepsis Associated with Acute Kidney Injury: A Narrative Review
by Jun Kamei, Masafumi Kanamoto, Yutaka Igarashi, Kodai Suzuki, Kensuke Fujita, Tsukasa Kuwana, Takayuki Ogura, Katsunori Mochizuki, Yuki Banshotani, Hiroyasu Ishikura, Yoshihiko Nakamura and J-STAD (Japan Sepsis Treatment and Diagnosis) Study Group
J. Clin. Med. 2023, 12(19), 6388; https://doi.org/10.3390/jcm12196388 - 6 Oct 2023
Cited by 1 | Viewed by 1913
Abstract
Sepsis leads to organ dysfunction. Acute kidney injury, a common type of organ dysfunction, is associated with a high mortality rate in patients with sepsis. Kidney replacement therapy can correct the metabolic, electrolyte, and fluid imbalances caused by acute kidney injury. While this [...] Read more.
Sepsis leads to organ dysfunction. Acute kidney injury, a common type of organ dysfunction, is associated with a high mortality rate in patients with sepsis. Kidney replacement therapy can correct the metabolic, electrolyte, and fluid imbalances caused by acute kidney injury. While this therapy can improve outcomes, evidence of its beneficial effects is lacking. Herein, we review the indications for blood purification therapy, including kidney replacement therapy, and the current knowledge regarding acute kidney injury in terms of renal and non-renal indications. While renal indications have been well-documented, indications for blood purification therapy in sepsis (non-renal indications) remain controversial. Excessive inflammation is an important factor in the development of sepsis; blood purification therapy has been shown to reduce inflammatory mediators and improve hemodynamic instability. Given the pathophysiology of sepsis, blood purification therapy may decrease mortality rates in these patients. Further trials are needed in order to establish the effectiveness of blood purification therapy for sepsis. Full article
(This article belongs to the Special Issue Artificial Organs and Extracorporeal Organ Support)
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