43 results on '"John W. Stokes"'
Search Results
2. Bridge to Transplant: Central Extracorporeal Membrane Oxygenation With Pulmonary Artery Drainage
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Yatrik Patel, John W. Stokes, Whitney D. Gannon, James T. Zorn, Jordan Hoffman, Ashish S. Shah, and Matthew Bacchetta
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Pulmonary and Respiratory Medicine ,Surgery ,Cardiology and Cardiovascular Medicine - Published
- 2022
3. Association between Availability of Extracorporeal Membrane Oxygenation and Mortality in Patients with COVID-19 Eligible for Extracorporeal Membrane Oxygenation: A Natural Experiment
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Whitney D. Gannon, John W. Stokes, Sean A. Francois, Yatrik J. Patel, Meredith E. Pugh, Clayne Benson, Todd W. Rice, Matthew Bacchetta, Matthew W. Semler, and Jonathan D. Casey
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Pulmonary and Respiratory Medicine ,Critical Care and Intensive Care Medicine - Published
- 2022
4. Extracorporeal Membrane Oxygenation Circuits in Parallel for Refractory Hypoxemia in COVID-19: A Case Series
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Yatrik J, Patel, John W, Stokes, Whitney D, Gannon, Sean A, Francois, Wei Kelly, Wu, Todd W, Rice, and Matthew, Bacchetta
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Biomaterials ,Respiratory Distress Syndrome ,Extracorporeal Membrane Oxygenation ,Biomedical Engineering ,Biophysics ,COVID-19 ,Humans ,Bioengineering ,General Medicine ,Hypoxia ,Respiration, Artificial - Abstract
Refractory hypoxemia despite the use of extracorporeal membrane oxygenation (ECMO) for coronavirus disease 2019 (COVID-19)-related acute respiratory distress syndrome remains a challenging problem. A single ECMO circuit may not provide adequate physiologic support in the setting of an elevated cardiac output, physiologic demand, and impaired gas exchange. In select patients with refractory hypoxemia, addition of a second ECMO circuit in parallel can improve oxygenation, facilitate lung protective ventilation, awakening, and physical rehabilitation. We report the largest case series to date of patients receiving ECMO circuits in parallel and the first to report this approach in COVID-19.
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- 2022
5. Immune characterization of a xenogeneic human lung cross-circulation support system
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Wei K. Wu, Matthew T. Stier, John W. Stokes, Rei Ukita, Yatrik J. Patel, Michael Cortelli, Stuart R. Landstreet, Jennifer R. Talackine, Nancy L. Cardwell, Elizabeth M. Simonds, Meredith Mentz, Cindy Lowe, Clayne Benson, Caitlin T. Demarest, Sophoclis P. Alexopoulos, Ciara M. Shaver, and Matthew Bacchetta
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Multidisciplinary - Abstract
Improved approaches to expanding the pool of donor lungs suitable for transplantation are critically needed for the growing population with end-stage lung disease. Cross-circulation (XC) of whole blood between swine and explanted human lungs has previously been reported to enable the extracorporeal recovery of donor lungs that declined for transplantation due to acute, reversible injuries. However, immunologic interactions of this xenogeneic platform have not been characterized, thus limiting potential translational applications. Using flow cytometry and immunohistochemistry, we demonstrate that porcine immune cell and immunoglobulin infiltration occurs in this xenogeneic XC system, in the context of calcineurin-based immunosuppression and complement depletion. Despite this, xenogeneic XC supported the viability, tissue integrity, and physiologic improvement of human donor lungs over 24 hours of xeno-support. These findings provide targets for future immunomodulatory strategies to minimize immunologic interactions on this organ support biotechnology.
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- 2023
6. Xenogeneic cross-circulation for physiological support and recovery of ex vivo human livers
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Wei Kelly Wu, Rei Ukita, Yatrik J. Patel, Michael Cortelli, Vincent Q. Trinh, Ioannis A. Ziogas, Sean A. Francois, Meredith Mentz, Nancy L. Cardwell, Jennifer R. Talackine, William M. Grogan, John W. Stokes, Youngmin A. Lee, Jinho Kim, Sophoclis P. Alexopoulos, and Matthew Bacchetta
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Hepatology - Published
- 2023
7. Area Deprivation Index and Distress Community Index Scores Are Not Associated With Short-Term and Long-Term Extracorporeal Life Support Outcomes
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Aniket S. Rali, Emilee E. Larson, Lena E. Tran, Zakiur M. Rahaman, Lawrence J. Charles, John W. Stokes, Clifford Chin, Alistair Hilton, Whitney D. Gannon, Matthew D. Bacchetta, and Ashish S. Shah
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Biomaterials ,Biomedical Engineering ,Biophysics ,Bioengineering ,General Medicine - Published
- 2023
8. Bleeding and clotting while supported with ECMO: time to move forward
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Elias H. Pratt, John W. Stokes, and Eddy Fan
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Critical Care and Intensive Care Medicine - Published
- 2022
9. Safety and Feasibility of a Protocolized Daily Assessment of Readiness for Liberation From Venovenous Extracorporeal Membrane Oxygenation
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Matthew W. Semler, Whitney D. Gannon, Sarah Bloom, Jonathan D Casey, Wren H Sherrill, John W. Stokes, Todd W. Rice, and Matthew Bacchetta
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Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Critical Care ,medicine.medical_treatment ,Pilot Projects ,Protocol Deviation ,Critical Care and Intensive Care Medicine ,Single Center ,Extracorporeal Membrane Oxygenation ,Clinical Protocols ,Interquartile range ,medicine ,Extracorporeal membrane oxygenation ,Humans ,Weaning ,Prospective Studies ,Adverse effect ,Prospective cohort study ,Duration of Therapy ,business.industry ,Middle Aged ,Outcome and Process Assessment, Health Care ,surgical procedures, operative ,Withholding Treatment ,Respiratory failure ,Critical Care: Original Research ,Emergency medicine ,Feasibility Studies ,Female ,Risk Adjustment ,Patient Safety ,Symptom Assessment ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background Decannulation from venovenous extracorporeal membrane oxygenation (ECMO) at the earliest and safest possible time may improve outcomes and reduce cost. Yet, no prospective studies have compared weaning strategies for liberation from ECMO. Research Question Is a protocolized daily assessment of readiness to liberate from venovenous ECMO safe and feasible? Study Design and Methods We conducted a prospective, single-arm safety and feasibility study of a protocol for daily assessment of readiness to liberate from venovenous ECMO among consecutive adult patients receiving venovenous ECMO across four ICUs at a single center between June 20, 2020, and November 24, 2020. The ECMO-free protocol included three phases: (1) the safety screening, (2) non-ECMO F io 2 titration, and (3) the ECMO-free trial. Enrollment, interventions, and data collection were performed prospectively by trained study staff. Results Twenty-six patients received the ECMO-free protocol on 385 patient-days. The safety screening was passed during a total of 59 ECMO-free daily assessments (15.3%) among 20 patients. Every passed safety screening proceeded to an ECMO-free trial. Twenty-eight passed ECMO-free trials (47.5%) occurred among 16 patients (61.5%). No missed safety screenings, protocol deviations, or adverse events occurred. Of the 16 patients who passed an ECMO-free trial, 14 patients (87.5%) were decannulated. Among decannulated patients, 12 patients (85.7%) were decannulated on the same day as a passed ECMO-free trial, 6 patients (42.9%) were decannulated on the first day that they passed an ECMO-free trial, and 6 patients (42.9%) passed an ECMO-free trial at least twice consecutively before decannulation. The median time from first passed ECMO-free trial to decannulation was 2 days (interquartile range, 0-3 days). Interpretation The ECMO-free protocol is feasible and may identify patients for decannulation earlier than gradual approaches to weaning.
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- 2021
10. Cross-Circulation for Extracorporeal Liver Support in a Swine Model
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John W. Stokes, Matthew Bacchetta, Gordana Vunjak-Novakovic, Clayne Benson, Jennifer Talackine, Jonathan A. Reimer, Sophoclis P. Alexopoulos, John D. O’Neill, Michael J. Lee, Charles R. Flynn, Rei Ukita, Ahmed E. Hozain, Andrew Tumen, Nancy L. Cardwell, Meghan R. Pinezich, and Wei Kelly Wu
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medicine.medical_specialty ,Synthetic function ,Swine ,medicine.medical_treatment ,Biomedical Engineering ,Biophysics ,Urology ,Bioengineering ,Economic shortage ,Liver transplantation ,Article ,Extracorporeal ,Unmet needs ,Biomaterials ,medicine ,Animals ,Humans ,Machine perfusion ,business.industry ,Organ Preservation ,General Medicine ,Liver Transplantation ,Perfusion ,Lactate clearance ,Preservation Technique ,Liver ,Reperfusion Injury ,Cross Circulation ,business - Abstract
Although machine perfusion has gained momentum as an organ preservation technique in liver transplantation, persistent organ shortages and high waitlist mortality highlight unmet needs for improved organ salvage strategies. Beyond preservation, extracorporeal organ support platforms can also aid the development and evaluation of novel therapeutics. Here, we report the use of veno-arterial-venous (V-AV) cross-circulation (XC) with a swine host to provide normothermic support to extracorporeal livers. Functional, biochemical, and morphological analyses of the extracorporeal livers and swine hosts were performed over 12 hours of support. Extracorporeal livers maintained synthetic function through alkaline bile production and metabolic activity through lactate clearance and oxygen consumption. Beyond initial reperfusion, no biochemical evidence of hepatocellular injury was observed. Histopathologic injury scoring showed improvements in sinusoidal dilatation and composite acute injury scores after 12 hours. Swine hosts remained hemodynamically stable throughout XC support. Altogether, these outcomes demonstrate the feasibility of using a novel V-AV XC technique to provide support for extracorporeal livers in a swine model. V-AV XC has potential applications as a translational research platform and clinical biotechnology for donor organ salvage.
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- 2021
11. Venovenous extracorporeal membrane oxygenation during high-risk airway interventions
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James Katsis, Whitney D. Gannon, John W. Stokes, Robert J. Lentz, Matthew Bacchetta, Clayne Benson, Fabien Maldonado, Sameer K Avasarala, Todd W. Rice, and Otis B. Rickman
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Adult ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Thoracic ,Deep vein ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,03 medical and health sciences ,Extracorporeal Membrane Oxygenation ,0302 clinical medicine ,Bronchoscopy ,Interquartile range ,medicine ,Extracorporeal membrane oxygenation ,Humans ,Decompensation ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,Retrospective cohort study ,medicine.disease ,Thrombosis ,Airway Obstruction ,surgical procedures, operative ,medicine.anatomical_structure ,030228 respiratory system ,Emergency medicine ,Surgery ,Cardiology and Cardiovascular Medicine ,Airway ,business - Abstract
OBJECTIVES Practice patterns for the use of extracorporeal membrane oxygenation (ECMO) during high-risk airway interventions vary, and data are limited. We aim to characterize our recent experience using ECMO for procedural support during whole-lung lavage (WLL) and high-risk bronchoscopy for central airway obstruction (CAO). METHODS We performed a retrospective cohort study of adults who received ECMO during WLL and high-risk bronchoscopy from 1 July 2018 to 30 March 2020. Our primary end point was successful completion of the intervention. Secondary end points included ECMO-associated complications and hospital survival. RESULTS Eight patients received venovenous ECMO for respiratory support during 9 interventions; 3 WLLs for pulmonary alveolar proteinosis were performed in 2 patients, and 6 patients underwent 6 bronchoscopic interventions for CAO. We initiated ECMO prior to the intervention in 8 cases and during the intervention in 1 case for respiratory decompensation. All 9 interventions were successfully completed. Median ECMO duration was 17.8 h (interquartile range, 15.9–26.6) for the pulmonary alveolar proteinosis group and 1.9 h (interquartile range, 1.4–8.1) for the CAO group. There was 1 cannula-associated deep vein thrombosis; there were no other ECMO complications. Seven patients (87.5%) and 4 (50.0%) patients survived to discharge and 1 year postintervention, respectively. CONCLUSIONS Use of venovenous ECMO to facilitate high-risk airway interventions is safe and feasible. Planned preprocedural ECMO initiation may prevent avoidable respiratory emergencies and extend therapeutic airway interventions to patients otherwise considered too high-risk to treat. Guidelines are needed to inform the utilization of ECMO during high-risk bronchoscopy and other airway interventions.
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- 2021
12. Reply to Mang
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Whitney D, Gannon, John W, Stokes, Sean A, Francois, Yatrik J, Patel, Meredith E, Pugh, Clayne, Benson, Todd W, Rice, Matthew, Bacchetta, Matthew W, Semler, and Jonathan D, Casey
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- 2022
13. Extracorporeal Membrane Oxygenation as a Bridge to Lung Transplant
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John W. Stokes, Matthew Bacchetta, and Whitney D. Gannon
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Lung Diseases ,Pulmonary and Respiratory Medicine ,High rate ,medicine.medical_specialty ,Lung ,business.industry ,Patient Selection ,medicine.medical_treatment ,Critical Care and Intensive Care Medicine ,Review article ,Clinical Practice ,Extracorporeal Membrane Oxygenation ,Treatment Outcome ,surgical procedures, operative ,medicine.anatomical_structure ,Lung disease ,Candidacy ,Extracorporeal membrane oxygenation ,Humans ,Medicine ,Respiratory function ,business ,Intensive care medicine ,Lung Transplantation - Abstract
Extracorporeal membrane oxygenation (ECMO) is a cardiopulmonary technology capable of supporting cardiac and respiratory function in the presence of end-stage lung disease. Initial experiences using ECMO as a bridge to lung transplant (ECMO-BTLT) were characterized by high rates of ECMO-associated complications and poor posttransplant outcomes. More recently, ECMO-BTLT has garnered success in preserving patients' physiologic condition and candidacy prior to lung transplant due to technological advances and improved management. Despite recent growth, clinical practice surrounding use of ECMO-BTLT remains variable, with little data to inform optimal patient selection and management. Although many questions remain, the use of ECMO-BTLT has shown promising outcomes suggesting that ECMO-BTLT can be an effective strategy to ensure that complex and rapidly decompensating patients with end-stage lung disease can be safely transplanted with good outcomes. Further studies are needed to refine and inform practice patterns, management, and lung allocation in this high-risk and fragile patient population.
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- 2021
14. Technique for xenogeneic cross-circulation to support human donor lungs ex vivo
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W. Kelly Wu, Brandon A. Guenthart, John D. O'Neill, Ahmed E. Hozain, Yuliya Tipograf, Rei Ukita, John W. Stokes, Yatrik J. Patel, Meghan Pinezich, Jennifer R. Talackine, Nancy L. Cardwell, Kenmond Fung, Gordana Vunjak-Novakovic, and Matthew Bacchetta
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Pulmonary and Respiratory Medicine ,Transplantation ,Surgery ,Cardiology and Cardiovascular Medicine ,Article - Abstract
BACKGROUND: Xenogeneic cross-circulation (XC) is an experimental method for ex vivo organ support and recovery that could expand the pool of donor lungs suitable for transplantation. The objective of this study was to establish and validate a standardized, reproducible, and broadly applicable technique for performing xenogeneic XC to support and recover injured human donor lungs ex vivo. METHODS: Human donor lungs (n = 9) declined for transplantation were procured, cannulated, and subjected to 24 hours of xenogeneic XC with anesthetized xeno-support swine (Yorkshire/Landrace) treated with standard immunosuppression (methylprednisolone, mycophenolate mofetil, tacrolimus) and complement-depleting cobra venom factor. Standard lung-protective perfusion and ventilation strategies, including periodic lung recruitment maneuvers, were used throughout xenogeneic XC. Every 6 hours, ex vivo donor lung function (gas exchange, compliance, airway pressures, pulmonary vascular dynamics, lung weight) was evaluated. At the experimental endpoint, comprehensive assessments of the lungs were performed by bronchoscopy, histology, and electron microscopy. Student’s t-test and 1-way analysis of variance with Dunnett’s post-hoc test was performed, and p < 0.05 was considered significant. RESULTS: After 24 hours of xenogeneic XC, gas exchange (PaO2/FiO2) increased by 158% (endpoint: 364 ± 142 mm Hg; p = 0.06), and dynamic compliance increased by 127% (endpoint: 46 ± 20 ml/cmH(2)O; p = 0.04). Airway pressures, pulmonary vascular pressures, and lung weight remained stable (p > 0.05) and within normal ranges. Over 24 hours of xenogeneic XC, gross and microscopic lung architecture were preserved: airway bronchoscopy and parenchymal histomorphology appeared normal, with intact blood–gas barrier. CONCLUSIONS: Xenogeneic cross-circulation is a robust method for ex vivo support, evaluation, and improvement of injured human donor lungs declined for transplantation.
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- 2022
15. Extracorporeal membrane oxygenation circuits in parallel for refractory hypoxemia in patients with COVID-19
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Yatrik J. Patel, Whitney D. Gannon, Sean A. Francois, John W. Stokes, Yuliya Tipograf, Janna S. Landsperger, Matthew W. Semler, Jonathan D. Casey, Todd W. Rice, and Matthew Bacchetta
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Pulmonary and Respiratory Medicine ,Surgery ,Cardiology and Cardiovascular Medicine - Abstract
Refractory hypoxemia can occur in patients with acute respiratory distress syndrome from COVID-19 despite support with venovenous (VV) extracorporeal membrane oxygenation (ECMO). Parallel ECMO circuits can be used to increase physiologic support. We report our clinical experience using ECMO circuits in parallel for select patients with persistent severe hypoxemia despite the use of a single ECMO circuit.We performed a retrospective cohort study of all patients with COVID-19-related acute respiratory distress syndrome who received VV-ECMO with an additional circuit in parallel at Vanderbilt University Medical Center between March 1, 2020, and March 1, 2022. We report demographic characteristics and clinical characteristics including ECMO settings, mechanical ventilator settings, use of adjunctive therapies, and arterial blood gas results after initial cannulation, before and after receipt of a second ECMO circuit in parallel, and before removal of the circuit in parallel, and outcomes.Of 84 patients with COVID-19 who received VV-ECMO during the study period, 22 patients (26.2%) received a circuit in parallel. The median duration of ECMO was 40.0 days (interquartile range, 31.6-53.1 days), of which 19.0 days (interquartile range, 13.0-33.0 days) were spent with a circuit in parallel. Of the 22 patients who received a circuit in parallel, 16 (72.7%) survived to hospital discharge and 6 (27.3%) died before discharge.In select patients, the additional use of an ECMO circuit in parallel can increase ECMO blood flow and improve oxygenation while allowing for lung-protective mechanical ventilation and excellent outcomes.
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- 2022
16. Predicting Mortality for Patients Eligible for Extracorporeal Membrane Oxygenation for COVID-19
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Whitney D. Gannon, John W. Stokes, Wu Gong, Christopher J. Lindsell, Joseph E. Tonna, Matthew Bacchetta, Todd W. Rice, Matthew W. Semler, and Jonathan D. Casey
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Pulmonary and Respiratory Medicine ,Respiratory Distress Syndrome ,Extracorporeal Membrane Oxygenation ,COVID-19 ,Humans ,Hospital Mortality ,Critical Care and Intensive Care Medicine ,Respiration, Artificial ,Retrospective Studies - Published
- 2022
17. Extracorporeal Membrane Oxygenation Selection by Multidisciplinary Consensus: The ECMO Council
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Whitney D. Gannon, Anil J. Trindade, John W. Stokes, Jonathan D. Casey, Clayne Benson, Yatrik J. Patel, Meredith E. Pugh, Matthew W. Semler, Matthew Bacchetta, and Todd W. Rice
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Biomaterials ,Biomedical Engineering ,Biophysics ,Bioengineering ,General Medicine - Abstract
Coronavirus disease 2019 (COVID-19) has increased the demand for extracorporeal membrane oxygenation (ECMO) and introduced distinct challenges to patient selection for ECMO. Standardized processes for patient selection amidst resource limitations are lacking, and data on ECMO consults are underreported. We retrospectively reviewed consecutive adult ECMO consults for acute respiratory failure received at a single academic medical center from April 1, 2020, to February 28, 2021, and evaluated the implementation of a multidisciplinary selection committee (ECMO Council) and standardized framework for patient selection for ECMO. During the 334-day period, there were 202 total ECMO consults; 174 (86.1%) included a diagnosis of COVID-19. Among all consults, 157 (77.7%) were declined and 41 (20.3%) resulted in the initiation of ECMO. Frequent reasons for decline included the presence of multiple relative contraindications (n = 33), age greater than 60 years (n = 32), and resource limitations (n = 27). The ECMO Council deliberated on every case in which an absolute contraindication was not present (n = 96) via an electronic teleconference platform. Utilizing multidisciplinary consensus together with a standardized process for patient selection in ECMO is feasible during a pandemic and may be reliably exercised over time. Whether such an approach is feasible at other centers remains unknown.
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- 2022
18. Left Pulmonary Artery Ligation and Chronic Pulmonary Artery Banding Model for Inducing Right Ventricular—Pulmonary Hypertension in Sheep
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Keith E. Cook, Nancy L. Cardwell, Erika B. Rosenzweig, Rachel Donocoff, Jennifer Talackine, Rei Ukita, Andrew Tumen, Neal M. Foley, John W. Stokes, Yuliya Tipograf, and Matthew Bacchetta
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Male ,medicine.medical_specialty ,Hypertension, Pulmonary ,Ventricular Dysfunction, Right ,Biomedical Engineering ,Biophysics ,Bioengineering ,Pulmonary Artery ,030204 cardiovascular system & hematology ,Article ,Pulmonary artery banding ,Biomaterials ,03 medical and health sciences ,0302 clinical medicine ,Afterload ,Right ventricular hypertrophy ,Internal medicine ,Animals ,Medicine ,Ligation ,Sheep ,Hypertrophy, Right Ventricular ,business.industry ,General Medicine ,Left pulmonary artery ,medicine.disease ,Pulmonary hypertension ,Disease Models, Animal ,medicine.anatomical_structure ,030228 respiratory system ,Ventricle ,Cardiology ,business ,Destination therapy - Abstract
Pulmonary hypertension (PH) is a progressive disease that leads to cardiopulmonary dysfunction and right heart failure from pressure and volume overloading of the right ventricle (RV). Mechanical cardiopulmonary support has theoretical promise as a bridge to organ transplant or destination therapy for these patients. Solving the challenges of mechanical cardiopulmonary support for PH and RV failure requires its testing in a physiologically relevant animal model. Previous PH models in large animals have used pulmonary bead embolization, which elicits unpredictable inflammatory responses and has a high mortality rate. We describe a step-by-step guide for inducing pulmonary hypertension and right ventricular hypertrophy (PH-RVH) in sheep by left pulmonary artery (LPA) ligation combined with progressive main pulmonary artery (MPA) banding. This approach provides a controlled method to regulate RV afterload as tolerated by the animal in order to achieve PH-RVH, while reducing acute mortality. This animal model can facilitate evaluation of mechanical support devices for PH and RV failure.
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- 2020
19. Rapid Training in Extracorporeal Membrane Oxygenation for a Large Health System
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Whitney D. Gannon, Matthew W. Semler, Matthew Bacchetta, Yuliya Tipograf, Todd W. Rice, Lynne Craig, John W. Stokes, and Ashish S. Shah
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education ,medicine.medical_specialty ,intensive care units ,business.industry ,medicine.medical_treatment ,General Medicine ,critical care ,surgical procedures, operative ,Intensive care ,medicine ,Extracorporeal membrane oxygenation ,Innovations ,Intensive care medicine ,business - Abstract
Background: Despite the rapid integration of extracorporeal membrane oxygenation (ECMO) into intensive care units over the past decade, established programs for training critical care clinicians to provide ECMO are lacking. Objective: To evaluate the development and implementation of a multidisciplinary ECMO training program for the rapid deployment of ECMO training for a high volume of critical care clinicians. Methods: We performed a prospective cohort study examining a program for rapid training of multiple disciplines of critical care clinicians to deliver ECMO during the implementation of ECMO services across the intensive care units of an academic tertiary care center between October 2018 and January 2019. The multidisciplinary ECMO training program included didactic and simulation-based teaching and emphasized new, universal clinical protocols to improve consistency of care across the institution. Pre- and post-program written examinations evaluated knowledge acquisition, and an electronically distributed program evaluation assessed perceptions of content and delivery. Results: Among the 97 clinicians who completed the program, 49 (51%) were physicians and 48 (49%) were advanced practice providers from the departments of surgery (n = 42), medicine (n = 29), and anesthesia (n = 26). There was a significant difference in knowledge about ECMO between the pre- and post-program examination score (median [interquartile range] 70% [60–80%] vs. 90% [80–90%], respectively, P
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- 2020
20. Large animal preclinical investigation into the optimal extracorporeal life support configuration for pulmonary hypertension and right ventricular failure
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Rei Ukita, John W. Stokes, W. Kelly Wu, Yatrik J. Patel, Jennifer R. Talackine, Nancy Cardwell, Clayne Benson, Ryan J. Lefevre, Susan Eagle, Caitlin Demarest, Elizabeth Simonds, Yuliya Tipograf, Michael Cortelli, David J. Skoog, Keith Cook, Erika B. Rosenzweig, and Matthew Bacchetta
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Pulmonary and Respiratory Medicine ,Transplantation ,Surgery ,Cardiology and Cardiovascular Medicine - Abstract
Right ventricular failure (RVF) is a major cause of mortality in pulmonary hypertension (PH). Mechanical circulatory support holds promise for patients with medically refractory PH, but there are no clinical devices for long-term right ventricular (RV) support. Investigations into optimal device parameters and circuit configurations for PH-induced RVF (PH-RVF) are needed.Eleven sheep underwent previously published chronic PH model. We then evaluated a low-profile, ventricular assist device (VAD)-quality pump combined with a novel low-resistance membrane oxygenator (Pulmonary Assist Device, PAD) under one of four central cannulation strategies: right atrium-to-left atrium (RA-LA, N = 3), RA-to-pulmonary artery (RA-PA, N=3), pumpless pulmonary artery-to-left atrium (PA-LA, N = 2), and RA-to-ascending aorta (RA-Ao, N = 3). Acute-on-chronic RVF (AoC RVF) was induced, and mechanical support was provided for up to 6 hours at blood flow rates of 1 to 3 liter/min. Circuit parameters, physiologic, hemodynamic, and echocardiography data were collected.The RA-LA configuration achieved blood flow of 3 liter/min. Meanwhile, RA-PA and RA-Ao faced challenges maintaining 3 liter/min of flow due to higher circuit afterload. Pumpless PA-LA was flow-limited due to anatomical limitations inherent to this animal model. RA-LA and RA-Ao demonstrated serial RV unloading with increasing circuit flow, while RA-PA did not. RA-LA also improved left ventricular (LV) and septal geometry by echocardiographic assessment and had the lowest inotropic dependence.RA-LA and RA-Ao configurations unload the RV, while RA-LA also lowers pump speed and inotropic requirements, and improves LV mechanics. RA-PA provide inferior support for PH-RVF, while an alternate animal model is needed to evaluate PA-LA.
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- 2022
21. Acute Normovolemic Hemodilution-assisted Terminal Blood Procurement in Swine for Ex Vivo Organ Perfusion
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W Kelly Wu, John W Stokes, Rei Ukita, Ioannis A. Ziogas, Yatrik J Patel, Sophoclis P Alexopoulos, Matthew Bacchetta, and Clayne Benson
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Perfusion ,Hemodilution ,Hemoglobins ,Blood Volume ,Swine ,Preoperative Care ,Animals ,Humans ,Animal Science and Zoology ,Original Research - Abstract
Swine (Sus scrofa domesticus) are commonly used large animal subjects for the study of disease and preclinical therapies. Organ machine perfusion is a therapy that has gained momentum as a research platform for the study of ex vivo organ preservation and therapeutics. However, complex perfusion circuits and research protocols often require large volumes of blood as perfusate. Here, we report a technique for increasing terminal blood yield during swine organ and blood procurement; our method involves acute normovolemic hemodilution and exsanguination via the femoral artery. We collected a total of 47 ± 4 mL/kg of blood and 4.3 ± 0.6 g/kg of hemoglobin, representing 73% ± 6% of the estimated blood volume and 64% ± 8% of the total estimated intravascular hemoglobin (n = 4). Neither pH, lactate, nor pO2 levels changed significantly during blood procurement. Acute normovolemic hemodilution is an effective method for increasing RBC and hemoglobin yield during blood procurement in swine.
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- 2022
22. Xenogeneic cross-circulation for extracorporeal recovery of injured human lungs
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Andrew Tumen, Rei Ukita, Kenmond Fung, Jinho Kim, Ya-Wen Chen, Jonathan A. Reimer, Brandon A. Guenthart, Ahmed E. Hozain, Rachel Donocoff, Edward C. Ruiz, Katherine M. Cunningham, Hans-Willem Snoeck, Nancy L. Cardwell, Michael T. Simpson, Dawn Queen, Alexander Romanov, Meghan R. Pinezich, Yuliya Tipograf, Charles C. Marboe, John W. Stokes, Jennifer Talackine, John D. O’Neill, Matthew Bacchetta, Adam Griesemer, and Gordana Vunjak-Novakovic
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0301 basic medicine ,Pathology ,medicine.medical_specialty ,Lung ,business.industry ,medicine.medical_treatment ,General Medicine ,Cross Circulation ,respiratory system ,General Biochemistry, Genetics and Molecular Biology ,Poor quality ,Extracorporeal ,respiratory tract diseases ,Transplantation ,03 medical and health sciences ,030104 developmental biology ,0302 clinical medicine ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Marginal (quality) ,Medicine ,Lung transplantation ,business ,Whole blood - Abstract
Patients awaiting lung transplantation face high wait-list mortality, as injury precludes the use of most donor lungs. Although ex vivo lung perfusion (EVLP) is able to recover marginal quality donor lungs, extension of normothermic support beyond 6 h has been challenging. Here we demonstrate that acutely injured human lungs declined for transplantation, including a lung that failed to recover on EVLP, can be recovered by cross-circulation of whole blood between explanted human lungs and a Yorkshire swine. This xenogeneic platform provided explanted human lungs a supportive, physiologic milieu and systemic regulation that resulted in functional and histological recovery after 24 h of normothermic support. Our findings suggest that cross-circulation can serve as a complementary approach to clinical EVLP to recover injured donor lungs that could not otherwise be utilized for transplantation, as well as a translational research platform for immunomodulation and advanced organ bioengineering. In a new strategy for increasing the availability of lungs for transplantation, human lungs declined for transplantation because of their poor quality can be recuperated by connecting them to the circulation of a pig.
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- 2020
23. POINT: Should Patients With Advanced Lung Disease Be Offered Extracorporeal Membrane Oxygenation as a Bridge to Transplant If They Have Not Yet Been Listed for Lung Transplant? Yes
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Matthew Bacchetta, Whitney D. Gannon, and John W. Stokes
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Lung Diseases ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Bridge to transplant ,Tissue and Organ Procurement ,Lung ,Critical Care ,Waiting Lists ,business.industry ,Patient Selection ,medicine.medical_treatment ,MEDLINE ,Critical Care and Intensive Care Medicine ,Extracorporeal Membrane Oxygenation ,medicine.anatomical_structure ,Lung disease ,medicine ,Extracorporeal membrane oxygenation ,Humans ,Bridge to decision ,Cardiology and Cardiovascular Medicine ,Intensive care medicine ,business ,Lung Transplantation - Published
- 2020
24. Extracorporeal Membrane Oxygenation for Patients with Traumatic Injury and Respiratory Failure
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John W. Stokes, Mauer Biscotti, Whitney D. Gannon, and Matthew Bacchetta
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Traumatic injury ,Respiratory failure ,business.industry ,medicine.medical_treatment ,Anesthesia ,Extracorporeal membrane oxygenation ,medicine ,business - Published
- 2021
25. Simulation Versus Interactive Mobile Learning for Teaching Extracorporeal Membrane Oxygenation to Clinicians: A Randomized Trial
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Todd W. Rice, Matthew Bacchetta, Matthew W. Semler, Jonathan D Casey, Meredith E. Pugh, Whitney D. Gannon, John W. Stokes, Clayne Benson, Ashish S. Shah, Ashley Troutt, and Lynne Craig
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medicine.medical_specialty ,Academic Medical Centers ,Randomization ,Critical Care ,business.industry ,medicine.medical_treatment ,Clinical performance ,Psychological intervention ,Critical Care and Intensive Care Medicine ,Knowledge retention ,law.invention ,Extracorporeal Membrane Oxygenation ,Randomized controlled trial ,Interquartile range ,law ,Baseline characteristics ,Physical therapy ,medicine ,Extracorporeal membrane oxygenation ,Humans ,Computer Simulation ,business ,Simulation Training ,Retrospective Studies - Abstract
Objectives Extracorporeal membrane oxygenation has become integral to critical care. Data informing optimal extracorporeal membrane oxygenation education modalities are lacking. We aimed to compare the effect of high-fidelity simulation versus interactive mobile learning on extracorporeal membrane oxygenation knowledge acquisition and retention among clinicians. Design Observer-blinded, randomized controlled trial. Setting A single academic medical center. Subjects Forty-four critical care clinicians with limited extracorporeal membrane oxygenation experience. Interventions Participants were randomized to receive: 1) simulation: three high-fidelity training scenarios, 2) QuizTime: 15 total multiple-choice questions delivered over 3 weeks via mobile device, or 3) experiential: no formal training. Participants completed a survey, written knowledge examination, and simulation assessment prior to randomization, immediately following the intervention, and 4 month postintervention. Measurements and main results The primary outcome was knowledge about extracorporeal membrane oxygenation assessed by score on the immediate postintervention written examination. Secondary outcomes included performance in extracorporeal membrane oxygenation simulation postintervention and 4 months later assessed by a rater blinded to group assignment. Clinicians randomized to simulation (n = 15), QuizTime (n = 14), and experiential (n = 15) had similar baseline characteristics. Adjusting for baseline knowledge, postintervention examination scores were higher in the simulation group (90.0%; interquartile range, 85.0-90.0%) than the QuizTime group (70.0%; interquartile range, 65.0-80.0%; p = 0.0003) and the experiential group (75.0%; interquartile range, 65.0-80.0%; p = 0.001). Scores did not differ between the groups at 4 months (p > 0.05 in all analyses). In postintervention extracorporeal membrane oxygenation simulations, the simulation group demonstrated shorter time to critical action compared with QuizTime (80.0 s [interquartile range, 54.0-111.0 s] vs 300.0 s [interquartile range 85.0-300.0 s]; p = 0.02) and compared with both QuizTime (45.0 s [interquartile range, 34.0-92.5 s] vs 255.5 s [interquartile range, 102.0-300.0 s]; p = 0.008) and experiential (300.0 s [interquartile range, 58.0-300.0 s]; p = 0.009) at 4 months. Conclusions Simulation was superior to QuizTime and experiential learning with regard to extracorporeal membrane oxygenation knowledge acquisition. Further studies are needed to ascertain the effect of these interventions on knowledge retention, clinical performance, and patient outcomes.
- Published
- 2021
26. A Large Animal Model for Pulmonary Hypertension and Right Ventricular Failure: Left Pulmonary Artery Ligation and Progressive Main Pulmonary Artery Banding in Sheep
- Author
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Matthew Bacchetta, Emily J. Tsai, Keith Cook, Erika B. Rosenzweig, Caitlin T. Demarest, Clayne Benson, Yatrik Patel, Nancy Cardwell, Jennifer Talackine, W. Kelly Wu, John W. Stokes, and Rei Ukita
- Subjects
General Immunology and Microbiology ,General Chemical Engineering ,General Neuroscience ,General Biochemistry, Genetics and Molecular Biology - Published
- 2021
27. A Large Animal Model for Pulmonary Hypertension and Right Ventricular Failure: Left Pulmonary Artery Ligation and Progressive Main Pulmonary Artery Banding in Sheep
- Author
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Erika B. Rosenzweig, Caitlin T. Demarest, Yatrik Patel, Emily J Tsai, Rei Ukita, Jennifer Talackine, John W. Stokes, Matthew Bacchetta, Nancy L. Cardwell, Clayne Benson, Keith E. Cook, and W Kelly Wu
- Subjects
medicine.medical_specialty ,Pleural effusion ,Hypertension, Pulmonary ,Ventricular Dysfunction, Right ,General Chemical Engineering ,Pulmonary Artery ,Article ,General Biochemistry, Genetics and Molecular Biology ,Pulmonary artery banding ,Internal medicine ,medicine ,Animals ,Decompensation ,Heart Failure ,Sheep ,General Immunology and Microbiology ,business.industry ,General Neuroscience ,Left pulmonary artery ,medicine.disease ,Pulmonary hypertension ,Disease Models, Animal ,Blood pressure ,Cuff ,Ventricular Function, Right ,Cardiology ,business ,Ligation - Abstract
Decompensated right ventricular failure (RVF) in pulmonary hypertension (PH) is fatal, with limited medical treatment options. Developing and testing novel therapeutics for PH requires a clinically relevant large animal model of increased pulmonary vascular resistance and RVF. This manuscript discusses the latest development of the previously published ovine PH-RVF model that utilizes left pulmonary artery (PA) ligation and main PA occlusion. This model of PH-RVF is a versatile platform to control not only the disease severity, but also the RV’s phenotypic response. METHODS: Adult sheep (60–80 kg) underwent left PA (LPA) ligation, placement of main PA cuff, and insertion of RV pressure monitor. PA cuff and RV pressure monitor were connected to subcutaneous ports. Subjects underwent progressive PA banding twice per week for 9 weeks with sequential measures of RV pressure, PA cuff pressures, and mixed venous blood gas (SvO(2)). At the initiation and endpoint of this model, ventricular function and dimensions were assessed using echocardiography. RESULTS: In a representative group of 12 animal subjects, RV mean and systolic pressure increased from 28 ± 5 and 57 ± 7 mmHg at week 1, respectively, to 44 ± 7 and 93 ± 18 mmHg (mean ± standard deviation) by week 9. Echocardiography demonstrated characteristic findings of PH-RVF, notably RV dilation, increased wall thickness, and septal bowing. The longitudinal trend of SvO(2) and PA cuff pressure demonstrate that the rate of PA banding can be titrated to elicit varying RV phenotypes. A faster PA banding strategy led to precipitous decline in SvO(2)
- Published
- 2021
28. Progression Toward Decompensated Right Ventricular Failure in the Ovine Pulmonary Hypertension Model
- Author
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W Kelly Wu, Andrew Tumen, Nancy L. Cardwell, Rei Ukita, Kelsey R Finnie, Yatrik Patel, Erika B. Rosenzweig, Keith E. Cook, John W. Stokes, Emily J Tsai, Matthew Bacchetta, Christopher Pinelli, and Jennifer Talackine
- Subjects
medicine.medical_specialty ,Pleural effusion ,Hypertension, Pulmonary ,Ventricular Dysfunction, Right ,Biomedical Engineering ,Biophysics ,Bioengineering ,Pulmonary Artery ,Article ,Biomaterials ,Internal medicine ,Ascites ,Occlusion ,medicine ,Animals ,Humans ,Decompensation ,Heart Failure ,Sheep ,Hypertrophy, Right Ventricular ,business.industry ,General Medicine ,Left pulmonary artery ,medicine.disease ,Pulmonary hypertension ,Pathophysiology ,Disease Models, Animal ,Circulatory system ,Cardiology ,medicine.symptom ,business - Abstract
Decompensated right ventricular failure (RVF) in patients with pulmonary hypertension (PH) is fatal, with limited treatment options. Novel mechanical circulatory support systems have therapeutic potential for RVF, but the development of these devices requires a large animal disease model that replicates the pathophysiology observed in humans. We previously reported an effective disease model of PH in sheep through ligation of the left pulmonary artery (PA) and progressive occlusion of the main PA. Herein, we report a case of acute decompensation with this model of chronic RVF. Gradual PA banding raised the RV pressure (maximum RV systolic/mean pressure = 95 mmHg/56 mmHg). Clinical findings and laboratory serum parameters suggested appropriate physiologic compensation for 7 weeks. However, mixed venous saturation declined precipitously on week 7, and creatinine increased markedly on week 9. By the 10th week, the animal developed dependent, subcutaneous edema. Subsequently, the animal expired during the induction of general anesthesia. Post-mortem evaluation revealed several liters of pleural effusion and ascites, RV dilatation, eccentric RV hypertrophy, and myocardial fibrosis. The presented case supports this model's relevance to the human pathophysiology of RVF secondary to PH and its value in the development of novel devices, therapeutics, and interventions.
- Published
- 2021
29. Bleeding, Thromboembolism, and Clinical Outcomes in Venovenous Extracorporeal Membrane Oxygenation
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John W. Stokes, Leslie B Armistead, Matthew W. Semler, Wren H Sherrill, Jonathan D Casey, Whitney D. Gannon, Matthew Bacchetta, and Todd W. Rice
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education.field_of_study ,Adult patients ,business.industry ,medicine.medical_treatment ,Brief Report ,adult ,Population ,Length of hospitalization ,Retrospective cohort study ,General Medicine ,extracorporeal membrane oxygenation ,thromboembolism ,Cannula ,law.invention ,respiratory distress syndrome ,critical care ,Randomized controlled trial ,law ,Anesthesia ,Cohort ,Extracorporeal membrane oxygenation ,Medicine ,hemorrhage ,business ,education - Abstract
Objectives Bleeding and thromboembolism are common during venovenous extracorporeal membrane oxygenation. The relative frequency of these complications and their impact on clinical outcomes have not been described, and no randomized trials exist to guide anticoagulation strategies in extracorporeal membrane oxygenation. Our objective was to examine the relative frequencies of bleeding and thromboembolic events and their associations with survival among a cohort of consecutive patients receiving venovenous extracorporeal membrane oxygenation. Design Retrospective cohort study. Setting A single academic medical center. Patients Adult patients receiving venovenous extracorporeal membrane oxygenation and anticoagulation. Eligibility criteria for this analysis were selected to emulate the population that would be recruited for a randomized trial of anticoagulation strategies during venovenous extracorporeal membrane oxygenation. Patients were excluded if they had active bleeding or thromboembolism prior to extracorporeal membrane oxygenation initiation, a history of trauma or surgery in the 7 days prior to extracorporeal membrane oxygenation initiation, an arterial extracorporeal membrane oxygenation cannula, or if they received greater than 48 hours of extracorporeal membrane oxygenation support at another institution. Interventions None. Measurements and main results Outcomes included bleeding and thromboembolic events, duration of extracorporeal membrane oxygenation support, hospital length of stay, and in-hospital survival among 55 patients receiving venovenous extracorporeal membrane oxygenation. Bleeding events occurred in 25 patients (45.5%), and thromboembolism occurred in eight patients (14.5%). Bleeding events were associated with longer duration of extracorporeal membrane oxygenation support (p = 0.007) and worse in-hospital survival (p = 0.02). Thromboembolic events did not appear to be associated with clinical outcomes. Conclusions In this cohort of patients receiving venovenous extracorporeal membrane oxygenation and anticoagulation, bleeding occurred more frequently than thromboembolism and was associated with worse survival. These results highlight the need for randomized trials to evaluate the safety and efficacy of continuous IV anticoagulation among patients receiving venovenous extracorporeal membrane oxygenation.
- Published
- 2020
30. Extracorporeal Carbon Dioxide Removal or Extracorporeal Membrane Oxygenation: Why Should We Care?
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John W. Stokes, Todd W. Rice, and Whitney D. Gannon
- Subjects
Extracorporeal carbon dioxide removal ,Extracorporeal Circulation ,Respiratory Distress Syndrome ,Extracorporeal Membrane Oxygenation ,business.industry ,medicine.medical_treatment ,Anesthesia ,Extracorporeal membrane oxygenation ,Humans ,Medicine ,Carbon Dioxide ,Critical Care and Intensive Care Medicine ,business - Published
- 2021
31. Xenogeneic cross-circulation for extracorporeal recovery of injured human lungs
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Ahmed E, Hozain, John D, O'Neill, Meghan R, Pinezich, Yuliya, Tipograf, Rachel, Donocoff, Katherine M, Cunningham, Andrew, Tumen, Kenmond, Fung, Rei, Ukita, Michael T, Simpson, Jonathan A, Reimer, Edward C, Ruiz, Dawn, Queen, John W, Stokes, Nancy L, Cardwell, Jennifer, Talackine, Jinho, Kim, Hans-Willem, Snoeck, Ya-Wen, Chen, Alexander, Romanov, Charles C, Marboe, Adam D, Griesemer, Brandon A, Guenthart, Matthew, Bacchetta, and Gordana, Vunjak-Novakovic
- Subjects
Perfusion ,Extracorporeal Circulation ,Swine ,Acute Lung Injury ,Animals ,Humans ,Organ Preservation ,Lung ,Tissue Donors ,Lung Transplantation - Abstract
Patients awaiting lung transplantation face high wait-list mortality, as injury precludes the use of most donor lungs. Although ex vivo lung perfusion (EVLP) is able to recover marginal quality donor lungs, extension of normothermic support beyond 6 h has been challenging. Here we demonstrate that acutely injured human lungs declined for transplantation, including a lung that failed to recover on EVLP, can be recovered by cross-circulation of whole blood between explanted human lungs and a Yorkshire swine. This xenogeneic platform provided explanted human lungs a supportive, physiologic milieu and systemic regulation that resulted in functional and histological recovery after 24 h of normothermic support. Our findings suggest that cross-circulation can serve as a complementary approach to clinical EVLP to recover injured donor lungs that could not otherwise be utilized for transplantation, as well as a translational research platform for immunomodulation and advanced organ bioengineering.
- Published
- 2019
32. Rare Undiagnosed Primary Amyloidosis Unmasked During Surgical Treatment of Primary Hyperparathyroidism: A Case Report
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Kathleen C. Gallagher, Ariana B Geromes, James S. Lewis, John W. Stokes, India A. Reddy, and Naira Baregamian
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medicine.medical_specialty ,Parathyroid, Bone, and Mineral Metabolism ,endocrine system diseases ,Endocrinology, Diabetes and Metabolism ,Case Reports ,Surgical pathology ,03 medical and health sciences ,0302 clinical medicine ,Gammopathy ,medicine ,primary hyperparathyroidism ,primary amyloidosis ,multinodular goiter ,business.industry ,Amyloidosis ,Thyroid ,amyloid ,medicine.disease ,Comorbidity ,Obstructive sleep apnea ,Dissection ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Radiology ,business ,lambda light chains ,030217 neurology & neurosurgery ,Primary hyperparathyroidism - Abstract
Primary amyloidosis (PA) is a protein deposition disorder that presents with localized or multisystemic disease. The incidence is low in the general public, ranging from three to eight cases per million, and with nonspecific presenting symptoms typically occurring later in life. Due to late presentation, substantial and irreversible damage has usually already occurred by the time of the diagnosis. However, if inadvertent diagnosis occurs before irreversible damage has taken place, as it did in the following case, some patients may benefit from the disease-arresting treatment. A 70-year-old female with a history of obstructive sleep apnea, hypertension, and arthritis presented with worsening dysphagia and biochemically confirmed primary hyperparathyroidism (PHPT). Further workup demonstrated multinodular goiter with compressive symptoms and substernal extension, osteopenia, and discrepant parathyroid localization on imaging. Intraoperatively, markedly difficult dissection and obliteration of tissue planes were encountered. Extensive, diffuse amyloid deposition in both the normal and pathologic parathyroid glands and thyroid tissue on surgical pathology leads to subsequent fibril typing by mass spectrometry and leads to the diagnostic of primary amyloid light-chain (AL) amyloidosis (PA; λ light chains). Subsequent workup for the underlying cause of the amyloid deposition revealed an immunoglobulin A monoclonal gammopathy of unknown significance. The surgical treatment of PHPT and compressive thyroid nodule unmasked an undiagnosed PA, allowing for early workup and monitoring of the progression of amyloidosis. The temporal comorbidity of PHPT and PA raises an interesting and, as yet, unanswered question regarding the pathophysiologic association between the two conditions., Surgical neck exploration in the setting of primary hyperparathyroidism revealed deposition of hypocellular material in the thyroid and parathyroid tissues. Pathology revealed a primary amyloidosis.
- Published
- 2018
33. Pneumomediastinum in Acute Respiratory Distress Syndrome from COVID-19
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Matthew W. Semler, Stephanie G Norfolk, Lisa N Flemmons, John W. Stokes, Jonathan D Casey, Anil J. Trindade, E. Wesley Ely, Matthew Bacchetta, Michael J. Noto, and Matthew F. Mart
- Subjects
Adult ,Male ,Pulmonary and Respiratory Medicine ,Respiratory Distress Syndrome ,medicine.medical_specialty ,2019-20 coronavirus outbreak ,Fatal outcome ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,MEDLINE ,COVID-19 ,Acute respiratory distress ,Images in Pulmonary, Critical Care, Sleep Medicine and the Sciences ,Middle Aged ,Critical Care and Intensive Care Medicine ,medicine.disease ,Radiography ,Fatal Outcome ,Humans ,Medicine ,Pneumomediastinum ,business ,Intensive care medicine ,Mediastinal Emphysema - Published
- 2021
34. SOCIAL AND ECONOMIC DISPARITIES ARE NOT ASSOCIATED WITH SHORT-TERM ECLS OUTCOMES
- Author
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John W. Stokes, Aniket S Rali, Zakiur Rahaman, Alistair Hilton, Clifford Chin, Matthew Bacchetta, Emilee E. Larson, and Ashish S. Shah
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Gerontology ,business.industry ,Medicine ,Cardiology and Cardiovascular Medicine ,business ,Term (time) - Published
- 2021
35. Rebuttal From Ms Gannon and Drs Stokes and Bacchetta
- Author
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Matthew Bacchetta, Whitney D. Gannon, and John W. Stokes
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Lung Diseases ,Pulmonary and Respiratory Medicine ,Extracorporeal Membrane Oxygenation ,business.industry ,Rebuttal ,MEDLINE ,Humans ,Medicine ,Theology ,Cardiology and Cardiovascular Medicine ,Critical Care and Intensive Care Medicine ,business ,Lung Transplantation - Published
- 2020
36. Gut Dysfunction as Etiology for Prolonged Length of Stay after an Enhanced Recovery Program Implementation
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Alexander T. Hawkins, Matthew D. McEvoy, Daniella M. Di Nizo, Timothy M. Geiger, Jonathan P. Wanderer, and John W. Stokes
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Enhanced recovery ,business.industry ,Anesthesia ,Etiology ,Medicine ,Surgery ,business - Published
- 2018
37. Transoesophageal echocardiography in routine cardiac surgery
- Author
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John W. Stokes
- Subjects
medicine.medical_specialty ,business.industry ,Internal medicine ,medicine ,Cardiology ,General Medicine ,Transoesophageal echocardiography ,business ,Cardiac surgery ,Insurance coverage - Published
- 2005
38. Communication History
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Robert W. Desmond, Bernard Bailyn, John B. Hench, John D. Stevens, John W. Stokes, James R. Smart, Robert C. Toll, Philip K. Eberly, and Bernard Sendall
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General Engineering - Published
- 1983
39. The Japanese Restaurant Industry
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M.H. Matsusaki and John W. Stokes
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Tourism, Leisure and Hospitality Management ,Automated restaurant ,Advertising ,Business ,Restaurant industry - Published
- 1971
40. Purchasing Food Service Equipment For the Hospital
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John W. Stokes
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Food service ,General Medicine ,Business ,Marketing ,Purchasing - Abstract
(1962). Purchasing Food Service Equipment For the Hospital. Hospital Topics: Vol. 40, No. 1, pp. 54-56.
- Published
- 1962
41. Significant discrepancies exist between clinician assessment and patient self-assessment of functional capacity by validated scoring tools during preoperative evaluation
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John W. Stokes, Matthew D. McEvoy, and Jonathan P. Wanderer
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0209 industrial biotechnology ,Pathology ,medicine.medical_specialty ,Self-triage ,Population ,02 engineering and technology ,01 natural sciences ,Metabolic equivalent ,IRB Approval ,020901 industrial engineering & automation ,Functional capacity ,Medicine ,Patient self assessment ,education ,education.field_of_study ,business.industry ,Research ,010401 analytical chemistry ,Preoperative assessment ,Electronic questionnaire ,Perioperative ,Human physiology ,0104 chemical sciences ,Activity Status ,Physical therapy ,Perioperative risk ,business - Abstract
Background Preoperative assessment of functional capacity is necessary to direct decisions regarding cardiac evaluation and may help identify patients at high risk for perioperative complications. Patient self-triage regarding functional capacity could be useful for discerning which patients benefit from a clinician evaluation at a Preoperative Evaluation Center prior to the day of surgery. We evaluated the feasibility of preoperative, patient self-triage regarding functional capacity. Methods Patients were recruited immediately prior to their preoperative evaluation. Study participants completed electronic versions of the Duke Activity Status Index (DASI) and the Patient-Reported Outcomes Measurement System (PROMIS)–Short Form 12a–Physical Function. DASI and PROMIS questionnaire responses were scored and evaluated for correlation with clinician assessments of functional capacity. Correlation was analyzed around the dichotomous outcome of
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42. The New Projective-Type Tests for Selection of Salesmen
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John W. Stokes
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Marketing ,Combinatorics ,Business and International Management ,Type (model theory) ,Projective test ,Psychology ,Selection (genetic algorithm) - Published
- 1945
43. 70 Years of Radio Tubes and Valves: A Guide for Electronic Engineers, Historians, and Collectors
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George Wise and John W. Stokes
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History ,Engineering (miscellaneous) - Published
- 1984
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