Pubblicazioni - Laratta Dott. Matteo

• Effects of Levosimendan on Endothelial Function and Hemodynamics During Weaning From Veno-Arterial Extracorporeal Life Support.
  J Cardiothorac Vasc Anesth

  2016 Dec;30(6):1449-1453. doi: S1053-0770(16)00270-6.
  
  Sangalli Fabio, Avalli Leonello, Laratta Matteo, Formica Francesco, Maggioni Elena, Caruso Rosa, Cristina Costa Maria, Guazzi Marco, Fumagalli Roberto
  
  Abstract
  
  OBJECTIVE:
  Weaning from veno-arterial extracorporeal life support is challenging. The objective of this trial was to investigate the endothelial and hemodynamic effects of levosimendan in cardiogenic shock patients supported with veno-arterial extracorporeal life support.
  
  DESIGN:
  This was a prospective observational trial.
  
  SETTING:
  Cardiovascular intensive care unit of a large tertiary care university hospital in Monza, Italy.
  
  PARTICIPANTS AND INTERVENTIONS:
  Flow-mediated dilatation of the brachial artery and hemodynamic parameters were assessed in 10 cardiogenic shock patients supported with veno-arterial extracorporeal life support, before and after the infusion of levosimendan.
  
  MEASUREMENTS AND RESULTS:
  Flow-mediated dilatation increased both as absolute value and as a percentage after levosimendan, from 0.10±0.12 to 0.61±0.21 mm (p<0.001) and from 3.2±4.2% to 17.8±10.4% (p<0.001), respectively. Cardiac index increased from 1.93±0.83 to 2.64±0.97 L/min/m (p = 0.008) while mixed venous oxygen saturation increased from 66.0% to 71.5% (p = 0.006) and arterial lactate levels decreased from 1.25 to 1.05 mmol/L (p = 0.004) without significant variations in arterial oxygen saturation or hemoglobin levels. This made it possible for clinicians to reduce extracorporeal membrane oxygenation blood flow from 1.92±0.65 to 1.12±0.49 L/min/m (p<0.001).
  
  CONCLUSION:
  In conclusion, in the authors' study population of adult cardiogenic shock patients supported with veno-arterial extracorporeal life support, their observations supported the use of levosimendan to improve endothelial function and hemodynamics and facilitate weaning from the extracorporeal support.
  
  Copyright Ā© 2016 Elsevier Inc. All rights reserved.
  
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• Ion-Exchange Resin Anticoagulation (I-ERA): A Novel Extracorporeal Technique for Regional Anticoagulation.
  Shock

  2016 09;46(3):304-11. doi: 10.1097/SHK.0000000000000597.
  
  Zanella Alberto, Scaravilli Vittorio, Castagna Luigi, Giani Marco, Magni Federico, Laratta Matteo, Rezoagli Emanuele, Ferrari Chiara, Mazzola Silvia, Albertini Mariangela, Pesenti Antonio
  
  Abstract
  
  BACKGROUND:
  Extracorporeal treatments always require blood anticoagulation. We tested feasibility and efficacy of a novel technique for regional extracorporeal blood anticoagulation based on calcium removal by ion-exchange resins (i-ER), called ion-exchange resin anticoagulation (i-ERA).
  
  METHODS:
  Eight swine were connected to a veno-venous extracorporeal circuit comprising a hemodiafilter and an i-ER. Blood flow was 150?mL/min. Hemodiafiltrate was generated at 975?mL/min and passed through the i-ER. A fraction of the calcium-free hemodiafiltrate was returned to the hemodiafilter (675?mL/min), while the remaining was recirculated prior the hemodiafilter (300?mL/min) to dilute blood entering the hemodiafilter. A calcium replacement solution was continuously infused. Two hours after i-ERA start, blood was sampled from inlet, before the hemodiafilter (prehemodiafilter blood) and from outlet of the extracorporeal circuit for ionized calcium (iCa) concentration and thromboelastography (TEG). Arterial blood was collected for blood gas analyses, electrolytes concentrations, and plasma free hemoglobin. Hemodynamics and ventilation were monitored.
  
  RESULTS:
  i-ERA reduced iCa from 1.28?±?0.05?mmol/L (inlet) to 0.47?±?0.03?mmol/L (prehemodiafilter blood) and 0.25?±?0.03?mmol/L (outlet). Prehemodiafilter blood and outlet samples showed no sign of clot formation (reaction time (R)?>60?min; maximal amplitude (MA)?=?0 (0-0) mm), while blood-inlet had normal coagulation (R?=?8.5 (5.8-10.2) min; MA?=?65.2 (63.2-68.7) mm). Arterial gas analyses and electrolytes concentrations, hemodynamics, and ventilation were unchanged. No hemolysis was recorded.
  
  CONCLUSIONS:
  In a swine model, i-ERA proved feasible and effective in reducing iCa and preventing clot formation with TEG analyses. Further studies are warranted to evaluate the long-term efficacy and safety of i-ERA.
  
  LEVEL OF EVIDENCE:
  V-therapeutic animal experiment.
  
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