Novel tubing connectors reduce ECMO circuit thrombosis.

BACKGROUND: Thrombosis within extracorporeal membrane oxygenation (ECMO) circuits is a common complication that dominates clinical management of patients receiving mechanical circulatory support. Prior studies have identified that over 80% of circuit thrombosis can be attributed to tubing-connector junctions. METHODS: A novel connector was designed that reduces local regions of flow stagnation at the tubing-connector junction to eliminate a primary source of ECMO circuit thrombi. To compare clotting between the novel connectors and the traditional connectors, both in vitro loops and an in vivo caprine model of long-term (48 h) ECMO were used to generate tubing-connector junction clots. RESULTS: In vitro, the traditional connectors uniformly (9/9) formed large thrombi, while novel connectors formed a small thrombus in only one of nine (p < 0.0001). In the long-term goat ECMO circuits, the traditional connectors exhibited more thrombi (p < 0.04), and these thrombi were more likely to protrude into the lumen of the tubing (p < 0.001). CONCLUSION: Both in vitro and in vivo validation experiments successfully recreated circuit thrombosis and demonstrate that the adoption of novel connectors can reduce the burden of circuit thrombosis.

Lower Socioeconomic Status Is Associated with Groin Wound Complications after Revascularization for Peripheral Artery Disease.

BACKGROUND: Surgical site infections (SSIs) after lower extremity revascularization are a common cause of increased morbidity in patients with peripheral artery disease (PAD). Understanding the multifaceted risk factors for SSIs may suggest closer monitoring for certain patients. The objective of this study is to evaluate the risk factors associated with incidence of SSIs, including patient demographics, operative factors, and socioeconomic status. METHODS: A retrospective review of a prospectively maintained database was queried for all patients who underwent any femoral exposure for the purposes of treating PAD from 2014 to 2017 at a single, academic, public hospital. Patient demographics, procedural data, and a variety of socioeconomic parameters were collected from chart review. Zip code geocoding was also used to obtain surrogates for local socioeconomic factors. The primary outcome measure was SSI within 90 days of operation. RESULTS: A total of 136 patients were identified, of which 19 (14%) developed an SSI. The only demographic variable associated with an increased risk of infection was body mass index (24.8 vs 30.1, P < 0.05). Major preoperative comorbid conditions, smoking status, and insurance status were not associated with an increased risk of complications. In addition, the type of procedure performed [infrainguinal bypass (n = 68), femoral endarterectomy (n = 36), aortofemoral bypass (n = 17), femoral-femoral bypass (n = 8), axillofemoral bypass (n = 7)] was not associated with any trend toward SSI. Estimated blood loss (292 vs 463 mL, P < 0.05), postoperative glucose (169 vs 212, P < 0.05), and postoperative white blood cell count (13.6 vs 18.3, P < 0.05) were the only periprocedural variables associated with SSIs. Lower mean household income, mean family income, and per capita income were all associated with an increased risk of postoperative infection (all P < 0.05). CONCLUSIONS: Socioeconomic factors, including poorer household income, are strongly associated with an increased risk of postoperative SSIs after lower extremity revascularization. Modifiable variables, such as preoperative optimization and procedural conduct, also display an effect on the development of an SSI. As a result, health care providers should maintain a high index of suspicion for the development of SSI in patients with lower socioeconomic status.