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- Biancari, Fausto, et al.
(author)
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Inter-institutional analysis of the outcome after postcardiotomy veno-arterial extracorporeal membrane oxygenation
- 2024
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In: International Journal of Artificial Organs. - 0391-3988. ; 47:1, s. 25-34
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Journal article (peer-reviewed)abstract
- Introduction: Patients requiring postcardiotomy veno-arterial extracorporeal membrane oxygenation (V-A-ECMO) have a high risk of early mortality. In this analysis, we evaluated whether any interinstitutional difference exists in the results of postcardiotomy V-A-ECMO. Methods: Studies on postcardiotomy V-A-ECMO were identified through a systematic review for individual patient data (IPD) meta-analysis. Analysis of interinstitutional results was performed using direct standardization, estimation of observed/expected in-hospital mortality ratio and propensity score matching. Results: Systematic review of the literature yielded 31 studies. Data from 10 studies on 1269 patients treated at 25 hospitals were available for the present analysis. In-hospital mortality was 66.7%. The relative risk of in-hospital mortality was significantly higher in six hospitals. Observed versus expected in-hospital mortality ratio showed that four hospitals were outliers with significantly increased mortality rates, and one hospital had significantly lower in-hospital mortality rate. Participating hospitals were classified as underperforming and overperforming hospitals if their observed/expected in-hospital mortality was higher or lower than 1.0, respectively. Among 395 propensity score matched pairs, the overperforming hospitals had significantly lower in-hospital mortality (60.3% vs 71.4%, p = 0.001) than underperforming hospitals. Low annual volume of postcardiotomy V-A-ECMO tended to be predictive of poor outcome only when adjusted for patients’ risk profile. Conclusions: In-hospital mortality after postcardiotomy V-A-ECMO differed significantly between participating hospitals. These findings suggest that in many centers there is room for improvement of the results of postcardiotomy V-A-ECMO.
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| 2. |
- Pettinari, Matteo, et al.
(author)
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Impact of the Regulation Strategy on the Transient Behavior of a Brayton Heat Pump
- 2024
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In: Energies. - : Multidisciplinary Digital Publishing Institute (MDPI). - 1996-1073. ; 17:5
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Journal article (peer-reviewed)abstract
- High-temperature heat pumps are a key technology for enabling the complete integration of renewables into the power grid. Although these systems may come with several variants, Brayton heat pumps are gaining more and more interest because of the higher heat sink temperatures and the potential to leverage already existing components in the industry. Because these systems utilize renewable electricity to supply high-temperature heat, they are particularly suited for industry or energy storage applications, thus prompting the development of various demonstration plants to evaluate their performance and flexibility. Adapting to varying load conditions and swiftly responding to load adjustments represent crucial aspects for advancing such systems. In this context, this study delves into assessing the transient capabilities of Brayton heat pumps during thermal load management. A transient model of an emerging prototype is presented, comprising thermal and volume dynamics of the components. Furthermore, two reference scenarios are examined to assess the transient performance of the system, namely a thermal load alteration due to an abrupt change in the desired heat sink temperature and, secondly, to a sudden variation in the sink mass flow rate. Finally, two control methodologies—motor/compressor speed variation and fluid inventory control—are analyzed in the latter scenario, and a comparative analysis of their effectiveness is discussed. Results indicate that varying the compressor speed allows for a response time in the 8–20 min range for heat sink temperature regulation (first scenario). However, the regulation time is conditioned by the maximum thermal stress sustained by the heat exchangers. In the latter scenario, regulating the compressor speed shows a faster response time than the inventory control (2–5 min vs. 15 min). However, the inventory approach provides higher COPs in part-load conditions and better stability during the transient phase.
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