Circulación extracorpórea

Am J Case Rep. 2025 Oct 6;26:e949607. doi: 10.12659/AJCR.949607.

ABSTRACT

BACKGROUND Witnessed hypothermic cardiac arrest is a rare injury with high mortality, particularly at extreme temperatures. We describe a case of witnessed accidental hypothermia with a profoundly low core temperature of 20°C, resulting in pre-hospital cardiac arrest. The patient was successfully treated with cardiopulmonary bypass rewarming, but the clinical course was further complicated by a liver injury from device-assisted cardiopulmonary resuscitation (CPR), necessitating exploratory laparotomy. CASE REPORT A 30-year-old man was found roadside in -15°C weather and suffered pre-hospital cardiac arrest, witnessed by emergency medical personnel. Rewarming treatment with cardiopulmonary bypass was performed at our level-1 trauma center after the patient presented with a core temperature of 20°C and underwent 195 minutes of CPR. Intraoperatively, he was noted to have constant loss of volume on bypass as well as a tense, distended abdomen. Exploratory laparotomy was performed showing hemoperitoneum from a liver laceration secondary to CPR with a Lund University Cardiopulmonary Assist System (LUCAS) device. Delayed sternal and abdominal closure was performed with definitive closure occurring on hospital day 3. The patient experienced full neurologic recovery and was discharged home on hospital day 23. CONCLUSIONS Extracorporeal rewarming is a definitive treatment for cardiac arrest from accidental severe hypothermia and can be accomplished with cardiopulmonary bypass. Providers should have heightened clinical suspicion for solid organ injury when CPR is facilitated by a LUCAS device rather than manual compressions. Disproportionately low return volumes on the cardiopulmonary bypass circuit should prompt consideration of a differential diagnosis which in post-resuscitation patients can include traumatic hemoperitoneum.

PMID:41052020 | DOI:10.12659/AJCR.949607

Intensive Care Med. 2025 Oct 6. doi: 10.1007/s00134-025-08142-2. Online ahead of print.

ABSTRACT

Extracorporeal membrane oxygenation (ECMO) is providing an increasingly important therapy for patients in severe heart and lung failure. Care of these patients is complex, with changes in circulation that mean standard advanced life support algorithms may not always be applicable. Through collaboration between all UK ECMO centres and eight national societies, we have assessed the current evidence base and, using a modified Delphi process, produced national guidelines on the management of emergencies on ECMO. The guidelines focus on the recognition of cardiac arrest, team prioritisation, and early ECMO troubleshooting for key life-saving interventions. The guidelines are applicable to all staff and types of ECMO performed in the UK and should be utilised in conjunction with appropriate training. In summary, the joint British societies and ECMO centres working group present the UK guideline for the management of emergencies in ECMO.

PMID:41051555 | DOI:10.1007/s00134-025-08142-2

J Clin Apher. 2025 Oct;40(5):e70061. doi: 10.1002/jca.70061.

ABSTRACT

Extracorporeal membrane oxygenation (ECMO) is a last resort treatment for children with cardio-respiratory failure. Some of these patients will develop thrombocytopenia-associated multiple organ failure (TAMOF), which is sometimes managed with therapeutic plasma exchange (TPE). Our objective is to describe critically ill children on ECMO who underwent TPE for TAMOF. We conducted a single-center retrospective case series of seven children with congenital cardiac disease, requiring ECMO, diagnosed with TAMOF, and treated with TPE between 12/2023 and 6/2024. A centrifugation-based apheresis instrument was used to process 1.5 total blood volume. One packed red blood cell was used to prime the apheresis circuit. Systemic bivalirudin was used for anticoagulation. Seven patients (median age: 55 days, median weight: 4.0 kg, median bypass time: 172 min, 100% VA ECMO, 85% central cannulation, 100% bivalirudin) underwent a total of 30 TPE sessions. The median number of sessions per patient was 3, with a median time to first session of 27.3 h after cannulation. Plasma was used as the replacement fluid in all sessions, with a median volume of 168 mL/kg. The median platelet count increased from 45 × 109/L (38; 54) pre-TPE to 64 (IQR: 45; 75, p < 0.001) post-TPE, despite no platelet transfusions during TPE. The modified organ severity index decreased significantly from 13 to 12 (p < 0.001). The mortality rate was 71%. TPE may improve platelet counts and reduce organ severity scores in critically ill children with TAMOF on ECMO.

PMID:41046521 | DOI:10.1002/jca.70061

Int J Cardiol. 2025 Oct 2:133951. doi: 10.1016/j.ijcard.2025.133951. Online ahead of print.

ABSTRACT

OBJETIVE: Chronic thromboembolic pulmonary hypertension (CTEPH) is a potentially curable cause of pulmonary hypertension, characterized by persistent organized thrombi and micro vasculopathy leading to increased pulmonary vascular resistance and right heart failure. Pulmonary endarterectomy (PEA) remains the treatment of choice for operable patients. Although vitamin K antagonists (VKAs) are traditionally used for lifelong anticoagulation, direct oral anticoagulants (DOACs) have gained popularity despite limited evidence supporting their use in CTEPH. Histopathological assessment may provide new insights into anticoagulation effectiveness. This study aimed to evaluate the presence of recent thrombi in PEA specimens from patients using DOACs versus VKAs and to correlate these findings with surgical and hemodynamic outcomes.

METHODS: Retrospective cohort study included 115 patients with CTEPH who underwent PEA at a national referral center for the treatment of CTEPH between 2018 and 2023. Patients were categorized based on anticoagulant type (DOAC or VKA). All surgical specimens underwent histopathological evaluation. Pre- and postoperative hemodynamic and clinical data were analyzed. Statistical comparisons were performed using appropriate parametric and non-parametric tests.

RESULTS: Recent thrombi were identified in 26.2 % of patients on DOACs and 9.2 % of those on VKAs (p < 0.05). Despite the higher prevalence of thrombi in the DOAC group, no significant differences were observed in extracorporeal circulation time, cardiac arrest duration, or postoperative hemodynamic parameters between groups. Microscopic evaluation proved to be more sensitive than macroscopic analysis for detecting thrombi.

CONCLUSION: Our findings demonstrate the presence of recent thrombi in patients with CTEPH undergoing PEA. This observation raises questions regarding the use of DOACs in patients with CTEPH.

PMID:41046019 | DOI:10.1016/j.ijcard.2025.133951

Stud Health Technol Inform. 2025 Oct 2;332:27-31. doi: 10.3233/SHTI251489.

ABSTRACT

Extracorporeal Membrane Oxygenation (ECMO) is a life-saving cardiopulmonary support for patients with acute heart failure. However, the process of weaning from veno-arterial (V-A) ECMO remains complex and risky. We developed a machine learning-based predictive model to assist clinicians in identifying patients with a high probability of successful weaning. This retrospective monocentric study included 122 patients admitted to Rennes University Hospital between January 2020 and January 2023. Data from the eHOP clinical data warehouse were used to train and evaluate various machine learning algorithms, including Random Forest, XGBoost, KNN, SVM, and regularized logistic regressions. The best-performing models showed an AUC of 0.84-0.86, with XGBoost offering the highest results (0.86 [0.72-0.96]). Key predictors included ECMO flow rate, oxygenation fraction (FmO2), and duration of ECMO. While these results are promising, further validation is required before such tools can be translated into clinical decision-making processes.

PMID:41041740 | DOI:10.3233/SHTI251489

Intensive Care Med Exp. 2025 Sep 30;13(1):99. doi: 10.1186/s40635-025-00812-1.

ABSTRACT

BACKGROUND: The reach of dialysis in toxicology is limited by two factors, high toxicant volume of distribution and low dialytic extraction of protein bound toxicants in blood. Therapeutic actions for lipid emulsion as antidote are thought involve a "lipid shuttle", whereby lipid droplets in the circulation "shuttle" lipophilic toxicants with "boarding" in well perfused heart and brain tissue with high toxicant concentrations and "exit" to biologically inert slower equilibrating sites such as muscle or adipose where toxicant concentrations are lower. Such a mechanism raises the conceptual possibility of an extracorporeal "exit" potentially mitigating toxicity through increased drug clearance. In experimental models drug binding nanoparticles in dialysate have been shown to mitigate the problem of blood proteins binding toxicant. We investigated whether the addition of intravenous lipid emulsion would increase extraction of amitriptyline into nanoparticle augmented peritoneal dialysate in rats orally dosed with amitriptyline for 1 week.

METHODS: Rats were dosed with amitriptyline in drinking water for a week. On the day of the experiment, anaesthetised rats received either an initial bolus then infusion of lipid emulsion for one hour, or a bolus of saline at the initiation of the experiment equal to the total volume of lipid emulsion given. After a 50 min equilibration period, a 10 min pH gradient nanoparticle augmented peritoneal dialysis dwell was undertaken. Animals were humanely euthanised at the end of the experiment. Blood was sampled 0, 10, 45 and 60 min and peritoneal dialysate was analysed for amitriptyline concentration.

RESULTS: There were no significant differences in baseline physiology, initial amitriptyline blood concentration, nor pulse and blood pressure at any time between groups. Time weighted individual subject mean blood amitriptyline concentrations (median (IQR)); control 104 (87-125) nmol/l, lipid 219 (148-357) nmol/L, p = 0.03 and dialysate amitriptyline concentration; control 31(14-52) nmol/L, lipid 105 (62-185) nmol/L, p = 0.03 were greater in animals given intravenous lipid emulsion.

CONCLUSION: These are the first data to our knowledge showing experimental support for the approach of simultaneously decreasing volume of distribution with an intravascular nanoparticle in conjunction with a drug binding particle in dialysate. Further work in this area is warranted.

PMID:41026446 | PMC:PMC12484478 | DOI:10.1186/s40635-025-00812-1

Trials. 2025 Sep 29;26(1):374. doi: 10.1186/s13063-025-09067-3.

ABSTRACT

BACKGROUND: Opioids were considered the main analgesics for pain management during and after cardiac surgery. There are many complications associated with the use of opioids. Paravertebral block (PVB) is injecting Anaesthetics into the paravertebral space. We designed a randomised controlled trial to investigate whether PVB-based opioid-free general Anaesthesia, as compared to traditional low-dose opioid-based fast-track anaesthesia, can reduce opioid consumption within 24 h after thoracotomy incision cardiac surgery with cardiopulmonary bypass (CPB) in paediatric patients.

METHODS: This is a single-centre, single-blinded, randomised controlled trial with a 1:1 allocation ratio. Patients will be randomised into two groups (control group and PVB group); 20 children will be enrolled in this trial, with 10 subjects in each group. Block randomisation will be performed. Patients aged 1-6 years, with the diagnosis of atrial and/or ventricular septal deficient And scheduled for cardiac surgery via a right thoracotomic incision, will be eligible for enrolment. The primary outcome is opioid consumption during the first 24 h after surgery. The main secondary outcomes include the perioperative stress response, inflammatory level, and intraoperative haemodynamics.

DISCUSSION: This is the first randomised clinical study investigating opioid-free anaesthesia based on PVB for paediatric congenital thoracotomy surgery with CPB. If the OPTION trial proves that opioid-free anaesthesia based on PVB is safe for children undergoing thoracotomic cardiac surgery, we would be glad to provide an OPTION for the perioperative management of these children, especially in the era of ERAS.

TRIAL REGISTRATION: Chinese Clinical Trial Registry: ChiCTR2200066517 ( www.chictr.org.cn ), Registered on December 7, 2022.

PMID:41024258 | PMC:PMC12482201 | DOI:10.1186/s13063-025-09067-3

Medicina (Kaunas). 2025 Sep 15;61(9):1669. doi: 10.3390/medicina61091669.

ABSTRACT

Background and Objectives: Atrial fibrillation (AF) is a common complication of cardiac surgery. c-Src has been implicated in atrial remodeling in chronic AF, but its role in the early postoperative setting remains unclear. We, therefore, investigated whether baseline c-Src expression in atrial tissue is associated with the subsequent development of postoperative AF (PoAF). The aim of the present work was the evaluation of atrial c-Src expression and activity in patients subjected to open heart surgery who were previously free from AF and to check if changes to the initial level of this protein predispose to the development of postoperative AF (PoAF). Materials and Methods: Forty-two patients without previous AF history we enrolled. Patients with an AF episode during postoperative in-hospital follow-up were assigned to the PoAF group, while the rest (in sinus rhythm-SR) constituted the control group. Samples of the right atrial appendage were harvested before the introduction of the extracorporeal circulation. The expression of c-Src and phospho-c-Src(Tyr416), as well as upstream regulators of c-Src kinase, STAT3, ERK1/2, PDGFRα, and PDGFRβ, was assessed using Western blot. Results: AF occurred in 14 subjects. Expression of c-Src and phospho-c-Src was significantly higher in the PoAF group than in the SR group (c-Src: 1.65×, p = 0.037, and phospho-c-Src: 2.75×, p = 0.003). In addition, in the right atrium of PoAF patients, there was significantly elevated expression of STAT3, ERK1/2, and PDGF receptors, which may facilitate activation of c-Src kinase in patients with PoAF. Conclusions: Our preliminary findings suggest that c-Src expression and activity may contribute to atrial vulnerability and could represent a molecular target for future therapeutic interventions to prevent PoAF.

PMID:41011060 | PMC:PMC12471775 | DOI:10.3390/medicina61091669

J Cardiovasc Dev Dis. 2025 Sep 18;12(9):365. doi: 10.3390/jcdd12090365.

ABSTRACT

Cardiopulmonary bypass (CPB) is one of the most groundbreaking medical innovations in history, enabling safe and effective heart surgery by temporarily replacing the function of the heart and lungs. This review starts with ancient concepts of cardiopulmonary function and then traces the evolution of CPB through important physiological and anatomical discoveries, culminating in the development of the modern heart-lung machine. In addition to examining the contributions of significant figures like Galen, Ibn al-Nafis, William Harvey, and John Gibbon, we also examine the ethical and technical challenges faced in the early days of open heart surgery. Modern developments are also discussed, such as miniature extracorporeal systems, off-pump surgical techniques, and the increasing importance of extracorporeal membrane oxygenation (ECMO) and extracorporeal life support (ECLS), while the evolving role of perfusionists in diverse cardiac teams and the variations in global access to CPB technology are also given special attention. We look at recent advancements in CPB, including customized methods, nanotechnology, artificial intelligence-guided perfusion, and organ-on-chip testing, emphasizing CPB's enduring significance as a technological milestone and a living example of the cooperation of science, medicine, and human inventiveness because it bridges the gap between the past and the future.

PMID:41002644 | PMC:PMC12471178 | DOI:10.3390/jcdd12090365

Kyobu Geka. 2025 Sep;78(9):677-683.

ABSTRACT

PURPOSE: Our objective is to develop a new device for the treatment of mitral regurgitation by transapical chordal implantation, allowing procedures to be conducted while the heart is beating, thus eliminating the need for extracorporeal circulation. This approach promises both simpler and more reliable procedure than existing devices.

METHODS: The target disease is mitral valve prolapse, where adequate coaptation of the anterior and posterior leaflets can be achieved solely through chordal implantation. Our treatment approach involves accessing the mitral valve via the left ventricular apex, attaching an artificial chorda tendineae to the prolapsed mitral valve leaflet, and pulling it to an appropriate length towards the left ventricular apex. We propose the design and operational mechanism of a device to facilitate this procedure.

RESULTS: The device utilizes a grasper with a hollow structure to catch the prolapsed valve leaflet and then attaches the artificial chordae tendineae to the valve leaflet by using a clip within the hollow structure. This structure enables visual confirmation of the procedure using a fiber scope, thus ensuring greater procedural reliability.

CONCLUSION: This device represents a conceptual breakthrough, although several considerations remain, such as the durability of the materials used and their compatibility with tissue.

PMID:40998366

Kyobu Geka. 2025 Sep;78(10):787-792.

ABSTRACT

While it may seem that there have been no significant changes in the field of cardiopulmonary bypass (CPB) over the past decade, there have been advances in management concepts, such as coagulation management strategies and the use of oxygen delivery index (DO2i) and carbon dioxide (CO2)-derived variables during CPB. It will be important to examine what changes in outcomes are observed as a result of advances in management methods. The development of a variety of monitoring devices is expected if better outcomes are observed as a result of advances in CPB management. In addition, the introduction and study of different perfusion-assist functions are hoped to lead to the automation of operations in CPB.

PMID:40998341

Drug Des Devel Ther. 2025 Sep 18;19:8451-8462. doi: 10.2147/DDDT.S541433. eCollection 2025.

ABSTRACT

PURPOSE: Dexmedetomidine, an alpha-2 adrenergic agonist, has shown potential benefits in various surgical settings, but its impact on microcirculation and renal function in cardiac surgery patients remains unclear.

PATIENTS AND METHODS: This randomized, controlled, double-blind clinical trial was conducted at a single university hospital. Seventy patients undergoing non-emergency cardiac and aortic surgery requiring cardiopulmonary bypass were enrolled, and 68 patients were included in the final analysis. Patients were randomized to receive either dexmedetomidine (0.5 mcg/kg loading dose, followed by 0.5 mcg/kg/h) or saline. The infusion of dexmedetomidine or saline began at anesthesia induction and continued until the end of surgery. Key microcirculatory variables-total vessel density, proportion of perfused vessels, perfused vessel density, De Backer's score, microvascular flow index, and heterogeneity index-were measured at five time points: baseline, 1 hour after cardiopulmonary bypass, 1 hour after arrival in the intensive care unit, 24 hours after surgery, and 48 hours after surgery. Data were analyzed using a mixed-effects model with Tukey's Honestly Significant Difference correction. Intraoperative urine output, the incidence of postoperative acute kidney injury, and other postoperative complications were also compared.

RESULTS: Patients in the dexmedetomidine group maintained higher postoperative proportion of perfused vessels and perfused vessel density compared to the saline group, with a significant interaction effect for perfused vessel density. Baseline perfused vessel density was comparable between the two study groups (17.5 [15.9-18.6] vs 18.0 [16.1-19.8] mm/mm², p = 0.540). At 48 hours postoperatively, patients in the dexmedetomidine group had significantly higher PVD values than those in the saline group (17.0 [15.0-19.0] vs 15.6 [13.7-16.9] mm/mm²; P = 0.041). The dexmedetomidine group also had significantly higher intraoperative urine output (950 vs 605 mL, p = 0.002). Additionally, the incidence of postoperative acute kidney injury was significantly lower in the dexmedetomidine group (11.8% vs 50%, p = 0.001).

CONCLUSION: Intraoperative dexmedetomidine infusion during cardiac surgery is associated with higher postoperative microcirculatory state and a reduced incidence of acute kidney injury.

PMID:40989246 | PMC:PMC12452957 | DOI:10.2147/DDDT.S541433

Medicine (Baltimore). 2025 Sep 19;104(38):e44646. doi: 10.1097/MD.0000000000044646.

ABSTRACT

RATIONALE: Acute mitral regurgitation (MR) secondary to papillary muscle rupture is a rare but often life-threatening mechanical complication post-acute myocardial infarction (MI). The use of peripheral venoarterial extracorporeal membrane oxygenation (VA-ECMO) as a bridge to mitral valve replacement surgery may improve outcome of such patients.

PATIENT CONCERNS: We reported the case of a 70-year old woman with past history who presented to the emergency department at People's Hospital of Rizhao with "a 5-day history of chest distress." She developed refractory cardiogenic shock, severe pulmonary edema and severe acidosis.

DIAGNOSES: Restoration of spontaneous circulation following PCI, VA-ECMO, IABP, and early mitral valve replacement.

INTERVENTIONS: After performing percutaneous coronary intervention (PCI) supported by VA-ECMO and intra-aortic balloon pump (IABP), our group performed a early mitral valve replacement for this patient.

OUTCOMES: This patient preliminarily made a good recovery after VA-ECMO and IABP discontinued.

LESSONS: This case demonstrated that VA ECMO combined with PCI, VA-ECMO, IABP and early mitral valve replacement can result in favorable outcomes, and might be viable emergency therapeutic options.

PMID:40988190 | PMC:PMC12459457 | DOI:10.1097/MD.0000000000044646

Mil Med. 2025 Sep 1;190(Supplement_2):719-728. doi: 10.1093/milmed/usaf316.

ABSTRACT

INTRODUCTION: Limb loss after combat injury is a major factor for morbidity in combat casualties. Although tourniquets clearly save lives, they can result in prolonged ischemia in large scale combat operations where evacuation from the point of injury is significantly delayed. We are developing a dedicated extracorporeal limb perfusion system suitable for organ preservation and present preliminary data on the feasibility of this approach.

MATERIALS AND METHODS: Amputated donor swine hindlimbs were perfused for 6 hours in a circulation system consisting of: containment unit, cardiotomy filter, peristaltic pump, with (OXY+) and without (OXY-) membrane oxygenator. Temperature, blood flow, pump revolutions per minute, and arterial blood gas analyses were performed hourly for 6 hours. Histology results were compared with limbs in cold storage. Statistics using SAS 9.4, 1-way mixed model with Dunnett correction and repeated measures mixed model with Tukey's adjustment (α = .05).

RESULTS: Flow rates and pump settings were consistent. After 6 hours, the OXY+ group showed higher blood pH (7.38 ± 0.70 vs. 7.03 ± 0.7, P = .006), base excess (-15.8 ± 2.0 vs. -23.2 ± 1.8 mmol/L, P = .019) and oxygen saturation (64 ± 11% vs. 18 ± 4%, P = .003) compared to the OXY- group. Similarly, the pCO2 was lower in OXY+ (18.2 ± 2.1 vs. 27.6 ± 3.5 mmHg) compared to the OXY- group. Both groups showed an increase in potassium (OXY+: 6.2 ± 0.4 to 9.15 ± 0.70 mmol/L, P < .001; OXY-: 5.5 ± 0.2 to 10.3 ± 0.5 mmol/L, P < .001) and lactate (OXY+: 9.1 ± 1.3 to 15.9 ± 1.3 mmol/L, P < .001; OXY-: 6.7 ± 0.6 to 16.78 ± 0.83 mmol/L, P < .001), with no between group difference. Histological biopsy analysis showed a reduction of sarcoplasm and sarcolemma damage in the treatment group at 6 hours.

CONCLUSIONS: Explanted limbs were successfully cannulated and perfused, and circulation was maintained at a constant flow rate with no adverse clotting events. Development of a purpose-built perfusion system is a promising avenue for limb preservation during large scale combat operations.

PMID:40984058 | DOI:10.1093/milmed/usaf316

BMJ Case Rep. 2025 Sep 17;18(9):e266174. doi: 10.1136/bcr-2025-266174.

ABSTRACT

The acute management of patients presenting with electrical storm secondary to ventricular arrhythmias (VAs) can be quite challenging, even with traditional attempts at rhythm control. Novel approaches are necessary to incorporate contemporary diagnostic investigations and therapeutic interventions to improve outcomes. Endomyocardial biopsy is an important but underutilised diagnostic tool that can rapidly guide the selection of tailored interventions, such as cardiac transplantation and other non-pharmacological interventions, to maximise survival. In our case, a previously healthy woman in her early 50s was hospitalised for symptomatic, pleomorphic ventricular tachycardia. Early rhythm control was achieved, but VAs recurred, consistent with electrical storm. Cardiac MRI demonstrated biventricular patchy fibrosis and late gadolinium enhancement. Endomyocardial biopsy confirmed giant cell myocarditis. She continued to deteriorate, developing cardiogenic shock requiring extracorporeal membrane oxygenation followed by urgent cardiac transplantation, eventually making a full recovery. We propose a contemporary algorithm for the management of electrical storm to maximise survival.

PMID:40967662 | PMC:PMC12477422 | DOI:10.1136/bcr-2025-266174

Zhonghua Er Ke Za Zhi. 2025 Oct 2;63(10):1126-1130. doi: 10.3760/cma.j.cn112140-20250516-00421.

ABSTRACT

Objective: To evaluate the safety and clinical efficacy of enteral nutrition (EN) initiated within 24 h after heart transplantation in pediatric patients. Methods: A retrospective cohort study was conducted. Clinical data from 16 pediatric heart transplant recipients at the Seventh Medical Center of the Chinese People's Liberation Army General Hospital between October 2022 and October 2024 were collected, including demographics, anthropometric measurements, biochemical markers, cytokine levels, and clinical outcomes. Based on the timing of EN initiation, the patients were divided into EN-initiated within 24 h and EN-initiated after 24 h 2 groups. Demographic data, preoperative extracorporeal membrane oxygenation (ECMO) support, physical examination indicators, laboratory parameters, and cytokine levels were compared between groups using independent samples t-test, Mann-Whitney U test, Fisher's exact probability test. Results: The cohort comprised 16 patients (10 males and 6 females) with an age of (12.5±1.9) years. The EN-initiated within 24 h group comprised 6 cases, and the EN-initiated after 24 h group comprised 10 cases. No significant difference was observed between the two groups in age, preoperative body mass index Z-score, preoperative ECMO support, physical examination indicators, laboratory parameters (total protein, albumin, hemoglobin), or cytokine levels (all P>0.05). Compared to the EN-initiated after 24 h group, the EN-initiated within 24 h group exhibited a shorter intensive care unit stay (t=2.65,P<0.05) and shorter mechanical ventilation duration (t=2.23,P<0.05) than EN-initiated after 24 h group. Total hospitalization length had no significant difference (P>0.05). At 72 h post-transplant, the EN-initiated within 24 h group had a lower interleukin-12 P70 (t=2.46, P<0.05) and interferon-γ levels (t=2.55, P<0.05) than EN-initiated after 24 h group. Prior to discharge, the EN-initiated within 24 h group has a lower mean skinfold thickness (t=2.49, P<0.05) and lower mid-upper arm circumference (t=2.36, P<0.05) compared with the EN-initiated after 24 h group. Conclusions: Initiating EN within 24 h postoperatively is safe and feasible in pediatric heart transplant recipients. Early EN may shorten the length of intensive care unit stay and mechanical ventilation while attenuating postoperative release of inflammatory cytokine.

PMID:40962547 | DOI:10.3760/cma.j.cn112140-20250516-00421

Braz J Cardiovasc Surg. 2025 Nov 1;40(6):e20240313. doi: 10.21470/1678-9741-2024-0313.

ABSTRACT

OBJECTIVE: We herein probed the effects of ozone autohemotherapy (O3-AHT) on inflammatory response and postoperative cognitive function in patients undergoing valve replacement with cardiopulmonary bypass (CPB).

METHODS: Totally, 130 patients undergoing valve replacement with CPB were included in the study (O3-AHT) and control (banked blood transfusion) groups. Blood samples were taken for blood gas analysis, with arterial oxygen saturation, jugular venous oxygen saturation, partial pressure of arterial oxygen and jugular venous PO₂, hemoglobin, and cerebral oxygen extraction rate documented. Interleukin (IL)-6, tumor necrosis factor alpha (TNF-α), and IL-1β levels and serum S100β and neuron-specific enolase (NSE) concentrations were measured by enzyme-linked immunosorbent assay, followed by cognitive function assessment by Mini-Mental State Examination and Montreal Cognitive Assessment scales.

RESULTS: The research group exhibited elevated thrombin time, activated partial thromboplastin time, and prothrombin time and decreased fibrinogen level immediately after surgery; it also presented reduced 24-hour postoperative serum IL-6, TNF-α, IL-1β, S100β, and NSE levels. Intraoperative cerebral oxygen metabolism was improved, and cognitive dysfunction was alleviated in the research group. The comparison of transfusion complication incidence between the two groups showed no significant difference.

CONCLUSION: The application of O3-AHT in patients undergoing valve replacement with CPB enhanced intraoperative brain oxygen metabolism and reduced postoperative 24-hour inflammatory response and cognitive dysfunction.

PMID:40961278 | PMC:PMC12448251 | DOI:10.21470/1678-9741-2024-0313

J Korean Med Sci. 2025 Sep 15;40(36):e233. doi: 10.3346/jkms.2025.40.e233.

ABSTRACT

BACKGROUND: Patients undergoing extracorporeal membrane oxygenation are at a high risk of developing intracranial hemorrhage as a neurological complication. Consequently, many physicians consider a history of intracranial hemorrhage as a relative contraindication for extracorporeal membrane oxygenation and are hesitant to use it in these patients, even in cases of acute severe heart or lung failure. This study aimed to examine the clinical outcomes of extracorporeal membrane oxygenation use in patients with intracranial hemorrhage.

METHODS: We retrospectively obtained the medical records of patients diagnosed with intracranial hemorrhage who received extracorporeal membrane oxygenation owing to acute cardiopulmonary failure between January 2011 and July 2020. Data pertaining to patients' characteristics and clinical outcomes were collected. Disseminated intravascular coagulation score and extracorporeal membrane oxygenation score before and after application of extracorporeal membrane oxygenation were also examined to observe trends.

RESULTS: Eighteen patients were included. Ten had traumatic intracranial hemorrhage, and the most common indication for extracorporeal membrane oxygenation was acute respiratory distress syndrome. The 30-day survival rate was 72% (13 patients), and 61% (11 patients) survived to discharge. Two patients underwent neurosurgery due to worsening of intracranial hemorrhage. However, both were discharged without neurological deterioration.

CONCLUSION: A 72% survival rate was observed in extracorporeal membrane oxygenation patients with intracranial hemorrhage, suggesting that extracorporeal membrane oxygenation could be a viable option in patients with intracranial hemorrhage unresponsive to conventional therapy.

PMID:40955613 | PMC:PMC12437245 | DOI:10.3346/jkms.2025.40.e233

J Extra Corpor Technol. 2025 Sep;57(3):160-163. doi: 10.1051/ject/2025002. Epub 2025 Sep 15.

ABSTRACT

The development of multi-organ failure resulting from cardiopulmonary bypass (CPB) is acknowledged as a significant contributor to increased morbidity and mortality rates during the postoperative period. This report discusses a patient who presents with multiple comorbidities, including renal failure, reduced ejection fraction, and a history of hypertension, and is being considered for coronary artery bypass grafting (CABG) along with aortic valve replacement surgery. The administration of CPB was customized to address the unique comorbid conditions of the patient, highlighting the critical objective of maintaining an oxygen delivery index (DO2i) exceeding 280 mL/min/m2, while also integrating pulsatile flow methodologies. The management of CPB, as previously discussed, resulted in a notable enhancement of kidney function, accompanied by a reduction in the patient's lactate levels post-surgery.

PMID:40953244 | PMC:PMC12435815 | DOI:10.1051/ject/2025002

J Extra Corpor Technol. 2025 Sep;57(3):147-152. doi: 10.1051/ject/2025018. Epub 2025 Sep 15.

ABSTRACT

BACKGROUND: The use of VA extracorporeal membrane oxygenation (ECMO) for cardiac recovery is widely adopted, with extensive publications on assessing readiness to wean from VA ECMO. Techniques to reduce ECMO support vary, including reducing flows to a low continuous cardiac index, adding bridges, temporary flow cessation, or decreasing ECMO RPMs.

METHOD: We propose an alternative method involving repeated cycles of 3-4 min of ECMO flow cessation ("clamp") followed by a 30-second return ("flash") of flow. This method requires additional anticoagulation to achieve an elevated ACT, targeting 220 s for adults and 210 s for pediatrics with heparin drip and bolus, or 240 s for adults and 225 s for pediatrics with bivalirudin drip and heparin bolus. During the clamp period, flow is stopped in adult ECMO circuits with a single venous line clamp, while in pediatric circuits, flow continues via the manifold shunt but is stopped in the arterial and venous lines with a single venous line clamp. Flashing the circuit resumes patient flow for 30 s to circulate stagnant blood.

RESULTS: This method significantly reduces support during the trial, which lasts one hour for adults and up to two hours for pediatric patients. The heart is unsupported 85-90% of the time, with an 85% decrease in cardiac support compared to low-flow trials.

CONCLUSION: Since 2011, our center has used this technique without thrombotic complications when the protocol is followed. Most patients removed from ECMO did not require reinstitution, with rare cases needing VV support or VA support due to sepsis onset.

PMID:40953242 | PMC:PMC12435822 | DOI:10.1051/ject/2025018