Circulación extracorpórea

Front Immunol. 2025 May 16;16:1583460. doi: 10.3389/fimmu.2025.1583460. eCollection 2025.

ABSTRACT

INTRODUCTION: Extracorporeal photopheresis (ECP) is a viable treatment that slows the progression of chronic lung allograft dysfunction. Despite its immunoregulatory potential, data on extracorporeal photopheresis as an induction therapy remain rather limited.

METHODS: We conducted a pilot randomized controlled study on ECP as induction therapy in cystic fibrosis patients undergoing primary lung transplantation. Primary endpoints included safety, assessed based on the incidence of adverse events, treatment-related toxicity, and procedure-related complication rates; and feasibility, evaluated through the completion rate of scheduled ECP sessions, patient tolerability, and treatment discontinuation rates. Secondary endpoint consisted of an exploratory assessment of efficacy, using a composite measure that included three key components: freedom from biopsy-proven acute rejection within the first 12 months, absence of chronic lung allograft dysfunction at 36 months, and optimal graft function, defined as a predicted forced expiratory volume in the first second ≥ 90% at 36 months. Finally, exploratory endpoints included cell phenotypic and functional analyses, secreted immune protein profiling, and gene expression analysis for mechanistic insights. Patients were randomly assigned to receive either standard immunosuppressive therapy alone or standard therapy plus six sessions of extracorporeal photopheresis, with a follow-up period of 36 months.

RESULTS: Among 36 cystic fibrosis patients who underwent lung transplantation between 2018 and 2021 and met the eligibility criteria, 21 were randomized (9 to the study group and 12 to the control group). No patients in the treatment group experienced adverse events. The enrollment rate was 61%, and the treatment discontinuation rate was 22%. The clinical composite endpoint was achieved by 28.6% of patients in the treatment group and 16.7% in the control group. Exploratory endpoint analyses revealed significant decreases in pro-inflammatory cytokines, degranulating CD8+ T lymphocytes, and NK cells in the treatment group. Moreover, significant increases in Treg lymphocytes, IL-10-producing NK cells, and anti-inflammatory cytokines appeared to be associated with improved pulmonary function in the treatment group.

CONCLUSIONS: Induction therapy with extracorporeal photopheresis is safe and feasible in lung transplantation for cystic fibrosis. Some clinical benefits appear to persist for the first 36 months of follow-up. Interestingly, a correlation between immunological modulation induced by extracorporeal photopheresis and pulmonary function was observed.

CLINICAL TRIAL REGISTRATION: https://clinicaltrials.gov/study/NCT03500575?cond=NCT03500575&rank=1, identifier NCT03500575.

PMID:40453071 | PMC:PMC12122324 | DOI:10.3389/fimmu.2025.1583460

Trials. 2025 May 30;26(1):181. doi: 10.1186/s13063-025-08895-7.

ABSTRACT

BACKGROUND: Cardiac procedures, particularly those requiring cardiopulmonary bypass (CPB), are associated with the development of cardiac surgery-associated acute kidney injury (CSA-AKI). Development of CSA-AKI occurs as a result of inflammation, uncontrolled complement activation, and kidney cell damage. In patients with preoperative renal impairment, such as those with chronic kidney disease (CKD), there is an increased risk of both CSA-AKI and poorer clinical outcomes. Currently, there are limited effective, targeted pharmacological interventions for the prevention or treatment of CSA-AKI, although emerging therapies are being investigated, particularly in patients with existing CKD. The ARTEMIS (RAvulizumab to PRotect PaTients with Chronic Kidney DisEase froM CSA-AKI and Subsequent Major Adverse Kidney Events) trial will assess the efficacy and safety of ravulizumab (a complement C5 inhibitor) in reducing the risk of major adverse kidney events (MAKE) in patients with preoperative CKD undergoing non-emergent cardiac surgery with CPB.

METHODS: This trial is currently recruiting patients with CKD who have planned cardiac surgery requiring CPB including coronary artery bypass grafting, valve replacement or repair, or combined procedures. This is a phase 3, randomized, double-blind, placebo-controlled, global study assessing the efficacy and safety of a single preoperative dose of ravulizumab. These outcomes will be assessed using the occurrence of MAKE and its components, as well as the occurrence and severity of CSA-AKI throughout the study period.

DISCUSSION: Complement activation is known to occur during and after cardiac procedures as a result of CPB and ischemia-reperfusion injury, leading to a cycle of cell damage and death. Therefore, it is hypothesized that preoperative administration of ravulizumab will provide immediate and complete complement inhibition, which will be sustained throughout the surgical period, preventing the uncontrolled complement activation associated with the development of CSA-AKI, thus minimizing poor outcomes for patients.

TRIAL REGISTRATION: ClinicalTrials.gov NCT05746559. Registered on February 27, 2023.

PMID:40448185 | PMC:PMC12125780 | DOI:10.1186/s13063-025-08895-7

Braz J Cardiovasc Surg. 2025 May 30;40(3):e20240244. doi: 10.21470/1678-9741-2024-0244.

ABSTRACT

INTRODUCTION: Blood transfusion is associated with adverse clinical and surgical outcomes. Strategies like the Patient Blood Management program, which includes blood cell salvage, contribute to reducing the use of blood components. Blood cell salvage is very useful in heart surgeries where the patient's blood loss can be massive.

OBJECTIVE: The present study aimed to evaluate the impact of using the blood cell salvage in the intraoperative and postoperative periods (up to 24 hours) on the hemoglobin and hematocrit values, transfusion of red blood cells, infection rates, and postoperative length of stay in patients undergoing cardiac surgery with cardiopulmonary bypass.

METHODS: Forty-one patients who underwent cardiac surgery with cardiopulmonary bypass according to the inclusion criteria were selected in an observational study and separated into two groups: with the use of the blood cell salvage group (BCS, n = 21) and without the use of the blood cell salvage (WBCS, n = 20).

RESULTS: Patients in the group using blood cell salvage had higher postoperative hemoglobin (P = 0.018) and postoperative hematocrit levels (P = 0.009), lower consumption of red blood cells in the postoperative period and hospital discharge (P < 0.001), shorter postoperative length of stay (P = 0.020), and lower infection rates (P = 0.009).

CONCLUSION: Patient Blood Management strategies, particularly the use of blood cell salvage in the intraoperative and immediate postoperative periods of patients undergoing cardiac surgery with cardiopulmonary bypass, are associated with less use of blood components and consequently better clinical outcomes.

PMID:40445084 | PMC:PMC12124749 | DOI:10.21470/1678-9741-2024-0244

Braz J Cardiovasc Surg. 2025 May 30;40(3):e20240071. doi: 10.21470/1678-9741-2024-0071.

ABSTRACT

INTRODUCTION: Cardioplegia solution, also called the del Nido solution, has been widely used in pediatric cardiac surgeries, and has recently started to be used in adult cardiac surgeries. In this context, this study aimed to investigate the relationship between the use of del Nido and blood cardioplegia solutions and postoperative atrial fibrillation rates in our clinic.

METHODS: The study sample comprised 140 patients who underwent coronary artery bypass grafting. The del Nido and blood cardioplegia solutions were used in 70 (50%) patients. The postoperative atrial fibrillation rates of both groups were compared. Additionally, patients' preoperative, intraoperative, and postoperative data were evaluated.

RESULTS: The cardiopulmonary bypass duration and defibrillation rate were lower in the del Nido cardioplegia group than in the blood cardioplegia group (P < 0.001). Atrial fibrillation rates on postoperative days one, five, and 30 were significantly lower in the del Nido cardioplegia group than in the blood cardioplegia group (P < 0.001, P < 0.001, and P = 0.007, respectively).

CONCLUSION: The postoperative atrial fibrillation rate was significantly lower in the del Nido cardioplegia group than in the blood cardioplegia group. In addition, the del Nido cardioplegia solution did not interrupt the surgical flow, thus resulting in less total perfusion, shorter cross-clamping durations, and fewer defibrillation needs. In conclusion, the del Nido cardioplegia solution can be used safely and effectively in coronary artery bypass grafting surgeries.

PMID:40445078 | PMC:PMC12131428 | DOI:10.21470/1678-9741-2024-0071

ASAIO J. 2025 May 30. doi: 10.1097/MAT.0000000000002467. Online ahead of print.

ABSTRACT

Extracorporeal circulation (ECC) procedures, including extracorporeal membrane oxygenation (ECMO), provide essential support for critically ill patients, but complications such as hemolysis and thromboembolic events remain significant concerns. This study evaluates the hemocompatibility of the CBM LifeMotion centrifugal ECMO pump, designed with a low priming volume and shrouded impeller, comparing its performance to three commercially available pumps (Maquet, Sorin, and Novalung). Human blood was used in a simulated ECC model, following American Society for Testing and Materials (ASTM) testing protocols, to evaluate hemolysis and white blood cell damage. The CBM pump demonstrated hemolysis levels similar to the Maquet and Sorin pumps, all of which exhibited low hemolysis compared to the Novalung pump, which showed the highest hemolysis. A numerical analysis further assessed the CBM pump's performance under low-flow conditions, revealing reduced fluid shear stress due to the lower rotor speed, whereas the blood's exposure time to this shear stress increased. Despite these differences, the overall hemolytic potential under low-flow conditions was comparable to ASTM conditions. These results suggest that the CBM LifeMotion pump, with its reduced priming volume and favorable hemocompatibility, shows promise for ECMO applications. Further clinical research is required to validate these findings in real-world settings.

PMID:40444779 | DOI:10.1097/MAT.0000000000002467

Pediatr Int. 2025 Jan-Dec;67(1):e70098. doi: 10.1111/ped.70098.

ABSTRACT

BACKGROUND: Postoperative oral feeding difficulties in infants with congenital heart disease (CHD) are associated with prolonged hospital stays, increased readmission rates, and decreased patients' and their family's quality of life. They have recently been recognized as part of post-intensive care syndrome in pediatrics. The purpose of this study was to identify the risk factors for acquired feeding difficulties after surgery for CHD in infants. We hypothesized that infants who underwent more complex surgical procedures would be at higher risk.

METHODS: We conducted a retrospective observational cohort study in a PICU with 20 beds. Included were 124 eligible patients aged 1-11 months, who had established oral feeding preoperatively and underwent surgery under cardiopulmonary bypass between 2018 and 2022. The primary outcome was the duration from surgery to the re-establishment of oral feeding. We classified the patients into two groups according to the Society of Thoracic Surgeons - European Association for CardioThoracic Surgery (STAT) mortality category.

RESULTS: Eighty-one patients were classified as STAT 1-2 (low) and 43 as STAT 3-5 (high). The duration from surgery to re-establishment of oral feeding was significantly longer in the high-STAT group in one minus Kaplan-Meier curve estimate (p = 0.016). In a multivariable Cox proportional hazards model analysis, longer operative time (HR 0.83, 95% CI 0.72-0.95, p = 0.005) and higher STAT (HR 0.56, 95% CI 0.32-0.95, p = 0.032) were identified as significant risk factors for delayed oral feeding.

CONCLUSIONS: Longer operative times and procedures with higher STAT categories may be associated with acquired feeding difficulties after surgery for CHD in infants.

PMID:40444535 | DOI:10.1111/ped.70098

Clin Neurophysiol. 2025 Jul;175:2110769. doi: 10.1016/j.clinph.2025.2110769. Epub 2025 May 25.

ABSTRACT

OBJECTIVE: This study aims to utilize HFO analysis to enhance existing SSEP modality and develop it as a bedside diagnostic tool for acute brain injury (ABI) detection in Extracorporeal Membrane Oxygenation (ECMO) patients.

SIGNIFICANCE: Timely diagnosis of ABI in ECMO patients is challenging due to logistical complexities with computed tomography (CT) and magnetic resonance imaging (MRI). Integrating time-frequency analysis into routine SSEP monitoring for early ABI detection can facilitate timely medical decisions.

METHOD: Consecutive SSEP data were collected from Johns Hopkins Intensive Care Units (ICUs), including 31 ECMO and 45 non-ECMO patients from 2016 to 2022. ABIs were determined using CT and MRI as clinically indicated. Using wavelet techniques, two SSEP-HFO components were quantified: HFOL (80-200 Hz) and HFOH (200-600 Hz), which were later fed to a Support Vector Machine (SVM) with a linear kernel.

RESULT: ECMO patients with ABI (N = 22) exhibited suppressed HFOH (Median = -9.09, Interquartile Range (IQR) = [ -13.5; -4.73] dB) compared to patients without (N = 9, Median = -4.39, IQR = [-6.35; -3.28] dB, P = 0.035). The SVM classifier achieved an accuracy of 75 % and a sensitivity of 82 % for detecting ABI, outperforming SSEP-N20.

CONCLUSION: SSEP-HFO can potentially improve early detection of ABI in ECMO patients at the bedside.

PMID:40440954 | DOI:10.1016/j.clinph.2025.2110769

Crit Care Sci. 2025 May 23;37:e20250320. doi: 10.62675/2965-2774.20250320. eCollection 2025.

ABSTRACT

OBJECTIVE: To evaluate the consistency of current evidence supporting the use of extracorporeal cardiopulmonary resuscitation to treat patients with cardiac arrest and assess the plausibility of implementing an extracorporeal cardiopulmonary resuscitation program in a public health care system hospital in a middle-income country.

METHODS: A systematic review, meta-analysis, meta-regression analysis, and trial sequence analysis were performed to assess the consistency of current evidence supporting the use of extracorporeal cardiopulmonary resuscitation to treat patients with cardiac arrest. Additionally, a local cardiac arrest registry was analyzed to identify potential patients eligible for extracorporeal cardiopulmonary resuscitation.

RESULTS: The systematic review included 31 studies. The main and sensitivity analyses consistently demonstrated that extracorporeal cardiopulmonary resuscitation was associated with favorable neurological outcomes (cerebral performance category 1 or 2, RR 1.45, 95%CI 1.19 - 1.77) and survival (RR 1.29, 95%CI 1.10 - 1.52). Age was inversely related to neurological outcome and survival. Our cardiac arrest registry included 55 patients with a median age of 54 years and a survival rate of 18.2% (10/55). Survivors had an initial shockable rhythm. In the most inclusive scenario, 13 patients would have been eligible for extracorporeal cardiopulmonary resuscitation. Under stricter criteria (age ≤ 65 years, low-flow time ≤ 30 min, and number of defibrillations ≥ 3), 4 patients would have been eligible.

CONCLUSION: Extracorporeal cardiopulmonary resuscitation in patients with refractory cardiac arrest is associated with improved neurological outcomes and survival. The use of an extracorporeal cardiopulmonary resuscitation program in our hospital is plausible. Using conservative eligibility criteria, we estimate that at least four patients would be eligible for extracorporeal cardiopulmonary resuscitation within six months of the program initiation.

PMID:40435032 | PMC:PMC12094697 | DOI:10.62675/2965-2774.20250320

Eur J Cardiothorac Surg. 2025 May 6;67(5):ezaf066. doi: 10.1093/ejcts/ezaf066.

NO ABSTRACT

PMID:40432250 | DOI:10.1093/ejcts/ezaf066

Medicina (Kaunas). 2025 May 15;61(5):896. doi: 10.3390/medicina61050896.

ABSTRACT

Background and Objectives: Although transesophageal or intracardiac echocardiography and radiofrequency needles are employed to guide transseptal puncture, their routine utilization is associated with substantial expense. No reports have analyzed the use of the foramen ovale position to effectively guide transseptal punctures on chest X-rays or computed tomography scout views, which are more cost-effective approaches to safely and effectively guide the procedure. We aimed to find the foramen ovale position on chest computed tomography scout views to effectively guide percutaneous transseptal punctures. Materials and Methods: The study population included 31 patients treated with extracorporeal membrane oxygenation (ECMO) for cardiogenic shock, 32 patients diagnosed with atrial fibrillation (AF) who underwent MDCT, and 197 patients who underwent MDCT for non-cardiac conditions. Vertebral body units, defined as the distance between two adjacent vertebral bodies (the sixth and seventh thoracic spines) inclusive of the intervertebral disk space, were used to express the distance from the carina to the foramen ovale on computed tomography scout views. Results: The mean vertebral body units, distance from the carina to the foramen ovale (carina-foramen ovale), and distance from the carina to the foramen ovale on chest computed tomography scout views (carina-foramen ovale vertebral body units-1) were 2.3 ± 0.2 cm, 6.9 ± 0.9 cm, and 3.0 ± 0.3, respectively. Multivariate analysis showed significant correlations between the carina-foramen ovale vertebral body units-1 and sex (β = 0.080; p = 0.028), body mass index (β = -0.020; p < 0.001), age (β = 0; p = 0.013), and the application of extracorporeal membrane oxygenation or the presence of atrial fibrillation (β = 0.130; p = 0.004). Conclusions: Although a three-dimensional approach was not employed, the foramen ovale position may serve as a radiologic guide in various clinical settings where transseptal punctures are required. This technique may be an effective aid in transseptal puncture procedures.

PMID:40428854 | PMC:PMC12113258 | DOI:10.3390/medicina61050896

Medicina (Kaunas). 2025 Apr 25;61(5):801. doi: 10.3390/medicina61050801.

ABSTRACT

Background and Objectives: Extracorporeal membrane oxygenation (ECMO) can support patients with severe cardiopulmonary failure, but it poses risks such as hemolysis, leading to complications. Plasma-free hemoglobin (PFH) is a hemolysis biomarker, with elevated levels linked to mortality. This study evaluates PFH and ECMO survival in COVID-19, non-COVID-19 pulmonary, and cardiac patients, focusing on late PFH spikes. Materials and Methods: We retrospectively analyzed 122 ECMO patients treated at our tertiary hospital (January 2020-December 2021). Patients were categorized by indication: post-COVID-19, non-COVID-19 pulmonary, or cardiac. We classified patients as Expired (died during ECMO or ≤30 days post-ECMO) or Survived (>30 days post-ECMO). Data included demographics, ECMO duration, and PFH values at 24 h and during the last 3 and 5 ECMO days. Groups were compared using two-tailed t-tests, with p < 0.05 indicating significance. Results: COVID-19 patients survived after significantly longer ECMO duration than non-COVID-19 pulmonary and cardiac patients. Expired COVID-19 patients had higher PFH values during the last 3 and 5 days of ECMO compared to survivors. Cardiac patients had the highest overall PFH levels regardless of mortality. No significant differences in PFH trends were observed between non-COVID-19 pulmonary and cardiac patients. Conclusions: Late PFH spikes correlated with mortality in COVID-19 patients, suggesting the utility of measuring late PFH spikes in ECMO management. Additionally, COVID-19 pulmonary patients survived when undergoing ECMO significantly longer than both groups, while VA ECMO was more prone to hemolysis. However, technical cannulation differences and frequent use of an Impella pump in cardiac patients may increase blood stress and PFH values.

PMID:40428759 | PMC:PMC12112789 | DOI:10.3390/medicina61050801

BMC Anesthesiol. 2025 May 26;25(1):267. doi: 10.1186/s12871-025-03141-8.

ABSTRACT

BACKGROUND: Delirium is a common neurological complication after cardiac surgery. The purpose of the present study was to analyze the association between hemodynamic fluctuations during cardiopulmonary bypass (CPB) and the incidence of postoperative delirium (POD) in patients undergoing cardiac surgery with CPB.

METHODS: This post hoc analysis included one-hundred-ninety-five (n = 195) patients aged ≥ 65 years of whom seventy (n = 70) patients developed POD. Intraoperative hemodynamic variables specifically related to the conduct of CPB were digitally recorded at 1-minute intervals. Variables outside the presumed safe boundaries for mean arterial pressure (MAP), systemic perfusion flow index- L/min/BSA (QBSAI), systemic venous oxygen saturation (SVO2) and arterial oxygen delivery- ml/min/BSA (DO2) were defined and analyzed with reference to indices of area under the curve (AUC) and the relative proportion of registrations related to POD. POD was diagnosed according to DSM-5 criteria based on a test battery performed preoperatively and repeated twice postoperatively. Statistical tests used to verify observations outside the predefined norm included the Mann-Whitney U test and the chi-squared test.

RESULTS: Markers of hemodynamic control during CPB showed significant associations with POD. Both DO2 (P = 0.02) and QBSAI (P < 0.001) identified POD patients outside the predefined upper and lower safety limits. SVO2 values > 84% (P < 0.001) werealso associated with the development of POD. The number of SVO2 registrations below the lower safety limit was negligible, why statistical analysis seemed not useful. No association between MAP and POD registrations was identified.

CONCLUSIONS: This study revealed a clear association between markers of hemodynamic control and POD. These associations were most pronounced for DO2 and QBSAI. The detected association between high SVO2 and POD warrants further insight.

PMID:40419968 | PMC:PMC12105260 | DOI:10.1186/s12871-025-03141-8

Medicine (Baltimore). 2025 May 23;104(21):e42529. doi: 10.1097/MD.0000000000042529.

ABSTRACT

This study aims to explore the effect of mild hypothermic circulatory arrest anesthesia on postoperative lung function in patients with aortic dissection (AD). A total of 71 patients who underwent modified aortic arch replacement surgery in hospitals from January 2021 to December 2023 were selected as the study subjects. According to the differences in rectal temperature and mild hypothermia circulatory arrest temperature during surgery, patients were divided into mild hypothermia group and moderate hypothermia group. The intraoperative surgery time, infusion status, and postoperative complications of patients were compared from 3 dimensions: preoperative, intraoperative, and postoperative. The differences between 2 groups of patients under different anesthesia methods were evaluated. The general situation of preoperative grouping for patients in the mild hypothermia group and the moderate hypothermia group was basically the same, and there was no significant difference, indicating a certain degree of comparability. In the comparison of intraoperative surgery time, the surgery time, cardiopulmonary bypass time, cooling time, and rewarming time of the mild hypothermia group were (406.41 ± 35.14) min, (147.75 ± 22.58) min, (15.87 ± 6.78) min, and (70.45 ± 9.48) min, respectively, with P < .05 between the mild hypothermia group and the moderate hypothermia group. Starting from the second day after surgery and by the third day, there were a significant difference in the patient's respiratory index and oxygenation index (P < .05). There were significant postoperative changes in alanine lminotransferase, total bilirubin, and creatinine levels in both groups. On the third day after surgery, there was a significant difference in the levels of alanine lminotransferase and total bilirubin between the shallow hypothermia group and the moderate hypothermia group, with statistical significance (P < .05). Compared to the group of moderate to low temperature circulatory arrest modes, shallow low temperature circulatory arrest anesthesia is safer and more effective in the treatment of Stanford type A AD patients, and has better therapeutic effects on long-term postoperative lung function recovery in AD patients. This method can not only shorten the cardiopulmonary bypass time and hospitalization time, but also improve the postoperative recovery of patients.

PMID:40419886 | PMC:PMC12113933 | DOI:10.1097/MD.0000000000042529

Neurol India. 2025 May 1;73(3):480-487. doi: 10.4103/neurol-india.Neurol-India-D-24-00199. Epub 2025 May 23.

ABSTRACT

INTRODUCTION: Therapeutic large-volume plasmapheresis (LVP) effectively manages neurological diseases, such as Guillain-Barre syndrome (GBS) and myasthenia gravis (MG), but it induces alterations in intravascular volume, necessitating vigilant monitoring. This study investigated the hemodynamic changes and the utility of non-invasive cardiac output monitoring (NICOM) during LVP.

METHODS: This prospective observational study included 50 neurological patients receiving their first LVP cycle. Standard monitoring of heart rate (HR), non-invasive blood pressure (NIBP), pulse oximetry (SpO2), and cardiac output (CO) using NICOM was performed. Changes in HR, NIBP, CO, total peripheral resistance (TPR), stroke volume (SV), and stroke volume variation (SVV) were recorded at baseline and multiple time points during LVP.

RESULTS: The mean age was 36 ± 15.05 years. The mean arterial pressure (MAP) significantly decreased from baseline at 30 and 60 minutes, and LVP completion (P < 0.05). While HR and systolic/diastolic blood pressure (SBP/DBP) remained stable, SV, CO, and cardiac index (CI) significantly decreased (P < 0.05), peaking at 60 minutes. TPR significantly increased (P < 0.05) with a maximum of 30 minutes. The volume of plasma removed directly influenced CO, CI, and SV changes (P < 0.05).

DISCUSSION: LVP induced transient hemodynamic alterations, primarily affecting CO and TPR. Despite fluid replacement, significant changes occurred, highlighting the need for close CO monitoring, especially in GBS patients with potential autonomic dysfunction.

CONCLUSION: LVP significantly alters hemodynamics, impacting CO and TPR. Standard monitoring might miss these changes, emphasizing the importance of NICOM, particularly in neurological patients. Further research is warranted to solidify NICOM's role in optimizing LVP protocols and improving patient outcomes.

PMID:40408575 | DOI:10.4103/neurol-india.Neurol-India-D-24-00199

Dimens Crit Care Nurs. 2025 Jul-Aug 01;44(4):181-185. doi: 10.1097/DCC.0000000000000701.

ABSTRACT

Cardiogenic shock poses a significant challenge in health care, with high mortality rates despite advancements in treatment. This case report details the management of a severe cardiogenic shock using venoarterial extracorporeal membrane oxygenation and an Impella CP device (Abiomed Inc, Danvers, Massachusetts), collectively referred to as ECPELLA, with a focus on nursing interventions. A 31-year-old man presented with acute myocarditis-induced cardiogenic shock. Initial assessment revealed severe biventricular dysfunction and respiratory failure requiring double mechanical support with ECPELLA, combined with continuous inotropic therapy and antibiotics. Mechanical support stabilized hemodynamics, allowing for cardiac and respiratory weaning. After 6 days, the patient showed significant improvement, permitting device removal and discharge after 9 days without complications. Managing cardiogenic shock patients with dual mechanical support demands vigilant nursing care to mitigate risks of complications such as pressure injuries, infections, and limb ischemia. Nursing care included meticulous monitoring, maintenance of assistive devices, and a series of specific interventions encompassing skin care, infection prevention, limb assessment, nutritional support, and vital parameter monitoring. Continuous monitoring and adherence to protocols are crucial. The successful management of cardiogenic shock with ECPELLA requires a multidisciplinary approach and specialized nursing care. Further research is needed to establish best practices and improve outcomes in these complex cases.

PMID:40408172 | DOI:10.1097/DCC.0000000000000701

Med Sci (Basel). 2025 May 12;13(2):60. doi: 10.3390/medsci13020060.

ABSTRACT

BACKGROUND: Aim of the study is to analyze the trends and outcomes in Left Ventricular Assist Device (LVAD) placements between the years 2016 and 2022 using the National Inpatient Sample (NIS).

METHODS: Using the NIS for the years 2016-2022, we identified the total number of LVAD placements using the PCS 10 code 02HA0QZ. In-hospital outcomes and healthcare resource utilization burden were assessed. Stratification of outcomes with Extracorporeal Membrane Oxygenation (ECMO) support were performed for the years 2018-2022. Outcome analysis variance in admissions requiring ECMO support was performed using multivariate regression analysis. A two tailed p-value < 0.05 was used to determine statistical significance.

RESULTS: A general decreasing trend was observed in the total number of LVAD placements, with 852 total admissions requiring LVAD placements identified in 2016 compared to 665 in 2022. The admissions for LVAD placements requiring ECMO support had an increasing trend, with 2.21% of admissions needing ECMO support in 2018 compared to 12.18% in 2018. After multivariate regression analysis, the association between all-cause mortality during the hospital stay for LVAD placements and requirement of ECMO was found to be significant, with an odds ratio of 2.34 (1.83-4.42, p-value: 0.001).

CONCLUSIONS: A general decreasing trend in LVAD placements was observed between 2016 and 2022. All-cause mortality and hospital charges during the admission had a stable trend over the years. The requirement of ECMO support had an increasing trend from 2018 to 2022. Requirement of ECMO support during the admissions for LVAD placements had a statistically significant association with all-cause mortality during the admission. A 11.50% readmission rate was observed in the 30 days following discharge, with heart failure being the major cause of readmission.

PMID:40407555 | PMC:PMC12101218 | DOI:10.3390/medsci13020060

Br J Hosp Med (Lond). 2025 May 23;86(5):1-15. doi: 10.12968/hmed.2024.0928. Epub 2025 May 22.

ABSTRACT

Aims/Background Uremia is a severe manifestation of end-stage renal failure, with high cardiovascular risk, and current dialysis treatments like hemodialysis (HD) face limitations in toxin clearance, necessitating more effective therapeutic strategies. This study aims to evaluate the clinical efficacy of HD combined with hemodiafiltration (HDF) in treating uremia and its influence on cardiac ultrasound indices. Methods This study retrospectively analyzed clinical data from 80 uremic patients treated at the Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University between April 2019 and April 2023. Based on different therapeutic regimens, patients were divided into a control group (n = 41) and an observation group (n = 39). The control group received HD, while the observation group underwent HD combined with HDF. The cardiac structure, cardiac function, lipid metabolism, and other biochemical indicators were comparatively assessed between the two groups. Results There were no significant differences in baseline characteristics between the two groups (p > 0.05). Before treatment, both groups demonstrated no significant difference in left atrial diameter (LAD), left ventricular posterior wall thickness (LVPWT), interventricular septal thickness (IVST), left ventricular end-diastolic diameter (LVEDD), brain natriuretic peptide (BNP), and troponin T (TnT) (p > 0.05). However, after 6 months of treatment, these indices were significantly declined in the observation group (p < 0.05). Similarly, no significant differences were observed in left ventricular ejection fraction (LVEF), fractional shortening (FS), cardiac output (CO), stroke volume (SV), and peak mitral E-wave velocity/peak mitral A-wave velocity (E/A) before treatment (p > 0.05). However, a significant improvement was observed in the observation group following 6 months of treatment (p < 0.05). Before treatment, there were no significant differences in serum creatinine (Scr), blood urea nitrogen (BUN), β2-microglobulin (β2-MG), and parathyroid hormone (PTH) between the two groups (p > 0.05). However, the observation group showed significant improvements in Scr, BUN, β2-MG, and PTH after treatment (p < 0.001). Additionally, the two study groups had no significant differences in total cholesterol (TC), triglycerides (TG), and low-density lipoprotein (LDL) before treatment (p > 0.05). However, their levels decreased significantly in the observation group after treatment (p < 0.05). Hypertension and hypotension occurred less frequently in the observation group (p < 0.05), with no significant differences observed in the incidence of arrhythmia and infection between the two groups (p > 0.05). Conclusion HD combined with HDF effectively improves cardiac structure and function, reduces metabolic wastes such as Scr, BUN and β2-MG, and decreases blood lipid levels in uremic patients. This study further confirmed the clinical efficacy of this combined approach in treating uremia, which is of positive significance for the prevention and treatment of cardiovascular diseases in uremic patients.

PMID:40405851 | DOI:10.12968/hmed.2024.0928

Thorac Cardiovasc Surg. 2025 Jun 10. doi: 10.1055/a-2618-4744. Online ahead of print.

ABSTRACT

After cardiac surgery, long aortic clamping times and extracorporeal circulation times are associated with worse outcomes. This study compares hemodynamic performance, myocardial metabolism, and ultrastructural preservation in rat hearts after applying esmolol crystalloid cardioplegia (ECCP) or Calafiore blood cardioplegia (Cala).Hearts from 18 Wistar rats were perfused in a Langendorff system. Following 120 minutes of ischemia at 36 °C, hearts received either ECCP at 32 °C for 3 minutes or Cala at 36 °C for 2 minutes every 20 minutes. During 90 minutes of reperfusion, coronary blood flow (CF), left ventricular developed pressure (LVDP), and contraction/relaxation velocities (±dp/dt) were recorded. Myocardial oxygen consumption, lactate production, and troponin I levels were measured. Electron microscopy was used for ultrastructural assessment.Baseline (BL) values of LVDP, CF, and ±dp/dt were similar between the two groups. After 90 minutes of reperfusion, CF was significantly higher in the ECCP group: 85 ± 43% of BL in the ECCP group versus 42 ± 24% of BL in the Cala group (p = 0.002). At the end of reperfusion, hearts exposed to ECCP had higher LVDP (91 ± 40%) values than Cala (43 ± 10%), indicating improved cardiac recovery with ECCP. Myocardial contraction and relaxation were notably better in the ECCP group: dLVP/dtmax was 111 ± 40% versus 59 ± 13% in the Cala group (p = 0.002), and dLVP/dtmin was 88 ± 34% versus 40 ± 7% (p = 0.001). Troponin I levels measured in Cala hearts at the end of reperfusion were higher than in ECCP hearts (Cala 1,102.6 ± 361.3 ng/mL vs. ECCP 442.3 ± 788.4 ng/mL, p = 0.036).In rat hearts, ECCP offers better hemodynamic recovery and protects the myocardium from ischemia/reperfusion-related damage, better than Cala blood cardioplegia, even with aortic clamping times of 120 minutes.

PMID:40404136 | DOI:10.1055/a-2618-4744

Perfusion. 2025 May 20:2676591251344859. doi: 10.1177/02676591251344859. Online ahead of print.

ABSTRACT

IntroductionCardiopulmonary bypass (CPB) is essential for cardiac surgery but poses risks, including gaseous micro emboli (GME). While the incidence of stroke-a common clinical consequence of embolism-ranges from 1-5% in cardiac surgery, prevalence of GME during CPB remain poorly understood.ObjectivesTo quantitatively compare GME incidence in the arterial line between cavoatrial and bicaval cannulation during open-heart surgery. Secondary exploratory objectives include evaluating the impact of venous reservoir volume on GME, and the correlation between GME in the venous and arterial lines.MethodsThis single center randomized controlled trial was conducted at Sahlgrenska University Hospital, Sweden. Patients ≥18 years undergoing planned aortic valve repair/replacement with cavoatrial cannulation, or mitral valve repair/replacement with bicaval cannulation, with or without coronary artery revascularization, were screened for eligibility. Patients were further randomized to either venous reservoir volume of ≥300 mL (control) or 200-300mL (intervention). GME detection was performed using GAMPT BCC300 with probes positioned at multiple locations within the CPB circuit.Results39 patients were included. No significant differences in GME quantity in the arterial line were observed between the cannulation methods (count p=.444; volume p=967). Similarly, no significant differences were found based on venous reservoir volume (count p=.074; volume p=.166). Furthermore, no significant correlation was observed between GME in venous line entering the arterial line (count p-value=492; volume p-value=.750). The CPB circuit effectively removed 99.14% of GME, with no adverse events reported.ConclusionNo significant differences were found in arterial GME count or volume between cavoatrial and bicaval cannulation during CPB. These findings underscore the importance of the bypass circuit's air-handling capacity, as well as the role of modern oxygenators and arterial line filters in effectively minimizing the passage of GME. Trial Registration:ClinicalTrials.gov Identifier: NCT05820828URL: https://clinicaltrials.gov/ct2/show/NCT05820828.

PMID:40393695 | DOI:10.1177/02676591251344859

Thorac Cardiovasc Surg. 2025 Jun 5. doi: 10.1055/a-2616-4962. Online ahead of print.

ABSTRACT

Sodium-glucose cotransporter-2 (SGLT2) inhibitors (SGLT2i) are nephroprotective in patients with recompensated acute and chronic heart failure (HF) and chronic kidney disease, but their potential influence during cardiac surgery is unclear. Currently, discontinuation of SGLT2i at least 2 days before surgery is recommended.Between March 2022 and December 2023, 53 cardiac surgical patients on SGLT2i therapy in addition to standard medical treatment for HF were compared with 447 other HF patients from the same period. After 1:1 covariate adjustment, 33 patients with SGLT2i treatment were matched with 33 controls. The primary endpoint was a change in estimated glomerular filtration rate (eGFR) 36 hours after surgery. Secondary endpoints were changes in eGFR, cumulative urine output, diuretic efficacy, and albuminuria over seven postoperative days.Mean baseline eGFR was similar between the groups (p = 0.973). Thirty-six hours postoperatively, eGFR was significantly higher in the SGLT2i group by a mean difference (MD) of 11.8 mL/min (95% CI [3.12-20.44]; p = 0.009) compared with the control group. The mean urinary albumin level was 18.1 mg/mL lower in the SGLT2i group (95% CI [-42.5-6.33]; p = 0.143). There were numerically positive changes in urine output and diuretic efficacy in the SGLT2i group without significant difference: MD 131.4 mL/24 hours (95% CI [-366.7-629.5]; p = 0.600) and MD 11.3 mL/mg (95% CI [-12.2-34.7]; p = 0.301), respectively, although the dosage of diuretics was higher in controls (30.6 ± 43.7 vs. 51.3 ± 130.1 mg/24 hours; p = 0.268, respectively).SGLT2i may have nephroprotective effects in patients undergoing heart surgery with extracorporeal circulation. More evidence is needed to determine whether SGTL2i needs to be discontinued before surgery.

PMID:40393690 | DOI:10.1055/a-2616-4962