Extracorporeal circulation

Emerg Med Australas. 2025 Jun;37(3):e70071. doi: 10.1111/1742-6723.70071.

ABSTRACT

Extracorporeal cardiopulmonary resuscitation (ECPR) has gained increasing traction worldwide as a strategy to improve survival in carefully selected patients experiencing refractory cardiac arrest. Historically, New Zealand (NZ) stood at the forefront of extracorporeal membrane oxygenation (ECMO) use in the early 2000s, establishing one of the first national retrieval services in the world. Despite limited evidence and the nascent state of ECMO technology, this made NZ a pioneer. Over the following two decades, international guidelines evolved, ECMO systems became more streamlined, and research demonstrated the clinical and economic viability of ECPR in selected patient cohorts. However, NZ persisted with a single-provider framework, seemingly reluctant to adapt to global developments. Recent initiatives are addressing this by decentralising access to ECMO and formalising governance structures. This paper focuses on ECPR specifically, examining equity gaps in access and outcomes, discussing the country's position relative to global standards and proposing directions for the future.

PMID:40490422 | DOI:10.1111/1742-6723.70071

Front Pharmacol. 2025 May 23;16:1541131. doi: 10.3389/fphar.2025.1541131. eCollection 2025.

ABSTRACT

OBJECTIVES: To better understand nafamostat mesylate (NM) dose requirements during extracorporeal membrane oxygenation (ECMO), this study investigated its pharmacokinetic/pharmacodynamic (PK/PD) properties by comparing samples from the systemic circulation of patients and from the ECMO circuit. It specifically examined the relationship between NM concentration and activated partial thromboplastin time (aPTT) changes, aiming to provide a foundation for future dosing optimization.

METHODS: In this prospective study, 24 ECMO patients received a continuous infusion of NM through a dedicated stopcock located before the ECMO pump. This placement targets the anticoagulant effects of NM specifically to the ECMO circuit without substantially affecting the patient's overall coagulation status. The starting dose was 15 mg/h, adjusted to keep the aPTT within a target range of 40-80 s. Blood samples were collected from both the patient's central venous catheter and the ECMO circuit for PK/PD analysis using a nonlinear mixed effects model.

RESULTS: The PK profiles of NM, derived from samples taken from both the patient's catheter and the ECMO circuit, were best described by a two-compartment model. In the PK/PD models, the effect of NM on prolonging aPTT was described using a turnover model. NM was shown to inhibit the decrease in aPTT in the turnover model. In the patient model, the maximum inhibitory effect (Imax) of NM on the reduction of aPTT was 35.5%, and the concentration of NM required to achieve half of this maximum effect (IC50) was 350 μg/L. On the other hand, in the ECMO model, the Imax for aPTT reduction was 43.6%, with an IC50 of 581 μg/L.

CONCLUSION: The PK/PD models developed from samples collected from both the patient and the ECMO circuit indicate significant differences in PD. Given the observed variability and the high risk of bleeding in ECMO patients, a predictive model incorporating these differences and patient-specific variables could significantly improve anticoagulation management.

PMID:40487408 | PMC:PMC12141017 | DOI:10.3389/fphar.2025.1541131

Ann Med Surg (Lond). 2025 May 21;87(6):3819-3822. doi: 10.1097/MS9.0000000000002837. eCollection 2025 Jun.

ABSTRACT

INTRODUCTION: Over the last half-century, mortality from renal cell carcinoma (RCC) has seen a dramatic reduction, while 5-year survival rates have reached an all-time high (34% to 75%).

CASE PRESENTATION: A 77-year-old female with Stage 4 RCC (cT3c, cN1, cM1) presented with acute onset chest and back pain. Imaging revealed interval enlargement of a left renal mass with propagation of tumor thrombus (TT) throughout the left renal vein, intrahepatic and suprahepatic inferior vena cava (IVC) with extension into the right atrium (RA). The patient successfully underwent a high-risk open left nephrectomy with caval thrombectomy, retroperitoneal lymph node dissection, and atrial thrombectomy.

DISCUSSION: Approximately, 1% of RCC cases involve the right atrium, and radical nephrectomy with vena caval thrombectomy remains the most effective treatment for cavoatrial TT, with 5-year survival rates between 30% and 72%. While patients with renal vein involvement have better survival rates than those with IVC involvement, advanced TT cases (Types III and IV) often require extracorporeal circulation. Though the patient understood the prognosis of her RCC, discussing the risks of a complex procedure versus not intervening was challenging. Despite a typical median survival of 12 months for level IV tumor thrombus (TT), she remains stable 28 months post-surgery.

CONCLUSION: Although the 5-year survival rate for renal cell carcinoma (RCC) has increased from 34% to 75%, the disease still adversely affects patients' quality of life. A multidisciplinary approach is essential when managing metastatic RCC, particularly involving the heart. Despite the associated risks, surgical intervention is more effective in prolonging life by preventing sudden cardiac death due to embolic events.

PMID:40486613 | PMC:PMC12140791 | DOI:10.1097/MS9.0000000000002837

World J Pediatr Congenit Heart Surg. 2025 Jun 9:21501351251338834. doi: 10.1177/21501351251338834. Online ahead of print.

ABSTRACT

ObjectivesReview our clinical experience with eight patients at the University of Florida undergoing En-bloc combined heart+liver transplantation (ECH + LTX).MethodsContinuous variables are reported as median (interquartile range = IQR) and categorical variables are reported as N (%).ResultsEight patients underwent ECH + LTX between August 2020 and May 2023 at the University of Florida, with triple heart+liver+kidney transplantation performed in 2/8 = 25%. Median age at ECH + LTX was 47.34 years (IQR = 33.66-53.37), and all eight patients were >18 years of age. Six out of eight patients (75%) had congenital heart disease (CHD): one had biventricular CHD and five had functionally univentricular circulation and Fontan failure. Two out of eight patients (25%) had structurally normal hearts and acquired heart disease: one patient with hemochromatosis and combined cardiac and hepatic failure with nonischemic restrictive cardiomyopathy and one patient with nonischemic cardiomyopathy and alcoholic cirrhosis. Median wait list time was 93 days (IQR = 27.50-176.25). Three patients (3/8 = 37.5%) were supported with an intra-aortic balloon pump prior to ECH + LTX, and two of these three patients were subsequently also supported with extracorporeal membrane oxygenation secondary to progressive decompensation prior to ECH + LTX. Median hospital length of stay was 147 days. Median posttransplant length of stay was of 29 days. Seven of eight patients survived ECH + LTX and are alive today. One patient died two days after ECH + LTX. Mean length of follow-up after ECH + LTX of seven surviving patients (years) is 3.60 ± 0.38 (median = 3.79, IQR = 3.05-4.38, range = 1.91-4.64).ConclusionEn-bloc heart-liver transplantation is an effective treatment option for patients with combined heart and liver failure.

PMID:40485338 | DOI:10.1177/21501351251338834

Crit Care Clin. 2025 Jul;41(3):555-572. doi: 10.1016/j.ccc.2025.02.006. Epub 2025 Apr 12.

ABSTRACT

Ultrasonography is essential in intensive care units for rapid, real-time assessment and management of various organ systems, particularly for patients with mechanical circulatory support (MCS) devices. It aids in the diagnosis, safe placement, and monitoring of MCS devices such as extracorporeal membrane oxygenation, Impella, and implantable left ventricular assist devices, used for conditions like cardiogenic shock and severe respiratory failure. Ultrasonography ensures precise device positioning, identifies complications, and facilitates weaning. Future advancements in AI, portable devices, and advanced imaging techniques will enhance diagnostic accuracy and patient care.

PMID:40484621 | DOI:10.1016/j.ccc.2025.02.006

Int J Artif Organs. 2025 Jun;48(6):399-405. doi: 10.1177/03913988251346714. Epub 2025 Jun 7.

ABSTRACT

BACKGROUND: Despite veno-venous extracorporeal membrane oxygenation (VV-ECMO) support, hypoxemia may persist due to venous shunting past the ECMO circuit into diseased lungs. Heart rate (HR) control therapy in patients with elevated cardiac output (CO) is one strategy to improve the ratio of ECMO flow to CO and reduce shunting.

METHODS: This retrospective study examined VV-ECMO patients between June 2019 and June 2023 that received ⩾1 HR control agent within 10 days post-cannulation. Efficacy outcomes included trends in hemodynamics, oxygenation, and ventilator and ECMO parameters within 72 h after HR control initiation. Safety outcomes included incidence of hypotension or bradycardia requiring intervention.

RESULTS: Thirty-nine patients were included. The most common HR control strategy was initiation of esmolol infusion with transition to an oral beta-blocker after a median overlap of 6 days. Patients experienced reductions in HR and CO; however, there were no substantial changes in oxygenation parameters. Adverse events were minimal, with only two cases of hypotension requiring intervention.

CONCLUSIONS: While HR control therapy was well tolerated and effectively reduced HR, it did not seem to improve oxygenation. Larger prospective studies should be designed to ascertain the role of HR control strategies in VV-ECMO patients with elevated CO experiencing refractory hypoxemia.

PMID:40481753 | DOI:10.1177/03913988251346714

Cureus. 2025 Jun 4;17(6):e85315. doi: 10.7759/cureus.85315. eCollection 2025 Jun.

ABSTRACT

Perioperative cardiogenic shock can be fatal, and assisted circulation with an Impella percutaneous ventricular support pump catheter (Abiomed, Danvers, MA, USA) is useful in patients with severely compromised cardiac function. However, we report a case in which an Impella implanted preoperatively deepened its position during off-pump coronary artery bypass grafting decannulation. This change in position caused the Impella to interfere with the posterior mitral valve leaflet and led to severe mitral regurgitation and difficulty with intraoperative circulatory control. In patients without significant left ventricular enlargement, the heart team should discuss the risk of interference with the mitral valve and inhalation failure during decannulation. In such cases, other forms of assisted circulation, such as intra-aortic balloon pumping or cardiopulmonary bypass, should be considered.

PMID:40469888 | PMC:PMC12134815 | DOI:10.7759/cureus.85315

Emerg Med Australas. 2025 Jun;37(3):e70073. doi: 10.1111/1742-6723.70073.

ABSTRACT

Extracorporeal cardiopulmonary resuscitation (ECPR) is a time-critical, resource-intensive intervention used in select cases of refractory cardiac arrest. Its success depends on rapid initiation, streamlined workflows, and coordination across multidisciplinary teams. This article outlines the phases of ECPR, key resuscitation modifications, and inclusion criteria. It also provides practical guidance on equipment, personnel roles, environmental setup, and post-initiation priorities.

PMID:40468856 | DOI:10.1111/1742-6723.70073

Lung. 2025 Jun 4;203(1):68. doi: 10.1007/s00408-025-00822-6.

ABSTRACT

Poor or worsening functional status of lung transplant (LTx) candidates is a key risk factor for waitlist and post-transplant mortality. As more critically ill adults and children are listed for LTx, the use of extracorporeal membrane oxygenation (ECMO) as bridge to LTx is also increasing. Sustaining optimal functional status while on the waitlist to LTx is crucial for LTx candidates as deterioration in functional status can negatively impact pre- and post-LTx outcomes. We conducted an analysis of the United Network for Organ Sharing Registry which showed that most patients (70%) on ECMO successfully bridged to LTx. The majority had severely limited functional status at the time of waitlisting but 96% of adults requiring ECMO on the waitlist for LTx either maintained or improved functional status from the time of waitlist to the time of LTx while all children on ECMO maintained or improved their functional status. With continuing medical and technical advances, the use of ECMO may also evolve to improve LTx candidates' functional status.

PMID:40467879 | DOI:10.1007/s00408-025-00822-6

Braz J Cardiovasc Surg. 2025 Jun 4;40(4):e20240237. doi: 10.21470/1678-9741-2024-0237.

ABSTRACT

OBJECTIVE: A variety of cardioplegia techniques with different components are implemented to ensure myocardial protection, in addition to keeping the operationa field immobile and free of blood during cardiac surgery. The implemented cardioplegia has unwanted negative effects on other end organs. In this study, our aim was to compare the effects of Del Nido cardioplegia and blood cardioplegia solutions on postoperative intensive care duration, drainage, and renal functions for patients undergoing cardiopulmonary bypass and bypass graft operations.

METHODS: Selections were made from patients undergoing elective bypass graft operations in our clinic from January 1, 2022 to December 31, 2023. Patients were randomly selected, retrospectively assessed, and divided into two groups - De Nido group (Group 1) and blood cardioplegia group (Group 2). Comparisons were made between these groups in terms of intensive care duration, drainage, and renal functions.

RESULTS: The study included 120 patients. The Del Nido cardioplegia group included 60 patients, with 60 patients in the blood cardioplegia group. Comparisons between the groups found that the aortic cross-clamping duration was significantly high in Group 1 (P = 0.014). The noradrenaline dose given to Group 1 was high (P = 0.004). In terms of renal injury, significant degree of elevation was present in Group 1 (P = 0.027). The longer aortic cross-clamping duration in Group 1 may be assessed as a determinant factor for noradrenaline dose and acute kidney injury.

CONCLUSION: This study concluded that it willbe appropriate to choose the cardioplegia method by performing broader meta-analysis studies and minimizing limiting factors.

PMID:40464404 | PMC:PMC12135678 | DOI:10.21470/1678-9741-2024-0237

Lancet Respir Med. 2025 May 30:S2213-2600(25)00122-5. doi: 10.1016/S2213-2600(25)00122-5. Online ahead of print.

ABSTRACT

When conventional cardiopulmonary resuscitation (CCPR) cannot restore spontaneous circulation, the initiation of venoarterial extracorporeal membrane oxygenation during refractory cardiac arrest-known as extracorporeal CPR (ECPR)-might restore circulation and adequate tissue oxygenation. ECPR could substantially improve survival with favourable functional recovery. However, the complexity and time-sensitive nature of the intervention, high costs, resource demands, considerable risks, and complications restrict the availability of ECPR. Patient age and comorbidities, timely and effective CCPR, and time-to-ECPR are major contributors to the outcome of patients. The primary goal of ECPR is full recovery of the patient, but in some cases, transition to a long-term ventricular assist device or heart transplantation can be additional options for survival. In patients diagnosed with brain death or, according to local regulation, in those with irreversible post-anoxic brain damage, organ donation is possible after ECPR. Ongoing research aims to assess the efficacy of ECPR versus continued CCPR and uncover key prognostic indicators.

PMID:40456239 | DOI:10.1016/S2213-2600(25)00122-5

Multimed Man Cardiothorac Surg. 2025 Jun 2;2025. doi: 10.1510/mmcts.2025.028.

ABSTRACT

The patient presents with a genetic condition named Li-Fraumeni syndrome, which predisposes her to multiple neoplasms during her lifespan. Due to the chemotherapeutic treatment of an osteosarcoma, the patient presents with cardiotoxicity secondary to doxorubicin that is refractory to conventional management. The patient is initially stabilized with a peripheral veno-arterial extracorporeal membrane oxygenation device, with no improvement after 14 days of support. Later she was assisted with a HeartMate 3 mechanical circulatory device as a bridge to candidacy or as a destination therapy. She is the first paediatric patient in Spain to be assisted with long-term circulatory support using the HeartMate 3 device.

PMID:40454942 | DOI:10.1510/mmcts.2025.028

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