Extracorporeal circulation

J Extra Corpor Technol. 2025 Sep;57(3):129-136. doi: 10.1051/ject/2025006. Epub 2025 Sep 15.

ABSTRACT

BACKGROUND: Data is limited regarding the effects of supraphysiologic blood oxygen tension in patients requiring extracorporeal life support (ECLS). We sought to evaluate the association between hyperoxia and outcomes in pediatric patients requiring veno-arterial (VA) ECLS.

METHODS: Retrospective single-center study at an academic children's hospital that included all patients 0-18 years who required VA-ECLS between 01/2014 and 12/2019.

RESULTS: During the study period, 229 VA-ECLS runs occurred in 229 patients. The majority of patients were neonates (73.4%), with cardiac being the most common indication (48.9%). The median time from admission to cannulation was 78.5 h (IQR 14, 356) with a median ECLS duration of 111.5 h (IQR 65.5, 184.5). The overall mortality rate was 44.5%. Using a receiver operating curve, a mean PaO2 of 233 mmHg in the first 48 h of ECLS was determined to have the optimal discriminatory ability for mortality (sensitivity 36% and specificity 76%). Of the VA-ECLS cohort, 68 (29.7%) had a mean PaO2 > 233 mmHg (hyperoxia group). The hyperoxia group tended to be older (median age 4.6 vs 1.5 months, p = 0.019), had a primary cardiac indication for VA-ECLS (60% vs 44%, p = 0.0004), and had a higher mortality rate (54% vs 40%, p = 0.050). In the multivariable analysis, after adjusting for covariables, the data demonstrated increased odds of mortality (aOR 2.02, 95% CI [1.03, 3.97], p = 0.03). The odds of development of stage II or III acute kidney injury (AKI) (aOR 2.04, 95% CI [0.82, 5.50]), but that did not reach statistical significance (p = 0.120).

CONCLUSION: There is evidence that hyperoxia during the first 48 h of VA-ECLS may be associated with mortality and development of acute kidney injury, although this did not reach statistical significance. Multicenter and prospective evaluation of this modifiable risk factor is imperative to improve the care of this high-risk cohort.

PMID:40953240 | PMC:PMC12435806 | DOI:10.1051/ject/2025006

PLoS One. 2025 Sep 15;20(9):e0332597. doi: 10.1371/journal.pone.0332597. eCollection 2025.

ABSTRACT

Short-term mechanical circulatory supports (MCS) are used to stabilize patients with severe cardiogenic shock (CS). Catheter ablation may be an option to suppress recurrent arrhythmias preventing MCS weaning. We retrospectively analysed a dedicated registry to identify CS patients who underwent a catheter ablation between January 2020 and August 2024 for treatment resistant and hemodynamically significant arrhythmias while being on the MCS. Patients with supraventricular and ventricular tachycardias (SVT/VT) were analysed separately. Nine patients (8 males, 69 [IQR 60;74] years) were ablated for a refractory VT. Impella CP was used in 6 patients, VA ECMO in 2 patients, and 1 patient was on ECPELLA. Seven patients (78%) were successfully weaned off the MCS after the catheter ablation. 3 patients (33%) died within 30 days. The arrhythmia recurred in 5 patients (56%). Significant complications of MCS were reported in 6 patients (66%). The catheter ablation was complicated in one patient. SVT ablation was performed in 4 patients (3 males, 73 [IQR 67; 78] years, 1x VA ECMO, 2x Impella CP, 1x Impella 5.5). Three patients with atrial fibrillation were treated by a non-selective AV node ablation (pace and ablate strategy). One patient underwent an ablation of focal atrial tachycardia. The MCS was successfully explanted in all patients and no patient died in 30 days. The MCS use was complicated in one patient. Catheter ablation of refractory arrhythmias in CS patients treated by MCS is a safe and feasible approach to facilitate the MCS weaning process.

PMID:40953065 | PMC:PMC12435639 | DOI:10.1371/journal.pone.0332597

A A Pract. 2025 Sep 15;19(9):e02054. doi: 10.1213/XAA.0000000000002054. eCollection 2025 Sep 1.

ABSTRACT

Microbubbles during extracorporeal membrane oxygenation (ECMO) can cause systemic embolism. We report a 33-year-old woman in late pregnancy with COVID-19-associated myocarditis supported by veno-veno-arterial ECMO and Impella 5.5. During rapid transfusion via central venous catheter for massive hemorrhage after emergency cesarean section, transesophageal echocardiography (TEE) revealed microbubbles entering the arterial circulation. The bubbles resolved after pausing transfusion. Although the patient initially recovered without neurological deficits, she later died from unrelated intracranial hemorrhage. This case highlights the need to prevent air entrainment during transfusion and illustrates the diagnostic value of intraoperative TEE in detecting systemic microembolism under mechanical circulatory support.

PMID:40952022 | DOI:10.1213/XAA.0000000000002054

J Clin Med. 2025 Aug 27;14(17):6064. doi: 10.3390/jcm14176064.

ABSTRACT

Background: The perfusion of viscera, kidney, and spinal cord represents one of the main concerns during open repair (OR) of Thoraco-Abdominal Aortic Aneurisms (TAAAs). Passive shunting (PS) has been historically used for intraoperative distal aortic perfusion but has been progressively replaced almost entirely by partial left-sided heart or total cardiopulmonary bypass with extra-corporeal circulation (ECC). Despite several advantages of these methods, PS still has potential in mitigating some drawbacks of long extracorporeal circuits connected with centrifugal or roller pumps, such as the need for cardiac and great vessels cannulation, priming and large intravascular fluid volume shifts, high heparin dose, immunosuppressive effects, and systemic inflammatory response syndrome. Methods: This study prospectively analyzed data of a cohort of patients who underwent TAAA OR using a PS in a single institution. Outcomes of interest were mortality, rate of mesenteric, renal and spinal cord ischemia, cardiac complications, and intraoperative hemodynamic stability achieved in this setting. Our institutional bundle and a comprehensive literature review about the different configurations and applicability of PS for TAAA OR is also reported. The search was performed based on three databases (PubMed, EMBASE, and Cochrane Library) by two independent reviewers (LS and AA) from inception to 31 December 2023, and the reported clinical results (visceral, renal, and spinal cord complications and mortality) using PS during TAAAs OR were analyzed. Results: Between March 2021 and December 2023, 51 TAAA repairs were performed and eleven patients (n = 8, 73% male; mean age 67 years, range 63-79) were operated using a PS for a total of one (9%) type I, one (9%) type II, two (18%) type III, five (45%) type IV, and two (18%) type V TAAA. In our early experience, PS was indicated for limited staff resources during the COVID-19 pandemic to treat five non-deferable cases. The sixth and seventh patients were selected for PS as they already had a functioning axillo-bifemoral bypass that was used for this purpose. For the most recent cases, PS was chosen as the primary perfusion method according to a score based on clinical and anatomical factors with ECC as a bailout strategy. Selective renal perfusion with cold (4 °C) Custodiol solution was the method of choice for renal protection in all cases while antegrade perfusion of the coeliac trunk and the superior mesenteric artery was assured by PS through a loop graft (8-10mm) proximally anastomosed to the axillary artery (10 patients, 90.9%) or the descending thoracic aorta (one patient, 9%) and distally anastomosed to the infrarenal aorta (3), common iliac (3), or femoral vessels (5). In-hospital mortality was 9% as one patient died on the 10th postoperative day from mesenteric ischemia following hemodynamic instability; permanent spinal cord ischemia rate was 0% and the rate of AKI stage 3 was 9% (one patient). Bailout shifting to ECC was never required. No cardiac complications, nor a significant increase in serum CK-MB were reported in any patient. No prolonged severe intraoperative hypotension episodes (Mean Arterial Pressure < 50 mmHg) were assessed using the Software Acumen Analytics (Edwards LifeSciences, Irvine CA, USA). No peri-operative coagulopathy nor major bleeding was reported. Conclusions: Our experience showed satisfactory outcomes with the use of PS in specifically selected cases. Current data indicate that PS may represent an alternative to ECC techniques during TAAAs OR in high volume centers where assisted extracorporeal circulation could eventually be applied as a bailout strategy. However, due to the small sample size of this and previously published series, more data are needed to clearly define the potential role of such approach during TAAA OR.

PMID:40943821 | PMC:PMC12429315 | DOI:10.3390/jcm14176064

Cells. 2025 Aug 31;14(17):1357. doi: 10.3390/cells14171357.

ABSTRACT

Patients with heart failure with a reduced ejection fraction (HFrEF) are at an increased risk of developing postoperative hemodynamic instability and vasoplegia after surgery on cardiopulmonary bypass (CPB). Potentially pre-existing endothelial cell (EC) alterations due to chronic HF influence EC responses to cardiac surgery and might be responsible for the altered vascular responsiveness observed postoperatively. In this study, well-described EC activation markers were measured in blood samples collected pre- and perioperatively at four time points from HFrEF and control patients undergoing cardiac surgery on cardiopulmonary bypass (CPB). Circulating levels of Angiopoietin 2 (ANG2), von Willebrand Factor (vWF), and soluble P-selectin were measured using ELISA. Additionally, we investigated the responses of the cultured EC to patient-derived plasma through morphological profiling and mitochondrial functional assays. In total, 36 patients were included (67 (61-71) years, 78% male). HFrEF patients had higher baseline ANG2 and vWF levels when compared to controls. Both markers peaked during the first postoperative day. A pronounced increase in vWF was seen in controls after CPB. Ex vivo EC responses to patient-derived plasma showed distinct morphological differences between the two groups at baseline. A mitochondrial analysis indicated alterations in function and morphology for both groups after CPB. In conclusion, HFrEF patients exhibit a dampened EC response to cardiac surgery on CPB. Stable circulating factors in HFrEF plasma are responsible for inducing EC stress. Moreover, the mitochondrial function is highly affected postoperatively. This pre-existing mitochondrial and EC dysfunction predispose HFrEF patients to postoperative hemodynamic instability.

PMID:40940768 | PMC:PMC12428422 | DOI:10.3390/cells14171357

Circ Rep. 2025 Jul 23;7(9):715-726. doi: 10.1253/circrep.CR-25-0098. eCollection 2025 Sep 10.

ABSTRACT

BACKGROUND: The optimal timing for mechanical circulatory support (MCS) initiation in patients with acute myocardial infarction complicated by cardiogenic shock (CS) is unknown, so in this study we analyzed whether MCS implementation before percutaneous coronary intervention (PCI) is associated with better outcomes compared to after PCI.

METHODS AND RESULTS: We conducted a systematic review and meta-analysis using a random-effects model to account for potential heterogeneity. Risk ratios and 95% confidence intervals were used for dichotomous outcomes. PubMed, Web of Science, and CENTRAL were searched up to April 30, 2023. Certainty of evidence was evaluated according to the Risk of Bias in Non-Randomized Studies of Interventions-I tool. A total of 14 observational studies met the inclusion criteria. We found that venoarterial-extracorporeal membrane oxygenation (VA-ECMO) may have little to no positive effect on short-term survival, but the evidence was very uncertain. Impella use probably increases short-term survival (moderate certainty of evidence), whereas the timing of intra-aortic balloon pump (IABP) insertion improves outcomes (very low certainty of evidence). Pre- and post-PCI MCS implementation may result in little to no difference in bleeding complications or stroke incidence across all device types (low to very low certainty of evidence).

CONCLUSIONS: Early Impella implementation before PCI may increase short-term survival, whereas the timing of ECMO or IABP implementation may have little to no effect on outcomes; however, the evidence is very uncertain.

PMID:40937035 | PMC:PMC12421136 | DOI:10.1253/circrep.CR-25-0098

Circ Rep. 2025 Jul 23;7(9):784-790. doi: 10.1253/circrep.CR-25-0058. eCollection 2025 Sep 10.

ABSTRACT

BACKGROUND: Grip strength is a simple predictor of cardiovascular events and their prognosis. Early ambulation is related to an increase in functional independence, shortening of hospital stay, and a decrease in the need for readmission in patients with cardiovascular disease. However, little is known about the relationship between grip strength and early ambulation after cardiac surgery.

METHODS AND RESULTS: In this observational study, 92 patients who underwent scheduled cardiac surgery with extracorporeal circulation without unexpected complications and in whom grip strength was measured before surgery were included. We divided them into 48 low and 44 preserved grip strength groups according to the criterion for frailty and sarcopenia. Age, the percentage of females, and the New York Heart Association classification in the low grip strength group were significantly higher than in the preserved grip strength group. All of the measures of functional status were significantly low in the low grip strength group. There were no significant differences in perioperative procedures between the groups. In-hospital outcomes were poorer, step-ups of rehabilitation were significantly later and the hospitalization stays were significantly longer in the low grip strength group. In the multiple regression analysis, grip strength was an independent predictor of early ambulation.

CONCLUSIONS: The results suggest that grip strength is an independent predictor of early ambulation in patients after cardiac surgery with extracorporeal circulation.

PMID:40933486 | PMC:PMC12419942 | DOI:10.1253/circrep.CR-25-0058

Medicine (Baltimore). 2025 Sep 5;104(36):e44325. doi: 10.1097/MD.0000000000044325.

ABSTRACT

RATIONALE: Extracorporeal membrane oxygenation (ECMO) is a life-support technology for refractory cardiac arrest, but the massive blood transfusions required during treatment significantly increase the risk of transfusion-related infections. Hepatitis E virus (HEV) - traditionally linked to fecal-oral transmission - is increasingly recognized as a transfusion-transmitted pathogen, especially in emergency settings where urgent blood product infusion is common and routine HEV screening in blood banks is often lacking. However, nursing strategies for managing acute HEV infection after ECMO remain poorly defined, highlighting the need to address this clinical gap.

PATIENT CONCERNS: A 35-year-old female nurse developed sudden cardiac arrest due to idiopathic ventricular fibrillation and underwent ECMO. Post-ECMO, she received red blood cells and plasma transfusions. On postoperative day 15, she had worsening liver function (alanine aminotransferase 938 U/L, total bilirubin 69.3 μmol/L) and abnormal coagulation function (prothrombin time [PT] 14.5 seconds), along with intermittent low-grade fever (37.3-38.0°C); subsequent jaundice of the skin, sclera, and urine developed.

DIAGNOSES: Next-generation sequencing confirmed acute HEV infection. The diagnosis was further supported by typical liver function abnormalities (marked elevation of transaminases and bilirubin), abnormal coagulation (PT 14.5 seconds), and clinical manifestations of HEV infection (fever, jaundice), with no evidence of other etiologies (e.g., viral hepatitis A/B/C, drug-induced liver injury).

INTERVENTIONS: Comprehensive nursing and clinical interventions were implemented. Daily monitoring: liver function (alanine aminotransferase, aspartate aminotransferase, bilirubin), coagulation status (with focus on PT, e.g., baseline PT 14.5 seconds), and jaundice-related symptoms (skin/sclera color, pruritus, urine color); gastrointestinal management: Bacillus licheniformis (0.5 g twice daily) to regulate intestinal flora, and lactulose (15 mL twice daily) to promote bowel movement, maintaining gut-liver axis balance; personalized nutritional support: Collaboration with the nutrition department to provide a low-fat semi-liquid diet (1500-1600 kcal/d, 75-80 g branched-chain amino acid-rich protein, and adequate vitamins/minerals); and cardiac follow-up: planning and implementation of implantable cardioverter defibrillator (ICD) implantation on postoperative day 50 (after resolution of liver injury and stabilization of coagulation function).

OUTCOMES: After 49 days of hospitalization, the patient's liver function normalized (total bilirubin within normal range, albumin increased from 31.3 to 35.1 g/L), coagulation function (PT) returned to normal, and jaundice resolved. She successfully underwent ICD implantation on postoperative day 50. A 3-month follow-up showed no chronic liver damage, and serum HEV-IgM turned negative at 6 months; no malignant arrhythmias or ICD discharges were recorded during follow-up.

LESSONS: This case emphasizes 3 key lessons: Firstly, for patients receiving ECMO and blood transfusions, close monitoring of liver function, coagulation indicators (e.g., PT), and clinical signs of HEV infection (fever, jaundice) is critical for early diagnosis; secondly, multimodal interventions - combining targeted monitoring (including coagulation tracking), gut-liver axis regulation, and personalized nutrition - are effective for managing acute HEV infection post-ECMO; and thirdly, timing of ICD implantation (e.g., postoperative day 50, after liver and coagulation stabilization) and collaboration between nursing teams, nutrition departments, and cardiac specialists ensure holistic care, supporting both liver recovery and long-term cardiac safety.

PMID:40922328 | PMC:PMC12419282 | DOI:10.1097/MD.0000000000044325

J Surg Res. 2025 Oct;314:657-661. doi: 10.1016/j.jss.2025.08.008. Epub 2025 Sep 4.

ABSTRACT

INTRODUCTION: Application of extracorporeal life support during cardiac arrest is termed extracorporeal cardiopulmonary resuscitation (eCPR). Mortality in pediatric patients undergoing eCPR for noncardiac conditions remains high and factors influencing survival are not well-defined. We hypothesized that eCPR survivors are more likely to have less severe electrolyte derangements prior to cannulation than nonsurvivors.

METHODS: A retrospective review of extracorporeal membrane oxygenation (ECMO) data at our free-standing children's hospital from January 2013 through December 2023 was performed. Variables evaluated included demographics, diagnosis, blood gas values, CPR time, and survival. Kruskal-Wallis test was used to compare precannulation labs and CPR duration in those who survived to the nonsurvivors.

RESULTS: We identified 21 patients who underwent CPR during ECMO cannulation over a 10-year period. The most common diagnosis was respiratory failure (n = 8, 38%). The median duration of CPR prior to successful ECMO initiation was 60 min (interquartile range 15-80). Veno-arterial ECMO (n = 20, 95%) was the most common method of cannulation. The median ECMO run time was 84 h (interquartile range 27-183). A single patient died during ECMO cannulation (n = 1, 4.7%). Eight patients survived to discharge (38%). Higher pH, partial pressure of arterial oxygen, and bicarbonate levels prior to cannulation were associated with survival (P < 0.05).

CONCLUSIONS: In this study, precannulation pH, partial pressure of arterial oxygen, and bicarbonate median values were significantly higher in those who survived compared to the nonsurvivors. Precannulation characteristics that may influence survivability can potentially assist with decision making regarding inclusion and exclusion criteria for eCPR candidates.

PMID:40912082 | DOI:10.1016/j.jss.2025.08.008

BMJ Open Respir Res. 2025 Sep 3;12(1):e002912. doi: 10.1136/bmjresp-2024-002912.

ABSTRACT

BACKGROUND: We previously demonstrated a high prevalence of transpulmonary bubble transit (TPBT) using transcranial Doppler (TCD) in patients with COVID-19 pneumonia, but these observations require confirmation.

METHODS: Patients at two academic medical centres, hospitalised with COVID-19 pneumonia and requiring any form of respiratory support, were studied. The first TCD study was performed at the time of enrolment and repeated approximately 7 and 14 days later if participants remained hospitalised.

RESULTS: 91 participants were enrolled. At the first TCD, 14 participants (15%) were receiving oxygen by nasal cannula, 41 participants (45%) were receiving oxygen by high flow nasal cannula, 8 participants (9%) were receiving non-invasive positive pressure, 28 participants (31%) were receiving mechanical ventilation and 2 participants (2%) were receiving extracorporeal membrane oxygenation. 33 participants (36%) demonstrated TPBT at the first TCD. There was evidence that the presence of TPBT and increased heart rate together was associated with in-hospital death (p=0.02). For every one-unit increase in heart rate, the odds of death increased 11% (OR 1.11, 95% CI 1.02 to 1.20, p=0.01) for those with TPBT; however, there was no evidence of this increase for those without TPBT (OR 1.01, 95% CI 0.97 to 1.05, p=0.76). For participants with subsequent TCD assessments, 55% demonstrated TPBT during the second TCD assessment, and 85% demonstrated TPBT at the third TCD assessment.

CONCLUSIONS: The prevalence of TPBT in hospitalised patients with COVID-19 pneumonia is higher than expected and the presence of TPBT increases over time in those that remained alive and hospitalised. In patients with TPBT, increased heart rate, a marker of hyperdynamic circulation, is associated with increased mortality.

PMID:40903187 | PMC:PMC12410680 | DOI:10.1136/bmjresp-2024-002912

Biochem Biophys Res Commun. 2025 Sep 30;782:152552. doi: 10.1016/j.bbrc.2025.152552. Epub 2025 Sep 2.

ABSTRACT

Reperfusion arrhythmia (RA) poses a significant risk to the prognosis of patients undergoing extracorporeal circulation cardiac surgery, and its occurrence closely linked to disturbances in myocardial electrical conduction. Our prior research indicated that ischemia-reperfusion (I/R) affects the localization of connexin 43 (Cx43) at the intercalated discs (IDs) by inducing depolymerization of microtubules, resulting in myocardial electrical conduction abnormalities in rats. Although sevoflurane preconditioning (SPC) has demonstrated considerable protective effects on ischemic myocardium, the underlying mechanisms remain inadequately understood. This prompted us to study the effect of SPC on the stability of microtubules in I/R myocardium to explore the protective mechanism of SPC based on microtubule cytoskeleton. Western blotting, immunofluorescence colocalization, and ex vivo cardiac electrophysiological mapping demonstrated that SPC attenuated myocardial I/R-induced microtubule depolymerization, recovered the distribution of Cx43 at the IDs, and improved myocardial electrical conduction and RA score in rats. Furthermore, the microtubule depolymerization agent nocodazole abolished the protective effect of SPC on microtubules and significantly inhibited the ameliorative effects of sevoflurane on Cx43 localization and electrical conduction. These findings substantiate that the ability of SPC to restore the localization of Cx43 and electrophysiological functions in I/R myocardium depends on microtubule stability. In conclusion, our study shows that SPC ensures the targeted transport of Cx43 to the IDs by stabilizing microtubule structure, thereby ameliorating myocardial electrical conduction and RA after I/R.

PMID:40902546 | DOI:10.1016/j.bbrc.2025.152552

J Multidiscip Healthc. 2025 Aug 27;18:5263-5269. doi: 10.2147/JMDH.S533452. eCollection 2025.

ABSTRACT

OBJECTIVE: This study aimed to evaluate the myocardial protective efficacy of different myocardial protection solutions used during extracorporeal circulation in pediatric patients undergoing surgery for complex congenital heart disease. The analysis focused on the effects of these solutions on perioperative cardiac rhythm and serum sodium levels.

METHODS: A retrospective analysis was performed on clinical data from 60 pediatric patients who underwent surgery with extracorporeal circulation for complex congenital heart disease between January 2022 and October 2024. Patients were categorized into the St. Thomas cardioplegic solution group (n = 30) and the histidine-tryptophan-ketoglutarate (HTK) solution group (n = 30). Serum sodium levels and myocardial enzyme markers were monitored perioperatively. Additionally, the incidence of postoperative cardiac arrhythmia and the duration of cardiac reperfusion were recorded.

RESULTS: No significant differences in serum sodium concentrations were observed between the groups preoperatively, or at 12 and 48 hours postoperatively (p > 0.05). However, intraoperative serum sodium levels at 30 and 60 minutes were significantly lower in the HTK solution group compared to the St. Thomas cardioplegic solution group (p < 0.05). Postoperative levels of creatine kinase-MB and B-type natriuretic peptide at 12 and 48 hours were significantly lower in the HTK solution group than in the St. Thomas cardioplegic solution group (p < 0.05). Additionally, the cardiac reperfusion duration was significantly shorter in the HTK solution group (p < 0.05). No significant difference was observed in the incidence of postoperative cardiac arrhythmia between the two groups (p > 0.05).

CONCLUSION: Compared with St. Thomas cardioplegic solution, the HTK solution was associated with significant intraoperative fluctuations in serum sodium concentrations, which stabilized postoperatively. HTK solution demonstrated improved myocardial protection as evidenced by reduced cardiac reperfusion time and lower postoperative myocardial enzyme levels, without an increased risk of postoperative cardiac arrhythmias.

PMID:40900717 | PMC:PMC12400945 | DOI:10.2147/JMDH.S533452

Circ Cardiovasc Imaging. 2025 Sep;18(9):e017620. doi: 10.1161/CIRCIMAGING.124.017620. Epub 2025 Sep 3.

ABSTRACT

BACKGROUND: 2D-speckle tracking echocardiography may help detect subclinical ventricular dysfunction, but data in multisystem inflammatory syndrome in children (MIS-C) are scarce. We investigated left ventricular (LV) strain parameters in MIS-C and their association with outcomes.

METHODS: We performed an ambi-directional, 32-center cohort study on hospitalized patients with MIS-C (March 2020-November 2021) with at least 1 echocardiogram read by the Core Lab. Generalized estimating equation modeling was used to test associations between LV strain and a composite in-hospital adverse cardiovascular outcome (vasoactive support, arrhythmias, cardiac arrest, extracorporeal support, death, or heart transplant).

RESULTS: Of 349 patients (median age, 8.7 years [interquartile range, 5.3-12.9]), 35% had decreased LV ejection fraction during hospitalization, and 45% had depressed LV strain (either 4-chamber LV longitudinal strain [4CH-LVLS] or mid-ventricular LV circumferential strain [mid-LVCS]). The worst 4CH-LVLS and mid-LVCS occurred at ≈5 days of illness; 50% of abnormal LV strain normalized within 1 week, and 95% within 50 days. In-hospital adverse outcomes occurred in 35% of patients; these patients were older (P=0.003) and, at admission, had more likely abnormal troponin (P<0.001) higher C-reactive protein (P<0.001), higher indexed LV end-diastolic volume (P<0.001) and mass (P=0.015), worse LV ejection fraction (P<0.001), and worse LV strain (4CH-LVLS, P=0.002; mid-LVCS, P=0.001). Covariate-adjusted individual models for each strain parameter showed that 4CH-LVLS (adjusted odds ratio, 1.09 [95% CI, 1.07-1.12]), mid-LVCS (adjusted odds ratio, 1.06 [95% CI, 1.04-1.09]), worst LV strain Z score between 4CH-LVLS and mid-LVCS (adjusted odds ratio, 1.30 [95% CI, 1.21-1.41]), and early diastolic longitudinal strain rate (adjusted odds ratio, 1.68 [95% CI, 1.26-2.23]) at admission were found to be associated with adverse outcomes.

CONCLUSIONS: About half of patients with MIS-C had abnormal LV strain during hospitalization. 4CH-LVLS, mid-LVCS, the most abnormal strain Z score, and early diastolic longitudinal strain rate at admission were independently associated with in-hospital adverse cardiovascular outcome. These data may help early characterization and prognostication in MIS-C.

PMID:40899279 | DOI:10.1161/CIRCIMAGING.124.017620

BMC Pediatr. 2025 Aug 29;25(1):664. doi: 10.1186/s12887-025-06083-9.

ABSTRACT

BACKGROUND: We analyzed the perioperative metabolomic alterations in children undergoing ventricular septal defect (VSD) repair under cardiopulmonary bypass (CPB), identified evidence of postoperative injury, and explored strategies to mitigate such injuries.

METHODS: We conducted an untargeted metabolomic analysis of serum at three distinct time points (preoperative (Tp), immediate postoperative (T0), and 24 h postoperative (T24)) in eight children undergoing VSD repair under CPB. Subsequently, we identified the key enzymes associated with perioperative injury for molecular docking prediction studies.

RESULTS: We identified 623 metabolites in serum samples with VIP scores exceeding 1 in all three groups; 37 of these metabolites exhibited significant differences throughout the study phases. Three metabolic pathways-glycerophospholipid metabolism, arginine and proline metabolism, and retrograde endogenous cannabinoid signaling recurred in various comparisons between the two groups. Molecular docking predictions confirmed that arginine-glycine amidinotransferase may possess binding sites for bosentan and AdipoRon.

CONCLUSION: The perioperative metabolic profiles in children undergoing VSD repair under CPB were significantly altered, presumably because of the inflammatory response and endothelial cell dysfunction induced by CPB. Molecular docking predictions suggested that bosentan and AdipoRon may be potent compounds that influence perioperative damage.

PMID:40883731 | PMC:PMC12395897 | DOI:10.1186/s12887-025-06083-9

J Am Heart Assoc. 2025 Sep 2;14(17):e042734. doi: 10.1161/JAHA.125.042734. Epub 2025 Aug 29.

ABSTRACT

BACKGROUND: Selecting appropriate patients for extracorporeal cardiopulmonary resuscitation (ECPR) in cases of out-of-hospital cardiac arrest remains challenging, particularly for those with initial nonshockable rhythms. Our aim is to develop a prediction score to identify suitable ECPR candidates in patients with initial nonshockable rhythm.

METHODS: The data were sourced from the SAVE-J II (Study of Advanced Life Support for Ventricular Fibrillation With Extracorporeal Circulation in Japan II) study, a retrospective multicenter observational study in Japan. Included were adult patients with out-of-hospital cardiac arrest who underwent ECPR with initial pulseless electrical activity or asystole. The primary outcome was survival to hospital discharge. We developed a prediction score, employing logistic regression analysis and internally validating it with 1000 bootstrap samples. The performance of the score in predicting a favorable neurological outcome at discharge was also evaluated.

RESULTS: Among 648 eligible patients, 86 (13.3%) survived to hospital discharge. The median age was 60.5 years, 75.9% (492) were male, and 74.4% (482) had pulseless electrical activity as the initial rhythm. Three clinical predictors for the START-ECPR Score (Signs of Life, Transient ROSC, Not Asystole Rhythm to ECPR Score) were identified: shockable rhythm or pulseless electrical activity at hospital arrival, transient return of spontaneous circulation before hospital arrival, and signs of life at hospital arrival. Survival rates were 4.4% (7/159) for a score of 0, 10.7% (38/356) for a score of 1, and 30.8% (39/130) for scores of 2 to -3. The bias-corrected C-index for the score was 0.696. For predicting favorable neurologic outcomes at discharge, the C-index was 0.761.

CONCLUSIONS: We developed a straightforward 3-factor prediction score for predicting survival to hospital discharge and favorable neurologic outcomes in patients with out-of-hospital cardiac arrest with initial nonshockable rhythms receiving ECPR.

PMID:40878992 | DOI:10.1161/JAHA.125.042734

Eur J Med Res. 2025 Aug 29;30(1):818. doi: 10.1186/s40001-025-03096-z.

ABSTRACT

BACKGROUND: Critical gaps persist in clinical guidelines and resuscitation strategies for induction and maintenance phase peri-anesthetic cardiac arrest (IM-PACA), urgently necessitating exploration of feasible solutions during anesthesia induction and maintenance periods. This study evaluates a modified cardiopulmonary bypass (CPB) strategy for managing IM-PACA in valvular heart disease (VHD) surgical patients.

METHODS: A retrospective analysis was performed on IM-PACA patients (n = 21) from 1,043 cardiac valve surgeries between March 2019 and January 2022 as the cardiac arrest-resuscitation group (CAR group). Patients who completed normal cardiac valve surgery (n = 84) were randomly selected from the medical record database as the Routine Surgery group (RS group), serving as a benchmark control for the standard efficacy of routine surgery. The CAR group completed surgery after modified cardiopulmonary bypass strategy; the RS group completed surgery as planned. This study reviewed the possible causes of cardiac arrest in the CAR group and performed statistical analysis on surgical time-related metrics (total surgical duration, cardiopulmonary bypass duration, etc.) and postoperative follow-up data (paravalvular leak, cardiac-related complications, etc.) using SPSS 26.0.

RESULTS: The short-term postoperative survival rate was 95.24% in the CAR group and 100% in the RS group. Baseline characteristics including gender, age, and smoking history showed no significant differences between the two groups (P > 0.05). The CAR group showed a significantly shorter pericardiotomy-to-CPB time (250.00 (205.00-269.50) vs. 512.50 (459.25-563.00) s; P < 0.001), but longer rewarming time (68.00 (63.50-74.50) vs. 48.00 (35.25-61.75) min; P < 0.001), ventilator duration (980.00 (619.00-1106.50) vs. 900.00 (630.00-1103.75) min; P = 0.002), and higher day 2 drainage (190 (157.50-215.00) vs. 105 (71.25-150.00) ml; P < 0.001) compared to the RS group. Other intraoperative and postoperative parameters revealed no statistically significant differences when compared with the RS group (P > 0.05).

CONCLUSIONS: For IM-PACA patients undergoing cardiac valve surgery, the modified cardiopulmonary bypass strategy is an effective rescue method, and the strategy of continuing surgery after resuscitation is completely feasible.

PMID:40877919 | PMC:PMC12395764 | DOI:10.1186/s40001-025-03096-z

Medicina (Kaunas). 2025 Aug 6;61(8):1420. doi: 10.3390/medicina61081420.

ABSTRACT

Background and Objectives: Effective myocardial protection is essential for successful cardiac surgery outcomes, especially in complex and prolonged procedures. To this end, Del Nido (DN) and histidine-tryptophan-ketoglutarate (HTK) cardioplegia solutions are widely used; however, their comparative efficacy in adult surgeries with prolonged aortic cross-clamp (ACC) times remains unclear. This study aimed to compare the efficacy and safety of DN and HTK for myocardial protection during prolonged ACC times in adult cardiac surgery and to define clinically relevant thresholds. Materials and Methods: This retrospective study included a total of 320 adult patients who underwent cardiac surgery under cardiopulmonary bypass (CPB) with an aortic cross-clamp time ≥ 90 min. Data were collected from the medical records of elective adult cardiac surgery cases performed at a single center between 2019 and 2025. Patients were categorized into two groups based on the type of cardioplegia received: Del Nido (n = 160) and HTK (n = 160). The groups were compared using 1:1 propensity score matching. Clinical and biochemical outcomes-including troponin I (TnI), CK-MB, lactate levels, incidence of low cardiac output syndrome (LCOS), and need for mechanical circulatory support-were analyzed between the two cardioplegia groups. Subgroup analyses were performed according to ACC duration (90-120, 120-150, 150-180 and >180 min). The predictive threshold of ACC duration for each complication was determined by ROC analysis, followed by the analysis of independent predictors of each endpoint by multivariate logistic regression. Results: Intraoperative cardioplegia volume and transfusion requirements were lower in the DN group (p < 0.05). HTK was associated with lower TnI levels and less intra-aortic balloon pump (IABP) requirement at ACC times exceeding 180 min. Markers of myocardial injury were lower in patients with an ACC duration of 120-150 min in favor of HTK. The propensity for ventricular fibrillation after ACC was significantly lower in the DN group. Significantly lower postoperative sodium levels were observed in the HTK group. Prolonged ACC duration was an independent risk factor for LCOS (odds ratio [OR]: 1.023, p < 0.001), VIS > 15 (OR, 1.015; p < 0.001), IABP requirement (OR: 1.020, p = 0.002), and early mortality (OR: 1.016, p = 0.048). Postoperative ejection fraction (EF), troponin I, and CK-MB levels were associated with the development of LCOS and a VIS > 15. Furthermore, according to ROC analysis, HTK cardioplegia was able to tolerate ACC for up to a longer duration in terms of certain complications, suggesting a higher physiological tolerance to ischemia. Conclusions: ACC duration is a strong predictor of major adverse outcomes in adult cardiac surgeries. Although DN cardioplegia is effective and economically advantageous for shorter procedures, HTK may provide superior myocardial protection in operations with long ACC duration. This study supports the need to individualize cardioplegia choice according to ACC duration. Further prospective studies are needed to establish standard dosing protocols and to optimize cardioplegia selection according to surgical duration and complexity.

PMID:40870465 | PMC:PMC12388088 | DOI:10.3390/medicina61081420

Medicine (Baltimore). 2025 Aug 22;104(34):e43695. doi: 10.1097/MD.0000000000043695.

ABSTRACT

This retrospective study evaluates the efficacy of dexmedetomidine (Dex) combined with stellate ganglion block (SGB) in cardiac valve replacement under extracorporeal circulation. A total of 93 patients with cardiopulmonary bypass heart valve replacement were included between June 2021 and June 2023. The study group (n = 46) received SGB before anesthesia induction followed by Dex infusion, while the control group (n = 47) received Dex alone. Hemodynamics, cerebral oxygen metabolism (D(a-jv)O₂ and CERO₂), serum biomarkers (S100β, neuron-specific enolase, malondialdehyde, superoxide dismutase), postoperative cognitive dysfunction (POCD), and anesthesia-related adverse events were compared. Repeated-measures ANOVA revealed significant differences in mean arterial pressure (MAP) trends between groups (P < .05). The study group exhibited higher MAP during anesthesia induction and extracorporeal circulation but lower MAP postoperatively versus controls (all P < .05). D(a-jv)O₂ and CERO₂ were significantly lower in the study group at extracorporeal circulation initiation and cessation (P < .05). At 24 hours post-surgery, the control group showed elevated S100β, neuron-specific enolase, and malondialdehyde levels (P < .05) and reduced superoxide dismutase (P < .05) compared to the study group. The incidence of POCD in the study group was significantly lower at postoperative day 3 (10.87% vs 29.79%) and day 5 (4.35% vs 14.89%) (P < .05). Anesthesia-related adverse events were reduced in the study group (15.22% vs 36.17%, P < .05). Preoperative Dex combined with SGB stabilizes hemodynamics, mitigates oxidative stress, and reduces risks of POCD and anesthesia complications in cardiac valve replacement surgery.

PMID:40859584 | PMC:PMC12385058 | DOI:10.1097/MD.0000000000043695

Medicine (Baltimore). 2025 Aug 22;104(34):e44008. doi: 10.1097/MD.0000000000044008.

ABSTRACT

RATIONALE: The long-term complications of extracorporeal membrane oxygenation (ECMO) have not been well documented, especially the rare lower extremity drop foot (LEDF). Understanding the mechanisms and management of such complications is critical to improving patient outcomes. What is the role of patient-based on user portrait and health management journey map (HMJM) for rehabilitation management of patients with post-intensive care syndrome (PICS)?

PATIENT CONCERNS: We reported a case of a patient who developed LEDF after receiving ECMO for severe heart failure. The patient's user profile revealed a 17-year-old female athlete with a past history of hypertension. After treatment with ECMO, the patient developed LEDF with loss of sensation and motor deficits resulting in third-degree burns, which were inadvertently caused by using an electric stove for heating in the winter. During her hospitalization, she experienced several medical interventions and became more sensitive to pain and dysfunction perception. After discharge from the ICU, the patient reported significant difficulties in mobility, quality of life, and mental health.

DIAGNOSES: The diagnosis of LEDF was confirmed by clinical electromyography, third-degree burns were assessed using the burn assessment criteria, and the scale confirmed PICS.

INTERVENTIONS: User portrait and HMJM provided patients with personalized integrated rehabilitation care from a multidisciplinary team. This included physical and pharmacological treatment for foot drop. A skin graft was applied to the burned area. In addition, psychotherapy was received during the peri-rehabilitation period.

OUTCOMES: Despite comprehensive interventions, the patient showed only partial recovery of foot function and required long-term rehabilitation and assistive devices for daily activities. However, mental health performance was better than before.

LESSONS: This case highlighted the importance of monitoring patients with ECMO for neuromuscular injuries, such as LEDF. The need for early intervention to prevent secondary injuries, such as burns. It also demonstrated the value of user portrait and HMJM in guiding individualized rehabilitation care plans for PICS.

PMID:40859570 | PMC:PMC12384982 | DOI:10.1097/MD.0000000000044008

Medicine (Baltimore). 2025 Aug 22;104(34):e43975. doi: 10.1097/MD.0000000000043975.

ABSTRACT

RATIONALE: Acute myocardial infarction (AMI) in young individuals has become increasingly prevalent in recent years, with the age of onset progressively declining. According to the China Acute Myocardial Infarction Registry, which included over 24,000 cases, approximately 8.5% of AMI patients were aged ≤45 years. However, AMI occurring in adolescents remains exceptionally rare. Early recognition and timely intervention in such patients pose significant clinical challenges and carry important implications for improving outcomes in this population.

PATIENT CONCERNS: We report the case of a 16-year-old previously healthy male who presented with persistent precordial pain lasting over 4 hours. On admission, an emergency electrocardiogram showed atrial fibrillation with a heart rate of 117 bpm, abnormal Q waves in leads I, aVL, V2, and V3, and ST segment elevations ranging from 0.1 to 0.8 mV in leads I, aVL, and V1-V5.

DIAGNOSES: Based on clinical presentation and ECG findings, the patient was diagnosed with acute extensive anterior and high lateral wall myocardial infarction.

INTERVENTIONS: Emergency coronary angiography revealed total occlusion of the left main coronary artery. The patient was immediately treated with venoarterial extracorporeal membrane oxygenation (VA-ECMO) and received comprehensive supportive care.

OUTCOMES: Despite aggressive intervention, the patient developed catastrophic intracranial hemorrhage and subsequently died.

LESSONS: This case highlights the importance of considering AMI in the differential diagnosis of chest pain even in adolescents, and underscores the need for heightened clinical awareness, early diagnostic evaluation, and rapid therapeutic decision-making. Further research is needed to understand the underlying mechanisms and risk factors contributing to early-onset AMI in young individuals.

PMID:40859521 | PMC:PMC12384938 | DOI:10.1097/MD.0000000000043975