Circ Heart Fail. 2025 May 20. doi: 10.1161/CIRCHEARTFAILURE.124.012702. Online ahead of print.
ABSTRACT
Background: The sex-related prognosis of patients with cardiogenic shock (CS) undergoing veno-arterial extracorporeal membrane oxygenation (VA-ECMO) remains unclear. Our analyses aim to assess sex-specific outcomes in patients with CS receiving VA-ECMO and explored whether the effect of moderate hypothermia (MH) on clinical outcomes was modified by sex. Methods: In this post-hoc analysis of the HYPO-ECMO trial, clinical outcomes were compared by sex. The primary outcome was 30-day all-cause mortality (ACM). Key secondary outcomes included ACM and a composite outcome of ACM, heart transplant, escalation to left ventricular assist device implantation, or stroke at 30, 60 and 180 days. Results: Among the 334 patients enrolled in the trial, 81 (24%) were female. At 30 days, 45.7% of female and 46.6% of male patients experienced the primary outcome, with no sex differences (adjusted OR, 1.01 [0.57 - 1.78], p=0.98 and log-rank test, p=0.93). No significant sex differences were observed in all-cause mortality at 60 and 180 days (adjusted OR, 0.87 [0.49 - 1.52], p=0.61 and 0.83 [0.47 - 1.46], p=0.51, respectively) or in the composite outcome up to 180 days (p>0.2 for all). The effect of MH on the primary outcome (aOR, 0.73 [0.43 - 1.25], p=0.25 and 0.67 [0.26 - 1.76], p=0.41, in male and female respectively, interaction p-value = 0.88) and secondary outcomes (interaction p-value >0.3 for all) was not modified by sex. Conclusions: In this post-hoc analysis of the HYPO-ECMO trial, male and female experienced similar outcomes in CS treated with VA-ECMO. Sex did not significantly modify the effect of moderate hypothermia on outcomes. Registration: URL: https://clinicaltrials.gov Unique Identifier: NCT02754193.
PMID:40390595 | DOI:10.1161/CIRCHEARTFAILURE.124.012702
PLoS One. 2025 May 19;20(5):e0323795. doi: 10.1371/journal.pone.0323795. eCollection 2025.
ABSTRACT
OBJECTIVE: Cardiac arrest happens in 0.7%-5.2% patients after cardiovascular surgery, and cases with asystole or severe bradycardia need timely temporary pacing. However, routine temporary pacing wire insertion in cardiopulmonary bypass (CPB)-assisted cardiovascular surgery has been questioned for its noteworthy complications. This study aimed to quantify the risk of temporary pacing for cardiac arrest after CPB-assisted cardiovascular surgery.
METHODS: 2326 patients undergoing CPB-assisted cardiovascular surgery were enrolled. Age, sex, body mass index, preoperative rhythm, operation type, ablation, CPB pump, cardioplegia type and volume, hypothermia, circulation, CPB time, aortic clamping time were compared between patients having and not having temporary pacing according to the indications by multiple logistic regression (MLR). A scoring system was developed based on the β parameters of identified independent risk factors in MLR analyses. The score cutoff was determined by the negative likelihood ratio to exclude the need of temporary pacing.
RESULTS: 108 patients (4.6%) had temporary pacing. Old age (per year) (P < 0.001), preoperative atrial fibrillation (P < 0.001), long CPB time (per minute) (P = 0.017) contributed to the risk of cardiac arrest. Having mitral valve replacement (MVR) (P = 0.033), double valve replacement (DVR), MVR+tricuspid valvuloplasty (TVP) (P = 0.009), coronary artery bypass grafting (CABG)+MVR (P = 0.0495) (versus CABG) were independent risk factors. The scoring system, score = age (year)/40 + CPB time (min)/350+ [preoperative atrial fibrillation]×1, can quantitatively assess the associated risk with an area under receiver of characteristic (ROC) curve (AUC) of 0.74 (95% confidential interval 0.69-0.79) (P < 0.001). The negative likelihood ratio was < 0.1 when score≤1.138. Therefore, the cutoff of excluding temporary pacing was set as ≤1, which achieved a 0% false negative rate in our cases.
CONCLUSION: To minimize iatrogenic complications caused by unnecessary temporary pacing wire insertion, while ensuring patients with risks of asystole or severe bradycardia receive timely pacing, surgeons may identify cases with negligible risks of cardiac arrest through the scoring system.
PMID:40388430 | PMC:PMC12088002 | DOI:10.1371/journal.pone.0323795
Perfusion. 2025 May 19:2676591251340976. doi: 10.1177/02676591251340976. Online ahead of print.
ABSTRACT
ObjectiveThis study aims to evaluate the operational feasibility of a self-designed minimally invasive extracorporeal circulation integrated circuit (miECC) type IV system and to assess the effectiveness of the venous gas filter and automatic exhaust mechanism.MethodsA blood recycler was utilized in place of a heart to connect the arteriovenous line, venous gas filter, centrifugal pump head, and integrated membrane-lung connection, thereby establishing a loop circulation model for the miECC IV system. The venous gas filter was linked to a negative pressure suction device positioned at its top. During operation, gas was introduced from the venous end to determine the maximum gas storage capacity of the venous gas filter, the gas removal efficiency of the negative pressure suction device, the conversion capabilities between open and closed operations, and the adequacy of the pipeline design.ResultsThe minimally invasive extracorporeal circulation integrated pipeline demonstrated stable operational performance and successfully facilitated the transition between closed and open states. The venous gas filter exhibited a gas storage capacity of less than 80 mL across various flow rates. Experimental results indicated that at flow rates of 3.0-4.5 L/min, the automatic venting device effectively removed gas when the volume did not exceed 80 mL. At flow rates of 5.0-5.5 L/min, the device also successfully vented gas under the same conditions.ConclusionThe self-designed minimally invasive extracorporeal circulation integrated pipeline operates effectively and can transition between closed and open configurations. The gas filter effectively prevents venous gas accumulation. At the same time, the enhanced automatic gas-exhausting device, utilizing negative pressure, efficiently removes gas from the venous filter, thereby improving the safety of the closed-circulation operation.
PMID:40384547 | DOI:10.1177/02676591251340976
ASAIO J. 2025 May 14. doi: 10.1097/MAT.0000000000002458. Online ahead of print.
ABSTRACT
Heart transplantation using donation after circulatory death (DCD) has recently re-emerged alongside donation after brain death (DBD). This technique can potentially increase the number of available cardiac grafts. However, its clinical outcomes remain limited. We compared data from patients who received grafts from DCD versus DBD between 2012 and 2023. During this period, 131 adult patients underwent isolated heart transplantation. Of these, 25 (19%) were DCD donors. Donation after circulatory death donors were predominantly local (66% vs. 42%; p = 0.027). Donation after circulatory death graft recipients had fewer ventricular assist devices (12% vs. 35%; p = 0.025) and were less frequently urgent (12% vs. 39%; p = 0.009). Donation after circulatory death grafts had shorter myocardial ischemia and extracorporeal circulation times than DBD grafts (70 min [63.5-91] vs. 168 [83-219]; p < 0.001); (90 min [78-103) vs. 120 [96-148], p < 0.001). We observed no significant differences in the incidence of primary graft failure (16% vs. 22%; p = 0.526) or hospital mortality (8% vs. 14%; p = 0.410) between both groups. In conclusion, cardiac DCD demonstrates hospital outcomes comparable to those of cardiac DBD. Further long-term follow-up of these patients is necessary to determine their rejection, graft vascular disease, and mortality outcomes.
PMID:40377428 | DOI:10.1097/MAT.0000000000002458
MedEdPORTAL. 2025 May 15;21:11521. doi: 10.15766/mep_2374-8265.11521. eCollection 2025.
ABSTRACT
INTRODUCTION: Extracorporeal cardiopulmonary resuscitation (eCPR) has demonstrated patient outcome-driven benefits for those with out-of-hospital cardiac arrest in refractory ventricular fibrillation/pulseless ventricular tachycardia but remains an infrequent procedure requiring hands-on training.
METHODS: We created a high-fidelity simulation utilizing a cannulation manikin to simulate cardiac arrest in a 57-year-old patient in ventricular fibrillation refractory to standard resuscitation. Participants (consisting of emergency medicine and critical care resident and attending physicians, critical care fellows, advanced practice providers, nurses, pharmacists, and respiratory therapists) were instructed to respond to the simulation by recognizing the indication for eCPR and performing ultrasound-guided percutaneous extracorporeal membrane oxygenation (ECMO) cannulation to facilitate patient transfer to the cardiac catheterization lab. Participants rated their comfort level with various aspects of eCPR on a 5-point Likert scale, both presimulation (N = 27) and postsimulation (n = 17).
RESULTS: A total of 27 participants with varied levels of training completed the simulation, with positive feedback from all respondents on the postsimulation survey. A statistically significant increase in comfort scores from pre- to postsimulation was observed across all domains, including knowledge of eCPR candidacy (p < .001), cannulation procedures (p < .001), and overall process (p = .001).
DISCUSSION: Simulation is a valuable tool for ensuring procedural competency, especially for rarely performed and high-risk procedures such as ECMO cannulation. As eCPR becomes more prevalent, it is vital that simulation models be available and practiced on a multidisciplinary level to ensure general knowledge of the indications, procedures, and overall process of eCPR.
PMID:40376250 | PMC:PMC12078624 | DOI:10.15766/mep_2374-8265.11521