Search Results (579)

Background: Sex-based differences in complications after venoarterial extracorporeal membrane oxygenation (VA-ECMO) for cardiogenic shock are not well defined. We compared 30-day coded acute kidney injury and other short-term outcomes between female and male patients receiving ECMO. Methods: We performed a retrospective multicenter cohort study using the TriNetX U.S. Collaborative Network from 2012 through 2025. Adults with cardiogenic shock supported with VA-ECMO were identified. Patients with a diagnosis-coded AKI (ICD-10-CM N17) recorded on or before the index ECMO procedure were excluded, and female and male cohorts were then matched 1:1 by propensity score on 23 characteristics. The primary endpoint was diagnosis-coded AKI between day 1 and day 30 after ECMO initiation. Secondary endpoints were all-cause mortality, newly diagnosis-coded sepsis, and newly diagnosis-coded ischemic stroke. Results: Among 11,229 adults meeting cohort criteria, 3773 were women, and 7456 were men. After exclusion of 8272 patients with previously coded AKI, 1152 women and 1805 men were eligible, and 1100 patients were matched in each group. Diagnosis-coded AKI occurred in 222 women (20.2%) and 276 men (25.1%) (risk ratio, 0.80; 95% confidence interval [CI], 0.69–0.94; hazard ratio [HR], 0.78; 95% CI, 0.65–0.93; p = 0.005). All-cause mortality was identical between groups (29.5% vs. 29.5%; risk ratio, 1.00; 95% CI, 0.88–1.14). Newly coded sepsis (5.1% vs. 6.3%) and newly coded ischemic stroke (4.0% vs. 3.2%) did not differ significantly. In an unadjusted Aalen–Johansen analysis performed in the unmatched eligible cohorts, the 30-day cumulative incidence of coded AKI was 21.6% among women and 27.8% among men. Conclusions: In this propensity-matched federated electronic health record cohort of adults with cardiogenic shock receiving VA-ECMO and without previously coded AKI, recorded female sex was associated with a lower 30-day risk of diagnosis-coded AKI. Mortality, newly coded sepsis, and newly coded ischemic stroke were similar. These findings are hypothesis-generating and support further investigation of sex-associated differences in datasets with granular renal and ECMO-specific variables. Full article

Background: Early extubation after bilateral lung transplantation (LT) may reduce intensive care unit (ICU) complications, but evidence from heterogeneous real-world cohorts and of its impact on mid-term functional recovery remains limited. Methods: We conducted a single-centre observational study of 149 consecutive adult bilateral LT recipients (February 2016–February 2023). Patients extubated within 24 h were assigned to the early extubation (EE) group (n = 63, 42%) (extubated within 24 h of the end of surgery), while those extubated later comprised the late extubation (LE) group (n = 86, 58%) (extubated beyond 24 h). Multivariable logistic regression identified predictors of late extubation. Outcomes included postoperative extracorporeal membrane oxygenation (ECMO), pneumonia, ICU length of stay, and spirometric parameters at 9–12 months after LT. Results: Higher Lung Allocation Score (LAS; adjusted OR 1.19, 95% CI 1.02–1.38) and intraoperative red blood cell (RBC) transfusions (adjusted OR 1.47, 95% CI 1.04–2.06) independently predicted late extubation. Compared with the LE group, EE recipients required less postoperative ECMO (2% vs. 23%; p = 0.008), had shorter inhaled nitric oxide treatment (7 vs. 17 h; p = 0.006), lower pneumonia rates (8% vs. 23%; p = 0.043), and shorter ICU stays (6 vs. 9 days; p = 0.005). In-hospital and 1-year mortality were similar between groups. At 9 ± 1 months, EE recipients showed better volumetric lung recovery, with higher FVC as a percentage of pre-transplant baseline (78.0% vs. 69.5%; p = 0.048) and higher TLC percentage predicted (77% vs. 68%; p = 0.015). Airflow indices and respiratory muscle strength did not differ. Conclusions: In a broadly inclusive LT cohort, higher LAS and intraoperative RBC transfusion independently predicted late extubation. Early extubation was associated with lower postoperative support requirements and was associated with higher FVC relative to pretransplant baseline, an association that should be interpreted in light of the unadjusted comparison and baseline heterogeneity rather than as evidence of a causal benefit. Full article

Vasoplegia remains one of the most challenging and incompletely understood complications across the spectrum of mechanical circulatory support (MCS). Initially described following cardiopulmonary bypass, it is increasingly recognized in patients supported with veno-arterial extracorporeal membrane oxygenation (V-A ECMO) and combined unloading strategies such as ECPELLA (ECMO and Impella support) as well as in patients bridged to heart transplantation with temporary or durable mechanical circulatory support (MCS). Despite occurring in different clinical settings, these syndromes share common pathophysiological features, including systemic inflammation, endothelial dysfunction, glycocalyx degradation, dysregulated nitric oxide signaling, neurohormonal imbalance, microcirculatory impairment and severe vasomotor dysregulation. Although vasoplegia is commonly considered a technology-specific complication, growing evidence suggests that CPB-associated vasoplegia, postcardiotomy vasoplegic syndrome, ECMO-related vasodilatory shock and distributive shock during ECPELLA may represent distinct manifestations of a common pathobiological process driven by blood–artificial surface interactions, ischemia–reperfusion injury, hemolysis and immune activation. This narrative review proposes a unified framework of vasoplegia across the continuum of MCS. Key mechanistic pathways and current therapeutic strategies, including catecholamines, vasopressin, angiotensin II, methylene blue and hydroxocobalamin, are discussed. By integrating evidence from cardiac surgery, critical care and mechanical circulatory support, vasoplegia is presented as a unifying syndrome of extracorporeal circulation. This perspective may support earlier recognition, phenotype-based management and the development of more targeted therapeutic strategies in a clinically significant yet underexplored area of cardiovascular critical care. Full article

Background and Clinical Significance: Peripheral veno-arterial extracorporeal membrane oxygenation (VA-ECMO) substantially alters aortic flow dynamics, generating catastrophic false-positive pathology on standard imaging. We report a case of ECMO-induced artifacts mimicking a Stanford type A aortic dissection (TAAD), which led to an unnecessary exploratory sternotomy. Case Presentation: A 67-year-old man underwent extracorporeal cardiopulmonary resuscitation (ECPR) for a shockable out-of-hospital cardiac arrest. Post-resuscitation chest computed tomography angiography (CTA) and preoperative transesophageal echocardiography (TEE) demonstrated a prominent flap-like structure in the ascending aorta, prompting emergency sternotomy. Intraoperative exploration revealed no intimal tear. Subsequent evaluation confirmed an acute anterior myocardial infarction, managed with coronary intervention. Following a dismal neurological prognosis due to hypoxic encephalopathy, VA-ECMO was palliatively withdrawn on day 9, and the patient expired on day 19. The interaction between retrograde ECMO flow and varying levels of intrinsic cardiac function dictates the topology of flow disturbances. Absent native flow creates contrast layering within the aortic root, whereas preserved native flow creates a volatile downstream watershed zone. Based on these distinct phenotypes, we propose a novel conceptual framework for tailor-made imaging strategies titrated to native flow strength—such as temporary ECMO flow reduction for preserved native output, or circuit contrast injections for profound cardiac depression. Conclusions: ECMO-related artifacts present substantial diagnostic pitfalls. Clinicians should adopt a context-aware approach, integrating multi-modality imaging with hemodynamic status to implement individualized, physiologically guided imaging protocols. Full article

Objective: Intentional pharmaceutical poisoning is one of the most common methods of self-harm among adolescents and frequently results in pediatric intensive care unit (PICU) admission because of the potential for severe pharmaceutical-related toxicity. Although mortality is generally low, a subset of patients may require advanced intensive care interventions. Methods: This retrospective observational cohort study was conducted in the pediatric intensive care unit of a tertiary referral hospital between January 2022 and January 2026 and included adolescents admitted to the PICU due to intentional pharmaceutical poisoning. Demographic characteristics, psychiatric history, clinical findings, laboratory parameters, administered treatments, and clinical outcomes were evaluated. The primary outcome measure was defined as the requirement for a major PICU intervention, including invasive or noninvasive mechanical ventilation, vasoactive support, continuous renal replacement therapy (CRRT), therapeutic plasma exchange, extracorporeal membrane oxygenation (ECMO), intensive care-level seizure management, or clinically significant arrhythmia requiring intensive care support. Patients with and without major PICU intervention requirements were compared. Results: A total of 125 adolescent patients were included in the study, and the majority were female. Multiple-pharmaceutical ingestion and a history of psychiatric diagnoses were common comorbidities. Although the clinical course was stable in most patients, 15 patients (12%) required major pediatric intensive care interventions. Patients requiring major interventions had lower Glasgow Coma Scale scores, higher lactate levels, more frequent symptomatic presentation, and higher rates of Poisoning Severity Score (PSS) ≥ 3. Overall mortality in the cohort was low. Conclusions: Although most adolescents admitted to the PICU due to intentional pharmaceutical poisoning experienced mild-to-moderate toxicity, a subgroup required advanced intensive care support. Neurological impairment at presentation, symptomatic clinical presentation, and markers of increased physiologic stress appeared to be associated with more severe clinical courses. In pediatric poisonings, evaluating the need for advanced intensive care support rather than focusing solely on mortality may better reflect clinical severity. Full article

Extracorporeal membranes oxygenation (ECMO) has been proposed as a useful tool to support ablation of unstable ventricular arrhythmias (VAs). The aim of this study is to assess the clinical outcome of cardiopulmonary support of VAs catheter ablation during a long-term follow-up. In this retrospective observational study, we included 47 patients referred to our center for catheter ablation of repeated episodes of hemodynamically unstable sustained VAs between April 2016 and February 2025. All patients underwent catheter ablation, supported by ECMO, of ventricular arrhythmias symptomatic for syncope or presyncope. The primary endpoint is overall cardiovascular death, including death due to heart failure, cardiogenic shock or ventricular arrhythmias. In particular, arrhythmic death was defined as death occurring during an electrical storm. After a median follow-up of 28 (7–63.5) months, cardiovascular death occurred in 26 patients (55.3%) but arrhythmic death befell only 11 patients (23.4%). All deaths occurred within 6–7 years of follow-up. No difference exists between ischemic and non-ischemic cardiomyopathy with regard to primary endpoints. Moreover, arrhythmic recurrences occurred in 21 patients (44.7%), among whom only 15 (31.9%) had ICD shocks; 25 patients (55.3%) encountered further hospitalizations. ECMO may facilitate procedural mapping and acute ablation success in selected high-risk patients, while long-term prognosis remains mainly driven by advanced heart failure. Full article

Objective: Extracorporeal Membrane Oxygenation (ECMO) has long been used in the treatment of acute respiratory and circulatory failure by providing time for damaged organs to recover. The aim of this study was to evaluate the safety and feasibility of interhospital transport of pediatric patients with acute respiratory failure who had undergone venovenous extracorporeal membrane oxygenation (VV ECMO) initiated at the referring facilities. Subjects and methods: Because of the critical condition of these patients, the high risk associated with transport, and the failure of conventional therapies, ECMO was initiated at the referring center. After cannulation, the patients were transported by ground ambulance to the Pediatric Intensive Care Unit in Poznań for further treatment. Results: Fourteen patients aged 2 months to 11 years with acute respiratory failure were transferred to our ECMO center. The mean time from decision to departure was 7.62 h, and the mean ICU stay before transfer was 4.14 days. The mean transport distance was 157.5 km. No mortality occurred during transport, and no serious adverse events were reported. Two technical complications were noted. Conclusions: Interhospital transport of pediatric patients on VV ECMO initiated at referring centers was feasible and safe, with favorable outcomes in patients who have exhausted conventional intensive care options. Effective collaboration between referring hospitals, ECMO centers, and emergency medical services was essential for optimal results. Full article

Extracorporeal cardiopulmonary resuscitation (ECPR) has emerged as a promising strategy for selected patients with refractory cardiac arrest, improving survival and the likelihood of favorable neurological outcomes. However, neurological prognostication in this setting remains highly challenging and insufficiently standardized. The pathophysiological complexity of ECPR, including global ischemia–reperfusion injury, altered cerebral perfusion, systemic inflammation, anticoagulation and prolonged sedation, limits the reliability of conventional post-cardiac arrest prognostic tools. This narrative review provides a focused and clinically oriented synthesis of current evidence on brain injury and neuroprognostication in patients undergoing veno-arterial extracorporeal membrane oxygenation (V-A ECMO) for cardiac arrest. Key determinants of neurological outcome across pre-ECMO and peri-resuscitation phases are examined, alongside the role and limitations of multimodal monitoring strategies, including neurological examination, electroencephalography, neuroimaging, cerebral oximetry and circulating biomarkers. Particular attention is given to the timing of prognostication and the risk of premature or inaccurate predictions leading to self-fulfilling prophecies. Emerging data suggest that neurological recovery in ECPR patients may be delayed, supporting a more cautious and time-adapted approach. A pragmatic, multimodal framework for neurological assessment in this population is outlined. By addressing current gaps and proposing a structured approach, this review aims to inform clinical decision making and contribute to improved neurologically meaningful survival in ECPR-treated cardiac arrest. Full article

Background: Biotrauma from invasive mechanical ventilation (IMV) and extracorporeal membrane oxygenation (ECMO) drives systemic inflammation, metabolic dysregulation, and organ dysfunction in critically ill patients. Therefore, this study aimed to identify clinical and metabolomic features associated with ICU mortality in patients receiving IMV or ECMO, as these remain incompletely characterized. Methods: The retrospective analysis included 30 ICU patients on IMV and 22 on ECMO. Metabolomic and proteomic profiling were performed using ultra-high-performance liquid chromatography coupled with high-resolution mass spectrometry (UHPLC-HRMS), and serum spectral analysis by Fourier-transform infrared spectroscopy (FTIRS). Significant variables were incorporated into multivariate logistic regression models, ranked by AIC, AUC, and statistical significance. Model performance was evaluated using stratified 5-fold cross-validation. Final models were adjusted for relevant demographic and clinical covariates. Results: The IMV cohort showed discriminatory FTIRS wavenumbers across all preprocessings, and 155 metabolites plus 14 proteins were significantly altered, with unadjusted models achieving mean AUCs above 0.9. The ECMO cohort showed discriminatory FTIRS wavenumbers in one preprocessing, and 15 metabolites plus 3 proteins were highlighted. FTIRS, metabolomic, and proteomic models reached mean AUCs of 0.967, 0.867, and 0.783, respectively, with lower stability during cross-validation. Adjustment for demographic and clinical covariates reduced model robustness. Conclusions: Stronger and more reproducible molecular signatures related to ICU mortality were observed in the IMV cohort, whereas the ECMO cohort showed reduced model stability, likely reflecting increased biological heterogeneity and small sample size. These findings support the utility of integrated omics for characterizing critical illness and outcome stratification, while reinforcing the need for validation in larger and independent cohorts. Full article

Background: Extracorporeal membrane oxygenation (ECMO) is a vital intervention for acute respiratory and cardiac failure. This study evaluates the outcomes, safety, and long-term survival of patients stabilized at external hospitals and transferred to a supra-regional center under ECMO support, comparing results with current global standards. Methods: A retrospective analysis was conducted on 20 patients (14 male, 6 female, mean age 50.6 years) transferred to our hospital. The cohort was divided into veno-venous (vv-ECMO, n = 16) and veno-arterial (va-ECMO, n = 4) support. Key metrics included weaning success, complication rates, and long-term survival determined via follow-up with a median follow-up of 23 months. Results: Inter-hospital transfer was highly safe; 0% mortality occurred during transport despite a mean distance of 28.7 km (max. 54 km). In the mixed cohort, weaning was successful in 60% of cases, evaluated via 30-day survival. Major complications occurred in eight patients (40%), including bleeding (n = 6) and compartment syndrome (n = 2). Long-term survival analysis showed that patients who survived the first 30 days had a high probability of continued long-term stability. Conclusions: Remote ECMO cannulation followed by inter-hospital transfer is a safe strategy. While va-ECMO patients face higher mortality due to the underlying severity of cardiac failure, vv-ECMO shows favorable survival rates for ARDS. The specialized “ECMO-retrieval team” model is essential for extending advanced life support to peripheral hospitals. Full article

Transseptal puncture (TSP) is a critical technique for accessing the left atrium in various structural and electrophysiological cardiac procedures. Originally introduced for diagnostic catheterization in the mid-20th century, it has evolved into a cornerstone of modern interventional cardiology. This article was designed as a targeted narrative review, rather than a systematic or comprehensive review, and synthesizes selected peer-reviewed evidence spanning 1955 to 2025, retrieved through a targeted literature search. We explore the anatomical foundations of TSP, its historical development, and modern refinements such as radiofrequency-assisted puncture, balloon septoplasty, and fluoroless or image-fusion-guided access. Clinical applications—including mitral valve interventions, left atrial appendage closure, and decompression during extracorporeal membrane oxygenation (ECMO)—are reviewed alongside safety considerations and complication management strategies. Advances in imaging modalities, including three-dimensional echocardiography and computed tomography, have enhanced precision and safety. Because of the narrative design, the review emphasizes clinical relevance, procedural applicability, and evidence synthesis without formal risk-of-bias scoring or quantitative evidence grading. Overall, TSP demonstrates a high success rate and low complication profile when performed with appropriate imaging and operator expertise. Ongoing innovation in technique and technology continues to expand its utility across cardiac disciplines. Full article

Background: Percutaneous dilatational tracheostomy (PDT) is increasingly performed without interrupting therapeutic anticoagulation in critically ill patients with extracorporeal membrane oxygenation (ECMO) or ventricular assist devices (VADs). However, the safety of PDT performed under ongoing therapeutic anticoagulation, particularly regarding periprocedural bleeding risk, remains uncertain. This study compared periprocedural bleeding complications between patients undergoing PDT under therapeutic and prophylactic anticoagulation. Methods: This observational cohort study in a cardiovascular ICU included all patients who underwent PDT between 2016 and 2024. The cohort comprised critically ill patients receiving uninterrupted therapeutic anticoagulation for ECMO, VAD, MVs (mechanical heart valves), and arrhythmia, as well as patients receiving low-dose anticoagulation for venous thromboprophylaxis. The primary endpoint was any severe procedure-related or late bleeding complication, while secondary endpoints included all minor procedure-related or late bleeding complications. Results: The cohort included 174 patients of whom 84 (48.3%) underwent PDT receiving uninterrupted therapeutic anticoagulation for ECMO, VAD, MVs, or arrhythmia. None experienced severe procedure-related bleeding. The incidence of major and minor bleeding complications did not differ between patients receiving uninterrupted therapeutic anticoagulation and those undergoing PDT under low-dose prophylactic anticoagulation. Other bleeding complications were also rare and comparable between the two groups. Conclusions: In this cohort, the incidence of severe and minor bleeding was low among patients undergoing PDT under uninterrupted therapeutic anticoagulation for ECMO, VAD, MVs, or arrhythmia and did not differ from that in patients receiving low-dose anticoagulation for venous thromboprophylaxis. BMI, but not anticoagulation intensity, was independently associated with post-PDT bleeding. Full article

Preterm infants, especially extremely preterm infants under 28 weeks of gestation, face high mortality rates due to respiratory distress resulting from pulmonary immaturity. Conventional mechanical ventilation and extracorporeal membrane oxygenation (ECMO) therapy inevitably cause irreversible lung injury or severe complications, respectively. Here, we developed a microfluidic oxygenator (MO) mimicking the human alveolar-capillary barrier to provide respiratory support for preterm infants. These structures promoted uniform flow distribution, reduced high-shear stress and flow stagnation, and improved gas exchange efficiency. In vitro experiments demonstrated that a single-layer MO raised blood oxygen saturation from 64.7% to 96.5% at 8 mL/min, with a corrected vol% oxygen transfer of 5.24% (52.4 mL O₂/L blood). Hemolysis and coagulation measurements after a 6 h circulation confirmed good hemocompatibility, with most blood damage attributable to the pump. An eight-layer stacked MO was configured with a total priming volume of approximately 5.6 mL and a pressure drop of 25–35 mmHg at 24–40 mL/min, indicating its potential in pumpless extracorporeal circulation for preterm neonates. This MO holds promise for providing minimally invasive and customizable respiratory support in an artificial uterus system. Full article

Background/Objectives: Adult patients supported with extracorporeal membrane oxygenation (ECMO) frequently require invasive diagnostic, therapeutic, surgical, or bedside procedures during ongoing extracorporeal support. These procedures are clinically challenging because ECMO-related anticoagulation, platelet dysfunction, acquired coagulopathy, and circuit-related coagulation activation may increase both bleeding and thrombotic risks. This systematic review evaluated the safety of invasive procedures performed during adult ECMO support, excluding tracheostomy/tracheotomy because this procedure has recently been addressed in a dedicated systematic review. Methods: A systematic search of PubMed/MEDLINE and Scopus was performed. The final bibliographic data collection was completed in April 2026. Studies were eligible if they included adult ECMO or extracorporeal life support patients undergoing invasive procedures during ongoing ECMO support, or with ECMO used as procedural support, and reported at least one procedure-specific safety outcome. Primary outcomes were procedure-related complications, bleeding, major bleeding, and transfusion requirements. Secondary outcomes included thrombotic and circuit-related complications, oxygenator exchange, reintervention, reoperation, procedural failure, ECMO duration, intensive care unit and hospital length of stay, and mortality. Results: The final qualitative synthesis included 46 studies, comprising 26 studies from PubMed/MEDLINE and 20 additional unique studies from Scopus. Included procedures were grouped into six domains: airway, bronchoscopic, and tracheobronchial procedures; thoracic surgery and lung resections; abdominal surgery, gastrointestinal endoscopy, and decompressive laparotomy; lung transplantation and perioperative extracorporeal life support; cardiovascular, vascular, pulmonary embolism-related, and mechanical circulatory support-related procedures; and mixed non-cardiac surgery. Airway and bronchoscopic procedures generally showed high procedural success in selected cohorts, although registry-level tracheal procedure data reported hemorrhagic complications in 26.0% and surgical-site bleeding in 13.0%. Emergency thoracic and abdominal procedures carried the highest bleeding, transfusion, reintervention, and mortality burden. Lung transplantation studies showed that ECMO can be integrated into perioperative pathways, but hemothorax, transfusion, thromboembolism, and anticoagulation strategy remained central safety issues. Conclusions: Invasive procedures during adult ECMO are feasible in selected patients and experienced centers, but procedural safety varies markedly by procedure type, urgency, baseline disease severity, and anticoagulation strategy. A procedure-centered, multidisciplinary approach with individualized anticoagulation management and careful planning is essential. Full article

Background: Stroke significantly increases morbidity and mortality in patients receiving extracorporeal membrane oxygenation (ECMO). This study evaluates the prognostic impact of stroke subtypes, acute ischemic stroke (AIS) and hemorrhagic stroke (HS), and neurologic injury severity in a contemporary adult population. Methods: We conducted a retrospective cohort study using the TriNetX federated electronic health record network, including adult patients who underwent ECMO between 1 October 2015 and 31 December 2025. Stroke was defined as a first-instance diagnosis of AIS, HS, or unspecified cerebrovascular event occurring within 24 h of ECMO cannulation during the index hospitalization. Propensity score matching (1:1 nearest neighbor) was performed to balance baseline demographics, comorbidities, anticoagulant use, and ECMO modality between the stroke and non-stroke cohorts. Primary outcomes included all-cause mortality at 30 days, 90 days, and 1 year. Secondary outcomes included cardiac arrest, seizures, palliative care utilization, and hospital readmission. Kaplan–Meier survival analysis and multivariable Cox proportional hazards modeling were performed. Results: Among 18,981 ECMO patients, 1481 (7.8%) developed a stroke within 24 h of ECMO cannulation, including 814 AIS (54.9%), 454 HS (30.6%), and 213 unspecified cerebrovascular events (14.4%). After propensity score matching, stroke was associated with significantly higher all-cause mortality at 30 days (RR 1.16), 90 days (RR 1.18), and 1 year (RR 1.18), all p < 0.05. Stroke was also associated with higher rates of cardiac arrest, seizures, hospital readmission, and palliative care utilization (all p < 0.001). AIS was associated with significantly lower mortality than HS at 30 days, 90 days, and 1 year (all p < 0.0001). In multivariable Cox regression, only HS was independently associated with increased 30-day mortality compared with no stroke. Markers of neurologic injury severity, including cerebral edema, brain compression, and coma, were among the strongest independent predictors of mortality. Conclusions: Stroke occurring early after ECMO cannulation is associated with substantially worse short- and long-term survival, with hemorrhagic subtype and markers of neurologic injury severity driving the strongest prognostic signals. These findings support early stroke recognition and subtype-informed prognostic discussions in ECMO patients. Full article