Extracorporeal circulation

J Extra Corpor Technol. 2025 Jun;57(2):66-73. doi: 10.1051/ject/2024037. Epub 2025 Jun 16.

ABSTRACT

Medical procedural registries are uniquely positioned to support shared decision-making through risk prediction modeling, support quality assessment and improvement through performance benchmarking, and provide public reporting of evidence-based practices and outcomes. For example, the Centers for Disease Control and Prevention (CDC) consulted the Extracorporeal Life Support Organization (ELSO) registry to assess the severity of the swine flu outbreak in 2009-2010. The development and growth of The Society of Thoracic Surgeons Congenital Heart Surgery Database (STS-CHSD) has positively contributed to the congenital heart surgery community by developing objective mortality STAT categories and complexity stratification for operations, a common nomenclature for classifying operations and reporting the costs associated with complications for nine benchmark operations. Within the setting of adult cardiac surgery, the Perfusion Down Under Collaborative has used its registry to develop quality improvement initiatives, including those related to the management of arterial outlet temperature, glucose, and arterial pCO2. The PERForm registry leverages data from nearly 50 US hospitals to support targeted quality improvement initiatives within the setting of adult cardiac surgery. The PERForm registry participants receive benchmark reports and participate in quarterly collaborative learning meetings noted for unblinding hospital performance data. In 2014, with no current congenital cardiopulmonary bypass (CPB) registries, various experts within the congenital perfusion community and leaders from the PERForm registry began working to develop a pediatric perfusion registry. From this work, the PediPERForm Learning Network (PLN) and its associated congenital perfusion registry became active and began collecting data in October 2021.

PMID:40523133 | PMC:PMC12169737 | DOI:10.1051/ject/2024037

Circulation. 2025 Jun 17;151(24):1752-1754. doi: 10.1161/CIRCULATIONAHA.124.073533. Epub 2025 Jun 16.

NO ABSTRACT

PMID:40523048 | DOI:10.1161/CIRCULATIONAHA.124.073533

J Am Heart Assoc. 2025 Jun 17;14(12):e039673. doi: 10.1161/JAHA.124.039673. Epub 2025 Jun 16.

ABSTRACT

BACKGROUND: Fulminant myocarditis is life-threatening and often requires mechanical circulatory support. Predicting its clinical course is crucial, yet data on early recovery predictors, particularly with veno-arterial extracorporeal membrane oxygenation, remain lacking.

METHODS AND RESULTS: We aimed to identify prognostic factors of early recovery in fulminant myocarditis requiring veno-arterial extracorporeal membrane oxygenation by retrospective analysis of a nationwide registry in Japan. Early recovery was defined as successful weaning from mechanical circulatory support within 7 days and discharge without heart transplantation or long-term mechanical circulatory support. A total of 343 patients were analyzed; 71 were classified as early recovery and 272 as nonearly recovery. The early recovery group was significantly younger, had higher white blood cell counts, and lower creatine kinase-myocardial band level than the nonearly recovery group. To enhance clinical interpretability, we dichotomized continuous variables using optimal cutoff values derived from the Youden index. Multivariable logistic regression analysis showed the independent factors of early recovery were age ≤40 years (odds ratio [OR], 3.25), white blood cell count ≥11 000/μL (OR, 3.10), and creatine kinase-myocardial band ≤61 U/L (OR, 2.46), and if all conditions were fulfilled, the early recovery rate increased to 61.5%. Additionally, although not statistically significant, the number of rehospitalization with cardiovascular causes, death, or heart transplantation at 1-year follow-up was higher in the nonearly recovery group.

CONCLUSIONS: Our study suggested younger patients who have a strong inflammatory response but less myocardial damage on admission could recover earlier. Conversely, in cases where mechanical circulatory support duration is prolonged, careful monitoring is required for prolonged left ventricular dysfunction and subsequent prognosis.

REGISTRATION: URL: https://www.umin.ac.jp/; Unique identifier: UMIN000039763.

PMID:40521639 | DOI:10.1161/JAHA.124.039673

Metabolomics. 2025 Jun 14;21(4):80. doi: 10.1007/s11306-025-02276-6.

ABSTRACT

INTRODUCTION: Amino acids (AAs) serve diverse roles, and insufficient delivery is associated with worse outcomes in ill patients. In the case of congenital heart disease (CHD) surgery with cardiopulmonary bypass (CPB), AA levels are often dysregulated. Changes at the individual AA level, impact of clinical factors, and association with outcomes are less understood.

OBJECTIVES: We evaluated AA levels at multiple timepoints, the impact of pre-operative nutrition on these levels, and their association with the combined outcome: cardiac arrest, death, mechanical circulatory support, or ICU length of stay (LOS) above the 75% quantile of the cohort.

METHODS: Infants < 120 days undergoing CHD surgery with CPB were evaluated, excluding those < 2 kg or 34 weeks corrected gestational age. Relative AA quantification was performed pre-operatively, during rewarming, and 24 h post-ICU admission. Partial least squares discriminant analysis was used to compare AA levels between timepoints and feeding status. Univariate and multivariate analysis assessed for association with the combined outcome.

RESULTS: 16 of 19 AAs decreased during rewarming with 11 continuing to decrease at 24 h. Patients who did not receive enteral feeds pre-operatively had lower levels of certain AAs. Univariate analysis identified that decreased levels of glutamine, aspartate, and glutamate, and increased phenylalanine and lysine levels, were associated with increased risk of the combined outcome.

CONCLUSION: AA levels decreased following CPB and are impacted by pre-operative feeding status. Decreased levels of certain AAs are associated with increased risk of the combined outcome. Emphasizing pre-operative enteral nutrition and post-operative AA supplementation could improve outcomes in this population.

PMID:40515782 | DOI:10.1007/s11306-025-02276-6

J Clin Med. 2025 Jun 5;14(11):4011. doi: 10.3390/jcm14114011.

ABSTRACT

Background: Cardiogenic shock is a life-threatening condition characterized by the failure of the heart to maintain adequate circulation, leading to multi-organ dysfunction. While it is most commonly associated with acute myocardial infarction or cardiomyopathies, cardiogenic shock can also arise in unusual settings, such as severe malnutrition in patients with anorexia nervosa, a psychiatric disorder characterized by extreme restriction of food intake. Methods: Here, we describe the management of three patients with anorexia nervosa and severe cardiogenic shock, who were treated in our cardiological intensive care unit between December 2022 and January 2025. Two patients were successfully resuscitated after experiencing cardiac arrest, and two required mechanical circulatory support, including Venoarterial Extracorporeal Membrane Oxygenation and microaxial flow pump. The patients presented with a range of complications including multi-organ failure and respiratory distress. Due to the fragile balance between intensive cardiac and nutritional management, as well as the comorbidity of chronic malnutrition, therapeutic decisions were made carefully, including cautious electrolyte management, targeted nutritional therapy, and the use of advanced circulatory support. Conclusions: The treatment approach and beneficious outcomes underline the necessity of a multidisciplinary strategy in managing these critically ill patients with complex, interwoven pathologies. Our experience suggests that early recognition of cardiogenic shock and timely intervention with mechanical circulatory support may significantly improve patient survival in this high-risk cohort. Careful management of nutritional therapy and supplementation of trace elements and vitamins is crucial.

PMID:40507773 | PMC:PMC12155902 | DOI:10.3390/jcm14114011

Kyobu Geka. 2025 Apr;78(4):301-306.

ABSTRACT

Although our hospital is not a heart transplant facility, we accept many patients requiring temporary mechanical circulatory support (T-MCS), such as extracorporeal membrane oxygenation (ECMO), as part of our role as a destination therapy (DT) facility. From May 2021 to December 2024, we performed 17 cases of DT using HeartMate 3. The patients' average age was 58±7 years. The underlying conditions included ischemic heart disease (nine cases), idiopathic dilated cardiomyopathy (seven cases), and drug-induced cardiomyopathy( one case). The average J-HeartMate risk score was 1.52. In this paper, we discuss the current status and challenges of DT at non-heart transplant facilities and present our unique approach to T-MCS strategies and patient education.

PMID:40494527

Acta Anaesthesiol Scand. 2025 Jul;69(6):e70073. doi: 10.1111/aas.70073.

ABSTRACT

INTRODUCTION: Cardiac surgery in infants often triggers a severe inflammatory response. The role of biomarkers in predicting clinical outcomes in this group of patients has been debated in the literature. This study aimed to investigate the predictive value of 20 inflammatory biomarkers, in combination with clinical data, for acute kidney injury, ventilator support duration, and inotropic score following infant cardiac surgery by developing and comparing three models: Clinical-Data-Only, Biomarker-Only, and Combined.

METHODS: This secondary analysis of the MiLe-1 study included infants undergoing surgery with cardiopulmonary bypass. Biomarkers were measured before and after CPB. Using BIC-guided logistic regression, we developed and compared three multivariable models-Clinical-Data-Only, Biomarker-Only, and Combined-for each outcome. Model performance was assessed using c-statistics and p-contrast tests.

RESULTS: Regarding AKI risk prediction, the c-statistics for Biomarker-Only, Clinical-Data-Only, and Combined Model were 0.79, 0.60, and 0.78 respectively. The difference in performance between the Combined and Clinical-Data-Only Models was statistically significant (p < 0.001). Concerning ventilator support time prediction, the c-statistics were 0.80, 0.72, and 0.77 for the models respectively (p-contrast = 0.10). As for inotropic score prediction, the c-statistics were 0.83, 0.77, and 0.85 for the models (p-contrast = 0.007).

CONCLUSION: Inflammatory biomarkers may enhance risk stratification for postoperative outcomes in infant cardiac surgery. However, given the exploratory nature of this study, further validation in larger and more diverse cohorts is needed.

PMID:40492379 | PMC:PMC12150254 | DOI:10.1111/aas.70073

Front Cardiovasc Med. 2025 May 26;12:1588088. doi: 10.3389/fcvm.2025.1588088. eCollection 2025.

ABSTRACT

INTRODUCTION: Cardioplexol™ was recently proven effective and non-inferior to Buckberg's solution in a pivotal Phase-3 clinical trial. We hypothesized here that a standardized training program for surgeons without prior experience of Cardioplexol™ could increase its administration reliability and participate to its overall benefit.

METHODS: Open label, single group, observational study involving 29 surgeons from 7 centers in 3 countries. The training program included a theoretical part, and two surgical procedures performed under trainer supervision. In a subsequent evaluation part, surgeons operated on 4 additional patients. The number of major deviations from the pre-defined administration protocol (incorrect volume of initial/second/third/fourth dose, incorrect duration of injection of initial dose, incorrect timing of application of initial/second/third/fourth dose) was set as primary endpoint.

RESULTS: A total of 171 patients were screened of which 157 were operated on (57 in the training part and 100 in the evaluation part). No major deviations were observed. Other outcomes, including postoperative TnT and CK-MB profiles, cumulative inotropic support provided during the first 24 h after myocardial reperfusion, cardiac conversion rate, ICU length of stay, were all similar to or better than the results observed in the previous pivotal study.

CONCLUSION: Cardiac surgeons not familiar to Cardioplexol™ benefit from a structured and supervised training. This kind of training contributes to improve the efficiency and safety of a new cardioplegic solution such as Cardioplexol™.

TRIAL REGISTRATION: [ClinicalTrials.gov]: identifier [NCT03823521, and EudraCT No: 2018-002311-10].

PMID:40491721 | PMC:PMC12146177 | DOI:10.3389/fcvm.2025.1588088

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