Extracorporeal cardiopulmonary resuscitation (ECPR) for pediatric cardiac arrest relies on enhanced resources and time-critical decision-making. We aimed to evaluate variations in systems and clinical practice among extr...Extracorporeal cardiopulmonary resuscitation (ECPR) for pediatric cardiac arrest relies on enhanced resources and time-critical decision-making. We aimed to evaluate variations in systems and clinical practice among extracorporeal membrane oxygenation (ECMO) centers that offer ECPR for neonatal and pediatric patients using an online survey. Fifty-three ECMO centers participated, representing all five ELSO chapters. All centers had a similar understanding of the ECPR definition. The predominant intensive care unit (ICU) patient population was: cardiac (34%), mixed (51%), general (7.5%), neonatal (1%), and mixed adult and pediatric (6.5%). All centers activated ECPR teams within 10 minutes of starting conventional CPR. Thirty-four (64%) centers keep a primed circuit available for ECPR 24/7. Thirty-six (68%) centers have an institutional protocol on ECPR. The cardiac surgeon was the most common (94%) cannulator. Staffing levels varied during working hours compared to nights and weekends. Thirty-eight (71%) centers did not apply cooling measures during and after the initiation of ECPR. Oxygenation and CO2 strategy varied between centers upon ECMO flow commencement. Forty-two (81%) centers aimed to maintain normothermia and avoid hyperthermia. Twenty-three (44%) centers have guidelines on organ donation and neurodevelopmental follow-up. Conclusion-significant variations exist in systems and clinical practice among ECMO centers offering pediatric ECPR. Further research is needed to understand the reasons for these differences and their impacts on patient outcomes.
Limited data describe children with pulmonary hypertension (PH) supported on extracorporeal membrane oxygenation (ECMO). This retrospective study (2017-2023), including children less than 18 years with PH at a quaternary...Limited data describe children with pulmonary hypertension (PH) supported on extracorporeal membrane oxygenation (ECMO). This retrospective study (2017-2023), including children less than 18 years with PH at a quaternary institution, identified associations with 1) mortality in ECMO-supported patients, 2) extracorporeal cardiopulmonary resuscitation (ECPR), and 3) inpatient death without ECMO (DWE). Among 113 children with PH supported on ECMO, the median age was 31 days (interquartile range [IQR]: 1-332), mortality was 41%, with 19% requiring ECPR. Lung disease was the most common PH-subgroup (52%). In multivariable models including pre-cannulation factors, ECPR (adjusted odds ratios [aOR]: 4.9 [1.4-17.2]) and pulmonary vein stenosis (PVS) (aOR: 7.5 [1.1-51.4]) were associated with mortality. After adding post-cannulation factors, ECPR (aOR: 9.41 [2.21-40.12]), PVS (aOR: 8.07 [1.05-61.93]), and longer ECMO duration (aOR: 3.21 [1.41-9.90]) were independently associated with mortality. Extracorporeal cardiopulmonary resuscitation was associated with cardiac intensive care unit (CICU) admission (OR: 11.7 [3.2-42.5]), single-ventricle physiology (OR: 6.6 [2.3-18.5]), and left heart disease PH-subgroup (OR: 8.9 [3.1-25.6]). Compared to ECMO-supported patients, DWE patients (n = 75) were older and more likely to have a tracheostomy, had lower pulmonary artery pressures, received fewer PH medications, and differed in PH-subgroup. While ECPR and PVS confer increased mortality risk in children with PH requiring ECMO, survival remains achievable. Incorporating patient-level data into prognostic frameworks may support individualized approaches to ECMO decision-making in this cohort.
Acute kidney injury (AKI) and fluid accumulation (FA) are common during extracorporeal membrane oxygenation (ECMO) support and are associated with increased morbidity and mortality. Despite their clinical importance, con...Acute kidney injury (AKI) and fluid accumulation (FA) are common during extracorporeal membrane oxygenation (ECMO) support and are associated with increased morbidity and mortality. Despite their clinical importance, contemporary data describing the epidemiology and management of these conditions remain limited. Founded in 2021, the Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Disease (WE-ROCK) seeks to improve outcomes for children requiring extracorporeal organ support. This report describes the design of the WE-ROCK ECMO study, an international, multicenter, retrospective cohort of patients supported with ECMO from 2018 to 2022. We include 1,264 children aged 0-25 years treated at 43 centers across 10 countries. Collected data include demographics, clinical characteristics before ECMO initiation, and detailed information from the first 14 days of ECMO support, including fluid intake and output, diuretic use, and continuous renal replacement therapy (CRRT) practices. Primary outcomes include major adverse kidney events at 90 days (mortality, dialysis dependence, and persistent kidney dysfunction) as well as functional status outcomes. The WE-ROCK ECMO study represents the largest international investigation of kidney and fluid-related variables in pediatric ECMO, providing critical insight into practice variation and the relationships among AKI, FA, CRRT, and clinical outcomes, and establishing a foundation for future interventional trials.
Aortic insufficiency (AI) is associated with worse outcomes in patients with left ventricular assist device (LVAD). Microaxial flow pumps (mAFP) are increasingly used to stabilize cardiogenic shock pre-LVAD, but their tr...Aortic insufficiency (AI) is associated with worse outcomes in patients with left ventricular assist device (LVAD). Microaxial flow pumps (mAFP) are increasingly used to stabilize cardiogenic shock pre-LVAD, but their transvalvular nature raises concerns for valvular damage. We studied AI incidence and outcomes in HeartMate 3 (HM3) recipients supported by mAFP. A single-center retrospective analysis (2014-2023) compared HM3 recipients bridged with mAFP to those supported by inotropes or other mechanical circulatory support. A secondary analysis used a propensity-matched cohort. The primary outcome was the incidence of significant (≥ moderate) AI at 6 and 12 months. Secondary outcomes were hemocompatibility-related adverse events, late right heart failure, aortic valve intervention (AVI), and mortality. A total of 170 HM3 patients were included: 27 with pre-LVAD mAFP and 143 without. Median age 58.9 years; 83.5% male; 37.6% White. More patients with pre-LVAD mAFP underwent AVI at implantation (22.9% vs. 13.2%, p = 0.130). At 1 year, significant AI was more prevalent in the mAFP group (22.2% vs. 4.2%, p = 0.003). In the propensity-matched cohort, 12 month significant AI was numerically higher with mAFP (20.8% vs. 5%, p = 0.198). Secondary outcomes did not differ. Pre-HM3 mAFP support is associated with higher rates of post-HM3 AI. Further large-scale studies are needed to validate these findings.
Extracorporeal cardiopulmonary resuscitation (ECPR) is an emerging rescue strategy for select patients with refractory out-of-hospital cardiac arrest (OHCA). Mobile ECPR programs aim to reduce low-flow time by initiating...Extracorporeal cardiopulmonary resuscitation (ECPR) is an emerging rescue strategy for select patients with refractory out-of-hospital cardiac arrest (OHCA). Mobile ECPR programs aim to reduce low-flow time by initiating extracorporeal membrane oxygenation (ECMO) before hospital arrival. Here we report the first ECPR performed within a patient's home in North America. We describe a 66-year-old woman with witnessed ventricular fibrillation OHCA who underwent successful venoarterial ECMO cannulation on scene, on the floor of her bedroom by a mobile ECMO team. Cannulation was performed under challenging conditions, including confined residential space, ongoing mechanical cardiopulmonary resuscitation, limited lighting, and improvised equipment placement. Following ECMO initiation, the patient converted to sinus rhythm, was transported directly to the cardiac catheterization laboratory, and achieved recovery of left ventricular systolic function before discharge. This case demonstrates the feasibility of on-scene, residential ECPR cannulation within a large metropolitan environment and highlights the critical importance of operational logistics, team coordination, and environmental adaptability. As mobile ECPR programs expand, systems-level considerations may be as important as technical cannulation expertise.
Napolitano D, Körver E, Cornelisse Y
… +17 more, Doddema A, Wang Y, Hendrix R, Verkerk K, Oostveen C, de Jong M, Gelsomino S, Simons J, Jiritano F, Serraino GF, Li X, Nia PS, Verheule S, Kawczynski MJ, Heuts S, Bidar E, Lorusso R
Distal limb ischemia is a frequent complication of femoro-femoral veno-arterial extracorporeal membrane oxygenation (V-A ECMO) associated with high morbidity and mortality. The optimal distal limb perfusion strategies re...Distal limb ischemia is a frequent complication of femoro-femoral veno-arterial extracorporeal membrane oxygenation (V-A ECMO) associated with high morbidity and mortality. The optimal distal limb perfusion strategies remain a challenge. Furthermore, during a prolonged weaning phase, a significant distal limb hypoperfusion due to the reduced ECMO-based flow may occur. This study evaluated the hemodynamics of different distal perfusion cannula (DPC) configurations (6Fr, 8Fr, or 10Fr introducer sheaths, 8Fr and 9Fr arterial pediatric cannulas [APC], and a 19Fr bidirectional cannula incorporating a perfusion port) through an in vitro V-A ECMO model. A simulated ECMO weaning trial was tested with gradually reduced ECMO flows and related distal perfusion. Four flow conditions were tested: continuous or pulsatile V-A ECMO flow with different simulated native cardiac output, and V-A weaning conditions. Key metrics included distal pressure, distal flow, and flow/resistance ratio. Reinforced APCs achieved the highest distal perfusion pressure and flow at the high ECMO flow, whereas the bidirectional cannula ensured consistent perfusion with low hydraulic resistance, outperforming both introducer sheaths and APCs, especially under reduced ECMO flows. Overall, the bidirectional cannula showed the most favorable hemodynamic performance across all ECMO flow conditions, followed by the APCs and the introducer sheaths.
Pediatric patients undergoing cardiac catheterization are at risk of major adverse events, including cardiac arrest and the need for extracorporeal membrane oxygenation support. The primary aim of this study was to chara...Pediatric patients undergoing cardiac catheterization are at risk of major adverse events, including cardiac arrest and the need for extracorporeal membrane oxygenation support. The primary aim of this study was to characterize the use of extracorporeal cardiopulmonary resuscitation (eCPR) and its outcomes in a large pediatric cardiac catheterization laboratory (PCCL). The secondary aims were to identify key clinical and procedural risk factors associated with eCPR deployment and to assess the utility of novel risk scoring metrics in predicting the need for eCPR. Between January 1, 2000 and December 31, 2023, eCPR occurred in 39 of 29,480 (0.13%) cases in the PCCL, with a statistically significant decrease over time. Most eCPR events occurred during interventional cases and were procedure-related. Extracorporeal cardiopulmonary resuscitation was not limited to those patients with elevated patient- or procedure-specific risk scores. Survival to discharge was 61.5%. Neurological complications were present in 46.2%. Further work will need to concentrate on better understanding which patients are at risk of eCPR in the PCCL and on refining risk scoring metrics to better capture that risk. Enhanced predictive risk modeling has the potential to reduce morbidity and mortality in the pediatric congenital heart disease population.
We present the first characterization of multiple organ dysfunction (OD) patterns and their associations with in-hospital mortality for children on extracorporeal membrane oxygenation (ECMO). We retrospectively assessed...We present the first characterization of multiple organ dysfunction (OD) patterns and their associations with in-hospital mortality for children on extracorporeal membrane oxygenation (ECMO). We retrospectively assessed OD for 317 children on ECMO support at a single center between 2011 and 2024. Organ dysfunction was calculated in 24 hour intervals using Pediatric Organ Dysfunction Information Update Mandate (PODIUM) criteria, as well as Pediatric Sequential Organ Failure Assessment (pSOFA) and Pediatric Logistic Organ Dysfunction-2 (PELOD-2) scores. Multiple logistic regression and survival analyses observed the same pattern; there was no difference in the number of concurrent PODIUM ODs between survivors and non-survivors before cannulation. However, starting as early as the day of cannulation, an accumulation of more ODs developed in non-survivors (median of 7 ODs [interquartile range {IQR}: 6-8]) as compared to survivors (6 [IQR: 5-7], p < 0.001). This difference persisted throughout the ECMO course and further widened after decannulation. Pediatric Sequential Organ Failure Assessment and PELOD-2 scores followed the same pattern and were significantly different between the two groups. Because differences in the number of concurrent ODs between survivors and non-survivors only began to emerge shortly after cannulation, this suggests that identifying intervenable risk factors before and peri-cannulation could change the trajectory of multiple OD and mortality risk.
Hospital-acquired infection (HAI) is a major complication in pediatric patients on extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT). Infection detection is challenging, as tradit...Hospital-acquired infection (HAI) is a major complication in pediatric patients on extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT). Infection detection is challenging, as traditional inflammatory markers such as C-reactive protein (CRP) and procalcitonin (PCT) are unreliable. Coagulopathy, common in both sepsis and extracorporeal life support (ELS), may serve as an early infection signal on ELS, but has not been explored. We conducted a single-center, retrospective, propensity-matched, case-control study comparing 62 pediatric patients with 85 HAIs to 169 matched controls without HAIs. Patients with HAIs had more ECMO circuit changes (20 vs. 3, p < 0.001) and greater anticoagulation variability. They required more heparin adjustments on ECMO (p < 0.001) and CRRT monotherapy (p = 0.002), and more bivalirudin adjustments on CRRT monotherapy (p = 0.014) and tandem therapy (p = 0.012). Absolute neutrophil count (ANC) was higher in infected patients (7.0 × 103/µl vs. 4.8 × 103/µl, p = 0.003), whereas CRP, PCT, and white blood cell count did not differ. Anticoagulation variability and ECMO circuit instability may represent early physiologic signals of HAIs in pediatric ELS. These may complement traditional laboratory tests, enabling earlier detection and intervention, and warrant prospective multicenter validation.
Postcardiotomy extracorporeal membrane oxygenation (PC-ECMO) is a critical rescue therapy for pediatric patients with refractory circulatory failure following cardiac surgery. This study aimed to evaluate in-hospital mor...Postcardiotomy extracorporeal membrane oxygenation (PC-ECMO) is a critical rescue therapy for pediatric patients with refractory circulatory failure following cardiac surgery. This study aimed to evaluate in-hospital mortality and identify potential risk factors for adverse outcomes in pediatric PC-ECMO patients, using data from the Chinese Society of Extracorporeal Life Support registry. We analyzed pediatric patients (< 18 years) who received PC-ECMO for circulatory support from December 2016 to April 2024. Surgical complexity was categorized using the Risk Adjustment in Congenital Heart Surgery-2 (RACHS-2) method. A total of 487 patients were included, with an overall in-hospital survival rate of 48.9%. Higher mortality was observed in neonates (61.4%) than in infants and children. Independent predictors of in-hospital mortality included RACHS-2 category 4-5 (odds ratio [OR]: 2.976, p < 0.001), aortic cross-clamp time greater than 90 minutes (OR: 1.931, p = 0.007), elevated lactate at 24 hours post-ECMO (OR: 1.221 per mmol/L, p < 0.001), and renal complications (OR: 3.135, p < 0.001). The combined model achieved an area under the curve of 0.737, outperforming the individual predictors. In-hospital mortality in pediatric patients receiving PC-ECMO remains high, and is strongly influenced by surgical complexity, aortic cross-clamp time, metabolic recovery, and renal function.
Neurological injury remains a major concern during neonatal aortic arch surgery. Near-infrared spectroscopy (NIRS) is commonly used to monitor cerebral oxygenation but does not provide direct quantitative information on...Neurological injury remains a major concern during neonatal aortic arch surgery. Near-infrared spectroscopy (NIRS) is commonly used to monitor cerebral oxygenation but does not provide direct quantitative information on cerebral blood flow. Transit-time flow measurement (TTFM) allows real-time volumetric flow assessment and may represent an additional tool for intraoperative monitoring of cerebral perfusion. We report the intraoperative use of TTFM for continuous monitoring of cerebral inflow during the repair of an interrupted aortic arch in a neonate. A perivascular flow probe was placed around the left common carotid artery to allow real-time measurement of carotid flow during cardiopulmonary bypass and selective cerebro-myocardial perfusion. Baseline flow in the brachiocephalic trunk was approximately 87 ml/min. During selective cerebro-myocardial perfusion, carotid flow remained stable at 45-50 ml/min. After aortic clamping, the carotid waveform changed from pulsatile to continuous, with a reduction in pulsatility index from 1.5 to 0.6. Flow values remained stable throughout arch reconstruction and were consistent with arterial pressure and NIRS monitoring. Transit-time flow measurement enabled direct real-time assessment of cerebral inflow during neonatal arch repair and provided quantitative information complementary to conventional monitoring. This technique may represent a useful adjunct for evaluating cerebral perfusion during complex neonatal cardiac surgery.
Extracorporeal life support (ECLS) components designed to reduce clot formation have been developed, but thrombosis remains a significant challenge, requiring systemic anticoagulation. To address this, we evaluated a nit...Extracorporeal life support (ECLS) components designed to reduce clot formation have been developed, but thrombosis remains a significant challenge, requiring systemic anticoagulation. To address this, we evaluated a nitric oxide (NO) releasing extracorporeal circuit (ECC) in a 5 day ovine venovenous ECLS model without systemic anticoagulation. Fifteen sheep, weighing 40-52 kg, were instrumented and assigned to three groups (n = 5 each): 1) Control- "naïve" ECC without anticoagulation; 2) Sham-CarboSil-coated ECC; and 3) NOSA-NO-releasing ECC+100 ppm NO in the sweep gas. Animals were monitored until meeting two of the three end-point criteria defined by device resistance five times baseline, greater than 50% decrease in blood flow after RPM adjustments, or post-oxygenator SO2 less than 95%. Extracorporeal Life Support flow was adjusted from 1 L/min (0-24 h), 0.75 L/min (25-48 h) to 0.5 L/min (49 h to study end). Data collected included hemodynamics, ECC performance, coagulation markers, cellular activity, and NO toxicity. The NO-releasing ECC prolonged survival to ~120 h with lower resistance and plasma-free hemoglobin, stable coagulation, and final MetHb levels less than 5%. Activated clotting times (ACTs) were less than 200 s in all groups. These findings suggest that NO-releasing ECCs in a highly translational preclinical ovine model may improve ECLS safety while reducing reliance on systemic anticoagulation.
Veno-venous (VV) extracorporeal membrane oxygenation (ECMO) has many limitations, including patient comfort and, oftentimes, mobility issues. Veno-pulmonary (VP) ECMO offers respiratory support without recirculation and...Veno-venous (VV) extracorporeal membrane oxygenation (ECMO) has many limitations, including patient comfort and, oftentimes, mobility issues. Veno-pulmonary (VP) ECMO offers respiratory support without recirculation and right heart support. For longer mechanical circulatory support (MCS) and improved mobility, non-femoral cannulation is preferred. The current standard is a double-lumen single-cannula via the right internal jugular vein. This requires cannula fixation to the head with a headband, which limits head movement and is uncomfortable due to its size. Flow fluctuations can also occur with cannula position. To address the limitations of VV ECMO and dual-lumen single-cannula PV ECMO, we developed a VP ECMO tunneling technique similar to tunneled catheters, utilizing two separate cannulae. Ten patients underwent this procedure at our institution with zero complications, vascular injuries, or cannula kinks. Maximum flow reached 5.2 L/min. Patients maintained head mobility and upper extremity function comfortably over a month period. This technique improves patient comfort, ensures stable cannula position, maintains reliable flow, and is cost-effective.
Dibert T, Wang W, Vázquez-Colón Z
… +11 more, Stukov Y, Jacobs J, Schecter M, Cornman J, Raymond S, Stahl R, Jaudon A, Philip J, Narasimhulu S, Bleiweis M, Peek G
Extracorporeal membrane oxygenation (ECMO) has been used to support children with pediatric acute respiratory distress syndrome (PARDS) who fail to respond to conventional management strategies. There is limited literatu...Extracorporeal membrane oxygenation (ECMO) has been used to support children with pediatric acute respiratory distress syndrome (PARDS) who fail to respond to conventional management strategies. There is limited literature and guidance on long-term ECMO support for severe PARDS and its impact on lung recovery. We present a case of a 4 month old female who developed severe necrotizing pneumonia following respiratory syncytial virus (RSV) infection. She had subsequent cardiogenic shock and deterioration of lung function, initially requiring venoarterial (VA) ECMO cannulation. She had improvement in cardiac function but developed large pneumatoceles with minimal functional lung tissue, prompting transition to venovenous (VV) ECMO via a right atrial double-lumen cannula and later multisite VV ECMO when she outgrew her previous cannulation. Nitric oxide was added to the sweep gas (sNO) to preserve the membrane oxygenator, extending the life of one oxygenator to over 5 months. The massive bilateral pneumatoceles regressed over time, and the compressed normal lung tissue recovered, allowing her to be weaned off ECMO support and decannulated after 233 days. She underwent tracheostomy decannulation and was discharged home on room air after nearly 10 months in the hospital.
Axillary percutaneous ventricular assist devices (pVADs) are increasingly utilized for refractory cardiogenic shock, yet standardized mobilization protocols are lacking. This study describes a structured mobilization pro...Axillary percutaneous ventricular assist devices (pVADs) are increasingly utilized for refractory cardiogenic shock, yet standardized mobilization protocols are lacking. This study describes a structured mobilization protocol and evaluates its implementation in 196 patients supported with an axillary pVAD from December 2020 to June 2025. Of this cohort, 131 (67%) were mobilized per a progressive multidisciplinary exercise protocol. Mobilized patients achieved significantly higher functional status by intensive care unit (ICU) discharge via Johns-Hopkins Highest Level of Mobility (JH-HLM) scoring (p < 0.001) and hospital discharge (p = 0.002). Longitudinal analysis demonstrated significant stepwise improvement in JH-HLM scores across sessions (p < 0.001) with statistical gains appearing as early as the third session (p < 0.001). Stratified analysis confirmed feasibility across all clinical outcomes, including recovery (p = 0.002), durable left ventricular assist device (LVAD) (p < 0.001), and heart transplant (p = 0.023). Regarding clinical outcomes, the mobilized cohort had a lower mortality rate (12% vs. 58%), higher rates of myocardial recovery (46% vs. 25%), durable LVAD implantation (21% vs. 9%), and heart transplantation (20% vs. 8%) (p < 0.001). This technical report details a safe, reproducible framework for patients with axillary pVAD support, showing that a structured mobilization protocol is feasible and associated with progressive improvement in functional status.
Jena A, Pareek A, Bateh S
… +25 more, Faiz S, Olaizola G, Huespe I, Bauque S, Prado E, Hanson A, Sujanyal S, Haney J, Amoroso P, Vilela S, Britton K, Matos N, Ojard M, Kiley S, Hannon R, Moreno JCL, Thomas M, Sareyyupoglu B, Sura L, Worsowicz G, Lyle M, Patel P, Franco PM, Sanghavi D, Shapiro A
Prehabilitation with Impella 5.5 offers hemodynamic support while allowing early mobilization, yet its overall effect on post-transplant recovery remains unclear. The aim was to assess recovery during Impella 5.5-support...Prehabilitation with Impella 5.5 offers hemodynamic support while allowing early mobilization, yet its overall effect on post-transplant recovery remains unclear. The aim was to assess recovery during Impella 5.5-supported prehabilitation and determine its association with early post-heart transplant outcomes, including a potential dose-response relationship with ambulatory activity. We conducted a single-center retrospective cohort study of adults bridged to transplant with Impella 5.5 between April 1, 2022 and September 30, 2024. Daily walking distance, recorded by nursing staff, served as the intervention. Primary outcome was postoperative hospital length of stay (LOS); the secondary outcome was time to extubation. Fine-Gray competing-risk models, adjusted for age, Sequential Organ Failure Assessment (SOFA) score, New York Heart Association (NYHA) class, and days of Impella support, assessed associations. Longitudinal recovery trajectories were analyzed with linear mixed-effects models incorporating restricted cubic splines. Among 82 eligible patients, 65 met the inclusion criteria. Patients who walked farther during Impella 5.5 support in the intensive care unit (ICU) had shorter hospital stays and were taken off the ventilator sooner after transplantation. The overall recovery peaked during the first 2-3 weeks of support, with smaller recovery thereafter, indicating that most functional recovery occurred early during prehabilitation.
The United Network for Organ Sharing (UNOS) Database was studied to evaluate the state of extracorporeal membrane oxygenation (ECMO) utilization before pediatric heart transplantation and to compare outcomes over the las...The United Network for Organ Sharing (UNOS) Database was studied to evaluate the state of extracorporeal membrane oxygenation (ECMO) utilization before pediatric heart transplantation and to compare outcomes over the last two decades. A total of 1,078 ECMO-supported pediatric patients (< 18 years at listing) were included in the final waitlisted cohort. Among these patients, 630/1,078 = 58.4% were in era 1 (2005-2014), and 448/1,078 = 41.6% were in era 2 (2015-2024). A total of 561/1,078 = 52.0% were transplanted, and total waitlist mortality (death or removal from waitlist due to clinical deterioration) was 376/1,078 = 34.9%. At all assessed timepoints, patients in era 2 demonstrated significantly higher waitlist survival compared to those in era 1, with survival estimates of 79.6% (95% confidence interval [CI] = 75.6-83.9%) vs. 65.6% (95% CI = 61.5-70.1%) at 1 month (log-rank p < 0.001). Additionally, listing in era 2 was protective of waitlist mortality (hazard ratio [HR] = 0.69; 95% CI = 0.57-0.85; p < 0.001). Among the 561 transplanted patients, 316/561 = 56.3% were transplanted in era 1, and 245/561 = 43.7% were transplanted in era 2. Overall posttransplant stroke rate was 8.1%, with no significant difference across era 1 and era 2 ( p = 0.466). Patients in era 2 had significantly better longitudinal posttransplant survival at 5 years (79.2% [95% CI = 73.7-85.2%] vs. 66.5% [95% CI = 61.5-72.0%], p < 0.001). In conclusion, ECMO support before transplantation is associated with lower waitlist mortality and improved long-term survival in the most recent decade.
Temporary mechanical circulatory support is recommended for cardiogenic shock management. Although surgical device implantation usually requires general anesthesia and orotracheal intubation with inherent hemodynamic ris...Temporary mechanical circulatory support is recommended for cardiogenic shock management. Although surgical device implantation usually requires general anesthesia and orotracheal intubation with inherent hemodynamic risk, local anesthesia with analgosedation in spontaneously breathing patients offers a promising alternative. This retrospective, single-center study analyzed 374 patients receiving surgical implantation of a micro-axial flow pump (mAFP) between January 2023 and December 2024. Fifty (13.4%) of them were performed under local anesthesia. Of the 49 investigated patients, 79.6% were male, with a median age of 62 years (53-67). Cardiogenic shock was caused by dilated (51.0%) and ischemic (26.5%) cardiomyopathy. Preoperatively, 91.8% of patients required catecholamines, with a median vasoactive inotropic score of 11 (3.8-24.0) and a median lactate level of 1.9 (1.4-3.4) mmol/L. According to the SCAI Shock classification (SCAI), 49.0% of patients were classified as stage C and 38.8% as stage D. Ten patients (20.4%) received combined mAFP and venoarterial extracorporeal life support. Sedation was most commonly achieved with remifentanil, and lidocaine 2% was used for local anesthesia at the implantation site. Four patients required conversion to general anesthesia due to respiratory or cardiac complications. Procedure-related complications were infrequent (n = 6). Implantation of mAFP under analgosedation and local anesthesia appears to be feasible.