Perfusion-Uk最新文献

{"title":"Is pulse pressure a mediator in the relationship between hyperoxemia and acute brain injury in veno-arterial extracorporeal membrane oxygenation (VA-ECMO) patients? An ELSO registry study.","authors":"Leon Fan, Winnie L Liu, Shi Nan Feng, Yaman B Ahmed, Matteo Di Nardo, Melissa A Vogelsong, Aniket S Rali, Akram M Zaaqoq, Daniel Brodie, Glenn J R Whitman, Sung-Min Cho","doi":"10.1177/02676591261427660","DOIUrl":"10.1177/02676591261427660","url":null,"abstract":"<p><p>IntroductionHyperoxemia is associated with increased mortality and acute brain injury (ABI) in patients receiving veno-arterial extracorporeal membrane oxygenation (VA-ECMO), though the role of native cardiac function in this relationship is unclear. Pulse pressure (PP) can reflect the proximal shift of dual circulation between ECMO and native heart function. We aimed to investigate the relationship between PP, hyperoxemia, and ABI.MethodsWe included adults (≥18 years) receiving peripheral VA-ECMO for cardiogenic shock from the ELSO Registry (2013-2024).ResultsABI occurred in 1012/8486 (11.9%) patients. In multivariable logistic regression adjusting for demographic and clinical covariates, severe hyperoxemia (PaO₂ ≥ 300 mmHg) remained independently associated with ABI (aOR: 1.40, 95% CI: 1.04-1.86). Low pulse pressure (PP) was more frequent among ABI patients, but PP was not independently associated with ABI after adjustment (aOR: 1.01, 95% CI: 0.81-1.25). PaO₂ and PP were inversely related. In mediation analysis PP accounted for 8.2% of the total effect of hyperoxemia on ABI overall (14% in the non-LV-vented cohort).ConclusionSevere hyperoxemia during ECMO was associated with increased ABI risk. Low PP was not. PP mediated the relationship between hyperoxemia and ABI. Reduced cardiac function may drive proximal dual circulation shift, predisposing patients to hyperoxemia and ABI. Hyperoxemia appears modifiable, and improved PP may reduce ABI.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":"41 1_suppl","pages":"126S-136S"},"PeriodicalIF":1.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147844588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ELSO guidelines development: A roadmap.","authors":"Erika R O'Neil, Giles J Peek, Andrea Ontaneda, Hwa Jin Cho, Christine Stead, Peter Rycus, Matteo Di Nardo","doi":"10.1177/02676591261425548","DOIUrl":"10.1177/02676591261425548","url":null,"abstract":"<p><p>The Extracorporeal Life Support Organization (ELSO) has progressively transformed its guideline framework to meet the increasing clinical, scientific, and operational demands of modern extracorporeal life support. Since its establishment in 1989, ELSO has supported Extracorporeal Membrane Oxygenation (ECMO) programs worldwide through education, data reporting, and consensus-building. Recent expansions in ECMO utilization, coupled with rapidly growing evidence, have necessitated a more structured, transparent, and internationally representative approach to guideline development.In 2023, ELSO expanded the Guideline Subcommittee (GSC) to ensure participation from all ELSO chapters and key professional disciplines. This expansion enables the implementation of a standardized workflow encompassing proposal submission, methodological review, authorship requirements, external peer review, plagiarism screening, and final Board approval. The updated process emphasizes consistency, timely production, and methodological rigor across all ELSO guidelines.This manuscript summarizes the current ELSO guideline development process and highlights four recently published guidelines addressing early mobility, adult neuromonitoring, ECMO in pregnancy and the peripartum period, and accidental hypothermia. Each guideline reflects the available evidence integrated with multidisciplinary expert input, with the goal of providing globally applicable, practical recommendations for ECMO clinicians. The review also outlines the formal guideline update cycle and ELSO's expanding collaborations with international societies to produce joint guidance documents.As ECMO practice continues to evolve, ELSO remains committed to advancing high-quality, accessible guidelines that support consistent standards of care across diverse healthcare systems. Future priorities include guidelines on ECMO during cardiopulmonary resuscitation, trauma, and other high-impact clinical areas, along with enhanced education and training pathways to strengthen ECMO practice globally.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":"41 1_suppl","pages":"8S-15S"},"PeriodicalIF":1.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147845321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modified Extracorporeal Circulation (mECC) for enhanced blood conservation in thoracoabdominal aortic surgery: A single-center experience.","authors":"Mehmet Cahit Sarıcaoğlu, Fatma Akça, Evren Özçınar, Ali İhsan Hasde, Nur Dikmen, Oğuzhan Durmaz, Ali Fuat Karaçuha, Levent Yazıcıoğlu","doi":"10.1177/02676591261446469","DOIUrl":"https://doi.org/10.1177/02676591261446469","url":null,"abstract":"<p><p>BackgroundThoracoabdominal aortic aneurysm (TAAA) repair is associated with significant risks of blood loss and organ ischemia. This study evaluates the efficacy of a novel, modified Extracorporeal Circulation (mECC) circuit system designed to enhance blood conservation and selective organ perfusion during open TAAA repair.MethodsIn this retrospective analysis, 7 patients underwent open thoracoabdominal aortic repair between January 2022 and October 2024 using a modified extracorporeal circulation system. The system incorporated integrated roller pumps for selective visceral and renal perfusion, a centrifugal pump, and an integrated autotransfusion system reservoir to optimize hemodynamic control and minimize allogeneic blood transfusion. Demographic data, intraoperative parameters, transfusion requirements, and postoperative outcomes were assessed.ResultsThe cohort consisted of 7 patients (57.1% male; mean age 54.4 ± 15.0 years). Crawford type I repair was performed in 71.4% of cases. The mean ECC duration was 104.4 ± 16.8 min, and mean aortic clamp time was 72.0 ± 18.5 min. The use of the integrated autotransfusion system resulted in reduced postoperative transfusion requirements and helped maintain hemoglobin levels. Postoperative complications included gastrointestinal events (42.9%), wound infections (42.9%), and spinal cord deficit (14.3%). Early in-hospital mortality was 14.3% (one patient, postoperative day 5). Kaplan-Meier analysis showed a 1-week survival rate of 85.7%, with all surviving patients remaining alive throughout the follow-up period.ConclusionThe modified ECC system with integrated roller pumps and cell-saver technology demonstrated favorable short-term outcomes and effective blood conservation in open TAAA repair. This reservoirless, isothermic, centrifugal circuit with peripheral cannulation may offer a safe and efficient alternative for complex aortic surgery. Larger, prospective studies with extended follow-up are warranted to confirm these findings and evaluate long-term durability.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"2676591261446469"},"PeriodicalIF":1.1,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147787495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Defining the learning curve of multi-vessel MIDCAB using CUSUM analysis.","authors":"Barış Timur, Zinar Apaydın, Batuhan Yazıcı, Alper Selim Kocaoğlu, Mehmet Emin Öner, Fatime Üçdağ, Zihni Mert Duman","doi":"10.1177/02676591261446466","DOIUrl":"https://doi.org/10.1177/02676591261446466","url":null,"abstract":"<p><p>BackgroundMinimally invasive direct coronary artery bypass (MIDCAB) has emerged as an alternative to conventional coronary artery bypass grafting; however, its adoption remains limited due to technical complexity and a steep learning curve, particularly in patients requiring multi-vessel revascularization. Objective data defining the learning curve of multi-vessel MIDCAB are scarce.MethodsThis retrospective study included consecutive patients who underwent multi-vessel MIDCAB between January 2020 and December 2025. Patients requiring single-vessel revascularization were intentionally excluded to ensure procedural homogeneity. The learning curve was evaluated using cumulative sum (CUSUM) analysis, and cases were stratified into three phases based on CUSUM inflection points. Perioperative and postoperative outcomes were compared across learning curve phases.ResultsA total of 169 patients were analyzed. CUSUM analysis identified three distinct learning phases: an initial learning phase (cases 1-48), a transition phase (cases 49-107), and a proficiency phase (cases 108-169). With increasing surgical experience, cardiopulmonary bypass time, aortic cross-clamp time, and total operative duration decreased significantly. The rate of conversion to open surgery declined markedly across learning phases, whereas in-hospital mortality and major postoperative complications remained low and comparable. These findings indicate improved procedural efficiency without compromising early clinical outcomes.ConclusionsMulti-vessel MIDCAB is associated with a substantial learning curve that can be objectively characterized using CUSUM analysis. Surgical proficiency is achieved only after a considerable number of cases, emphasizing the importance of adequate case volume and structured performance monitoring. These results provide a practical benchmark for centers aiming to adopt or expand multi-vessel MIDCAB programs.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"2676591261446466"},"PeriodicalIF":1.1,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147787456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current use and limitations of direct thrombin inhibitors in pediatric ECMO: A European survey.","authors":"Philippe Gardeton, Nicolas Drillaud, Ariane Willems, Nicolas Joram, Alexis Chenouard, Matteo Di Nardo, Chiara Giorni, Nina Buchtele, Pierre Bourgoin","doi":"10.1177/02676591261446158","DOIUrl":"https://doi.org/10.1177/02676591261446158","url":null,"abstract":"<p><p>IntroductionDirect thrombin inhibitors (DTIs) are an alternative to unfractionated heparin during pediatric ECMO. We aimed to describe their use and limitations across Europe.MethodsFifty-two pediatric EuroELSO centers were surveyed from July to December 2025. Thirty-seven respondents were analyzed across 11 countries.ResultsMost centers (n = 30, 81.1%) were referral sites for pediatric cardiothoracic surgery and 20 (54.1%) also provided non-ECMO mechanical support (<i>i</i>.<i>e</i>., ventricular assist devices [VADs]). Seventeen (45.9%) centers reported having used DTIs for the maintenance of systemic anticoagulation during ECMO at least once over the last years. Of these 17 centers, only 3 (17.6%) use DTIs as a first-line anticoagulant for pediatric ECMO. Most centers (n = 11/17, 64.7%) reserve DTIs for specific situations, such as VAD patients or suspected heparin-induced thrombocytopenia. Among the 17 respondents who reported using DTIs, bivalirudin (BIV) was identified as the preferred agent by 16 (94.1%). Dedicated protocols for DTIs management are implemented in 12 (70.6%) out of these 17 centers. Activated partial prothrombin time is the primary assay for monitoring BIV anticoagulation. From the 16 centers using BIV, only 4 (25.0%) reported having specific assays available. The main reported barrier for DTIs implementation was the lack of guidelines and published protocols (n = 14/20, 70.0%).ConclusionAlthough recent studies have discussed the interest in DTIs, their adoption as first-line anticoagulant during pediatric ECMO remains limited. Findings from this survey indicate the need for more evidence of DTIs clinical benefit, as well as robust guidelines regarding their protocolized use during pediatric ECMO.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"2676591261446158"},"PeriodicalIF":1.1,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147787484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Goal-directed perfusion during cardiopulmonary bypass: Physiological rationale, clinical evidence, and critical appraisal.","authors":"Hiroshi Mukaida, Yuki Minami","doi":"10.1177/02676591261446139","DOIUrl":"https://doi.org/10.1177/02676591261446139","url":null,"abstract":"<p><p>ObjectivesCardiopulmonary bypass (CPB) is essential to cardiac surgery but is associated with organ injury from non-physiological perfusion. Goal-directed perfusion (GDP) has emerged as a physiology-based strategy to optimize intraoperative perfusion by targeting specific hemodynamic and metabolic parameters, particularly oxygen delivery (DO₂). This review critically appraises the evidence supporting GDP during CPB, emphasizing comparative strategies, clinical outcomes, and limitations.MethodsA narrative review of the literature was conducted, incorporating evidence from randomized controlled trials, observational studies, meta-analyses, and international guidelines addressing perfusion strategies during CPB. This review included studies evaluating DO₂-guided, pressure-guided, and oxygen-metabolic-indicator-guided approaches, focusing on target definitions, outcome measures, and patient populations.ResultsRandomized and observational studies have consistently demonstrated that maintaining adequate DO₂ levels during CPB is associated with a reduced incidence of cardiac surgery-associated acute kidney injury (CSA-AKI), leading to the guideline endorsement of DO₂-guided perfusion. In contrast, evidence on neurological outcomes, length of stay, and mortality remains limited and inconsistent. Pressure-guided and venous-oxygen-saturation- or oxygen-metabolic-indicator-guided strategies provide complementary physiologic information but have not independently demonstrated superiority in randomized trials. Substantial heterogeneity has been reported in perfusion targets, outcome definitions, patient risk profiles, and potential trade-offs, including increased transfusion exposure and implementation complexity.ConclusionsCurrent evidence supports DO₂-guided perfusion as an effective strategy to reduce CSA-AKI during CPB, although its impact on broader clinical outcomes remains uncertain. Future studies should focus on individualized perfusion targets that account for patient-specific risk, metabolic demand, temperature, and autoregulatory capacity, rather than universal thresholds.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"2676591261446139"},"PeriodicalIF":1.1,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147730547","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of the myocardial protection efficacy between Del Nido cardioplegia and HTK cardioplegia in adult cardiac valve surgery.","authors":"Yinying Xue, Shangyu Chen, Mengqiu Jiang, Jilai Xiao, Xiao Shen, Huan Xu, Liang Hong, Xiaochun Song, Cui Zhang","doi":"10.1177/02676591261446483","DOIUrl":"https://doi.org/10.1177/02676591261446483","url":null,"abstract":"&lt;p&gt;&lt;p&gt;BackgroundWith the advancement of cardiopulmonary bypass technology, several cardioplegia solutions have been introduced, including del Nido cardioplegia (DN) and histidine-tryptophan-ketoglutarate (HTK) solutions. However, the cardioplegia solution with the most effective myocardial protection in patients undergoing cardiac valve surgery remains controversial. Therefore, we aimed to evaluate the efficacy of myocardial protection using DN cardioplegia solution versus HTK solution in patients who underwent adult cardiac valve surgery by measuring left ventricular strain using two-dimensional speckle-tracking echocardiography (2D-STE) combined with monitoring myocardial enzymes.MethodsThe study population consisted of 99 patients who underwent cardiac valve surgery and were transferred to the intensive care unit postoperatively at Nanjing First Hospital between March 2022 and June 2023. The patients were divided into groups based on the type of cardioplegia solution used intraoperatively: the HTK and Del Nido groups. Using conventional transthoracic echocardiography, we measured left ventricular end-diastolic diameter, left ventricular end-systolic diameter, stroke volume, left ventricular ejection fraction, left atrial diameter, and left ventricular outflow tract velocity time integral (VTI). Left ventricular global longitudinal strain (LV-GLS) was measured preoperatively and on postoperative days 1, 3, and 7 using the 2D-STE technique. The left ventricular longitudinal strain values were recorded in the apical long-axis, two-chamber, and four-chamber views (LAX-GLS, A2C-GLS, A4C-GLS). Serum levels of Troponin I (TNI) and heart-type fatty acid-binding protein (H-FABP) were monitored at each time point. Baseline characteristics, surgical details, biochemical indicators, and postoperative vasopressor use data were collected for both groups. Differences in conventional echocardiography, left ventricular strain, and myocardial enzyme markers between the two groups were compared. Perioperative composite adverse events, including malignant arrhythmias, sudden cardiac arrest, respiratory failure, low cardiac output syndrome, delirium, and mortality, were recorded in both groups.ResultsMyocardial injury is reflected by changes in cardiac enzyme levels and left ventricular strain measurements in patients undergoing valve surgery procedures. TNI and H-FABP concentrations in the two groups reached their peaks on the first day after surgery, then showed a gradual downtrend throughout the first week. Compared to the HTK group, the concentration of serum H-FABP at T1 was lower in the Del Nido group (28.42 ± 10.69 vs 20.31 ± 11.20 pg/mL, &lt;i&gt;p&lt;/i&gt; = 0.03), but there were no significant differences between the two groups at T0, T3, and T7. The serum cardiac troponin I (TNI) concentrations were comparable between the HTK group and the Del Nido group. Similarly, no significant differences were observed between the two groups for VTI, LV-GLS, LAX-GLS, A4C-GLS, ","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"2676591261446483"},"PeriodicalIF":1.1,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147730509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between platelet indices and next-day bleeding and clotting in children and adults on extracorporeal membrane oxygenation: A retrospective study.","authors":"Madhuradhar Chegondi, Aravinth Jawahar, Aditya Badheka, Oliver Karam","doi":"10.1177/02676591261445354","DOIUrl":"https://doi.org/10.1177/02676591261445354","url":null,"abstract":"<p><p>IntroductionBleeding and clotting phenotypes are common in patients supported with Extracorporeal Membrane Oxygenation (ECMO) and are associated with increased mortality. However, tools to distinguish bleeding from clotting phenotypes remain limited. Readily available platelet indices may help characterize these phenotypes.MethodsWe retrospectively studied patients admitted to neonatal, pediatric, and adult intensive care units (ICUs) at two centers from 2018 to 2022, who were on ECMO and required platelet transfusions. The association between pre-transfusion platelet indices (platelet count, mean platelet volume, platelet mass index) and bleeding or clotting on subsequent day was assessed with day-level univariable and multivariable logistic regression models.ResultsWe enrolled 268 patients receiving ECMO support (75% veno-arterial), with a median age was 51 years (IQR 18.9-65.6). A total of 1395 platelet transfusion events were analyzed, of which 18% were followed by bleeding and 5% by thrombosis within 24 h. After multivariable adjustment, higher pre-transfusion platelet counts independently associated with subsequent bleeding (adjusted odds ratio [aOR] 1.001, <i>p</i> = 0.03) but not with subsequent thrombosis (aOR 0.99, <i>p</i> = 0.18). Lower pre-transfusion mean platelet volume (MPV) were independently associated with increased bleeding risk (aOR 0.87, <i>p</i> = 0.049), while MPV was not associated with thrombosis (aOR 1.03, <i>p</i> = 0.47). Platelet mass index (PMI) was not independently associated with bleeding (aOR 1.00, <i>p</i> = 0.80) or thrombosis (aOR 1.00, <i>p</i> = 0.32). All platelet indices demonstrated poor discriminatory performance for predicting bleeding or thrombosis, with area under the curve values ranging from 0.42 to 0.55.ConclusionsAlthough platelet count and MPV were independently associated with subsequent bleeding, neither index reliably distinguished bleeding phenotypes. Improved tools are needed to predict hemostatic outcomes in patients supported with ECMO.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"2676591261445354"},"PeriodicalIF":1.1,"publicationDate":"2026-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147718849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing early detection of acute brain injury using heart rate variability in patients on venoarterial extracorporeal membrane oxygenation.","authors":"Shivalika Khanduja, Prachi Agarwal, Andrew Kalra, Mingfeng Cao, Yaman B Ahmed, Glenn Whitman, Nitish V Thakor, Sung-Min Cho","doi":"10.1177/02676591261445368","DOIUrl":"https://doi.org/10.1177/02676591261445368","url":null,"abstract":"<p><p>IntroductionEarly detection of acute brain injury (ABI) in patients on venoarterial extracorporeal membrane oxygenation (VA ECMO) is challenging. We aimed to investigate if heart rate variability (HRV) in the first 24 h of ECMO cannulation correlated with ABI in VA ECMO patients.MethodsWe retrospectively analyzed adults (≥18 years) on VA ECMO support in our center (June 2016-April 2022). ABI included ischemic stroke, intracranial hemorrhage (ICH), and hypoxic ischemic brain injury (HIBI) as diagnosed on neuroimaging performed within 48 to 72 h of ECMO cannulation. The primary outcome was ABI, and secondary outcomes were mortality and neurological outcomes at discharge assessed by modified Rankin Score (mRS), poor (mRS>3) and good (mRS≤3). Continuous electrocardiographic recordings during ECMO support were used to compute sample entropy (HRV-SE), a measure of HRV. Logistic regression models were used to evaluate the association between early HRV-SE and primary and secondary outcomes.ResultsAmong 139 patients (median age 56 years; mean ECMO duration 6 days; 66% male), 61 (44%) developed ABI, most commonly ischemic stroke (54%) followed by ICH (30%). HRV-SE in the first 24 h was lower in ABI versus no-ABI (0.29 ± 0.22 vs 0.41 ± 0.24; p = 0.009) and lower with central versus peripheral cannulation (0.31 ± 0.25 vs 0.41 ± 0.22; p = 0.02). Furthermore, ABI occurred slightly more frequently in patients with central compared to peripheral cannulation (23% vs 20%). Reduced HRV-SE within the first 24 h demonstrated strong diagnostic performance for ABI (90% accuracy, 100% sensitivity, 82% specificity; AUC = 0.86) and was also associated with increased mortality (0.30 ± 0.23 vs 0.42 ± 0.23; p = 0.002 and poor neurological outcomes (0.35 ± 0.25 vs 0.44 ± 0.16; p = 0.05).ConclusionsLower HRV-SE within 24 h of VA ECMO cannulation was associated with ABI, mortality, and poor neurological outcomes at discharge, supporting HRV-SE as a potential adjunctive early bedside screening marker that warrants prospective validation.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"2676591261445368"},"PeriodicalIF":1.1,"publicationDate":"2026-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147718876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Brain tissue perfusion during pulmonary endarterectomy - The impact of controlled regional cooling.","authors":"Roberto Veronesi, Sara Bozzini, Chiara Dezza, Andrea Pellegrini, Barbara Rossini, Elisa Milanesi, Federica Valsecchi, Monica Toscani, Andrea Maria D'Armini, Mirko Belliato","doi":"10.1177/02676591261429813","DOIUrl":"https://doi.org/10.1177/02676591261429813","url":null,"abstract":"<p><p>BackgroundOpen pulmonary endarterectomy (PEA) carries a high risk of neurological complications due to cerebral hypoperfusion and ischemia-reperfusion injury. Systemic cooling during extracorporeal circulation may not sufficiently reduce brain temperature. Combining systemic and targeted head-neck cooling may enhance neuroprotection.MethodsIn this single-center retrospective study, 22 PEA patients were analyzed. All underwent deep systemic hypothermia (22-24°C). Eleven received adjunctive external head cooling using the Aurora head-neck device, and eleven used ice packs (Control). Cerebral oxygenation was monitored with near-infrared spectroscopy (NIRS), and neuron-specific enolase (NSE) levels were measured preoperatively and postoperatively.ResultsCerebral desaturation events (rSO₂ < 40%) occurred in 22.2% of Aurora patients versus 77.8% of Controls (p = 0.030). Postoperative NSE levels were lower in the Aurora group; however, the difference did not reach statistical significance (p = 0.087).ConclusionDual-modality cooling combining extracorporeal hypothermia and targeted head-neck cooling improved intraoperative cerebral oxygenation and were associated with lower postoperative NSE levels; however, due to the limited sample size, no definitive conclusions regarding neuronal injury can be drawn.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"2676591261429813"},"PeriodicalIF":1.1,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147692781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}