ASAIO Journal最新文献_第7页

Driveline Relocation With Omentoplasty for Severe Ventricular Assist Device-Specific Infection. 驱动系重建术治疗严重心室辅助装置特异性感染。

IF 2.2 3区医学

ASAIO Journal Pub Date : 2026-09-09 DOI: 10.1097/MAT.0000000000002853

Anna Stegmann, Pia Lanmüller, Georg Arlt, Felix Schoenrath, Evgenij V Potapov, Wenzel Schöning, Johanna Mulzer

{"title":"Driveline Relocation With Omentoplasty for Severe Ventricular Assist Device-Specific Infection.","authors":"Anna Stegmann, Pia Lanmüller, Georg Arlt, Felix Schoenrath, Evgenij V Potapov, Wenzel Schöning, Johanna Mulzer","doi":"10.1097/MAT.0000000000002853","DOIUrl":"https://doi.org/10.1097/MAT.0000000000002853","url":null,"abstract":"Percutaneous driveline infections (DLI) are a serious complication in patients with a durable ventricular assist device, affecting approximately 50% within 5 years. When conservative treatment fails, driveline relocation combined with omentum major wrapping (OMW), leveraging its anti-inflammatory properties, may serve as a bailout approach. In this retrospective single-center analysis, 72 patients who underwent driveline relocation with OMW for severe DLI between October 2015 and September 2024 were included. The 1 year reinfection incidence was 53.0% overall, and 62.3% among patients with complete 12 months of follow-up. Median time-to-reinfection was 3 months, with 84.2% involving the same pathogen as preoperatively. Most DLIs (88.5%) were polymicrobial. Common pathogens included coagulase-negative Staphylococci (59.0%), Staphylococcus aureus (54.1%), Corynebacterium spp (54.1%), Pseudomonas spp (23.0%), and Escherichia coli (21.3%). Preoperative bloodstream infections were present in 39.3%. Frequent reinfection recurrence was noted for all commonly isolated pathogens, except coagulase-negative Staphylococci. Complications occurred in 59.0%, mainly relaparotomy (41.7%), bleeding (33.3%), and impaired wound healing (35.0%). Postoperative 1 year survival was 78.3%. Freedom from 1 year reinfection showed a nonsignificant reduced hazard of death (hazard ratio [HR]: 0.57). Driveline relocation with OMW reduces the infection burden in a subset of patients. Given the procedure's substantial complication rate, it should be reserved as a last-resort therapy.","PeriodicalId":8844,"journal":{"name":"ASAIO Journal","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148918291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Infectious Adverse Events in Pediatric Paracorporeal Ventricular Assist Devices: An Analysis of the Advanced Cardiac Therapies Improving Outcomes Network (ACTION) Registry. 儿科辅助心室装置的感染性不良事件：对先进心脏治疗改善结果网络（ACTION）注册的分析。

IF 2.2 3区医学

ASAIO Journal Pub Date : 2026-09-07 DOI: 10.1097/MAT.0000000000002836

Neha Bansal, Lara Danziger-Isakov, Madeleine Townsend, Rashmita Naorem, Muhammad Farrukh Shezad, Lydia K Wright, Charles Bergstrom, E Kevin Hall, Allison Reichhold, David N Rosenthal, Firezer Haregu, Scott R Auerbach

{"title":"Infectious Adverse Events in Pediatric Paracorporeal Ventricular Assist Devices: An Analysis of the Advanced Cardiac Therapies Improving Outcomes Network (ACTION) Registry.","authors":"Neha Bansal, Lara Danziger-Isakov, Madeleine Townsend, Rashmita Naorem, Muhammad Farrukh Shezad, Lydia K Wright, Charles Bergstrom, E Kevin Hall, Allison Reichhold, David N Rosenthal, Firezer Haregu, Scott R Auerbach","doi":"10.1097/MAT.0000000000002836","DOIUrl":"https://doi.org/10.1097/MAT.0000000000002836","url":null,"abstract":"Infectious adverse events (IAEs) are common in children supported with paracorporeal ventricular assist devices (VADs). This study aimed to identify risk factors for IAEs from the Advanced Cardiac Therapy Improving Outcomes Network (ACTION) registry. We conducted a retrospective study including pediatric patients supported with paracorporeal VADs. Patients were stratified by device type (paracorporeal pulsatile [PP], paracorporeal continuous [PC], or overlapping). Kaplan-Meier analysis, the log-rank test, and Cox proportional hazards models evaluated factors associated with survival and time to first IAE. Among 812 patients on paracorporeal VADs, 270 (33.2%) experienced IAEs (479 events). Localized non-device IAEs were most common (40.9%). Patients with IAEs were younger, had lower body surface area (BSA), were more likely to require mechanical ventilation pre-implant, and had longer VAD support duration. Freedom from IAEs was lower in patients with PC devices or overlapping support (p = 0.0081). Survival was worse after IAEs (p = 0.0096). Overlapping device support was independently associated with an increased risk of IAE (hazard ratio [HR]: 1.387; p = 0.0354), while larger BSA was protective (HR: 0.542; p = 0.0264). IAEs remain common in children on VAD support and are associated with mortality, with device overlaps and smaller patient size as independent risk factors.","PeriodicalId":8844,"journal":{"name":"ASAIO Journal","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148905079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

En Bloc Kidney HOPE in DCD. 在DCD中加入了Kidney HOPE。

IF 2.2 3区医学

ASAIO Journal Pub Date : 2026-09-07 DOI: 10.1097/MAT.0000000000002844

Duilio Pagano, Kejd Bici, Barbara Buscemi, Silvia Leonello, Sarah Verville, Gaetano Burgio, Salvatore Gruttadauria

{"title":"En Bloc Kidney HOPE in DCD.","authors":"Duilio Pagano, Kejd Bici, Barbara Buscemi, Silvia Leonello, Sarah Verville, Gaetano Burgio, Salvatore Gruttadauria","doi":"10.1097/MAT.0000000000002844","DOIUrl":"https://doi.org/10.1097/MAT.0000000000002844","url":null,"abstract":"Hypothermic oxygenated machine perfusion (HOPE) is increasingly applied in donation after circulatory death (DCD) kidney transplantation to improve graft preservation, enable functional assessment, and reduce organ discard. In DCD settings characterized by prolonged mandatory agonal and warm ischemia phases, graft susceptibility to ischemia-reperfusion injury is amplified, rendering the preservation strategy particularly consequential. We describe a pragmatic technical workaround consisting of prolonged hypothermic perfusion of en bloc kidneys via aortic cannulation using a multiorgan perfusion system (VitaSmart Hypothermic Oxygenated Perfusion System, Bridge to Life Ltd., Northbrook, IL) operated under its standard renal perfusion settings. This approach allows continuous low-pressure perfusion, real-time monitoring, and the possibility of pharmacological intervention when renal-dedicated disposables are unavailable or when prolonged hypothermic preservation is required for logistical reasons. The technique was applied as a feasibility stress test in two DCD kidney grafts, which were perfused for 18 hours at controlled low pressure following an initial oxygenated flushing phase and maintained on continuous perfusion until implantation. The procedure proved technically stable and biologically informative, supporting its use as a rescue preservation strategy in selected DCD scenarios that require extended hypothermic oxygenated preservation and real-time graft assessment.","PeriodicalId":8844,"journal":{"name":"ASAIO Journal","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148905044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Leveraging Navier-Stokes Principles to Engineer Perfusable Bioorgans: A Physics-Guided Paradigm for Bioprinting. 利用纳维-斯托克斯原理来设计可灌注的生物器官：生物打印的物理指导范式。

IF 2.2 3区医学

ASAIO Journal Pub Date : 2026-09-07 DOI: 10.1097/MAT.0000000000002834

Sahil Khan, Ryan Idnani, Alejandro Vera Garcia

引用次数: 0

Circuit Change, Peri-Change Anticoagulation and Transfusion, and Survival in Pediatric Postcardiotomy Extracorporeal Membrane Oxygenation. 电路改变，围术期抗凝和输血，以及儿童心脏切开术后体外膜氧合的存活率。

IF 2.2 3区医学

ASAIO Journal Pub Date : 2026-09-07 DOI: 10.1097/MAT.0000000000002843

Keisuke Nishida, Takanori Yanai, Chikashi Takeda, Muneyuki Takeuchi, Koji Kawakami

{"title":"Circuit Change, Peri-Change Anticoagulation and Transfusion, and Survival in Pediatric Postcardiotomy Extracorporeal Membrane Oxygenation.","authors":"Keisuke Nishida, Takanori Yanai, Chikashi Takeda, Muneyuki Takeuchi, Koji Kawakami","doi":"10.1097/MAT.0000000000002843","DOIUrl":"https://doi.org/10.1097/MAT.0000000000002843","url":null,"abstract":"Circuit and oxygenator changes during pediatric postcardiotomy extracorporeal membrane oxygenation (PC-ECMO) are clinically significant; however, their timing and management are poorly described. Moreover, outcomes beyond discharge remain unclear. We describe circuit changes, temporal trends in anticoagulant use and transfusion, and mid- to long-term survival in pediatric PC-ECMO. This study used a Japanese administrative database spanning 2014-2024. Cardiac surgery cases in patients aged <18 years with congenital heart disease were classified into PC-ECMO and non-ECMO groups. For the PC-ECMO group, we assessed the cumulative incidence of the first circuit change, temporal trends in anticoagulant use and transfusion around each change, and postoperative and post-discharge 1 year survival. Among 4,395 cases, 73 involved PC-ECMO. Of these, 24 (32.9%) required at least one circuit change, with a cumulative incidence of 33.1% (95% confidence interval [CI], 19.4-46.7) within 3 days. Anticoagulants were switched from heparin to nafamostat mesylate alone or no anticoagulation (p = 0.001), and fresh-frozen plasma transfusion increased on the day of change (p = 0.016). Postoperative 1 year survival was 0.566 (95% CI, 0.449-0.713); among those discharged alive, 1 year post-discharge survival was 0.967 (95% CI, 0.901-1.000). Circuit changes were common and occurred early after PC-ECMO initiation. Post-discharge survival was favorable among patients discharged alive.","PeriodicalId":8844,"journal":{"name":"ASAIO Journal","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148905106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Upper-Body Versus Femoral Return in Peripheral Veno-Arterial Extracorporeal Membrane Oxygenation: A Systematic Review and Meta-analysis. 外周静脉-动脉体外膜氧合中上肢与股骨回流：系统回顾和荟萃分析。

IF 2.2 3区医学

ASAIO Journal Pub Date : 2026-09-03 DOI: 10.1097/MAT.0000000000002842

Saif-Eddin Dabour, Diya Asad, Abdullah Kouli, Elmustafa Hamed, Sana Tahir, Matthew Frank, Waqas Ullah

{"title":"Upper-Body Versus Femoral Return in Peripheral Veno-Arterial Extracorporeal Membrane Oxygenation: A Systematic Review and Meta-analysis.","authors":"Saif-Eddin Dabour, Diya Asad, Abdullah Kouli, Elmustafa Hamed, Sana Tahir, Matthew Frank, Waqas Ullah","doi":"10.1097/MAT.0000000000002842","DOIUrl":"https://doi.org/10.1097/MAT.0000000000002842","url":null,"abstract":"Upper-body peripheral arterial return is used during veno-arterial extracorporeal membrane oxygenation (VA-ECMO), but its clinical tradeoffs versus femoral return are uncertain. We reviewed observational studies comparing upper-body to femoral arterial return for peripheral VA-ECMO in cardiogenic shock and related rescue states. Seven retrospective cohorts (2,987 patients) were included. Upper-body return included axillary, subclavian, and combined approaches with direct and graft-mediated techniques. In the primary short-term mortality analysis (five studies; 2,317 patients), mortality did not differ significantly between upper-body and femoral return (odds ratio [OR]: 1.01, 95% confidence interval [CI]: 0.62-1.65; p = 0.96; I2 = 44%). In crude pooled analyses, upper-body return was associated with higher ischemic stroke (six studies; OR: 1.78, 95% CI: 1.31-2.42; p = 0.005; I2 = 0%), hemorrhagic stroke (four studies; OR: 2.34, 95% CI: 1.41-3.87; p = 0.01; I2 = 0%), and any stroke/cerebrovascular event (five studies; OR: 1.63, 95% CI: 1.28-2.09; p = 0.005; I2 = 0%). Limb ischemia was extremely imprecise and not statistically significant (three studies; OR: 0.34, 95% CI: < 0.01-44.78; p = 0.44; I2 = 82%). The available observational evidence does not suggest the superiority of either access strategy over the other. Given the heterogeneous data and stroke signal, the arterial return strategy should be individualized rather than broadly adopted as a default approach.","PeriodicalId":8844,"journal":{"name":"ASAIO Journal","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886142","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Feasibility and Midterm Outcomes of Concomitant Aortic Valve Plasty in Contemporary HeartMate 3 Practice. 主动脉瓣成形术的可行性和中期结果。

IF 2.2 3区医学

ASAIO Journal Pub Date : 2026-09-02 DOI: 10.1097/MAT.0000000000002817

Kohei Tonai, Kota Suzuki, Nana Kitahata, Kizuku Yamashita, Takuma Sato, Yasumasa Tsukamoto, Satsuki Fukushima

{"title":"Feasibility and Midterm Outcomes of Concomitant Aortic Valve Plasty in Contemporary HeartMate 3 Practice.","authors":"Kohei Tonai, Kota Suzuki, Nana Kitahata, Kizuku Yamashita, Takuma Sato, Yasumasa Tsukamoto, Satsuki Fukushima","doi":"10.1097/MAT.0000000000002817","DOIUrl":"https://doi.org/10.1097/MAT.0000000000002817","url":null,"abstract":"De novo aortic regurgitation (AR) remains a clinically significant complication of continuous-flow left ventricular assist device support, including the HeartMate 3 (HM3). Contemporary durability and safety data for concomitant aortic valve plasty (AVP) in HM3 recipients-particularly those bridged with temporary mechanical circulatory support (tMCS)-are limited. We retrospectively analyzed 115 consecutive adults undergoing primary HM3 implantation between August 2019 and December 2024; 35 (30%) received concomitant AVP. Time-to-event outcomes were estimated using Kaplan-Meier methods with a 30 day landmark and corroborated by Aalen-Johansen competing-risk cumulative incidence functions. One early technical failure (postoperative day 1) was excluded from the primary analysis, and one additional de novo event occurred during follow-up. Freedom from greater than or equal to moderate AR in the AVP cohort was 100% at 1 year and 94.7% (95% confidence interval [CI], 68.1-99.2) at 2-3 years; AR severity distributions remained stable, with no severe AR. Operative and cardiopulmonary bypass times were longer in the AVP group, whereas early hemodynamics and in-hospital and midterm adverse-event rates were comparable. These findings support selective concomitant AVP as a feasible valve-sparing strategy in contemporary HM3 practice, including tMCS-exposed recipients. Prospective multicenter studies are warranted to refine patient selection and to characterize long-term durability.","PeriodicalId":8844,"journal":{"name":"ASAIO Journal","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148879100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Noninvasive Respiratory Support Before Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome: A Meta-Analysis. 急性呼吸窘迫综合征体外膜氧合前无创呼吸支持：一项荟萃分析。

IF 2.2 3区医学

ASAIO Journal Pub Date : 2026-09-02 DOI: 10.1097/MAT.0000000000002833

Alberto Marabotti, Giovanni Cianchi, Pietro Bertini, Gianluca Paternoster, Fabio Sangalli, Marina Orlandi, Andrea Franci, Manuela Bonizzoli

{"title":"Noninvasive Respiratory Support Before Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome: A Meta-Analysis.","authors":"Alberto Marabotti, Giovanni Cianchi, Pietro Bertini, Gianluca Paternoster, Fabio Sangalli, Marina Orlandi, Andrea Franci, Manuela Bonizzoli","doi":"10.1097/MAT.0000000000002833","DOIUrl":"https://doi.org/10.1097/MAT.0000000000002833","url":null,"abstract":"The optimal timing for transitioning from noninvasive respiratory support to invasive mechanical ventilation and extracorporeal membrane oxygenation (ECMO) in severe acute respiratory distress syndrome (ARDS) remains controversial. PubMed and Embase were searched for studies reporting the duration of noninvasive respiratory support and the total duration of pre-ECMO respiratory support among survivors and non-survivors. A random-effects model with the Hartung-Knapp adjustment was used. Certainty of evidence was rated using the GRADE approach. Ten studies involving 718 patients were included. Survivors spent significantly fewer days on noninvasive respiratory support before ECMO (mean difference [MD]: -1.88 days [95% confidence interval (CI): -2.81 to -0.96]; p < 0.01), with a 95% prediction interval (PI) ranging from -3.71 to -0.05; GRADE certainty: Low. In the total pre-ECMO respiratory support duration (noninvasive plus invasive) analysis, the MD widened to -3.49 days (95% CI: -6.20 to -0.78, p = 0.03), with a PI ranging from -8.04 to 1.06; GRADE certainty: Very Low. These data suggest that the duration of pre-ECMO noninvasive respiratory support could jeopardize the success of the treatment; however, they are based on observational studies and should be considered hypothesis-generating, advocating further research on this topic.","PeriodicalId":8844,"journal":{"name":"ASAIO Journal","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148879136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Use of Extracorporeal Membrane Oxygenation (ECMO) in Pediatric Patients With Hemophagocytic Lymphohistiocytosis: A Multicenter Sub-Analysis. 体外膜氧合（ECMO）在小儿噬血细胞淋巴组织细胞症患者中的应用：一项多中心亚分析。

IF 2.2 3区医学

ASAIO Journal Pub Date : 2026-09-02 DOI: 10.1097/MAT.0000000000002831

Rohit P Nair, Michael C Mowrer, David Farbo, James A Thomas, Andrea Ontaneda, Saad Ghafoor, Renee M Potera, Lakshmi Raman, Saleh Bhar

{"title":"Use of Extracorporeal Membrane Oxygenation (ECMO) in Pediatric Patients With Hemophagocytic Lymphohistiocytosis: A Multicenter Sub-Analysis.","authors":"Rohit P Nair, Michael C Mowrer, David Farbo, James A Thomas, Andrea Ontaneda, Saad Ghafoor, Renee M Potera, Lakshmi Raman, Saleh Bhar","doi":"10.1097/MAT.0000000000002831","DOIUrl":"https://doi.org/10.1097/MAT.0000000000002831","url":null,"abstract":"Hemophagocytic lymphohistiocytosis (HLH) is a rare condition causing severe systemic inflammatory activation, cytokine storm, and multiorgan dysfunction for which extracorporeal membrane oxygenation (ECMO) may be required. There is a paucity of data to guide clinicians in the care of these patients; we aimed to address this need. From the Hematology and Oncology Pediatric Patients on ECMO (HOPPE) database, 30 patients diagnosed with HLH were identified from 13 of the 16 total participating centers between 2009 and 2021. Of those 30 patients, 63% survived to ECMO decannulation, 43% to ICU discharge, and 37% to hospital discharge. Among survivors, there was a median of 44.9 days between decannulation and hospital discharge. Half of the ECMO mortality occurred within the first 10 days on ECMO. Patients who survived to hospital discharge also had evidence of functional limitation and significant multiorgan dysfunction. A total of 90% of patients diagnosed with HLH on ECMO survived to decannulation vs. 50% of patients diagnosed before. Survival has improved in this patient population compared to previous literature but is still lower than the overall pediatric ECMO population. Clinical suspicion for HLH in these critically ill patients should not exclude them from escalation of support, including ECMO.","PeriodicalId":8844,"journal":{"name":"ASAIO Journal","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148879116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Early Lactate Trajectories and Outcomes in Veno-Arterial Extracorporeal Membrane Oxygenation-Supported Cardiogenic Shock: A Multicenter Study. 静脉-动脉体外膜氧合支持的心源性休克的早期乳酸轨迹和结局：一项多中心研究。

IF 2.2 3区医学

ASAIO Journal Pub Date : 2026-09-02 DOI: 10.1097/MAT.0000000000002837

Zhe Li, Wan Chen, Chenglong Li, Lei Shi, Guozheng Qiu, Wenlong Duan, Mingyu Pei, Yao Zhou, Bo Wang, Xiaotong Hou, Liwen Lyu

{"title":"Early Lactate Trajectories and Outcomes in Veno-Arterial Extracorporeal Membrane Oxygenation-Supported Cardiogenic Shock: A Multicenter Study.","authors":"Zhe Li, Wan Chen, Chenglong Li, Lei Shi, Guozheng Qiu, Wenlong Duan, Mingyu Pei, Yao Zhou, Bo Wang, Xiaotong Hou, Liwen Lyu","doi":"10.1097/MAT.0000000000002837","DOIUrl":"https://doi.org/10.1097/MAT.0000000000002837","url":null,"abstract":"In this multicenter retrospective study (Chinese Society of Extracorporeal Life Support [CSECLS] registry), we evaluated early lactate trajectories in 1,465 adults with cardiogenic shock surviving greater than 24 hours on veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Unsupervised k-means clustering of serial lactates (baseline, 4 hours, 24 hours) defined four metabolic phenotypes. The \"Persistent High\" phenotype (5.7%) exhibited refractory hyperlactatemia (median 24 hour lactate 17.0 mmol/L) and the highest in-hospital mortality (85.7% vs. 27.9% in the \"Low Stable\" group; p < 0.001). Notably, this persistent hyperlactatemia occurred despite comparable ECMO flow indices (2.8 vs. 2.6 L/min/m2) and preserved venous oxygen saturation (72.2% ≥ 50%). The \"Persistent High\" trajectory independently predicted mortality (adjusted hazard ratio [HR]: 6.36, 95% confidence interval [CI]: 4.83-8.36) and severe organ failure, with findings reproduced in an external validation cohort (MIMIC-IV, n = 136). In conclusion, persistent hyperlactatemia during VA-ECMO may reflect impaired systemic oxygen utilization rather than insufficient macrocirculatory flow. Early trajectory-based phenotyping helps identify a refractory state of flow-metabolism decoupling, signaling a high-risk subgroup where conventional flow escalation alone may be insufficient.","PeriodicalId":8844,"journal":{"name":"ASAIO Journal","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148879084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0