Perfusion News

Effect of Albumin Concentration

Effect of Albumin Concentration and Timing on Acute Kidney Injury After Adult Cardiac Surgery: A Systematic Review and Meta-Analysis

This systematic review and meta-analysis evaluated whether hyperoncotic 20%–25% human albumin affects acute kidney injury after adult on-pump cardiac surgery. Across four studies including 6,651 patients, albumin was associated with a modest but consistent increase in postoperative AKI risk compared with crystalloids or 4%–5% albumin. Risk appeared similar whether albumin was given during surgery or within 24 hours afterward, supporting cautious, selective use.

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Global Bypass Balance

Anticoagulation Monitoring Strategies During Cardiopulmonary Bypass in Patients With Antiphospholipid Syndrome: A Systematic Review

This systematic review examines anticoagulation monitoring during cardiopulmonary bypass in patients with antiphospholipid syndrome, a high-risk prothrombotic condition that can make activated clotting time unreliable. Across 17 studies and 62 patients, ACT, Hepcon, anti-Xa, and viscoelastic testing were used inconsistently. The review found no evidence proving one strategy superior but highlights the need for multimodal monitoring and future prospective research.

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Thrombotic Mitral Valve Obstruction

Thrombotic Mitral Valve Obstruction During Venoarterial Extracorporeal Membrane Oxygenation With Left Ventricular Venting Following Complex Valve Surgery

This case report describes a 69-year-old woman who developed thrombotic obstruction of a mitral bioprosthesis while receiving VA-ECMO with left ventricular venting after complex multivalve surgery. Delayed anticoagulation, prosthetic material, altered intracardiac flow, and postoperative bleeding likely combined to trigger thrombosis. The report highlights diagnostic difficulty during ECMO weaning and stresses individualized anticoagulation, echocardiographic monitoring, and careful unloading strategy selection.

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ECMO Under Pressure

The Invisible Face of ECMO: Anxiety Levels and Challenges Among Intensive Care Nurses

This cross-sectional study examined 137 ICU nurses in Turkey who cared for patients receiving ECMO, a complex life-support therapy. Nurses reported mild-to-moderate anxiety, with higher stress linked to bleeding risk, infection concerns, workload, complications, and team-related organizational problems. More ECMO-specific experience was associated with lower anxiety, highlighting the value of structured training, standardized protocols, and experienced staffing.

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Perfusion Under Pressure

Elevated Oxygen Extraction During Heart Transplantation Is Associated With Increased Morbidity and Mortality: Implications for Goal-Directed Perfusion

This single-center retrospective study of 381 adult heart transplants found that prolonged oxygen extraction ratio, or O2ER, above 0.20 during cardiopulmonary bypass was linked to higher post-transplant morbidity and early mortality. O2ER outperformed low indexed oxygen delivery alone in predicting risk, especially around reperfusion, suggesting that perfusion strategies should focus on matching oxygen delivery to metabolic demand rather than relying only on fixed delivery thresholds.

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Triple Transplant Breakthrough

Heart-Liver-Kidney Transplantation for AL Amyloidosis Using Normothermic Recovery and Storage From a Donor Following Circulatory Death: Short-Term Outcome in a First-in-World Experience

This case report describes the first known heart-liver-kidney transplant for AL amyloidosis using organs recovered from a donation-after-circulatory-death donor with thoracoabdominal normothermic regional perfusion. A 40-year-old man with terminal multiorgan AL amyloidosis underwent sequential heart, liver, and kidney transplantation and remained free of graft dysfunction or rejection at 8 months, highlighting a new path to expand complex transplant access. 

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Kidney on Call

Incidence, Risk Factors and Outcomes of Postoperative Acute Kidney Injury Requiring Dialysis After Cardiac Surgery: A Retrospective Study from the National Heart Institute of Malaysia

This retrospective Malaysian cohort study examined 6,779 adult cardiac surgery patients and found that 4.5% developed postoperative acute kidney injury requiring dialysis. Risk was higher in patients with chronic kidney disease, urgent surgery, diabetes, reoperation, and longer ICU stay. Dialysis-requiring AKI was linked to sharply increased mortality, especially among patients without baseline CKD, highlighting the need for earlier renal risk stratification and kidney-protective perioperative care.

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The Combined Use of HA380 Hemoperfusion

The Combined Use of HA380 Hemoperfusion in Cardiopulmonary Bypass Alleviates Postoperative Inflammatory Response and Organ Dysfunction Following Cardiac Surgery

This randomized single-center trial evaluated 65 patients undergoing elective cardiac surgery with cardiopulmonary bypass and found that adding the HA380 hemoperfusion cartridge reduced early postoperative inflammatory cytokines, including IL-1β, IL-6, IL-8, and IL-10. The HA380 group also had lower vasoactive-inotropic requirements and better short-term liver and kidney laboratory markers, although ICU ventilation time and ICU stay were not significantly improved. 

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ECLS Lab Standards

Standardization of In-Vitro Evaluation of Extracorporeal Life Support (ECLS) Devices for Research and Development

This guideline article argues that extracorporeal life support device testing should follow standardized in-vitro protocols so results can be reproduced, compared across research groups, and translated more effectively into practice. It outlines reporting criteria, relevant ISO standards, preferred test conditions, and key considerations for pumps, oxygenators, cannulae, tubing, hemolysis, and thrombogenicity assessment.

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Transfusion Blood Cardiac Surgery

Quality Management of Comprehensive Blood Conservation Strategies During Cardiopulmonary Bypass in Pediatric Cardiac Surgery

This retrospective single-center study evaluated 9,792 children aged 14 years or younger undergoing cardiac surgery with cardiopulmonary bypass. After implementation of a quality-managed, multimodal blood conservation program, matched analysis showed lower PRBC and plasma transfusion rates, smaller CPB priming volumes, and fewer postoperative complications, especially liver injury and acute kidney injury, without increased mortality or longer recovery.

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