Designing a Cardiac Arrest System That Includes Extracorporeal Cardiopulmonary Resuscitation: A Contemporary Review

Extracorporeal cardiopulmonary resuscitation (ECPR) can achieve survival approaching 30% for selected patients with refractory out-of-hospital cardiac arrest, but success depends on the entire system of care. This contemporary review examines patient selection, EMS optimization, geographic planning, rapid transport, hospital-based, rendezvous and prehospital ECPR models, specialized cardiac arrest centers, postresuscitation care, cost effectiveness, and continuous quality improvement.

August 31, 2026

Predictive Preoperative Score of Prolonged Mechanical Ventilation After Coronary Artery Bypass Grafting

A study of 2,083 patients undergoing CABG found that 11.6% required prolonged mechanical ventilation for more than 48 hours. Researchers developed a simple preoperative risk score using readily available clinical factors, with risk ranging from 2.9% in the lowest-risk group to 44.3% in the highest. Anemia, severe kidney and ventricular dysfunction, urgent surgery, and other factors predicted increased risk, while risk also rose as cardiopulmonary bypass exceeded about 120 minutes.

August 30, 2026

Blood-Based Versus Crystalloid Cardiopulmonary Bypass Priming in Left Ventricular Assist Device Surgery: Impact on End-Organ Function and Survival

This retrospective study compared blood-based versus crystalloid cardiopulmonary bypass priming in 92 patients undergoing HeartMate 3 LVAD implantation. Blood-based priming was associated with significantly less postoperative right heart failure and delirium and a trend toward less dialysis. Major bleeding was numerically lower, while survival differences were not statistically significant. Prospective randomized trials are needed to confirm these findings.

August 7, 2026

Does Sternal-Sparing Outweigh Prolonged Bypass? Inflammatory Resolution in MICS Versus Median Sternotomy: A SIRI-Based Analysis

A propensity score-matched study of 178 patients undergoing mitral valve surgery compared minimally invasive cardiac surgery (MICS) with conventional median sternotomy. Although MICS required longer operative, cardiopulmonary bypass, and cross-clamp times, patients experienced faster resolution of systemic inflammation by postoperative day 5, measured using the Systemic Inflammation Response Index (SIRI). Early postoperative SIRI also showed promise for predicting pulmonary complications.

August 6, 2026

Impact of Antegrade Selective Cerebral Perfusion Flow Ranges on Clinical and Neurological Outcomes in Aortic Arch Surgery

This retrospective single-center study evaluated 492 adults undergoing aortic arch surgery with bilateral selective antegrade cerebral perfusion (SACP). Patients were grouped by indexed cerebral perfusion flow (<10, 10–15, or >15 mL/kg/min). No significant differences were found in 30-day mortality, permanent neurological dysfunction, or transient neurological deficits across flow ranges. The findings support individualized intraoperative perfusion management while maintaining recommended flow targets.

August 6, 2026

Comparable Survival Over an Extended Follow-Up After On-Pump Versus Off-Pump Coronary Artery Bypass Grafting: A Propensity Score-Matched Cohort

Researchers evaluated long-term outcomes after on-pump (ONCAB) and off-pump (OPCAB) coronary artery bypass grafting in 2,935 patients treated between 1999 and 2016. After propensity score matching, 402 OPCAB patients were compared with 804 ONCAB patients over follow-up extending nearly 24 years. Survival and cardiovascular mortality were similar between groups, suggesting that when performed by experienced surgeons and appropriately selected patients, both techniques provide comparable long-term outcomes.

June 16, 2026

Topical Use of Tranexamic Acid for Antifibrinolysis in Cardiac Surgery With Cardiopulmonary Bypass: A Randomized Clinical Study

This randomized trial compared topical intrapericardial tranexamic acid (TXA) with standard intravenous TXA in 492 adults undergoing cardiac surgery with cardiopulmonary bypass. Topical TXA appeared similarly safe, with fewer composite 30-day adverse events numerically, but it did not meet strict efficacy non-inferiority: red blood cell transfusions and 24-hour drainage were higher. IV TXA remains first-line; topical TXA may suit selected patients who cannot tolerate systemic therapy.

May 5, 2026

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.

April 30, 2026

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.

April 23, 2026

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.

April 14, 2026

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