Relatively Increased CO2 Delivered to the Brain From the Descending Aorta Leading to an Elevated Respiratory Rate Causing Differential Hypocapnia (RIDDLER or East-West Syndrome): New Pitfalls in Awake Peripheral V-A ECMO

March 16, 2025 No Comments

This article describes a newly recognized physiological phenomenon, RIDDLER (East-West Syndrome), in patients on awake peripheral V-A ECMO. It occurs when CO2-rich blood from the ECMO circuit reaches the brain, triggering an increased respiratory rate despite paradoxically low CO2 levels in the right radial artery. This leads to a cycle of worsening hypercapnia, respiratory distress, and potential neurological injury. Proper CO2 monitoring strategies are needed to prevent mismanagement.

Thoracoabdominal Normothermic Regional Perfusion: Real-World Experience and Outcomes of DCD Liver Transplantation

March 16, 2025 No Comments

This study evaluates the effectiveness of thoracoabdominal normothermic regional perfusion (TA-NRP) in liver transplantation from donation after circulatory death (DCD) donors. Compared to static cold storage (SCS), TA-NRP significantly reduces ischemic cholangiopathy (IC) at six months (1.2% vs. 9.5%, p = 0.03), despite higher-risk donor-recipient pairs. The findings suggest TA-NRP improves organ utilization and supports its integration into liver transplantation protocols.

Indications for Extracorporeal Membrane Oxygenation in Older Adult Patients with Accidental Hypothermia and Hemodynamic Instability

March 16, 2025 No Comments

This study analyzes the efficacy of extracorporeal membrane oxygenation (ECMO) in older adults with accidental hypothermia (AH) and hemodynamic instability before cardiac arrest. A post-hoc analysis of the ICE-CRASH study (2019–2022) found no significant survival difference between ECMO and non-ECMO patients at 28 days. ECMO accelerated rewarming but increased bleeding complications. The study concludes ECMO may not benefit this patient group, challenging existing treatment criteria.

Buckberg vs. Del Nido in Isolated Aortic Valve Replacement: A Prospective, Two-Center, Randomized Trial

March 16, 2025 No Comments

This study compares Buckberg (BS) and Del Nido (DNS) cardioplegia in isolated aortic valve replacement (AVR) through a two-center randomized trial with 311 patients. While postoperative creatine kinase and troponin levels showed no significant differences, the DNS group had better intraoperative glycemic control, higher spontaneous rhythm rates, and fewer cases of ventricular fibrillation requiring defibrillation. The study supports DNS as a viable alternative with workflow advantages.

Assistance from a Mixing Zone Model to Perform Aortic Femoral Perfusion Strategy with Severe Atherosclerotic and Artheromic Aortic Disease for Endoscopic Minimally Invasive Redo Mitral Valve Repair

March 15, 2025 No Comments

This study explores a novel perfusion strategy for minimally invasive redo mitral valve surgery in patients with severe atherosclerotic and artheromic aortic disease. Using a combination of antegrade and retrograde perfusion, the study evaluates the mixing zone during cardiopulmonary bypass (CPB) to optimize outcomes. A case study demonstrates the effectiveness of this approach, with no postoperative cerebral complications. Findings suggest that adjusting cannulation sizes can improve perfusion safety.

Pediatric Cardiac Patients with Pulmonary Hemorrhage Supported on ECMO: An ELSO Registry Study

March 15, 2025 No Comments

This study examines pediatric cardiac patients with pulmonary hemorrhage (PH) supported on extracorporeal membrane oxygenation (ECMO) using data from the ELSO registry (2011–2020). Analyzing 161 cases, the study identifies high-frequency oscillatory ventilation (HFOV) before ECMO cannulation as a key predictor of survival. The absence of hemorrhagic and renal complications also improved outcomes. Findings suggest that optimized pre-ECMO ventilation strategies may enhance survival rates in these high-risk patients.

Gradual Oxygen Exposure During Coronary Bypass for Acute Myocardial Infarction: A Retrospective Cohort Study

March 15, 2025 No Comments

This study examines the impact of gradual oxygen exposure during emergency coronary bypass surgery for acute myocardial infarction (MI). A retrospective cohort of 66 patients was analyzed, comparing outcomes between those receiving venous blood cardioplegia with controlled oxygen exposure and those undergoing standard hyperoxic procedures. The findings indicate a significant reduction in mortality, improved ventricular function, lower readmission rates for heart failure, and reduced need for defibrillators.

Prolonged ECMO Support in a Pediatric Patient with Complex Cardiac Conditions During Wartime in Kyiv, Ukraine

March 14, 2025 No Comments

This case report details the prolonged extracorporeal membrane oxygenation (ECMO) support of a 12-year-old girl with severe congenital heart disease and myocarditis in wartime Kyiv. Due to a lack of transplant options and supply shortages, alternative oxygenators were used despite suboptimal long-term performance. The patient underwent 259 days of ECMO support but ultimately succumbed to multi-organ dysfunction. The study highlights the urgent need for medical resource mobilization in conflict zones.

Variability in Triggers for Mechanical Left Ventricular Unloading in VA-ECMO: A Literature Search

March 13, 2025 No Comments

VA-ECMO provides critical cardiopulmonary support but increases left ventricular afterload, potentially leading to left ventricular distension (LVD). This literature review explores various clinical, hemodynamic, and imaging-based triggers for mechanical LV unloading. Findings highlight significant variability in defining LVD and initiating mechanical unloading. The study underscores the need for standardized criteria to optimize patient outcomes while minimizing risks associated with invasive procedures.

Evaluating the Need for Magnesium Administration Following Cardioplegic Arrest with Del Nido Cardioplegia Solution

March 11, 2025 No Comments

This study evaluates whether magnesium administration is necessary following cardioplegic arrest with del Nido cardioplegia (dNC) solution at Cincinnati Children’s Hospital Medical Center (CCHMC). Analyzing serum magnesium levels in 100 patients, results showed hypermagnesemia in most cases. Given the potential risks of excessive magnesium, findings suggest eliminating routine post-cross-clamp magnesium administration in dNC settings.

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Relatively Increased CO2 Delivered to the Brain From the Descending Aorta Leading to an Elevated Respiratory Rate Causing Differential Hypocapnia (RIDDLER or East-West Syndrome): New Pitfalls in Awake Peripheral V-A ECMO

Thoracoabdominal Normothermic Regional Perfusion: Real-World Experience and Outcomes of DCD Liver Transplantation

Indications for Extracorporeal Membrane Oxygenation in Older Adult Patients with Accidental Hypothermia and Hemodynamic Instability

Buckberg vs. Del Nido in Isolated Aortic Valve Replacement: A Prospective, Two-Center, Randomized Trial

Assistance from a Mixing Zone Model to Perform Aortic Femoral Perfusion Strategy with Severe Atherosclerotic and Artheromic Aortic Disease for Endoscopic Minimally Invasive Redo Mitral Valve Repair

Pediatric Cardiac Patients with Pulmonary Hemorrhage Supported on ECMO: An ELSO Registry Study

Gradual Oxygen Exposure During Coronary Bypass for Acute Myocardial Infarction: A Retrospective Cohort Study

Prolonged ECMO Support in a Pediatric Patient with Complex Cardiac Conditions During Wartime in Kyiv, Ukraine

Variability in Triggers for Mechanical Left Ventricular Unloading in VA-ECMO: A Literature Search

Evaluating the Need for Magnesium Administration Following Cardioplegic Arrest with Del Nido Cardioplegia Solution

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