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Aim: Extracorporeal cardiopulmonary resuscitation (ECPR) is used to resuscitate patients with cardiac arrest; however, its effect in treating hypothermic cardiac arrest has not been well studied. Therefore, in this study, we aimed to examine the characteristics and outcomes of patients with hypothermic cardiac arrest who underwent ECPR, using a multicenter out-of-hospital cardiac arrest (OHCA) registry in Japan. Methods: Baseline characteristics of patients with hypothermic OHCA and body temperature below 32 °C were assessed. Logistic regression analysis was performed to identify factors associated with in-hospital mortality and neurological outcomes in these patients. Outcomes of hypothermic and cardiogenic OHCA cases were compared using propensity-score matching to investigate differences among subgroups. Results: We included 2,157 patients, with 102 and 1,646 in the hypothermic and cardiogenic groups, respectively. Higher age and longer low-flow time were independent risk factors for mortality, and higher age was an independent risk factor for unfavorable neurological outcomes in the hypothermic OHCA group.Eighty matched pairs were selected during propensity-score matching, and the mortality rate was lower in the hypothermic group than in the cardiogenic group (46.2% vs. 77.5%; p

Objective: In this study, we investigated the effect of various oxygen therapy regimens on oxygenation in patients with acute type A aortic dissection (AAD). Methods: A quasi-randomized controlled trial was conducted, in which patients with AAD hospitalized for surgery from June to September 2021 were assigned to the control group (patients received conventional oxygen therapy after postoperative mechanical ventilation, weaning, and extubation) and those who were admitted from October to December 2021 were assigned to the observation group [patients underwent optimally adjusted therapy based on the treatment of the control group, which mainly included prioritized elevation of positive end-expiratory pressure (PEEP) and restricted use of the fraction of inspired oxygen (FiO2)].The postoperative oxygenation index, blood gas analysis, and duration of mechanical ventilation were compared between the two groups. Results: There were significant differences in oxygenation observed at 2 h postoperatively between the groups. 12, 24, and 72 h postoperatively, the oxygenation index varied significantly between the two groups. There were statistically significant differences in the time effects of the oxygenation index and PaO2 between the two groups, as well as significant differences in the length of stay in the intensive care unit. Conclusion: For the postoperative care of patients with AAD, it is suggested that the minimum FiO2 required for oxygenation of patients be maintained. In addition, it is possible to enhance PEEP as a priority when PaO2 is low.

Background: Blood transfusion is often necessary during and after lung transplantation surgery. Point-of-care guided bleeding strategies, such as rotational thromboelastometry (ROTEM), can reduce blood transfusion in cardiovascular surgery. This study aimed to assess the effect of ROTEM-guided bleeding management on the need for allogenic blood transfusion, prohemostatic medication, and clinical outcomes in lung transplantation patients. Methods: This single-center retrospective cohort study compared patients receiving bilateral lung transplantation between 2010-2014 and 2017-2020. The first cohort was treated with a clinically guided bleeding strategy and the second cohort with a ROTEM-guided bleeding strategy. Multivariable regression analyses were performed to determine the effects on primary outcomes. Results: A total of 167 (66 clinically guided vs 101 ROTEM-guided) patients were included for analysis. Baseline, intraoperative, and postoperative characteristics were mostly similar, but differed regarding the number of patients with cystic fibrosis, use of cardiopulmonary bypass, and surgical technique. The ROTEM-guided group received significantly less median red blood cells (7 [3; 13] vs 4 [1; 9] units, p

Detailed knowledge of the various venous anomalies is important to optimize the surgical approach and minimize catastrophic complications during retroperitoneal surgery. We report a rare case of an isolated left inferior vein cava (IVC) in a patient with left renal cell carcinoma with level IV IVC thrombus extension, which was successfully treated with terminal–lateral anastomoses between the left and right IVC. We also reviewed the types of duplicated IVCs and discussed the intraoperative management.

Summary: Background: Refractory out-of-hospital cardiac arrest (OHCA) treated with standard advanced cardiac life support (ACLS) has poor outcomes. Transport to hospital followed by in-hospital extracorporeal cardiopulmonary resuscitation (ECPR) initiation may improve outcomes. We performed a pooled individual patient data analysis of two randomised controlled trials evaluating ECPR based approach in OHCA. Methods: The individual patient data from two published randomised controlled trials (RCTs) were pooled: ARREST (enrolled Aug 2019–June 2020; NCT03880565) and PRAGUE-OHCA (enrolled March 1, 2013–Oct 25, 2020; NCT01511666). Both trials enrolled patients with refractory OHCA and compared: intra-arrest transport with in-hospital ECPR initiation (invasive approach) versus continued standard ACLS. The primary outcome was 180-day survival with favourable neurological outcome (defined as Cerebral Performance Category 1–2). Secondary outcomes included: cumulative survival at 180 days, 30-day favourable neurological survival, and 30-day cardiac recovery. Risk of bias in each trial was assessed by two independent reviewers using the Cochrane risk-of-bias tool. Heterogeneity was assessed via Forest plots. Findings: The two RCTs included 286 patients. Of those randomised to the invasive (n = 147) and standard (n = 139) groups, respectively: the median age was 57 (IQR 47–65) and 58 years (IQR 48–66), and the median duration of resuscitation was 58 (IQR 43–69) and 49 (IQR 33–71) minutes (p = 0.17). In a modified intention to treat analysis, 45 (32.4%) in the invasive and 29 (19.7%) patients in the standard arm survived to 180 days with a favourable neurological outcome [absolute difference (AD), 95% CI: 12.7%, 2.6–22.7%, p = 0.015]. Forty-seven (33.8%) and 33 (22.4%) patients survived to 180 days [HR 0.59 (0.43–0.81); log rank test p = 0.0009]. At 30 days, 44 (31.7%) and 24 (16.3%) patients had favourable neurological outcome (AD 15.4%, 5.6–25.1%, p = 0.003), 60 (43.2%), and 46 (31.3%) patients had cardiac recovery (AD: 11.9%, 0.7–23%, p = 0.05), in the invasive and standard arms, respectively. The effect was larger in patients presenting with shockable rhythms (AD 18.8%, 7.6–29.4; p = 0.01; HR 2.26 [1.23–4.15]; p = 0.009) and prolonged CPR (>45 min; HR 3.99 (1.54–10.35); p = 0.005). Interpretation: In patients with refractory OHCA, the invasive approach significantly improved 30- and 180-day neurologically favourable survival. Funding: None.

Clinical practice guidelines consolidate and evaluate all pertinent evidence on a specific topic available at the time of their formulation. The goal is to assist physicians in determining the most effective management strategies for patients with a particular condition. These guidelines assess the impact on patient outcomes and weigh the risk-benefit ratio of various diagnostic or therapeutic approaches. While not a replacement for textbooks, they provide supplementary information on topics relevant to current clinical practice and become an essential tool to support the decisions made by specialists in daily practice. Nonetheless, it is crucial to understand that these recommendations are intended to guide, not dictate, clinical practice, and should be adapted to each patient's unique needs. Clinical situations vary, presenting a diverse array of variables and circumstances. Thus, the guidelines are meant to inform, not replace, the clinical judgement of healthcare professionals, grounded in their professional knowledge, experience and comprehension of each patient's specific context. Moreover, these guidelines are not considered legally binding; the legal duties of healthcare professionals are defined by prevailing laws and regulations, and adherence to these guidelines does not modify such responsibilities. The European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Cardiothoracic Anaesthesiology and Intensive Care (EACTAIC) and the European Board of Cardiovascular Perfusion (EBCP) constituted a task force of professionals specializing in cardiopulmonary bypass (CPB) management. To ensure transparency and integrity, all task force members involved in the development and review of these guidelines submitted conflict of interest declarations, which were compiled into a single document available on the EACTS website (https://www.eacts.org/resources/clinical-guidelines). Any alterations to these declarations during the development process were promptly reported to the EACTS, EACTAIC and EBCP. Funding for this task force was provided exclusively by the EACTS, EACTAIC and EBCP, without involvement from the healthcare industry or other entities. Following this collaborative endeavour, the governing bodies of EACTS, EACTAIC and EBCP oversaw the formulation, refinement, and endorsement of these extensively revised guidelines. An external panel of experts thoroughly reviewed the initial draft, and their input guided subsequent amendments. After this detailed revision process, the final document was ratified by all task force experts and the leadership of the EACTS, EACTAIC and EBCP, enabling its publication in the European Journal of Cardio-Thoracic Surgery, the British Journal of Anaesthesia and Interdisciplinary CardioVascular and Thoracic Surgery. Endorsed by the EACTS, EACTAIC and EBCP, these guidelines represent the official standpoint on this subject. They demonstrate a dedication to continual enhancement, with routine updates planned to ensure that the guidelines remain current and valuable in the ever-progressing arena of clinical practice., Competing Interests: Conflict of interest Adrian Bauer reports a leadership role for LivaNova related to customer meetings for new products. Friedhelm Beyersdorf reports receiving consulting fees from Franz Köhler Chemie, Germany (<10,000 EUR), and honoraria from AtriCure. Friedhelm Beyersdorf also reports leadership roles in EACTS and DGTHG. Filip De Somer reports receiving a grant and consulting fees from LivaNova, both paid to University Ghent. Filip De Somer also reports a leadership position in EBCP (unpaid). Gudrun Kunst reports receiving honoraria from Edwards for contributions to two discussion workshops in 2024 and 2022, and from BioMerieux for a presentation contribution to a webinar. Gudrun Kunst also reports leadership roles for the National Institute of Academic Anaesthesia Royal College of Anaesthesia UK as Grant Officer and Board and Research Council Member, for the Association of Cardiothoracic Anaesthesia and Critical Care UK as Scientific Chair and Board Member, and for the European Board of Cardiovascular Perfusion as Scientific Chair and Board Member. Frank Merkle reports receiving consulting fees and honoraria from LivaNova and Terumo Europe (both to the institution). Benjamin Milne reports receiving consulting fees from Edwards Lifesciences. Milan Milojevic reports receiving a speaker fee from Corcym in relation to ERAS (<1000K) and one from Medtronic in relation to CPB (<1000K). Milan Milojevic also reports a role of Guidelines Program Director at EACTS. Francesco Onorati reports receiving grants from Edwards Lifesciences, and honoraria from Edwards Lifesciences and Abbott. Francesco Onorati reports receiving support from Edwards Lifesciences and Abbott for attending meetings. Francesco Onorati reports participation on an advisory board for the IMPACT and INDURE trials. Francesco Onorati reports leadership positions in EBCTS and the Italian Society of Cardiac Surgery. Francesco Onorati also reports receiving equipment from IPP Med. Davide Pacini reports receiving grants from Artivion, Terumo Aortic, Peters, and Corcym. Davide Pacini reports receiving consulting fees and honoraria from Terumo Aortic and Peters. Davide Pacini reports receiving support for attending meetings from Corcym. Davide Pacini reports participating on the advisory board for the TRACS trial. Davide Pacini also reports leadership positions for the Italian Society of Cardiac Surgery and the Francis Fontan Foundation. Marco Ranucci reports receiving royalties from LivaNova for a GDP monitor patent. Marco Ranucci reports receiving consulting fees from LivaNova as a personal payment, and honoraria from LivaNova and Medtronic as personal payments. Marco Ranucci also reports receiving personal payment from LivaNova for participating on an advisory board., (Copyright © 2025 Alexander Wahba, Gudrun Kunst, Filip De Somer, Henrik Agerup Kildahl, Benjamin Milne, Gunilla Kjellberg, Adrian Bauer, Friedhelm Beyersdorf, Hanne Berg Ravn, Gerdy Debeuckelaere, Gabor Erdoes, Renard Gerhardus Haumann, Tomas Gudbjartsson, Frank Merkle, Davide Pacini, Gianluca Paternoster, Francesco Onorati, Marco Ranucci, Nemanja Ristic, Marc Vives, Milan Milojevic, EACTS/EACTAIC/EBCP Scientific Document Group. Published by Elsevier Ltd.. All rights reserved.)

Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are among the most prevalent complications associated with cardiac surgery involving extracorporeal circulation (ECC), contributing to adverse outcomes and representing a significant impediment to successful cardiac surgical procedures. Vascular endothelial growth factor (VEGF) is implicated in the etiology of ALI/ARDS; however, its precise role remains a subject of debate due to the presence of somewhat contradictory findings in the literature, necessitating further investigation. To date, numerous studies have explored the role of VEGF in the pathophysiology of ALI/ARDS, with ongoing discussions regarding whether VEGF exerts a protective or detrimental effect. The genetic polymorphism of the VEGF gene is a significant factor in the development of ALI/ARDS. Research has indicated that the prevalence of the VEGF polymorphic gene is markedly higher in postoperative cardiac surgery patients who develop ALI/ARDS compared to the general population. Furthermore, the mortality rate among patients possessing the VEGF polymorphic gene is significantly elevated. Concurrently, it has been demonstrated that ARDS patients who are positive for the VEGF polymorphism exhibit a reduction in VEGF levels within alveolar lavage fluid, which correlates with an exacerbation of lung injury. The present paper provides a comprehensive review of the genetic polymorphisms of VEGF and their implications in the pathophysiological alterations observed in postoperative cardiac surgery patients with ALI/ARDS, thereby offering novel insights and evidence to further elucidate the mechanisms underlying ALI/ARDS., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Resumen: Objetivos: Valorar si el peso ≤ 2,5 kg supone un incremento en la morbimortalidad de la cirugía cardiaca neonatal bajo circulación extracorpórea (CEC) y caracterizar este grupo de pacientes. Métodos: Estudio retrospectivo de todos los neonatos sometidos a una primera cirugía cardiaca con CEC entre 2007 y 2019, analizando los factores independientes de morbimortalidad. Resultados: Cuarenta y nueve pacientes ≤ 2,5 kg vs. 246 > 2,5 kg, sin diferencias significativas con relación a la edad en el momento de la reparación, aunque sí en la prematuridad y el sexo femenino, mayores en ≤ 2,5 kg. Los diagnósticos más frecuentes fueron hipoplasia del arco y truncus en ≤ 2,5 kg, y transposición de grandes arterias e hipoplasia de arco en > 2,5 kg. El tiempo de CEC y el uso de parada circulatoria fueron significativamente mayores en ≤ 2,5 kg. A pesar de que el grupo ≤ 2,5 kg tuvo una mortalidad mayor (22,4 vs. 8,1%; p 2,5 kg. El análisis de la prematuridad no mostró incremento significativo de morbimortalidad. Conclusiones: A pesar de los avances en el manejo peri-extracorpórea en ≤ 2,5 kg, disminuyendo la mortalidad en algunas enfermedades, el bajo peso sigue asociándose a aumento de mortalidad. El momento de cuándo intervenir deberá individualizarse por paciente, diagnóstico y resultados del propio centro. Abstract: Objectives: Evaluate whether a weight ≤2.5 kg carries an increase in morbi-mortality in neonatal cardiac surgery under cardiopulmonary bypass (CPB) and stablish the profile of these patients. Methods: Retrospective study of the neonates who underwent the first cardiac surgery under CPB between 2007-2019, analyzing independent risk factors for morbi-mortality. Results: Group of patients ≤2.5 kg: n = 49. Group of patients >2.5 kg: n = 246. No statistical differences found in age, although there were in prematurity and female sex, which were more frequent in ≤2.5 kg. Most frequent diagnosis in ≤2.5 kg was arch hypoplasia and truncus versus transposition of the great arteries (TGA) and arch hypoplasia in >2.5 kg. Cardiopulmonary bypass time and the use of circulatory arrest were significantly higher in ≤2.5 kg. Although ≤2.5 kg group presented a greater mortality (22.4 vs 8.1% p

Extracorporeal circuit (EC) anticoagulation with heparin is a key advance in hemodialysis (HD), but anticoagulation is problematic in inpatients at risk of bleeding. We prospectively evaluated a heparin-avoidance HD protocol, clotting of the EC circuit (CEC), impact on dialysis efficiency, and associated risk factors in our acute care inpatients who required HD (January 17, 2014 to May 31, 2015). Methods: HD sessions without routine EC heparin were performed using airless dialysis tubing. Patients received systemic anticoagulation therapy and/or antiplatelets for non-HD indications. We observed patients for indications of CEC (interrupted HD session, circuit loss, or inability to return blood). The primary outcome was CEC. Logistic regression with generalized estimating equations assessed associations between CEC and other variables. Results: HD sessions (n = 1200) were performed in 338 patients (204 with end-stage renal disease; 134 with acute kidney injury); a median session was 211 minutes (interquartile range [IQR]: 183−240 minutes); delivered dialysis dose measured by Kt/V was 1.4 (IQR: 1.2 Kt/V 1.7). Heparin in the EC was prescribed in only 4.5% of sessions; EC clotting rate was 5.2%. Determinants for CEC were temporary catheters (odds ratio [OR]: 2.8; P < 0.01), transfusions (OR: 2.4; P = 0.04), therapeutic systemic anticoagulation (OR: 0.2; P

Background: Ex vivo lung perfusion (EVLP) has expanded the donor pool for lung transplantation. Pulmonary Staphylococcus aureus infection, especially that caused by multidrug-resistant strains, is a severe threat to posttransplantation outcomes. Sphingosine is a lipid compound that exhibits broad-spectrum antibacterial activity. Therefore, we aimed to evaluate the effects of S aureus infection on EVLP and whether sphingosine administration during EVLP prevents infection with S aureus., Methods: Eighteen pigs were randomly assigned to 3 groups: uninfected, infected with S aureus with NaCl treatment, or infected with sphingosine treatment. Bacterial numbers were determined before and after treatment. Sphingosine concentrations in the lung tissues were determined using biochemical assays. Lung histology, lung physiological parameters, perfusate content, lung weight, and cell death were measured to analyze the effects of infection and sphingosine administration on EVLP., Results: Sphingosine administration significantly reduced the bacterial load. The concentration of sphingosine in the bronchial epithelium was elevated after sphingosine administration. S aureus infection increased pulmonary artery pressure and pulmonary vascular resistance. Lung edema, histology scores, lactate and lactate dehydrogenase levels in the perfusate, ΔPO 2 in the perfusate, static lung compliance, and lung peak airway pressure did not differ among the groups., Conclusions: Infection of S aureus did not affect the lung function during EVLP but induced higher pulmonary artery pressure and pulmonary vascular resistance. Administration of sphingosine effectively eliminated S aureus without side effects in isolated, perfused, and ventilated pig lungs., (Copyright © 2023 International Society for the Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.)

Heparin concentration c in a blood extracorporeal circulation has been real-timely predicted based on the relaxation strength Δε m at relaxation frequency f m extracted by relaxation time distribution (RTD). The simulated extracorporeal circulation was conducted to optimize the number of Δε m for the prediction of c using the porcine whole blood (WB) and low-leukocyte and -platelet blood (LLPB) under the condition of the gradual increment of c from 0 to 8 U/mL with constant flow rate and blood temperature. The experimental results show that among the three relaxation strengths Δε 1 , Δε 2 and Δε 3 (in ascending order of frequency), Δε 2 at f 2  = 5.2 ∼ 6.2 MHz and Δε 3 at f 3  = 42 ∼ 50 MHz were correlated to c. The Δε 3 was decreasing with increasing c in both cases, which was influenced by the plasma macromolecular concentrations, while the Δε 2 was increased with increasing c in WB case but was hardly changed in LLPB case because the Δε 2 is influenced by the blood cell concentrations and the shape changes of blood cell membranes. Heparin concentration c is estimated by the linear regression formula c PRE =a 1 (Δε 2 -Δε 2 c=0 )+a 2 (Δε 3 -Δε 3 c=0 ) (a 1  = -0.991, a 2  = -0.123) within the mean absolute percentage error (MAPE) of 0.291., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2025 The Authors. Published by Elsevier B.V. All rights reserved.)

Hepatoblastoma with intraatrial tumor thrombus is relatively rare. We report a case of hepatoblastoma with tumor thrombus extending into the right atrium, which responded well to chemotherapy and was resected using extracorporeal circulation. A 4-year-old girl was referred to our hospital because of abdominal distention and tenderness. A computed tomography (CT) scan showed a large tumor occupying the left 3 segments of the liver with tumor thrombus extending into the right atrium. There was also a small intrahepatic metastasis in the right lobe of the liver. She was diagnosed with hepatoblastoma on the basis of the results of open biopsy. Neoadjuvant chemotherapy with an intense CDDP-based regimen was performed. The tumor responded well to chemotherapy, and intrahepatic metastasis became undetectable on CT scan, although the tumor thrombus remained in the right atrium. After 7 courses of chemotherapy, we performed resection using extracorporeal circulation. The postoperative course was uneventful, and adjuvant chemotherapy was started 10 days after the operation. Her serum alpha-fetoprotein (AFP) level decreased to the normal range, and she was free of disease for 1 year after the operation. Tumor resection using extracorporeal circulation can be performed safely and is justified in patients with intraatrial tumor thrombus.

Background: Heart transplantation in donation after circulatory death (DCD) relies on warm perfusion using either in situ normothermic regional perfusion (NRP) or ex situ normothermic machine perfusion. In this study, we explore an alternative: oxygenated hypothermic machine perfusion (HMP) using a novel clinically applicable perfusion system, which is compared to NRP with static cold storage (SCS)., Methods: In a porcine model, a DCD setting was simulated, followed by either (1) NRP and SCS (2) NRP and HMP with the XVIVO Heart preservation system or (3) direct procurement (DPP) and HMP. After preservation, heart transplantation (HTX) was performed. After weaning from cardiopulmonary bypass (CPB), biventricular function was assessed by admittance and Swan-Ganz catheters., Results: Only transplanted hearts in the HMP groups showed significantly increased biventricular contractility (end-systole elastance) 2 hour post-CPB (left ventricle absolute change: NRP HMP: +1.8 ± 0.56, p = 0.047, DPP HMP: +1.5 ± 0.43, p = 0.045 and NRP SCS: +0.97 ± 0.47 mmHg/ml, p = 0.21; right ventricle absolute change: NRP HMP: +0.50 ± 0.12, p = 0.025, DPP HMP: +0.82 ± 0.23, p = 0.039 and NRP SCS: +0.28 ± 0.26, p = 0.52) while receiving significantly less dobutamine to maintain a cardiac output >4l/min compared to SCS. Diastolic function was preserved in all groups. Post-HTX, both HMP groups showed significantly less increments in plasma troponin T compared to SCS., Conclusion: In DCD HTX, increased biventricular contractility post-HTX was only observed in hearts preserved with HMP. In addition, the need for inotropic support and signs of myocardial damage were lower in the HMP groups. DCD HTX can be successfully performed using DPP followed by preservation with HMP in a preclinical setting., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

OBJETIVO: apresentar a evolução clínica de recém-nascido portador de insuficiência respiratória grave neonatal secundária à Sindrome de Aspiração Meconial tratado por Circulação Extracorpórea por Membrana, ou, conforme o termo consagrado em língua inglesa, ECMO (Extracorporeal Membrane Oxygenation), o efeito do uso de surfactante exógeno neste caso e os custos do procedimento. MÉTODOS: Descrição de um caso de Síndrome de Aspiração Meconial, tratado na UCINE (Unidade de Cuidados Intensivos Neonatais) do Instituto da Criança Prof. Pedro de Alcantara, Hospital das Clínicas da Universidade de São Paulo. RESULTADOS: O suporte extracorpóreo teve a duração de 5 dias, sem complicações clínicas ou mecânicas. Surfactante exógeno de origem porcina foi administrado no 4o dia, após o quê observamos uma melhora significativa na complacência pulmonar. O recém-nascido pôde então ser rapidamente decanulado. Os custos do tratamento foram compatíveis com a realidade nacional em relação a um recém-nascido criticamente enfermo. CONCLUSÕES: a ECMO é indicada em casos de insuficiência respiratória neonatal que não respondam a outros tratamentos existentes. Deve ser disponível em Unidades de Tratamento Intensivo (UTIs) neonatais de hospitais terciários e ser empregada conforme critérios bem estabelecidos. A utilização de surfactante exógeno aparentemente antecipou a retirada da ECMO e, portanto, deve ser considerada em casos semelhantes. Os custos do tratamento justificam a organização de Equipes de ECMO nessas UTIs.OBJECTIVES: to present the clinical outcome of a newborn with severe respiratory distress secondary to meconium aspiration syndrome and treated by extracorporeal membrane oxygenation (ECMO); and to present the effect of the use of exogenous surfactant in this case and the cost of the procedure. METHODS: Case report of a newborn with meconium aspiration syndrome and treated at the neonatal ICU of the Instituto da Criança Prof. Pedro de Alcantara, Hospital das Clínicas of the Universidade de São Paulo. RESULTS: ECMO was carried out for 5 days with no clinical or mechanical complications. On the 4th day of ECMO, we administered porcine exogenous surfactant; a significant improvement in lung compliance was observed and the newborn was decannulated shortly after that. Treatment costs were compatible with the situation of healthcare in Brazil for treatment of critically ill newborn patients. CONCLUSIONS: ECMO is indicated in cases of neonatal respiratory distress not responding to other treatments. The technique should be made available in neonatal Intensive Care Units (ICUs) of tertiary hospitals according to well-established protocols. The use of exogenous surfactant apparently allowed for earlier decannulation of the patient and should be considered in similar cases. The treatment costs do justify the organizing of ECMO teams in this type of ICUs.

The use of extended criteria donor grafts is a promising strategy to increase the number of organ transplantations and reduce waitlist mortality. However, these organs are often compromised and/or damaged, are more susceptible to preservation injury, and are at risk for developing post-transplant complications. Ex vivo organ perfusion is a novel technology to preserve donor organs while providing oxygen and nutrients at distinct perfusion temperatures. This preservation method allows to resuscitate grafts and optimize function with therapeutic interventions prior to solid organ transplantation. Stem cell-based therapies are increasingly explored for their ability to promote regeneration and reduce the inflammatory response associated with in vivo reperfusion. The aim of this review is to describe the current state of stem cell-based therapies during ex vivo organ perfusion for the kidney, liver, lung, and heart. We discuss different strategies, including type of cells, route of administration, mechanisms of action, efficacy, and safety. The progress made within lung transplantation justifies the initiation of clinical trials, whereas more research is likely required for the kidney, liver, and heart to progress into clinical application. We emphasize the need for standardization of methodology to increase comparability between future (clinical) studies., (© 2022 The Authors. American Journal of Transplantation published by Wiley Periodicals LLC on behalf of The American Society of Transplantation and the American Society of Transplant Surgeons.)

Background: In the US, only 23% of lungs offered for transplantation are transplanted. Ex vivo lung perfusion (EVLP) allows for evaluation of additional donor lungs; its adoption has been limited by resources and expertise. Dedicated facilities with a centralized lung evaluation system (CLES) could expand access to EVLP., Methods: In this unblinded, nonrandomized, traditional feasibility study, 7 US transplant centers referred lungs declined for standard transplantation to a dedicated EVLP facility, which utilized a CLES. EVLP was remotely monitored by the transplant teams. CLES lungs were matched with contemporaneous conventional static cold-preserved controls at each center., Results: A total of 115 recipients were enrolled, and 66 received allografts from 63 donors after EVLP at the dedicated CLES facility. Forty-nine contemporaneous patients served as controls. Primary graft dysfunction grade 3 at 72 hours (PGD3-72 hours) was higher in the CLES group with 16 (24%) vs 2 (4%) in the control (common RD 95% CI, 0.07-0.32; p = 0.0009). All recipients survived to 30 days and 1-year survival was similar for both groups (92% controls vs 89% CLES; common RD 95% CI, -0.14-0.08; p = 0.58). Total preservation time, hospital and ICU lengths of stay, and time to first extubation were longer in the CLES group., Conclusions: Remote ex vivo perfusion of lung allografts declined for conventional transplantation at a dedicated CLES facility is feasible and resulted in additional transplants. Recipients of allografts assessed with a CLES had a higher rate of PGD3-72 hours, but similar 30-day and 1-year outcomes compared to conventional lung recipients. (NCT02234128)., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

An increased focus on improving efficiency and decreasing costs has resulted in alternative models of donor management and organ recovery. The specialized donor care facility model provides highly efficient and cost-effective donor care at a free-standing facility, resulting in improved organ yield, shorter ischemic times, decreased travel, and fewer nighttime operations. Ex vivo lung perfusion (EVLP) improves utilization of extended criteria donor lungs, and centralized EVLP facilities have the potential to increase transplant volumes for smaller transplant programs in specified geographic regions. These alternative models are increasingly being used in the United States to improve waitlist mortality and combat the ongoing donor organ shortage., Competing Interests: Disclosure M. Cypel is a founder of XOR Labs Toronto and a consultant for Lung Bioengineering Inc. D. Kreisel has a pending patent entitled “Compositions and methods for detecting CCR2 receptors” (application number 15/611,577). DK is supported by National Institutes of Health grants 1P01AI116501, R01HL094601, R01HL151078, The Cystic Fibrosis Foundation, and The Foundation for Barnes-Jewish Hospital. AB is supported by National Institutes of Health grant 5T32HL007317-44., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Indroduction: Rupture of and abdominal aortic aneurysm (AAA) in a kidney transplant patient is a rare and rarely reported event. Emergent treatment can be challenging and should achieve effective aortic repair while minimizing ischemic damage to the renal graft during aortic cross-clamping. Several renal protective measures have been proposed such as permanent or temporary shunts, renal cold perfusion and general hypothermia., Case Report: We report the effective treatment of a para-renal AAA in a patient with a functional renal allograft. A temporary extra-corporeal axillofemoral shunt was constructed to maintain graft's perfusion during open surgical repair. EVAR was not an option due to a short aortic neck. The postoperative period was complicated by colon ischemia and aortic graft infection. At 3 years follow-up the patient was well and graft's function was unchanged., Conclusion: This case is a reminder that renal graft protection must be accounted for when AAA rupture occurs in kidney transplant patients. We reviewed the literature to find previously reported cases and how they were managed., (Copyright © 2021. Published by Elsevier Inc.)

We report of a patient with abdominal aortic aneurysm and renal transplant who underwent aneurysm repair. These patients can be treated by eather open or endovascular approach, depending on several factors, including aneurysm morphologic suitability for endovascular tretament, age of patient, and comorbidities.The main challange with open repair approach is to maintain renal transplant perfusion during the aortic cross clamping. Several methods of renal transplant perfusion during aneurysm repair have been described. In this case, we opted for open aneurysm repair beacuse of the age of the patient. The femoral venoarterial perfusion technique using extracorporal circulation machine was employed. We found this technique safe and easy in treating such patients., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Ex vivo lung perfusion (EVLP) has being increasingly used for the pretransplant assessment of extended-criteria donor lungs. Mathematical models to predict lung acceptance during EVLP have not been reported so far. Thus, we hypothesized that predictors of lung acceptance could be identified and used to develop a mathematical model describing the clinical decision-making process used in our institution. Donor lungs characteristics and EVLP physiologic parameters included in our EVLP registry were examined (derivation cohort). Multivariable logistic regression analysis was performed to identify predictors independently associated with lung acceptance. A mathematical model (EX vivo lung PerfusIon pREdiction [EXPIRE] model) for each hour of EVLP was developed and validated using a new cohort (validation cohort). Two hundred eighty donor lungs were assessed with EVLP. Of these, 186 (66%) were accepted for transplantation. ΔPO 2 and static compliance/total lung capacity were identified as independent predictors of lung acceptance and their respective cut-off values were determined. The EXPIRE model showed a low discriminative power at the first hour of EVLP assessment (AUC: 0.69 [95% CI: 0.62-0.77]), which progressively improved up to the fourth hour (AUC: 0.87 [95% CI: 0.83-0.92]). In a validation cohort, the EXPIRE model demonstrated good discriminative power, peaking at the fourth hour (AUC: 0.85 [95% CI: 0.76-0.94]). The EXPIRE model may help to standardize lung assessment in centers using the Toronto EVLP technique and improve overall transplant rates., (© 2021 The American Society of Transplantation and the American Society of Transplant Surgeons.)

Clinical practice shows that a critical unmet need in the field of medical device-associated thrombosis prevention is the availability of an anticoagulant therapy without hemorrhagic risk. In the quest for new drugs that are at least as effective as those currently available, while avoiding bleeding complications, molecules that target nearly every step of the coagulation pathway have been developed. Among these molecules, inhibitors of factor XII (FXII) or factor XI (FXI) are promising alternatives as deficiencies in these factors protect against thrombosis without causing spontaneous hemorrhage, as revealed by epidemiological and preclinical data. Ixodes ricinus-contact phase inhibitor (Ir-CPI), a new anticoagulant candidate with an innovative mechanism of action could be this ideal anticoagulant agent for safe prevention from clotting on medical devices. This protein, which selectively binds to FXIIa, FXIa, and plasma kallikrein and inhibits the reciprocal activation of FXII, prekallikrein, and FXI in human plasma, was shown to prevent thrombosis in an ovine cardiopulmonary bypass system associated with cardiac surgeries. Furthermore, as opposed to unfractionated heparin, Ir-CPI appears to be devoid of bleeding risk. This review outlines the rationale for targeting upstream coagulation factors in order to prevent medical device-associated thrombosis; examines the novel approaches under development; and focuses on Ir-CPI, which shows promising properties in the field of thrombosis prevention., (© 2020 International Society on Thrombosis and Haemostasis.)