Background: High‐quality evidence for post‐cardiotomy extracorporeal life support (PC‐ECLS) management is lacking. This study investigated real‐world PC‐ECLS clinical practices.Methods: This cross‐sectional, multi‐institutional, international pilot survey explored center organization, anticoagulation management, left ventricular unloading, distal limb perfusion, PC‐ECLS monitoring, and transfusion practices. Twenty‐nine questions were distributed among 34 hospitals participating in the Post‐cardiotomy Extra‐Corporeal Life Support Study.Results: Of the 32 centers [16 low‐volume (50%); 16 high‐volume (50%)] that responded, 16 (50%) had dedicated ECLS specialists. Twenty‐six centers (81.3%) reported using additional mechanical circulatory supports. Anticoagulation practices were highly heterogeneous: 24 hospitals (75%) reported using patients bleeding status as a guide, without a specific threshold in 54.2% of cases. Transfusion targets ranged from 7 to 10 g/dL. Most centers used cardiac venting on a case‐by‐case basis (78.1%) and regular distal limb perfusion (84.4%). Nineteen (54.9%) centers reported dedicated monitoring protocols, including daily echocardiography (87.5%), Swan‐Ganz catheterization (40.6%), cerebral near‐infrared spectroscopy (53.1%), and multimodal assessment of limb ischemia. Inspection of the circuit (71.9%), oxygenator pressure drop (68.8%), plasma free hemoglobin (75%), d‐dimer (59.4%), lactate dehydrogenase (56.3%), and fibrinogen (46.9%) are used to diagnose hemolysis and thrombosis.Conclusions: This study shows remarkable heterogeneity in clinical practices for PC‐ECLS management. More standardized protocols and better implementation of the available evidence are recommended.

Acute pericardial tamponade is one of the most emergent clinical scenarios in cardiac surgery. With numerous causes in the background, pericardial tamponade can lead to cardiogenic shock and death. In modern diagnostic era, the recognition of pericardial tamponade is simple, but its management and the long-term effects can still be challenging. Without the detailed understanding of the pathophysiological pathways diagnostic and therapeutic management plans of pericardial tamponade is very difficult. The aim of this review was to give a complex picture of pericardial tamponade, from its role in medical history to pathophysiology and its significance in surgical experimental models. Orv Hetil. 2018; 159(5): 163–167.

Objectives: Post‐cardiotomy extracorporeal life support (ECLS) cannulation might occur in a general post‐operative ward due to emergent conditions. Its characteristics have been poorly reported and investigated This study investigates the characteristics and outcomes of adult patients receiving ECLS cannulation in a general post‐operative cardiac ward.Methods: The Post‐cardiotomy Extracorporeal Life Support (PELS) is a retrospective (2000–2020), multicenter (34 centers), observational study including adult patients who required ECLS for post‐cardiotomy shock. This PELS sub‐analysis analyzed patients´ characteristics, in‐hospital outcomes, and long‐term survival in patients cannulated for veno‐arterial ECLS in the general ward, and further compared in‐hospital survivors and non‐survivors.Results: The PELS study included 2058 patients of whom 39 (1.9%) were cannulated in the general ward. Most patients underwent isolated coronary bypass grafting (CABG, n = 15, 38.5%) or isolated non‐CABG operations (n = 20, 51.3%). The main indications to initiate ECLS included cardiac arrest (n = 17, 44.7%) and cardiogenic shock (n = 14, 35.9%). ECLS cannulation occurred after a median time of 4 (2–7) days post‐operatively. Most patients' courses were complicated by acute kidney injury (n = 23, 59%), arrhythmias (n = 19, 48.7%), and postoperative bleeding (n = 20, 51.3%). In‐hospital mortality was 84.6% (n = 33) with persistent heart failure (n = 11, 28.2%) as the most common cause of death. No peculiar differences were observed between in‐hospital survivors and nonsurvivors.Conclusions: This study demonstrates that ECLS cannulation due to post‐cardiotomy emergent adverse events in the general ward is rare, mainly occurring in preoperative low‐risk patients and after a postoperative cardiac arrest. High complication rates and low in‐hospital survival require further investigations to identify patients at risk for such a complication, optimize resources, enhance intervention, and improve outcomes.

Background: Post-cardiotomy cardiogenic shock (PCCS) remains one of the most lethal complications of cardiac surgery, with high in-hospital mortality despite major improvements in operative techniques, and intensive care management. Temporary mechanical circulatory support (tMCS) is widely applied as a rescue therapy for refractory PCCS. However, outcomes remain suboptimal, also due to delayed initiation after the onset of severe hemodynamic collapse and irreversible compromised end-organ states. This review summarizes current concepts of PCCS management and evaluates the emerging role of prophylactic tMCS within the framework of “protected cardiac surgery”. Methods: A narrative review of the current international guidelines, expert consensus statements, and major observational studies addressing post-cardiotomy tMCS and prophylactic support strategies was carried out. Emphasis was placed on pathophysiology, indications, timing of support, and device selection. Results: Prophylactic tMCS has been applied in selected high-risk scenarios including acute coronary syndromes, acute valvular dysfunction, ventricular septal rupture, papillary muscle rupture, advanced heart failure requiring bridge-to-decision or to-transplant, or difficult and complex weaning from cardiopulmonary bypass. The concepts of preoperative (Type 1), planned intraoperative (Type 2), and unplanned early intraoperative (Type 3) protected cardiac surgery provide a practical framework for a timely evaluation and related action aiming at metabolic stabilization to reduce or prevent postoperative low cardiac output syndrome. Successful implementation depends on multidisciplinary Heart Team decision-making, advanced hemodynamic assessment, and tailored perfusion strategies as well as device selection also based on local resources and expertise. Conclusions: Prophylactic tMCS represents a paradigm shift from reactive rescue therapy toward proactive cardio-circulatory protection in selected high-risk patients undergoing cardiac surgery procedures. While early observational data are encouraging, prospective trials, standardized risk stratification tools, and cost-effectiveness analyses are required to define its role in modern cardiac surgery.

Background: Severe respiratory failure often requires veno-venous extracorporeal membrane oxygenation (v-v ECMO) treatment, a procedure frequently associated with acute kidney injury (AKI). Preclinical studies have demonstrated the anti-inflammatory properties of inhaled methane (CH₄). This experimental protocol aimed to investigate whether CH₄ gas administration could mitigate the development of AKI in a clinically relevant large animal model of v-v ECMO. Methods: Anesthetized miniature pigs were divided into three groups (n = 6 each). Following cannulation of the right femoral and internal jugular veins, v-v ECMO was initiated and maintained for 24 h, followed by a 6-h post-ECMO observation. The control group underwent cannulation without ECMO, while the v-v ECMO+CH₄ group received a 2% CH₄-air mixture via the oxygenator. Urine output was recorded, and kidney injury was assessed using plasma and urine neutrophil gelatinase-associated lipocalin levels. Inflammatory activation was evaluated through plasma interleukin-1β (IL-1β) and interleukin-8 (IL-8) levels. Kidney tissue samples were analyzed for histopathological changes, xanthine oxidoreductase and myeloperoxidase activities, and nitrite/nitrate levels. Results: The CH₄-treated group exhibited significantly higher post-ECMO renal arterial flow (244.7 ± 70 vs. 96.3 ± 21 mL/min) and increased average urine output (5.75 ± 1.6 vs. 3.25 ± 0.4 mL/h/kg) compared to the v-v ECMO group. CH₄ administration reduced urine and plasma neutrophil gelatinase-associated lipocalin levels and demonstrated lower histological damage scores (0.8 ± 0.3 vs. 3.3 ± 0.8). Furthermore, CH₄ treatment decreased xanthine oxidoreductase and myeloperoxidase activities and reduced inflammatory mediators, including IL-1β, IL-8, and nitrite/nitrate. Conclusion: CH₄ admixture significantly mitigates inflammatory activation and renal injury associated with v-v ECMO. These findings suggest that CH₄ may serve as an effective adjunctive means to reduce renal complications of v-v ECMO therapy.

Összefoglaló. Az extracorporalis membránoxigenizációt egyre gyakrabban alkalmazzák világszerte refrakter légzési és/vagy keringési elégtelenség kezelésében. Intézetünkben 2015-ben kezdtük meg a program előkészítését és felépítését. Célunk az extracorporalis membránoxigenizációs kezelés élettani alapjainak rövid ismertetése, különös tekintettel a venovenosus konfigurációra, és az eddig kezelt eseteink eredményeinek összefoglalása. Az irodalom szisztematikus áttekintése és a kezelt esetek adatainak retrospektív értékelése voltak a módszereink. 2016 óta összesen 14 beteg esetében használtunk extracorporalis membránoxigenizációt (8 férfi, 6 nő, életkor 51 ± 15 év, APACHE II. score 24 ± 7). Az indikáció 9 esetben súlyos refrakter hypoxaemiás légzési elégtelenség, 1 esetben tracheooesophagealis fistula és légzési elégtelenség, 1 esetben műtét alatti támogatás tervezett trachearekonstrukció során és 3 beteg esetében refrakter cardiogen shock volt. Az extracorporalis membránoxigenizáció 11 betegben a légzés, 3 betegben a keringés támogatását szolgálta, 13 venovenosus, 1 venoarteriosus konfigurációban. Az extracorporalis támogatás ideje légzéstámogatás esetében 14 ± 6 nap, a cardialis támogatások esetében 5 ± 4 nap volt. Az intenzív osztályos ápolási idő 27 ± 13, illetve 21 ± 17 nap volt a két betegcsoportban. 9 beteget jó funkcionális állapotban bocsátottunk el, 5 beteg halt meg osztályunkon, további 3 később a kórházi bennfekvés során. Az extracorporalis membránoxigenizációs program regionális centrumokban Magyarországon is megvalósítható. A nemzetközi ajánlások, oktatási módszerek alkalmazásával a nemzetközi irodalomban közölt túlélési eredményekhez hasonló eredmények érhetők el hazánkban is. Orv Hetil. 2021; 162(11): 425–431. Summary. Extracorporeal membrane oxygenisation is commonly used worldwide for refractory respiratory and circulatory failure. We started to organise the introduction of this therapeutic modality in 2015. Our aim is to give a short review about extracorporeal life support, especially veno-venous extracorporeal membrane oxygenation, and to present our first results. We provide a systematic review of the currently available literature and a summary of our first treatments. As of 2016, we supported 14 patients with extracorporeal membrane oxygenisation (8 men, age 51 ± 15 years, APACHE II score 24 ± 7). The indications were refractory hypoxaemic respiratory failure in 9, tracheo-oesophageal fistula and respiratory failure in 1, support during surgery for planned tracheal reconstruction in 1, and refractory cardiogenic shock in 3 patients. We provided respiratory support in 11, circulatory support in 3 cases, with 13 veno-venous and 1 veno-arterial configuration. The support lasted for 14 ± 6 days in respiratory, and for 5 ± 4 days in cardiac cases. Intensive care length of stay was 27 ± 13 and 21 ± 17 days in the two patient groups. We discharged 9 patients in good functional state, 5 patients died during intensive care and further 3 later, during the hospital stay. Our results show that the implementation of an extracoporeal membrane oxygenation program is feasible in Hungarian tertiary centers. In line with international recommendations and adapting international training courses, the survival is very similar to that reported in the literature. Orv Hetil. 2021; 162(11): 425–431.