HELLP syndrome is characterized by hemolysis, elevated liver enzymes, and a low platelet count and poses an increased risk to the pregnant woman and the unborn child. Individual risk factors such as obesity may alter immunocompetence and influence the course of preeclampsia (PE) or HELLP syndrome. Blood samples were collected from 21 pregnant women (7 healthy, 6 with PE, and 8 with HELLP syndrome) and polymorphonuclear neutrophils (PMNs) were subsequently isolated. Production of radical oxygen species (ROS), cell movement, and NETosis were assessed by live-cell imaging. Surface protein expression and oxidative burst were analyzed by flow cytometry. PE and HELLP patients had significantly higher BMI compared to the healthy control group. Depending on the expression of CD11b, CD62L, and CD66b on PMNs, a surface protein activation sum scale (SPASS) was calculated. PMNs from patients with high SPASS values showed prolonged and more targeted migration with delayed ROS production and NETosis. Obesity is associated with a chronic inflammatory state, which in combination with immunological triggers during pregnancy could modulate PMN functions. Pregnant women with higher BMI tend to have higher SPASS values, indicating activation of the innate immune system that could co-trigger PE or HELLP syndrome.

Background/Objectives: Evidence on outcomes after repeat VA-ECMO in adults remains limited. This study aimed to compare survival and post-discharge functional outcomes between adults requiring a second VA-ECMO run and propensity-matched patients supported with a single VA-ECMO run and to characterize the clinical course during repeat support. Methods: This is an observational, single-center, retrospective cohort study with a propensity score–matched comparative analysis, conducted at a university tertiary-care referral center between 2006 and 2024. This study included 1496 adult patients (≥18 years) treated with VA-ECMO, of whom 30 (2.0%) required a second VA-ECMO run. Primary endpoints were in-hospital mortality, 30-day outcomes, and overall survival. Secondary exploratory analyses assessed baseline hemodynamic and metabolic parameters, multiorgan failure, neurological complications, and cannulation-related complications. Results: Repeat VA-ECMO was associated with longer support duration (median 6 vs. 4 days; p = 0.003) and a higher risk of MOF (OR 3.45; 95% CI 1.45–8.19; p = 0.003). No statistically significant differences in survival were observed (in-hospital mortality (OR 1.01; 95% CI, 0.48–2.11; p = 0.984); 30-day survival (OR 1.49; 95% CI, 0.72–3.07; p = 0.280); overall survival (OR 1.27; 95% CI, 0.59–2.73; p = 0.272). Repeat VA-ECMO was associated with higher transfusion requirements (RBC median 7.5 vs. 2 units; p < 0.001). After propensity matching, prolonged support, increased MOF, and higher transfusion burden persisted. ECOG outcomes were comparable overall; however, a borderline trend toward worse functional status was observed in patients undergoing repeat VA-ECMO during the same hospitalization (p = 0.057). Conclusions: Repeat VA-ECMO may be feasible in carefully selected adults, with no significant differences in survival, but is associated with prolonged support, increased transfusion requirements, and substantially higher MOF risk.