Ventricular assist devices (VADs) invigorated the management of patients with advanced heart failure, providing a lifeline for patients awaiting transplantation or requiring long-term circulatory support. This article reviews recent advances in VAD technologies, focusing on key areas of progress to overcome existing challenges and the potential for future applications. The reduction or possible elimination of infection-prone components and the evolution to transcutaneous energy transfer systems are two main research fields to reach a new quality of life category for VADs patients. Miniaturization and enhanced biocompatibility have resulted in smaller, less invasive devices with a significantly reduced risk of complications and mortality. Advances in percutaneous ventricular assist devices have emerged, contributing to the creation of less invasive options with or without intracardiac pumps, and facilitating their use for both left and right ventricles. These devices have gained more and more features, including the use of artificial intelligence. Moreover, the possibility of long-term use of intracardiac pumps offers a potential bridge to transplantation, allowing ambulation and probably also long-term circulatory support. Despite considerable advances, challenges remain, particularly in terms of improving durability, reducing the risk of ischemic events, further refining materials, and more sophisticated control and synchronization between systems that adapt to changing physiological demands.

Background: Multiple organ failure is a common complication in patients undergoing ECLS significantly affecting patient outcomes. Gaining knowledge about the mechanisms of onset, clinical course, risk factors, and potential therapeutic targets is highly desirable.Methods: Data of 354 patients undergoing ECLS with one‐, two, three‐, and four organ failures were retrospectively analyzed. Incidence of multiple organ dysfunction (MODS), its impact on survival, risk factors for its occurrence, and the impact of proinflammatory mediators on the occurrence of MODS in patients undergoing ECLS were investigated.Results: The median follow‐up was 66 (IQR 6; 820) days. 245 (69.2%) patients could be weaned from ECLS, 30‐day survival and 1‐year survival were 194 (54.1%) and 157 (44.4%), respectively. The duration of mechanical support was 4 (IQR 2; 7) days in the median. Increasing severity of MODS resulted in significant prolongation of mechanical circulatory support and worsening of the outcome. Liver dysfunction had the strongest impact on patient mortality (OR = 2.5) and survival time (19 vs 367 days). The serum concentration of analyzed interleukins rose significantly with each, additional organ affected by dysfunction (p < 0.001). All analyzed proinflammatory cytokines showed significant predictivity relative to the occurrence of MODS with interleukin 8 serum level prior to ECLS showing the strongest predictive potential for the occurrence of MODS (AUC 0.78).Conclusion: MODS represents a frequent complication in patients undergoing ECLS with a significant impact on survival. Proinflammatory cytokines show prognostic capacity regarding the occurrence and severity of multi‐organ dysfunction.

Background Use of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in elderly patients is controversial because of presumed poor outcome. Our primary aim was to determine the influence of advanced age on short- and long-term outcome; the secondary aim was to analyze risk factors for impaired outcome. Methods Between January 2006 and June 2020, 645 patients underwent VA-ECMO implantation in our department. The patients were categorized into four groups:= 70 years old. Data were retrospectively analyzed for short- and long-term outcome. Risk factors for in-hospital mortality and mortality during follow-up were assessed using multivariate regression analysis. Results VA-ECMO support duration was comparable in all age groups (median 3 days). Weaning rates were 60.8%/n = 104 (= 70, p = 0.048). Hospital mortality was highest in the patients aged 50-59.9 years (68%/n = 119), but not in the elderly patients (60-69.9, >= 70:62.1%/n = 113, 58,1%/n = 68). At discharge, the cerebral performance category scores were superior in the patients <50 years. Multivariate logistic regression analysis revealed chronic kidney failure requiring hemodialysis, duration of cardiopulmonary resuscitation, and elevated blood lactate levels before VA-ECMO, but not age as predictors of in-hospital mortality. Cox's regression disclosed age as relevant risk factor for death during follow-up. The patients' physical ability was comparable in all age groups. Conclusion VA-ECMO support should not be declined in patients only because of advanced age. Mortality and neurological status at hospital discharge and during follow-up were comparable in all age groups.

Background The outcome after veno-venous extracorporeal membrane oxygenation in elderly patients is supposed to be unsatisfactory. Our primary aim was to determine the influence of advanced age on short- and long-term outcomes; the secondary aim was to analyze risk factors for impaired outcomes. Methods Between January 2006 and June 2020, 755 patients received V-V ECMO support at our department. Patients were grouped according to age (18-49.9, 50-59.9, 60-69.9, >= 70 years old), and then retrospectively analyzed for short- and long-term outcomes. Risk factors for in-hospital mortality and death during follow-up were assessed using multivariate regression analysis. Results Duration of V-V ECMO support was comparable between all groups median (8-10 days, p = 0.256). Likewise, the weaning rate was comparable in all age groups 68.2%-76.5%; (p = 0.354), but in-hospital mortality was significantly climbing with increasing age (n = 91 vs. 50-59.9 years 37.1%/n = 73, vs. 60-69.9 years 45.6%/n = 78 vs. >= 70 years 51.8%/n = 44; p < 0.001). Older age groups also showed significantly reduced cerebral performance category scores. The multivariate logistic analysis yielded age, acute and chronic hemodialysis, bilirubin on day 1 of support, malignancy, and primary lung disease as relevant risk factors for in-hospital mortality. Age, coronary artery disease, presence of another primary lung disease, malignancy, and immunosuppression were risk factors for death during follow-up. Conclusion In V-V ECMO patients, advanced age is associated with more comorbidity, impaired short- and long-term outcome, and worse neurological outcome.

Extracorporeal life support (ECLS) is increasingly employed for severe respiratory or cardiac failure, alongside a rising adoption of extracorporeal cardiopulmonary resuscitation (eCPR). Despite increased adoption, limited evidence underscores possible cytokines’ pivotal role in the inflammatory response during ECLS. The study involved 546 eCPR patients using veno-arterial extracorporeal membrane oxygenation from 2013 to 2023. Categorized into in-hospital eCPR (IHCA, 358 patients) and out-of-hospital eCPR (OHCA, 188 patients) groups, a retrospective analysis explored associations among interleukin 6 (IL6), interleukin 8 (IL8), tumor necrosis factor-alpha (TNF-alpha), soluble interleukin-2 receptor (sIL2R), and pivotal post-resuscitation syndrome (PRS) components. Cytokine dynamics were assessed before and after ECLS initiation. CPR-to-ECLS time was significantly longer in the OHCA group (p = 0.009), correlating with elevated IL6 and IL8 levels. The IHCA group showed more favorable neurological outcomes (p < 0.001), but presented with a higher incidence of multiple organ failure (p < 0.001) compared to the OHCA group. The IHCA group exhibited pronounced IL6 and IL8 levels prior to ECLS initiation significantly decreasing post-ECLS initiation (p = 0.01 and p = 0.008), whereas OHCA patients showed peak levels of IL6 and IL8 during the course of ECLS (p < 0.001). IL6 and IL8 are associated with key elements of the post-resuscitation syndrome (neurological outcome, organ dysfunction and hemodynamic status) in patients undergoing eCPR for refractory cardiac arrest, possibly providing a predictive ability of organ dysfunction in OHCA patients without a preceding pro-inflammatory burden.