Background: Open cardiac surgery involving cardiopulmonary bypass (CPB) triggers a systemic inflammatory response that significantly affects clinical outcomes. However, the dynamics and specific roles of cytokine release after CPB in the pediatric population remain unclear.Purpose: To evaluate the dynamics of cytokine levels and their association with low cardiac output syndrome (LCOS)-related outcomes.Methods: A prospective observational cohort study was conducted of 32 children who underwent elective open cardiac surgery with CPB at Songklanagarind Hospital, Thailand. Levels of interleukin (IL)-1β, IL-6, IL-8, IL-10, and tumor necrosis factor (TNF)-α were analyzed preoperatively and immediately (T0), 6, 12, and 24 hours after intensive care unit admission. LCOS-related outcomes were defined with at least two of the following criteria being met within 24 hours postoperative: clinical and laboratory parameters, vasopressor-inotropic score ≥20, ejection fraction 56 pg/mL from baseline to T0 showed the strongest association with LCOS (odds ratio, 37.34; 95% confidence interval, 4.53–836.53).Conclusion: An elevated postoperative IL-8 level is a robust predictor of LCOS-related outcomes in pediatric patients undergoing cardiac surgery. These findings emphasize the importance of monitoring cytokine dynamics to guide interventions and improve patient outcomes.

Background: Oxidative stress and systemic inflammation during cardiac surgery can lead to postoperative complications. Although vitamin C and thiamine (vitamin B1) have individually demonstrated protective effects, their combined effects remain underexplored. This study aimed to evaluate the efficacy of combined vitamin C and B1 therapy versus that of vitamin C alone in reducing inflammatory and cardiac biomarkers and improving postoperative outcomes in patients undergoing cardiac surgery. Methods: In this prospective, double-blind, randomized controlled trial, 64 patients scheduled for elective cardiac surgery at a tertiary care center were randomized to receive either 1000 mg vitamin C or a combination of 1000 mg vitamin C and 100 mg vitamin B1 at four perioperative time points. Primary outcomes included changes in inflammatory biomarkers [C-reactive protein, interleukin-6 (IL-6), and white blood cells], and cardiac biomarkers [creatine kinase-MB, Troponin-I, and lactate dehydrogenase]. Secondary outcomes included hemodynamic parameters and left ventricular function. Results: Compared with vitamin C alone, combined vitamin B1 and vitamin C significantly reduced postoperative cardiac biomarker levels. IL-6 levels were significantly lower immediately in the combined group; however, this effect was not sustained at 24 h post-surgery. Up to 24 h after surgery, no significant differences in hemodynamic stability or left ventricular ejection were observed between the groups. Notably, the combined therapy group demonstrated a lower incidence of postoperative arrhythmias and shorter dobutamine duration within 24 postoperatively. Conclusions: Combined vitamin C and B1 therapy significantly reduced markers of myocardial injury and early inflammatory responses (IL-6) in patients undergoing cardiac surgery, suggesting its potential as a protective agent.

Objective Extracorporeal membrane oxygenation (ECMO) is a relatively new technology used for life support in patients with cardiopulmonary failure from various causes. The objective of this study is to review the first 5-year experience in adopting this technology in a teaching hospital in southern Thailand.Methods The data of ECMO-supported patients in Songklanagarind Hospital, from the years 2014 to 2018, were retrospectively reviewed. Data sources were from electronic medical records and the database of the perfusion service. Parameters in focus included prior conditions and indications of ECMO, type of ECMO and cannulation method, complications during and after the treatment, and discharge statuses.Results A total of 83 patients received ECMO life support during the 5-year period and the number of cases per year increased. The proportion of venovenous: venoarterial ECMO in our institute was 49:34 cases and there were three cases who used ECMO as a part of cardiopulmonary resuscitation. Moreover, there were 57 cases who used ECMO for cardiac failure and 26 cases were for respiratory causes, while premature withdrawal was decided in 26 cases (31.3%). Overall survival from ECMO was 35/83 cases (42.2%) and survival to discharge was 32/83 (38.6%). During therapy, ECMO could restore serum pH to the normal range in all cases. Furthermore, those who used ECMO for respiratory failure had significantly higher survival probability (57.7%) when compared to the cardiac counterpart (29.8%, p-value = 0.03). Patients with younger ages also had significantly better survival outcomes. The most common complications were cardiac (75 cases, 85.5%), followed by renal (45 cases, 54.2%), and hematologic systems (38 cases, 45.8%). In those who survived to discharge, average ECMO duration was 9.7 days.Conclusion Extracorporeal life support is a technology that bridges the patients with cardiopulmonary failure to their recovery or definitive surgery. Despite the high complication rate, survival can be expected, especially in respiratory failure cases and relatively young patients.

Purpose: Venoarterial extracorporeal membrane oxygenation (VA‐ECMO) is a life‐saving intervention for refractory cardiopulmonary failure. Identifying factors associated with survival is essential for optimizing patient selection and management. In this study, we aimed to identify VA‐ECMO survival predictors and evaluate the associated complications, costs, and outcomes. Methods: A retrospective analysis was conducted on data from 123 adult patients who underwent VA‐ECMO at the Songklanagarind Hospital between 2017 and 2023. Clinical characteristics, ECMO‐related complications, hospital expenses, and survival outcomes were analyzed. Univariate and multivariate logistic regression analyses were used to determine independent predictors of survival. Results: Fifty (40.7%) patients survived until hospital discharge. Compared to central VA‐ECMO, peripheral VA‐ECMO was significantly associated with improved survival (adjusted OR: 26.44, 95% CI: 1.95–358.7, p = 0.014). Preexisting liver dysfunction (adjusted OR: 0.27, 95% CI: 0.09–0.79, p = 0.016) and renal dysfunction (adjusted OR: 0.29, 95% CI: 0.1–0.85, p = 0.023) were independent mortality predictors. Survival odds were significantly lower in patients with American Society of Anesthesiologists (ASA) Class 5 (adjusted OR: 0.07, 95% CI: 0.01–0.67, p = 0.022). Neurological complications were more common in nonsurvivors than in survivors (41.1% vs. 18%, p = 0.012). Survivors had significantly higher total hospital costs (997,563.5 vs. 696,191 THB, p = 0.004) and longer hospital stays (28.5 vs. 3 days, p < 0.001). The multivariate model demonstrated strong predictive performance, with an area under the curve of 0.85. Conclusions: ECMO cannulation strategy, preexisting liver and renal dysfunction, and ASA classification were key factors associated with survival. Peripheral VA‐ECMO was associated with better outcomes, and organ dysfunction significantly increased the mortality risk.

Background: A few prognostic scoring systems have been developed for predicting mortality in patients with cardiogenic shock requiring veno-arterial extracorporeal membrane oxygenation (VA-ECMO), albeit with variations in performance. This study aimed to assess and compare various mortality prediction models in a cohort of patients receiving VA-ECMO following cardiogenic shock or arrest. Methods: We retrospectively analyzed 77 patients with cardiogenic shock who were placed on VA-ECMO support between March 2014 and August 2021. The APACHE II, SAPS II, SAVE, Modified SAVE, ENCOURAGE, and ECMO-ACCEPTS scores were calculated for each patient to predict the in-hospital mortality. Results: Fifty-six (72.7%) patients died. All prediction model scores, except the ECMO-ACCEPTS, differed significantly between non-survivors and survivors as follows: ENCOURAGE, 23 versus 16 ( p < 0.001); SAVE, −6 versus −3 ( p = 0.008); Modified SAVE, −5 versus 0 ( p = 0.005); APACHE II, 32 versus 22 ( p = 0.009); and SAPS II, 67 versus 49 ( p = 0.002). The ENCOURAGE score demonstrated the best discriminatory ability with an area under the receiver–operating characteristic curve of 0.81 (95% confidence interval: 0.7–0.81). All prognostic scoring systems possessed limited calibration ability. However, the SAPS II, SAVE, and ENCOURAGE scores had lower Akaike and Bayesian information criteria values, which were consistent with the results of the Hosmer–Lemeshow C statistic test, indicating better performance than the other scores. Conclusions: The ENCOURAGE score can help predict in-hospital mortality in all subsets of VA-ECMO patients, even though it was originally designed to predict intensive care unit mortality in the post-acute myocardial infarction setting.

Background/Objectives: Accurate preoperative risk stratification is critical in older adults undergoing cardiac surgery, particularly for predicting postoperative cardiopulmonary complications (PCPCs). Although EuroSCORE II and the Society of Thoracic Surgeons (STS) score are widely used to estimate mortality risk, their ability to predict morbidity in older adults remains unclear. This study compared the performance of EuroSCORE II and the STS score in predicting PCPCs after on-pump cardiac surgery. Methods: This retrospective cohort study included patients aged ≥ 60 years who underwent elective on-pump cardiac surgery at Songklanagarind Hospital between January 2017 and December 2022. PCPCs included prolonged mechanical ventilation (>48 h), reintubation within 72 h, pneumonia, respiratory failure, new-onset atrial fibrillation, or low cardiac output requiring inotropic or mechanical support. Predictive performance was evaluated using receiver operating characteristic (ROC) curve analysis, logistic regression, calibration analysis, and overall prediction accuracy measures. Results: Among 638 patients, 273 (42.8%) developed PCPCs. Both scores were significantly associated with PCPCs. EuroSCORE II showed modest discrimination (area under the curve [AUC]: 0.581; 95% CI: 0.536–0.626); in contrast, the STS Score performed better (AUC: 0.625; 95% CI: 0.580–0.669; p = 0.017). In logistic regression, EuroSCORE II (odds ratio [OR]: 1.06; 95% CI: 1.01–1.10; p = 0.006) and the STS Score (OR: 1.05; 95% CI: 1.03–1.07; p < 0.001) were independently associated with PCPCs. Both models demonstrated acceptable calibration, although STS score showed better overall predictive performance than EuroSCORE II. Conclusions: EuroSCORE II and the STS score were both associated with postoperative cardiopulmonary complications but demonstrated only modest discriminative ability. Although the STS score performed significantly better than EuroSCORE II, neither model achieved sufficient accuracy for clinically meaningful individualized risk prediction.