Introduction: Pumpless interventional lung assist (iLA) is used in patients with acute respiratory distress syndrome (ARDS) aimed at improving extracorporeal gas exchange with a membrane integrated in a passive arteriovenous shunt. In previous studies, feasibility and safety of the iLA system was demonstrated, but no survival benefit was observed. In the present pilot study we tested the hypothesis that timely initiation of iLA using clear algorithms and an improved cannulation technique will positively influence complication rates and management of lung protective ventilation. Methods: iLA was implemented in 51 patients from multiple aetiologies meeting ARDS-criteria (American-European Consensus) for more than 12 hours. Initiation of iLA followed an algorithm for screening, careful evaluation and insertion technique. Patients with cardiac insufficiency or severe peripheral vascular disease were not considered suitable for iLA. Arterial and venous cannulae were inserted using a new strategy (ultrasound evaluation of vessels by an experienced team, using cannulae of reduced diameter). The incidence of complications and the effects on tidal volumes and inspiratory plateau pressures were primary outcome parameters, while oxygenation improvement and carbon dioxide removal capabilities were secondary study parameters. Results: Initiation of iLA resulted in a marked removal in arterial carbon dioxide allowing a rapid reduction in tidal volume (≤ 6 ml/kg) and inspiratory plateau pressure. Adverse events occurred in 6 patients (11.9%). The hospital mortality rate was 49%. Conclusions: The use of an indication algorithm for iLA in early ARDS, combined with a refined application technique was associated with efficient carbon dioxide removal and a reduced incidence of adverse events. iLA could serve as an extracorporeal assist to support mechanical ventilation by enabling low tidal volume and a reduced inspiratory plateau pressure.

This observational report depicts typical problems of extracorporeal membrane oxygenation cannulation from a large case series of a single center. We analysed our experience with 720 consecutive patients receiving veno-venous or veno-arterial extracorporeal membrane oxygenation focusing on the spectrum of complications occurring in a subset of 159 patients treated with percutaneous veno-arteria extracorporeal membrane oxygenation in our institution between January 2009 to December 2014. The main problems were: vascular complications or ischemia of the corresponding extremity (leading to surgical revision in 16.9 % of patients); blood loss and/or relocation of cannulas. Hypoxia of the upper body (Harlequin syndrome) occurred in 8.8 % of patients. Cannulation failure and malfunction were infrequent. Careful insertion technique, close surveillance and monitoring are compelling. As lack of experience is the trigger of many complications, adequate training of cannulation techniques is essential to minimize adverse events.

High intensity focused ultrasound (HIFU) energy has evolved as a new surgical tool to treat atrial fibrillation (AF). We evaluated safety and efficacy of AF ablation with HIFU and analyzed predictors of success in a prospective clinical study.

Impact of minimized extracorporeal circulation (MECC) for coronary surgery on mortality remains controversial and gender significantly influence outcome.

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.