Search Results (39)

Objectives: The Impella 5.5 (J&J MedTech, USA) is increasingly used for refractory cardiogenic shock (CS), yet early predictors of mortality and recovery remain unclear. This study aimed to evaluate early patient characteristics and device-related parameters in relation to clinical outcomes; to compare outcome-based phenotypic groups (native heart recovery (NHR), heart replacement therapy (HRT), and death on the device (DEC)); and to analyze P-level impact on hemolysis and acute kidney injury. Methods: This retrospective single-center study included 28 CS patients supported with Impella 5.5 between May 2023 and August 2024. Data included intensive care unit (ICU) hemodynamics, vasoactive-inotropic score (VIS), lab markers, and pump parameters. Primary analysis evaluated early (first 24 h) parameters as potential indicators associated with mortality on the device and recovery, while secondary analyses compared hemodynamic and pump performance parameters across outcome groups, evaluated the association between P-level and hemolysis, and assessed the impact of shock etiology on clinical outcomes. Results: Among 28 patients (mean age 56 years, 10.7% female, body mass index (BMI) 27.7 kg/m²), NHR occurred in 39.3% and bridged to HRT in 42.9%. Non-survivors (17.8%) had significantly higher lactate (3.1 vs. NHR: 1.9 vs. HRT: 1.4 mmol/L, p < 0.001) and VIS (307.0 vs. NHR: 18.8 vs. HRT: 12.6, p < 0.001) at implantation. Higher VIS values (>69) were strongly associated with mortality on the device, with 100% sensitivity and 77% specificity (area under the curve (AUC) = 0.86); VIS < 9.9 was related to NHR (AUC = 0.63, 94% sensitivity, 45% specificity). P-levels were not linked to hemolysis index (r = −0.03, p = 0.64) or lactate dehydrogenase (r = −0.06, p = 0.37). Conclusions: Early vasoactive burden was associated with clinical outcomes in Impella 5.5-supported patients. No association between P-levels and the analyzed hemolysis surrogates was detected in this cohort. Distinct phenotypes across recovery outcomes may guide personalized management, but prospective validation of this exploratory and hypothesis-generating analysis is needed. Full article

Background/Objectives: Intraoperative hemodynamic instability during liver transplantation (LT) is common and results from cirrhosis-related circulatory dysfunction and profound hemodynamic changes during graft reperfusion. High catecholamine requirements may contribute to secondary organ injury, including myocardial damage. Terlipressin, a selective vasopressin V1 receptor agonist, has been shown to improve hemodynamic stability during LT; however, the impact of a short, targeted intraoperative infusion on cardiac biomarkers remains unclear. Methods: This retrospective single-center study included adult patients undergoing elective orthotopic liver transplantation between May 2017 and December 2025. Emergency transplantations and retransplantations were excluded. All transplant procedures were performed by a single transplant surgeon, while anesthesia care was provided by multiple teams following standardized institutional protocols. Patients receiving a fixed intraoperative dose of terlipressin (0.85 mg administered over 10 min after portal vein clamping; n = 61) were compared with a control group not receiving terlipressin (n = 44). The primary outcome was the vasoactive-inotropic score (VIS), assessed intraoperatively and during the first three postoperative days. Secondary outcomes included postoperative high-sensitivity troponin I (Hs-TnI) concentrations measured on the day of surgery and on postoperative days 1 and 3. Results: Baseline demographic and clinical characteristics, including liver disease severity and baseline Hs-TnI, were comparable between groups. VIS values were significantly lower in the terlipressin group on the day of transplantation (14.3 ± 2.4 vs. 37.0 ± 5.0, p < 0.001) and on postoperative day 1 (10.4 ± 2.2 vs. 17.3 ± 3.4, p < 0.05). Differences were no longer significant on postoperative days 2 and 3. Postoperative Hs-TnI concentrations were significantly lower in the terlipressin group at all assessed time points, including day 0 (51.5 ± 11.3 vs. 150.4 ± 29.0 ng/L, p < 0.001), postoperative day 1 (124.7 ± 28.8 vs. 275.0 ± 74.0 ng/L, p < 0.05), and day 3 (51.1 ± 18.4 vs. 167.2 ± 54.2 ng/L, p < 0.05). Conclusions: In this retrospective cohort, intraoperative terlipressin administration was associated with lower perioperative vasoactive requirements and reduced postoperative troponin release. These findings suggest that targeted terlipressin administration during liver transplantation may contribute to improved perioperative hemodynamic stability. Prospective randomized studies are required to confirm these observations and determine their impact on clinically relevant outcomes. Full article

Background: The microbiological landscape and infection-source profiles of severe sepsis in Asian ICUs differ markedly from Western cohorts and may influence the effectiveness and prognosis of adjunctive therapies such as polymyxin B hemoperfusion (PMX-HP). However, real-world data on how pathogen categories, multidrug resistance (MDR), and infection sources affect outcomes in PMX-HP-treated patients are lacking. Methods: We conducted a retrospective cohort study in a tertiary medical ICU in Taiwan, including adult patients with severe sepsis or septic shock who received PMX-HP between 2013 and 2019. Microbiological data, infection sources, MDR profiles, organ support requirements, vasoactive–inotropic score (VIS), and mortality outcomes were retrieved from electronic records. Pathogen groups (Gram-negative, Gram-positive, fungal, no-growth), MDR status, and infection sources were analyzed for associations with 28-day, ICU, and hospital mortality. Results: Among 64 patients (mean age 66.1 years; 67.2% male), Gram-negative pathogens predominated (70.3%), with Escherichia coli (31.3%) and Klebsiella pneumoniae (21.9%) being the most frequently identified organisms. MDR organisms were isolated in 26.6% of patients. The most common infection sources were pneumonia (29.7%), intra-abdominal infection (18.8%), and urinary tract infection (17.2%). Gram-negative infections were associated with higher CRRT utilization (71.9% vs. 47.1%, p = 0.04) and higher VIS at 24 h. MDR status was significantly associated with early CRRT requirement (64.7% vs. 38.6%, p = 0.048), but not with 28-day mortality (52.9% vs. 43.2%, p = 0.42). No infection source was independently associated with mortality after adjustment for APACHE II, CRRT, and VIS. Instead, greater organ failure severity—particularly renal failure requiring CRRT—was strongly associated with mortality in this cohort. Conclusions: In PMX-HP-treated severe sepsis patients, Gram-negative predominance and MDR status were associated with increased organ support requirements but were not independently associated with mortality. Outcomes were primarily associated with overall illness severity rather than microbiological category. These findings highlight the importance of combining microbiological data with dynamic physiological markers for prognostic risk stratification in Asian ICUs. Full article

Background: Severe sepsis and septic shock remain major causes of ICU mortality despite advances in critical care. Polymyxin B hemoperfusion (PMX-HP) is widely used in Asia for refractory endotoxemia, yet the optimal session strategy remains unclear. Methods: We retrospectively analyzed adult ICU patients with severe sepsis or septic shock treated with PMX-HP between 2013 and 2019 in a tertiary center in Taiwan. Patients were divided into sequential (≥2 sessions within 24 h) and non-sequential groups. The primary outcome was 28-day mortality; secondary outcomes included ICU and hospital mortality, length of stay, organ support, and vasoactive-inotropic score (VIS) changes. Results: Among 64 patients, 33 (51.6%) received sequential therapy. The 28-day mortality was 46.9%, with no difference between groups after adjustment for baseline severity. Patients receiving sequential PMX-HP had longer hospital stays and more frequent CRRT use, likely reflecting greater underlying disease severity rather than a causal effect of treatment sequencing. Conclusions: Multivariate analysis identified higher APACHE II score, positive VIS change, and CRRT requirement as independent predictors of mortality. Sequential therapy itself was not associated with improved outcomes. Prognosis in PMX-HP-treated patients is determined mainly by underlying severity and hemodynamic instability, underscoring the need for patient selection and biomarker-guided strategies rather than routine sequential use. Full article

Background: Thyroid hormone dysregulation is a well-recognized consequence of cardiopulmonary bypass (CPB), particularly in neonates undergoing congenital heart surgery. Triiodothyronine (T3) plays a crucial role in maintaining cardiovascular stability, and an early decline in serum levels may adversely impact clinical outcomes. This study aimed to evaluate perioperative thyroid hormone changes and their association with morbidity and mortality. Methods: We retrospectively analyzed 132 neonates who underwent congenital cardiac surgery with CPB between January 2021 and June 2024. Serum free T3 (FT3), free thyroxine (FT4), and thyroid-stimulating hormone (TSH) levels were measured preoperatively and within one hour after admission to the cardiac intensive care unit. Demographic, clinical, and surgical variables were recorded. Associations between thyroid hormone levels and postoperative outcomes, including in-hospital mortality, ventilation duration, vasoactive-inotropic score (VIS), and length of stay, were assessed using correlation analyses, logistic regression, and receiver operating characteristic (ROC) analysis. Results: Postoperatively, both FT3 and TSH levels declined significantly (p < 0.01), while FT4 levels remained unchanged. Lower postoperative FT3 levels were negatively correlated with prolonged invasive mechanical ventilation (rho = −0.196, p = 0.029) and longer hospital stay (rho = −0.183, p = 0.042). Overall mortality was 7.6% (n = 10). Non-survivors had significantly lower postoperative FT3 levels compared with survivors (p = 0.001). In multivariable logistic regression, postoperative FT3 was independently associated with mortality (OR = 0.22, 95% CI 0.05–1.03, p = 0.048). ROC analysis demonstrated good predictive performance of postoperative FT3 for mortality (AUC = 0.818), with an optimal cutoff of 2.17 pg/mL (sensitivity 72%, specificity 70%). Conclusions: Early postoperative suppression of FT3 is common after CPB in neonates and is independently associated with increased mortality and adverse short-term outcomes. Early assessment of thyroid function, particularly FT3, may provide valuable prognostic information and aid in risk stratification in this high-risk population. Full article

Background: Severe pediatric influenza remains a major clinical burden, yet its phenotype in the post-COVID-19 period has not been fully characterized. The pandemic’s infection-control measures created an “immunity gap” among children, altering viral epidemiology and severity. This multicenter study from Türkiye defines the clinical spectrum and outcomes of influenza cases requiring intensive care, providing one of the first regional datasets after the pandemic. Methods: We retrospectively analyzed 85 children with influenza admitted to five tertiary PICUs in İstanbul between 2024 and 2025. Demographics, clinical features and outcomes were compared across groups. Predictors of sepsis, pediatric ARDS, and mechanical ventilation were identified through multivariate logistic regression. Results: Influenza A + RSV co-infection occurred in 14% and affected significantly younger infants, presenting with more severe respiratory distress, hypoxemia, and bronchiolitis. Influenza B was associated with distinct neurotropic features—encephalopathy and seizures in 48%—and a higher risk of sepsis (OR 3.27, 95% CI 1.02–10.53). Hypoxemia, elevated vasoactive–inotropic score, and high PaCO₂ independently predicted mechanical ventilation and poor outcomes. Only 2–4% of children had received influenza vaccination. Conclusions: This multicenter analysis reveals a post-pandemic surge of severe pediatric influenza characterized by dual respiratory and neurological phenotypes. RSV co-infection drives early respiratory failure in infants, whereas Influenza B carries a disproportionate risk of neuroinflammation and sepsis. The study provides evidence from Türkiye that the post-COVID “immunity gap” and critically low vaccination coverage contribute to increased PICU admissions. Strengthening pediatric influenza immunization and RSV prevention policies is urgently warranted to mitigate these outcomes. Full article

Background: Polymyxin B hemoperfusion (PMX-HP) is increasingly used as an adjunctive therapy for severe sepsis and septic shock, yet the prognostic significance of continuous renal replacement therapy (CRRT) and vasoactive-inotropic score (VIS) dynamics under real-world ICU practice remains unclear. This study aimed to evaluate whether CRRT requirement and hemodynamic responses to PMX-HP influence short-term mortality among critically ill patients. Methods: We conducted a retrospective cohort study of 64 ICU patients in Taiwan with severe sepsis or septic shock who received PMX-HP. Clinical characteristics, illness severity, VIS measurements before and after PMX-HP, organ-support therapies, and outcomes—including 28-day mortality, ICU and hospital mortality, and lengths of stay—were analyzed. Patients were stratified by CRRT use, and multivariate logistic regression was performed to identify independent predictors of 28-day mortality. Results: Among 64 patients (mean age 66 years; 67% male), 67.2% received CRRT and the overall 28-day mortality was 46.9%. CRRT users exhibited higher crude mortality and higher APACHE II scores. Survivors were younger and had lower baseline severity. Hemodynamic trajectories differed substantially: VIS increased after PMX-HP more frequently in non-survivors than survivors. In multivariate analysis, post-PMX-HP VIS elevation and higher APACHE II were independent predictors of 28-day mortality, whereas CRRT requirement was not an independent determinant. Conclusions: In this real-world cohort, PMX-HP did not significantly reduce mortality. Illness severity and inadequate vasopressor improvement, rather than CRRT use, primarily determined outcomes. VIS elevation following PMX-HP may serve as an early indicator of poor hemodynamic recovery in septic shock. Full article

Background/Objectives: Whether a remote history of SARS-CoV-2 infection independently affects early haemodynamic stability after elective cardiopulmonary bypass (CPB) remains uncertain. We evaluated whether prior COVID-19 (>7 weeks before surgery) was associated with postoperative vasopressor requirements or early complications in adults undergoing elective CPB. Methods: We conducted a single-centre prospective cohort study including adults (≥18 years) scheduled for elective on-pump coronary, valve, or combined cardiac surgery between 1 August 2022 and 30 October 2023. Patients undergoing emergency procedures or surgery < 7 weeks after infection were excluded. The exposure was a documented history of COVID-19 for >7 weeks preoperatively. The primary outcome was postoperative vasopressor use within 24 h of ICU admission; secondary outcomes included inotrope use, arrhythmias, acute cardiac or respiratory failure, pneumonia, acute kidney injury (KDIGO), delirium, stroke, length of stay, and mortality. Multivariable logistic regression adjusted for age, CPB duration, obesity, anaemia, chronic kidney disease, sex, EuroSCORE I, left ventricular ejection fraction, and procedure type. Results: Of 351 screened patients, 280 elective CPB cases were analyzed; 101 (36.1%) had prior COVID-19. Vasopressor use occurred in 151/280 (53.9%) patients, with no difference between COVID and non-COVID groups (53.5% vs. 54.2%; p = 1.00). Prior COVID-19 was not associated with vasopressor requirement (adjusted OR 0.94, 95% CI 0.56–1.59). Independent predictors were longer CPB duration (aOR 2.80 per hour; p < 0.001) and older age (aOR 1.028 per year; p = 0.02). Secondary outcomes, including organ dysfunction and mortality, did not differ between groups. Conclusions: In adults undergoing elective CPB ≥ 7 weeks after SARS-CoV-2 infection, prior COVID-19 did not increase early vasopressor needs or short-term postoperative complications. Haemodynamic requirements were primarily driven by CPB duration and age. Further research using dose-standardized vasoactive metrics and formal COVID-19 severity stratification is warranted. Full article

Background: Surgical aortic valve replacement (SAVR) is the main treatment for severe aortic valve disease, the most common valvular heart disease worldwide. Methods: We evaluated the in-hospital mortality risk factors and predictors following on-pump SAVR. We retrospectively reviewed data from consecutive patients treated at a tertiary center from 2022 to 2024, focusing on routine hematological data and inflammatory indexes, alongside established factors. Results: Postoperative vasoactive-inotropic score (VIS) (OR 1.058, CI 95%: 1.007–1.112), platelet count (OR 1.033, CI 95%: 1.002–1.064), lymphocyte counts (OR 3.532, CI 95%: 1.507–8.278), and perioperative fresh frozen plasma transfusion (OR 1.335, CI 95%: 1.068–1.669) were independent risk factors for SAVR in-hospital mortality. VIS best predicted the endpoint (AUC 0.929, p = 0.001). Postoperative platelet count and platelet-to-lymphocytes ratio (PLR) outperformed the additive EuroSCORE in predicting the outcome, but not EuroSCORE II. Conclusions: Although EuroSCORE II remained superior to inflammatory indexes in predicting in-hospital death, the dynamic postoperative monitoring provided added value beyond static preoperative risk scores. This dynamic approach supported personalized monitoring and targeted therapeutic interventions. Postoperative VIS, platelet, lymphocyte counts, and PLR represent dynamic, low-cost predictors of in-hospital mortality after on-pump SAVR, offering a complementary value to EuroSCORE II–based models. Full article

Background: Despite advances in temporary mechanical circulatory support (tMCS), patients with cardiogenic shock (CS) who are treated with a microaxial flow pump (mAFP; Impella^®, Abiomed) still have a high mortality rate. A dysregulated systemic inflammatory response significantly contributes to multiorgan failure in this population. CytoSorb^® hemadsorption has emerged as a potential adjunctive therapy for modulating inflammation, but data on its use in CS are limited. Methods: This retrospective, single-center study used propensity score matching analysis (1:1 matching; n = 15 per group) to compare the outcomes of patients receiving mAFP support with and without concomitant CytoSorb therapy. Baseline data (T0), including comorbidities and clinical status at ICU admission, were collected for all patients. In the CytoSorb group, data were collected at two additional time points: 24 h before the start of CytoSorb therapy (T1), and 24 h after its completion (T2). At these time points, laboratory values and parameters on respiratory, hemodynamic, and organ function were assessed. Corresponding data were also collected for matched patients in the non-CytoSorb group at equivalent time points relative to their matched counterparts. Results: In the propensity score-matched cohort, patients treated with CytoSorb exhibited significant improvements between T1 and T2. Specifically, reductions were observed in the vasoactive-inotropic score (p = 0.035), procalcitonin levels (p = 0.041), peak inspiratory pressure (p = 0.036), and positive end-expiratory pressure (p = 0.016). Flow rates through the mAFP declined significantly (p = 0.014), suggesting stabilization of hemodynamics. These changes were not observed in the non-CytoSorb group, where most parameters remained unchanged or exhibited less pronounced trends. We observed a lower in-hospital mortality rate in the CytoSorb group (33.3% versus 46.7%), though the difference was not significant, potentially due to limited statistical power. Conclusions: CytoSorb hemadsorption in mAFP-supported CS was associated with improved hemodynamic stability and reduced inflammatory burden. These findings suggest a potential therapeutic benefit of adjunctive hemadsorption in this high-risk population. Full article

Background and Objectives: Enhancing recovery after cardiac surgery involves minimally invasive procedures, early extubation/mobilization, and swift discharge. While mechanical ventilation is often essential post-operation, prolonged invasive ventilation (IMV) increases mortality risk. Duration is influenced by patient factors (age and comorbidities), surgical complexity, and complications. Prognostic scores like EuroSCORE II, sequential organ failure assessment (SOFA), the Charlson Comorbidity Index (CCI), and the vasoactive–inotropic score (VIS) help to predict ventilation needs. The aim of this study is to analyze the effect of pre-/post-operation factors and procedure type as predictors of ventilation time. Materials and Methods: This is a retrospective cohort observational study analyzing factors affecting the duration of postoperative mechanical ventilation in elective cardiac surgical patients treated between 1 January and 31 December 2024 in a tertiary center in continental Croatia. Patients were stratified into two groups according to the duration of IMV: normal (first three quartiles) and prolonged (upper quartile). In total, 493 elective cardiac surgical patients operated on under general endotracheal anesthesia with sternotomy or mini-sternotomy were admitted postoperatively to the cardiovascular ICU and mechanically ventilated during the observed period, and 463 patients were included in the final analysis after the exclusion criteria had been applied. Results: The mean age was 64.7 ± 9.8 years, and 28.7% of the cohort were females while 71.3% were males. The median Charlton Comorbidity Index was 4 (IQR 3–5), the VIS was 2 (IQR 0–3), the SOFA score at ICU admission was 5 (IQR 3–6), and the adjusted SOFA score was 3 (IQR 2–4). In the multivariate logistic regression model, a significant effect of female sex (OR 1.98), age (OR 1.05), VIS (OR 1.05), and history of previous cardiac surgery (OR 6.67) on the duration of mechanical ventilation was observed. In the time-to-extubation multivariate analysis, there was a significant effect of re-do surgery (HR 3.70), corrected SOFA score (HR 1.14), and VIS (HR 1.05) on the duration of mechanical ventilation. There was no significant effect of the type of surgery (CABG, aorta, aortic valve, mitral/tricuspid valve, or other) or the amount of chest tube drainage on the duration of mechanical ventilation. Conclusions: A history of previous cardiac surgery and the vasoactive–inotropic score during the first 24 postoperative hours in the ICU are the strongest predictors of the duration of mechanical ventilation after elective cardiac surgery, with a statistically significant effect present in both the logistic regression model and hazard ratio analysis. Further analyses with more variables are warranted in the future to refine the prognostic model. Full article

Background: Acute kidney injury (AKI) following cardiac surgery can lead to chronic kidney disease, increased hospitalization costs, and higher mortality risk. Our retrospective study identified risk factors of severe AKI (AKI 3) in patients undergoing on-pump surgical aortic valve replacement (SAVR). Additionally, we analyzed the significance of inflammatory indexes and risk scores in predicting AKI 3, focusing on sex differences. These findings could provide cost-efficient tools for clinical practice to identify patients at risk, improve preoperative risk stratification, and personalize monitoring. Methods: We reviewed the on-pump SAVR patients from our tertiary center between 2022 and 2024. Results: Out of 422 patients, 121 (28.67%) experienced AKI, including 27 (6.39%) AKI 3 patients. The multivariable binary logistic regression identified AKI 3 independent risk factors: hemostasis reintervention (OR9.76, CI 95%: 3.565–26.716, p = 0.001), early postoperative vasoactive-inotropic score (VIS) (OR1.049, CI 95%: 1.013–1.086, p = 0.007), postoperative lymphocyte (OR2.252, CI 95%: 1.224–4.144, p = 0.009). Preoperative systemic inflammatory response index (AUC0.700, p = 0.019), preoperative aggregate index of systemic inflammation (AUC0.712, p = 0.011), postoperative platelet-to-lymphocyte ratio (PLR) (AUC 0.759, p = 0.001), and the delta value of preoperative-to-postoperative PLR (AUC0.752, p = 0.001) were better predictors of AKI 3 occurrence in female SAVR patients than the additive EuroSCORE (AUC0.692, p = 0.011), but were less accurate compared to EuroSCORE II (AUC0.841, p = 0.001). None of the studied inflammatory indexes or additive EuroSCORE predicted our endpoint in male SAVR patients, while Thakar score was able to predict it exclusively in males. Conclusions: Early postoperative VIS, lymphocyte count, and hemostasis reintervention were independent risk factors for severe AKI in SAVR patients. There is a differentiation between males and females from the AKI prediction perspective. Full article

Background: Severe sepsis and septic shock remain major contributors to ICU mortality. Polymyxin B hemoperfusion (PMX-HP) has been widely adopted as adjunctive therapy in Asian ICUs for endotoxemia, but its real-world effectiveness and prognostic factors remain uncertain, especially in high Gram-negative settings. Methods: This retrospective cohort study included 64 adult patients with severe sepsis or septic shock who received at least one session of PMX-HP in a 25-bed tertiary medical ICU in Taiwan between July 2013 and December 2019. Demographic, clinical, microbiological, and treatment data were extracted. The primary outcome was 28-day mortality. Prognostic factors were analyzed using logistic regression. Results: The mean age was 66.1 ± 12.3 years; 67.2% were male. Pneumonia (29.7%) and intra-abdominal infection (18.8%) were the most common sources of sepsis, with E. coli and K. pneumoniae as leading pathogens. Median APACHE II score at ICU admission was 26 (IQR 21–32), and 79.7% received two PMX-HP sessions. The 28-day mortality rate was 46.9%, with ICU and hospital mortality both 53.1%. Non-survivors were older, had higher APACHE II scores, and more frequent use of continuous renal replacement therapy (CRRT). Positive changes in vasoactive-inotropic score (VIS) after PMX-HP were also more common among non-survivors. Multivariate analysis identified advanced age, higher APACHE II score, and CRRT requirement as independent predictors of mortality. Conclusions: In this real-world Asian ICU cohort, PMX-HP was used mainly for severe cases with a high disease burden and Gram-negative predominance. Despite its frequent use, overall mortality remained high. Prognosis was primarily determined by underlying disease severity, organ dysfunction (especially renal failure), and persistent hemodynamic instability. In this high-severity cohort, mortality appeared to be primarily driven by baseline organ dysfunction and persistent hemodynamic instability; PMX-HP session number or sequencing showed no association with survival. Given the absence of a contemporaneous non-PMX-HP control group, mortality observations in this cohort cannot be causally attributed to PMX-HP and should be interpreted with caution as hypothesis-generating rather than definitive evidence of efficacy. Further multicenter studies are needed to clarify the optimal role of PMX-HP in modern sepsis management. Full article

Background: Patients with end-stage heart failure-related cardiogenic shock (HF-CS) are conclusively associated with a poor health-related quality of life (HRQL). Axillary mechanical circulatory support (aMCS), such as the Impella 5.5, is increasingly used in this population and may improve HRQL during hospitalization by providing enhanced left ventricular unloading. We aimed to assess changes in HRQL between admission and two weeks after Impella 5.5 placement in patients with HF-CS, using the Kansas City Cardiomyopathy Questionnaire (KCCQ). Methods: We conducted a prospective longitudinal analysis on patients with the Impella 5.5 between May 2023 and July 2023. Participants completed the condensed KCCQ-12 at admission and again two weeks post-implantation. Changes in the scores were evaluated using the Wilcoxon signed-rank test. Results: Fifteen patients were enrolled. The median age was 59 years (50–63), and the median ejection fraction at implantation was 20% (15–30). On admission, most patients reported an overall HRQL of poor-to-fair (46.7%) according to the summary KCCQ-12 score. The median overall summary score increased significantly after Impella 5.5 support (50.52 vs. 28.13, p = 0.005). Symptom frequency (70.83 vs. 43.75, p = 0.009) and quality-of-life (50.00 vs. 12.50, p = 0.023) domains improved significantly, while physical limitation showed a positive trend and social limitation remained unchanged. These HRQL improvements occurred alongside a significant shift toward lower SCAI shock stages, marked increases in cardiac output and cardiac index, and no escalation in vasoactive-inotropic requirements. Conclusions: Impella 5.5 support in HF-CS patients was associated with early and clinically meaningful improvements in HRQL, particularly in symptom frequency and quality of life, during the critical pre-transplant or recovery period. These findings suggest that the Impella 5.5 may provide both physiological and patient-perceived benefits in this high-risk population. Full article

Objective: The aim of this study was to describe the presenting characteristics and outcomes of neonates with respiratory failure referred for extracorporeal membrane oxygenation (ECMO) support, compare those who received ECMO support (ECMO group) to those who did not (non-ECMO group), and evaluate the predictive variables requiring ECMO support. Methods: All neonates (<15 days) with respiratory failure (without congenital diaphragmatic hernia or congenital heart disease) referred to our regional ECMO center from 2014 to 2023 were included in this retrospective study. Patient demographics, birth history, and clinical and outcome variables were analyzed. Oxygenation indices and vasoactive–inotropic scores obtained at PICU arrival and four hours after arrival were compared between the two groups using ROC analysis, with ECMO initiation as an outcome variable. Youden’s index was used for optimal threshold values. Chi-square, Mann–Whitney U, and binary logistic regression were used for comparative analyses. Results: Out of the 147 neonates, 96 (65%) required ECMO support. The two groups significantly differed in the prevalence of pulmonary hypertension (pHTN; systemic or suprasystemic pulmonary pressures), lactate level, and oxygenation indices. Mortality was not different between the two groups. Presence of oxygen saturation index (OSI) ≥ 10 had a sensitivity 96.8% in predicting the need for ECMO support. On regression analysis, OSI and pHTN were independent predictors of ECMO support. Conclusions: Oxygenation indices and echo findings predict the need for ECMO support in neonatal hypoxemic respiratory failure. These findings help non-ECMO centers make appropriate and timely transfers of neonates with respiratory failure to ECMO centers. Full article