Background:Pediatric cardiac surgery requiring cardiopulmonary bypass (CPB) is associated with high transfusion rates. While transfusions increase risks of adverse events, existing evidence cannot differentiate whether risks arise from transfusion itself or cumulative volumes. This study aims to explore the relationship between intra-operative transfusion volume and adverse outcomes, exploring whether transfusion volume has a linear or threshold effect on adverse outcomes. Methods:This retrospective cohort study included pediatric patients (≤14 years old) undergoing cardiac surgery with CPB, categorized by intra-operative red blood cell (RBC) volume transfused: 0, 0.1-22.2 mL/kg, 22.3-27.0 mL/kg, 27.1-34.5 mL/kg and >34.5 mL/kg. Outcomes included prolonged mechanical ventilation (MV), acute kidney injury (AKI), severe AKI and composite complications (chest drainage >10 mL/kg/d, culture-confirmed pulmonary infection, extracorporeal membrane oxygenation (ECMO) implantation, and in-hospital mortality). Multivariable logistic regression was used to analyze the relationship between intra-operative RBC transfusion volume and outcomes. Results:A total of 19,081 children were included, of whom 44.5% received RBC transfusion during surgery. Among these, 10.7% received 0.1-22.2 mL/kg, 11.3% received 22.3-27.0 mL/kg, 11.3% received 27.1-34.5 mL/kg and 11.0% received >34.5 mL/kg RBC transfusion. Higher RBC transfusion volumes correlated with certain adverse events. However, after adjustment for potential confounders, no consistent linear dose-effect relationship was observed. Instead, a threshold-effect association was identified. Compared with no transfusion, RBC transfusion >34.5 mL/kg was associated with increased risks of prolonged MV [odds ratio (OR): 3.45, 95% confidence interval (CI): 2.78-4.28; P<0.001], AKI (OR: 1.21, 95% CI: 1.01-1.44; P=0.04), and composite complications (OR: 2.30, 95% CI: 1.54-3.43; P<0.001), whereas low-volume transfusion was inversely associated with composite complications (0.1-22.2 mL/kg: OR, 0.36; 95% CI: 0.17-0.76; P=0.007), prolonged MV (0.1-22.2 mL/kg: OR, 0.55; 95% CI: 0.40-0.77; P=0.001; 22.3-27.0 mL/kg: OR, 0.64; 95% CI: 0.48-0.85; P=0.002), and AKI (0.1-22.2 mL/kg: OR, 0.81; 95% CI: 0.68-0.95; P=0.01). Conclusions:In this large cohort of pediatric patients undergoing surgery for congenital heart disease (CHD), there was a threshold effect between intraoperative RBC transfusion volume and adverse outcomes. Besides, low-volume transfusion was inversely associated with these outcomes. These findings highlight the importance of evaluating RBC transfusion using weight-adjusted volume and suggest that an optimal transfusion range may exist in pediatric cardiac surgery.

Background Interrupted aortic arch with aortopulmonary window is a rare congenital entity that is associated with high morbidity and mortality.Such patients usually manifest symptoms of pulmonary overcirculation and systemic hypoperfusion in the neonatal period and need urgent surgical correction. Case presentation We report a 3-day-old neonate with type A IAA associated with type III APW who underwent successful one-stage surgical repair. The patient was extubated on postoperative day 3, transferred out of the pediatric intensive care unit on day 6, and discharged on postoperative day 11. Conclusions Strict perioperative management and early definitive surgery ensure satisfactory postoperative recovery. One-stage repair is safe and effective for suitable neonatal patients.

Study objective: This systematic review and network meta-analysis aimed to compare the effects of coffee consumption and gum chewing on postoperative bowel function recovery in patients undergoing colorectal surgery. Design: Systematic review and network meta-analysis of randomized controlled trials. Patients: Patients undergoing colorectal surgery. Interventions: Coffee consumption and gum chewing for postoperative bowel function recovery. Measurements: The primary outcomes included the time to first defecation and flatus postoperatively. Secondary outcomes comprised the time to first toleration of food, length of hospital stay, time to first feeling of hunger, postoperative opioid analgesic use, incidence of complications, postoperative ileus, anastomotic leakage, nausea, vomiting, and in-hospital mortality. Main results: Twenty-one studies involving 1536 patients were included. Six studies compared coffee consumption to a control group, while 15 studies compared gum chewing to a control group. Compared with control groups, coffee consumption significantly reduced the time to first defecation [mean difference (95% CI): −10.91 (−16.17, −5.65); I 2 = 43%; P < 0.0001] and flatus [mean difference (95% CI): −6.38 (−11.89, −0.87); I 2 = 0%; P = 0.02]. Similarly, gum chewing demonstrated significant reductions in time to first defecation [mean difference (95% CI): −17.83 (−22.60, −13.07); I 2 = 83%; P < 0.00001] and flatus [mean difference (95% CI): −13.71 (−17.88, −9.54); I 2 = 88%; P < 0.00001]. Network meta-analysis revealed a non-significant trend favoring gum chewing over coffee for these outcomes. Notably, gum chewing provided additional clinical benefits including reduced incidence of postoperative ileus and shorter hospitalization. In contrast, coffee showed superior effects in facilitating earlier oral intake and reducing postoperative opioid requirements. Both interventions exhibited comparable safety profiles with no significant differences in complication rates. Conclusions: This study demonstrates that both chewing gum and coffee consumption can promote postoperative bowel function recovery in patients undergoing colorectal surgery, with chewing gum appearing to yield superior outcomes. Both interventions were significantly more effective than standard care in reducing the time to first flatus and first defecation. Trial registration: PROSPERO identifier: CRD420251114493. The protocol can be accessed at PROSPERO.

Background: Albumin is a key protein essential for maintaining multiple physiological functions. During extracorporeal membrane oxygenation (ECMO) support, serum albumin concentration may decline as a result of hemodilution or capillary leakage. This reduction may be more pronounced in pediatric patients, whose hepatic synthetic function is not fully mature. However, evidence regarding the association between serum albumin concentration and clinical outcomes in pediatric postcardiotomy ECMO patients remains limited. This study aims to explore this association in pediatric patients. Methods: This single-center retrospective study included 96 pediatric patients who underwent venoarterial ECMO (VA-ECMO) after cardiac surgery. The association between nadir albumin concentration during ECMO and 30-day and 180-day mortality was explored using Cox regression model. Additionally, exploratory analyses were performed to assess the relationship between albumin concentration and ECMOrelated complications using logistic regression, aiming to further characterize potential factors associated with lower nadir albumin concentration and mortality. Subgroup and sensitivity analyses were performed to assess robustness. Results: In this study, the median age at ECMO initiation was 12.42 months [interquartile range (IQR): 6.42-40.06], with 64% being male. Overall, 30-day and 180-day mortality rates were 37.5% and 52.1%. Nadir albumin concentration was found to be inversely associated with the risk of 30-day [hazard ratio (HR): 0.924, 95% confidence interval (CI): 0.866-0.987] and 180-day mortality (HR: 0.929, 95% CI: 0.880-0.981). Exploratory analyses suggested no statistically significant associations between nadir albumin concentration and continuous renal replacement therapy (CRRT), hemolysis, thrombosis, major bleeding, and liver injury. Subgroup analyses showed no significant interactions by age, weight, or the Society of Thoracic Surgeons and European Association for Cardiothoracic Surgery Congenital Heart Surgery (STAT) Mortality Categories. Sensitivity analyses restricted to patients with early nadir occurrence and excluding those without albumin supplementation yielded consistent results. Conclusions: In pediatric patients receiving postcardiotomy ECMO support, a lower nadir albumin concentration was independently correlated with an elevated risk of mortality and may serve as a readily available marker for risk stratification, warranting validation in prospective studies.

Background: Corticosteroids are commonly used in neonatal cardiac surgery to reduce inflammation. Previous studies have shown that administering methylprednisolone (MP) during the perioperative period can reduce the inflammatory response. However, the impact of MP on postoperative clinical outcomes in neonates remains unclear. Thus, this study aimed to assess the effects of MP on postoperative inflammation and clinical outcomes in neonates undergoing cardiac surgery involving cardiopulmonary bypass (CPB).Methods: This was a prospective, non-randomized, unblinded, controlled trial in which the clinicians determined treatment assignment. A total of 86 neonates who underwent cardiac surgery with CPB between December 2020 and August 2023 were included. After induction of anesthesia, the MP group received a single dose of 30 mg/kg MP, while the placebo group received an equal volume of saline solution. Primary endpoints were plasma interleukin (IL-6, IL-8, and IL-10) and D-dimer concentrations. Composite outcomes included death, respiratory infection, cardiac arrest, need for extracorporeal membrane oxygenation, acute kidney injury, low cardiac output syndrome, and need for prolonged mechanical ventilation.Results: Consistent with the observed anti-inflammatory effects, MP administration was associated with significantly lower levels of proinflammatory cytokines (IL-6, IL-8) and higher levels of the anti-inflammatory cytokine (IL-10). MP did not significantly reduce the likelihood of the composite outcome (p = 0.664), with 25 patients (58.1%) in the MP group and 23 patients (53.5%) in the placebo group experiencing such outcomes. The MP group also showed a significantly lower postoperative vasoactive-inotropic score and higher postoperative procalcitonin levels and nadir mixed venous oxygen saturation during the first 24 hours. No significant differences in postoperative D-dimer, blood glucose, or insulin administration were observed between the two groups.Conclusions: Prophylactic administration of 30 mg/kg MP in neonates undergoing cardiac surgery with CPB did not result in a statistically significant improvement in clinical outcomes compared with placebo. However, this intervention was associated with a reduction in the inflammatory response.The Clinical Trial Registration: ChiCTR 2000040230, https://www.chictr.org.cn/showproj.html?proj=64716.

Pediatric cardiac surgery with cardiopulmonary bypass (CPB) carries substantial transfusion requirements, exposing patients to increased risks of complications during hospital stay. This study evaluates the clinical impact of a quality-controlled, multimodal blood conservation strategy during CPB in pediatric cardiac surgery. We collected the medical data of 9792 children (aged ≤ 14 years and weight > 10 kg) undergoing CPB cardiac surgery between September 2014 and December 2021. Since January 2016, the pediatric CPB center has implemented patient blood management. Subsequently, patients were divided into two groups: conventional management group (premanagement, n = 1762) and patient blood management group (postmanagement, n = 8030). Compare blood transfusion and outcomes. A 1:1 propensity score matching was performed. 1760 matched patient pairs were obtained. Compared with the premanagement group, the postmanagement group demonstrated significant reduction in packed red blood cell (PRBC) transfusion rates (during hospital stay: 38.1

Cardiac fibromas are rare benign primary tumors of the heart; nearly one-third of affected patients are less than 1 year old, and only 15

BACKGROUND: Preoperative liver function in children with congenital heart disease is often compromised to varying degrees because of the unique pathophysiology. We aimed to investigate the relationships between liver function indicators at hospital admission and mortality in children receiving veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support following cardiac surgery. METHODS: We retrospectively analysed the clinical data of pediatric patients who received postcardiotomy VA-ECMO support at Fuwai Hospital between January 2010 and June 2020. Univariable and multivariable-adjusted Cox proportional hazard models were constructed to evaluate the risk factors associated with 30-day and 180-day mortality. The cut-off values for the liver function variables measured at hospital admission were categorized into high and low groups and then compared using Kaplan-Meier survival curves and log-rank tests. RESULTS: Our study included 96 pediatric patients who received VA-ECMO support after cardiotomy. Among the patients receiving VA-ECMO, the 30-day and 180-day mortality rates were 37.5% and 52.1%, respectively. The level of aspartate aminotransferase (AST) at admission was associated with 30-day mortality (hazard ratios [HRs]=1.852, 95%CI 1.010-3.398, P=0.046). The AST and alkaline phosphatase (ALP) levels were predictors of 180-day mortality, with adjusted HRs of 1.799 (95%CI 1.074-3.014; P=0.025) and 1.384 (95%CI 1.050-1.825; P=0.021), respectively. The cut-off value for AST to predict mortality at 30 d was 77 U/L, and that for ALP to predict mortality at 180 d was 269 U/L. CONCLUSION: Liver function indicators, including AST and ALP, at hospital admission are associated with mortality risk in children with congenital heart disease receiving VA-ECMO after cardiac surgery.

BACKGROUND:Timely recognition of perioperative red blood cell transfusion (PRT) risk is crucial for developing personalized blood management strategies in pediatric patients. In this study, we sought to construct a prediction model for PRT risk in pediatric patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). METHODS:From September 2014 to December 2021, 23,884 pediatric patients under the age of 14 were randomly divided into training and testing cohorts at a 7:3 ratio. Variable selection was performed using univariate logistic regression and least absolute shrinkage and selection operator (LASSO) regression. Multivariate logistic regression was then used to identify predictors, and a nomogram was developed to predict PRT risk. The model's performance was evaluated based on discrimination, calibration, and clinical utility in both cohorts. RESULTS:After multiple rounds of variable selection, eight predictors of PRT risk were identified: age, weight, preoperative hemoglobin levels, presence of cyanotic congenital heart disease, CPB duration, minimum rectal temperature during CPB, CPB priming volume, and the use of a small incision. The predictive model incorporating these variables demonstrated strong performance, with an area under the curve (AUC) of 0.886 (95% CI: 0.880-0.891) in the training cohort and 0.883 (95% CI: 0.875-0.892) in the testing cohort. The calibration plot closely aligned with the ideal diagonal line, and decision curve analysis indicated that the model provided a net clinical benefit. CONCLUSIONS:Our predictive model exhibits good performance in assessing PRT risk in pediatric patients undergoing cardiac surgery with CPB, providing clinicians a practical tool to optimize individualized perioperative blood management strategies for this vulnerable population.

PURPOSE:The systemic immune-inflammation index (SII) is a useful predictor in cardiovascular diseases. The purpose of this study was to investigate the association of SII with in-hospital mortality in patients with cardiogenic shock (CS) supported with extracorporeal membrane oxygenation (ECMO). PATIENTS AND METHODS:A total of 126 CS patients received ECMO implantation between January 2020 and December 2023. SII was calculated as follows: SII ​= ​neutrophil count × platelet count / lymphocyte count at admission. Participants were divided into high or low SII group based on the cut-off value of SII. In-hospital mortality was compared between the groups. RESULTS:The optimal SII cut-off value for predicting in-hospital mortality in CS patients supported with ECMO was 1735.9 (AUC 0.68, p ​= ​0.001). In-hospital mortality was significantly higher in the high SII group compared to the low SII group (59.09 % vs. 21.67 %, p <0.001). The univariate and multivariate logistic regression analyses had shown that SII and left ventricular ejection fraction (LVEF) were identified as independent predictors of in-hospital mortality in CS patients supported with ECMO (OR: 1.001, 95 % CI: 1.000-1.002, p ​= ​0.007 and OR: 0.881, 95 % CI: 0.803-0.966, p ​= ​0.007, respectively). SII combined with LVEF offered a superior prognostic capability compared to SII alone (AUC 0.707, v. s. AUC 0.68). CONCLUSION:We demonstrated that elevated admission SII was independently associated with in-hospital mortality in CS patients supported with ECMO. These findings highlight the potential role of SII as an indicator of mortality risk in this population.

STUDY OBJECTIVE:This systematic review and network meta-analysis aimed to compare the effects of coffee consumption and gum chewing on postoperative bowel function recovery in patients undergoing cesarean sections. DESIGN:Systematic review and network meta-analysis of randomized controlled trials. PATIENTS:Patients undergoing cesarean section. INTERVENTIONS:Coffee consumption and gum chewing for postoperative bowel function recovery. MEASUREMENTS:The primary outcomes included the time to first defecation, first flatus, and first bowel sound postoperatively. Secondary outcomes comprised the time to first feeling of hunger, time to first toleration of food, length of hospital stay, incidence of complications, and patient satisfaction. MAIN RESULTS:Twenty studies involving 2876 patients were included. Four studies compared coffee consumption to a control group, while sixteen studies compared gum chewing to a control group. Compared to the control group, the coffee group demonstrated a significant reduction in the time to first defecation (mean difference [95% CI]: -4.4 [-5.97, -2.91]; I 2  = 39%; P < 0.00001) and the time to first flatus (mean difference [95% CI]: -4.59 [-5.67, -3.51]; I 2  = 48%; P < 0.00001). Similarly, the gum chewing group showed significant reductions compared to the control group in the time to first defecation (mean difference [95% CI]: -8.04 [-11.49, -4.58]; I 2  = 98%; P < 0.00001), first flatus (mean difference [95% CI]: -7.52 [-10.14, -4.90]; I 2  = 98%; P < 0.00001), and first bowel sound (mean difference [95% CI]: -4.67 [-7.29, -2.06]; I 2  = 99%; P < 0.00001). However, network meta-analysis revealed no significant differences between the coffee and gum chewing groups in these three outcomes. Additionally, coffee consumption significantly reduced the time to first toleration of food, whereas gum chewing did not shorten the time to first feeling of hunger or first toleration of food. Compared to the control group, gum chewing, but not coffee consumption, was associated with a shorter postoperative hospital stay. Furthermore, gum chewing reduced the incidence of complications and improved patient satisfaction. CONCLUSIONS:Gum chewing is more effective than coffee consumption in promoting postoperative bowel function recovery. However, both interventions are superior to the control group in reducing the time to first defecation and first flatus.

Background: Corticosteroids are widely used in neonatal cardiac surgery for anti-inflammatory purposes. Previous research has demonstrated that perioperative use of methylprednisolone (MP) leads to a reduced inflammatory response. Nevertheless, the benefit of MP for postoperative clinical outcomes is controversial, especially in neonates. This study aimed to evaluate the effect of MP on postoperative inflammation and outcomes in neonatal cardiac surgery with cardiopulmonary bypass (CPB). Methods: From September 2020 to August 2023, 86 neonates who underwent cardiac surgery with CPB were enrolled in this double-blind randomized controlled trial. After anesthesia induction, the MP group received a single dose of 30 mg/kg MP, and the placebo group received an equal volume of saline solution. The primary endpoints were plasma concentrations of interleukins (IL-6, IL-8, and IL-10) and D-dimer. Composite outcomes included death, respiratory infection, cardiac arrest, the need for extracorporeal membrane oxygenation, acute kidney injury, low cardiac output syndrome, and prolonged mechanical ventilation. Results: MP did not reduce the odds of a composite outcome (OR, 1.208; 95% CI, 0.515-2.832; p = 0.664), which occurred in 25 patients (58.1%) in the MP group and 23 patients (53.5%) in the control group. Consistent with the observed anti-inflammatory effects, MP resulted in significantly lower concentrations of proinflammatory cytokines (IL-6 and IL-8) and higher concentrations of an anti-inflammatory cytokine (IL-10). The postoperative vasoactive inotropic score (VIS) was significantly lower, while postoperative procalcitonin and nadir mixed venous oxygen saturation (SvO 2 ) during the first 24 h were distinctly greater in the MP group. No differences in postoperative D-dimer, blood glucose or insulin administration were detected between the two groups. Conclusion: Compared with placebo, the prophylactic administration of 30 mg/kg MP to neonates who underwent cardiac surgery with CPB did not improve clinical outcomes. However, a decreased inflammatory response was detected.

IntroductionThe impact of non heparin-induced thrombocytopenia on the clinical outcomes for pediatric cardiac surgery patients who required veno-arterial extracorporeal membrane support (VA-ECMO) for failure to wean from cardiopulmonary bypass (CPB) is uncertain. This study aimed to investigate the relationship between thrombocytopenia and prognosis in these patients.MethodsThis retrospective study enrolled 96 pediatric patients (age < 18) who received VA-ECMO directly transitioned from CPB at Fuwai Hospital from January 2010 to June 2020. The association between relative decrease in platelet count (△PLT) post-ECMO 24 h and clinical outcomes was explored.ResultsThere were significant differences in Post-ECMO 24 h platelet counts, platelet count nadir, and duration of platelet decline between the survivors and non-survivors in CPB-ECMO groups. A positive correlation was found between △PLT post-ECMO 24 h and plasma-free hemoglobin (pFHb) (p = .014, r = 0.305), peak serum creatinine (p = .016, r = 0.299), peak AST (p = .014, r = 0.302), duration of platelet transfusion (p = .032, r = 0.270),The △PLT post-ECMO 24 h had predictive value on in-hospital mortality [(p < .001, AUROC = 0.781 (95% CI: 0.670-0.892)], massive bleeding (p = .001, AUROC 95% CI: 0.627-0.870), hemolysis (p = .046, AUROC 95% CI: 0.510-0.780), and nosocomial infection (p = .020, AUROC 95% CI: 0.536-0.801). Multivariate logistic regression showed that △PLT post-ECMO 24 h was associated with in-hospital mortality and hemolysis.ConclusionsThe relative early decrease in platelet count 24 h following transition to ECMO is associated with increased patient mortality, and is positively associated with adverse outcomes in pediatric cardiac surgery patients transferred from CPB to ECMO. Moreover, this decline rate can predict in-hospital survival, major bleeding, hemolysis, and hospital-acquired infections.

INTRODUCTION:Observational studies have revealed an association between waist circumference (WC) and atrial fibrillation (AF). However, it is difficult to infer a causal relationship from observational studies because the observed associations could be confounded by unknown risk factors. Therefore, the causal role of WC in AF is unclear. This study was designed to investigate the causal association between WC and AF using a two-sample Mendelian randomization (MR) analysis.METHODS:In our two-sample MR analysis, the genetic variation used as an instrumental variable for MR was acquired from a genome-wide association study (GWAS) of WC (42 single nucleotide polymorphisms with a genetic significance of P <5 × 10 -8 ). The data of WC (from the Genetic Investigation of ANthropometric Traits consortium, containing 232,101 participants) and the data of AF (from the European Bioinformatics Institute database, containing 55,114 AF cases and 482,295 controls) were used to assess the causal role of WC on AF. Three different approaches (inverse variance weighted [IVW], MR-Egger, and weighted median regression) were used to ensure that our results more reliable.RESULTS:All three MR analyses provided evidence of a positive causal association between high WC and AF. High WC was suggested to increase the risk of AF based on the IVW method (odds ratio [OR] = 1.43, 95% confidence interval [CI], 1.30-1.58, P = 2.51 × 10 -13 ). The results of MR-Egger and weighted median regression exhibited similar trends (MR-Egger OR = 1.40 [95% CI, 1.08-1.81], P = 1.61 × 10 -2 ; weighted median OR = 1.39 [95% CI, 1.21-1.61], P = 1.62 × 10 -6 ). MR-Egger intercepts and funnel plots showed no directional pleiotropic effects between high WC and AF.CONCLUSIONS:Our findings suggest that greater WC is associated with an increased risk of AF. Taking measures to reduce WC may help prevent the occurrence of AF.

Total cavopulmonary connection (TCPC) is a definitive palliative procedure for functionally univentricular congenital heart disease. The study aims to compare the impact of on-pump cardioplegic arrest and on-pump beating heart cardiopulmonary bypass (CPB) on the prognosis of pediatric patients undergoing extracardiac TCPC. The medical data of patients (< 18 years) who underwent extracardiac TCPC with CPB between January 2008 and December 2020 in the cardiac surgery center were retrospectively analyzed. Depending on CPB strategies, the patients were assigned to the beating-heart (BH) and cardioplegic arrest (CA) groups. Data including baseline characteristics, intra/postoperative variables, and clinical outcomes were collected for analysis with 1:1 propensity score matching and multivariable stepwise logistic regressions. Fifty-seven matched patient pairs were obtained. No significant difference existed between the two groups in the in-hospital mortality (3.5

BackgroundIn recent years, extracorporeal membrane oxygenation (ECMO) has been increasingly used in critically ill patients with respiratory or cardiac failure. Heparin is usually used as anticoagulation therapy during ECMO support. However, heparin-induced thrombocytopenia (HIT) in ECMO-supported patients, which results in considerable morbidity and mortality, has not yet been well described. This meta-analysis and systematic review aimed to thoroughly report the incidence of HIT on ECMO, as well as the characteristics and outcomes of HIT patients.MethodsWe searched the PubMed, Embase, Cochrane Library, and Scopus databases for studies investigating HIT in adult patients supported by ECMO. All studies conforming to the inclusion criteria were screened from 1975 to August 2023. Nineteen studies from a total of 1,625 abstracts were selected. The primary outcomes were the incidence of HIT and suspected HIT.ResultsThe pooled incidence of HIT in ECMO-supported patients was 4.2% (95% CI: 2.7-5.6; 18 studies). A total of 15.9% (95% CI: 9.0-22.8; 12 studies) of patients on ECMO were suspected of having HIT. Enzyme-linked immunosorbent assay (ELISA) is the most commonly used immunoassay. The median optical density (OD) of the ELISA in HIT-confirmed patients ranged from 1.08 to 2.10. In most studies, the serotonin release assay (SRA) was performed as a HIT-confirming test. According to the subgroup analysis, the pooled incidence of HIT in ECMO patients was 2.7% in studies whose diagnostic mode was functional assays, which is significantly lower than the incidence in studies in which the patients were diagnosed by immunoassay (14.5%). Argatroban was most commonly used as an alternative anticoagulation agent after the withdrawal of heparin. Among confirmed HIT patients, 45.5% (95% CI: 28.8-62.6) experienced thrombotic events, while 50.1% (95% CI: 24.9-75.4) experienced bleeding events. Overall, 46.6% (95% CI: 30.4-63.1) of patients on ECMO with HIT died.ConclusionAccording to our study, the pooled incidence of HIT in ECMO-supported patients is 4.2%, and it contributes to adverse outcomes. Inappropriate diagnostic methods can easily lead to misdiagnosis of HIT. Further research and development of diagnostic algorithms and laboratory assays are warranted.

Background: Refractory hemorrhage is generally considered a relative contraindication to the application of veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Previous reports have presented the use of ECMO in the presence of various hemorrhages. Methods: Our clinical experience involves six pediatric patients supported with ECMO for postcardiotomy refractory hemorrhage. Results: All patients were weaned from ECMO successfully. Only one patient died of protein-losing enteropathy two months after ECMO weaning. The ECMO duration ranged from 32 to 134 hours. Conclusion: In our experience, ECMO could be used for postcardiotomy refractory hemorrhage. The timing of ECMO implantation, anticoagulation regimen and auxiliary measures are the keys to successful treatment.

Abstract Background Neutrophil–lymphocyte ratio (NLR) is a valuable indicator for evaluating inflammation and adverse outcomes after cardiac surgery. The objective of this study was to evaluate the association of perioperative NLR with clinical outcomes in infants undergoing congenital heart surgery with cardiopulmonary bypass. Methods We performed a retrospective review of 424 consecutive infants (≤ 1 year) undergoing cardiac surgery between January 2019 and September 2019. Neonates (≤ 28 days) and patients with incomplete NLR data were excluded. The study endpoint was a composite of poor outcomes after surgery. We assess the correlation between perioperative NLR and clinical outcomes. A receiver operating characteristic curve and multivariable logistic regression were applied to identify the prognosis performance of postoperative NLR for poor outcomes. Results A total of 68 (16%) infants experienced at least one of the poor outcomes. Postoperative NLR on the third day after the surgery showed the best prognostic significance (AUC = 0.763, 95%CI 0.700–0.826) among perioperative period, with a cut-off value of 2.05. Postoperative NLR was also strongly correlated with mechanical ventilation time, length of ICU and hospital stay (p < 0.001). Multivariable logistic regression revealed that elevated postoperative NLR (OR 3.722, 95%CI 1.895–7.309, p < 0.001) was an independent risk factor for poor outcomes in infants after cardiac surgery. Conclusions Postoperative NLR was correlated with increased mechanical ventilation time, length of ICU and hospital stay. Elevated postoperative NLR was an independent predictor for poor outcomes after cardiac surgery in infants.

Background Acute kidney injury (AKI) is a common complication following cardiopulmonary bypass (CPB) which can affect morbidity and mortality. Goal-directed perfusion (GDP) intended to avoid the nadir oxygen delivery index below the critical value is associated with reduced postoperative AKI. However, current studies suggested that GDP can only decrease the incidence of AKI stage 1 but showed no effects on AKI stages 2–3 and mortality. The objective of the present meta-analysis is to deter the effects of GDP on postoperative AKI in any stage and mortality following cardiac surgery. Methods MEDLINE, Embase, and the Cochrane Library were searched to identify all clinical trials comparing GDP with control (standard care) during cardiopulmonary bypass conducting in adults undergoing cardiac surgery. The primary outcome was postoperative acute kidney injury. Secondary outcomes included postoperative mortality and length of ICU stay. Data synthesis was obtained by using risk ratio with 95% confidence interval by a random-effects model. Result From 1094 potential studies, 3 trials enrolling 777 patients were included. Meta-analysis suggested the GDP strategy based on DO2i reduced postoperative AKI compared with standard CPB management (RR = 0.52; 95% CI: 0.38–0.70; p < .0001), especially in AKI stage I (RR = 0.47; 95% CI: 0.33–0.66; p < .0001). But the GDP strategy did not reduce the incidence of severe AKI (stages 2–3) and postoperative mortality. Conclusion The GDP strategy based on DO2i during CPB obviously reduces AKI stage 1 and thus reduces overall AKI incidence. But it shows no effects on severe AKI (stages 2–3) and mortality.

Background KDIGO and pRIFLE classifications are commonly used in pediatric acute kidney injury (AKI). As a novel AKI definition, pROCK considered the high variability of serum creatinine in children. This study aimed to compare the above three definitions for AKI in infants undergoing cardiac surgery. Methods We analyzed a clinical cohort of 413 infants undergoing cardiac surgery. AKI was defined and staged according to pRIFLE, KDIGO, and pROCK, respectively. Incidence differences and diagnostic agreement across definitions were assessed. The association between postoperative outcomes and AKI by each definition was investigated. Results Postoperative AKI was identified in 185 (44.8%), 160 (38.7%), and 77 (18.6%) patients according to pRIFLE, KDIGO, and pROCK, respectively. The agreement between pRIFLE and KDIGO was almost perfect (κ = 0.88), while there was only a slight agreement between pROCK and them. AKI by pROCK was independently associated with adverse outcomes ( p = 0.003) and prolonged mechanical ventilation ( p = 0.002). Conclusions There were considerable differences in AKI incidence and staging among definitions. Compared with pRIFLE and KDIGO, AKI defined by pROCK was significantly reduced and better associated with postoperative adverse outcomes.