Background: Post-cardiac arrest syndrome (PCAS) following out-of-hospital cardiac arrest (OHCA) is driven by global ischemia–reperfusion injury, endothelial dysfunction, and a dysregulated inflammatory response. This cascade frequently culminates in profound vasoplegia and multiorgan failure, even when guideline-directed post-resuscitation management is applied. Hemoadsorption using the CytoSorb device may attenuate hyperinflammation and vasoplegia by removing circulating inflammatory and injury-related mediators. Methods: This single-centre, retrospective cohort study compared adults with PCAS following OHCA who received hemoadsorption with propensity score-matched controls (1:1 matching; n = 50 per group). For patients treated with hemoadsorption, data were analyzed within predefined intervals covering the 24 h preceding therapy initiation (T1) and the 24 h following the completion of the hemoadsorption treatment period (T2). Controls were evaluated at time points aligned to those of their matched hemoadsorption counterparts. Hemodynamic, metabolic, respiratory, and organ injury markers were assessed. Results: Formal between-group comparisons of temporal change between T1 and T2 showed no statistically significant differences between hemoadsorption-treated patients and matched controls across key parameters, including VIS (Δ −18.7 vs. −7.7; p = 0.183) and lactate (Δ −1.8 vs. −1.25 mmol/L; p = 0.780), as well as markers of organ injury, pH, and oxygenation. In exploratory ANCOVA models, only base excess was associated with treatment group (p = 0.035). Survival to hospital discharge was comparable (48% vs. 40%; p = 0.423), with similar neurological outcomes. Within the hemoadsorption group, pre–post comparisons around hemoadsorption initiation (T1–T2) demonstrated marked improvements, including reduced vasoactive support (VIS 70.0 to 12.1; p = 0.039), substantial lactate clearance (4.1 to 1.1 mmol/L; p < 0.001), and declines in organ injury markers (AST, ALT, LDH, myoglobin), alongside more pronounced platelet reduction compared with controls (129 to 57 × 103/µL vs. 189 to 123 × 103/µL). However, adjusted analyses indicated that these changes were primarily driven by baseline shock severity rather than a treatment-specific effect. Conclusions: In this propensity score-matched cohort of PCAS patients after OHCA, hemoadsorption was associated with within-group physiological changes but showed no detectable advantage over matched controls, with similar survival. These findings are hypothesis-generating and warrant prospective studies with standardized timing and phenotype-guided patient selection.

Background : Acute myocardial infarction-related cardiogenic shock (AMI-CS) remains associated with high mortality. We investigated early hemodynamic and metabolic changes following adjunctive extracorporeal hemadsorption in a real-world AMI-CS cohort. Methods : This retrospective single-center landmark analysis included adult intensive care unit (ICU) patients with AMI-CS classified as Society for Cardiovascular Angiography and Interventions (SCAI) stage C or higher between January 2017 and July 2025. Patients who died within 24 h of ICU admission were excluded; among patients receiving hemadsorption, only those treated for at least 24 h were included. Propensity score matching was performed using sex, prior cardiopulmonary resuscitation (CPR), temporary mechanical circulatory support (tMCS), continuous renal replacement therapy (CRRT), admission lactate, admission vasoactive-inotropic score (VIS), and admission Horovitz index. The principal analysis compared pretreatment values with those at 24 h after treatment initiation; corresponding pseudo-timepoints were assigned in matched controls. Serial assessments at 12 h, 24 h, and 48 h characterized VIS and lactate trajectories. Results : Of 479 screened patients with AMI-CS, 398 met eligibility criteria for the 24-h landmark analysis, including 57 treated with adjunctive hemadsorption and 341 controls. Propensity score matching yielded 35 matched pairs and improved balance across the prespecified covariates, although residual imbalance persisted for prior CPR, CRRT, admission lactate, and admission VIS. In the matched cohort, hemadsorption-treated patients showed early within-group reductions in VIS (56.2 to 23.0; P=0.009) and lactate (2.0 to 1.5 mmol/L; P<0.001) as well as declines in aspartate aminotransferase (P=0.031) and lactate dehydrogenase (P=0.018). In matched controls, lactate likewise decreased significantly, whereas VIS remained unchanged, and tissue-injury markers did not show a comparable early decline. Although VIS and lactate improved over time overall, no significant time-by-treatment interaction was observed over 48 h for VIS (P=0.834) or lactate (P=0.427). Exploratory subgroup and multivariable analyses revealed no evidence of a differential mortality benefit. In-hospital mortality was similar between matched groups (45.7% vs. 42.9%; P=1.000), and hemadsorption was not independently associated with mortality (odds ratio=1.05, 95% CI: 0.36–3.08; P=0.934). Conclusions : In this exploratory propensity score-matched landmark analysis of AMI-CS, hemadsorption-treated patients showed early within-group hemodynamic and metabolic changes, but subsequent VIS and lactate trajectories did not differ significantly from matched controls, and in-hospital survival was not improved. Residual imbalance and the observational design limit causal interpretation. These findings should be considered hypothesis-generating and require prospective validation.

BackgroundTranscatheter aortic valve replacement (TAVR) has become a widely used treatment option for severe aortic stenosis (AS), particularly in elderly and multimorbid patients. The New York Heart Association (NYHA) classification, which assesses the severity of heart failure (HF), is a key factor influencing TAVR outcomes. However, its impact on procedural success, complications, and outcomes remains underrepresented in recent studies.MethodsIn this multicenter study, data from 2,256 patients who underwent TAVR between 2017 and 2022 at two high-volume German Heart Centers were analyzed. Demographics, comorbidities, and peri-procedural parameters were evaluated to determine the influence of pre-procedural NYHA classification on complications, hospital stay, and outcomes. Multivariable logistic regression analyses were performed to assess the independent prognostic impact of pre-procedural NYHA class on 30-day and 1-year mortality.ResultsNYHA class III/IV prior to the procedure was associated with higher peri-procedural complication rates, prolonged hospital stays, and increased mortality compared to class NYHA I/II. In particular, the rates for cardiopulmonary resuscitation (5.3% vs. 0.7%; p < 0.001), acute coronary intervention (1.9% vs. 0.0%; p = 0.006), vasopressor use >6 h (11.7% vs. 1.6%; p < 0.001), and renal replacement therapy (6.8% vs. 0.2%; p < 0.001) were higher. Procedure-related complications like vascular closure device failure (4.9% vs. 1.3%; p = 0.008), need for vascular surgery (9.0% vs. 6.3%; p = 0.002), and blood transfusion (9.4% vs. 4.7%; p = 0.017) were more common in NYHA IV. Median hospital stay was longer in NYHA IV (10.0 vs. 6.0 days; p < 0.001). The 30-day mortality rate was 8.3% (NYHA IV) vs. 1.4% (NYHA I/II), and 1-year mortality was 19.2% vs. 5.2% (p < 0.001). After multivariable adjustment for relevant clinical confounders, NYHA class IV remained independently associated with both 30-day and 1-year mortality.ConclusionsPre-procedural NYHA class provides important prognostic information in patients undergoing TAVR, with higher symptom burden associated with increased peri-procedural risk and mortality. These findings highlight the relevance of comprehensive pre-procedural evaluation and optimized timing of intervention. Incorporating functional status into pre-procedural assessment may support risk stratification and individualized patient management.

BACKGROUND:In physician-staffed emergency medical services (EMS) systems, emergency physicians may differ in postgraduate specialist and critical care training. Whether such differences are associated with outcomes after out-of-hospital cardiac arrest (OHCA) remains uncertain. We investigated the association between emergency physician qualification and outcomes after non-traumatic OHCA. METHODS:This retrospective cohort study included adult patients with non-traumatic OHCA from the Marburg-Biedenkopf EMS region from 2018 to 2024. Patients were treated by residents, specialists without additional critical care training, or specialists with additional critical care training. The primary outcome was survival to discharge. Secondary outcomes included return of spontaneous circulation (ROSC), hospital admission with ROSC, 24-h survival, and favorable neurological outcome. Multivariable logistic regression was performed for each endpoint with residents as reference. RESULTS:Among 1426 patients, any ROSC did not differ significantly between groups (39.9%, 42.5%, and 45.7%; p = 0.211). Operational response times and time to first ROSC were comparable. Specialists with additional critical care training achieved faster vascular access and earlier vasopressor administration, with fewer access failures. Survival to discharge increased across groups (12.2%, 14.4%, and 18.0%; p = 0.047). In adjusted analyses, specialists with additional critical care training had higher odds of hospital admission with ROSC (OR 1.42, 95% CI 1.05-1.93) and survival to discharge (OR 1.59, 95% CI 1.05-2.40) compared with residents. CONCLUSIONS:Additional critical care training was associated with selected prehospital procedural measures and higher odds of hospital admission with ROSC and survival to discharge. These observational findings are hypothesis-generating and do not establish causality.

Background: Cardiogenic shock (CS) and post-cardiac arrest syndrome (PCAS) are frequently associated with a systemic inflammatory response resulting from ischemia-reperfusion injury, endothelial dysfunction, and microcirculatory impairment. This inflammatory biology may be further amplified by temporary mechanical circulatory support (tMCS) through blood-surface interactions and shear-related hemolysis. Extracorporeal cytokine adsorption has therefore been proposed as an adjunctive strategy to attenuate hyperinflammation and facilitate shock reversal in selected patients. Methods: We conducted a narrative review, guided by a targeted PubMed and Scopus search and reference screening, to summarize the current pathophysiological concepts and clinical evidence on extracorporeal cytokine adsorption in CS-, PCAS-, and tMCS-supported states. Results: Across porous polymer hemoadsorption cartridges (e.g., CytoSorb®), membrane-based or hybrid filters with adsorptive properties (e.g., oXiris®), and selective approaches targeting inflammatory mediators (e.g., PentraSorb® CRP), available studies most consistently report short-term physiological effects, including reduced vasopressor demand, improved metabolic stabilization, and modulation of inflammatory markers. However, evidence of benefits to clinically relevant endpoints remains inconsistent in various clinical settings, and randomized data are limited. Conclusions: Extracorporeal cytokine adsorption is a biologically plausible adjunct in inflammation-driven acute cardiovascular syndromes, but current evidence does not support routine use. Phenotype-guided patient selection, early timing, and adequately powered, mechanism-informed randomized trials are required to define clinical efficacy and safety in defined patient populations.

BackgroundAcute kidney injury (AKI) is common and prognostically relevant after out-of-hospital cardiac arrest (OHCA), yet early risk prediction at admission remains limited.ObjectiveTo assess whether radiomics features from dual-phase contrast-enhanced CT obtained at admission predict AKI after non-traumatic OHCA.MethodsThis retrospective single-center study included consecutive non-traumatic OHCA patients with return of spontaneous circulation undergoing standardized admission dual-phase CT. AKI within 5 days was defined by KDIGO criteria or renal replacement therapy. Bilateral whole-kidney masks were generated using TotalSegmentator, reviewed, and corrected if necessary. Radiomics features were extracted with PyRadiomics within 3DSlicer. Features with poor reproducibility (CCC < 0.75) were excluded. Arterial-venous difference features were computed. Data were split into a training cohort and test cohort. Feature selection used mRMR followed by LASSO regression, yielding seven predictors for training of a logistic regression (LR) model, a support vector machine (SVM), and a k-nearest neighbors (kNN) model. Additionally, a limited clinical variable LR model and a combined model were evaluated. Stability was assessed by post hoc repeated resampling of the primary radiomics LR model across 100 stratified 70/30 splits, summarizing repetitions yielding 3–9 LASSO-selected features.ResultsOf 383 screened patients, 155 were included, of which 47 (30.3%) developed AKI. In the test cohort, radiomics-LR showed the highest AUC (0.783), with kNN (0.778) and SVM (0.757) performing comparable. The limited clinical model performed poorly (AUC 0.549), and the combined model (AUC 0.779) did not materially improve upon radiomics alone. In the repeated resampling analysis, 29 of 100 repetitions fulfilled the predefined feature-count criterion. Among these repetitions, median test-set AUC was 0.663 (IQR, 0.623–0.699), indicating moderate but variable discriminatory performance and limited feature-selection stability. Most selected predictors were arterial-venous difference features.ConclusionsThis exploratory single-center proof-of-concept study suggests that admission dual-phase CT radiomics may contain information relevant to early AKI risk stratification after OHCA, with arterial-venous difference features appearing particularly informative. However, limited stability of feature selection and model performance indicates that these findings should be considered hypothesis-generating and require methodological refinement, comparison with more comprehensive clinical models, and external validation in prospective multicenter cohorts before clinical application can be considered.

Quadricuspid aortic valve (QAV) is a rare congenital anomaly with an estimated incidence of 0.008% to 0.043% based on autopsy and echocardiographic studies. Although often asymptomatic, it can lead to progressive aortic regurgitation (AR), left ventricular (LV) dysfunction, and arrhythmias such as atrial fibrillation (AF). Due to its rarity, QAV is often misdiagnosed or discovered incidentally, highlighting the need for advanced cardiac imaging in young patients presenting with unexplained heart failure symptoms and arrhythmias. We present the case of a 41-year-old female patient who was admitted with new-onset dyspnea classified as New York Heart Association (NYHA) class III and palpitations due to persistent AF with a European Heart Rhythm Association (EHRA) symptom class 2b. There was no family history of congenital or structural heart disease, with arterial hypertension being the only identified predisposing condition. Initial transthoracic echocardiography revealed moderate AR, but more detailed transesophageal echocardiography performed before pulmonary vein isolation incidentally revealed a QAV. Further cardiac magnetic resonance imaging confirmed normal aortic root dimensions with early LV remodeling. The patient was managed conservatively with rate control, anticoagulation, and regular follow-up to monitor disease progression. This case highlights the importance of advanced imaging techniques in the diagnosis of rare structural heart abnormalities in young patients presenting with unexplained heart failure symptoms and arrhythmias. Early identification of QAV allows for timely medical intervention, optimal patient monitoring, and prevention of long-term complications. Regular follow-up is essential to monitor disease progression and determine the need for surgical intervention.

Background: Cardiogenic shock (CS), characterized by inadequate tissue perfusion due to cardiac dysfunction, has a high mortality rate despite advances in treatment. Systemic inflammation and organ failure exacerbate the severity of CS. Extracorporeal hemadsorption techniques such as CytoSorb® have been introduced to control inflammation. However, evidence of their efficacy, particularly in patients on various mechanical circulatory support (MCS) systems, remains limited. Methods: This retrospective study analyzed data from 129 CS patients treated with CytoSorb® at the University Hospital of Marburg between August 2019 and December 2023. Those patients receiving MCS were grouped according to MCS type: (1) Impella, (2) VA-ECMO, and (3) ECMELLA. The hemodynamic parameters of circulatory support (e.g., MCS flow rates and vasoactive inotropic score, VIS) and laboratory and ventilation parameters were assessed 24 h before start of CytoSorb® therapy (T1) and 24 h after completion of CytoSorb® therapy (T2). Results: Of 129 CS patients (mean age: 64.7 ± 13.1 years), 103 (79.8%) received MCS. Comparing T1 and T2, there was a significant reduction in VIS in the entire cohort (T1: 38.0, T2: 16.3; p = 0.002), with a concomitant significant reduction in the level of MCS support in all subgroups, indicating successful weaning. Analysis of laboratory parameters showed significant reductions in lactate (T1: 2.1, T2: 1.3 mmol/L; p = 0.014), myoglobin (T1: 1549.0, T2: 618.0 µg/L; p < 0.01), lactate dehydrogenase (T1: 872.0, T2: 632.0 U/L; p = 0.048), and procalcitonin (T1: 2.9, T2: 1.6 µg/L; p < 0.001). However, a significant decrease in platelets (T1: 140.0, T2: 54.0 tsd/µL; p < 0.001) and albumin (T1: 25.0, T2: 22.0 g/dL; p < 0.001) was also documented. The median SOFA score of the entire cohort was 15.0 (IQR 12.0–16.0), predicting a mortality rate of >80%, which could be reduced to 60.5% in the present study. Conclusions: During CytoSorb® therapy in CS, a significant reduction in VIS was demonstrated, resulting in improved organ perfusion. Therefore, the results of this study underline that CytoSorb® therapy can be considered a useful “component” in the complex management of CS, especially when combined with MCS. To refine and optimize treatment strategies in CS, prospective studies are needed to better define the role of hemadsorption.

Background: Emerging evidence suggests the role of mechanical circulatory support (MCS) devices in the therapy of refractory cardiogenic shock (CS). However, largerandomized trials addressing the role of Impella in the therapy of infarct-associated CS are sparse. As such, evidence coming from comprehensive retrospective studies or meta-analyses is of major importance in order to clarify the role of the Impella device in this setting. Methods: Only clinical trials involving patients receiving Impella 2.5 and Impella CP for treatment of CS caused in terms of acute coronary syndrome (ACS) were included in this meta-analysis. The primary endpoint was 30-day mortality, with major bleeding and ischemic vascular complications serving as secondary endpoints. Results: A total of 18 observational retrospective studies (2617 patients with CS and Impella implantation) were included in this analysis. The mean age of the total participants was 64.7 ± 2.93 years. A mean mortality incidence of 45% was found between all included participants. The ischemia rate was in total 8.5 ± 4.4%, and the incidence of bleeding was 13.9 ± 5.6%. Conclusions: The 30-day mortality rate for patients with ACS-associated CS treated with Impella remains high. The high complication rates underline the importance of Impella use in only a very well-selected population of patients.

Background Current guidelines recommend transcatheter aortic valve implantation (TAVI) for patients with aortic stenosis and porcelain aorta (PA). Neurological outcomes of patients with PA undergoing TAVI with modern valves require clarification as most trials examined balloon-expandable valves (BEV) and self-expandable valves in intermediate or high-risk patients, but not specifically in patients with PA. Our aim was to compare outcomes, including stroke and mortality, in well-matched patients with and without PA who received BEV during transfemoral TAVI procedures.Methods Consecutive patients undergoing TAVI were entered into a registry. For this single-centre (Zentralklinik Bad Berka, Germany), retrospective analysis, we only selected patients who received BEV. PA diagnosis was made when non-contrast axial CT images fulfilled Valve Academic Research Consortium-2 criteria for PA. There was 2:1 nearest neighbour matching of patients without and with PA. The primary outcome measure was 30-day mortality or stroke within 72 hours. Secondary outcome measures were 30-day mortality, stroke within 72 hours, technical success and 30-day device success.Results After matching patients with (n=141) and without PA (n=282), the primary outcome of mortality at <30 days or stroke within 72 hours was higher in PA versus non-PA (7.8% vs 2.5%; OR 3.32 (95% CI 1.25 to 8.85); p=0.019). With regard to secondary outcomes, PA was not associated with mortality at 30 days (4.3% vs 2.1%; OR 2.04 (95% CI 0.65 to 6.48); p=0.23); however, stroke within 72 hours was significantly higher in PA versus non-PA (3.5% vs 0.4%; OR 10.33 (95% CI 1.17 to 91.12); p=0.017). Technical and device success were uninfluenced by PA.Conclusions Transfemoral TAVI with BEV in patients with PA was associated with a higher risk of the primary combined endpoint of mortality at 30 days or stroke within 72 hours, which was primarily driven by stroke within 72 hours. These findings might influence cerebral embolic protection device use in patients with PA.

The steadily increasing number of transcatheter aortic valve replacement (TAVR) procedures being performed on a heterogeneous patient population highlights the need for robust risk assessment. While EuroSCORE II is well established for surgical risks, it is less effective for TAVR, and the newer STS/ACC TAVR score has so far been validated mainly for in-hospital and 30-day mortality. This study aims to improve risk stratification for TAVR patients by identifying real-time predictors of 30-day and 1-year mortality that incorporate comprehensive, procedure-specific factors. Five-year data from 2256 transfemoral TAVR procedures performed at two German Heart Centers (2017–2022) were retrospectively analyzed. Predictors of 1-year and 30-day mortality were assessed using multivariable logistic and LASSO regression, considering a broad spectrum of patient demographics, comorbidities, and peri-procedural factors. The analyses revealed a predictor model (PRE-TAVR predictors) for 1-year mortality (AUC 0.770; 95

Aims The role of temporary mechanical circulatory support (tMCS) after out-of-hospital cardiac arrest (OHCA) remains controversial. This study evaluates machine learning (ML) models for predicting mortality and neurological outcomes, highlighting their potential as a tool to guide early tMCS decision-making. Methods and results This retrospective study analysed five years of data from 564 adult non-traumatic OHCA patients treated at Marburg University Hospital. Four ML models (ANN, SVM, RF, XGBoost) were trained to predict in-hospital mortality and neurological outcome based on demographic, clinical, and treatment-related variables. Feature selection and SHAP analysis were used to optimize performance and identify patients potentially benefiting from tMCS. Overall, 144 patients (31.2%) out of 461 patients who fulfilled the inclusion criteria received tMCS: 39 left-ventricular microaxial flow pump, 76 venoarterial extracorporeal membrane oxygenation (VA-ECMO), and 29 biventricular support (ECMELLA). In 69 patients (14.9%) VA-ECMO implantation was performed as part of extracorporeal cardiopulmonary resuscitation. The survival rate of the tMCS group was 34.7% (50/144) compared to 52.7% (167/317) in the non-tMCS group. The highest predictive power for survival probability (with/without tMCS) could be achieved by XGBoost and RF when applied to the non-tMCS group. Machine learning identified 2.5% of non-tMCS patients likely to survive if treated with tMCS. In 23 (RF model) and 31 (XGBoost model) patients, the probability of survival increased by at least 5% with tMCS compared to their predicted outcome without tMCS. RF slightly outperformed XGBoost [area under the receiver operating characteristic curve (AUC) 0.85 vs. AUC 0.82]. Conclusion XGBoost and RF models accurately predict mortality and tMCS benefit in OHCA patients, supporting ML-based personalized therapy.

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.

Background: Cardiogenic shock remains a significant cause of mortality in patients with acute coronary syndrome, despite early interventions, such as coronary revascularization. Mechanical circulatory support devices, particularly venoarterial extracorporeal membrane oxygenation (VA-ECMO), are increasingly being utilized to address this issue. Limited randomized controlled trials (RCTs) exist to evaluate the efficacy of VA-ECMO in cardiogenic shock related to acute coronary syndrome. Methods: A meta-analysis was conducted to assess the effectiveness of VA-ECMO in adult patients with infarct-related cardiogenic shock. Trials were identified through database searches and selected based on specific inclusion criteria. The primary outcome was 30-day all-cause mortality, with secondary outcomes including bleeding and vascular complications. Results: A total of 24 studies met the inclusion criteria and were included in the meta-analysis, involving 4706 patients. The median age of the patients was 61.8 ± 4.1 years, with 76% of them being males. The analysis revealed that 30-day mortality rates for patients with cardiogenic shock receiving ECMO were still high, with a mortality of 63%. Vascular complications were identified as factors associated with a worse prognosis. Conclusions: The meta-analysis highlights the ongoing challenge of high mortality rates in cardiogenic shock patients despite the use of VA-ECMO. While VA-ECMO shows promise in providing circulatory support, further research is needed to explore ways to improve outcomes and reduce complications associated with the use of these devices. The complexity of patient management in cardiogenic shock cases underscores the need for a multidisciplinary approach to optimize treatment strategies and enhance patient outcomes.

Background: Right ventricular (RV) dysfunction or failure occurs in more than 30% of patients in cardiogenic shock (CS). However, the importance of timely diagnosis of prognostically relevant impairment of RV function is often underestimated. Moreover, data regarding the impact of mechanical circulatory support like the Impella on RV function are rare. Here, we investigated the effects of the left ventricular (LV) Impella on RV function. Moreover, we aimed to identify the most optimal and the earliest applicable parameter for bedside monitoring of RV function by comparing the predictive abilities of three common RV function parameters: the pulmonary artery pulsatility index (PAPi), the ratio of right atrial pressure to pulmonary capillary wedge pressure (RA/PCWP), and the right ventricular stroke work index (RVSWI). Methods: The data of 50 patients with CS complicating myocardial infarction, supported with different flow levels of LV Impella, were retrospectively analyzed. Results: Enhancing Impella flow (1.5 to 2.5 L/min ± 0.4 L/min) did not lead to a significant variation in PAPi (p = 0.717), RA/PCWP (p = 0.601), or RVSWI (p = 0.608), indicating no additional burden for the RV. PAPi revealed the best ability to connect RV function with global hemodynamic parameters, i.e., cardiac index (CI; p < 0.001, 95% CI: 0.181–0.663), pulmonary capillary wedge pressure (PCWP; p = 0.005, 95% CI: −6.721–−1.26), central venous pressure (CVP; p < 0.001, 95% CI: −7.89–5.575), and indicators of tissue perfusion (central venous oxygen saturation (SvO2); p = 0.008, 95% CI: 1.096–7.196). Conclusions: LV Impella does not impair RV function. Moreover, PAPi seems to be to the most effective and valid predictor for early bedside monitoring of RV function.

Background Despite continuous advances in post-resuscitation management, the outcome after out-of-hospital cardiac arrest (OHCA) is limited. To improve the outcome, interdisciplinary cardiac arrest centres (CACs) have been established in recent years, but survival remains low, and treatment strategies vary considerably in clinical and geographical aspects. Here we analysed a strategy of in-hospital post-resuscitation management while evaluating the outcome.Methods A broad spectrum of pre- and in-hospital parameters of 545 resuscitated patients admitted to the Cardiac Arrest Center of the University Hospital of Marburg between January 2018 and December 2022 were retrospectively analysed. Inclusion criteria were >= 18 years, resuscitation by emergency medical services, and non-traumatic cause of OHCA.Results In the overall patient cohort, the survival rate to hospital discharge was 39.8% (n = 217/545), which is 50.7% higher than in the EuReCa-TWO registry. A total of 77.2% of the survivors had CPC status 1 or 2 (favourable neurological outcome) before and after therapy. A standardized 'therapy bundle' for in-hospital post-resuscitation management was applied to 445 patients who survived the initial treatment in the emergency department. In addition to basic care (standardized antimicrobial therapy, adequate anticoagulation, targeted sedation, early enteral, and parenteral nutrition), it includes early whole-body CT (n = 391; 87.9%), invasive coronary diagnostics (n = 322; 72.4%), targeted temperature management (n = 293; 65.8%), and if indicated, mechanical circulatory support (n = 145; 32.6%), and appropriate neurological diagnostics.Conclusions Early goal-directed post-resuscitation management in a well-established and highly frequented CAC leads to significantly higher survival rates. However, our results underline the need for a broader standardization in post-resuscitation management to ultimately improve the outcome. Graphical Abstract

Background/Objectives: Secondary mitral regurgitation (MR) is a common valvular heart disease burdening the prognosis of patients with co-existing chronic heart failure. Transcatheter edge-to-edge mitral valve repair (MV-TEER) is a minimally invasive treatment option for high-risk patients. However, the effects of MV-TEER on expanded hemodynamics, tissue perfusion, and quality of life, particularly in patients with advanced renal failure, remain underexplored. Methods: This prospective, single-center study evaluated the impact of MV-TEER on hemodynamics, renal function, and quality of life in 45 patients with severe MR. Non-invasive bioimpedance monitoring with NICaS® was used to assess hemodynamics pre- and 3–5 days post-procedure. Quality of life was assessed using the EQ-5D-3L questionnaire before and 3 months post-procedure. For further analysis, patients were divided into subgroups based on the estimated baseline glomerular filtration rate (eGFR < 35 mL/min vs. eGFR ≥ 35 mL/min). Results: A significant reduction in systemic vascular resistance (SVR; p = 0.003) and an increase in eGFR (p = 0.03) were observed in the entire cohort after MV-TEER, indicating improved tissue perfusion. Notably, particularly patients with eGFR < 35 mL/min showed a significant increase in cardiac output (CO; p = 0.035), cardiac index (CI; p = 0.031), and eGFR (p = 0.018), as well as a reduction in SVR (p = 0.007). Consistent with these findings, quality of life significantly improved, with the EQ-5D-3L index and EQ-VAS score increasing from 0.44 to 0.66 (p < 0.001) and from 51.7% to 62.9% (p < 0.001).

Background Mechanical circulatory support (MCS) devices may stabilize patients with severe cardiogenic shock (CS) following myocardial infarction (MI). However, the canonical understanding of hemodynamics related to the determination of the native cardiac output (CO) does not explain or support the understanding of combined left and right MCS. To ensure the most optimal therapy control, the current principles of hemodynamic measurements during biventricular support should be re-evaluated. Methods Here we report a protocol of hemodynamic optimization strategy during biventricular MCS (VA-ECMO and left ventricular Impella) in a case series of 10 consecutive patients with severe cardiogenic shock complicating myocardial infarction. During the protocol, the flow rates of both devices were switched in opposing directions (+ / − 0.7 l/min) for specified times. To address the limitations of existing hemodynamic measurement strategies during biventricular support, different measurement techniques (thermodilution, Fick principle, mixed venous oxygen saturation) were performed by pulmonary artery catheterization. Additionally, Doppler ultrasound was performed to determine the renal resistive index (RRI) as an indicator of renal perfusion. Results The comparison between condition 1 (ECMO flow > Impella flow) and condition 2 (Impella flow > VA-ECMO flow) revealed significant changes in hemodynamics. In detail, compared to condition 1, condition 2 results in a significant increase in cardiac output (3.86 ± 1.11 vs. 5.44 ± 1.13 l/min, p = 0.005) and cardiac index (2.04 ± 0.64 vs. 2.85 ± 0.69, p = 0.013), and mixed venous oxygen saturation (56.44 ± 6.97% vs. 62.02 ± 5.64% p = 0.049), whereas systemic vascular resistance decreased from 1618 ± 337 to 1086 ± 306 s*cm −5 ( p = 0.002). Similarly, RRI decreased in condition 2 (0.662 ± 0.05 vs. 0.578 ± 0.06, p = 0.003). Conclusions To monitor and optimize MCS in CS, PA catheterization for hemodynamic measurement is applicable. Higher Impella flow is superior to higher VA-ECMO flow resulting in a more profound increase in CO with subsequent improvement of organ perfusion. Graphical Abstract

Abstract Acute kidney injury (AKI) is one of the most frequent and prognostic-relevant complications of cardiogenic shock (CS) complicating myocardial infarction (MI). Mechanical circulatory assist devices (MCS) like left ventricular Impella microaxial pump have increasingly been used in the last decade for stabilization of hemodynamics in those patients. Moreover, a protective effect of Impella on renal organ perfusion could recently be demonstrated. However, data identifying early risk predictors for developing AKI during Impella support in CS are rare. Data of hemodynamics and renal function from 50 Impella patients (January 2020 and February 2022) with MI-related CS (SCAI stage C), were retrospectively analyzed using e.g. multivariate logistic regression analysis as well as Kaplan–Meier curves and Cox regression analysis. 30 patients (60%) developed AKI. Central venous pressure as an indicator for venous congestion (OR 1.216, p = 0.02), GFR at admission indicating existing renal damage (OR 0.928, p = 0.002), and reduced central venous oxygen saturation (SvO2) as a marker for decreased tissue perfusion (OR 0.930, p = 0.029) were independently associated with developing an AKI. The 30-day mortality rate was significantly higher in patients with AKI stage 3 (Stage 1: 0%, Stage 2: 0%, Stage 3; 41.6%, p = 0.014) while AKI stage 3 (HR 0.095, p = 0.026) and norepinephrine dosage (HR 1.027, p = 0.008) were independent predictors for 30-day mortality. AKI as a complication of MI-related CS occurs frequently with a major impact on prognosis. Venous congestion, reduced tissue perfusion, and an already impaired renal function are independent predictors of AKI. Thus, timely diagnostics and a focused treatment of the identified factors could improve prognosis and outcome.

Background: Post-cardiac arrest syndrome (PCAS) after out-of-hospital cardiac arrest (OHCA) poses significant challenges due to its complex pathomechanisms involving inflammation, ischemia, and reperfusion injury. The identification of early available prognostic indicators is essential for optimizing therapeutic decisions and improving patient outcomes. Methods: In this retrospective single-center study, we analyzed real-world data from 463 OHCA patients with either prehospital or in-hospital return of spontaneous circulation (ROSC), treated at the Cardiac Arrest Center of the University Hospital of Marburg (MCAC) from January 2018 to December 2022. We evaluated demographic, prehospital, and clinical variables, including initial rhythms, resuscitation details, and early laboratory results. Statistical analyses included logistic regression to identify predictors of survival and neurological outcomes. Results: Overall, 46.9% (n = 217) of patients survived to discharge, with 70.1% (n = 152) achieving favorable neurological status (CPC 1 or 2). Age, initial shockable rhythm, resuscitation time to return of spontaneous circulation (ROSC), and early laboratory parameters like lactate, C-reactive protein, and glomerular filtration rate were identified as independent and combined Early Predictors of Outcome and Survival (EPOS), with high significant predictive value for survival (AUC 0.86 [95% CI 0.82-0.89]) and favorable neurological outcome (AUC 0.84 [95% CI 0.80-0.88]). Conclusion: Integration of EPOS into clinical procedures may significantly improve clinical decision making and thus patient prognosis in the early time-crucial period after OHCA. However, further validation in other patient cohorts is needed.