CANCARE RESEARCH
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An automated research-discovery feed. Summaries are based on published abstracts and are not clinical recommendations.
Initial V-A ECMO Flow-Index and Its Association With Inflammation, Organ Failure, and Outcomes.
Clinical takeaway Higher initial ECMO flow-index was associated with organ failure and poorer outcomes, but these findings do not establish that higher flow causes harm or that reducing flow improves outcomes.
Summary & abstract
Study summary
This retrospective single-center study compared higher versus lower initial flow-index in 553 patients receiving V-A ECMO between 2014 and 2024. After excluding cerebral death, multi-organ failure occurred in 32.7% of the high-flow group versus 23.0% of the low-flow group. Initial flow-index remained associated with multi-organ failure after adjustment (OR 1.102 per 0.1 L/min/m2, 95% CI 1.001–1.214). High-flow patients had greater baseline haemodynamic compromise, and exploratory mediation analysis suggested an indirect association through early hemolysis. Higher flow-index was also associated with worse neurological outcome and reduced survival.
Study limitation: Retrospective single-center data and greater shock severity in high-flow patients limit causal interpretation; mediation findings remain exploratory.
Published abstract
BACKGROUND: Refractory cardiogenic shock remains associated with high mortality despite macrocirculatory stabilization with V-A ECMO. We investigated the association between initial ECMO flow-index, organ dysfunction, inflammatory activation, hemolysis, and clinical outcome. METHODS: In this retrospective single-center study, 553 patients receiving V-A ECMO between 2014 and 2024 were divided into low-flow (< 1.63 L/min/m2, n = 269) and high-flow (≥ 1.63 L/min/m2, n = 284) groups. Patients were additionally stratified according to eCPR status. Multivariable logistic regression was used to assess factors associated with multi-organ failure (MOF), and exploratory mediation analyses evaluated day-1 free hemoglobin and IL-6 as potential mediators. RESULTS: High-flow patients were more hemodynamically compromised, with higher lactate, vasoactive-inotropic support, inflammatory markers, and early hemolysis. After exclusion of cerebral death, MOF occurred more frequently in the high-flow group (32.7% vs. 23.0%, p = 0.028). Initial flow-index remained independently associated with MOF in the overall cohort (OR 1.102 per 0.1 L/min/m2, 95% CI 1.001-1.214, p = 0.048) and in the eCPR subgroup (OR 1.117, 95% CI 1.028-1.214, p = 0.008). Day-1 free hemoglobin was independently associated with MOF, and mediation analysis demonstrated a significant indirect effect through early hemolysis. No significant indirect effect through IL-6 was observed. Higher flow index was also associated with worse neurological outcome and reduced survival. CONCLUSIONS: Higher initial V-A ECMO flow-index is associated with greater shock severity and multi-organ failure. Early hemolysis may partly contribute to this association, particularly in eCPR patients. These findings support individualized flow management with close monitoring of hemolysis and evolving organ dysfunction.
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External Validation of a Post-Cardiac Arrest Risk Score (SLANT) for In-Hospital Mortality in Patients Receiving Targeted Temperature Management.
Clinical takeaway SLANT showed reasonable mortality discrimination in this external cohort. These findings support further evaluation for contextual risk stratification, not its use as a standalone determinant of individual prognosis or care decisions.
Summary & abstract
Study summary
This retrospective cohort externally validated SLANT for predicting in-hospital mortality in 451 comatose adult out-of-hospital cardiac arrest survivors receiving targeted temperature management at three Taiwanese tertiary hospitals during 2016–2023. Overall, 300 patients (66.5%) died during hospitalisation. The score had an area under the receiver operating characteristic curve of 0.746 (95% confidence interval 0.696–0.796), with acceptable calibration, particularly at moderate to high risk. At a score threshold of ≥14, sensitivity was 65.7%, specificity 78.2%, and positive predictive value 85.7%.
Study limitation: Retrospective validation in three Taiwanese tertiary hospitals limits generalisability beyond similar patients and care settings.
Published abstract
BACKGROUND: Despite improvements in cardiopulmonary resuscitation and post-cardiac arrest care, in-hospital mortality among survivors of out-of-hospital cardiac arrest (OHCA) remains high, particularly in Asia. The SLANT score was developed to predict outcomes in patients with comatose OHCA receiving targeted temperature management (TTM), but its performance outside the original derivation cohort remains uncertain. We aimed to externally validate the SLANT score for predicting in-hospital mortality in an East Asian population. METHOD: We conducted a multicentre retrospective cohort study across three tertiary hospitals in Taiwan between 2016 and 2023. Adult patients with OHCA who achieved sustained return of spontaneous circulation, remained comatose, and received TTM were included. The SLANT score-comprising initial non-shockable rhythm, post-TTM leukocyte abnormality, total adrenaline dose ≥5 mg, absence of bystander cardiopulmonary resuscitation, and resuscitation duration ≥20 minutes-was calculated using original definitions. The outcome was in-hospital mortality. Discrimination was assessed using the area under the receiver operating characteristic curve (AUC), and calibration was evaluated with calibration plots. RESULTS: Among 451 eligible patients, 300 (66.5%) died during hospitalisation. The SLANT score demonstrated good discrimination for in-hospital mortality (AUC 0.746; 95% confidence interval 0.696-0.796), with acceptable calibration, particularly in moderate- to high-risk ranges. A score threshold ≥14 provided the optimal balance between sensitivity (65.7%) and specificity (78.2%), with a positive predictive value of 85.7%. CONCLUSIONS: In this East Asian cohort, the SLANT score showed reasonable discrimination and calibration for predicting in-hospital mortality. These findings support its potential role in post-cardiac arrest risk stratification, while underscoring the need for contextual clinical judgment.
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Incidence and Predictors of Acute Kidney Injury Among Postoperative Cardiac Surgery Patients in Tanzania.
Clinical takeaway Early postoperative AKI was common in this Tanzanian cardiac-surgery cohort. The reported associations identify potential risk markers but do not establish that modifying transfusion or bypass practices would reduce AKI.
Summary & abstract
Study summary
A prospective study of 177 cardiac-surgery patients at Tanzania’s National Cardiac Institute assessed AKI using serum creatinine changes at 24, 48, and 72 hours postoperatively. Postoperative AKI occurred in 53%, with stage I accounting for 72.9% of cases. In adjusted analyses, blood transfusion was associated with AKI (adjusted prevalence ratio 3.63, 95% CI 1.15–11.41), as was cardiopulmonary bypass exceeding 240 minutes (3.80, 95% CI 1.57–9.18). Diabetes and ASA IV status were also associated with AKI, while female sex was associated with lower AKI prevalence.
Study limitation: This single-centre observational study cannot establish causality; patient ages are unspecified, and several adjusted estimates have wide confidence intervals.
Published abstract
INTRODUCTION: Cardiac surgery-associated acute kidney injury (CSA-AKI) is a severe postoperative complication linked to increased morbidity and mortality. Data on the incidence and predictors of CSA-AKI in sub-Saharan Africa, including Tanzania, are limited. This study aimed to determine the incidence and predictors of AKI in patients who underwent cardiac surgery at Tanzania's National Cardiac Institute. METHODS: This prospective study included 177 patients. AKI was defined using the Kidney Disease: Improving Global Outcomes (KDIGO) criteria based on serum creatinine (SCr) changes at 24, 48, and 72 h postoperatively. The patients' clinical profiles were collected and analyzed using SPSS version 27.0 (IBM Corp., Armonk, NY, USA). Chi-square tests and modified Poisson regression were used to identify associated factors at 95% confidence intervals (CIs), with P < 0.05. RESULTS: The prevalence of postoperative AKI was 53%, with the majority of patients presenting with AKI stage I (72.9%). In the multivariable analysis, diabetes mellitus (Adjusted Prevalence Ratio (aPR )1.32, 95% CI 1.02-1.70; P = 0.038), American Society of Anesthesiologists (ASA) IV status (aPR 1.39, 95% CI 1.10-1.76; P = 0.007), blood transfusion (transfusion: aPR 3.63, 95% CI 1.15-11.41; P = 0.027), triple components (aPR 3.41, 95% CI 1.08-10.78; P = 0.037), and prolonged cardiopulmonary bypass (CPB) time of 181-240 min (aPR 3.53, 95% CI 1.51-8.25; P = 0.004) and > 240 min (aPR 3.80, 95% CI 1.57-9.18; P = 0.003) were independent predictors of AKI. Female sex was independently associated with a lower prevalence of AKI (aPR 0.66, 95% CI 0.50-0.88; P = 0.004). Patients who developed AKI had significantly longer stays in the intensive care unit (ICU) (aPR 2.39, 95% CI 1.39-4.12; P = 0.002). CONCLUSION: The prevalence of CSA-AKI is remarkably high in this setting, posing a significant clinical burden. Key preoperative and intraoperative predictors were also identified. These results reinforce the importance of perioperative patient optimization, strategies to minimize CPB exposure, transfusion practice optimization, and surveillance of high-risk patients.
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Intra-aortic balloon support for myocardial infarction with cardiogenic shock: insights from the Swedish Coronary Angiography and Angioplasty Registry.
Clinical takeaway This registry analysis found no clear mortality advantage associated with IABP and a signal for increased in-hospital complications. Wide mortality confidence intervals leave substantial uncertainty about benefit or harm.
Summary & abstract
Study summary
This prospective Swedish registry study included 2991 patients with myocardial infarction complicated by cardiogenic shock undergoing PCI; 737 received IABP. Investigators used hospital treatment preference as an instrumental variable to account for baseline differences. Overall 30-day mortality was 52%, and IABP was not associated with reduced 30-day mortality compared with no IABP (risk reduction −1.1%, 95% confidence interval −15.7 to 13.5). IABP use was associated with more in-hospital complications (reported increase 26.1%, 95% confidence interval 15.2–36.8), although the observational design limits causal interpretation.
Study limitation: Instrumental-variable adjustment cannot establish randomization, and the wide mortality confidence interval limits precision.
Published abstract
BACKGROUND: Cardiogenic shock remains the leading cause of in-hospital death in patients with acute myocardial infarction (MI). The intra-aortic balloon pump (IABP), once widely used, was downgraded in European guidelines after a major randomized trial showed no mortality benefit. This prospective observational study evaluated the impact of IABP on 30-day mortality and in-hospital complications in real-world patients with MI complicated by cardiogenic shock. METHODS: Data were obtained from the Swedish Coronary Angiography and Angioplasty Registry, including all percutaneous coronary intervention procedures performed across 31 hospitals in Sweden between 2005 and 2018. A total of 2991 patients with cardiogenic shock were included, of whom 737 (25%) received IABP. To account for baseline differences, instrumental variable analysis was applied using hospital treatment preference as the instrument. RESULTS: At 30 days, 52% of patients had died, and by 1 year, mortality reached 63.2%. In-hospital complications occurred in 13.4% of patients. IABP treatment was not associated with reduced mortality at 30 days [risk reduction: -1.1%, 95% confidence interval (CI): -15.7 to 13.5; P = 0.881] or at 1 year (risk reduction: -0.8%, 95% CI: -23.2 to 0.06; P = 0.258). However, IABP use was associated with a significantly higher risk of in-hospital complications (increase of 26.1%, 95% CI: 15.2-36.8; P < 0.001). CONCLUSION: IABP did not improve short- or long-term survival in patients with MI-related cardiogenic shock but was linked to increased complications, supporting current guideline recommendations against its routine use.
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The red blood cell distribution width-to-albumin ratio and 28-day mortality in patients with severe cardiogenic shock: a retrospective cohort study based on MIMIC-IV with single-center external validation.
Clinical takeaway RAR was associated with short-term mortality in cardiogenic shock, but prospective validation is needed before its added value for clinical risk stratification is established.
Summary & abstract
Study summary
This retrospective study included 1,314 cardiogenic-shock patients across MIMIC-IV and a single-center external validation cohort. Higher red cell distribution width-to-albumin ratio (RAR) was associated with 28-day ICU mortality after adjustment (HR per unit 1.134, 95% CI 1.076–1.197). The association persisted in external validation (HR 1.359, 95% CI 1.177–1.568). For 28-day in-hospital mortality, the adjusted HR per unit was 1.085 (95% CI 1.031–1.141). A model incorporating RAR and five other clinical features showed moderate discrimination, with AUCs of 0.71, 0.70, and 0.75 in training, test, and external validation sets.
Study limitation: Retrospective observational data remain vulnerable to residual confounding; external validation came from only one center.
Published abstract
BACKGROUND: Cardiogenic shock (CS) is a critical syndrome with a very high fatality rate, and in-hospital mortality ranges from 27% to 51%. Among the various prognostic approaches, serum biomarkers have attracted considerable attention because they are easy to measure, inexpensive, and can be monitored dynamically. The red cell distribution width-to-albumin ratio (RAR) is a novel composite marker that integrates red blood cell heterogeneity (reflecting inflammation and oxidative stress) with albumin levels (indicating nutritional and anti-inflammatory capacity). It has shown initial promise for risk stratification in critically ill patients. However, the independent prognostic value of RAR specifically in CS remains unclear. Therefore, this study aims to systematically evaluate the ability of RAR to predict 28-day mortality in these patients. MATERIALS AND METHODS: This study used a two-cohort retrospective design. The internal training cohort was derived from CS patients in the MIMIC-IV v2.2 database, and the external validation cohort came from the medical record system of the Affiliated Hospital of Guizhou Medical University. To explore the association between RAR and short-term poor outcomes in severe CS, we applied multivariable Cox regression, restricted cubic spline (RCS) regression, subgroup analysis, and Kaplan-Meier survival curves. To develop a simple prediction model, the internal cohort was randomly split into a training set and a test set in a 7:3 ratio. In the training set, we used five methods-Boruta algorithm, LASSO-Cox regression, random forest (RF), gradient boosting (GBDT), and support vector machine (SVM)-to select key features associated with poor CS prognosis, covering laboratory indicators, comorbidities, demographic characteristics, and vital signs. Based on the selected feature variables, we built prognostic prediction models using multivariable Cox regression in each of the three cohorts. The discriminative ability of the model was compared with that of traditional disease severity scores using receiver operating characteristic (ROC) curves, with the area under the curve (AUC) as the measure of predictive performance. RESULT: A total of 1,314 CS patients were included in this study. In the fully adjusted model (Model 3), both continuous RAR and RAR quartiles were independently associated with 28-day adverse outcomes. For 28-day ICU mortality, each unit increase in RAR was associated with a 13.4% higher risk (HR 1.134, 95% CI 1.076-1.197, p < 0.001); compared with the lowest quartile (Q1), the highest quartile (Q4) had a significantly increased risk of 51.7% (HR 1.517, 95% CI 1.123-2.049, p = 0.007). For 28-day in-hospital mortality, the HR for continuous RAR was 1.085 (95% CI 1.031-1.141, p = 0.002), and the HR for Q4 vs. Q1 was 1.576 (95% CI 1.196-2.076, p = 0.001). Restricted cubic spline analysis further confirmed a significant positive dose-response relationship between RAR and mortality (overall p < 0.05). In the external validation cohort, the predictive value of RAR for 28-day ICU mortality remained consistent and was even stronger (HR for continuous RAR: 1.359, 95% CI 1.177-1.568, p < 0.001). the RAR-based risk prediction model showed moderate but consistent discriminative performance, with areas under the receiver operating characteristic curve of 0.71, 0.70, and 0.75 in the training, test, and external validation sets, respectively, all of which were higher than those of traditional severity scores (all DeLong tests p < 0.05). CONCLUSION: This study demonstrated in both cohorts that RAR is an independent associated with 28-day mortality risk in CS patients. The prediction model built on RAR and five other clinical features exhibited good clinical performance. With further prospective validation, this model may become a valuable exploratory tool for risk stratification in CS patients.
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Socioeconomic Disparities in Patients With Cardiogenic Shock Treated With Extracorporeal Support.
Clinical takeaway Higher neighborhood income was associated with lower in-hospital mortality among cardiogenic shock hospitalizations receiving VA-ECMO. These findings highlight socioeconomic disparities but do not establish their causes.
Summary & abstract
Study summary
This retrospective National Inpatient Sample study included 3,032 adult hospitalizations for cardiogenic shock treated with VA-ECMO during 2018–2022, examining ZIP code-level income and in-hospital mortality. Compared with the lowest-income quartile, the highest-income quartile had lower adjusted mortality risk (adjusted risk ratio 0.83; 95% confidence interval 0.74–0.94). Time-to-event analysis also showed a lower adjusted hazard of death for the highest versus lowest quartile (adjusted hazard ratio 0.76; 95% confidence interval 0.64–0.89). Mortality risk did not differ significantly between the second or third quartiles and the lowest quartile.
Study limitation: The retrospective design limits causal inference, and ZIP code-level income may not reflect individual socioeconomic circumstances.
Published abstract
Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is a resource-intensive therapy that can be used in severe cardiogenic shock (CS). Socioeconomic factors are known determinants of cardiovascular outcomes, yet their association with mortality among patients receiving mechanical circulatory support remains unclear. We conducted a retrospective cohort study using the Healthcare Cost and Utilization Project National Inpatient Sample, including adult hospitalizations with CS receiving VA-ECMO between 2018 and 2022. Exposure was Zone Improvement Plan (ZIP) code-level median household income quartile. The primary outcome was in-hospital mortality. We used multivariable regression to estimate risk ratios and Cox-proportional hazards for time-to-event analyses, adjusting for confounders. The 3,032 hospitalizations were evenly distributed across income quartiles. Compared with the lowest-income quartile, the adjusted mortality risk ratio of the second (adjusted risk ratio [aRR], 0.97; 95% confidence interval [CI], 0.86-1.09) and third quartiles (aRR, 0.94; 95% CI, 0.84-1.05) had no significant difference. The highest-income quartile had a significantly lower risk of in-hospital mortality (aRR, 0.83; 95% CI, 0.74-0.94). Time-to-event analyses showed a lower adjusted hazard of death for the fourth versus first quartile (adjusted hazard ratio [aHR], 0.76; 95% CI, 0.64-0.89), whereas second and third quartiles were not significantly different. These findings suggest that disparities persist among patients receiving resource-intensive life-support therapies, highlighting the need to measure socioeconomic variables and address structural factors influencing outcomes in critical care.
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Prognostic significance of the glucose-to-lymphocyte ratio in acute pulmonary embolism.
Clinical takeaway GLR showed modest prognostic discrimination in acute pulmonary embolism, but its mortality association was sensitive to adjustment for active infection. These findings do not establish a clinically actionable threshold.
Summary & abstract
Study summary
This retrospective study included 631 patients with acute pulmonary embolism; 41 (6.5%) died in hospital. Admission glucose-to-lymphocyte ratio (GLR) had modest mortality discrimination (area under the curve 0.626, 95% confidence interval 0.548–0.705). An exploratory GLR threshold of 80.06 was associated with mortality in the primary multivariable model (adjusted odds ratio 2.43, 95% confidence interval 1.15–5.15). After additional adjustment for active infection, the association weakened and was no longer statistically significant (adjusted odds ratio 1.85, 95% confidence interval 0.86–3.97), limiting confidence in its independent prognostic value.
Study limitation: Retrospective observational design and a data-derived exploratory threshold limit causal interpretation and confidence in generalizability.
Published abstract
BACKGROUND: Acute pulmonary embolism has a heterogeneous clinical course, and simple laboratory markers reflecting metabolic and inflammatory stress may provide additional prognostic information. We investigated the association between the glucose-to-lymphocyte ratio (GLR) and in-hospital mortality in acute pulmonary embolism. METHODS: This retrospective observational study included 631 consecutive patients diagnosed between January 2023 and June 2025. GLR was calculated as admission blood glucose divided by absolute lymphocyte count. Receiver operating characteristic (ROC) analysis assessed the discriminatory ability of GLR for in-hospital mortality and identified a ROC-derived exploratory threshold for subsequent analyses. Clinical characteristics and in-hospital outcomes were compared between GLR groups, and logistic regression analyses identified factors associated with mortality. RESULTS: The median age was 69 years, 52.6% were female, and in-hospital mortality occurred in 41 patients (6.5%). GLR showed modest discrimination for mortality (area under the curve 0.626, 95% confidence interval [CI] 0.548-0.705; p=0.007), with a ROC-derived exploratory threshold of 80.06. Mortality was higher in patients with GLR ≥80.06 than in those with GLR <80.06 (9.5% vs. 3.3%; p=0.001). Elevated GLR was also associated with right ventricular dysfunction, vasopressor requirement, intensive care unit admission, hemodynamic deterioration, active infection, and longer hospital stay. GLR ≥80.06 remained associated with mortality in the primary multivariable model (adjusted odds ratio [OR] 2.43, 95% CI 1.15-5.15; p=0.020), but this association was attenuated after additional adjustment for active infection (adjusted OR 1.85, 95% CI 0.86-3.97; p=0.118). CONCLUSION: Higher admission GLR was associated with in-hospital mortality in the primary multivariable analysis. Although its discriminatory performance was modest, GLR may provide complementary prognostic information; however, the attenuation of the association after adjustment for active infection warrants cautious interpretation.
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Oxygen delivery during cardiopulmonary bypass and postoperative mortality: A retrospective cohort study.
Clinical takeaway Lower oxygen delivery during bypass was associated with worse postoperative outcomes. These findings support further investigation but do not establish that increasing oxygen delivery improves survival.
Summary & abstract
Study summary
This single-center retrospective cohort included 4,358 adults undergoing cardiac surgery with cardiopulmonary bypass in 2018–2024. Thirty-day mortality was 1.7% (75 deaths). Each 10 ml/min/m² decrease in indexed oxygen delivery was associated with higher mortality odds (adjusted OR 1.16, 95% CI 1.09–1.23). Adjusted mortality was 1.69% (95% CI 1.32–2.05%) at the 25th oxygen-delivery percentile versus 0.74% (95% CI 0.41–1.07%) at the 75th percentile. Lower oxygen delivery was also associated with acute kidney injury and longer ICU and hospital stays; no statistically significant association with stroke was observed.
Study limitation: The retrospective, single-center design leaves residual confounding possible despite multivariable adjustment and limits causal interpretation.
Published abstract
BACKGROUND: Oxygen delivery during cardiopulmonary bypass reflects the balance between pump flow, hemoglobin concentration, and arterial oxygenation and is a key determinant of tissue oxygen transport. While inadequate oxygen delivery has been linked to postoperative organ dysfunction, its association with mortality remains unclear. METHODS: We conducted a retrospective cohort study including 4,358 adult patients undergoing cardiac surgery with cardiopulmonary bypass at a tertiary center between 2018 and 2024. Time-weighted average indexed oxygen delivery (DO2i) was calculated from pump flow, arterial oxygen saturation, hemoglobin concentration, and body surface area. The primary outcome was 30-day mortality. Secondary outcomes included postoperative acute kidney injury (AKI), stroke, and intensive care unit (ICU) and hospital length of stay. Associations were evaluated using multivariable regression models adjusted for demographic, clinical, and procedural factors. RESULTS: Lower intraoperative DO2i was associated with higher 30-day mortality. Overall, 75 patients (1.7%) died within 30 days. Each 10 ml · min -1 · m -2 decrease in DO2i was associated with increased odds of mortality (adjusted odds ratio [ORadj] 1.16; 95% CI 1.09-1.23; P < 0.001). The adjusted 30-day mortality was 1.69% (95% CI 1.32-2.05%) at the 25th percentile of DO2i (226.2 ml · min⁻¹ · m⁻²), compared with 0.74% (95% CI 0.41-1.07%) at the 75th percentile (295.6 ml · min⁻¹ · m⁻²). Lower DO2i was also associated with AKI (ORadj 1.05; 95% CI 1.03-1.07; P < 0.001), longer ICU (adjusted incidence rate ratio [IRRadj] 1.02; 95% CI 1.01-1.03; P < 0.001) and hospital length of stay (IRRadj 1.01; 95% CI 1.01-1.02; P < 0.001), but not with stroke (ORadj 1.00; 95% CI 0.95-1.06; P = 0.877). CONCLUSIONS: Patients receiving lower intraoperative DO2i during cardiopulmonary bypass had a higher risk of postoperative mortality, AKI, and prolonged recovery. These findings support the clinical relevance of oxygen delivery during bypass and provide a rationale for future mechanistic and interventional studies.
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Intraoperative Goal-Directed Perfusion Improves Outcomes in Left Ventricular Assist Device Explant Heart Transplantation.
Clinical takeaway Cumulative oxygen extraction burden may be a prognostic marker in LVAD-explant transplantation. This observational analysis does not establish that targeting it improves renal outcomes or survival.
Summary & abstract
Study summary
This single-centre observational study evaluated cumulative oxygen extraction burden during cardiopulmonary bypass in 110 adult LVAD-explant heart transplant recipients, comparing groups defined by median burden. After inverse probability weighting, higher burden was associated with postoperative renal replacement therapy (OR 4.16, 95% CI 1.35–12.83) and 2-year mortality (HR 7.61, 95% CI 1.49–38.73). Higher burden was also associated with lower immediate postoperative cardiac index and greater vasoactive inotrope requirements. These findings link intraoperative oxygen extraction burden with adverse postoperative outcomes in this transplant population.
Study limitation: Single-centre observational data remain vulnerable to residual confounding, and wide confidence intervals indicate substantial uncertainty in effect magnitude.
Published abstract
Left ventricular assist device (LVAD) explant heart transplantation represents a metabolically vulnerable population with an increased risk for renal failure and mortality. Oxygen extraction ratio (O2ER), which integrates oxygen delivery and tissue oxygen demand, may provide a physiologic marker of cumulative metabolic stress during cardiopulmonary bypass (CPB). Adult LVAD-explant heart transplant recipients at a single center from October 2021 to June 2025 were analyzed using continuous perfusion data captured during CPB. Oxygen extraction ratio was calculated continuously, and cumulative oxygen extraction burden was quantified as the area above an O2ER threshold of 0.20. Patients were stratified by median O2ER burden. Among 110 patients, a higher intraoperative O2ER burden was associated with increased postoperative renal replacement therapy (odds ratio [OR], 4.16; 95% confidence interval [CI], 1.35-12.83) and increased 2-year mortality (hazard ratio [HR], 7.61; 95% CI, 1.49-38.73) after inverse probability weighting adjustment. A higher O2ER burden was also associated with a lower immediate postoperative cardiac index and increased vasoactive inotrope requirements. Donor hypertension, recipient diabetes, static storage modality, and a lower intraoperative oxygen delivery index were associated with an increased O2ER burden. These findings suggest that cumulative oxygen extraction during CPB reflects intraoperative metabolic stress and may represent a physiologically integrated perfusion target in LVAD-explant heart transplantation.
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Automated Derivation of Cerebral Performance Category at Hospital Discharge After Cardiac Arrest Using Natural Language Processing and Machine Learning.
Clinical takeaway Automated discharge CPC classification showed promising holdout performance, but these results do not establish reliable early prognostication independent of clinician documentation or withdrawal-of-life-sustaining-therapy decisions.
Summary & abstract
Study summary
This retrospective study across three US academic hospitals evaluated automated discharge CPC classification in adults comatose after cardiac arrest. Good outcomes were defined as CPC 1–3 and poor outcomes as CPC 4–5. An NLP logistic regression model trained on 249 patients was evaluated in 108 holdout patients. Using hospitalization-wide notes, accuracy was 81% and AUROC 0.90; using first-24-hour notes, these fell to 74% and 0.83. Precision for poor outcomes was higher, particularly among patients undergoing withdrawal of life-sustaining therapy, highlighting the importance of documentation context.
Study limitation: Performance was evaluated in a 108-patient holdout set, and early documentation may reflect prognostic framing as well as patient biology.
Published abstract
BACKGROUND: Clinical notes in the electronic health record (EHR) contain rich information that may be leveraged for automated prognostication using natural language processing (NLP) and machine learning. We evaluated the performance and potential biases of an NLP-based machine learning model for deriving cerebral performance category (CPC) for comatose patients following cardiac arrest using EHR clinical notes. METHODS: We conducted a retrospective cohort study of adult patients who were comatose after in-hospital or out-of-hospital cardiac arrest across three academic hospitals in the USA. Neurological outcomes were assessed at hospital discharge, with CPC scores of 1-3 indicating good outcomes and 4-5 indicating poor outcomes. An NLP-based logistic regression model was trained on 249 patients using all clinical notes throughout hospitalization. Model performance was evaluated on a holdout set of 108 patients. Performance was also evaluated on the holdout set using only notes documented within the first 24 h of hospitalization. RESULTS: Using all clinical notes, the model achieved an overall accuracy of 81%, with an area under the receiver operating characteristic curve (AUROC) of 0.90 and an area under the precision-recall curve (AUPRC) of 0.89. When restricted to notes documented within the first 24 h of hospitalization, model accuracy decreased to 74%, with AUROC of 0.83 and AUPRC of 0.83. The model demonstrated higher precision in predicting poor neurological outcomes, particularly among patients who underwent withdrawal of life-sustaining therapy. CONCLUSIONS: An NLP-based machine learning model demonstrated high accuracy in deriving CPC for comatose patients after cardiac arrest using EHR clinical notes. Clinical documentation within 24 h after cardiac arrest contained substantial prognostic signals about neurological outcomes, reflecting a combination of patient biology, clinician assessment, and potentially early prognostic framing. Future research should incorporate multimodal data and employ interpretable advanced language models to increase accuracy toward fully automatable CPC derivation.
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Perioperative temporary microaxial left ventricular assist device support in patients with low ejection fraction undergoing coronary artery bypass grafting.
Clinical takeaway These findings describe survival after CABG with temporary microaxial support in a selected high-risk population. Without a comparator group, they do not establish a survival benefit from support.
Summary & abstract
Study summary
This retrospective study examined 111 high-risk patients undergoing CABG with Impella 5.5 or LD temporary microaxial pump support during the same hospitalization between April 2018 and January 2025. Patients receiving ECMO were excluded, and the cohort had a mean age of 69 years. Support was planned in 30% (33/111) and unplanned in 70% (78/111). Survival was 89.2% (99/111) at 30 days and 74.8% (83/111) at one year. Mortality did not differ significantly by concomitant procedures or between the 2018–2020 and 2021–2025 operative periods.
Study limitation: The retrospective, supported-only cohort lacks a comparison group without microaxial support, limiting causal interpretation of survival outcomes.
Published abstract
PURPOSE: Despite advances in mechanical circulatory support (MCS), outcomes in high-risk coronary artery bypass grafting (CABG) with low ejection fraction (EF) remain unclear. We evaluate short-term outcomes associated with temporary microaxial flow pump (TMFP) support in high-risk patients undergoing CABG during the same hospitalization. METHODS: This retrospective study reviewed 111 patients who underwent CABG with Impella 5.5 or LD TMFP support during the same hospitalization between April 2018 and January 2025. Patients receiving extracorporeal membrane oxygenation (ECMO) were excluded. Baseline demographics, procedural characteristics, and postoperative outcomes were collected. Statistical analyses were performed using R version 4.4.0 with significance defined as p < 0.05. RESULTS: The cohort (n = 111) had a mean age of 69 years and was 75% male (83/111). Comorbidities documented prior to index hospitalization included hypertension (85%, 94/111), diabetes mellitus (57%, 63/111), coronary artery disease (CAD) (47%, 52/111), and at least one prior cardiac surgery or intervention (31%, 34/111). Support was planned in 30% (33/111) of cases and unplanned in 70% (78/111). 30-day survival was 89.2% (99/111) and 1-year survival of 74.8% (83/111). No statistically significant differences in mortality were observed according to performance of concomitant procedures or operative time periods (2018-2020 vs. 2021-2025). CONCLUSION: In high-risk low-EF patients undergoing CABG, TMFP support during the same hospitalization was associated with acceptable 30-day and 1-year survival outcomes among patients considered unsuitable for PCI and/or advanced therapies at the time of surgery. Mortality was not significantly different among patients undergoing concomitant procedures or between planned vs. unplanned TMFP placement. These findings support TMFP's growing role in complex coronary surgeries and warrant further studies to define optimal application and surgical candidacy.
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Prehospital predictors of clinical outcomes in out-of-hospital cardiac arrest with pulseless electrical activity: a JCS-ReSS report.
Clinical takeaway Prehospital information may support risk stratification after arrest with initial pulseless electrical activity, but its prognostic meaning varies by presumed aetiology. These observational associations do not establish individual prognosis.
Summary & abstract
Study summary
This nationwide Japanese cohort included 442,630 adults with out-of-hospital cardiac arrest and initial pulseless electrical activity; the primary outcome was favourable neurological outcome at one month. Witnessed arrest predicted a favourable outcome (RR 1.65), while longer response time predicted a worse outcome (RR 0.66; 10 versus 5 minutes). Prehospital return of spontaneous circulation was the strongest predictor at hospital arrival (RR 23.31). Conversion to a shockable rhythm had opposite associations by presumed aetiology: favourable in cardiac arrest (RR 1.37), but worse in non-cardiac arrest (RR 0.73).
Study limitation: The abstract reports no confidence intervals or absolute neurological outcome rates, limiting assessment of precision and clinical magnitude.
Published abstract
BACKGROUND: Out-of-hospital cardiac arrest (OHCA) with pulseless electrical activity (PEA) has a poor prognosis and is aetiologically heterogeneous. We aimed to identify prehospital predictors of a favourable outcome, overall and by presumed aetiology. METHODS: This nationwide cohort study analysed 442,630 adults with OHCA and an initial rhythm of PEA from the All-Japan Utstein Registry between 2005 and 2024. The primary outcome was a favourable neurological outcome at 1 month. Two models were fitted, at the scene and at hospital arrival, each also within each aetiology. Epinephrine and advanced airway management (AAM) were assessed by time-dependent propensity score sequential matching. RESULTS: At the scene, a witnessed arrest (risk ratio [RR], 1.65) predicted a favourable neurological outcome, and a longer response time predicted a worse one (RR, 0.66; 10 versus 5 min). The gradient with age was steeper in cardiac than non-cardiac PEA (RR, 0.38 versus 0.78). At hospital arrival, prehospital return of spontaneous circulation (RR, 23.31) was the strongest predictor, but conversion to a shockable rhythm predicted a favourable outcome only in cardiac PEA and a worse outcome in non-cardiac PEA (RR, 1.37 versus 0.73). Standardised to a common covariate distribution, 1-month survival was higher in non-cardiac PEA, whereas a favourable neurological outcome was more likely in cardiac PEA. After time-dependent adjustment, the apparent harm from epinephrine and AAM was attenuated. CONCLUSIONS: Prehospital information available before hospital arrival predicted a favourable neurological outcome, but its prognostic meaning depended on the presumed aetiology. These independent prehospital predictors could inform future risk stratification.
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