2f:I[703058,["/_next/static/immutable/chunks/3bhq_5eh1d760.js","/_next/static/immutable/chunks/1855-ogyi8eh4.js","/_next/static/immutable/chunks/2pfsjpn6k6zlg.js","/_next/static/immutable/chunks/26c7v3_3uwnwu.js","/_next/static/immutable/chunks/25a3ozcrvi1ff.js","/_next/static/immutable/chunks/2r4wx50nvjh_4.js","/_next/static/immutable/chunks/23fsw06hsi5b1.js","/_next/static/immutable/chunks/06_yt270h41rg.js","/_next/static/immutable/chunks/3ezsiz-7shkna.js","/_next/static/immutable/chunks/20x2y96ldu5wx.js","/_next/static/immutable/chunks/2lxntcm3pd1_h.js","/_next/static/immutable/chunks/00dgco8irq3jw.js","/_next/static/immutable/chunks/00nwe-kq0rboc.js","/_next/static/immutable/chunks/2051ffx3xzio9.js"],"PaperListPageClient"] 30:Ta65,Heparin-induced thrombocytopenia (HIT) in cardiac surgical patients presents unique diagnostic and management challenges due to universal perioperative heparin exposure, postoperative platelet kinetics, and the high prevalence of critical illness in this population. Current guidelines do not fully address these cardiac surgical-specific features, leading to practice variation in screening, diagnosis, anticoagulation management, and perioperative planning. Consolidated, practical, and evidence-based recommendations are needed that are tailored to cardiac surgery and to temporary mechanical circulatory support after cardiac surgery. The American Association for Thoracic Surgery (AATS) Clinical Practice Standards Committee convened a multidisciplinary panel of 16 experts in cardiac surgery, hematology, critical care, anesthesiology, perfusion, and pharmacology. A comprehensive literature review was performed with medical librarian support. Using a modified Delphi methodology, the panel evaluated the evidence, developed clinical statements, and assigned a class of recommendation and a level of evidence to each recommendation. Consensus was achieved for 32 recommendations across 5 domains: (1) epidemiology and natural history of HIT after cardiac surgery; (2) diagnostic evaluation, including appropriate Thrombocytopenia, Timing, Thrombosis, oTher cause (4Ts) score use, time-dependent platelet count patterns, and integration of immunoassay and functional testing; (3) therapeutic management with nonheparin anticoagulants, including the selection of direct thrombin inhibitors, factor Xa inhibitors, and adjunctive therapies; (4) perioperative management of patients with HIT who require cardiac surgery, including the timing of surgery, intraoperative anticoagulation strategy, and adjunctive therapies; and (5) screening, testing, and anticoagulation strategies for patients supported by extracorporeal membrane oxygenation or temporary mechanical circulatory support after cardiac surgery. Additional best practices are included for cardiopulmonary bypass circuit management for patients with HIT. This AATS expert consensus document provides practical, cardiac surgery-specific guidance for the diagnosis and management of HIT across the continuum of cardiac surgical care. By addressing the complexities unique to cardiac surgery, high-risk anticoagulation environments, and extracorporeal and temporary mechanical circulatory support, these recommendations aim to improve diagnostic accuracy, standardize care, reduce complications, and support safe heparin re-exposure or alternative anticoagulation strategies when surgery is required.31:T68e,Patients with severe pulmonary embolism (PE) may experience hemodynamic instability with intubation and mechanical ventilation. However, the characteristics and outcomes of intubated PE patients have not been previously described in the literature. We conducted a retrospective cohort study of patients requiring activation of our hospital's Pulmonary Embolism Response Team (PERT) from 2012 to 2021 who were intubated within 24 h of their acute PE diagnosis. Our primary outcome was peri-intubation hemodynamic instability and death occurring within 30 min. Our secondary outcome was peri-intubation hemodynamic instability and death within 3 h of intubation. We included 51 patients. Within 30 min of intubation, seven (14%) patients had a new or increased vasopressor requirement, four (8%) suffered cardiac arrest, and 1 (2%) required ECMO. Within 3 h, 26 (51%) patients had a new or increased vasopressor requirement, six (12%) suffered cardiac arrest, and five (10%) required ECMO. Patients with a central PE (n = 29, 57%) were more likely to experience peri-intubation hemodynamic instability (OR 3.4, 95% CI [0.95, 13], p = 0.048). Patients who had right ventricular strain on CT (OR 3.7, 95% CI [1.01, 15], p = 0.043) or echocardiogram (OR 8.0, 95% CI [1.9, 42], p = 0.0014) were also more likely to experience hemodynamic instability. Peri-intubation hemodynamic deterioration occurs in more than half of patients with acute PE, and severe events, like cardiac arrest, are common. Physicians should be cautious when intubating PE patients. Further research is needed to identify optimal strategies to treat PE patients who require intubation.32:Ta5f,ABSTRACT Background Patients with severe pulmonary embolism (PE) may experience hemodynamic instability with intubation and mechanical ventilation. However, the characteristics and outcomes of intubated PE patients have not been previously described in the literature. Methods We conducted a retrospective cohort study of patients requiring activation of our hospital's Pulmonary Embolism Response Team (PERT) from 2012 to 2021 who were intubated within 24 h of their acute PE diagnosis. Our primary outcome was peri‐intubation hemodynamic instability and death occurring within 30 min. Our secondary outcome was peri‐intubation hemodynamic instability and death within 3 h of intubation. Results We included 51 patients. Within 30 min of intubation, seven (14%) patients had a new or increased vasopressor requirement, four (8%) suffered cardiac arrest, and 1 (2%) required ECMO. Within 3 h, 26 (51%) patients had a new or increased vasopressor requirement, six (12%) suffered cardiac arrest, and five (10%) required ECMO. Patients with a central PE ( n = 29, 57%) were more likely to experience peri‐intubation hemodynamic instability (OR 3.4, 95% CI [0.95, 13], p = 0.048). Patients who had right ventricular strain on CT (OR 3.7, 95% CI [1.01, 15], p = 0.043) or echocardiogram (OR 8.0, 95% CI [1.9, 42], p = 0.0014) were also more likely to experience hemodynamic instability. Conclusion Peri‐intubation hemodynamic deterioration occurs in more than half of patients with acute PE, and severe events, like cardiac arrest, are common. Physicians should be cautious when intubating PE patients. Further research is needed to identify optimal strategies to treat PE patients who require intubation. 33:T6ee,Primary graft dysfunction (PGD) after lung transplantation (LTx) is associated with increased mortality. Retrospective studies have reported inconsistent PGD incidence when comparing intraoperative Veno-Arterial Extracorporeal Membrane Oxygenation (VA ECMO) and off-pump LTx. To address this, we initiated a prospective, randomized trial comparing intraoperative support techniques in LTx. This trial compares intraoperative VA ECMO and off-pump LTx outcomes at 90 days. Six centers are currently enrolling. Age > 18 years, bilateral LTx with mean pulmonary artery pressure < 35 mmHg. Multiorgan transplant, donation after circulatory death, re-transplantation, planned postoperative ECMO, previous lung surgery or pleurodesis, preoperative ECMO or mechanical ventilation. Patients were randomized 1:1 to VA ECMO or off-pump with an intention to treat analysis. The primary endpoint was PGD grade 3 at 48-72 hours and 15 secondary endpoints were studied. Sample size estimation: 228 patients to detect a 15% absolute risk reduction in PGD grade 3 at 48-72 hours. The interim analysis includes 75 patients. Of these, 44(58.6%) were randomized to VA ECMO, and 31(41.3%) to off-pump LTx. Four patients (12.9%) crossed over from off-pump to VA ECMO. There was no significant difference between groups in PGD grade 3 at 48-72 hours. VA ECMO 6 (13.6%) versus off-pump 6 (19.4%), p=0.506. No significant differences were observed in the safety profile and secondary endpoints. There was significantly more fresh frozen plasma and platelet transfusion in the VA ECMO group. In this interim analysis of the VIP BOLT trial, no significant primary endpoint difference was noted between VA ECMO and off-pump LTx. Continued enrollment is needed to ensure the study is adequately powered.25:[[["$","script","0",{"type":"application/ld+json","dangerouslySetInnerHTML":{"__html":"{\"@context\":\"https://schema.org\",\"@type\":\"CollectionPage\",\"name\":\"Extracorporeal Membrane Oxygenation: modality Research & Clinical Takeaways\",\"description\":\"Explore peer-reviewed papers on Extracorporeal Membrane Oxygenation (modality). Clinician-written summaries and actionable practice insights. Updated daily.\",\"url\":\"https://www.reachrx.ai/hub/tag/modality/Extracorporeal%20Membrane%20Oxygenation\",\"breadcrumb\":{\"@type\":\"BreadcrumbList\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https://www.reachrx.ai\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Research Hub\",\"item\":\"https://www.reachrx.ai/hub\"},{\"@type\":\"ListItem\",\"position\":3,\"name\":\"Modalities\",\"item\":\"https://www.reachrx.ai/hub/tag/modality\"},{\"@type\":\"ListItem\",\"position\":4,\"name\":\"Extracorporeal Membrane Oxygenation\",\"item\":\"https://www.reachrx.ai/hub/tag/modality/Extracorporeal%20Membrane%20Oxygenation\"}]}}"}}]],["$","$L2f",null,{"title":"Extracorporeal Membrane Oxygenation: Research & Clinical Takeaways","description":"Review evidence by treatment modality: Extracorporeal Membrane Oxygenation — concise summaries and practical next steps.","papers":[{"doi":"10.1016/j.resuscitation.2026.111289","pmid":"42692184","title":"Pulseless electrical activity versus asystole as initial pulseless rhythm in children: challenging convention regarding non-shockable rhythms","journal_title":"Resuscitation","journal_issn":"0300-9572","published_at":"2026-09-04T00:00:00.000Z","url":"https://doi.org/10.2139/ssrn.6984586","source_score":1,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-09-11T06:20:06.802Z","updated_at":"2026-09-11T06:20:06.802Z","tags":[{"paper_doi":"10.1016/j.resuscitation.2026.111289","tag_type":"age_group","value":"pediatric","value_numeric":null},{"paper_doi":"10.1016/j.resuscitation.2026.111289","tag_type":"category","value":"Emergency Medicine","value_numeric":null},{"paper_doi":"10.1016/j.resuscitation.2026.111289","tag_type":"condition","value":"Asystole","value_numeric":null},{"paper_doi":"10.1016/j.resuscitation.2026.111289","tag_type":"condition","value":"Pediatric In-Hospital Cardiac Arrest","value_numeric":null},{"paper_doi":"10.1016/j.resuscitation.2026.111289","tag_type":"condition","value":"Pulseless Electrical Activity","value_numeric":null},{"paper_doi":"10.1016/j.resuscitation.2026.111289","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1016/j.resuscitation.2026.111289","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1016/j.resuscitation.2026.111289","tag_type":"modality","value":"Cardiopulmonary Resuscitation","value_numeric":null},{"paper_doi":"10.1016/j.resuscitation.2026.111289","tag_type":"modality","value":"Extracorporeal Membrane Oxygenation","value_numeric":null},{"paper_doi":"10.1016/j.resuscitation.2026.111289","tag_type":"sample_size","value":"n=9423","value_numeric":9423},{"paper_doi":"10.1016/j.resuscitation.2026.111289","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1016/j.resuscitation.2026.111289","tag_type":"study_design","value":"Retrospective Cohort Study","value_numeric":null},{"paper_doi":"10.1016/j.resuscitation.2026.111289","tag_type":"warning","value":"Neonatal subgroup findings are registry-derived and may reflect NICU-specific management patterns not generalizable to all centers.","value_numeric":null},{"paper_doi":"10.1016/j.resuscitation.2026.111289","tag_type":"warning","value":"The impact_flag 'practice_changing' is applied cautiously — the finding challenges a long-standing convention (grouping non-shockable rhythms), but this is a registry study and not an RCT; clinical uptake should await further validation.","value_numeric":null},{"paper_doi":"10.1016/j.resuscitation.2026.111289","tag_type":"warning","value":"The study spans 2000–2023, a period with significant evolution in resuscitation practices; temporal heterogeneity may affect interpretation of pooled results.","value_numeric":null}],"summaries":{"what_studied":"This registry study compared outcomes of PEA vs. asystole as the initial non-shockable rhythm in pediatric (<18 years) in-hospital cardiac arrest (IHCA) using the AHA GWTG-R registry (2000–2023, n=9,423), adjusting for demographics, comorbidities, event features, and hospital factors.","key_result":"Asystole was associated with lower odds of ROSC (aOR 0.70), ROC (aOR 0.71), and survival to discharge (aOR 0.89) vs. PEA overall — but when NICU events were excluded, survival to discharge no longer differed (36.1% PEA vs. 34.1% asystole; aOR 0.99). The survival gap was driven entirely by neonates; no significant survival difference was found in older children.","limitations":"Registry-based design limits causal inference and may have unmeasured confounders. NICU events and neonatal physiology heavily influenced overall results, making findings less generalizable across all pediatric age groups. Rhythm classification accuracy depends on site-level data entry quality.","practice_takeaway":"For children older than the neonatal period, PEA and asystole carry similar survival odds — clinicians should not assume meaningfully worse prognosis based on one rhythm label over the other. Grouping PEA and asystole as a single \"non-shockable\" category may still be reasonable outside the NICU, but neonatal arrests warrant separate consideration."}},{"doi":"10.1016/j.healun.2026.08.019","pmid":"42685997","title":"Donor Type and Organ Preservation in Heart Transplantation: Association with Recovery Following Severe Primary Graft Dysfunction","journal_title":"The Journal of Heart and Lung Transplantation","journal_issn":"1053-2498","published_at":"2026-09-02T00:00:00.000Z","url":"https://doi.org/10.1016/j.healun.2026.08.019","source_score":3,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-09-07T06:30:43.863Z","updated_at":"2026-09-07T06:30:43.863Z","tags":[{"paper_doi":"10.1016/j.healun.2026.08.019","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1016/j.healun.2026.08.019","tag_type":"category","value":"Respiratory System","value_numeric":null},{"paper_doi":"10.1016/j.healun.2026.08.019","tag_type":"condition","value":"Heart Transplant Rejection","value_numeric":null},{"paper_doi":"10.1016/j.healun.2026.08.019","tag_type":"condition","value":"Primary Graft Dysfunction","value_numeric":null},{"paper_doi":"10.1016/j.healun.2026.08.019","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1016/j.healun.2026.08.019","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1016/j.healun.2026.08.019","tag_type":"modality","value":"Extracorporeal Membrane Oxygenation","value_numeric":null},{"paper_doi":"10.1016/j.healun.2026.08.019","tag_type":"modality","value":"Ex-Vivo Heart Perfusion","value_numeric":null},{"paper_doi":"10.1016/j.healun.2026.08.019","tag_type":"modality","value":"Normothermic Regional Perfusion","value_numeric":null},{"paper_doi":"10.1016/j.healun.2026.08.019","tag_type":"modality","value":"Organ Transplantation","value_numeric":null},{"paper_doi":"10.1016/j.healun.2026.08.019","tag_type":"modality","value":"Ventricular Assist Device","value_numeric":null},{"paper_doi":"10.1016/j.healun.2026.08.019","tag_type":"sample_size","value":"n=7059","value_numeric":7059},{"paper_doi":"10.1016/j.healun.2026.08.019","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1016/j.healun.2026.08.019","tag_type":"study_design","value":"Retrospective Cohort Study","value_numeric":null},{"paper_doi":"10.1016/j.healun.2026.08.019","tag_type":"warning","value":"Preservation strategy subgroups (NRP, EVP, cold storage) were too small for reliable adjusted comparisons — findings in this area should be considered exploratory only.","value_numeric":null},{"paper_doi":"10.1016/j.healun.2026.08.019","tag_type":"warning","value":"The 'practice_changing' impact flag is applied cautiously — the DCD survival advantage after PGD is a novel and counterintuitive finding, but subgroup analyses remain underpowered.","value_numeric":null},{"paper_doi":"10.1016/j.healun.2026.08.019","tag_type":"warning","value":"The study is from a future publication date (September 2026); data should be interpreted with that context in mind. No peer-review status was explicitly stated in the provided text.","value_numeric":null}],"summaries":{"what_studied":"This registry study examined adult heart transplant recipients (September 2023–December 2025) from the SRTR to determine whether donor type (DCD vs. DBD) and preservation strategy (NRP, ex-vivo perfusion, static cold storage) are associated with survival after severe primary graft dysfunction (PGD), defined as new ECMO or VAD dependence at 24 hours post-transplant.","key_result":"6.5% of 7,059 recipients (n=462) developed severe PGD. DCD recipients with severe PGD had markedly better 1-year survival than DBD recipients (84.1% vs. 65.1%; log-rank P=0.001), and this held after IPTW adjustment (aHR 0.44; 95% CI 0.23–0.85; P=0.014). Preservation strategy was not independently associated with survival. VAD support at 24 hours (vs. ECMO) was linked to lower odds of 30-day survival.","limitations":"Subgroup analyses by preservation strategy were limited by small numbers, reducing statistical power. Observational design with IPTW adjustment cannot fully eliminate unmeasured confounding. The study window (Sept 2023–Dec 2025) is relatively short, limiting longer-term follow-up data.","practice_takeaway":"When severe PGD occurs after heart transplant, DCD-sourced grafts appear to recover better than DBD grafts — clinicians should not assume DCD hearts carry worse post-PGD prognosis. Among patients on mechanical support at 24 hours, ECMO may be preferable to VADs as a bridge strategy for early survival."}},{"doi":"10.1016/j.chest.2026.06.056","pmid":"42468849","title":"ECMO Ethics: A Call for Action","journal_title":"CHEST","journal_issn":"0012-3692","published_at":"2026-07-17T00:00:00.000Z","url":"https://doi.org/10.1016/j.chest.2026.06.056","source_score":2,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-07-22T13:37:17.605Z","updated_at":"2026-07-22T13:37:17.605Z","tags":[{"paper_doi":"10.1016/j.chest.2026.06.056","tag_type":"age_group","value":"mixed","value_numeric":null},{"paper_doi":"10.1016/j.chest.2026.06.056","tag_type":"category","value":"Respiratory System","value_numeric":null},{"paper_doi":"10.1016/j.chest.2026.06.056","tag_type":"condition","value":"Critical Illness","value_numeric":null},{"paper_doi":"10.1016/j.chest.2026.06.056","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1016/j.chest.2026.06.056","tag_type":"level_of_evidence","value":"5","value_numeric":null},{"paper_doi":"10.1016/j.chest.2026.06.056","tag_type":"modality","value":"Extracorporeal Membrane Oxygenation","value_numeric":null},{"paper_doi":"10.1016/j.chest.2026.06.056","tag_type":"sample_size","value":"n=37","value_numeric":37},{"paper_doi":"10.1016/j.chest.2026.06.056","tag_type":"study_design","value":"Expert Consensus / Narrative Review","value_numeric":null},{"paper_doi":"10.1016/j.chest.2026.06.056","tag_type":"warning","value":"Study design label 'Expert Consensus / Narrative Review' is inferred from the abstract description; the paper does not explicitly self-label its design.","value_numeric":null},{"paper_doi":"10.1016/j.chest.2026.06.056","tag_type":"warning","value":"The 'level of evidence' rating reflects the narrative/consensus nature of the work, not a graded clinical trial.","value_numeric":null},{"paper_doi":"10.1016/j.chest.2026.06.056","tag_type":"warning","value":"This paper is a consensus/framework paper; the full clinical recommendations are distributed across companion papers not available here, so the complete evidence base cannot be assessed from this abstract alone.","value_numeric":null}],"summaries":{"what_studied":"An expert workgroup of 37 members (ECMO Ethics Workgroup, formed 2021) conducted narrative and meta-narrative reviews across five major ethical themes in ECMO care: experiencing ECMO, starting ECMO, stopping ECMO, specialist consultants in ECMO care, and miscellaneous 'other' themes.","key_result":"The workgroup proposes replacing the singular 'bridge' conceptual framework with three distinct categories — **therapeutic**, **potentially therapeutic**, and **non-therapeutic** bridges — and introduces 'bridge to palliative care' as a more honest alternative to the term 'bridge to nowhere.'","limitations":"No primary data collected; insights are derived from expert experience and narrative/meta-narrative review only. The full recommendations are distributed across companion papers not yet reviewed here. The workgroup composition and selection process may introduce expert bias.","practice_takeaway":"When ECMO cannot lead to a meaningful clinical outcome, clinicians should reframe the conversation as 'bridge to palliative care' rather than 'bridge to nowhere' — a shift that may support more honest goals-of-care discussions. Adopting the three-bridge framework (therapeutic, potentially therapeutic, non-therapeutic) at the time of ECMO initiation can help set clearer expectations with patients and families."}},{"doi":"10.1007/s15010-026-02883-y","pmid":"42467174","title":"Severe pneumonia and acute respiratory distress syndrome caused by avian influenza A (H10N3) in a young female: a case report","journal_title":"Infection","journal_issn":"0300-8126","published_at":"2026-07-17T00:00:00.000Z","url":"https://doi.org/10.1007/s15010-026-02883-y","source_score":8,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-07-21T13:34:30.457Z","updated_at":"2026-07-21T13:34:30.457Z","tags":[{"paper_doi":"10.1007/s15010-026-02883-y","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1007/s15010-026-02883-y","tag_type":"brand","value":"Tamiflu","value_numeric":null},{"paper_doi":"10.1007/s15010-026-02883-y","tag_type":"brand","value":"Xofluza","value_numeric":null},{"paper_doi":"10.1007/s15010-026-02883-y","tag_type":"category","value":"Infectious Diseases","value_numeric":null},{"paper_doi":"10.1007/s15010-026-02883-y","tag_type":"condition","value":"Acute Respiratory Distress Syndrome","value_numeric":null},{"paper_doi":"10.1007/s15010-026-02883-y","tag_type":"condition","value":"Avian Influenza A (H10N3)","value_numeric":null},{"paper_doi":"10.1007/s15010-026-02883-y","tag_type":"condition","value":"Severe Pneumonia","value_numeric":null},{"paper_doi":"10.1007/s15010-026-02883-y","tag_type":"generic","value":"baloxavir marboxil","value_numeric":null},{"paper_doi":"10.1007/s15010-026-02883-y","tag_type":"generic","value":"oseltamivir","value_numeric":null},{"paper_doi":"10.1007/s15010-026-02883-y","tag_type":"impact_flag","value":"safety_signal","value_numeric":null},{"paper_doi":"10.1007/s15010-026-02883-y","tag_type":"level_of_evidence","value":"5","value_numeric":null},{"paper_doi":"10.1007/s15010-026-02883-y","tag_type":"modality","value":"Extracorporeal Membrane Oxygenation","value_numeric":null},{"paper_doi":"10.1007/s15010-026-02883-y","tag_type":"modality","value":"Neuraminidase Inhibitor","value_numeric":null},{"paper_doi":"10.1007/s15010-026-02883-y","tag_type":"modality","value":"Polymerase Acidic Inhibitor","value_numeric":null},{"paper_doi":"10.1007/s15010-026-02883-y","tag_type":"sample_size","value":"n=1","value_numeric":1},{"paper_doi":"10.1007/s15010-026-02883-y","tag_type":"sex","value":"female","value_numeric":null},{"paper_doi":"10.1007/s15010-026-02883-y","tag_type":"study_design","value":"Case Report","value_numeric":null},{"paper_doi":"10.1007/s15010-026-02883-y","tag_type":"warning","value":"Dual antiviral (baloxavir + oseltamivir) efficacy inference is based on a single patient without a control; viral clearance timing may reflect natural disease course.","value_numeric":null},{"paper_doi":"10.1007/s15010-026-02883-y","tag_type":"warning","value":"Neurological complication (lower limb numbness and motor dysfunction) noted in this case was not reported in prior H10N3 cases; causality vs. ECMO-related complication is unclear.","value_numeric":null},{"paper_doi":"10.1007/s15010-026-02883-y","tag_type":"warning","value":"Only 4 human H10N3 cases exist globally; cross-case comparisons are descriptive and limited by very small numbers.","value_numeric":null}],"summaries":{"what_studied":"This case report describes a 23-year-old previously healthy female in Nanning, China, who developed severe pneumonia and ARDS after occupational exposure to poultry, confirmed as the fourth documented human infection with avian influenza A (H10N3). Clinical course, treatment response, and genomic characteristics were compared across all four known human H10N3 cases.","key_result":"The patient required invasive mechanical ventilation and V-V ECMO (PaO2/FiO2 ratio of 44.1 at nadir) and recovered after ~3 months of intensive care. RT-PCR cleared negative within 48 h of starting combined baloxavir marboxil + oseltamivir. Across all 4 reported human H10N3 cases, 75% (3/4) required mechanical ventilation or ECMO; ARDS onset was typically 8–10 days after symptom onset. The strain carried the human-adapted P221 substitution but lacked G228S, suggesting G228S is not required for human infection. No NAI-resistance mutations were found.","limitations":"- Single case with no environmental sampling from exposure sites, leaving the spillover pathway uncharacterized.\n- No seroepidemiological studies in high-risk occupational contacts, so asymptomatic exposure burden is unknown.\n- Dual antiviral efficacy (baloxavir + oseltamivir) is based on one patient with no comparator arm.","practice_takeaway":"Clinicians should consider avian influenza (including H10N3) in patients with severe, rapidly progressive pneumonia and recent poultry or live-market exposure, especially when standard respiratory pathogen panels are negative. Early mNGS of BAL fluid enabled diagnosis here; baloxavir + oseltamivir achieved rapid viral clearance and the virus showed no NAI resistance."}},{"doi":"10.1111/petr.70392","pmid":"42400354","title":"Single‐Center Experience in Pediatric Lung Transplantation: Clinical Characteristics, Survival, and Post‐Transplant Morbidity","journal_title":"Pediatric Transplantation","journal_issn":"1397-3142","published_at":"2026-07-04T00:00:00.000Z","url":"https://doi.org/10.1111/petr.70392","source_score":4,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-07-05T13:38:47.000Z","updated_at":"2026-07-05T13:38:47.000Z","tags":[{"paper_doi":"10.1111/petr.70392","tag_type":"age_group","value":"adolescent","value_numeric":null},{"paper_doi":"10.1111/petr.70392","tag_type":"category","value":"Pediatrics","value_numeric":null},{"paper_doi":"10.1111/petr.70392","tag_type":"condition","value":"Cystic Fibrosis","value_numeric":null},{"paper_doi":"10.1111/petr.70392","tag_type":"condition","value":"End-Stage Lung Disease","value_numeric":null},{"paper_doi":"10.1111/petr.70392","tag_type":"impact_flag","value":"limited_evidence","value_numeric":null},{"paper_doi":"10.1111/petr.70392","tag_type":"level_of_evidence","value":"4","value_numeric":null},{"paper_doi":"10.1111/petr.70392","tag_type":"modality","value":"Extracorporeal Membrane Oxygenation","value_numeric":null},{"paper_doi":"10.1111/petr.70392","tag_type":"modality","value":"Lung Transplantation","value_numeric":null},{"paper_doi":"10.1111/petr.70392","tag_type":"sample_size","value":"n=28","value_numeric":28},{"paper_doi":"10.1111/petr.70392","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1111/petr.70392","tag_type":"study_design","value":"Retrospective Cohort Study","value_numeric":null},{"paper_doi":"10.1111/petr.70392","tag_type":"warning","value":"All recipients were adolescents at a median age of 16 years; findings may not apply to younger pediatric age groups (infants, children).","value_numeric":null},{"paper_doi":"10.1111/petr.70392","tag_type":"warning","value":"Cox regression mortality associations are exploratory only — the small sample size (n=28) and low event count mean these findings should not be used to drive clinical decisions without larger validation studies.","value_numeric":null},{"paper_doi":"10.1111/petr.70392","tag_type":"warning","value":"Single-center experience from Saudi Arabia; institutional protocols and patient demographics may limit generalizability to other regions.","value_numeric":null}],"summaries":{"what_studied":"Retrospective single-center review of 28 pediatric lung transplant recipients in Saudi Arabia (January 2010–December 2023), describing clinical characteristics, survival, post-transplant morbidity, and exploratory mortality associations using Kaplan-Meier and Cox regression analyses.","key_result":"One-year survival was 96.4% with a median post-transplant survival of 6.8 years overall; however, CF recipients had markedly shorter median survival than non-CF recipients (2.9 vs. 8.9 years). Post-transplant morbidities were common: hypertension 53.5%, acute kidney injury 46.4%, and diabetes 28.5%. CF diagnosis, longer waiting time, *Pseudomonas aeruginosa* colonization, and diabetes at 1 year were associated with mortality on adjusted Cox models.","limitations":"- Very small sample (n=28) with few events limits the reliability of Cox regression findings.\n- Single-center Saudi cohort restricts generalizability to other populations and healthcare settings.\n- Retrospective design with inherent risk of incomplete data capture.","practice_takeaway":"Excellent short-term survival is achievable in pediatric lung transplantation, but clinicians should closely monitor CF recipients and those with *Pseudomonas* colonization for worse long-term outcomes. Aggressive nutritional optimization pre-transplant may be an important modifiable target, given that nearly two-thirds of recipients had severe undernutrition at transplant."}},{"doi":"10.1016/j.jtcvs.2026.03.619","pmid":"42092507","title":"2026 American Association for Thoracic Surgery (AATS) Expert Consensus Document: Diagnosis and management of heparin-induced thrombocytopenia in cardiac surgery patients","journal_title":"The Journal of Thoracic and Cardiovascular Surgery","journal_issn":"0022-5223","published_at":"2026-05-07T00:00:00.000Z","url":"https://doi.org/10.1016/j.jtcvs.2026.03.619","source_score":14,"is_retracted":false,"is_open_access":false,"raw_metadata":{"ooir":{"day":"2026-05-06","doi":"10.1016/j.jtcvs.2026.03.619","days":"14","issn":"0022-5223","rank":"2","field":"Clinical Medicine","score":"14","category":"Respiratory System","categories":["Respiratory System","Surgery"],"_categories":["Respiratory System","Surgery"]},"pubmed":{"doi":"10.1016/j.jtcvs.2026.03.619","title":"2026 American Association for Thoracic Surgery (AATS) Expert Consensus Document: Diagnosis and management of heparin-induced thrombocytopenia in cardiac surgery patients.","journal":"The Journal of thoracic and cardiovascular surgery","methods":"","results":"Consensus was achieved for 32 recommendations across 5 domains: (1) epidemiology and natural history of HIT after cardiac surgery; (2) diagnostic evaluation, including appropriate Thrombocytopenia, Timing, Thrombosis, oTher cause (4Ts) score use, time-dependent platelet count patterns, and integration of immunoassay and functional testing; (3) therapeutic management with nonheparin anticoagulants, including the selection of direct thrombin inhibitors, factor Xa inhibitors, and adjunctive therapies; (4) perioperative management of patients with HIT who require cardiac surgery, including the timing of surgery, intraoperative anticoagulation strategy, and adjunctive therapies; and (5) screening, testing, and anticoagulation strategies for patients supported by extracorporeal membrane oxygenation or temporary mechanical circulatory support after cardiac surgery. Additional best practices are included for cardiopulmonary bypass circuit management for patients with HIT.","abstract":"$30","keywords":["anticoagulation","cardiac surgery","cardiopulmonary bypass","direct thrombin inhibitors","functional testing","heparin-induced thrombocytopenia","immunoassay"],"pubmed_id":"42092507","conclusions":"","publication_date":"2026-05-07T00:00:00"},"crossref":{"DOI":"10.1016/j.jtcvs.2026.03.619","URL":"https://doi.org/10.1016/j.jtcvs.2026.03.619","ISSN":["0022-5223"],"link":[{"URL":"https://api.elsevier.com/content/article/PII:S0022522326008895?httpAccept=text/xml","content-type":"text/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https://api.elsevier.com/content/article/PII:S0022522326008895?httpAccept=text/plain","content-type":"text/plain","content-version":"vor","intended-application":"text-mining"}],"page":null,"type":"journal-article","issue":null,"score":1,"title":["2026 American Association for Thoracic Surgery (AATS) Expert Consensus Document: Diagnosis and management of heparin-induced thrombocytopenia in cardiac surgery patients"],"author":[{"given":"Subhasis","family":"Chatterjee","sequence":"first","affiliation":[]},{"given":"Natalia I.","family":"Girardi","sequence":"additional","affiliation":[]},{"given":"Jessica","family":"Crow","sequence":"additional","affiliation":[]},{"given":"Patrick M.","family":"Wieruszewski","sequence":"additional","affiliation":[]},{"given":"Michael C.","family":"Grant","sequence":"additional","affiliation":[]},{"given":"Adam","family":"Cuker","sequence":"additional","affiliation":[]},{"given":"Theodore E.","family":"Warkentin","sequence":"additional","affiliation":[]},{"given":"Martha P.","family":"Mims","sequence":"additional","affiliation":[]},{"given":"Rakesh C.","family":"Arora","sequence":"additional","affiliation":[]},{"given":"Mark","family":"Martin","sequence":"additional","affiliation":[]},{"given":"Marc R.","family":"Moon","sequence":"additional","affiliation":[]},{"given":"Busra","family":"Cangut","sequence":"additional","affiliation":[]},{"given":"Ibrahim S.","family":"Sultan","sequence":"additional","affiliation":[]},{"given":"Arabesque","family":"Parker","sequence":"additional","affiliation":[]},{"given":"Jillian F.","family":"Holler","sequence":"additional","affiliation":[]},{"given":"Leora B.","family":"Balsam","sequence":"additional","affiliation":[]},{"given":"Daniel T.","family":"Engelman","sequence":"additional","affiliation":[]}],"issued":{"date-parts":[[2026,5]]},"member":"78","prefix":"10.1016","source":"Crossref","volume":null,"created":{"date-time":"2026-05-04T09:35:24Z","timestamp":1777887324000,"date-parts":[[2026,5,4]]},"indexed":{"date-time":"2026-05-05T03:21:33Z","timestamp":1777951293929,"date-parts":[[2026,5,5]]},"license":[{"URL":"https://www.elsevier.com/tdm/userlicense/1.0/","start":{"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000,"date-parts":[[2026,5,1]]},"delay-in-days":0,"content-version":"tdm"},{"URL":"https://www.elsevier.com/legal/tdmrep-license","start":{"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000,"date-parts":[[2026,5,1]]},"delay-in-days":0,"content-version":"tdm"}],"subject":[],"abstract":null,"language":"en","relation":{},"resource":{"primary":{"URL":"https://linkinghub.elsevier.com/retrieve/pii/S0022522326008895"}},"subtitle":[],"assertion":[{"name":"publisher","label":"This article is 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BV","reference":null,"short-title":[],"update-policy":"https://doi.org/10.1016/elsevier_cm_policy","alternative-id":["S0022522326008895"],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","jtcvsonline.org","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"original-title":[],"container-title":["The Journal of Thoracic and Cardiovascular Surgery"],"published-print":{"date-parts":[[2026,5]]},"reference-count":0,"published-online":null,"references-count":0,"short-container-title":["The Journal of Thoracic and Cardiovascular Surgery"],"is-referenced-by-count":0},"unpaywall":{"doi":"10.1016/j.jtcvs.2026.03.619","is_oa":false,"title":"2026 American Association for Thoracic Surgery (AATS) Expert Consensus Document: Diagnosis and management of heparin-induced thrombocytopenia in cardiac surgery patients","updated":"2026-05-05T11:59:32+00:00","published_date":"2026-05-01","best_oa_location":null}},"created_at":"2026-05-07T22:49:58.960Z","updated_at":"2026-05-14T15:13:26.918Z","tags":[{"paper_doi":"10.1016/j.jtcvs.2026.03.619","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1016/j.jtcvs.2026.03.619","tag_type":"category","value":"Respiratory System","value_numeric":null},{"paper_doi":"10.1016/j.jtcvs.2026.03.619","tag_type":"category","value":"Surgery","value_numeric":null},{"paper_doi":"10.1016/j.jtcvs.2026.03.619","tag_type":"condition","value":"Heparin-Induced Thrombocytopenia","value_numeric":null},{"paper_doi":"10.1016/j.jtcvs.2026.03.619","tag_type":"condition","value":"Thrombocytopenia","value_numeric":null},{"paper_doi":"10.1016/j.jtcvs.2026.03.619","tag_type":"condition","value":"Thrombosis","value_numeric":null},{"paper_doi":"10.1016/j.jtcvs.2026.03.619","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1016/j.jtcvs.2026.03.619","tag_type":"level_of_evidence","value":"5","value_numeric":null},{"paper_doi":"10.1016/j.jtcvs.2026.03.619","tag_type":"modality","value":"Anticoagulation","value_numeric":null},{"paper_doi":"10.1016/j.jtcvs.2026.03.619","tag_type":"modality","value":"Cardiopulmonary Bypass","value_numeric":null},{"paper_doi":"10.1016/j.jtcvs.2026.03.619","tag_type":"modality","value":"Direct Thrombin Inhibitor","value_numeric":null},{"paper_doi":"10.1016/j.jtcvs.2026.03.619","tag_type":"modality","value":"Extracorporeal Membrane Oxygenation","value_numeric":null},{"paper_doi":"10.1016/j.jtcvs.2026.03.619","tag_type":"modality","value":"Factor Xa Inhibitor","value_numeric":null},{"paper_doi":"10.1016/j.jtcvs.2026.03.619","tag_type":"modality","value":"Mechanical Circulatory Support","value_numeric":null},{"paper_doi":"10.1016/j.jtcvs.2026.03.619","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1016/j.jtcvs.2026.03.619","tag_type":"study_design","value":"Expert Consensus Document","value_numeric":null},{"paper_doi":"10.1016/j.jtcvs.2026.03.619","tag_type":"warning","value":"Level of evidence for individual recommendations is not broken out in the abstract; many recommendations likely rely on expert opinion given the rarity of HIT in cardiac surgery.","value_numeric":null},{"paper_doi":"10.1016/j.jtcvs.2026.03.619","tag_type":"warning","value":"No sample size is reported; this is a consensus guideline document, not an original research study with enrolled participants.","value_numeric":null},{"paper_doi":"10.1016/j.jtcvs.2026.03.619","tag_type":"warning","value":"The 'practice_changing' impact flag reflects the document's explicit aim to standardize a historically variable practice, but the underlying evidence base for some recommendations may be limited.","value_numeric":null}],"summaries":{"what_studied":"A multidisciplinary AATS expert panel used modified Delphi methodology to develop cardiac surgery-specific consensus recommendations for the diagnosis and management of heparin-induced thrombocytopenia (HIT), covering screening, anticoagulation, perioperative planning, and mechanical circulatory support (including ECMO).","key_result":"Consensus was achieved for 32 recommendations across 5 domains: HIT epidemiology/natural history; diagnostic evaluation (4Ts score, platelet kinetics, immunoassay/functional testing); therapeutic management with nonheparin anticoagulants (direct thrombin inhibitors, factor Xa inhibitors); perioperative management for cardiac surgery patients with HIT; and screening/anticoagulation for ECMO and temporary mechanical circulatory support.","limitations":"Recommendations are expert consensus rather than derived from prospective RCT data; the cardiac surgical population's unique platelet kinetics and near-universal heparin exposure limit direct applicability of general HIT guidelines, and evidence levels for many recommendations are likely low given the rarity and complexity of HIT in this setting.","practice_takeaway":"Use cardiac surgery-specific 4Ts scoring with awareness of postoperative platelet drop patterns, and integrate immunoassay with functional testing before switching to nonheparin anticoagulants. For patients with active or recent HIT who require cardiac surgery, follow this guidance on timing, intraoperative anticoagulation strategy, and ECMO/MCS anticoagulation to reduce thrombotic complications and standardize care."}},{"doi":"10.1111/acem.70317","pmid":"42084455","title":"Characteristics and Short‐Term Outcomes of Patients With Acute Pulmonary Embolism Requiring Intubation","journal_title":"Academic Emergency Medicine","journal_issn":"1069-6563","published_at":"2026-05-05T00:00:00.000Z","url":"https://doi.org/10.1111/acem.70317","source_score":3,"is_retracted":false,"is_open_access":false,"raw_metadata":{"ooir":{"day":"2026-05-09","doi":"10.1111/acem.70317","days":"7","issn":"1069-6563","rank":"3","field":"Clinical Medicine","score":"3","category":"Emergency Medicine","categories":["Emergency Medicine"],"_categories":["Emergency Medicine"]},"pubmed":{"doi":"10.1111/acem.70317","title":"Characteristics and Short-Term Outcomes of Patients With Acute Pulmonary Embolism Requiring Intubation.","journal":"Academic emergency medicine : official journal of the Society for Academic Emergency Medicine","methods":"","results":"We included 51 patients. Within 30 min of intubation, seven (14%) patients had a new or increased vasopressor requirement, four (8%) suffered cardiac arrest, and 1 (2%) required ECMO. Within 3 h, 26 (51%) patients had a new or increased vasopressor requirement, six (12%) suffered cardiac arrest, and five (10%) required ECMO. Patients with a central PE (n = 29, 57%) were more likely to experience peri-intubation hemodynamic instability (OR 3.4, 95% CI [0.95, 13], p = 0.048). Patients who had right ventricular strain on CT (OR 3.7, 95% CI [1.01, 15], p = 0.043) or echocardiogram (OR 8.0, 95% CI [1.9, 42], p = 0.0014) were also more likely to experience hemodynamic instability.","abstract":"$31","keywords":["intubation","mechanical ventilation","outcomes","pulmonary embolism","venous thromboembolism"],"pubmed_id":"42084455","conclusions":"Peri-intubation hemodynamic deterioration occurs in more than half of patients with acute PE, and severe events, like cardiac arrest, are common. Physicians should be cautious when intubating PE patients. Further research is needed to identify optimal strategies to treat PE patients who require intubation.","publication_date":"2026-05-05T00:00:00"},"crossref":{"DOI":"10.1111/acem.70317","URL":"https://doi.org/10.1111/acem.70317","ISSN":["1069-6563","1553-2712"],"link":[{"URL":"https://onlinelibrary.wiley.com/doi/pdf/10.1111/acem.70317","content-type":"application/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https://onlinelibrary.wiley.com/doi/full-xml/10.1111/acem.70317","content-type":"application/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https://onlinelibrary.wiley.com/doi/pdf/10.1111/acem.70317","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"page":null,"type":"journal-article","issue":"5","score":1,"title":["Characteristics and Short‐Term Outcomes of Patients With Acute Pulmonary Embolism Requiring Intubation"],"author":[{"given":"Isabel T.","family":"Dhar","sequence":"first","affiliation":[{"name":"Center for Vascular Emergencies, Department of Emergency Medicine Massachusetts General Hospital Boston Massachusetts USA"}]},{"given":"Cecilie D.","family":"Baltsen","sequence":"additional","affiliation":[{"name":"Center for Vascular Emergencies, Department of Emergency Medicine Massachusetts General Hospital Boston Massachusetts USA"},{"name":"Department of Anesthesiology and Intensive Care Aarhus University Hospital Aarhus Denmark"},{"name":"Department of Clinical Medicine Aarhus University Aarhus Denmark"}]},{"given":"Drew A.","family":"Birrenkott","sequence":"additional","affiliation":[{"name":"Center for Vascular Emergencies, Department of Emergency Medicine Massachusetts General Hospital Boston Massachusetts USA"},{"name":"Department of Emergency Medicine Massachusetts General Hospital Boston Massachusetts USA"},{"name":"Department of Emergency Medicine Harvard Medical School Boston Massachusetts USA"}]},{"given":"Matthew F.","family":"Freitas","sequence":"additional","affiliation":[{"name":"Center for Vascular Emergencies, Department of Emergency Medicine Massachusetts General Hospital Boston Massachusetts USA"}]},{"given":"Buse","family":"Bor","sequence":"additional","affiliation":[{"name":"Center for Vascular Emergencies, Department of Emergency Medicine Massachusetts General Hospital Boston Massachusetts USA"},{"name":"Department of Anesthesiology and Intensive Care Aarhus University Hospital Aarhus Denmark"},{"name":"Department of Clinical Medicine Aarhus University Aarhus Denmark"}]},{"given":"Asger","family":"Granfeldt","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care Aarhus University Hospital Aarhus Denmark"},{"name":"Department of Clinical Medicine Aarhus University Aarhus Denmark"}]},{"given":"Asger","family":"Andersen","sequence":"additional","affiliation":[{"name":"Department of Clinical Medicine Aarhus University Aarhus Denmark"},{"name":"Department of Cardiology Aarhus University Hospital Aarhus Denmark"}]},{"given":"Mads D.","family":"Lyhne","sequence":"additional","affiliation":[{"name":"Center for Vascular Emergencies, Department of Emergency Medicine Massachusetts General Hospital Boston Massachusetts USA"},{"name":"Department of Clinical Medicine Aarhus University Aarhus Denmark"},{"name":"Department of Anesthesiology and Intensive Care Regional Hospital Horsens Horsens Denmark"}]},{"given":"Christopher","family":"Kabrhel","sequence":"additional","affiliation":[{"name":"Center for Vascular Emergencies, Department of Emergency Medicine Massachusetts General Hospital Boston Massachusetts USA"},{"name":"Department of Emergency Medicine Massachusetts General Hospital Boston Massachusetts USA"},{"name":"Department of Emergency Medicine Harvard Medical School Boston Massachusetts 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may overestimate complication rates compared to all-comer intubated PE patients.","value_numeric":null},{"paper_doi":"10.1111/acem.70317","tag_type":"warning","value":"Sex distribution is reported as mixed but specific breakdown is not provided in the abstract.","value_numeric":null},{"paper_doi":"10.1111/acem.70317","tag_type":"warning","value":"Small sample size (n=51) means confidence intervals are wide — especially for ECMO outcomes — and findings should be interpreted cautiously.","value_numeric":null}],"summaries":{"what_studied":"Retrospective cohort study of 51 intubated acute PE patients activated through a hospital PERT (2012–2021), examining peri-intubation hemodynamic instability and death within 30 min and 3 h of intubation.","key_result":"Within 30 min: 14% had new/increased vasopressor need, 8% had cardiac arrest, 2% required ECMO. Within 3 h: 51% had new/increased vasopressor need, 12% had cardiac arrest, 10% required ECMO. Central PE (OR 3.4), RV strain on CT (OR 3.7), and RV strain on echo (OR 8.0) were each associated with higher odds of hemodynamic instability.","limitations":"Single-center retrospective design with only 51 patients limits generalizability and statistical power. PERT activation as inclusion criterion may select for higher-acuity cases, introducing selection bias. No control group of non-intubated PE patients for comparison.","practice_takeaway":"Clinicians should anticipate hemodynamic collapse when intubating PE patients — especially those with central clot or RV strain on imaging — and prepare vasopressors, resuscitation resources, and ECMO backup in advance. Over half of intubated PE patients deteriorated within 3 hours."}},{"doi":"10.1016/j.ajem.2026.04.040","pmid":"42066650","title":"Alcoholic cardiomyopathy presenting with severe circulatory failure requiring mechanical circulatory support: A systematic review","journal_title":"The American Journal of Emergency Medicine","journal_issn":"0735-6757","published_at":"2026-04-25T00:00:00.000Z","url":"https://doi.org/10.1016/j.ajem.2026.04.040","source_score":7,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-05-07T22:49:39.367Z","updated_at":"2026-05-07T22:49:39.367Z","tags":[{"paper_doi":"10.1016/j.ajem.2026.04.040","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1016/j.ajem.2026.04.040","tag_type":"brand","value":"Impella","value_numeric":null},{"paper_doi":"10.1016/j.ajem.2026.04.040","tag_type":"category","value":"Emergency Medicine","value_numeric":null},{"paper_doi":"10.1016/j.ajem.2026.04.040","tag_type":"condition","value":"Alcoholic Cardiomyopathy","value_numeric":null},{"paper_doi":"10.1016/j.ajem.2026.04.040","tag_type":"condition","value":"Cardiac Arrest","value_numeric":null},{"paper_doi":"10.1016/j.ajem.2026.04.040","tag_type":"condition","value":"Cardiogenic Shock","value_numeric":null},{"paper_doi":"10.1016/j.ajem.2026.04.040","tag_type":"condition","value":"Dilated Cardiomyopathy","value_numeric":null},{"paper_doi":"10.1016/j.ajem.2026.04.040","tag_type":"impact_flag","value":"limited_evidence","value_numeric":null},{"paper_doi":"10.1016/j.ajem.2026.04.040","tag_type":"level_of_evidence","value":"4","value_numeric":null},{"paper_doi":"10.1016/j.ajem.2026.04.040","tag_type":"modality","value":"Extracorporeal Membrane Oxygenation","value_numeric":null},{"paper_doi":"10.1016/j.ajem.2026.04.040","tag_type":"modality","value":"Left Ventricular Assist Device","value_numeric":null},{"paper_doi":"10.1016/j.ajem.2026.04.040","tag_type":"modality","value":"Mechanical Circulatory Support","value_numeric":null},{"paper_doi":"10.1016/j.ajem.2026.04.040","tag_type":"sample_size","value":"n=10","value_numeric":10},{"paper_doi":"10.1016/j.ajem.2026.04.040","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1016/j.ajem.2026.04.040","tag_type":"study_design","value":"Systematic Review","value_numeric":null},{"paper_doi":"10.1016/j.ajem.2026.04.040","tag_type":"warning","value":"Level of evidence assigned as 4 (case series/systematic review of case-level data) rather than a higher grade, given the absence of controlled studies.","value_numeric":null},{"paper_doi":"10.1016/j.ajem.2026.04.040","tag_type":"warning","value":"Only 10 patients from case reports and small case series were included; publication bias strongly favors survival and recovery outcomes, so these results should not be generalized to all ACM patients in severe circulatory failure.","value_numeric":null},{"paper_doi":"10.1016/j.ajem.2026.04.040","tag_type":"warning","value":"The paper's DOI references 2026, consistent with today's date — no anachronism concern, but the very small evidence base warrants caution in clinical extrapolation.","value_numeric":null}],"summaries":{"what_studied":"This systematic review evaluated survival outcomes and myocardial recovery in patients with alcoholic cardiomyopathy (ACM) presenting with cardiogenic shock or cardiac arrest requiring temporary mechanical circulatory support (MCS), including VA-ECMO/PCPS, Impella, intra-aortic balloon pump, or LVAD. Studies published up to February 28, 2026 were included.","key_result":"Across 10 patients (median age 43, 90% male, median baseline LVEF 15%), all published cases survived. Median LVEF improved from 15% to 55% — a ~40 percentage-point absolute gain — after MCS and alcohol abstinence. One patient required heart transplantation.","limitations":"- Only 10 patients from 5 studies (3 case reports, 2 case series), making conclusions highly susceptible to publication bias toward favorable outcomes.\n- No control group or comparative data; causal attribution of recovery to MCS or abstinence cannot be established.\n- Follow-up data were not available for all patients, limiting reliability of the LVEF recovery estimate.","practice_takeaway":"In patients with ACM presenting in cardiogenic shock, aggressive but time-limited MCS (especially VA-ECMO) combined with alcohol abstinence may support meaningful myocardial recovery — even from severely depressed LVEF (≤15%). Clinicians should recognize ACM as a potentially reversible phenotype before defaulting to permanent device therapy or delisting for transplant."}},{"doi":"10.1016/j.jtcvs.2025.12.021","pmid":"41485583","title":"Veno-Arterial Extracorporeal Membrane Oxygenation versus Off-Pump Lung Transplantation: Interim Analysis of a Prospective, Randomized Clinical Trial","journal_title":"The Journal of Thoracic and Cardiovascular Surgery","journal_issn":"0022-5223","published_at":"2026-01-05T00:00:00.000Z","url":"https://doi.org/10.1016/j.jtcvs.2025.12.021","source_score":3,"is_retracted":false,"is_open_access":false,"raw_metadata":{"ooir":{"day":"2026-01-06","doi":"10.1016/j.jtcvs.2025.12.021","days":"14","issn":"0022-5223","rank":"9","field":"Clinical Medicine","score":"3","category":"Respiratory System","categories":["Respiratory System"],"_categories":["Respiratory System"]},"pubmed":{"doi":"10.1016/j.jtcvs.2025.12.021","title":"Veno-Arterial Extracorporeal Membrane Oxygenation versus Off-Pump Lung Transplantation: Interim Analysis of a Prospective, Randomized Clinical Trial.","journal":"The Journal of thoracic and cardiovascular surgery","methods":"","results":"The interim analysis includes 75 patients. Of these, 44(58.6%) were randomized to VA ECMO, and 31(41.3%) to off-pump LTx. Four patients (12.9%) crossed over from off-pump to VA ECMO. There was no significant difference between groups in PGD grade 3 at 48-72 hours. VA ECMO 6 (13.6%) versus off-pump 6 (19.4%), p=0.506. No significant differences were observed in the safety profile and secondary endpoints. There was significantly more fresh frozen plasma and platelet transfusion in the VA ECMO group.","abstract":"$33","keywords":["extracorporeal membrane oxygenation","lung transplantation","surgical outcomes"],"pubmed_id":"41485583","conclusions":"","publication_date":"2026-01-05T00:00:00"},"crossref":{"DOI":"10.1016/j.jtcvs.2025.12.021","URL":"https://doi.org/10.1016/j.jtcvs.2025.12.021","ISSN":["0022-5223"],"link":[{"URL":"https://api.elsevier.com/content/article/PII:S0022522325011201?httpAccept=text/xml","content-type":"text/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https://api.elsevier.com/content/article/PII:S0022522325011201?httpAccept=text/plain","content-type":"text/plain","content-version":"vor","intended-application":"text-mining"}],"page":null,"type":"journal-article","issue":null,"score":1,"title":["Veno-Arterial Extracorporeal Membrane Oxygenation versus Off-Pump Lung Transplantation: Interim Analysis of a Prospective, Randomized Clinical 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undergoing bilateral lung transplantation with mean pulmonary artery pressure <35 mmHg. This interim analysis reports outcomes focused on PGD grade 3 at 48–72 hours with intention‑to‑treat randomization 1:1 across six centers.","key_result":"Among 75 patients (VA ECMO 44; off‑pump 31), PGD grade 3 at 48–72 hours occurred in 6/44 (13.6%) with VA ECMO vs 6/31 (19.4%) off‑pump (p=0.506). No significant differences were seen in safety or secondary endpoints; VA ECMO required significantly more fresh frozen plasma and platelet transfusions (quantities not reported).","limitations":"Interim analysis with 75 patients versus a planned 228 leaves the study underpowered for the primary endpoint. Crossover from off‑pump to VA ECMO occurred in 4/31 (12.9%), which may dilute differences. Narrow eligibility (bilateral LTx, mPAP <35; excludes DCD, retransplants, planned postoperative ECMO, prior lung surgery/pleurodesis) limits generalizability.","practice_takeaway":"Early randomized data show no difference in PGD grade 3 at 48–72 hours between intraoperative VA ECMO and off‑pump bilateral lung transplantation, but VA ECMO is linked to higher use of FFP and platelets. Clinicians can choose either approach for eligible patients while anticipating greater transfusion needs with VA ECMO and awaiting full trial results."}},{"doi":"10.1016/j.burns.2022.10.003","pmid":"36357253","title":"Extracorporeal membrane oxygenation utilization in burn patients with severe acute respiratory distress syndrome","journal_title":"Burns","journal_issn":"0305-4179","published_at":"2022-11-11T00:00:00.000Z","url":"https://www.ncbi.nlm.nih.gov/pmc/articles/9646255","source_score":260,"is_retracted":false,"is_open_access":true,"raw_metadata":{"ooir":{"day":"2023-02-19","doi":"10.1016/j.burns.2022.10.003","days":"30","issn":"0305-4179","rank":"4","field":"Clinical Medicine","score":"260","category":"Dermatology","categories":["Dermatology"],"_categories":["Dermatology"]},"pubmed":{"doi":"10.1016/j.burns.2022.10.003","title":"Extracorporeal membrane oxygenation utilization in burn patients with severe acute respiratory distress syndrome.","journal":"Burns : journal of the International Society for Burn Injuries","methods":"","results":"","abstract":"","keywords":[],"pubmed_id":"36357253","conclusions":"","publication_date":"2022-11-11T00:00:00"},"crossref":{"DOI":"10.1016/j.burns.2022.10.003","URL":"https://doi.org/10.1016/j.burns.2022.10.003","ISSN":["0305-4179"],"link":[{"URL":"https://api.elsevier.com/content/article/PII:S0305417922002741?httpAccept=text/xml","content-type":"text/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https://api.elsevier.com/content/article/PII:S0305417922002741?httpAccept=text/plain","content-type":"text/plain","content-version":"vor","intended-application":"text-mining"}],"page":"244-246","type":"journal-article","issue":"1","score":1,"title":["Extracorporeal membrane oxygenation utilization in burn patients with severe acute respiratory distress syndrome"],"author":[{"given":"Tom W.","family":"Fouché","sequence":"first","affiliation":[]},{"given":"Sebastian Q.","family":"Vrouwe","sequence":"additional","affiliation":[]},{"given":"Lawrence J.","family":"Gottlieb","sequence":"additional","affiliation":[]},{"given":"Tae H.","family":"Song","sequence":"additional","affiliation":[]},{"given":"Sachin","family":"Mehta","sequence":"additional","affiliation":[]},{"given":"Avery","family":"Tung","sequence":"additional","affiliation":[]},{"given":"Stephen R.","family":"Estimé","sequence":"additional","affiliation":[]}],"issued":{"date-parts":[[2023,2]]},"member":"78","prefix":"10.1016","source":"Crossref","volume":"49","created":{"date-time":"2022-11-10T00:59:10Z","timestamp":1668041950000,"date-parts":[[2022,11,10]]},"indexed":{"date-time":"2025-09-20T20:28:07Z","timestamp":1758400087358,"date-parts":[[2025,9,20]]},"license":[{"URL":"https://www.elsevier.com/tdm/userlicense/1.0/","start":{"date-time":"2023-02-01T00:00:00Z","timestamp":1675209600000,"date-parts":[[2023,2,1]]},"delay-in-days":0,"content-version":"tdm"}],"subject":[],"abstract":null,"language":"en","relation":{},"resource":{"primary":{"URL":"https://linkinghub.elsevier.com/retrieve/pii/S0305417922002741"}},"subtitle":[],"assertion":[{"name":"publisher","label":"This article is maintained by","value":"Elsevier"},{"name":"articletitle","label":"Article Title","value":"Extracorporeal membrane oxygenation utilization in burn patients with severe acute respiratory distress syndrome"},{"name":"journaltitle","label":"Journal Title","value":"Burns"},{"name":"articlelink","label":"CrossRef DOI link to publisher maintained version","value":"https://doi.org/10.1016/j.burns.2022.10.003"},{"name":"content_type","label":"Content Type","value":"simple-article"},{"name":"copyright","label":"Copyright","value":"© 2022 Elsevier Ltd and ISBI. 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for patients transferred already on ECMO.","value_numeric":null}],"summaries":{"what_studied":"Retrospective review at an American Burn Association–verified center of 12 adult burn patients with severe ARDS placed on ECMO for refractory hypoxemia (Apr 1, 2017–Jun 30, 2022). Mean TBSA was 37.3%; 83.3% had inhalation injury; 75% were male; none were proned before ECMO.","key_result":"Survival to discharge was 8/12 (66.7%), including 7/9 (77.7%) on VV ECMO and 1/3 (33.3%) on VA/V‑VA. Mean ECMO run was 258 h (range 112.5–692.5); median transfusion while on ECMO was 17.9 L (IQR 47.7); predicted mortality was 40.0% (APACHE II) and 40.2% (revised Baux); deaths were due to comfort care (n=2), thrombotic circuit occlusion (n=1), and cardiac arrest (n=1).","limitations":"Retrospective, single-center series with heterogeneous patients and practice patterns and variable ECMO expertise. Some data were unavailable for patients cannulated at referring centers.","practice_takeaway":"In selected adult burn patients with severe ARDS who cannot be proned or fail standard measures, ECMO support was feasible, with 66.7% survival to discharge in this series and higher survival on VV ECMO than VA/V‑VA. 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