Acute and Critical Care

Original Article

Cardiology
Utility of procalcitonin in diagnosing early postoperative sepsis after pediatric cardiac surgery in Malaysia: Muhammad Yusoff Mohd Ramdzan, Kah Kee Tan, Kok Wai Soo; Acute Crit Care. 2025;40(4):567-573. Published online November 28, 2025; DOI: https://doi.org/10.4266/acc.005016

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Abstract PDF: Background
Systemic inflammation following cardiopulmonary bypass (CPB) can interfere with analysis of routine clinical and biochemical parameters. Procalcitonin (PCT) is a potential biomarker for diagnosing early postoperative sepsis in pediatric patients following cardiac surgery utilizing CPB. This study aimed to evaluate the diagnostic accuracy of PCT compared to other biomarkers, especially C-reactive protein (CRP), in this clinical setting.
Methods
A prospective single-center study was conducted over a 10-month period during the coronavirus disease 2019 (COVID-19) pandemic (2021–2022), enrolling 89 pediatric patients postcardiac surgery. PCT, CRP, and complete blood count were analyzed, and area under the curve (AUC) was employed for statistical analysis.
Results
PCT and CRP demonstrated moderate discriminatory ability with AUCs of 0.678 and 0.635, respectively. White cell count exhibited fair discriminatory power, and platelet count performed poorly in distinguishing septic from nonseptic cases (AUC: white cell count, 0.545; platelet, 0.486).
Conclusions
PCT and CRP hold promise as diagnostic markers for early postoperative sepsis in pediatric cardiac surgery patients. However, these biomarkers are not adequate standalone indicators, emphasizing the continued need for clinical judgment supported by multiple diagnostic parameters.

Review Article

Basic Science and Research
Extracorporeal circulation models in small animals: beyond the limits of preclinical research: Mukhammad Kayumov, Reverien Habimana, Dowan Kim, Francis O Obiweluozor, In Seok Jeong, Hwa Jin Cho; Acute Crit Care. 2023;38(1):1-7. Published online February 28, 2023; DOI: https://doi.org/10.4266/acc.2023.00381

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9 Crossref

Extracorporeal membrane oxygenation (ECMO) use has remarkably increased in recent years. Although ECMO has become essential for patients with refractory cardiac and respiratory failure, extracorporeal circulation (ECC) is associated with significant complications. Small-animal models of ECC have been developed and widely used to better understand ECC-induced pathophysiology. This review article summarizes the development of small-animal ECC models, including the animal species, circuit configuration, priming, perioperative procedures, cannulation, and future perspectives of small-animal ECMO models.

Citations

Citations to this article as recorded by

Reversal of ACLF and ALF using whole blood extracorporeal system combining HLA-depleted liver organoids with granulocyte-monocyte apheresis
Hitomi Yamaguchi, Yosuke Yoneyama, Kentaro Ichimura, Kanae Ohtsu, Mika Soen, Chiharu Moriya, Maki Kumagai, Robert P. Myers, G. Mani Subramanian, Takanori Takebe
Journal of Hepatology.2026; 84(2): 293. CrossRef
Current rat models of extracorporeal life support following global ischaemia: a scoping review
Johannes Dinkelaker, Jan-Steffen Pooth, Georg Trummer, Sonja Bröer, Hans-Jörg Busch, Marius Schimmel, Jakob Wollborn, Sam Joé Brixius
Intensive Care Medicine Experimental.2026;[Epub] CrossRef
A miniaturized mouse extracorporeal circulation model to characterize early hematologic and metabolic alterations
Xiaoyu Wang, Xiaohan Cheng, Xinzhi Pan, Yijie Guo, Ruishi Shen, Yueyang Zhu, Adili Abudourousuli, Jiahao Guo, Qi Peng, Huifang Tang, Huashun Cui
Frontiers in Physiology.2026;[Epub] CrossRef
A systematic review of adult animal models investigating ECMO use for ARDS: where to from here
Muhtadi Alnababteh, Xizhong Cui, Mark Jeakle, Yan Li, Nancy Terry, Tom Gamble, Junfeng Sun, Shreya Kanth, Peter Q. Eichacker, Parizad Torabi-Parizi
Intensive Care Medicine Experimental.2025;[Epub] CrossRef
A Miniaturized Centrifugal Pump ECMO System Enhances Hemocompatibility in Small Animal Models
Zhen Yang, Yiai Li, Jingyi Peng, Danhe Jia, Youpeng Zhang, Wenxing Huo, Zhigang Liu, Xian Huang
Biotechnology Journal.2025;[Epub] CrossRef
Silk-based multilayer coatings for anticoagulation and durability improvement in ECMO hollow fiber membranes
Wenbo Zhang, Yilin Zhang, Chenlu Wang, Xingji Fu, Yuan Li, Hongyu Wang, Xiuyuan Luo, Linhao Li, Yubo Fan, Zengsheng Chen
Acta Biomaterialia.2025; 207: 205. CrossRef
Venoarterial Extracorporeal Membrane Oxygenation Implementation in Septic Shock Rat Model
Tianlong Wang, Mingru Zhang, Wenhao Dong, Jing Wang, Han Zhang, Yuefu Wang, Bingyang Ji
ASAIO Journal.2024; 70(8): 653. CrossRef
Multiorgan recovery in a cadaver body using mild hypothermic ECMO treatment in a murine model
Nodir Madrahimov, Vitalii Mutsenko, Ruslan Natanov, Dejan Radaković, André Klapproth, Mohamed Hassan, Mathias Rosenfeldt, Florian Kleefeldt, Ivan Aleksic, Süleyman Ergün, Christoph Otto, Rainer G. Leyh, Constanze Bening
Intensive Care Medicine Experimental.2023;[Epub] CrossRef
Post-Mortem Extracorporeal Membrane Oxygenation Perfusion Rat Model: A Feasibility Study
Matthias Manfred Deininger, Carl-Friedrich Benner, Lasse Johannes Strudthoff, Steffen Leonhardt, Christian Simon Bruells, Gernot Marx, Christian Bleilevens, Thomas Breuer
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Original Articles

Association of Hyperlactatemia and IL-6 Hypercytokinemia after Cardiopulmonary Bypass: A Preliminary Report: Sang Hoon Yoon, Seung Zhoo Yoon, Hye Won Shin, Sung Uk Choi, Choon Hak Lim; Korean J Crit Care Med. 2011;26(1):18-23.; DOI: https://doi.org/10.4266/kjccm.2011.26.1.18

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Abstract PDF: BACKGROUND
In cardiac surgery with cardiopulmonary bypass (CPB), hyperlactatemia (HL) is common and is associated with postoperative morbidity and mortality. At present, the cause of HL during CPB is proposed to be tissue hypoxia. Tissue perfusion and oxygen delivery can be impaired to varying degrees during CPB. Although surgery involving CPB apparatus is associated with increased pro-inflammatory mediators, such as TNF-alpha and IL-6, tissue hypoxia that occurs during CPB may be an additionally potent stimulus to inflammation. We hypothesized that hypoxic patients during CPB that experience elevated serum lactate levels, may be related to higher serum cytokine level after CPB than normoxic patients during CPB with normal serum lactate levels.
METHODS
Levels of TNF-alpha and IL-6 were measured by ELISA in a) Time 1; before initiation of CPB, b) Time 2; 30 min after aortic de-clamping, c) Time 3; 24 hrs after aortic de-clamping. Levels of lactate was measured at a) Time A; before initiation of CPB, b) Time B; 30 min after aortic de-clamping. Postoperative ICU stay, intubation time and oxygen index were evaluated as postoperative morbidity scale.
RESULTS
There were no statistical differences between HL (n = 43, lactate > or =3 mMol/L at time B) and normal lactate group (NL) (n = 63, lactate <3 mMol/L at time B) in demographic data, preoperative left ventricular ejection fraction, CPB time, and aortic cross-clamp time. Level of IL-6 in HL at time 3 was higher than that of NL. The ICU stay and intubation time were longer in HL. The oxygen index on 1st postoperative day was lower in HL.
CONCLUSIONS
Our results suggest that hyperlactatemia after weaning from CPB may be related to IL-6 hypercytokinemia, and therefore related to postoperative morbidity.

The Effect of Blood Transfusion on the Tissue Perfusion and Lung Injury during Cardiopulmonary Bypass: Sung Jin Hong, Se Ho Moon, Choon Ho Sung, Hae Jin Lee, Jin Hwan Choi, Ji Young Lee, Yong Suk Kim; Korean J Crit Care Med. 2004;19(2):98-105.

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Abstract PDF: BACKGROUND
The blood components of priming solution for cardiopulmonary bypass (CPB) may have opposite roles for tissue perfusion, which are the activation of inflammatory reaction and the improvement of oxygen carrying capacity. This study is aimed to investigate the effect of blood transfusion of priming solution on inflammatory response and tissue perfusion. METHODS: Twenty mongrel dogs randomly allocated and received hypothermic CPB with blood- containing (H group, n=10), or non-hemic (NH group, n=10) priming solution. Gastric intramucosal CO2 concentration (PrCO2), intramucosal pH (pHi), interleukin-8 (IL-8), blood gas and hemodynamic parameters were measured at 1) before CPB, 2) 1 hour during CPB, 3) the end of CPB, 4) 2 hours after CPB, 5) 4 hours after CPB. The ratio of wet to dried lung weight was measured. Statistical verification was performed using repeated measures ANOVA and unpaired t-test.
RESULTS
PrCO2 increased and pHi decreased during the study without significant difference between the groups. IL-8 increased in both groups and IL-8 of H group increased higher than that of NH group during the study. The difference between PaCO2 and end-tidal CO2 of NH group was higher than that of H group at 4 hours after CPB. The ratio of wet to dried lung weight was not significantly different between the groups. CONCLUSIONS: We conclude that the allogenic blood in priming solution aggravates the CPB- induced inflammatory reaction, however, the CPB-induced impairment of gastric mucosal perfusion and the pulmonary edema are not significantly affected, compared to non-hemic solution.

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