Acute and Critical Care

Original Articles

Cardiology
Percutaneous vascular closure technique using parallel closure in extracorporeal membrane oxygenation decannulation: technical note and case series: Huong Giang Thi Bui, Van Huy Nguyen, Ngoc Son Do, Quoc Tuan Dang, Xuan Co Dao, The Thach Pham, Cong Tan Nguyen, Ba Cuong Nguyen, Thao Dung Nguyen, Huong Giang Nguyen; Acute Crit Care. 2026;41(2):335-343. Published online April 17, 2026; DOI: https://doi.org/10.4266/acc.002675

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Abstract PDF: Background
Achieving safe and effective closure of large-bore femoral arterial access after venoarterial extracorporeal membrane oxygenation (VA-ECMO) decannulation remains challenging. Percutaneous closure with suture-mediated devices is an established alternative to surgical repair for VA-ECMO decannulation. However, the optimal suture configuration is not well defined, and conventional cross-suture placement may have limitations. This study describes a parallel percutaneous closure technique with the potential to improve outcomes and evaluates its initial feasibility and safety.
Methods
This prospective case series included 30 adult patients who underwent bedside decannulation from percutaneous femoral VA-ECMO between March 2024 and March 2025. The closure technique involved deploying two Perclose ProGlide devices (Abbott Vascular) in a parallel configuration. The primary endpoints of technical success and vascular complications were assessed clinically and by duplex Doppler ultrasound 24 hours post-procedure.
Results
Technical success was achieved in all 30 patients (100%) without surgical conversion or adjunctive vascular intervention. Duplex ultrasound confirmed normal arterial flow in 23 patients (76.7%). Vascular complications included arterial thrombosis (16.7%), dissection (3.3%), and hematoma (3.3%). No patient required reintervention or developed limb ischemia within 24 hours.
Conclusions
This preliminary case series suggests that the parallel percutaneous closure technique is feasible and potentially safe for large-bore femoral decannulation following VA-ECMO. Its bedside application under local anesthesia and low rate of early complications support its utility in critical care. Further studies comparing closure configurations and evaluating long-term outcomes are warranted.

Trauma
Comparison of ropivacaine, bupivacaine, and lignocaine in femoral nerve block to position fracture femur patients for central neuraxial blockade in Indian population: Manik Seth, Santvana Kohli, Madhu Dayal, Arin Choudhury; Acute Crit Care. 2024;39(2):275-281. Published online May 30, 2024; DOI: https://doi.org/10.4266/acc.2023.01606

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2 Web of Science
3 Crossref

Background
Patients with a fractured femur experience intense pain during positioning for neuraxial block for definitive surgery. Femoral nerve block (FNB) is therefore often given prior to positioning for analgesia. In our study, we compare the onset and quality of block of 0.25% bupivacaine, 0.5% ropivacaine, and 1.5% lignocaine for FNB in fracture femur patients.
Methods
Seventy-five adult femur fracture patients were equally and randomly divided into three groups to receive 15 ml of either 0.25% bupivacaine (group B), 0.5% ropivacaine (group R), or 1.5% lignocaine (group L) for FNB prior to positioning for neuraxial blockade. Onset and quality of block were assessed, as well as improvement in visual analog scale (VAS) score, ease of positioning, and patient satisfaction.
Results
Percentage decrease in VAS was found to be highest in group R (82.8%) followed by groups L and B. Time to achieve a VAS of less than 4 was found to be 26.2±2.4 minutes in group B, 8.5±1.9 minutes in group R, and 4.1±0.7 minutes in group L (P<0.001). In group B, 12 patients required additional fentanyl to achieve a VAS <4. Patient positioning was reported to be satisfactory in all patients in group R and L, while in B it was satisfactory in 13 (52%) patients only. Patient acceptance of FNB was 100% in group R and L, but only 64% in group B.
Conclusions
Based on our findings, 0.5% ropivacaine is a favorable choice for FNB due to early onset, ability to yield a good quality block, and good safety profile.

Citations

Citations to this article as recorded by

Efficacy and Safety of Ropivacaine versus Levobupivacaine in Ultrasound-Guided Femoral Nerve Blocks for Perioperative Analgesia in Femur Fracture Patients: A Systematic Review
Arpita Chowdhury, Vaskar Majumdar, Chirasree Chowdhury, Bhaskar Biswas, Simmons Debbarma
International Journal of Health Sciences and Research.2026; : 238. CrossRef
Concentration of local anesthetics is important in nerve blocks
Raghuraman M. Sethuraman
Acute and Critical Care.2025; 40(1): 150. CrossRef
Post-surgical pain: evolving drug treatments and challenges
Mohammad Khudirat, Loay Allafy, Bhuvrit Raj Dhakal, Adriana Baranov, Alparslan Turan
Expert Opinion on Pharmacotherapy.2025; 26(18): 2027. CrossRef

Case Reports

Thoracic surgery
Acute Peripheral Arterial Tumorous Embolism after Lung Cancer Surgery: Yoohwa Hwang, Hyun Joo Lee, Young Tae Kim; Korean J Crit Care Med. 2015;30(3):234-237. Published online August 31, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.3.234

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Abstract PDF: Systemic tumor embolisms after pulmonary resections for malignancy are rare, but usually severe and sometimes fatal. Here, we report a case of a 70-year-old woman who underwent pulmonary resection for lung cancer and subsequently developed acute arterial occlusion of the lower extremities caused by a tumorous embolus.

Use of Femorofemoral Bypass for Life Saving before the Emergency Replacement of Thrombotic Prosthetic Mitral Valve: Il Woo Shin, Hyoung Chan Cho, Wan Soo Choi, Woo Chang Yang, Hyun Keun Lee, Young Kyun Chung; Korean J Crit Care Med. 2000;15(1):47-51.

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Abstract PDF: Mechanical valves have generally good hemodynamic function and indefinite durability, but they have a higher thromboembolic potential and thus a requirement for permanent anticoagulation, because thrombotic occlusion is a potentially fatal complication of heart valve replacement surgery. We had experienced mitral valve replacement because of thrombosis around the replaced prosthetic valve. The patient's mechanical prosthetic valve was acutely obstructed by thrombosis, and it was a life threatening condition. We performed partial bypass through femorofemoral bypass for life saving. Femorofemoral bypass improved oxygenation and cardiovascular stability, and mitral valve replacement was successfully performed without complication.

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