Journal of Yeungnam Medical Science

Original articles

Emergency and Critical Care Medicine
Hemocompatibility of Emergency Bypass System versus Permanent Life Support extracorporeal membrane oxygenation in a propensity score-matched cohort: analysis of hematologic trajectories and transfusion requirements: Woo Sung Jang, Jung Uk Woo, Kyungsub Song; J Yeungnam Med Sci. 2026;43:31. Published online May 7, 2026; DOI: https://doi.org/10.12701/jyms.2026.43.31 [Epub ahead of print]

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Abstract PDF: Background
The Emergency Bypass System (EBS, Terumo Corporation) and Permanent Life Support (PLS, MAQUET Cardiopulmonary GmbH) platforms differ in pump design and surface coating, which may influence hemocompatibility. This study compared the longitudinal hematological profiles and transfusion requirements of these systems.
Methods
Adult patients who underwent extracorporeal membrane oxygenation were analyzed using 1:1 propensity score matching (74 matched pairs). The primary endpoints included hemoglobin and platelet trajectories during the first 5 days, which were analyzed using linear mixed-effects models.
Results
In the matched cohort, both groups demonstrated statistically similar longitudinal declines in hemoglobin and platelet counts (p=0.525 and p=0.501, respectively). However, this apparent stability in the EBS group was achieved at a significantly higher hematological cost. Within 5 days, the EBS group required 25.5% more red blood cell transfusions (p<0.001) and 34.2% more platelet transfusions (p<0.001) than the PLS group. Multivariable analysis confirmed that the use of the PLS system was independently associated with a lower transfusion demand.
Conclusion
Although laboratory trajectories were comparable during the acute phase, patients supported by EBS experienced a substantially higher transfusion burden. These findings suggest a masking effect, in which compensatory transfusions may obscure the accelerated blood cell consumption associated with EBS. Therefore, clinicians should remain vigilant regarding the potential hidden hematologic costs of EBS support, even when laboratory parameters appear stable.

Thoracic and Cardiovascular Surgery
Surgical results of only antegrade del Nido cardioplegia infusion in conventional coronary artery bypass grafting: a retrospective study: Sang-Uk Park, Yo Han Bae, Yun Seok Kim, Kyungsub Song, Woo Sung Jang; J Yeungnam Med Sci. 2023;40(Suppl):S23-S28. Published online June 28, 2023; DOI: https://doi.org/10.12701/jyms.2023.00283

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Background
Additional retrograde cardioplegia infusion in conventional coronary artery bypass grafting (CABG) was introduced to address the concern of inappropriate cardioplegia delivery through the stenotic coronary artery. However, this method is complex and requires repeated infusions. Therefore, we investigated the surgical outcomes of only antegrade cardioplegia infusion in conventional CABG.
Methods
We included 224 patients who underwent isolated CABG between 2017 and 2019. The patients were divided into two groups according to the cardioplegia infusion method: antegrade cardioplegia infusion with del Nido solution (n=111, group I) and antegrade+retrograde cardioplegia infusion with blood cardioplegia solution (n=113, group II).
Results
The sinus recovery time after release of the aorta cross-clamp was shorter in group I (3.8±7.1 minutes, n=98) than in group II (5.8±4.1 minutes, n=73) (p=0.033). The total cardioplegia infusion volume was lower in group I (1,998.6±668.6 mL) than in group II (7,321.0±2,865.3 mL) (p<0.001). Creatine kinase-MB levels were significantly lower in group I than in group II (p=0.039). Newly developed regional wall motion abnormalities on follow-up echocardiography were detected in two patients (1.8%) in group I and five patients (4.4%) in group II (p=0.233). There was no significant difference in ejection fraction improvement between the two groups (3.3%±9.3% in group I and 3.3%±8.7% in group II, p=0.990).
Conclusion
The only antegrade cardioplegia infusion strategy in conventional CABG is safe and has no harmful effects.

Citations

Citations to this article as recorded by

Del Nido versus conventional blood cardioplegia in patients with combined aortic root surgery: A retrospective study
Yingshan Huang, Xiangni Zhu, Jichang Kong, Ling Zhang, Wenting Gui, Jiao Wang, Yunling Yang, Yan Xie, Dongmei Wang, Xinyue Li, Long Zhou, Yi Song, Xiaoqi Wang
Perfusion.2025; 40(5): 1258. CrossRef
Effect of del Nido Cardioplegia on Isolated Coronary Artery Bypass Grafting: A Study-level Meta-analysis
Yoshiyuki Yamashita, Massimo Baudo, Dimitrios E. Magouliotis, Serge Sicouri, Marry Ann C. Wertan, Danielle D. Spragan, Gianluca Torregrossa, Basel Ramlawi, Francis P. Sutter
Journal of Cardiothoracic and Vascular Anesthesia.2025; 39(6): 1538. CrossRef

Thoracic and Cardiovascular Surgery
Safety of low-dose anticoagulation in extracorporeal membrane oxygenation using the Permanent Life Support System: a retrospective observational study: Kyungsub Song, Jae Bum Kim; J Yeungnam Med Sci. 2023;40(3):276-282. Published online May 18, 2023; DOI: https://doi.org/10.12701/jyms.2023.00339

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Abstract PDF

Background
Bleeding and thrombosis are major complications associated with high mortality in extracorporeal membrane oxygenation (ECMO) management. Anticoagulant therapy should be adequate to reduce thrombosis. However, related studies are limited.
Methods
We retrospectively reviewed all patients supported with ECMO at a single institution between January 2014 and July 2022 and included those on all types of ECMO using the Permanent Life Support System. Patients were classified into two groups according to their measured mean activated partial thromboplastin time (aPTT) during ECMO management: a high-anticoagulation (AC) group (aPTT, ≥55 seconds; n=52) and a low-AC group (aPTT, <55 seconds; n=79). The primary outcome was thrombotic or bleeding events during ECMO.
Results
We identified 10 patients with bleeding; significantly more of these patients were in the high-AC group (n=8) than in the low-AC group (15.4% vs. 2.5%, p=0.01). However, thrombus events and oxygenator change-free times were not significantly different between the two groups. Four patients in the high-AC group died of bleeding complications (brain hemorrhage, two; hemopericardium, one; and gastrointestinal bleeding, one). One patient in the low-AC group developed a thrombus and died of ECMO dysfunction due to circuit thrombosis.
Conclusion
Heparin did not significantly improve thrombotic outcomes. However, maintaining an aPTT of ≥55 seconds was a significant risk factor for bleeding events, especially those associated with mortality.

Citations

Citations to this article as recorded by

Small Patients, Big Decisions: Unraveling Anticoagulation in Pediatric Extracorporeal Membrane Oxygenation
Sangeeta B Gupta, Anil Sachdev
Indian Journal of ECMO.2026; 3(4): 178. CrossRef

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