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Cardiology459 papers

Postoperative cardiopulmonary failure

Last edited: 4/23/2026

Overview

Postoperative cardiopulmonary failure involves severe impairment of cardiac and pulmonary function requiring advanced life support measures, often including extracorporeal membrane oxygenation (ECMO) for temporary circulatory and respiratory assistance. 1318

Diagnosis

  • Clinical signs of respiratory distress and hemodynamic instability.
  • Imaging studies (chest X-ray, CT) to assess pulmonary edema and cardiac function.
  • Laboratory tests: arterial blood gases, cardiac biomarkers, coagulation profile. 1429
  • Management

  • First-line treatments:
  • - Extracorporeal membrane oxygenation (ECMO) for circulatory and respiratory support. 1318 - Mechanical ventilation with optimized settings.
  • Adjunctive treatments:
  • - Anticoagulation to prevent circuit thrombosis (e.g., heparin, bivalirudin). 52153 - Inotropic support (e.g., levosimendan) to improve cardiac function. 15 - Consideration of intra-aortic balloon pump for left ventricular support. 66

    Special Populations

  • Pregnancy and postpartum: ECMO use is rare but critical in refractory cardiopulmonary failure; outcomes vary. 2039
  • Pediatrics: Special attention to CPR techniques and ECMO weaning strategies; ECMO can improve outcomes with careful management. 1458
  • Elderly: Use of VA-ECMO is controversial due to higher mortality risks; individualized assessment is crucial. 26
  • Comorbidities: Patients with significant comorbidities may require tailored anticoagulation strategies and closer monitoring for complications like infections. 2955
  • Key Recommendations

  • Initiate ECMO early in severe postoperative cardiopulmonary failure to improve survival rates. (Evidence: Moderate 13)
  • Tailor anticoagulation strategies; routine systemic anticoagulation may not be necessary and can be associated with adverse events. (Evidence: Moderate 5154)
  • Implement structured weaning protocols from ECMO to minimize complications and optimize recovery. (Evidence: Expert opinion 633)
  • Consider palliative care consultation early in the course of treatment for patients with poor prognosis to address quality of life and end-of-life issues. (Evidence: Expert opinion 13)
  • References

    Showing 100 most recent of 227 indexed papers.

    1 Nilsson F, Sochor B, Henriksson S, Roth SV, Broman LM, Prahl Wittberg L. Multimodal characterization of flow-induced thrombus initiation and growth in extracorporeal membrane oxygenation. Scientific reports 2026. link 2 Rob D, Macoun J, Tonna JE, Svitekova K, Dusik M, Pudil J et al.. Impact of rhythm changes during CPR on ECPR outcomes: an ELSO Registry study. Resuscitation 2026. link 3 Wang H, Cen Z, Liu X, Liu Z, Hou X, Guan X et al.. Use of extracorporeal membrane oxygenation in adult trauma patients with refractory acute cardiopulmonary failure: guideline from the Chinese society of extracorporeal life support 2025. Critical care (London, England) 2025. link 4 Kalra R, Gaisendrees C, Alexy T, Kosmopoulos M, Voicu S, Bartos JA et al.. Left ventricular energetics in patients receiving veno-arterial extracorporeal membrane oxygenation for extracorporeal cardiopulmonary resuscitation. Resuscitation 2025. link 5 Priest JR, Hebert D, Jutras C. Anticoagulation during extracorporeal membrane oxygenation: A narrative review. Perfusion 2025. link 6 Brewer JM, Maybauer MO. Technique for Weaning From Peripheral Venopulmonary Extracorporeal Membrane Oxygenation in Combined Cardiopulmonary Failure. ASAIO journal (American Society for Artificial Internal Organs : 1992) 2025. link 7 Beshish AG, Shamah R, Qian J, Keane-Lerner K, Morales PR, Zinyandu T et al.. Is hyperoxia during veno-arterial extracorporeal life support due to cardiopulmonary failure associated with mortality in pediatric patients?. The journal of extra-corporeal technology 2025. link 8 Robinson DH, Peter K, McFadyen JD. Shear-induced dysregulation of haemostasis during extracorporeal membrane oxygenation: From cells to circuit. European journal of heart failure 2025. link 9 Marefat M, Hashemzadeh M, Movahed MR. Weight Categories Have no Impact on Mortality in Patients Treated with Extracorporeal Membrane Oxygenation (ECMO). Journal of intensive care medicine 2025. link 10 Razzaq A, Prager KM, Garan AR, Hastie J, Brodie D, Abrams D. Ethical Considerations for Mechanical Support. Anesthesiology clinics 2025. link 11 Petermichl W, Philipp A, Foltan M, Stadlbauer A, Ellmauer PP, Merten C et al.. Long-term outcomes of out-of-center veno-arterial ECMO cannulation for cardiopulmonary failure: investigation of prognostic parameters for a decision support tool - a 16-year retrospective study. Scandinavian journal of trauma, resuscitation and emergency medicine 2025. link 12 Rosenthal LL, Mühlbauer AM, Grinninger C, Haas NA, Netz H, Pozza RD et al.. Four decades of heart-lung transplantation: Milestones and outcomes in advanced cardiorespiratory failure. ESC heart failure 2025. link 13 Stevens K, Anandan SR, Rahman H, Parikh S, Leung AG, Benintendi A et al.. Caring for Patients Requiring Venous Arterial Extracorporeal Membrane Oxygenation: Can Upstream Palliative Care Make a Difference?. The American journal of hospice & palliative care 2024. link 14 Zinna SS, Morgan RW, Reeder RW, Ahmed T, Bell MJ, Bishop R et al.. Chest compressions for pediatric organized rhythms: A hemodynamic and outcomes analysis. Resuscitation 2024. link 15 Liu Y, Zhang L, Yao Y, Li Y, Qin W, Li Y et al.. Effects of levosimendan on the outcome of veno-arterial extracorporeal membrane oxygenation: a systematic review and meta-analysis. Clinical research in cardiology : official journal of the German Cardiac Society 2024. link 16 Hockstein MA, Fan E. The Roles of Venopulmonary Arterial Extracorporeal Membrane Oxygenation. Critical care medicine 2024. link 17 Leerson J, Tulloh A, Lopez FT, Gregory S, Buscher H, Rosengarten G. Detecting Oxygenator Thrombosis in ECMO: A Review of Current Techniques and an Exploration of Future Directions. Seminars in thrombosis and hemostasis 2024. link 18 Fine-Goulden MR, Lillie J. Fifteen-minute consultation: When to consider extracorporeal membrane oxygenation. Archives of disease in childhood. Education and practice edition 2024. link 19 Parrett M, Yi C, Weaver B, Jones M, Almachar MB, Davidson J et al.. Nursing Roles in Extracorporeal Membrane Oxygenation. The American journal of nursing 2024. link 20 Wong RW, Seasely AR, Gongora E, Hoopes CW, Bellot S, McElwee SK et al.. Strategies and outcomes of extracorporeal membrane oxygenation use in peripartum patients: a single institution experience. The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 2024. link 21 Seelhammer T, Ninan J, Nei S, Nabzdyk CG, Wang Z, Gerberi D et al.. Anticoagulation during extracorporeal membrane oxygenation. The Cochrane database of systematic reviews 2024. link 22 Soliman SI, Panuganti BA, Francis DO, Pang J, Klebaner D, Asturias A et al.. Factors Associated With Otolaryngologists Performing Tracheotomy. JAMA otolaryngology-- head & neck surgery 2023. link 23 Bruckner M, Neset M, O'Reilly M, Lee TF, Cheung PY, Schmölzer GM. Haemodynamic changes with varying chest compression rates in asphyxiated piglets. Archives of disease in childhood. Fetal and neonatal edition 2023. link 24 Kang Y, Wang W, Ma X, Sun Y, Huang S, Liu L et al.. A computer model of the effect of venous-arterial-venous extracorporeal membrane oxygenation venous return of oxygenated blood on right atrial recirculation and tricuspid valve blood oxygen saturation. Perfusion 2023. link 25 Hekmatjah N, Escallier K, Singh S. PICC entrapment and air embolism on veno-venous extracorporeal membrane oxygenation: A case report. The journal of vascular access 2023. link 26 Provaznik Z, Philipp A, Müller T, Kostiantyn K, Lunz D, Schmid C et al.. Outcome after veno-arterial extracorporeal membrane oxygenation in elderly patients: A 14-year single-center experience. Artificial organs 2023. link 27 Hoehne SN, Hopper K, Epstein SE. Association of point-of-care blood variables obtained from dogs and cats during cardiopulmonary resuscitation and following return of spontaneous circulation with patient outcomes. Journal of veterinary emergency and critical care (San Antonio, Tex. : 2001) 2023. link 28 Stephens AF, Šeman M, Diehl A, Pilcher D, Barbaro RP, Brodie D et al.. ECMO PAL: using deep neural networks for survival prediction in venoarterial extracorporeal membrane oxygenation. Intensive care medicine 2023. link 29 Uygun Kızmaz Y, Külahçıoğlu Ş, Doğan Kaya S, Gürcü ME, Karagöz A, Kırali MK. Epidemiology and risk factors of infections among patients with extracorporeal membrane oxygenation in a tertiary heart center. European review for medical and pharmacological sciences 2023. link 30 Pouplet C, Colin G, Guichard E, Reignier J, Le Gouge A, Martin S et al.. The accuracy of various neuro-prognostication algorithms and the added value of neurofilament light chain dosage for patients resuscitated from shockable cardiac arrest: An ancillary analysis of the ISOCRATE study. Resuscitation 2022. link 31 Carvajal HG, Costello JP, Miller JR, Eghtesady P, Nath DS. Pediatric heart-lung transplantation: Technique and special considerations. The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation 2022. link 32 Gao S, Liu G, Yan S, Lou S, Gao G, Hu Q et al.. Outcomes from adult veno-arterial extracorporeal membrane oxygenation in a cardiovascular disease center from 2009 to 2019. Perfusion 2022. link 33 Kaesler A, Rudawski FL, Zander MO, Hesselmann F, Pinar I, Schmitz-Rode T et al.. In-Vitro Visualization of Thrombus Growth in Artificial Lungs Using Real-Time X-Ray Imaging: A Feasibility Study. Cardiovascular engineering and technology 2022. link 34 Mani S, Gugino S, Helman J, Bawa M, Nair J, Chandrasekharan P et al.. Laryngeal mask ventilation with chest compression during neonatal resuscitation: randomized, non-inferiority trial in lambs. Pediatric research 2022. link 35 Tam CW, Shen L, Zeidman AD, Srivastava A, Ivascu NS. Mechanical Circulatory Support: Primer for Consultant Specialists. Clinical journal of the American Society of Nephrology : CJASN 2022. link 36 Kittnar O. Ten years of our translational research in the field of veno-arterial extracorporeal membrane oxygenation. Physiological research 2022. link 37 Huang CC, Chen KC, Lin ZY, Chou YH, Chen WL, Lee TH et al.. The effect of the head-up position on cardiopulmonary resuscitation: a systematic review and meta-analysis. Critical care (London, England) 2021. link 38 Makhoul M, Heuts S, Mansouri A, Taccone FS, Obeid A, Mirko B et al.. Understanding the "extracorporeal membrane oxygenation gap" in veno-arterial configuration for adult patients: Timing and causes of death. Artificial organs 2021. link 39 Zhang JJY, Ong JA, Syn NL, Lorusso R, Tan CS, MacLaren G et al.. Extracorporeal Membrane Oxygenation in Pregnant and Postpartum Women: A Systematic Review and Meta-Regression Analysis. Journal of intensive care medicine 2021. link 40 Hunt MF, Clark KT, Grant MC, Choi CW, Whitman G, Cho SM et al.. Therapeutic drug monitoring of valproic acid in extracorporeal membrane oxygenation. Perfusion 2021. link 41 Mihama T, Bahatyrevich N, Cavarocchi N, Hirose H. Outcomes of end-organ function and survival with veno-arterial extracorporeal membrane oxygenation. Perfusion 2021. link 42 Lo Coco V, Swol J, De Piero ME, Massimi G, Chiarini G, Broman LM et al.. Dynamic extracorporeal life support: A novel management modality in temporary cardio-circulatory assistance. Artificial organs 2021. link 43 Enumah ZO, Carrese J, Choi CW. The Ethics of Extracorporeal Membrane Oxygenation: Revisiting the Principles of Clinical Bioethics. The Annals of thoracic surgery 2021. link 44 Gaisendrees C, Djordjevic I, Sabashnikov A, Adler C, Eghbalzadeh K, Ivanov B et al.. Gender-related differences in treatment and outcome of extracorporeal cardiopulmonary resuscitation-patients. Artificial organs 2021. link 45 Moury PH, Zunarelli R, Bailly S, Durand Z, Béhouche A, Garein M et al.. Diaphragm Thickening During Venoarterial Extracorporeal Membrane Oxygenation Weaning: An Observational Prospective Study. Journal of cardiothoracic and vascular anesthesia 2021. link 46 Xu X, Shi J, Peng G, Yang C, Liu M, Zhao Y et al.. Non-In Situ Technique of Heart-Lung Transplantation: Case Series and Technique Description. The Annals of thoracic surgery 2021. link 47 Nelson LS, Aguirri AB. Meeting Code Blue Requirements Using a Team-Based Simulation. Journal of continuing education in nursing 2020. link 48 De Lazzari C, De Lazzari B, Iacovoni A, Marconi S, Papa S, Capoccia M et al.. Intra-aortic balloon counterpulsation timing: A new numerical model for programming and training in the clinical environment. Computer methods and programs in biomedicine 2020. link 49 Burden E, Pollock L, Paget C. Quality of life after in-hospital cardiopulmonary resuscitation for patients over the age of 80 years. Postgraduate medical journal 2020. link 50 Dalia AA, Lu SY, Villavicencio M, D'Alessandro D, Shelton K, Cudemus G et al.. Extracorporeal Cardiopulmonary Resuscitation: Outcomes and Complications at a Quaternary Referral Center. Journal of cardiothoracic and vascular anesthesia 2020. link 51 Wood KL, Ayers B, Gosev I, Kumar N, Melvin AL, Barrus B et al.. Venoarterial-Extracorporeal Membrane Oxygenation Without Routine Systemic Anticoagulation Decreases Adverse Events. The Annals of thoracic surgery 2020. link 52 Keyser A, Philipp A, Zeman F, Lubnow M, Lunz D, Zimmermann M et al.. Percutaneous Cannulation for Extracorporeal Life Support in Severely and Morbidly Obese Patients. Journal of intensive care medicine 2020. link 53 Thomas M, Kreibich M, Beyersdorf F, Benk C, Maier S, Trummer G. Standardized Weaning from Temporary Extracorporeal Life Support in Cardiovascular Patients. The Thoracic and cardiovascular surgeon 2020. link 54 Fina D, Matteucci M, Jiritano F, Meani P, Lo Coco V, Kowalewski M et al.. Extracorporeal membrane oxygenation without therapeutic anticoagulation in adults: A systematic review of the current literature. The International journal of artificial organs 2020. link 55 Guimbretière G, Anselmi A, Roisne A, Lelong B, Corbineau H, Langanay T et al.. Prognostic impact of blood product transfusion in VA and VV ECMO. Perfusion 2019. link 56 Yamamoto M, Oshima Y, Matsuhisa H, Higuma T, Iwaki R, Matsushima S et al.. Left Atrial Decompression by Minithoracotomy During Extracorporeal Life Support. The Annals of thoracic surgery 2019. link 57 Rupprecht L, Camboni D, Philipp A, Lunz D, Müller T, Schmid C et al.. Further options and survival results after failure following extracorporeal life support implantation. The Journal of cardiovascular surgery 2019. link 58 Zhang Q, Liu B, Zhao L, Lian Y, Yuan X, Zhang Y et al.. Venoarterial Extracorporeal Membrane Oxygenation Increased Immune Function of Spleen and Decreased Reactive Oxygen Species During Post-Resuscitation. Artificial organs 2019. link 59 Tipograf Y, Liou P, Oommen R, Agerstrand C, Abrams D, Brodie D et al.. A decade of interfacility extracorporeal membrane oxygenation transport. The Journal of thoracic and cardiovascular surgery 2019. link 60 O'reilly M, Schmölzer GM. Evidence for vasopressors during cardiopulmonary resuscitation in newborn infants. Minerva pediatrica 2019. link 61 Wengenmayer T, Duerschmied D, Graf E, Chiabudini M, Benk C, Mühlschlegel S et al.. Development and validation of a prognostic model for survival in patients treated with venoarterial extracorporeal membrane oxygenation: the PREDICT VA-ECMO score. European heart journal. Acute cardiovascular care 2019. link 62 Pasrija C, Bittle GJ, Zhang J, Morales D, Tran D, Deatrick KB et al.. A novel adaptor system enables endovascular access through extracorporeal life support circuits. The Journal of thoracic and cardiovascular surgery 2019. link 63 Constantinescu AR, Adler JL, Watkins E, Negroni-Balasquide XL, Laufenberg D, Scholl FG et al.. Aquapheresis (AQ) in Tandem with Extracorporeal Membrane Oxygenation (ECMO) in Pediatric Patients. The journal of extra-corporeal technology 2019. link 64 Berg RA, Sutton RM, Reeder RW, Berger JT, Newth CJ, Carcillo JA et al.. Association Between Diastolic Blood Pressure During Pediatric In-Hospital Cardiopulmonary Resuscitation and Survival. Circulation 2018. link 65 Guilló Moreno V, Gutiérrez Martínez A, Romero Berrocal A, Sánchez Castilla M, García-Fernández J. Experience in the management of ECMO therapy as a mortality risk factor. Revista espanola de anestesiologia y reanimacion 2018. link 66 Bréchot N, Demondion P, Santi F, Lebreton G, Pham T, Dalakidis A et al.. Intra-aortic balloon pump protects against hydrostatic pulmonary oedema during peripheral venoarterial-extracorporeal membrane oxygenation. European heart journal. Acute cardiovascular care 2018. link 67 Chen KH, Chen YT, Yeh SL, Weng LC, Tsai FC. Changes in quality of life and health status in patients with extracorporeal life support: A prospective longitudinal study. PloS one 2018. link 68 Eliet J, Gaudard P, Zeroual N, Rouvière P, Albat B, Mourad M et al.. Effect of Impella During Veno-Arterial Extracorporeal Membrane Oxygenation on Pulmonary Artery Flow as Assessed by End-Tidal Carbon Dioxide. ASAIO journal (American Society for Artificial Internal Organs : 1992) 2018. link 69 Lastrucci V, D'Arienzo S, Collini F, Lorini C, Zuppiroli A, Forni S et al.. Diagnosis-related differences in the quality of end-of-life care: A comparison between cancer and non-cancer patients. PloS one 2018. link 70 Wood T. Human factors: role of cognitive and social skills in clinical practice. Emergency nurse : the journal of the RCN Accident and Emergency Nursing Association 2017. link 71 Garcia YA, Quintero L, Singh K, Lakticova V, Iakovou A, Koenig SJ et al.. Feasibility, Safety, and Utility of Advanced Critical Care Transesophageal Echocardiography Performed by Pulmonary/Critical Care Fellows in a Medical ICU. Chest 2017. link 72 Bataillard A, Hebrard A, Gaide-Chevronnay L, Martin C, Durand M, Albaladejo P et al.. Extubation in patients undergoing extracorporeal life support. The International journal of artificial organs 2017. link 73 Sanfilippo F, Asmussen S, Maybauer DM, Santonocito C, Fraser JF, Erdoes G et al.. Bivalirudin for Alternative Anticoagulation in Extracorporeal Membrane Oxygenation: A Systematic Review. Journal of intensive care medicine 2017. link 74 Staudacher DL, Gold W, Biever PM, Bode C, Wengenmayer T. Early fluid resuscitation and volume therapy in venoarterial extracorporeal membrane oxygenation. Journal of critical care 2017. link 75 Richardson AS, Schmidt M, Bailey M, Pellegrino VA, Rycus PT, Pilcher DV. ECMO Cardio-Pulmonary Resuscitation (ECPR), trends in survival from an international multicentre cohort study over 12-years. Resuscitation 2017. link 76 Kuo KW, Barbaro RP, Gadepalli SK, Davis MM, Bartlett RH, Odetola FO. Should Extracorporeal Membrane Oxygenation Be Offered? An International Survey. 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Liver function during mechanical circulatory support: from witness to prognostic determinant. Critical care (London, England) 2016. link 86 Yang ZH, Ning BT, Zhang CM, Lin R, Ye S, Liu T. Clinical application of extracorporeal membrane oxygenation in children with refractory cardiopulmonary failure. World journal of pediatrics : WJP 2016. link 87 Chou HW, Chang TI, Wang CH, Chou NK, Chi NH, Huang SC et al.. The outcome of patients requiring multiple extracorporeal membrane oxygenation: how many runs of ECMO is reasonable?. The International journal of artificial organs 2016. link 88 Benassi F, Giuliani E, Corticelli D, Parravicni R. A novel portable extra-corporeal life support system for the treatment of cardio-pulmonary failure under controlled hypothermia. Preliminary study in experimental animals. Acta bio-medica : Atenei Parmensis 2016. link 89 Tretter JT, Radunsky GS, Rogers DJ, Daugherty LE. A pediatric case of autoresuscitation. 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Chest compression alone cardiopulmonary resuscitation is associated with better long-term survival compared with standard cardiopulmonary resuscitation. Circulation 2013. link 99 Yuan S, Tsukahara E, De La Cruz K, Kelly RB. How we provide transfusion support for neonatal and pediatric patients on extracorporeal membrane oxygenation. Transfusion 2013. link 100 Segal N, Parquette B, Ziehr J, Yannopoulos D, Lindstrom D. Intrathoracic pressure regulation during cardiopulmonary resuscitation: a feasibility case-series. Resuscitation 2013. link

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