Felix Arne Rottmann

Background: Posthepatectomy liver failure (PHLF) remains a major cause of mortality after liver resection, with limited therapeutic options. PHLF can be categorized into primary (small‐for‐size) and secondary forms, the latter resulting from complications such as sepsis or hemorrhage. Extracorporeal albumin dialysis (ECAD), including open albumin dialysis (OPAL), may support hepatic detoxification by removing albumin‐bound toxins. While most studies focus on primary PHLF, data on secondary PHLF are scarce. Methods: This retrospective cohort study includes all patients receiving OPAL after liver surgery until February 2026 at the Medical Center of the University of Freiburg, Germany. A detailed chart review was performed. The primary endpoint was bilirubin reduction per filter cycle. Survival and changes in laboratory parameters were analyzed as secondary endpoints. Results: Eighteen patients were included, predominantly with secondary PHLF (15/18, 83.3%). Sepsis was the leading cause of secondary liver failure (8/15, 53.3%), followed by hemorrhage (6/15, 40.0%). Median bilirubin reduction per filter cycle was 1.52 mg/dL (relative reduction 14.64%; p < 0.0001), with greater reductions at higher prefilter levels ( p < 0.0001). Relative reductions were also observed in creatinine (16.84%) and urea (14.75%; both p < 0.0001). Platelet count and hemoglobin showed minor decreases, while MELD 3.0 scores improved modestly. Multiple consecutive filters did not increase overall bilirubin reduction. Thirty‐day survival after surgery was 66.7% and 38.9% after OPAL initiation. Conclusion: OPAL effectively reduces bilirubin levels and improves related parameters in PHLF. It may provide temporary detoxification support, particularly in secondary PHLF. Prospective studies are needed to assess its impact on patient survival.

Introduction: Refractory cardiac arrest carries a poor prognosis. Extracorporeal cardiopulmonary resuscitation (ECPR) can be lifesaving but is associated with high morbidity and mortality. We report a likely underdiagnosed complication — non-occlusive mesenteric ischemia (NOMI) — following ECPR, emphasizing the diagnostic challenges and the role of early endoscopic evaluation and an interdisciplinary assessment of these patients. Case Presentation: A 48-year-old man presented with ST-elevation myocardial infarction and developed refractory cardiac arrest due to ventricular fibrillation. ECPR was initiated, and extracorporeal membrane oxygenation (ECMO) flow was achieved after 77 min of cardiopulmonary resuscitation. Early after arrest, the patient passed bloody stool, raising suspicion of mesenteric ischemia. Computed tomography was inconclusive, but colonoscopy revealed ischemic bowel injury. Given the fatal potential of untreated NOMI, prompt colectomy was performed. The patient stabilized postoperatively, recovered progressively, and was discharged from the intensive care unit in good condition after 14 days. Conclusion: NOMI should be considered in ECPR patients presenting with gastrointestinal bleeding, even when cross-sectional imaging findings are inconclusive. Early colonoscopy enables timely diagnosis and surgical intervention, potentially improving survival in this high-risk setting.

Background: Prognostication in patients receiving veno‐venous extracorporeal membrane oxygenation (V‐V ECMO) remains challenging, particularly during prolonged support. Accurate prognostic indicators are essential for patients, caregivers, and clinicians. This study evaluates outcomes in patients supported with V‐V ECMO for at least seven days. Methods: We conducted a single‐center retrospective cohort study of patients cannulated for V‐V ECMO due to respiratory failure. The primary endpoint was hospital survival. The subgroup of patients still on V‐V ECMO on day 7, stratified by respirator and ECMO parameters, was analyzed with respect to predictors of the primary outcome. A survival favorability margin was defined as the bound of the hospital survivors' 95% confidence interval closest to the non‐survivor median. Results: Among 299 patients treated with V‐V ECMO (median age 55 years, 66.9% male), hospital survival was 44.8%. Pneumonia was the primary cause of respiratory failure in 216 patients (72.2%). By day 7, 182/299 patients (60.9%) remained on V‐V ECMO, with a hospital survival rate of 45.1%. Three respiratory parameters (ventilator FiO ₂ , tidal volume, compliance) and three V‐V ECMO parameters (blood flow, sweep gas flow, O ₂ fraction) significantly predicted hospital survival (all p ≤ 0.015). All six predictors separated survivors and non‐survivors through day 1 to 10 (all p < 0.001). Moreover, the clustering of several parameters above the favorability margin showed a clear discrimination of the overall survival (≥ 5 vs. zero parameters, survival 67.5% vs. 13.8%, OR 13.0, 95% CI 3.5–38.6, p < 0.001). Conclusion: Among patients still on V‐V ECMO on day seven, respiratory and ECMO parameters above the favorability margin correlated strongly with hospital survival. Survival was rare in patients with all predictors below the favorability margin. Day seven could provide a useful, though not definitive, time point for prognostication based on respiratory and ECMO parameters.

Introduction: Desirable outcome after venovenous extracorporeal membrane oxygenation for acute respiratory distress syndrome (ARDS) is frequently defined by survival. However, quality of life (QoL) and mental health status may take precedence over mere survival, from a patient-centered perspective. We aimed to evaluate QoL and mental health status in survivors after V-V ECMO for coronavirus disease 2019 (COVID-19)-related ARDS, hypothesizing a similar QoL comparable to the general population. Methods: All patients supported with venovenous ECMO for COVID-19-related ARDS between 01/2020 and 03/2022 in our center were included. Survivors were invited to participate in a follow-up interview assessing QoL, anxiety, and depression one year after hospital discharge. Primary endpoint was the quality of life, measured by the SF-36 questionnaire, with results compared to data from the DEGS1 study (German normative population). Results: During the study period, 97 patients received venovenous ECMO for COVID-19 ARDS at our ICU. Overall, 43/97 (44.3%) survived, and 21/97 (21.6%) completed the SF-36 questionnaire. The median follow-up duration was 1.7 years. Patients who completed the SF-36 were significantly younger than those who did not (48.7 vs. 55.6 years, p = 0.012); other patient characteristics and ECMO parameters were similar between those with and without questionnaire. Anxiety, depression, and post-traumatic stress disorder were detected in 33%, 14%, and 29% of patients, respectively. Compared to the German normative population, ECMO survivors had significantly lower QoL (mean 77.2 vs. 61.0, p < 0.001). Conclusions: QoL and mental health status after venovenous ECMO for ARDS was significantly lower compared to the normative population. These findings highlight the importance of further research and comprehensive follow-up care for ECMO survivors.

An 81-year-old male patient in Germany had prosthetic valve endocarditis caused by Pasteurella dagmatis after a domestic cat bite. We surgically treated a paravalvular abscess and administered definitive antibiotic therapy consisting of penicillin G and levofloxacin. The patient was discharged from the intensive care unit in good condition 21 days after the surgery.

Objectives: To investigate the burden of disease of myocarditis in Germany and identify similarities and differences in myocarditis with or without COVID-19. Methods: All patients hospitalized with myocarditis in Germany were included in this nationwide retrospective analysis. Data were retrieved from the Federal Statistical Office of Germany (DESTATIS) for the years from 2007 to 2022. The primary endpoint was hospital mortality. Results: A total of 88,159 patients hospitalized with myocarditis were analyzed. Annual cases increased from 5100 in 2007 to 6593 in 2022 (p < 0.001 for trend) with higher incidence during winter months. Incidence per 100,000 inhabitants was 6.2 in 2007 rising to 7.8 in 2022 (p < 0.001 for trend). Hospital mortality remained constant at an average of 2.44% (p = 0.164 for trend). From 2020 to 2022, 1547/16,229 (9.53%) patients were hospitalized with both, myocarditis and COVID-19 (incidence 0.62/100,000 inhabitants and 180/100,000 hospitalizations with COVID-19). These patients differed significantly in most patient characteristics and had a higher rate of hospital mortality compared to myocarditis without COVID-19 (12.54% vs. 2.26%, respectively, p < 0.001). Conclusions: Myocarditis hospitalizations were slowly rising over the past 16 years with hospital mortality remaining unchanged. Incidence of hospitalizations with combined myocarditis and COVID-19 was low, but hospital mortality was high.

Background: Diabetes mellitus is a major risk factor for the development of chronic kidney disease (CKD). There is limited data addressing the value of glycated hemoglobin (HbA1c) to predict renal outcomes independent of diabetes status.Methods: This single‐center retrospective observational study presents data of 19,285 subjects, irrespective of initial CKD or diabetes status. The primary endpoint was defined as the time to manifestation of moderate CKD (estimated glomerular filtration rate [eGFR] 2) in subjects with eGFR ≥60 mL/min/1.73 m² at baseline. The secondary endpoint was defined as time to progression of CKD (eGFR 2) in subjects with eGFR 30–60 mL/min/1.73 m². Multivariate time‐to‐event and logistic regression models were applied to estimate the influences of HbA1c, sex, age, eGFR, triglycerides, and cholesterol on both endpoints.Results: Lowest baseline HbA1c levels were associated with the slowest decline of kidney function (median time to manifestation of moderate CKD for HbA1c 8.5%: 8.3 years [95% CI: 7.8–9.2]; p < 0.001). Similar results were observed for the secondary endpoint. Covariate‐adjusted time‐to‐event analysis demonstrated an almost linear correlation between continuous baseline HbA1c levels and the probabilities of reaching both endpoints.Conclusions: HbA1c levels are a strong predictor for eGFR decline, irrespective of diabetes status or CKD stage, demonstrating a tight concentration‐dependent relationship. This association becomes apparent in the prediabetic HbA1c range and remains constant over the entire HbA1c spectrum.