Elmadhoun, Omar

ABSTRACT Reliable assessment of infarct severity is essential in experimental stroke research, yet commonly used approaches such as 2,3,5‐triphenyltetrazolium chloride (TTC) staining and magnetic resonance imaging require additional tissue processing, specialized equipment, or substantial time and cost. In this study, we developed and validated a rapid visual Infarct Score to determine infarct volume and evaluate neuroprotective efficacy in rat middle cerebral artery occlusion (MCAO) models. A retrospective analysis was performed using data from 315 male Sprague–Dawley rats, including TTC‐derived infarct volume, visual Infarct Score, neurological deficit scores, and body weight changes. The Infarct Score demonstrated the strongest correlation with infarct volume among individual indicators in both nontreatment (Rho = 0.71) and treatment cohorts (Rho = 0.68). We further developed a Comprehensive Score by integrating the Infarct Score with the Longa 5‐point score at 48 h, which showed the highest overall correlation with infarct volume (Rho = 0.75 in both cohorts) and strong discrimination of infarct severity (AUC = 0.90). Interrater reliability analysis demonstrated excellent agreement among independent raters (intraclass correlation coefficient = 0.89; Kendall's W = 0.83, both p < 0.001). Neuroprotective interventions, including therapeutic hypothermia, nitroglycerin, and remote ischemic conditioning combined with physical exercise, significantly reduced infarct volume, Infarct Score, Comprehensive Score, neurological deficits, and weight loss. These findings indicate that the Infarct Score offers a rapid, practical, and cost‐effective method for infarct assessment, whereas the Comprehensive Score further improves the predictive accuracy and may serve as a useful tool for evaluating stroke severity and treatment outcomes in preclinical studies.

Abstract: Extracorporeal membrane oxygenation (ECMO) is increasingly used to support patients with severe cardiac or respiratory failure. Neurological complications occur across ECMO configurations and represent a major contributor to mortality and long-term disability. Major neurological complications include ischemic and hemorrhagic stroke, hypoxic ischemic brain injury, seizures, delirium, spinal cord and peripheral nervous system injury, and brain death. The mechanisms underlying neurological injury during ECMO are multifactorial and are influenced by ECMO configuration, reflecting differences in cerebral perfusion, gas exchange, anticoagulation exposure, and precannulation physiologic insults. This review synthesizes neurological complications associated with ECMO, neurological monitoring, and outcomes.

Cardiac arrest is a leading cause of global mortality, with low survival rates despite advances in resuscitation science. Reported survival ranges from 8% to 34% for out-of-hospital and in-hospital cardiac arrest. Extracorporeal cardiopulmonary resuscitation (ECPR) has emerged as a rescue therapy for patients unresponsive to conventional CPR, leveraging veno-arterial extracorporeal membrane oxygenation (ECMO) to provide artificial circulation, gas exchange, and maintenance of organ perfusion in the absence of spontaneous native circulation. Successful ECPR depends on minimizing time to ECMO initiation and selecting appropriate patients. While several aspects are consistent across countries, ECPR protocols vary in logistics, team composition, cannulation methods, and monitoring, which may influence patient-important outcomes such as survival and neurological recovery. This narrative review explores current global practices in ECPR, and identifies opportunities for standardization while recognizing elements that should remain context specific.

Pulmonary embolism (PE) is a leading cause of cardiovascular morbidity and mortality. Systemic thrombolysis is recommended for high-risk PE, but risk of major bleeding limits its use despite its efficacy. While mechanical thrombectomy (MT) has emerged as an alternative reperfusion strategy, real-world safety data remains limited. The objective of this single-center retrospective observational cohort study was to characterize the safety profile and procedural complications of MT. Methods Adult patients with intermediate-risk and high-risk PE who underwent MT at a quaternary academic medical center between January 1, 2017, and December 31, 2024, were included. Demographic, clinical, laboratory, imaging, procedural, outcome, and mortality data were collected. Major adverse events and bleeding were defined according to established criteria. Results From a total of 103 screened patients, 65 were included. Of these, 22 (34%) were classified as high-risk and 43 (66%) as intermediate-risk. Baseline demographics were similar between groups. High-risk patients demonstrated greater clinical disease severity, with higher mean Pulmonary Embolism Severity Index (PESI) scores (188.5 vs 122.4). Clinical deterioration prior to MT occurred in 35% of intermediate-risk patients. Extracorporeal membrane oxygenation (ECMO) consultation rate (32% vs 7%), peri-procedural ECMO use (18% vs 2.3%), major bleeding (27% vs 4.7%), and in-hospital mortality (36% vs 11.6%) were higher in the high-risk group. Thrombus removal was achieved in 77% and 88% of high- and intermediate-risk patients, respectively. High-risk patients had longer ICU (mean 4 vs 1.3 days) and hospital stays (mean 21.5 vs 6.4 days), higher thirty-day mortality (36% vs 14%), and lower 90-day survival (59% vs 79%). Conclusions MT achieved high rates of thrombus removal in both groups. In this retrospective cohort, high-risk patients had greater baseline clinical severity and was associated with higher bleeding rates, greater resource utilization, including ECMO consultation and peri-procedural use, prolonged ICU and hospital stays, as well as increased mortality.