Cardiopulmonary resuscitation refers to the emergency procedure performed in response to a sudden loss of consciousness with cessation of breathing and cardiac activity. It requires immediate interventions including airway management, ventilation, chest compressions, and defibrillation. According to the World Health Organization, with ischemic heart disease responsible for 13% of global mortality, widespread cardiopulmonary resuscitation training is critical, particularly outside health care settings. School and community nursing provide an effective platform to educate young people, reinforce the chain of survival, and promote health literacy in educational environments. This study aimed to determine whether structured theoretical-practical workshops enhance cardiopulmonary resuscitation knowledge and self-efficacy among high school and university students compared with a control group and explore associations with sociodemographic variables. A quasi-experimental design was used. Nursing-led workshops were delivered in high schools and universities, with pre- and postintervention assessments measuring cardiopulmonary resuscitation knowledge and self-perceived competence. The sample comprised 472 participants aged 12 to 74 years (mean = 21.27; SD = 12.54 years). Participants exhibited significant improvements in cardiopulmonary resuscitation knowledge and confidence after the intervention. Gains exceeded those observed in the control group and were consistent across sociodemographic subgroups. Nursing-led educational interventions in school and university settings substantially improve cardiopulmonary resuscitation knowledge and self-efficacy, enhancing preparedness for cardiac emergencies. Integrating such programs into educational curricula supports the chain of survival, strengthens community resilience, and aligns with public health priorities for early intervention and prevention.
Coronary microvascular disease (CMVD) is a major cause of angina in patients with ischemia and nonobstructive coronary arteries (INOCA) syndrome. It is characterized by an imbalance between myocardial oxygen supply and demand, leading to reduced exercise tolerance and impaired quality of life. Because of heterogeneous diagnostic approaches and the lack of disease-modifying therapies, CMVD remains underdiagnosed and undertreated. Shexiang Tongxin Dropping Pill (STDP), a traditional Chinese medicine formulation, has shown protective effects on the coronary microvasculature in preclinical and preliminary clinical studies. However, high-quality randomized evidence and objective functional validation are still lacking. This study therefore aims to evaluate the efficacy and safety of STDP in patients with CMVD using cardiopulmonary exercise testing (CPET) as the primary functional outcome and to develop an artificial intelligence (AI)-assisted myocardial contrast echocardiography (MCE) tool to improve CMVD detection and subgroup classification. This is a prospective, multicenter, randomized, double-blind, placebo-controlled clinical trial with a nested diagnostic design. CMVD will be diagnosed by stress MCE, and eligibility will require evidence of reduced myocardial perfusion or perfusion defects. Eligible patients with CMVD will be randomized at a 1:1 ratio to receive STDP or a matched placebo for 12 weeks. The primary endpoint is the change in peak oxygen uptake (peak VO₂) measured by cardiopulmonary exercise testing (CPET). The secondary outcomes include other CPET indices, angina severity, quality of life, and circulating biomarkers. The nested diagnostic study uses retrospectively and prospectively collected MCE datasets to develop AI-based models for automated myocardial segmentation, perfusion curve analysis, and CMVD classification, with performance assessed against established reference standards. By combining quantitative microvascular imaging, functional exercise assessment, and AI-assisted diagnostics in a single protocol, this study proposes a therapeutic-diagnostic framework for CMVD. This study is expected to provide high-quality randomized evidence for the use of STDP in CMVD and to offer a scalable and objective approach to improve diagnosis, risk stratification, and individualized management in patients with functional coronary ischemia. http://itmctr.ccebtcm.org.cn/, International Traditional Medicine Clinical Trial Registry (ITMCTR), TMCTR2025000414.
Background: Cardiac surgery-associated acute kidney injury (CS-AKI) is reported in 20-30% of patients undergoing cardiac surgery, leading to poor outcomes and increased healthcare costs. Because the pathophysiology of CS-AKI remains incompletely understood, no effective preventive strategies exist. Nitrite, a nitric oxide donor under hypoxic conditions, has been shown to exert organ-protective effects in various preclinical models. However, its protective effects against CS-AKI remain unexplored. This study aimed to generate a rat cardiopulmonary bypass (CPB) model to induce CS-AKI, identify the key molecular pathways involved in its pathophysiology, and evaluate the potential renoprotective effects of nitrite. Methods: A rat CPB model was established, and CS-AKI was confirmed through molecular and histological analyses. RNA-sequencing (RNA-seq) was performed to identify differentially expressed genes and enriched pathways. Nitrite (2 mg/kg) was administered before CPB, and its effects on kidney injury markers and inflammation-related pathways were evaluated. Results: CS-AKI was successfully induced in our rat CPB model, as evidenced by increased KIM-1 and NGAL expression and renal histological damage. RNA¬-seq revealed activation of inflammation-related pathways, including the TNF and NFκB signaling pathways. Nitrite administration significantly reduced KIM-1 and NGAL expression and suppressed pathways associated with CS-AKI development. Conclusion: This study underscores the role of inflammation in the pathophysiology of CS-AKI and demonstrates that nitrite attenuates early tubular injury markers and inflammation-related pathways. These findings support further investigation of nitrite as a strategy to mitigate tubular injury during cardiac surgery.
Cardiac Arrest (CA) is considered a medical emergency and survival after CA is approximately 10%. Recognizing and providing effective intervention can have a significant impact on a patient's outcome. To evaluate baseline knowledge of Cardiopulmonary Resuscitation (CPR) and the impact of a CPR training intervention to high school students in Aracaju, Sergipe. This study was a pre-post educational intervention with 3-month follow-up involving 5 institutions that were chosen randomly from March to October 2023. The intervention was delivered in Portuguese, in four stages, aligned with the Kids Save Lives initiative: a pre-test was applied in 410 students before starting the course with questions regarding CPR and students' expectations; a theoretical-practical course was taught; after the course, students answered a post-test, an evaluation and satisfaction questionnaire. Finally, three months later, 343 students answered the post-test. The primary outcome was mean total score on a validated 14-item BLS knowledge test. We observed an increase in scores after training from 5.8 (2.2) pre-test to 10.9 (2.0) three months after. Scores decreased significantly from the immediate post-test to the 3-month follow-up, with a mean difference of 0.9-points (95% CI 0.61 to 1.13; Cohen's d = 0.354), but remained substantially higher than baseline. Self-perceived ability to perform CPR increased from 10.9% before training to 91% immediately after the course. Teaching CPR in educational institutions can improve CPR knowledge retention at 3-months following the intervention, supporting the feasibility of integrating similar programs in Brazilian schools and alignment with the trend of Brazilian education policies. INSTITUTIONAL RESEARCH BOARD APPROVAL: https://shorturl.at/u4pYb.
To assess the evidence on volume-controlled mechanical ventilation versus manual ventilation or other ventilation modes during cardiopulmonary resuscitation (CPR). On 18 March 2026, we searched PubMed, Embase, and Web of Science (PROSPERO: CRD420251110999). Randomized trials and non-randomized studies in children or adults with cardiac arrest and an advanced airway were included. Risk of bias was assessed using RoB2 and ROBINS-I tools. Meta-analyses were performed when appropriate, and certainty of evidence was assessed using GRADE. We screened 12,004 abstracts and included 13 articles consisting of six trials enrolling 461 patients and seven non-randomized studies including 4,607 patients. No study reported data on children. Meta-analysis of 120 patients from two randomized trials comparing volume-controlled to manual ventilation showed no difference for return of spontaneous circulation (ROSC) (odds ratio (OR), 1.31; 95%-confidence interval (CI), 0.64 to 2.71). Comparisons to pressure-controlled and CPR-specific modes were limited to a single trial each, with uncertain results. Randomized trials were at low to high risk of bias. Non-randomized studies were at serious or critical risk of bias. The certainty of evidence was very low to low across comparisons. Very low to low certainty evidence from randomized trials suggests no significant difference in clinical outcomes between volume-controlled mechanical ventilation and manual ventilation. The relative effectiveness of volume-controlled ventilation compared to other mechanical ventilation modes is uncertain.
The incidence of subsyndromal delirium (SSD) after cardiac surgery with cardiopulmonary bypass (CPB) is relatively high. In this study, we aimed to analyze the risk factors associated with postoperative SSD and to construct a predictive model to facilitate early identification of SSD, thereby providing an effective clinical prediction tool. We conducted a retrospective cohort study, including patients who underwent cardiac surgery with CPB at a tertiary hospital in Sichuan Province from January 2023 to March 2024. Clinical nurses performed six daily assessments for SSD by using the Confusion Assessment Method for the Intensive Care Unit until delirium occurred or the patient was discharged from the intensive care unit or died. A total of 994 patients were included and divided into a non-SSD group (n = 832) and an SSD group (n = 162). Univariate and multivariable logistic regression analyses were performed to identify independent risk factors for postoperative SSD. A nomogram was constructed using R software, and the model's discriminative ability was evaluated using the area under the receiver operating characteristic (ROC) curve. Among the 994 patients who underwent cardiac surgery, the incidence of SSD was 16.30% (n = 162), and 46.30% (n = 52) of these patients subsequently progressed to delirium. Multivariable logistic regression analysis showed that age (OR = 1.039), body mass index (OR = 1.078), the use of pain medication after extubation (OR = 2.918), postoperative stress hyperglycemia (OR = 1.848), a postoperative minimum albumin level < 33.4 g/L (OR = 1.97), and a postoperative minimum hemoglobin level < 90 g/L (OR = 2.284) were independent risk factors for SSD after cardiac surgery. A risk prediction model was constructed based on these variables. The area under the ROC curve was 0.744 (95% CI [0.701-0.787]; p < 0.001), indicating moderate predictive accuracy of the model. The incidence of SSD after cardiac surgery with CPB was high. The predictive model developed in this study demonstrated good predictive performance and may assist healthcare professionals in the early identification of high-risk patients, enabling timely preventive interventions to reduce the risk of postoperative SSD.
Remote patient monitoring (RPM) has shown potential benefits for patients with chronic conditions. This study aimed to compare healthcare utilization between RPM and non-RPM patients with congestive heart failure (CHF) or chronic obstructive pulmonary disease (COPD). RPM patients were identified based on a history of CHF and COPD and receipt of RPM services. A 1:4 propensity score matching approach was used to identify comparable non-RPM patients with CHF or COPD, adjusting for demographics, comorbidity burden, and baseline healthcare use. The final analytic cohort comprised 1,050 patients. RPM patients were generally older adults with high Charlson Comorbidity Index scores. Compared to non-RPM patients, those receiving RPM had a significantly shorter hospital length of stay (2.4±5.4 vs. 4.7±11.3 days, p<0.01) and reduced frequency of hospitalizations (0.6±1.1 vs. 1.7±3.9, p<0.01) on an annual basis. Our results demonstrated the utility of RPM in the management of patients with chronic cardiopulmonary conditions.
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Surgical stabilization of rib fractures (SSRF) is increasingly performed in patients with severe rib fractures or flail chest. It has been shown to reduce ventilator days and pulmonary complications. Nevertheless, SSRF carries perioperative morbidity, particularly pulmonary and cardiac events, and the optimal preoperative cardiac risk stratification tool for this population has not been established. This study evaluated the association between the Revised Cardiac Risk Index (RCRI) and in-hospital mortality and cardiopulmonary complications in SSRF patients. This retrospective cohort study used the ACS-TQIP National Trauma Data Bank (2019-2023) to identify adult patients undergoing SSRF. Patients with AIS ≥ 2 in non-thoracic regions, blunt cardiac injury (AIS ≥ 2), or aortic injury were excluded. Because SSRF is an intrathoracic procedure, each patient carried a minimum RCRI of 1; patients were stratified into RCRI = 1, RCRI = 2, and RCRI ≥ 3. The primary outcomes were in-hospital mortality and a composite of cardiopulmonary complications (myocardial infarction, cardiac arrest, pneumonia, ARDS, deep vein thrombosis, and pulmonary embolism). Modified Poisson regression with robust standard errors estimated adjusted risk ratios (RRs), with RCRI = 1 as the reference and adjustment for demographics, regional and chest AIS, fixation details, and comorbidities. After exclusions, 6,139 patients were analyzed (RCRI = 1, n = 4,678; RCRI = 2, n = 1,208; RCRI ≥ 3, n = 253). Adverse outcomes increased stepwise with higher RCRI in both unadjusted and adjusted analyses. Compared with RCRI = 1, RCRI ≥ 3 was associated with significantly higher adjusted risks of in-hospital mortality (RR 3.34, 95% CI 2.06-5.43, p <0.001) and cardiopulmonary complications (RR 3.42, 95% CI 2.08-5.62; both p < 0.001), as well as myocardial infarction (RR 9.28, 95% CI 2.84-30.34, p < 0.001) and pneumonia (RR 5.85, 95% CI 2.72-12.59, p < 0.001). RCRI = 2 was also associated with increased mortality (RR 2.13, 95% CI 1.50-3.04, p < 0.001) and cardiopulmonary complications (RR 1.72, 95% CI 1.20-2.48, p = 0.003). RCRI is a simple, readily available bedside tool that independently stratifies the risk of in-hospital mortality and cardiopulmonary complications in patients undergoing SSRF. Incorporating the RCRI into preoperative assessment may help identify high-risk patients and guide perioperative management.
The American Heart Association recommends using end-tidal carbon dioxide during cardiac arrest for advanced airway confirmation and for monitoring and optimizing cardiopulmonary resuscitation; practice patterns of its use during in-hospital cardiac arrest are not well described. We used the prospectively collected get with the guidelines-resuscitation registry to characterize trends and hospital-level variation in end-tidal carbon dioxide use for airway confirmation in arrests with a newly placed airway, and to monitor cardiopulmonary resuscitation in arrests with a new or prior airway. Proportions were displayed by month from 2000 to 2023. Hospital use rates were displayed visually and calculated for contemporary practice (2019-2023). Proportions were reported using means or medians depending on the distribution. Among 257,057 in-hospital cardiac arrests with a new airway, 92.6% were confirmed with end-tidal carbon dioxide in 2019-2023. Among the 554,693 in-hospital cardiac arrests with either a new airway or an airway already in place, 35.3% had end-tidal carbon dioxide applied for monitoring cardiopulmonary resuscitation in 2019-2023. There was little variation in hospital proportions for airway confirmation, with a median of 94.0%; however, a high degree of variation was observed across hospitals for monitoring cardiopulmonary resuscitation. End-tidal carbon dioxide application is widespread for confirming airway placement during in-hospital cardiac arrest, but gaps remain in adherence to guideline recommendations for monitoring cardiopulmonary resuscitation with end-tidal carbon dioxide.
To determine the prevalence of iron deficiency and iron deficiency anemia and their association with adverse outcomes in children undergoing cardiac surgery with cardiopulmonary bypass. Retrospective review. Single-center, academic quaternary children's hospital. Eight hundred eighty-six cardiac surgery patients aged 0 to 18 years at the authors' institution between 2019 and 2023. None. Patients were screened for iron deficiency and anemia using ferritin, hemoglobin, and reticulocyte hemoglobin equivalent levels. Perioperative outcomes were measured and analyzed using multiple logistic and linear regression adjusting for both surgical complexity and cardiopulmonary bypass times. Patients with iron deficiency received greater perioperative red blood cell transfusion volumes (31.2 ± 36.8 mL/kg v 21.9 ± 29 mL/kg, p < 0.001) and had an increased incidence of postoperative acute kidney injury (30.2% v 20.8%, p = 0.002) than those without iron deficiency. Patients with iron deficiency anemia received larger red blood cell transfusion volumes (33 ± 33.7 mL/kg v 22 ± 29 mL/kg, p = 0.002) and were more likely to develop acute kidney injury (37% v 21%, p = 0.006) compared with those with normal iron and hemoglobin levels. These findings persisted after adjusting for age, weight, surgical complexity, and cardiopulmonary bypass time. Iron deficiency is common in children undergoing cardiac surgery and is associated with an increased risk of adverse outcomes. Future prospective studies aimed at understanding and managing iron deficiency in patients with congenital heart disease are urgently needed.
Children after cardiac surgery with cardiopulmonary bypass are susceptible to a variety of complications and poor outcomes, e.g., acute kidney injury or infection. Postoperative monitoring in children is a complex process, characterized by frequent interventions, age-varying reference ranges, different data sources, among other factors. Visual analysis of retrospective data could offer significant clinical value by improving understanding of trajectories and potential factors for complications. Therefore, we aim to create an interactive visualization tool to assist in exploration of retrospective postoperative trajectories of children following heart surgery. We present the prototype TRACE (Trajectory(-based) Retrospective Analysis for Clinical Exploration) that was developed in close collaboration with clinicians. Feedback was collected using a questionnaire with qualitative and quantitative items, designed to assess usability, utility in clinical, research and teaching settings, and effectiveness of the proposed visualizations. The tool achieved a mean system usability scale score of 82.5. Future work will focus on releasing TRACE to researchers with access to the ELISE dataset, a comprehensive, open pediatric ICU dataset, facilitating data understanding and analysis of trajectories in critically ill children following cardiopulmonary bypass.
Extracorporeal membrane oxygenation (ECMO) has become a valuable tool in critical care medicine when conventional treatment to severe cardiopulmonary failure fails. ECMO use in adults has significantly increased over the past several years to approximately 60 per million adults because of its potential survival benefits. This drastic increase in ECMO use comes from its technological evolution over the last decade. However, ECMO utilization in obstetric patients remains limited, although the incidence of life-threatening cardiopulmonary conditions potentially benefiting from ECMO continues to rise in these patients. The objective of this systematic review was to evaluate the evolution of ECMO and its use in the extended peripartum period. PRISMA 2020 guidelines were followed. We constructed searches in PubMed, Embase, and the Cochrane Central Register of Controlled Trials (Wiley). Results were limited to articles published since 2010 with adult subjects till 2020. Inclusion criteria Literature published in English since 2010 regarding adult peripartum patients requiring ECMO extending up to 3 months post-delivery. Exclusion criteria Animal studies, National Inpatient Sample (NIS) data, reviews, editorials, and conference abstracts. Cases involving EXIT-to-ECMO or support initiated beyond three months postpartum were also excluded. Data was collected and reviewed using Covidence portal. Initially, 2169 studies were screened for title and abstract review. Afterwards, 304 studies were selected for retrieval and full text review. Finally,136 articles were included in the study after full text review. Studies were separated based on their nature into two broad groups - case reports (110) and cohort studies & case series (26). The most common indication to initiate ECMO was cardiomyopathy (heart failure), and most mothers requiring ECMO were in the antenatal period. Mean duration on ECMO was 8, 9 and 11 days (case series, case reports and cohort studies, respectively). Maternal survival was noted to be as high as 89% in case reports, 87% in case series, and 78% in cohort studies. Fetal survival rate was also generally high. Nevertheless, it is important to point out that a significant number of the included studies did not report fetal outcomes and, hence, the fetal survival rate could not be confidently inferred. Timely initiation of ECMO in the peripartum period is associated with favorable maternal and fetal outcomes. Given the rarity of ECMO utilization in obstetrics, case reports were highly represented in the study. Accordingly, regression findings should be interpreted cautiously and considered hypothesis-generating rather than confirmatory.
Point-of-care ultrasound (POCUS) is an essential tool in perioperative and cardiac critical care, providing rapid, bedside evaluation of cardiac function, pulmonary pathology, and volume status. This article introduces a protocolized, whole-body POCUS approach centered on the sonographic congestion cascade, conceptualizing the cardiopulmonary venous system as a continuous physiologic unit. By integrating cardiac, lung, and multisite venous Doppler findings, clinicians can identify shock etiologies, characterize congestion phenotypes, and guide individualized, physiology-driven management in patients with undifferentiated shock and respiratory failure.
Pulmonary hypertension (PH) is a progressive cardiopulmonary disorder characterized by vascular remodeling, abnormal vasoconstriction of small lung arteries, and right heart failure. Hypoxia causes vascular damage, leading to vessel stenosis or occlusion by aberrant endothelial cells, hypertrophy of the tunica media, and thrombus formation. But the precise molecular mechanisms underlying the pathology of PH have been uncertain. To investigate the pathogenic role of Myl (myosin light chain) 9/12 in PH, we utilized the Sugen/hypoxia mouse model, generated by administration of the VEGF (vascular endothelial growth factor) receptor inhibitor SU5416 under hypoxic conditions (10% O2). Lung tissues of patients with PH and human lung microvascular endothelial cells were used to examine their endothelial changes. Platelet-specific Myl9-deficient mice were generated to determine the contribution of platelet-derived Myl9 to the development of PH. The therapeutic efficacy of the anti-Myl9/12 antibody was evaluated by hemodynamics, histological analyses, and single-cell RNA sequencing. Furthermore, serum MYL9, MYL12A, and MYL12B levels were measured in patients with PH and analyzed for clinical correlation. We identified microthrombi containing Myl9/12 in both patients with PH and the PH mouse model. Platelet-derived Myl9 partially contributed to PH development by promoting cellular infiltration. Furthermore, hypoxia upregulated the expression of Myl9/12 through EPAS1 (endothelial PAS domain protein 1) in proliferated lung vascular endothelial cells and induced the release of Myl9/12 into the extracellular space. Anti-Myl9/12 antibody treatment attenuated PH in the mouse model by reducing microthrombus formation, inflammatory cell infiltration, tissue hypoxia, and vascular remodeling. The established PH in Sugen/hypoxia mice was also attenuated by the treatment with anti-Myl9/12 antibody. Moreover, serum levels of Myl9 but not MYL12A or MYL12B levels reflected the severity of PH in patients. These findings reveal that Myl9/12 play a pathogenic role in developing vascular lesions of PH and could be a new therapeutic target for PH.
Postcardiotomy shock (PCS) is a complex, high-mortality complication following cardiac surgery, driven by cardiopulmonary bypass-related inflammation, vasoplegia, myocardial dysfunction, and pulmonary hypertension. Conventional shock definitions are poorly applicable to this population; a vasoactive inotropic score greater than 20 to 25 with evidence of hypoperfusion is proposed as a practical operational definition. Overlapping PCS phenotypes (cardiogenic, vasoplegic, obstructive, arrhythmic, mixed) necessitate multimodal hemodynamic profiling incorporating pulmonary artery catheter data, echocardiography, and dynamic perfusion indices. Management focuses on judicious fluid and blood product administration, phenotype-directed inotropes and vasopressors, lung-protective ventilation, and early initiation of temporary mechanical circulatory support.
Pediatric lung transplantation remains a life-saving option for selected children and adolescents with end-stage lung disease. We aimed to describe clinical characteristics, survival, post-transplant morbidity, and exploratory factors associated with mortality in a single-center Saudi cohort. We retrospectively reviewed all pediatric patients who underwent lung transplantation between January 2010 and December 2023. Demographic, anthropometric, perioperative, and post-transplant data were extracted. Survival was assessed with Kaplan-Meier analysis, and Cox regression was used to explore associations with mortality. Twenty-eight recipients underwent transplantation, predominantly bilateral sequential procedures, at a median age of 16 years. All recipients were adolescents, and cystic fibrosis (CF) was the most common indication. Severe undernutrition was common, with 64.3% meeting failure-to-thrive criteria (< 1st centile for weight) and 71.4% below the 3rd centile. Intraoperative extracorporeal membrane oxygenation replaced cardiopulmonary bypass after 2016. One-year survival was 96.4%, and median post-transplant survival was 6.8 years. Survival did not differ significantly by intraoperative extracorporeal support, but median survival was shorter in CF than in non-CF recipients (2.9 vs. 8.9 years). Hypertension developed in 53.5% of patients, diabetes in 28.5%, and acute kidney injury in 46.4%. In age- and sex-adjusted Cox models, CF, longer waiting time, Pseudomonas aeruginosa colonization, and diabetes at 1 year were associated with mortality. Pediatric lung transplantation in this cohort achieved excellent short-term survival but substantial long-term morbidity. Mortality associations should be interpreted cautiously, given the small sample size and event count. The shorter survival observed in CF recipients warrants further study, particularly in the context of severe undernutrition and chronic airway colonization.
Liver transplantation (LT) is increasingly performed in the setting of acute-on-chronic liver failure (ACLF). In this context, pre-transplant evaluation must be completed rapidly while minimizing the risk of overlooking contraindications. We aimed to describe current practices for pre-transplant assessment in patients with ACLF. We conducted a survey across 34 European LT centers (including 16 French) and 22 French non-LT centers to assess pre-transplant evaluation practices, focusing on cardiopulmonary, addiction, oncological, and nutritional assessments. Practices were compared across three clinical scenarios: outpatients (OutPat), hospitalized decompensated patients without ACLF (Hosp), and patients with ACLF admitted to intensive care units (ACLF-ICU). In parallel, we retrospectively evaluated post-transplant outcomes in patients with cirrhosis and severe ACLF transplanted in two high-volume centers. Fifty-three centers (96%) responded. Cardiological stress testing was reported in 2% of ACLF-ICU patients vs. 21% of OutPat (p = 0.002) vs. 17% of Hosp patients (p = 0.008). Coronary angiography following abnormal non-invasive testing was less frequently performed in ACLF (42%) than in OutPat (76%, p = 0.0004) or Hosp patients (66%, p = 0.01). Alcohol abstinence requirements were more often decided on a case-by-case basis in patients with ACLF (62%) than in OutPat or Hosp patients. Oncological screening, including colonoscopy and ear, nose, and throat consultation, was also less frequently performed in ACLF-ICU patients. Median time from assessment initiation to listing was 7 days in ACLF-ICU vs. 45 days in OutPat and 18 days in Hosp patients (both p <0.0001). In the retrospective cohort (n = 221), patients listed after ACLF onset had a higher 1-year incidence of cardiovascular events than those listed before ACLF onset (19% vs. 9%). In ACLF-ICU patients, pre-transplant evaluation is markedly abbreviated, with critical gaps-particularly in cardiological assessment-highlighting the need for dedicated, evidence-based guidelines. We sent a questionnaire to centers with an expertise in the management of patients with ACLF to assess current practices in pre-transplant evaluation in patients with ACLF admitted to an intensive care unit, as compared with patients without (outpatients and patients hospitalized in a regular ward). According to the responses from 53 centers, cardiological stress test and coronary angiography were less commonly performed as part of the pre-transplant evaluation in patients with ACLF admitted to the ICU, as well as colonoscopy and ear, nose, and throat consultation. Median timeframe from pre-LT workup initiation to listing was 7 days in patients with ACLF admitted to the ICU, which was significantly shorter than in patients without ACLF. These results suggest that pre-transplant workup is abbreviated in patients with ACLF, and might have an impact on post-transplant outcome, especially cardiovascular complications. Further dedicated studies are needed to specifically address the relation between pre-transplant workup and post-LT complications in patients with ACLF.