M Velia Antonini

TA #NRP in cDCD heart donors using closed #ECMO circuit, modified to provide 🩸🌡️effective NRP despite prolonged fWIT 🫀LV venting 🫀 fast conversion to central configuration as needed ⭕️ shunt for recirculation 🫧 air management #FOAMcc @asaiojournal 🔓bit.ly/TANRPasaio TA-NRP using fully mobile, closed #ECLS circuit could be safe strategy to support combined thoracic/abdominal organs recovery also in peripheral centers without cardiac surgery program, contributing to the expansion of DCD programs, increasing availability/quality of grafts, improving recipients’ outcome. @ESOTtransplant @gabriel_oniscu @LuPoten @Unibo @AUSLRomagna

We got 2 abstracts accepted for #ELSO2026, 37th conference of @ELSOOrg 🫁 Extracorporeal support before and beyond failure: #ECMO use in thoracic surgery ⚠️ Characterizing adverse events and complications associated with normothermic regional perfusion in DCD donors Particularly honoured as these are the first abstracts drafted with my new team at @OspedalePadova !! Can't wait to present in Nashville 🎶 in September! 🖇️ bit.ly/ELSO2026

Simple monitoring strategy to help recognizing readiness for weaning during peripheral VA-ECMO?? 🖥️ bilateral radial A-lines: pressure concordance (left–right SBP difference < 10 mmHg, small MAP/DBP differences, similar waveform amplitude/morphology) + concordant ABG values = similar arterial blood source? 🖥️ strong association with LVOT VTI  meeting threshold used for weaning assessment Emergence of left radial pulsatility + bilateral radial pressure-gas concordance may serve as low-invasive, real-time bedside marker to facilitate early recognition of cardiac recovery, prompting formal #POCUS assessment (rather than stand-alone marker). #FOAMcc #FOAMecmo @Crit_Care 🔓 rdcu.be/ftBoJ

Pediatric controlled donation after circulatory determination of death Bucharest international @ESOTtransplant consensus 🕯️ avoiding missed opportunities: normalization of integrating donation into #PedsICU end-of-life 🩺 donor identification & assessment for suitability ⚖️ decisions about pcDCDD and approach to communication about pcDCDD: obtaining consent for pcDCDD/antemortem interventions for patients that have never expressed a valid intent to donate ⏱️ ante-mortem interventions for pcDCDD There are substantial and differing barriers across countries (ie clinical, legal, ethical issues), but pcDCDD programs may be developed in varied international settings, if explicitly supported by robust administrative and legal frameworks. Open access #FOAMcc on @Transpl_Int 🔓 bit.ly/44nQPQE

Distal limb perfusion in peripheral VA #ECMO and minimally invasive cardiac surgery with femoral arterial cannulation?? 🔬 in vitro study evaluating flow/pressure of sheaths with side ports (widely used) vs catheter w/o side port 🩸 flow augmentation limited primarily by resistance at side port; catheters w/o side ports exhibit more linear pressure-flow relationship without saturation 🩸 catheters w/o side ports potential alternative when conventional devices provide insufficient limb perfusion 🩸 side port accounted for majority of pressure loss: likely dominant role in limiting antegrade flow. This may explain why DPCs may fail to resolve limb ischemia. @asaiojournal 🖇️ bit.ly/4fhASRc

Contemporary #extracorporeal cardiopulmonary resuscitation programs for refractory cardiac arrest 🔑 key features of #ECPR programs ⚖️ appropriate patient selection 🚑 response system & cannulation model/methods 🩺 team composition 🎓 training programs and education Several aspects are consistent across countries, but #ECMO protocols may be extremely variable. Here, narrative review exploring current global practices, and identifying opportunities for standardization while recognizing elements that should remain context specific #FOAMcc #FOAMecmo @FrontiersIn 🔓 bit.ly/3RqXzKz

60 years of #ARDS and the evolution of extracorporeal lung support, from #ECMO to #ECCO2R 📚 history of #ECLS in ARDS, from emergence to pandemics 🔍 randomized evidence for ECLS in severe ARDS 🚑 selection and transport of ECLS candidates 🩺 management of ARDS patients during ECLS ⚠️ complications of ECLS in respiratory failure 🔭 long-term outcomes and survivorship after ECLS 🔮 the future of ECLS for ARDS #FOAMcc #FOAMecmo 🔓 rdcu.be/fszcS

#ECPR for refractory cardiopulmonary arrest occurring after major after cardiac surgery 🔍 institutional experience including adults who underwent #ECMO for CA within 30 days after major cardiac surgery outside OR, 2015 - 2023 🩸 42.9% underwent central cannulation with open chest, 57.1% femoral cannulation ⚖️ 57.4% successfully decannulated, 42.6% died on #ECLS; in-hospital mortality 47.6% (similar between central vs peripheral cannulation); 1 year survival 41.2% 🧠 33.3% neurologically intact at discharge @asaiojournal 🖇️ bit.ly/4vib0dI

Multisite cannulation for VV #ECMO in neonates & infants with respiratory failure: 🔍 ELSO Registry analysis, 2013-2023 💨 VVMS vs VVDL associated with higher SaO2 + 🩸 blood flows at 24 hours in neonates/infants ⚖️ in infants, VVMS vs VVDL associated with fewer mechanical complications (23% vs. 37%) ⚖️ no association between cannulation technique and complications or mortality of VVMS vs dual lumen #FOAMcc #PedsICU @PedCritCareMed 🔓 bit.ly/4eEU5gs

#ECMO Unfiltered: come ready to challenge at #ELSO2026 pre-conference on Sep 28 📆 ! 🔦 Highlights: real debates, real cases, real progress: a day of interacting with pediatric/adult ECMOlogists. You’ll vote, debate, question, rethink. 📌 Nashville, TN 🖇️ bit.ly/ELSO2026

Nitric oxide in #ECMO sweep gas may promote membrane lung longevity and maintain performance! Technical case reporting preserved function of ML in the setting of a prolonged #ECLS. A single ML functioned effectively for 5 months. This (first known) structural evaluation of PMP ML postdecannulation revealed no thrombus or fibrin deposition after prolonged clinical use with sNO. @asaiojournal 🖇️ bit.ly/4vcjYJj Additional details at 🖇️ bit.ly/4ewkz3C

#ECMO for patients with obesity, evidence & practice 🩺 epidemiology and physiological considerations 🩸 pharmacology, anticoagulation, hemostasis 🫁 VV #ECLS for respiratory failure in patients with obesity: patient selection, timing of initiation + specific considerations for cannulation/management, outcomes 🫀 VA ECMO for circulatory failure & ECPR: patient selection, timing of initiation, challenges and outcomes ⚖️ ethical, logistical, and resource considerations 🩺 strategies to improve care and research gaps #FOAMcc #FOAMecmo 🔓 rdcu.be/fq35I

Our latest in @JCVAonline: We know peri-surgical patients have lower thresholds for ECMO. Using survey data, we found that *processes* are similar in SICUs vs. MICUs, suggesting that discrepancies may emerge at the clinician level. jcvaonline.com/article/S1053-… Our lab info ⤵️

Ethical dilemmas & complexities in pediatric #ECPR: qualitative study aimed to explore multidisciplinary perspectives using semi-structured interviews. 📋 five major themes identified, including 1️⃣ informed consent; 2️⃣ decision-making authority; 3️⃣ past experiences; 4️⃣ end-of-life care; 5️⃣ resource allocation Perspectives often differ, particularly around consent, decision-making, resources. Interprofessional #ECMO providers involved in the study were motivated by professional virtues. Centers could consider applying a virtues-based ethical framework to facilitate team discussion. @PedCritCareMed #PedsICU 🖇️ bit.ly/4vz8fFJ

📊 #ECLS Common Data Model, ECLS CDM, open-source expansion to the Observational Medical Outcomes Partnership Common Data Model! New model, specifically designed to enable capture + processing of data collected in context of #ECMO support. Model is freely available as open-source project. 🖇️ bit.ly/4oIhp04

Neonatal & pediatric #ECPR survey all centers activated ECPR teams within 10' of starting conventional CPR 💦 64% centers keep a primed circuit available 24/7 📋 68% centers have an institutional ECPR protocol; staffing varied working hours vs nights/weekends 🫀 cardiac surgeon most common (94%) cannulator 🧊 71% centers did not apply cooling 💨 oxygenation/CO2 strategy varied upon initiation 🧠 44% centers have guidelines on OD/follow-up Significant variations exist in clinical practice + organizational systems in #ECLS centers offering neonatal and pediatric ECPR. Lack of high-quality evidence and well-established guidelines are key contributing factors. Limitations in resources, including staffing, equipment, training, affect the ability to provide consistent pediatric ECPR services at all times. @asaiojournal #PedsICU 🖇️ bit.ly/4ad1ssR

Venopulmonary #ECLS, ELSO Registry analysis: 🫀🫁 indications: heart failure/CS 54.4%; acute respiratory failure/#ARDS 26.6%; PC shock 6.7; ACS/ischemic heart disease 5.3%; valvular disease/complications of intracardiac devices 4.2%; PE 2.9% 🚧 common adverse events included need for #CRRT or AKI, infections, arrhythmias, bleedings Hospital outcomes, complications, survival differed according to the diagnosis leading to VP #ECMO use. Younger age, male sex, lower BMI, and no CRRT use prior to cannulation confer a lower risk of death. @TheJHLT 🖇️ bit.ly/4uRqTrr

#ECLS in adult critically ill pts, modes & mechanisms of benefit in different pathophysiological states: 🫁 respiratory: bridge to lung recovery + mitigating RV injury in in #ARDS, BTR in life-threatening airflow limitation, BT lung #transplantation + post-Tx recovery 🫀 cardiac #ECMO: bridge to myocardial recovery, bridge to heart or lung Tx + post-Tx recovery, #ECPR 🫀🫁 cardiorespiratory: bridge to lung + myocardial recovery in ARDS, BT LTx and post-Tx recovery 🩺 bridging mechanisms & clinical heterogeneity 🚧 limitations of ECLS Beyond simple gas exchange/circulatory support, ECLS stabilizes cardiorespiratory function and preserves end-organ perfusion serving as a bridge to recovery or definitive therapy. However, relative contribution of these mechanisms remains incompletely defined across clinical contexts and configurations. @ATSBlueEditor 🖇️ bit.ly/3Sk7D8m

Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Disease WE-ROCK #ECMO study aimed to study kidney-centric practices and outcomes in critically ill children: 🫘 💦 >1.2K patients 0-25 years treated at 43 centers across 10 countries included = largest international investigation of kidney and fluid-related variables in pediatric #ECLS, providing critical insight into practice variation and the relationships among #AKI, FA, #CRRT, clinical outcomes, establishing a foundation for future interventional trials. @asaiojournal #PedsICU 🖇️ bit.ly/4vlQJF9

Characterization of multiple organ dysfunction for children on #ECMO ⏱️ OD calculated in 24 hour intervals using PODIUM criteria, Pediatric SOFA and PELOD-2 scores ⚖️ starting as early as the day of cannulation, an accumulation of more ODs developed in non-survivors vs survivors; difference persisted throughout run and widened after decannulation 🔍 there may be opportunities to investigate and intervene on risk factors in peri-cannulation period that may affect trajectory of MOD so in-hospital mortality #PedsICU @asaiojournal 🖇️ bit.ly/4gmBSW3

📖 Bob Bartlett: Clinician, Researcher, Friend. Dr. Bartlett’s memoir traces defining moments of a life shaped by curiosity, resilience, enduring commitment to learning. He reveals stories that shaped his path 📓 Free PDF bit.ly/4vSdcti 📓 Printed elso.org/publications.a…