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

📢 Are you involved in solid organ #transplantation?? We need your contribution‼️ ESOT launched a survey to better understand current clinical practice in managing CMV in recipients of solid organ #Tx, aimed to support the development of a consensus document in this field. Participation includes: ⏱️ short 5' registration survey 🎯 few qualifying questions 🖋️ 30-40' full survey Interested?? Register at 🔗 cmvsurvey2026.com ⏰ deadline to register April 8, 2026 All responses are confidential. Participants remain anonymous unless they explicitly consent to be identified. @LuPoten

Now in full PDF format! doi.org/10.1016/j.yjca…

The Dr. Bartlett legacy 24-hour virtual summit continues! LATAM & APELSO Chapters celebrated Dr. Bartlett! Now SWAAC ELSO is on stage, the EuroELSO will conclude the meeting! Watch live on our Youtube Channel 🎥 @TheELSO" target="_blank" rel="nofollow noopener">youtube.com/@TheELSO

Sweep gas nitric oxide during #ECMO in neonates and children, NECTAR pilot randomized controlled trial to test the feasibility & safety of a RCT delivering NO into SGF (sNO) in critically ill children, and its influence on outcomes: 🔍 53 children from birth to 16 years requiring VA or VV #ECLS underwent randomization (2020–2023): SGF with O2/N mix vs O2/N + sNO (20 parts per milliion)  ⚖️ median survival free of ECMO and free of PICU similar 🩸 blood product use, circuit duration to replacement, fHb, degree of ML thrombosis, incidence of methemoglobinemia similar between 🚧 no major adverse events occurred related to the treatment allocation or intervention Trial is safe and feasible, but no detectable clinical benefit of sNO over standard care was detected; data do not support implementing sNO as routine treatment in this population. A larger, definitive trial of NO during ECMO seems unwarranted at this stage, until optimal NO dosing and route of delivery is further explored. 🔗 bit.ly/4cJmRfm

Major haemorrhage, transfusions & anticoagulation in VA #ECMO for cardiogenic shock, OBLEX study: 🔍 545 pts/12 centers 3, subgroups: #ECPR, PC, CS 🪦 hospital mortality 46% 🩸 52% pts had major bleedings, for ⬆️ PC/ECPR 🩸 88% received RBCs, ⬆️ for PC/ECPR 🩸 PLT transfusion rates highest in PC group Hemorrhagic risk in VA ECMO is complex! RBC transfusion exposure is by far higher than in other critically ill populations. ECPR and antiplatelets act as additional risk factors. Transfusion practice for variable and does not always follow international guidelines. #FOAMcc #FOAMecmo @Crit_Care 🔓 rdcu.be/e70k0

Pulmonary hemodynamics in #ARDS pts undergoing VV #ECMO? Pulmonary hypertension highly prevalent, reflecting underlying disease severity: 🫁 independent determinants of higher mPAP included intrapulmonary shunt fraction, lower venous pH, higher PAOP, increased PEEP, reduced respiratory system compliance, and longer run 🫁 higher PVO2 & SVO2 associated with lower mPAP 🪦 early upward trajectories in mPAP, rather than initial value, independently predicted higher mortality Invasive pulmonary hemodynamic monitoring may provide relevant pathophysiological and prognostic insights in selected patients at higher risk of RV dysfunction or with early signs of RV failure #FOAMcc #FOAMecmo @Crit_Care 🔓 rdcu.be/e7Dof

#ECMO without systemic anticoagulation: are we there yet? Before trying to adopt anticoagulation-free ECMO, some important factors need to be considered: 🩸 adults in VV for ARDS probably safest population... smaller pts, with lower EBF (ie small children/infants) are at high thrombosis risk 🩸 VV & VA have different impact of thrombotic complications: VA at greater risk Novel circuit coatings, emerging strategies as NO in SGF or novel anticoagulants hold the promise of reduce risks. Meanwhile, anticoagulation-free ECMO should be regarded as exception, maybe safe in some highly selected adults on VV with relatively high blood flows. Editorial @CritCareMed 🔗 bit.ly/4u6yqUd 🩸 Refers to study investigating association between systemic anticoagulation & outcomes in #ARDS patients receiving VV #ECLS. Authors observed no link between systemic anticoagulation and short-term survival. 🔗 bit.ly/3P1pkrv

Antimicrobial stewardship in #ECMO? Challenging & evolving discipline, with limited data available! 🧫 infections & 🧪 infection biomarkers during #ECLS 💉 PK/PD & appropriate antimicrobial dosing 💉 ABT prophylaxis in ECMO: yes or no? 🔮 empirical antimicrobials and circuit/cannula change 🩺 ABT and diagnostic stewardship in ECMO 🚧 infection control strategies The prominent PK alterations induced by circuits + prolonged ICU stays + high infection risk make optimal ABT therapy complex. Evidence for use of stewardship in #ICU patients remains applicable to those receiving ECMO. 🔗 bit.ly/4cXVzlj

Understanding lung physiology through ventilator screen 🫁 airway pressure waveform at a glance: respiratory system equation of motion, conductive pressure, stress index, driving pressure 🌊 flow waveform during pressure-controlled ventilation 💨 expiratory flow and the time constant of the respiratory system 🛌 dynamic bedside maneuvers: airway opening pressure, recruitability & recruitment-to-inflation ratio 🚧 the way forward #FOAMcc 🔓 rdcu.be/e6iG6

Prolonged VA #ECMO? Characterizing patients requiring long run: 🔍 29% pts in PRECISE-ECLS cohort underwent prolonged #ECLS (> 7 days) 🔎 at 1 y, mortality + HRQoL comparable for 7 days or longer support Patients with prolonged run represent highly selected but heterogeneous group. A prediction model including baseline variables + parameters reflecting first week clinical trajectory showed moderate performance in predicting long term mortality for those still on ECMO at day 7, and may assist in decision-making regarding treatment goals beyond the first week. #FOAMcc @Crit_Care 🔓rdcu.be/e6gIm

The evolution of deceased organ donation in 🇺🇸 📋 historical & legal framework 🔍 donor epidemiology ⚖️ policy modernization 🩸donor evolution in the era of perfusion & preservation: NRP, NMP, HOPE 🔮 implications and future directions As modernization initiatives unfold, alignment between technology adoption, transparent data reporting, equitable allocation will be essential. Ultimately, these developments can ethically expand donor opportunities and transform organ donation from a finite model of scarcity into an abundant, technology-enabled continuum of care. 🔗 bit.ly/3MLW1IV

Argatroban in patients with #ECMO? Pilot RCT 🇦🇹 💉 pts received bolus of 50-100 IU/kg UFH upon cannulation + continuous UFH 5-10 IU/kg/h targeting anti-Xa 0.2-0.3 IU/ml ⚖️ 1:1 received argatroban (starting 0.2 µg/kg/min targeting hemoclottm 0.6-0.8 µg/ml) or continued UFH 🫁🫀same targets for VV and VA #ECLS; 90-day survival 77% for VV, 72% for VA 🩸no difference in incidence/time to event regarding bleeding events and thrombosis 🩸transfusion requirement for pRBCs/PLTs similar #FOAMcc #FOAMecmo 🔓 bit.ly/4szm05J

Advanced #ECMO workshop joint with @EuroELSO in beautiful Padua... Thanks to the course directors @AmigoniAngela, @LucaMarchetto4 & @AlviseTosoni for inviting me to talk about #ECLS as a bridge to organ donation!

Despite increasing ECMO use there is little understanding of how #ECLS candidacy is considered. Here, study highlighting that determining VV #ECMO candidacy may be based on gestalt + different interpretations of data NOT to objective guidelines or criteria... Institutional cultures + experience, team dynamics, patient factors might lead to significant inter-clinician differences in judgements of suitability. Collecting data on candidacy decisions pivotal! by bit.ly/rubin-lab on @AnnalsATS 🔓bit.ly/3OtMV46

2026 guideline for evaluation & management of acute pulmonary embolism in adults @AHAScience @ACCinTouch ACCP @ACEPNation @accpchest @SCAI SHM @SIRspecialists @SVM_tweets @vascularnurses 📋 definitions and classifications 🩺 evaluation and diagnosis 🩸 acute management 🖥️ monitoring and follow-up 🚧 complications and sequelae 🔍 evidence gaps and future directions Including recommendations on the use on #ECMO support (summarized below): 🫀 in patients with acute, refractory cardiogenic shock due to known/suspected acute PE (category E2), it is reasonable to institute VA ECMO, if appropriate resources are available, to stabilize hemodynamics + improve oxygenation. While on ECMO, continuation of IV systemic anticoagulation is recommended (if no bleeding) to prevent further thrombotic or embolic complications. In these patients, the usefulness of additional advanced therapies is not well established. 🚑 for patients with acute PE hemodynamically stable but at high-risk (categories C3-D), transferring to a center that can provide advanced therapies, including ECLS, may be considered to ensure access to appropriate interventions 💉in patients with acute PE (categories C-E) who require sedation for intubation, hemodynamic supportive therapies (vasopressors, inotropes, and/or ECMO) should be available in the event the patient becomes unstable Open access #FOAMcc @CircAHA 🔓 bit.ly/4tNACzF or @JACCJournals 🔓 bit.ly/4b0JZoe

The 2026 @ISHLT consensus statement on clinical cardiac xenotransplantation: 📖 2000 consensus & original recommendations of Xeno #transplantation Advisory Committee 🐖 immunology of pig-to-human xenotransplantation 🐒 preclinical models: state-of-the-art, issues & challenges 🫀human cardiac xenotransplantation experiences 🩺 surgical, anesthesiologic, periop considerations 💉 immunosuppression in human xenotransplantation 🔬 immune monitoring and pathology after xenotransplantation 🧫 infectious disease considerations 🫀 cardiac xenotransplantation in children ⚖️ regulatory challenges in xenotransplantation 📋 consensus statements @TheJHLT 🖇️ bit.ly/4rzqqcG

⚙️ #ECMO continues to evolve: education remains foundation of safe, effective care! Join us at ELSO & @SCCM Pre #SCCM2026 course for two exceptional 1️⃣ day programs to strengthen clinical understanding & decision-making 📌 Chicago, IL 📅 March 20 & 21 🔗 bit.ly/49nEhL5

Integrating #CRRT into ex-situ normothermic liver machine perfusion? To ⚖️ support solute clearance vs accumuling metabolic waste, electrolyte imbalances, inflammatory mediators 💦 reduce risk of tissue edema maintaining stable perfusion dynamics and improving graft function during extended NMP periods. Here, reproducible & safe method to connect CVVHDF into NMP independently from main perfusion circuit + how to prime, monitor & manage. 🖇️ bit.ly/4roiMS2

Too much of a good thing? on hyperoxemia in acute brain injured patients: 🧠 hypoxic-ischaemic encephalopathy 🧠 other acute brain injuries How to balance competing risks of hypo vs hyperoxemia? While hypoxemia must be vigilantly avoided, accumulating data suggest that excessive O2 exposure may contribute to secondary brain injury, with observational studies consistently linking hyperoxemia with worse outcomes (even if trial results remain mixed). Optimal systemic oxygenation strategy in brain-injured #ICU patients remains one of most important unanswered questions in critical care; moreover definition of hyperoxia in terms of PaO₂, FiO₂ should be better clarified. #FOAMcc 🔓 rdcu.be/e4wuW

#ECMO center volume: any association with #ECLS related complications?? 🔎 analysis of @ELSOOrg Registry, 2018-2021 🫁 >9.4K adults underwent VV; average annual center-volume 74 🫀 >10.7K VA; average volume 80 🚑 >3.5 #ECPR; average volume 89 Higher volumes associated with ⬇️ hemorrhagic complications for VA & VV, ⬇️ pulmonary complications for VV, ⬆️ mechanical complications for VA (not ECPR). Higher volume may lead to ⬆️ experience which may translate to ⬆️ vigilance = early detection of ECMO complications, but also to initiation within larger, more complex patient population. @CritCareMed 🖇️ bit.ly/3MP3mr1