The Journal Of Extra-corporeal Technology[JOURNAL]
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200 papers
A comparative study of the effect of slow and rapid initiation of cardiopulmonary pump on tissue oxygenation index and ischemic complications.
Bagherinasab M, Rezaei S, Moradi AR … +4 more , Jabbari A, Noori A, Archer Z, Darban NH
J Extra Corpor Technol · 2026 Mar · PMID 41823492 · Full text
INTRODUCTION: Although the use of the heart-lung machine (HLM) is routine in cardiac operating theaters, there is still a lack of evidence-based guidelines concerning the optimal speed to reach full flow during initiatio...
INTRODUCTION: Although the use of the heart-lung machine (HLM) is routine in cardiac operating theaters, there is still a lack of evidence-based guidelines concerning the optimal speed to reach full flow during initiation to reduce critical episodes of cerebral ischemia. Therefore, we have designed a study to compare two distinct initiation times for the commencement of cardiopulmonary bypass (CPB). METHODS: We conducted a randomized, monocentric, double-blind, prospective study to assess the impact of two different CPB initiation speeds - rapid initiation at 30 s and slow initiation at 180 s - on cerebral tissue oxygenation (TOI via NIRS), arterial oxygen pressure, hematocrit (HCT) variation, and the incidence of postoperative delirium. The target flow rate was set at 2.4 L/min/m, with adjustments made according to the patient's body surface area. RESULTS: The absolute values of the tissue oxygenation index (TOI) and HCT showed no differences between the study during the first 180 s following commencement of CPB. Patients in the fast group exhibited significantly lower arterial oxygen pressure at the initiation of the (P < 0.05). Additionally, patients in the fast group experienced a higher incidence of delirium in the second and third days following surgery. While clinically relevant, the elevated incidence of delirium fell short of being statistically significant, with post-operative days 2 and 3 having P-values of 0.06 and 0.08, respectively. CONCLUSION: The results of this study indicate that, despite the absence of a significant difference in TOI between the study groups, patients in the slow group exhibited a not statistically significant trend for a lower incidence of delirium, as defined by CAMICU-7, in comparison to those in the fast group.
Initiating cardiopulmonary bypass using a dry venous line: implications and analysis.
Benedict T, Brownlee R, Foley C … +4 more , Hoyer N, Dell'Aiera L, Dooley M, Fitzgerald D
J Extra Corpor Technol · 2026 Mar · PMID 41823491 · Full text
BACKGROUND: Autologous priming of the cardiopulmonary bypass (CPB) circuit is a critical technique for reducing hemodilution during cardiac surgery. Vacuum-assisted venous drainage (VAVD) offers access to an alternative...
BACKGROUND: Autologous priming of the cardiopulmonary bypass (CPB) circuit is a critical technique for reducing hemodilution during cardiac surgery. Vacuum-assisted venous drainage (VAVD) offers access to an alternative method using a dry venous line, aiming to reduce hemodilution associated with crystalloid priming. METHODS: This study investigates the impact of initiating CPB with a dry venous line on gaseous microemboli (GME) production, compared to a traditional primed venous line in an adult CPB circuit. Using a controlled experimental setup with an oxygenator featuring an integrated arterial filter, we examined GME counts and sizes throughout the circuit under varying VAVD pressures and initiation techniques. RESULTS: Results show that higher VAVD pressures and the immediate initiation of CPB correlate with increased GME production post-oxygenator. Statistical analysis reveals significant differences in GME counts and sizes between control and experimental groups. CONCLUSION: The statistical differences in GME size and count observed between initiation types and pressures emphasize the importance of optimal CPB initiation strategies to minimize GME transmission. These findings underscore the need for further research to refine CPB techniques and enhance patient safety in cardiac surgery.
Evaluation of bivalirudin-based anticoagulation for extracorporeal membrane oxygenation, including patients with COVID-19.
Raguindin M, Bardsley C, Bast C … +3 more , Sugrue D, Kazmi H, Milkovits A
J Extra Corpor Technol · 2026 Mar · PMID 41823490 · Full text
BACKGROUND: Although unfractionated heparin (UFH) has traditionally been used for anticoagulation during extracorporeal membrane oxygenation (ECMO), bivalirudin may be preferred due to fewer complications. A prior medica...
BACKGROUND: Although unfractionated heparin (UFH) has traditionally been used for anticoagulation during extracorporeal membrane oxygenation (ECMO), bivalirudin may be preferred due to fewer complications. A prior medication use evaluation of ECMO patients who received bivalirudin resulted in dosing updates for our pharmacist-directed bivalirudin protocol. This study intended to evaluate the efficacy and safety of bivalirudin for anticoagulation during ECMO support post-protocol initiation. METHODS: This was a retrospective, single-center, pre-post study. Adult patients requiring ECMO support for at least 24 h and who received bivalirudin between January 1, 2015 to July 31, 2018 (pre-group) and May 1, 2019 to June 30, 2021 (post-group) were included. RESULTS: There were 38 patients in the pre- and 35 patients in the post-group. The primary outcome, median time to two consecutive activated partial thromboplastin times (aPTTs) within therapeutic range for the initial goal range, was 8.9 h in the pre- and 14.2 h in the post-group (p = 0.517). In a subgroup analysis of the post-group, the primary outcome was higher in patients with COVID-19 (26.5 vs. 8.6 h, p = 0.018). The median number of dose adjustments to achieve goal aPTT was higher in COVID-19 patients (4 vs. 2, p = 0.017). CONCLUSION: These results suggest that a standardized pharmacist-directed protocol for bivalirudin in ECMO achieves timely therapeutic anticoagulation levels. Patients with COVID-19 trended toward longer times to two consecutive therapeutic aPTTs. Further studies are needed to evaluate dosing strategies in patients with and without COVID-19.
A bedside staffing model with perfusionists for pediatric extracorporeal membrane oxygenation (ECMO) at a high-volume center★.
Nemeh C, Cain-Trivette C, Schmoke N … +9 more , Varner C, Brewer M, Clark E, Ream H, Vargas Chaves D, Choudhury T, Stylianos S, Middlesworth W, Cheung EW
J Extra Corpor Technol · 2026 Mar · PMID 41823489 · Full text
BACKGROUND: Extracorporeal membrane oxygenation (ECMO) in pediatric patients requires monitoring by specialists to optimize outcomes. Practice variability exists among pediatric ECMO centers across the country. We presen...
BACKGROUND: Extracorporeal membrane oxygenation (ECMO) in pediatric patients requires monitoring by specialists to optimize outcomes. Practice variability exists among pediatric ECMO centers across the country. We present a bedside pediatric ECMO staffing model with perfusionists that combines personnel expertise and technology. METHODS: At our institution, ECMO care is provided in three intensive care units across one floor. Our primary bedside ECMO provider consists of pediatric perfusionists who provide 24/7 coverage of ECMO patients via remote monitoring and hourly bedside rounding. Neonatal and pediatric ECMO patients are supported using the Cardiohelp System, which uses Spectrum Medical Quantum Elite Workstation and Variable Input Patient Electronic Records (VIPER) software that remotely delivers ECMO circuit parameters and alarms digitally to a monitor in a workroom and mobile devices. ECMO education and skills are reinforced via dedicated didactic and simulation sessions by an ECMO program coordinator. We compared institutional complication rates to other centers tracked by ELSO. RESULTS: From 2017 to 2023, 289 cannulations were performed, consisting of a total of 62,742 cumulative ECMO hours, of which 92% of that time there were simultaneous ECMO patients. This rounding model has institutional mortality and complication rates that are comparable to ELSO rates. CONCLUSION: We describe a bedside ECMO staffing model with perfusionists, in contrast to ECMO specialists seen at other institutions. The complication and mortality rates are comparable to ELSO rates, suggesting the safety of this model. Further exploration regarding resource utilization and costs is warranted.
Is continuous in-line blood gas monitoring reliable during cardiopulmonary bypass when PaO and PaCO are calculated rather than measured?
Lee MH, Rosenthal T
J Extra Corpor Technol · 2026 Mar · PMID 41823488 · Full text
BACKGROUND: The accuracy and precision of continuous in-line blood gas monitoring (CILBGM) are crucial for optimal blood gas management during cardiopulmonary bypass (CPB) and improved patient outcomes. CILBGM devices, s...
BACKGROUND: The accuracy and precision of continuous in-line blood gas monitoring (CILBGM) are crucial for optimal blood gas management during cardiopulmonary bypass (CPB) and improved patient outcomes. CILBGM devices, such as the CDI 500/550 system, measure PaO and PaCO and B-Capta measures PaO through direct contact with arterial blood. However, the Quantum perfusion system with Quantum Ventilation (Quantum System) does not measure but calculates PaO and PaCO using several non-invasive sensors and proprietary formulas. We have observed that the calculated in-line PaO and PaCO values from Quantum System are frequently significantly higher than those obtained from iSTAT, a point-of-care blood analyzer, exceeding acceptable targets. METHODS: We conducted a retrospective study involving 81 patients who underwent cardiac surgery using the Quantum System with its own CILBGM and the FX05 oxygenator. The aim was to identify the degree, timing, and possible patterns of error of the calculated in-line PaO and PaCO. RESULTS: Our study showed that the errors of calculated in-line PaO exceed the acceptable target at the 1st blood gas series and during the rewarming and rewarmed periods, correlating with patient weight. The calculated in-line PaCO exhibited an upward drift during the rewarming period, correlating with the temperature gradient rather than patient weight. Based on several correlations identified, we derived a formula to predict FiO based on patient weight, which would achieve the target PaO at the 1st blood gas series when using the FX05 oxygenator. CONCLUSION: We identified when and how the errors in calculating in-line PaO and PaCO occurred and developed several recommendations to minimize significant deviations from actual PaO and PaCO during CPB. Our results suggest that achieving acceptable PaO and PaCO calculations throughout CPB using a single universal formula for each, embedded in the Quantum System, is challenging due to the variety of oxygenators available, different patient sizes, and changing conditions during CPB.
Incidence and pathophysiology of gastrointestinal bleeding during mechanical circulatory support: A retrospective analysis using machine learning algorithms.
Gore K, Linder D, Duque JJM … +5 more , Wang J, Rudnicki C, Alexis Ruiz A, Yockelson S, Nossaman B
J Extra Corpor Technol · 2026 Mar · PMID 41823487 · Full text
BACKGROUND: End-organ hypoperfusion from cardiopulmonary shock may require mechanical circulatory support (MCS). However, patients receiving MCS risk the development of hemorrhagic complications, including gastrointestin...
BACKGROUND: End-organ hypoperfusion from cardiopulmonary shock may require mechanical circulatory support (MCS). However, patients receiving MCS risk the development of hemorrhagic complications, including gastrointestinal bleeding (GI). Examining potential risk factors for these complications improves clinical understanding. The purpose of this investigation was to study the risk for GI bleeding in MCS patients. METHODS: Following IRB approval, patient characteristics, previously reported comorbidities, and the incidence of GI bleeding were reviewed from January 2017 to October 2023. Clinical variables underwent machine learning with autovalidation. Support vector machine modeling provided the best performance among the ensemble models tested. RESULTS: In this study of 156 patients who underwent 284 MCS procedures, the incidence of GI bleeding was 6.0% CI 3.3-10.4%. Following machine learning, patients with insulin-dependent diabetes were associated with GI bleeding. The Receiver Operating Characteristic (ROC) curve demonstrated an area under the curve (AUC) of 0.85 with a misclassification rate of 7.5%. The relative risk of the need for major transfusion (>2 packed red blood cell units/episode) was 1.7 CI 1.1-2.5. The majority (87%), but not all, of these patients received unfractionated heparin therapy. Finally, hospital length of stay was increased in patients with GI bleeding. CONCLUSION: Insulin-dependent diabetes was associated with increased risk for GI bleeding during MCS, and these patients more often required major transfusions. Further evaluation of continuous anticoagulation therapy is warranted. Knowledge derived from this analytical study may guide the development of institutional protocols to improve care in this patient population.
Impact of early hyperoxia on outcomes during neonatal and pediatric veno-arterial extracorporeal life support★.
Saini A, Shamah R, Qian J … +8 more , Keane-Lerner K, Morales PR, Nayi P, Shyam A, Davis J, John M, Viamonte H, Beshish AG
J Extra Corpor Technol · 2026 Mar · PMID 41823486 · Full text
BACKGROUND: Hyperoxia induces oxidative stress and can exacerbate inflammatory response to Veno-Arterial Extracorporeal Life Support (VA-ECLS). This study aimed to evaluate the association between hyperoxia during VA-ECL...
BACKGROUND: Hyperoxia induces oxidative stress and can exacerbate inflammatory response to Veno-Arterial Extracorporeal Life Support (VA-ECLS). This study aimed to evaluate the association between hyperoxia during VA-ECLS and morbidity, complications, and in-hospital mortality. METHODS: This study included pediatric patients who received VA-ECLS between 2014 and 2019. Hyperoxia severity was categorized as mild (PaO: 101-200 mmHg), moderate (PaO: 201-300 mmHg), and severe (PaO > 300 mmHg. The primary outcome was all-cause in-hospital mortality. Secondary outcomes included a composite measure of cardiovascular or renal complications, AKI, and change in Functional Status. RESULTS: Among 229 patients supported on VA-ECLS runs, 73.4% involved neonates. Median age and weight of the entire cohort were 2.5 months (IQR 0.3, 19.0), and 4.4 kg (IQR 3.2, 10.7), respectively. Cardiac indications accounted for 48.9% of cases. Hyperoxia occurred in 79% of patients and was more common in those requiring ECLS for cardiac indications. The overall in-hospital mortality rate was 45%, increasing to 64% in the severe hyperoxia cohort (p = 0.23). Severe hyperoxia was significantly associated with the composite outcome of cardiovascular or renal complications but not in-hospital mortality in multivariable analysis. No association was found between hyperoxia, AKI, and adverse functional outcomes. CONCLUSIONS: Standardized PaO targets to minimize hyperoxia may improve outcomes for patients supported on VA-ECLS.
The effect of surgical field suction flow rate and venous reservoir levels on gaseous microemboli transmission⋆.
Rath T, Sugden M, Evans E … +4 more , Dana K, Rentschler M, Bolch C, Darban NH
J Extra Corpor Technol · 2026 Mar · PMID 41823485 · Full text
BACKGROUND: Minimizing Gaseous microemboli (GME) introduced into the CPB circuit can help alleviate neurologic injury. This study focuses on understanding how suction flow rate and the reservoir level can influence the i...
BACKGROUND: Minimizing Gaseous microemboli (GME) introduced into the CPB circuit can help alleviate neurologic injury. This study focuses on understanding how suction flow rate and the reservoir level can influence the introduction of GME past the venous reservoir during CPB. METHODS: An in vitro mock CPB loop filled with bovine blood was used to simulate adult CPB. A Gampt BCC-300 bubble detector measured bubble size, volume, and count at three locations: post-reservoir (venous), post-oxygenator/arterial filter (arterial), and the venous inlet to the reservoir (recirculation). Room air was added into the suction line at 200 mL/min and mixed with blood to simulate aerated suction return. Bubble transmission was measured for three minutes at three reservoir levels, 200 mL, 500 mL, and 1000 mL, and at four pump sucker flow rates: 25 RPM (0.32 L/min), 50 RPM (0.65 L/min), 75 RPM (0.99 L/min), and 100 RPM (1.32 L/min). GME count data were pooled from three commonly used, coated, disposable reservoirs/oxygenator combinations: Medtronic Affinity Fusion, Terumo CAPIOX FX25, and Sorin Inspire 8F. RESULTS: A total of 284 measurements were conducted, and the data from all reservoir manufacturers were analyzed and averaged. A statistically significant interaction was noticed between roller pump suction rate and reservoir level (p-value < 0.0001) at the venous sensor. As the suction flow rate increased, the reservoir level decreased, or a combination of the two occurred, a significant increase in GME count was observed at the post-reservoir sensor. Analysis of the GME count from the post-oxygenator/filter sensor revealed a significant increase as the suction flow rate increased from 25 RPM to 100 RPM. CONCLUSION: A minimum effective suction flow rate and maximum practical reservoir level are recommended to prevent the transmission of GME through the cardiopulmonary bypass circuit and potentially to the patient. Care should be taken to continuously monitor these variables throughout the case and adjust them accordingly.
Cybersecurity as it relates to perfusion.
Lung K
J Extra Corpor Technol · 2026 Mar · PMID 41823484 · Full text
Perfusionists must maintain strong digital security habits, know the inherent risks of devices in use, and have a healthy respect for the consequences of a security breach at a hospital. While perfusion has largely been...
Perfusionists must maintain strong digital security habits, know the inherent risks of devices in use, and have a healthy respect for the consequences of a security breach at a hospital. While perfusion has largely been able to operate without much interaction with cybersecurity experts, the relentless advancement of the digital age means that perfusionists cannot remain oblivious to the intersection of their devices and hospital digital security. This article provides a historical overview of healthcare cybersecurity with specific recommendations for perfusion teams looking to ensure best practices for protected health information (PHI). Critical recommendations include keeping physical copies of downtime procedures, routine practice of downtime procedures, discussion with the hospital information technology (IT) team to confirm perfusion-based asset lists, and the creation of an American Society of Extracorporeal Technology (AmSECT) standard or guideline regarding attention to cybersecurity.
The never-ending process of adaptation.
Puis L
J Extra Corpor Technol · 2026 Mar · PMID 41823483 · Full text
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Delta-P as an early indicator of oxygenator failure: the case for standardized manufacturer reference values.
Butt SP, Abdulaziz S, Mahdaly A … +4 more , Razzaq N, Paul D, Darr U, Bhatnagar G
J Extra Corpor Technol · 2025 Dec · PMID 41405048 · Full text
The evolution of extracorporeal membrane oxygenation (ECMO) has led to an increasing reliance on objective parameters to detect complications early and enhance patient safety. One such parameter is the transmembrane pres...
The evolution of extracorporeal membrane oxygenation (ECMO) has led to an increasing reliance on objective parameters to detect complications early and enhance patient safety. One such parameter is the transmembrane pressure gradient, more commonly referred to as delta P (ΔP), the difference between the inlet and outlet pressures of the oxygenator. This measure has increasingly been recognized as a critical early indicator of thrombus formation within the oxygenator during ECMO support. However, its interpretation remains complex and context-dependent, particularly because delta P values are significantly influenced by the design features of different ECMO circuits, including pump head geometry and oxygenator configuration.
Redefining flow measurement in centrifugal pump: the case for RPM and power consumption-based estimation.
Condello I
J Extra Corpor Technol · 2025 Dec · PMID 41405047 · Full text
Mechanical circulatory support (MCS) devices, particularly those utilizing centrifugal pumps (CP), are crucial in sustaining patients with severe cardiac conditions. Traditional flowmeters, integral to these systems, pre...
Mechanical circulatory support (MCS) devices, particularly those utilizing centrifugal pumps (CP), are crucial in sustaining patients with severe cardiac conditions. Traditional flowmeters, integral to these systems, present considerable challenges, including substantial physical bulk, complex wiring, and a dependency on robust backup systems. These challenges become acute in portable applications, where compact, reliable, and discrete solutions are essential for enhancing patient mobility and quality of life. This paper proposes a strategic shift towards integrating RPM (Revolutions Per Minute) and power consumption-based flow estimation as a standard in MCS device design. This approach reduces device complexity, enhances reliability, and diminishes the need for invasive hardware, aligning with broader goals of patient safety and device efficiency. By adopting RPM and power consumption-based estimation, MCS devices can achieve improved ergonomics, fail-safe operational integrity, and enhanced energy efficiency, which are crucial for achieving patient-centric outcomes. This advancement signals a move towards more intelligent, adaptive medical devices that could redefine standards in mechanical circulatory support.
Redefining the role of perfusionists in ECMO: from technical operators to clinical stakeholders.
Butt SP, Abdulaziz S, Razzaq N … +4 more , Kumar A, Ashiq F, Darr U, Bhatnagar G
J Extra Corpor Technol · 2025 Dec · PMID 41405046 · Full text
Extracorporeal Membrane Oxygenation (ECMO) is increasingly used in refractory cardiac and respiratory failure, yet the role of perfusionists remains narrowly defined. While traditionally viewed as technical operators, pe...
Extracorporeal Membrane Oxygenation (ECMO) is increasingly used in refractory cardiac and respiratory failure, yet the role of perfusionists remains narrowly defined. While traditionally viewed as technical operators, perfusionists possess advanced expertise that are essential across the continuum of care. Their exclusion from key clinical and academic roles represents a structural gap possibly with implications for safety and outcomes. This letter advocates for redefining perfusionists as clinical stakeholders, formally integrated into decision-making, quality improvement, and research initiatives. Their engagement can enhance ECMO practice across a multitude of areas. Recognizing perfusionists as integral members of the multidisciplinary team is essential to advancing outcomes, and meeting the demands of increasingly complex extracorporeal therapies.
Endo-aortic balloon occlusion for reoperative minimally invasive mitral valve replacement on intra-aortic balloon pump: a case report.
Cornibe JL, Patel V, Erney A
J Extra Corpor Technol · 2025 Dec · PMID 41405045 · Full text
Minimally invasive approaches are the future of cardiac surgery. Coupled with that are devices such as endo-aortic balloon occlusion (EABO) which allow the success of such procedures. EABO has also proven invaluable in h...
Minimally invasive approaches are the future of cardiac surgery. Coupled with that are devices such as endo-aortic balloon occlusion (EABO) which allow the success of such procedures. EABO has also proven invaluable in high-risk or reoperative cases. We report a severely high-risk patient who presented for reoperative minimally invasive mitral valve replacement with an intra-aortic balloon pump (IABP) and multiple high-dose vasopressors. The EABO was utilized over a transthoracic cross clamp (TCC). With careful maneuvering upon ascent into the aorta, the deflated endoballoon easily passed beyond the deflated IABP balloon under transesophageal echocardiogram (TEE) guidance. After completion of arrest, surgical placement of the bioprosthetic valve, and spontaneous return of cardiac rhythm once EABO was completed, the deflated endoballoon was carefully retracted back down through the aorta past the deflated IABP balloon. The integrity of the IABP balloon remained intact and was able to resume function once cardiopulmonary bypass (CPB) was terminated. We found that EABO was a safe and effective alternative technique for aortic occlusion in our patient supported on IABP with previous sternotomy.
Pulmonary hemorrhage after pulmonary endarterectomy in a patient with chronic thromboembolic pulmonary hypertension: a case report.
Moroz G, Edemskiy A, Kornilov I … +2 more , Nasyrtdinov R, Chernyavskiy A
J Extra Corpor Technol · 2025 Dec · PMID 41405044 · Full text
Massive pulmonary hemorrhage is the severe complication of pulmonary endarterectomy, associated with high mortality rates. ECMO may be a life-saving option for patients with pulmonary hemorrhage. In this case, we have de...
Massive pulmonary hemorrhage is the severe complication of pulmonary endarterectomy, associated with high mortality rates. ECMO may be a life-saving option for patients with pulmonary hemorrhage. In this case, we have described the successful sequential application of both VA and VV ECMO modalities. VA ECMO was employed initially to reduce blood flow to the right heart and pulmonary artery. Once hemodynamic stability was achieved, VV-ECMO was utilized to support severe respiratory failure. A six-month follow-up demonstrated good clinical outcome, with no evidence of pulmonary artery rethrombosis.
Leveraging the perfusionist-surgeon dyad to improve the culture of safety.
Shann KG, Sundt TM
J Extra Corpor Technol · 2025 Dec · PMID 41405043 · Full text
The cardiac surgical operating room is a complex, high risk environment dependent on efficient teamwork and communication between multiple role groups to deliver safe and effective care. As awareness of the critical impo...
The cardiac surgical operating room is a complex, high risk environment dependent on efficient teamwork and communication between multiple role groups to deliver safe and effective care. As awareness of the critical importance of culture on team performance broadens, there has been increasing focus in cardiac surgery on developing a culture of safety to minimize, trap and recover from errors in order to optimize patient outcome. Fundamental to this effort are concepts such as Just Culture, collective responsibility and perhaps most fundamentally the establishment of psychological safety where individuals have a "sense of being able to show and employ oneself without fear of negative consequences to self-image, status or career". Team members who are engaged and feel empowered to raise concerns can help to recognize issues, improve intraoperative decision making and contribute to resilience of the team. Over the past decade we have made a concerted effort in our institution to establish such a culture, and have found principles of organizational psychology helpful in this endeavor.
ECMO to CPB: A single circuit approach.
Zalfa J, Duncan D, Kerins P
J Extra Corpor Technol · 2025 Dec · PMID 41405042 · Full text
BACKGROUND: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and cardiopulmonary bypass (CPB) are used during pediatric heart surgery to provide cardiopulmonary support to patients as they undergo and recover...
BACKGROUND: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and cardiopulmonary bypass (CPB) are used during pediatric heart surgery to provide cardiopulmonary support to patients as they undergo and recover from surgical procedures. On occasion, CPB and extracorporeal membrane oxygenation (ECMO) circuits are used within the same surgical period. In this technique article, we report on our experience using an ECMO circuit with the addition of a cardiotomy reservoir to convert to CPB. METHODS: Patients on VA-ECMO were converted to CPB by the splicing of a cardiotomy reservoir and ECMO circuit. RESULTS: Seven patients underwent conversion from VA-ECMO to CPB with a total of eight procedures. Mean nadir hematocrit on CPB was 31.1% ± 6.06. Mean blood product usage on CPB was 238 ± 155 mL. All the patients were decannulated from CPB or ECMO. CONCLUSION: Conversion from VA-ECMO to CPB with the use of the same circuit is an effective technique for congenital heart patients on VA-ECMO who require surgical intervention with CPB.
Effects of hyperoxia in pediatric perfusion patients: a scoping review.
DeRenzo M, Velazquez-Milton V, Johnson S
J Extra Corpor Technol · 2025 Dec · PMID 41405041 · Full text
Hyperoxia in pediatric cardiopulmonary bypass patients is associated with adverse effects, including reoxygenation injury, increased mortality, heightened inflammatory response, and cerebral injury. Although prior resear...
Hyperoxia in pediatric cardiopulmonary bypass patients is associated with adverse effects, including reoxygenation injury, increased mortality, heightened inflammatory response, and cerebral injury. Although prior research has demonstrated a correlation between these adverse effects and hyperoxia during cardiac surgery, definitions of "hyperoxia' vary across the literature. This scoping review synthesizes findings from PubMed, CINAHL, Embase, and Web of Science to categorize the adverse effects of hyperoxia based on age range, presence of cyanosis, and PaO levels. The results highlight the need for standardized oxygenation management protocols in pediatric bypass procedures and a consistent definition of "hyperoxia" for cyanotic and acyanotic patients.
Evolution of extracorporeal membrane oxygenation: historical milestones and advanced developments.
Szentgyorgyi L, Butt SP, Krishnamoorthy B
J Extra Corpor Technol · 2025 Dec · PMID 41405040 · Full text
Extracorporeal membrane oxygenation (ECMO) has a history that is a testament to the pioneering spirit of medical innovators. It is intricately linked with the development of cardiopulmonary bypass (CPB) technology. The j...
Extracorporeal membrane oxygenation (ECMO) has a history that is a testament to the pioneering spirit of medical innovators. It is intricately linked with the development of cardiopulmonary bypass (CPB) technology. The journey of ECMO can be traced back to the mid-20th century when experiments with CPB began to support patients undergoing cardiac surgery. However, it was not until the 1970s that ECMO emerged as a standalone therapy. Throughout the following decades, ECMO technology advanced rapidly, with improvements in circuit design, oxygenators, and pump technology enhancing its safety and efficacy. ECMO's versatility soon became apparent as it was employed in various clinical scenarios, including acute respiratory distress syndrome (ARDS), cardiac failure, and even as a bridge to lung or heart transplantation. In recent years, efforts have focused on miniaturisation, cost reduction, and the development of portable systems, enabling their use outside traditional intensive care settings. Today, ECMO remains not just a tool but a lifeline in the management of life-threatening cardiorespiratory failure. It offers hope and a second chance to patients when conventional therapies fall short, underscoring its critical importance in critical care medicine, cardiology, transplant and cardiothoracic surgery. This article provides a concise yet comprehensive overview of the history and recent advancements in ECMO.
Severe cholestasis in neonatal extracorporeal membrane oxygenation.
Jancaric M, Langworthy B, Guiang S … +4 more , Segura B, Wallace R, Larson-Nath C, Satrom KM
J Extra Corpor Technol · 2025 Dec · PMID 41405039 · Full text
INTRODUCTION: Cholestasis is a common complication of Extracorporeal Membrane Oxygenation (ECMO) secondary to patient physiology and circuit-induced factors. In our institution's Neonatal Intensive Care Unit (NICU), we n...
INTRODUCTION: Cholestasis is a common complication of Extracorporeal Membrane Oxygenation (ECMO) secondary to patient physiology and circuit-induced factors. In our institution's Neonatal Intensive Care Unit (NICU), we noted cases of severe cholestasis, with peak conjugated bilirubin levels much higher than previously reported in the literature. The objective of our study was to identify the contributing factors to the development of severe cholestasis in neonatal ECMO cases. METHODS: Using our institutional ECMO database, all neonates who received ECMO at our institution were identified. A retrospective chart review was completed for a sample of 30 neonates. Univariate, multivariate, and logistic regression models were utilized. RESULTS: Twenty percent of the patients in our study developed severe cholestasis (peak conjugated bilirubin > 10.0 mg/dL). Comparing the group of neonates that developed severe cholestasis to those who did not, we found that severe cholestasis was associated with the use of the Getinge Pediatric Quadrox-iD oxygenator. Mean plasma free hemoglobin levels were significantly higher in cases using pediatric oxygenators vs. adult (204.6 mg/dL vs. 110.4 mg/dL, p = 0.01). Longer ECMO courses and percent time within the ACT goal were also associated with severe cholestasis. CONCLUSION: Our study describes a cohort of neonatal ECMO cases complicated by severe cholestasis that was mediated by hemolysis due to circuit factors. In particular, circuit factors (the use of a pediatric oxygenator), longer duration of ECMO, and anticoagulation management were all significant factors. Future studies are needed to further elucidate the impact of these circuit factors and how they interplay with neonatal physiology.
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