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New Advances in Extracorporeal Membrane Oxygenation (ECMO)
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New Advances in Extracorporeal Membrane Oxygenation (ECMO)

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Emergency Medicine".

Deadline for manuscript submissions: 20 June 2025 | Viewed by 3331

Special Issue Editor

Dr. Camilla L'Acqua

E-Mail Website
Guest Editor
1. IRCCS Centro Cardiologico Monzino, via C. . Parea 4, 20138 Milano, Italy
2. IRCCS Fondazione Istituto Nazionale dei Tumori, Via Venezian 1, 20133 Milano, Italy
Interests: VA ECMO; hemodynamic monitoring; thromboelastography; transfusion medicine

Special Issue Information

Dear Colleagues,

ECMO centers all over the world provide the clinical care that is needed in order to provide patients and families with hope and the opportunity to live beyond hospital discharge. Nurses, ECMO specialist, perfusionists, respiratory therapists, physicians, surgeons, researchers, and managers pursue advances in clinical care and research, devoting immense amounts of effort to this endeavor.

Recent evidence mapping based on systematic reviews highlights the need for large-sample, multi-center, and multinational trials to strengthen the evidence base for ECMO.

Centers that would like to lead this path should incorporate the following:

  • embracing technological improvements, such as enhanced biocompatibility in extracorporeal surfaces to allow the continual expansion of ECMO applications;
  • addressing the challenges of patient selection and the management of anticoagulation and neurological complications, critical for improving ECMO outcomes;
  • promoting global collaboration to share knowledge and standardize ECMO practices, as diverse contributions can lead to a more comprehensive understanding and application of ECMO;
  • a focus on a patient-centered approach that considers the individual needs and circumstances of each patient undergoing ECMO.

By fostering a collaborative educational environment, we can lead effectively in the evolving landscape of ECMO.

Dr. Camilla L’Acqua
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • ECMO
  • anticoagulation
  • circuit
  • global collaboration

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Published Papers (4 papers)

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Research

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15 pages, 1661 KiB  
Article
Quality of Life and Mental Health in COVID-ARDS Survivors After V-V ECMO Support: Results from the Freiburg ECMO Outcome Study (FEOS)
by Dawid L. Staudacher, Meret Felder, Markus Jäckel, Felix A. Rottmann, Alexander Supady, Xavier Bemtgen, Philipp Diehl, Tobias Wengenmayer and Viviane Zotzmann
J. Clin. Med. 2025, 14(7), 2206; https://doi.org/10.3390/jcm14072206 - 24 Mar 2025
Viewed by 339
Abstract
Introduction: Desirable outcome after venovenous extracorporeal membrane oxygenation for acute respiratory distress syndrome (ARDS) is frequently defined by survival. However, quality of life (QoL) and mental health status may take precedence over mere survival, from a patient-centered perspective. We aimed to evaluate [...] Read more.
Introduction: Desirable outcome after venovenous extracorporeal membrane oxygenation for acute respiratory distress syndrome (ARDS) is frequently defined by survival. However, quality of life (QoL) and mental health status may take precedence over mere survival, from a patient-centered perspective. We aimed to evaluate QoL and mental health status in survivors after V-V ECMO for coronavirus disease 2019 (COVID-19)-related ARDS, hypothesizing a similar QoL comparable to the general population. Methods: All patients supported with venovenous ECMO for COVID-19-related ARDS between 01/2020 and 03/2022 in our center were included. Survivors were invited to participate in a follow-up interview assessing QoL, anxiety, and depression one year after hospital discharge. Primary endpoint was the quality of life, measured by the SF-36 questionnaire, with results compared to data from the DEGS1 study (German normative population). Results: During the study period, 97 patients received venovenous ECMO for COVID-19 ARDS at our ICU. Overall, 43/97 (44.3%) survived, and 21/97 (21.6%) completed the SF-36 questionnaire. The median follow-up duration was 1.7 years. Patients who completed the SF-36 were significantly younger than those who did not (48.7 vs. 55.6 years, p = 0.012); other patient characteristics and ECMO parameters were similar between those with and without questionnaire. Anxiety, depression, and post-traumatic stress disorder were detected in 33%, 14%, and 29% of patients, respectively. Compared to the German normative population, ECMO survivors had significantly lower QoL (mean 77.2 vs. 61.0, p < 0.001). Conclusions: QoL and mental health status after venovenous ECMO for ARDS was significantly lower compared to the normative population. These findings highlight the importance of further research and comprehensive follow-up care for ECMO survivors. Full article
(This article belongs to the Special Issue New Advances in Extracorporeal Membrane Oxygenation (ECMO))
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12 pages, 767 KiB  
Article
Impact of Body Mass Index on Stroke in Extracorporeal Cardiopulmonary Resuscitation: Data from the Extracorporeal Life Support Organization Registry
by Jin Kook Kang, Shi Nan Feng, Winnie L. Liu, Jiah Kim, Andrew Kalra, Patricia Brown, Christopher J. Wilcox, Daniel Brodie, Steven P. Keller, Bo Soo Kim, Glenn J. R. Whitman and Sung-Min Cho
J. Clin. Med. 2025, 14(7), 2202; https://doi.org/10.3390/jcm14072202 - 24 Mar 2025
Viewed by 332
Abstract
Objective: We aimed to characterize the impact of body mass index (BMI) on stroke in patients receiving extracorporeal cardiopulmonary resuscitation (ECPR). Methods: We queried the Extracorporeal Life Support Organization registry for patients receiving ECPR (2020–2024). Patients were categorized into five BMI groups: underweight [...] Read more.
Objective: We aimed to characterize the impact of body mass index (BMI) on stroke in patients receiving extracorporeal cardiopulmonary resuscitation (ECPR). Methods: We queried the Extracorporeal Life Support Organization registry for patients receiving ECPR (2020–2024). Patients were categorized into five BMI groups: underweight (<18.5 kg/m2), normal weight (18.5–24.9 kg/m2), overweight (25–29.9 kg/m2), class 1 obesity (30–34.9 kg/m2), and class 2 obesity or above (≥35 kg/m2). A generalized additive model (GAM) analysis was used to identify the BMI range with the greatest stroke risk. Multivariable regression was used to compare odds of stroke between standard BMI groups and normal weight. Propensity score matching was used to compare stroke and mortality between normal weight and the BMI group with the highest predicted stroke risk. Results: Of 6390 patients (median age = 57.5, 68.6% male), 470 (7.4%) had a stroke during ECMO support (4.5% ischemic; 3.4% hemorrhagic). A total of 9.6% (n = 131) of class 1 obesity patients experienced stroke compared with 6.6% (n = 111) of normal weight, 6.9% (n = 79) of class 2 obesity or above, 6.9% (n = 143) of overweight, and 5.4% (n = 6) of underweight patients (p = 0.01). The GAM analysis showed a highest predicted stroke risk for class 1 obesity patients (n = 1366), which was confirmed by multivariable regression (adjusted odds ratio (aOR) = 1.63, 95%CI = 1.01–2.62, p = 0.045). After propensity matching (n = 357 each), class 1 obesity was associated with ischemic (aOR = 2.01, 95%CI = 1.02–4.08, p = 0.047) but not hemorrhagic stroke. Odds of hospital mortality were higher in both class 1 and 2 obesity patients compared with normal weight. Conclusions: Class 1 obesity was associated with increased odds of ischemic but not hemorrhagic stroke compared with normal weight patients. Full article
(This article belongs to the Special Issue New Advances in Extracorporeal Membrane Oxygenation (ECMO))
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14 pages, 1227 KiB  
Article
Prevalence, Predictors and Decompressive Laparotomy in Abdominal Compartment Syndrome in Patients Requiring Extracorporeal Membrane Oxygenation
by Matthias Lubnow, Chiara T. Koch, Maximilian V. Malfertheiner, Maik Foltan, Alois Philipp, Dirk Lunz, Hans J. Schlitt, Frank Brennfleck, Barbara Dietl, Okka W. Hamer, Andrea Stadlbauer, Christof Schmid, Florian Zeman, Thomas Müller and Christoph Fisser
J. Clin. Med. 2025, 14(3), 855; https://doi.org/10.3390/jcm14030855 - 28 Jan 2025
Viewed by 571
Abstract
Background: Critically ill patients requiring extracorporeal membrane oxygenation (ECMO) have several risk factors to suffer from abdominal compartment syndrome (ACS). Little is known about this subgroup. The aim of this study was to investigate the prevalence and associated factors for ACS in patients [...] Read more.
Background: Critically ill patients requiring extracorporeal membrane oxygenation (ECMO) have several risk factors to suffer from abdominal compartment syndrome (ACS). Little is known about this subgroup. The aim of this study was to investigate the prevalence and associated factors for ACS in patients requiring ECMO to assess the effect of decompressive laparotomy (DL) and the impact on mortality. Methods: This retrospective observational study analyzed adult patients requiring ECMO in four intensive care units at the University Medical Center Regensburg between 01/2010 and 06/2020. Patients with clinically suspected ACS were screened by measuring intra-abdominal pressure (IAP) with the trans-bladder technique. ACS was defined as IAP > 20 mmHg and survival was defined as successful discharge from hospital. Results: The prevalence of ACS in non-ECMO ICU patients was 0.8% (291/36,795) and 2.9% (47/1643) in ECMO patients. In the subgroup of resuscitated ECMO patients, ACS was present in 4.2% (32/766). Procalcitonin was associated with ACS. ECMO patients with ACS receiving DL were significantly more ill compared to those without DL (SOFA score at ICU admission 18 [15; 20], vs. 16 [13; 17], p = 0.048). DL decreased IAP and significantly improved ventilation; vasopressor and lactate stabilized within 24 hours. Survival was comparable between the DL and the non-DL groups (11% [1/9] vs. 14% [1/7], p = 1.000). Conclusions: ECMO patients are at high risk of developing ACS, even more so for resuscitated patients. This and high procalcitonin may be taken into consideration when screening for ACS. Decompressive laparotomy did improve respiratory compliance and stabilized hemodynamic parameters with low rates of complication. Even though patients that received DL were significantly more ill, the mortality rates were not higher. Full article
(This article belongs to the Special Issue New Advances in Extracorporeal Membrane Oxygenation (ECMO))
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Review

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16 pages, 6273 KiB  
Review
Recent Advances and Future Directions in Extracorporeal Carbon Dioxide Removal
by Tomás Lamas, Susana M. Fernandes, Francesco Vasques, Christian Karagiannidis, Luigi Camporota and Nicholas Barrett
J. Clin. Med. 2025, 14(1), 12; https://doi.org/10.3390/jcm14010012 - 24 Dec 2024
Viewed by 1518
Abstract
Extracorporeal carbon dioxide removal (ECCO2R) is an emerging technique designed to reduce carbon dioxide (CO2) levels in venous blood while enabling lung-protective ventilation or alleviating the work of breathing. Unlike high-flow extracorporeal membrane oxygenation (ECMO), ECCO2R operates [...] Read more.
Extracorporeal carbon dioxide removal (ECCO2R) is an emerging technique designed to reduce carbon dioxide (CO2) levels in venous blood while enabling lung-protective ventilation or alleviating the work of breathing. Unlike high-flow extracorporeal membrane oxygenation (ECMO), ECCO2R operates at lower blood flows (0.4–1.5 L/min), making it less invasive, with smaller cannulas and simpler devices. Despite encouraging results in controlling respiratory acidosis, its broader adoption is hindered by complications, including haemolysis, thrombosis, and bleeding. Technological advances, including enhanced membrane design, gas exchange efficiency, and anticoagulation strategies, are essential to improving safety and efficacy. Innovations such as wearable prototypes that adapt CO2 removal to patient activity and catheter-based systems for lower blood flow are expanding the potential applications of ECCO2R, including as a bridge-to-lung transplantation and in outpatient settings. Promising experimental approaches include respiratory dialysis, carbonic anhydrase-coated membranes, and electrodialysis to maximise CO2 removal. Further research is needed to optimise device performance, develop cost-effective systems, and establish standardised protocols for safe clinical implementation. As the technology matures, integration with artificial intelligence (AI) and machine learning may personalise therapy, improving outcomes. Ongoing clinical trials will be pivotal in addressing these challenges, ultimately enhancing the role of ECCO2R in critical care and its accessibility across healthcare settings. Full article
(This article belongs to the Special Issue New Advances in Extracorporeal Membrane Oxygenation (ECMO))
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