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New Advances in Extracorporeal Life Support (ECLS)
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New Advances in Extracorporeal Life Support (ECLS)

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

Deadline for manuscript submissions: closed (26 December 2025) | Viewed by 8568

Editors

Prof. Robertas Stasys Samalavičius

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Guest Editor
Clinic of Emergency Medicine, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
Interests: extracorporeal life support; cardiac anesthesia; heart failure; anesthesia for minimally invasive cardiac surgery
Prof. Dr. Pranas Šerpytis

E-Mail Website
Guest Editor
Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania
Interests: cardiogenic shock; assisted circulation; ventricular assist device; aortic stenosis; transcatheter aortic valve implanta-tion; echocardiography
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Holger Thiele

grade E-Mail Website
Guest Editor
Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, 04289 Leipzig, Germany
Interests: acute myocardial infarction; cardiogenic shock; interventional cardiology; structural heart disease; cardiac imaging
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The use of extracorporeal life support (ECLS) is expanding worldwide. As of now, more than 200.000 patients have been reported to the ELSO registry. Indeed, it is successfully being used to support patients with severe respiratory failure, cardiogenic shock, and during cardiopulmonary resuscitation, as well as for organ procurement from donations after circulatory death. Moreover, ECLS is increasingly being used to support high-risk patients during cardiac procedures in a cathlab, patients with drug poisoning and cases of severe septic shock. It is also being used for trauma patients, such as severe combat casualties in war zones. However, the duration of supporting patients and the age of the patients themselves are going beyond the boundaries of ECMO care. For instance, patients are being transported under ECMO support for thousands of kilometers. In addition, ECLS is still associated with frequent complications and high patient mortality. New technological advances and new applications of this support mode, alongside research and academic collaboration, might lead to better outcomes for our patients. This Special Issue of the Journal of Clinical Medicine is dedicated to new advances in extracorporeal life support.

Prof. Dr. Robertas Stasys Samalavičius
Prof. Dr. Pranas Šerpytis
Prof. Dr. Holger Thiele
Guest Editors

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Keywords

  • extracorporeal life support (ECLS)
  • extracorporeal membrane oxygenation (ECMO)
  • innovations in ECLS
  • respiratory failure
  • cardiogenic shock
  • eCPR

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Published Papers (4 papers)

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Research

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12 pages, 236 KB  
Article
Building an ECMO/ECPR Pathway—Operational Metrics and Patient Outcomes in One Year
by Edgars Prozorovskis, Katrina Loceniece, Davis Polins and Eva Strike
J. Clin. Med. 2026, 15(2), 912; https://doi.org/10.3390/jcm15020912 - 22 Jan 2026
Viewed by 583
Abstract
Background/Objectives: Pauls Stradins Clinical University Hospital in Riga, Latvia, introduced an ECMO program in 2008. Since the program’s start, countless patients have had their lives saved by this necessary technology. Our goal was to review the ECMO program results and gain insight into [...] Read more.
Background/Objectives: Pauls Stradins Clinical University Hospital in Riga, Latvia, introduced an ECMO program in 2008. Since the program’s start, countless patients have had their lives saved by this necessary technology. Our goal was to review the ECMO program results and gain insight into the organization’s operations. We wanted not only to assess the program’s efficiency in terms of time, but also to visualize patient outcomes at least a month after decannulation from ECMO and discharge from the hospital. Methods: A retrospective observational study was performed using hospital patient data files from October 2024 to October 2025. The selected patient group was those who had suffered an in-hospital cardiac arrest and successfully had ECMO inserted; this criterion fit fifteen patients. Data were collected on multiple factors, including from collapse to flow time, the number of days spent in the ICU, and post-ECMO complications. Afterwards, the data were analyzed to understand the program’s and patients’ outcomes. Results: Of the fifteen patients analyzed, seven did not survive to hospital discharge. The statistically significant quantitative results were the first lactate levels after ECMO cannulation and the first troponin levels after cardiac arrest. In terms of qualitative results, CHF, survival to ECMO decannulation, cannulation failure, and survival to ICU discharge were statistically significant. Conclusions: The ECMO program at Pauls Stradins Clinical University Hospital provides patients with a necessary technology after an intra-hospital cardiac arrest. This study highlights data about these patients and their outcomes, as well as areas for improvement within the hospital’s ECMO/ECPR program. Full article
(This article belongs to the Special Issue New Advances in Extracorporeal Life Support (ECLS))

Review

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19 pages, 1344 KB  
Review
Alternate and Emerging Anticoagulation Strategies for Extracorporeal Membrane Oxygenation: A Scoping Review
by Akshay Kumar, Nicole Carlo, Rithish Nimmagadda, Juber Dastagir Shaikh, Sourabh Khatri and Vivek Varghese
J. Clin. Med. 2026, 15(6), 2337; https://doi.org/10.3390/jcm15062337 - 18 Mar 2026
Viewed by 768
Abstract
Background: Unfractionated heparin (UFH) remains the standard anticoagulant for extracorporeal membrane oxygenation (ECMO), despite complications, such as heparin resistance, heparin-induced thrombocytopenia, bleeding and variable pharmacokinetics. This has prompted the search for alternative and novel anticoagulation strategies, including pharmacologic agents, circuit modifications, and [...] Read more.
Background: Unfractionated heparin (UFH) remains the standard anticoagulant for extracorporeal membrane oxygenation (ECMO), despite complications, such as heparin resistance, heparin-induced thrombocytopenia, bleeding and variable pharmacokinetics. This has prompted the search for alternative and novel anticoagulation strategies, including pharmacologic agents, circuit modifications, and monitoring approaches. This scoping review aimed to map the breadth and characteristics of evidence on ECMO anticoagulation strategies beyond UFH. Methods: A comprehensive search of peer-reviewed and gray literature was conducted across PubMed, Cochrane, Clinical Trials, WHO Trials Registry, and conference abstracts through manual searches in key journals. Clinical, pre-clinical, and gray literature studies evaluating pharmacologic agents, anticoagulation-free or heparin-sparing, biocompatible circuits, and monitoring innovations were included. Data were charted and synthesized descriptively to identify trends, gaps, and emerging directions. Results: A total of 269 records were included. Evidence was highly heterogeneous among study designs, populations, ECMO modalities, and outcome definitions. Most clinical studies were retrospective cohorts and adult-centered, with limited multicenter randomized controlled trials and underrepresentation of neonatal and pediatric populations. Direct thrombin inhibitors were frequently studied and clinically implemented alternatives to UFH. Other agents, including nafamostat mesylate, prostaglandin E1, and factor pathway inhibitors remain early in clinical investigation. Anticoagulation-free strategies and biocompatible circuit technologies were mostly supported through pre-clinical and single-center studies. Monitoring and modeling innovations, like TEG, ROTEM, real-time imaging, and machine learning, are quickly emerging. Conclusions: ECMO anticoagulation is transitioning from UFH reliance toward diversified and personalized strategies. Future research should prioritize multicenter randomized controlled trials, standardize protocols, expand to neonatal and pediatric investigation, and integrate strategies. Full article
(This article belongs to the Special Issue New Advances in Extracorporeal Life Support (ECLS))
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24 pages, 650 KB  
Review
Heparin Resistance in Patients Receiving Extracorporeal Membrane Oxygenation: A Review
by Tatyana Li, Azhar Zhailauova, Aidyn Kuanyshbek, Iwan Wachruschew, Shaimurat Tulegenov, Vitaliy Sazonov and Timur Kapyshev
J. Clin. Med. 2024, 13(24), 7633; https://doi.org/10.3390/jcm13247633 - 14 Dec 2024
Cited by 3 | Viewed by 4407
Abstract
Heparin resistance (HR) in patients on extracorporeal membrane oxygenation (ECMO) exacerbates bleeding and thrombogenesis. Thus far, there is no universal definition of what this condition entails and no unified strategy for assessing heparin’s efficacy in ECMO patients. The most frequent discrepancy when it [...] Read more.
Heparin resistance (HR) in patients on extracorporeal membrane oxygenation (ECMO) exacerbates bleeding and thrombogenesis. Thus far, there is no universal definition of what this condition entails and no unified strategy for assessing heparin’s efficacy in ECMO patients. The most frequent discrepancy when it comes to defining HR is the difference in the reported doses: units per day (U/d) or per kilogram per hour (U/kg/h). Another disagreement arises with regard to the various methods of measuring unfractionated heparin (UFH) efficacy. Due to numerous processes that begin with ECMO initiation, including protein layer formation on the surface of circuits, the recruitment of immune cells, the activation of complement and contact activation systems, and platelets, assessing pure antithrombin consumption is complicated. Moreover, there is an alternative anticoagulation procedure performed by a serine protease inhibitor named heparin cofactor II, which could also contribute to heparin consumption. Considering simultaneously launched processes of inflammation and thrombogenesis in response to contact with artificial surfaces on ECMO, we listed the possible mechanisms contributing to additional antithrombin consumption. The effect of the flow on the platelets’ activation and von Willebrand factor (vWF) assembly was also described. We reviewed the scientific literature from PubMed and Embase to identify possible definitions of heparin resistance during ECMO treatment among pediatric and adult cohorts. We identified 13 records describing different approaches to assessing HR and described our vision of delineating HR on ECMO. Full article
(This article belongs to the Special Issue New Advances in Extracorporeal Life Support (ECLS))
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Other

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7 pages, 839 KB  
Brief Report
Echocardiographic and Hemodynamic Effects of Intraaortic Balloon Pump in Patients with Cardiogenic Shock on Veno-Arterial Extracorporeal Membrane Oxygenation
by Misa Fister, Tomaz Goslar, Peter Radsel and Marko Noc
J. Clin. Med. 2025, 14(11), 3687; https://doi.org/10.3390/jcm14113687 - 24 May 2025
Viewed by 1585
Abstract
We investigated echocardiographic and hemodynamic effects of intraaortic balloon pump (IABP) in 26 patients with cardiogenic shock on veno-arterial membrane oxygenation (VA ECMO). Our study demonstrated an 8.1% increase in left ventricular velocity time integral (p = 0.023) without reduction in left [...] Read more.
We investigated echocardiographic and hemodynamic effects of intraaortic balloon pump (IABP) in 26 patients with cardiogenic shock on veno-arterial membrane oxygenation (VA ECMO). Our study demonstrated an 8.1% increase in left ventricular velocity time integral (p = 0.023) without reduction in left ventricular diameters and 4.7% decrease in right ventricular end diastolic base diameter (p = 0.05) when using IABP 1:1 mode compared to no augmentation. This was associated with a 3.2% decrease in heart rate (p < 0.001) and a 3.0% increase in mixed venous oxygen saturation (p = 0.057). Since the magnitude of the documented favorable changes is rather small, the clinical relevance of concomitant IABP in patients with cardiogenic shock on VA ECMO remains questionable. Full article
(This article belongs to the Special Issue New Advances in Extracorporeal Life Support (ECLS))
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