Extracorporeal Membrane Oxygenation (ECMO): New Insights and Future Directions

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Pulmonology".

Deadline for manuscript submissions: 30 May 2025 | Viewed by 5238

Special Issue Editor


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Guest Editor
Methodist Hospital, San Antonio, TX 78229, USA
Interests: ECMO; extracorporeal life support

Special Issue Information

Dear Colleagues,

Extracorporeal membrane oxygenation has become increasingly prominent over the previous four decades. Over the last several years especially, in the wake of the COVID-19 pandemic, there has been accelerated awareness and growth in interest in applications including ARDS, cardiogenic shock, cardiac arrest, pulmonary embolism, and beyond.

While there is clearly increasing interest in the field, significant knowledge gaps remain. These include the need for more accurate prediction models, identification of molecular and biologic markers for pathophysiologic mechanisms, and defining the role of adjunctive therapies. Additionally, innovation will play a role, as improvements to cannulas, oxygenators, pumps, and circuits have the potential to transform the way that ECMO is delivered.

As such, this Special Issue is calling for abstracts geared towards new insights and future directions. The scope of this Special Issue is to focus on gaps that exist in the field of extracorporeal support. Potential areas of interest include novel clinical applications, prediction models, innovative applications of technology, blood purification, mechanistic approaches, novel strategies for rehabilitation, and long-term outcomes.

Dr. Jeffrey D. DellaVolpe
Guest Editor

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Keywords

  • ECMO
  • extracorporeal life support
  • technology
  • innovation
  • prediction
  • biomarkers

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Published Papers (4 papers)

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Research

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10 pages, 1126 KiB  
Article
Inflammatory and Hemolytic Responses of Microaxial Flow Pump Temporary Ventricular Assist Devices via Axillary Access in Cardiogenic Shock
by Leonie Schmack, Sadeq Ali-Hasan-Al-Saegh, Alexander Weymann, Nikolaus Pizanis, Payam Akhyari, Alina Zubarevich, Jasmin Sarah Hanke, Aron-Frederik Popov, Arjang Ruhparwar, Tienush Rassaf, Markus Kamler, Peter Luedike and Bastian Schmack
Medicina 2024, 60(12), 1960; https://doi.org/10.3390/medicina60121960 - 28 Nov 2024
Viewed by 1078
Abstract
Background and Objectives: The use of temporary left ventricular assist devices (tLVADs) for patients suffering from cardiogenic shock (CS) is becoming more common. This study examines the indications and outcomes of microaxial flow pumps (Impella®, Abiomed Inc., Danvers, MA, USA) when [...] Read more.
Background and Objectives: The use of temporary left ventricular assist devices (tLVADs) for patients suffering from cardiogenic shock (CS) is becoming more common. This study examines the indications and outcomes of microaxial flow pumps (Impella®, Abiomed Inc., Danvers, MA, USA) when cannulated through the axillary artery in patients with severe CS, with a particular focus on acute phase reactions and hemolytic responses. Materials and Methods: This single-center, retrospective cohort involved patients who received microaxial Impella implantation via the axillary artery from 2020 to 2022 (n = 47). Results: Among the patients, 66% (N = 31 cases) were treated with the Impella 5.5, 25.5% (N = 12 cases) with the Impella 5.0, and 8.5% (N = 4 cases) with the Impella CP. Additionally, 28% were managed using the ECMELLA concept. The mean length of time for Impella support was 8 days. The overall 30-day survival rate was 78%, with no significant differences observed between the ECMELLA group and the various Impella types. At 30 days post-therapy, 47% of survivors no longer required mechanical support, while 26% were upgraded to a durable LVAD. Interleukin-6 (IL-6) levels were significantly lower in patients receiving Impella 5.5 (n = 17 vs. 12) immediately following implantation (p = 0.03) compared with those with smaller devices. Haptoglobin levels were significantly higher in the Impella 5.5 group (n = 17 vs. 11, p = 0.02), with overall lower rates of hemolysis (45.1%, p < 0.01). Conclusions: The mortality rate in critical CS appears reduced with axillary artery implantation of Impella devices relative to existing literature. A full-flow microaxial pump (Impella 5.5) seems advantageous regarding systemic inflammatory response syndrome (SIRS) and acute hemolysis, indicated by lower IL-6 and higher haptoglobin levels, compared with smaller Impella devices. A tailored escalation/de-escalation concept using axillary access for different mAFP types appears feasible and safe. Full article
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Review

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32 pages, 776 KiB  
Review
Hemodynamic Monitoring During Liver Transplantation for Patients on Perioperative Extracorporeal Membrane Oxygenation (ECMO) Support: A Narrative Review
by Stefano Tigano, Giulio Casolaro, Amedeo Bianchini, Enrico Bernardi, Cristiana Laici, Linda Ramahi, Giovanni Vitale and Antonio Siniscalchi
Medicina 2025, 61(4), 768; https://doi.org/10.3390/medicina61040768 - 21 Apr 2025
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Abstract
Background and Objectives: Indications for liver transplants are increasing worldwide due to the growing number of transplants performed on patients with significant cardiovascular and respiratory risk factors. Additional support for this trend comes from the growing use of marginal organs, which is [...] Read more.
Background and Objectives: Indications for liver transplants are increasing worldwide due to the growing number of transplants performed on patients with significant cardiovascular and respiratory risk factors. Additional support for this trend comes from the growing use of marginal organs, which is made possible by donations made after circulatory death (DCD). Liver transplantation (LT) in such high-risk patients may be challenging and may require perioperative Extracorporeal Membrane Oxygenation (ECMO). There is a lack of evidence on the best hemodynamic monitoring techniques for patients undergoing ECMO support during the perioperative period of LT. This review aims to provide a comprehensive overview of the hemodynamic monitoring standards of patients supported by ECMO before, during, and after LT. Materials and Methods: Comprehensive research was conducted through the PubMed database, and 153 articles regarding patients who needed perioperative ECMO support were found. Among these, 18 articles were finally included in our analysis as the authors specified hemodynamic monitoring techniques and data. The articles included case reports, letters to the editor, and correspondence. Results: We identified 20 cases of patients supported by ECMO as a planned preoperative strategy (9 patients), as a rescue therapy during surgery (7 patients), and as a postoperative support (4 patients). Cardiac catheterism and echocardiography (transthoracic and transesophageal) were the authors’ most cited hemodynamic monitoring techniques. Conclusions: Data on hemodynamic monitoring methods used to manage patients supported by ECMO during the whole perioperative period of LT are poor and derived from descriptive low-quality studies. However, a multimodal approach that includes continuous monitoring of pulmonary pressures and echocardiography can increase diagnostic accuracy and improve the decision-making process to manage this complex patient population. Full article
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10 pages, 641 KiB  
Review
Recirculation in Veno-Venous Extracorporeal Membrane Oxygenation
by Veronica Gagliardi and Giuseppe Gagliardi
Medicina 2024, 60(12), 1936; https://doi.org/10.3390/medicina60121936 - 25 Nov 2024
Cited by 1 | Viewed by 1546
Abstract
This review focuses on recirculation in the context of Veno-Venous Extracorporeal Life Support in adults. The methods employed to calculate and quantify the extent of recirculation, as well as factors affecting recirculation and interventions that could reduce recirculation, are detailed. As recirculation may [...] Read more.
This review focuses on recirculation in the context of Veno-Venous Extracorporeal Life Support in adults. The methods employed to calculate and quantify the extent of recirculation, as well as factors affecting recirculation and interventions that could reduce recirculation, are detailed. As recirculation may significantly reduce extracorporeal oxygen delivery, leading to refractory hypoxemia, detecting and quantifying the recirculation fraction is fundamental in order to optimize VV-ECMO lung support. Although it is necessary to assess extracorporeal oxygen delivery, quantifying the amount of recirculation may be difficult. Besides mathematical methods, different experimental techniques for the direct measurement of recirculation are in development at present. Moreover, specific interventions and ECMO configurations could significantly reduce recirculation, and innovative systems are under study in this regard. Nevertheless, further human studies are needed to validate and standardize their use in clinical practice, and there remain limited data on their effectiveness and safety. More pre-clinical and clinical studies are required to assess the results obtained thus far and to improve the technologies to minimize the potential complications associated with their use. Full article
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Other

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6 pages, 237 KiB  
Opinion
Age as a Mortality Predictor in ECPR Patients
by Radim Spacek, Vojtech Weiss, Petra Kavalkova, Otakar Jiravsky, Jan Barcak and Jan Belohlavek
Medicina 2024, 60(9), 1444; https://doi.org/10.3390/medicina60091444 - 4 Sep 2024
Viewed by 1514
Abstract
Extracorporeal cardiopulmonary resuscitation (ECPR) is an advanced technique using extracorporeal membrane oxygenation (ECMO) to support patients with refractory cardiac arrest. Age significantly influences ECPR outcomes, with younger patients generally experiencing better survival and neurological outcomes due to many aspects. This review explores the [...] Read more.
Extracorporeal cardiopulmonary resuscitation (ECPR) is an advanced technique using extracorporeal membrane oxygenation (ECMO) to support patients with refractory cardiac arrest. Age significantly influences ECPR outcomes, with younger patients generally experiencing better survival and neurological outcomes due to many aspects. This review explores the impact of age on ECPR effectiveness, emphasizing the need to consider age alongside other clinical factors in patient selection. Survival rates differ notably between in-hospital (IHCA) and out-of-hospital cardiac arrest (OHCA), highlighting the importance of rapid intervention. The potential of artificial intelligence to develop predictive models for ECPR outcomes is discussed, aiming to improve decision-making. Ethical considerations around age-based treatment decisions are also addressed. This review advocates for a balanced approach to ECPR, integrating clinical and ethical perspectives to optimize patient outcomes across all age groups. Full article
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