Search Results (193)

Background/Objectives: Femoro-femoral veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is associated with limb ischemic complications. Routine near-infrared spectroscopy (NIRS) monitoring and a more standardized distal perfusion strategy were introduced at our institution in 2016. We compared ischemia-related interventions, amputations, and early mortality between the treatment eras. Methods: Consecutive patients undergoing femoro-femoral VA-ECMO from 2012 to 2024 were analyzed retrospectively and stratified by VA-ECMO initiation before 2016 or from 2016 onward. The primary endpoint was a peripheral ischemic vascular complication requiring surgical or interventional therapy; an inclusive sensitivity definition additionally incorporated four clinically plausible but less certain events. Period-specific rates were estimated using Poisson regression adjusted for baseline distal perfusion cannula (DPC) status and extracorporeal cardiopulmonary resuscitation (eCPR). Results: The analytic cohort comprised 270 patients (45 pre-2016 and 225 post-2016). The primary endpoint occurred in 50 patients (18.5%, 95% confidence interval (CI) 14.1–23.7): 3/45 (6.7%, 95% CI 1.4–18.3) before 2016 and 47/225 (20.9%, 95% CI 15.8–26.8) thereafter. Adjusted rates were 4.6% (95% CI 1.0–20.5) and 18.9% (95% CI 13.6–26.3), with an adjusted risk ratio of 4.11 (95% CI 1.06–17.93). The inclusive sensitivity analysis yielded similar estimates (adjusted risk ratio 3.31, 95% CI 1.05–11.47). Five patients underwent lower-limb amputation (1/45 pre-2016 and 4/225 post-2016). Kaplan–Meier 30-day mortality estimates were 56.8% overall (95% CI 50.8–62.9), 58.9% pre-2016 (95% CI 44.9–73.5), and 56.4% post-2016 (95% CI 49.9–63.1). Conclusions: Ischemia-related interventions were more frequently recorded after 2016, while amputations remained rare and 30-day mortality was similar. Because monitoring, DPC practice, and other aspects of care changed concurrently, and NIRS was used without a standardized trigger algorithm, the reasons for the observed era difference cannot be determined. The findings are exploratory and do not establish causal effects of NIRS or DPC use. Full article

Background: Isavuconazole, a broad-spectrum triazole antifungal, exhibits high lipophilicity and extensive plasma protein binding, properties that may predispose it to sequestration within extracorporeal membrane oxygenation (ECMO) circuits. This study aimed to characterize the pharmacokinetics (PK) of isavuconazole and to evaluate drug sequestration within the ECMO circuit in critically ill patients receiving ECMO support. Methods: We conducted a prospective, exploratory, single-center observational study including critically ill patients receiving ECMO (veno-venous (VV) or veno-arterial (VA)) and treated with intravenous isavuconazole. Serial blood samples were collected simultaneously from the patient’s arterial line and from pre- and post-membrane oxygenator sampling sites. Non-compartmental analysis was performed on arterial line samples to estimate PK measures, and concentration differences across sampling sites were analyzed to estimate circuit-related drug loss. PK/pharmacodynamic (PD) target attainment was assessed using established efficacy thresholds (AUC_0–24/MIC ≥ 25 and Cmin > 2 mg/L). Results: A total of 41 plasma samples from 3 critically ill patients (2 VV-ECMO, 1 VA-ECMO) were included in the analysis. Limited, component-specific isavuconazole loss was observed in tubing and connectors (6.62% ± 20.8%, p = 0.294) and across the entire ECMO circuit (7.74% ± 20.2%, p = 0.211). Likewise, no relevant concentration difference was detected across the membrane oxygenator (0.849% ± 6.15%, p = 0.642). Interindividual variability was observed across PK parameters, particularly in measures of elimination and distribution. All patients achieved predefined PK/PD efficacy targets, with mean Cmin and AUC_0–24/MIC of 3.07 ± 0.261 mg/L and 85.3 ± 4.03, respectively, and none exceeded the established toxicity threshold. Conclusions: Preliminary results showed variable concentration differences across ECMO sampling sites, with no consistent pattern of isavuconazole loss across the ECMO circuit under the conditions evaluated. All patients achieved predefined PK/PD efficacy targets using currently recommended dosing regimens; however, interindividual PK variability was observed, supporting the potential value of therapeutic drug monitoring (TDM) to guide individualized dosing decisions in this population. Larger population PK studies are warranted to further characterize determinants of isavuconazole exposure during ECMO support and refine evidence-based dosing strategies. Full article

Background: Hantavirus pulmonary syndrome (HPS), also designated hantavirus cardiopulmonary syndrome, is caused by New World hantaviruses, principally Sin Nombre virus in North America and Andes virus in South America. The syndrome is characterized by rapidly progressive noncardiogenic pulmonary edema and myocardial depression, with case fatality rates of 25% to 40%. A 2026 outbreak aboard an expedition cruise ship in the South Atlantic, comprising 13 cases and three deaths, confirmed that Andes virus can be transmitted between humans in a confined setting remote from the rodent reservoir. Methods: Virological, pathophysiological, clinical, and therapeutic aspects of HPS were reviewed, with particular emphasis on cardiopulmonary mechanisms. Sources were identified through PubMed, Scopus, and Google Scholar, with priority given to original research articles, clinical series, and controlled trials published through 2025. Literature published in English and Spanish was included. Results: Pathogenic hantaviruses enter endothelial cells and platelets via αvβ3 integrins, disrupting the VEGF-VEGFR2 signaling axis and rendering endothelial cells hypersensitive to physiological VEGF concentrations. Expansion of CD8+ T cells and activated macrophages releases TNF-alpha, IFN-gamma, and nitric oxide, amplifying microvascular permeability and contributing to myocardial depression. Autopsy studies demonstrate direct hantaviral myocarditis with viral antigen in cardiac endothelium and interstitial macrophages. Transpulmonary thermodilution confirms simultaneous hypovolemia, reduced global ejection fraction, and elevated extravascular lung water. Because the incubation period is long and the cardiopulmonary phase is substantially immune-mediated, seroconversion precedes rather than follows clinical deterioration, which preserves the diagnostic utility of IgM serology in a disease that can kill within 48 h. VA-ECMO initiated at the first signs of cardiopulmonary decompensation has reported survival rates approaching 80% in selected experienced centers. No antiviral has demonstrated efficacy in controlled trials during the cardiopulmonary phase, and no licensed vaccine exists. Conclusions: HPS produces a mixed shock state through increased microvascular permeability, T cell-mediated immunopathology, and direct myocarditis. Management follows a stepwise algorithm: suspected HPS triggers immediate complete blood count with peripheral blood smear and concurrent hantavirus IgM serology and RT-PCR, followed by ICU admission, conservative fluid resuscitation guided by transpulmonary thermodilution, and early contact with an ECMO-capable center at the first sign of rising lactate, falling cardiac index, refractory shock, arrhythmia, or rapid oxygenation failure. Full article

Objective: To evaluate the response of various oxygenation indices to the oxygen challenge test (OCT), prior to decannulation, in neonates supported with VA ECMO for respiratory indications, and to compare these responses between survivors and non-survivors. Design: Single-center retrospective observational study. Setting: Single, tertiary care, 40-bed Pediatric Intensive Care Unit in Miami, Florida. Patients: Neonates cannulated to VA ECMO for respiratory failure from 2012 to 2022 who had an OCT. Patients with congenital heart disease were excluded. Measurements and Main Results: A total of 63 neonates were included, of whom 13 patients died (20.6%). Oxygenation indices compared before and during OCT include PaO2, Delta PaO2, P/F ratios, Alveolar-arterial gradient, arterial/alveolar ratios, and shunt fraction. The Wilcoxon signed-rank test demonstrated increases in all oxygenation indices during OCT compared to pre-OCT, except for P/F ratios. There were no differences in oxygenation indices between survivors and non-survivors during OCT. However, after decannulation, all oxygenation indices were worse in non-survivors (p < 0.05). Linear regression analysis demonstrated that delta FiO2 on the ventilator, P/F before OCT, and ECMO flow during OCT significantly affected PaO2 response during OCT. Shunt fraction above 28.8% after decannulation demonstrated the highest discriminatory ability for mortality (AUC 0.853). Conclusions: The OCT response during ECMO is not a reliable predictor of survival in neonates on VA ECMO, and its value in assessing readiness for ECMO trial-off warrants further evaluation. Further studies investigating the role of oxygenation indices at the time of trial-off for predicting outcomes may be helpful. Full article

Clinical Rationale and Objectives: Refractory out-of-hospital cardiac arrest (OHCA) is associated with very poor outcomes when treated with conventional cardiopulmonary resuscitation alone, particularly when low-flow time is prolonged. Prehospital extracorporeal cardiopulmonary resuscitation (ECPR) may shorten the interval to extracorporeal perfusion, but its implementation requires a highly standardized operational framework to ensure appropriate patient selection, procedural safety, and efficient use of specialized resources. This manuscript describes the PrehospECPR-GOKVI operational framework, a standardized prehospital ECPR protocol developed by the Gottsegen National Cardiovascular Center in cooperation with the Hungarian National Ambulance Service and the Hungarian Air Ambulance. ECPR Pathway: The programme is based on a dedicated two-person ECPR team, consisting of an experienced physician and a paramedic, deployed with mobile ECPR-specific equipment, including point-of-care ultrasound, a pre-primed VA-ECMO circuit, an ECMO console, and a mobile oxygenator/gas blender. The protocol defines strict inclusion and exclusion criteria, emphasizing witnessed OHCA, age below or apparently below 50 years, initial shockable rhythm or selected pulseless electrical activity with suspected pulmonary embolism, refractory cardiac arrest lasting at least 15 min, no-flow time below 5 min or signs of life, and the feasibility of establishing ECMO flow within 60 min from collapse or emergency call. Two mandatory sonographic STOP criteria are incorporated before cannulation: relevant pericardial effusion or suspected aortic dissection, and inability to safely visualize the femoral artery, femoral vein, and bifurcation. The operational workflow further specifies dispatch activation, ALS continuation, equipment layout, ultrasound-guided femoro-femoral cannulation, failed-access management, air-free circuit connection, post-flow stabilization, receiving-centre notification, and transport to GOKVI. A target interval of no more than 15 min from initiation of ECPR-specific steps to ECMO flow is mandated. Conclusions: The PrehospECPR-GOKVI framework describes a locally developed, standardized operational pathway intended to support early identification, safe procedural preparation, and structured delivery of prehospital ECPR for selected patients with refractory OHCA. The protocol is designed to reduce avoidable delays, standardize ALS–ECPR coordination, and incorporate predefined sonographic safety checkpoints before cannulation. As no patient-level data are reported in this manuscript, feasibility, safety, complication rates, survival, neurological outcomes, resource utilization, and transferability remain to be evaluated prospectively after programme launch. Full article

Background: Sex-based differences in complications after venoarterial extracorporeal membrane oxygenation (VA-ECMO) for cardiogenic shock are not well defined. We compared 30-day coded acute kidney injury and other short-term outcomes between female and male patients receiving ECMO. Methods: We performed a retrospective multicenter cohort study using the TriNetX U.S. Collaborative Network from 2012 through 2025. Adults with cardiogenic shock supported with VA-ECMO were identified. Patients with a diagnosis-coded AKI (ICD-10-CM N17) recorded on or before the index ECMO procedure were excluded, and female and male cohorts were then matched 1:1 by propensity score on 23 characteristics. The primary endpoint was diagnosis-coded AKI between day 1 and day 30 after ECMO initiation. Secondary endpoints were all-cause mortality, newly diagnosis-coded sepsis, and newly diagnosis-coded ischemic stroke. Results: Among 11,229 adults meeting cohort criteria, 3773 were women, and 7456 were men. After exclusion of 8272 patients with previously coded AKI, 1152 women and 1805 men were eligible, and 1100 patients were matched in each group. Diagnosis-coded AKI occurred in 222 women (20.2%) and 276 men (25.1%) (risk ratio, 0.80; 95% confidence interval [CI], 0.69–0.94; hazard ratio [HR], 0.78; 95% CI, 0.65–0.93; p = 0.005). All-cause mortality was identical between groups (29.5% vs. 29.5%; risk ratio, 1.00; 95% CI, 0.88–1.14). Newly coded sepsis (5.1% vs. 6.3%) and newly coded ischemic stroke (4.0% vs. 3.2%) did not differ significantly. In an unadjusted Aalen–Johansen analysis performed in the unmatched eligible cohorts, the 30-day cumulative incidence of coded AKI was 21.6% among women and 27.8% among men. Conclusions: In this propensity-matched federated electronic health record cohort of adults with cardiogenic shock receiving VA-ECMO and without previously coded AKI, recorded female sex was associated with a lower 30-day risk of diagnosis-coded AKI. Mortality, newly coded sepsis, and newly coded ischemic stroke were similar. These findings are hypothesis-generating and support further investigation of sex-associated differences in datasets with granular renal and ECMO-specific variables. Full article

Vasoplegia remains one of the most challenging and incompletely understood complications across the spectrum of mechanical circulatory support (MCS). Initially described following cardiopulmonary bypass, it is increasingly recognized in patients supported with veno-arterial extracorporeal membrane oxygenation (V-A ECMO) and combined unloading strategies such as ECPELLA (ECMO and Impella support) as well as in patients bridged to heart transplantation with temporary or durable mechanical circulatory support (MCS). Despite occurring in different clinical settings, these syndromes share common pathophysiological features, including systemic inflammation, endothelial dysfunction, glycocalyx degradation, dysregulated nitric oxide signaling, neurohormonal imbalance, microcirculatory impairment and severe vasomotor dysregulation. Although vasoplegia is commonly considered a technology-specific complication, growing evidence suggests that CPB-associated vasoplegia, postcardiotomy vasoplegic syndrome, ECMO-related vasodilatory shock and distributive shock during ECPELLA may represent distinct manifestations of a common pathobiological process driven by blood–artificial surface interactions, ischemia–reperfusion injury, hemolysis and immune activation. This narrative review proposes a unified framework of vasoplegia across the continuum of MCS. Key mechanistic pathways and current therapeutic strategies, including catecholamines, vasopressin, angiotensin II, methylene blue and hydroxocobalamin, are discussed. By integrating evidence from cardiac surgery, critical care and mechanical circulatory support, vasoplegia is presented as a unifying syndrome of extracorporeal circulation. This perspective may support earlier recognition, phenotype-based management and the development of more targeted therapeutic strategies in a clinically significant yet underexplored area of cardiovascular critical care. Full article

Background and Clinical Significance: Peripheral veno-arterial extracorporeal membrane oxygenation (VA-ECMO) substantially alters aortic flow dynamics, generating catastrophic false-positive pathology on standard imaging. We report a case of ECMO-induced artifacts mimicking a Stanford type A aortic dissection (TAAD), which led to an unnecessary exploratory sternotomy. Case Presentation: A 67-year-old man underwent extracorporeal cardiopulmonary resuscitation (ECPR) for a shockable out-of-hospital cardiac arrest. Post-resuscitation chest computed tomography angiography (CTA) and preoperative transesophageal echocardiography (TEE) demonstrated a prominent flap-like structure in the ascending aorta, prompting emergency sternotomy. Intraoperative exploration revealed no intimal tear. Subsequent evaluation confirmed an acute anterior myocardial infarction, managed with coronary intervention. Following a dismal neurological prognosis due to hypoxic encephalopathy, VA-ECMO was palliatively withdrawn on day 9, and the patient expired on day 19. The interaction between retrograde ECMO flow and varying levels of intrinsic cardiac function dictates the topology of flow disturbances. Absent native flow creates contrast layering within the aortic root, whereas preserved native flow creates a volatile downstream watershed zone. Based on these distinct phenotypes, we propose a novel conceptual framework for tailor-made imaging strategies titrated to native flow strength—such as temporary ECMO flow reduction for preserved native output, or circuit contrast injections for profound cardiac depression. Conclusions: ECMO-related artifacts present substantial diagnostic pitfalls. Clinicians should adopt a context-aware approach, integrating multi-modality imaging with hemodynamic status to implement individualized, physiologically guided imaging protocols. Full article

Extracorporeal membranes oxygenation (ECMO) has been proposed as a useful tool to support ablation of unstable ventricular arrhythmias (VAs). The aim of this study is to assess the clinical outcome of cardiopulmonary support of VAs catheter ablation during a long-term follow-up. In this retrospective observational study, we included 47 patients referred to our center for catheter ablation of repeated episodes of hemodynamically unstable sustained VAs between April 2016 and February 2025. All patients underwent catheter ablation, supported by ECMO, of ventricular arrhythmias symptomatic for syncope or presyncope. The primary endpoint is overall cardiovascular death, including death due to heart failure, cardiogenic shock or ventricular arrhythmias. In particular, arrhythmic death was defined as death occurring during an electrical storm. After a median follow-up of 28 (7–63.5) months, cardiovascular death occurred in 26 patients (55.3%) but arrhythmic death befell only 11 patients (23.4%). All deaths occurred within 6–7 years of follow-up. No difference exists between ischemic and non-ischemic cardiomyopathy with regard to primary endpoints. Moreover, arrhythmic recurrences occurred in 21 patients (44.7%), among whom only 15 (31.9%) had ICD shocks; 25 patients (55.3%) encountered further hospitalizations. ECMO may facilitate procedural mapping and acute ablation success in selected high-risk patients, while long-term prognosis remains mainly driven by advanced heart failure. Full article

Extracorporeal cardiopulmonary resuscitation (ECPR) has emerged as a promising strategy for selected patients with refractory cardiac arrest, improving survival and the likelihood of favorable neurological outcomes. However, neurological prognostication in this setting remains highly challenging and insufficiently standardized. The pathophysiological complexity of ECPR, including global ischemia–reperfusion injury, altered cerebral perfusion, systemic inflammation, anticoagulation and prolonged sedation, limits the reliability of conventional post-cardiac arrest prognostic tools. This narrative review provides a focused and clinically oriented synthesis of current evidence on brain injury and neuroprognostication in patients undergoing veno-arterial extracorporeal membrane oxygenation (V-A ECMO) for cardiac arrest. Key determinants of neurological outcome across pre-ECMO and peri-resuscitation phases are examined, alongside the role and limitations of multimodal monitoring strategies, including neurological examination, electroencephalography, neuroimaging, cerebral oximetry and circulating biomarkers. Particular attention is given to the timing of prognostication and the risk of premature or inaccurate predictions leading to self-fulfilling prophecies. Emerging data suggest that neurological recovery in ECPR patients may be delayed, supporting a more cautious and time-adapted approach. A pragmatic, multimodal framework for neurological assessment in this population is outlined. By addressing current gaps and proposing a structured approach, this review aims to inform clinical decision making and contribute to improved neurologically meaningful survival in ECPR-treated cardiac arrest. Full article

Background: Extracorporeal membrane oxygenation (ECMO) is a vital intervention for acute respiratory and cardiac failure. This study evaluates the outcomes, safety, and long-term survival of patients stabilized at external hospitals and transferred to a supra-regional center under ECMO support, comparing results with current global standards. Methods: A retrospective analysis was conducted on 20 patients (14 male, 6 female, mean age 50.6 years) transferred to our hospital. The cohort was divided into veno-venous (vv-ECMO, n = 16) and veno-arterial (va-ECMO, n = 4) support. Key metrics included weaning success, complication rates, and long-term survival determined via follow-up with a median follow-up of 23 months. Results: Inter-hospital transfer was highly safe; 0% mortality occurred during transport despite a mean distance of 28.7 km (max. 54 km). In the mixed cohort, weaning was successful in 60% of cases, evaluated via 30-day survival. Major complications occurred in eight patients (40%), including bleeding (n = 6) and compartment syndrome (n = 2). Long-term survival analysis showed that patients who survived the first 30 days had a high probability of continued long-term stability. Conclusions: Remote ECMO cannulation followed by inter-hospital transfer is a safe strategy. While va-ECMO patients face higher mortality due to the underlying severity of cardiac failure, vv-ECMO shows favorable survival rates for ARDS. The specialized “ECMO-retrieval team” model is essential for extending advanced life support to peripheral hospitals. Full article

Cardiogenic shock (CS) is the most lethal complication of acute myocardial infarction (AMI), with a 30-day mortality of approximately 40–50% despite early revascularization. Temporary mechanical circulatory support (tMCS) devices, including the intra-aortic balloon pump (IABP), microaxial flow pumps (MAFP) and veno-arterial extracorporeal membrane oxygenation (VA-ECMO), are used as adjunctive therapy in refractory shock, but evidence of a survival benefit is limited and often conflicting. The IABP-SHOCK II trial found no 30-day mortality reduction with IABP, supporting a Class III (no benefit) recommendation, whereas the DanGer Shock trial reported a 12.7% absolute mortality reduction at 180 days with the MAFP Impella CP in highly selected patients. In contrast, the ECLS-SHOCK and ECMO-CS trials showed no improvement in survival with early VA-ECMO and noted high complication rates. Real-world data reveal significant disparities between trial populations and clinical practice, highlighting limitations of current evidence, since many AMI-CS patients are older, in more advanced shock or have multiple comorbidities and would not meet typical randomized controlled trial (RCT) inclusion criteria. In clinical practice, in-hospital mortality with IABP or VA-ECMO often exceeds 50–60%. Given the heterogeneity of AMI-CS, rapid identification of appropriate tMCS candidates and personalized therapy are essential. Management guided by individual patient profile, hemodynamic stage and neurological status, supported by multidisciplinary shock teams, may improve timely triage, device selection and outcomes. This review emphasizes the need for individualized, protocol-driven care within structured shock systems to optimize tMCS use in AMI-CS. Full article

Background: Percutaneous coronary intervention (PCI) during extracorporeal cardiopulmonary resuscitation (ECPR) before sustained return of spontaneous circulation (ROSC) is increasingly performed, yet most published reports fail to document ROSC status at the time of intervention—leaving this specific clinical phenotype poorly characterized. We aimed to clarify this ambiguity by systematically separating studies with explicit no-ROSC documentation from those in which the phenotype is only inferred and to describe selection, feasibility, and outcomes for the resulting cohorts. Methods: PubMed, Embase, and Cochrane CENTRAL were searched on 30 January 2026. Studies were pre-classified as DEFINITE (explicit no-sustained-ROSC documentation at PCI) or PROBABLE (workflow strongly implying no sustained ROSC). The 13 DEFINITE studies served as the primary analysis population; the 14 PROBABLE studies provided supportive evidence. Risk of bias was assessed using ROBINS-I (DEFINITE, primary) and JBI checklists (all studies). Sensitivity analyses excluded overlapping registries (ELSO, SAVE-J). Data were synthesized descriptively along three axes—selection, feasibility, and outcomes—without meta-analysis. Registered in PROSPERO (CRD420251252255); PRISMA 2020 compliant. Results: Twenty-seven studies encompassing 12,882 patients were included. In the DEFINITE primary cohort (13 studies, N = 3320), median survival to discharge was 30.3% (IQR 26.5–40.8; range 21.0–69.0; and n = 11) and favourable neurological outcome (CPC 1–2) 33.5% (IQR 16.8–45.8; range 10.4–92.0; and n = 12). Exclude-overlap sensitivity analysis (19 studies, N = 2741) yielded concordant estimates (survival 31.1%, IQR 27.2–37.0). PCI rates spanned 24–100% and post-procedural TIMI 3 flow 62.4–84.0%. ROBINS-I rated 9/13 DEFINITE studies at serious overall risk of bias and 4/13 at moderate (none low), predominantly from confounding by indication and selection bias—substantially more stringent than the JBI appraisal. Conclusions: PCI without sustained ROSC under ECPR is technically feasible, but the practice is widespread while remaining insufficiently standardized in ROSC reporting. Descriptive benchmarks from DEFINITE studies provide realistic outcome ranges for shared decision-making; no inference regarding comparative effectiveness is possible from observational data. Standardized documentation of ROSC status at PCI initiation is an immediate priority for future ECPR research. Full article

The right ventricle (RV) is a primary determinant of outcomes in cardiac critical care. RV dysfunction independently predicts morbidity and mortality in conditions such as acute coronary syndromes, pulmonary embolism, and cardiogenic shock. This review synthesizes RV evaluation and management by integrating physiologic principles with bedside diagnostic and therapeutic strategies. The RV is exceptionally sensitive to acute afterload increases due to its adaptation to low-pressure pulmonary circulation. Evaluation utilizes a multimodal approach combining echocardiography, invasive hemodynamics, and specifically the pulmonary artery pulsatility index and central venous pressure/pulmonary capillary wedge pressure (CVP/PCWP) ratio and biomarkers. Management focuses on three pillars: individualized preload optimization, afterload reduction via selective pulmonary vasodilators, and contractility augmentation with inotropes. For refractory cases, mechanical circulatory support options like Impella RP, ProtekDuo, and VA-ECMO provide critical bridges to recovery or transplantation. Full article

Background: Refractory cardiac arrest, cardiogenic shock, and severe acute respiratory failure remain associated with substantial mortality despite advances in advanced life support and extracorporeal membrane oxygenation (ECMO). Transportable ECMO platforms may enable rapid deployment, uninterrupted extracorporeal support, and safer in-hospital transport, but early real-world experience with newer systems remains limited. Methods: We conducted a retrospective single-center observational cohort study including all VitalFlow veno-arterial ECMO (VA-ECMO) and veno-venous ECMO (VV-ECMO) deployments performed between November 2025 and March 2026 at a high-volume tertiary cardiac surgery center. Fifteen cases were analyzed, comprising 12 VA-ECMO and 3 VV-ECMO deployments. Data were extracted from electronic health records, perfusion protocols, and ICU documentation. Outcomes included survival to hospital discharge, 30-day survival, neurological outcomes, and complications. Analyses were descriptive. Results: The cohort was exclusively male and clinically unstable at implantation, with high lactate and low pH levels consistent with severe hypoperfusion. Median time-to-flow was 33 min, and median ECMO duration was 8 days. Survival to discharge was 60% overall (66.7% VA-ECMO, 33.3% VV-ECMO), with ECMO weaning success in 86.7% and the primary death cause being multiorgan failure (83.3% of non-survivors). All survivors achieving a favorable neurologic outcome (CPC 1). Thirty-day survival was 73.3%. No major bleeding or stroke occurred. Limb ischemia was observed in 4 patients, with 2 patients requiring fasciotomy, all in the VA-ECMO group. Bronchial infection occurred in 3 patients. Lactate levels improved within the first 24 h, and survivors showed a more pronounced metabolic response. Conclusions: In this early single-center experience, VitalFlow ECMO was feasible and associated with rapid flow establishment, survival to discharge of 60% of patients, and good neurologic outcome among survivors. The complication profile was acceptable, with limb ischemia as the main adverse event. These findings support further evaluation of this transportable ECMO platform in larger multicenter cohorts. Full article