🕊️ PEACE Pediatric Extracorporeal Membrane Oxygenation Anticoagulation CollaborativE Consensus Conference
⚙️ influence of #ECLS circuit & components
💉 anticoagulant medications
🎯 monitoring & targets
🧪 monitoring & replacement of AT, fibrinogen, vWF
💉 antifibrinolytic & adjunct hemostatic agents
🔪 perioperative period
🩸 bleeding & thrombotic complications
🔍 priorities for clinical Research
#FOAMcc #FOAMecmo #PedsICU
Summary 🔓 https://bit.ly/3RU7l5c
& special issue 🔓 https://bit.ly/3XVOqL7

Investigating/characterizing platelet & leukocyte adsorption in #ECMO circuits
💡detailed protocol utilizing immunofluorescence to help extend knowledge in binding mechanisms + pathophysiology of adsorption, providing guidance for better circuit design. Protocol enabling comprehensive characterization of cellular binding to circuits collected from patients, could also be adapted to circuit binding studies of other #ECLS systems, such as #CPB, #VAD, #RRT devices.
🖇️ https://bit.ly/3XK4oYD

Acquired von Willebrand syndrome in #ECMO support, review of current evidence
🔍 prevalence of AVWS in #ECLS children & adults
🩸 bleeding complications in AVWS
⚙️ management
💉 desmopressin & VWF-containing concentrates.
🛑 inhibition of ADAMTS-13-mediated proteolysis of VWF
Limited evidence & need for a consensus definition, but data suggest almost all pts develop partial/complete loss of VWF HMW multimers within hours since initiation; weaning completely resolves AVWS.
🖇️ https://bit.ly/3RK3OGp

Thrombolysis before VA #ECMO cannulation in high-risk pulmonary embolism
🔍 72 high-risk PE pts; 43% underwent pre-ECMO thrombolysis
🩸incidence of moderate-to-severe bleeding notably elevated in both groups
🪦 no difference in 90-day survival if systemic thrombolysis or not
🗓️ long-term QoL acceptable; no chronic thromboembolic pulmonary hypertension
Recent systemic thrombolysis, as a single parameter, should not be considered contraindication for #ECLS in this population
🔓 https://rdcu.be/dLOBk

📢 The June 2024 ELSO newsletter is out! DoN'T miss:
🖋️ Message from our President, Graeme MacLaren
🛏 Bedside with Dr Bartlett: why we have gas blender in the sweep gas?? Answer is different for VV & VA #ECMO
🎓 ELSO Academy: the Neonatal & Pediatric Foundations training course
🌏 #ECLS around the world, updates from ELSO Chapters including next annual meetings & conferences
📃 News from ELSO Committees
🖋️ CEO Christine Stead remarks & more! Read all on ELSO website at
🔗 bit.ly/2IR8RCl

Mechanical circulatory support in cardiogenic shock:
🏛️ VA #ECMO to be consigned to the museum? NO: systematic use of #ECLS in AMICS not supported, but is useful as optimal therapies fail
🔍 available evidence & need for: real benefit of ECMO difficult to show in RCTs, especially as will likely continue to be used as rescue strategy
🪡 personalize management! Both VA-ECMO & MFP have a role in severe CS: select most appropriate #MCS for the specific patient
🔓 https://rdcu.be/dLt6T

Consumptive coagulopathy during #ECLS
🔎 close monitoring & follow up pivotal during the #ECMO run
⛔️ giving platelets/clotting factors to fix numbers often worsens underlying process
🩸 low doses of anticoagulants may protect both circuit (vs thrombotic complications) & patient (vs bleeding & thrombosis)
⛔️ bleeding complications should NOT always prompt complete cessation of UFH
Detailed underlying pathophysiological process & physiological rationale free to read #FOAMcc
🔓 https://rdcu.be/dLmXO

Beyond VA & VV #ECMO, novel, alternative cannulation strategies to address unique factors related to individual cases when traditional configuration are not enough...
🫁 parallel VV circuits: to provide higher EBF/CO2 clearance in patients with ARDS with high CO & VO2
🫁🫀veno-venopulmonary #ECLS: added benefit of RV support
🫀 LAVA ECMO: biventricular support with biatrial unloading
🫀 LV apical insertion of dual-lumen cannula if significant peripheral vascular disease
🖇️ https://bit.ly/3zk1O0Y

📢 Unmissable opportunity if you want to learn everything about VV (dual site + bicaval-dual lumen) & VA #ECLS cannulation 📢
Some (few) spots still available for ELSO #ECMO Cannulation Workshop on June 23!
A hands-on event aimed to learn how to safely perform percutaneous cannulation with a team of international experts... Register NOW ‼️
🔗 https://bit.ly/3sUQcPq
🎓 Adult #cannulation workshop
🗺️ ELSO Headquarters, Ann Arbor MI
🗓️ June 23 2024 (1 one day session)
📫 ecmotraining@elso.org

🔍 For #ECPR as for all patients keep on caring & keep on analyzing! Initial lactate can indicate higher burden of ischemia prior to #ECMO, with subsequent clearance determined by relationship between lactate catabolism vs generation. Neurologic survival advantage if adequate #extracorporeal BF/catabolic function & no longer ischemia. Pts who fail to rapidly clear lactate warrant evaluation for: ongoing ischemia or insufficient #ECLS
🖇️ https://bit.ly/3KGs2xo

Refers to
🔓 https://bit.ly/3x997bt

Beyond one-size-fits-all in cardiogenic shock: microaxial flow pump, VA #ECMO or tailored use of mechanical circulatory support? Overview of recent evidence
🫀 VA ECMO in AMI should be reserved for extreme CS
🫀 mAFP appears promising for CS due to STEMI & should be preferred MCS
🪜 initial mAFP use in CS with LV failure + #ECLS in refractory cases or if severe RV failure may be promising
⚠️ high complication rates associated with #MCS underscores need for personalized use
🖇️ https://bit.ly/4ekPmyd

📢 June issue of Intensive Care Medicine is now available!!
💦 European Society of Intensive Care Medicine (ESICM) fluid therapy guidelines
🗺️ critical care in LMICs
🩸emergency chemotherapy for hematological patients in #ICU
🫘 #RRT in PedsICU
🧫 #sepsis & bloodstream infection
🫁 proning in #ECMO
🫁 Pes
🫀 #ECLS in cardiogenic shock
🧠 neuromonitoring
& more! Full texts free to read #FOAMcc if you follow the links we share in our social media posts... enjoy!
📎 https://bit.ly/ICMJun2024

Drug treatments for critically ill #COVID19 patients in #ECMO?? PK is affected! Ex vivo study on an adult #ECLS model aimed to measure extracorporeal circuit effects on concentrations of remdesivir, nafamostat, tocilizumab:
💉 relative to baseline, study drug recoveries in both controls & circuits at 6h significantly lower for remdesivir (32.2% - 12.4%), nafamostat (21.4% - 0%)
Results confirm significant circuit drug loss for highly protein-bound & lipophilic drugs.
🔓 https://bit.ly/3x1BtnV

🌅 The second day of #SEECMO2024 the 34th Specialist Education in #ECMO conference is starting here in Marina del Rey... yesterday we had amazing talks/labs, interactive competitions on #ECLS, ethical debates & patients who received ECMO support as a bridge to 🫁 lung & 🫀 heart #transplantation on stage telling their stories!

🚑 Practicing on #ECLS transportation, prone positioning patients on #ECMO & connection #RRT circuits to ECMO circuits at #SEECMO2024, the 34th Specialist Education in #ECMO conference... Meanwhile, the heart & lung lab is ongoing! 🫀🫁
🔗 https://bit.ly/4bYQGpx

🚨 Few spots still available for the ELSO #ECMO Cannulation Workshop in June! A hands-on event aimed to learn how to safely perform percutaneous veno-venous (dual site and bicaval-dual lumen) & veno-arterial #ECLS cannulation with a team of international experts, training on realistic #simulation models!
Register NOW‼️
🔗 https://bit.ly/3sUQcPq
🎓 Adult #cannulation workshop
🗺️ ELSO Headquarters, Ann Arbor MI
🗓️ June 21, 22, or 23 2024 (3 one day sessions)
📫 ecmotraining@elso.org

🎥 Recording of #EuroELSO2024 session: Organizing #ECMO care in a changing world is now available!
🌎 The importance of education, training and quality assurance - individual qualification and center accreditation - Christine Stead
🌍 The relevance of worldwide registry, benchmarking and collaboration - Elizabeth Moore
🌏 Where is #ECLS heading?? Upcoming trials, upcoming initiatives, Roberto Lorusso & John Fraser
be.com/watch?v=Mq1pUvHcL6Y

🎥 Recording of #EuroELSO2024 session: How to design, perform, read & interpret clinical #ECMO trials is now available!
🎙️ Trial methodology and patients selection for #ECLS - A Combes
🎙️ OSIRIS trial: OHCA refractory cardiac arrest treated with #ECPR. How to overcome study design limitations - J Belohlávek
🎙️ Future trials on #ECMO in the pediatric population - A Hoskote
🎙️ Unmet needs in ECMO research - R Lorusso
Open access #FOAMcc on EuroElso YouTube channel
🔓 www.youtube.com/watch?v=VN0AzZA2zjs

Hypothermia in patients with cardiac arrest prior to VA #ECMO, post hoc analysis of HYPO-ECMO trial:
🫀 #ECLS may be considered in cardiogenic shock complicated by cardiac arrest
❄️ favourable effects of hypothermia are likely: moderate hypothermia appears to be associated with potential reduction in mortality in patients with cardiogenic shock on ECMO
Open access #FOAMcc #FOAMecmo
🔓 https://bit.ly/3KhHRdq

🫀🫁 Central venopulmonary #ECMO, review detailing surgical approaches & introducing terminology guide to support effective knowledge exchange and advancements in patient care:
➡️ standardized nomenclature: the ELSO Maastricht Treaty
➡️ central PA access for #ECLS
➡️ nomenclature & abbreviations for central PA access
➡️ combined central & peripheral configurations
➡️ combination with independent devices
Open access #FOAMcc #FOAMecmo on ASAIO Journal
🔓 https://bit.ly/4bpjlTH