Kinetics of sevoflurane vaporized directly in #ECMO membrane lung  🔬ex-vivo trials using circuits primed with Ringer’s lactate; sevoflurane vaporized at concentrations of 1–8% with SGF of 1–10 L/min.  💨 sevoflurane effectively crossed PMP membranes, rapidly reaching reproducible peak concentrations to values consistent with clinical targets for deep sedation; clearance increased significantly with higher SGF  ⚠️ environmental concentrations well below occupational safety thresholds  Delivering sevoflurane vaporized directly into ECMO circuits feasible/safe alternative sedative strategy. These results provide a robust foundation for translating this into pilot clinical trial aimed at optimizing ECMO sedation with inhaled sevoflurane in patients with severe ARDS. 🔓 rdcu.be/fk2xq

SAVECMO study, consensus of international experts on key aspects of cannula-site infections complicating peripheral #ECMO: 🔍 Delphi study involving 39 international #ECLS experts definition 🩺 suspicion & methodology for diagnosis 🧫 bacteriology 💉 treatment & treatment failure ⚠️ preventive measures #FOAMcc #FOAMecmo 🔗 rdcu.be/eZd0g

Frailty & outcomes after #ECMO 🔍 cohort study across 116 🇦🇺 🇳🇿 ICUs 🔎 > 2K pts (2018-2024); frailty in 12.2% 🪦 1y mortality 41.9% w/o, 42.1% w frailty; results consistent across sensitivity + subgroup analyses Frailty not associated with short or long-term mortality among #ECLS patients: a reflection of eligibility patterns (selection practices + candidacy)? #FOAMcc #FOAMecmo @Crit_Care 🔓 rdcu.be/eWWRx

Permissive hypercapnia in acute severe respiratory failure: should we target PaCO2, pH or both?? Safe thresholds in critically ill? 🩺mechanisms & management of hypercapnia requiring IMV 🫁 impact of hypercapnia on outcomes 🫁 🫀🧠significant physiological effects: RV & pulmonary circulation, brain & other organs Hypercapnic acidemia during lung-protective MV may have significant consequences, and perhaps should not be a goal per se, but prompt early consideration of adjunctive therapies. Open access #FOAMcc 🔓 bit.ly/49TxOY8

#ECMO following aortic surgery ⚖️ pts undergoing aortic operations younger, with more emergencies, longer cross-clamp times, and more postoperative bleedings + stroke 🪦 mortality (8%) higher vs other groups, but not enough to consider aortic surgery as contraindication; 49.9% on-ECLS mortality. Emergency status did not affect mortality Better complication prevention pivotal to improve outcomes, particularly bleeding & neurological events, among most critical factors for in-hospital outcomes: 🩸 strategies as standardized anticoagulation protocols, early coagulation monitoring, meticulous hemostasis (& delayed chest closure when appropriate) essential 🧠 individualized cerebral protection strategies, careful perfusion pressure management, preop cerebrovascular imaging should be considered, particularly, to reduce stroke risk @asaiojournal 🔗 bit.ly/49jJAMM

Variability in adult VV #ECMO candidacy: 🔍 international survey: global disparities observed! 📋 82% centers reported formal inclusion/exclusion criteria; very few shared identical contraindications 🚦 95% have absolute contraindications to initiating ECMO as bridge to recovery; most common severe neurologic injury and disseminated malignancy ⚖️ clinician judgment perceived as equally or more important than institutional guidelines in most center ⚖️ inconsistent decisions for clinically identical patients reported by over half of responding centers 🔍< ½ centers routinely reviewed candidacy decisions Some inconsistencies expected (likely appropriate), but extent suggests significant need/opportunities for more standardized, evidence-based approaches to improve consistency & equity in ECMO allocation @CritCareMed 🔗 bit.ly/4n7zmmg

Simulation-based education for #ECMO & strategies for implementation: a systematic scoping review 🎓 SBE beneficial, improving competency scores, confidence, teamwork, troubleshooting, outcomes as times to critical actions and cannulation 🎓 retention of knowledge and skills over time unclear; regular simulation training may be beneficial 🎓 establishing standardized ECMO curricula, of which SBE should be a core component, crucial 🔗 bit.ly/48P6xYj

Optimal transfusion threshold for VA #ECMO?? 🔍OBLEX study data: 534 patients/12 centres in 🇦🇺🇪🇺🇺🇸, 2019-22 ⚖️ emulated target trial comparing liberal (transfusion initiated at Hb ≥ 9 g/dL) vs restrictive practice ( ≤ 7g/dL) 🪦46% in hospital mortality 🩸liberal transfusion practice demonstrated modest survival advantage within first 2 #ECLS days; no apparent benefit beyond day 3 @Crit_Care rdcu.be/eBqR2

#ECLS for adult patients with #ARDS ⚙️ technical aspects 📚 evidence for VV #ECMO & #ECCO2R 🫁 indications & timing 🩺 clinical management 🚦special considerations 🏥 centre volume, logistics, hospital networks 🗺️ ECMO during respiratory pandemics 🔗 liberation from ECMO & outcomes 🔮 future research #FOAMcc #FOAMecmo 🔓 rdcu.be/ezDWp

💊ECMO presents unique challenges complicating pharmacotherapy. Here position paper providing focused review on evidence/knowledge gaps & identifying key research priorities: 🗝️ PK/PD reporting 🗝️ interactions between #ECLS & #RRT 🗝️ antimicrobial dosing 🗝️ analgesia and sedation for pain/agitation 🗝️ sedation/NMBAs for increased work of breathing 🗝️ anticoagulation @CritCareMed 🖇️ bit.ly/4m0alKi