
Perfusionist ECMO & NRP specialist ๐ซ๐ซ๐ซ & ๐ฅ๏ธ POCUS ๐ชChair Normothermic Regional Perfusion EuroELSO WG ๐ฑ#SoMe Director @ELSOOrg/SoMe Editor @asaiojournal
Italy
Joined February 2011
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TA #NRP in cDCD heart donors using closed #ECMO circuit, modified to provide
๐ฉธ๐ก๏ธeffective NRP despite prolonged fWIT
๐ซLV venting
๐ซ fast conversion to central configuration as needed
โญ๏ธ shunt for recirculation
๐ซง air management
#FOAMcc @asaiojournal
๐bit.ly/TANRPasaio
TA-NRP using fully mobile, closed #ECLS circuit could be safe strategy to support combined thoracic/abdominal organs recovery also in peripheral centers without cardiac surgery program, contributing to the expansion of DCD programs, increasing availability/quality of grafts, improving recipientsโ outcome. @ESOTtransplant @gabriel_oniscu @LuPoten @Unibo @AUSLRomagna
Pharmacology of vasopressors & inotropes during #ECMO
๐ซhemodynamic dysregulation
๐ฉธunique considerations during #ECLS: in-parallel circulation + afterload mismatch, concomitant circulatory devices + unloading
๐ catecholamines & derivatives
๐ non-catecholamines
#FOAMcc #FOAMecmo
๐ rdcu.be/MZ5Q1syp79Ua
๐ข Call for abstracts! Submit original research for 1st @ISOPPT Congress. Relevant clinical, translational, scientific and engineering work may be considered for oral or poster presentation. Among the categories:
๐ซ๐ซ Thoracic & ๐ซ Abdominal organs
๐ฉธ Artificial organ support systems
๐ฌ Bioengineering & mechanical engineering
๐ Drug testing
๐ Research models
& more... Submit now ๐๏ธ bit.ly/3UHJI4c
Join us to discuss about hypo & normothermic machine perfusion, viability assessment, #AI, abdominal & thoraco-abdominal normothermic regional perfusion, immunomodulation, cold static preservation & cryopreservation/supercooling, #extracorporeal supporting devices... Save the date:
๐ February 19-20, 2027
๐ Turin, Italy ๐ฎ๐น
๐ข Reducing anticoagulation in #ECMOโ๏ธ Here's the upcoming #EuroELSOwebinar
๐ค moderated & introduced by Mark Davidson & Nina Buchtele
Speakers:
๐ก๐ฌ Becoming an early career researcher in #ECLS - Walter van den Bergh & Olivier van Minnen
๐ฉธStandard-dose unfractionated heparin versus low-dose unfractionated heparin and low-molecular-weight heparin in extracorporeal life support (RATE): an open-label, randomised, non-inferiority trial
... & lot of Q/A and discussion! Join us:
๐ October 27 2026
โฐ 16:00-17:30 CET
Save the date & register now! ๐ euroelso.net/webinars/
๐ฅ PS all previous @EuroELSO webinars are available on demand, free open access enjoy! #FOAMcc #FOAMecmo
๐ bit.ly/EuroELSOyoutube
Acute Pulmonary Embolism 2026 Guidelines, an expert perspective including statements on:
๐ซVA #ECMO & #ECPR as #MCS for patients exhibiting fulminant RV failure resulting in profound refractory cardiogenic shock or impending cardiac arrest
๐ฉธadvanced reperfusion strategies in patients already supported by VA #ECLS
๐ซ alternative percutaneous right ventricular assist devices to provide targeted RV support
๐๏ธ bit.ly/3W3fWY0
I had the opportunity to run a workshop on how to implement normothermic regional perfusion in DCD donors, sharing some tips & trick (from the perfusionist perspective) in beautiful Innsbruck ๐ฆ๐น! It was a pleasure engaging in an extremely interactive (& challenging) discussion with the outstanding team of Tirol Kliniken. Impressive to experience the exponential growth of the utilization #NRP throughout Europe (& beyond...), allowing for the expansion of DCDDs enrollment in procurement programs!
Hot Topics ๐ก๏ธ in ECMO #ELSO2026 session
๐ซ ECPR in the geriatric population
๐ Artificial womb technology for extreme prematurity
๐ #ECPR ON-Scene Trial
๐งLiquid ventilation on ECMO
โ ๏ธ Contraindications?? No more!
Virtual program of 37th Annual @ELSOOrg conference is live!! (both pre & main conference).
Register as virtual attendee at
๐ฅ bit.ly/4rUws8A
If you joined in Nashville visit:
๐ฅ bit.ly/4ASyWZh
M Velia Antonini retweeted
New in ASAIO Journal. We imaged microcirc before & during Impella 5.5 support in 18 cardiogenic shock patients. Impaired baseline MFI, PPV, and PVD improved w Impella. Preserved values did not change. Perhaps pts with HD discordance may benefit most?
doi.org/10.1097/MAT.00000000โฆ
Recovery & survival in VA #ECMO for cardiogenic shock: may lactate normalization, as reflection of metabolic recovery, provide additional prognostic value vs static markers of initial disease severity??
๐ฉธ lactate normalization associated with higher rate of favorable neurologic discharge + 12 months survival
This time-dependent threshold can be used to assist in early neuroprognosis + to guide decision-making on #MCS treatment. @asaiojournal
๐๏ธ bit.ly/4irdnHS
Expert analysis for cardiothoracic anesthesia & critical care @EACTS @STS_CTsurgery @AATSHQ guidelines on temporary #MCS in adult cardiac surgery:
โฐ from deterioration to support: activation, candidacy, timing
๐ซ protected cardiac surgery + failure to wean from CPB
๐ฉบ physiology-matched device and configuration selection: #IABP, VA #ECMO & LV unloading, microaxial flow pumps, temporary LV & RV assist device, OxyRVAD, and biventricular support, combined/staged support
๐ฅ๏ธ anesthesia, implantation, and periprocedural monitoring
๐ฅ๏ธ intensive care: verify intended support and prevent secondary injury
๐ซ recovery, weaning, transition, transport, explantation
๐ evidence interpretation and practice implications
๐ฎ knowledge gaps and future directions
๐๏ธ bit.ly/47oWuaF
Wondering how to deliver #CRRT during #ECMO? Best practices by the Joint ADQI & @ELSOOrg Consensus Conference on ECMO, AKI, Fluid Management & CRRT are out!
๐ institutional standards required for delivery
๐ง technical considerations #ECMO
โ ๏ธ factors guiding integration of CRRT into ECMO circuit vs use of separate vascular access sites
๐ key performance indicators
๐ฉธ factors guiding choice of anticoagulation
Open access #FOAMcc #FOAMecmo
๐ bit.ly/4hLY0K2
Cannulas are direct/indispensable interface between patients & #ECMO but may also cause severe side-effects, as thrombosis and hemolysis! Simulation study evaluating impact of drainage cannulas design
๐ฉธ current design reveals no-flow/stagnation areas, which may induce thrombosis, especially if EBF <2LPM
๐ฉธ largest proportion of flow drains through proximal row of holes = risk area for hemostasis distal
โ๏ธ new geometric design improved pressure loss, but at the expense of pronounced distal no-flow zones
โ๏ธ geometry of side holes has an important impact: distal growth of hole area results improved flow
@ICMexperimental
๐ rdcu.be/jMXLG1avSyoa
Prognostic implications of complications during veno-arterial #ECLS for cardiogenic shock
๐ ELSO Registry analysis including > 22.5K adults
๐ชฆ 54% patients died during hospitalization; 74% non-survivors vs 54% survivors experienced complications
๐ง neuro complications increased mortality by 3.6
Complications on VA #ECMO have a significant and cumulative effect on on survival. Absolute 30-day risk of mortality greater if a complication occurred, increasing from 48.6% (0 complications) to 93.1% with neurologic complication. Neurologic and pulmonary complications associated with greatest risk
๐๏ธ bit.ly/4dxaHWu
Pulmonary arterial pressure in VA #ECMO for patients with acute cardiogenic shock?
๐ @ELSOOrg Registry analysis
๐ฅ๏ธ invasive hemodynamic status assessed at 24h
PAC use alone not associated with lower mortality, but helped assess hemodynamic variables associated with lower mortality. Higher PAD at 24h significantly associated with graded increase in mortality, including if concomitant LV mechanical unloading (no significant difference in ealry PAD according to concomitant LVMU modality). Early on-support PAD potentially important hemodynamic marker during VA #ECLS.
๐๏ธ bit.ly/4hH8ysu
Acute Kidney Injury after initiating #ECMO in children:
๐ cohort study; 284 neo/peds patients requiring #ECLS at a quaternary hospital in ๐บ๐ธ (80% VA, 20% VV)
๐ซ AKI classified as early if diagnosed โค 48hr after cannulation, late if > 48hr; transient if lasting < 48hr, persistent if > 48hr
Persistent AKI frequent and independently associated with major adverse kidney events at 30 days (MAKE30); no association identified in patients with transient AKI.
@PedCritCareMed
๐๏ธ bit.ly/4djcWN1
๐ซ Coming with editorial: Do #AKI phenotypes MAKE a difference in #ECMO?
๐๏ธ bit.ly/3VwivBF
๐
I received the biggest honour of an #ECMOlogist career, being appointed as Fellowship of the Extracorporeal Life Support Organization. Pleased that the work in ECMO education and training, and in the field of DCD organ donation and Normothermic Regional Perfusion, have been among the motivations underlying this designation, recognizing an extraordinary contributions to the art and science of #ECMO and #ECLS.
I would like to thank the ELSO Leadership, particularly President Daniel Brodie, the Board of Directors, the CEO @stead_christine, Peter Rycus & the whole team, @DrGilesPeek, quintessential of ECMOlogy, and all the ELSO family. I am grateful for you welcoming me many years ago, and for the trust and the confidence you had/have in my potential. I am overwhelmed, well aware of both the prestige and responsibility coming with this (undeserved) award.
Standing on the shoulder of giants.
M Velia Antonini retweeted
๐ The countdown starts now!
In exactly ๐ผ๐ป๐ฒ ๐๐ฒ๐ฎ๐ฟ, the international transplantation community will come together under the theme โ๐๐๐ฃ๐จ ๐๐ฉ ๐๐๐๐๐๐ฃ๐ โ ๐๐๐บ๐ฎ๐ป-๐๐ฒ๐ป๐๐ฟ๐ฒ๐ฑ ๐ง๐ฟ๐ฎ๐ป๐๐ฝ๐น๐ฎ๐ป๐๐ฎ๐๐ถ๐ผ๐ป ๐ถ๐ป ๐ฎ๐ป ๐๐ ๐ช๐ผ๐ฟ๐น๐ฑโ:
๐ Prague
๐
26-29 Sep 2027
๐ go.esot.org/c27_home
#ESOTcongress #MensEtMachina #PoweredByESOT
Membrane lung dead space in #ECMO: any relationship with functional impairment??
๐ pilot study including 27 ECMO circuits from 20 adults with acute respiratory failure.
๐งฎ ML dead space (MLDS) calculated from ML exhaust CO2 + blood gas measurements, and used to assess ML effectiveness/need for circuit exchange
๐ฆ 10 circuits required replacement; replaced circuits showed higher dead space + lower CO2 in ML exhaust gas + membrane lung CO2 removal vs circuits that completed run (with similar oxygenation-related measures/baseline characteristics)
MLDS could be associated with conventional ML performance indicators (as resistances), contributing to a better understanding of ML physiology. MLDS thresholds associated with failure to be defined.
Open access #FOAMcc #FOAMecmo
๐ bit.ly/4yUDVqr
The (influential) role of regret in #ECMO candidacy decision-making
๐ secondary analysis of qualitative semi-structured interview study w #ECLS international clinicians from urban, rural, public, private centers, Sep-Dec 2024
Three themes identified:
1๏ธโฃ clinicians prefer utility-based reasoning: often not possible
2๏ธโฃ regret of omission & commission both influence candidacy decisions
3๏ธโฃ clinicians employ various strategies to minimize past + anticipated regret
This may partly explain known inconsistencies in candidacy decisions within centers. @accpchest
๐๏ธ bit.ly/3TeJ5yt
FRESH OFF THE PRESSES from our lab
(๐rubin-lab.mgh.harvard.edu/)
How does anticipated regret influence ECMO candidacy decision-making?
With a team including economists, we apply Regret Theory to analyze this question and demonstrate its role in ECMO candidacy.
Clinicians prefer clear-cut cases, but even then, and certainly in more gray-zone cases, fear of regret emerges:
1โฃ Regret of omission: Even if we know ECMO won't help, we will feel terrible for not trying.
2โฃ Regret of commission: Even if there's a chance ECMO will help, it's very small and we will almost certainly regret having tried when this inevitably becomes a bridge to nowhere.
Many questions follow:
Is regret-dominated decision-making ever appropriate? Should it be corrected for? Does it exist across critical care or medicine more broadly?
This is only the beginning
journal.chestnet.org/articleโฆ
Thank you to Boston College Economics (@bc_econ) and @accpchest @journal_CHEST
@MGBResearchNews @HMSbioethics @MGHHeartHealth @MGHHeartHealth @PCCSM_BIDMC @MGH_PCCM @HarvardPulm


































