ASAIO JournalPub Date : 2026-09-01Epub Date: 2025-10-31DOI: 10.1097/MAT.0000000000002593
April Slamowitz, Todd Sweberg, Katie Labgold, Taylor Nickerson
{"title":"Extracorporeal Membrane Oxygenation for Calcium Channel Blocker Intoxication: A Multicenter Retrospective Registry Review.","authors":"April Slamowitz, Todd Sweberg, Katie Labgold, Taylor Nickerson","doi":"10.1097/MAT.0000000000002593","DOIUrl":"10.1097/MAT.0000000000002593","url":null,"abstract":"<p><p>Calcium channel blocker (CCB) toxicity can lead to cardiogenic shock and circulatory collapse. Extracorporeal membrane oxygenation (ECMO) has been used as salvage therapy when conventional treatments fail, but outcomes data-especially comparing pediatric and adult populations-are limited. We conducted a retrospective analysis of the Extracorporeal Life Support Organization (ELSO) registry from 2015 to 2023, identifying 157 patients aged greater than or equal to 28 days with CCB toxicity. The primary outcome was survival to discharge. Univariate logistic regression identified survival-associated factors. Overall survival was higher in pediatric patients, compared to adults (80% vs . 63%, p = 0.0536). Veno-arterial ECMO was used in 90% of cases. Extracorporeal membrane oxygenation use increased over time without a decrease in survival. Higher age (1 year increase: odds ratio [OR] = 0.97/year, 95% confidence interval [CI]: 0.95-0.99) and lower arterial pH (per 0.1 pH increase, OR = 1.39, 95% CI: 1.04-1.86) had lower unadjusted odds of survival. The presence of pre-ECMO cardiac arrest (OR = 0.29, 95% CI: 0.12-0.65) and use of extracorporeal cardiopulmonary resuscitation (CPR) (OR = 8.27, 95% CI: 1.91-57) had lower unadjusted odds of survival. Extracorporeal membrane oxygenation is increasingly used as a rescue therapy for severe CCB toxicity. Factors such as younger age, preserved pH, and absence of cardiac arrest before cannulation are associated with improved outcomes.</p>","PeriodicalId":8844,"journal":{"name":"ASAIO Journal","volume":" ","pages":"792-797"},"PeriodicalIF":2.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145407943","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
ASAIO JournalPub Date : 2026-09-01Epub Date: 2025-10-27DOI: 10.1097/MAT.0000000000002580
Eric M Robinson, Shohei Yoshida, Benjamin Bryner, Melissa Medina, Christopher K Mehta, Stephen Chiu, Heather Wilson, Randy McGregor, Tingqing Wu, Rebecca S Harap, Abigail S Baldridge, Esther Vorovich, Duc Thinh Pham
{"title":"Comparison of Left Ventricular Unloading Strategies During Extracorporeal Membrane Oxygenation.","authors":"Eric M Robinson, Shohei Yoshida, Benjamin Bryner, Melissa Medina, Christopher K Mehta, Stephen Chiu, Heather Wilson, Randy McGregor, Tingqing Wu, Rebecca S Harap, Abigail S Baldridge, Esther Vorovich, Duc Thinh Pham","doi":"10.1097/MAT.0000000000002580","DOIUrl":"10.1097/MAT.0000000000002580","url":null,"abstract":"<p><p>Venoarterial extracorporeal membrane oxygenation (VA-ECMO) offers cardiopulmonary support with the tradeoff of increased left ventricular (LV) afterload and its adverse sequelae. LV decompression strategies include the use of intra-aortic balloon pump (IABP), indirect LV venting (pulmonary artery cannula [PAC] venting), left atrial venting, and direct LV venting with microaxial flow pump (mAFP). This is a single-institution retrospective study investigating the effect of LV unloading in patients undergoing peripheral VA-ECMO for cardiogenic shock over the study period, January 2017 to November 2022. A total of 184 patients received VA-ECMO support. LV venting/decompression was used in 78 patients (patient underwent an LV venting/decompression strategy [LV+]: 17 IABP, 51 mAFP, 5 PAC vent). Among the LV+ patients, 36 patients received venting before initiation or within 24 hours after initiation of VA-ECMO (early, eLV+), whereas 35 patients were vented greater than 24 hours after VA-ECMO initiation (delayed, dLV+). Post-ECMO diastolic pulmonary artery pressure was similar between vented and unvented groups ( p = 0.367) despite worse baseline cardiac function in the vented group (ejection fraction [EF] 25%). LV venting/decompression strategies had similar ECMO-related complication rates to non-vented patients. Patients who received IABP with ECMO (of whom the majority were in the eLV+ group ) had an improved post-decannulation survival relative to other venting strategies.</p>","PeriodicalId":8844,"journal":{"name":"ASAIO Journal","volume":" ","pages":"750-756"},"PeriodicalIF":2.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13521257/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145371991","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
ASAIO JournalPub Date : 2026-09-01Epub Date: 2025-11-18DOI: 10.1097/MAT.0000000000002608
Sonja Hamed, Nikolaos Kalampokas, Jan Beckendorf, Anna L Meyer, Christina Ballazs, Yvonne Mueller, Udo Boeken, Philipp Ehlermann, Bilal Ünal, Artur Lichtenberg, Matthias Karck, Norbert Frey, Hug Aubin, Philipp Schlegel
{"title":"Exploring the Safety of Sodium-Glucose Co-Transporter 2 Inhibitors in Left Ventricular Assist Device Patients: Clinical Outcomes in a Multicenter Experience.","authors":"Sonja Hamed, Nikolaos Kalampokas, Jan Beckendorf, Anna L Meyer, Christina Ballazs, Yvonne Mueller, Udo Boeken, Philipp Ehlermann, Bilal Ünal, Artur Lichtenberg, Matthias Karck, Norbert Frey, Hug Aubin, Philipp Schlegel","doi":"10.1097/MAT.0000000000002608","DOIUrl":"10.1097/MAT.0000000000002608","url":null,"abstract":"<p><p>Heart failure (HF) remains a progressive condition even with optimal medical therapy, often requiring advanced interventions like left ventricular assist devices (LVAD). Recent advancements in HF treatment, including sodium-glucose co-transporter 2 inhibitors (SGLT2i), have demonstrated benefits such as reduced mortality, symptom improvement, and renal protection. Their effects in LVAD patients remain unexplored. This study aims to evaluate the safety and therapeutic potential of SGLT2i in LVAD recipients, addressing a critical gap in current knowledge. A retrospective analysis of 176 consecutive patients who underwent LVAD implantation at two major academic centers in Germany (2018-2023) was conducted. In 139 LVAD patients (58 SGLT2i vs. 81 controls), we compared clinical and laboratory parameters at 6 and 12 months. In an additional group of 37 SGLT2i naïve patients who were already established on LVAD support the clinical course was compared to the pre-SGLT2i era. Renal function and cardiac biomarkers were not negatively affected during the first year of SGLT2i use. Complication rates ( eg , infections, hypovolemic events, acute kidney injury) were comparable to both the control group and pre-SGLT2i era. Sodium-glucose co-transporter 2 inhibitors as part of contemporary HF medication appear to be safe for LVAD patients. Further research and longer follow-up periods are necessary to draw robust conclusions on cardiovascular and renal outcomes.</p>","PeriodicalId":8844,"journal":{"name":"ASAIO Journal","volume":" ","pages":"e243-e250"},"PeriodicalIF":2.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145628461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
ASAIO JournalPub Date : 2026-09-01Epub Date: 2025-12-01DOI: 10.1097/MAT.0000000000002598
Zachary Daniels, Ashley B Walczak, Eric A Lloyd, Lydia K Wright, Deipanjan Nandi, Matthew Deitemyer, Vicky Duffy, Isaac S Kistler, Sara Conroy, Sergio A Carrillo, Patrick I McConnell, W Joshua Frazier, Amee M Bigelow
{"title":"A Comparative Analysis of Bivalirudin and Heparin for Extracorporeal Membrane Oxygenation in a Pediatric Cardiothoracic Intensive Care Unit.","authors":"Zachary Daniels, Ashley B Walczak, Eric A Lloyd, Lydia K Wright, Deipanjan Nandi, Matthew Deitemyer, Vicky Duffy, Isaac S Kistler, Sara Conroy, Sergio A Carrillo, Patrick I McConnell, W Joshua Frazier, Amee M Bigelow","doi":"10.1097/MAT.0000000000002598","DOIUrl":"10.1097/MAT.0000000000002598","url":null,"abstract":"<p><p>Unfractionated heparin has long been the conventional anticoagulant for pediatric mechanical circulatory support (MCS). As bivalirudin has gained traction in ventricular assist devices (VAD) management, its role in extracorporeal membrane oxygenation (ECMO) is less well defined. We conducted a retrospective, single-center study investigating the safety and outcomes of bivalirudin, a direct thrombin inhibitor, compared to heparin in a pediatric cardiothoracic intensive care unit (ICU). Outcomes included thrombotic and bleeding events, neurologic complications, survival to decannulation/transplant, and discharge. There were 122 patients for a total of 130 ECMO runs. Bivalirudin was used in 30% of ECMO runs, and bivalirudin demonstrated a 33% risk reduction in major bleeding (95% confidence interval: [-49.9, -16.0], p < 0.01) with fewer circuit component changes per 10 ECMO days (0.64 [0.4-0.7] vs . 2.6 [1.9-5.0], p < 0.01). Extracorporeal membrane oxygenation patients on bivalirudin had greater odds of survival to decannulation (odds ratio [OR]: 3.7 [1.4, 11.5], p = 0.01) and discharge (OR: 3.1 [1.4, 7.2], p < 0.01). The use of bivalirudin for ECMO in the pediatric cardiothoracic ICU population appears safe with fewer major bleeding and thrombotic complications and may be associated with improved survival compared to heparin.</p>","PeriodicalId":8844,"journal":{"name":"ASAIO Journal","volume":" ","pages":"798-804"},"PeriodicalIF":2.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145666479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
ASAIO JournalPub Date : 2026-09-01Epub Date: 2026-04-06DOI: 10.1097/MAT.0000000000002708
Benjamin Hohlfelder, Xin Zou, Maureen Converse, Sudhir Krishnan
{"title":"Evaluation of Neuromuscular Blocking Agent Utilization in Extracorporeal Membrane Oxygenation.","authors":"Benjamin Hohlfelder, Xin Zou, Maureen Converse, Sudhir Krishnan","doi":"10.1097/MAT.0000000000002708","DOIUrl":"10.1097/MAT.0000000000002708","url":null,"abstract":"<p><p>Neuromuscular blocking agent (NMB) utilization has been infrequently described in patients requiring extracorporeal membrane oxygenation (ECMO). The goal of this analysis was to evaluate NMB utilization at a high-volume ECMO center. This was a retrospective cohort study of patients who required ECMO at the Cleveland Clinic between January 2022 and December 2023. NMB utilization was collected, including the agent, dose, duration (if continuous infusion), and indication. Other clinical outcomes recorded included duration of ECMO support, evidence of neuromuscular dysfunction, and hospital mortality. In total, 329 patients were evaluated, and 280 patients were included. Nearly 50% of patients received NMB during their ECMO course. Most utilization was rocuronium bolus. Continuous infusion NMB was only used in 12%. Common indications for NMB were for bedside procedures (66%), hypoxemia (9%), and ECMO low flows (6%). When used for hypoxemia or ECMO low flows, administration of NMB was associated with an improvement in partial pressure of arterial oxygen (PaO 2 ) (64 vs . 105 mm Hg, p < 0.001) and ECMO flow (2.9 vs . 4.0 L/min, p = 0.016) at 1 hour, respectively. Evidence of neuromuscular dysfunction was documented in 6% of patients. Neuromuscular blocking agent use was needed in about half of patients on ECMO, but few patients required continuous NMB.</p>","PeriodicalId":8844,"journal":{"name":"ASAIO Journal","volume":" ","pages":"781-785"},"PeriodicalIF":2.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147621676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
ASAIO JournalPub Date : 2026-09-01Epub Date: 2026-04-27DOI: 10.1097/MAT.0000000000002715
Yin Xi, Jie Zhang, Ya Wang, Yonghao Xu
{"title":"Decompensated Differential Carbon Dioxide Removal During Venoarterial Extracorporeal Membrane Oxygenation: A Physiologic Framework.","authors":"Yin Xi, Jie Zhang, Ya Wang, Yonghao Xu","doi":"10.1097/MAT.0000000000002715","DOIUrl":"10.1097/MAT.0000000000002715","url":null,"abstract":"<p><p>Decompensated differential carbon dioxide (CO 2 ) removal can occur during spontaneous breathing on peripheral venoarterial extracorporeal membrane oxygenation (V-A ECMO) when a low right radial arterial partial pressure of carbon dioxide (PaCO 2 ) prompts sweep gas flow (SGF) reduction, decreasing extracorporeal CO 2 removal and shifting the compensatory burden to the native lung. When cardiac output (CO) remains low, this shift may require disproportionately higher alveolar ventilation, manifesting as tachypnea and increased work of breathing. We therefore frame this phenotype as a CO-dependent CO 2 \"budget\" imbalance that is modulated by the aortic mixing point, rather than solely cerebral exposure to CO 2 -rich retrograde ECMO blood. We outline a pragmatic, non-protocol bedside heuristic anchored to post-membrane pH/PaCO 2 targets, using multi-site blood gases to contextualize the mixing point and guide physiologic optimization of preload, ECMO blood flow, and SGF. Treating the loop, rather than isolated right-radial values, may reduce iatrogenic escalation and provide a testable foundation for future mechanistic studies.</p>","PeriodicalId":8844,"journal":{"name":"ASAIO Journal","volume":" ","pages":"e251-e253"},"PeriodicalIF":2.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147760762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
ASAIO JournalPub Date : 2026-09-01Epub Date: 2025-11-26DOI: 10.1097/MAT.0000000000002605
Yeahwa Hong, Umar Nasim, Ander Dorken-Gallastegi, Nidhi Iyanna, Brian E Woolley, Samantha N Machinski, Mary E Keebler, Roy Sriwattanakomen, Edward T Horn, Raj Ramanan, Gavin W Hickey, David J Kaczorowski
{"title":"Utilization of Hearts Donated After Circulatory Death Improves All-Cause Survival in Candidates With Durable Left Ventricular Assist Devices.","authors":"Yeahwa Hong, Umar Nasim, Ander Dorken-Gallastegi, Nidhi Iyanna, Brian E Woolley, Samantha N Machinski, Mary E Keebler, Roy Sriwattanakomen, Edward T Horn, Raj Ramanan, Gavin W Hickey, David J Kaczorowski","doi":"10.1097/MAT.0000000000002605","DOIUrl":"10.1097/MAT.0000000000002605","url":null,"abstract":"<p><p>Heart transplantation practices have evolved significantly following the 2018 heart allocation policy changes and the introduction of donation after circulatory death (DCD) heart transplantation in 2019. Under the new system, candidates supported with durable left ventricular assist devices (DLVADs) experience longer waitlist times with worse outcomes. This study evaluates the impact of DCD heart utilization on waitlist outcomes among DLVAD candidates using the United Network for Organ Sharing (UNOS) registry. Adult candidates with DLVADs listed for isolated heart transplantation from December 1, 2019, to March 31, 2023, with a 2 year follow-up period extending to March 31, 2025. Candidates were stratified by approval status to accept DCD donor offers. The outcomes were 2 year cumulative incidences of transplantation, delisting due to death or clinical deterioration, and all-cause survival from the time of initial waitlisting. Among 2,993 candidates, 487 (16.3%) were approved to accept DCD donor offers. Approval for DCD donor offers was associated with a significantly lower risk of delisting, a higher likelihood of transplantation, and improved all-cause survival. Moreover, this survival improvement persisted in the multivariable Cox regression. These findings highlight the growing use and clinical value of DCD heart utilization in expanding access to transplantation and improving outcomes in DLVAD candidates awaiting transplantation.</p>","PeriodicalId":8844,"journal":{"name":"ASAIO Journal","volume":" ","pages":"e235-e242"},"PeriodicalIF":2.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145601990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Comparative Outcomes of Heart Transplant Recipients Aged Below and Above 65 Years: A Single-Center Experience.","authors":"Nicola Pradegan, Valentina Lombardi, Giulia Guerra, Tea Lena, Veronica Geatti, Giulia Lorenzoni, Dario Gregori, Chiara Tessari, Marny Fedrigo, Annalisa Angelini, Giuseppe Toscano, Vincenzo Tarzia, Gino Gerosa","doi":"10.1097/MAT.0000000000002628","DOIUrl":"10.1097/MAT.0000000000002628","url":null,"abstract":"<p><p>Despite the increasing prevalence of advanced heart failure among older patients, current guidelines remain cautious regarding the safety of heart transplantation (HT) in elderly recipients. This study aimed to evaluate early and late outcomes in older HT recipients. We retrospectively analyzed all patients aged ≥18 years who underwent HT at our center between January 2012 and December 2022, comparing early and late outcomes of recipients ≥65 years (group 1) vs . those <65 (group 2). Groups 1 and 2 comprised 73 (female = 10, median age = 67 years, interquartile range [IQR] = 66-69) and 212 patients (female = 58, median age = 54 years, IQR = 46-60), respectively. Group 1 presented a higher burden of cardiovascular (CV) risk factors and impaired renal function ( p < 0.001); additionally, they more often received older donors ( p < 0.001) with a higher incidence of coronary artery disease ( p = 0.041). Group 1 experienced a significantly higher rate of postoperative complications and in-hospital mortality (n = 21, 28.8%; p < 0.001). At a median follow-up time of 4.2 years (IQR = 1.3-6.9), group 1 showed lower survival rates ( p < 0.001) (1 year = 68%, 95% confidence interval [CI] = 58-80; 5 year = 62%, 95% CI = 51-74). In our experience, HT in patients aged ≥65 years shows worse early and late outcomes; however, among elderly recipients, modifiable factors such as donor age and perioperative complications significantly influence survival and may be targeted to improve clinical results.</p>","PeriodicalId":8844,"journal":{"name":"ASAIO Journal","volume":" ","pages":"774-780"},"PeriodicalIF":2.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145803199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
ASAIO JournalPub Date : 2026-09-01Epub Date: 2026-06-29DOI: 10.1097/MAT.0000000000002750
Enock Adjei, Amir T Dereshgi, John W Stokes, Caitlin T Demarest, Matthew Bacchetta, Konrad Hoetzenecker
{"title":"Letter to the Editor Regarding the Article \"Parallel Dual-Lumen Venovenous Extracorporeal Membrane Oxygenation Following Extracorporeal Cardiopulmonary Resuscitation\".","authors":"Enock Adjei, Amir T Dereshgi, John W Stokes, Caitlin T Demarest, Matthew Bacchetta, Konrad Hoetzenecker","doi":"10.1097/MAT.0000000000002750","DOIUrl":"10.1097/MAT.0000000000002750","url":null,"abstract":"","PeriodicalId":8844,"journal":{"name":"ASAIO Journal","volume":" ","pages":"e269"},"PeriodicalIF":2.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148350399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}