Lars Mikael Broman

Introduction: The blood pump is a central component of the extracorporeal life support (ECLS) circuit. Modern centrifugal and diagonal pumps are mainly used in preference to roller pumps. Compared to roller pumps, centrifugal and diagonal pumps offer lower priming volume, less hemolysis and enable miniaturization of circuits. Drawback is the open design promoting internal recirculation, which influences performance and, in few studies at low flow, may increase risk of coagulation activation and hemolysis. The aim of this work was to provide performance data on available pumps. Methods: Manufacturers were asked to lend ECLS consoles and donate pump samples for the study. No financial support was accepted. Missing pumps were bought by the investigators. In a mock-loop, measurements of volume flow and pressures were performed. Pumps were assessed over the operating flow range stated by the manufacturer at different preloads and afterload levels. Results: Eight different ECLS pumps were tested, two available for pediatric use and six for adult use. Six pumps were centrifugal and two were of diagonal design. All were magnetically driven and three were magnetically levitated. Five had impellers with shrouded (covered) design. Water or water-glucose were used as a test fluid and choice of medium is herewith also discussed. Flow-pressure maps for each pump were generated over its operating range. As agreed with manufacturers, no direct comparisons between pumps were made. Conclusions: Performance curves for blood pumps designed for ECLS use in children and adults were reported and important aspects of design features discussed to support clinicians.

Acute right ventricular failure (ARVF) is a life‐threatening condition commonly encountered in the intensive care unit. The treatment of ARVF profoundly changed in the last years, with a growing number of mechanical circulatory support (MCS) devices that have been deployed in clinical practice to support patients with severe forms of ARVF. However, comparative clinical data addressing the superiority of the different MCS strategies are lacking. Several animal models addressing ARVF have been proposed in the literature, and they have been crucial to increase the knowledge on right ventricular (RV) pathophysiology and response to different stressors. Nevertheless, models that reliably mimic acute RV severe failure, ventricular–pulmonary artery uncoupling, and cardiogenic shock are comparatively scarce. Furthermore, only a limited number of experimental studies have incorporated MCS devices in this setting, and direct head‐to‐head comparisons between different support strategies are largely lacking. This gap in preclinical experiences significantly limits the development of evidence‐based algorithms for right‐sided MCS deployment. In this review, we summarize currently available animal models of ARVF, critically highlighting their methodological strengths and limitations, and examining the evidence supporting the use of MCS within these frameworks. By highlighting the translational limitations of the existing preclinical experiences, we underscore the urgent need for standardized, reproducible, and clinically relevant ARVF models. Such efforts are essential to improve the current treatment of ARVF, and they could be particularly relevant in developing and optimizing MCS devices and their selection, ultimately enhancing outcomes in patients with ARVF.

Background: Extracorporeal membrane oxygenation (ECMO) is an established life support technique for refractory acute cardiorespiratory failure in children and adult patients. However, ECMO support is provided only by specialized centers; therefore, demand for ECMO transport retrieval services is increasing. Mobile teams assess, accept, implant ECMO, and then transport for continued support at an ECMO center. Aim: To provide an updated practical review to support ECMO teams for safe and effective transports. Material and methods: We retrospectively reviewed literature limited to ECMO transport published between January 2014 to October 2025. Results: Forty-five manuscripts were included in this narrative review. Patient selection focused on reversible, refractory respiratory or cardiac failure not responding to maximal conventional therapy. Time to reach the referring hospital is the most frequent factor limiting the feasibility of transport; both ground ambulances and aircraft were the most common means used, depending on distance. Weather and road conditions may influence transport safety. Familiar equipment was generally used during transport, but with adaptation and certification for transport. Team experience and training were important factors for safe transport since complications frequently occurred, requiring fast decision and action. Foreign country missions required involvement of insurance, legal, and administrative support. Conclusions: Regional, national, and international inter-hospital ECMO transports can be conducted safely. Preparation of ECMO transport services regarding adapted equipment, checklists, and comprehensive training for ECMO team members is essential to ensure secure transport, enabling early identification and appropriate management of adverse events. International transports operate within different regulatory frameworks and therefore require special considerations.

Extracorporeal life support (ECLS) technology has witnessed remarkable advancements during the last decades. However, further research and development of devices are required to increase, for example, performance-efficiency, hemocompatibility, and long-term stability. All novel devices, even in early research stages, must undergo rigorous testing and evaluation. Yet, these early evaluations are often conducted under nonstandardized conditions, resulting in data difficult to compare, interpret, or translate into clinical practice. Establishing well-defined, standardized in-vitro testing protocols for all ECLS components and devices would represent a major step forward. Such protocols would improve methodological consistency and ensure reproducibility across research groups. This document, developed by an international group of ECLS experts from all disciplines in which such components are designed, developed, and applied, provides clear recommendations and standardized criteria for device testing according to international norms. Adoption of these criteria including the ways of reporting results will foster a unified approach among scientists, engineers, clinicians, and the medical device industry. Ultimately, this common framework will facilitate data interpretation, improve comparability of study results between different groups, making the review of studies more straightforward, as not every aspect of testing requires additional review and discussion, certainly favoring decision-making in the development and application of ECLS technologies.

Extracorporeal life support (ECLS) technology has witnessed remarkable advancements during the last decades. However, further research and development of devices are required to increase, for example, performance-efficiency, hemocompatibility, and long-term stability. All novel devices, even in early research stages, must undergo rigorous testing and evaluation. Yet, these early evaluations are often conducted under nonstandardized conditions, resulting in data difficult to compare, interpret, or translate into clinical practice. Establishing well-defined, standardized in-vitro testing protocols for all ECLS components and devices would represent a major step forward. Such protocols would improve methodological consistency and ensure reproducibility across research groups. This document, developed by an international group of ECLS experts from all disciplines in which such components are designed, developed, and applied, provides clear recommendations and standardized criteria for device testing according to international norms. Adoption of these criteria including the ways of reporting results will foster a unified approach among scientists, engineers, clinicians, and the medical device industry. Ultimately, this common framework will facilitate data interpretation, improve comparability of study results between different groups, making the review of studies more straightforward, as not every aspect of testing requires additional review and discussion, certainly favoring decision-making in the development and application of ECLS technologies.

Background: A vascular closure device (VCD) may be employed to close arteriotomy of the femoral artery following endovascular surgery, catheterization, and extracorporeal life support cannulation. Such devices aim to reduce the time to hemostasis and avoid the need for manual compression. Despite ubiquity of VCDs in clinical practice, limited research on the hemodynamic impact of these devices has been published. Methodology: Four commonly-used VCDs were applied on a 10 mm longitudinal incision in a 3/8 inch diameter polyvinylchloride tubing for geometry. Each sample was imaged with micro-computed tomography and reconstructed into a 3-dimensional model. Using computational fluid dynamics, blood flow over the 4 VCDs was simulated in a straight cylinder. In addition, 1 sample was simulated in a patient-specific femoral artery geometry. Time-averaged wall shear stress (TAWSS), oscillatory shear index (OSI), and endothelial cell activation potential were used to assess the impact of each device on vessel hemodynamics. Results and Conclusions: The results suggest that anchor-based devices, resulted in larger flow disturbances, decreasing TAWSS and increasing OSI in their wake, compared with suture-based devices. Such conditions are likely to be pro-thrombotic. While the choice of VCD may be multifactorial, the present study offers new comparative data on their hemodynamic impact. Clinical Impact: The results from the present study offer unique comparative data on the hemodynamic impact of 4 vascular closure devices. These findings may help in the selection of devices. The pro-thrombotic nature of anchor-based devices may make these less suitable for certain clinical scenarios where there is a high risk of thrombosis and vessel occlusion.

Extracorporeal life support (ECLS) technology has witnessed remarkable advancements during the last decades. However, further research and development of devices are required to increase, for example, performance-efficiency, hemocompatibility, and long-term stability. All novel devices, even in early research stages, must undergo rigorous testing and evaluation. Yet, these early evaluations are often conducted under nonstandardized conditions, resulting in data difficult to compare, interpret, or translate into clinical practice. Establishing well-defined, standardized in-vitro testing protocols for all ECLS components and devices would represent a major step forward. Such protocols would improve methodological consistency and ensure reproducibility across research groups. This document, developed by an international group of ECLS experts from all disciplines in which such components are designed, developed, and applied, provides clear recommendations and standardized criteria for device testing according to international norms. Adoption of these criteria including the ways of reporting results will foster a unified approach among scientists, engineers, clinicians, and the medical device industry. Ultimately, this common framework will facilitate data interpretation, improve comparability of study results between different groups, making the review of studies more straightforward, as not every aspect of testing requires additional review and discussion, certainly favoring decision-making in the development and application of ECLS technologies.

Objectives: Bleeding is a common complication of extracorporeal membrane oxygenation (ECMO) support. While chest tube treatment is infrequently linked to bleeding in non-ECMO patients, several reports suggest a markedly increased risk during ECMO support, sometimes requiring surgical intervention. The true incidence, contributing factors, and effect on outcome from chest tube related bleeding in ECMO patients is unknown. Methods: This was a single-centre observational study conducted between 2010 and 2024, including both paediatric and adult patients treated with chest tube for pneumothorax or non-haemorrhagic pleural fluid during their ECMO treatment. Major bleeding was defined by chest tube output amount adjusted to patient age, need for multiple red blood cell transfusions, or need for surgical intervention. Results: Of the 1158 screened ECMO patients, 168 (14.5%) required chest drainage for pleural effusions or pneumothorax during the study period, and a total of 279 chest tubes were analysed. Major bleeding occurred in 21 patients (12.5%) and from 23 chest tubes (8.1%). Fourteen patients required thoracotomy. Bleeding was more common with tubes placed during ECMO support (11.3%) compared to pre-ECMO (4.7%, P = .036). Affected patients had longer ECMO durations (median 42 vs 17 days, P = .003) and lower hospital survival (47.6% vs 71.4%, P = .043). No associations were observed between bleeding and tube size, laterality, type, insertion technique, or ECMO mode. The chest wall was the most commonly identified bleeding location. Conclusions: There was a markedly increased risk of major bleeding from chest tubes during ECMO, particularly when inserted after cannulation. Patients who experienced bleeding complications had longer hospital stays and lower survival.

Congenital diaphragmatic hernia (CDH) is a rare and severe malformation that can lead to life-threatening postnatal physiological challenges which may require lifesaving extracorporeal membrane oxygenation (ECMO) support, sometimes more than once. However, the benefits of multiple ECMO courses remain uncertain. Data on all patients with CDH supported on ECMO from 1976 to 2020 were retrieved from the Extracorporeal Life Support Organization (ELSO) Registry. Outcomes for patients with CDH undergoing more than one ECMO course were analyzed. This group was then stratified into two subgroups, “treated before 2010” and “treated after 2010,” which were analyzed separately. A total of 9,928 patients were identified. The overall survival to discharge for CDH supported with ECMO was 51.9%. Three hundred and thirty-nine patients (3.5%) were supported with ECMO more than once. The overall survival to discharge in this group was 39%. After 2010, the survival rate had increased from 34.7 (n = 213) to 46.8% (n = 126) (p = 0.018). We found that the rate of CDH patients requiring repeated ECMO support was low, and that survival rates were acceptable and improving over time.