Marco Giani

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

Early mechanical reperfusion in high-risk pulmonary embolism during VA #ECMO support? 🔍 large international study including 492 adult patients with life-threatening PE treated with VA #ECLS at 39 ECMO centers, 2014–2024 🫀 69% had cardiac arrest 🩸 28% received early mechanical reperfusion, catheter-directed therapy or surgical embolectomy within 48h of ECMO initiation 🪦 90-day mortality 32% with early mechanical reperfusion on ECMO vs 39% with ECMO stand-alone ⚖️ ECMO duration and weaning rates were similar; however, early reperfusion improved ECMO weaning in patients without prior thrombolysis. Bleeding 50%, no significant difference between groups The addition of early mechanical reperfusion therapy did not significantly reduced mortality or shorten run duration; reperfusion using newer CDT techniques may provide advantages in selected patients by enabling earlier weaning, additional evidence required. Meanwhile, pragmatic, stepwise, individualized approach favouring an initial ECMO stand-alone strategy may be preferable to routine mechanical reperfusion. Open access #FOAMcc #FOAMecmo 🔓 bit.ly/4t2GSTI

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

Weaning from VV #ECMO: results of @ESICM endorsed WEAN-ECMO survey, aimed to better understanding of this complex intervention, are out ‼️ 🔍 303 responses from 187 centers, 🗺️ 46 countries 🚧 marked variability in current practices exists, mirroring #ECLS candidate selection & management 🫁 clinicians mostly rely on gas exchange; objective measures of lung mechanics considered relevant but less influential, Pes monitoring still uncommon 🫁 protocolized sweep gas-off trials implemented in most centres, but duration/evaluation criteria vary widely + ventilatory management heterogeneous ⛔️ perceived weaning failure mostly reflects persistent gas-exchange impairment, respiratory distress, or clinical instability Standardization of weaning criteria/protocols, including monitoring + SGOT duration, may improve comparability across centers and support future consensus recommendations. Open access #FOAMcc #FOAMecmo on @yourICM 🔓 rdcu.be/eVTEY

Thrombocytopenia in VV #ECMO? Highly prevalent in VV ECMO, and strongly associated with bleeding risk and reduced survival. Platelet transfusions do not appear to significantly reduce bleeding risk: targeted prevention strategies needed! #FOAMcc @Crit_Care 🔓 rdcu.be/ez2mh 🔎 adults w resp failure; baseline thrombocytopenia 27.9%, mild 14.7%, moderate 8.7%, severe 4.4% ⚖️ thrombocytopenia in #ECLS occurred at least once in 80.2%; mild 21.3%, moderate 32.2%, severe 26.7% 🩸mild thrombocytopenia increased risk of bleedings by 61%; moderate & severe by 90% 🚧 risk for thrombocytopenia  increased with ICU days prior to ECMO, postop admission, immunocompromised state, RRT, septic shock, low hemoglobin, circuit replacement.

We need you to understand how to wean patients from Veno-Venous #ECMO... Participate in WeanECMO, an international, multicenter, cross-sectional survey, investigating current practices for weaning patients from VV #ECLS. The survey is endorsed by @ESICM 🔗 bit.ly/WeanECMO @marcogiani @jrdelbrio @ERezoagli

🩸🔗 🫁 How do you wean patients from Veno-Venous #ECMO? What's the optimal strategy?? You still have time to give your contribution, participating in WeanECMO, an international, multicenter, cross-sectional survey, investigating current practices for weaning patients from VV #ECLS! The survey aims to explore the criteria used to assess patient eligibility for weaning trials and the methods employed across different ECMO centers. This short (10') & anonymous survey consists of 4️⃣ domains: 1️⃣ General information 2️⃣ Criteria for weaning from veno-venous ECMO 3️⃣ Sweep gas-off trial 4️⃣ Ventilation modality during weaning phase The survey is endorsed by @ESICM 🔗 bit.ly/WeanECMO

🔗🫁 How to wean from VV #ECMO?? Participate in WeanECMO survey, investigating how to assess eligibility for #ECLS weaning trials + methods employed across different centers. The short (10')/anonymous survey is endorsed by @ESICM 🔗 bit.ly/WeanECMO

Prone positioning during VV #ECMO, systematic review & meta-analysis aimed to assess association of PP vs non with clinical outcomes in different subgroups: 🔍 2 RCTs + 20 non-RCTs 🔎 >3.4K patients included 🫁 pts with acute hypoxemic respiratory failure on VV #ECLS who received PP showed improved mortality, despite fewer 28-day ventilator-free days & longer run ⚖️ younger age, higher SOFA score, non #COVID19 etiology, lower rates of proning before cannulation associated with a greater benefit from PP #FOAMcc on @yourICM 🔓rdcu.be/ekhBC

MDR Gram - bacteria on VV #ECMO, RANGER STUDY 🧫 overall isolation 50%: 21% detected pre, 29% post initiation 🪦17 mortality 42%, higher if isolation before ECMO 🏥 larger annual hospital volume? lower probability of acquiring on ECMO #FOAMcc @Crit_Care 🔓rdcu.be/dScaF