Background: Hemostatic dysfunction during extracorporeal membrane oxygenation (ECMO) due to blood-circuit interaction and the consequences of shear stress imposed by flow rates lead to rapid coagulation cascade and thrombus formation in the ECMO system and blood vessels. We aimed to identify the incidence and risk factors for cannula-associated arterial thrombosis (CaAT) post-decannulation. Methods: A retrospective study of patients undergoing arterial cannula removal following ECMO was performed. We evaluated the incidence of CaAT and compared the characteristics, ECMO machine parameters, cannula sizes, number of blood products transfused during ECMO, and daily hemostasis parameters in patients with and without CaAT. Multivariate analysis identified the risk factors for CaAT. Results: Forty-seven patients requiring venoarterial ECMO (VA-ECMO) or hybrid methods were recruited for thrombosis screening. The median Sequential Organ Failure Assessment score was 11 (interquartile range, 8–13). CaAT occurred in 29 patients (61.7%), with thrombosis in the superficial femoral artery accounting for 51.7% of cases. The rate of limb ischemia complications in the CaAT group was 17.2%. Multivariate analysis determined that the ECMO flow rate–body surface area (BSA) ratio (100 ml/min/m2) was an independent factor for CaAT, with an odds ratio of 0.79 (95% confidence interval, 0.66–0.95, P=0.014). Conclusions: We found that the incidence of CaAT was 61.7% following successful decannulation from VA-ECMO or hybrid modes, and the ECMO flow rate–BSA ratio was an independent risk factor for CaAT. We suggest screening for arterial thrombosis following VA-ECMO, and further research is needed to determine the risks and benefits of such screening.

Amniotic fluid embolism (AFE) is an obstetric complication that can result in acute circulatory failure during and after labor. The effectiveness of extracorporeal membrane oxygenation (ECMO) in AFE patients has not been established, especially in the context of coagulopathy. This review aims to evaluate the efficacy of ECMO support in AFE patients. We conducted a systematic review of case reports following the Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Quality assessment was performed using a standardized tool. Out of 141 studies screened, 33 studies included 79 AFE patients. The median age was 34 years, and the median gestational age was 37.5 weeks. The majority of AFE cases occurred during cesarean section delivery (55.2%), followed by labor before fetal delivery (26.7%). Extracorporeal membrane oxygenation configurations included venoarterial ECMO (81.3%) and extracorporeal cardiopulmonary resuscitation (CPR, 10.7%). The maternal survival rate was 72%, with 21.2% experiencing minor neurological sequelae and 5.8% having major neurological sequelae. Rescue ECMO to support circulation has demonstrated both safety and efficacy in managing AFE. We suggest early activation of local or mobile ECMO as soon as an AFE diagnosis is established. Further studies are needed to assess the benefits and implications of early ECMO support in AFE patients.

Background: Transporting patients on extracorporeal membrane oxygenation (ECMO) is a standard practice in high-resource settings but remains limited in low- and middle-income countries due to financial, infrastructural, and staffing constraints. This study evaluated the safety, complications, and outcomes of ECMO transport in a low-resource setting. Methods: This retrospective study conducted ECMO transport at a tertiary hospital in Ho Chi Minh City, Vietnam, from January 2019 to January 2023. Data on demographics, transport logistics, ECMO configuration, complications, and clinical outcomes were analyzed, including subgroup comparisons between COVID-19 and non-COVID-19 patients. Results: Thirty-nine patients (mean age 45 years; 56.4% female) underwent inter-hospital ECMO transport over a median distance of 7.9 km. All patients survived transport, although one patient (2.6%) had a mechanical complication. Other complications recorded during ECMO support included infection in 53.8%, major bleeding in 23.1%, and pneumothorax in 5.1%. Overall survival to discharge was 69.2%. COVID-19 patients had a significantly lower discharge survival than non-COVID-19 patients (42.9% vs. 81.8%, p = 0.029) Conclusion: ECMO transport can be safely implemented in low-resource settings, achieving outcomes comparable to in-house ECMO support. Further research is essential to develop standardized protocols and expand ECMO networks to improve patient outcomes in resource-limited settings.

The association between early magnesium sulfate administration and outcomes in sepsis remains incompletely understood, particularly in relation to differences in systemic immune–inflammatory status. In this retrospective cohort study using Medical Information Mart for Intensive Care IV (version 3.1), adult critically ill patients with sepsis were included. Systemic immune–inflammation index (SII) was calculated from platelet, neutrophil, and lymphocyte counts obtained within a peri-intensive care unit window (6 hours before to 24 hours after intensive care unit admission). Early magnesium administration was defined as intravenous magnesium sulfate initiated within the same window. The primary outcome was 30-day all-cause mortality. Propensity score matching was performed to balance baseline characteristics. Associations were examined overall and across SII quartiles using stratified multivariable Cox proportional hazards models, with nonlinear relationships explored using restricted cubic splines. Among 12,087 patients, 6039 received early intravenous magnesium. After propensity score matching, 3396 matched pairs were analyzed. Early magnesium administration was associated with lower 30-day mortality overall (15.8% vs 18.3%, P = .007). In stratified analyses, adjusted hazard ratios were 0.66 (95% confidence interval: 0.51–0.87), 0.65 (0.49–0.85), 0.75 (0.59–0.94), and 0.85 (0.70–1.04) across quartiles 1 to 4. Restricted cubic spline analyses showed descriptive attenuation at higher SII values ( P for interaction = .208), without evidence of a statistically definitive interaction. Early magnesium administration was associated with lower 30-day mortality in critically ill patients with sepsis. Although formal interaction testing did not reach statistical significance, adjusted hazard ratios showed a descriptive gradient of attenuation across increasing SII quartiles, directionally consistent across sensitivity analyses. These findings are hypothesis-generating and require prospective validation.