Background. Major bleeding has been a common and serious complication with poor outcomes in ECMO patients. With a novel, less-invasive cannulation approach and closer coagulation monitoring regime, the incidence of major bleeding is currently not determined yet. Our study aims to examine the incidence of major bleeding, its determinants, and association with mortality in peripheral-ECMO patients. Method. We conducted a single-center retrospective study on adult patients undergoing peripheral-ECMO between January 2019 and January 2020 at a tertiary referral hospital. Determinants of major bleeding were defined by logistic regression analysis. Risk factors of in-hospital mortality were determined by Cox proportional hazard regression analysis. Results. Major bleeding was reported in 33/105 patients (31.4%) and was associated with higher in-hospital mortality [adjusted hazard ratio (aHR) 3.56, 95% confidence interval (CI) 1.63–7.80, ). There were no significant difference in age, sex, ECMO indications, ECMO modality, pre-ECMO APACHE-II and SOFA scores between two groups with and without major bleeding. Only APTT >72 seconds [adjusted odds ratio (aOR) 7.10, 95% CI 2.60–19.50, ], fibrinogen <2 g/L [aOR = 7.10, 95% CI 2.60–19.50, ], and ACT >220 seconds [aOR = 3.9, 95% CI 1.20–11.80, ] on days with major bleeding were independent predictors. Conclusions. In summary, major bleeding still had a fairly high incidence and poor outcome in peripheral-ECMO patients. APTT > 72 seconds, fibrinogen < 2 g/L were the strongest predicting factors for major bleeding events.

Extracorporeal blood purification is a technique for reducing elevated levels of inflammatory mediators and/or endotoxins in critically ill patients with sepsis or other hyperinflammatory conditions. The oXiris filter combines endotoxin adsorption, cytokine adsorption, hemofiltration, and anti-thrombosis, and an emerging body of evidence demonstrates its use in critical care patients with hyperinflammatory conditions and acute kidney injury (AKI). A group of Asia-Pacific experts convened to formulate consensus statements for the use of the oXiris filter based on a comprehensive review of publications. After evaluation using a Delphi methodology, 17 statements achieved consensus (three recommendations and 14 practice points). These offer guidance on the initiation, monitoring, and evaluation of treatment with the oXiris filter in patients with sepsis, septic shock, severe COVID-19, or other hyperinflammatory states. We also recommend using the oXiris filter in patients undergoing cardiopulmonary bypass for cardiac surgery who are at risk for developing AKI. Other statements discuss modality, dosage, filter lifespan, anticoagulation, and combining the oXiris filter set with other extracorporeal therapies. Taken together, our statements offer targeted guidance for clinicians on the use of the oXiris filter across different patient populations. Additionally, we highlight the limitations of the current evidence base and identify key areas requiring further research.

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.

Little is known about the role of neutrophil CD64 (nCD64) in detecting sepsis early in Asian populations. We examined the cut-off and predictive values of nCD64 for diagnosing sepsis in Vietnamese intensive care units (ICU) patients. A cross-sectional study was conducted at the ICU of Cho Ray Hospital between January 2019 and April 2020. All 104 newly admitted patients were included. Sensitivity (Sens), specificity (Spec), positive and negative predictive values (PPV and NPV), and receiver operating characteristic (ROC) curves were calculated to compare the diagnostic values of nCD64 with those of procalcitonin (PCT) and white blood cell (WBC) for sepsis. The median nCD64 value in sepsis patients was statistically higher than that of non-sepsis patients (3106 [1970–5200] vs. 745 [458–906] molecules/cell, p < 0.001). ROC analysis found that the AUC value of nCD64 was 0.92, which was higher than that of PCT (0.872), WBC (0.637), and nCD64 combined, with WBC (0.906) and nCD64 combined with WBC and PCT (0.919), but lower than that of nCD64 combined with PCT (0.924). With an AUC value of 0.92, the nCD64 index of 1311 molecules/cell-detected sepsis with 89.9% Sens, 85.7% Spec, 92.5% PPV, and 81.1% NPV. nCD64 can be a useful marker for early sepsis diagnosis in ICU patients. nCD64 combined with PCT may improve the diagnostic accuracy.

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.

Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is a form of extracorporeal circulation that provides cardiopulmonary support in cardiogenic shock unresponsive to conventional therapy. Historically, VA-ECMO was limited to the operating room and primarily used to manage postcardiotomy cardiogenic shock cases. However, with advances in ECMO technology and a better understanding of patient selection criteria, VA-ECMO has expanded its role as a temporary and adaptable intervention in cardiogenic shock of diverse etiologies. This review provides an updated overview of the indications for peripheral VA-ECMO, discussing how recent studies have enhanced our understanding of when VA-ECMO should be considered. In addition, we discuss the feasibility of surgery during VA-ECMO support to improve perioperative planning and tailored anesthetic strategies following ECMO-related physiologic and pharmacological changes.