Extracorporeal membrane oxygenation (ECMO) is a crucial life support therapy for patients with severe cardiac and respiratory failure. However, the complications associated with venoarterial ECMO (VA-ECMO), including thrombus formation, bleeding, and hemolysis, remain significant challenges that impact patient outcomes and healthcare costs. These complications primarily arise from blood–material interactions within the ECMO circuit, necessitating the development of biocompatible materials to optimize hemocompatibility. This review provides an updated overview of the latest advancements in VA-ECMO materials, focusing on cannula, oxygenators, and centrifugal pumps. Various surface modifications, such as heparin coatings, nitric oxide-releasing polymers, phosphorylcholine (PC)-based coatings, and emerging omniphobic surfaces, have been explored to mitigate thrombosis and bleeding risks. Additionally, novel oxygenator membrane technologies, including zwitterionic polymers and endothelial-mimicking coatings, offer promising strategies to enhance biocompatibility and reduce inflammatory responses. In centrifugal pumps, magnetic levitation systems and hybrid polymer-composite impellers have been introduced to minimize shear stress and thrombogenicity. Despite these advancements, no single material has fully addressed all complications, and further research is needed to refine surface engineering strategies. This review highlights the current progress in ECMO biomaterials and discusses future directions in developing more effective and durable solutions to improve patient safety and clinical outcomes.

While immune checkpoint inhibitors (ICIs) have revolutionised cancer treatment, they can cause immune-related adverse events, including thyroid dysfunction and rarely, thyroid storm. Here, we present a rare case of thyroid storm occurring during ICI therapy, in which clinical and immunological findings strongly suggested Graves’ disease. A man in his 80s with advanced lung cancer was hospitalised for multiple rib fractures. During admission, he developed fever, delirium, atrial fibrillation and marked thyrotoxicosis, leading to a diagnosis of thyroid storm. Given his prior treatment with nivolumab and ipilimumab, destructive thyroiditis was initially suspected, as this is the most common mechanism of ICI-associated thyrotoxicosis. However, marked thyroid-stimulating antibody positivity was more suggestive of Graves’ disease than destructive thyroiditis. This case highlights that ICI therapy-associated thyroid storm can arise not only from destructive thyroiditis but also from Graves’ disease. Therefore, careful clinical evaluation is essential to determine the underlying pathophysiology and guide optimal management.

Introduction: Sepsis remains a critical global health issue, causing multiple organ failure and high mortality rates, despite advances in antimicrobial therapies and supportive care. Extracorporeal blood purification (EBP) techniques have emerged as promising adjunctive strategies for the management of severe infections. The Seraph® 100 Microbind® Affinity Blood Filter (Seraph 100, ExThera Medical, Martinez, CA, USA) targets pathogens, while the Selective Cytopheretic Device (SCD, SeaStar Medical, Denver, CO, USA) neutralizes activated leukocytes. Although individually validated, evidence of the combined use of Seraph 100 and SCD remains scarce. Case Presentations: We present two cases that illustrate the combined use of Seraph 100 and SCD. The first case involves a 43-year-old woman with bacterial pneumonia, septic shock, and acute kidney injury (AKI). She underwent Seraph 100 hemoperfusion followed by SCD therapy, which improved her hemodynamics, oxygenation, and renal function, ultimately leading to full recovery. The second case involved a 31-year-old man with influenza, severe hypoxemia, and multi-organ failure. Despite advanced therapies, including veno-arterial venous extracorporeal membrane oxygenation, Seraph 100, and SCD, his condition deteriorated, resulting in multi-organ failure and eventual death. Conclusion: These cases highlight the potential benefits and challenges of combining EBP, such as Seraph 100 and SCD. While successful in one case, the fatal outcome in the second underscores the importance of optimal patient selection, timing, and therapeutic strategies. Further research is needed to evaluate the efficacy of combined EBP and to identify approaches for improving outcomes in critically ill patients.

Introduction: This study aimed to describe bronchoalveolar lavage fluid (BALF) findings in cases of refractory respiratory failure, despite standard treatment, among patients with severe coronavirus disease 2019 (COVID‐19), compare BALF findings between patients with mechanical ventilation (MV) weaning success and those with failure within 28 days, and evaluate the safety and impact on respiratory mechanics of BALF examination in patients with severe COVID‐19. Methods: This study was conducted at the Department of Emergency Medicine, Sapporo Medical University, Japan. We included 21 patients with concurrent severe COVID‐19 and refractory respiratory failure who could not be weaned from MV despite standard treatment. We compared BALF cellular composition and culture results between patients who were successfully weaned from MV within 28 days and those who were not. Respiratory mechanics before and after BALF collection were also evaluated. Results: BALF analysis revealed a mixed cellular pattern with a median total cell count of 174/μL (interquartile range [IQR], 104–400/μL). The successfully weaned group showed significantly higher macrophage percentages (24.7% vs. 3.5%, p = 0.034) and counts (56.4 vs. 10.5/μL, p = 0.024) than did the failure group. The failure group had higher neutrophil proportions (34.4% vs. 8.5%, p = 0.098). Positive cultures were found in 42.9% of patients. No deterioration in respiratory mechanics was observed after BALF. Conclusions: BALF analysis revealed a mixed cellular pattern. The successfully weaned group had significantly higher macrophage percentages and counts. BALF examination can be safely performed in patients with severe COVID‐19.