ECMO Anticoagulation Innovation in Critical Care

Alternate and Emerging Anticoagulation Strategies for Extracorporeal Membrane Oxygenation: A Scoping Review

This scoping review maps the evidence on ECMO anticoagulation strategies beyond unfractionated heparin. Across 135 included records, direct thrombin inhibitors—especially bivalirudin—were the most studied alternatives, while nafamostat, prostaglandin E1, circuit modifications, anticoagulation-free protocols, and newer monitoring tools remain emerging areas. The authors conclude that ECMO anticoagulation is shifting toward more personalized, diversified management.

March 31, 2026

Bridging the Distance: Pediatric ECMO Access Across America

State and Regional Variation in Access to Pediatric Extracorporeal Membrane Oxygenation

This geospatial cross-sectional study examined how access to pediatric extracorporeal membrane oxygenation varies across U.S. states and Pediatric Emergency Referral Regions. Researchers identified 258 pediatric ECMO centers and 169 ECPR centers, finding major differences in direct access, especially in rural areas. Although interfacility transport made ECMO access nearly universal in many places, access to ECPR remained very limited for most children.

March 30, 2026

Sevoflurane Delivery During Cardiopulmonary Bypass

Estimated End-Tidal Sevoflurane Concentration to Maintain Optimal Anesthetic Depth During Cardiopulmonary Bypass: A Meta-Analysis

This meta-analysis examined how much end-tidal sevoflurane is needed to maintain appropriate anesthetic depth during cardiopulmonary bypass. Across five prospective studies involving 129 adults, the pooled estimate was 0.88 vol% for a BIS target of 40–60. Older patients required less sevoflurane, while body temperature did not significantly change dosing needs. The findings offer a practical reference point, although evidence certainty remained limited by heterogeneity and small study sizes.

March 29, 2026

Mechanical Circulatory Support in Cardiogenic Shock: A Contemporary Head-to-Head Comparison

This mini review compares the three main temporary mechanical circulatory support options for cardiogenic shock: Impella, venoarterial extracorporeal life support (VA-ECLS), and intra-aortic balloon pump (IABP). It explains each device’s physiology, indications, risks, and evidence base, then proposes practical algorithms for selection, escalation, de-escalation, and anticoagulation to help clinicians tailor support to shock severity and cause.

March 28, 2026

Safer Bypass: Oxygenator Design and Delirium Risk in CABG

Oxygenator-Related Gaseous Microemboli and Postoperative Delirium After On-Pump Coronary Artery Bypass Grafting: A Prospective Cohort Study

This prospective cohort study examined 102 adults undergoing first-time isolated on-pump CABG and compared three membrane oxygenators: Capiox FX25, Inspire 8, and Inspire 8F. The Capiox FX25 showed the lowest arterial gaseous microemboli volume and the best volume reduction, while postoperative delirium occurred in 29.4% overall and was least frequent with Capiox FX25. The findings suggest oxygenator choice may influence neurocognitive outcomes after cardiac surgery.

March 28, 2026

Ranolazine and Cardioprotection During Myocardial Ischemia

Cardioprotective Effects of Ranolazine in Myocardial Infarction Mediated by Stimulation of the Endogenous Mediators Involved in Ischemic Preconditioning

This experimental rat-heart study tested whether ranolazine protects the myocardium through pathways similar to ischemic preconditioning. Using a Langendorff ischemia-reperfusion model, ranolazine reduced infarct size, LDH, CK-MB, troponin I, and improved ventricular function. These benefits were lost when nitric oxide, adenosine, bradykinin, or ATP-sensitive potassium channel pathways were blocked, supporting their role in ranolazine-mediated cardioprotection.

March 26, 2026

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