Anticoagulation Management and Monitoring in ECMO: An International Survey From the ISTH SSC Subcommittee on Pediatric and Neonatal Thrombosis and Hemostasis

March 22, 2026 No Comments

This international survey evaluates anticoagulation strategies in ECMO patients across 17 countries. Findings show unfractionated heparin remains the primary anticoagulant, while bivalirudin use is rising. Despite widespread protocol use, significant variability persists in dosing, monitoring, and transfusion practices. Hematology involvement is often limited to complex cases, highlighting the need for standardized, collaborative approaches to improve ECMO outcomes.

Perfusionist-Led Pediatric ECMO Monitoring in a High-Tech ICU

A Bedside Staffing Model With Perfusionists for Pediatric Extracorporeal Membrane Oxygenation (ECMO) at a High-Volume Center

March 19, 2026 No Comments

This study describes a pediatric ECMO staffing model using perfusionists supported by remote monitoring technology and hourly bedside rounding. Implemented at a high-volume center, the model enables one perfusionist to oversee multiple patients safely. Across 289 cannulations and over 62,000 ECMO hours, outcomes including mortality and complications were comparable to ELSO benchmarks, supporting the model’s safety and feasibility.

Seamless Transition: Single-Circuit ECMO to CPB in Pediatric Surgery

ECMO to CPB: A Single Circuit Approach

February 27, 2026 No Comments

This technique article describes a novel method for converting pediatric patients from veno-arterial extracorporeal membrane oxygenation (VA-ECMO) to cardiopulmonary bypass (CPB) using a single circuit with the addition of a cardiotomy reservoir. In seven patients (eight procedures), the approach preserved circulating blood volume, limited donor exposure, and maintained effective surgical support. All patients were successfully decannulated, demonstrating feasibility and safety in complex congenital heart surgery.

High-Exchange Ultrafiltration During Pediatric Cardiopulmonary Bypass

High-Exchange Ultrafiltration to Enhance Recovery After Pediatric Cardiac Surgery: The ULTRA Randomized Controlled Trial

February 18, 2026 No Comments

The ULTRA randomized controlled trial evaluated whether high-exchange subzero-balance ultrafiltration (H-SBUF) during pediatric cardiopulmonary bypass improves recovery compared with low-exchange SBUF. In 104 children under 15 kg, high-exchange ultrafiltration did not reduce peak postoperative vasoactive-ventilation-renal (VVR) scores or improve clinical outcomes. Inflammatory mediator profiles were largely similar, suggesting limited immunomodulatory benefit.

Evaluation of Transcutaneous Non-Invasive Blood Gas Analysis for Monitoring Gas Exchange in Pediatric Cardiac Surgical Patients Post Extubation

April 13, 2025 No Comments

This study evaluates the effectiveness of transcutaneous blood gas monitoring (TcPCO₂ and TcPO₂) in detecting carbon dioxide and oxygen levels in pediatric cardiac surgery patients after extubation. It found a strong correlation between TcPCO₂ and arterial PaCO₂, suggesting transcutaneous CO₂ can be a reliable, non-invasive monitoring tool. However, TcPO₂ showed less precision and cannot substitute PaO₂.

Is Surgery for Congenital Heart Defects in Neonates, Infants, and Children More Challenging and Demanding Than Surgery for Acquired Heart Defects in Adults?

March 5, 2025 No Comments

Pediatric cardiac surgery presents unique challenges due to the complexity of congenital heart defects (CHD), requiring highly specialized techniques, individualized interventions, and long-term patient care. Unlike adult cardiac surgery, which addresses standardized conditions, CHD surgery demands precision, adaptability, and multidisciplinary expertise. Limited cardiovascular reserves in younger patients increase surgical risks. Addressing global disparities in pediatric cardiac care is crucial for improving outcomes.

Lethal Myocardial Infarction in a Neonate During Extracorporeal Membrane Oxygenation

March 4, 2025 No Comments

This case study explores a neonate with congenital diaphragmatic hernia (CDH) who experienced a lethal myocardial infarction (MI) while on extracorporeal membrane oxygenation (ECMO). The patient developed a large thrombus extending from the arterial cannula into the left main coronary artery, leading to severe cardiac dysfunction. Despite anticoagulation efforts, the clot progressed, resulting in a fatal outcome. The study highlights the challenges of managing neonatal ECMO and intracardiac thrombosis.

Pulmonary Artery Systolic Pressure Associated with Inflammatory Factors Among Pediatric Congenital Heart Disease with Pulmonary Arterial Hypertension After Cardiopulmonary Bypass

March 3, 2025 No Comments

This study investigates the relationship between pulmonary artery systolic pressure (PASP) and inflammatory factors in pediatric congenital heart disease (CHD) patients with pulmonary arterial hypertension (PAH) after cardiopulmonary bypass (CPB). The study found that elevated preoperative PASP correlates with increased postoperative inflammatory cytokines, particularly IL-6 and IL-10. Higher PASP (>52 mmHg) predicted prolonged ventilation time (>21 hours), suggesting worsened postoperative outcomes.

Neurodevelopmental Outcomes After Nitric Oxide During Cardiopulmonary Bypass for Open Heart Surgery: A Randomized Clinical Trial

February 8, 2025 No Comments

This randomized clinical trial examined whether nitric oxide (NO) administered during cardiopulmonary bypass (CPB) improves neurodevelopmental and health-related quality of life (HRQOL) outcomes in infants undergoing open heart surgery. Conducted across six centers, the study followed 927 infants at 12 months post-surgery. Results showed no significant differences in neurodevelopment or HRQOL between the NO and standard CPB groups, suggesting NO does not enhance long-term neurological outcomes.

Comparison of Immediate Outcomes of Pulmonary Valve-Sparing and Transannular Patch Techniques for Correction of Tetralogy of Fallot

December 12, 2024 No Comments

This retrospective cohort study compared pulmonary valve-sparing and transannular patch techniques for correcting Tetralogy of Fallot (ToF) in 102 pediatric patients. The study found that the valve-sparing approach led to shorter durations of mechanical ventilation, ICU stays, and hospitalization, with fewer complications like arrhythmias. However, transannular patch patients had higher rates of severe pulmonary regurgitation. Weight was identified as an independent predictor of ventilation duration.