M Velia Antonini

#ECMO for severe CCB toxicity? #ECLS provides potentially lifesaving intervention for pts unresponsive to medical therapy. Outcomes most favourable without pre ECMO CA & with preserved pH. Early identification, rapid cannulation, avoidance of #ECPR may be critical for success.
🔗 bit.ly/48PYtGW

Take a look at the 💉 Medication section of the ELSO's #ECMO Bedside Guide:
🩸anticoagulants
🩸 blood products
🩸 hemostatic agents
🌸 opioids
🛌 sedatives
Open access app, to be useful to everyone with interest in #ECLS.
Apple store 📱 bit.ly/ELSOBedsideG...
Google Play (Android) 📱 bit.ly/ELSOBedsideG...

Another successful @esicm.bsky.social & EuroELSO #ECMO workshop at #LIVES2025 in Munich 🇩🇪 !!
We had 5 sessions over 3 days
🫀VA 🫁 VV #ECLS + ECPR #simulation
🚧 circuit & complications troubleshooting
🚑 ECPR cannulation/initiation
See you at #EuroELSO2026 in Dublin 🇮🇪 & #LIVES2026 in Lisbon 🇵🇹!

Dear ELSO Community, thank you for all the fond memories and support regarding Dr. Bartlett. His wishes are to gather friends in a few months' time on his behalf. The planning for this memorial is under way and we expect to have a date identified soon. More information to come soon.

🧵 2/2 #ECMO may be reasonable
🐝 in refractory anaphylaxis
🫁 life-threatening refractory asthma
🫀 in cath-lab or after cardiac surgery if failing cCPR
🫁 if CA from confirmed/suspected PE or peripartum
amniotic fluid embolism
🧊 in life-threatening hypothermia
☠️ in poisonings
🔓 bit.ly/3LeVAWd

Adult & pediatric special circumstances of #resuscitation: 2025 @americanheart.bsky.social guidelines are are out! While #ECMO is not available in every setting, may be considered for adults & children in CA or peri-arrest state with potentially reversible etiology
🔓 bit.ly/3LeVAWd
See thread 🧵🪡 1/2

The ELSO guideline on #ECMO for accidental hypothermia:
🧊 do NOT use criteria established for normothermic pts!
Hypothermic CA? better survival/neuro-outcome. Unwitnessed CA, asystole, long no/low-flow times, age ≥70, low EtCO2 NOT contraindications to #ECPR in hypothermia.
🔓 bit.ly/475GUkR

The ERC 2025 cardio-pulmonary resuscitation guidelines are out!
🫀 adult basic & advanced life support
🧸 pediatric life support
🍼 neonatal life support
🚧 special circumstances
🩺 post-resus care
⚖️ ethics
📋 system saving lives
🎓 education for #resuscitation
🔍 epidemiology
🩹 first aid
🔓 bit.ly/4qkPTWO

Key point from my invasive CO talk the other day #CHEST2025

Myth-busting on periop autologous red blood cell salvage
🚿overview of process
Myths on cell-salvaged blood
⚖️ 1️⃣ poor quality/inferior to allogeneic RBCs
🩸 2️⃣ increases bleeding
🚧 3️⃣ not safe in many surgeries
💶 4️⃣ not cost-effective
#FOAMcc @anesthesiology.bsky.social @asahq.bsky.social
🔓 bit.ly/47vZfrk

I would normally not have batted an eye at this paper

But it’s by Robert Hahn, and is a nice overview of everything we know about fluid redistribution in the critically unwell- including gel phase, some glycocalyx stuff, 3 compartment models, and albumin escape rates

#foamed

🧠 Left Ventricular venting associated with increased risk of ABI (hypoxic-ischemic brain injury, ischemic stroke, intracranial hemorrhage) in pts w CS in peripheral VA #ECMO
🪦 similar mortality: unmeasured survival benefit of venting?
@critcaremed.bsky.social
🖇️ bit.ly/4hng6QK

Where does the fluid go?
💦 morphological changes/damage by fluid overload
🛌 fluid distribution in anesthesia
3️⃣ extracellular fluid compartments
💧 physiology, manipulation & max filling of slow-exchange fluid space
🔥 inflammation, capillary leakage & lymphatic flow 💦
🥚 albumin
🔓 rdcu.be/eLnfi

VV #ECMO candidacy? Global disparities in absolute contraindications, decision-making processes, perceived consistency of decisions observed. Some expected (likely appropriate), but extent suggests significant need/opportunities for more standardized, evidence-based approaches.
🔗 bit.ly/4n7zmmg

#ECMO in adults with CHD? Despite high mortality can be lifesaving used judiciously!
🗝️ challenges, complicating cannulation & perfusion goals, include: altered vascular access, residual shunts, circulatory configurations as Fontan/systemic right ventricles, cyanotic heart disease
🖇️ bit.ly/4narwIT

Inadvertent left atrial return during VV #ECMO? Significant implications!
Early recognition essential to avoid misinterpreting as treatment failure. Although carries potential risks as systemic embolism or LA overload, may confer physiological benefits in carefully selected pts.
🔗 bit.ly/3KRvCYI

Inadvertent LA return in VV #ECMO? Rare but underrecognized!
🔍 nonmultistage return cannula in fem-fem VV crossed IAS
🩸V-LA ECLS resulted in massive R-to-L shunt of hyperoxy blood
🚧 malposition not clinically evident until weaning
🩺 solved by repositioning, no IA defect at follow-up
🔗 bit.ly/3KRvCYI

The @eacts.bsky.social Consensus on pre-emptive t #MCS in adult cardiac surgery
🔍 epidemiology
👥 heart team
🚧 high-risk pts
🪜 protected cardiac surgery classification
🫀 periop management
🩺 #ICU management
📦 device selection: #ECMO, #LVAD...
🔮 outcome
⚖️ ethics and consent
#FOAMcc
🔓 bit.ly/3J68mpo

📢 #EuroELSOwebinar: Post-Cardiotomy #ECLS
⚖️ Indications, timing and settings
🫀 Unloading, hybrid configurations & difficult cases
🖥️ Joint #ICU management: monitoring, anticoagulation, ventilation
🩺 Clinical case - Anne Schaefer
🎙 Discussion
🗓️ October 30, 16:00 CET
🖋 www.euroelso.net/webinars/
#ECMO

Ready to take your career to the next level? 🚀
Join the 12-month online ESOT Mentorship Programme: connect with leaders in transplantation, grow your skills, and gain one-to-one guidance.

Apply now 👉 go.esot.org/mentorship26_00

#Mentorship #ESOTeducation #ProfessionalDevelopment

🎥 Virtual #ELSO2025 Is now live!
To access virtual platform (pre-conference included), available through 🗓️ January 28, 2026, register at
🔗 bit.ly/ELSO2025virtual

If you joined in Washington visit:
🔗 elso2025.teneventsmedia.com
using username/password received by email
🎓 CME/CEU for MD/RN/Pharm

Take a look at calculators section of @theelso.bsky.social #ECMO Bedside Guide
🧮 BSA
🧮 Units
🧮 Flow calculators
🧮 O2 transfer
🧮 DO2i
🧮 Estimated post-dilutional Ht
🧮 OI
🧮 P/F ratio
🧮 Recirculation %
🧮 Tubing volume constants/conversions
Apple 📱 bit.ly/ELSOBedsideG...
Android 📱 bit.ly/ELSOBedsideG...

Weaning from VA #ECMO: which approach best reflects true cardiopulmonary reserve??
🔄 PCRTO feasible/safe: retrograde flow through pump, creating controlled VA shunt mimicking native physiology, challenges RV + reducing LV afterload + enabling assessment of native lung function
🔓 rdcu.be/eJf91

#ARDS in pts with malignancies? Experience high mortality, irrespective of #ECMO. Nuanced ICU goals-of-care discussions needed, as caution when considering
#ECLS: general recommendations may not apply to this population
#FOAMcc @intenscaremed.bsky.social @schellongowski.bsky.social
🔓 rdcu.be/eI44I

Delighted to present results of my group(s) latest research on normothermic regional perfusion at #ELSO2025 in Washington!
🫘 Regional saturation directed NRP in in #DCDDs (spin off of my PhD project!)
🔓 bit.ly/489UWTC
💨 ML exhaust CO2 monitoring to guide SGF management during #NRP
🔓 bit.ly/489gYWC

#ECPR demonstration at #ELSO2025!!
ECPR may improve outcome in refractory CA if
🎓 done with a high #ECLS experience
⚖️ pts are selected well
⏱️ EBF can be initiated fast (<60')
Still to be defined ideal location ECMO to pt or pt to #ECMO?
🩺 optimal post-CA care
🚧 complications are recognized timely

#ELSO2025 Zakhary B 🪡🧵 2/2
🩸/🫀manipulate extracorporeal Blood Flow/CO ratio to acceptable goal
Equation in the slide = oxygenation on VV #ECLS assuming no native lung gas exchange
EF = effective flow = extracorporeal blood flow going to RV
CO = cardiac output
dissolved O2 component could be ignored

Hypoxemia on VV #ECMO? Develop a systematic approach
🚧 quickly rule out (with circuit check + blood gas analysis) things killing the patient rapidly but that you can quickly troubleshoot: extreme recirculation, ML failure and gas supply interruption, drainage insufficiency 
#ELSO2025 Zakhary B 🪡🧵1/2

🌡️ heat exchange
〰️ shunts accesss points, particularly useful in #PedsICU
🖥️ additional tools to provide monitoring, servoregulation and safety features
📑 data collection required for both internal/Registry use
Talk by Claire Jara at #ELSO2025 annual @theelso.bsky.social conference
🪡🧵3/3

➰tubings connecting components: keep shortest possible but long enough to allow safe movements
⛽️ pump essential to circulate blood, trying to minimize cells damage
🫁 membrane lung: mimics native lung function, supporting gas exchange
〰️ shunts/access points, particularly in #PedsICU
🧵2/3 #ELSO2025