M Velia Antonini

Perfusionist ECMO & NRP specialist 🫁🫘🫀 & 🖥️ POCUS
🪑Chair Normothermic Regional Perfusion EuroELSO WG
📱#SoMe Director @ELSOOrg/SoMe Editor @asaiojournal

[M Velia Antonini @FOAMecmo]

TA #NRP in cDCD heart donors using closed #ECMO circuit, modified to provide
🩸🌡️effective NRP despite prolonged fWIT
🫀LV venting
🫀 fast conversion to central configuration as needed
⭕️ shunt for recirculation
🫧 air management
#FOAMcc @asaiojournal
🔓https://t.co/CfbhR1cUCA
TA-NRP using fully mobile, closed #ECLS circuit could be safe strategy to support combined thoracic/abdominal organs recovery also in peripheral centers without cardiac surgery program, contributing to the expansion of DCD programs, increasing availability/quality of grafts, improving recipients’ outcome. @ESOTtransplant @gabriel_oniscu @LuPoten @Unibo @AUSLRomagna

[M Velia Antonini @FOAMecmo]

Micro-axial flow pump vs VA #ECMO for high-risk percutaneous coronary interventions?
🔍 prospective, multicenter RCT
🫀 pts with complex three-vessel disease, unprotected left main coronary disease or last patent conduit and LVEF ≤ 35% assigned to prophylactic mechanical circulatory support with micro-axial flow pump vs #ECLS during non-emergent PCI
⚖️ mAFP non-inferior to ECMO in the incidence of major adverse events, and associated with shorter post-procedural LoS + fewer device-related adverse events.
🖇️ https://t.co/UD2nxgJUct

[M Velia Antonini @FOAMecmo]

Ethical implementation of organ donation following medical assistance in dying: recommendations of the ethics committee of the @ttsorg providing practical guidance to support end-of-life wishes while safeguarding ethical/legal standards, and maintaining trust in both MAiD & #transplantation:
⚖️ regulatory safeguards for MAID
📋 clinical pathway for OD following MAID
🔑 key ethical considerations in OD following MAID:
- Integrity of patients’ decision-making: right to request to be considered for OD, ensuring voluntariness/validity of consent, timing and disclosure of information about OD
- ethical governance of the donation process: respecting DDR and integrity of determination of death, premortem interventions subject to patient consent, donor anonymity and potential recipient consent
- ethical implications for care relationships and professional practice: end-of-life care, managing conscientious objection and supporting professionals
MAiD is legally permitted in a growing number of jurisdictions, and in 6 (Australia 🇦🇺, Belgium 🇧🇪, Canada 🇨🇦, The Netherlands 🇳🇱, New Zealand 🇳🇿, Spain 🇪🇸), it can currently be followed by organ donation. OD offers patients an opportunity, but it also raises complex ethical questions that require strong safeguards to protect patients, professionals, and public trust.
Open access @TransplantJrnl
🔓 https://t.co/OG4zIkJjGG

[M Velia Antonini @FOAMecmo]

📖 Procedures on #ECMO?? #ECLS should not be considered a barrier to any intervention or surgery! With proper planning, a broad range of procedures can be safely managed during the run! @DrGilesPeek @EcmoNinja
📘 The Blue Book: latest edition of the ELSO #ECMO Specialist Training Manual
🛒 https://t.co/GuD4BPsvgP

[ELSO @ELSOOrg]

📖 Procedures on ECLS - chapter 25
📋 preparation, positioning, environment
☢️ interventional cardiology and radiology
🧠 trauma & neurosurgery
🫁🫀 thoracic, abdominal vascular, cardiac procedures
⚙️ circuit procedures
🚑 return to ICU
📘 The Blue Book🛒 https://t.co/u1vLUUDByo

[M Velia Antonini @FOAMecmo]

Recirculation-guided blood flow adjustment in high-flow VV #ECMO in patients with #ARDS
🖥️ recirculation assessed by #POCUS dilution measure
🩸 recirculation frequent: median RF 14%, 57% patients had a recirculation ≥10% = clinically relevant
🫀 patients with RV dysfunction showed significantly higher recirculation
🩸 if relevant recirculation, blood flow was reduced stepwise by estimated recirculating volume; flow reduction feasible in most patients, and maintained adequate oxygenation
@asaiojournal
🖇️ https://t.co/emxTPWytMt

[ECMO Barcelona @ECMOHUVH]

El Programa #ECMOBARNA2026 ya está aquí!!
Programa e inscripciones en
https://t.co/ntB7oQh7eS
Pocas plazas ya!!

[M Velia Antonini @FOAMecmo]

Modeling cost-effectiveness of implementing #ECPR strategy in refractory #OHCA arrest vs cCPR
🔍 simulation-based analysis including > 1.4 OHCA 🇸🇬
💵 #ECMO likely to be cost-effective strategy across different age-based scenarios, compared with existing practice
🚑 however, timely transport to #ECLS-capable centers critical! Cost-effectiveness of ECPR sensitive to delays in transport and initiation, highlighting the need to define patient eligibility criteria and optimize prehospital system. @CritCareMed
🖇️ https://t.co/2MSWjZkdM3

[M Velia Antonini @FOAMecmo]

Normothermic regional perfusion in controlled donation after circulatory determination of death, results of the @ESOTtransplant consensus
📋 definitions in #NRP adoption
⚙️ machine perfusion
🩺 team composition & training
🩸NRP procedures and their technical success
🫀🫁 preservation of lung/heart function
📋 evaluation of donor organs during NRP
⏱️ sequence of organ recovery
⚖️ ethical issues
🧠 brain perfusion
🔍 unmet needs and future research
Open access #FOAMcc @Transpl_Int
🔓 https://t.co/Gp5DhyoX2h

[M Velia Antonini @FOAMecmo]

Hemoperfusion during #ECMO 🩸🧽 ?
🔍 SR/MA evaluating clinical efficacy and safety of HP
🔎 13 studies involving >8K adults
🪦 no significant reduction in all-cause mortality with addition of hemoperfusion to #ECLS vs ECMO alone; ECMO + HP may be associated with increased mortality in RCT subgroup; no survival benefit with either VV or VV
⚖️ no significant differences observed in run duration, ICU or hospital LoS, duration of MV, complication rates
Available evidence does not demonstrate consistent therapeutic advantage of hemoperfusion during ECMO: although several studies reported transient decreases in inflammatory biomarkers, effects inconsistent and did not translate into measurable clinical benefit. Until such data are available, routine use of  HP should be only considered an adjunctive/investigational strategy rather than routine component of ECLS in #ICU.
Open access #FOAMcc #FOAMecmo @Crit_Care
🔓 https://t.co/gL11yp2sY6

[M Velia Antonini @FOAMecmo]

#ECMO in congenital lung malformations related severe respiratory failure in early infancy??
🔍 ELSO Registry study aimed to determine incidence of #ECLS use and identify predictors of survival
🔎 451 infants, 2000 to 2024; 88% neonates
🫁 overall survival 47%, varying by diagnosis subtype: congenital pulmonary airway malformation (67%), congenital lobar emphysema (50%), other CLMs (42%)
⚖️ higher weight at ECMO initiation and postnatal corticosteroids associated with survival
🪦 #ECPR, hemorrhagic and neurologic complications associated with higher mortality
@asaiojournal #PedsICU
🖇️ https://t.co/SvDJ1m2FAJ

[M Velia Antonini @FOAMecmo]

@DrGilesPeek @Mirjanaxxx @ELSOOrg Thank you!!

[M Velia Antonini @FOAMecmo]

We got 2 abstracts accepted for #ELSO2026, 37th conference of @ELSOOrg
🫁 Extracorporeal support before and beyond failure: #ECMO use in thoracic surgery
⚠️ Characterizing adverse events and complications associated with normothermic regional perfusion in DCD donors
Particularly honoured as these are the first abstracts drafted with my new team at @OspedalePadova !!
Can't wait to present in Nashville 🎶 in September!
🖇️ https://t.co/zUdAfTGfWY

[M Velia Antonini @FOAMecmo]

Simple monitoring strategy to help recognizing readiness for weaning during peripheral VA-ECMO??
🖥️ bilateral radial A-lines: pressure concordance (left–right SBP difference < 10 mmHg, small MAP/DBP differences, similar waveform amplitude/morphology) + concordant ABG values = similar arterial blood source?
🖥️ strong association with LVOT VTI  meeting threshold used for weaning assessment
Emergence of left radial pulsatility + bilateral radial pressure-gas concordance may serve as low-invasive, real-time bedside marker to facilitate early recognition of cardiac recovery, prompting formal #POCUS assessment (rather than stand-alone marker).
#FOAMcc #FOAMecmo @Crit_Care
🔓 https://t.co/pARdmDpGHb

[M Velia Antonini @FOAMecmo]

Pediatric controlled donation after circulatory determination of death Bucharest international @ESOTtransplant consensus
🕯️ avoiding missed opportunities: normalization of integrating donation into #PedsICU end-of-life
🩺 donor identification & assessment for suitability
⚖️ decisions about pcDCDD and approach to communication about pcDCDD: obtaining consent for pcDCDD/antemortem interventions for patients that have never expressed a valid intent to donate
⏱️ ante-mortem interventions for pcDCDD
There are substantial and differing barriers across countries (ie clinical, legal, ethical issues), but pcDCDD programs may be developed in varied international settings, if explicitly supported by robust administrative and legal frameworks. Open access #FOAMcc on @Transpl_Int
🔓 https://t.co/3xG6jq49YG

[M Velia Antonini @FOAMecmo]

Distal limb perfusion in peripheral VA #ECMO and minimally invasive cardiac surgery with femoral arterial cannulation??
🔬 in vitro study evaluating flow/pressure of sheaths with side ports (widely used) vs catheter w/o side port
🩸 flow augmentation limited primarily by resistance at side port; catheters w/o side ports exhibit more linear pressure-flow relationship without saturation
🩸 catheters w/o side ports potential alternative when conventional devices provide insufficient limb perfusion
🩸 side port accounted for majority of pressure loss: likely dominant role in limiting antegrade flow. This may explain why DPCs may fail to resolve limb ischemia.
@asaiojournal
🖇️ https://t.co/7S3gMwXbfu

[M Velia Antonini @FOAMecmo]

Contemporary #extracorporeal cardiopulmonary resuscitation programs for refractory cardiac arrest
🔑 key features of #ECPR programs
⚖️ appropriate patient selection
🚑 response system & cannulation model/methods
🩺 team composition
🎓 training programs and education
Several aspects are consistent across countries, but #ECMO protocols may be extremely variable. Here, narrative review exploring current global practices, and identifying opportunities for standardization while recognizing elements that should remain context specific
#FOAMcc #FOAMecmo @FrontiersIn
🔓 https://t.co/KyzJ7toYrJ

[M Velia Antonini @FOAMecmo]

60 years of #ARDS and the evolution of extracorporeal lung support, from #ECMO to #ECCO2R
📚 history of #ECLS in ARDS, from emergence to pandemics
🔍 randomized evidence for ECLS in severe ARDS
🚑 selection and transport of ECLS candidates
🩺 management of ARDS patients during ECLS
⚠️ complications of ECLS in respiratory failure
🔭 long-term outcomes and survivorship after ECLS
🔮 the future of ECLS for ARDS
#FOAMcc #FOAMecmo
🔓 https://t.co/mCy09mO9VC

[M Velia Antonini @FOAMecmo]

#ECPR for refractory cardiopulmonary arrest occurring after major after cardiac surgery
🔍 institutional experience including adults who underwent #ECMO for CA within 30 days after major cardiac surgery outside OR, 2015 - 2023
🩸 42.9% underwent central cannulation with open chest, 57.1% femoral cannulation
⚖️ 57.4% successfully decannulated, 42.6% died on #ECLS; in-hospital mortality 47.6% (similar between central vs peripheral cannulation); 1 year survival 41.2%
🧠 33.3% neurologically intact at discharge
@asaiojournal
🖇️ https://t.co/ZB52UPxQCP

[M Velia Antonini @FOAMecmo]

Multisite cannulation for VV #ECMO in neonates & infants with respiratory failure:
🔍 ELSO Registry analysis, 2013-2023
💨 VVMS vs VVDL associated with higher SaO2 + 🩸 blood flows at 24 hours in neonates/infants
⚖️ in infants, VVMS vs VVDL associated with fewer mechanical complications (23% vs. 37%)
⚖️ no association between cannulation technique and complications or mortality of VVMS vs dual lumen
#FOAMcc #PedsICU @PedCritCareMed
🔓 https://t.co/KGXXOVmXff

[ELSO @ELSOOrg]

#ECMO Unfiltered: come ready to challenge at #ELSO2026 pre-conference on Sep 28 📆 !
🔦 Highlights: real debates, real cases, real progress: a day of interacting with pediatric/adult ECMOlogists. You’ll vote, debate, question, rethink.
📌 Nashville, TN
🖇️ https://t.co/KExNyp6X5L

[M Velia Antonini @FOAMecmo]

Nitric oxide in #ECMO sweep gas may promote membrane lung longevity and maintain performance! Technical case reporting preserved function of ML in the setting of a prolonged #ECLS. A single ML functioned effectively for 5 months. This (first known) structural evaluation of PMP ML postdecannulation revealed no thrombus or fibrin deposition after prolonged clinical use with sNO.
@asaiojournal
🖇️ https://t.co/VFw0xcR0J9

Additional details at 🖇️ https://t.co/2lLfqXzDWo