Background: Airway obstruction is rare but highly critical. Patients often present with nonspecific symptoms and airway compromise may progress rapidly. Conventional airway management strategies are frequently limited. In this context, extracorporeal membrane oxygenation (ECMO) has emerged as a lifesaving adjunct, providing adequate gas exchange when conventional approaches fail. Case Presentation: A 53-year-old female, previously healthy, presented with shortness of breath and hemoptysis for one week. She was tachycardic but otherwise hemodynamically stable, with oxygen saturation maintained on room air. Her physical examination was positive for wheezing. A suspicion of pulmonary embolism was raised as she has normal chest x-ray and normal inflammatory markers. CT pulmonary angiography revealed endotracheal lesion located 4.9 cm from the tracheal bifurcation. The lesion infiltrated the right tracheal wall, causing 70% luminal narrowing, with extratracheal extension contacting the right thyroid lobe and partially encasing the right common carotid artery. The patient’s condition deteriorated with worsening hypoxemia, awake fiberoptic intubation was tried to secure the airway but failed because of significant narrowing distal to the vocal cords. Elective insertion of Veno-Venous ECMO (VV-ECMO) was done as a bridge for further intervention. She underwent rigid bronchoscopy with biopsy followed by tumor debulking and tracheostomy. Histopathology confirmed a high-grade tracheal malignancy. The patient was successfully weaned off ECMO after three days and gradually was weaned from ventilator and kept on tracheal mask and later discharged to the Oncology ward for further management. Conclusion: This case highlights the role of VV-ECMO in managing complex airway emergencies. By providing time and stability, ECMO can serve as an essential bridge to definitive bronchoscopic and surgical interventions when conventional airway management fails. Broader clinical recognition of ECMO’s utility in similar scenarios may expand safe treatment options for high-risk airway cases.

Introduction: Severe Acute Respiratory Distress Syndrome (ARDS) in the third trimester of pregnancy is a rare, high-mortality event. Venovenous Extracorporeal Membrane Oxygenation (VV ECMO) is a critical salvage therapy, but data on the long-term health of the mother and child are extremely limited. We present a case with three-year follow-up to provide vital information on the long-term sequelae of this complex intervention. Case Presentation: A 26-year-old primigravida, and a known case of bronchial asthma, presented at 30 weeks gestation with acute respiratory failure secondary to severe community-acquired pneumonia. Despite maximal conventional lung-protective ventilation, her oxygenation remained refractory (P/F ratio <60). VV ECMO was initiated for gas exchange support. The mother was successfully weaned from ECMO on day 7. An urgent Cesarean section was performed 5 days later, delivering a preterm female neonate (Apgars 1/4, birth weight 1.2 kilogram). She was successfully discharged on hospital day 39. Outcomes and Follow-up: At 3-year follow-up, both mother and child exhibited remarkably favorable outcomes. The mother reported no respiratory symptoms. She has a good Health‑Related Quality Of Life Index (EQ‑5D). The child met all developmental milestones at the 3-year assessment according to the Bayley Scales of Infant and Toddler Development, Fourth Edition (Bayley-4). Conclusion: This case report demonstrates that VV ECMO for severe ARDS pneumonia in the second trimester can lead to excellent long-term outcomes for both the mother and the surviving child. Successful outcomes depend on prompt cannulation at a specialized center, a multidisciplinary team approach, and optimized timing of delivery. This three-year follow-up provides a rare, reassuring data point to guide clinical decision-making and parental counseling for this high-risk population, emphasizing the potential for complete recovery. Reference: Ramanathan, K., et al. Extracorporeal Membrane Oxygenation in Pregnancy: An Analysis of the Extracorporeal Life Support Organization Registry. Crit Care Med. 2020.

Background/Introduction: Cardiogenic shock (CS) is a severe heart failure causing critical organ hypoperfusion. Veno-arterial ECMO (VA-ECMO) can be lifesaving but may increase left ventricular afterload and pulmonary congestion, often requiring additional unloading devices. Synchronized Cardiac Support (SCS) has been proposed as a novel treatment approach for patients with CS and need for VA-ECMO. During SCS, the pulsatile blood flow is synchronized via Electrocardiogram (ECG) with the patient’s cardiac cycle, aiming at diastolic augmentation and improving microcirculation through enhanced diastolic flow and reduced cardiac afterload by reducing blood flow during cardiac systole. This study aims to evaluate the efficacy and safety of the SCS treatment using the Novalung ultimate kit SCS in combination with Xenios 2.0 console (Xenios AG, Germany) in patients with CS due to Acute myocardial infarction (AMI). Methods: This prospective, multi-centre PMCF study will be conducted in four sites in Germany, the Czech Republic, and Spain, enrolling ca. 25 patients. Upon inclusion, patients will receive SCS treatment for up to 7 days. Cardiac performance will be assessed daily by Echocardiography and Pulmonary Artery Catheter (PAC) measurements in both, SCS and continuous flow conditions. Laboratory parameters (e.g. lactate) will serve as surrogate for organ perfusion and oxygen delivery. The study protocol is subject to final regulatory and ethical approval. Results: The study is scheduled to start 2026, results are planned to be published end 2027. Conclusion: This study aims to extend knowledge on SCS treatment in patients suffering from CS due to AMI. Moreover, the results will also help to understand whether ECG-triggered pulsatile blood flow may improve organ perfusion and may be capable of improving cardiac performance when compared to continuous flow ECMO, thus reducing the need to add unloading or venting devices in at least selected patients.

Background: The concurrent use of therapeutic plasma exchange (PLEX) and extracorporeal membrane oxygenation (ECMO) is uncommon and technically challenging, with limited data on safety and outcomes. PLEX may offer benefit in conditions driven by severe autoimmunity, hyperinflammation, or toxin overdose, which may co-exist with cardiopulmonary failure requiring ECMO. This case series elucidates our single-center experience with PLEX performed during ECMO support. Methods: We retrospectively reviewed all adult patients admitted to our cardiac thoracic intensive care unit in our hospital between December 2023 and June 2025 who underwent both ECMO and PLEX during the same admission. Demographic data, primary diagnoses, ECMO configuration, number and timing of PLEX sessions, and clinical outcomes were collected. Results: Four patients (median age 53 years, range 41–72; two female) underwent concomitant ECMO and PLEX. Indications for PLEX were thyroid storm (n=1), ANCA-associated vasculitis (n=2), and calcium channel blocker overdose (n=1). ECMO modalities included VA (n=2), VV (n=1), and VVA (n=1). PLEX was initiated within 72 hours of ECMO initiation in three patients. Three patients survived to hospital discharge (ANCA vasculitis with diffuse alveolar hemorrhage, Microscopic polyangiitis and CCB overdose), while one patient died from refractory shock (thyroid storm). No PLEX-related complications such as circuit clotting, hemolysis, or access issues were observed. In survivors, clinical and biochemical improvements facilitated ECMO decannulation and recovery. Limitations: This was a retrospective, small case series without a control group; causality between PLEX and outcome cannot be inferred. Conclusion: PLEX during ECMO runs is technically feasible and may provide additional therapeutic benefit in selected patients with autoimmune or toxin-mediated disease. Further prospective studies are warranted to define its role and optimal timing.

Introduction: Inhaled alkyl nitrite analogues, commonly known as “poppers,” are short-acting vasodilators that can cause euphoria, dizziness, and related effects. Nitrites rarely result in acute life-threatening complications such as ventricular dysrhythmias. We report a case of electrical storm following accidental inhalation of isobutyl nitrite. Case Presentation: A 40-year-old male had accidental occupational exposure to isobutyl nitrite, after which he became unconscious and was brought to our hospital. On arrival, he was found to be in ventricular fibrillation, and cardiopulmonary resuscitation was initiated as per Advanced Cardiac Life Support protocol. He required three defibrillations, with return of spontaneous circulation achieved after 30 minutes. Post-resuscitation, an SaO2–SpO2 gap of 15% was noted, suggesting a high probability of methemoglobinemia. The patient was immediately treated with methylene blue (2 mg/kg) and transferred to the intensive care unit. Due to hypotension, vasopressors and inotropes were initiated. Two-dimensional echocardiography revealed severe left ventricular systolic dysfunction with an ejection fraction of approximately 30%. Management and Outcome: In the ICU, the patient developed multiple episodes of ventricular tachycardia requiring cardioversion, without sustained return of spontaneous circulation. Extracorporeal cardiopulmonary resuscitation was initiated using a 25 Fr multistage venous cannula in the left femoral vein and a 19 Fr return cannula in the right common femoral artery. Spontaneous circulation was achieved within eight minutes. Over the next 24 hours, the patient experienced eight additional episodes of ventricular tachycardia, all managed with cardioversion, and was started on a lignocaine infusion for 48 hours. The patient gradually regained sensorium, and co-oximetry showed no evidence of methemoglobinemia. Left ventricular function improved to 40%. ECMO was weaned and discontinued on day three. The patient was extubated on day four and discharged on day nine with no recurrence of arrhythmias on telemetry. Conclusion: This case highlights a rare but life-threatening complication of isobutyl nitrite exposure presenting as refractory ventricular arrhythmias. Prompt recognition and timely initiation of extracorporeal support were crucial for survival.

Background: Harlequin syndrome, also referred to as differential hypoxemia or North South syndrome, is a critical yet underrecognized complication of venoarterial extracorporeal membrane oxygenation and hybrid configurations such as ECpella. It occurs when recovering native cardiac output competes with retrograde extracorporeal flow, leading to differential oxygenation between the upper and lower body. Current detection methods are largely operator dependent and often delayed, increasing the risk of cerebral and myocardial hypoxia. Objective: To propose an artificial intelligence integrated multimodal monitoring platform for early detection and proactive management of Harlequin syndrome using continuous physiologic and imaging data analysis. Methods: This conceptual framework integrates six multimodal data streams, including continuous right radial pulse oximetry, continuous left radial pulse oximetry, continuous cerebral near infrared spectroscopy, intermittent arterial blood gas derived partial pressure of oxygen measurements, dynamic respiratory system mechanics, and artificial intelligence assisted chest radiograph analysis. The artificial intelligence model continuously evaluates trends and interrelationships across these inputs to detect early oxygenation mismatch. Intermittent arterial blood gas values serve as calibration references to maintain accuracy over time. Outputs are displayed on an interactive extracorporeal membrane oxygenation dashboard that provides early alerts and actionable management suggestions, including ventilator adjustments, extracorporeal flow optimization, or cannulation strategy modification. Expected Outcomes: The proposed system is expected to detect right radial oxygen desaturation and cerebral near infrared spectroscopy changes earlier than conventional clinician recognition. Multimodal signal validation is anticipated to provide high sensitivity with a low false alert rate. Conclusion: This conceptual model introduces a predictive and data driven approach for early identification and management of Harlequin syndrome. By integrating physiologic monitoring with imaging analytics, the platform has the potential to enhance patient safety, optimize extracorporeal membrane oxygenation performance, and support the development of future intelligent closed loop extracorporeal systems.

Introduction: There is a high-risk cohort of patients with refractory unstable ventricular tachycardia (VT). A main treatment modality for these patients is catheter ablation (CA). To perform the CA, it is necessary to activate the paroxysm of VT which can lead to hemodynamic collapse. This is especially problematic in patients with impaired myocardial contractility, such as ischemic or dilated cardiomyopathy. Methods: From July 2022 to July 2024, 12 cases of the catheter ablation for VT with veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support were performed at E.N Meshalkin National Medical Research Center. Before CA, patients were assessed using the PAINESD score. VA-ECMO was used in patients with PAINESD score ≥ 15 points. The average age of patients was 61,4 ± 6,4 years. The cause of congestive heart failure (CHF) was ischemic cardiomyopathy in all patients. The average left ventricular ejection fraction was 27,5 ± 5,2 %, the average end-diastolic volume was 223 ± 54,5ml; 41,6 % of patients had concomitant heart valve pathology, 41,6% had CABG and 41,6% of patients had PCI in the anamnesis. Results: In all cases, VA-ECMO was weaned in the cath lab. The average ECMO time was 223 ± 58min. All patients required inotropic support after weaning the VA-ECMO. The average ICU time was 1,3 ± 0,5 days, and the average stay at the hospital was 10,4 ± 4,3 days. Mortality: one patient died in the hospital due to recurrent VT with an electrical storm, one patient died in 3 months because of decompensation of CHF, all other patients completed a six-month follow-up (by phone call), four patients completed a one-year follow-up. Conclusions: Preemptive ECMO is an effective measure for hemodynamic support in high-risk patients who require ablation of unstable VT. It allows successful mapping and catheter ablation with good clinical outcome.