{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T16:57:23Z","timestamp":1781629043219,"version":"3.54.5"},"reference-count":18,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T00:00:00Z","timestamp":1767571200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T00:00:00Z","timestamp":1767571200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100007833","name":"Hamad Medical Corporation","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100007833","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Artif Organs"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>The expanding use of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) for cardiogenic shock and post-cardiotomy support necessitates a focus on perfusion beyond traditional targets. The gastrointestinal tract (GIT) is particularly vulnerable, yet its dysfunction is often overlooked in ECMO management. This editorial synthesizes current literature and pathophysiological principles to analyze the mechanisms of GIT injury during VA-ECMO support. We examine the impact of VA-ECMO on hemodynamics, microcirculation, and inflammation, with a focus on the heart-gut axis. VA-ECMO compromises gut integrity through multiple interconnected pathways. These include microcirculatory dysfunction due to non-pulsatile flow and vasopressor use, increased left ventricular afterload, and ischemia-reperfusion injury. The phenomenon of \u201cdual circulation\u201d in peripheral VA-ECMO creates a risk of heterogeneous oxygen delivery, potentially leaving the GIT hypoperfused. These insults lead to mucosal barrier failure, bacterial translocation, and systemic inflammation, driving sequential organ failure. Early recognition of gut dysfunction, through clinical monitoring and biomarkers, is challenging but critical. Given the high morbidity and mortality associated with VA-ECMO, the GIT must be acknowledged as a critical target organ. A paradigm shift integrating gut-protective strategies, such as meticulous fluid management, enteral nutrition, and monitoring for signs of hypoperfusion into standard VA-ECMO protocols is essential to improve patient outcomes.<\/jats:p>","DOI":"10.1007\/s10047-025-01543-6","type":"journal-article","created":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T19:18:40Z","timestamp":1767640720000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Heart\u2013gut interaction in veno-arterial extracorporeal membrane oxygenation: a forgotten axis in critical care perfusion"],"prefix":"10.1007","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8560-2745","authenticated-orcid":false,"given":"Amr","family":"Omar","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,1,5]]},"reference":[{"issue":"1","key":"1543_CR1","doi-asserted-by":"publisher","first-page":"408","DOI":"10.1186\/s13054-023-04703-3","volume":"27","author":"R Asija","year":"2023","unstructured":"Asija R, Fried JA, Siddall EC, Mullin DA, Agerstrand CL, Brodie D, Sonett JR, Lemaitre PH, Abrams D. How I manage differential gas exchange in peripheral venoarterial extracorporeal membrane oxygenation. Crit Care. 2023;27(1):408. https:\/\/doi.org\/10.1186\/s13054-023-04703-3. PMID: 37891688; PMCID: PMC10612193.","journal-title":"Crit Care"},{"key":"1543_CR2","doi-asserted-by":"publisher","first-page":"1231016","DOI":"10.3389\/fphys.2023.1231016","volume":"14","author":"KF Bachmann","year":"2023","unstructured":"Bachmann KF, Berger D, Moller PW. Interactions between extracorporeal support and the cardiopulmonary system. Front Physiol. 2023;14:1231016. https:\/\/doi.org\/10.3389\/fphys.2023.1231016. PMID: 37772062; PMCID: PMC10523013.","journal-title":"Front Physiol"},{"issue":"4","key":"1543_CR3","doi-asserted-by":"publisher","first-page":"ezad083","DOI":"10.1093\/ejcts\/ezad083","volume":"63","author":"J Stern","year":"2023","unstructured":"Stern J, Dupuis C, Kpeglo H, Reuter J, Vinclair C, Para M, Nataf P, Pelletier AL, de Montmollin E, Bouadma L, Timsit JF, Sonneville R. Upper Gastrointestinal bleeding in adults treated with veno-arterial extracorporeal membrane oxygenation: a cohort study. Eur J Cardiothorac Surg. 2023;63(4):ezad083. https:\/\/doi.org\/10.1093\/ejcts\/ezad083. PMID: 36916745; PMCID: PMC10089675.","journal-title":"Eur J Cardiothorac Surg"},{"issue":"1","key":"1543_CR4","doi-asserted-by":"publisher","first-page":"104","DOI":"10.1186\/s13613-024-01326-x","volume":"14","author":"Q de Roux","year":"2024","unstructured":"de Roux Q, Disli Y, Bougouin W, Renaudier M, Jendoubi A, Merle JC, Delage M, Picard L, Sayagh F, Cherait C, Folliguet T, Quesnel C, Becq A, Mongardon N. Upper Gastrointestinal bleeding on veno-arterial extracorporeal membrane oxygenation support. Ann Intensive Care. 2024;14(1):104. https:\/\/doi.org\/10.1186\/s13613-024-01326-x. 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