{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T14:10:55Z","timestamp":1790604655237,"version":"4.1.0"},"reference-count":10,"publisher":"Springer Science and Business Media LLC","issue":"4","license":[{"start":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T00:00:00Z","timestamp":1790553600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T00:00:00Z","timestamp":1790553600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Artif Organs"],"published-print":{"date-parts":[[2026,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Veno-arterial (V-A) and veno-venous (V-V) extracorporeal membrane oxygenation (ECMO) are frequently employed in the management of cardiopulmonary failure in critically ill patients. Utilization, however, is controversial in the Jehovah\u2019s Witness (JW) population as temporary mechanical circulatory support (tMCS) typically is associated with blood loss requiring transfusions. Despite this fact, use of ECMO is still feasible in this population while avoiding blood transfusions and there have been few reported cases in the literature. However, its use as part of cardiopulmonary resuscitation is limited. Multiple strategies have been employed to limit blood loss and maximize endogenous hematopoiesis to assist in maintaining normal physiology while utilizing tMCS. Though these tactics are most useful when applied in the preintervention setting, they are applicable in the emergency setting including extracorporeal cardiopulmonary resuscitation (ECPR). This can be achieved with conscientious cannulation technique and circuit management. Presented here is a case report of the successful use of V-A ECMO in the resuscitation for a JW, avoiding blood product transfusions. The protocol utilized to eliminate the need for blood transfusions is also discussed. This approach adds to the growing body of evidence emphasizing that the use of tMCS as part of bloodless medicine practice is feasible, even in the emergency setting.<\/jats:p>","DOI":"10.1007\/s10047-026-01591-6","type":"journal-article","created":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T13:43:20Z","timestamp":1790603000000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Extracorporeal cardiopulmonary resuscitation for cardiogenic shock in a Jehovah\u2019s witness"],"prefix":"10.1007","volume":"29","author":[{"given":"Derek K.","family":"Afflu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louis","family":"F. Chai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiromu","family":"Kehara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sean M.","family":"Baskin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshiya","family":"Toyoda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4474-8075","authenticated-orcid":false,"given":"Roh","family":"Yanagida","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,9,28]]},"reference":[{"key":"1591_CR1","doi-asserted-by":"publisher","first-page":"60","DOI":"10.1177\/02676591211047774","volume":"39","author":"A Mera","year":"2024","unstructured":"Mera A, Argudo E, Mart\u00ednez-Mart\u00ednez M, Palmada C, Bonilla C, Pacheco A, et al. Extracorporeal membrane oxygenation in Jehovah\u2019s Witness patients: Case report, literature review, and summary of recommendations. Perfusion. 2024;39:60\u20135. https:\/\/doi.org\/10.1177\/02676591211047774.","journal-title":"Perfusion"},{"key":"1591_CR2","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1051\/ject\/201244039","volume":"44","author":"TJ Preston","year":"2012","unstructured":"Preston TJ, Olshove VF, Chase M. Bloodless extracorporeal membrane oxygenation in the Jehovah\u2019s Witness patient. J Extra Corpor Technol. 2012;44:39\u201342. https:\/\/doi.org\/10.1051\/ject\/201244039.","journal-title":"J Extra Corpor Technol"},{"key":"1591_CR3","doi-asserted-by":"publisher","first-page":"843","DOI":"10.1016\/S2213-2600(25)00122-5","volume":"13","author":"A Supady","year":"2025","unstructured":"Supady A, B\u011blohl\u00e1vek J, Combes A, Hutin A, Lorusso R, MacLaren G, et al. Extracorporeal cardiopulmonary resuscitation for refractory cardiac arrest. Lancet Respir Med. 2025;13:843\u201356. https:\/\/doi.org\/10.1016\/S2213-2600(25)00122-5.","journal-title":"Lancet Respir Med"},{"key":"1591_CR4","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1186\/s13613-024-01253-x","volume":"14","author":"S Isokawa","year":"2024","unstructured":"Isokawa S, Hifumi T, Hirano K, Watanabe Y, Horie K, Shin K, et al. Risk factors for bleeding complications in patients undergoing extracorporeal cardiopulmonary resuscitation following out-of-hospital cardiac arrest: a secondary analysis of the SAVE-J II study. Ann Intensive Care. 2024;14:16. https:\/\/doi.org\/10.1186\/s13613-024-01253-x.","journal-title":"Ann Intensive Care"},{"key":"1591_CR5","doi-asserted-by":"publisher","first-page":"1003","DOI":"10.1016\/j.ajem.2017.11.016","volume":"36","author":"T Otani","year":"2018","unstructured":"Otani T, Sawano H, Natsukawa T, Matsuoka R, Nakashima T, Takahagi M, et al. D-dimer predicts bleeding complication in out-of-hospital cardiac arrest resuscitated with ECMO. Am J Emerg Med. 2018;36:1003\u20138. https:\/\/doi.org\/10.1016\/j.ajem.2017.11.016.","journal-title":"Am J Emerg Med"},{"key":"1591_CR6","doi-asserted-by":"publisher","first-page":"2432","DOI":"10.1111\/aor.14321","volume":"46","author":"C Li","year":"2022","unstructured":"Li C, Cai T, Xie H, Wang L, Yang F, Du Z, et al. Risk factors and outcomes for patients with bleeding complications receiving extracorporeal membrane oxygenation: An analysis of the Chinese Extracorporeal Life Support Registry. Artif Organs. 2022;46:2432\u201341. https:\/\/doi.org\/10.1111\/aor.14321.","journal-title":"Artif Organs"},{"key":"1591_CR7","doi-asserted-by":"publisher","first-page":"387","DOI":"10.3390\/ijerph19010387","volume":"19","author":"B van Pavlikova","year":"2021","unstructured":"Pavlikova B, van Dijk JP Jehovah\u2019s witnesses and their compliance with regulations on smoking and blood treatment. Int J Environ Res Public Health. 2021;19:387. https:\/\/doi.org\/10.3390\/ijerph19010387.","journal-title":"Int J Environ Res Public Health"},{"key":"1591_CR8","doi-asserted-by":"publisher","first-page":"1913237","DOI":"10.1155\/2024\/1913237","volume":"2024","author":"R Davids","year":"2024","unstructured":"Davids R, Robinson G, Van Tonder C, Robinson J, Ahmed N, Domingo A. Jehovah\u2019s witness needing critical care: A narrative review on the expanding arsenal. Crit Care Res Pract. 2024;2024:1913237. https:\/\/doi.org\/10.1155\/2024\/1913237.","journal-title":"Crit Care Res Pract"},{"key":"1591_CR9","doi-asserted-by":"publisher","first-page":"303","DOI":"10.1097\/MAT.0000000000001652","volume":"68","author":"ABV McMichael","year":"2022","unstructured":"McMichael ABV, Ryerson LM, Ratano D, Fan E, Faraoni D, Annich GM. 2021 ELSO adult and pediatric anticoagulation guidelines. ASAIO J. 2022;68:303\u201310. https:\/\/doi.org\/10.1097\/MAT.0000000000001652.","journal-title":"ASAIO J"},{"key":"1591_CR10","doi-asserted-by":"publisher","first-page":"177","DOI":"10.1007\/s12055-023-01601-9","volume":"40","author":"MI Malik","year":"2024","unstructured":"Malik MI, Fakim D, Drullinksy D, Nagpal AD. Indication for ECMO predicts time to first actionable bleeding complication. Indian J Thorac Cardiovasc Surg. 2024;40:177\u201383. https:\/\/doi.org\/10.1007\/s12055-023-01601-9.","journal-title":"Indian J Thorac Cardiovasc Surg"}],"container-title":["Journal of Artificial Organs"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10047-026-01591-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s10047-026-01591-6","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10047-026-01591-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T13:43:20Z","timestamp":1790603000000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s10047-026-01591-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,28]]},"references-count":10,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,12]]}},"alternative-id":["1591"],"URL":"https:\/\/doi.org\/10.1007\/s10047-026-01591-6","relation":{},"ISSN":["1434-7229","1619-0904"],"issn-type":[{"value":"1434-7229","type":"print"},{"value":"1619-0904","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,28]]},"assertion":[{"value":"26 May 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"29 August 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 September 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"All authors of this work have no conflicts of interest to disclose.","order":1,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"65"}}