{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,23]],"date-time":"2026-05-23T19:05:00Z","timestamp":1779563100685,"version":"3.53.1"},"reference-count":14,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T00:00:00Z","timestamp":1778112000000},"content-version":"vor","delay-in-days":7,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,4,30]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Patients with Fontan circulation represent a high-risk population when facing acute cardiopulmonary decompensation. The use of extracorporeal membrane oxygenation (ECMO) in this patient cohort is rare and technically demanding due to the unique circulatory physiology with passive pulmonary blood flow and predisposition to thromboembolic events.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case Presentation<\/jats:title>\n                    <jats:p>We report the case of a 17-year-old male patient with a history of extracardiac Fontan palliation who developed a life-threatening diffuse pulmonary haemorrhage following blunt chest trauma. The bleeding pattern precluded both interventional and surgical management. Despite initial stabilization attempts, the patient developed progressive respiratory failure refractory to mechanical ventilation, necessitating the initiation of VV-ECMO therapy as a bridge to recovery.<\/jats:p>\n                    <jats:p>Ongoing pulmonary bleeding further complicated the course, precluding the implementation of systemic anticoagulation. Consequently, a heparin-free ECMO strategy was employed. Tailored administration of coagulation factors allowed for the preservation of ECMO circuit patency while maintaining haemostasis. Following gradual respiratory improvement, the patient was successfully weaned from ECMO and discharged without residual organ dysfunction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case demonstrates the need for personalized ECMO strategies, even in highly challenging haemodynamic scenarios such as Fontan physiology. Favourable outcomes can be achieved when personalized interdisciplinary management is provided in high-volume expert centres for mechanical circulation support (MCS).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytag322","type":"journal-article","created":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T11:42:31Z","timestamp":1778067751000},"source":"Crossref","is-referenced-by-count":0,"title":["Management of a rare triad of trauma-induced pulmonary haemorrhage in an adult with Fontan physiology: a case report"],"prefix":"10.1093","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4334-9371","authenticated-orcid":false,"given":"Mukaram","family":"Rana","sequence":"first","affiliation":[{"name":"Department of Cardiology, Goethe University Frankfurt, University Heart Center , Theodor-Stern-Kai 7, Frankfurt 60596 ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Ochs","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Goethe University Frankfurt, University Heart Center , Theodor-Stern-Kai 7, Frankfurt 60596 ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lukas","family":"Probst","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Goethe University Frankfurt, University Heart Center , Theodor-Stern-Kai 7, Frankfurt 60596 ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David M","family":"Leistner","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Goethe University Frankfurt, University Heart Center , Theodor-Stern-Kai 7, Frankfurt 60596 ,","place":["Germany"]},{"name":"Institute for Cardiovascular Regeneration, Goethe University , Theodor-Stern-Kai 7, Frankfurt 60590 ,","place":["Germany"]},{"name":"German Center for Cardiovascular Research, Partner Site Frankfurt Rhine-Main , Berlin 60590 ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"St\u00f6hr","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Goethe University Frankfurt, University Heart Center , Theodor-Stern-Kai 7, Frankfurt 60596 ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,5,7]]},"reference":[{"key":"2026052314562330000_ytag322-B1","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1136\/thx.26.3.240","article-title":"Surgical repair of tricuspid atresia","volume":"26","author":"Fontan","year":"1971","journal-title":"Thorax"},{"key":"2026052314562330000_ytag322-B2","doi-asserted-by":"crossref","DOI":"10.12688\/f1000research.13792.1","article-title":"State of the art of the Fontan strategy for treatment of univentricular heart disease","volume":"7","author":"van der Ven","year":"2018","journal-title":"F1000Res"},{"key":"2026052314562330000_ytag322-B3","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1177\/2150135119894478","article-title":"A tribute to the pioneers of right heart bypass: an historical review","volume":"11","author":"Stellin","year":"2020","journal-title":"World J Pediatr Congenit Heart Surg"},{"key":"2026052314562330000_ytag322-B4","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1111\/chd.12570","article-title":"Five decades of the Fontan operation: a systematic review of international reports on outcomes after univentricular palliation","volume":"13","author":"Kverneland","year":"2018","journal-title":"Congenit Heart Dis"},{"key":"2026052314562330000_ytag322-B5","doi-asserted-by":"crossref","first-page":"1341","DOI":"10.1016\/j.athoracsur.2003.09.042","article-title":"Extracorporeal membrane oxygenation support of the Fontan and bidirectional Glenn circulations","volume":"77","author":"Booth","year":"2004","journal-title":"Ann Thorac Surg"},{"key":"2026052314562330000_ytag322-B6","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1016\/j.jtcvs.2010.11.050","article-title":"Extracorporeal membrane oxygenation support after the fontan operation","volume":"142","author":"Rood","year":"2011","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2026052314562330000_ytag322-B7","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1016\/j.ejcts.2006.11.043","article-title":"Factors influencing early and late outcome following the fontan procedure in the current era. 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