{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T23:44:11Z","timestamp":1789515851726,"version":"build-2803163510"},"reference-count":26,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,1,27]],"date-time":"2025-01-27T00:00:00Z","timestamp":1737936000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,1,27]],"date-time":"2025-01-27T00:00:00Z","timestamp":1737936000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Artificial Organs"],"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Veno\u2010venous extracorporeal membrane oxygenation (V\u2010V ECMO) is increasingly used in the treatment of severe respiratory failure. Despite a significant increase in the worldwide use of extracorporeal lung assist devices recirculation remains a common complication and is associated with a reduced effectiveness of ECMO support and increased hemolysis. In this observational study we aimed to investigate the impact of cannula configuration and extracorporeal flow on recirculation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>An observational retrospective study was performed, which included all patients, who received V\u2010V ECMO and recirculation measurements at the University Medical Center Freiburg between August 2021 and June 2023. Recirculation and extracorporeal flow were determined using ultrasonic indicator dilution technology. Patients were divided into subgroups according to their type of cannulation (dual lumen single\u2010site vs. bifemoral vs. femoro\u2010jugular).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 215 recirculation measurements in 47 patients were performed. Dual lumen single\u2010site cannulation was associated with significantly lower recirculation rates (8.7% [0.0; 12.0]) compared to single lumen dual\u2010site cannulation (femoro\u2010jugular: 17.6% [0.0; 25.8]; bifemoral: 27.9%\u2009\u00b1\u200913.4%). In addition, a positive linear correlation was observed between extracorporeal flow and recirculation in all subgroups. Recirculation increased significantly with rising extracorporeal flow in all subgroups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Recirculation is a common complication in V\u2010V ECMO and can lead to a reduction of ECMO effectiveness. Particular attention should be paid to optimal positioning of the cannulas in patients with more than one cannula. The ultrasonic indicator dilution method is a simple and quick method for measuring recirculation in V\u2010V ECMO and can be used at an early stage if effectiveness decreases.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/aor.14961","type":"journal-article","created":{"date-parts":[[2025,1,27]],"date-time":"2025-01-27T06:23:15Z","timestamp":1737958995000},"page":"1012-1020","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Impact of Cannulation Strategy and Extracorporeal Blood Flow on Recirculation During Veno\u2010Venous Extracorporeal Membrane Oxygenation"],"prefix":"10.1111","volume":"49","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6882-2009","authenticated-orcid":false,"given":"Jan\u2010Steffen","family":"Pooth","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine Faculty of Medicine, University Medical Centre Freiburg, University of Freiburg  Freiburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jil Kristin","family":"F\u00f6rster","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery Faculty of Medicine, University Medical Centre Freiburg, University of Freiburg  Freiburg Germany"},{"name":"Centre for Applied Simulation University of Applied Sciences Furtwangen  Villingen\u2010Schwenningen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"Benk","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery Faculty of Medicine, University Medical Centre Freiburg, University of Freiburg  Freiburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patric","family":"Diel","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery Faculty of Medicine, University Medical Centre Freiburg, University of Freiburg  Freiburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sam Jo\u00e9","family":"Brixius","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery Faculty of Medicine, University Medical Centre Freiburg, University of Freiburg  Freiburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4118-948X","authenticated-orcid":false,"given":"Sven","family":"Maier","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery Faculty of Medicine, University Medical Centre Freiburg, University of Freiburg  Freiburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Supady","sequence":"additional","affiliation":[{"name":"Interdisciplinary Medical Intensive Care Faculty of Medicine, University Medical Centre Freiburg, University of Freiburg  Freiburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tobias","family":"Wengenmayer","sequence":"additional","affiliation":[{"name":"Interdisciplinary Medical Intensive Care Faculty of Medicine, University Medical Centre Freiburg, University of Freiburg  Freiburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9423-9682","authenticated-orcid":false,"given":"Dawid Leander","family":"Staudacher","sequence":"additional","affiliation":[{"name":"Interdisciplinary Medical Intensive Care Faculty of Medicine, University Medical Centre Freiburg, University of Freiburg  Freiburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerd\u2010Walter","family":"Haimerl","sequence":"additional","affiliation":[{"name":"Centre for Applied Simulation University of Applied Sciences Furtwangen  Villingen\u2010Schwenningen 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