{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T17:33:38Z","timestamp":1777916018418,"version":"3.51.4"},"reference-count":13,"publisher":"SAGE Publications","issue":"7","license":[{"start":{"date-parts":[[2025,2,17]],"date-time":"2025-02-17T00:00:00Z","timestamp":1739750400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Perfusion"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Extracorporeal membrane oxygenation (ECMO) is utilized in critically ill neonates with severe cardiopulmonary failure. Hemolysis is a potential complication and is associated with significantly increased morbidity and mortality. The etiology of hemolysis in neonates is multifactorial, including shear forces generated by the ECMO pump, higher flow resistance from smaller tubing and smaller cannulas, the oxygenator, and other patient factors. Centrifugal pumps and oxygenators commonly have shunts with partially occluding clamps to regulate blood flow. We hypothesized that these clamps are significant contributors to hemolysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>An in vitro study was conducted with three identical ECMO circuits containing an integrated polymethylpentene (PMP) oxygenator and centrifugal pump (Cardiohelp HLS 5.0) and 1\/4\u2033 arteriovenous (AV) loop tubing. The circuits were primed with equal components, including expired ABO-compatible packed red blood cells (pRBCs), 25% albumin, 5% albumin, sodium bicarbonate, heparin, and calcium chloride. Circuit A had a completely occluded shunt. Circuit B had a partially occluded shunt, allowing 500\u00a0mL\/min of shunt flow back to the oxygenator. Circuit C had a fully open shunt, generating 1000\u00a0mL\/min of shunt flow back to the oxygenator. Plasma-free hemoglobin values were measured serially over 5\u00a0days.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Baseline plasma-free hemoglobin levels were equal in all three circuits. Circuit C had the greatest increase in plasma-free hemoglobin daily (26.3\u00a0mg\/dL\/day) compared to Circuit A and Circuit B, which were 14.1\u00a0mg\/dL\/day and 12.9\u00a0mg\/dL\/day, respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Our data suggests that partially occluding clamps are not a significant contributor to hemolysis; rather, increased flow through the oxygenator significantly increased the rate of hemolysis in neonatal ECMO circuits.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/02676591251322000","type":"journal-article","created":{"date-parts":[[2025,2,18]],"date-time":"2025-02-18T01:36:22Z","timestamp":1739842582000},"page":"1646-1652","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Evaluation of the impact of extracorporeal membrane oxygenation (ECMO) oxygenator shunt flow on neonatal hemolysis: An in vitro study"],"prefix":"10.1177","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3516-6719","authenticated-orcid":false,"given":"Christopher","family":"Nemeh","sequence":"first","affiliation":[{"name":"Division of Pediatric Surgery, Department of Surgery, Columbia University Vagelos College of Physicians and Surgeons\/NewYork-Presbyterian Morgan Stanley Children\u2019s Hospital, New York, NY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Caleb","family":"Varner","sequence":"additional","affiliation":[{"name":"Department of Perfusion, NewYork-Presbyterian \u2013 Morgan Stanley Children\u2019s Hospital, New York, NY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicholas","family":"Schmoke","sequence":"additional","affiliation":[{"name":"Division of Pediatric Surgery, Department of Surgery, Columbia University Vagelos College of Physicians and Surgeons\/NewYork-Presbyterian Morgan Stanley Children\u2019s Hospital, New York, NY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elon","family":"Trager","sequence":"additional","affiliation":[{"name":"Department of Perfusion, NewYork-Presbyterian \u2013 Morgan Stanley Children\u2019s Hospital, New York, NY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-3224-3204","authenticated-orcid":false,"given":"Yeu Sanz","family":"Wu","sequence":"additional","affiliation":[{"name":"Division of Pediatric Surgery, Department of Surgery, Columbia University Vagelos College of Physicians and Surgeons\/NewYork-Presbyterian Morgan Stanley Children\u2019s Hospital, New York, NY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Brewer","sequence":"additional","affiliation":[{"name":"Department of Perfusion, NewYork-Presbyterian \u2013 Morgan Stanley Children\u2019s Hospital, New York, NY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Caitlin","family":"Cain-Trivette","sequence":"additional","affiliation":[{"name":"Division of Pediatric Surgery, Department of Surgery, Columbia University Vagelos College of Physicians and Surgeons\/NewYork-Presbyterian Morgan Stanley Children\u2019s Hospital, New York, NY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nikki","family":"Aw","sequence":"additional","affiliation":[{"name":"Division of Laboratory Medicine, Columbia University Vagelos College of Physicians and Surgeons\/NewYork-Presbyterian, New York, NY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard O","family":"Francis","sequence":"additional","affiliation":[{"name":"Department of Pathology and Cell Biology, Columbia University Irving Medical Center\/NewYork-Presbyterian Hospital, New York, NY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Diana","family":"Vargas Chaves","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neonatology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons\/NewYork-Presbyterian Morgan Stanley Children\u2019s Hospital, New York, NY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eva W","family":"Cheung","sequence":"additional","affiliation":[{"name":"Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons\/NewYork-Presbyterian Morgan Stanley Children\u2019s Hospital, New York, NY, USA"},{"name":"Division of Pediatric Critical Care and Hospitalist Medicine, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons\/NewYork-Presbyterian Morgan Stanley Children\u2019s Hospital, New York, NY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William","family":"Middlesworth","sequence":"additional","affiliation":[{"name":"Division of Pediatric Surgery, Department of Surgery, Columbia University Vagelos College of Physicians and Surgeons\/NewYork-Presbyterian Morgan Stanley Children\u2019s Hospital, New York, NY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2025,2,17]]},"reference":[{"key":"e_1_3_5_2_2","doi-asserted-by":"publisher","DOI":"10.1542\/neo.21-11-e728"},{"key":"e_1_3_5_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.siny.2022.101405"},{"key":"e_1_3_5_4_2","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0000000000001709"},{"key":"e_1_3_5_5_2","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0000000000001699"},{"key":"e_1_3_5_6_2","doi-asserted-by":"publisher","DOI":"10.1097\/MAT.0000000000001121"},{"key":"e_1_3_5_7_2","doi-asserted-by":"publisher","DOI":"10.1177\/0267659120957183"},{"key":"e_1_3_5_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpedsurg.2017.03.022"},{"key":"e_1_3_5_9_2","doi-asserted-by":"publisher","DOI":"10.1038\/sj.jp.7211748"},{"key":"e_1_3_5_10_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12967-020-02599-z"},{"key":"e_1_3_5_11_2","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0b013e31824174c8"},{"key":"e_1_3_5_12_2","doi-asserted-by":"publisher","DOI":"10.1097\/MAT.0000000000000444"},{"key":"e_1_3_5_13_2","doi-asserted-by":"publisher","DOI":"10.1111\/aor.13626"},{"key":"e_1_3_5_14_2","doi-asserted-by":"publisher","DOI":"10.3389\/fphys.2023.1287207"}],"container-title":["Perfusion"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/02676591251322000","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/02676591251322000","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/02676591251322000","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T17:35:46Z","timestamp":1777656946000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/02676591251322000"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,17]]},"references-count":13,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2025,10]]}},"alternative-id":["10.1177\/02676591251322000"],"URL":"https:\/\/doi.org\/10.1177\/02676591251322000","relation":{},"ISSN":["0267-6591","1477-111X"],"issn-type":[{"value":"0267-6591","type":"print"},{"value":"1477-111X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,17]]}}}