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While the potential benefits of the technology are leading to increasing use, there are very real risks associated with it. Several studies demonstrated major bleeding and clotting complications, often associated with hemolysis and poorer outcomes in patients receiving ECCO\n                      <jats:sub>2<\/jats:sub>\n                      R. A better understanding of the risks originating specifically from the rotary blood pump component of the circuit is urgently needed.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>High-resolution computational fluid dynamics was used to calculate the hemodynamics and hemocompatibility of three current rotary blood pumps for various pump flow rates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The hydraulic efficiency dramatically decreases to 5\u201310% if operating at blood flow rates below 1\u2009L\/min, the pump internal flow recirculation rate increases 6\u201312-fold in these flow ranges, and adverse effects are increased due to multiple exposures to high shear stress. The deleterious consequences include a steep increase in hemolysis and destruction of platelets.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      The role of blood pumps in contributing to adverse effects at the lower blood flow rates used during ECCO\n                      <jats:sub>2<\/jats:sub>\n                      R is shown here to be significant. Current rotary blood pumps should be used with caution if operated at blood flow rates below 2\u2009L\/min, because of significant and high recirculation, shear stress, and hemolysis. There is a clear and urgent need to design dedicated blood pumps which are optimized for blood flow rates in the range of 0.5\u20131.5\u2009L\/min.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s13054-019-2622-3","type":"journal-article","created":{"date-parts":[[2019,11,6]],"date-time":"2019-11-06T13:03:19Z","timestamp":1573045399000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":122,"title":["Low-flow assessment of current ECMO\/ECCO2R rotary blood pumps and the potential effect on hemocompatibility"],"prefix":"10.1186","volume":"23","author":[{"given":"Sascha","family":"Gross-Hardt","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felix","family":"Hesselmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jutta","family":"Arens","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulrich","family":"Steinseifer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leen","family":"Vercaemst","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wolfram","family":"Windisch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Brodie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3247-2849","authenticated-orcid":false,"given":"Christian","family":"Karagiannidis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2019,11,6]]},"reference":[{"issue":"6","key":"2622_CR1","doi-asserted-by":"publisher","first-page":"557","DOI":"10.1001\/jama.2019.9302","volume":"322","author":"D Brodie","year":"2019","unstructured":"Brodie D, Slutsky AS, Combes A. 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WW received fees for advisory board meetings and lectures from Maquet Cardiopulmonary, Rastatt, Germany. CK and WW received an open research grant for the hospital from Maquet Cardiopulmonary, Rastatt, Germany. DB reports serving as the co-chair of the trial steering committee for the VENT-AVOID trial sponsored by ALung Technologies; serving on the medical advisory boards for Baxter, BREETHE, and Hemovent (unpaid); and previously serving on the medical advisory board of ALung Technologies. SGH is half-time employed at enmodes GmbH Aachen. FH, JA, LV, and US declare that they have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"348"}}