The MAMBO Framework and the Future of Modern Perfusion: Artificial Intelligence, Cognitive Ergonomics, and Sustainable Workflow Integration

Artificial intelligence (AI), predictive analytics, and digital health technologies are progressively reshaping extracorporeal circulation and perioperative cardiovascular care. In this evolving landscape, cardiopulmonary bypass management is transitioning from a predominantly technical discipline to a model of precision extracorporeal medicine that integrates physiologic optimization, cognitive ergonomics, and workflow sustainability. The Modern Advanced Management of Blood Oxygenation (MAMBO) Framework was originally developed as a physiologic strategy centered on monitoring, adaptation, management, balance, and optimization during cardiopulmonary bypass. However, its applications may extend beyond patient physiology alone. Increasing evidence highlights the growing impact of cognitive workload, operator stress, alarm fatigue, and organizational complexity in contemporary perfusion practice, while advances in AI-assisted monitoring, explainable machine learning, and predictive analytics are creating new opportunities to enhance both clinical performance and professional sustainability. In this editorial perspective, we discuss the expanded role of the MAMBO Framework as a human-centered and workflow-oriented model for the future of perfusion science. We explore how AI-supported systems and adaptive decision-support strategies may contribute not only to physiologic precision and the optimization of oxygen delivery but also to reduced cognitive overload, improved situational awareness, and greater efficiency in multidisciplinary workflows. The convergence of AI, cognitive ergonomics, and precision perfusion may ultimately redefine the role of the modern perfusionist, promoting a more adaptive, sustainable, and data-driven approach to cardiovascular care.