Clinical Evaluation of Two Different Extracorporeal Membrane Oxygenation Systems: A Single Center Report

Abstract

Refinements in extracorporeal membrane oxygenation (ECMO) equipment, including heparin-coated surfaces, centrifugal pump, membrane oxygenator, and more biocompatible pump-oxygenator circuits, have reduced procedure-related complications and have made ECMO a safe and effective therapy for critical patients. The aim of this study was to evaluate the performance of two different ECMO circuit systems in a clinical setting and compare their outcomes. From December 2004 to December 2009, 121 patients required ECMO for primary or postcardiotomy cardiogenic shock at our heart center. We used the Medtronic circuit system in our earlier series (Group M, n = 64), and from July 2007, ECMO was carried out mainly with the Quadrox D PLS circuit system (Group Q, n = 56). We retrospectively summarized and analyzed the data of these patients. The evaluation was based on the comparison between properties of the membrane oxygenators and pumps, anticoagulation therapy, circuit-related complications, and clinical outcomes. Support pump flow rates, platelet counts, and trans-membrane pressure drops (TMPDs) of preoxygenator and postoxygenator pressures were compared between two groups at the time of support established (T1) and support established for 24 h (T2). There were no significant differences between the two groups with regard to patient characteristics and pre-ECMO data. The support pump flow rates and platelet counts at different times were comparable in the two groups. The cannulation technique, ECMO duration, and mean heparin dosage were similar in both groups. There were also no significant differences between the groups in mortality or complications related to bleeding and organ dysfunction. Compared with the M group, the Q group experienced less mechanical failure of the ECMO circuit. The Quadrox PLS circuit system showed less circuit thrombus formation (P < 0.045), less plasma leakage (P < 0.001), and less need for replacement of oxygenators (P < 0.001). Furthermore, frequency of hemolysis during ECMO was significantly lower (P < 0.045). In addition, at T1 and T2, TMPDs were significantly lower in the Q group. Our results suggest that both ECMO circuit systems provide similar effects for safe clinical application, but the Quadrox PLS ECMO circuit system demonstrated partially improved biocompatibility in terms of improved cell preservation, lower TMPDs, less plasma leakage, and thrombus formation.

Hemolytic and thrombocytopathic characteristics of extracorporeal membrane oxygenation systems at simulated flow rate for neonates*

“…Additionally, hollow-fiber membrane oxygenators have demonstrated little to no plasma leakage, excellent blood compatibility, and low blood flow resistance (40). A recent retrospective clinical evaluation comparing the Medtronic centrifugal pump/hollow-fiber system with the Maquet centrifugal pump/hollow-fiber system found the latter system to have less hemolysis, lower transmembrane pressures, and less thrombus formation (41). This research correlates with previous published reports showing this latter system is ideal for long-term support such as ECMO and could be used in various sizes of patients (42).…”

First Experience With a New Miniaturized Pump-Driven Venovenous Extracorporeal CO2 Removal System (iLA Activve)

“…22 Easy insertion of cannulas, simple filling and starting the extracorporeal circuit, less extracorporeal blood volume, and sustainable mobility of patients offer an intriguing perspective for a more widespread use of these systems. [25][26][27][28][29] No reports on the use of the miniaturized pump-driven systems described herein exist to date. 19,23,24 With the development of novel techniques like heparin coating of tubes and cannulas, new materials for gas exchange membranes, magnetically suspended centrifugal pumps, and a new generation of cannulas, the incidence of complications seems to have decreased.…”

Mechanical assistance of the circulation during cardiogenic shock

“…Ã Ready made rapidly deployed systems, Multifunctional Life Support Systems, minimized, hand-held ECMOs independent from wall connection points, with integrated sensors (for venous and arterial line pressures, blood temperature, haemoglobin concentration and SVO 2 ) make possible rapid support and safer transfer [16,25,26,57]. Heparin-coated surfaces, newer pumps and oxygenators offer improved biocompatibility, mechanical reliability, simplified care and maintenance [12,44,67,94] [85]. Percutaneous VV cannulation (femoral veins, femoral and jugular vein), inflow cannula to the right atrium, outflow cannula to pulmonary artery.…”