Comparison between clinical indicators of transmembrane oxygenator thrombosis and multidetector computed tomographic analysis

Panigada, Mauro; L’Acqua, Camilla; Passamonti, Serena Maria; Mietto, Cristina; Protti, Alessandro; Riva, Roberto; Gattinoni, Luciano

doi:10.1016/j.jcrc.2014.12.005

Cited by 25 publications

(33 citation statements)

References 13 publications

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“…A major area for clot formation was identified close to the blood inlet in the venous part inside the devices. However, thrombus formation did not correlate with ECMO support time, nor any patient characteristics .…”

mentioning

confidence: 79%

Technical Indicators to Evaluate the Degree of Large Clot Formation Inside the Membrane Fiber Bundle of an Oxygenator in an In Vitro Setup

et al. 2018

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The most common technical complication during ECMO is clot formation. A large clot inside a membrane oxygenator reduces effective membrane surface area and therefore gas transfer capabilities, and restricts blood flow through the device, resulting in an increased membrane oxygenator pressure drop (dpMO). The reasons for thrombotic events are manifold and highly patient specific. Thrombus formation inside the oxygenator during ECMO is usually unpredictable and remains an unsolved problem. Clot sizes and positions are well documented in literature for the Maquet Quadrox-i Adult oxygenator based on CT data extracted from devices after patient treatment. Based on this data, the present study was designed to investigate the effects of large clots on purely technical parameters, for example, dpMO and gas transfer. Therefore, medical grade silicone was injected into the fiber bundle of the devices to replicate large clot positions and sizes. A total of six devices were tested in vitro with silicone clot volumes of 0, 30, 40, 50, 65, and 85 mL in accordance with ISO 7199. Gas transfer was measured by sampling blood pre and post device, as well as by sampling the exhaust gas at the devices' outlet at blood flow rates of 0.5, 2.5, and 5.0 L/min. Pre and post device pressure was monitored to calculate the dpMO at the different blood flow rates. The dpMO was found to be a reliable parameter to indicate a large clot only in already advanced "clotting stages." The CO concentration in the exhaust gas, however, was found to be sensitive to even small clot sizes and at low blood flows. Exhaust gas CO concentration can be monitored continuously and without any risks for the patient during ECMO therapy to provide additional information on the endurance of the oxygenator. This may help detect a clot formation and growth inside a membrane oxygenator during ECMO even if the increase in dpMO remains moderate.

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confidence: 79%

Technical Indicators to Evaluate the Degree of Large Clot Formation Inside the Membrane Fiber Bundle of an Oxygenator in an In Vitro Setup

et al. 2018

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“…Thrombus volume was summed within the upper and lower portions of the proximal and distal fiber-containing chambers. Total thrombus and regional thrombus deposition is reported in cm 3 .…”

Section: Methodsmentioning

confidence: 99%

Externally visible thrombus partially predicts internal thrombus deposition in extracorporeal membrane oxygenators

Evans

Mishra

et al. 2016

Perfusion

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“…In a previous article, the same author described the requirement of ML replacements after a mean interval of 11±7 days in 3 out of 31 patients (10). In a retrospective study Lubnow et al described ECMO substitution due to ML failure, between 6 and 12 days of use in 28 out of 83 patients (24), while Panigada et al, in a total of 22 patients, with a median ECMO duration of 8 [6][7][8][9][10][11][12][13] days, observed the worsening of oxygenator performance in 7 (26%) patients (17).…”

Section: Gas Exchange Monitoring In Clinical Practicementioning

confidence: 99%

“…Even if ML P/F ratio is clearly a much more "user friendly" parameter, it has been demonstrated that the ML shunt only correlates significantly with its performance (17) and aging process. In fact, an abrupt and significant drop of ML P/F could occur without any evidence of ML impairment, for example with a low inlet blood O 2 saturation, in case of high metabolic demand (16).…”

Section: Oxygen Transfermentioning

confidence: 99%

Oxygenator performance and artificial-native lung interaction

Epis

Belliato

2018

J. Thorac. Dis.

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During extracorporeal membrane oxygenation (ECMO), oxygen (O) transfer (V'O) and carbon dioxide (CO) removal (V'CO) are partitioned between the native lung (NL) and the membrane lung (ML), related to the patient's metabolic-hemodynamic pattern. The ML could be assimilated to a NL both in a physiological and a pathological way. ML O transfer (V'OML) is proportional to extracorporeal blood flow and the difference in O content between each ML side, while ML CO removal (V'COML) can be calculated from ML gas flow and CO concentration at sweep gas outlet. Therefore, it is possible to calculate the ML gas exchange efficiency. Due to the ML aging process, pseudomembranous deposits on the ML fibers may completely impede gas exchange, causing a "shunt effect", significantly correlated to V'OML decay. Clot formation around fibers determines a ventilated but not perfused compartment, with a "dead space effect", negatively influencing V'COML. Monitoring both shunt and dead space effects might be helpful to recognise ML function decline. Since ML failure is a common mechanical complication, its monitoring is critical for right ML replacement timing and it also important to understand the ECMO system performance level and for guiding the weaning procedure. ML and NL gas exchange data are usually obtained by non-continuous measurements that may fail to be timely detected in critical situations. A real-time ECMO circuit monitoring system therefore might have a significant clinical impact to improve safety, adding relevant clinical information. In our clinical practise, the integration of a real-time monitoring system with a set of standard measurements and samplings contributes to improve the safety of the procedure with a more timely and precise analysis of ECMO functioning. Moreover, an accurate analysis of NL status is fundamental in clinical setting, in order to understand the complex ECMO-patient interaction, with a multi-dimensional approach.

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Comparison between clinical indicators of transmembrane oxygenator thrombosis and multidetector computed tomographic analysis

Cited by 25 publications

References 13 publications

Technical Indicators to Evaluate the Degree of Large Clot Formation Inside the Membrane Fiber Bundle of an Oxygenator in an In Vitro Setup

Technical Indicators to Evaluate the Degree of Large Clot Formation Inside the Membrane Fiber Bundle of an Oxygenator in an In Vitro Setup

Externally visible thrombus partially predicts internal thrombus deposition in extracorporeal membrane oxygenators

Oxygenator performance and artificial-native lung interaction

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