Efficiency in Extracorporeal Membrane Oxygenation—Cellular Deposits on Polymethypentene Membranes Increase Resistance to Blood Flow and Reduce Gas Exchange Capacity

Lehle, Karla; Philipp, Alois; Gleich, Otto; Holzamer, Andreas; Müller, Thomas; Bein, Thomas; Schmid, Çhristof

doi:10.1097/mat.0b013e318186a807

Cited by 101 publications

(100 citation statements)

References 24 publications

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“…Both clinically nontraceable increases in frHb concentrations or/and a significant increase in dpMO within 1 day suggested impending technical complications. Thus, knowledge of threshold values of different MOs can help to estimate the urgency of a MO exchange in clinical practice.The reason for an increase in dpMO is clot formation as well as fibrin/cellular deposition within the MO (18). As shown in the present study, rapid thrombus formation was an infrequent complication.…”

Section: Discussionmentioning

confidence: 58%

Flow Dynamics of Different Adult ECMO Systems: A Clinical Evaluation

Lehle

Philipp

Müller³

et al. 2013

Artificial Organs

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Membrane oxygenator (MO) failure is a known hazard during venovenous extracorporeal membrane oxygenation (v-v ECMO) therapy. Knowledge about technical and performance details of different ECMO systems (Maquet, Rastatt, Germany; Medos, Stolberg, Germany; Sorin, Modena, Italy) licensed for adults with acute lung failure might improve their handling. This retrospective study comprises 186 adult patients (Regensburg ECMO Registry) treated with v-v ECMO. Flow dynamic data were used to analyze the performance of different blood pumps, cannula types, and MOs to maintain an adequate blood flow (1-5 L/min). Usage of the Medos ECMO system in critically ill patients required a higher pump speed and generated a higher pressure drop across the MO (dpMO), however, without an increase in free plasma hemoglobin. The dpMO depended on the type of MO and increased with blood flow as expected. Type-specific normal values are reported. A distinct increase in dpMO above normal values within 1 day required an immediate MO exchange. This was an infrequent technical complication (3%). Finally, pressure-flow performance of single dual-lumen cannulas (27 Fr) was comparable with small single-lumen cannulas (15 Fr), without an increased risk of technical-induced hemolysis. Despite different performances, all current commercially available adult v-v ECMO systems produce adequate blood flow without an increased risk in technical-induced hemolysis. Familiarity with the specific properties of individual systems allows early detection of technical complications. Additionally, the choice of an adequate cannula requires a closer consideration of the individual patient situation.

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Section: Discussionmentioning

confidence: 58%

Flow Dynamics of Different Adult ECMO Systems: A Clinical Evaluation

Lehle

Philipp

Müller³

et al. 2013

Artificial Organs

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“…There were no massive occlusive clots or deposited materials in the fiber bundle as commonly observed in the explanted oxygenators used in cardiopulmonary bypass or respiratory support [10–12]. Three of the five explanted devices were free of gross thrombotic formation in the fiber bundle and flow path.…”

Section: Resultsmentioning

confidence: 98%

Thirty-Day In-Vivo Performance of a Wearable Artificial Pump-Lung for Ambulatory Respiratory Support

Zhang

Bianchi

et al. 2012

The Annals of Thoracic Surgery

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Background The purpose of this study was to evaluate the long-term in-vivo hemodynamics, gas transfer and biocompatibility of an integrated artificial pump-lung (APL) developed for ambulatory respiratory support. Methods The study was conducted in an ovine model by surgically placing the APL between the right atrium and pulmonary artery. Nine sheep were implanted. Heparin was infused as an anticoagulant. The device flow, gas transfer and plasma free hemoglobin (PFH) were measured daily. Hematological data, platelet activation and blood biochemistry were assessed twice a week. After 30 days, the sheep were euthanized for necropsy. The explanted devices were examined for gross thrombosis. Results Five sheep survived for 29 to 31 days and were electively terminated. Four sheep expired or were terminated early due to mechanical failure of IV lines or device. The APL devices in the five long-term animals were capable of delivering an oxygen transfer rate of 148±18 ml/min at a flow rate of 2.99±0.46 l/min with blood oxygen saturation of 96.7±1.3%. The device flow and oxygen transfer were stable over 30 days. The animals had normal end-organ functions except for surgery-related transient alteration in kidney function, liver function, and cell and tissue injury. There was no hemolysis. The device flow path and membrane surface were free of gross thrombus. Conclusions The APL exhibited the capability of providing respiratory support with excellent biocompatibility, long-term reliability and the potential for bridging to lung transplant.

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“…A recent publication describes the forming of fibrous and cellular accumulations on the gas exchange surface, increasing the pressure drop in polymethylpentene oxygenators. 2 Due to the rapid deployment of plasma leakage in our case, this was probably not the cause for the event.…”

Section: Discussionmentioning

confidence: 84%

Case report: plasma leakage in a polymethylpentene oxygenator during extracorporeal life support

Puis¹,

Ampe²,

Hertleer³

2009

Perfusion

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Plasma leakage is a phenomenon which has almost completely disappeared since the introduction of plasma-tight polymethylpentene (PMP) fibers in oxygenators used for extracorporeal life support (ECLS). We describe here a case of ECLS which was affected by the rapid occurrence of plasma leakage in oxygenators with polymethylpentene fibers. To our knowledge, this is the first report of the phenomenon since the introduction of this new generation of oxygenators.

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Efficiency in Extracorporeal Membrane Oxygenation—Cellular Deposits on Polymethypentene Membranes Increase Resistance to Blood Flow and Reduce Gas Exchange Capacity

Cited by 101 publications

References 24 publications

Flow Dynamics of Different Adult ECMO Systems: A Clinical Evaluation

Flow Dynamics of Different Adult ECMO Systems: A Clinical Evaluation

Thirty-Day In-Vivo Performance of a Wearable Artificial Pump-Lung for Ambulatory Respiratory Support

Case report: plasma leakage in a polymethylpentene oxygenator during extracorporeal life support

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