Flow Dynamics of Different Adult <scp>ECMO</scp> Systems: A Clinical Evaluation

Lehle, Karla; Philipp, Alois; Müller, Thomas; Schettler, F; Bein, Thomas; Schmid, Çhristof; Lubnow, Matthias

doi:10.1111/aor.12180

Cited by 54 publications

(62 citation statements)

References 20 publications

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“…Most commonly they can appear in hypovolemic states with pumps run at high speed; in practice chattering of venous lines may be seen. We have demonstrated previously, that deliberate ECLS management with modern technical equipment, sufficiently sized cannulas, limited pump speed and blood flow rates below 4.5 L/min minimizes the risk of mechanical blood trauma in venovenous ECLS. While roller pumps potentially caused significant amounts of hemolysis, the new generation of centrifugal pumps produce at normal clincal use only low levels of hemolysis .…”

Section: Discussionmentioning

confidence: 99%

Prevalence of hemolysis and metabolic acidosis in patients with circulatory failure supported with extracorporeal life support: a marker for survival?

Lehle

Lubnow

Philipp

et al. 2017

European J of Heart Fail

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Aims Elevated levels of plasma free hemoglobin (fHb) indicate red blood cell (RBC) damage. The aim of this study was to analyze the prevalence of hemolysis and metabolic acidosis in patients on extracorporeal life support (ECLS) and to investigate whether it is a marker for outcome. Methods and Results This retrospective analysis included 215 adult patients with cardiac failure treated with ECLS. The cohort was divided into three groups: ECLS (1) during ongoing cardiopulmonary resuscitation (CPR, n = 110); (2) after CPR with return of spontaneous circulation and sustained cardiogenic shock (n = 45); (3) in severe cardiogenic shock without previous CPR (n = 60). Lactate, arterial pH value and fHb were measured daily before (pre‐fHb) and during ECLS. CPR caused a pronounced increase in pre‐fHb (group1, 318 (138/586) mg/L; group2, 212 (107/439) mg/L; group3, 79 (53/232) mg/L; p < 0.001). Within 24 hours on ECLS, fHb declined significantly. Compared to group 3 without CPR, group1 and 2 had a lower pH value (group1, 7.10 (6.93/7.20); group2, 7.21 (7.16/7.27); group3, 7.28 (7.20/7.35); p < 0.001), and an increased lactate level (group1, 88 (55/129) mg/dL; group2, 76 (36/111) mg/dL; group3, 52 (25/83) mg/dL; p < 0.0001). Multivariante analysis showed that pre‐fHb had no prognostic value for survival. Only a low pre‐lactate was a surrogate marker for successful weaning (p < 0.0001) and discharge from hospital (p = 0.0028). Conclusions CPR was associated with a strongly increased fHb irrespective of ECLS. Implantation of ECLS did not aggravate hemolysis but instead decreased it within 24 hours. In this study low pre‐fHb had no predictive value for survival.

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Section: Discussionmentioning

confidence: 99%

Prevalence of hemolysis and metabolic acidosis in patients with circulatory failure supported with extracorporeal life support: a marker for survival?

Lehle

Lubnow

Philipp

et al. 2017

European J of Heart Fail

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“…DLCs during VV ECMO did not induce hemolysis compared to single lumen cannulas (SLCs, p = 0.358). Small-sized inflow cannulas (17 Fr) at a blood flow of � 2.5 l/min (low flow) and > 3.0 l/ min (high flow) did not induce hemolysis during VV ECMO [16]. Respective data for VA ECMO failed so far.…”

Section: Impact Of Cannulation On the Development Of Hemolysismentioning

confidence: 94%

Factors associated with hemolysis during extracorporeal membrane oxygenation (ECMO)—Comparison of VA- versus VV ECMO

et al. 2020

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Venovenous (VV) and venoarterial (VA) extracorporeal membrane oxygenation (ECMO) are effective support modalities to treat critically ill patients. ECMO-associated hemolysis remains a serious complication. The aim was to disclose similarities and differences in VAand VV ECMO-associated hemolysis. This is a retrospective single-center analysis (January 2012 to September 2018) including 1,063 adult consecutive patients (VA, n = 606; VV, n = 457). Severe hemolysis (free plasma hemoglobin, fHb > 500 mg/l) during therapy occurred in 4% (VA) and 2% (VV) (p�0.001). VV ECMO showed significantly more hemolysis by pump head thrombosis (PHT) compared to VA ECMO (9% vs. 2%; p�0.001). Pretreatments (ECPR, cardiac surgery) of patients who required VA ECMO caused high fHb pre levels which aggravates the proof of ECMO-induced hemolysis (median (interquartile range), VA: fHb pre: 225.0 (89.3-458.0); VV: fHb pre: 72.0 (42.0-138.0); p�0.001). The survival rate to discharge from hospital differed depending on ECMO type (40% (VA) vs. 63% (VV); p�0.001). Hemolysis was dominant in VA ECMO patients, mainly caused by different indications and not by the ECMO support itself. PHT was the most severe form of ECMOinduced hemolysis that occurs in both therapies with low frequency, but more commonly in VV ECMO due to prolonged support time. OPEN ACCESS Citation: Appelt H, Philipp A, Mueller T, Foltan M, Lubnow M, Lunz D, et al. (2020) Factors associated with hemolysis during extracorporeal membrane oxygenation (ECMO)-Comparison of VA-versus VV ECMO. PLoS ONE 15(1): e0227793.

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“…After exchange in 11 patients, the levels of D-dimers decreased significantly within 2 days (day of exchange, 35 [34-35] mg/L; 2 days after exchange, 12 [8][9][10][11][12][13][14][15][16] mg/L, P = 0.004) ( Fig. 1).…”

Section: Recovery Of D-dimer Levels After Renewal Of the Momentioning

confidence: 99%

D-dimers Are a Predictor of Clot Volume Inside Membrane Oxygenators During Extracorporeal Membrane Oxygenation

et al. 2015

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Thrombosis inside the membrane oxygenator (MO) is a critical complication during venovenous extracorporeal membrane oxygenation (ECMO). The aim of this study was to prove if thrombotic clots manifest within the MO when D-dimer levels are elevated over a long-term period. Heparin-coated polymethylpentene MOs (n = 13) were exchanged due to high plasma D-dimer levels. Clot volume was calculated using multidetector computed tomography (MDCT). Coagulation parameters and MO function were analyzed before and after MO exchange. Before MO exchange, D-dimer levels increased significantly in each patient (11.5 [6.5-15.5] mg/L to 35.0 [34-35] mg/L, P ≤ 0.001). High levels of D-dimers were tolerated for 1 to 6 days. Additionally, fibrinogen concentration (n = 8) and platelet count decreased (n = 8). Within 48 h after exchange, D-dimer levels decreased significantly (n = 11, 12 [8-16] mg/L, P = 0.004). Fibrinogen concentration and platelet counts increased. Clots were found in all MOs in the inlet part of the device. Clot volume (16-106 cm(3) ) did not correlate with MO support time but increased significantly when high D-dimer levels were accepted for >2 days. An increase or high levels of D-dimers in absence of other explaining pathology during ECMO therapy reflected coagulation activity within the MO. Evidence of clots within the MO at high D-dimer levels and decrease after exchange underline the relevance of D-dimer testing during ECMO treatment. Besides, surveillance of MOs during ongoing ECMO therapy will help to predict clot formation, and to avoid system-induced coagulation disorders as well as critical situations.

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Flow Dynamics of Different Adult ECMO Systems: A Clinical Evaluation

Cited by 54 publications

References 20 publications

Prevalence of hemolysis and metabolic acidosis in patients with circulatory failure supported with extracorporeal life support: a marker for survival?

Prevalence of hemolysis and metabolic acidosis in patients with circulatory failure supported with extracorporeal life support: a marker for survival?

Factors associated with hemolysis during extracorporeal membrane oxygenation (ECMO)—Comparison of VA- versus VV ECMO

D-dimers Are a Predictor of Clot Volume Inside Membrane Oxygenators During Extracorporeal Membrane Oxygenation

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