Life span of different extracorporeal membrane systems for severe respiratory failure in the clinical practice

Abstract

Over the past decade, veno-venous extracorporeal membrane oxygenation (vvECMO) has been increasingly utilized in respiratory failure in patients. This study presents our institution´s experience focusing on the life span of ECMO systems reflecting the performance of a particular system. A retrospective review of our ECMO database identified 461 adult patients undergoing vvECMO (2010–2017). Patients that required more than one system and survived the first exchange >24 hours (n = 139) were included. Life span until the first exchange and exchange criteria were analyzed for all systems (PLS, Cardiohelp HLS-set, both Maquet Cardiopulmonary, Rastatt, Germany; Deltastream/Hilite7000LT, iLA-activve, Xenios/NovaLung, Heilbronn, Germany; ECC.O5, LivaNova, Mirandola, Italy). At our ECMO center, the frequency of a system exchange was 30%. The median (IQR) life span was 9 (6–12) days. There was no difference regarding the different systems (p = 0.145 and p = 0.108, respectively). However, the Deltastream systems were exchanged more frequently due to elective technical complications (e. g. worsened gas transfer, development of coagulation disorder, increased bleedings complications) compared to the other exchanged systems (p = 0.013). In summary, the used ECMO systems are safe and effective for acute respiratory failure. There is no evidence for the usage of a specific system. Only the increased predictability of an imminent exchange preferred the usage of a Deltastream system. However, the decision to use a particular system should not depend solely on the possible criteria for an exchange.

Comparison of anticoagulation strategies for veno-venous ECMO support in acute respiratory failure

“…For the RotaFlow device, the permanent-life-support system was used and for the CardioHelp system the HLS Set Advanced was used. Both systems were manufactured by Getinge, were Bioline-coated and possessed equivalent durability [ 11 ]. Patients were identified via established ECMO databases at both sites.…”

Establishment and Evaluation of a Rat Model of Extracorporeal Membrane Oxygenation (ECMO) Thrombosis Using a 3D-printed Mock Oxygenator

“…Third, the oxygenator was manufactured using 3D printing, which allows a smaller prime volume and greater reproducibility. The commercially available Micro1 (Kewei Medical Instrument Inc., China) has a surface area of 0.05 m 2 and requires a 3.5 mL priming volume [25,30,32,33]. Similarly, commercially available HPO-003 (Senko Medical Co., Ltd, Japan) has a surface area of 0.03 m 2 and a 3.3 mL priming volume but utilizes blood ow inside bers, unlike current ECMO oxygenators [24].…”

“…Despite advancements in ECMO technology over the last decade, currently available commercial oxygenators last for only a few weeks due to thrombus formation [2][3][4][5]. While anticoagulation can be used to slow thrombus formation, its use must be signi cantly limited to avoid bleeding complications [1,4,5].…”

The effect of flow and pressure on the intraoxygenator flow path of different contemporary oxygenators: an in vitro trial

“…If flow through these short, preferential pathways increases, the low flow areas will receive even less flow and are thus even more prone to clot development. 7 , 8 Clotting, in turn, adds to the decreased gas transfer efficiency by blocking part of the gas transfer membrane and might eventually lead to oxygenator failure necessitating oxygenator exchange, clot embolism or coagulation disorders. 9 – 12 …”