Outcomes of Infants Supported With Extracorporeal Membrane Oxygenation Using Centrifugal Versus Roller Pumps: An Analysis From the Extracorporeal Life Support Organization Registry

O’Halloran, Conor P.; Thiagarajan, Ravi R.; Yarlagadda, Vamsi V.; Barbaro, Ryan P.; Nasr, Viviane G.; Rycus, Peter; Anders, Marc; Alexander, Peta

doi:10.1097/pcc.0000000000002103

Cited by 38 publications

(28 citation statements)

References 36 publications

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“…It is therefore not surprising that bleeding related complications are common in cardiac ECMO patients with 28% of ECMO patients experiencing hemorrhagic complications. 36 Surgical site bleeding and other bleeding and clotting complications for the cohort are similar to those reported in the pediatric ELSO report. 4 TEG guided interventions could provide an avenue for appropriate targeted therapies and reduce these very significant complications.…”

Section: Discussionsupporting

confidence: 77%

Measures of anticoagulation and coagulopathy in pediatric cardiac extracorporeal membrane oxygenation patients

et al. 2020

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Introduction: Pediatric cardiac Extracorporeal Membrane Oxygenation (ECMO) is effective, however, bleeding and clotting issues continue to cause significant morbidity and mortality. The objective of this study was to assess the correlation between measures of anticoagulation, the heparin dose in pediatric cardiac ECMO patients as well as to assess covert coagulopathy as measured by thromboelastography (TEG). Methods: Retrospective study of cardiac ECMO patients in a large, academic referral center using anticoagulation data during the ECMO support. Results: Five hundred and eighty-four sets of anticoagulation tests and 343 TEG from 100 patients with median age of 26 days were reviewed. ECMO was post-surgical for congenital heart disease in 94% with resuscitation (ECPR) in 38% of the cases. Mean duration of support was 6.3 days. Overall survival to discharge was 35%. There was low but statistically significant correlation between individual anticoagulation measures and low correlation between Anti-Xa levels and heparin dose. There was no correlation between PTT and heparin dose. 343 TEG with Heparinase were reviewed to assess covert coagulopathy which was present in 25% of these. The coagulopathy noted was pro-hemorrhagic in almost all of the cases with high values of reaction time and kinetics and low values for angle and maximum amplitude. Conclusion: Coagulation monitoring on ECMO may benefit from addition of Heparinase TEG to diagnose covert coagulopathy which can contribute to significant hemorrhagic complications. There is a need for a prospective, thromboelastography guided intervention trial to reduce coagulopathy related morbidity and mortality in ECMO.

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Section: Discussionsupporting

confidence: 77%

Measures of anticoagulation and coagulopathy in pediatric cardiac extracorporeal membrane oxygenation patients

et al. 2020

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“…Although most European centers use centrifugal pumps, differently to the USA, where the roller pump is common practice, this discrepancy in the management would not seem to impact on mortality even if O'Halloran et al demonstrated contrasting data in favor of the use of roller versus centrifugal pump [90].…”

Section: Ecmo For Neonatal Cardiac Failurementioning

confidence: 99%

Neonatal respiratory and cardiac ECMO in Europe

et al. 2021

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Neonatal extracorporeal membrane oxygenation (ECMO) is a life-saving procedure for critically ill neonates suffering from a potentially reversible disease, causing severe cardiac and/or respiratory failure and refractory to maximal conventional management. Since the 1970s, technology, management, and clinical applications of neonatal ECMO have changed. Pulmonary diseases still represent the principal neonatal diagnosis, with an overall 74% survival rate, and up to one-third of cases are due to congenital diaphragmatic hernia. The overall survival rate in cardiac ECMO is lower, with congenital heart defect representing the main indication. This review provides an overview of the available evidence in the field of neonatal ECMO. We will address the changing epidemiology, basic principles, technologic advances in circuitry, and monitoring, and deliver a current multidisciplinary management framework, focusing on ECMO applications, complications, and long-term morbidities. Lastly, areas for further research will be highlighted. Conclusions : ECMO is a life support with a potential impact on long-term patients’ outcomes. In the next years, advances in knowledge, technology, and expertise may push neonatal ECMO boundaries towards more premature and increasingly complex infants, with the final aim to reduce the burden of ECMO-related complications and improve overall patients’ outcomes. What is Known: • ECMO is a life-saving option in newborns with refractory respiratory and/or cardiac failure. • The multidisciplinary ECMO management is challenging and may expose neonates to complications with an impact on long-term outcomes. What is New: • Advances in technology and biomaterials will improve neonatal ECMO management and, eventually, the long-term outcome of these complex patients. • Experimental models of artificial placenta and womb technology are under investigation and may provide clinical translation and future research opportunities.

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“…As mentioned, we transitioned from the roller pump to the centrifugal pump in 2008, and this may define a major change in practice between the early compared with the later time epochs evaluated. However, several reports have suggested the centrifugal pump has been associated with increased hemolysis and organ injury (including neurologic complications) compared with the roller pump, 33,34 and thus, it is unlikely that this change can account for the improvement in outcomes observed over time. Further investigation regarding changes in injury rates over time, and the reasons behind them, are warranted.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Brain Injury in Newborns Treated with Extracorporeal Membrane Oxygenation

et al. 2020

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Objective This study aimed to assess the association of clinical risk factors with severity of magnetic resonance imaging (MRI) brain injury in neonatal extracorporeal membrane oxygenation (ECMO) patients. Study Design This is a single-center retrospective study conducted at an outborn level IV neonatal intensive care unit in a free-standing academic children's hospital. Clinical and MRI data from neonates treated with ECMO between 2005 and 2015 were reviewed. MRI injury was graded by two radiologists according to a modified scoring system that assesses parenchymal injury, extra-axial hemorrhage, and cerebrospinal fluid spaces. MRI severity was classified as none (score = 0), mild/moderate (score = 1–13.5), and severe (score ≥ 14). The relationship between selected risk factors and MRI severity was assessed by Chi-square, analysis of variance, and Kruskal–Wallis tests where appropriate. Combinative predictive ability of significant risk factors was assessed by logistic regression analyses. Results MRI data were assessed in 81 neonates treated with ECMO. Veno-arterial (VA) patients had more severe injury compared with veno-venous patients. There was a trend toward less severe injury over time. After controlling for covariates, duration of ECMO remained significantly associated with brain injury, and the risk for severe injury was significantly increased in patients on ECMO beyond 210 hours. Conclusion Risk for brain injury is increased with VA ECMO and with longer duration of ECMO. Improvements in care may be leading to decreasing incidence of brain injury in neonatal ECMO patients. Key Points

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Outcomes of Infants Supported With Extracorporeal Membrane Oxygenation Using Centrifugal Versus Roller Pumps: An Analysis From the Extracorporeal Life Support Organization Registry

Cited by 38 publications

References 36 publications

Measures of anticoagulation and coagulopathy in pediatric cardiac extracorporeal membrane oxygenation patients

Measures of anticoagulation and coagulopathy in pediatric cardiac extracorporeal membrane oxygenation patients

Neonatal respiratory and cardiac ECMO in Europe

Risk Factors for Brain Injury in Newborns Treated with Extracorporeal Membrane Oxygenation

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