Plasma Leakage of Oxygenators in ECMO Depends on the Type of Oxygenator and on Patient Variables

Meyns, Bart; Vercaemst, Leen; Vandezande, E; Bollen, Hilde; Vlasselaers, Dirk

doi:10.1177/039139880502800106

Cited by 36 publications

(25 citation statements)

References 13 publications

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“…During the animal experiments, there was no increased fluid transfer on the gas side and no plasma leakage of the oxygenators observed. This is consistent with clinical data from ECMO therapy with polymethylpentene oxygenators, where no plasma leakage of polymethylpentene fibers occurred (22).…”

Section: R Kopp Et Al 18supporting

confidence: 90%

Hemocompatibility of a Miniaturized Extracorporeal Membrane Oxygenation and a Pumpless Interventional Lung Assist in Experimental Lung Injury

Kopp¹,

Bensberg

Henzler

et al. 2010

Artificial Organs

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Extracorporeal membrane oxygenation (ECMO) is used for most severe acute respiratory distress syndrome cases in specialized centers. Hemocompatibility of devices depends on the size and modification of blood contacting surfaces as well as blood flow rates. An interventional lung assist using arteriovenous perfusion of a low-resistance oxygenator without a blood pump (Novalung, Hechingen, Germany) or a miniaturized ECMO with reduced filling volume and a diagonal blood pump (Deltastream, Medos AG, Stolberg, Germany) could optimize hemocompatibility. The aim of the study was to compare hemocompatibility with conventional ECMO. Female pigs were connected to extracorporeal circulation for 24 h after lavage induced lung injury (eight per group). Activation of coagulation and immune system as well as blood cell damage was measured. A P value <0.05 was considered significant. Plasmatic coagulation was slightly activated in all groups demonstrated by increased thrombin-anti-thrombin III-complex. No clinical signs of bleeding or thromboembolism occurred. Thrombelastography revealed decreased clotting capacities after miniaturized ECMO, probably due to significantly reduced platelet count. These resulted in reduced dosage of intravenous heparin. Scanning electron microscopy of oxygenator fibers showed significantly increased binding and shape change of platelets after interventional lung assist. In all groups, hemolysis remained negligible, indicated by low plasma hemoglobin concentration. Interleukin 8 and tumor necrosis factor-alpha concentration as well as leukocyte count remained unchanged. Both devices demonstrated adequate hemocompatibility for safe clinical application, although a missing blood pump did not increase hemocompatibility. Further studies seem necessary to analyze the influence of different blood pumps on platelet drop systematically.

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Section: R Kopp Et Al 18supporting

confidence: 90%

Hemocompatibility of a Miniaturized Extracorporeal Membrane Oxygenation and a Pumpless Interventional Lung Assist in Experimental Lung Injury

Kopp¹,

Bensberg

Henzler

et al. 2010

Artificial Organs

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“…Instead, gas exchange occurs via diffusion across the PMP membrane. Thus, the Quadrox D prevents plasma leakage and eliminates it as a contributor to the need for oxygenator exchange during ECMO support 24,25 …”

Section: Discussionmentioning

confidence: 99%

Have Changes in ECMO Technology Impacted Outcomes in Adult Patients Developing Postcardiotomy Cardiogenic Shock?

Pokersnik¹,

Buda²,

Bashour

et al. 2012

Journal of Cardiac Surgery

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Extracorporeal membrane oxygenation (ECMO) technology has undergone several advancements over the last decade. We sought to compare current ECMO technology to older ones to determine how these technological improvements have impacted outcomes in patients suffering from postcardiotomy cardiogenic shock (PCS). Between 2005 and 2010, 49 patients received ECMO as support for PCS following elective cardiac surgery. Patients were divided into three groups. Group 1 (Gp 1, n = 11) patients received a Biomedicus pump with an Affinity oxygenator, Group 2 (Gp 2, n = 11) patients received a Biomedicus pump with a Quadrox D oxygenator, and Group 3 (Gp 3, n = 27) patients received a Rotaflow pump with a Quadrox D oxygenator. Groups were compared with regards to adverse events and ability to wean. Adverse event analysis showed no statistically significant difference between groups in incidence of stroke (p = 0.08), renal failure (p = 0.88), or bleeding requiring reexploration (p = 0.10). Changes in technology did little to improve weaning rates from ECMO (Gp 1 = 63.6%, Gp 2 = 45.5%, and Gp 3 = 55.6%). Similar trends were detected in hospital survival (Gp 1 = 27.3%, Gp 2 = 27.3%, and Gp 3 = 33.3%). Technology did impact oxygenator durability with Gp 1 requiring seven (63.6%) oxygenator exchanges compared to zero (0.0%) in Gp 2 and two (7.4%) in Gp 1. While advancements in ECMO technology have resulted in improved oxygenator durability, outcomes in patients requiring such support for PCS continue to be poor.

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“…Microporous polypropylene hollow fiber oxygenators have limitations such as development of plasma leakage (14). At first, plasma leakage does not influence the gas transfer, but later the oxygenators will malfunction and need to be changed.…”

Section: Discussionmentioning

confidence: 99%

Clinical Evaluation of Two Different Extracorporeal Membrane Oxygenation Systems: A Single Center Report

Yu¹,

Long²,

Hei³

et al. 2011

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Refinements in extracorporeal membrane oxygenation (ECMO) equipment, including heparin-coated surfaces, centrifugal pump, membrane oxygenator, and more biocompatible pump-oxygenator circuits, have reduced procedure-related complications and have made ECMO a safe and effective therapy for critical patients. The aim of this study was to evaluate the performance of two different ECMO circuit systems in a clinical setting and compare their outcomes. From December 2004 to December 2009, 121 patients required ECMO for primary or postcardiotomy cardiogenic shock at our heart center. We used the Medtronic circuit system in our earlier series (Group M, n = 64), and from July 2007, ECMO was carried out mainly with the Quadrox D PLS circuit system (Group Q, n = 56). We retrospectively summarized and analyzed the data of these patients. The evaluation was based on the comparison between properties of the membrane oxygenators and pumps, anticoagulation therapy, circuit-related complications, and clinical outcomes. Support pump flow rates, platelet counts, and trans-membrane pressure drops (TMPDs) of preoxygenator and postoxygenator pressures were compared between two groups at the time of support established (T1) and support established for 24 h (T2). There were no significant differences between the two groups with regard to patient characteristics and pre-ECMO data. The support pump flow rates and platelet counts at different times were comparable in the two groups. The cannulation technique, ECMO duration, and mean heparin dosage were similar in both groups. There were also no significant differences between the groups in mortality or complications related to bleeding and organ dysfunction. Compared with the M group, the Q group experienced less mechanical failure of the ECMO circuit. The Quadrox PLS circuit system showed less circuit thrombus formation (P < 0.045), less plasma leakage (P < 0.001), and less need for replacement of oxygenators (P < 0.001). Furthermore, frequency of hemolysis during ECMO was significantly lower (P < 0.045). In addition, at T1 and T2, TMPDs were significantly lower in the Q group. Our results suggest that both ECMO circuit systems provide similar effects for safe clinical application, but the Quadrox PLS ECMO circuit system demonstrated partially improved biocompatibility in terms of improved cell preservation, lower TMPDs, less plasma leakage, and thrombus formation.

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Plasma Leakage of Oxygenators in ECMO Depends on the Type of Oxygenator and on Patient Variables

Cited by 36 publications

References 13 publications

Hemocompatibility of a Miniaturized Extracorporeal Membrane Oxygenation and a Pumpless Interventional Lung Assist in Experimental Lung Injury

Hemocompatibility of a Miniaturized Extracorporeal Membrane Oxygenation and a Pumpless Interventional Lung Assist in Experimental Lung Injury

Have Changes in ECMO Technology Impacted Outcomes in Adult Patients Developing Postcardiotomy Cardiogenic Shock?

Clinical Evaluation of Two Different Extracorporeal Membrane Oxygenation Systems: A Single Center Report

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