Comparison of Hemolysis Between CentriMag and RotaFlow Rotary Blood Pumps During Extracorporeal Membrane Oxygenation

Abstract

The purpose of this investigation was to compare the hemolysis levels for patients on extracorporeal membrane oxygenation (ECMO) incorporating two different rotary blood pumps (CentriMag [CMAG] and RotaFlow [RF]) in identical circuits otherwise. The difference between the two pumps is the cost. One is 20-30 times less expensive than the other. A retrospective analysis of all patients placed on ECMO from June 2008 through May 2012 was done to evaluate hemolysis. Daily plasma hemoglobin (pHb), lactate dehydrogenase (LDH), and lactate levels were collected on all patients. Values were compared between those patients who received a CMAG and those who received an RF. Patients had to be on ECMO for more than 2 days to be included in the study. Linear mixed effects models were fit to the data to assess differences over time for each continuous outcome. Forty patients were placed on ECMO incorporating CMAG, whereas 40 patients received an RF. There were no significant statistical differences between CMAG and RF groups when comparing days on support (8.7 ± 5.0; 8.4 ± 5.7), age (44.8 ± 18.3; 46.1 ± 16.0), body surface area (2.03 ± 0.36; 1.96 ± 0.31), gender (male: 58%, female: 42%; male: 55%, female: 45%), etiology, type of support (veno-arterial [VA)]: 78%, veno-venous [VV)]: 22%; VA: 82%, VV: 18%) and pre-ECMO LDH levels (4004.0 ± 3583.2; 3603.7 ± 3354.1). There were also no significant differences between the CMAG and RF groups when comparing the mean values for daily pHb levels (5.7 ± 3.6; 5.7 ± 4.2), lactate levels (2.8 ± 1.9; 3.0 ± 2.1), and LDH levels (2656.3 ± 1606.8; 2688.6 ± 1726.1) or daily lactate, LDH, and pHb levels for the first 10 days of support. From our investigation, there is no difference between the CMAG and the RF blood pumps in regard to the creation of hemolysis during ECMO. The difference in cost of the devices does not correlate with the performance and outcomes.

Analysis of haematological and biochemical blood parameters after electrical cardioversion of atrial fibrillation in dogs

“…Mechanical forces generated by implanted continuous-flow left ventricular assist devices (LVADs) may lead to red blood cell lysis regardless of a patient's baseline osmotic red cell fragility (8). This phenomenon is also observed in patients on extracorporeal membrane oxygenation (ECMO), with centrifugal pumps being superior to roller pumps in terms of haemolysis induction (1,16). Haemolysis is a significant complication in paediatric patients during cardiopulmonary bypass and is associated with the postoperative development of acute kidney injury (10).…”

A Multidisciplinary Approach to Expand the Use of Pediatric ECLS Systems in Turkey

“…It is a leading research center and presents its reports as "Translational Research" (9)(10)(11). Otherwise, it has been proven that increased expenses will be lost from the economic sources of countries (20,21). The selection of equipment should be chosen in accordance with current scientific data (16)(17)(18)(19).…”

“…The selection of equipment should be chosen in accordance with current scientific data (16)(17)(18)(19). Otherwise, it has been proven that increased expenses will be lost from the economic sources of countries (20,21).…”

Evaluation of centrifugal blood pumps in term of hemodynamic performance using simulated neonatal and pediatric ECMO circuits

“…In addition, we have completed several in vitro as well as clinical studies to directly compare these two centrifugal pumps for use in adult ECMO patients. Based on our extensive in vitro evaluations, the RotaFlow centrifugal pump system demonstrated better hemodynamic performance, and there were no clinical differences in terms of hemolysis, lactate, and lactate dehydrogenase (LDH) levels between the RotaFlow and CentriMag groups ( n = 40 for each group) . In a separate pilot study using fresh bovine blood, normalized (NIH) and modified indices of hemolysis (MIH) were better in the RotaFlow group compared to the CentriMag group: RotaFlow: NIH = 0.021 ± 0.003 g/100 L, MIH = 3.28 ± 0.52 mg/mg compared to CentriMag: NIH = 0.041 ± 0.010 g/100 L, MIH = 6.08 ± 1.45 mg/mg) …”

“…Based on our extensive in vitro evaluations, the RotaFlow centrifugal pump system demonstrated better hemodynamic performance, 3 and there were no clinical differences in terms of hemolysis, lactate, and lactate dehydrogenase (LDH) levels between the RotaFlow and CentriMag groups (n = 40 for each group). 10 In a separate pilot study using fresh bovine blood, normalized (NIH) and modified indices of hemolysis (MIH) were better in the RotaFlow group compared to the CentriMag group: RotaFlow: NIH = 0.021 ± 0.003 g/100 L, MIH = 3.28 ± 0.52 mg/mg compared to CentriMag: NIH = 0.041 ± 0.010 g/100 L, MIH = 6.08 ± 1.45 mg/mg). 11 With confidence that the RotaFlow served our program better than the CentriMag, we undertook the present translational study to evaluate PediMag, CentriMag, and RotaFlow centrifugal blood pumps in terms of flow rate, circuit pressure, pressure drop, and hemodynamic energy transmission in simulated neonatal and pediatric ECMO circuits using various arterial and venous cannulae.…”