Early Experience with Low-Prime (99 ml) Extracorporeal Membrane Oxygenation Support in Children

Abstract

Quick setup is mandatory for cardiopulmonary resuscitation using an extracorporeal membrane oxygenation (ECMO) assist device. Our conventional ECMO circuit for pediatric patients consists of a centrifugal pump (CX-HP) and membrane oxygenator (CX10H). Because of the large priming volume (260 ml), the circuit had to be primed with donor blood and required 30 minutes for setup. We started to use a low-prime ECMO with small centrifugal pump (HPM-15) and membrane oxygenator (MENOX Alpha Cube) for induction of ECMO beginning in 2000. The priming volume of this low-prime circuit is only 99 ml. The circuit can be primed without donor blood, even in the small patient, and requires only 10 minutes to set up. We review our experiences with cardiopulmonary resuscitation for sudden cardiopulmonary collapse in pediatric patients, including postcardiotomy patients. From 1997 to 2000, 23 patients underwent ECMO support with a conventional circuit (group A). From 2000 to 2004, we used low-prime circuit for induction of ECMO in 12 patients (group B). After the induction of ECMO with low-prime circuit, ECMO was converted to conventional heparin-bonded circuit for the longer support. The results suggested that the quick induction of ECMO with low-prime circuit has significant advantages in cardiopulmonary support in pediatric patients.

Dexmedetomidine extraction by the extracorporeal membrane oxygenation circuit: results from an in vitro study

“…inflammation). 31,32 Finally, altered clearance is secondary to underlying organ dysfunction and direct clearance of drug by the circuit (e.g. hemofiltration).…”

Part 10: Pediatric Basic and Advanced Life Support

“…Two LOE 4 studies 560,581 found insignificant improvements in outcome after ECPR in children following protocol changes leading to shorter durations of CPR. One LOE 2 554 and 3 LOE 4 555,559,565 studies found no relationship between CPR duration and outcome after ECPR in children.…”

SAGM blood for neonatal large volume transfusion

“…did however note the use of SAGM blood for neonatal ET, without any adverse effects (although renal function was closely monitored). Of note, two pertinent studies were found regarding a lower pump priming volume for neonatal ECLS, but the effect on DE was not noted 11,12 . Given that it is not yet national or local policy to routinely use SAGM additive blood for LVT, an alternate option could be to split CPD additive blood into smaller packs valid for up to 28 days for both SVT and LVT 13 .…”

“…Of note, two pertinent studies were found regarding a lower pump priming volume for neonatal ECLS, but the effect on DE was not noted. 11,12 Given that it is not yet national or local policy to routinely use SAGM additive blood for LVT, an alternate option could be to split CPD additive blood into smaller packs valid for up to 28 days for both SVT and LVT. 13 Since staff routinely requested CPD units at our center, some extremely premature infants had been transfused single CPD units for SVT.…”