Experience with the Jostra Rotaflow and QuadroxD oxygenator for ECMO

Abstract

Since April 1988, we have been able to offer extracorporeal membrane oxygenation (ECMO) to patients who are either failing ventilation or who need cardiopulmonary support following cardiac surgery. During this time, we have supported 211 patients, the majority of whom have been supported with the Avecor (Affinity, Avecor Cardiovascular Inc., Minneapolis, MN, USA) spiral wound silicone-membrane oxygenator. Microporous hollow-fibre oxygenators have been used (18%) at our center. However, due to their early failure, they have necessitated conversion to a device that potentially would last for the entire ECMO course, i.e., Avecor and, subsequently, have not been used routinely until the introduction of the QuadroxD (Jostra Medizintechnik AG, Hirrlingen, Germany). The recent development of the poly-4-methyl-1-pentene diffusion membrane allows us to utilize hollow-fibre technology with a true (nonmicroporous) membrane. This has enabled us to use this low-resistance device with all its inherent advantages, without plasma leakage necessitating circuit changeover. From July 2000, we have used the QuadroxD oxygenator for our patients requiring ECMO support. This has been in patients with weights ranging from 2.16-51.0 kg (n = 23), with the longest support being for 1119 hours. This new technology has enabled us to utilize a single device for all patient sizes, so we now have an ECMO circuit set up at all times, minimizing the time required for support to be available, potentially improving survivor morbidity.

A Polymethylpentene Fiber Gas Exchanger for Long-Term Extracorporeal Life Support

“…In this series, each patient required only a single PMP device for use up to 46 days without any incident of plasma leakage. 10 This study confirms that hollow fiber membranes lead to greater gas exchange efficiency. Both the CO 2 and O 2 gas exchange rates of the PMP devices were equal or superior to those of the SRML group at the same blood flow rates, V/Q ratio, and inlet blood conditions.…”

Thrombelastography change after bridging to left ventricular assist device from extracorporeal membrane oxygenation patients

“…On the other hand, inflammatory response is also triggered by coagulation, hemolysis, and thromboembosis, all of which can injure vital organs. 10 Hence, it is very important to maintain the APTT at 1.3e1.6 times the normal range, and ACT at approximately 160e180 seconds.…”

Emprego do suporte cardiopulmonar com bomba centrífuga e oxigenador de membrana em cirurgia cardiovascular pediátrica

“…The inflammatory cascade activation occurs, followed by coagulation activation, hemolysis and thromboembolytic phenomena are generated, all contributing to multiple-organ injury. The use of membrane oxygenators with a better profile 24 and heparin-coated circuits can minimize these complications.…”