Extracorporeal Membrane Oxygenation With a Poly-Methylpentene Oxygenator (Quadrox D). The Experience of a Single Italian Centre in Adult Patients With Refractory Cardiogenic Shock

Abstract

Although microporous polypropylene hollow fiber oxygenators are standard devices used for extracorporeal membrane oxygenation (ECMO), they have limitations such as development of plasma leakage. Poly-methylpentene (PMP) is a new material used for the last generation of oxygenators. We reviewed our experience with a new PMP oxygenator (Quadrox D) and a centrifugal pump (RotaFlow) used to support adult patients with refractory cardiogenic shock. Between January 2000 and April 2007, 25 patients required ECMO for primary or postcardiotomy cardiogenic shock. Eighteen patients were analyzed [mean age 60.2 years; 11 (61%) men; 7 (39%) women]. Nine patients (50%) suffered primary cardiogenic shock. Cardiopulmonary resuscitation was applied in 11 patients (61%) with a mean duration time of 31.5 minutes. Mean ECMO duration time was 7.1 +/- 6.3 days (range, 1-27 days). Intra-aortic balloon pump was used in 13 patients (72.2%) with a mean duration time of 7.7 +/- 5 (range, 2-17 days). Twelve patients (66.7%) survived on ECMO and five patients (27.8%) were discharged. Our results indicate the PMP oxygenator and the centrifugal pump provided acceptable results in terms of surviving on ECMO and discharge. Patients with an initial catastrophic hemodynamic status could benefit by means of a rapid institution of ECMO with PMP oxygenators.

Short-term Mechanical Circulatory Support with a Centrifugal Pump - Results of Peripheral Extracorporeal Membrane Oxygenator According to Clinical Situation

“…Development of bioengineering for oxygentors has increased the survival of patients with cardiopulmonary failure and the uses of ECLS or PCPS, greatly valuable to cardiothoracic surgeons [9]. The improvement of PCPS has enabled the maintenance of the blood supply just adequate for perfusion to vital organs, and it has decreased the myocardial oxygen demand.…”

Clinical review: mechanical circulatory support for cardiogenic shock complicating acute myocardial infarction

“…VA-ECMO is associated with bleeding in 30% to 60% of cases [38,39], sometimes requiring massive transfusions. New pumps and improved circuit biocompatibility allow lower levels of anticoagulation to be used and should reduce the impact of this complication.…”

“…Clotting abnor-malities predispose to hemorrhagic stroke, which, combined with circuit embolic complications such as air bubbles or clots, results in an overall stroke rate of 3% to 12% [33,40,41]. Other complications include nosocomial infection in 50% to 60% [40,41] and multi-organ dysfunction in 33% [39], although the contribution of ECMO is not easy to separate from the complications of severe critical illness. Device and circuit complications appear to be declining [33].…”

“…In 1999, Pittsburgh's Allegheny Hospital reported ECMO use in high-risk patients undergoing PCI, of whom 85% survived to hospital discharge [44]. In 2008, two studies from Europe (Formica and colleagues [39] and Combes and colleagues [38]) demonstrated survival to discharge rates of 28% to 31% when ECMO was used for postcardiotomy cardiogenic shock or cardiogenic shock complicating AMI (Table 3). Patients were selected for ECMO if they failed conventional treatment, including inotropes, ventilation, or IABP.…”

Dynamic filling index: a novel parameter to monitor circulatory filling during minimized extracorporeal bypass

“…Minimized extracorporeal bypass circuits (MEC) can be used for circulatory support in (postcardiotomy) heart failure, during percutaneous interventions, and in respiratory failure [1][2][3][4]. MEC are also used for full cardiopulmonary bypass during heart surgery [5], have been reported to reduce preoperative hemodilution and transfusion requirements, and show a lower incidence of postoperative complications [6][7][8][9].…”