First serial in vivo results of mechanical circulatory support in children with a new diagonal pump

Fleck, Thilo; Benk, Christoph; Klemm, Rolf; Kroll, Johannes; Siepe, Matthias; Grohmann, Jochen; Hohn, R B; Humburger, Frank; Beyersdorf, Friedhelm; Stiller, Brigitte

doi:10.1093/ejcts/ezt427

Cited by 25 publications

(28 citation statements)

References 17 publications

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“…18,25 Compared with other studies, our pediatric patient cohort was heterogeneous comprising patients with pulmonary, postcardiotomy and other support indications, with both single and biventricular morphology. Of all seven patients with isolated respiratory support, only one patient with myelodysplastic syndrome (patient 20) could not be weaned from the device.…”

Section: Outcomementioning

confidence: 99%

Pediatric Extracorporeal Life Support Using a Third Generation Diagonal Pump

et al. 2016

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This study reports a single-centre experience of the Medos Deltastream diagonal-pump (DP3) for extracorporeal cardiac, pulmonary, or combined support in a single-center pediatric cohort. Twenty-seven consecutive patients with 28 runs of the DP3 between January 2013 and June 2014 were included for analysis. Median patient age, weight, and duration of support were 278 days (range: 0 days-14.2 years), 7.2 kg (range: 2.5-39 kg), and 8 days (range: 2-69 days). Midline sternotomy (n = 20, 71.4%) or cervical approaches (n = 8, 28.6%) were used for cannulation. The DP3 was employed for either veno-arterial extracorporeal life support (ECLS, n = 16), veno-venous extracorporeal membrane oxygenation (ECMO, n = 5), or ventricular assist devices (right ventricular assist device [RVAD], n = 1; left ventricular assist device [LVAD], n = 1; and univentricular assist device [UNIVAD], n = 5). Three patients initially supported with ECLS were switched to UNIVAD and one patient with UNIVAD was changed to ECLS. Required flow for neonates (n = 8) ranged between 0.2 and 0.75 L/min. Irreversible pump damage occurred in one patient during deairing after air block. Successful weaning, 30 day and hospital survival were 89.3% (n = 25), 85.7% (n = 24), and 71.4% (n = 20). All patients on UNIVAD, who did not require further extracorporeal respiratory assist, survived. In conclusion, the DP3 can be used for individual patient demands and adapted to their most suitable method of support. Meticulous flow adjustments render this pump highly effective for extracorporeal support particularly in pediatric patients.

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Section: Outcomementioning

confidence: 99%

Pediatric Extracorporeal Life Support Using a Third Generation Diagonal Pump

et al. 2016

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“…46 In this experiment, a slight to moderate hemolysis occurred induced by the ExMeTrA oxygenator using an integrated pulsatile pump by collapsing and expanding silicone tubes placed in the fiber bundle in combination with active valves. 20,39,47,48 In conclusion, our study analyzed the feasibility and hemocompatibility of a novel pediatric oxygenator with integrated Figure 4: Blood flow stayed stable over the time of ECC. Blood flow was measured using a flow meter behind the ExMeTrA oxygenator at the beginning of the ECC and after 1, 5, 10, 20, 30, 60, 120, 270, and 360 min.…”

Section: Figurementioning

confidence: 87%

“…decrease in platelet count and an increase in leukocyte count would be expected by sticking of platelets to the artificial surface of the oxygenator and tubing system and inflammatory responses. 14,39,40 During the entire experimental period, the concentration of total hemoglobin was on a very low level and extremely low red blood cell damage could be detected. Barrett et al 31 reported an increase in ECMO complications including hyperbilirubinemia, acute renal failure, and hemolysis in pediatric patients receiving ECMO support with a centrifugal pump.…”

Section: Figurementioning

confidence: 99%

First In Vivo Results of a Novel Pediatric Oxygenator with an Integrated Pulsatile Pump

Stang

Borchardt²,

Neumann

et al. 2015

ASAIO Journal

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Extracorporeal membrane oxygenation (ECMO) is a pivotal bridge to recovery for cardiopulmonary failure in children. Besides its life-saving quality, it is often associated with severe system-related complications, such as hemolysis, inflammation, and thromboembolism. Novel oxygenator and pump systems may reduce such ECMO-related complications. The ExMeTrA oxygenator is a newly designed pediatric oxygenator with an integrated pulsatile pump minimizing the priming volume and reducing the surface area of blood contact. The aim of our study was to investigate the feasibility and safety of this new ExMeTrA (expansion mediated transport and accumulation) oxygenator in an animal model. During 6 h of extracorporeal circulation (ECC) in pigs, parameters of the hemostatic system including coagulation, platelets and complement activation, and flow rates were investigated. A nonsignificant trend in C3 consumption, thrombin-antithrombin-III (TAT) complex formation and a slight trend in hemolysis were detected. During the ECC, the blood flow was constantly at 500 ml/min using only flexible silicone tubes inside the oxygenator as pulsatile pump. Our data clearly indicate that the hemostatic markers were only slightly influenced by the ExMeTrA oxygenator. Additionally, the oxygenator showed a constant quality of blood flow. Therefore, this novel pediatric oxygenator shows the potential to be used in pediatric and neonatal support with ECMO.

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“…In fact, a satisfactory hospital survival of nearly 40% as recorded herein does not allow ignoring that late mortality and permanent disability, particularly due to neurologic sequelae, are still observed after mechanical life support. Factors that may exacerbate these complications include the type of the pump itself (7,8,13), duration of support, components of the circuit, particularly the oxygenator, and exposure of red blood cells to sheer stress generated by the high negative or positive pressure (6), the surface of the tube circuit, and, possibly, nonphysiological conditions, such as the continuous, nonpulsatile flow (13)(14)(15)(16). Neonates, especially of low body weight, and young infants are uniquely vulnerable to ECMO-related complications, including neurologic injury, hemolysis, hyperbilirubinemia, hypertension, renal failure, and sustained systemic inflammatory response syndrome (5)(6)(7)(8).…”

Section: Discussionmentioning

confidence: 99%

Improved Outcome of Cardiac Extracorporeal Membrane Oxygenation in Infants and Children Using Magnetic Levitation Centrifugal Pumps

et al. 2015

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Extracorporeal membrane oxygenation (ECMO) has traditionally been and, for the most part, still is being performed using roller pumps. Use of first-generation centrifugal pumps has yielded controversial outcomes, perhaps due to mechanical properties of the same and the ensuing risk of hemolysis and renal morbidity. Latest-generation centrifugal pumps, using magnetic levitation (ML), exhibit mechanical properties which may have overcome limitations of first-generation devices. This retrospective study aimed to assess the safety and efficacy of veno-arterial (V-A) ECMO for cardiac indications in neonates, infants, and children, using standard (SP) and latest-generation ML centrifugal pumps. Between 2002 and 2014, 33 consecutive neonates, infants, and young children were supported using V-A ECMO for cardiac indications. There were 21 males and 12 females, with median age of 29 days (4 days-5 years) and a median body weight of 3.2 kg (1.9-18 kg). Indication for V-A ECMO were acute circulatory collapse in ICU or ward after cardiac repair in 16 (49%) patients, failure to wean after repair of complex congenital heart disease in 9 (27%), fulminant myocarditis in 4 (12%), preoperative sepsis in 2 (6%), and refractory tachy-arrhythmias in 2 (6%). Central cannulation was used in 27 (81%) patients and peripheral in 6. Seven (21%) patients were supported with SP and 26 (79%) with ML centrifugal pumps. Median duration of support was 82 h (range 24-672 h), with 26 (79%) patients weaned from support. Three patients required a second ECMO run but died on support. Seventeen (51%) patients required peritoneal dialysis for acute renal failure. Overall survival to discharge was 39% (13/33 patients). All patients with fulminant myocarditis and with refractory arrhythmias were weaned, and five (83%) survived, whereas no patient supported for sepsis survived. Risk factors for hospital mortality included lower (<2.5 kg) body weight (P = 0.02) and rescue ECMO after cardiac repair (P = 0.03). During a median follow-up of 34 months (range 4-62 months), there were three (23%) late deaths and two late survivors with neurological sequelae. Weaning rate (5/7 vs. 21/26, P = NS) and prevalence of renal failure requiring dialysis (4/7 vs. 13/26, P = NS) were comparable between SP and ML ECMO groups. Patients supported with ML had a trend toward higher hospital survival (1/7 vs. 12/26, P = 0.07) and significantly higher late survival (0/7 vs. 10/26, P = 0.05). The present experience shows that V-A ECMO for cardiac indications using centrifugal pumps in infants and children yields outcomes absolutely comparable to international registry (ELSO) data using mostly roller pumps. Although changes in practice may have contributed to these results, use of ML centrifugal pumps appears to further improve end-organ recovery and hospital and late survival.

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First serial in vivo results of mechanical circulatory support in children with a new diagonal pump

Abstract: The use of the Deltastream DP3 seems to be safe and effective for MCS in children and may show a low degree of haemolysis. We observed no system-related complications and an overall good outcome in this demanding patient cohort.

Cited by 25 publications

References 17 publications

Pediatric Extracorporeal Life Support Using a Third Generation Diagonal Pump

Pediatric Extracorporeal Life Support Using a Third Generation Diagonal Pump

First In Vivo Results of a Novel Pediatric Oxygenator with an Integrated Pulsatile Pump

Improved Outcome of Cardiac Extracorporeal Membrane Oxygenation in Infants and Children Using Magnetic Levitation Centrifugal Pumps

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