Hollow Fiber Oxygenator Composition Has a Significant Impact on Failure Rates in Neonates on Extracorporeal Membrane Oxygenation: A Retrospective Analysis

Daniel, Jessica Henderson; Bernard, Philip; Skinner, Sean C.; Bhandary, Prasad; Ruzic, Ana; Bacon, Matthew; Ballard, Hubert O.

doi:10.1055/s-0037-1599150

Cited by 17 publications

(6 citation statements)

References 12 publications

(15 reference statements)

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“…This may have provided roller pumps with an advantage not accounted for by the variables studied in this analysis. Regardless of the pump type, the PMP membrane oxygenators, with lower pressure drop compared with high-compliant silicone membrane oxygenators, may also play a role in significantly improving clinical outcomes, independent from other circuit components, around the globe during the past decade (2,(11)(12)(13).…”

Section: At the Bedsidementioning

confidence: 99%

Centrifugal or Roller Blood Pumps for Neonatal Venovenous Extracorporeal Membrane Oxygenation: Extracorporeal Life Support Organization Database Comparison of Mortality and Morbidity

Ündar¹,

Kunselman²,

Barbaro³

et al. 2023

Pediatric Critical Care Medicine

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OBJECTIVES: To investigate outcomes associated with conventional roller or centrifugal pumps during neonatal venovenous extracorporeal membrane oxygenation (ECMO). Our primary hypothesis is that in comparison with conventional roller-pump support, centrifugal pump use is associated with greater odds of survival. Our secondary hypothesis is that centrifugal pump use is associated with lesser odds of complications. DESIGN: Retrospective cohort identified using the Extracorporeal Life Support Organization (ELSO) registry 2016 to 2020 dataset. SETTING: All ECMO centers reporting to the ELSO registry. PATIENTS: All neonates (≤ 28 d) supported with venovenous ECMO and cannulated via right internal jugular vein using dual-lumen venovenous cannulas and polymethyl pentene membrane oxygenators. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A total of 612 neonates (centrifugal, n = 340; conventional roller, n = 272) were included in the analysis. Using a multivariable logistic regression model, centrifugal pump use—as opposed to roller pump use—was associated with lesser odds of survival (odds ratio [OR], 0.53; 95% CI, 0.33–0.84; p < 0.008). Thrombosis and clots in the circuit components were also associated with lesser odds of survival (OR, 0.28; 95% CI, 0.16–0.60; p < 0.001). We failed to show that hemolysis was an independent variable for survival (OR, 0.60; 95% CI, 0.31–1.19; p = 0.14). The primary diagnosis of neonatal aspiration/meconium aspiration is associated with more than seven-fold greater odds of survival (OR, 7.57; 95% CI, 4.02–15.74; p < 0.001). CONCLUSIONS: Contrary to our hypotheses, conventional roller pump use was associated with greater odds of survival. While thrombosis and clots in circuit components were independent variables for lesser odds of survival, further research is needed better to understand the use of centrifugal pumps in neonatal practice.

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Section: At the Bedsidementioning

confidence: 99%

Centrifugal or Roller Blood Pumps for Neonatal Venovenous Extracorporeal Membrane Oxygenation: Extracorporeal Life Support Organization Database Comparison of Mortality and Morbidity

Ündar¹,

Kunselman²,

Barbaro³

et al. 2023

Pediatric Critical Care Medicine

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“…In a study on VV ECMO that compared COVID-19 patients to those presenting with influenza, there were similar thrombosis rates between groups, but oxygenator failures were higher in patients with COVID-19 (20%) than influenza (0.0%). 34 Oxygenator failures during ECMO are influenced by the fiber material (polypropylene failing at a rate as high as 91%, 35 but all oxygenators used in the present study were made of polymethylpentene and are less prone to failure.…”

Section: Discussionmentioning

confidence: 91%

Variation in outcomes with extracorporeal membrane oxygenation in the era of coronavirus: A multicenter cohort evaluation

Stammers¹,

Tesdahl²,

Sestokas³

et al. 2022

Perfusion

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Extracorporeal membrane oxygenation (ECMO) is used in critically ill patients with coronavirus disease 2019 (COVID-19) with acute respiratory distress syndrome unresponsive to other interventions. However, a COVID-19 infection may result in a differential tolerance to both medical treatment and ECMO management. The aim of this study was to compare outcomes (mortality, organ failure, circuit complications) in patients on ECMO with and without COVID-19 infection, either by venovenous (VV) or venoarterial (VA) cannulation. This is a multicenter, retrospective analysis of a national database of patients placed on ECMO between May 2020 and January 2022 within the United States. Nine-hundred thirty patients were classified as either Pulmonary (PULM, n = 206), Cardiac (CARD, n = 279) or COVID-19 (COVID, n = 445). Patients were younger in COVID groups: PULM = 48.4 ± 15.8 years versus COVID = 44.9 ± 12.3 years, p = 0.006, and CARD = 57.9 ± 15.4 versus COVID = 46.5 ± 11.8 years, p < 0.001. Total hours on ECMO were greatest for COVID patients with a median support time two-times higher for VV support (365 [101, 657] hours vs 183 [63, 361], p < 0.001), and three times longer for VA support (212 [99, 566] hours vs 70 [17, 159], p < 0.001). Mortality was highest for COVID patients for both cannulation types (VA-70% vs 51% in CARD, p = 0.041, and VV-59% vs PULM-42%, p < 0.001). For VA supported patients hepatic failure was more often seen with COVID patients, while for VV support renal failure was higher. Circuit complications were more frequent in the COVID group as compared to both CARD and PULM with significantly higher circuit change-outs, circuit thromboses and oxygenator failures. Anticoagulation with direct thrombin inhibitors was used more often in COVID compared to both CARD (31% vs 10%, p = 0.002) and PULM (43% vs 15%, p < 0.001) groups. This multicenter observational study has shown that COVID patients on ECMO had higher support times, greater hospital mortality and higher circuit complications, when compared to patients managed for either cardiac or pulmonary lesions.

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“…As V–V ECLS gained acceptance, percutaneous techniques, and double-lumen cannulae simplified cannulation. The current generation of polymethyl pentene hollow-fiber oxygenators is smaller and more efficient with lower resistance and smaller priming volumes which is ideal for neonatal and pediatric patients [ 100 , 101 ]. They are also less likely to fail, reducing the need for changing out circuit components [ 100 ].…”

Section: Equipmentmentioning

confidence: 99%

“…The current generation of polymethyl pentene hollow-fiber oxygenators is smaller and more efficient with lower resistance and smaller priming volumes which is ideal for neonatal and pediatric patients [ 100 , 101 ]. They are also less likely to fail, reducing the need for changing out circuit components [ 100 ]. All of these changes in technology, including centrifugal pumps with integrated batteries, are associated with more compact circuits, which also facilitate patient transport.…”

Section: Equipmentmentioning

confidence: 99%

Pediatric and neonatal extracorporeal life support: current state and continuing evolution

2021

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The use of extracorporeal life support (ECLS) for the pediatric and neonatal population continues to grow. At the same time, there have been dramatic improvements in the technology and safety of ECLS that have broadened the scope of its application. This article will review the evolving landscape of ECLS, including its expanding indications and shrinking contraindications. It will also describe traditional and hybrid cannulation strategies as well as changes in circuit components such as servo regulation, non-thrombogenic surfaces, and paracorporeal lung-assist devices. Finally, it will outline the modern approach to managing a patient on ECLS, including anticoagulation, sedation, rehabilitation, nutrition, and staffing.

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Hollow Fiber Oxygenator Composition Has a Significant Impact on Failure Rates in Neonates on Extracorporeal Membrane Oxygenation: A Retrospective Analysis

Cited by 17 publications

References 12 publications

Centrifugal or Roller Blood Pumps for Neonatal Venovenous Extracorporeal Membrane Oxygenation: Extracorporeal Life Support Organization Database Comparison of Mortality and Morbidity

Centrifugal or Roller Blood Pumps for Neonatal Venovenous Extracorporeal Membrane Oxygenation: Extracorporeal Life Support Organization Database Comparison of Mortality and Morbidity

Variation in outcomes with extracorporeal membrane oxygenation in the era of coronavirus: A multicenter cohort evaluation

Pediatric and neonatal extracorporeal life support: current state and continuing evolution

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