North American Neonatal Extracorporeal Membrane Oxygenation (ECMO) Devices: 2002 Survey Results

Abstract

In mid 2002, surveys of active extracorporeal membrane oxygenation (ECMO) centers in the United States and Canada were conducted via E-mail regarding neonatal equipment and personnel. Seventy-four out of 99 (75%) North American ECMO centers listed in the Extracorporeal Life Support Organization (ELSO) directory responded to the survey. Of the responding centers, 95% use roller pumps, and the remaining 5% use centrifugal pumps. Silicone membrane oxygenators were used by 97% of the respondents, while 3% used hollow fiber oxygenators. Of the silicone membrane oxygenator users, 82% used the Medtronic ECMOtherm heat exchanger, 15% used a Gish heat exchanger, and 3% used the Dideco D720 heat exchanger. Sixty-one percent of the responding centers used some form of in-line blood gas monitoring. Five percent of the centers used a bubble trap in the arterial line, and 12% used an arterial line filter. A bladder was used by 92% of the centers, and 29% used a mechanical bladder box for servo regulation, the remaining 71% used pressure servo regulation. An air bubble detector was used by 65% of the responding centers, although 81% had the device available. Heparin coating was used by 5% of the centers on all their neonatal ECMO patients. The average low range ACT was 183 seconds, and the average high range ACT was 216 seconds. At 49% of the responding centers, perfusionists were involved with the ECMO program, registered nurses were involved at 84% of the centers, and respiratory therapists were involved at 61% of the centers, perfusion assistants were involved at one center (1%), and biomedical engineers were involved at one of the centers. When compared to a 1990 survey, a shift away from using bladder boxes and toward using air bubble detectors is apparent. But other than those two shifts, ECMO is done in much the same manner as it was done 12 years ago.

A Description of a Prototype Miniature Extracorporeal Membrane Oxygenation Circuit Using Current Technologies in a Sheep Model

“…Numerous ECMO equipment surveys indicate that there has been little change in the basic ECMO circuit design during the last two decades in the United States (2,7,8). The backbone of this standard ECMO system is the silicone membrane oxygenator, roller pump, and venous line bladder.…”

“…This configuration has remained largely the same today. A 2002 survey of ELSO centers by Lawson et al found that 97% use the Kolobow silicone membrane oxygenator that was first developed in 1972 (2,3).…”

Effects of shorter activated coagulation time on hemorrhage during venoarterial extracorporeal membrane oxygenation

“…ELSO recommends the use of unfractionated heparin and targeting the ACT of 180–220 seconds [ 1 ]. The recommendation was made depending on limited evidence and expert opinions [ 9 , 10 ]. The appropriate targeted ACT remains unknown.…”

One-Way Valve Malfunction in an Extracorporeal Membrane Oxygenation Priming Circuit

“…Since 2002 there has been a steady shift in the components used for extracorporeal membrane oxygenation (ECMO) support (1)(2)(3). Centrifugal blood pumps have gained widespread use in ECMO as a result of advances in oxygenator technology.…”