Pediatric Extracorporeal Life Support Using a Third Generation Diagonal Pump

Abstract

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.

Initial Clinical Experiences With Novel Diagonal ECLS System in Pediatric Cardiac Patients

“…The system operated without any difficulty after resolving these problems and none of the patients required system changes. Similar to the recent report about the DP3 system, the immediate correction of hypovolemia, surgical revision, or the adequate positioning of the cannula might have solved these problems . Similar to the findings of previous reports, higher lactate levels ( P = 0.009) and longer time required for normalization ( P < 0.001) were both linked to failure to wean off ECLS support and, hence, to hospital deaths .…”

“…Although improved, our overall survival rate was still lower than other reported rates . This low overall survival rate might be due to the induction of ECLS support for extended CPR, irreversible cardiac failure, and, most importantly, inappropriate patient selection.…”

“…Proper anticoagulation should reveal a delicate balance between coagulation and anticoagulation to decrease the hemorrhagic complications during the provision of ECLS support . With the DP3 system, no peripheral embolic complications have been reported . Unfortunately, we faced embolic complications to a greater degree than usual in our patients who were treated with the DP3 system under a condition of proper anticoagulation support (peripheral embolic complications in eight patients and cerebral embolic complications in three patients).…”

“…In this study, our experience with the DP3 system for ECLS was evaluated. To the best of our knowledge, this is the largest single‐center serial study in a pediatric patient cohort . The technical considerations and risk factors related to survival outcomes in pediatric cardiac patients who were mostly postoperative were described.…”

Multicenter Experience With Mechanical Circulatory Support Using a New Diagonal Pump in 233 Children

“…Hemato‐oncologic patients were excluded from this study. Two single‐center reports focusing on different aspects have been published on 40 of these patients . Weaning success was defined as survival longer than 24 h without mechanical support.…”