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Hemostatic Complications During Neonatal Extracorporeal Membrane Oxygenation: Roller Pump and Centrifugal Pump Driven Circuits

Recently three different neonatal extracorporeal membrane oxygenation (ECMO) circuits have been employed in our clinic. These circuits were compared for clotting and bleeding complications. Initially, we used an ECMO circuit containing a roller pump and venous bladder without severe complications. M...

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Autores principales: Vermeer, Harry, de Jong, Sytse F., Koers, Erik J., Peeters, Theo L.M., van der Lee, Robin, de Boode, Willem P., Morshuis, Wim J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10226466/
https://www.ncbi.nlm.nih.gov/pubmed/36574471
http://dx.doi.org/10.1097/MAT.0000000000001878
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author Vermeer, Harry
de Jong, Sytse F.
Koers, Erik J.
Peeters, Theo L.M.
van der Lee, Robin
de Boode, Willem P.
Morshuis, Wim J.
author_facet Vermeer, Harry
de Jong, Sytse F.
Koers, Erik J.
Peeters, Theo L.M.
van der Lee, Robin
de Boode, Willem P.
Morshuis, Wim J.
author_sort Vermeer, Harry
collection PubMed
description Recently three different neonatal extracorporeal membrane oxygenation (ECMO) circuits have been employed in our clinic. These circuits were compared for clotting and bleeding complications. Initially, we used an ECMO circuit containing a roller pump and venous bladder without severe complications. Manufacturing of circuit components was discontinued, necessitating the replacement of this circuit by a circuit with a centrifugal pump with 3/8 inch inlet and outlet. Acute increase of oxygenator resistance requiring emergency changeout became unexpectedly a regularly occurring complication. The increase in resistance was suspected to be caused by oxygenator clotting, although oxygenator function was preserved. To prevent this complication, we changed to a levitating centrifugal pump with 1/4 inch inlet and outlet, after which no oxygenator malfunction has been observed. Macroscopic and electron microscopic analysis demonstrates that small clots are formed within the circuit, presumably in or near the centrifugal pump, which are transported to the oxygenator and clog up the hollow fiber layer at the inlet side, barely penetrating the oxygenator beyond this first layer. Our results suggest that low blood velocities accompanied with recirculation of blood within or near the centrifugal pump and/or heat generation within the pump could contribute to the formation of these clots.
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spelling pubmed-102264662023-05-30 Hemostatic Complications During Neonatal Extracorporeal Membrane Oxygenation: Roller Pump and Centrifugal Pump Driven Circuits Vermeer, Harry de Jong, Sytse F. Koers, Erik J. Peeters, Theo L.M. van der Lee, Robin de Boode, Willem P. Morshuis, Wim J. ASAIO J Pediatric Circulatory Support Recently three different neonatal extracorporeal membrane oxygenation (ECMO) circuits have been employed in our clinic. These circuits were compared for clotting and bleeding complications. Initially, we used an ECMO circuit containing a roller pump and venous bladder without severe complications. Manufacturing of circuit components was discontinued, necessitating the replacement of this circuit by a circuit with a centrifugal pump with 3/8 inch inlet and outlet. Acute increase of oxygenator resistance requiring emergency changeout became unexpectedly a regularly occurring complication. The increase in resistance was suspected to be caused by oxygenator clotting, although oxygenator function was preserved. To prevent this complication, we changed to a levitating centrifugal pump with 1/4 inch inlet and outlet, after which no oxygenator malfunction has been observed. Macroscopic and electron microscopic analysis demonstrates that small clots are formed within the circuit, presumably in or near the centrifugal pump, which are transported to the oxygenator and clog up the hollow fiber layer at the inlet side, barely penetrating the oxygenator beyond this first layer. Our results suggest that low blood velocities accompanied with recirculation of blood within or near the centrifugal pump and/or heat generation within the pump could contribute to the formation of these clots. Lippincott Williams & Wilkins 2022-12-27 2023-06 /pmc/articles/PMC10226466/ /pubmed/36574471 http://dx.doi.org/10.1097/MAT.0000000000001878 Text en Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the ASAIO. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (https://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
spellingShingle Pediatric Circulatory Support
Vermeer, Harry
de Jong, Sytse F.
Koers, Erik J.
Peeters, Theo L.M.
van der Lee, Robin
de Boode, Willem P.
Morshuis, Wim J.
Hemostatic Complications During Neonatal Extracorporeal Membrane Oxygenation: Roller Pump and Centrifugal Pump Driven Circuits
title Hemostatic Complications During Neonatal Extracorporeal Membrane Oxygenation: Roller Pump and Centrifugal Pump Driven Circuits
title_full Hemostatic Complications During Neonatal Extracorporeal Membrane Oxygenation: Roller Pump and Centrifugal Pump Driven Circuits
title_fullStr Hemostatic Complications During Neonatal Extracorporeal Membrane Oxygenation: Roller Pump and Centrifugal Pump Driven Circuits
title_full_unstemmed Hemostatic Complications During Neonatal Extracorporeal Membrane Oxygenation: Roller Pump and Centrifugal Pump Driven Circuits
title_short Hemostatic Complications During Neonatal Extracorporeal Membrane Oxygenation: Roller Pump and Centrifugal Pump Driven Circuits
title_sort hemostatic complications during neonatal extracorporeal membrane oxygenation: roller pump and centrifugal pump driven circuits
topic Pediatric Circulatory Support
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10226466/
https://www.ncbi.nlm.nih.gov/pubmed/36574471
http://dx.doi.org/10.1097/MAT.0000000000001878
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