Hemolytic and thrombocytopathic characteristics of extracorporeal membrane oxygenation systems at simulated flow rate for neonates

Andrew D Meyer, Andrew A. Wiles, Oswaldo Rivera, Edward C. Wong, Robert J. Freishtat, Khoydar Rais-Bahrami, Heidi J. Dalton

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

OBJECTIVE:: A state-of-the-art centrifugal pump combined with hollow-fiber oxygenator for extracorporeal membrane oxygenation has potential advantages such as smaller priming volumes and decreased potential to cause tubing rupture as compared with the traditional roller head/silicone membrane systems. Adoption of these state-of-the-art systems has been slow in neonates as a result of past evidence of severe hemolysis that may lead to renal failure and increased mortality. Extracorporeal systems have also been linked to platelet dysfunction, a contributing factor toward intracranial hemorrhage, a leading cause of infant morbidity. Little data exist comparing the centrifugal systems with the roller systems in terms of hemolysis and platelet aggregation at low flow rates commonly used in neonatal extracorporeal membrane oxygenation. DESIGN:: Prospective, comparative laboratory study. SETTING:: University research laboratory. SUBJECTS:: Centrifugal pump, roller pump, hollow-fiber oxygenator, and silicone membrane oxygenator. INTERVENTIONS:: Comparative study using two pumps, the centrifugal Jostra Rotaflow (Maquet, Wayne, NJ) and the roller-head (Jostra, Maquet, Wayne, NJ), and two oxygenators, polymethlypentene Quadrox-D (Maquet) and silicone membrane (Medtronic, Minneapolis, MN). Five test runs of four circuit combinations were examined for hemolysis and platelet aggregation during 6 hrs of continuous use in a simulated in vitro extracorporeal membrane oxygenation circuit circulating whole swine blood at 300 mL/min. MEASUREMENTS AND MAIN RESULTS:: Hemolysis was assessed by spectrophometric measurement of plasma-free hemoglobin. Platelet aggregation was evaluated using monoclonal CD61 antibody fluorescent flow cytometry profiles. All of the extracorporeal membrane oxygenation systems created plasma-free hemoglobin at a similar rate compared with static blood control. There was no difference in the mean normalized index of hemolysis of the centrifugal/hollow-fiber oxygenator system as compared with the roller-head/silicone membrane systems (0.0032 g/100 L vs. 0.0058 g/100 L, p .7). None of the extracorporeal membrane oxygenation systems had a significant increase in platelet aggregation above baseline. CONCLUSIONS:: In a low-flow neonatal environment, a state-of-the-art centrifugal pump combined with new fiber-type oxygenators appear to be safe in regard to hemolysis and platelet aggregation.

Original languageEnglish (US)
JournalPediatric Critical Care Medicine
Volume13
Issue number4
DOIs
StatePublished - Jul 2012

Fingerprint

Extracorporeal Membrane Oxygenation
Oxygenators
Hemolysis
Platelet Aggregation
Newborn Infant
Silicones
Head
Membranes
Hemoglobins
Membrane Oxygenators
Intracranial Hemorrhages
Renal Insufficiency
Rupture
Flow Cytometry
Swine
Blood Platelets
Monoclonal Antibodies
Morbidity
Mortality
Research

Keywords

  • cardiopulmonary bypass
  • centrifugation
  • extracorporeal membrane oxygenation
  • flow cytometry
  • hemolysis
  • platelet aggregates

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Critical Care and Intensive Care Medicine

Cite this

Hemolytic and thrombocytopathic characteristics of extracorporeal membrane oxygenation systems at simulated flow rate for neonates. / Meyer, Andrew D; Wiles, Andrew A.; Rivera, Oswaldo; Wong, Edward C.; Freishtat, Robert J.; Rais-Bahrami, Khoydar; Dalton, Heidi J.

In: Pediatric Critical Care Medicine, Vol. 13, No. 4, 07.2012.

Research output: Contribution to journalArticle

Meyer, Andrew D ; Wiles, Andrew A. ; Rivera, Oswaldo ; Wong, Edward C. ; Freishtat, Robert J. ; Rais-Bahrami, Khoydar ; Dalton, Heidi J. / Hemolytic and thrombocytopathic characteristics of extracorporeal membrane oxygenation systems at simulated flow rate for neonates. In: Pediatric Critical Care Medicine. 2012 ; Vol. 13, No. 4.
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AU - Rivera, Oswaldo

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AU - Freishtat, Robert J.

AU - Rais-Bahrami, Khoydar

AU - Dalton, Heidi J.

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KW - cardiopulmonary bypass

KW - centrifugation

KW - extracorporeal membrane oxygenation

KW - flow cytometry

KW - hemolysis

KW - platelet aggregates

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