Coagulation complications after conversion from roller to centrifugal pump in neonatal and pediatric extracorporeal membrane oxygenation

Özge Erdem,Jan Willem Kuiper,Robert Jan Houmes,Cornelia Heleen Van Ommen,Joost Van Rosmalen,Dick Tibboel,Enno Diederik Wildschut

doi:10.1016/j.jpedsurg.2020.11.018

Abstract

Background/purposeCoagulation complications are frequent, unwanted occurrences in extracorporeal membrane oxygenation (ECMO) treatment, possibly influenced by the pump in the ECMO-circuit. We hypothesized that fewer complications would occur with a smaller, heparin-coated ECMO system with a centrifugal pump (CP) than with one with a roller pump (RP) and that after conversion, complication rates would decrease over time. MethodsThis single-center, retrospective chart study included all first neonatal and pediatric ECMO runs between 2009 and 2015. Differences between groups were assessed with Mann–Whitney U tests and Kruskal–Wallis tests. Determinants of complication rates were evaluated through Poisson regression models. The CP group was divided into three consecutive groups to assess whether complication rates decreased over time. ResultsThe RP group comprised 90 ECMO runs and the CP group 82. Hemorrhagic complication rates were significantly higher with the CP than with the RP, without serious therapeutic consequences, while thrombotic complications rates were unaffected. Intracranial hemorrhage rates and coagulation-related mortality rates were similar. Gained experience with the CP did not improve complication rates or survival over time. ConclusionsAlthough the CP seems safe, it does not seem beneficial over the RP. Further research is warranted on how pump type affects coagulation, taking into account the severity and implications of coagulation complications. Level of EvidenceLevel III.

Highlights

Extracorporeal membrane oxygenation (ECMO) treatment entails the temporary use of an extracorporeal circulation for acute respiratory and/or cardiac failure
Except for more veno-arterial ECMO (VA-ECMO) runs in the roller pump (RP) group, 60.0% versus 46.3% (p = 0.046), and the greater use of continuous veno-venous hemofiltration (CVVH) in the RP group, 96.7% versus 29.3% (p
Our study has demonstrated that conversion from an ECMO system with the roller pump to a new smaller and heparin-coated ECMO system with the centrifugal pump increased hemorrhagic complications rates

Summary

Introduction

Extracorporeal membrane oxygenation (ECMO) treatment entails the temporary use of an extracorporeal circulation for acute respiratory and/or cardiac failure. The interaction between circulating blood and the non-biological surface of the ECMO circuit activates several inflammatory and coagulation cascades [1]. These cascades and the shear stress induced by ECMO can cause throm-. Dalton et al showed that thrombotic events occur in 31% of pediatric ECMO runs [2]. To counteract these cascades patients receive continuous anticoagulation therapy, often unfractionated heparin (UFH), increasing the risk of hemorrhagic complications. In addition to anticoagulation therapy, the hemorrhaging risk increases with extensive use or loss of coagulation factors following the start of ECMO treatment [3]. Both thrombotic and hemorrhagic events complicate ECMO treatment and are important causes of morbidity and mortality in neonatal and pediatric ECMO [2, 4]

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