Abstract
Over the past decade, veno-venous extracorporeal membrane oxygenation (vvECMO) has been increasingly utilized in respiratory failure in patients. This study presents our institution´s experience focusing on the life span of ECMO systems reflecting the performance of a particular system. A retrospective review of our ECMO database identified 461 adult patients undergoing vvECMO (2010–2017). Patients that required more than one system and survived the first exchange >24 hours (n = 139) were included. Life span until the first exchange and exchange criteria were analyzed for all systems (PLS, Cardiohelp HLS-set, both Maquet Cardiopulmonary, Rastatt, Germany; Deltastream/Hilite7000LT, iLA-activve, Xenios/NovaLung, Heilbronn, Germany; ECC.O5, LivaNova, Mirandola, Italy). At our ECMO center, the frequency of a system exchange was 30%. The median (IQR) life span was 9 (6–12) days. There was no difference regarding the different systems (p = 0.145 and p = 0.108, respectively). However, the Deltastream systems were exchanged more frequently due to elective technical complications (e. g. worsened gas transfer, development of coagulation disorder, increased bleedings complications) compared to the other exchanged systems (p = 0.013). In summary, the used ECMO systems are safe and effective for acute respiratory failure. There is no evidence for the usage of a specific system. Only the increased predictability of an imminent exchange preferred the usage of a Deltastream system. However, the decision to use a particular system should not depend solely on the possible criteria for an exchange.
Highlights
Veno-venous extracorporeal membrane oxygenation has been increasingly used for potentially reversible severe refractory acute respiratory failure associated with severe influenza A (H1N1) pneumonia [1,2,3]
No significant difference could be found between the used ECMO systems (p = 0.145; Table 1), while HL showed the lowest frequency with 24% and iLA-activve the highest with 40%
The total ECMO support of patients that required more than one system was significantly prolonged [median (IQR), 19 (13–27) days] compared to patients with only one system [median (IQR), 7 (4–10) days; p
Summary
Veno-venous extracorporeal membrane oxygenation (vvECMO) has been increasingly used for potentially reversible severe refractory acute respiratory failure associated with severe influenza A (H1N1) pneumonia [1,2,3]. Still, it remains an expensive, resource-intensive procedure. Several devices are available for clinical use. At our ECMO center five different ECMO-systems are available [8,9,10]. The choice of a specific device is based upon clinical considerations and preferences and by the availability of equipment in the unit. Up to now long-term application as an artificial lung failed due to the development of coagulation disorders and thrombus formation [11,12]
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