Abstract
To identify predictors of neonatal ECMO circuit health, a retrospective analysis of circuit functional pressure and flow parameters as well as infant clotting values were collected 48 h prior to and 24 h post circuit change. Circuit impairment was defined as need for partial or total circuit change. Statistical analysis used multivariate statistics and non-parametric Mann–Whitney U-test with possible non-normality of measurements. A total of 9764 ECMO circuit and clotting values in 21 circuits were analyzed. Circuit delta-P mean, and maximum values increased from 8.62 to 48.59 mmHg (p < 0.011) and 16.00 to 53.00 mmHg (p < 0.0128) respectively prior to need for circuit change. Maximum and mean Pump Flow Revolutions per minute (RPM) increased by 75% (p < 0.0043) and 81% (p < 0.0057), respectively. Mean plasma free hemoglobin (pfHb) increased from 26.45 to 76.00 mg/dl, (p < 0.0209). Sweep, venous pressure, and clotting parameters were unaffected. ECMO circuit delta-P, RPM, and pfHb were early predictors of circuit impairment.
Highlights
To identify predictors of neonatal Extracorporeal membrane oxygenation (ECMO) circuit health, a retrospective analysis of circuit functional pressure and flow parameters as well as infant clotting values were collected 48 h prior to and 24 h post circuit change
A total of 53 infants were identified as having ECMO care during the study period with 32 infants excluded due to lack of documentation of ECMO circuit parameters yielding a total of 21 infants included in the study
In the circuit change group, 25 circuit change events occurred in 7 infants. 288 data point values were identified per circuit change
Summary
To identify predictors of neonatal ECMO circuit health, a retrospective analysis of circuit functional pressure and flow parameters as well as infant clotting values were collected 48 h prior to and 24 h post circuit change. Previous evaluations of possible circuit health indicators identified significant associations of increased shunt flow with distal circuit obstruction[7], clotting parameters of increased d-dimer[10,11], decreased fibrinogen, decreased platelet count, decreased heparin dose, as well as increased circuit sweep with subsequent need for oxygenator c hange[10]. We hypothesized that increased delta-P, RPM, pfHb and decreased circuit flow, platelet count and fibrinogen are reflective of circuit health and can assist in early prediction of circuit health or circuit failure risk in the neonatal patient. Key areas of determination were timing of occurrence of identifiable circuit parameters and individual coagulation values associated with impending need for circuit change in this high risk ECMO population
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