Polymethylpentene Oxygenators Research Articles

Water Condensation and Gas Exchange Correlation in Different Models and Fibers of Blood Oxygenators: “How Can We Improve Performance?”

Creation of water condensation in blood oxygenators is a phenomenon that is constantly present during cardiopulmonary bypass and in medium- to long-term extracorporeal life support. Clinical observation of condensation at the oxygenator exit is still a common event normally associated with sudden cooling of the gas flow proximal to the outlet cover (after exiting the fiber bundle), where the warming effect of blood is no longer present. Condensation could progressively obstruct a certain number of fibers, reducing the efficiency of gaseous exchange in the membrane of the oxygenator surface. The study included 48 patients divided into four oxygenator groups of 12 each: group 1 used an Inspire 6 F oxygenator from Livanova; group 2, an Affinity Fusion from Medtronic; group 3, an Alone from Eurosets, and group 4, an ECMO Alone from Eurosets; while the last group used an ECMO Alone oxygenator from Eurosets with polymethylpentene fiber. Each group of oxygenators comprising 12 patients were divided into two groups, namely, A and B, with six patients in each group. Group A used mild hypothermia during the procedure, and group B of six patients used normothermia; Groups A and B were further subdivided into four subgroups: A1, A2, B1, and B2, each consists of three patients; subgroups A1 and B1 used negative aspiration (−8 mmHg) measuring humidity (%) and temperature (°C) in the gas oxygenator output; consequently, a measurement system was necessary to be created; Subgroups A2 and B2 did not use negative aspiration in the oxygenator outlet. No statistically significant difference for PaO2 and humidity values was found in polypropylene and polymethylpentene oxygenators with mild hypothermia management with vacuum and without vacuum in the gas outlet in the first 60 minutes and 60 minutes later during cardiopulmonary bypass. In normothermia, a statistically significant difference in the PaO2–humidity relationship was observed with polypropylene and polymethylpentene fiber models. Results of this study show an inversely proportional correlation between gas exchange and condensation in statistically significant values during the use of normothermia and a reduction in oxygenation performance, in polypropylene and polymethylpentene fiber oxygenators.

Pediatric Extracorporeal Life Support Organization Registry International Report 2016.

The purpose of this report is to describe the international growth, outcomes, complications, and technology used in pediatric extracorporeal life support (ECLS) from 2009 to 2015 as reported by participating centers in the Extracorporeal Life Support Organization (ELSO). To date, there are 59,969 children who have received ECLS in the ELSO Registry; among those, 21,907 received ECLS since 2009 with an overall survival to hospital discharge rate of 61%. In 2009, 2,409 ECLS cases were performed at 157 centers. By 2015, that number grew to 2,992 cases in 227 centers, reflecting a 24% increase in patients and 55% growth in centers. ECLS delivered to neonates (0-28 days) for respiratory support was the largest subcategory of ECLS among children <18-years old. Overall, 48% of ECLS was delivered for respiratory support and 52% was for cardiac support or extracorporeal life support to support cardiopulmonary resuscitation (ECPR). During the study period, over half of children were supported on ECLS with centrifugal pumps (51%) and polymethylpentene oxygenators (52%). Adverse events including neurologic events were common during ECLS, a fact that underscores the opportunity and need to promote quality improvement work.

Hollow Fiber Oxygenator Composition Has a Significant Impact on Failure Rates in Neonates on Extracorporeal Membrane Oxygenation: A Retrospective Analysis.

In extracorporeal life support (ECLS), there are two main types of oxygenators in clinical use for neonates: polymethylpentene (PMP) hollow fiber and polypropylene (PP) hollow fiber. A retrospective study was performed on neonates ( n = 44) who had undergone ECLS for noncardiac indications from 2009 to 2015. Between the two groups (PMP n = 21, PP n = 23), the PP oxygenators failed 91% of the time, whereas the PMP oxygenators failed 43% of the time ( p < 0.05). Analysis suggests PMP oxygenators are less prone to failure than PP oxygenators, and they require fewer number of oxygenator changes during a neonatal ECLS.

Artificial placenta: Recent advances and potential clinical applications.

Lung immaturity remains a major cause of morbidity and mortality in extremely premature infants. Positive-pressure mechanical ventilation, the method of choice for respiratory support in premature infants, frequently promotes by itself lung injury and a negative impact in the circulatory function. Extracorporeal lung support has been proposed for more than 50 years as a potential alternative to mechanical ventilation in the treatment of severe respiratory failure of extremely premature infants. Recent advances in this field included the development of miniaturized centrifugal pumps and polymethylpentene oxygenators, as well as the successful use of pump-assisted veno-venous extracorporeal gas exchange systems in experimental artificial placenta models. This review, which includes studies published from 1958 to 2015, presents an update on the artificial placenta concept and its potential clinical applications. Special focus will be devoted to the milestones achieved so far and to the limitations that must be overcome before its clinical application. Notwithstanding, the artificial placenta stands as a promising alternative to mechanical ventilation in extremely premature infants. Pediatr Pulmonol. 2016;51:643-649. © 2016 Wiley Periodicals, Inc.

Protein-bound drugs are prone to sequestration in the extracorporeal membrane oxygenation circuit: results from an ex vivo study.

IntroductionVital drugs may be degraded or sequestered in extracorporeal membrane oxygenation (ECMO) circuits, with lipophilic drugs considered to be particularly vulnerable. However, the circuit effects on protein-bound drugs have not been fully elucidated. The aim of this experimental study was to investigate the influence of plasma protein binding on drug disposition in ex vivo ECMO circuits.MethodsFour identical ECMO circuits comprising centrifugal pumps and polymethylpentene oxygenators and were used. The circuits were primed with crystalloid, albumin and fresh human whole blood and maintained at a physiological pH and temperature for 24 hours. After baseline sampling, known quantities of study drugs (ceftriaxone, ciprofloxacin, linezolid, fluconazole, caspofungin and thiopentone) were injected into the circuit to achieve therapeutic concentrations. Equivalent doses of these drugs were also injected into four polypropylene jars containing fresh human whole blood for drug stability testing. Serial blood samples were collected from the controls and the ECMO circuits over 24 hours, and the concentrations of the study drugs were quantified using validated chromatographic assays. A regression model was constructed to examine the relationship between circuit drug recovery as the dependent variable and protein binding and partition coefficient (a measure of lipophilicity) as explanatory variables.ResultsFour hundred eighty samples were analysed. There was no significant loss of any study drugs in the controls over 24 hours. The average drug recoveries from the ECMO circuits at 24 hours were as follows: ciprofloxacin 96%, linezolid 91%, fluconazole 91%, ceftriaxone 80%, caspofungin 56% and thiopentone 12%. There was a significant reduction of ceftriaxone (P = 0.01), caspofungin (P = 0.01) and thiopentone (P = 0.008) concentrations in the ECMO circuit at 24 hours. Both protein binding and partition coefficient were highly significant, with the model possessing a high coefficient of determination (R2 = 0.88, P <0.001).ConclusionsRecovery of the highly protein-bound drugs ceftriaxone, caspofungin and thiopentone was significantly lower in the ECMO circuits at 24 hours. For drugs with similar lipophilicity, the extent of protein binding may determine circuit drug loss. Future clinical population pharmacokinetic studies should initially be focused on drugs with greater lipophilicity and protein binding, and therapeutic drug monitoring should be strongly considered with the use of such drugs.

A paediatric ECMO case of plasma leakage through a polymethylpentene oxygenator

Polymethylpentene (PMP) oxygenators, utilised for ECMO, are commonly believed to be resistant to plasma leakage. Whilst uncommon, plasma leakage has been previously reported with PMP fibres, both in vivo and in vitro. We describe a paediatric ECMO case during which plasma leakage occurred and oxygenator function gradually deteriorated, ultimately necessitating device replacement. To our knowledge, this is the first case of plasma leakage described using a PMP device during paediatric ECMO. Subsequent investigation is described, demonstrating that a protein coating reduces the free passage of solution across the PMP membrane.

Impact of Polymethylpentene Oxygenators on Outcomes of All Extracorporeal Life Support Patients in the United States

Artificial OrgansVolume 37, Issue 12 p. 1080-1081 Letters to the Editor Impact of Polymethylpentene Oxygenators on Outcomes of All Extracorporeal Life Support Patients in the United States Akif Ündar, Akif Ündar Departments of Pediatrics, Surgery and Bioengineering, Pediatric Cardiovascular Research Center, Penn State Hershey College of Medicine, Penn State Hershey Children's Hospital, Hershey, PA, USASearch for more papers by this authorShigang Wang, Shigang Wang Departments of Pediatrics, Surgery and Bioengineering, Pediatric Cardiovascular Research Center, Penn State Hershey College of Medicine, Penn State Hershey Children's Hospital, Hershey, PA, USASearch for more papers by this authorDavid A. Palanzo, David A. Palanzo aundar@psu.edu Heart and Vascular Institute, Penn State Milton S. Hershey Medical Center, Penn State Hershey College of Medicine, Penn State Hershey Children's Hospital, Hershey, PA, USASearch for more papers by this author Akif Ündar, Akif Ündar Departments of Pediatrics, Surgery and Bioengineering, Pediatric Cardiovascular Research Center, Penn State Hershey College of Medicine, Penn State Hershey Children's Hospital, Hershey, PA, USASearch for more papers by this authorShigang Wang, Shigang Wang Departments of Pediatrics, Surgery and Bioengineering, Pediatric Cardiovascular Research Center, Penn State Hershey College of Medicine, Penn State Hershey Children's Hospital, Hershey, PA, USASearch for more papers by this authorDavid A. Palanzo, David A. Palanzo aundar@psu.edu Heart and Vascular Institute, Penn State Milton S. Hershey Medical Center, Penn State Hershey College of Medicine, Penn State Hershey Children's Hospital, Hershey, PA, USASearch for more papers by this author First published: 11 December 2013 https://doi.org/10.1111/aor.12242Citations: 14Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume37, Issue12December 2013Pages 1080-1081 RelatedInformation

Plasma-Free Hemoglobin Levels in Advanced vs. Conventional Infant and Pediatric Extracorporeal Life Support Circuits

Extracorporeal life support (ECLS) is a reliable method to support pediatric patients with reversible cardiorespiratory failure associated with congenital heart disease, respiratory insufficiency, or after cardiac surgery. In 2010, our institution adopted an infant/pediatric extracorporeal membrane oxygenation (ECMO) circuit that contains a magnetically levitated centrifugal pump, polymethylpentene oxygenator, and shorter tubing length (ECMO II circuit). Our prior circuit contained a nonocclusive roller pump, polypropylene oxygenator, venous compliance chamber, and hemoconcentrator (ECMO I circuit). A retrospective chart review comparing ECMO I and ECMO II daily plasma-free hemoglobin (PFH) values was conducted. We hypothesized that the PFH is similar between the two ECMO circuit groups. We reviewed medical records of children 3 years of age or younger weighing less than 13 kg who required ECLS between January 2008 and February 2012. PFH levels from 18 ECMO II patients were compared with levels in a retrospective group of an equal number of well-matched ECMO I circuit patients. There was no significant difference between ECMO I and ECMO II circuit groups regarding mean time on ECMO, age in days, and weight. There was also no significant difference in the group mean levels of PFH between ECMO I and ECMO II circuits. There was a significant increase in PFH with hours on ECMO (p &lt; .01) within and between both circuit groups (p &lt; .01) and a significantly greater increase in PFH with ECMO hours (p = .0091) in the ECMO I circuit group. Although there was no significant difference in average PFH with the change in ECMO II circuit technology, advancements such as the magnetically levitated blood pump and polymethylpentene gas exchange device has been associated with significantly fewer mechanical component change-outs (p = .0156) and less clots and fibrin build-up in the circuits (p = .0548).

Extracorporeal Membrane Oxygenation Clinical Dilemmas

Three scenarios are presented, based on real patients, illustrating various clinical dilemmas involving critical illness and extracorporeal membrane oxygenation (ECMO). The scenarios are outlined in the form of questions and answers. In most cases there is no single correct answer to the dilemmas presented. The pros and cons of particular interventions are discussed along with the actual treatment provided. In all cases, the ECMO circuit consisted of a polymethylpentene oxygenator (Quadrox PLS; MAQUET Cardiovascular, Hirlingen, Germany) and a centrifugal pump (Rotaflow; MAQUET Cardiovascular). Case 2 has been previously published as a letter to the editor (1).

A new phosphorylcholine-coated polymethylpentene oxygenator for extracorporeal membrane oxygenation: a preliminary experience

Phosphorylcholine coating has a major role in the improvement of biocompatibility, durability and antihrombogenicity of the circuit for extracorporeal membrane oxygenation (ECMO). Moreover, if heparin-induced thrombocytopenia ensues, removal of all the sources of heparin is challenging if the circuit is coated with heparin. We report our preliminary experience with the new EUROSETS A.L.ONE ECMO oxygenator (Eurosets, Medolla, MO, Italy), which is aimed at providing better biocompatibility thanks to its full coating with phosphorylcholine. We retrospectively collected data on the 16 patients supported with ECMO and with the EUROSETS A.L.ONE ECMO oxygenator at San Raffaele Hospital. Mean ECMO duration was 6 ± 4 days, and 37.5% of the patients died on ECMO. Four episodes of major bleeding and three episodes of minor bleeding were recorded. The oxygenator had an excellent performance in gas exchange and the median pressure drop was 57 (26-85) mmHg at full blood flow (2.5 L/m2/min). The EUROSETS A.L.ONE ECMO oxygenator was an excellent device in our preliminary experience. Further evaluation on a larger sample is encouraged.

A pilot study comparing two polymethylpentene extracorporeal membrane oxygenators

We compared two polymethylpentene oxygenators being used in our unit: the Maquet Quadrox-iD paediatric and the Medos Hilite 800LT. A mono-centric, prospective pilot study was conducted on ten consecutive newborn patients who had been admitted to our hospital service for extracorporeal circulation (EC) treatment. We examined the rate of oxygen transfer, the CO2 removal capacity and the average sweep gas flow required to produce this result. We also assessed the disturbances of haemostasis, the need for labile blood products and the membrane oxygenator lifetime and cost of use. According to our study, it seems to us that Medos Hilite 800LT membrane oxygenators demonstrate greater oxygen transfer and CO2 removal capacity than Maquet Quadrox-iD paediatric membrane oxygenators, at a similar cost. These results lead us to conclude that it is reasonable to continue using Medos Hilite 800LT membrane oxygenators. A broader comparison study would be necessary in order to support these initial results.

Invited Commentary

The authors [1Hartwig M.G. Walczak R. Lin S.S. Davis R.D. Improved survival but marginal allograft function in patients treated with extracorporeal membrane oxygenation after lung transplantation.Ann Thorac Surg. 2012; 93: 366-371Abstract Full Text Full Text PDF PubMed Scopus (68) Google Scholar] report a retrospective single-center analysis about their extracorporeal membrane oxygenation (ECMO) experience to support patients with severe primary graft dysfunction. Twenty-eight of 498 patients (6%) required ECMO support. Congratulations to the authors for their outcomes that were superior to other published series. This study addresses an important problem for the transplant team: what to do when the graft fails? What is the best time to start ECMO? Is venovenous ECMO better than venoarterial ECMO? The question about long-term consequences after severe primary graft dysfunction and ECMO support is answered in the present work and provides some important advice for practice. Is it possibly better to establish ECMO when inspired oxygen content (Fio2) surpasses 0.60? Is this a significant limit? In my experience physicians in most centers are more patient and start ECMO later (Fio2 0.8–1.0). The low threshold used by the Duke University group can be 1 reason for the good results. However other centers perhaps wait too long to initiate ECMO. The best time to begin ECMO support is not exactly defined. Nevertheless the indication for ECMO support must be decided individually in every patient. I, as well as the authors, seek more studies regarding evaluation of quality of life and not only functional assessments. Analysis of the cost-effectiveness is necessary, as mentioned by the authors, is a matter of taste. Improved Survival but Marginal Allograft Function in Patients Treated With Extracorporeal Membrane Oxygenation After Lung TransplantationThe Annals of Thoracic SurgeryVol. 93Issue 2PreviewPrevious reports demonstrate that 1-year survival is severely compromised in patients with severe primary graft dysfunction (PGD) after lung transplantation. We examined if advances in extracorporeal membrane oxygenation (ECMO) support, including polymethylpentene oxygenators and reliance on venovenous (VV) ECMO have improved outcomes in patients with severe PGD after lung transplantation. Full-Text PDF

Improved Survival but Marginal Allograft Function in Patients Treated With Extracorporeal Membrane Oxygenation After Lung Transplantation

Previous reports demonstrate that 1-year survival is severely compromised in patients with severe primary graft dysfunction (PGD) after lung transplantation. We examined if advances in extracorporeal membrane oxygenation (ECMO) support, including polymethylpentene oxygenators and reliance on venovenous (VV) ECMO have improved outcomes in patients with severe PGD after lung transplantation. The analysis included data prospectively collected on all single-lung or double-lung transplants between November 2001 and December 2009. Heart-lung transplants were excluded. Comparisons were made between recipients who did and did not require ECMO for PGD after transplant. Since November 2001, when VV ECMO became the routine treatment for severe PGD after transplant at our center, 28 of 498 patients (6%) have required VV ECMO support. Successful weaning occurred in 27 of 28 (96%). Support was withdrawn for 1 patient with irreversible neurologic injury. Survival was substantially better than in previous reports: 30 days, 82%; 1 year, 64%; and 5 years, 49%. Freedom from bronchiolitis obliterans syndrome was 88% in the ECMO survivors at 3 years, but maximum allograft function was considerably worse than in transplant recipients not requiring ECMO (peak forced expiratory volume in 1 second: 58% in ECMO vs 83% in non-ECMO, p=0.001). Advances in ECMO technology, particularly VV ECMO, have greatly improved the ability to support patients with severe PGD after lung transplantation. VV ECMO is an important tool in the armamentarium of any lung transplant program to optimize patient outcomes; however, strategies to improve lung allograft function in patients experiencing severe PGD are still needed.

Troubleshooting Adult ECMO

The following scenarios explore some of the common problems encountered during extracorporeal membrane oxygenation (ECMO) in adults. In each scenario, the circuit is comprised of a centrifugal pump and a polymethylpentene oxygenator.

RE: Extracorporeal circulatory systems in the interhospital transfer of critically ill patients: experience of a single institution

RE: Extracorporeal circulatory systems in the interhospital transfer of critically ill patients: experience of a single institution

Case report: plasma leakage in a polymethylpentene oxygenator during extracorporeal life support

Plasma leakage is a phenomenon which has almost completely disappeared since the introduction of plasma-tight polymethylpentene (PMP) fibers in oxygenators used for extracorporeal life support (ECLS). We describe here a case of ECLS which was affected by the rapid occurrence of plasma leakage in oxygenators with polymethylpentene fibers. To our knowledge, this is the first report of the phenomenon since the introduction of this new generation of oxygenators.

Extracorporeal Membrane Oxygenation With a Poly-Methylpentene Oxygenator (Quadrox D). The Experience of a Single Italian Centre in Adult Patients With Refractory Cardiogenic Shock

Although microporous polypropylene hollow fiber oxygenators are standard devices used for extracorporeal membrane oxygenation (ECMO), they have limitations such as development of plasma leakage. Poly-methylpentene (PMP) is a new material used for the last generation of oxygenators. We reviewed our experience with a new PMP oxygenator (Quadrox D) and a centrifugal pump (RotaFlow) used to support adult patients with refractory cardiogenic shock. Between January 2000 and April 2007, 25 patients required ECMO for primary or postcardiotomy cardiogenic shock. Eighteen patients were analyzed [mean age 60.2 years; 11 (61%) men; 7 (39%) women]. Nine patients (50%) suffered primary cardiogenic shock. Cardiopulmonary resuscitation was applied in 11 patients (61%) with a mean duration time of 31.5 minutes. Mean ECMO duration time was 7.1 +/- 6.3 days (range, 1-27 days). Intra-aortic balloon pump was used in 13 patients (72.2%) with a mean duration time of 7.7 +/- 5 (range, 2-17 days). Twelve patients (66.7%) survived on ECMO and five patients (27.8%) were discharged. Our results indicate the PMP oxygenator and the centrifugal pump provided acceptable results in terms of surviving on ECMO and discharge. Patients with an initial catastrophic hemodynamic status could benefit by means of a rapid institution of ECMO with PMP oxygenators.

A comparison of radiographic signs of pulmonary inflammation during ECMO between silicon and poly-methyl pentene oxygenators

The inflammatory response caused by extracorporeal membrane oxygenation (ECMO) is clearly visible within the first 24 h of cannulation. The inflammatory process affects all areas of the lung, even areas previously spared by the primary disease. To compare the change in the radiographic signs of inflammatory response to ECMO between poly-methyl pentene and silicon oxygenators. Retrospective review of neonates and adults pre- and post-replacement of silicon oxygenators with poly-methyl pentene devices. Data were collected from Extracorporeal Life Support Organisation (ELSO) registry forms and patient records. Results were analysed by quantitative and semi-quantitative methods. There was a significant reduction in the radiographic signs of inflammatory response to ECMO, and a reduction in the time taken to revert to pre-ECMO state in the neonatal poly-methyl pentene group compared to silicon. However, there was no significant reduction in the duration of ECMO runs and the percentage survival between these groups in the neonates. In adults, there was no difference in severity of radiographic signs between groups. However, the inflammatory changes were relatively delayed in the adult poly-methyl pentene group. Polymethyl pentene (Medos) oxygenators have reduced the host's response phenomenon 'white out' in neonates, and caused a delayed response in adults. This is most likely a consequence of smaller blood contact surface area combined with the effect of heparin coating of the oxygenator membrane. However, recovery was not a function of the type of gas exchange device used.

DIDECMO: a new polymethylpentene oxygenator for pediatric extracorporeal membrane oxygenation.

We reviewed the performance of a new polymethylpentene oxygenator (DIDECMO, Dideco, Mirandola, Italy) in terms of clinical safety and efficiency in priming, oxygenation, and oxygenator resistance in neonatal and pediatric extracorporeal membrane oxygenation (ECMO) patients. Between March 2005 and January 2006, 14 patients required ECMO in the San Vincenzo Hospital. Of these, 8 (median age, 9 days; range, 3 days to 15 months) received normothermic ECMO for postcardiotomy heart failure after surgery for congenital heart disease. The DIDECMO oxygenator was used in all patients (median weight, 2.4 kg; range, 2 to 7 kg). According to our previous experience, all patients received the same anticoagulation management. DIDECMO is a new phosphorylcholine-coated, polymethylpentene hollow-fiber oxygenator recommended for a maximum blood flow of 2300 ml/min with a membrane surface area of 0.67 m2 and validated to be used up to 5 days. Static priming was 100 ml and mean support time 05 hours (range, 36 to 198 hours). No oxygenators were changed during support. Median pressure drop during overall assistance was 24 mm Hg. Carbon dioxide elimination was obtained with a 1:1 blood flow/air flow ratio. Neither oxygenator-related major nor minor adverse events occurred during support. In our initial experience, the new polymethylpentene DIDECMO oxygenator provided adequate gas exchange and offered technical advantages in terms of low priming volume and acceptable hemodynamic resistance despite pulsatile flow regimen. Also, we used this device for more than 8 days without any technical problems.

Poly-Methyl Pentene Oxygenators Have Improved Gas Exchange Capability and Reduced Transfusion Requirements in Adult Extracorporeal Membrane Oxygenation

The performance of poly-methyl pentene (PMP) oxygenators (Medos Hilite 7000LT) was compared with that of silicone membrane (SM) oxygenators (Medtronic 1-4500-2A) for adult extracorporeal membrane oxygenation (ECMO). Forty consecutive patients were selected retrospectively pre- and post-introduction of PMP oxygenators. They were selected according to the dates they received ECMO and were separated into two equal groups with similar backgrounds. The flow path resistance, gas and heat exchange efficiency, consumption of coagulation factors and platelets, blood transfusion requirements, and incidence of clots for each oxygenator type was assessed. Adult PMP oxygenators showed lower blood path resistance than SM oxygenators. However, lower consumption of blood products in these oxygenators was a direct result of their smaller surface area and heparin coated design, reducing contact activation of coagulation factors. These oxygenators are noticeably smaller, require lower priming volumes, and have better gas exchange capability than SM oxygenators. They showed greater stability and preservation of coagulation factors and platelets compared with SM oxygenators. They also had the advantage of a functioning integrated heat exchanger. Using a single PMP oxygenator in the first instance may be adequate for the majority of patients and would significantly reduce red blood cell consumption during ECMO.