North American neonatal extracorporeal membrane oxygenation (ECMO) devices and team roles: 2008 survey results of Extracorporeal Life Support Organization (ELSO) centers

Abstract

In early 2008, surveys of active extracorporeal membrane oxygenation (ECMO) centers in North America were conducted by electronic mail regarding neonatal ECMO equipment and professional staff. Eighty of 103 (78%) North American ECMO centers listed in the Extracorporeal Life Support Organization directory as neonatal centers responded to the survey. Of the responding centers, 82.5% routinely used roller pumps for neonatal ECMO, and the remaining 17.5% used centrifugal pumps. Silicone membrane oxygenators were used by 67% of the respondents, whereas 19% used micro-porous hollow fiber oxygenators, and 14% used polymethylpentene hollow fiber oxygenators. Of the silicone membrane oxygenator users, 86% used the Medtronic Ecmotherm heat exchanger, 10% used the Gish HE-4 heat exchanger, and 4% used the Terumo Conducer device. Sixty-four percent of the responding centers used some form of in-line blood gas monitoring. Six percent of the centers used a bubble trap in the arterial line, and 5% used an arterial line filter. A bladder was used by 85% of the centers, and 4% of these used a mechanical bladder box for servo regulation; the remaining 96% used pressure servo regulation. An air bubble detector was used by 88% of the responding centers. A surface coating was used by 44% of the centers on all their neonatal ECMO patients. Thirty-one percent of the centers use an activated clotting time of 180-220 seconds. At 54% of the responding centers, perfusionists were involved with the ECMO program, registered nurses were involved at 70% of the centers, and respiratory therapists were involved at 46% of the centers. Compared with a 2002 survey, silicone membrane use is declining, and the use of centrifugal blood pumps and coated ECMO circuits is becoming more apparent. ECMO teams are still multidisciplinary, made up of combinations of registered nurses, respiratory therapists, and perfusionists.

Figure 1.

Percentage of responding centers using each type of roller pump console for neonatal ECMO applications compared with survey results from 2002. CAPS, Sorin Computer-Assisted Perfusion System.

Figure 2.

Percentage of responding centers using each type of oxygenation membrane for neonatal ECMO applications compared with survey results from 2002. Silicone, Medtronic 0800; Minimax, Medtronic Minimax Plus; Quadrox D, Maquet Quadrox D; Terumo RX, Terumo RX05, Baby RX; Medos, Medos Hilite 800 LT.

Figure 3.

Percentage of responding centers using each type of heat exchange device in conjunction with the Medtronic 0800 silicone membrane for neonatal ECMO applications compared with survey results from 2002.

Figure 4.

Percentage of responding centers using each type of compliance bladder for neonatal ECMO applications compared with survey results from 2002.

Figure 5.

Number of responding centers using each type of surface coating compared with survey results from 2002. The Medtronic Carmeda, Gish GBS, and Maquet Bioline coatings are heparin based. The Maquet Safeline coating is albumin based. The Sorin Phisio, Medtronic Trillium, and Terumo X coatings are non–heparin-based hydrophilic surface coatings.

Figure 6.

Percentage of responding centers using each type of ACT monitoring device for neonatal ECMO applications compared with survey results from 2002.

Figure 7.

ACT ranges of responding centers for neonatal ECMO applications compared with survey results from 2002. Range units, seconds.

Figure 8.

Percentage of responding centers using each type of in-line monitoring devices for neonatal ECMO applications compared with survey results from 2002. CDI 500, Terumo Cardiovascular CDI 500; CDI 100, Terumo Cardiovascular CDI 100, Spectrum Med; M3, Spectrum Medical M3.

Figure 9.

Percentage of Allied Health Professionals who make up the ECMO Specialist teams at responding centers compared with survey results from 2002. RN, registered nurse; RRT, registered respiratory therapist; CCP, certified clinical perfusionist.

Figure 10.

Geographic locations of responding ELSO centers.