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. 2019 Dec;20(12):1177-1184.
doi: 10.1097/PCC.0000000000002103.

Outcomes of Infants Supported With Extracorporeal Membrane Oxygenation Using Centrifugal Versus Roller Pumps: An Analysis From the Extracorporeal Life Support Organization Registry

Conor P O'Halloran  1 , Ravi R Thiagarajan  2   3 , Vamsi V Yarlagadda  4 , Ryan P Barbaro  5 , Viviane G Nasr  6 , Peter Rycus  7 , Marc Anders  8 , Peta M A Alexander  2   3
Affiliations

Outcomes of Infants Supported With Extracorporeal Membrane Oxygenation Using Centrifugal Versus Roller Pumps: An Analysis From the Extracorporeal Life Support Organization Registry

Conor P O'Halloran et al. Pediatr Crit Care Med. 2019 Dec.

Abstract

Objectives: To determine whether mortality differs between roller and centrifugal pumps used during extracorporeal membrane oxygenation in infants weighing less than 10 kg.

Design: Retrospective propensity-matched cohort study.

Setting: All extracorporeal membrane oxygenation centers reporting to the Extracorporeal Life Support Organization.

Patients: All patients less than 10 kg supported on extracorporeal membrane oxygenation during 2011-2016 within Extracorporeal Life Support Organization Registry.

Interventions: Centrifugal and roller pump recipients were propensity matched (1:1) based on predicted probability of receiving a centrifugal pump using demographic variables, indication for extracorporeal membrane oxygenation, central versus peripheral cannulation, and pre-extracorporeal membrane oxygenation patient management.

Measurements and main results: A total of 12,890 patients less than 10 kg were supported with extracorporeal membrane oxygenation within the Extracorporeal Life Support Organization registry during 2011-2016. Patients were propensity matched into a cohort of 8,366. Venoarterial and venovenous extracorporeal membrane oxygenation runs were propensity matched separately. The propensity-matched cohorts were similar except earlier year of extracorporeal membrane oxygenation (standardized mean difference, 0.49) in the roller pump group. Within the propensity-matched cohort, survival to discharge was lower in the centrifugal pump group (57% vs 59%; odds ratio, 0.91; 95% CI, 0.83-0.99; p = 0.04). Hemolytic, infectious, limb injury, mechanical, metabolic, neurologic, pulmonary, and renal complications were more frequent in the centrifugal pump group. Hemorrhagic complications were similar between groups. Hemolysis mediated the relationship between centrifugal pumps and mortality (indirect effect, 0.023; p < 0.001).

Conclusions: In this propensity score-matched cohort study of 8,366 extracorporeal membrane oxygenation recipients weighing less than 10 kg, those supported with centrifugal pumps had increased mortality and extracorporeal membrane oxygenation complications. Hemolysis was evaluated as a potential mediator of the relationship between centrifugal pump use and mortality and met criteria for full mediation.

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Conflict of interest statement

Copyright form disclosure: Dr. Thiagarajan’s institution received funding form Pfizer and Bristol Myers Squibb. Dr. Barbaro disclosed that he is the Extracorporeal Life Support Organization (ELSO) Registry Chair, and he received support for article research from National Institutes of Health (NIH) and K12 HL138039 Training to Advance Care Through Implementation science in Cardiac And Lung illnesses (TACTICAL). Dr. Alexander’s institution received funding from Tenax Therapeutics (supplied levosimendan for an expanded access protocol clinical trial) and Novartis, and he disclosed off-label product use of ECMO. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Figures

Fig 1:
Fig 1:
Schematic diagram of the propensity matching process.
Fig 2:
Fig 2:
Total number of Extracorporeal Membrane Oxygenation (ECMO) runs in pediatric patients <10kg by pump type and year
See this image and copyright information in PMC

Comment in

References

    1. Green TP, Kriesmer P, Steinhorn RH, et al.: Comparison of pressure-volume-flow relationships in centrifugal and roller pump extracorporeal membrane oxygenation systems for neonates. ASAIO Trans 1991; 37:572–6 - PubMed
    1. Dalton HJ, Reeder R, Garcia-Filion P, et al.: Factors Associated with Bleeding and Thrombosis in Children Receiving Extracorporeal Membrane Oxygenation (ECMO). Am J Respir Crit Care Med 2017; 196:rccm.201609–1945OC - PMC - PubMed
    1. Morgan IS, Codispoti M, Sanger K, et al.: Superiority of centrifugal pump over roller pump in paediatric cardiac surgery: prospective randomised trial. Eur J Cardiothorac Surg 1998; 13:526–32 - PubMed
    1. Meyer AD, Wiles AA, Rivera O, et al.: Hemolytic and thrombocytopathic characteristics of extracorporeal membrane oxygenation systems at simulated flow rate for neonates. Pediatr Crit Care Med 2012; 13 - PMC - PubMed
    1. Luciani GB, Hoxha S, Torre S, et al.: Improved Outcome of Cardiac Extracorporeal Membrane Oxygenation in Infants and Children Using Magnetic Levitation Centrifugal Pumps. Artif Organs 2016; 40:27–33 - PubMed

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