Fibrin formation, Hemolysis and Blood Product Usage in Children on the Cardiohelp ECMO circuit
CCCF ePoster library. Muttalib F. Nov 1, 2016; 150942; 63
Fiona Muttalib
Fiona Muttalib
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Topic: Retrospective or Prospective Cohort Study

Fibrin formation, Hemolysis and Blood Product Usage in Children on the Cardiohelp ECMO circuit


Francoeur, Conall1; Calaritis, Christos2; Muttalib, Fiona3; Zavalkoff, Samara4
1-4Division of Pediatric Critical Care, Montreal Children’s Hospital, Montreal, Canada



Abstract:

INTRODUCTION: During extracorporeal membrane oxygenation (ECMO) support, there is ongoing need for platelet transfusion due to the adherence and aggregation of platelets to the artificial surface. There is also regular need for red blood cell transfusion related to patient factors, systemic anticoagulation and/or destruction of red cells through the circuit. This hemolysis may vary depending on circuit components and materials.
 
The recently released Cardiohelp (Maquet) device combines ECMO components into a compact, portable machine. This technology differs in several ways from our previous QDR technology, a Quadrox D oxygenator,Rotaflow centrifugal pump and modified bypass circuit with Carmeda coating. Cardiohelp is designed specifically for ECMO, is coated completely in Bioline (vs. combination of Carmeda and Bioline), has fewer connectors, a modified oxygenator inlet and far fewer tubing size transition zones. In 2016, the Montreal Children’s Hospital transitioned to this system.
 
OBJECTIVE: Evaluate hemolysis and fibrin formation measured by platelet and packed red blood cell transfusion needs, plasma free hemoglobin and observed fibrin formation in the Cardiohelp circuit vs. our previous technology.
 
METHODS: We reviewed our institution’s early experience with Cardiohelp through a retrospective, matched cohort study. We evaluated hemolysis (measured by plasma free hemoglobin), fibrin formation (visual), platelet and packed red blood cell (PRBC) transfusion volumes. We compared this data in characteristic-matched cases that were treated with our previous QDR system. We matched for age, indication (respiratory vs post-cardiotomy) and type of ECMO (veno-venous (VV) vs. veno-arterial (VA)) support. We excluded patients with pre-existing coagulopathy, surgery on ECMO, major surgical bleeding and those with no comparable age match. All cases were selected from a period in which our ECMO teams members, procedures, and protocols remained grossly unchanged. Statistics were analyzed in a descriptive manner and with the Wilcoxon signed rank test.
 
RESULTS: We reviewed six cases: three Cardiohelp and three supported with the QDR technology. Each group consisted of 2 VV and 1 VA case. Transfusion thresholds, for all cases, were a hematocrit of 40% and platelets of 100,000. Mean pRBC volume transfused from 0 to 72h of ECMO was more than double in the non-Cardiohelp group as compared to the Cardiohelp group (8.56 vs. 21.97 ml/kg/day, p = 0.021). The average platelet volume needed in the first 72h of ECMO was significantly lower in the Cardiohelp vs non-Cardiohelp group (2.22 vs 18.43 ml/kg/day, p= 0.014). The mean plasma free hemoglobin levels at 72h were also significantly lower in the Cardiohelp vs non-Cardiohelp group (0.412 vs. 0.991 mg/dl, p = 0.027). By day 3 of ECMO, 2/3 of patients on QDR had fibrin visualized in the circuit, whereas none (3/3) of the Cardiohelp patients did. At 96h of ECMO, neither of the 2 Cardiohelp patients still on ECMO had fibrin while all comparative non-Cardiohelp patients had fibrin.
 
CONCLUSION:  Our early experience with Cardiohelp demonstrates a significant reduction in hemolysis, fibrin formation and PRBC and platelet transfusions as compared to our previous ECMO system. 
 


References:
Bartlett et al. ECMO : Extracorporeal Cardiopulmonary Support in Critical Care. Red Book 4th Edition. ELSO
Haneya, A et al. First experience with the new portable extracorporeal membrane oxygenation system Cardiohelp for severe respiratory failure in adults. Perfusion. 27(2) 150-155
Philipp, A et al. First experience with the ultra compact mobile extracorporeal membrane oxygenation system Cardiohelp in interhospital transport. Interactive Cardiovasc and Thoracic Surgery. 12 (2011). 978-981


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