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Efficiency of gas transfer in venovenous extracorporeal membrane oxygenation: analysis of 317 cases with four different ECMO systems

Abstract

Purpose

Polymethylpentene membrane oxygenators used in venovenous extracorporeal membrane oxygenation (vvECMO) differ in their physical characteristics. The aim of the study was to analyze the gas transfer capability of different ECMO systems in clinical practice, as the choice of the appropriate system may be influenced by the needs of the patient.

Methods

Retrospective study on prospectively collected data of adults with severe respiratory failure requiring vvECMO support (Regensburg ECMO Registry, 2009–2013). Oxygen (O2) transfer and carbon dioxide (CO2) elimination of four different ECMO systems (PLS system, n = 163; Cardiohelp system (CH), n = 59, Maquet Cardiopulmonary, Rastatt, Germany; Hilite 7000 LT system, n = 56, Medos Medizintechnik, Stolberg, Germany; ECC.05 system, n = 39, Sorin Group, Mirandola (MO), Italy) were analyzed.

Results

Gas transfer depended on type of ECMO system, blood flow, and gas flow (p ≤ 0.05, each). CO2 removal is dependent on sweep gas flow and blood flow, with higher blood flow and/or gas flow eliminating more CO2 (p ≤ 0.001). CO2 elimination capacity was highest with the PLS system (p ≤ 0.001). O2 transfer at blood flow rates below 3 l/min depended on blood flow, at higher blood flow rates on blood flow and gas flow. The system with the smallest gas exchange surface (ECC.05 system) was least effective in O2 transfer, but in terms of the gas exchange surface was the most effective.

Conclusion

Our analysis suggests that patients with severe hypoxemia and need for high flow ECMO benefit more from the PLS/CH or Hilite 7000 LT system. The ECC.05 system is advisable for patients with moderate hypoxemia and/or hypercapnia.

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Acknowledgments

The authors would like to thank the nursing staff of the intensive care units and the perfusionists for excellent patient care and ECMO control.

Conflicts of interest

The study was supported by departmental resources without external funding. CS is an adviser to Maquet Cardiopulmonary AG, Rastatt, Germany. ML, AP, and TM received travel support and lecture honoraria from Maquet Cardiopulmonary AG, Rastatt, Germany. None of the other authors has a financial relationship with a commercial entity that has an interest in the subject of the presented manuscript or other conflicts of interest to disclose.

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Correspondence to Matthias Lubnow.

Additional information

Take-home message: This is the first clinical study comparing the CO2 and O2 transfer capability of different ECMO systems. Better knowledge of the gas exchange performances of MOs is important to choose a suitable system for the patient initially and to assess the functionality of the system while in use.

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Lehle, K., Philipp, A., Hiller, KA. et al. Efficiency of gas transfer in venovenous extracorporeal membrane oxygenation: analysis of 317 cases with four different ECMO systems. Intensive Care Med 40, 1870–1877 (2014). https://doi.org/10.1007/s00134-014-3489-z

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  • DOI: https://doi.org/10.1007/s00134-014-3489-z

Keywords

  • ECMO
  • Gas transfer
  • PMP oxygenator
  • CO2 removal
  • O2 transfer