Key result
Impending ECMO circuit impairment was significantly predicted by early increases in mean circuit delta-P (48.59 vs 8.62 mmHg), pump flow RPM, and plasma free hemoglobin.
Why the study?
Predictors of circuit health in neonatal patients receiving extracorporeal membrane oxygenation needed to be identified.
Do ECMO circuit parameters (delta-P, RPM, pfHb) predict the need for circuit change in neonatal patients receiving ECMO?
Observational (n=21)
No
Do ECMO circuit parameters (delta-P, RPM, pfHb) predict the need for circuit change in neonatal patients receiving ECMO?
Absolute Event Rate: 48.59% vs 8.62%
p-value: p=<0.011
Increases in ECMO circuit delta-P, pump RPM, and plasma free hemoglobin are early predictors of impending circuit impairment in neonatal patients.
Increases in delta-P, RPM, and pfHb may herald neonatal ECMO circuit impairment; hypothesis-generating and requires prospective validation.
To identify predictors of neonatal ECMO circuit health, a retrospective analysis of circuit functional pressure and flow parameters as well as infant clotting values were collected 48 h prior to and 24 h post circuit change. Circuit impairment was defined as need for partial or total circuit change. Statistical analysis used multivariate statistics and non-parametric Mann-Whitney U-test with possible non-normality of measurements. A total of 9764 ECMO circuit and clotting values in 21 circuits were analyzed. Circuit delta-P mean, and maximum values increased from 8.62 to 48.59 mmHg (p < 0.011) and 16.00 to 53.00 mmHg (p < 0.0128) respectively prior to need for circuit change. Maximum and mean Pump Flow Revolutions per minute (RPM) increased by 75% (p < 0.0043) and 81% (p < 0.0057), respectively. Mean plasma free hemoglobin (pfHb) increased from 26.45 to 76.00 mg/dl, (p < 0.0209). Sweep, venous pressure, and clotting parameters were unaffected. ECMO circuit delta-P, RPM, and pfHb were early predictors of circuit impairment.
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Hazboun et al. (2022) conducted an observational in Neonatal cardiorespiratory failure requiring ECMO (n=21). Impending ECMO circuit impairment vs. No circuit change was evaluated on Mean circuit delta-P (mmHg) (p=<0.011). Impending ECMO circuit impairment was significantly predicted by early increases in mean circuit delta-P (48.59 vs 8.62 mmHg), pump flow RPM, and plasma free hemoglobin.
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