ECMO support using centrifugal pumps was associated with a higher incidence of nonsurgical bleeding compared to roller pumps (26.1 vs. 9.0 events/1,000 patient-days, p=0.024).
Cohort (n=95)
Yes
Does centrifugal pump use increase adverse bleeding complications compared to roller pumps in adult patients on prolonged ECMO support?
In adult patients on prolonged ECMO support, the use of centrifugal pumps is associated with a significantly higher incidence of nonsurgical bleeding compared to roller pumps, despite lower heparin requirements.
Absolute Event Rate: 26.1% vs 9%
p-value: p=0.024
Centrifugal pumps are increasingly used for extracorporeal membrane oxygenation (ECMO) rather than roller pumps. However, shear forces induced by these types of continuousflow pumps are associated with acquired von Willebrand factor deficiency and bleeding complications. This study was undertaken to compare adverse bleeding complications with the use of centrifugal and roller pumps in patients on prolonged ECMO support. The records of all adult ECMO patients from June 2002 to 2013 were retrospectively reviewed using the University of Michigan Health System database and the Extracorporeal Life Support Organization registry, focusing on patients supported for at least 5 days. Ninety-five ECMO patients met criteria for inclusion (48 roller vs. 47 centrifugal pump). Indications included pulmonary (79%), cardiac (15%), and extracorporeal cardiopulmonary resuscitation (6%), without significant difference between the two groups. Despite lower heparin anticoagulation (10.9 vs. 13.7 IU/kg/hr) with centrifugal pumps, there was a higher incidence of nonsurgical bleeding (gastrointestinal, pulmonary, and neurological) in centrifugal pump patients (26.1 vs. 9.0 events/1,000 patient-days, p = 0.024). In conclusion, in our historical comparison, despite reduced anticoagulation, ECMO support using centrifugal pumps was associated with a higher incidence of nonsurgical bleeding. The mechanisms behind this are multifactorial and require further investigation.
Halaweish et al. (Sat,) conducted a cohort in Prolonged ECMO support (n=95). Centrifugal pumps vs. Roller pumps was evaluated on Nonsurgical bleeding (gastrointestinal, pulmonary, and neurological) (p=0.024). ECMO support using centrifugal pumps was associated with a higher incidence of nonsurgical bleeding compared to roller pumps (26.1 vs. 9.0 events/1,000 patient-days, p=0.024).
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