A wet-primed extracorporeal membrane oxygenation circuit with hollow-fiber membrane oxygenator maintains adequate function for use during cardiopulmonary resuscitation after 2 weeks on standby.
OBJECTIVE
To assess the durability of wet-preprimed extracorporeal membrane oxygenation (ECMO) circuits for potential use in resuscitation after a 2-wk period of storage.


METHODS
Experimental laboratory study.


METHODS
Tertiary care pediatric cardiac intensive care unit.


METHODS
None.


METHODS
14 ECMO circuits (polyvinyl chloride and super-Tygon tubing with hollow-fiber oxygenator, Medos Hilite 800LT) were primed with crystalloid under sterile conditions and stored for 0 (control, n = 4), 7 (n = 5) and 14 (n = 5) days and maintained at 8 degrees C on pump at 10 rpm and gas flow at 0.2 L/min. Daily samples were inspected for plasticizers by means of high-performance liquid chromatography and for microorganisms by culture and polymerase chain reaction techniques. After storage, the oxygenators were primed with red blood cells (hemoglobin, 12 g/dL) and tested in vitro with a deoxygenator according to Association for Advancement of Medical Instrumentation standards. Oxygen and CO(2) transfer rates were calculated by standard formulae at maximum blood flow (800 mL/min) and maximum sweep gas flow (1.6 L/min).


RESULTS
Oxygen transfer was linearly related to venous oxygen saturation, increasing by 11 mL/min for each 10% decrease in venous oxygen saturation. Estimated oxygen transfer at venous oxygen saturation of 60% was 45.8 mL/min (95% confidence interval [CI], 43.5-48.1) for controls, 51.0 mL/min (95% CI, 48.9-53.2) for 7-day oxygenators, and 49.0 mL/min (95% CI, 47.8-50.1) for 14-day oxygenators. CO(2) transfer declined to 29.2 mL/min at 14 days of storage, a mean fall of 11.5 mL/min (95% CI, 4.2-18.7) in comparison with 7-day storage. All circuits were free from microbes/microbial DNA. Plasticizer levels fell below the lower limit of detection (0.003 microg/mL) at 7 and 14 days.


CONCLUSIONS
A wet-preprimed ECMO circuit with hollow-fiber membrane oxygenator can be stored for up to 2 wks with adequately preserved function if prepared appropriately. These data may improve safe access to rapid-response ECMO support.
Karimova
Ann
A
Cardiothoracic Unit, Great Ormond Street Hospital for Children, NHS Trust, London, United Kingdom.
Robertson
Alex
A
Cross
Nigel
N
Smith
Liz
L
O'callaghan
Maura
M
Tuleu
Catherine
C
Long
Paul
P
Beeton
Allison
A
Han
Jihong
J
Ridout
Deborah
D
Goldman
Allan
A
Brown
Kate
K
D001692:Biological Transport; D002245:Carbon Dioxide / Q000097:blood; D016887:Cardiopulmonary Resuscitation / Q000295:instrumentation*; D002851:Chromatography, High Pressure Liquid; D004869:Equipment Safety; D004912:Erythrocytes / Q000378:metabolism; D015199:Extracorporeal Membrane Oxygenation / Q000295:instrumentation*; D005942:Gluconates / Q000737:chemistry; D006454:Hemoglobins / Q000737:chemistry; D066298:In Vitro Techniques; D015278:Intensive Care Units, Pediatric; D015636:Magnesium Chloride / Q000737:chemistry; D010100:Oxygen / Q000097:blood; D010107:Oxygenators, Membrane / Q000382:microbiology; D010968:Plasticizers / Q000737:chemistry; D016133:Polymerase Chain Reaction; D011189:Potassium Chloride / Q000737:chemistry; D012828:Silicones / Q000737:chemistry; D019346:Sodium Acetate / Q000737:chemistry; D012965:Sodium Chloride / Q000737:chemistry; D013997:Time Factors
D005942:Gluconates; D006454:Hemoglobins; C012499:Plasma-lyte 148; D010968:Plasticizers; D012828:Silicones; D015636:Magnesium Chloride; D002245:Carbon Dioxide; D012965:Sodium Chloride; D019346:Sodium Acetate; D011189:Potassium Chloride; D010100:Oxygen