A potential propensity for failure secondary to clot embolism in neonatal ECMO.
OBJECTIVE
To report a single case of oxygenator failure caused by clot embolism originating from the bladder; and to discuss some preventative options.


METHODS
A 2.5 kg neonate with a diagnosis of influenza A received veno-arterial (V-A) extracorporeal membrane oxygenation (ECMO) for cardiorespiratory support. Halfway through treatment, she underwent an elective circuit change for numerous clots in her circuit. The patient continued to consume vast quantities of platelets and developed a fatal oxygenator failure after 18 days.


CONCLUSIONS
Amongst the factors influencing the outcome in events of a sudden unexpected oxygenator failure are the severity of patient illness, the size of the clot relative to the size of the oxygenator, the availability of a previously primed circuit and the ease and speed of priming a new oxygenator.


CONCLUSIONS
There is a need for improvement in the design of small oxygenators and ECMO circuits. Adjustment of the coagulation parameters and lowering the tolerance towards clots in the circuit by electively changing them may reduce the incidence of sudden unexpected oxygenator failure. However, using a slightly larger Medos oxygenator may gain valuable time needed to arrange an oxygenator/circuit change.
Khoshbin
Espeed
E
Division of Cardiac Surgery, University of Leicester/Heart Link ECMO Centre, Glenfield Hospital, Leicester, UK. khoshbinuk@yahoo.co.uk
Machin
David
D
Killer
Hilliary
H
Peek
Giles J
GJ
Sosnowski
Andrzej W
AW
Firmin
Richard K
RK
D004867:Equipment Design; D004868:Equipment Failure; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects* / Q000379:methods; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007251:Influenza, Human / Q000150:complications; D010107:Oxygenators, Membrane / Q000009:adverse effects*; D010976:Platelet Count; D011014:Pneumonia / Q000150:complications / Q000628:therapy; D018805:Sepsis / Q000150:complications; D013923:Thromboembolism / Q000209:etiology*; D017211:Treatment Failure