title: Hemolytic and thrombocytopathic characteristics of extracorporeal membrane oxygenation systems at simulated flow rate for neonates.
abstract: OBJECTIVE
  A state-of-the-art centrifugal pump combined with hollow-fiber oxygenator for extracorporeal membrane oxygenation has potential advantages such as smaller priming volumes and decreased potential to cause tubing rupture as compared with the traditional roller head/silicone membrane systems. Adoption of these state-of-the-art systems has been slow in neonates as a result of past evidence of severe hemolysis that may lead to renal failure and increased mortality. Extracorporeal systems have also been linked to platelet dysfunction, a contributing factor toward intracranial hemorrhage, a leading cause of infant morbidity. Little data exist comparing the centrifugal systems with the roller systems in terms of hemolysis and platelet aggregation at low flow rates commonly used in neonatal extracorporeal membrane oxygenation.
  
  
  METHODS
  Prospective, comparative laboratory study.
  
  
  METHODS
  University research laboratory.
  
  
  METHODS
  Centrifugal pump, roller pump, hollow-fiber oxygenator, and silicone membrane oxygenator.
  
  
  METHODS
  Comparative study using two pumps, the centrifugal Jostra Rotaflow (Maquet, Wayne, NJ) and the roller-head (Jostra, Maquet, Wayne, NJ), and two oxygenators, polymethlypentene Quadrox-D (Maquet) and silicone membrane (Medtronic, Minneapolis, MN). Five test runs of four circuit combinations were examined for hemolysis and platelet aggregation during 6 hrs of continuous use in a simulated in vitro extracorporeal membrane oxygenation circuit circulating whole swine blood at 300 mL/min.
  
  
  RESULTS
  Hemolysis was assessed by spectrophometric measurement of plasma-free hemoglobin. Platelet aggregation was evaluated using monoclonal CD61 antibody fluorescent flow cytometry profiles. All of the extracorporeal membrane oxygenation systems created plasma-free hemoglobin at a similar rate compared with static blood control. There was no difference in the mean normalized index of hemolysis of the centrifugal/hollow-fiber oxygenator system as compared with the roller-head/silicone membrane systems (0.0032 g/100 L vs. 0.0058 g/100 L, p ≥ .7). None of the extracorporeal membrane oxygenation systems had a significant increase in platelet aggregation above baseline.
  
  
  CONCLUSIONS
  In a low-flow neonatal environment, a state-of-the-art centrifugal pump combined with new fiber-type oxygenators appear to be safe in regard to hemolysis and platelet aggregation.
authors.affiliation: Division of Pediatric Critical Care, Department of Pediatrics, University of Texas Health Science Center, San Antonio, TX, USA. adjmeyer@yahoo.com
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Meyer
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Wiles
authors.forename: Oswaldo
authors.initials: O
authors.lastname: Rivera
authors.forename: Edward C
authors.initials: EC
authors.lastname: Wong
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Freishtat
authors.forename: Khoydar
authors.initials: K
authors.lastname: Rais-Bahrami
authors.forename: Heidi J
authors.initials: HJ
authors.lastname: Dalton
mesh_terms: D002498:Centrifugation / Q000295:instrumentation; D004867:Equipment Design; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects / Q000295:instrumentation*; D005434:Flow Cytometry; D006461:Hemolysis; D006801:Humans; D007231:Infant, Newborn; D010107:Oxygenators, Membrane / Q000009:adverse effects; D010974:Platelet Aggregation; D011446:Prospective Studies