title: Outcomes of neonates undergoing extracorporeal membrane oxygenation support using centrifugal versus roller blood pumps.
abstract: BACKGROUND
  Advances in centrifugal blood pump technology have led to increased use of centrifugal pumps in extracorporeal membrane oxygenation (ECMO) circuits. Their efficacy and safety in critically ill neonates remains unknown. Blood cell trauma leading to hemolysis may result in end-organ injury in critically ill neonates receiving centrifugal pump ECMO. We hypothesized that neonates undergoing ECMO support using centrifugal pumps were at increased odds of hemolysis and subsequent end-organ injury.
  
  
  METHODS
  Children 30 days of age or younger who received support with venoarterial ECMO and were reported to the Extracorporeal Life Support Registry during 2007 to 2009 underwent propensity score matching (Greedy matching 1:1) using pre-ECMO support characteristics.
  
  
  RESULTS
  A total of 1,592 neonates receiving ECMO (centrifugal pump = 163 and roller pump = 1,492) were identified. Significant differences in demographic, presupport, and cannulation variables were present before matching. One hundred seventy-six neonates who were supported using either centrifugal (n = 88) or roller pumps (n = 88) were matched using propensity scoring. No significant differences in demographic, presupport, or cannulation variables were present after matching. Neonates undergoing support using centrifugal pumps had increased odds of hemolysis (odds ratio [OR], 7.7 [2.8-21.2]), hyperbilirubinemia (OR, 20.8 [2.7-160.4]), hypertension (OR, 3.2 [1.3-8.0]), and acute renal failure (OR, 2.4 [1.1-5.6]). Survival to discharge was not different between pump types.
  
  
  CONCLUSIONS
  Use of ECMO using centrifugal pumps is associated with increased odds of hemolysis that likely contributes to other end-organ injury. Research into the optimal use of centrifugal pumps and strategies to prevent support-related complications need to be investigated.
authors.affiliation: Department of Cardiology, Children's Hospital Colorado and Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado. cindy.barrett@childrenscolorado.org
authors.forename: Cindy S
authors.initials: CS
authors.lastname: Barrett
authors.forename: James J
authors.initials: JJ
authors.lastname: Jaggers
authors.forename: E Francis
authors.initials: EF
authors.lastname: Cook
authors.forename: Dionne A
authors.initials: DA
authors.lastname: Graham
authors.forename: Satish K
authors.initials: SK
authors.lastname: Rajagopal
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Almond
authors.forename: John D
authors.initials: JD
authors.lastname: Seeger
authors.forename: Peter T
authors.initials: PT
authors.lastname: Rycus
authors.forename: Ravi R
authors.initials: RR
authors.lastname: Thiagarajan
mesh_terms: D004867:Equipment Design; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects / Q000295:instrumentation*; D005260:Female; D006461:Hemolysis; D006801:Humans; D007231:Infant, Newborn; D008297:Male