title: Platelet-derived microparticles generated by neonatal extracorporeal membrane oxygenation systems.
abstract: Current anticoagulation strategies do not eliminate thromboembolic stroke or limb loss during neonatal extracorporeal membrane oxygenation (ECMO), a form of cardiopulmonary bypass (CPB). In adults, CPB surgery generates prothrombotic platelet-derived microparticles (PMPs), submicron membrane vesicles released from activated platelets. However, information on PMP generation in neonatal ECMO systems is lacking. The objective of this study was to compare PMP generation in five different neonatal ECMO systems, using a simulated circuit with swine blood at 300 ml/min for 4 hours. Systems were composed of both newer components (centrifugal pump and hollow-fiber oxygenator) and traditional components (roller-head pump and silicone membrane oxygenator). Free plasma hemoglobin levels were measured as an indicator of hemolysis and flow cytometry-measured PMP. Hemolysis generated in all ECMO systems was similar to that observed in noncirculated static blood (p = 0.48). There was no difference in net PMP levels between different oxygenators with a given pump. In contrast, net PMP generation in ECMO systems with a centrifugal pump was at least 2.5 times greater than in roller-head pump systems. This was significant when using either a hollow-fiber (p < 0.005) or a silicone membrane (p < 0.05) oxygenator. Future studies are needed to define the relationship between pump-generated PMP and thrombosis.
authors.affiliation: From the *Division of Pediatric Critical Care, Department of Pediatrics, University of Texas Health Science Center at San Antonio, San Antonio, Texas; †Department of Epidemiology and Biostatistics, University of Texas Health Science Center at San Antonio, San Antonio, Texas; ‡Department of Integrative Systems Biology, Children's National Medical Center, Washington, District of Columbia; and §Division of Neonatology, Center for Hospital-based Subspecialties, Children National Medical Center, Washington, District of Columbia.
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Meyer
authors.forename: Jonathan A L
authors.initials: JA
authors.lastname: Gelfond
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Wiles
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Freishtat
authors.forename: Khoydar
authors.initials: K
authors.lastname: Rais-Bahrami
mesh_terms: D000818:Animals; D001792:Blood Platelets / Q000473:pathology*; D055252:Cell-Derived Microparticles / Q000473:pathology*; D004867:Equipment Design; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects*; D006461:Hemolysis; D006801:Humans; D066298:In Vitro Techniques; D007231:Infant, Newborn; D023421:Models, Animal; D008955:Models, Cardiovascular; D013552:Swine