A comparison of radiographic signs of pulmonary inflammation during ECMO between silicon and poly-methyl pentene oxygenators

Introduction: The inflammatory response caused by extracorporeal membrane oxygenation (ECMO) is clearly visible within the first 24 h of cannulation. The inflammatory process affects all areas of the lung, even areas previously spared by the primary disease. Objective: To compare the change in the radiographic signs of inflammatory response to ECMO between poly-methyl pentene and silicon oxygenators. Study design: Retrospective review of neonates and adults pre- and post-replacement of silicon oxygenators with poly-methyl pentene devices. Data were collected from Extracorporeal Life Support Organisation (ELSO) registry forms and patient records. Results were analysed by quantitative and semi-quantitative methods. Results: There was a significant reduction in the radiographic signs of inflammatory response to ECMO, and a reduction in the time taken to revert to pre-ECMO state in the neonatal poly-methyl pentene group compared to silicon. However, there was no significant reduction in the duration of ECMO runs and the percentage survival between these groups in the neonates. In adults, there was no difference in severity of radiographic signs between groups. However, the inflammatory changes were relatively delayed in the adult poly-methyl pentene group. Conclusion: Poly-methyl pentene (Medos) oxygenators have reduced the host's response phenomenon `white out' in neonates, and caused a delayed response in adults. This is most likely a consequence of smaller blood contact surface area combined with the effect of heparin coating of the oxygenator membrane. However, recovery was not a function of the type of gas exchange device used. Perfusion (2007) 22, 15-21.

[1]  A. Sosnowski,et al.  Performance of polymethyl pentene oxygenators for neonatal extracorporeal membrane oxygenation: a comparison with silicone membrane oxygenators , 2005, Perfusion.

[2]  A. Sosnowski,et al.  Poly-Methyl Pentene Oxygenators Have Improved Gas Exchange Capability and Reduced Transfusion Requirements in Adult Extracorporeal Membrane Oxygenation , 2005, ASAIO journal.

[3]  G. Tangen,et al.  Heparin‐Coated Circuits (Duraflo II) With Reduced Versus Full Anticoagulation During Coronary Artery Bypass Surgery , 2003, Journal of cardiac surgery.

[4]  G. Peek,et al.  Early Experience with a Polymethyl Pentene Oxygenator for Adult Extracorporeal Life Support , 2002, ASAIO journal.

[5]  L. Menicanti,et al.  The antithrombin III-saving effect of reduced systemic heparinization and heparin-coated circuits. , 2002, Journal of cardiothoracic and vascular anesthesia.

[6]  T. Karlsson,et al.  Neurological and general outcome in low-risk coronary artery bypass patients using heparin coated circuits. , 2001, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[7]  L. V. von Segesser,et al.  Impact of hollow-fiber membrane surface area on oxygenator performance: Dideco D903 Avant versus a prototype with larger surface area. , 2000, The journal of extra-corporeal technology.

[8]  G. Peek,et al.  The inflammatory and coagulative response to prolonged extracorporeal membrane oxygenation. , 1999, ASAIO journal.

[9]  H. Gerlach,et al.  Morphological changes in chest radiographs of patients with acute respiratory distress syndrome (ARDS) , 1998, Intensive Care Medicine.

[10]  C. Ziegler,et al.  The use of extracorporeal membrane oxygenation in patients with Gram-negative or viral sepsis , 1997, Perfusion.

[11]  E. Fosse,et al.  Effects of heparin coating on the expression of CD11b, CD11c and CD62L by leucocytes in extracorporeal circulation in vitro , 1997, Perfusion.

[12]  C. Hack,et al.  Specific complement inhibition with heparin-coated extracorporeal circuits. , 1996, The Annals of thoracic surgery.

[13]  P. Beckley,et al.  Comparison of the performance characteristics of three generations of membrane oxygenators: Univox®, Univox® Gold™ and SpiralGold™ , 1996 .

[14]  R. Colman,et al.  Surface-bound heparin fails to reduce thrombin formation during clinical cardiopulmonary bypass. , 1996, The Journal of thoracic and cardiovascular surgery.

[15]  L. Menicanti,et al.  Beneficial effects of Duraflo II heparin-coated circuits on postperfusion lung dysfunction. , 1996, The Annals of thoracic surgery.

[16]  J. Maessen,et al.  Influence of Duraflo II heparin-treated extracorporeal circuits on the systemic inflammatory response in patients having coronary bypass. , 1995, The Journal of thoracic and cardiovascular surgery.

[17]  E. Fosse,et al.  High and low heparin dose with heparin-coated cardiopulmonary bypass: activation of complement and granulocytes. , 1995, The Annals of thoracic surgery.

[18]  N. Hatori,et al.  Biocompatibility of heparin-coated membrane oxygenator during cardiopulmonary bypass. , 1994, Artificial organs.

[19]  E. Fosse,et al.  Reduced complement and granulocyte activation with heparin-coated cardiopulmonary bypass. , 1994, The Annals of thoracic surgery.

[20]  B. Nilsson,et al.  Complement activation during cardiopulmonary bypass: effects of immobilized heparin. , 1994, The Annals of thoracic surgery.

[21]  W. Baumgartner,et al.  Heparin-coated bypass circuits reduce pulmonary injury. , 1993, The Annals of thoracic surgery.

[22]  W. van Oeveren,et al.  Heparin-coated circuits reduce the inflammatory response to cardiopulmonary bypass. , 1993, The Annals of thoracic surgery.

[23]  T. Evans,et al.  Organ dysfunction and cardiopulmonary bypass: the role of complement and complement regulatory proteins. , 1993, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[24]  W. van Oeveren,et al.  Blood activation during neonatal extracorporeal life support. , 1993, The Journal of thoracic and cardiovascular surgery.

[25]  R. Bartlett,et al.  A heparin-coated circuit reduces complement activation and the release of leukocyte inflammatory mediators during extracorporeal circulation in a rabbit. , 2008, Artificial organs.

[26]  P. Venge,et al.  Heparin-coated circuits reduce activation of granulocytes during cardiopulmonary bypass. A clinical study. , 1992, The Journal of thoracic and cardiovascular surgery.

[27]  E. Fosse,et al.  Reduced complement activation with heparin-coated oxygenator and tubings in coronary bypass operations. , 1992, The Journal of thoracic and cardiovascular surgery.

[28]  C. Wildevuur,et al.  Clinical experience with heparin-coated cardiopulmonary bypass circuits , 1991, Perfusion.

[29]  V. Videm,et al.  Biocompatibility of extracorporeal circulation. In vitro comparison of heparin-coated and uncoated oxygenator circuits. , 1991, The Journal of thoracic and cardiovascular surgery.

[30]  M. R. Rolfs,et al.  Evaluation of Duraflo II heparin immobilized cardiopulmonary bypass circuits. , 1990, ASAIO transactions.

[31]  M L BRAMSON,et al.  A NEW DISPOSABLE MEMBRANE OXYGENATOR WITH INTEGRAL HEAT EXCHANGE. , 1965, The Journal of thoracic and cardiovascular surgery.