Trauma/Critical Care
Centrifugal pumps and hemolysis in pediatric extracorporeal membrane oxygenation (ECMO) patients: An analysis of Extracorporeal Life Support Organization (ELSO) registry data

https://doi.org/10.1016/j.jpedsurg.2017.03.022Get rights and content

Abstract

Purpose

It is currently unclear whether centrifugal pumps cause more hemolysis than roller pumps in extracorporeal membrane oxygenation (ECMO) circuits. The aim of this study was to help answer that question in pediatric patients.

Methods

A limited deidentified data set was extracted from the international multicenter Extracorporeal Life Support Organization (ELSO) registry comprising all reported ECMO runs for patients 18 years or younger between 2010 and 2015. Logistic regression was used to evaluate a possible association between hemolysis and pump type, controlling for patient demographics, circuit factors, and complications.

Results

14,776 ECMO runs for 14,026 patients had pump type recorded. Centrifugal pumps were employed in 60.4% of ECMO circuits. Hemolysis was a reported complication for 1272 (14%) centrifugal pump runs and for 291 (5%) roller pump runs. 1755 (20%) centrifugal pump runs reported kidney injury as compared to 797 (14%) roller pump runs. In the full logistic regression, the odds of hemolysis were significantly greater for runs using centrifugal pumps (OR 3.3, 95% CI 2.9–3.8, p < 0.001).

Conclusions

In this retrospective analysis of a large international data set, the use of centrifugal pumps was associated with increased rates of hemolysis, hyperbilirubinemia, and kidney injury.

Level of evidence

Level III.

Section snippets

Methods

Data for this study were obtained from the ELSO registry. This registry is a voluntary database to which 160 member institutions from across the world report data. Multiple data elements are captured in the registry, including patient demographics, clinical parameters (before and during ECMO), circuit configuration (including pump type), complications, and survival to decannulation and to discharge. A data set of all ECMO runs for patients 18 years and younger between 2010 and 2015 was extracted

Results

15,111 patients aged birth to 18 years underwent 15,903 cannulations reported to ELSO between 2010 and 2015. Of these, 14,776 ECMO runs for 14,026 patients had pump type recorded. For the multivariate analysis we included only the 13,941 runs that had data recorded for all of the parameters of interest. 27 different pump types were used; with 60.4% of ECMO runs performed using centrifugal pumps, and 39.6% using roller pumps. 54.8% of the ECMO runs were on male and 44.3% were on female patients.

Discussion

In this study, the authors review data from the ELSO database to determine whether or not there is an association between pump type (centrifugal versus roller) and occurrence of hemolysis in pediatric patients. The ELSO database is a large registry that includes voluntarily-entered data from patients treated at ELSO-member organizations in the US and abroad. The size and scope of the data set would support the idea that generalizable conclusions may be drawn from it. This study demonstrates a

References (14)

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