Division of Pediatric Critical Care, Department of Pediatrics, University of Texas Health Science Center, San Antonio, TX, USA.
Pediatr Crit Care Med. 2012 Jul;13(4):e255-61. doi: 10.1097/PCC.0b013e31823c98ef.
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.
Prospective, comparative laboratory study.
University research laboratory.
Centrifugal pump, roller pump, hollow-fiber oxygenator, and silicone membrane oxygenator.
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.
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.
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.
与传统的滚轴头/硅胶膜系统相比，结合空心纤维氧合器的先进离心式血泵具有较小的预充量和降低管破裂的潜在风险。由于过去严重溶血的证据可能导致肾衰竭和死亡率增加，因此新生儿采用这些先进系统的速度较慢。体外系统也与血小板功能障碍有关，这是导致颅内出血的一个因素，颅内出血是婴儿发病的主要原因。在新生儿体外膜氧合中常用的低流量下，关于离心系统与滚轴系统在溶血和血小板聚集方面的比较数据很少。
前瞻性、对比性实验室研究。
大学研究实验室。
离心泵、滚轴泵、空心纤维氧合器和硅胶膜氧合器。
使用两种泵，即离心式 Jostra Rotaflow（Maquet，Wayne，NJ）和滚轴式（Jostra，Maquet，Wayne，NJ），以及两种氧合器，聚甲基戊烯 Quadrox-D（Maquet）和硅胶膜（Medtronic，Minneapolis，MN）进行对比研究。在模拟体外体外膜氧合回路中，连续使用 6 小时，以 300 mL/min 的速度循环全猪血，对四种回路组合的五个测试运行进行了溶血和血小板聚集的检查。
通过分光光度法测量血浆游离血红蛋白来评估溶血。血小板聚集通过单克隆 CD61 抗体荧光流式细胞术图谱进行评估。所有体外膜氧合系统产生的血浆游离血红蛋白与静态血液对照相似。与滚轴头/硅胶膜系统相比，离心/空心纤维氧合器系统的平均归一化溶血指数无差异（0.0032 g/100 L 比 0.0058 g/100 L，p ≥.7）。体外膜氧合系统均未出现血小板聚集明显高于基线的情况。
在低流量新生儿环境中，结合新型纤维型氧合器的先进离心式血泵在溶血和血小板聚集方面似乎是安全的。
