Nikolai Krivitski1, Gregory Galyanov1, Deborah Cooper1, Mariam M Said2, Oswaldo Rivera3, Gerald T Mikesell4, Khodayar Rais-Bahrami2. 1. 1 Research & Development Department, Transonic Systems Inc., Ithaca, NY. 2. 2 Department of Neonatology, Children's National Medical Center and The George Washington University School of Medicine, Washington, D.C. 3. 3 Biomedical Engineering, Children's National Medical Center and The George Washington University School of Medicine, Washington, D.C. 4. 4 Cardiovascular Surgery, Children's National Medical Center and The George Washington University School of Medicine, Washington, D.C.
Abstract
INTRODUCTION: Clotting is one of the major causes of mortality and morbidity during extracorporeal membrane oxygenation (ECMO). A large meta-analysis study suggests that 29% of patients require the oxygenator to be replaced during ECMO. As clots usually form in the oxygenator, the oxygenator blood volume (OXBV) decreases over time. The currently used pressure gradient as a predicator of clot formation is unreliable. OBJECTIVE: The aim of this study was to develop and validate ultrasound dilution technology in a quantitative assessment of clotting, using measurements of OXBV. METHODS: OXBV was measured using the ELSA monitor (Transonic Systems Inc., Ithaca, NY, USA) from the transit time of a saline bolus passing through the oxygenator as recorded by a sensor placed after the oxygenator. The accuracy and reproducibility (coefficient of variation [CV]) of OXBV measurement and its independence from ECMO flow was assessed in vitro in lambs and from a clinical data archive. RESULTS: The in vitro accuracy compared with volumetric measurements of OXBV of 22-134 ml at flows of 300-700 ml/min was -0.8±6.6%. For an OXBV of 355 ml at flows of 1020-7000 ml/min, accuracy was -0.4±1.6%. In 88 animal OXBV measurements, the CV was 1.49±1.12%. For an OXBV of 153 (range 42-387 ml), clinical measurements at flow ranged from 210-5960 ml/min, with a CV of 3.20±2.44 %. CONCLUSION: Dilution technology has the ability to accurately and reproducibly assess the clotting process in the oxygenator. Larger studies are needed to establish guidelines for the prediction of imminent clotting and may help to avoid unnecessary circuit changes.
INTRODUCTION: Clotting is one of the major causes of mortality and morbidity during extracorporeal membrane oxygenation (ECMO). A large meta-analysis study suggests that 29% of patients require the oxygenator to be replaced during ECMO. As clots usually form in the oxygenator, the oxygenator blood volume (OXBV) decreases over time. The currently used pressure gradient as a predicator of clot formation is unreliable. OBJECTIVE: The aim of this study was to develop and validate ultrasound dilution technology in a quantitative assessment of clotting, using measurements of OXBV. METHODS: OXBV was measured using the ELSA monitor (Transonic Systems Inc., Ithaca, NY, USA) from the transit time of a saline bolus passing through the oxygenator as recorded by a sensor placed after the oxygenator. The accuracy and reproducibility (coefficient of variation [CV]) of OXBV measurement and its independence from ECMO flow was assessed in vitro in lambs and from a clinical data archive. RESULTS: The in vitro accuracy compared with volumetric measurements of OXBV of 22-134 ml at flows of 300-700 ml/min was -0.8±6.6%. For an OXBV of 355 ml at flows of 1020-7000 ml/min, accuracy was -0.4±1.6%. In 88 animal OXBV measurements, the CV was 1.49±1.12%. For an OXBV of 153 (range 42-387 ml), clinical measurements at flow ranged from 210-5960 ml/min, with a CV of 3.20±2.44 %. CONCLUSION: Dilution technology has the ability to accurately and reproducibly assess the clotting process in the oxygenator. Larger studies are needed to establish guidelines for the prediction of imminent clotting and may help to avoid unnecessary circuit changes.
Authors: Andreas Kaesler; Freya Lilli Rudawski; Mark Oliver Zander; Felix Hesselmann; Isaac Pinar; Thomas Schmitz-Rode; Jutta Arens; Ulrich Steinseifer; Johanna Charlotte Clauser Journal: Cardiovasc Eng Technol Date: 2021-09-16 Impact factor: 2.305
Authors: Rik H J Hendrix; Eva R Kurniawati; Sanne F C Schins; Jos G Maessen; Patrick W Weerwind Journal: PLoS One Date: 2022-02-02 Impact factor: 3.240