Hemolysis During Cardiac Extracorporeal Membrane Oxygenation: A Case-Control Comparison of Roller Pumps and Centrifugal Pumps in a Pediatric Population
Hemolysis During Cardiac Extracorporeal Membrane Oxygenation: A Case-Control Comparison of Roller Pumps and Centrifugal Pumps in a Pediatric Population
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DOI：
10.1097/mat.0b013e31822e2475
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发表时间：
2011-09-01
期刊：
影响因子：
4.2
通讯作者：
Fiser, Richard
中科院分区：
文献类型：
--
作者：
Byrnes, Jonathan;McKamie, Wes;Fiser, Richard
体外膜氧合（ECMO）是一种挽救生命的治疗方法，已被用于支持患有多种疾病的儿童。两种不同机制的泵已被用于产生体外流动：滚柱泵和离心泵。2007年7月至2009年7月，7例患者在ECMO期间支持Levitronix Centrimag （Centrimag组[CG]）与14例支持stockt - shiley SIII （stockt - shiley组[SSG]）的患者进行匹配。我们假设在心脏ECMO期间，通过血浆游离血红蛋白（PFH）测量的溶血在SSG中比在CG中升高。分类数据采用Fisher精确检验进行分析。采用Wilcoxon秩和和和β回归分析各组间无血浆血红蛋白差异。总体而言，经重复测量调整后，SSG患者PFH高于CG患者的几率为其两倍（优势比[OR] = 1.96, 95%可信区间[CI]: [1.15-3.34], p < 0.014）。前168 h回路失效组间差异无统计学意义（1/7 CG vs 7/14 SSG; p = 0.174）。在这组需要ECMO支持的心脏病患者中，滚动头泵支持组SSG比离心泵支持组CG发生了更多的溶血。电路寿命差异无统计学意义。这项初步研究与过去的研究形成对比，过去的研究表明，与滚柱泵相比，离心泵更容易发生溶血。ASAIO Journal 2011；57:456 - 461。
Extracorporeal membrane oxygenation (ECMO) is a lifesaving therapy, which has been used for the support of children with a broad range of diseases. Two pumps of differing mechanisms have been used to generate the extracorporeal flow: roller-head pumps and centrifugal pumps. Seven patients supported during ECMO with Levitronix Centrimag (Centrimag group [CG]) were matched to 14 patients supported with Stockert-Shiley SIII (Stockert-Shiley group [SSG]) at a single institution from July 2007 to July 2009. We hypothesized that hemolysis as measured by plasma-free hemoglobin (PFH) is elevated in the SSG versus the CG during cardiac ECMO. Categorical data were analyzed using Fisher's exact test. Plasma-free hemoglobin differences between groups were analyzed using both Wilcoxon rank sum and beta regression. Overall, SSG patients had two times the odds of having a higher PFH than CG patients adjusting for repeated measures (odds ratio [OR] = 1.96, 95% confidence interval [CI]: [1.15-3.34], p < 0.014). Differences between circuit failure in the first 168 hours did not reach statistical significance (1/7 CG vs. 7/14 SSG; p = 0.174). In this population of cardiac patients requiring ECMO support, more hemolysis occurred in the SSG, a roller-head pump supported group, when compared with the CG, a centrifugal pump supported group. Differences in circuit life did not reach statistical significance. This pilot study contrasts with past studies, which have demonstrated more hemolysis occurring with centrifugal pumps when compared with roller-head pumps. ASAIO Journal 2011; 57:456-461.