A single center’s conversion from roller pump to centrifugal pump technology in extracorporeal membrane oxygenation

Abstract

Overview:

Recent advances in blood pump technology have led to an increased use of centrifugal pumps for prolonged extracorporeal membrane oxygenation (ECMO). Data from the Extracorporeal Life Support Organization confirms that many institutions have converted to centrifugal pumps after prior experience with roller pump technology. Centrifugal pump technology is more compact and may generate less heat and hemolysis than a conventional roller pump. Based on the potential advantages of centrifugal pumps, a decision was made institution-wide to convert to centrifugal pump technology in pediatric implementation of ECMO. Based on limited prior experience with centrifugal pumps, a multidisciplinary approach was used to implement this new technology. The new centrifugal pump (Sorin Revolution, Arvada, CO) was intended for ECMO support in the cardiac intensive care unit (CICU), the pediatric intensive care unit (PICU) and the neonatal intensive care unit (NICU).

Description:

The perfusion team used their knowledge and expertise with centrifugal pumps to create the necessary teaching tools and interactive training sessions for the technical specialists who consisted primarily of registered nurses and respiratory therapists. The first phase consisted of educating all personnel involved in the care of the ECMO patient, followed by patient implementation in the CICU, followed by the PICU and NICU.

Conclusion:

The institution-wide conversion took several months to complete and was well received among all disciplines in the CICU and PICU. The NICU personnel did use the centrifugal pump circuit, but decided to revert back to using the roller pump technology. A systematic transition from roller pump to centrifugal pump technology with a multidisciplinary team can ensure a safe and successful implementation.

Keywords

extracorporeal membrane oxygenation extracorporeal life support centrifugal blood pumps roller pumps intensive care unit technological advancement

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References

Tayama

Raskin

Nosé

Blood pumps. In: Gravlee

Davis

Kurusz

Utley

(eds). Cardiopulmonary bypass principles and practice. 2nd ed. Philadelphia: Lippincott Williams & Wilkins, 2000, pp. 40–41.

Palanzo

Qui

Baer

. Evolution of the extracorporeal life support circuitry. Artificial Organs 2010; 34: 869–873.

Khoshbin

Roberts

Harvey

. Poly-methyl pentene oxygenators have improved gas exchange capability and reduced transfusion requirements in adult extracorporeal membrane oxygenation. ASAIO J 2005; 51: 281–287.

Kurusz

Christman

Williams

. Roller pump induced tubing wear: another argument in favor of arterial line filtration. J ExtraCorp Technol 1980; 12: 49–59.

Kim

Yoon

. Roller pump induced tubing wear of polyvinylchloride and silicone rubber tubing: phase contrast and scanning electron microscopic studies. Artif Organs 1998; 22: 892–897.

Morgan

Codispoti

Sanger

. Superiority of centrifugal pump over roller pump in paediatric cardiac surgery: prospective randomised trial. Eur J Cardiothorac Surg 1998; 13: 526–532.

Barrett

Jaggers

Cook

. Pediatric ECMO outcomes: comparison of centrifugal versus roller blood pumps using propensity score matching. ASAIO J 2013; 59: 145–151.

Klein

Hans-Peter

Hagen

. Centrifugal pumps during routine open heart surgery improves clinical outcome. Artificial Organs 1998; 22: 326–336.

Bottrell

Bennett

Augustin

. A comparison study of haemolysis production in three contemporary centrifugal pumps. Perfusion 2014; 29: 411–416.

10.

Terry

Gunst

Melchior

. A description of a prototype miniature extracorporeal membrane oxygenation circuit using current technologies in a sheep model. J ExtraCorp Technol 2005; 37: 315–317.

11.

Jahanmir

Hesmat

Ren

. Design of a small centrifugal blood pump with hybrid magnetic bearings. ASAIO J 2006; 33: 714–726.

12.

Motomura

Maeda

Kawahito

. Development of silicone rubber hollow fiber membrane oxygenator for ECMO. Artif Organs 2003; 27: 1050–1053.

13.

Thiara

Hoel

Kristiansen

. Evaluation of oxygenators and centrifugal pumps for long-term pediatric extracorporeal membrane oxygenation. Perfusion 2007; 22: 323–326.

14.

Lawson

Ellis

Butler

. Neonatal extracorporeal membrane oxygenation devices, techniques and team roles: 2011 survey results of the United States’ Extracorporeal Life Support Organization centers. J ExtraCorp Technol 2011; 43: 236–244.

15.

ECMO Registry of the Extracorporeal Life Support Organization (ELSO), Ann Arbor, Michigan. June, 2015.

16.

Fatimah

. Simulation-based learning: just like the real thing. J Emerg Trauma Shock 2010; 3: 348–352.

17.

Lou

McLaren

Best

. Hemolysis in pediatric patients receiving centrifugal-pump extracorporeal membrane oxygenation: prevalence, risk factors, and outcomes. Crit Car Med 2014; 42: 1213–1220.

18.

Barret

Jaggers

Cook

. Outcomes of neonates undergoing extracorporeal membrane oxygenation support using centrifugal versus roller blood pumps. Ann Thorac Surg 2012; 94: 1635–1641.