Experience with the Jostra Rotaflow and QuadroxD oxygenator for ECMO

Since April 1988, we have been able to offer extracorporeal membrane oxygenation (ECMO) to patients who are either failing ventilation or who need cardiopulmonary support following cardiac surgery. During this time, we have supported 211 patients, the majority of whom have been supported with the Avecor (Affinity, Avecor Cardiovascular Inc., Minneapolis, MN, USA) spiral wound silicone-membrane oxygenator. Microporous hollow-fibre oxygenators have been used (18%) at our center. However, due to their early failure, they have necessitated conversion to a device that potentially would last for the entire ECMO course, i.e., Avecor and, subsequently, have not been used routinely until the introduction of the QuadroxD (Jostra Medizintechnik AG, Hirrlingen, Germany). The recent development of the poly-4-methyl-1-pentene diffusion membrane allows us to utilize hollow-fibre technology with a true (nonmicroporous) membrane. This has enabled us to use this low-resistance device with all its inherent advantages, without plasma leakage necessitating circuit changeover. From July 2000, we have used the QuadroxD oxygenator for our patients requiring ECMO support. This has been in patients with weights ranging from 2.16-51.0 kg (n = 23), with the longest support being for 1119 hours. This new technology has enabled us to utilize a single device for all patient sizes, so we now have an ECMO circuit set up at all times, minimizing the time required for support to be available, potentially improving survivor morbidity.