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Pediatric ECMO outcomes: comparison of centrifugal versus roller blood pumps using propensity score matching
Cindy S Barrett1, James J Jaggers, E Francis Cook
1Department of Cardiology, Children's Hospital Colorado and Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO 80045, USA. cindy.barrett@childrenscolorado.org
Insights
Centrifugal pumps in pediatric extracorporeal membrane oxygenation (ECMO) are linked to higher risks of complications like hemolysis and acute kidney injury. However, survival rates were similar compared to roller pumps in this study.
Area of Science:
- Pediatric critical care medicine
- Cardiovascular support technologies
- Extracorporeal Life Support Organization (ELSO) registry analysis
Background:
- Centrifugal blood pumps are increasingly used for pediatric extracorporeal membrane oxygenation (ECMO).
- Venoarterial (VA) ECMO is a critical support method for pediatric patients with severe cardiorespiratory failure.
- Understanding pump-related morbidities is crucial for optimizing pediatric ECMO care.
Purpose of the Study:
- To compare survival and ECMO-related morbidities between centrifugal and roller blood pumps in pediatric VA ECMO.
- To identify specific complications associated with different pump types in this vulnerable population.
- To inform clinical decisions regarding blood pump selection for pediatric ECMO.
Main Methods:
- Propensity score matching (Greedy 1:1) of pediatric patients (<18 years) on VA ECMO from 2007-2009 using ELSO registry data.
- Inclusion of 548 patients (274 per group) after matching, comparing centrifugal and roller pump support.
- Statistical analysis of pre-ECMO characteristics, in-ECMO morbidities, and survival to hospital discharge.
Main Results:
- Centrifugal pumps were associated with significantly increased odds of hemolysis, hyperbilirubinemia, need for inotropic support, metabolic alkalosis, and acute renal failure.
- Odds ratios for complications ranged from 1.54 to 5.48, with significant confidence intervals.
- Survival to hospital discharge did not differ significantly between children supported with centrifugal versus roller pumps.
Conclusions:
- In a propensity score-matched cohort, pediatric patients on VA ECMO supported by centrifugal pumps experienced higher rates of specific ECMO-related complications.
- Despite increased morbidities, centrifugal pump use did not negatively impact survival to hospital discharge.
- Further research may explore strategies to mitigate centrifugal pump-associated complications in pediatric ECMO.
Abstract:
Centrifugal blood pumps are being increasingly utilized in children supported with extracorporeal membrane oxygenation (ECMO). Our aim was to determine if survival and ECMO-related morbidities in children supported with venoarterial (VA) ECMO differed by blood pump type.Children aged less than 18 years who underwent VA ECMO support from 2007 to 2009 and reported to the Extracorporeal Life Support Organization registry were propensity score matched (Greedy 1:1 matching) using pre-ECMO characteristics.A total of 2,656 (centrifugal = 2,231, roller = 425) patients were identified and 548 patients (274 per pump type) were included in the propensity score-matched cohort. Children supported with centrifugal pumps had increased odds of hemolysis (odds ratio [OR], 4.03 95% confidence interval [CI], 2.37-6.87), hyperbilirubinemia (OR, 5.48; 95% CI, 2.62-11.49), need for inotropic support during ECMO (OR, 1.54; 95% CI, 1.09-2.17), metabolic alkalosis (blood pH > 7.6) during ECMO (OR, 3.13; 95% CI, 1.49-6.54), and acute renal failure (OR, 1.61; 95% CI, 1.10-2.39). Survival to hospital discharge did not differ by pump type.In a propensity score-matched cohort of pediatric ECMO patients, children supported with centrifugal pumps had increased odds of ECMO-related complications. There was no difference in survival between groups.
