Thrombosis in Extracorporeal Membrane Oxygenation (ECMO) Circuits

Area of Science:

• Cardiovascular Research
• Biomedical Engineering
• Pediatric Critical Care

Background:

• Thrombosis is a common and serious complication in extracorporeal membrane oxygenation (ECMO) circuits.
• Understanding thrombus characteristics is crucial for improving patient safety and circuit longevity.

Purpose of the Study:

• To characterize the location, extent, structure, and clinical implications of thrombi within explanted ECMO circuits.
• To identify specific thrombus types and locations associated with ECMO circuit dysfunction and adverse patient events.

Main Methods:

• Examination of 53 ECMO circuits from 46 pediatric patients for visible thrombi.
• Histologic, immunofluorescence, and immunohistochemical analysis of collected thrombus samples.
• Correlation of thrombus findings with clinical data and ECMO circuit performance.

Main Results:

• Thrombi were present in 81% of analyzed ECMO circuits.
• Clinically significant thrombi included oxygenator membrane surface (11%), arterial tubing (30%), and venous tubing/connector (26%) thrombi.
• Oxygenator thrombi led to failure and replacement; arterial thrombi caused major vascular events; venous thrombi embolized, increasing hemolysis.
• Antifibrinolytic therapy was linked to increased pump thromboembolism risk.

Conclusions:

• Post-use ECMO circuit examination is a valuable quality improvement tool.
• Identifying thrombus patterns can predict circuit issues and patient risk.
• Findings suggest areas for improving ECMO circuit design and management to mitigate thrombosis.