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Predictors of membrane oxygenator failure in pediatric extracorporeal membrane oxygenation
Makoto Ikeda1,2, Hiroomi Murayama3, Satoshi Aoki1
1Department of Anesthesiology, Aichi Children's Health and Medical Center, Obu, Aichi, Japan.
Insights
Early membrane oxygenator failure in pediatric V-A ECMO is predicted by a high blood flow to limit ratio (B/L >0.5), increased body weight, and elevated aspartate aminotransferase levels. Identifying these risk factors is crucial for patient safety.
Area of Science:
- Pediatric critical care medicine
- Cardiopulmonary support technologies
Background:
- Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) is increasingly used in pediatric patients.
- Recognizing membrane oxygenator failure is vital to prevent critical complications.
- Risk factors for membrane oxygenator exchange in pediatric V-A ECMO are not well-defined.
Purpose of the Study:
- To identify predictors of early membrane oxygenator failure in pediatric V-A ECMO.
- To evaluate risk factors associated with the need for membrane oxygenator exchange.
Main Methods:
- Retrospective cohort study of pediatric patients (<18 years) receiving V-A ECMO.
- Data collected from August 2018 to July 2023 at a Japanese tertiary-care pediatric hospital.
- Cox proportional hazards model used to assess predictors of membrane oxygenator failure within 72 hours.
Main Results:
- Membrane oxygenator failure occurred within 72 hours in 32.7% of pediatric V-A ECMO cases.
- A blood flow to limit ratio (B/L) ≥0.5 was associated with a 4.97-fold increased risk of early failure (adjusted hazards ratio, 4.97; p=0.017).
- Increased body weight and aspartate aminotransferase levels were also linked to early membrane oxygenator failure.
Conclusions:
- A B/L ratio >0.5, increased body weight, and elevated aspartate aminotransferase are independent risk factors for early membrane oxygenator failure in pediatric V-A ECMO.
- These findings highlight critical parameters for monitoring and managing V-A ECMO.
- Further prospective multicenter studies are needed to confirm these associations and improve generalizability.
Background:
Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) is increasingly utilized in pediatric patients. Failure to recognize membrane oxygenator failure can lead to critical complications due to rapid deterioration of membrane oxygenator function. Therefore, identifying the predictors for membrane oxygenator exchange is crucial. However, risk factors for membrane oxygenator exchange in pediatric V-A ECMO remain unclear; therefore, this study aimed to evaluate these risk factors.
Methods:
This retrospective cohort study enrolled all pediatric patients aged <18 years who received V-A ECMO between August 2018 and July 2023 at a tertiary-care pediatric hospital in Japan. The Cox proportional hazards model was used to evaluate the predictors of membrane oxygenator failure within 72 h after initiation.
Results:
During the study period, membrane oxygenator failure occurred in 18/55 (32.7%) children within 72 h; membrane oxygenator failure within 72 h occurred in 4/29 (13.8%) and 14/26 (53.8%) in the groups with ratio of blood flow divided by the blood flow limit of the membrane oxygenator (B/L) of <0.5 and ≥0.5, respectively (adjusted hazards ratio, 4.97 [95% confidence interval, 1.33-18.5]; p = 0.017). After adjusting for delta pressure of the oxygenator, an increase in body weight and aspartate aminotransferase levels were associated with an increase in early membrane oxygenator failure.
Conclusions:
This retrospective study demonstrated that a B/L ratio >0.5, an increase in body weight, and elevated aspartate aminotransferase were independent risk factors for early membrane oxygenator failure in pediatric V-A ECMO. However, a prospective multicenter study with an appropriate sample size is warranted to mitigate potential bias, and enhance generalizability for further investigation of the association between a B/L ratio and early membrane oxygenator failure.
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