Thrombus formation and microaggregate removal during extracorporeal membrane oxygenation

Contemporary microporous membrane oxygenators have adequate gas transfer capacity and even prolonged oxygenation is relatively atraumatic to the blood elements. However, even with adequate heparinization, thrombus formation still takes place, albeit to a lesser degree than in direct blood-gas contact devices. In this work, scanning electron microscopy of the dissected devices in the extracorporeal circuit was performed on devices used during four aorto-coronary bypasses and two cardiac valve replacements. Membrane surfaces remained free of major deposits although thrombotic material could still be observed in parts of the oxygenators and the filters. Blood filtration from the cardiotomy reservoir may be more critical as it removes surgical debris and cells injured by suction which appear to enhance thrombus formation within the oxygenator. The return line arterial filter appears more useful as a bubble remover; its value appears much diminished as microemboli do not leave the device in large quantities.