Exploring the Nexus: Gaseous Micro-embolic Activity and Pressure Drop on ALONE ECMO Oxygenator

Abstract

AbstractThe role of inlet and outlet oxygenator pressure know as pressure drop (ΔP) in the elimination of the gaseous micro-emboli activity (GMEA) remains obscured during Extracorporeal Membrane Oxygenation (ECMO) and Minimally Invasive Extracorporeal Circulation (MiECC). There is conflicting literature on the role of pressure drop in oxygenators as well as on oxygenating performance, fluid dynamics and in the role of gaseous micro-embolic activity elimination. We analyzed 14 procedures, 10 MiECC with polypropylene fibers ALONE AF oxygenator and 4 ECMO with polymethylpentene Alone ECMO Oxygenator (Eurosets, SRL, Medolla,Italy), in the central and peripheral cannulation configuration, respectively, through the use of GAMPT BCC300 for air gas micro-emboli (GME) in relation to the ΔP of Oxygenator and incidence of cavitation. The groups of MiECC, Central Cannulation VS Peripheral Cannulation reported: mean values for cavitation n° of bubbles was 330 ± 12 vs 80 ± 13; 1.5 vs 0% reported a diameter > 500 μm; GME volume was 1.51 ± 0.2 vs 0.121 ± 0.2 (μL) in the arterial line, the mean ΔP of oxygenator reported was 89 ± 11 vs 130 ± 29 mmHg. The groups of ECMO, Central Cannulation VS Peripheral Cannulation reported: mean values for cavitation n° of bubbles was 470 ± 12 vs 140 ± 17; 2.1 vs 0% reported a diameter > 500 μm; GME volume was 2.5 ± 0.5 vs 0.355 ± 0.7 (μL) in the arterial line, the mean ΔP of oxygenator reported was 88 ± 15vs 150 ± 23 mmHg. In this report, patients with low pressure drop in the oxygenator reported a statistically significant increase in GMEA in the arterial line of the circuit for each cavitation phenomenon, compared to the group with high pressure drop in the oxygenator who reported a reduced GMEA. In this report, oxygenators with higher pressure drops demonstrated a significant reduction of GMEA, however, further studies are needed to confirm these results.