Predictors of Circuit Health in Neonatal Patients Receiving Extracorporeal Membrane Oxygenation (ECMO)

To identify predictors of neonatal ECMO circuit health, a retrospective analysis of circuit functional pressure and flow parameters as well as infant clotting values were collected 48 h prior to and 24 h post circuit change. Circuit impairment was defined as need for partial or total circuit change. Statistical analysis used multivariate statistics and non-parametric Mann–Whitney U-test with possible non-normality of measurements. A total of 9764 ECMO circuit and clotting values in 21 circuits were analyzed. Circuit delta-P mean, and maximum values increased from 8.62 to 48.59 mmHg (p \u3c 0.011) and 16.00 to 53.00 mmHg (p \u3c 0.0128) respectively prior to need for circuit change. Maximum and mean Pump Flow Revolutions per minute (RPM) increased by 75% (p \u3c 0.0043) and 81% (p \u3c 0.0057), respectively. Mean plasma free hemoglobin (pfHb) increased from 26.45 to 76.00 mg/dl, (p \u3c 0.0209). Sweep, venous pressure, and clotting parameters were unaffected. ECMO circuit delta-P, RPM, and pfHb were early predictors of circuit impairment

Assessing Opportunities to Improve Sedation/Analgesia Use in Neonatal Patients on ECMO

Background: Sedation is used during ECMO to prevent agitation. Analgesia is used to dampen pain perception as neonatal procedural pain related stress is associated with later altered neurodevelopment with poorer perceptual reasoning and visual perception. Common sedatives/analgesics used during ECMO are opiates and benzodiazepines. Studies have shown that lipophilic drugs such as Fentanyl and Midazolam are significantly sequestered in the circuit suggesting opportunities to improve delivery for pain. Hypothesis and Methods: We hypothesized opportunities to improve sedation/analgesia drug treatment in ECMO patients. Using a retrospective analysis of all neonatal patients receiving ECMO between 2015-2020, we aimed to assess the relationship between sedative/analgesia type and dose and clinical complications. We identified patient demographics, medication type, dose used, days to wean, length of hospital stay, mortality, medical complications at discharge and MRI results. Results: 49 patients were included, mean gestational age 37.6 wks ±3.6. Seventeen (35%) infants died. Race was not associated with mortality. All patients received Fentanyl and Midazolam with one patient who also received Morphine infusion. Fentanyl and Midazolam dose during ECMO was associated with risk for oxygen at discharge 296 vs 517 mcg/kg/days for Fentanyl (p=0.04), and 358 vs 2598 mcg/kg/days for Midazolam (p=0.002) as well as need for feeding tube at discharge 272 vs 420 mcg/kg/days for Fentanyl (p=0.049) and 1.03 vs 1.60 mg/kg/days for Midazolam(p=0.04). Risk for abnormal MRI was increased with Fentanyl ECMO dose exposure (p=0.016). Male gender was associated with greater fentanyl dose exposure by 27% (p=0.038). Conclusion: Fentanyl and Midazolam increased dose exposure was associated with increased risk for later neurological clinical complications in infants undergoing ECMO. Further studies are needed to assess serum drug concentrations in ECMO patients to better understand development of drug tolerance, circuit sequestration and dose exposure to adjust the therapeutic range of sedation and analgesia use

Predictors of Circuit Health in Neonatal Patients Receiving Extracorporeal Membrane Oxygenation

Background: Clot formation is the most common mechanical complication of ECMO and can lead to oxygenator failure and the need for subsequent circuit changes. The goals of this study were to identify early indicators of circuit failure to alert providers of ECMO circuit health. Hypothesis: We hypothesized that patient-specific circuit parameters can predict circuit health to identify risk of early circuit failure in neonate ECMO patients. Using a retrospective chart analysis ECMO flow parameters and clotting factors were identified during the 48 hours prior to ECMO circuit change through the 24 hours post circuit change. Statistical analysis included non-parametric Mann-Whitney U-test. Results: There was a significant increase in maximum and mean delta-p prior to need for circuit changes compared to those without (p=0.011 and p=0.0128 respectively) and a significant increase in the maximum RPM and mean RPM (p=0.0043 and p=0.0057 respectively). There was a significant increase in mean plasma free hemoglobin (hgb) (p=0.0209); however, the maximum plasma free hgb was not significant (p=0.0569). No differences were notable for sweep and venous pressure in those with circuit changes. Furthermore, clotting parameters were not found to be significant, including ACT, heparin, platelet count, fibrinogen, PT, PTT, INR, AT III (%), anti-Xa. Conclusion: Changes in Delta-p, RPM, and flow may be valuable predictors of early circuit impairment in neonates on ECMO. Sweep, venous pressure and clotting parameters may not reliable predictors of circuit health.https://scholarscompass.vcu.edu/gradposters/1167/thumbnail.jp