A new phosphorylcholine-coated polymethylpentene oxygenator for extracorporeal membrane oxygenation: a preliminary experience.

Phosphorylcholine coating has a major role in the improvement of biocompatibility, durability and antihrombogenicity of the circuit for extracorporeal membrane oxygenation (ECMO). Moreover, if heparin-induced thrombocytopenia ensues, removal of all the sources of heparin is challenging if the circuit is coated with heparin. We report our preliminary experience with the new EUROSETS A.L.ONE ECMO oxygenator (Eurosets, Medolla, MO, Italy), which is aimed at providing better biocompatibility thanks to its full coating with phosphorylcholine. We retrospectively collected data on the 16 patients supported with ECMO and with the EUROSETS A.L.ONE ECMO oxygenator at San Raffaele Hospital. Mean ECMO duration was 6 ± 4 days, and 37.5% of the patients died on ECMO. Four episodes of major bleeding and three episodes of minor bleeding were recorded. The oxygenator had an excellent performance in gas exchange and the median pressure drop was 57 (26-85) mmHg at full blood flow (2.5 L/m2/min). The EUROSETS A.L.ONE ECMO oxygenator was an excellent device in our preliminary experience. Further evaluation on a larger sample is encouraged.

Infections occurring in adult patients receiving mechanical circulatory support: the two-year experience of an Italian National Referral Tertiary Care Center.

OBJECTIVE: Infection during mechanical circulatory support is a frequent adverse complication. We analyzed infections occurring in this population in a national tertiary care center, and assessed the differences existing between the setting of extracorporeal membrane oxygenation (ECMO) and ventricular assist devices (VADs). DESIGN, SETTING, AND PARTICIPANTS: An observational study was made of patients treated with ECMO or VAD in the San Raffaele Scientific Institute (Italy) between 2009 and 2011. INTERVENTIONS: None. RESULTS: Thirty-nine percent of the 46 patients with ECMO and 69% of the 15 patients with VAD developed infection. We observed a mortality rate of 36.1% during mechanical circulatory support and of 55.7% during the global hospitalization period. Although Gram-negative infections were predominant overall, patients with ECMO were more prone to develop Candida infection (29%), and patients with VAD tended to suffer Staphylococcus infection (18%). Patients with infection had longer ECMO support (p=0.03), VAD support (p=0.01), stay in the intensive care unit (p=0.002), and hospital admission (p=0.03) than patients without infection. Infection (regression coefficient=3.99, 95% CI 0.93-7.05, p=0.02), body mass index (regression coefficient=0.46, 95% CI 0.09-0.83, p=0.02), fungal infection (regression coefficient=4.96, 95% CI 1.42-8.44, p=0.009) and obesity (regression coefficient=10.47, 95% CI 1.77-19.17, p=0.02) were predictors of the duration of ECMO support. Stepwise logistic regression analysis showed the SOFA score at the time of implant (OR=12.33, 95% CI 1.15-132.36, p=0.04) and VAD (OR=1.27, 95% CI 1.04-1.56, p=0.02) to be associated with infection. CONCLUSIONS: Infection is a major challenge during ECMO and VAD support. Each mechanical circulatory support configuration is associated with specific pathogens; fungal infections play a major role.

Infections occurring in adult patients receiving mechanical circulatory support: The two-year experience of an Italian National Referral Tertiary Care Center

Objective Infection during mechanical circulatory support is a frequent adverse complication. We analyzed infections occurring in this population in a national tertiary care center, and assessed the differences existing between the setting of extracorporeal membrane oxygenation (ECMO) and ventricular assist devices (VADs). Design, setting, and participants An observational study was made of patients treated with ECMO or VAD in the San Raffaele Scientific Institute (Italy) between 2009 and 2011. InterventionsNone. ResultsThirty-nine percent of the 46 patients with ECMO and 69% of the 15 patients with VAD developed infection. We observed a mortality rate of 36.1% during mechanical circulatory support and of 55.7% during the global hospitalization period. Although Gram-negative infections were predominant overall, patients with ECMO were more prone to develop Candida infection (29%), and patients with VAD tended to suffer Staphylococcus infection (18%). Patients with infection had longer ECMO support (p=0.03), VAD support (p=0.01), stay in the intensive care unit (p=0.002), and hospital admission (p=0.03) than patients without infection. Infection (regression coefficient=3.99, 95% CI 0.93–7.05, p=0.02), body mass index (regression coefficient=0.46, 95% CI 0.09–0.83, p=0.02), fungal infection (regression coefficient=4.96, 95% CI 1.42–8.44, p=0.009) and obesity (regression coefficient=10.47, 95% CI 1.77–19.17, p=0.02) were predictors of the duration of ECMO support. Stepwise logistic regression analysis showed the SOFA score at the time of implant (OR=12.33, 95% CI 1.15–132.36, p=0.04) and VAD (OR=1.27, 95% CI 1.04–1.56, p=0.02) to be associated with infection. Conclusions Infection is a major challenge during ECMO and VAD support. Each mechanical circulatory support configuration is associated with specific pathogens; fungal infections play a major role (AU)

Objetivos La infección es una complicación asociada habitualmente al soporte circulatorio mecánico. Analizamos las infecciones manifestadas en esta población en un centro de atención terciaria italiano y evaluamos las diferencias existentes entre la oxigenación con membrana extracorpórea (ECMO) y los dispositivos de asistencia ventricular (VAD).Diseño, ámbito y participantes Se llevó a cabo un estudio observacional de pacientes tratados con ECMO o VAD en el Instituto Científico de San Raffaele (Italia) entre 2009 y 2011. Intervenciones: Ninguna. Resultados: El 39 % de los 46 pacientes tratados con ECMO y el 69 % de los 15 pacientes tratados con VAD manifestaron una infección. Observamos una tasa de mortalidad del 36,1 % durante el soporte circulatorio mecánico y del 55,7 % durante el periodo de hospitalización global. Si bien en general las infecciones gramnegativas eran las predominantes, los pacientes con ECMO fueron más propensos a desarrollar infección por Candida (29 %), mientras que los pacientes tratados con VAD tendieron a sufrir infección por Staphylococcus (18 %). Los pacientes con infección recibieron más soporte con ECMO (p=0,03), más soporte con VAD (p=0,01), permanecieron durante más tiempo en la unidad de cuidados intensivos (p=0,002), y presentaron una tasa de ingreso hospitalario más elevada (p=0,03) que los pacientes que no sufrieron una infección. Las infecciones (coeficiente de regresión=3.99, IC del 95 % 0,93-7,05, p=0,02), el índice de masa corporal