End Organ Recovery and Survival with the QuadroxD Oxygenator in Adults on Extracorporeal Membran Oxygenation


Introduction: Extracorporeal Membrane Oxygenation (ECMO) is used in selected patient with cardiogenic and/or re- spiratory shock. We report our experience with standardized management protocols and the application of the Qua- droxD oxygenator with a centrifugal pump to maximize end-organ recovery and improve survival. Methods: This is an Internal Review Board (IRB) approved, single institution retrospective study of end-organ recovery and survival in pa- tients who required ECMO for cardiogenic and/or respiratory shock between July 2010 and June 2011. Results: Sixteen patients (median age: 46 years) were initiated on either Veno-Arterial (VA) or Veno-Venous (VV) ECMO. Cardiogenic shock, acute respiratory distress syndrome (ARDS) and a combined respiratory and cardiogenic compromise were the primary indications for ECMO in 8 (50%), 5 (31%) and 3 (19%) patients respectively. The median time on ECMO was 8 days (range: 4 - 26 days). Twelve patients (75%) were successfully weaned off ECMO, of which four (25%) were bridged to a ventricular assist device (VAD) and eight (50%) were weaned to recovery. All eight patients (100%) that were weaned to recovery and two patients (50%) that were bridged to a VAD were successfully discharged from the hospital, resulting in a discharge rate of 63%. There was an improvement in pre- vs. post-ECMO AST (449 IU/L vs. 63 IU/L, p < 0.05) in 5 patients (31%) with liver injury; serum lactate (9.1 mmol/L vs. 1.9 mmol/L, p < 0.05) in 8 patients (50%); and PaO2/FiO2 ratio (87 to 161, p = 0.01) in 10 patients (62%) with ARDS. Patients with evidence of pulmonary edema (n = 8. 50%) and ARDS (n = 8, 50%) on chest X-ray showed radiographic evidence of complete resolution. Renal function was preserved in 15 patients (94%). Conclusion: ECMO using the QuadroxD oxygenator and a centrifugal pump, coupled with standardized management protocols is beneficial in carefully selected patients. Improvement or main- tenance of end-organ function is associated with successful bridge to device therapy and/or increased survival.

Share and Cite:

J. Wong, V. Siow, H. Hirose, P. Karbowski, J. Miessau, M. Baram, M. DeCaro, H. Pitcher and N. Cavarocchi, "End Organ Recovery and Survival with the QuadroxD Oxygenator in Adults on Extracorporeal Membran Oxygenation," World Journal of Cardiovascular Surgery, Vol. 2 No. 4, 2012, pp. 73-80. doi: 10.4236/wjcs.2012.24015.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] J. D. Hill, T. G. O’Brien, J. J. Murray, L. Dontigny, M. L. Bramson, J. J. Osborn and F. Gerbode, “Prolonged Extracorporeal Oxygenation for Acute Post-Traumatic Respiratory Failure (Shock-Lung Syndrome). Use of the Bramson Membrane Lung,” The New England Journal of Medicine, Vol. 286, No. 12, 1972, pp. 629-634. doi:10.1056/NEJM197203232861204
[2] D. Brodie and M. Bacchetta, “Extracorporeal Membrane Oxygenation for ARDS in Adults,” The New England Journal of Medicine, Vol. 365, No. 20, 2011, pp 1905-1914. doi:10.1056/NEJMct1103720
[3] D. Sidebotham, A. McGeorge, S. McGuinness, M. Edwards, T. Willcox and J. Beca, “Extracorporeal Membrane Oxygenation for Treating Severe Cardiac and Respiratory Disease in Adults: Part 1—Overview of Extracorporeal Membrane Oxygenation,” Journal of Cardiothoracic and Vascular Anesthesia, Vol. 23, No. 6, 2009, pp. 886-892. doi:10.1053/j.jvca.2009.08.006
[4] D. Sidebotham, A. McGeorge, S. McGuinness, M. Edwards, T. Willcox and J. Beca, “Extracorporeal Membrane Oxygenation for Treating Severe Cardiac and Respiratory failure in adults: Part 2—Technical Considerations. Journal of Cardiothoracic and Vascular Anesthesia, Vol. 24, No. 1, 2010, pp. 164-172. doi:10.1053/j.jvca.2009.08.002
[5] N. G. Smedira, N. Moazami, C. M. Golding and P. M. McCarthy, C. Apperson-Hansen, E. H. Blackstone, et al. “Clical Experience with 202 Adults Receiving Extracorporeal Membrane Oxygenation for Cardiac Failure: Survival at Five Years,” The Thoracic and Cardiovascular Surgeon, Vol. 122, No. 1, 2001, pp. 92-102. doi:10.1067/mtc.2001.114351
[6] F. Hei, S. Lou, J. Li, K. Yu, J. Liu, Z. Feng, J. Zhao, S. Hu, J. Xu, Q. Chang, Y. Liu, X. Wang, P. Liu and C. Long, “Five-Year Results of 121 Consecutive Patients Treated with Extracorporeal Membrane Oxygenation at Fu Wai Hospital,” Artifical Organs, Vol. 35, No. 6, 2011, pp. 572-578. doi:10.1111/j.1525-1594.2010.01151.x
[7] E. Khoshbin, N. Roberts, C. Harvey, D. Machin, H. Killer, G. J. Peek, A. W. Sosnowski and R. K. Firmin, “Polymethyl Pentene Oxygenators Have Improved Gas Exchange Capability and Reduced Transfusion Requirements in Adult Extracorporeal Membrane Oxygenation,” ASAIO Journal, Vol. 51, No. 3, 2005, pp. 281-287. doi:10.1097/01.MAT.0000159741.33681.F1
[8] G. J. Peek, H. M. Killer, R. Reeves, A. W. Sosnowski and R. K. Firmin, “Early Experience with a Polymethyl Pentene Oxygenator for Adult Extracorporeal Life Support,” ASAIO Journal, Vol. 48, No 5, 2002, pp. 421-480. doi:10.1097/00002480-200209000-00007
[9] J. M. Toomasian, R. J. Schreiner, D. E. Meyer, M. E. Schmidt, S. E. Hagan, G. W. Griffith, R. H. Bartlett and K. E. Cook, “A Polymethylpentene Fiber Gas Exchanger for Long-Term Extracorporeal Life Support,” ASAIO Journal, Vol. 51, 2005, pp. 390-397. doi:10.1097/01.mat.0000169111.66328.a8
[10] F. Formica, L. Avalli, A. Martino, E. Maggioni, M. Muratore, O. Ferro, A. Pesenti and G. Paolini, “Extracorporeal Membrane Oxygenation with a Poly-Methylpentene Oxygenator (QuadroxD). The Experience of a Single Italian Center in Adult Patients with Refractory Cardiogenic Shock,” ASAIO Journal, Vol. 54, No. 1, 2008, pp. 89-94. doi:10.1097/MAT.0b013e31815ff27e
[11] A. M. Horton and W. Butt, “Pump-Induced Haemolysis: Is the Constrained Vortex Pump Better or Worse Than the Roller Pump,” Perfusion, Vol. 8, No. 3, 1993, pp. 103-108.
[12] D. S. Lawson, R. Ing, I. M. Cheifetz, R. Walczak, D. Craig, S. Schulman, F. Kern, I. R. Shearer, A. Lodge and J. Jaggers, “Hemolytic Characteristics of Three Commercially Available Centrifugal Blood Pumps,” Pediatric Critical Care Medicine, Vol. 6, No. 5, 2005, pp. 573-577. doi:10.1097/01.PCC.0000163282.63992.13
[13] F. J. Mateen, R. Muralidharan, R. T. Shinohara, J. E. Parisi, G. J. Schears and E. F. Wijdicks, “Neurological Injury in Adults Treated with Extracorporeal Membrane Oxygenation,” Archives of Neurology, Vol. 68, No. 12, 2011, pp. 1543-1549. doi:10.1001/archneurol.2011.209
[14] G. J. Magovern Jr. and K. A. Simpson, “Extracorporeal Membrane Oxygenation for Adult Cardiac Support: The Allegheny Experience,” The Annals of Thoracic Surgery, Vol. 68, No. 2, 1999, pp. 655-661. doi:10.1016/S0003-4975(99)00581-0
[15] C. A. Bermudez, R. V. Rocha, Y. Toyoda, D. Zaldonis, P. L. Sappington, S. Mulukutla, O. C. Marroquin, C. Toma, J. K. Bhama and R. L. Kormos, “Extracorporeal Membrane Oxygenation for Advanced Refractory Shock in Acute and Chronic Cardiomyopathy,” The Annals of Thoracic Surgery, Vol. 92, No. 6, 2011, pp. 2125-2131. doi:10.1016/j.athoracsur.2011.07.029
[16] M. R. Hemmila, S. A. Rowe, T. N. Boules, J. Miskulin, J. W. McGillicuddy, D. J. Schuerer, J. W. Haft, F. Swaniker, S. Arbabi, R. B. Hirschl and R. H. Bartlett, “Extracorporeal Life Support for Severe Acute Respiratory Distress Syndrome in Adults,” The Annals of Thoracic Surgery, Vol. 240, No. 4, 2004, pp. 595-605.
[17] S. A. Conrad, P. T. Rycus and H. Dalton, “Extracorporeal Life Support Registry,” ASAIO Journal, Vol. 51, No. 1, 2005, pp. 4-10. doi:10.1097/01.MAT.0000151922.67540.E9
[18] D. Hoefer, E. Ruttmann, G. Poelzl, J. Kilo, C. Hoermann, R. Margreiter, G. Laufer and H. Antretter, “Outcome Evaluation of the Bridge-to-Bridge Concept in Patients with Cardiogenic Shock,” The Annals of Thoracic Surgery, Vol. 82, No. 1, 2006, pp. 28-33. doi:10.1016/j.athoracsur.2006.02.056
[19] F. D. Pagani, W. Lynch, F. Swaniker, D. B. Dyke, R. Bartlett, T. Koelling, M. Moscucci, G. M. Deeb, S. Bolling, H. Monaghan and K. D. Aaronson, “Extracorporeal Life Support to Left Ventricular Assist Device Bridge to Heart Transplant: A Strategy to Optimize Survival and Resource Utilization,” Circulation, Vol. 100, No. 19, 1999, pp. 206-210.
[20] S. S. Wang, W. J. Ko, Y. S. Chen, R. B. Hsu, N. K. Chou and S. H. Chu, “Mechanical Bridge with Extracorporeal Membrane Oxygenation and Ventricular Assist Device to Heart Transplantation,” Artifical Organs, Vol. 25, No. 8, 2001, pp. 99-602. doi:10.1046/j.1525-1594.2001.025008599.x
[21] M. C. Oz, D. J. Goldstein, P. Pepino, A. D. Weinberg, S. M. Thompson, K. A. Catanese, R. L. Vargo, P. M. McCarthy, E. A. Rose and H. R. Levin, “Screening Scale Predicts Patients Successfully Receiving Long-Term Implantable Left Ventricular Assist Devices,” Circulation, Vol. 92, No. 9, 1995, pp. 169-173. doi:10.1161/01.CIR.92.9.169

Copyright © 2021 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.