Venoarterial ECMO support was initiated in patients with systolic arterial hypotension (<80 mm Hg) or other clinical signs of cardiogenic shock, end‐organ failure, or anaerobic metabolism despite optimized supportive therapeutic measures (fluid, inotropes, intra‐aortic balloon pump). The ECMO system consisted of a pump console (Bio‐Console560, Medtronic, Fridley, MN; or Cardiohelp system, Maquet, Germany) and an inline plasma‐tight hollow‐fiber microporous membrane oxygenator (Affinity‐NTTM, Medtronic, Fridley, MN; or HLS module advanced, Maquet, Germany). All parts of the system were routinely checked every 24 hours by the on‐shift intensive care physician or an experienced perfusionist. The complete system was coated with heparin to prevent clotting. If any signs of fibrin deposits or blood clots were present or if blood oxygenation levels declined drastically, the circuit was changed. Ventilator settings were adapted to ensure lung‐protective ventilation with peak airway pressures below 25 cm H2O and respiratory tidal volumes between 6 and 8 mL/kg. The fraction of inspired oxygen on the oxygenator was adjusted to maintain a target partial pressure of oxygen of 80 to 100 mm Hg.
Affinity nttm
Manufactured by Medtronic
Sourced in Germany
Affinity‐NTTM is a lab equipment product designed for protein purification. It functions as a chromatography resin for the capture and purification of target proteins from complex mixtures.
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3 protocols using affinity nttm
1
Venoarterial ECMO for Cardiogenic Shock
2
Venoarterial ECMO After Cardiac Surgery
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We prospectively enrolled all patients undergoing venoarterial ECMO support after cardiovascular surgery between February 2002 and December 2009 at the Vienna General Hospital, a university-affiliated tertiary care center in our registry, as previously published [10 (link)]. No exclusion criteria were applied. The study protocol was reviewed and approved by the Ethics Committee of the Medical University of Vienna and conforms to the Declaration of Helsinki; all patients admitted to the Medical University of Vienna provided written consent at hospital admission. The ECMO circuit consisted of a centrifugal pump console (Bio-Console560; Medtronic, New York, NY, USA) with a hollow-fiber membrane oxygenator (Affinity-NTTM; Medtronic). An experienced perfusionist and the on-shift intensive care physician routinely serviced the ECMO circuit once daily. The circuit was changed if blood oxygenation declined sharply or if significant fibrin deposition or clots were present. Under ECMO therapy, lungs were ventilated at peak airway pressures <25 cmH2O, physiologic respiratory tidal volumes (6 to 8 ml/kg), a respiratory rate (≤10/min), and the fractional inspired oxygen (FiO2) was reduced to 0.3. FiO2 was adjusted by using the ECMO circuit to maintain a PO2 between 80 and 100 mm Hg. A more-detailed description regarding ECMO management was previously published [10 (link)].
3
Refractory Post-Cardiotomy Cardiogenic Shock Managed with ECMO
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Between January 2019 and June 2021, 35 patients with refractory PCCS were placed on Arterio-Venous (A-V) ECMO using heparin-coated circuits that consist of centrifugal pump console either Biomedicus (Medtronic) or Jostra-Maquet (Jostra Medizintechnik, Germany). These centrifugal pumps propel blood through a hollow-fiber membrane oxygenator (Affinity NTTM; Medtronic or Medos Medizintechnik AG, Stolberg, Germany). (Figure 1) (Figure 2) Our indication to implant ECMO was for patients who could not be weaned from cardiopulmonary bypass (CPB) because of refractory PCCS. Our criteria to define PCCS include failure to build up a systolic pressure above 80 mmHg, persistent metabolic acidosis in serial blood gas analysis samples (e.g. pH <7.3, lactate level >3mmol/L) in spite of using maximal support by various means including catecholamines, phosphodiesterase inhibitors, and the utilization of IABP.
ECMO was implanted while the patient was fully heparinized with activated clotting time (ACT) >350 seconds. Once ECMO flow was established heparin was antagonized, however the aim was to keep ACT ≥180 seconds and to keep partial thromboplastin time (PTT) between 50-60 seconds. The aim of ECMO implantation was reduction of inotropic
ECMO was implanted while the patient was fully heparinized with activated clotting time (ACT) >350 seconds. Once ECMO flow was established heparin was antagonized, however the aim was to keep ACT ≥180 seconds and to keep partial thromboplastin time (PTT) between 50-60 seconds. The aim of ECMO implantation was reduction of inotropic
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