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New South Wales has recently added the capability of extracorporeal membrane oxygenation to the neonatal and paediatric retrieval process and this paper describes the early experiences and protocol development for the first eight cases transported., (© 2021 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).)

Polymethylpentene (PMP) oxygenators, utilised for ECMO, are commonly believed to be resistant to plasma leakage. Whilst uncommon, plasma leakage has been previously reported with PMP fibres, both in vivo and in vitro. We describe a paediatric ECMO case during which plasma leakage occurred and oxygenator function gradually deteriorated, ultimately necessitating device replacement. To our knowledge, this is the first case of plasma leakage described using a PMP device during paediatric ECMO. Subsequent investigation is described, demonstrating that a protein coating reduces the free passage of solution across the PMP membrane., (© The Author(s) 2015.)

Background: Neonatal extracorporeal membrane oxygenation (ECMO) patients are particularly vulnerable to the effects of uncompensated insensible water loss resulting in hypernatraemia. There exists a long-standing relationship between hypernatraemia and varying degrees of cerebral dysfunction. The aim of this study is to explore the degree to which free water loss occurs across a commonly used ECMO oxygenator, the polymethylpentene (PMP) membrane Hilite 2400LT (Medos, Medizintechnik AG, Stolberg, Germany). The secondary aim is to assess to what extent the addition of heat and/or humidity ameliorates this water loss., Methods: An ECMO circuit consisting of a centrifugal pump and a Hilite 2400LT oxygenator was primed with crystalloid and albumin. Each experimental trial was carried out in triplicate, with gas flow rates of 1, 3 and 4.8 L/min being investigated. Fluid loss was assessed at six time points over a 24-hour period., Results: Water loss increased significantly from 1 to 3 L/min gas flow (p=0.05) and from 3 to 4.8 L/min gas flow (p=0.025). The mean water loss differences between the differing gas flow trials per L/min gas flow were non-significant (72.4 ±3.9 ml/24 hrs). The effect of heating the gas to 37 °C did not significantly alter water loss, whereas heat and humidity reduced water loss significantly (p=0.009)., Conclusions: Insensible water loss from a Hilite 2400LT oxygenator is approximately 72 ml/day per L/min gas flow over 24 hrs. Heating and humidifying the gas reduces the fluid loss significantly to approximately 8 ml/L/min gas flow over 24 hrs (p=0.009).

Typically, the standard practice for measuring the arterial blood carbon dioxide tension (PaCO2) during cardiopulmonary bypass (CPB) is to take intermittent blood samples for analysis by a bench blood gas analyzer. Continuous inline blood gas monitors are available but are expensive. A potential solution is the capnograph, which was evaluated by determining how accurately the carbon dioxide tension in the oxygenator exhaust gases (PECO2) predicts PaCO2. A standard capnograph monitoring line was attached to the exhaust port of the membrane oxygenator. During CPB, the capnograph reading and arterial blood temperature were recorded at the same time as routine arterial blood gases were taken. One hundred fifty-seven blood samples were collected from 78 patients. A good correlation was found between the PECO2 and the temperature corrected PaCO2 (r2 = 0.833, P < .001). There was also a reasonable degree of agreement between the PECO2 and the temperature corrected PaCO2 during all phases of CPB: accuracy (bias or mean difference between PaCO2 and PECO2) of -1.2 mmHg; precision (95% limits of agreement) of +/- 4.7 mmHg. These results suggest that oxygenator exhaust capnography may be a simple and inexpensive adjunct to the bench blood gas analyzer in continuously estimating PaCO2 of a clinically useful degree of accuracy during CPB.