Original Articles

Novel Applications of Modified Ultrafiltration and Autologous Priming Techniques to Reduce Blood Product Exposure on ECMO

^* Cardiovascular Perfusion Services, Mayo Clinic, Rochester, Minnesota
^† Division of Anesthesiology and Critical Care, Mayo Clinic, Rochester, Minnesota
^‡ Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota

Address correspondence to: James R. Neal, CCP, Cardiovascular Perfusion Services, Division of Cardiovascular Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905. E-mail: neal.james@mayo.edu

Received: 20 November 2015
Accepted: 3 March 2016

Abstract

Patients needing the assistance of extracorporeal membrane oxygenation (ECMO) are at risk of hemodilution and, in some instances, may require exposure to large amounts of allogeneic blood products. Patient outcomes can be improved by taking steps to reduce transfusions and hemodilution. Currently, modified ultrafiltration (MUF) is used across the world to reduce hemodilution after cardiopulmonary bypass (CPB). Another common technique during bypass initiation is autologous priming. By applying modified versions of these techniques, ECMO patients may potentially benefit. Usually, patients requiring immediate transition from CPB to ECMO are not stable enough to tolerate MUF. Through alterations of the CPB and ECMO circuit tubing, MUF can be performed once on ECMO. Another technique to potentially lower the transfusion requirements for ECMO patients is a complete circuit blood transfer during an ECMO circuit exchange. While selective component changes are preferred if possible, occasionally a complete circuit change must be done. To minimize hemodilution or prevent priming with blood products, the original ECMO circuit's blood can be transferred to the new ECMO circuit before connecting to the patient. Both of these techniques, in our opinion, helped to reduce the number of transfusions that our ECMO patients have seen during these critical time periods.