32, 3
A decline in measured oxygen transfer over a run is the EXPECTED trajectory rather than a finding, so it is not on its own a trigger for exchange. And within the current generation of adult devices there is no evidence that the choice of oxygenator changes gas exchange or haemocompatibility at the level of the patient, which means device selection should turn on local familiarity, circuit compatibility and supply rather than on claimed performance differences.
Head-to-head between the four devices, with propensity weighting and adjustment for APACHE II and baseline Charlson Comorbidity Index
DOI 10.1097/MAT.0000000000002805; PMID 42574647
Four contemporary adult oxygenators: Medtronic Nautilus and Nautilus Smart, Getinge Heart Lung Support Module Advanced 7.0, Getinge Quadrox-iD Adult, and Fresenius X-Lung
ABSTRACT READ ONLY; full text not retrieved. Single centre and retrospective; propensity weighting does not remove confounding by indication in device selection. THE AUTHORS STATE THEY HAD NO DIRECT MEASUREMENT OF GAS TRANSFER and call for prospective multicentre work incorporating direct measurements — so this is an absence of a detectable difference at the level of the patient, not a demonstration of equivalence at the level of the membrane. NOTE ADDED BY THIS BOOK AND NOT STATED BY THE AUTHORS: measured oxygen transfer across a membrane falls when the inlet blood arrives better oxygenated, so both the decline over the course of support (patients recover and their venous saturation rises) and the venovenous-versus-venoarterial difference are partly predicted by that arithmetic alone and cannot be read straightforwardly as device or configuration effects.
No statistically significant difference in oxygen transfer across the membrane between oxygenator types after adjustment for covariates. OXYGEN TRANSFER DECLINED OVER TIME DURING SUPPORT (p under 0.001) and was higher on venovenous than on venoarterial ECMO (p equal to 0.002). A higher Charlson Comorbidity Index was associated with lower oxygen transfer (p equal to 0.046). Coagulation and haemolysis markers were comparable across all devices. The authors conclude that current-generation oxygenators provide similar gas exchange efficiency and haemocompatibility in clinical practice.
282 adults receiving venovenous or venoarterial ECMO at a single centre between January 2020 and December 2023