G . Budhu et al .: J Extra Corpor Technol 2024 , 56 , 211 – 215 213
Figure
1 . Connection of TPE circuit to the ECMO circuit .
Figure 2 . PFH trend for patient in case # 1 who received two rounds of plasmapheresis .
Figure 3 . PFH trend for patient in case # 2 who received one round of plasmapheresis .
In our center , if the rate of PFH rises ( doubling every 12 h ) and / or levels of 500 mg / dL are noted , the oxygenator is changed first , then cannulae are checked and repositioned if needed , subsequently , the circuit change is performed , and if PFH does not decline , TPE is considered . This approach is similar to the reported strategies for decreasing ECMO-induced hemolysis , which include circuit replacement , whether partially or wholly , exchange transfusions ( ET ) – one to two times blood volume , peripherally or centrally – and plasma exchange – one to two times plasma volume [ 6 , 15 ]. If these strategies fail , no immediate solution is available . In the cases highlighted , TPE showed early signs of benefit . The uniqueness is the use of
TPE as first-line therapy in severe ECMO-induced hemolysis after ruling out other causes and visualizing the absence of thrombi or fibrin deposition in the ECMO circuit .
TPE has been employed in severe intravascular hemolysis [ 16 ] and is similar to ET in that it can reduce PFH and TB significantly . Early implementation has been shown to prevent acute kidney injury [ 15 ].
Plasma exchange in tandem with the ECMO circuit can exchange 1.5 – 2 times the estimated plasma volume [ 15 ]. Complications associated with TPE during ECMO include access malfunction , circuit complications ( i . e ., thrombosis ), hypotension , and hypocalcemia . It is important to note that