The Journal of ExtraCorporeal Technology No 57-1 | Page 52

46 D . Rusnak et al .: J Extra Corpor Technol 2025 , 57 , 42 – 49

Figure

2 . Plasma Leakage on Polypropylene Oxygenator .

encountered , including thrombosis and high transmembrane pressures , each oxygenator had varying durations of use . EUROSETS oxygenators were notably durable , with the third EUROSETS model ( EUROSETS nr 3 ) lasting the longest at 88 days . In contrast , the Terumo Fx15 models had shorter durations , with some lasting only 1 – 2 days , primarily due to plasma leakage , which were recurrent issues with polypropylene-based oxygenators . Additionally , plasma leakage was particularly observed in the Terumo Fx15 oxygenators , necessitating more frequent replacements ( Figure 2 ). The high LDH levels and elevated free Hb , particularly with the Quadrox-i and Terumo Fx15 models , indicate the hemolytic stress and ongoing coagulation challenges faced over the course of treatment . Continuous anticoagulation was maintained throughout the ECMO support , although three Terumo oxygenators were operated without anticoagulation to manage hemorrhage risks . The tables summarize the performance parameters and laboratory parameters observed across each oxygenator type during the treatment . Parameters such as Hb , PaO 2 post-ox , PaCO 2 post-ox , and FiO 2 show the adaptation to each oxygenator ’ s functionality , with fluctuations reflecting the technical limitations and biological responses ( Table 1 ). Table 2 summarizes the highest and lowest parameters from the scientific evidence for each oxygenator models presented as mean and deviation standard values . Figure 3 presents the graphical trend of the values in the different Oxygenator models .

Discussion

This case highlights the profound challenges of managing prolonged ECMO support in a resource-limited , conflictaffected environment . Prolonged ECMO support for 259 days is an exceptional scenario , particularly in a war-torn setting

Table 2 . The highest and lowest parameters for each oxygenator models presented as mean and deviation standard values .

Lowest Pressure Drop ( DP ) ( Mean ± SD )

( mmHg )

Highest Pressure Drop ( DP ) ( Mean ± SD )

( mmHg )

Lowest Blood Flow Rate ( Mean ± SD )

( L / min )

Highest Blood Flow Rate ( Mean ± SD )

( L / min )

Lowest Air Flow

( Mean ± SD ) ( L / min )

Highest Air Flow

( Mean ± SD ) ( L / min )

Lowest pCO2 post-ox

( Mean ± SD ) ( mmHg )

Highest pCO2 post-ox

( Mean ± SD ) ( mmHg )

Lowest pO2 post-ox

( Mean ± SD ) ( mmHg )

Highest

pO2 post-ox ( Mean ± SD )

( mmHg )

Duration ( Days )

Oxygenator Model