What is the difference between Centrimag (Centrifugal Magnetically Levitated Ventricular Assist Device) and ECMO (Extracorporeal Membrane Oxygenation)?

Differences Between CentriMag and ECMO

CentriMag is primarily a ventricular assist device (VAD) that provides circulatory support, while ECMO is a complete cardiopulmonary bypass system that provides both oxygenation and circulatory support. 1

Core Differences

• Primary Function:

  • ECMO: Provides both oxygenation and circulatory support through a membrane oxygenator and pump system 1
  • CentriMag: Primarily functions as a ventricular assist device focusing on circulatory support without integrated oxygenation 1

• Components:

  • ECMO: Consists of a nonpulsatile pump, membrane oxygenator, and inflow/outflow cannulas 1
  • CentriMag: Centrifugal magnetically levitated pump without an integrated oxygenator 1

• Oxygenation Capability:

  • ECMO: Directly oxygenates blood through the membrane oxygenator 1
  • CentriMag: No inherent oxygenation capability unless integrated into an ECMO circuit 1

Clinical Applications

• ECMO Applications:

  • Used for medically refractory cardiogenic shock with poor oxygenation 1
  • Provides rapid emergency biventricular support 1
  • Available in VV (venovenous) configuration for respiratory support or VA (venoarterial) configuration for cardiopulmonary support 1
  • Typically supports patients for weeks 1

• CentriMag Applications:

  • Used for temporary ventricular support in cardiogenic shock 2, 3
  • Can support patients for longer periods (up to 100 days reported without pump failure) 1
  • Can be incorporated into ECMO circuits as the pump component 1
  • More suitable for longer-term support compared to conventional ECMO 3

Technical Aspects

• Duration of Support:

  • ECMO: Generally limited to weeks of support 1
  • CentriMag: Reported support for up to 100 days without pump failure or thromboembolic events 1, 3

• Flow Rates:

  • ECMO: Typically operates at high flow rates (up to 7 L/min) 1
  • CentriMag: Can provide flows similar to ECMO but with potentially more physiological circulation patterns 4

• Configuration Options:

  • ECMO: Available in VV (respiratory support) or VA (cardiopulmonary support) configurations 1
  • CentriMag: Can be used as standalone VAD or integrated into an ECMO circuit as the pump component 1, 4

Clinical Outcomes

• Survival Rates:

  • CentriMag as VAD: Survival rates of 82% in precardiotomy cardiogenic shock, 63% in postcardiac surgery shock, and 62% in post-transplant graft failure 3
  • ECMO: Adult survival rates of 58% to hospital discharge in one study; 76% (3 days), 38% (30 days), and 24% (5 years) in another 1

• Physiological Impact:

  • CentriMag may provide more physiological circulation patterns compared to conventional ECMO, particularly in high-flow support scenarios 4
  • High-flow ECMO patients showed lower survival compared to high-flow extracorporeal VAD patients using CentriMag 4

Common Pitfalls and Considerations

• ECMO Limitations:

  • Limited durability (weeks of support) 1
  • Requires specialized perfusion support 1
  • Higher risk of vascular access complications 1
  • May be insufficient for extended support needs 1

• CentriMag Considerations:

  • Requires monitoring of blood lactate levels and CK-MB relative index as predictors of mortality 2, 5
  • Number of packed red blood cells transfused should be monitored during support 2
  • Central configuration associated with higher rates of continuous veno-venous hemofiltration need and bleeding events compared to peripheral configuration 5

In some centers, CentriMag is being used as the pump component in ECMO systems, combining the durability advantages of CentriMag with the oxygenation capabilities of ECMO 1, 4.