Does an Open Recirculation Line Affect the Flow Rate and Pressure in a Neonatal Extracorporeal Life Support Circuit With a Centrifugal or Roller Pump?

2016 ◽  
Vol 41 (1) ◽  
pp. 70-75 ◽  
Author(s):  
Shigang Wang ◽  
Shannon B. Spencer ◽  
Karl Woitas ◽  
Kristen Glass ◽  
Allen R. Kunselman ◽  
...  
Keyword(s):  
Flow Rate ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Roller Pump

Blood Platelet Activation and Membrane Glycoprotein Changes during Extracorporeal Life Support (Ecls). In Vitro Studies

1995 ◽  
Vol 18 (6) ◽  
pp. 315-321 ◽  
Author(s):  
K. Mellgren ◽  
L.G. Friberg ◽  
T. Hedner ◽  
G. Mellgren ◽  
H. Wadenvik
Keyword(s):  
Centrifugal Pump ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Membrane Receptors ◽  
Receptor Protein ◽  
Roller Pump ◽  
Platelet Surface ◽  
Continuous Increase ◽  
Significant Difference

The aim of this study was to evaluate an in vitro model for investigation of platelet function parameters in an extracorporeal system. Two different perfusion pumps were compared, a roller pump (Polystan) and a centrifugal pump (Biomedicus). A continuous increase in glycoprotein (GP)1b-negative platelets was observed in both circuits. A marked increase of plasma β-thromboglobulin thromboglobulin concentration and a decrease of the intracellular pool of serotonin was observed, indicating a marked release of alpha as well as of dense granules. The plasma concentration of glycocalicin increased in parallel with a reduced platelet surface expression of GP1b, suggesting that the loss of GP1b is caused by proteolysis rather than by a downregulation of this receptor protein. It is concluded that ECLS results in a pronounced platelet degranulation and causes changes of important membrane receptors which might explain some of the bleeding problems observed in patients treated with ECLS. No significant difference was noted between the roller pump and the centrifugal pump. Trial of strategies, e.g. protease inhibitors and nitric oxide to revert this untoward effect of ECLS are highly warranted.

scholarly journals Cannula position and Bernoulli effect contribute to leg malperfusion during extracorporeal life support with femoral arterial cannulation—an in silico simulation study

2019 ◽  
Vol 29 (2) ◽  
pp. 312-319 ◽  
Author(s):  
Markus Bongert ◽  
Johannes Gehron ◽  
Marius Geller ◽  
Andreas Böning ◽  
Philippe Grieshaber
Keyword(s):  
Cardiac Output ◽  
Flow Rate ◽  
Femoral Artery ◽  
Life Support ◽  
Vascular System ◽  
Extracorporeal Life Support ◽  
Human Aorta ◽  
Limb Ischaemia ◽  
Artery Cannulation ◽  
Cannulation Site

Abstract OBJECTIVES Limb ischaemia during extracorporeal life support (ECLS) using femoral artery cannulation is frequently observed even in patients with regular vessel diameters and without peripheral arterial occlusive disease. We investigated underlying pathomechanisms using a virtual fluid-mechanical simulation of the human circulation. METHODS A life-sized model of the human aorta and major vascular branches was virtualized using 3-dimensional segmentation software (Mimics, Materialise). Steady-state simulation of different grades of cardiac output (0–100%) was performed using Computational Fluid Dynamics (CFX, ANSYS). A straight cannula [virtualized 16 Fr (5.3 mm)] was inserted into the model via the left common femoral artery. The ECLS flow was varied between 1 and 5 l/min. The pressure boundary conditions at the arterial outlets were selected to demonstrate the downstream vascular system. Qualitative and quantitative analyses concerning flow velocity and direction were carried out in various regions of the model. RESULTS During all simulated stages of reduced cardiac output and subsequently adapted ECLS support, retrograde blood flow originating from the ECLS cannula was observed from the cannulation site up to the aortic bifurcation. Analysis of pressure showed induction of zones of negative pressure close to the cannula tip, consistent with the Bernoulli principle. Depending on cannula position and ECLS flow rate, this resulted in negative flow from the ipsilateral superficial femoral artery or the contralateral internal iliac artery. The antegrade flow to the non-cannulated side was generally greater than that to the cannulated side. CONCLUSIONS The cannula position and ECLS flow rate both influence lower limb perfusion during femoral ECLS. Therefore, efforts to optimize the cannula position and to avoid limb malperfusion, including placement of a distal perfusion cannula, should be undertaken in patients treated with ECLS.

Extracorporeal Life Support

2017 ◽  
Author(s):  
Heidi J. Dalton ◽  
Mark Davidson ◽  
Peter P. Roeleveld
Keyword(s):  
Decision Tree ◽  
Extracorporeal Membrane Oxygenation ◽  
Flow Rate ◽  
Blood Product ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Bridge To Recovery ◽  
Stepwise Approach ◽  
Definitive Therapy ◽  
Ventilator Management

Extracorporeal membrane oxygenation (ECMO) can provide support as a bridge to recovery or a bridge to more definitive therapy for patients with severe respiratory or cardiorespiratory disease. In this chapter, the criteria for ECMO are discussed and a practical decision tree for mode of ECMO (venovenous or venoarterial) is presented. A stepwise approach to initiation and management of ECMO for the patient is described, including flow rate goals, ventilator management, anticoagulation, blood product replacement, identification of recovery, weaning procedures, and specific issues relating to the two different modes of ECMO.

Hematological changes during short-term tidal flow extracorporeal life support

Perfusion ◽  
2004 ◽  
Vol 19 (6) ◽  
pp. 359-363 ◽  
Author(s):  
G W Griffith ◽  
J M Toomasian ◽  
R J Schreiner ◽  
C M Dusset ◽  
K E Cook ◽  
...  
Keyword(s):  
Life Support ◽  
Extracorporeal Life Support ◽  
Tidal Flow ◽  
Venous Drainage ◽  
Venous Access ◽  
Roller Pump ◽  
Single Lumen ◽  
Lumen Catheter ◽  
Hematological Changes

Various methods exist in the clinical practice of long-term venovenous (VV) extracorporeal life support (ECLS). Among the clinical techniques used are single venous access with a dual-lumen catheter, and cannulation of the jugular and femoral veins. Tidal flow VV ECLS uses a single-lumen catheter to achieve both venous drainage and arterialized reinfusion through a series of tubing occluders that are automated by a pump. A single venous occluder tidal flow system with a 15 Fr single-lumen cannula (n- 6) and passive filling M pump was compared to a conventional 14 Fr dual-lumen cannula (n- 7) and roller pump for four hours of VV ECLS. The changes in platelet count and plasma-free hemoglobin (pHgb) were compared. The results showed a decline in platelet counts typical of ECLS in both groups that were not significantly different from each other. A small elevation in pHgb did not rise above normal clinical levels of 15 mg/dL in either group after four hours of ECLS. Some recirculation was observed and needs to be addressed in future studies. Single occluder tidal flow ECLS may be feasible and efficacious for long-term application once recirculation is resolved and the system evaluated for long-term support.

Role of extracorporeal life support in thoracic surgery

2020 ◽  
Vol 99 (10) ◽  
Keyword(s):  
Thoracic Surgery ◽  
Extracorporeal Circulation ◽  
Life Support ◽  
Close Contact ◽  
Extracorporeal Life Support ◽  
Tumour Resection ◽  
R0 Resection ◽  
Malignant Tumours ◽  
En Bloc ◽  
Frequent Use

Besides the conventional extracorporeal circulation, commonly used in cardiac surgery, the methods of extracorporeal life support (ECLS) have been applied ever more frequently in thoracic surgery in recent years. The most commonly used modalities of such supports include extracorporeal membrane oxygenation (ECMO) and the Novalung interventional lung assist device (iLA). Successful application of ECLS has led to its more frequent use in general thoracic surgery, especially as a tool to treat hypercapnia and to ensure oxygenation and haemodynamic support. However, these methods are essential in lung transplant programmes; without their help, in most cases, it would not be possible to perform the transplantatioz or prevent the severe complications associated with critical primary graft dysfunction. Additionally, the extracorporeal circulation also facilitates the performing of specific surgical procedures that would not be feasible under standard conditions or would be associated with an inadequate risk. The application of extracorporeal life supports can fundamentally increase the level of resection when treating advanced intrathoracic malignancies that are in close contact with the heart and large vessels or even directly extend into them. Without the possibility of resecting such structures en bloc, together with the tumour, and, thus, achieving an R0 resection, these malignant tumours are often directly contraindicated for surgery or are operated non-radically, i.e. unsuccessfully. Complete tumour resection is the most important prognostic factor in the surgery.

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