The Effect of Decreasing Flow Rate on Cerebral Hemodynamics During Veno-Arterial Extracorporeal Membrane Oxygenation in Piglets

ASAIO Journal ◽  
2015 ◽  
Vol 61 (4) ◽  
pp. 448-452 ◽  
Author(s):  
Luella C. Gerrits ◽  
Arno F.J. van Heijst ◽  
Jeroen C.W. Hopman ◽  
Anton F.J. de Haan ◽  
Kian D. Liem
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Flow Rate ◽  
Cerebral Hemodynamics ◽  
Membrane Oxygenation

Impact of bypass flow rate and catheter position in veno-venous extracorporeal membrane oxygenation on gas exchange in vivo

2014 ◽  
Vol 18 (2) ◽  
pp. 128-135 ◽  
Author(s):  
Konomi Togo ◽  
Yoshiaki Takewa ◽  
Nobumasa Katagiri ◽  
Yutaka Fujii ◽  
Satoru Kishimoto ◽  
...  
Keyword(s):  
Gas Exchange ◽  
Extracorporeal Membrane Oxygenation ◽  
Flow Rate ◽  
Bypass Flow ◽  
Catheter Position ◽  
Membrane Oxygenation

scholarly journals Annexin V positive microvesicles are elevated and correlate with flow rate in patients receiving veno-arterial extracorporeal membrane oxygenation

2020 ◽  
Vol 31 (6) ◽  
pp. 884-891
Author(s):  
Patrick M Siegel ◽  
Dominik Hentschel ◽  
István Bojti ◽  
Tobias Wengenmayer ◽  
Thomas Helbing ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Flow Rate ◽  
Annexin V ◽  
Healthy Controls ◽  
Clinical Trial Registration ◽  
Cellular Activation ◽  
Membrane Oxygenation ◽  
Registration Number ◽  
Poor Outcomes ◽  
Va Ecmo

Abstract OBJECTIVES Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is used in critically ill patients requiring haemodynamic support. Microvesicles (MV) are released by activated blood cells acting as mediators of intercellular communication. We aimed to determine MV count and composition over time in patients with VA-ECMO and explore what drives MV formation. METHODS VA-ECMO patients and healthy controls were recruited prospectively, and blood was taken at different time points (day 0, 1, 3 after ECMO placement and after explantation) for MV analysis. RESULTS Annexin V positive MV were increased in patients (n = 14, mean age = 61.4 ± 9.0 years, 11 males, 3 females) compared to healthy controls (n = 6, Annexin V positive MV count per millilitre day 1 versus healthy controls: 2.3 × 106 vs 1.3 × 105, P < 0.001). Furthermore, patients had higher proportions of endothelial and leukocyte MV [leukocyte MV day 1 versus healthy controls (%): 32.8 vs 17.5, P = 0.001; endothelial MV day 1 versus healthy controls (%): 10.5 vs 5.5, P = 0.01]. Annexin V positive and leucocyte MV correlated with the flow rate (r = 0.46, P = 0.01). CONCLUSIONS Patients on VA-ECMO have increased levels of circulating MV and a changed MV composition. Our data support the hypothesis that MV release may be driven by higher flow rate and cellular activation in the extracorporeal circuit leading to poor outcomes in these patients. Clinical trial registration number German Clinical Trials Register—ID: DRKS00011106

Flow Rate Through Pigtail Catheter Used for Left Heart Decompression in an Artificial Model of Extracorporeal Membrane Oxygenation Circuit

ASAIO Journal ◽  
2017 ◽  
Vol 63 (3) ◽  
pp. 346-350 ◽  
Author(s):  
Won Ho Kim ◽  
Tae Hee Hong ◽  
Joung Hun Byun ◽  
Jong Woo Kim ◽  
Sung Hwan Kim ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Flow Rate ◽  
Pigtail Catheter ◽  
Left Heart ◽  
Membrane Oxygenation ◽  
Artificial Model

scholarly journals Low flow rate alters haemostatic parameters in an ex-vivo extracorporeal membrane oxygenation circuit

2019 ◽  
Vol 7 (1) ◽  
Author(s):  
Katrina K. Ki ◽  
Margaret R. Passmore ◽  
Chris H. H. Chan ◽  
Maximilian V. Malfertheiner ◽  
Jonathon P. Fanning ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Flow Rate ◽  
Ex Vivo ◽  
Low Flow ◽  
Membrane Oxygenation ◽  
Low Flow Rate

Assessment of Current Continuous Hemofiltration Systems and Development of a Novel Accurate Fluid Management System for Use in Extracorporeal Membrane Oxygenation

2008 ◽  
Vol 2 (3) ◽  
Author(s):  
Philippe Sucosky ◽  
Lakshmi P. Dasi ◽  
Matthew L. Paden ◽  
James D. Fortenberry ◽  
Ajit P. Yoganathan
Keyword(s):  
Fluid Flow ◽  
Extracorporeal Membrane Oxygenation ◽  
Flow Rate ◽  
Fluid Balance ◽  
Management System ◽  
Fluid Management ◽  
Flow Rates ◽  
Fluid Removal ◽  
Replacement Fluid ◽  
Membrane Oxygenation

Extracorporeal membrane oxygenation (ECMO) with a renal replacement therapy such as continuous venovenous hemofiltration (CVVH) provides life-saving temporary heart and lung, and renal support in pediatric and neonatal intensive care units. However, studies have shown that this approach may be hampered due to the potentially inaccurate fluid delivery∕drainage of current intravenous (IV) fluid pumps, creating potential for excessive fluid removal and undesired degrees of dehydration. We present a simple and novel accurate fluid management system capable of working against the high volume flow and pressures typically seen in patients on ECMO. The accuracy of the in-line system implemented at Children’s Healthcare of Atlanta at Egleston was assessed experimentally. The data assisted in the development of a novel automated and accurate fluid management system that functions based on a conservation of volume approach to limit the inaccuracies observed in typical clinical implementations of CVVH. IV pump accuracy measurements demonstrated a standard error in net ultrafiltrate volume removed from the patient of up to 848.5±156ml over a period of 24h, supporting previous observations of patient’s dehydration during the course of a combined ECMO-CVVH treatment and justifying the need for a new fluid management system. The innovative design of the new device is expected to achieve either a perfect or controlled negative fluid balance between the ultrafiltrate and replacement fluid flow rates. Perfect fluid balance is achieved by imposing an identical displacement on two pistons, one delivering replacement fluid to the circuit and the other draining ultrafiltrate from the hemofilter. Fluid removal is managed via a second syringe-pump system that reduces the net replacement fluid flow rate with respect to the ultrafiltration flow rate. The novel fluid management system described in this paper is expected to provide an effective method to control precisely fluid flow rates in patients on ECMO. Therefore, this device could potentially improve the efficacy of ECMO therapy and constitute a safe and effective way of reducing fluid overload in patients with cardiorespiratory failure.

scholarly journals Contradictory responses of the microcirculation to changes in extracorporeal membrane oxygenation pump flow in patients on venoarterial extracorporeal membrane oxygenation: a prospective observational study

2020 ◽  
Author(s):  
Tzu-Jung Wei ◽  
Chih-Hsien Wang ◽  
Wing-Sum Chan ◽  
Yi-Chun Yeh ◽  
Chien-Heng Lai ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Flow Rate ◽  
Tissue Perfusion ◽  
Clinical Parameters ◽  
Sublingual Microcirculation ◽  
Membrane Oxygenation ◽  
Pump Flow ◽  
Venoarterial Extracorporeal Membrane Oxygenation ◽  
Pump Flow Rate ◽  
Va Ecmo

Abstract Background: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) pump flow is crucial for maintaining tissue and organ perfusion in patients with cardiogenic shock. Determining the optimal VA-ECMO pump flow rate to maintain adequate tissue perfusion remains a clinical challenge. Poor microcirculation is associated with higher mortality in patients using VA-ECMO. Change in VA-ECMO pump flow is expected to result in a coherent change in microcirculatory blood flow, but this has not been investigated. This study investigated the effect of altering VA-ECMO pump flow rate on sublingual microcirculation. Methods: Sublingual microcirculation images were recorded using an incident dark-field hand held vital microscope at two time points, within 24 h (T1) and at 24-48 h (T2) after VA-ECMO placement. Microcirculation was measured before and 5 minutes after the changes in VA-ECMO pump flow rate at each time point. Events of changing VA-ECMO pump flow rate at T1 and T2 were divided into four groups according to changes in perfused vessel density (PVD): Group A, increased pump flow rate and increased or sustained PVD; Group B, increased pump flow rate and decreased PVD; Group C, decreased pump flow rate and increased or sustained PVD; and Group D, decreased pump flow rate and decreased PVD. The microcirculatory parameters, clinical parameters, and prognosis of each subgroup were recorded. Clinical parameters on 14-day and 28-day survivors and non-survivors were also compared. Results: A total of 25 patients were enrolled, and 38 events with good-quality images at T1 and T2 were categorized. Opposing response of microcirculation was observed in 43.5% of events when VA-ECMO pump flow rate was increased. Microcirculation was decreased in 33.4% of events when VA-ECMO pump flow rate was reduced. No predictive values in microcirculatory or macrocirculatory parameters before changing VA-ECMO pump flow rate were identified. Conclusions: Changes in VA-ECMO pump flow rate may have opposing effects on sublingual microcirculatory functional capillary density. We suggest that tandem measurements of microcirculation before and after altering the VA-ECMO pump flow may help to ensure optimal tissue perfusion.

scholarly journals High-efficiency, high-flux in-line hemofiltration using a high blood flow extracorporeal circuit

Perfusion ◽  
2019 ◽  
Vol 35 (4) ◽  
pp. 351-355
Author(s):  
Alison Grazioli ◽  
Sanjeev R Shah ◽  
Joseph Rabin ◽  
Rashmikant Shah ◽  
Ronson J Madathil ◽  
...  
Keyword(s):  
Blood Flow ◽  
Renal Replacement Therapy ◽  
Extracorporeal Membrane Oxygenation ◽  
Replacement Therapy ◽  
Flow Rate ◽  
High Efficiency ◽  
Membrane Surface ◽  
Blood Flow Rate ◽  
Membrane Surface Area ◽  
Membrane Oxygenation

The ability of current renal replacement therapy modalities to achieve rapid solute removal is limited by membrane surface area and blood flow rate. Extracorporeal membrane oxygenation offers high blood flow and hemodynamic support that may be harnessed to overcome limitations in traditional renal replacement therapy. Using an extracorporeal membrane oxygenation circuit, we describe a high blood flow, high-efficiency hemofiltration technique using in-line hemofilters (hemoconcentrators) and standard replacement fluid to enhance solute clearance. Using this approach and a total of 5 L of replacement volume per treatment, creatinine (Cr) clearances of 8.3 L/hour and 11.2 L/hour using one and two hemoconcentrators, respectively, were achieved. With use of a high blood flow rate of up to 5 L/min, this hemofiltration technique can potentially offer clearance of 30 times that of continuous renal replacement therapy and of 6 times that of hemodialysis which may expand the ability to remove substances traditionally not considered removable via existing extracorporeal therapies.

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