scholarly journals Pressure and flow properties of cannulae for extracorporeal membrane oxygenation I: return (arterial) cannulae

Perfusion ◽  
2019 ◽  
Vol 34 (1_suppl) ◽  
pp. 58-64 ◽  
Author(s):  
Lars Mikael Broman ◽  
Lisa Prahl Wittberg ◽  
C Jerker Westlund ◽  
Martijn Gilbers ◽  
Luisa Perry da Câmara ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Newtonian Fluid ◽  
Whole Blood ◽  
Cylindrical Tube ◽  
Fourth Power ◽  
Pressure Flow ◽  
Blood Flows ◽  
Membrane Oxygenation ◽  
Poiseuille's Law ◽  
Poiseuille’S Law

Adequate extracorporeal membrane oxygenation support in the adult requires cannulae permitting blood flows up to 6-8 L/minute. In accordance with Poiseuille’s law, flow is proportional to the fourth power of cannula inner diameter and inversely proportional to its length. Poiseuille’s law can be applied to obtain the pressure drop of an incompressible, Newtonian fluid (such as water) flowing in a cylindrical tube. However, as blood is a pseudoplastic non-Newtonian fluid, the validity of Poiseuille’s law is questionable for prediction of cannula properties in clinical practice. Pressure–flow charts with non-Newtonian fluids, such as blood, are typically not provided by the manufacturers. A standardized laboratory test of return (arterial) cannulae for extracorporeal membrane oxygenation was performed. The aim was to determine pressure–flow data with human whole blood in addition to manufacturers’ water tests to facilitate an appropriate choice of cannula for the desired flow range. In total, 14 cannulae from three manufacturers were tested. Data concerning design, characteristics, and performance were graphically presented for each tested cannula. Measured blood flows were in most cases 3-21% lower than those provided by manufacturers. This was most pronounced in the narrow cannulae (15-17 Fr) where the reduction ranged from 27% to 40% at low flows and 5-15% in the upper flow range. These differences were less apparent with increasing cannula diameter. There was a marked disparity between manufacturers. Based on the measured results, testing of cannulae including whole blood flows in a standardized bench test would be recommended.

A Case Report of Combat Blast Injury Requiring Combat Casualty Care, Far-Forward ECMO, Air Transport, and All Levels of Military Critical Care

2021 ◽  
Author(s):  
Lydia C Piper ◽  
Jason J Nam ◽  
John P Kuckelman ◽  
Valerie G Sams ◽  
Jeffry D DellaVolpe ◽  
...  
Keyword(s):  
Critical Care ◽  
Extracorporeal Membrane Oxygenation ◽  
Whole Blood ◽  
Operative Management ◽  
Blast Injury ◽  
Esophageal Injury ◽  
Resuscitative Thoracotomy ◽  
Membrane Oxygenation ◽  
Combat Casualty ◽  
Cord Injury

ABSTRACT We describe a 34-year-old soldier who sustained a blast injury in Syria resulting in tracheal 5 cm tracheal loss, cervical spine and cord injury with tetraplegia, multiple bilateral rib fractures, esophageal injury, traumatic brain injury, globe evisceration, and multiple extremity soft tissue and musculoskeletal injuries including a left tibia fracture with compartment syndrome. An emergent intubation of the transected trachea was performed in the field, and the patient was resuscitated with whole blood prehospital. During transport to the Role 2, the patient required cardiopulmonary resuscitation for cardiac arrest. On arrival, he underwent a resuscitative thoracotomy and received a massive transfusion exclusively with whole blood. A specialized critical care team transported the patient to the Role 3 hospital in Baghdad, and the DoD extracorporeal membrane oxygenation (ECMO) team was activated secondary to his unstable airway and severe hypoxia secondary to pulmonary blast injury. The casualty was cannulated in Baghdad approximately 40 hours after injury with bifemoral cannulae in a venovenous configuration. He was transported from Iraq to the U.S. Army Institute of Surgical Research Burn Center in San Antonio without issue. Extracorporeal membrane oxygenation support was successfully weaned, and he was decannulated on ECMO day 4. The early and en route use of venovenous ECMO allowed for maintenance of respiratory support during transport and bridge to operative management and demonstrates the feasibility of prolonged ECMO transport in critically ill combat casualties.

scholarly journals Fresh and Citrated Whole-Blood Specimens Can Produce Different Thromboelastography Results in Patients on Extracorporeal Membrane Oxygenation

2013 ◽  
Vol 140 (2) ◽  
pp. 165-169 ◽  
Author(s):  
Elizabeth A. Gilman ◽  
Christopher D. Koch ◽  
Paula J. Santrach ◽  
Gregory J. Schears ◽  
Brad S. Karon
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Whole Blood ◽  
Membrane Oxygenation ◽  
Blood Specimens

scholarly journals A novel veno-arteriovenous extracorporeal membrane oxygenation with double pump for the treatment of Harlequin syndrome

Perfusion ◽  
2020 ◽  
Vol 35 (1_suppl) ◽  
pp. 65-72 ◽  
Author(s):  
Carlo Contento ◽  
Andrea Battisti ◽  
Bruno Agrò ◽  
Marina De Marco ◽  
Alessandra Iaiza ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Blood Clot ◽  
The Body ◽  
Clotting Factor ◽  
Centrifugal Pumps ◽  
Blood Flows ◽  
Membrane Oxygenation ◽  
Venoarterial Extracorporeal Membrane Oxygenation ◽  
Harlequin Syndrome ◽  
Venovenous Extracorporeal Membrane Oxygenation

Objectives: The Harlequin syndrome is a complication observed in patients receiving peripheral venoarterial extracorporeal membrane oxygenation. This condition is defined as a critical variation in the oxygen saturation between the upper and the lower part of the body deriving from a poor lung function. Methods: Between July 2018 and November 2019, a total of 60 patients (42 men and 18 women; mean age 57.4 ± 10.0 years; range = 28-71 years) underwent peripheral venoarterial extracorporeal membrane oxygenation in our center. Harlequin syndrome was identified in eight cases (six men and two women; 13.3%) of the 60 venoarterial extracorporeal membrane oxygenation–supported patients. As a result of the Harlequin syndrome, all these patients required conversion to veno-arteriovenous extracorporeal membrane oxygenation. Control and monitoring of the blood flows of the return cannulae were performed using two centrifugal pumps, one for each inlet line, according to the patient requirements to achieve optimum hemodynamic and oxygenation. Results: Mean duration of veno-arteriovenous extracorporeal membrane oxygenation support was 5.3 ± 1.4 days. Seven patients (87.5%) were switched to venovenous extracorporeal membrane oxygenation, and after 13.5 ± 2.7 days, those patients were totally weaned from extracorporeal membrane oxygenation support. One patient (12.5%) had an improvement in the pulmonary function, but the cardiac function was poor. This patient was switched to venoarterial extracorporeal membrane oxygenation, and after 10 days, the patient was completely weaned from extracorporeal membrane oxygenation support. Conclusion: The use of a secondary centrifugal pump to manage the blood flow directed to the internal jugular vein, in the veno-arteriovenous extracorporeal membrane oxygenation setup, allows the reduction in the risk of blood clot formation, clotting factor consumption, and pulmonary embolism when compared to the use of an external clamp.

scholarly journals Pressure and flow properties of cannulae for extracorporeal membrane oxygenation II: drainage (venous) cannulae

Perfusion ◽  
2019 ◽  
Vol 34 (1_suppl) ◽  
pp. 65-73 ◽  
Author(s):  
Lars Mikael Broman ◽  
Lisa Prahl Wittberg ◽  
C Jerker Westlund ◽  
Martijn Gilbers ◽  
Luisa Perry da Câmara ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Life Support ◽  
Product Information ◽  
Large Diameter ◽  
Hydrodynamic Performance ◽  
Manufacturing Companies ◽  
Flow Properties ◽  
Pressure Flow ◽  
Membrane Oxygenation ◽  
Flow Charts

The use of extracorporeal life support devices such as extracorporeal membrane oxygenation in adults requires cannulation of the patient’s vessels with comparatively large diameter cannulae to allow circulation of large volumes of blood (>5 L/min). The cannula diameter and length are the major determinants for extracorporeal membrane oxygenation flow. Manufacturing companies present pressure-flow charts for the cannulae; however, these tests are performed with water. Aims of this study were 1. to investigate the specified pressure-flow charts obtained when using human blood as the circulating medium and 2. to support extracorporeal membrane oxygenation providers with pressure-flow data for correct choice of the cannula to reach an optimal flow with optimal hydrodynamic performance. Eighteen extracorporeal membrane oxygenation drainage cannulae, donated by the manufacturers (n = 6), were studied in a centrifugal pump driven mock loop. Pressure-flow properties and cannula features were described. The results showed that when blood with a hematocrit of 27% was used, the drainage pressure was consistently higher for a given flow (range 10%-350%) than when water was used (data from each respective manufacturer’s product information). It is concluded that the information provided by manufacturers in line with regulatory guidelines does not correspond to clinical performance and therefore may not provide the best guidance for clinicians.

Evaluation of an ex-vivo neonatal extracorporeal membrane oxygenation circuit on antiepileptic drug sequestration

Perfusion ◽  
2021 ◽  
pp. 026765912110281
Author(s):  
Shamir N Kalaria ◽  
Omayma A Kishk ◽  
Mathangi Gopalakrishnan ◽  
Dayanand N Bagdure
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Antiepileptic Drug ◽  
Centrifugal Pump ◽  
Normal Saline ◽  
Whole Blood ◽  
Ex Vivo ◽  
Ecmo Circuit ◽  
Human Whole Blood ◽  
Membrane Oxygenation ◽  
Drug Sequestration

Antiepileptic dosing information used to manage neonatal patients receiving extracorporeal membrane oxygenation (ECMO) is limited. The objective of this study is to quantify the extent of sequestration of various antiepileptic drugs using an ex-vivo neonatal ECMO circuit. Two neonatal closed-loop ECMO circuits were prepared using a Rotaflow centrifugal pump, custom polyvinylchloride tubing and a Quadrox-i Neonatal membrane oxygenator. After 5 minutes of circuit priming and stabilization with normal saline/albumin or expired human whole blood, single boluses of levetiracetam (200 mg), lacosamide (20 mg), and phenytoin (200 mg) were injected into the circuit. To account for spontaneous drug degradation, two polyvinylchloride beakers were filled with normal saline/albumin or expired human whole blood and equivalent antiepileptic drug doses were prepared. Simultaneous pharmacokinetic samples were collected from the control solution and the pre-centrifugal pump, pre-oxygenator, and post-oxygenator sampling ports from each circuit. Similar drug recovery profiles were observed among the three sampling sites investigated. Percent drug sequestration after a 24-hour circuit flow period was relatively similar between the two different circuits and ranged between 5.5%–13.2% for levetiracetam, 18.4%–22.3% for lacosamide, and 24.5%–30.2% for phenytoin. A comparison at 12 and 24 hours demonstrated similar percent drug sequestration across all three drugs in each circuit. Percent drug sequestrations for levetiracetam and lacosamide were less than 20% and for phenytoin were as high as 30% based on the sampling following single bolus dose administration into a neonatal ECMO circuit. Careful consideration of patient clinical status should be taken in consideration when optimizing antiepileptic therapy in neonates receiving ECMO.

Pressure–flow relationship of cannulae for extracorporeal membrane oxygenation

Perfusion ◽  
2019 ◽  
Vol 35 (3) ◽  
pp. 271-272
Author(s):  
Marco Giani ◽  
Alberto Lucchini ◽  
Roberto Rona ◽  
Salvatore Capalbi ◽  
Giacomo Grasselli ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Pressure Flow ◽  
Membrane Oxygenation ◽  
Relationship Of

Pressure and flow properties of dual-lumen cannulae for extracorporeal membrane oxygenation

Perfusion ◽  
2020 ◽  
Vol 35 (8) ◽  
pp. 736-744
Author(s):  
Lars Mikael Broman ◽  
C Jerker Westlund ◽  
Martijn Gilbers ◽  
Luisa Perry da Câmara ◽  
Lisa Prahl Wittberg ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Standardized Testing ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Flow Properties ◽  
Drainage Flow ◽  
Pressure Flow ◽  
The Public ◽  
Membrane Oxygenation ◽  
Flow Charts

Introduction: In the last decade, dual-lumen cannulae have been increasingly applied in patients undergoing extracorporeal life support. Well-performing vascular access is crucial for efficient extracorporeal membrane oxygenation support; thus, guidance for proper cannulae size is required. Pressure–flow charts provided by manufacturers are often based on tests performed using water, rarely blood. However, blood is a shear-thinning and viscoelastic fluid characterized by different flow properties than water. Methods: We performed a study evaluating pressure–flow curves during standardized conditions using human whole blood in two commonly available dual-lumen cannulae used in neonates, pediatric, and adult patients. Results were merged and compared with the manufacturer’s corresponding curves obtained from the public domain. Results: The results showed that using blood as compared with water predominantly influenced drainage flow. A 10-80% higher pressure-drop was needed to obtain same drainage flow (hematocrit of 26%) compared with manufacturer’s water charts in 13-31 Fr bi-caval dual-lumen cannulae. The same net difference was found in cavo-atrial cannulae (16-32 Fr), where a lower drainage pressure was required (Hct of 26%) compared with the manufacturer’s test using blood with an Hct of 33%. Return pressure–flow data were similar, independent whether pumping blood or water, to the data reported by manufacturers. Conclusion: Non-standardized testing of pressure–flow properties of extracorporeal membrane oxygenation dual-lumen cannulae prevents an adequate prediction of pressure–flow results when these cannulae are used in patients. Properties of dual-lumen cannulae may vary between sizes within same cannula family, in particular concerning the drainage flow.

Whole blood activated clotting time in infants during extracorporeal membrane oxygenation

1990 ◽  
Vol 18 (5) ◽  
pp. 494-498 ◽  
Author(s):  
THOMAS P. GREEN ◽  
BARBARA ISHAM-SCHOPF ◽  
ROBIN H. STEINHORN ◽  
CLARK SMITH ◽  
RICHARD J. IRMITER
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Whole Blood ◽  
Clotting Time ◽  
Membrane Oxygenation ◽  
Activated Clotting Time
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