Ecmo pump flow software

Using a rabbit model with duallumen cannulation, sreenan et al demonstrated a positive correlation between recirculation and ecmo pump flow r 0. Circuit flow is achieved using a pump either centrifugal or a roller pump. Viper software on the pump and then duplicate some of that. Extracorporeal life support organization elso general. Ecmo can even be initiated in outofhospital situations to allow for patient.

Setting up a minimized circuit program requires good planning. If recirculation is minimal, an ecmo circuit flow of greater than 70% of cardiac output, typically results in an s a o 2 of between 8595%, even in the absence of any pulmonary contribution to gas exchange. Intraaortic balloon pump protects against hydrostatic. Computational analysis of aortic hemodynamics during total. An intraaortic balloon pump iabp concomitant with venoarterial extracorporeal membrane oxygenation vaecmo is frequently used to support patients with refractory cardiogenic shock cs. Blood flow to the centrifugal head is augmented by the suction effect of the spinning pump head and thus. When the pump is connected to the patients arterial system but is not running, blood will flow backward through the pump and out of the patient unless the arterial line is clamped. The module also includes integrated sensors for measuring venous.

The institution of nonpulsatile vaecmo blood flow usually raises diastolic and systolic blood pressure, and may also reduce central venous pressure. It can be used for up to 30 days in cases of myocardial or respiratory failure. Blood pumps rotary continuous flow centrifugal flow pumps axial flow. Continuing education is essential for the success and safety of an extracorporeal membrane oxygenation ecmo programme. Adjust fio2 on ecmo to change po2 adjust sweep gas flow on ecmo to change pco2 speed adjusts flow venovenous is not a pump heart is the pump need enough flow to oxygenate blood and keep blood flowing through the circuit patient management on vvecmo wean from ventilator or ecmo. Highly oxygenated blood is returned to the arterial circuit, where it mixes with the blood. Extracorporeal membrane oxygenation circuitry ncbi. Effects of intraaortic balloon pump on cerebral blood. An ecmo circuit is designed to pump and oxygenate blood and remove co2. A pump is an essential component of the ecmo circuit. Experiments were conducted under pediatric and adult pump target flow rates simulating.

The cardiohelp system is a compact heartlung support system suitable for all indications requiring extracorporeal circulation for cardiopulmonary support. The purpose of this study was to determine whether passive leg raising plr can be used to predict fluid responsiveness in patients. Experience with the jostra rotaflow and quadroxd oxygenator for ecmo s horton, c thuys, m bennett, s augustin, m rosenberg, and c brizard perfusion 2004 19. Hemolysis the plasma hemoglobin should be less than 10 mgdl under most conditions.

Spectrum functionality continuous capture of pump flow, hemoglobin, arterial saturation, venous saturation. The most common cause of low circuit flow and high pump speed with both vv and va ecmo is impaired venous drainage due to either a poorly positioned drainage cannula or hypovolemia. In this circumstance, increasing the ecmo pump flow will increase the proportion of welloxygenated blood in the mixed venous circulation and therefore increase the arterial o2. A flow rate of approximately 66% of cardiac output is necessary to achieve patient saturation of 90%.

The pump should be able to provide full blood flow for the patient. Connection cable for the integrated sensors of the disposable components. Sustained recording of gas sweep flow and fio2 with display and trending. In va ecmo, blood is drained from the right side of the heart and is returned to the arterial side of the circulation, so that it bypasses the heart. Pdf an improved bladder for pump control during ecmo. In icus, fluid administration is frequently used to treat hypovolaemia. Initiation once it has been decided to initiate ecmo, the patient is anti coagulated with iv heparin and cannulae are inserted according to ecmo configuration. The emphasis of the workshop is maximising your time getting the. Flow characteristics and coherent structures in a centrifugal blood.

Ecmocannulate learn the practical skills required for ultrasound guided va and vv ecmo cannulation using high fidelity task trainers. The ecmo pump must provide flow appropriate for the patient typically 75 150 mlkgmin for infants and children, within a safe range of pressures to avoid hemolysis. Right next to the sweep control is the oxygen mixer, which controls the fio2. However, there is a maximum flow rate that the circuit can pull from the patient. Recently, the development of portable systems has allowed for implementation of therapy outside of the intensive care units. The drainage cannula allows blood to flow through the pump to the oxygenator. The return cannula returns blood from the oxygenator to the patient. The type of pump used to configure the ecmo circuit was categorized based on pump technology into centrifugal and roller pump types. Highly portable, the cardiohelp system can be rapidly deployed for transport of patients requiring respiratory. As the pump rpms, the pump generates a negative pressure on the patient venous side of the circuit in an attempt to increase the blood flow rate.

Ecmo, forward pump flow must not be allowed to exceed the rate of blood. Practical and theoretical considerations for ecmo system. The addition of an intraaortic balloon pump iabp during peripheral venoarterial extracorporeal membrane oxygenation va ecmo support has been shown to improve coronary bypass graft flows and cardiac function in refractory cardiogenic shock after cardiac surgery. A possible solution could be to artificially pulse the ecmo flow, through automated sinusoidal variation of ecmo pump speed timed to the patients ecg. Semiocclusive roller pumps have been the standard for decades, but have mainly been replaced by novel centrifugal pumps. A standard ecmo circuit consists of a mechanical blood pump, gas exchange device, and. Application of software for operating rooms, icu and tm, also suitable for haemodynamic rooms and patient transfer. Blood clot formation can be initiated by local flow conditions where regions of. Centrifugal pumps also are used for ecmo support figure 535. Intra aortic balloon pump and ecmo linkedin slideshare. The purpose of this study is to assess the influence of increasing extracorporeal blood flow ebf on lv performance during va ecmo therapy of decompensated chronic heart failure. Effect of an intraaortic balloon pump with venoarterial. Venoarterial extracorporeal membrane oxygenation vaecmo support under extracorporeal cardiopulmonary resuscitation ecpr is the last option and may be offered to selected patients.

Elso office 2800 plymouth rd building 300, room 303 ann arbor, mi 481092800 phone. Ecmo variables included number of hours from hospital admission to initiation of ecmo support, arterial and venous cannulation site, use of percutaneous cannulation strategy, ecmo pump flow rate at 4 and 24 hours. Following cannulation, patient is connected to ecmo circuit, the pump is started with the flow of 20mlkgmin and gradually increased every 5 10 min by 10 mlkgmin to reach the. In va ecmo, cardiac output is a mixture of native cardiac i. Patients very often have a large proportion of their blood volume flowing through the ecmo circuit in order to be supported. However, it is challenging due to the intrinsic characteristic of ecmoa complex, highrisk, lowvolume clinical activity which require teamwork, interprofessional communication, critical decision and rapid response especially in emergency.

Considerations objectives in adult ecmo venovenous veno. Venous probe for the measurement of venous oxygen saturation, hemoglobin, hematocrit and venous temperature. Because of the lack of evidence of the adjunctive benefit, the goal of the study was to compare the effect of vaecmo plus iabp with that of vaecmo alone. Several factors predict outcome in these patients, including initial heart rhythm, comorbidities, and bystander cardiopulmonary resuscitation cpr. Further reduction in the pump speed then results in retrograde flow the spectrum monitor demonstrates reverse flow at xxx mlmin. An improved bladder for pump control during ecmo procedures. Ecmo pump chatter as the pump rpms, the pump generates a negative pressure on the patient venous side of the circuit in an attempt to increase the blood flow rate. Introduction august 20 all ecmo circuits at chop were converted to centrifugal pump technology national trend based on elso registry data for all patients ecmo machine removes from the blood. Centrifugal ecmo the chop experience molly dreher, ccp, fpp i have no financial relationship with any of the devices or materials discussed within this presentation.

Peripheral venoarterialextracorporeal membrane oxygenation vaecmo is increasingly used as a firstline therapy for refractory cardiogenic shock. It is intended for teaching the principles of vv and va ecmo to those working in the fields of intensive care, anaesthesia or perfusion and can be used to simulate both venovenous vv and veno. Ecmo flow could then be increased during systole to stabilise the mixing zone further upstream, preventing the variation of. The mse ecmo simulator is a screenbased implementation of a highfidelity, medical simulation system the modular simulation environment mse. Flow in an ecmo circuit functions to deliver the oxygenated blood and can be thought of as cardiac output in va ecmo and the primary driver for delivery of oxygenated blood in vv ecmo. The centrifugal ecmo pump investigated in this study is compact and delivers. Because volume expansion ve can worsen acute respiratory distress syndrome ards and volume overload must be avoided, predictive indicators of fluid responsiveness are needed. The greater the ecmo pump flow, the greater the oxygen delivery. Outcomes of neonates undergoing extracorporeal membrane. Recirculation in venovenous extracorporeal membrane. Patients who are hypoxaemic despite maximal conventional ventilatory support, who have significant ventilatorinduced lung injury or who are in cardiogenic shock may be considered for ecmo support.

For many years now, maquet cardiovascular has been one of the worlds leading manufacturers of heartlung machines and components for extracorporeal circulation. Venoarterial extracorporeal membrane oxygenation va ecmo is widely used in the treatment of circulatory failure, but repeatedly, its negative effects on the left ventricle lv have been observed. Assuming the drainage cannula has not changed position, signs of hypovolemia should be sought. The pulsatility was obtained by means of the intraaortic balloon pump iabp, and two different cases were inve. The purpose of this study was to evaluate the impact of additional iabp support on the cerebral blood flow cbf in.