Recirculation in Venovenous Extracorporeal Membrane Oxygenation

Abrams, Darryl; Bacchetta, Matthew; Brodie, Daniel

doi:10.1097/mat.0000000000000179

Cited by 142 publications

(159 citation statements)

References 32 publications

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“…11 An important issue during veno-venous ECLS therapy is recirculation within the ECLS circuit. 12 Recirculation rates ranging from 30% to 70% with pump flows of 200-500 ml/min were previously reported in a veno-venous circuit via a unicaval dual-lumen cannula. 13 This aspect, however, did not seem to influence the different measurements in the present work.…”

Section: Discussionmentioning

confidence: 96%

Single-Site Low-Flow Veno-Venous Extracorporeal Lung Support Does Not Influence Hemodynamic Monitoring by Transpulmonary Thermodilution

Redwan¹,

Ziegeler²,

Freermann³

et al. 2016

ASAIO Journal

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The application of extracorporeal lung support (ECLS) in patients with acute respiratory distress syndrome is a well-established concept. In patients receiving ECLS therapy, hemodynamic monitoring is often required. However, less is known about the effect of ECLS on hemodynamic measurements. In the present work, the influence of single-site low-flow veno-venous ECLS (LFVV-ECLS) on hemodynamic monitoring by transpulmonary thermodilution (TPTD) was prospectively investigated. Five consecutive patients undergoing single-site LFVV-ECLS for severe hypercapnic respiratory failure were included in this study. For single-site LFVV-ECLS, a 22 Fr twin-port double-lumen cannula was inserted percutaneously into the right jugular vein. Hemodynamic monitoring was performed using the Pulse index Continuous Cardiac Output system. Before ECLS initiation, baseline measurements of cardiac index, systemic vascular resistance, mean arterial pressure, and extravascular lung water (EVLW) were performed. During the first 3 days of ECLS therapy, repeated hemodynamic measurements at different ECLS flow rates were performed. No significant differences were seen in hemodynamic measurements. With respect to EVLW, a significant decrease over the duration of ECLS therapy was observed. This study demonstrates that LFVV-ECLS does not interfere with TPTD. It needs to be further studied if these findings also apply to other ECLS modes.

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Section: Discussionmentioning

confidence: 96%

Single-Site Low-Flow Veno-Venous Extracorporeal Lung Support Does Not Influence Hemodynamic Monitoring by Transpulmonary Thermodilution

Redwan¹,

Ziegeler²,

Freermann³

et al. 2016

ASAIO Journal

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“…1). Alternatively, it is possible to use a double lumen cannula (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31) that is positioned through the internal jugular vein and the right atrium with the tip in the inferior vena cava [6,12,13,16,17].…”

Section: Extracorporeal Membrane Oxygenation (Ecmo)mentioning

confidence: 99%

“…If the tips of the two cannulas are too close together in venovenous ECMO, the blood primarily flows through the extracorporeal circuit from one cannula to the next so that the pulmonary circulation and thus also the systemic circulation primarily receive insufficiently oxygenated blood due to the recirculation [5,13,16,17] (▶ Fig. 4).…”

Section: Cannula Positionmentioning

confidence: 99%

Extrakorporale Membranoxygenierung bei Erwachsenen – Varianten, Komplikationen unter Therapie und die Rolle der radiologischen Diagnostik

Beck¹,

Burg²,

Heindel³

et al. 2016

Fortschr Röntgenstr

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ABSTR ACTBackground Extracorporeal membrane oxygenation (ECMO) and extracorporeal life support (ECLS) as respiratory and circulatory assist therapies are gaining in importance in the treatment of critically ill patients. Depending on the place of cannulation -veno-venous for ECMO and veno-arterial for ECLS -distinct changes in hemodynamics will occur. In this review we describe the different types of ECMO and ECLS systems, the typical cannula placement and frequent complications under therapy. The most suitable imaging modalities will be presented and typical hemodynamic pitfalls in contrast-enhanced computed tomography or angiography will be elucidated. MethodsThe review is based on a literature search in PubMed with the terms "ECMO" and/or "ECLS" and/or "extracorporeal life support" and/or "imaging" and/or "complications". Statistical data was taken from the ECMO register of the "Extracorporeal Life Support Organization (ELSO)".Results Critical illness-and therapy-associated complications are common so that imaging, particularly computed tomography, becomes increasingly important. Following veno-venous cannulation in ECMO, the normal sequential blood flow is preserved, so that no contrast enhancement irregularities should be expected when the right timing and an adequate amount of contrast agent are selected. After veno-arterial cannulation in ECLS, different artifacts like pseudo-filling defects, pseudomembranes and irregular/low contrast enhancement of heart and pulmonary vessels can be found, depending on the site of cannulation and the residual cardiac function.Key points ▪ Cannula placement is usually documented by radiography. This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.

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“…If it is too far into the RA, there is a risk of damage to structures. It will also increase the possibility of recirculation if the venous drainage cannula is too close to the reinjection cannula (36).…”

Section: Double Vv-ecmo Cannulationmentioning

confidence: 99%

“…Recirculation, a phenomenon in which reinjected oxygenated blood is withdrawn by the drainage venous cannula without passing through the systemic circulation, decreases the effectiveness of VV-ECMO (36). The effectiveness of VV-ECMO in supporting oxygenation depends on several factors, including the blood flow circulating through the device, the patient's CO and metabolic demand, the oxygen fraction in the sweep gas, the diffusion properties and surface area of the membrane and the amount of recirculation within the circuit (37,38).…”

Section: Double Vv-ecmo Cannulationmentioning

confidence: 99%

Veno-venous extracorporeal membrane oxygenation: cannulation techniques

et al. 2016

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The development of extracorporeal membrane oxygenation (ECMO) technology allows a new approach for the intensive care management of acute cardiac and/or respiratory failure in adult patients who are not responsive to conventional treatment. Current ECMO therapies provide a variety of options for the multidisciplinary teams who are involved in the management of these critically ill patients. In this regard, veno-venous ECMO (VV-ECMO) can provide quite complete respiratory support, even if this highly complex technique presents substantial risks, such as bleeding, thromboembolic events and infection.While VV-ECMO circuits usually include the cannulation of two vessels (double cannulation) in its classic configuration, the use of a single cannula is now possible for VV-ECMO support. Recently, experienced centers have employed more advanced approaches by cannulating three vessels (triple cannulation) which follows veno-arterio-venous (VAV) or veno-arterio-pulmonary-arterial cannulation (VAPa). However, 'triple' cannulation expands the field of application but increases the complexity of ECMO systems. In the present review, the authors focus on the indications for VV-ECMO, patient assessment prior to cannulation, the role of ultrasound-guided vessel puncture, double lumen single bicaval cannulations, and finally triple cannulation in VV-ECMO.

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Recirculation in Venovenous Extracorporeal Membrane Oxygenation

Cited by 142 publications

References 32 publications

Single-Site Low-Flow Veno-Venous Extracorporeal Lung Support Does Not Influence Hemodynamic Monitoring by Transpulmonary Thermodilution

Single-Site Low-Flow Veno-Venous Extracorporeal Lung Support Does Not Influence Hemodynamic Monitoring by Transpulmonary Thermodilution

Extrakorporale Membranoxygenierung bei Erwachsenen – Varianten, Komplikationen unter Therapie und die Rolle der radiologischen Diagnostik

Veno-venous extracorporeal membrane oxygenation: cannulation techniques

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