Hematological changes during short-term tidal flow extracorporeal life support

Abstract

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.

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References

Green TP , Timmons OT , Fackler JC , Moler FW , Thompson AE , Sweeney MF. The impact of extracorporeal membrane oxygenation on survival in pediatric patients with acute respiratory failure . Crit Care Med 1996: 24: 323-329 .

Kolla S , Awad S , Rich, PB , Schreiner R , Hirschl RB , Bartlett RH. Extracorporeal life support for 100 adult patients with severe respiratory failure . Ann Surg 1997; 226: 544-564 ; discussion 565-66.

Kolobow T , Fumagalli R , Arosio P , Chen V , Buckhold DK , Pierce JE. The use of the extracorporeal membrane lung in the successful resuscitation of severely hyper-capnic fetal lambs . ASAIO Trans 1982; 28: 365-368 .

Zwischenberger JB , Toomasian JM , Drake K , Andrews AF , Kolobow T , Bartlett RH. Total respiratory support with single cannula venovenous ECMO: double lumen continuous flow vs. single lumen tidal flow . ASAIO Trans 1985; 31: 610-615 .

Chevalier JY , Couprie C , Larroquet M , Renolleau S , Durandy Y , Costil J. Venovenous single lumen cannula extracorporeal lung support in neonates. A five year experience . ASAIO J 1993; 39: M654-M658 .

Malinauskas RA. Plasma hemoglobin measurement techniques for the in vitro evaluation of blood damage caused by medical devices . Artif Organs 1997; 21: 1255-1267 .

Cripps CM. Rapid method for the estimation of plasma haemoglobin levels . J Clin Pathol 1968; 21: 110-112 .

Anderson III HL , Otsu T , Chapman RA , Bartlett RH. Venovenous extracorporeal life support in neonates using a double lumen catheter . ASAIO Trans 1989; 35: 650-653 .

Keszler M , Moront MG , Cox C , Milewski M , Visner MS. Oxygen delivery with a single cannula tidal flow venovenous system for extracorporeal membrane oxygenation . ASAIO J 1995; 41: 850-854 .