Effect of flow rate and temperature on transmembrane blood pressure drop in an extracorporeal artificial lung

Park, M; Costa, Eduardo F.; Maciel, Alexandre Toledo; Barbosa, Evs; Hirota, AS; Schettino, GdeP; Azevedo, Lcp

doi:10.1177/0267659114525986

Cited by 7 publications

(10 citation statements)

References 21 publications

(27 reference statements)

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“…8 The relationship between ECMO blood flow rates and recirculation may, in part, be explained by an increase in negative venous pressures within the venous drainage limb that occurs at higher flow rates. 11 Relatively larger drainage cannulae may allow for comparable blood flow rates at lower pump speeds with less negative venous pressure, potentially mitigating the amount of recirculation (Figures 3 and 4).…”

Section: Pump Speed Cannula Size and Extracorporeal Blood Flowmentioning

confidence: 99%

Recirculation in Venovenous Extracorporeal Membrane Oxygenation

2015

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Recirculation, a phenomenon in which reinfused oxygenated blood is withdrawn by the drainage cannula without passing through the systemic circulation, decreases the efficiency with which venovenous extracorporeal membrane oxygenation (ECMO) provides oxygenation. The precise amount of recirculation may be difficult to quantify. However, interventions should be attempted to reduce recirculation when oxygen delivery is suboptimal and recirculation is suspected. Several techniques, including the use of dual-lumen cannulae, have been successful in minimizing recirculation in venovenous ECMO. This article will provide an overview of the factors that affect recirculation, methods that may be used to quantify recirculation, and interventions that may reduce recirculation, thereby increasing ECMO efficiency.

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Section: Pump Speed Cannula Size and Extracorporeal Blood Flowmentioning

confidence: 99%

Recirculation in Venovenous Extracorporeal Membrane Oxygenation

2015

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“…( 6 - 8 ) High TMP pressures (> 50 - 60mmHg in polymethylpentene oxygenators) indicate a high resistance to blood passage through the respiratory membrane. ( 7 , 12 ) Furthermore, this high resistance most commonly is secondary to oxygenator clotting. Other variables, such as the blood flow rate and temperature, are also determinants of the TMP.…”

Section: Discussionmentioning

confidence: 99%

“…The instrumentation, surgical preparation, pulmonary injury, induction of sepsis, and different clinical scenarios of data collection were performed as previously described. ( 12 , 15 , 16 ) Data were retrieved from a five-step protocol. Some of the data have already been published elsewhere: system pressures, ( 12 , 17 ) gases transfer analysis, ( 16 ) equilibrium analysis, PEEP titration, and multiple organ dysfunction phase.…”

Section: Methodsmentioning

confidence: 99%

“…( 12 , 15 , 16 ) Data were retrieved from a five-step protocol. Some of the data have already been published elsewhere: system pressures, ( 12 , 17 ) gases transfer analysis, ( 16 ) equilibrium analysis, PEEP titration, and multiple organ dysfunction phase. The ECMO system (Permanent life support system - PLS, Jostra - Quadrox D, Maquet Cardiopulmonary, Hirrlingen, Germany) was primed with a 37 degrees Celsius normal saline solution and was connected to a centrifugal pump (Rotaflow, Jostra, Maquet Cardiopulmonary, Hirrlingen, Germany).…”

Section: Methodsmentioning

confidence: 99%

“…For a given rotation, the centrifugal pump resulting blood flow depends on blood characteristics, ( 12 ) both pre andafter load. ( 13 , 14 ) Oxygenator failure mainly occurs due to clotting, resulting in reduced gas transfers and in a high resistance to blood passage, causing a high TMP.…”

Section: Introductionmentioning

confidence: 99%

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Blood flow/pump rotation ratio as an artificial lung performance monitoring tool during extracorporeal respiratory support using centrifugal pumps

Park¹,

Mendes²,

Hirota³

et al. 2015

Revista Brasileira De Terapia Intensiva

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ObjectiveTo analyze the correlations of the blood flow/pump rotation ratio and the transmembrane pressure, CO2 and O2 transfer during the extracorporeal respiratory support.MethodsFive animals were instrumented and submitted to extracorporeal membrane oxygenation in a five-step protocol, including abdominal sepsis and lung injury.ResultsThis study showed that blood flow/pump rotations ratio variations are dependent on extracorporeal membrane oxygenation blood flow in a positive logarithmic fashion. Blood flow/pump rotation ratio variations are negatively associated with transmembrane pressure (R2 = 0.5 for blood flow = 1500mL/minute and R2 = 0.4 for blood flow = 3500mL/minute, both with p < 0.001) and positively associated with CO2 transfer variations (R2 = 0.2 for sweep gas flow ≤ 6L/minute, p < 0.001, and R2 = 0.1 for sweep gas flow > 6L/minute, p = 0.006), and the blood flow/pump rotation ratio is not associated with O2 transfer variations (R2 = 0.01 for blood flow = 1500mL/minute, p = 0.19, and R2 = - 0.01 for blood flow = 3500 mL/minute, p = 0.46).ConclusionBlood flow/pump rotation ratio variation is negatively associated with transmembrane pressure and positively associated with CO2 transfer in this animal model. According to the clinical situation, a decrease in the blood flow/pump rotation ratio can indicate artificial lung dysfunction without the occurrence of hypoxemia.

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Extracorporeal respiratory support in adult patients

et al. 2017

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In patients with severe respiratory failure, either hypoxemic or hypercapnic, life support with mechanical ventilation alone can be insufficient to meet their needs, especially if one tries to avoid ventilator settings that can cause injury to the lungs. In those patients, extracorporeal membrane oxygenation (ECMO), which is also very effective in removing carbon dioxide from the blood, can provide life support, allowing the application of protective lung ventilation. In this review article, we aim to explore some of the most relevant aspects of using ECMO for respiratory support. We discuss the history of respiratory support using ECMO in adults, as well as the clinical evidence; costs; indications; installation of the equipment; ventilator settings; daily care of the patient and the system; common troubleshooting; weaning; and discontinuation.

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Effect of flow rate and temperature on transmembrane blood pressure drop in an extracorporeal artificial lung

Cited by 7 publications

References 21 publications

Recirculation in Venovenous Extracorporeal Membrane Oxygenation

Recirculation in Venovenous Extracorporeal Membrane Oxygenation

Blood flow/pump rotation ratio as an artificial lung performance monitoring tool during extracorporeal respiratory support using centrifugal pumps

Extracorporeal respiratory support in adult patients

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