Is it safe to leave an ECMO circuit primed?

Abstract

Extracorporeal membrane oxygenation (ECMO) is a means of life support for failing patients who require extreme life-saving measures due to failure of their heart, lungs or both organs. In a patient suffering cardiac arrest, the faster circulation via cardiopulmonary resuscitation (CPR) can be instituted the better the outcome is. If an ECMO circuit needs to be built and primed it may add significant minutes to the response time. The purpose of this study is to test for any growth in primed ECMO circuits at given time intervals to prove the safety of leaving an ECMO circuit primed. This, in turn, may lead to decreased response time, with an arrest and the placement of the arresting patient on ECMO. Five ECMO circuits were set up, primed and sampled for bacterial growth at 0, 24, 48 and 72 hours and then at one-week intervals, with an end point of four weeks. No bacterial growth was found at any point during the sampling process.

Benefits, key protocol components, and considerations for successful implementation of extracorporeal cardiopulmonary resuscitation: a review of the recent literature

“…Using preprimed ECMO circuits can reduce the time to ECMO initiation. Several studies reported that sterility of preprimed ECMO circuits remained uncompromised for more than 1 month [ 64 , 65 ]. Ultrasonography plays an important role in ECMO cannulation by localizing the femoral vessels and providing real-time imaging during cannulation ( Fig.…”

ECPR—extracorporeal cardiopulmonary resuscitation

“…Pre-primed circuits help to reduce the down time in ECPR. Primed circuits with only crystalloid (free of protein, glucose and blood products) have been found to be free of infection for 14 days and can be used up to 30 days [18,19]. Preassembled ECMO circuits are available for which setup time is only a few minutes, reducing the need for pre-primed circuits.…”

Sterility and performance of open and closed extracorporeal circuits after long-term dry-wet setups

“…Questions also arise on how long pre-primed circuits can safely be maintained wet and used without the fear of increased susceptibility to infection as well as concern for membrane failure and function. [11][12][13][14] Using coated circuits are our preference in all cases. Since this is a clinical question and there are no manufacturer studies in this arena, situations arise where there is a need to have a circuit quickly setup, to be able to support critical patients, when even the briefest time delay could affect outcomes.…”