Laboratory Evaluation of a Double Lumen Catheter for Venovenous Neonatal ECMO

Otsu, T; Merz, Scott I.; Hultquist, Karl; Attorri, Robert J.; Anderson, Harry L.; Scheffler, David E.; Ahmad, Amjad; Bartlett, Robert H.

doi:10.1097/00002480-198907000-00156

Cited by 25 publications

(13 citation statements)

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“…In particular, development of a double lumen venovenous catheter that has two lumens allowed excellent outcomes with venovenous bypass ECLS in neonates. 5,6 However, recirculation occurs in which a fraction of the oxygenated blood that has just been infused into the patient through the arterial limb is immediately drained into the venous limb. This is a factor that limits oxygen delivery to the patient and does not contribute to the oxygenation of the patient.…”

Section: Discussionmentioning

confidence: 99%

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Preliminary Experiment with a Newly Developed Double Balloon, Double Lumen Catheter for Extracorporeal Life Support Vascular Access

Okamoto¹,

Ichinose²,

Tanimoto³

et al. 2003

ASAIO Journal

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Recently, venovenous extracorporeal life support (VVECLS) using a double lumen catheter has been clinically used to avoid neurologic complications in the treatment of respiratory failure for neonates. However, recirculation, which is a limiting factor for oxygen delivery, still exists, and thus it does not contribute to oxygenation of the patient. We developed a newly designed double lumen catheter with a double balloon (DBDL) catheter for ECLS vascular access and performed two animal preliminary experiments in normal and hypoxic dog models (normal ventilation and one lung ventilation experiments) to investigate whether the DBDL catheter could prevent recirculation and maintain oxygen delivery to systemic circulation. The DBDL catheter (JCT Co., Hiroshima, Japan) of 15 Fr was fabricated from silicone. It consists of two lumens for drainage and return of blood with two balloons (distal and proximal balloons) that prevent oxygenated blood mixing with unoxygenated blood. VVECLS using a DBDL catheter was performed in 13 mongrel dogs (8 dogs for normal ventilation experiment weighing 12.9 +/- 1.6 kg [mean +/- SD], 5 dogs for one lung ventilation experiment weighing 16.6 +/- 2.5 kg [mean +/- SD]) under anesthesia in the two experiments. The bypass flow ranged from 10-40 ml/kg per minute in the normal ventilation experiment. VVECLS in the one lung ventilation experiment was performed with maximal bypass flow for 6 hours (ranged from 25.2 +/- 8.0-28.3 +/- 8.7 ml/kg per minute at balloon inflation and deflation). Recirculation and oxygen transfer of artificial lung with or without balloon inflation during VVECLS were studied. Recirculation decreased with balloon inflation at varied bypass flows during VVECLS in the normal ventilation experiment (varied from 1.5 +/- 14.6-12.8 +/- 16.7%) and for 6 hours after VVECLS initiation in the one lung ventilation experiment (varied from 12.2 +/- 12.2-19.2 +/- 6.5%). In particular, the values at 3 and 6 hours were significantly lower than that of balloon deflation in the one lung ventilation experiment. The difference in O2 content between inlet and outlet in the artificial lung with balloon inflation was significantly higher than that of balloon deflation (varied from 3.7 +/- 1.8-4.8 +/- 1.9 ml/dl, p < 0.05) at the bypass flow of 10-30 ml/kg per minute in the normal ventilation experiment and at 5 hours after VVECLS initiation in the one lung ventilation experiment (varied from 10.6 +/- 1.6-11.7 +/- 1.8 ml/dl). The blood gas analysis of systemic circulation with balloon inflation revealed that the values of PaO2 (varied from 83.8 +/- 11.4-96.9 +/- 23.4 mm Hg) and PaCO2 (37.7 +/- 9.2-40.4 +/- 11.8 mm Hg) were higher and lower, respectively, compared with balloon deflation. In particular, PaO2 level was significantly higher than that of the preECLS value at the bypass flow of 20-40 ml/kg per minute (varied from 83.8 +/- 11.4-96.9 +/- 23.4 mm Hg, p < 0.05). In the one lung ventilation experiment, systemic PaO2 and PaCO2 levels at balloon inflation were higher and lower, respectively, c...

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Section: Discussionmentioning

confidence: 99%

“…Generally, as recirculation increases, the efficacy to the systemic circulation decreases in terms of oxygen delivery. 2,5 Recirculation during VVECLS had previously been measured and quantified by various methods to achieve a reduction. 7,8 In this preliminary experiment, we calculated the recirculation by the gold standard method.…”

Section: Discussionmentioning

confidence: 99%

Preliminary Experiment with a Newly Developed Double Balloon, Double Lumen Catheter for Extracorporeal Life Support Vascular Access

Okamoto¹,

Ichinose²,

Tanimoto³

et al. 2003

ASAIO Journal

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“…The cannula has undergone several modifications since its original design in the 1980s. 24,[30][31][32][33] Initially, the cannula was designed to be unicaval, with its tip terminating in the Figure 6. Effect of cannula repositioning on recirculation.…”

Section: Use Of a Bicaval Dual-lumen Cannulamentioning

confidence: 99%

“…From Agerstrand et al 2 right atrium, and drainage and reinfusion ports were in relatively close proximity. 31,32 In an animal model of ECMO for severe respiratory failure, venovenous ECMO with this cannula design was able to provide full respiratory support. 31 However, the venovenous configuration, compared with a venoarterial configuration, required higher circuit blood flow rates (124 vs. 101 ml/kg/min) and achieved lower systemic arterial oxygenation (50 vs. 247 mm Hg).…”

Section: Use Of a Bicaval Dual-lumen Cannulamentioning

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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“…Specifically, we used diameter tube reductions of 0%, 25%, 50% and 75% to simulate baseline, mild obstruction, moderate obstruction and severe obstruction respectively; It is important to note that the descriptors, “mild”, “moderate” and “severe” obstructions are rather relative and the clinical significance of each depends on the pump target flow rates and 3) 0.9% saline was used as the experimental fluid instead of blood. 4 …”

Section: Methodsmentioning

confidence: 99%

Efficacy of Flow Monitoring During ECMO

Badheka

Stucker

Turek³

et al. 2017

ASAIO Journal

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The hypothesis that blood flow monitoring could serve as an effective early indicator of distal obstruction during ECMO was tested under controlled experimental conditions. The ECMO circuit typically includes (or could be easily modified to include) a shunt that bifurcates from the main line returning a small amount of blood back to the pump with access points for drug infusions. Distal circuit obstructions in the oxygenator and beyond will result in an increased diversion of flow from the distal line to the shunt. Thus, elevations in flow through the shunt can serve as a marker for distal circuit obstruction. An ECMO training circuit was adapted with a resistance chamber that simulates controlled and varying levels of distal obstructions. Experiments were conducted under pediatric and adult pump target flow rates simulating different levels of distal obstructions while documenting the shunt flow and pressure drop across the obstruction. There was measurable and statistically significant elevation in shunt flow at all flow rates due to different levels of obstruction from baseline values and hence consistent with the hypothesis that shunt flow can serve as an indicator of distal obstruction in the ECMO circuit. Flow monitoring is over the tube, hands-free, continuous and easy to implement. Therefore, it has the potential to serve as an early non-specific indicator of elevated distal resistance in the ECMO circuit which can then trigger other measurements (such as pressure drop across the oxygenator) for a more specific assessment of the source for distal resistance.

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Laboratory Evaluation of a Double Lumen Catheter for Venovenous Neonatal ECMO

Cited by 25 publications

References 0 publications

Preliminary Experiment with a Newly Developed Double Balloon, Double Lumen Catheter for Extracorporeal Life Support Vascular Access

Preliminary Experiment with a Newly Developed Double Balloon, Double Lumen Catheter for Extracorporeal Life Support Vascular Access

Recirculation in Venovenous Extracorporeal Membrane Oxygenation

Efficacy of Flow Monitoring During ECMO

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