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PCRRT & ECLS

PCRRT & ECLS. Dr. Peter Skippen, PICU. BC Children’s Hospital, Vancouver. CANADA. Outline. Indications Options Setups Conclusions. Clinical Scenarios. Acute respiratory failure / acute cardiac failure + acute inflammatory response to ECLS circuit

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PCRRT & ECLS

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  1. PCRRT & ECLS Dr. Peter Skippen, PICU. BC Children’s Hospital, Vancouver. CANADA.

  2. Outline • Indications • Options • Setups • Conclusions

  3. Clinical Scenarios • Acute respiratory failure / acute cardiac failure + acute inflammatory response to ECLS circuit + ongoing uncontrolled septic / inflammatory process + single / multi-organ failure + volume overload / ongoing fluid resuscitation + supporting nutrition

  4. Indications • volume overload • electrolyte / acid - base disorders • mediator clearance • hemofiltration post CPB / cardiac surgery • “making room” • preparing to wean from ECLS

  5. lasix infusion SCUF CVVH CVVHD “home made” customized machine access ECLS circuit separate site Options

  6. ECLS circuits • Biomedicus • VA • VV • Roller pump • VA • VV

  7. Basic ECLS Circuitry Venous line Arterial line H PUMP OXYGENATOR

  8. Biomedicus System - diagram Venous line Arterial line - + <+ H PUMP OXYGENATOR

  9. Biomedicus System -photo

  10. Roller Pump System - diagram - Venous line Arterial line Venous reservoir (gravity fed) + <+ H + PUMP OXYGENATOR

  11. Rollerpump ECLS Circuit

  12. CRRT & Rollerpump Filter

  13. Options for PCRRT • customized systems eg. PRISMA • home made systems • standard infusion pumps  pressure limited • roller pumps  NOT pressure limited

  14. Home Made Systems & ECLS: Problems • Infusion Pumps (max. 999mls/hr = 16.66mls/min) • no safety features eg. micro-air detector • may be unable to get adequate blood flow / dialysis flow / filtration flows • Roller Pump Systems (litres/min) • high pressure circuitry  no pressure limits • circuit rupture  no pressure limits • MUST incorporate bubble trap  insert pre-oxygenator

  15. PRISMA & ECLS • Problems • high pressure return pre-oxygenator / high pressure alarm of PRISMA • complexity of circuit? • V-A shunt (depending on placement)

  16. PCRRT & Biomedicus

  17. PCRRT & Roller pump

  18. PCRRT & Roller pump

  19. Technique • PRISMA: setup standard • infusion pumps: limited by blood flow rate - SCUF • roller pump circuit: allows flexibility at increased risk • high blood flow • anticoagulation • ECLS circuit already heparinized

  20. Conclusions • specific issues to be considered • biomedicus vs rollerpump • custom device vs. homemade • allows optimized nutritional support • allows weaning from ECLS • may reduce inflammatory response

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