“Most clinicians, when challenged as to what the basis is that they referenced a clinical decision on, will obviously defer to their residency or training program and cite a clinical policy- whether institutionally based, or part of the public domain.”
Welcome to PERFUSION POLICIES 101. This will be a continuing series provided to assist your programs with that one puzzle piece we all run into now and then- that one time that an unexpected patient condition may give you pause…
The intention here is to disseminate some basic recipes that have probably been implemented at countless institutions, for God knows how long. The usual disclaimers obviously apply:
Due Diligence is the Responsibility of the Reader!
Use the information as you feel fit, recognizing that this is information gleaned from multiple sources, it is recruited from the public domain of the internet, with no implied assurance of accuracy- but is cogent, and based on logical and reasonable clinical rationale.
Frank Aprile 🙂
ECMO – Adult
MAQUET ROTOFLOW ECMO WITH MAQUET QUADROX D
The recently FDA- approved Quadrox D oxygenator may be utilized for extracorporeal membrane oxygenation (ECMO) support of the patient in the setting of biventricular support with a centrifugal pump.
- Quadrox D
- Pressure monitoring for inlet/outlet pressure
- Temperature monitoring
- Oxygen blender
- Gas line
- Pump record
- ECMO checklist
HOLLOW AND DIFFUSION FIBER OXYGENATORS
A membrane oxygenator is an oxygenator that has a gas-permeable membrane interposed between the oxygenating gas and the blood. Fiber oxygenators (artificial lungs) transfer gas by diffusion across a membrane or through small micropores in the membrane. Sweep gas is the gas that is used to oxygenate the blood and remove CO2. Sweep gas is adjusted to obtain the desired gas parameters, similar to ventilator function. Faster sweep gas flow rate is like a higher rate of ventilation, which removes more CO2. Higher FiO2 will yield higher pO2 in the blood exiting the oxygenator. The sweep gas is delivered to the oxygenator through a blender and ¼” tubing.
All oxygenators exhibit some resistance to blood flow. Pressure drop is the resistance to blood flow produced by any membrane oxygenator. The difference between the inlet and outlet pressure is how we calculate pressure drop.
The pressure of the blood on the inlet side of the oxygenator will always be higher than the blood path on the outlet side of the oxygenator. Many factors may affect pressure drop such as tubing length and size, cannula size, gas pressure, flow rate, blood viscosity, hematocrit, and temperature. Do not be too alarmed by the absolute umber, but rather changes in pressure drop over time.
Most membrane oxygenators also incorporate a heat exchanger that allows for thermal regulation of the blood as it passes through the oxygenator. This is usually accomplished by passing warm or cool water through a series of small, stainless steel tubes that contact the blood, thus facilitation the exchange of heat.
Monitor patient/device parameters; temperature, blood gases, flow rated, oxygenator inlet and outlet pressures, sweep rate, and FiO2.
Call the Perfusionist before any Action