Download - PCRRT & ECLS
PCRRT & ECLSPCRRT & ECLS
Dr. Peter Skippen, PICU. Dr. Peter Skippen, PICU.
BC Children’s Hospital,BC Children’s Hospital,
Vancouver. CANADA.Vancouver. CANADA.
PCRRT & ECLSPCRRT & ECLS
OutlineOutline
• IndicationsIndications
• OptionsOptions
• SetupsSetups
• ConclusionsConclusions
PCRRT & ECLSPCRRT & ECLS
Clinical ScenariosClinical Scenarios
• Acute respiratory failure / acute cardiac failureAcute respiratory failure / acute cardiac failure
+ + acute inflammatory response to ECLS circuitacute inflammatory response to ECLS circuit
+ ongoing uncontrolled septic / inflammatory process + ongoing uncontrolled septic / inflammatory process
+ + single / multi-organ failuresingle / multi-organ failure
+ volume overload / ongoing fluid resuscitation+ volume overload / ongoing fluid resuscitation
+ + supporting nutritionsupporting nutrition
PCRRT & ECLSPCRRT & ECLS
IndicationsIndications
• volume overloadvolume overload
• electrolyte / acid - base disorders electrolyte / acid - base disorders
• mediator clearancemediator clearance
– hemofiltration post CPB / cardiac surgeryhemofiltration post CPB / cardiac surgery
• ““making room”making room”
• preparing to wean from ECLSpreparing to wean from ECLS
PCRRT & ECLSPCRRT & ECLS
OptionsOptions
• lasix infusionlasix infusion
• SCUFSCUF
• CVVHCVVH
• CVVHDCVVHD
• ““home made”home made”
• customized machinecustomized machine
• accessaccess
– ECLS circuitECLS circuit
– separate siteseparate site
PCRRT & ECLSPCRRT & ECLS
ECLS circuitsECLS circuits
• BiomedicusBiomedicus
– VAVA
– VVVV
• Roller pumpRoller pump
– VAVA
– VVVV
PCRRT & ECLSPCRRT & ECLS
Basic ECLS CircuitryBasic ECLS Circuitry
Venous line
Arterial line
H
PUMPOXYGENATOR
PCRRT & ECLSPCRRT & ECLS
Biomedicus System - diagramBiomedicus System - diagram
Venous line
Arterial line
H
PUMPOXYGENATOR
- + <+
Biomedicus System -photoBiomedicus System -photo
PCRRT & ECLSPCRRT & ECLS
Roller Pump System - diagramRoller Pump System - diagram
Venous line
Arterial line
H
PUMPOXYGENATOR
Venous reservoir (gravity fed)Venous reservoir (gravity fed)
++ <+
-
Rollerpump ECLS CircuitRollerpump ECLS Circuit
Filter
CRRT & RollerpumpCRRT & Rollerpump
PCRRT & ECLSPCRRT & ECLS
Options for PCRRTOptions for PCRRT
• customized systems eg. PRISMAcustomized systems eg. PRISMA
• home made systemshome made systems
– standard infusion pumps standard infusion pumps pressure limited pressure limited
– roller pumps roller pumps NOT pressure limited NOT pressure limited
PCRRT & ECLSPCRRT & ECLS
Home Made Systems & ECLS: ProblemsHome Made Systems & ECLS: Problems
• Infusion Pumps Infusion Pumps (max. 999mls/hr = 16.66mls/min)(max. 999mls/hr = 16.66mls/min)
– no safety features eg. micro-air detectorno safety features eg. micro-air detector
– may be unable to get adequate blood flow / dialysis may be unable to get adequate blood flow / dialysis
flow / filtration flows flow / filtration flows
• Roller Pump Systems Roller Pump Systems (litres/min)(litres/min)
– high pressure circuitry high pressure circuitry no pressure limits no pressure limits
– circuit rupture circuit rupture no pressure limits no pressure limits
– MUST incorporate bubble trap MUST incorporate bubble trap insert pre-oxygenator insert pre-oxygenator
PCRRT & ECLSPCRRT & ECLS
PRISMA & ECLSPRISMA & ECLS
• ProblemsProblems– high pressure return pre-oxygenator / high pressure high pressure return pre-oxygenator / high pressure
alarm of PRISMAalarm of PRISMA
– complexity of circuit?complexity of circuit?
– V-A shunt (depending on placement)V-A shunt (depending on placement)
PCRRT & BiomedicusPCRRT & Biomedicus
PCRRT & Roller pumpPCRRT & Roller pump
PCRRT & Roller pumpPCRRT & Roller pump
PCRRT & ECLSPCRRT & ECLS
TechniqueTechnique
• PRISMA: setup standardPRISMA: setup standard
• infusion pumps: limited by blood flow rate - SCUFinfusion pumps: limited by blood flow rate - SCUF
• roller pump circuit: allows flexibility at increased riskroller pump circuit: allows flexibility at increased risk
– high blood flowhigh blood flow
– anticoagulationanticoagulation • ECLS circuit already heparinizedECLS circuit already heparinized
PCRRT & ECLSPCRRT & ECLS
ConclusionsConclusions
• specific issues to be consideredspecific issues to be considered
– biomedicus vs rollerpumpbiomedicus vs rollerpump
– custom device vs. homemadecustom device vs. homemade
• allows optimized nutritional supportallows optimized nutritional support
• allows weaning from ECLSallows weaning from ECLS
• may reduce inflammatory responsemay reduce inflammatory response