1 / 21

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

rainer
Download Presentation

PCRRT & ECLS

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  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

More Related