Sakiewicz P G, Wright E, Robinson O, Mercer R, Kickel K, Paganini E P
Department of Nephrology and Hypertension, Cleveland Clinic Foundation, Ohio 44195, USA.
ASAIO J. 2000 Jan-Feb;46(1):142-5. doi: 10.1097/00002480-200001000-00031.
Malfunction of electronic medical support apparatus utilized in the ICU usually causes system failure. We report several occurrences of a potentially dangerous interaction between a continuous veno-venous hemodialysis (CVVHD) system and an intra-aortic balloon pump (IABP) counterpulsation device in four patients requiring both systems. The patients had acute renal failure in the face of multi-organ failure and were dependent upon the balloon pump for pressure support. Electrical interference created by the roller pump action of the CVVHD system was identified by the balloon pump as cardiac in origin, and it responded by inflation and deflation. As the blood pump rate was reduced, the interference reduced to the point of complete cessation when the blood pump was shut down. Whereas one patient transiently had a significant drop of mean arterial pressure (from 70 +/- 4 to 40 +/- 2 mm Hg) the other observed occurrences had no clinically significant sequelae. Electrocardiogram (ECG) tracings identified the abnormal stimulus and systematic review identified as potential sources for the creation of this interference static electricity buildup, piezoelectric properties of the polyvinyl chloride tubing, and, possibly but less likely, radiofrequency interference. A newer generation ECG cable and advanced cardiac rhythm recognition software (CardioSync) have been introduced with the Datascope System 98, and the ECG interference, although still occasionally present, does not cause erratic inflation and deflation of the intra-aortic balloon pump. Interference between different electrical support systems may occur, and we suggest that the systems be tested for compatibility before combined use and that older equipment be more rigorously tested for potential clinically significant interference.
重症监护病房（ICU）中使用的电子医疗支持设备故障通常会导致系统故障。我们报告了4例同时需要持续静静脉血液透析（CVVHD）系统和主动脉内球囊反搏（IABP）装置的患者发生的几次潜在危险的相互作用。这些患者在多器官功能衰竭的情况下出现急性肾衰竭，依赖球囊泵提供压力支持。CVVHD系统的滚压泵动作产生的电干扰被球囊泵识别为心脏源性，并导致其充气和放气。随着血泵速率降低，当血泵关闭时，干扰降低至完全停止。其中1例患者平均动脉压短暂显著下降（从70±4降至40±2 mmHg），而其他观察到的情况没有临床显著后遗症。心电图（ECG）描记识别出异常刺激，系统回顾确定静电积聚、聚氯乙烯管道的压电特性以及可能但可能性较小的射频干扰是产生这种干扰的潜在来源。Datascope System 98引入了新一代ECG电缆和先进的心律识别软件（CardioSync），尽管ECG干扰偶尔仍会出现，但不会导致主动脉内球囊泵出现不稳定的充气和放气。不同的电子支持系统之间可能会发生干扰，我们建议在联合使用前对系统进行兼容性测试，并且对旧设备进行更严格的潜在临床显著干扰测试。
