Mattke Christian Adrian, Haisz Emma, Pandya Nischal, Black Anthony, Venugopal Prem
1Pediatric Intensive Care Unit, Lady Cilento Children's Hospital, Brisbane, QLD, Australia. 2School of Medicine, University of Queensland, Brisbane, QLD, Australia. 3Pediatric Critical Care Research Group, Mater Mother's Research Institute, Brisbane, QLD, Australia. 4Department of cardiothoracic surgery, Lady Cilento Children's Hospital, Brisbane, QLD, Australia. 5Department of perfusion, Lady Cilento Children's Hospital, Brisbane, QLD, Australia.
Pediatr Crit Care Med. 2017 Oct;18(10):973-976. doi: 10.1097/PCC.0000000000001274.
To assess whether reversing the veno-arterial extracorporeal membrane oxygenation blood flow (thereby creating a controlled arterio-venous shunt) can be used to wean children off extracorporeal membrane oxygenation. The standard practice for weaning patients off VA extracorporeal membrane oxygenation is to gradually reduce the blood flows delivered through the extracorporeal membrane oxygenation pump to a minimum level followed by either insertion of an "arterio-venous bridge" and clamping of the blood flow to the patient or direct decannulation. "Pump controlled retrograde flow trial off" is a technique where the revolutions in the centrifugal pump are reduced to the point where the patient will drive the blood retrograde through the extracorporeal membrane oxygenation circuit, effectively turning the circuit into a controlled arterio-venous shunt. The revolutions per minute control the amount of shunt flow. This eliminates any cardiorespiratory support the extracorporeal membrane oxygenation circuit may provide to the patient.
Feasibility study.
Pediatric intensive care.
Extracorporeal membrane oxygenation-dependent pediatric patients, who were ready for weaning, and possible separation from extracorporeal membrane oxygenation entered the trial.
Pump controlled retrograde flow trial off.
During 2016, pump controlled retrograde flow trial off was used in 17 patients, for a total of 23 episodes. One episode was unsuccessful in a patient with a body weight of 2.2 kg, where cardiac output was insufficient to provide blood flow to both body and extracorporeal membrane oxygenation circuit, though from 2.8 kg body weight upward, the technique was tolerated. The duration of pump controlled retrograde flow trial off was 15 minutes to 2.5 hours. Five cases led to a continuation of the extracorporeal membrane oxygenation run, as they were not ready to be decannulated. Fifteen patients were decannulated after the pump controlled retrograde flow trial off. No patient needed to be recommenced on extracorporeal membrane oxygenation after decannulation.
Pump controlled retrograde flow trial off is an easy to use and easily reversible technique to assess patient readiness for separation from extracorporeal membrane oxygenation. Given pump controlled retrograde flow trial off can easily be stopped and-in our experience-is not associated with complications, it lowers the threshold to attempt coming off extracorporeal membrane oxygenation and facilitates accurate assessment of whether a patient will need further ongoing extracorporeal membrane oxygenation support.
评估逆转静脉 - 动脉体外膜肺氧合血流（从而形成可控的动静脉分流）是否可用于使儿童脱离体外膜肺氧合。使患者脱离静脉 - 动脉体外膜肺氧合的标准做法是逐渐将通过体外膜肺氧合泵输送的血流减少至最低水平，随后要么插入“动静脉桥”并夹闭通向患者的血流，要么直接拔管。“泵控逆向血流试验关闭”是一种技术，即降低离心泵的转速，使患者驱动血液逆向通过体外膜肺氧合回路，从而有效地将回路转变为可控的动静脉分流。每分钟转速控制分流血流量。这消除了体外膜肺氧合回路可能为患者提供的任何心肺支持。
可行性研究。
儿科重症监护室。
依赖体外膜肺氧合且准备好撤机并可能脱离体外膜肺氧合的儿科患者进入试验。
泵控逆向血流试验关闭。
2016年期间，17例患者共进行了23次泵控逆向血流试验关闭。1例体重2.2千克的患者试验未成功，其心输出量不足以同时为身体和体外膜肺氧合回路提供血流，但体重从2.8千克及以上时，该技术可耐受。泵控逆向血流试验关闭的持续时间为15分钟至2.5小时。5例患者因尚未准备好拔管而继续进行体外膜肺氧合治疗。15例患者在泵控逆向血流试验关闭后拔管。拔管后无患者需要重新开始体外膜肺氧合治疗。
泵控逆向血流试验关闭是一种易于使用且易于逆转的技术，用于评估患者脱离体外膜肺氧合的准备情况。鉴于泵控逆向血流试验关闭可轻松停止，且根据我们的经验不会引发并发症，它降低了尝试脱离体外膜肺氧合的门槛，并有助于准确评估患者是否需要进一步持续的体外膜肺氧合支持。
