Broman Lars Mikael, Prahl Wittberg Lisa, Westlund C Jerker, Gilbers Martijn, Perry da Câmara Luisa, Westin Jan, Taccone Fabio Silvio, Malfertheiner Maximilian Valentin, Di Nardo Matteo, Swol Justyna, Vercaemst Leen, Barrett Nicholas A, Pappalardo Federico, Belohlavek Jan, Müller Thomas, Belliato Mirko, Lorusso Roberto
1 ECMO Centre Karolinska, Department of Pediatric Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden.
2 Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
Perfusion. 2019 Apr;34(1_suppl):65-73. doi: 10.1177/0267659119830514.
The use of extracorporeal life support devices such as extracorporeal membrane oxygenation in adults requires cannulation of the patient's vessels with comparatively large diameter cannulae to allow circulation of large volumes of blood (>5 L/min). The cannula diameter and length are the major determinants for extracorporeal membrane oxygenation flow. Manufacturing companies present pressure-flow charts for the cannulae; however, these tests are performed with water. Aims of this study were 1. to investigate the specified pressure-flow charts obtained when using human blood as the circulating medium and 2. to support extracorporeal membrane oxygenation providers with pressure-flow data for correct choice of the cannula to reach an optimal flow with optimal hydrodynamic performance. Eighteen extracorporeal membrane oxygenation drainage cannulae, donated by the manufacturers (n = 6), were studied in a centrifugal pump driven mock loop. Pressure-flow properties and cannula features were described. The results showed that when blood with a hematocrit of 27% was used, the drainage pressure was consistently higher for a given flow (range 10%-350%) than when water was used (data from each respective manufacturer's product information). It is concluded that the information provided by manufacturers in line with regulatory guidelines does not correspond to clinical performance and therefore may not provide the best guidance for clinicians.
在成人中使用体外生命支持设备，如体外膜肺氧合，需要用直径相对较大的套管对患者血管进行插管，以允许大量血液（>5升/分钟）循环。套管的直径和长度是体外膜肺氧合流量的主要决定因素。制造公司提供套管的压力-流量图表；然而，这些测试是用水进行的。本研究的目的是：1. 研究以人体血液作为循环介质时获得的特定压力-流量图表；2. 为体外膜肺氧合提供者提供压力-流量数据，以正确选择套管，从而在最佳流体动力学性能下达到最佳流量。在由制造商捐赠的18根体外膜肺氧合引流套管（n = 6）上，在离心泵驱动的模拟回路中进行了研究。描述了压力-流量特性和套管特征。结果表明，当使用血细胞比容为27%的血液时，对于给定流量（范围为10%-350%），引流压力始终高于使用水时（来自各制造商产品信息的数据）。得出的结论是，制造商按照监管指南提供的信息与临床性能不相符，因此可能无法为临床医生提供最佳指导。
