Chan Kai Man, Wan Winnie Tsz Pan, Ling Lowell, So Jack Mei Chun, Wong Constance Hau Ling, Tam Sandy Bik Shan
From the Department of Anaesthesia and Intensive Care, Prince of Wales Hospital, Hong Kong, China.
Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, China.
ASAIO J. 2022 Mar 1;68(3):e39-e43. doi: 10.1097/MAT.0000000000001494.
Air in circuit in patients receiving extracorporeal membrane oxygenation (ECMO) is an emergency. Different protocols have been suggested to deal with this rare but fatal complication, but their efficacies are rarely reported. We report our institutions' experience in the management of circuit air in Cardiohelp HLS ECMO system. Between October 2009 and July 2020, 4 out of 116 patients developed gas bubbles in ECMO circuit or systemic gas embolism. The clinical characteristics of these patients, source of air, presence of arterial air or pump airlock, cardiorespiratory status during the event, techniques employed to re-establish flow, ECMO downtime, neurologic, and other clinical outcomes were reported. In all cases, the source of air was located, with three of them being on the venous side of the circuit. Centrifugal pump airlock with cessation of ECMO flow was reported in two patients. Strategies used to re-establish ECMO flow included circuit change or deairing using backflush technique. All patients were weaned from ECMO, and three of them were discharged from hospital alive. With effective management, systemic gas embolism could be avoided during air in circuit emergencies. Backflush technique is a safe and effective deairing method to overcome centrifugal pump airlock in Cardiohelp HLS system.
接受体外膜肺氧合（ECMO）治疗的患者回路中出现空气是一种紧急情况。针对这种罕见但致命的并发症，人们提出了不同的处理方案，但很少有关于其疗效的报道。我们报告我们机构在处理Cardiohelp HLS ECMO系统回路空气方面的经验。2009年10月至2020年7月期间，116例患者中有4例在ECMO回路中出现气泡或发生系统性气体栓塞。报告了这些患者的临床特征、空气来源、动脉空气或泵气锁的存在情况、事件发生期间的心肺状态、重新建立血流所采用的技术、ECMO停机时间、神经学及其他临床结局。在所有病例中，空气来源均已查明，其中3例位于回路的静脉侧。两名患者报告出现离心泵气锁并伴有ECMO血流停止。用于重新建立ECMO血流的策略包括更换回路或采用反冲技术排气。所有患者均成功撤离ECMO，其中3例出院存活。通过有效管理，可在回路空气紧急情况期间避免系统性气体栓塞。反冲技术是一种安全有效的排气方法，可克服Cardiohelp HLS系统中的离心泵气锁。
