Department of Medicine, Louisiana State University Health Sciences Center, Shreveport, LA, USA.
Departments of Medicine, Emergency Medicine, Pediatrics and Surgery, Louisiana State University Health Sciences Center, Shreveport, LA, USA.
Perfusion. 2023 Jul;38(5):963-965. doi: 10.1177/02676591221096223. Epub 2022 May 5.
Exchanging circuits in patients undergoing extracorporeal life support (ECLS) for component failure can be a life-threatening endeavor if the patient has no native organ function and is fully dependent on ECLS. Traditional circuit exchanges involve replacing the entire circuit at once, leading to a sufficient loss of support that risks hemodynamic deterioration in the absence of mechanical ventilation or mechanical circulatory support. A staged approach is described using a parallel circuit configuration to reduce the risk of physiologic decompensation in patients with total dependence on ECLS. The approach involves splicing in a second primed circuit in parallel, transitioning flow incrementally from old to new circuit, and removing the old circuit. This approach provides hemodynamic and physiologic stability even in patients with absent underlying cardiopulmonary function.
在体外生命支持（ECLS）患者中，如果患者没有自身器官功能且完全依赖 ECLS，那么因组件故障而更换整个回路可能是一项危及生命的任务。传统的回路更换涉及一次性更换整个回路，这会导致支持丢失过多，如果没有机械通气或机械循环支持，就会有血流动力学恶化的风险。本文描述了一种采用并联回路配置的分阶段方法，以降低对 ECLS 完全依赖的患者发生生理失代偿的风险。该方法涉及并联拼接第二个预充回路，逐渐将流量从旧回路过渡到新回路，并移除旧回路。即使在心肺功能丧失的患者中，这种方法也能提供血流动力学和生理稳定性。
