Matte Gregory S, Regan William L, Gadille Sarah I, Connor Kevin R, Boyle Sharon L, Fynn-Thompson Francis E
Department of Cardiac Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.
J Extra Corpor Technol. 2024 Dec;56(4):216-224. doi: 10.1051/ject/2024026. Epub 2024 Dec 20.
Membrane oxygenator failure remains a concern for perfusion teams. Successful outcomes for this low-frequency, high-risk intervention are predicated on having written institutional protocols for both the oxygenator change-out procedure as well as how often the procedure is practiced by staff perfusionists. A recent review of peer-reviewed journal articles, textbooks and online resources revealed a lack of a unified intervention algorithm for failure to oxygenate during cardiopulmonary bypass (CPB). While an oxygenator change-out procedure may still be considered the gold standard for a confirmed device failure, temporizing measures exist that, in select cases, can afford time to the clinical team and even obviate the need for an oxygenator change-out procedure. We now consider the venous piggyback technique sourcing blood from the venous limb of the circuit a first-line intervention to afford enhanced patient safety while the clinical team decides on required interventions when oxygenator failure presents during CPB.
膜式氧合器故障仍然是灌注团队关注的问题。这种低频、高风险干预的成功结果取决于是否有书面的机构规程，包括氧合器更换程序以及工作人员灌注师进行该程序的频率。最近对同行评审期刊文章、教科书和在线资源的综述显示，在体外循环（CPB）期间未能充分氧合缺乏统一的干预算法。虽然更换氧合器程序可能仍被视为已确认设备故障的金标准，但存在一些临时措施，在某些情况下，可以为临床团队争取时间，甚至无需进行更换氧合器程序。我们现在认为，从回路的静脉端获取血液的静脉旁通技术是一线干预措施，可在临床团队决定CPB期间出现氧合器故障时所需的干预措施时，提高患者安全性。
