PCRRT & ECLS Dr. Peter Skippen, PICU. BC Children’s Hospital, Vancouver. CANADA.
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Transcript of PCRRT & ECLS Dr. Peter Skippen, PICU. BC Children’s Hospital, Vancouver. CANADA.
![Page 1: PCRRT & ECLS Dr. Peter Skippen, PICU. BC Children’s Hospital, Vancouver. CANADA.](https://reader036.fdocuments.us/reader036/viewer/2022062309/56649e985503460f94b9b2b7/html5/thumbnails/1.jpg)
PCRRT & ECLSPCRRT & ECLS
Dr. Peter Skippen, PICU. Dr. Peter Skippen, PICU.
BC Children’s Hospital,BC Children’s Hospital,
Vancouver. CANADA.Vancouver. CANADA.
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PCRRT & ECLSPCRRT & ECLS
OutlineOutline
• IndicationsIndications
• OptionsOptions
• SetupsSetups
• ConclusionsConclusions
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PCRRT & ECLSPCRRT & ECLS
Clinical ScenariosClinical Scenarios
• Acute respiratory failure / acute cardiac failureAcute respiratory failure / acute cardiac failure
+ + acute inflammatory response to ECLS circuitacute inflammatory response to ECLS circuit
+ ongoing uncontrolled septic / inflammatory process + ongoing uncontrolled septic / inflammatory process
+ + single / multi-organ failuresingle / multi-organ failure
+ volume overload / ongoing fluid resuscitation+ volume overload / ongoing fluid resuscitation
+ + supporting nutritionsupporting nutrition
![Page 4: PCRRT & ECLS Dr. Peter Skippen, PICU. BC Children’s Hospital, Vancouver. CANADA.](https://reader036.fdocuments.us/reader036/viewer/2022062309/56649e985503460f94b9b2b7/html5/thumbnails/4.jpg)
PCRRT & ECLSPCRRT & ECLS
IndicationsIndications
• volume overloadvolume overload
• electrolyte / acid - base disorders electrolyte / acid - base disorders
• mediator clearancemediator clearance
– hemofiltration post CPB / cardiac surgeryhemofiltration post CPB / cardiac surgery
• ““making room”making room”
• preparing to wean from ECLSpreparing to wean from ECLS
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PCRRT & ECLSPCRRT & ECLS
OptionsOptions
• lasix infusionlasix infusion
• SCUFSCUF
• CVVHCVVH
• CVVHDCVVHD
• ““home made”home made”
• customized machinecustomized machine
• accessaccess
– ECLS circuitECLS circuit
– separate siteseparate site
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PCRRT & ECLSPCRRT & ECLS
ECLS circuitsECLS circuits
• BiomedicusBiomedicus
– VAVA
– VVVV
• Roller pumpRoller pump
– VAVA
– VVVV
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PCRRT & ECLSPCRRT & ECLS
Basic ECLS CircuitryBasic ECLS Circuitry
Venous line
Arterial line
H
PUMPOXYGENATOR
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PCRRT & ECLSPCRRT & ECLS
Biomedicus System - diagramBiomedicus System - diagram
Venous line
Arterial line
H
PUMPOXYGENATOR
- + <+
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Biomedicus System -photoBiomedicus System -photo
![Page 10: PCRRT & ECLS Dr. Peter Skippen, PICU. BC Children’s Hospital, Vancouver. CANADA.](https://reader036.fdocuments.us/reader036/viewer/2022062309/56649e985503460f94b9b2b7/html5/thumbnails/10.jpg)
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PCRRT & ECLSPCRRT & ECLS
Roller Pump System - diagramRoller Pump System - diagram
Venous line
Arterial line
H
PUMPOXYGENATOR
Venous reservoir (gravity fed)Venous reservoir (gravity fed)
++ <+
-
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Rollerpump ECLS CircuitRollerpump ECLS Circuit
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Filter
CRRT & RollerpumpCRRT & Rollerpump
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PCRRT & ECLSPCRRT & ECLS
Options for PCRRTOptions for PCRRT
• customized systems eg. PRISMAcustomized systems eg. PRISMA
• home made systemshome made systems
– standard infusion pumps standard infusion pumps pressure limited pressure limited
– roller pumps roller pumps NOT pressure limited NOT pressure limited
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PCRRT & ECLSPCRRT & ECLS
Home Made Systems & ECLS: ProblemsHome Made Systems & ECLS: Problems
• Infusion Pumps Infusion Pumps (max. 999mls/hr = 16.66mls/min)(max. 999mls/hr = 16.66mls/min)
– no safety features eg. micro-air detectorno safety features eg. micro-air detector
– may be unable to get adequate blood flow / dialysis may be unable to get adequate blood flow / dialysis
flow / filtration flows flow / filtration flows
• Roller Pump Systems Roller Pump Systems (litres/min)(litres/min)
– high pressure circuitry high pressure circuitry no pressure limits no pressure limits
– circuit rupture circuit rupture no pressure limits no pressure limits
– MUST incorporate bubble trap MUST incorporate bubble trap insert pre-oxygenator insert pre-oxygenator
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PCRRT & ECLSPCRRT & ECLS
PRISMA & ECLSPRISMA & ECLS
• ProblemsProblems– high pressure return pre-oxygenator / high pressure high pressure return pre-oxygenator / high pressure
alarm of PRISMAalarm of PRISMA
– complexity of circuit?complexity of circuit?
– V-A shunt (depending on placement)V-A shunt (depending on placement)
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PCRRT & BiomedicusPCRRT & Biomedicus
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PCRRT & Roller pumpPCRRT & Roller pump
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PCRRT & Roller pumpPCRRT & Roller pump
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PCRRT & ECLSPCRRT & ECLS
TechniqueTechnique
• PRISMA: setup standardPRISMA: setup standard
• infusion pumps: limited by blood flow rate - SCUFinfusion pumps: limited by blood flow rate - SCUF
• roller pump circuit: allows flexibility at increased riskroller pump circuit: allows flexibility at increased risk
– high blood flowhigh blood flow
– anticoagulationanticoagulation • ECLS circuit already heparinizedECLS circuit already heparinized
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PCRRT & ECLSPCRRT & ECLS
ConclusionsConclusions
• specific issues to be consideredspecific issues to be considered
– biomedicus vs rollerpumpbiomedicus vs rollerpump
– custom device vs. homemadecustom device vs. homemade
• allows optimized nutritional supportallows optimized nutritional support
• allows weaning from ECLSallows weaning from ECLS
• may reduce inflammatory responsemay reduce inflammatory response