Troubleshooting  in extracorporeal life support

Denis Berdajs

doi:10.4414/smw.2015.14117

Review article: Biomedical intelligence

Vol. 145 No. 0910 (2015)

Troubleshooting in extracorporeal life support

Denis Berdajs

DOI: https://doi.org/10.4414/smw.2015.14117
Cite this as:: Swiss Med Wkly. 2015;145:w14117
Published: 22.02.2015

Summary

Since the first clinical use of extracorporeal circulation in the last century by John Gibbon and the first successful mechanical support of the left ventricular function by Forest Dodrill, the progress of techniques and technologies has helped to develop minimised systems for extracorporeal circulatory and respiratory support. However, the fact is that, despite the advanced technologies used for extracorporeal support, successful application in order to be benefit a critically ill population requires highly trained and skilled teams. Application of these highly sophisticated techniques in life-saving situations inside and/or outside the operating room is a procedure with certain pitfalls and dangers.

The aim of this review is to provide a short overview of the technical aspects of extracorporeal circulation, with a look at the recent literature and clinical experiences focusing on technical as well surgical considerations regarding the urgent and/or emergent usage of a central as well as peripheral extracorporeal system.

References

Cohn L. Fifty years of open heart surgery 2003 6;107(17):2168–70 Circulation.
Norton J. Surgery: Basic science and clinical evidence 2008 Springer New York. p. 1473.
MacLaren G, Combes A, Bartlett RH. Contemporary extracorporeal membrane oxygenation for adult respiratory failure: life support in the new era. Intensive Care Med. 2012;38:210–20.
Bartlett RH, Gattinoni L. Current status of extracorporeal life support (ECMO) for cardiopulmonary failure. Minerva Anestesiol. 2010;76:534–40.
Davies A, Jones D, Bailey M, Beca J, Bellomo R, Blackwell N, et al., Australia and New Zealand Extracorporeal Membrane Oxygenation (ANZ ECMO) Influenza Investigators: Extracorporeal membrane oxygenation for 2009 influenza A(H1N1) acute respiratory distress syndrome. JAMA. 2009;302:1888–95.
Peek GJ, Mugford M, Tiruvoipati R. Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial. Lancet. 2009;374:1351–63.
von Segesser LK. Peripheral cannulation for cardiopulmonary bypass. Multimedia Man Cardiothorac Surg. 2006.
Jegger D, Tevaearai HT, Mueller XM, Horisberger J, von Segesser LK. Limitations using the vacuum-assist drainage technique during cardiopulmonary bypass procedures. J Extra Corpor Technol. 2003;35:207–21.
Berdajs D, Born F, Crosset M, Horisberger J, Künzli A, Ferrari E, et al. Superior venous drainage in the “LifeBox”: a portable extracorporeal oxygenator with a self-expanding venous cannula. Perfusion. 2010;25(4):211–5.
Berdajs DA, Bernandi E, Burki M, Hurni M, Tozzi P, Horisberger J, et al. Self-expanding mini-cannula for remote perfusion with pediatric scenarios. Interact Cardiovasc Thorac Surg. 2010;10(6):873–6.
von Segesser LK, Siniscalchi G, Kang K, Maunz O, Horisberger J, Ferrari E, et al. Temporary caval stenting improves venous drainage during cardiopulmonary bypass. Interact Cardiovasc Thorac Surg. 2008;7(6):1096–100.
Berdajs D Bicaval dual-lumen cannula for venovenous extracorporeal membrane oxygenation: Avalon© cannula in childhood disease. Perfusion. 2014 Jul 28.
Sidebotham D, McGeorge A, McGuinness S, Edwards M, Willcox T, Beca J. Extracorporeal membrane oxygenation for treating severe cardiac and respiratory failure in adults: part 2–technical considerations.J Cardiothorac Vasc Anesth. 2010;24(1):164–72.
Nosotti M, Rosso L, Tosi D, Palleschi A, Mendogni P, Nataloni I, et al. Extracorporeal membrane oxygenation with spontaneous breathing as a bridge to lung transplantation. Interact CardioVasc Thorac Surg. 2013;61:55–9.
Garcia JP, Iacono A, Kon ZN, Griffith BP. Ambulatory extracorporeal membrane oxygenation: a new approach for bridge-to-lung transplantation. J Thorac Cardiovasc Surg. 2010;139:e137–9.
Hirose H, Yamane K, Marhefka G, Cavarocchi N. Right ventricular rupture and tamponade caused by malposition of the Avalon cannula for venovenous extracorporeal membrane oxygenation. J Cardiothorac Surg. 2012;7:36.
Teman NR, Haft JW, Napolitano LM. Optimal endovascular methods for placement of bicaval dual-lumen cannulae for venovenous extracorporeal membrane oxygenation. ASAIO J. 2013;59: 442–7.
Chimot L, Marqué S, Gros A, et al. Avalon© bicaval dual-lumen cannula for venovenous extracorporeal membrane oxygenation: survey of cannula use in France. ASAIO J. 2013;59:157–61.
Pagani FD, Lynch W, Swaniker F, Dyke DB, Bartlett R, Koelling T, et al. Extracorporeal life support to left ventricular assist device bridge to heart transplant: A strategy to optimize survival and resource utilization. Circulation. 1999;100:206–10.
Pagani FD, Aaronson KD, Swaniker F, Bartlett RH. The use of extracorporeal life support in adult patients with primary cardiac failure as a bridge to implantable left ventricular assist device. Ann Thorac Surg. 2001;71:S82–85.
Takayama H, Truby L, Koekort M, Uriel N, Colombo P, Mancini DM, et al. Clinical outcome of mechanical circulatory support for refractory cardiogenic shock in the current era. J Heart Lung Transplant. 2013;32:106–11.
Lehmann S, Uhlemann M, Etz CD, Garbade J, Schroeter T, Borger M, et al. Extracorporeal membrane oxygenation: Experience in acute graft failure after heart transplantation. Clin Transplant. 2014;29:12380.
Cheng R, Hachamovitch R, Kittleson M, Patel J, Arabia F, Moriguchi J, et al. Complications of extracorporeal membrane oxygenation for treatment of cardiogenic shock and cardiac arrest: A meta-analysis of 1,866 adult patients. Ann Thorac Surg. 2014;97:610–6.
Brechot N, Luyt CE, Schmidt M, Leprince P, Trouillet JL, Leger P, et al. Venoarterial extracorporeal membrane oxygenation support for refractory cardiovascular dysfunction during severe bacterial septic shock. Crit Care Med. 2013;41:1616–26.
Trummer G, Benk C, Klemm R, Biever P, Kalbhenn J, Schmutz A, et al. Short-term heart and lung support: extracorporeal membrane oxygenation and extracorporeal life support Multimed Man Cardiothorac Surg. 2013;2013:mmt008. doi: 10.1093/mmcts/mmt008
Berdajs D, Ferrari E, Michalis A, Burki M, Pieterse CW, Horisberger J, et al. New prototype of femoral arterial SmartCannula with anterograde and retrograde flow. Perfusion. 2011;26(4):271–5.

How to Cite

1.

Berdajs D. Troubleshooting in extracorporeal life support. Swiss Med Wkly [Internet]. 2015 Feb. 22 [cited 2024 Nov. 21];145(0910):w14117. Available from: https://smw.ch/index.php/smw/article/view/2012

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

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[1] Cohn L. Fifty years of open heart surgery 2003 6;107(17):2168–70 Circulation.

[2] Norton J. Surgery: Basic science and clinical evidence 2008 Springer New York. p. 1473.

[3] MacLaren G, Combes A, Bartlett RH. Contemporary extracorporeal membrane oxygenation for adult respiratory failure: life support in the new era. Intensive Care Med. 2012;38:210–20.

[4] Bartlett RH, Gattinoni L. Current status of extracorporeal life support (ECMO) for cardiopulmonary failure. Minerva Anestesiol. 2010;76:534–40.

[5] Davies A, Jones D, Bailey M, Beca J, Bellomo R, Blackwell N, et al., Australia and New Zealand Extracorporeal Membrane Oxygenation (ANZ ECMO) Influenza Investigators: Extracorporeal membrane oxygenation for 2009 influenza A(H1N1) acute respiratory distress syndrome. JAMA. 2009;302:1888–95.

[6] Peek GJ, Mugford M, Tiruvoipati R. Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial. Lancet. 2009;374:1351–63.

[7] von Segesser LK. Peripheral cannulation for cardiopulmonary bypass. Multimedia Man Cardiothorac Surg. 2006.

[8] Jegger D, Tevaearai HT, Mueller XM, Horisberger J, von Segesser LK. Limitations using the vacuum-assist drainage technique during cardiopulmonary bypass procedures. J Extra Corpor Technol. 2003;35:207–21.

[9] Berdajs D, Born F, Crosset M, Horisberger J, Künzli A, Ferrari E, et al. Superior venous drainage in the “LifeBox”: a portable extracorporeal oxygenator with a self-expanding venous cannula. Perfusion. 2010;25(4):211–5.

[10] Berdajs DA, Bernandi E, Burki M, Hurni M, Tozzi P, Horisberger J, et al. Self-expanding mini-cannula for remote perfusion with pediatric scenarios. Interact Cardiovasc Thorac Surg. 2010;10(6):873–6.

[11] von Segesser LK, Siniscalchi G, Kang K, Maunz O, Horisberger J, Ferrari E, et al. Temporary caval stenting improves venous drainage during cardiopulmonary bypass. Interact Cardiovasc Thorac Surg. 2008;7(6):1096–100.

[12] Berdajs D Bicaval dual-lumen cannula for venovenous extracorporeal membrane oxygenation: Avalon© cannula in childhood disease. Perfusion. 2014 Jul 28.

[13] Sidebotham D, McGeorge A, McGuinness S, Edwards M, Willcox T, Beca J. Extracorporeal membrane oxygenation for treating severe cardiac and respiratory failure in adults: part 2–technical considerations.J Cardiothorac Vasc Anesth. 2010;24(1):164–72.

[14] Nosotti M, Rosso L, Tosi D, Palleschi A, Mendogni P, Nataloni I, et al. Extracorporeal membrane oxygenation with spontaneous breathing as a bridge to lung transplantation. Interact CardioVasc Thorac Surg. 2013;61:55–9.

[15] Garcia JP, Iacono A, Kon ZN, Griffith BP. Ambulatory extracorporeal membrane oxygenation: a new approach for bridge-to-lung transplantation. J Thorac Cardiovasc Surg. 2010;139:e137–9.

[16] Hirose H, Yamane K, Marhefka G, Cavarocchi N. Right ventricular rupture and tamponade caused by malposition of the Avalon cannula for venovenous extracorporeal membrane oxygenation. J Cardiothorac Surg. 2012;7:36.

[17] Teman NR, Haft JW, Napolitano LM. Optimal endovascular methods for placement of bicaval dual-lumen cannulae for venovenous extracorporeal membrane oxygenation. ASAIO J. 2013;59: 442–7.

[18] Chimot L, Marqué S, Gros A, et al. Avalon© bicaval dual-lumen cannula for venovenous extracorporeal membrane oxygenation: survey of cannula use in France. ASAIO J. 2013;59:157–61.

[19] Pagani FD, Lynch W, Swaniker F, Dyke DB, Bartlett R, Koelling T, et al. Extracorporeal life support to left ventricular assist device bridge to heart transplant: A strategy to optimize survival and resource utilization. Circulation. 1999;100:206–10.

[20] Pagani FD, Aaronson KD, Swaniker F, Bartlett RH. The use of extracorporeal life support in adult patients with primary cardiac failure as a bridge to implantable left ventricular assist device. Ann Thorac Surg. 2001;71:S82–85.

[21] Takayama H, Truby L, Koekort M, Uriel N, Colombo P, Mancini DM, et al. Clinical outcome of mechanical circulatory support for refractory cardiogenic shock in the current era. J Heart Lung Transplant. 2013;32:106–11.

[22] Lehmann S, Uhlemann M, Etz CD, Garbade J, Schroeter T, Borger M, et al. Extracorporeal membrane oxygenation: Experience in acute graft failure after heart transplantation. Clin Transplant. 2014;29:12380.

[23] Cheng R, Hachamovitch R, Kittleson M, Patel J, Arabia F, Moriguchi J, et al. Complications of extracorporeal membrane oxygenation for treatment of cardiogenic shock and cardiac arrest: A meta-analysis of 1,866 adult patients. Ann Thorac Surg. 2014;97:610–6.

[24] Brechot N, Luyt CE, Schmidt M, Leprince P, Trouillet JL, Leger P, et al. Venoarterial extracorporeal membrane oxygenation support for refractory cardiovascular dysfunction during severe bacterial septic shock. Crit Care Med. 2013;41:1616–26.

[25] Trummer G, Benk C, Klemm R, Biever P, Kalbhenn J, Schmutz A, et al. Short-term heart and lung support: extracorporeal membrane oxygenation and extracorporeal life support Multimed Man Cardiothorac Surg. 2013;2013:mmt008. doi: 10.1093/mmcts/mmt008

[26] Berdajs D, Ferrari E, Michalis A, Burki M, Pieterse CW, Horisberger J, et al. New prototype of femoral arterial SmartCannula with anterograde and retrograde flow. Perfusion. 2011;26(4):271–5.