PCRRT

1
PCRRT ECLS

• Dr. Peter Skippen, PICU.
• BC Childrens Hospital,
• Vancouver. CANADA.

2
Outline

• Indications
• Options
• Setups
• Conclusions

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Clinical Scenarios

• Acute respiratory failure / acute cardiac
  failure
• acute inflammatory response to ECLS
  circuit
• ongoing uncontrolled septic / inflammatory
  process
• single / multi-organ failure
• volume overload / ongoing fluid
  resuscitation
• supporting nutrition

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Indications

• volume overload
• electrolyte / acid - base disorders
• mediator clearance
• hemofiltration post CPB / cardiac surgery
• making room
• preparing to wean from ECLS

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Options

• home made
• customized machine
• access
• ECLS circuit
• separate site

• lasix infusion
• SCUF
• CVVH
• CVVHD

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ECLS circuits

• Biomedicus
• VA
• VV
• Roller pump
• VA
• VV

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Basic ECLS Circuitry
Venous line
Arterial line
H
PUMP
OXYGENATOR
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Biomedicus System - diagram
Venous line
Arterial line
-

lt
H
PUMP
OXYGENATOR
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Biomedicus System -photo
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(No Transcript)
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Roller Pump System - diagram
-
Venous line
Arterial line
Venous reservoir (gravity fed)

lt
H

PUMP
OXYGENATOR
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Rollerpump ECLS Circuit
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CRRT Rollerpump
Filter
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Options for PCRRT

• customized systems eg. PRISMA
• home made systems
• standard infusion pumps ? pressure limited
• roller pumps ? NOT pressure limited

15
Home Made Systems ECLS Problems

• Infusion Pumps (max. 999mls/hr 16.66mls/min)
• no safety features eg. micro-air detector
• may be unable to get adequate blood flow /
  dialysis flow / filtration flows
• Roller Pump Systems (litres/min)
• high pressure circuitry ? no pressure limits
• circuit rupture ? no pressure limits
• MUST incorporate bubble trap ? insert
  pre-oxygenator

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PRISMA ECLS

• Problems
• high pressure return pre-oxygenator / high
  pressure alarm of PRISMA
• complexity of circuit?
• V-A shunt (depending on placement)

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PCRRT Biomedicus
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PCRRT Roller pump
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PCRRT Roller pump
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Technique

• PRISMA setup standard
• infusion pumps limited by blood flow rate
  - SCUF
• roller pump circuit allows flexibility at
  increased risk
• high blood flow
• anticoagulation
• ECLS circuit already heparinized

21
Conclusions

• specific issues to be considered
• biomedicus vs rollerpump
• custom device vs. homemade
• allows optimized nutritional support
• allows weaning from ECLS
• may reduce inflammatory response