combining crrt with extracorporeal support technologies · separate ecmo and crrt circuits and...
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VV ECMO
Drainage from IVC or SVC
Pump & Oxygenator
Return to RA
VV ECMO
Heart & lung see full CO
Lungs supported
Heart not supported
Basics
VA ECMO
Drainage from RA or Cava
Pump & Oxygenator
Return to Distal Aorta
VA ECMO
Heart & lung see part of CO
Lungs supported
Heart supported
DoubleLumenCannulaforVVECMO
In-HospitalMortality
Methods for combining CRRT with ECMO:• Independent CRRT access• Introduction of a hemofiltration filter into the ECMO circuit• Introduction of a CRRT device into the ECMO circuit
CircuitConfigurationOxygenator
OxygenatorPumpPump
Combined Separated
Circuit Only ECMO circuit Separate ECMO and CRRT circuits
Advantages Only one circuitSame anticoagulation
Ø Fewer pressures alarmsØ Less hemolysisØ Less air embolismØ Flexible anticoagulation
Disadvantages ü Frequent pressures alarmsü Greater hemolysis riskü Higher air embolism riskü Impact on CRRT treatment
Separate ECMO and CRRT circuits and access are needed
Delivery of CRRT and ECMOSeparated vs. combined?
CRRTwithECMO
Ourapproach
InletofCRRTconnectedtothepost-oxygenator site
CRRToutflowconnectedbeforetheCentrifugalpump
Combined line of CRRT-ECMO
CRRTCombinedwithECCO2R
Pumpless extracorporeallungassist ECMO
ECCO2RLungAssist
AvailableECCO2RSystems
Ø ECCO2R or ECMO is the key method of blood purification for hypercapnia-acidosis.
AvailableECLSTechnologies
