Reserve-driven flow control for extracorporeal life support: proof of principle

Abstract

Extracorporeal life support systems lack volume-buffering capacity. Therefore, any decrease in venous intravascular volume available for drainage may result in acutely reduced support flow. We recently developed a method to quantify drainable volume and now conceived a reserve-driven pump control strategy, which is different from existing pressure or flow servo control schemes. Here, we give an outline of the algorithm and present animal experimental data showing proof of principle. With an acute reduction in circulatory volume (10-15%), pump flow immediately dropped from 4.1 to 1.9 l/min. Our pump control algorithm was able to restore bypass flow to 3.2 l/min (about 80% of the original level) and, thereby, reduced the duration of the low-flow condition. This demonstrates that a reserve-driven pump control strategy, based on the continuous monitoring of drainable volume, may maintain extracorporeal circulatory support flow, despite serious changes in filling conditions.

Keywords

ECMO extracorporeal circulation servo regulation venous return centrifugal pump

Get full access to this article

View all access options for this article.

References

Cooper DS , Jacobs JP , Moore L. , et al. Cardiac extracorporeal life support: state of the art in 2007 . Cardiol Young 2007; 17 Suppl 2: 104-115.

Lemos PA , Cummins P. , Lee CH , et al. Usefulness of percutaneous left ventricular assistance to support high-risk percutaneous coronary interventions. Am J Cardiol 2003; 91: 479-481.

Linden V. , Palmer K. , Reinhard J. , et al. Inter-hospital transportation of patients with severe acute respiratory failure on extracorporeal membrane oxygenation - national and international experience. Intensive Care Med 2001; 27: 1643-1648.

Bartlett RH , Roloff DW , Custer JR , Younger JG , Hirschl RB Extracorporeal life support: the University of Michigan experience. JAMA 2000; 283: 904-908.

Arlt M. , Philipp A. , Iesalnieks I. , Kobuch R. , Graf B. Successful use of a new hand-held ECMO system in cardiopulmonary failure and bleeding shock after thrombolysis in massive post-partal pulmonary embolism . Perfusion 2009; 24: 49-50.

Reesink K. , Dekker A. , van der Nagel T. , et al. Suction due to left ventricular assist: implications for device control and management. Artif Organs 2007; 31: 542-549.

Simons AP , Ganushchak Y. , Wortel P. , et al. Laboratory performance testing of venous cannulae during inlet obstruction. Artif Organs 2008; 32: 566-571.

Androne AS , Hryniewicz K. , Hudaihed A. , Mancini D. , Lamanca J. , Katz SD Relation of unrecognized hypervolemia in chronic heart failure to clinical status, hemodynamics, and patient outcomes. Am J Cardiol 2004; 93: 1254-1259.

Magder S. Central venous pressure monitoring. Curr Opin Crit Care 2006; 12: 219-227.

10.

Simons AP , Reesink KD , Molegraaf GV , et al. An in vitro and in vivo study of the detection and reversal of venous collapse during extracorporeal life support. Artif Organs 2007; 31: 152-159.

11.

Gelman S. Venous function and central venous pressure: a physiologic story. Anesthesiology 2008; 108: 735-748.

12.

Simons AP , Reesink KD , Lance MD , et al. Dynamic filling index: a novel parameter to monitor circulatory filling during minimized extracorporeal bypass. Eur J Cardiothorac Surg 2009; 36: 330-334.

13.

Tamari Y. , Lee-Sensiba K. , Ganju R. , Chan R. , Hall MH A new bladder allows kinetic venous augmentation with a roller pump. Perfusion 1999; 14: 453-459.

14.

Pedersen TH , Videm V. , Svennevig JL , et al. Extracorporeal membrane oxygenation using a centrifugal pump and a servo regulator to prevent negative inlet pressure . Ann Thorac Surg 1997; 63: 1333-1339.