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Impact Of Arterial And Venous Cannula Diameter In Venoarterial Extracorporeal Membrane Oxygenation (VA-ECMO)

出版	Morressier, 2017
URL	http://books.google.com.hk/books?id=MQLMzgEACAAJ&hl=&source=gbs_api

註釋Background: For cannulation in venoarterial extracorporeal membraneoxygenation (VA-ECMO) therapy, cannula with different diameters are available. While blood flow through a cannula is estimated by the Hagenu2013Poiseuille equation and thus dependent on diameter and length, in vivo data is missing.Methods: All patients with VA-ECMO cannulated at a tertiary referral hospitalwere included in a registry. Once every 24 hours within the first 7 days aftercannulation, VA-ECMO blood flow and pump speed were recorded. Resistance of the ECMO circuit (blood flow divided by 1000 rounds per minute (RPM)), was calculated and pooled for this research. The Sorin Centrifugal Pump Console was used as ECMO system and HLS cannulae (Maquet) with a length of 23 cm for arterial and 55 cm for venous drainage.Results: A total of 216 patients and 653 data points were evaluated. AverageBlood flow was 3.62u00b11.1 l/min with pump speed of 2677u00b1601 RPM. Mostcommonly used cannulas were 23Fr. venous and 17Fr. arterial (81 patients)followed by 23/15Fr. (66 patients), 21/17Fr. (30 patients), and 21/15Fr. (39patients). Normalized blood flow was highest in the 23/17 Fr. group(1,42l/min/1000RIM) and lowest in the 23/15Fr. group (1,27 l/min/1000 RPM).Concerning cannula size, there was no significant difference in blood flow in the 23Fr. and 21Fr. venous cannulas while arterial size impacted blood flowsignificantly with an average of 0.13l/min/1000RIM lower blood flow in the smaller cannulas (see figure 1).Conclusion: Blood flow to patients with VA-ECMO is primarily limited bydiameter of the arterial cannula. In larger arterial cannulas, also venous cannula diameter impacts resistance of the ECMO circuit.