Lean Ad hoc Extracorporeal Membrane Oxygenation Systems for COVID-19.
Journal
ASAIO journal (American Society for Artificial Internal Organs : 1992)
ISSN: 1538-943X
Titre abrégé: ASAIO J
Pays: United States
ID NLM: 9204109
Informations de publication
Date de publication:
01 01 2021
01 01 2021
Historique:
pubmed:
18
8
2020
medline:
5
1
2021
entrez:
18
8
2020
Statut:
ppublish
Résumé
Coronavirus disease (COVID-19) is overwhelming hospitals with patients requiring respiratory support, including ventilators and Extracorporeal Membrane Oxygenation (ECMO). Bottlenecks in device availability may contribute to mortality, and limited device availability even in ECMO centers has led to rationing recommendations. Therefore, we explored options for ad hoc construction of venovenous ECMO using readily available components, essentially, large cannulas, membrane oxygenators, and blood pumps. As thousands of certified cardiac Impella pumps are distributed worldwide, we assembled lean ECMO by embedding Impella pumps coaxially in tubes, combined with standard gas exchangers. Ad hoc integration of Impella blood pumps with gas exchange modules, large-bore venous cannulas, regular ECMO tubing, Y-pieces, and connectors led to lean ECMO systems with stable performance over several days. Oxygenation of 2.5-5 L of blood per minute is realistic. Benefit/risk analysis appears favorable if a patient needs respiratory support but required support systems in a center are exhausted. Ad hoc assembly of venovenous ECMO is feasible using Impella blood pumps, results in stable blood flow across gas exchange modules, and thus may offer another opportunity to oxygenate, "recover the lungs" and hopefully save lives in selected patients with severe COVID-19 disease even when conventional life support equipment is exhausted. The lean design also yields inspirations for future ECMO systems.
Identifiants
pubmed: 32804773
pii: 00002480-202101000-00005
doi: 10.1097/MAT.0000000000001278
doi:
Substances chimiques
Oxygen
S88TT14065
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
12-17Informations de copyright
Copyright © ASAIO 2020.
Références
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