Dr. Martin Ruß and his critical care team at the Intensive Care Clinic of Charité - Medical University and Institutes of Health in Berlin, Germany, report a case in which they used the Transonic ELSA Monitor to optimize oxygen flow in a 10-year-old ECMO patient.
Clotting and bleeding are major causes of mortality and morbidity during high risk ECMO therapy that treats the “sickest of the sick” by infusing patients with oxygen-rich blood drawn from an ECMO circuit. One key component of an ECMO circuit is the oxygenator. As a clot develops in the oxygenator over time, the volume of oxygenated blood decreases and less oxygen-rich blood is delivered to the critically ill patient. If the clot gets large enough, the oxygenator will need to be switched out by the perfusionist as quickly as possible and replaced by one that will continue to oxygenate the blood.
Extracorporeal membrane oxygenation (ECMO) remains a last ditch therapy to treat neonatal, pediatric and adult patients suffering from severe respiratory syndrome and/or cardiac failure after they have not responded to other medical treatments.
“The ELSA monitor provides an easy-to-use, non-invasive method to measure recirculation in VV ECMO without blood sampling.” SS Said, MD
The state-of-the-art Transonic® ELSA Monitor helps optimize and safeguard extracorporeal membrane oxygenation (ECMO) therapy in infants, children and adults by:
- Measuring true blood flow in ECMO circuits
- Quantifying recirculation in the ECMO circuit
- Detecting oxygenator clotting
With the ELSA, surgeons can place a cannula so that flow delivery is maximized. By maximizing flow delivery and minimizing recirculation, a perfusionist then has more time to change out the oxygenator if and when the ELSA identifies unacceptably high clot development within the oxygenator.
Knowing actual blood flow through the circuit at all times helps avoid catastrophic circuit failures in fragile ECMO patients. Kinks and circuit blockages can be immediately identified and corrected. When flow delivery is maximized, recirculation is minimized, and optimal cannula placement is achieved, the time a patient must be on ECMO is shortened. This translates into better outcomes and bottom line cost savings for an ECMO program.
Safeguard your ECMO program by using the Transonic ELSA Monitor.
1. Said MM et al, Children’s Hospital, Washington, D.C., “Influence of central hemodynamics on VV ECMO oxygen delivery in neonatal animal model,” J Neonatal Perinatal Med 2017.
Charles Lindberg's place in the annals of aviation history was solidified when he completed the first non-stop solo flight across the Atlantic from New York to Paris in 1927. Instantly, he became an American hero, and the object of incessant media attention. The press dubbed him "Lucky Lindy" or the "Lone Eagle." Although the main focus of his life continued to be dedicated to aeronautics, including the mapping of major air routes around the world, few know that Lindberg was also a biomedical innovator.
Extracorporeal membrane oxygenation (ECMO) was instituted in 1972 as a last ditch effort to save children experiencing cardiac and or respiratory failure. During the first decades of ECMO therapy, it was not widely used in adults because studies had not shown benefits for the adult population. However, within the last decade with better ECMO technology, patient management and the H1N1 swine flu epidemic of 2007-2008 that left patients with adult respiratory distress syndrome (ARDS), there has been a significant increase in adult ECMO.
As a perfusionist, you love what you do—you’re making a positive impact on people’s lives. For this very clinical profession that has been consigned to the OR, you might be surprised to learn that technology advancements and changes in procedures are allowing perfusionists to leave the OR and make their way to patients’ bedsides.
To get more insight into what’s on the horizon for cardiac perfusion, we spoke to an expert. Here are a few of the trends to watch if you’re a cardiac perfusionist.
A new challenge. A change of pace. For a profession that involves a lot of intense clinical work, these phrases might seem foreign to many cardiovascular perfusionists. But they don’t have to be.
The profession is evolving thanks to advancements in technology and medical procedures, and like other medical professionals, you can take advantage of locum tenens opportunities to expand your horizons, face new challenges or simply travel. It can be a career-shaping opportunity for many professionals.
In 1975, interest in ECMO was re-ignited after Dr. Robert H. Bartlett, then working at the University of California at Irvine, reported his first neonatal ECMO survivor. The baby‘s mother—a poor, illiterate woman from Baja, Mexico—crossed the border and headed for Los Angeles, determined that her child would have a better life as a U.S. citizen. En route, she went into labor and was taken to Orange County Medical Centre where her daughter was born. During delivery, the child had aspirated a large quantity of meconium and developed chemical pneumonitis. Even with maximal ventilatory support, the baby was unable to sustain adequate oxygenation.
A little over a half-century ago, the nation was transfixed by a struggle to save the life of Patrick Bouvier Kennedy, the infant son of President John F. and Jacqueline Bouvier Kennedy. Patrick, 5½ weeks premature and weighing only 4 pounds 10½ ounces, was delivered on Aug. 7, 1963. After birth, he immediately began having trouble breathing and was transferred from Cape Cod to Boston Children’s Hospital where he was placed in a hyperbaric chamber. He died 39 hours later of hyaline membrane disease, which was then the most common cause of death among premature infants (25,000 per year) in the United States.1 The disease is now known as infant respiratory distress syndrome (IRDS). In those days, there were no neonatal intensive care units (NICU), and ventilators had yet to be used for premature babies.