Technique for circuit exchange in high-risk patients on extracorporeal life support

Exchanging circuits in patients undergoing extracorporeal life support (ECLS) for component failure can be a life-threatening endeavor if the patient has no native organ function and is fully dependent on ECLS. Traditional circuit exchanges involve replacing the entire circuit at once, leading to a sufficient loss of support that risks hemodynamic deterioration in the absence of mechanical ventilation or mechanical circulatory support. A staged approach is described using a parallel circuit configuration to reduce the risk of physiologic decompensation in patients with total dependence on ECLS. The approach involves splicing in a second primed circuit in parallel, transitioning flow incrementally from old to new circuit, and removing the old circuit. This approach provides hemodynamic and physiologic stability even in patients with absent underlying cardiopulmonary function.