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Quantifying potential fluid transfused through pressure monitoring and circuit flushes in pediatric ECMO patients
Steven Robertson1, Katherine White1
1Children's Heart Center of Nevada, Las Vegas, NV, USA.
Insights
Continuous monitoring of pediatric Extracorporeal Membrane Oxygenation (ECMO) circuits using pressurized IV bags can lead to significant fluid transfusions. Automated syringe pumps drastically reduce this volume, improving patient safety.
Area of Science:
- Pediatric critical care medicine
- Biomedical engineering
Background:
- Pressure monitoring is crucial for pediatric Extracorporeal Membrane Oxygenation (ECMO) circuits, as recommended by ELSO guidelines.
- Maintaining patent pressure ports with crystalloid flushes can lead to unintended fluid administration.
- Current practices for fluid management during ECMO pressure monitoring lack standardized guidelines.
Purpose of the Study:
- To quantify the volume of fluid transfused to pediatric patients during ECMO when using standard pressure monitoring techniques.
- To compare fluid administration volumes between passive/active flushing methods and automated syringe pumps.
- To highlight the need for standardized practices in ECMO fluid management.
Main Methods:
- In vitro experiments simulating common negative and positive pressures in ECMO circuits.
- Utilized Edwards True Wave transducers and pressure bags to measure passive and active flushing volumes.
- Compared fluid volumes transfused using pressurized IV bags versus automated syringe pumps.
Main Results:
- Using pressurized IV bags for maintaining transducer patency resulted in a daily fluid transfusion of approximately 319.6 mL.
- This volume is comparable to a neonate's total blood volume.
- Automated syringe pumps reduced the daily transfused volume to 24 mL.
Conclusions:
- Standard fluid management for ECMO pressure monitoring can lead to excessive, unquantified fluid administration.
- Automated syringe pumps offer a significant reduction in transfused volume, enhancing patient safety.
- Further research is recommended to establish best practices for fluid management during ECMO pressure monitoring.
Abstract:
Pressure monitoring on pediatric Extracorporeal Membrane Oxygenation (ECMO) circuits is used to aid in the evaluation of patient hemodynamics and circuit health. Extracorporeal Life Support Organization (ELSO) recommends monitoring pressures on the venous line, pre-, and post-oxygenator. In order to keep pressure ports patent, crystalloid can be used as a flush. The fluid transfused to the patient through these lines can be challenging to quantify accurately due to variance in clinician practice. Currently, there is no published data or practice suggestions on this topic. In Vitro experiments using Edwards True Wave transducers and pressure bags were constructed, allowing for common negative and positive pressures to be simulated. Passive volume infused through the transducer as well as intermittent active flushing by pulling the snap tab were measured and the volumes were recorded. When the pressure transducer and associated tubing are kept patent by using a pressurized IV bag, per the instructions for use, the daily volume transfused was found to be 319.6 mL or close to a typical neonate's total blood volume. Rather than using passive or active flushing, the use of automated syringe pumps can reduce the transfused volume to 24 mL per day. Further study is recommended to develop and publish best practices.
