Is there a "safe" suction pressure in the venous line of extracorporeal circulation system?

Abstract

Successes of extracorporeal life support increased the use of centrifugal pumps. However, reports of hemolysis call for caution in using these pumps, especially in neonatology and in pediatric intensive care. Cavitation can be a cause of blood damage. The aim of our study was to obtain information about the cavitation conditions and to provide the safest operating range of centrifugal pumps. A series of tests were undertaken to determine the points at which pump performance decreases 3% and gas bubbles start to appear downstream of the pump. Two pumps were tested; pump R with a closed impeller and pump S with a semiopen impeller. The performance tests demonstrated that pump S has an optimal region narrower than pump R and it is shifted to the higher flows. When the pump performance started to decrease, the inlet pressure varies but close to −150 mmHg in the test with low gas content and higher than −100 mmHg in the tests with increased gas content. The same trend was observed at the points of development of massive gas emboli. Importantly, small packages of bubbles downstream of the pump were registered at relatively high inlet pressures. The gaseous cavitation in centrifugal pumps is a phenomenon that appears with decreasing inlet pump pressures. There are a few ways to increase inlet pump pressures: (1) positioning the pump as low as possible in relation to the patient; (2) selecting appropriate sized venous cannulas and their careful positioning; and (3) controlling patient’s volume status.