P52: ECMO Circuit Exchange on a Single Pump Console: Maximizing Mechanical Circulatory Support Resources in the High Census Pediatric Environment

Abstract

Background: Pediatric hospitals have faced an unprecedented period of high census due to a confluence of respiratory illnesses, resulting in increased use of ECMO for rescue and long-term therapy. Combined with equipment demands imposed by a cardiac surgical program, ECMO disposables and pump console inventories have been stretched to their limits in many centers. Circuit exchanges place additional burden on device numbers, as two pump consoles are typically used for the changeout procedure. We report the case of an infant cardiac surgical patient requiring ECMO circuit exchange while the remainder of appropriately sized systems were in use on other patients in the hospital. Methods: A 3kg infant with complex congenital heart disease on VA ECMO post repair required circuit exchange due to consumptive coagulopathy and significantly increased trans-oxygenator gradient after multiple weeks of support. Due to a concurrent period of high ECMO utilization, a size appropriate replacement system was unavailable. In our institution, cardiac patients under 20kg requiring mechanical circulatory assistance are supported on a roller system with multiple pump heads, allowing conversion from ECMO to cardiopulmonary bypass without exposing the patient to an additional circuit and associated sequalae. After careful planning, the decision was made to build and prime a replacement circuit on the currently used pump base, using one of the accessory roller heads to de-air and recirculate the system. The pump-mounted oxygen tank was used to oxygenate the blood-primed circuit, and an extra heater was used to bring the perfusate up patient temperature. Three-way stopcocks placed on the venous, pre-, and post-oxygenator transducers allowed simultaneous pressure monitoring of both circuits. After a period of recirculation, the new infusion and return lines were handed up to the field and marked with white tape to denote new versus old tubing. A brief period off support was well tolerated as the circuits were changed out at the arterial and venous cannula connections, and subsequently the old circuit was removed from the pump base and discarded. Sweep control was re-established by the on-board mixer and flow meters, and water lines were reconnected to the on-board heater.