Connecting Prismaflex CRRT to the Cardiohelp ECMO circuit

Connecting to the circuit is institution and unit specific.

Many medical centers do not allow this in practice due to:
1) Risk for error with inadequately trained or inexperienced technicians
2) Accessing the lines and circuit introduces the risk of air with improper technique
3) Centers want to keep the circuit a completely closed system

There are many medical centers that allow connecting to the ECLS device for the following reasons:
1) Decreased risk for infection while eliminating additional central line access
2) Adequately trained staff to trouble shoot CRRT/ECLS related problems and intervene appropriately
3) Competent staff who know how to safely connect and disconnect with sterile wet connect technique to and from the ECLS circuit
4) Ease of having all of your machines positioned together for easier management and visualization
5) Decreased risk of line and access related problems while on CRRT (kinking, high venous pressure related to volume status and other line access issues that are commonly experienced)

Connecting CRRT to the ECLS circuit requires appropriately trained staff who perform competency validation through wet lab, simulations, and bedside patient care. It is important that the ECMO Specialist is trained appropriately and able to intervene if air is introduced into the ECLS system via CRRT, ECLS pump failure occurs and other potential complications that can arise in emergent situations.

Technique:
1) CRRT access (red) line is usually connected post oxygenator on the Cardiohelp, Centrimag and Soren devices. The rationale is so that positive pressure is being delivered to the CRRT device to help eliminate too negative of a pull on the device. Some centers will connect the access line pre oxygenator post pump on the Centrimag/Soren so that if in the event air is introduced into the system, it could be trapped in the oxygenator and removed more easily.
2) CRRT return (blue) line is usually connected pre oxygenator on the Cardiohelp, Centrimag and Soren devices.

It is important to note that with this set up, you will no longer have a negative access pressure on the Prismaflex device and it may alarm due to this change. This is to be expected due to how the access line is connected to the ECLS circuit.

Common concerns:

What about recirculation?
The ECLS device is generally maintaining much higher flows than the CRRT machine, thus the potential for recirculation through the CRRT system is there but it is minimal.

What is my lines start chattering/chugging?
Stop fluid removal and assess your patient's volume status.


Learning Session Author & Creator
Daniel Marino BSN, RN, CCRN, CES-A

Daniel is a registered nurse who has dedicated the past decade of his career to the care of ECMO patients in both pediatrics and adults. He is currently serving as the ECLS program manager at St Christopher’s Hospital for Children. His interests lie in ECMO simulation education, ECMO research, and ECMO program development. He utilizes ECMO simulation training to develop nurse and respiratory therapist run ECMO programs. During this simulation training the learners develop vital skills on how to respond to ECMO emergencies. Daniel is passionate about ECLS education and is currently serving as one of the Extracorporeal Life Support Organizations (ELSO) simulation faculty. He also serves as adjunct faculty at Jefferson University Hospital teaching in their ECLS course.

For more information visit:
www.ECMOResource.com