Management strategies for connecting vascular access of blood purification circuit to ECMO circuit

Abstract

For continuous blood purification（CBP）therapy, it is challenging to secure routes, especially in patients who are children. In those patients vascular access can be achieved using an extracorporeal membrane oxygenation (ECMO) circuit. However, this approach has risk of bleeding through the connections or introducing air into the ECMO circuit, requiring better safety measures to anticipate such complications. Although there are various connection methods, our institution performs blood return and withdrawal for CBP at the ECMO venous drainage site and ECMO arterial infusion site, respectively. During this process, when the ECMO venous drainage operates under strong negative pressure, causing the CBP return pressure to become negative as well, additional resistance is incorporated at the CBP return site to counteract the impact. Using this approach, we confirmed that CBP could be safely performed without being affected by negative pressure from the ECMO circuit drainage.