J Extra Corpor Technol 2023 , 55 , 218 – 220 Ó The Author ( s ), published by EDP Sciences , 2023 https :// doi . org / 10.1051 / ject / 2023038
Available online at : ject . edpsciences . org
LETTER TO THE EDITOR
A multipurpose Extracorporeal Life Support Circuit : a concept for multiorgan transplant and circulatory support service Healthcare provider Salman Pervaiz Butt ( MBA MSc MPHYS ACCP FCCP CES-A ) 1 ,* , Nuno Raposo ( ECCP ) 2 , and Yasir Saleem ( MSc ) 3
1 Perfusionist & ECMO Specialist , Cleveland Clinic , Abu Dhabi , United Arab Emirates , Honorary Lecturer University of Bristol , AmSECT Membership No : 8270 , PO Box : 112412 , United Arab Emirates 2 Perfusionist , Perfusion Department , Cleveland Clinic , Abu Dhabi , United Arab Emirates 3 Clinical Perfusionist , Department of CTVS , All India Institute of Medical Science-Rishikesh
Received 22 July 2023 , Accepted 5 October 2023
Abstract – The demand for efficient and adaptable life support systems in the field of Extracorporeal Life Support ( ECLS ) is steadily increasing . To meet this growing need , there is a requirement for a versatile extracorporeal life support circuit that can be effectively applied in various medical scenarios , especially in tertiary hospitals where multiple ECLS services are utilized . These services include Extracorporeal Membrane Oxygenation ( ECMO ) for addressing respiratory or cardiac problems , Ventricular Assist Device ( VAD ) as a bridge to recovery or heart transplant , and Venovenous Bypass ( VVB ) for assisting liver transplantation . In light of this , we propose the creation of a multipurpose circuit that integrates multiple extracorporeal life support ( ECLS ) functions to cater to diverse medical needs . This innovative circuit not only offers cost-effectiveness and enhanced safety but also ensures optimal utilization , thereby revolutionizing the realm of life support technologies .
Key words : Extracorporeal life support , Versatile circuit , ECMO , VAD , VV bypass , Versatility in applications .
Design
ECLS applications demand tailored configurations and circuit modifications to address individual patient requirements , which can include additional cannulas or changing cannulation sites . Additionally , specialized procedures like lung transplantation may necessitate a hybrid ECMO and cardiopulmonary bypass ( CPB ) circuit to ensure optimal patient care [ 1 – 3 ].
We propose a design for a versatile ECLS circuit suitable for various clinical scenarios . Our objective was to create a customized ECLS system that could easily be manufactured by any of the existing market manufacturers and could be employed in different ECLS modes . Currently , we utilize ECLS in the forms of ECMO ( both VV and VA configurations ), VAD , and VVB for liver transplantation and they all come as separate consumables and require separate machines .
To accomplish this , the circuit base configuration consists of three essential components : a centrifugal pump , a venous bubble trap ( VBT ), and a heat exchanger ( HE ) ( refer to Figure 1
* Corresponding author : buttsab9 @ hotmail . com for configurations ). The bubble trap and the heat exchanger have connections before and after each of these devices to facilitate the alteration of the ECMO or VAD circuit .
For instance , if the base circuit requires converting to VAD , both VBT and HE can be excluded . In the case of converting the base circuit to an ECMO circuit , VBT can be excluded and HE can be replaced with an ECMO oxygenator .
From a hardware standpoint , the RotaFlow II and Maquet ’ s Heater Cooler are utilized for these applications . In terms of consumables , Maquet ’ s centrifugal pump ( MCP ) and Sorin cardioplegia device serve as heat exchangers for VV Bypass , the MCP in conjunction with its circuit is employed for VAD applications , and MCP , oxygenator with circuit are employed for ECMO applications ( Figure 2 ).
The multipurpose extracorporeal life support circuit provides a wide range of benefits , including cost-effectiveness , safety , patient care , workflow efficiency , training , and resource optimization .
From a cost-effectiveness perspective , this circuit consolidates four applications into a single system , optimizing equipment utilization and eliminating the need for separate circuits
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( https :// creativecommons . org / licenses / by / 4.0 ), which permits unrestricted use , distribution , and reproduction in any medium , provided the original work is properly cited .