Pumpless Extracorporeal Lung Assist

Abstract

Extracorporeallung assist (ECLA) is an established form of treatment for acute pulmonary insufficiency. Classically, it takes the form of veno-venous bypass. The femoral vein and the subclavian vein are favored cannulation sites. Blood is pumped with either a roller or a centrifugal pump. Sometimes heparin-coated cannulae, membrane oxygenators (MO), and tubing are used, which may significantly reduce the risk of bleeding. A device pumping 1.0 to 4.0 liters per minute nevertheless signifies a persistent mechanical stress for the cellular blood components and causes some degree of hemolysis. A 42 year old patient with acute pancreatitis and marginal clotting parameters developed profound pulmonary insufficiency. All modes of mechanical ventilation were exhausted and proved to be inadequate. Under good hemodynamic conditions, an arterio-venous pumpless ECLA was instituted for a duration of 10 days, when the patient could be successfully weaned. The membrane oxygenator was connected via cannulae in the femoral artery and femoral vein.