There is currently an issue with ECMO cannulae on the market and limb ischemia. My senior capstone group is curious as to what our target flow should be to prevent this issue. We understand that returning to homeostatic levels with a single insertion point is a lofty goal, so the minimum level gives us a starting point before beginning our concepts.
Hey Justin,
Yes, that is a lofty goal!
"Minimum flow" is a big variable- as you know. This will depend on the patient. However, in our experience, an 8F catheter inserted in the SFA has done the job for a patient about 100kg. We estimated 200-300cc flow per min for that particular patient.
Hope it helps. I am curious to know how/what you achieve this with single insertion. This has been a sticking point every time we have an ECMO.
Good luck
Sanjay
Sanjay Patel Thank you for your response. I am curious to why the 8Fr catheter was used as opposed to a larger catheter. Through our research we have been seeing larger French sizes being used, around 15-25Fr. Could you clarify why this size was chosen?
Thanks,
Justin
Oh. I may have misunderstood the question. 8F, inserted in the SFA, is used to antegrade perfuse the leg when the ECMO inflow cannula - 15F-25F, is obstructing the flow to that leg causing the limb ischemia. 8F is NOT the primary inflow cannula.
The catch 22 in fem-fem ECMO is - if you want to flow more, you will need a bigger cannula to minimize the blood trauma caused by the high pressure drop. Also, you may require very high RPM to flow through the smaller cannula. The bigger cannula on the other hand, like you mentioned, may obstruct the flow to the limb causing ischemia. I understood that your group is trying to tackle this very conundrum.
Sorry if I muddied this up for you...
Sanjay
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