Table 1 The concept of evaluation, insertion and clinical monitoring of the pumpless interventional lung assist (iLA) in patients with acute respiratory distress syndrome (ARDS)
Evaluation and preparation | Insertion | Monitoring |
|---|---|---|
Echocardiography: exclusion of significant cardiac dysfunction | Preparation of iLA system and introducer kit | System: - continuous calculation of blood flow through the device by transit time Doppler technology |
Ultrasound: assessment of femoral artery and vein diameter | Vascular cannula: Artery: allowing a residual lumen ≥ 30% of the vessel diameter maximum 17 Fr (adults) | Patient: - continuous limb pulse oxymetry distal the arterial cannulation site (toe) |
Coagulation: platelets > 60.000/μl aPTT < 60 seconds haemoglobin ≥ 9 mg/dl access to blood bank | Vein: + 2 Fr. compared with arterial cannula | - clinical inspection for any signs of restricted perfusion |
Contraindication: - coagulation disorder e.g. HIT | - cannulation by two experienced physicians | - assessment of serum creatine kinase and lactate regularly |
- severe peripheral vascular disease - continuously highly dosed vasoactive or inotropic agents (Noradrenaline > 0.4 μg/kg/minute) | - bolus application of 5000 IU heparin iv | Arterial blood gases: - early period (24 hours): frequently = every 4 hours |
- connection of the system stepwise increase of sweep gas flow to 10 l O2/minute | - late period (> 24 hours): every 8 hours | |
- continuous infusion of heparin (600 to 800 IU/hou via the arterial inflow cannula |