Stephen
agree that cardiopul. bypass is the gold standard, but access to it
can be difficult, hence my suggestion. The case report was in the Nov
2000 edition of the JAEM. I haven't got it to hand but I can't
remeber whether or not the patient had an arrest. There are one or
two case reports of it being used successfully (in Japanese!). The
machine works by using a roller pump on the venous circuit, perfusion
pressure isn't an issue, you would have to continue CPR. High venous
pressurews are not a problem in renal patients-its used on them! We
have used it here at the Royal but despite rapid warming the patient
died. Other centres have also tried -I don't know of the success rate
Anyone else got any experience?
Francis
---------------- reply --------------
> In message <[log in to unmask]>, Francis
Andrews
> <[log in to unmask]> writes
> >Tim
> >
> >Why not ring up your nearest ITU for these patients. Many DGHs
> >without renal physicians on site have ICUs with the capability to
> >perform venovenous filtration. You need to check that the machine
has
> >a warming circuit (most have), and the patient could be rapidly
warmed
> >this way. Unlike dialysis, no special water supply is needed and
> >theoretically it could be done in A&E with ICU support. Only
venous
> >access is required for the line. An example of this was recently
> >published in the journal of A&E medicine.
> >
> >Francis Andrews FFAEM
> >Lecturer in Intensive Care Medicine
> >Department of Medicine
> >University of Liverpool
> >Daulby St
> >L693GA
> >
>
> As there have been no takers for this particular line in the thread,
I
> might as well take it up!
>
> A cardiopulmonary bypass machine gives a reasonable perfusion
pressure.
> Does a venovenous circuit do likewise? I suspect not. A high venous
> pressure from an extracorporeal pump would lead to problems in a
renal
> patient. Does taking the filter out of the circuit allow the pump to
> develop a high enough head of pressure?
>
> In our arrested hypothermic patient, some other means of maintaing
> perfusion would probably need to be employed.
>
> Tim suggests that a cold chest does not compress well, so a
thoracotomy
> would be required.
>
> The case report referred to by Francis Andrews was indeed
interesting.
> However, I cannot find it at home. What was the reference?
> --
> Stephen Hughes
>
Francis Andrews FFAEM
Lecturer in Intensive Care Medicine
Department of Medicine
University of Liverpool
Daulby St
L693GA
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