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Table of Contents  目录

Dedication ..... v 奉献。。。。。v
Foreword ..... vii 前言。。。。。七
List of Contributors ..... ix
贡献者名单 .....九
Preface to the Edition ..... xxiii
.....版前言二十三
Section I. ECLS: General Principles
第一节 ECLS：一般原则
  1. The History and Development of Extracorporeal Support ..... 1
    体外支持的历史与发展 .....1
    The History and Development of Extracorporeal Support ..... 1
    体外支持的历史与发展 .....1
    Extracorporeal Support: Earliest Beginnings ..... 1
    体外支持：最早的开始 ..... 1
    Global Spread of ECMO ..... 6
    ECMO.....的全球传播6
    Perseverance: Experience and Growing Indications in ECMO ..... 9
    毅力：ECMO.....的经验和成长适应症9
    Technology and Clinical Indications for ECMO: the Future is Bright ..... 13
    ECMO的技术和临床适应症：未来是光明的.....13
    References ..... 14 引用。。。。。14
  2. Nomenclature ..... 17 命名法。。。。。17
    Introduction ..... 17 介绍。。。。。17
    Fundamental Nomenclature ..... 18
    基本命名法 .....18
    Abbreviations for Cannulation Configuration ..... 20
    Cannulation Configuration ..... 的缩写20
    Peripheral Cannulation Configuration ..... 21
    外周插管配置.....21
    Central Cannulation ..... 22
    中央插管.....22
    Combination of Central and Peripheral Applications ..... 26
    中央和外设应用的结合 .....26
    Independent Circuits ..... 26
    独立电路 .....26
    Commentary ..... 26 评论。。。。。26
    Conclusion ..... 27 结论。。。。。27
    References ..... 28 引用。。。。。28
  3. The Circuit ..... 29 电路.....29
    Introduction ..... 29 介绍。。。。。29
    Circuit Components and Composition ..... 30
    电路元件及组成 .....30
    Blood Pumps - Physics, Design, and Impact on Performance ..... 32
    血泵 - 物理、设计和对性能的影响 .....32
    Pressure Generating Pumps (Centrifugal Pumps) ..... 33
    压力发生泵（离心泵） .....33
    Circuit Composition. ..... 38
    电路组成。.....38
    Circuit Monitoring ..... 39
    电路监控.....39
    Summary ..... 42 总结。。。。。42
    References ..... 43 引用。。。。。43
  4. Cannulation ..... 47 插管。。。。。47
    Introduction ..... 47 介绍。。。。。47
    Basic Principles ..... 47
    基本原则。。。。。47
    Section 1: Percutaneous VA ECMO Cannulation in Older Children and Adults ..... 48
    第 1 部分：大龄儿童和成人经皮 VA ECMO 插管 .....48
    Section 2: Percutaneous VV ECMO Cannulation in Older Children and Adults ..... 54
    第 2 部分：大龄儿童和成人经皮 VV ECMO 插管 .....54
    Bicaval Double-lumen, Single Cannula ..... 55
    双腔双腔，单套管 .....55
    Section 3: Pulmonary Artery Cannulation, Percutaneous RVAD ..... 57
    第 3 节：肺动脉插管、经皮 RVAD .....57
    Section 4: Surgical Cannulation for VA (VV) ECMO in Older Children and Adults. ..... 57
    第 4 部分：年龄较大的儿童和成人 VA （VV） ECMO 手术插管。.....57
    Right Axillary/Subclavian Artery ..... 59
    右腋动脉/锁骨下动脉 .....59
Level 1 - Basic Cannulation Configuration
级别 1 - 基本插管配置
Configuration 配置 Abbrev 阿布雷夫 Specifics 细节 Comment 评论
Cannula placed in an artery
将套管放置在动脉中		 A

含氧血液回流或 用于无泵去除 CO2 的排水
Return of oxygenated blood or
drainage for pumpless CO2 removal
Cannula placed in a vein
将套管放置在静脉中		 V Drainage or return site 排水或回水场地

套管放入 肺动脉
Cannula placed in
pulmonary artery
P

含氧物质的排水或回流 血
Drainage or return of oxygenated
blood
One membrane lung 单膜肺 -

两个平行膜 肺
Two parallel membrane
lungs
Two serial membrane lungs
两个连续膜肺		 +
Configuration 配置 x

标志着外围设备和 组合单件的中心部分 电路
Marks the separation of peripheral and
central parts of a combined single
circuit

将中央和 外周插管
Combining central and
peripheral cannulation
I

标志着两者的分离 中使用的独立配置 平行
Marks the separation of two
independent configurations used in in
parallel

多个独立 电路
Multiple independent
circuits

（ca） 代表 （dl） 如果心房 DLC （bc） 代表 （dl） if 双骑士 DLC
(ca) for (dl) if cavo-atrial DLC
(bc) for (dl) if bi-caval DLC

双腔套管（用于 V- 五）
Dual-lumen cannula (for V-
V)
(dl)V-V （分升）V-V（V-V）

（ca） （公元前）
(ca)
(bc)

DLC 与一次动脉回输 套管相应地索引（模式： VVA）
DLC with one arterial reinfusion
cannula indexed accordingly (mode:
VVA)

双腔套管 + 动脉回流
Dual-lumen cannula +
arterial return
(dl)V-VA （分升）V-VA型

（ca） （公元前）
(ca)
(bc)

DLC，使用双肢的 Y 形件 用于静脉引流和一条动脉 回输套管（模式：VA）
DLC with Y-piece using both limbs
for venous drainage, and one arterial
reinfusion cannula (mode: VA)

双腔套管 + 动脉回流
Dual-lumen cannula +
arterial return

静脉肺动脉ECMO支持 右心室。可能等同 至经皮“oxyRVAD”
Venopulmoarterial ECMO supporting
the right ventricle. May be equivalent
to percutaneous "oxyRVAD"

双腔套管 在肺中返回 动脉
Dual-lumen cannula with
return in the pulmonary
artery
(dl)V-P （分升）V-P型

静脉动脉 ECLS 支持右侧 心室。
Venoarterial ECLS supporting the right
ventricle.

双腔套管 在巴勒斯坦权力机构返回
Dual-lumen cannula with
return in the PA
(dl)VxP （分升）VxP的

（pl）表示无泵驱动电路， A-V
(pl) indicates pumpless driven circuit,
A-V
Pumpless 无泵 (pl)A-V （波兰）A-V
Table 2-3. Abbreviations used for describing cannulation configurations in ECLS. Level 1 shows abbreviations for major flow cannula and membrane lung configuration for peripheral and central cannulations. Level 2 shows abbreviations describing the actual vessels cannulated. Level 3 provides for describing the cannula tip position, while Level 4 allows description of the cannula size (length and diameter)
表 2-3.用于描述ECLS中插管配置的缩写。级别 1 显示外周和中央插管的主要流量插管和膜肺配置的缩写。级别 2 显示描述实际插管容器的缩写。第 3 级用于描述套管尖端位置，而第 4 级用于描述套管尺寸（长度和直径）
Abbreviations: DLC, dual-lumen cannula; ECLS, extracorporeal life support; ECMO, extracorporeal membrane oxygenation; MCS, mechanical cardiac support; ML, extracorporeal membrane lung
缩写：DLC，双腔套管;ECLS，体外生命支持;ECMO，体外膜肺氧合;MCS， 机械心脏支持;ML，体外膜肺
Configuration 配置 Abbrev 阿布雷夫 Specifics 细节 Comment 评论
Cephalad draining catheter
头侧引流导管		 cep 美味牛肝菌

从静脉引流 颈静脉球，与“V”型套管同侧 在脖子上
Drainage of venous blood from the
jugular bulb, same side as "V" cannula
on neck
Venting catheter 通气导管 vnt

心房或心室通气 导管
Cardiac atrial or ventricular venting
catheter
Distal cannula 远端套管 d

在 V-A 中用于空心腿的灌注 与“A”在同一侧。在 V-V 或 V-A 中用于 静脉淤血引流 空心腿
In V-A for perfusion of cannulated leg
on same side as "A". In V-V or V-A for
drainage of venous congestion of
cannulated leg

远端灌注 套管
Distal perfusion within the
cannula
Ad 广告

Ad 下划线表示双端口 股动脉插管（设计有 远端端口）
Ad underlined indicates dual port
femoral arterial cannula (designed with
distal port)
Level 1 - Central Cannulation
1 级 - 中央插管
Configuration 配置 Abbrev 阿布雷夫 Specifics 细节 Comment 评论
Cannula placed in RA 套管放置在 RA 中 RA
Cannula placed in RV 放置在房车中的套管 RV
Cannula placed in PA 套管放置在 PA 中 PA Direct cannulation 直接插管
Cannula placed in LA 套管放置在洛杉矶 LA
Cannula placed in LV 套管放置在左心室 LV
Cannula placed in aorta 套管放置在主动脉中 AO Typically ascending aorta
通常为升主动脉

套管放置在 无名动脉
Cannula placed in the
innominate artery
IA Chimney graft may be used
可以使用烟囱嫁接

左跨瓣膜 心室支持
Transvalvular left
ventricular support
TVLS Transvalvular axial pump 跨瓣轴流泵

右瓣跨瓣膜 心室支持
Transvalvular right
ventricular support
TVRS Transvalvular axial pump 跨瓣轴流泵

左心室辅助 装置
Left ventricular assist
device
LVAD

如果将膜肺放入 电路：oxyLVAD
If a membrane lung is put into the
circuit: oxyLVAD

右心室辅助 装置
Right ventricular assist
device
RVAD

如果将膜肺放入 电路：oxyRVAD
If a membrane lung is put into the
circuit: oxyRVAD
Table 2-3 Continued. 表 2-3 续。
Level 2 - Cannulated Vessel
2 级 - 空心容器
Vessel 船

简单 方法
Simple
approach

扩展 方法
Extended
approach
Comment 评论
Atrium 心房 a (al) （al）

右心房 if 静脉指示器 套管（尖端位置在中部到上部）， 左心房 IF 导管通气指数
Right atrium if index for venous
cannula (tip position mid to upper part),
left atrium if index for venting catheter
Carotid artery 颈动脉 car 汽车 carl/carr 卡尔/卡尔 Left or right side 左侧或右侧
Femoral vessel 股骨血管 f

动脉或静脉，左侧或右侧
Artery or vein, left or right side
Chimney graft on left/right femoral
artery
左/右股骨烟囱移植物
动脉
Jugular vein 颈静脉 j Via left or right jugular vein
经左颈静脉或右颈静脉 Subclavian vessel 锁骨下血管 s

动脉或静脉，左侧或右侧 左/右锁骨下叶的烟囱移植物 动脉
Artery or vein, left or right side
Chimney graft on left/right subclavian
artery
Level 3 - Cannula Tip Position
3 级 - 套管尖端位置 Position 位置

简单 方法
Simple
approach

扩展 方法
Extended
approach
Comment 评论

髂下血管或下髂下部 腔静脉
Iliacal vessel or low inferior
vena cava
i il/ir Artery or ven, left or right side
动脉或静脉，左侧或右侧 Inferior vena cava 下腔静脉 ivc 静脉注射 ivc 静脉注射

静脉套管尖端位置处于 肝静脉
Venous cannula tip position at level of
liver vein
Superior vena cava 上腔静脉 svc SVC公司 svc SVC公司

静脉套管尖端位于上部 腔静脉
Venous cannula tip position in superior
vena cava
Distal perfusion 远端灌注 dt DT的

通过股骨灌注插管腿 动脉在同一侧
Perfusion of cannulated leg via femoral
artery on same side
Distal perfusion 远端灌注 dp DP型

经背足灌注或 同一侧的胫后动脉
Perfusion via the dorsal foot or
posterior tibial artery on same side
Level 4 - Cannula Size
4 级 - 套管尺寸 Diameter in French (Fr) 法语直径 （Fr） (outer cannula diameter)
（套管外径） Length in centimeters 长度（厘米） .../18 Do not print length alone
不要单独打印长度
Table 2-3 Continued. 表 2-3 续。

Combination of Central and Peripheral Applications
中央和外围应用的结合

To provide clarity on the use of circuits combining central and peripheral cannulation, the configuration is still formulated in the direction of flow, but the junction between the two parts of the circuit is marker with a slash "/". An example of such a configuration is Vjra-/IAg, which is VA support with peripheral venous drainage from the right atrium via a cannula placed through the right jugular vein (peripheral component), one membrane lung, and return flow into a chimney graft ( g ) on the innominate artery (IA, central component). Such an approach is often used for bridging to lung transplant.
为了明确使用结合中心和外围插管的电路，配置仍沿流动方向制定，但电路两部分之间的连接处用斜杠“/”标记。这种配置的一个例子是 Vjra-/IAg，它是 VA 支持，通过放置于右颈静脉（外周成分）、一个膜肺的套管从右心房引流外周静脉，并回流到无名动脉（IA，中央成分）上的烟囱移植物 （ g）。这种方法通常用于肺移植的桥接。

Independent Circuits 独立电路

If two independent extracorporeal circuits are used simultaneously, their respective configuration abbreviations are separated by a back slash ""'. The nomenclature allows for combined use of both central and peripheral circuits. An example isVfl-Afrdt\Vja-Asg, where the first circuit (Vfl-Afrdtl) drains via the left femoral vein with return flow via one membrane lung into the right femoral artery with a distal perfusion cannula in the right groin. The second circuit ( -Asg) drains via a jugular cannula with the tip in the (right) atrium and return flow via either subclavian artery where the cannula is put into a chimney graft.
如果同时使用两个独立的体外回路，则它们各自的配置缩写由反斜杠“”'分隔。该命名法允许同时使用中心电路和外围电路。 一个例子是 Vfl-Afrdt\Vja-Asg，其中第一回路 （Vfl-Afrdtl） 通过左股静脉引流，回流通过一个膜肺进入右股动脉，右腹股沟有一个远端灌注套管。第二回路 （ -Asg） 通过颈静脉套管引流，尖端位于（右）心房，并通过任一锁骨下动脉回流，套管被放入烟囱移植物中。

Commentary 评论

Although comprehensive, the nomenclature is intended to describe widely adopted approaches, and special applications may not fit within this nomenclature. These special applications should be described accordingly. Once in more widespread use, the nomenclature can be adapted to include these new approaches.
虽然内容全面，但该命名法旨在描述广泛采用的方法，特殊应用可能不适合该命名法。应相应地描述这些特殊应用。一旦得到更广泛的使用，就可以对命名法进行调整，以包括这些新方法。
Currently, cannula length of dual-lumen cannulas is not reported; however, with new devices emerging on the market, for example a dual-lumen cannula for femoral insertion, this may be a descriptor that will be added. The current nomenclature also does not provide information on cannula design, such as single-stage vs. multi-stage. Including such information would add unnecessary complexity without sufficient additional information to justify it.
目前，双腔插管的套管长度尚未见报道;然而，随着市场上出现新的设备，例如用于股骨插入的双腔套管，这可能是一个将被添加的描述符。目前的命名法也没有提供有关套管设计的信息，例如单级与多级。如果没有足够的额外信息来证明其合理性，包括此类信息将增加不必要的复杂性。
The final tip position of drainage and return cannulas has an impact on patient support, in particular with respect to recirculation during VV ECMO, but also in VA ECMO using a femoral return cannula, where differential hypoxia (formerly known as North-South or Harlequin syndrome) can occur. Blood flowing antegrade from native cardiac ejection and blood from the extracorporeal circuit flowing retrograde from the femoral artery cannula flow in opposing directions within the aorta. These competing flows meet at a mixing point (mixing zone, water-shedding zone), usually somewhere along the thoracic aorta. If respiratory failure is present, poorly oxygenated blood ejected from the left ventricle will perfuse the upper body, and well oxygenated blood will perfuse the lower body. The configuration solutions to the problem would be to consider conversion to VV or convert to VVA ECMO with an additional return cannula in the SVC.
引流插管和回流插管的最终尖端位置对患者支持有影响，特别是在 VV ECMO 期间的再循环方面，但在使用股骨回流插管的 VA ECMO 中也是如此，其中可能会出现差异缺氧（以前称为南北综合征或 Harlequin 综合征）。 从天然心脏射血而顺行流出的血液和从股动脉套管逆行流出的体外回路的血液在主动脉内以相反的方向流动。这些相互竞争的血流在混合点（混合区、缺水区）相遇，通常位于胸主动脉的某个地方。如果存在呼吸衰竭，从左心室射出的含氧量低的血液将灌注上半身，而含氧量好的血液将灌注下半身。该问题的配置解决方案是考虑转换为 VV 或转换为 VVA ECMO，并在 SVC 中增加一个回流套管。
Another rarely discussed issue related to the dual circulation with femoral VA ECMO is differential carbon dioxide tension (which can be found on the ELSO website www.elso.org for the Red Book). Upper body is determined by lung ventilation and lower body by circuit sweep gas flow. This phenomenon may easily pass undetected depending on where blood gases are sampled, and which regional blood stream supplies the respiratory center in the brainstem. Hypo or hypercarbia may develop in one or the other region depending on the interaction of the
另一个很少讨论的与股动脉 VA ECMO 双循环相关的问题是二氧化碳分压（可以在 ELSO 网站上找到，www.elso.org 红皮书）。上半身 由肺通气确定，下半身 由回路扫描气体流量确定。这种现象可能很容易在未被发现的情况下通过，这取决于血气采样的位置，以及哪个区域血流供应脑干中的呼吸中枢。低碳酸血症或高碳酸血症可能在一个或另一个区域发展，具体取决于
patient's own ventilation regulated by the respiratory center, degree of sedation and neuromuscular blockade, ventilator settings, cardiac output, and ECMO blood flow.
患者自身通气由呼吸中枢调节、镇静程度和神经肌肉阻滞、呼吸机设置、心输出量和 ECMO 血流量。

Conclusion 结论

The ELSO Maastricht Treaty for nomenclature ECLS provides a uniform, informative, and flexible system to describe ECLS practice and cannulation configurations. free online tool for the peripheral cannulation segment is available (https://ecls.eurosets.com).
ELSO 马斯特里赫特条约关于命名 ECLS 提供了一个统一、信息丰富且灵活的系统来描述 ECLS 实践和插管配置。 提供用于外周插管段的免费在线工具 （https://ecls.eurosets.com）。

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  9. Kim HE, Jung JW, Shin YR, Park HK, Park YH, Shin HJ: Left Atrial Decompression by Percutaneous Left Atrial Venting Cannula Insertion during Venoarterial Extracorporeal Membrane Oxygenation Support. Korean J Thorac Cardiovasc Surg 49 (3): 203-6, 2016.
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  11. Le Guyader A, Lacroix P, Ferrat P, Laskar M: Venous leg congestion treated with distal venous drainage during peripheral extracorporeal membrane oxygenation. Artif Organs 30 (8): 633-5, 2006.
    Le Guyader A、Lacroix P、Ferrat P、Laskar M：外周体外膜肺氧合期间用远端静脉引流治疗的静脉下腿淤血。Artif Organs 30 （8）： 633-5， 2006.
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    Chicotka S、Rosenzweig EB、Brodie D、Bacchetta M：“中央运动模型”：使用无名动脉为较小的患者提供体外膜肺氧合作为肺移植的桥梁。朝尾杂志63（4）：e39-e44,2017。
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    Hou ， Yang ， et al： 上腔静脉引流可改善绵羊静脉-动脉体外膜肺氧合过程中的上半身氧合。暴击护理19：68,2015。

3

The Circuit 电路

Leen Vercaemst, Timothy M. Maul, Jutta Arens, John M. Toomasian
Leen Vercaemst、Timothy M. Maul、Jutta Arens、John M. Toomasian

Introduction 介绍

The ECLS circuit is designed to support the function of a failing respiratory (sometimes referred to as extracorporeal lung assist, or ECLA) and/or cardiac system. The circuit is comprised of one or more cannula(s), a blood pump, an artificial lung, connectors, tubing, circuit monitoring and temperature control devices. In rare instances, the circuit can be directly connected from an artery to a vein without the need for a blood pump (pumpless extracorporeal lung assist, or PECLA). Throughout this chapter, all combinations or modalities will be referred to as ECLS for simplicity.
ECLS 回路旨在支持衰竭的呼吸系统（有时称为体外肺辅助或 ECLA）和/或心脏系统的功能。 该回路由一个或多个插管、一个血泵、一个人工肺、连接器、管道、电路监测和温度控制设备组成。在极少数情况下，该回路可以直接从动脉连接到静脉，而无需血泵（无泵体外肺辅助，或 PECLA）。为简单起见，在本章中，所有组合或模式都将称为 ECLS。
Variations in circuitry depend on the individual component design and composition, and clinical needs of the patient. These issues require detailed attention and management. There is also a variety of hardware controlling these circuits with different monitoring and safety features. The same circuitry can be adapted for intra- and interhospital transport. Depending on the position of the drainage and return cannulas in the vascular system, ECLS can provide either respiratory and/or hemodynamic support. High blood flow rates may be required, depending on the degree of organ failure or metabolic needs of an individual patient. To ensure sufficient support, all components need to be correctly selected, sized, and carefully managed.
电路的变化取决于各个组件的设计和组成，以及患者的临床需求。这些问题需要详细的关注和管理。此外，还有各种硬件控制这些电路，具有不同的监控和安全功能。相同的电路可以适用于医院内和医院间的运输。根据引流套管和回流套管在血管系统中的位置，ECLS 可以提供呼吸和/或血流动力学支持。可能需要高血流率，具体取决于器官衰竭的程度或个体患者的代谢需求。为确保足够的支持，需要正确选择所有组件、调整尺寸并仔细管理。
Historically, ECLS circuit components were adapted from cardiopulmonary bypass equipment used for cardiac surgery. Many of these devices are labelled for short-term use, typically less than six hours. These devices have been used for ECLS safely off-label for days, weeks, or months at a time. Recently, some newer devices and cannulas have received regulatory clearance for extended use for periods up to 30 days. Existing devices may be reclassified as long-term use devices based on the interests of manufacturers, regulatory agencies, and country of use.
从历史上看，ECLS 电路组件是由用于心脏手术的体外循环设备改编而来的。其中许多设备都贴上了短期使用的标签，通常不到 6 小时。这些设备已用于 ECLS，一次可以安全地脱离标签数天、数周或数月。 最近，一些较新的设备和插管已获得监管许可，可以延长使用时间长达 30 天。根据制造商、监管机构和使用国家/地区的利益，现有设备可能会被重新分类为长期使用设备。
In this chapter, ECLS circuit components will be described, and their proper assembly and operation will be outlined. This includes descriptions of disposable components, hardware, information provided by the device manufacturer, and some supporting tools to monitor circuit function. This chapter in previous editions of the Red Book provided specific commercial examples used in the ECLS circuit. However, descriptions of industry products will not be provided here. For information on specific devices, the reader is referred to 'Instructions for Use' (IFU) provided by the manufacturer that describe the materials, indications for use, and operational parameters for clinical application.
在本章中，将介绍ECLS电路组件，并概述其正确的组装和操作。 这包括一次性组件、硬件、设备制造商提供的信息以及一些用于监控电路功能的支持工具的描述。在《红皮书》的前几版中，这一章提供了ECLS电路中使用的具体商业示例。 但是，此处不会提供行业产品的描述。有关特定设备的信息，请参阅阅读器由制造商提供的“使用说明”（IFU），其中描述了临床应用的材料、使用适应症和操作参数。

Circuit Components and Composition
电路元件和组成

The main components of the circuit are drainage cannula(s), pump, artificial lung with integrated heat exchanger, and return cannula(s). These are interconnected with PVC tubing with an inner diameter of " (inch) in adults, or " or " in children (Figure 3-1).
回路的主要部件是引流插管、泵、带集成热交换器的人工肺和回流插管。它们与内径为 “（英寸）的 PVC 管相互连接，成人为”（英寸）“，儿童 为”或 “（图 3-1）。
The extracorporeal volume and bloodto-polymer exposure impact patient blood composition, inflammatory processes, and coagulation (see Chapter 6). The volume to fill (prime) the circuit typically ranges from in neonates to in adults. The priming fluid composition depends on the relative blood dilution (circuit versus patient volume) and aims to maintain a physiological intravascular composition (especially the hemoglobin level needed for oxygen transport) despite the expansion of the patient's circulating volume.
体外体积和血液聚合物暴露会影响患者的血液成分、炎症过程和凝血（见第 6 章）。填充（灌注）回路的体积通常在 新生儿到 成人中不等。启动液成分取决于相对血液稀释度（回路与患者体积），旨在维持生理血管内成分（尤其是氧转运所需的血红蛋白水平），尽管患者的循环体积扩大。
The knowledge of basic physiology of flow and physics of laminar flow through tubing as described by the Hagen-Poiseuille Law equation (Equation 1), illustrating the relationship between flow and resistance in a tube.
通过管道的流动的基本生理学知识和层流物理学的知识，如Hagen-Poiseuille定律方程（方程式1）所描述，说明了管道中流动和阻力之间的关系。

Equation 1 等式 1

The Hagen-Poiseuille Law states that volumetric flow is proportional to the power of the tubing pathway's radius ( ), pressure drop ( across the pathway, and inversely proportional to the pathway length (L) and dynamic fluid viscosity ( ). Resistance to flow within the ECLS circuit should be minimized. This provides important
Hagen-Poiseuille定律指出，体积流量 与管道路径的半径（ ）、 压降（ 穿过路径的 功率成正比，与路径长度（L）和动态流体粘度（ ）成反比 。应将 ECLS 回路内的流动 阻力降至最低。这提供了重要的
Figure 3-1. The ECLS circuit. (Illustration by Stephanie Philippaerts-copyright protected-Produced for UZ Leuven.)
图 3-1。ECLS 电路。（插图由 Stephanie Philippaerts 绘制-受版权保护-为 UZ Leuven 制作。
guidance in the selection, composition, and management of the circuit. However, low resistance comes at the price of larger priming volume (Table 3-1). Therefore, both should be carefully balanced accounting for the individual patient needs.
指导电路的选择、组成和管理。然而，低阻力的代价是更大的启动体积（表3-1）。因此，两者都应仔细平衡，考虑到个体患者的需求。

Cannulas 插管

Cannulas (Figure 3-2) are integral parts of the circuit and provide the intravascular connections between the patient and circuit. They have a tremendous bearing on the ability of the circuit to provide sufficient flow and support and are often a limiting factor. Cannulas come in a variety of sizes, lengths, and designs. These features are important with respect to the desired flow. Cannulas are selected based on cannulation site, insertion method (percutaneous or surgical), intended purpose (blood drainage or return), desired flow rate (relative to patient size), and vessel condition.
套管（图 3-2）是回路的组成部分，提供患者和回路之间的血管内连接。它们对回路提供足够流量和支持的能力有很大影响，并且通常是限制因素。套管有各种尺寸、长度和设计。这些特性对于所需的流量非常重要。插管的选择基于插管部位、插入方法（经皮或手术）、预期目的（血液引流或回流）、所需流速（相对于患者体型）和血管状况。
The most important variable for flow is the diameter (radius x 2), which is expressed in millimeters (mm) or French (Fr) ( ) and refers to the outer diameter of the cannula. The inner diameter can vary between different manufacturers, depending on the wall thickness of the canula. However, it is the inner diameter that defines the resistance of the canula (Equation 1). Since 2021, the international standard on cannulas for extracorporeal circulation (ISO 18193:2021) requires manufacturers to provide the inner diameter of the cannula on packaging in addition to the
流量最重要的变量是直径（半径 x 2），以毫米 （mm） 或法语 （Fr） （ ） 表示，指的是套管的外径。不同制造商的内径可能会有所不同，具体取决于套管的壁厚。然而，内径定义了套管的阻力（方程式 1）。自 2021 年起，关于体外循环套管的国际标准 （ISO 18193：2021） 要求制造商在包装上提供套管的内径以及

配管 标称（内部） 直径
TUBING
NOMINAL (inner)
DIAMETER

装雷管 每体积 长度
PRIMING
VOLUME PER
LENGTH

电阻 PER 长度为 1 L/MIN 血流**
RESISTANCE PER
LENGTH AT 1 L/min
BLOOD FLOW**

表面 每 个面积 长度
SURFACE
AREA PER
LENGTH
3/1" 17.8 mL/m 17.8 毫升/米 (LBlood )
（LBlood ）
"  “ )  ）
3/8"
L )
L ）
Table 3-1. Typical tubing diameters and their resulting priming volume and resistance as a function of length. outer diameter. The cannula length is a function of the size of the patient and the desired site for placement of blood drainage and return. Practitioners should keep in mind that cannula length linearly increases resistance to flow. Each specific cannula has its own flow/pressure curve, which can be found in the IFU to facilitate proper cannula selection. Generally, practitioners target working pressure drops for drainage cannulas and for return cannulas.
表 3-1.典型的卡套管直径及其产生的灌注量和阻力与长度的关系。外径。套管长度是患者大小的函数，也是放置血液引流和回流所需部位的函数。从业者应该记住，套管长度呈线性增加流动阻力。每个特定的套管都有自己的流量/压力曲线，可以在 IFU 中找到该曲线，以便于正确选择套管。通常，从业人员针对引流套管和 回流套管的工作压降 。
Information given by the manufacturers in the IFU typically includes the pressure drop (a surrogate for resistance) from cannula inlet to outlet that occurs at various flow rates. Historically, this information was based upon water as the test fluid (with a much lower viscosity compared to blood), and thus underestimated the true resistance of the cannula. The new standard ISO 18193, published in 2021, requires manufacturers to determine the resistance by using a blood analogue fluid with a viscosity matching that of blood. In approximately the next 5 years, there will be descriptive information on cannulas concerning the pressure drop based on both water and blood analogues.
制造商在 IFU 中提供的信息通常包括在不同流速下从套管入口到出口的压降（阻力的替代物）。从历史上看，这些信息是基于水作为测试流体（与血液相比，粘度要低得多），因此低估了套管的真实阻力。2021 年发布的新标准 ISO 18193 要求制造商使用粘度与血液粘度相匹配的血液类似液来确定耐药性。大约在接下来的 5 年内，将有关于基于水和血液类似物的压降的插管的描述性信息。
Cannulas are typically manufactured using PVC or polyurethane polymers and can be surface coated to improve hemocompatibility. Wire reinforcement is typically integrated within the wall to avoid kinking and collapsing and for radiographic visualization. Some cannulas contain additional radiographic
套管通常使用 PVC 或聚氨酯聚合物制造，并且可以进行表面涂层以改善血液相容性。钢丝加固通常集成在墙内，以避免扭结和坍塌，并用于射线照相可视化。一些插管含有额外的射线照相
Figure 3-2. Cannulas. (Illustrations by Stephanie Philippaerts-copyright protected-Produced for UZ Leuven.)
图 3-2。插管。（插图由 Stephanie Philippaerts 提供-受版权保护-为 UZ Leuven 制作。