Perfusion systems and methods for monitoring tissue oxygenation and reducing limb ischemia
Perfusion systems and methods are provided for increasing peripheral blood flow to reduce limb ischemia, in which an extracorporeal pump having a controller, and catheter/tubing set, employed alone or in conjunction with an interventional or circulatory assist device, withdraws blood from a patient's vasculature and reintroduces that blood at another location within the patient's vasculature at a controlled local pressure or flow rate, without interfering with operation of the interventional or circulatory assist device or surgical intervention.
1. A method for perfusing a target region of a patient, the method comprising:
coupling an inlet of an inlet lumen to a source of blood;
positioning an outlet of a return lumen in a target area of the patient's vasculature;
monitoring local blood pressure associated with the target area of the patient's vasculature;
causing an extracorporeal pump fluidically coupled to an outlet of the inlet lumen and an inlet of the return lumen to enter a local pressure control mode via a controller associated with the extracorporeal pump; and
causing the extracorporeal pump, in the local pressure control mode, to receive blood through the inlet of the inlet lumen and to deliver blood through the outlet of the return lumen to perfuse the target region of the patient at a selected local pressure.
2. The method of claim 1 , wherein positioning the outlet of the return lumen in the target area of the patient's vasculature comprises positioning the outlet of the return lumen in the patient's vasculature downstream of an obstruction of antegrade flow to the patient's extremity.
3. The method of claim 2 , wherein the obstruction is due to embolism, atherosclerosis, thrombosis, trauma, or medical procedures/devices.
4. The method of claim 1 , further comprising:
inserting an interventional or circulatory assist device through the inlet lumen via a hemostatic port disposed at a proximal end of the inlet lumen,
wherein, in the local pressure control mode, the extracorporeal pump receives blood through the inlet of the inlet lumen and delivers blood through the outlet of the return lumen to perfuse the target region of the patient at the selected local pressure independent of operation of the interventional or circulatory assist device.
5. The method of claim 1 , wherein the return lumen is disposed within a return cannula.
6. The method of claim 1 , wherein the inlet lumen is disposed within an inlet cannula.
7. The method of claim 6 , wherein the return lumen is disposed within the inlet cannula, and wherein the outlet of the return lumen defines a skive in a lateral surface of the inlet cannula.
8. The method of claim 6 , further comprising inflating an occlusion balloon disposed on the inlet cannula to at least partially occlude flow within the patient's vasculature antegrade to the inlet of the inlet lumen.
9. The method of claim 6 , further comprising inflating a sealing balloon disposed on the inlet cannula to seal an insertion site of the inlet lumen into the first area of patient's vasculature to prevent leakage.
10. The method of claim 1 , wherein the extracorporeal pump further comprises an extracorporeal membrane oxygenator system.
11. The method of claim 1 , wherein coupling the inlet of the inlet lumen to the source of blood comprises coupling the inlet of the inlet lumen to a supply of transfusion blood,
wherein causing the extracorporeal pump to receive blood through the inlet of the inlet lumen comprises causing the extracorporeal pump to receive transfusion blood through the inlet of the inlet lumen from the supply of transfusion blood, and
wherein causing the extracorporeal pump, in the local pressure control mode, to deliver blood through the outlet of the return lumen to perfuse the target region of the patient at the selected local pressure comprises causing the extracorporeal pump, in the local pressure control mode, to deliver transfusion blood oxygenated via an extracorporeal membrane oxygenator (ECMO) system through the outlet of the return lumen to perfuse the target region of the patient at the selected local pressure.
12. The method of claim 1 , wherein coupling the inlet of the inlet lumen to the source of blood comprises positioning the inlet of the inlet lumen in a vein of the patient, the method further comprising:
positioning a second inlet of a second inlet lumen in an artery of the patient, a second outlet of the second inlet lumen fluidically coupled to the extracorporeal pump; and
causing the extracorporeal pump to receive arterial blood through the second inlet of the second inlet lumen,
wherein causing the extracorporeal pump to receive blood through the inlet of the inlet lumen comprises causing the extracorporeal pump to receive venous blood through the inlet of the inlet lumen, and
wherein causing the extracorporeal pump, in the local pressure control mode, to deliver blood through the outlet of the return lumen to perfuse the target region of the patient at the selected local pressure comprises causing the extracorporeal pump, in the local pressure control mode, to deliver a mixture of venous and arterial blood through the outlet of the return lumen to perfuse the target region of the patient at the selected local pressure.
13. The method of claim 1 , wherein the extracorporeal pump is selected from amongst a vane pump, a centrifugal pump, a roller pump, an axial flow pump, a diaphragm pump, and a piston pump.
14. The method of claim 1 , wherein the extracorporeal pump is configured to generate pulsatile flow at the outlet of the return lumen.
15. The method of claim 1 , wherein the extracorporeal pump comprises an electric motor, the method further comprising controlling operation of the electric motor via the controller.
16. The method of claim 1 , further comprising:
receiving information indicative of at least one of tissue oxygenation, pH level, and lactate levels associated with the patient's vasculature from one or more sensors in communication with the extracorporeal pump; and
adjusting a vessel pressure or flow rate to achieve at least one of a target tissue oxygenation level, target pH level, or target lactate level.
17. The method of claim 1 , further comprising executing, via the controller, an AI module to determine a preferred flow rate to achieve a target local pressure that reduces a risk of ischemia.
18. The method of claim 1 , further comprising:
monitoring, via a first pressure sensor, blood pressure at the inlet of the inlet lumen;
monitoring, via a second pressure sensor, blood pressure at the outlet of the return lumen; and
determining an occurrence of an occlusion based on the blood pressures at the inlet of the inlet lumen and the outlet of the return lumen.
19. The method of claim 18 , further comprising generating, via the controller, an alarm if a pressure differential between the blood pressures at the inlet of the inlet lumen and the outlet of the return lumen deviates from a predetermined threshold.
20. The method of claim 1 , further comprising:
positioning a second outlet of a second return lumen in a second target area of the patient's vasculature, a second inlet of the second return lumen fluidically coupled to the extracorporeal pump;
monitoring local blood pressure associated with the second target area of the patient's vasculature; and
causing the extracorporeal pump, in the local pressure control mode, to deliver blood through the second outlet of the second return lumen to perfuse a second target region of the patient associated with second target area of the patient's vasculature at a second selected local pressure.
21. The method of claim 1 , further comprising delivering one or more reperfusion protection agents or donor blood for a transfusion via at least one delivery port of the return lumen.
22. The method of claim 1 , further comprising receiving input indicative of the selected local pressure via a user interface associated with the controller.
23. The method of claim 1 , further comprising regulating a flow rate of the extracorporeal pump to maintain the selected local pressure.
24. The method of claim 1 , further comprising:
causing, via the controller, the extracorporeal pump to transition between the local pressure control mode and a flow mode; and
causing the extracorporeal pump, in the flow mode, to pump at a set flow rate to perfuse the target region of the patient.
25. The method of claim 1 , further comprising inflating an occlusion balloon disposed adjacent to the outlet of the return lumen to at least partially occlude flow within the patient's vasculature to direct blood flow in an antegrade direction within the patient's vasculature.