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

APTT = activated partial thromboplastin time, HIT = heparin-induced thrombocytopenia, iv = intravenous.