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ECMO > An Interwoven Hx > Flashcards

An Interwoven Hx Flashcards

1
Q

Extracorporeal Life Support (ECLS)

A

General heading of mechanical

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2
Q

Cardiopulmonary Bypass (CPB)

A

when the heart/lung machine is used in the operating room to provide total support of the heart and lung function, the technique is called cardiopulmonary bypass (CPB)

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3
Q

ECLS Acronyms

A 
ECMO
ECLA
ECCOR
CPS
ECPR
LVAD/RVAD/BiVAD
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4
Q

ECLA

A

Extracorporeal Lung assist

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5
Q

ECCOR

A

Extracorporeal CO2 removal

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6
Q

CPS

A

Cardiopulmonary Support (Extra-thoracic cannulation) i.e. cath lab

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7
Q

ECPR

A

Extracorporeal cardiopulmonary resuscitation

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8
Q

Extracorporeal

A

a process in which blood is taken from a patient’s circulation before it is returned to the circulation

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9
Q

Extracorporeal Circuit

A

All of the apparatus carrying the blood outside the body

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10
Q

Oxygenator

A

Serves as an artificial lung, designed to expose the blood to oxygen and remove CO2. It is permeable to gas but impermeable to blood

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11
Q

Cardiac pump

A

serves as an artificial heart, rotating motor-driven pumps that propel blood forward through tubing. Pumps are considered roller or centrifugal depending on the design

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12
Q

Heat Exchanger

A

integral equipment build for efficient heat transfer from one medium to another. Blood and water is separate by a solid wall prohibiting mixing

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13
Q

Oxygenators

A

Silicone oxygenators

Hollow fiber design

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14
Q

Pumps

A

Roller

Centrifugal

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15
Q

Heat Exchangers

A

Integrated (Maquet)

Tubular (ECMOtherm)

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16
Q

What do we have in our ECMO circuit?

A

An artificial lung (oxygenator)
A pump (aritifical heart)
A heat exchanger
Tubing, bells, whistles, etc.

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17
Q

In what year was artificial oxygenation and perfusion support used for the first successful open heart operation utilizing a heart lung machine?

A

May 1953

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18
Q

Who used artificial oxygenation and perfusion support for the first successful open heart operation utilizing a heart lung machine?

A

John Gibbon

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19
Q

Artificial oxygenation and perfusion support was used for the first successful open heart operation utilizing a heart lung machine. This membrane utilized….

A

direct blood/gas interaction (bubble oxygenator)

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20
Q

Life Span of John H. Gibbon, Jr

A

1903-1973

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21
Q

In what year was the cross circulation technique used? By who?

A

1954; Lillehei

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22
Q

Life Span of Clarence Walton Lillehei

A

October 23, 1918 - July 5, 1999

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23
Q

What is Dr. John W. Kirklin known for?

A

He is an MD (1917-2004); In 1955 he improved Gibbon’s device and successfully repaired an ASD

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24
Q

When was Kirklin’s device adopted by doctors?

A

1956

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25
Q

Who discovered that dimethylpolysiloxane membranes (silicone) allowed for better diffusion rates than polyethylene, making it the membrane of choice.

A

Kammermeyer

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26
Q

The improved diffusion rates of _________ made ECLS possible.

A

Silicone membranes

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27
Q

In 1965, ______ and co-workers were the first to use a bubble oxygenator as support in a neonate dying of respiratory failure

A

Rashkind

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28
Q

In 1969, _____ and colleagues reported the use of a membrane oxygenator for CPB in infants.

A

Dorson

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29
Q

In 1970, ______ et al reported the successful use of extracorporeal membrane oxygenation as support in infants with congenital defects who were undergoing cardiac surgery.

A

Baffes

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30
Q

Who was the first to successfully use ECMO in neonates with severe respiratory distress and a new world of ECLS was born?

A

Robert Bartlett MD; 1975; University of Michigan

31
Q

Who is the father of ECMO?

A

Bartlett, University of Michigan

32
Q

Cardiopulmonary bypass used to be functionally limited initially to no more than ____ hours.

A

6

33
Q

Donald Hill and colleages treated a 24 y/o adult man who developed shock lung after blunt trauma. The patient was supported for ______ hours using a heart-lung machine with a membrane oxygenator. What happened to this patient?

A

75; the patient was weaned and recovered

34
Q

Hill’s second patient was supported for ____ days and recovered.

A

5

35
Q

When was the first successful ECLS patient?

A

1971

36
Q

What did HIll’s successful cases lead to?

A

Randomized trial supported by the national institutes of Health to determine the efficacy of this therapy for adults with respiratory failure

37
Q

Randomized trial was conducted what years? What did it show?

A

1972 to 1975; showed no significant difference in survival between patients managed by extracorporeal life support (9.5%) and those who received conventional ventilator therapy (8.3%).

38
Q

In what year did ECMO run into a major hurdle?

A

1976

39
Q

The NIH study included some centers with no prior ECMO experience and was dominated by who?

A

Victims of the 1976 influenza epidemic

40
Q

Influence 1976 epidemic patients had what problems? What happened to them?

A

Severe bleeding problems; and were placed on high respirator levels, which did not allow the lungs time to heal, negating one of the chief advantages of ECMO

41
Q

One partcipant in the adult trial (Dr. _________) decided to study neonates.

A

Bartlett

42
Q

The usual causes of neonatal respiratory failure have something in common….

A

abnormal postnatal blood shunts known as persistent fetal circulation (PFC) and this is a correctable condition

43
Q

In 1975, NIH study on ECMO had begun and in the same year what happened?

A

THe first newborn infant was successfully sustained using ECMO under the care of Dr. Bartlett, who is today called the “Father of ECMO”

44
Q

What was happening with ECMO in the early 1970’s?

A

ICU units forming
HD becoming more widely used
Positive pressure ventilation better understood: infants, children and adults all surviving initial cardia/pulmonary insults
ARDS emerging as the major problem ailing ICU population

45
Q

What was happening with ECMO in the 1980’s?

A

Several clinical trials published demonstrating clear survival benefit in infants suffering from severe respiratory failure

Randomized controlled studies in adults with ARDS demonstrated no such benefit, but smaller studies and case reports emerged with reports of >50% survival in those treated with ECMO in addition to maximal ventilator management

ECMO for neontates has much better results

46
Q

Who opened the first ECMO center? When?

A

University of Michigan; 1980’s

47
Q

By 1980, Bartlett team had treated ____ newborns with a success rate over ____%.

A

45 newborns; 50%

48
Q

Bartlett’s success led to more ECMO centers and by 1986, ____ nenonatal cases were reported at ___ centers around the country.

A

715 neonatal cases; 18 centers around the country

49
Q

As of 1996, there were over _____ centers around the country.

A

100

50
Q

Many more centers in what country that provide ECMO for newborns and the occasional adult.

A

Europe

51
Q

The newborn success is about ___% today, while the success for adults is only about ___%, a vast improvement over the same numbers 20 years ago.

A

80%; 50%

52
Q

More studies =

A

more attempts at ECMO

53
Q

More attempts at ECMO =

A

more learning from ECMO

54
Q

More learning from ECMO =

A

better results from ECMO

55
Q

The realization that the total combination of _____ AND ________ improved results.

A

ECMO AND medical treatment improved results

56
Q

What was ELSO established?

A

1980

57
Q

ELSO

A

Extracorporeal life support organization

58
Q

The outgrowth of a study group contributing to a registry of cases starting in ______.

A

1984

59
Q

Annual meeting of ELSO is where?

A

Ann Arbor

60
Q

What does ELSO focus on?

A

Collection and sharing of data and experiences

61
Q

Over time, many studies have shown the efficacy of ECLS for the management of neonatal ________ (2).

A

respiratory failure

62
Q

More than _______ neonatal patients have been treated using ECLS worldwide with a survival rate of ____% (ELSO registry data).

A

8000, 82%

63
Q

What is one the most important pieces that led to the increase in adult ECMO techniques and management?

A

H1N1

64
Q

What is CESAR?

A

Conventional Ventilation or ECMO for Severe Adult Respitory Failure

65
Q

Where is CESAR? When? Published when?

A

UK; July 2001 - August 2006

Published in Feb 2009

66
Q

What is the Cesar trial?

A

ECMO patients transferred to an ECMO center. Conventional Therapy patients treated at outlying hospitals.
180 patients total - 90 conventional, 90 ECMO
Conventional survival = 47%
ECMO survival = 63%

67
Q

When was the revival of Adult ECMO?

A

H1N1 influenza virus

68
Q

When was the first H1N1 ECMO case?

A

April 15, 2009

69
Q

When did CDC start working on an H1N1 vaccine?

A

April 21, 2009

70
Q

When does the US declare H1N1 a public health emergency.

A

April 26, 2009

71
Q

By June, ________ US bases, mostly young previously health patients.

A

18,000

72
Q

CDC estimates ______ to _______ million people had H1N1 between April 2009 and April 2010 with how many deahts?

A

43-89 million people had it

8870-18,300 deaths

73
Q

Survival rates are higher or lower as you get older?

A

Lower

ECMO (7 decks)

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